Daytime Dynamo Electrodynamics With Spiral Currents Driven by Strong Winds Revealed by Vapor Trails and Sounding Rocket Probes

We investigate the forces and atmosphere-ionosphere coupling that create atmospheric dynamo currents using two rockets launched nearly simultaneously on 4 July 2013 from Wallops Island (USA), during daytime Sq conditions with ΔH of -30 nT. One rocket released a vapor trail observed from an airplane which showed peak velocities of >160 m/s near 108 km and turbulence coincident with strong unstable shear. Electric and magnetic fields and plasma density were measured on a second rocket. The current density peaked near 110 km exhibiting a spiral pattern with altitude that mirrored that of the winds, suggesting the dynamo is driven by tidal forcing. Such stratified currents are obscured in integrated ground measurements. Large electric fields produced a current opposite to that driven by the wind, believed created to minimize the current divergence. Using the observations, we solve the dynamo equation versus altitude, providing a new perspective on the complex nature of the atmospheric dynamo.

Influence of an SGLT2 inhibitor, tofogliflozin, on the resting heart rate in relation to adipose tissue insulin resistance

AIMS

To examine the effects of a sodium-glucose co-transporter 2 (SGLT2) inhibitor, tofogliflozin, on resting heart rate by exploring baseline factors that independently influenced changes in the resting heart rate.

METHODS

Data on 419 participants in tofogliflozin phase 2/3 trials were analysed. Changes in resting heart rate from baseline to week 24 were analysed using an analysis of covariance (ANCOVA) model with groups (tofogliflozin/placebo) as a fixed effect and baseline values as covariates. The antilipolytic effect was evaluated as adipose tissue insulin resistance (Adipo-IR) and was calculated as the product of fasting insulin and free fatty acid. Multivariate analysis evaluated independent factors for changes in resting heart rate from baseline to week 24.

RESULTS

Of the participants, 58% were men, and mean age, HbA_1c , BMI and resting heart rate were 57.6 years, 65 mmol/mol (8.1%), 25.5 kg/m² and 66 bpm, respectively. At week 24, adjusted mean difference vs. placebo in the change from baseline was -2.3 bpm [95% confidence interval (CI) -4.6, -0.1] with tofogliflozin. Changes in resting heart rate were positively correlated with changes in Adipo-IR, whereas reductions in HbA_1c , body weight and blood pressure were similar independent of changes in resting heart among quartiles of resting heart rate change. On multivariate analysis, higher baseline resting heart rates and Adipo-IR values were significantly associated with greater reductions in resting heart rate.

CONCLUSIONS

Tofogliflozin corrected resting heart rate levels in accordance with baseline levels. Correction of high resting heart rates may be attributed to improved adipose tissue insulin resistance, leading to correction of hyperinsulinaemia.

Accelerometer-Determined Intensity and Duration of Habitual Physical Activity and Walking Performance in Well-Functioning Middle-Aged and Older Women: A Cross-Sectional Study

BACKGROUND

The association of physical activity (PA) intensities and duration spent in those activities with different walking tasks remains unclear.

OBJECTIVES

To examine the association between the duration of PA intensities and three walking speeds (usual walking speed, maximal walking speed and zig-zag walking speed).

DESIGN

Multiple linear regression analysis was used to estimate the association of age, BMI, maximum knee extension strength, light PA, moderate PA and vigorous PA with walking speeds.

SETTING

University lab.

PARTICIPANTS

Eighty-six older women (67 ± 7 years).

MEASUREMENTS

PA was measured for 30 consecutive days using the Lifecorder-EX accelerometer. Exercise intensity was categorized as light (levels 1-3), moderate (levels 4-6) and vigorous (levels 7-9) based on the manufacturer algorithms. Usual straight walking speed (20 m), maximal straight walking speed (20 m) and zig-zag walking speed tests (10 m) were performed by each participant.

RESULTS

For the usual straight walking speed model (R2 = 0.296, SEE = 0.15 m/s), the significant predictors were BMI, knee extension strength, light PA and vigorous PA. For the maximal straight walking speed model (R2 = 0.326, SEE = 0.20 m/s), only age was a significant predictor. For the zig-zag walking speed model (R2=0.417, SEE = 0.14 m/s), age and maximum knee strength were significant predictors in the model.

CONCLUSIONS

Overall, the results of this study suggest that vigorous PA and maximal knee extension strength are two important factors that are associated with different walking speeds in older women.

The role of adipocytokines and their receptors in bladder cancer: expression of adiponectin or leptin is an independent prognosticator

Adipocytokines such as leptin and adiponectin have functions in metabolism as well as the development and progression of various types of malignancies. However, little is known about their role in bladder cancer. In this study, we investigated whether leptin, adiponectin, and their receptors have an impact on bladder cancer outgrowth and the mechanisms involved. We performed immunohistochemistry for leptin, leptin receptor (Ob-R), adiponectin, and adiponectin receptors (AdipoR1, AdipoR2) in bladder cancer tissue microarrays. Wound healing assay and western blot were then performed in human bladder cancer lines. The positive rates (0 vs 1+/2+/3+) of Ob-R (P=0.004), adiponectin (P<0.001), AdipoR1 (P=0.016), and AdipoR2 (P<0.001) expression were significantly higher in bladder tumors than in benign urothelial tissues. Strong (3+) leptin expression tended to be present more often in tumors (10.2%; P=0.079) than in benign tissues (3.2%). Multivariate analysis revealed a lower risk of recurrence (hazard ratio [HR]=0.432; 95% confidence interval [CI]=0.198-0.942; P=0.034) in patients with an adiponectin-positive non-muscle-invasive tumor and a higher risk of progression (HR=5.148, 95% CI=1.190-22.273; P=0.028) in patients with a leptin-positive muscle-invasive tumor. Treatment of two bladder cancer cell lines with a synthetic adiponectin inhibited their migration and the expressions of phospho-NF-κB, NF-κB, snail, slug, Y-box-binding protein 1, and COX-2, whereas leptin showed reverse effects. Downregulation of adiponectin expression and upregulation of leptin expression were independent predictors for the recurrence of non-muscle-invasive bladder tumors and progression of muscle-invasive bladder tumors, respectively. In summary, synthetic adiponectin might exhibit antitumor activity against bladder cancer.

Gastrectomy with or without omentectomy for cT3–4 gastric cancer: a multicentre cohort study

Background

Omentectomy is performed widely for locally advanced gastric cancer to prevent disease recurrence. However, its clinical benefit is unknown.

Methods

This retrospective cohort study compared the outcome of gastrectomy with preservation of the omentum (GPO) and gastrectomy with resection of the omentum (GRO) among patients with cT3–T4 gastric cancer who underwent gastrectomy between 2006 and 2012 in one of five participating institutions. A consensus conference identified 28 variables potentially associated with outcome after gastrectomy for the estimation of propensity scores, and propensity score matching (PSM) was undertaken to control for possible confounders. Postoperative surgical outcomes, overall survival and disease recurrence were compared between GPO and GRO.

Results

A total of 1758 patients were identified, of whom 526 remained after PSM, 263 in each group. Median follow-up was 4·9 (i.q.r. 3·1–5·9) years in the GRO group and 5·0 (2·5–6·8) years in the GPO group. The incidence of postoperative complications of Clavien–Dindo grade III or more was significantly higher in the GRO group (17·5 versus 10·3 per cent; P = 0·016). Five-year overall survival rates were 77·1 per cent in the GRO group and 79·4 per cent in the GPO group (P = 0·749). There were no significant differences in recurrence rate or pattern of recurrence between the groups.

Conclusion

Overall survival and disease recurrence were comparable in patients with cT3–4 gastric cancer who underwent GPO or GRO.

Impact of Fat-Free Adipose Tissue on the Prevalence of Low Muscle Mass Estimated Using Calf Circumference in Middle-Aged and Older Adults

Previous studies proposed calf circumference cutoff values for predicting dual-energy X-ray absorptiometry (DXA)-derived low muscle mass. However, DXA-derived appendicular lean mass (aLM) includes non-skeletal muscle components such as the appendicular fat-free component of adipose tissue fat cells (aFFAT). The purpose of this study was to compare the calf circumference method of classification before (Model #1) and after (Model #2) eliminating the influence of FFAT in healthy Japanese adults (50 to 79 years; mean age 70 (SD 7) years). Model 1, and Model 2 for classifying low muscle mass had a sensitivity of 78% and 64%, specificity of 76% and 75%, positive predictive value of 31% and 28%, and negative predictive value of 96% and 93%, respectively. Appendicular fat-free component of adipose tissue has the potential to influence the ability of calf circumference to accurately classify individuals with low muscle mass. Consideration should be made when using this as a screening tool for low muscle mass.

Outcome of maintenance systemic chemotherapy with drug-free interval for metastatic urothelial carcinoma

OBJECTIVE

Aiming to achieve long-term disease control, maintenance systemic chemotherapy (MSC) with a 1-3-month drug-free interval is continued in selected patients. We report our experience of MSC for metastatic urothelial carcinoma (UC).

METHODS

Of 228 metastatic UC patients treated with systemic chemotherapy, 40 (17.5%, 40/228) had continuously undergone MSC. Data on the regimen, cycle number, and reason for the discontinuation of MSC were also collected. We analyzed OS from the initiation of MSC until death or the last follow-up, using the log-rank test to assess the significance of differences.

RESULTS

The median number of cycles of chemotherapy was 6, and the responses were CR in 6, PR in 20, SD in 13, and PD in 1 before MSC. Gemcitabine plus CDDP or carboplatin was mainly performed as MSC (70%, 28/40). MSC was repeated quarterly in 30 (75%, 30/40), every two months in 8 (20%, 8/40), and with other intervals in 2 (5%, 2/40). Overall, a median of 3.5 cycles (range: 1-29) of MSC was performed. The reason for the discontinuation of MSC was PD in 24 (60%, 24/40), favorable disease control in 9 (22.5%, 9/40), and myelosuppression in 3 (7.5%, 3/40), and for other reasons in 2 (5%, 2/40). MSC was ongoing in 2 (5%, 2/40). The median OS was 27 months from the initiation of MSC. PS0 (P = 0.0169), the absence of lung metastasis (P = 0.0387), and resection of the primary site (P = 0.0495) were associated with long-term survival after MSC.

CONCLUSIONS

In selected patients, long-term systemic chemotherapy could be performed with a drug-free interval. Our maintenance strategy with cytotoxic drugs may become one of the treatment options for long-term disease control.

Underlying Structure of Collective Bands and Self-Organization in Quantum Systems

The underlying structure of low-lying collective bands of atomic nuclei is discussed from a novel perspective on the interplay between single-particle and collective degrees of freedom, by utilizing state-of-the-art configuration interaction calculations on heavy nuclei. Besides the multipole components of the nucleon-nucleon interaction that drive collective modes forming those bands, the monopole component is shown to control the resistance against such modes. The calculated structure of ^{154}Sm corresponds to the coexistence between prolate and triaxial shapes, while that of ^{166}Er exhibits a deformed shape with a strong triaxial instability. Both findings differ from traditional views based on β/γ vibrations. The formation of collective bands is shown to be facilitated from a self-organization mechanism.

Neighborhood environment and physical activity among rural Japanese older adults

Background

Physical inactivity is one of the global health concerns. Rural populations in general tend to be more physically inactive and have higher risk for chronic conditions. Although numerous studies have assessed the association between neighborhood environment and physical activity to implement population level intervention, most are limited to urban adults. This study investigated potential neighborhood environment associated with physical activity for rural older adults in Japan.

Methods

The study subjects were from Shimane where is a rural-mountainous region in Japan. Those agreed to participate in the Shimane CoHRE study as of baseline (2010) and followed-up after 5 years were included in the analysis (mean age=71, n = 717). Subjects were asked if they engage in 30 minutes exercise more than twice a week at baseline and follow-up surveys. As a primary exposure, we computed mean land slope within 500 m street network buffer from residential point of each subject by geographic information system. Multiple logistic regression was conducted to estimate the odds of exercise engagement after 5 years by slope categorized in tertile, adjusting for age, BMI, and exercise habit at baseline.

Results

Significantly higher odds of exercise engagement was observed among those living in the hilly area compared to moderately hilly area after 5 years adjusting for baseline age, BMI, and exercise habit, (Odds ratio (OR): 1.71, 95% Confidence Interval (95%CI): 1.119, 2.616). There was no significant difference of odds between those in flat area and moderately hilly area (OR: 1.137, 95%CI: 0.738, 1.751).

Conclusions

This finding suggests that people living in hilly neighborhoods are more likely to maintain or start engaging in exercise after 5 years. Considering other potential environmental factors and farming culture within rural areas, future studies should capture various forms of environmental components and physical activity to dissect the mechanism.

Key messages

There are limited studies focus on rural older adults. Unique geographic feature in rural areas, i.e. hilly neighborhood might be associated with physical activity.

430Non-invasive estimation of right atrial pressure by IVC measurement differently predicts long-term prognoses in acute heart failure patients with reduced and preserved LVEF

Introduction

Inferior vena cava (IVC) measurement by bed-side echocardiography is a non-invasive, reproducible and feasible estimation of right atrial pressure (RAP). However, the effect of left ventricular systolic functions on the clinical efficacy of estimation of RAP using IVC parameters in hospitalized patients with acute heart failure (AHF) has not been fully discussed.

Purpose

We aimed to investigate the prognostic impact of RAP evaluation by IVC measurement in AHF patients, focusing on left ventricular ejection fraction (LVEF).

Methods

This observational study initially included 1,350 consecutive patients who were urgently hospitalized due to AHF. After the exclusion of patients receiving hemodialysis, those died in hospital, and those without full information of echocardiography during the index hospitalization, 507 patients with reduced (<40%; HFrEF) and 482 patients with preserved (≥40%; HFpEF) LVEF who discharged alive were respectively analyzed. In accordance with ESC guidelines, HFrEF and HFpEF patients were respectively divided into three groups depending on maximum IVC diameter and collapse; Normal-RAP group (IVC diameter ≤2.1cm and collapse >50%), High-RAP group (IVC diameter >2.1cm and collapse <50%), and Intermediate-RAP group (others). The endpoints of this study were cardiovascular (CV) death after the discharge, and hospitalization due to heart failure recurrence (HHF).

Results

During the observation period, 70 HFrEF patients (13.8%) and 51 HFpEF patients (10.5%) died by CV cause, and 223 HFrEF patients (43.9%) and 158 HFpEF patients (32.8%) were rehospitalized due to HF. In HFrEF patients, Kaplan-Meier analysis showed a low CV mortality rate only in the Normal-RAP group (Log-rank trend: P=0.001, Figure), but no significant difference in HHF rate among RAP groups (p=0.35, Figure). In multivariate Cox regression analysis, RAP classification was an independent predictor of CV mortality in HFrEF patients (adjusted hazard ratio (AHR) 1.90 [95% confidence interval (CI) 1.12–3.21)), even after the adjustment of diverse covariants. On the other hand, in HFpEF patients, Kaplan-Meier analysis showed the high mortality rate and HHF rate only in the High-RAP group (Log-rank trend: both p<0.001, Figure). Multivariate Cox regression analysis revealed that RAP classification independently predicted both prognoses (CV mortality: AHR 2.23 [95% CI 1.10–4.52]; HHF: AHR 1.34 [95% CI 1.03–1.74]) in HFpEF patients.

Figure 1

Conclusion

Non-invasive and easy classification of AHF patients by maximum IVC size and collapse may predict CV mortality after the discharge in HFrEF and HFpEF; while, it failed in HHF of HFrEF patients.

Blood flow restriction augments the skeletal muscle response during very low-load resistance exercise to volitional failure

The purpose of this study was to compare the acute muscular response with resistance exercise between the following conditions [labeled (% one-repetition maximum/% arterial occlusion pressure)]: high-load (70/0), very low-load (15/0), very low-load with moderate (15/40), and high (15/80) blood flow restriction pressures. Twenty-three participants completed four sets of unilateral knee extension to failure (up to 90 repetitions) with each condition, one condition per leg, each day. Muscle thickness and maximal voluntary contraction (MVC) were measured before (Pre), immediately after (Post-0), and 15 min after (Post-15) exercise and electromyography (EMG) amplitude during exercise. Pre to Post-0 muscle thickness changes in cm [95% CI] were greater with 15/40 [0.57 (0.41, 0.73)] and 15/80 [0.49 (0.35, 0.62)] compared to 70/0 [0.33 (0.25, 0.40)]. Pre to Post-0 MVC changes in Nm [95% CI] were higher with 15/40 [-127.0 (-162.1, -91.9)] and 15/80 [-133.6 (-162.8, -104.4)] compared to 70/0 [-48.4 (-70.1, -26.6)] and 15/0 [-98.4 (-121.9, -74.9)], which were also different. Over the first three repetitions, EMG increased across sets, whereas in the last three repetitions it did not. EMG was also different between conditions and was generally greater during 70/0. Repetitions decreased across sets reaching the lowest for 70/0, and for very low loads decreased with increased pressure. In trained participants exercising to failure, lower load and the application of restriction pressure augment changes in muscle thickness and torque. The EMG amplitude was augmented by load. Training studies should compare these conditions, as the results herein suggest some muscular adaptations may differ.

Tongue surface model can predict radiation tongue mucositis due to intensity-modulated radiation therapy for head and neck cancer

Acute radiation tongue mucositis has a profound effect on talking and eating. We examined whether the dose-volume histogram obtained from the tongue surface model correlates with mucositis severity, and whether it is useful for predicting acute radiation tongue mucositis in patients with head and neck cancer treated with intensity-modulated radiation therapy. Thirty-six patients who received intensity-modulated radiation therapy for head and neck cancer were analysed for acute radiation tongue mucositis according to the Common Terminology Criteria for Adverse Events, version 4.0, as well as the Radiation Therapy Oncology Group scoring systems. The corresponding high-dose locations in anatomical sub-regions in the tongue surface model and the development of high-grade acute radiation tongue mucositis were compared. The mucositis sites coincided with the high-dose anatomical sub-regions in the tongue surface model. There was a clear dose-response relationship between the mean dose to the tongue and the acute radiation tongue mucositis Radiation Therapy Oncology Group grade. According to the dose-volume histogram, patients receiving 16.0-73.0 Gy to the tongue were susceptible to grade 2-3 toxicity. The tongue surface model can predict the site and severity of acute radiation tongue mucositis. In future, radiation treatment plans ccould be optimized using this model.

An Ultrasound Prediction Equation to Estimate DXA-Derived Body Fatness for Middle-Aged and Older Caucasian Adults

BACKGROUND AND OBJECTIVES

Currently, only one study has used dual-energy X-ray absorptiometry (DXA)-derived percent body fat (BF%) as the criterion measure to develop ultrasound prediction equations to estimate BF% in adults between the ages of 50 and 80 years. The aim of this study was to examine the relationship between BF% estimated from subcutaneous fat thickness using a previously published Japanese-based prediction equation and DXA-derived BF% in Caucasian middle-aged and older adults. A secondary aim was to develop a new prediction equation for Caucasian adults if the previously published equation did not predict BF% well in Caucasians.

DESIGN

Cross-sectional study.

PARTICIPANTS AND MEASUREMENTS

One-hundred and two Caucasian adults aged 50-76 years (59 men and 43 women) had ultrasound fat thickness and DXA values measured. A new BF% prediction model was developed using ordinary least squares multiple linear regression.

RESULTS

There was a strong correlation between ultrasound predicted and DXA-derived BF% (r = 0.882, p<0.001). Bland-Altman analysis did not indicate a bias in the prediction of BF% for Caucasian adults (r = -0.092, p>0.05). However, the predicted BF% was significantly higher compared to DXA-derived BF% (approximately 4%). A newly developed nonlinear prediction model used to estimate BF% was significant [F(17,84) = 33.44, p<0.001] with an R2 of 0.871 and an adjusted R2 of 0.845. When examining the stability of the model, bootstrapping (n=1000) resulted in an optimism value of 0.1135 so that the corrected R2 was 0.758. After removing an outlier, the model was significant [F(17,83) = 34.82, p<0.001] and it's R2 was 0.877 and adjusted R2 was 0.852.

CONCLUSION

The developed equation was stable with a high degree of variance compared to results from previous studies. The results of this study also suggest that ethnicity should be considered when choosing which prediction equations should be used to estimate BF%.