Aqueous Electrochemical Partial Oxidation of Gaseous Ethylbenzene by a Ru-Modified Covalent Triazine Framework

Aqueous electrochemical oxidation of hydrocarbons into valuable compounds, such as alcohols and carbonyl compounds, has attracted much attention because these systems can operate under mild conditions without toxic oxidants or flammable solvents. The key requirements to achieve such oxidation reactions are (1) highly reactive species on an electrocatalyst for the activation of C-H bonds and (2) efficient transportation pathway for water-insoluble hydrocarbons to an electrode surface. We have determined that a gas diffusion electrode (GDE) supporting Ru atom-modified covalent triazine frameworks (Ru-CTF) has an activity for the electrooxidation of gaseous ethylbenzene to acetophenone using an aqueous electrolyte. A high-valency Ru═O species was formed in Ru-CTF as an effective active site for O-atom insertion into stable C-H bonds. Furthermore, Ru-CTF showed excellent stability during four consecutive cycles with the replacement of the electrolyte every 12 h, although the reactive Ru═O species is generated. As for the transportation pathway for substrates, the amount of acetophenone generated from gaseous ethylbenzene was much larger than that from ethylbenzene dissolved in an electrolyte. This result indicates that the three-dimensional microstructures in the GDE maximize the transportation of gaseous hydrocarbons and the oxidation reaction occurs at the triple-phase boundary, which enables the use of aqueous electrolytes.

FSBC: fast string-based clustering for HT-SELEX data

BACKGROUND

The combination of systematic evolution of ligands by exponential enrichment (SELEX) and deep sequencing is termed high-throughput (HT)-SELEX, which enables searching aptamer candidates from a massive amount of oligonucleotide sequences. A clustering method is an important procedure to identify sequence groups including aptamer candidates for evaluation with experimental analysis. In general, aptamer includes a specific target binding region, which is necessary for binding to the target molecules. The length of the target binding region varies depending on the target molecules and/or binding styles. Currently available clustering methods for HT-SELEX only estimate clusters based on the similarity of full-length sequences or limited length of motifs as target binding regions. Hence, a clustering method considering the target binding region with different lengths is required. Moreover, to handle such huge data and to save sequencing cost, a clustering method with fast calculation from a single round of HT-SELEX data, not multiple rounds, is also preferred.

RESULTS

We developed fast string-based clustering (FSBC) for HT-SELEX data. FSBC was designed to estimate clusters by searching various lengths of over-represented strings as target binding regions. FSBC was also designed for fast calculation with search space reduction from a single round, typically the final round, of HT-SELEX data considering imbalanced nucleobases of the aptamer selection process. The calculation time and clustering accuracy of FSBC were compared with those of four conventional clustering methods, FASTAptamer, AptaCluster, APTANI, and AptaTRACE, using HT-SELEX data (>15 million oligonucleotide sequences). FSBC, AptaCluster, and AptaTRACE could complete the clustering for all sequence data, and FSBC and AptaTRACE performed higher clustering accuracy. FSBC showed the highest clustering accuracy and had the second fastest calculation speed among all methods compared.

CONCLUSION

FSBC is applicable to a large HT-SELEX dataset, which can facilitate the accurate identification of groups including aptamer candidates.

AVAILABILITY OF DATA AND MATERIALS

FSBC is available at http://www.aoki.ecei.tohoku.ac.jp/fsbc/.

Which is more important in the management of splenic flexure colon cancer: strict central lymph node dissection or adequate bowel resection margin?

BACKGROUND

What qualifies as optimal lymph node (LN) dissection in the surgical management of splenic flexure colon cancer (SFCC) still remains controversial because few studies have evaluated the distribution of LN metastasis of SFCC. The aim of this study was to clarify detailed distribution of LN metastasis and long-term outcomes of SFCC.

METHODS

This retrospective study enrolled patients who had curative colectomy for primary transverse or descending colon cancer of pathological stage I, II, or III at a single high-volume cancer center between April 2002 and December 2018. The 538 eligible patients were divided into three groups: patients with SFCC (SFCC group, n = 168), patients with proximal transverse colon cancer (PTCC group, n = 290), and patients with distal descending colon cancer (DDCC group, n = 80). LNs were classified into horizontal (pericolic) and vertical (intermediate and main) nodes. Intermediate and main LN station numbers were defined according to the Japanese Society for Cancer of the Colon and Rectum classification. Distributions of LN metastasis and long-term outcomes were compared.

RESULTS

In the SFCC group, the mean age was 67.3 ± 10.5 years and 110 patients (65.5%) were male. The proportion of patients with LN metastasis in the intermediate or main region was significantly lower in the SFCC group (8%) than in the PTCC (37%) (p < 0.01) or DDCC group (29%) (p < 0.01) in pathological stage III patients. In the SFCC group, the incidence of pericolic LN metastasis on the oral side of tumor (43%) was significantly higher than in the PTCC group (21%) (p < 0.01) and was similar to that in the DDCC group (42%) (p = 0.51), while in the SFCC group, the incidence of pericolic LN metastasis on the anal side of tumor (17%) was lower than in the PTCC group (31%) and was also similar to that in the DDCC group (21%). There were no significant differences in disease-specific survival rates among all groups.

CONCLUSIONS

LN metastasis occurred mainly in the pericolic region, especially on the oral side of the tumor in SFCC. It may, therefore, be important to have an adequate bowel resection margin, especially on the oral side, for SFCC.

Bone strength of the proximal femur in healthy subjects with ossification of the posterior longitudinal ligament

We compared the bone strength measured via quantitative computed tomography-based finite element method (QCT/FEM) between healthy adults with and without ossification of the posterior longitudinal ligament (OPLL). No statistically significant difference was observed in the bone strength between healthy adults with and without OPLL. Hyperostosis of the posterior longitudinal ligament in OPLL may not be associated with the systemic bone strength.

INTRODUCTION

Although patients with OPLL have been reportedly associated with increased level of bone mineral density (BMD) using dual-energy X-ray absorptiometry (DXA), little is known about the bone strength in OPLL subjects. The aim of this study is to investigate the bone strength measured via QCT/FEM in healthy subjects with OPLL using the medical check-up data, including whole-body CT scans.

METHODS

We examined 796 participants (529 men and 267 women) who underwent CT scans in a single health center between January 2008 and May 2009. We identified OPLL in whole spine and divided the subjects into two groups: non-OPLL and OPLL groups. We calculated the predicted bone strength (PBS) of the proximal femur using QCT/FEM and examined the bone mineral status of the calcaneus using quantitative ultrasound (QUS). We compared the PBS and the QUS parameters between the non-OPLL and OPLL groups.

RESULTS

Seventy-four subjects (9.3%; 57 men and 17 women) were diagnosed with OPLL in the whole spine. The OPLL group was significantly older than the non-OPLL group. No statistically significant difference was observed in the PBS and the QUS parameters between the non-OPLL and OPLL groups in both sexes. Furthermore, no statistically significant difference was noted in the PBS and the QUS parameters between two groups in age- and gender-matched analysis.

CONCLUSIONS

Our results suggest that hyperostosis of the posterior longitudinal ligament in OPLL may not be associated with bone strength and bone mineral status at the extremities.

Fluorescence Polarization-Based Rapid Detection System for Salivary Biomarkers Using Modified DNA Aptamers Containing Base-Appended Bases

The field of care testing toward the analysis of blood and saliva lacks nowadays simple test techniques for biomarkers. In this study, we have developed a novel nucleobase analog, U^gu, which is a uracil derivative bearing a guanine base at the 5-position. Moreover, we attempted the development of aptamers that can bind to secretory immunoglobulin A (SIgA), which has been examined as a stress marker in human saliva. It was observed that the acquired aptamer binds strongly and selectively to the SIgA dimer (K_d = 13.6 nM) without binding to the IgG and IgA monomers of human serum. Reduction of the aptamer length (41 mer) successfully improved 4-fold the binding affinity (K_d = 3.7 nM), compared to the original, longer aptamer (78 mer). Furthermore, the development of a simple detection system for human saliva samples by fluorescence polarization was investigated, using the reported human salivary α-amylase (sAA) and the SIgA-binding aptamer. Comparison of the present method with conventional enzyme-linked immunosorbent assay techniques highlighted a significant Pearson's correlation of 0.94 and 0.83 when targeting sAA and SIgA, respectively. It is thus strongly suggested that a new simple test of stress markers in human saliva can be quantified quickly without bound/free (B/F) separation.

Centronuclear Myopathy with Abundant Nemaline Rods in a Japanese Black and Hereford Crossbred Calf

Histopathological examination was performed on skeletal and diaphragmatic muscles from an 8-month-old male crossbred calf showing abnormal gait and tremor of the hindlimbs. There were numerous round fibres with centrally placed nuclei forming nuclear chains in longitudinal sections, associated with interstitial fibrosis or adipose tissue infiltration. On nicotinamide adenine dinucleotide tetrazolium reductase (NADH-TR) staining, some muscle fibres in severe lesions showed a spoke-like appearance due to a radial arrangement of sarcoplasmic strands. Additionally, increased NADH-TR activity in the subsarcolemmal structures, appearingas ring-like or necklace-like forms, were observed. Transmission electron microscopy revealed dilated sarcoplasmic reticulum and variably shaped electron-dense inclusions consisting of myofibrillar streams. Another prominent feature was the existence of numerous nemaline rods within muscle fibres; these were stained red by Gomori's trichrome stain. Immunohistochemistry revealed that the nemaline rods showed strong immunoreactivity with α-actinin and desmin antibodies. Electron microscopically, these structures were composed of dense-homogeneous material and continuous with the Z disk. The case was diagnosed as centronuclear myopathy with increased nemaline rods.

5950Lymphocyte-to-monocyte ratio could predict adverse clinical outcomes in patients with heart failure with preserved ejection fraction

Background

Heart failure with preserved ejection fraction (HFpEF) is increasing with aging of the population, whereas the mechanisms of HFpEF remain poorly understood. It was reported that systemic inflammation is associated with pathophysiology of HFpEF. Lymphocyte-to-monocyte ratio (LMR) is a marker of systemic inflammation, which predicts clinical outcomes in various cancers. However, the prognostic value of LMR has not yet been elucidated in patients with HFpEF.

Purpose

The aim of this study was to investigate the impact of LMR on clinical outcomes in patients with HFpEF.

Methods and results

We prospectively analyzed 414 consecutive patients with HFpEF. Preserved EF was defined as an EF ≥50%. During a median follow-up period of 740 days, there were 111 major adverse cardiovascular events (MACE). When patients were divided into tertiles according to LMR, Kaplan-Meier analysis demonstrated that the low LMR was associated with the greatest risk for MACE. Multivariate Cox proportional hazard regression analysis showed that the low LMR was significantly associated with MACE after adjustment for confounding factors.

Conclusions

Low LMR could predict poor clinical outcomes in patients with HFpEF. LMR is a feasible marker for predicting MACE in patients with HFpEF.

129Elevated plasma xanthine oxidoreductase activity predicts cardiovascular events in patients with heart failure with preserved ejection fraction

Background

The pathophysiology of heart failure with preserved ejection fraction (HFpEF) remains poorly understood, although reactive oxygen species (ROS) is reportedly involved in underlying mechanisms. Xanthine oxidoreductase (XOR) is the rate-limiting enzyme of purine metabolism that plays an important role in producing uric acid, and also generates the ROS. However, the impact of plasma XOR activity on the clinical outcomes in patients with HFpEF remains unclear.

Purpose

The aim of this study was to assess whether plasma XOR activity predicts cardiovascular events in patients with HFpEF.

Methods and results

We measured plasma XOR activity in 257 patients with HFpEF. The patients were divided into 3 groups based on XOR activity: low XOR group (<33 pmol/h/mL, n=45), normal XOR group (33 - 120 pmol/h/mL, n=160), and high XOR group (≥120 pmol/h/mL, n=52). During a median follow-up period of 809 days, there were 74 major adverse cardiovascular events (MACEs). Kaplan-Meier analysis demonstrated that the patients with high XOR activity were at greatest risk for MACEs. A multivariate Cox proportional hazard regression analysis showed that high XOR activity was significantly associated with MACEs after adjustment for confounding factors. Furthermore, we divided the patients into 4 groups according to the presence of high XOR activity and/or hyperuricemia. Cox multivariate hazard regression analysis revealed that the patients with high XOR activity were associated with cardiovascular events in patients with HFpEF, regardless of whether hyperuricemia was present or not.

Conclusions

Elevated plasma XOR activity is significantly associated with adverse clinical outcomes in patients with HFpEF. Inhibition of XOR could be a potential therapy for HFpEF.

P1918Comparison of the clinical outcome of pulmonary vein isolation with cryoballoon and radiofrequency ablation for atrial fibrillation with pulmonary vein triggers

Background

Pulmonary vein isolation (PVI) using radiofrequency (RF) or cryoballoon (CB) has been an established treatment for atrial fibrillation. PVI using RF is the most common method with a rather complex technique of a point-by-point tissue heating and navigation of electro-anatomical-guided mapping system, and PVI with CB is also the common method with a relatively simple technique of freezing balloon occlusion. These 2 types of ablation are comparable in terms of the efficacy of the PVI procedure.

Purpose

The data on the clinical outcome of each AF type with PV triggers has been limited. We compared the outcome of success rate between RF and CB group with respect to each AF type, and further assessed the efficacy of pulmonary vein isolation for AF patients with the origin of only PV.

Methods

A total of 3402 AF patients (age 64±11; 2463 males) underwent initial PVI from May 2009 to July 2018 (PAF: 67%, non-PAF: 37%). Radiofrequency using irrigation-tip catheter was employed to 1796 patients since May 2009 (RF-PAF: 55%, RF-non-PAF: 45%). Second-generation cryoballoon was employed to other 1606 patients since September 2014 (CB-PAF: 81%, CB-non-PAF: 19%). In CB group, PV touch-up ablation with RF was needed for 113 patients (7%) (CB-PAF: 6%, CB-non-PAF: 13%; p<0.001). After PVI, additional ablation for non-PV foci was undergone after the induction by using isoproterenol infusion and rapid atrial pacing (RF-AF: 34%, CB-AF: 32%; p=0.107).

Results

In all PAF patients, AF free survival rate was significantly superior in CB group (2-years Kaplan-Meir event rate, CB 83.2%, RF 75.2%; log-rank p<0.001). The percentage of patients with non-PV foci was almost equivalent in both group (CB 30%, RF 31%, p=0.644). And in PAF patients with only PV-foci, AF free survival rate was significantly superior in CB group (2-years Kaplan-Meir event rate, CB 85.0%, RF 78.8%; log-rank p<0.001). On the other hand, in all non-PAF patients, AF free survival rate was almost equivalent in both non-PAF group (2-years Kaplan-Meir event rate, CB 65.5%, RF-non-PAF 70.0%; log-rank p=0.9). The percentage of patients with non-PV foci was almost equivalent in both group (CB 40%, RF 39%, p=0.731), And in non-PAF patients with only PV-foci, AF free survival rate was almost equivalent in both non-PAF group (2-years Kaplan-Meir event rate, CB 69.7%, RF 73.0%; log-rank p=0.376).

Conclusions

Our study showed better outcome of PVI with CB for PAF patients with PV triggers, and indicated the non-inferiority of PVI with CB for non-PAF patients with PV triggers to PVI with RF.

P6380The impact of coronary artery disease to predict mortality and neurological outcome in post-cardiac arrest patients

Background

Some studies reported that performing coronary angiography (CAG) for patients with out-of-hospital cardiac arrest (OHCA) is effective for the prognosis and neurological outcome. However, the impact of complexity of coronary artery disease (CAD) on CAG findings has not been evaluated sufficiently.

Purpose

We sought to investigate the complexity of CAD to predict the prognosis and neurological outcome in patients with OHCA.

Methods

A total of 1382 out-of-hospital cardiac arrest patients were transferred to our critical care center, of which 252 cardiovascular arrest patients achieving the return of spontaneous circulation (ROSC) were extracted from the institutional consecutive database between January 2015 and December 2018. Among those patients, we performed CAG for 160 patients. To predict mortality in hospital and neurological outcome at 30 days, we investigated basic patients' characteristics, pre-hospital information, coronary anatomical angiographical findings.

Results

Ventricular fibrillation (VF) (P=0.001), younger age (P=0.007), pre-hospital ROSC (P<0.001) and normal coronary artery on CAG findings (P=0.014) were associated with low 30-days mortality in hospital. VF (P=0.003), younger age (P=0.004), pre-hospital ROSC (P<0.001), bystander cardiopulmonary resuscitation (CPR) (P=0.043) and normal coronary artery (P=0.001) were associated with good neurological outcome (cerebral-performance-category (CPC) =1 or 2) at 30 days. We further investigated 100 patients who had any coronary artery stenosis on CAG findings. Among these patients, 55 patients (55.0%) had multi-vessel coronary artery disease and 29 patients (29.0%) had at least a chronic total occlusion lesion. VF survivor (P=0.035), without previous history of CAD (P=0.008), pre-hospital ROSC (P=0.013), and Syntax score (P=0.002) were associated with low 30-days mortality. In multivariate analysis, Syntax score (OR 0.94; 95% confidence interval (CI) 0.88–0.99; P=0.042) was independent predictor of mortality. Bystander CPR (P=0.001), pre-hospital ROSC (P<0.001) were associated with good neurological outcome at 30 days. Bystander CPR (OR 5.92; 95% CI 2.01–17.5; P<0.001) and pre-hospital ROSC (OR 9.22; 95% CI 3.34–25.5; P<0.001) were predictive for good neurological outcome.

Conclusions

OHCA patients with any coronary stenosis had high mortality and bad neurological outcome in comparison with those who had normal coronary arteries. OHCA patients with CAD had complex lesions such as multi-vessel disease or chronic total occlusion lesions. The coronary complexity in patients with OHCA was a predictor of in-hospital 30-days mortality. However, pre-hospital care such as bystander CPR and pre-hospital ROSC were the most important to achieve good neurological outcome at 30 days in the present study.

P1626MicroRNA-21 deteriorates left ventricular reverse remodeling by promoting cardiac fibrosis in non-ischemic cardiomyopathy

Background

Left ventricular reverse remodeling (LVRR) contributes to better outcomes in patients with non-ischemic cardiomyopathy (NICM). It is reported that LVRR is associated with progression of cardiac fibrosis. MicroRNAs (miRs) have emerged as powerful regulators of post-transcriptional gene expression. We focused on miR-21, which plays a key role in pathogenesis of fibrosis in multiple organs. The aim of this study was to clarify the effect of miR-21 on cardiac fibrosis and LVRR in patients with NICM.

Methods

We measured plasma miR-21 levels in 16 patients with NICM. LVRR was defined as increased LVEF by ≥10% and decreased LV end-diastolic diameter index by ≥10% from baseline data after optimal medication treatment at 1-year of follow-up. Further, we examined miR-21 expression and its potential role in cardiac fibrosis induced by transverse aortic constriction (TAC) in mice and angiotensin II (Ang II) stimulation in neonatal rat cardiomyocytes (NRCMs).

Results

There were 12 patients without LVRR and 4 patients with LVRR. Plasma miR-21 levels were significantly higher in patients without LVRR compared with those with LVRR. In TAC mice heart, miR-21 levels were significantly increased and programmed cell death 4 (PDCD4), a main target of miR-21, was decreased. In vitro, miR-21 levels were significantly increased and its upstream transcriptional factor, activator protein 1 (AP-1), was activated by Ang II stimulation in NRCMs. After transfection of miR-21 specific inhibitor, PDCD4 levels were upregulated. Furthermore, AP-1 activity, expression of collagen type I, and α-smooth muscle actin levels were significantly decreased after miR-21 inhibition.

Conclusions

These findings suggested that miR-21/PDCD4/AP-1 feedback loop pathway was involved in LVRR in patients with NICM by promoting cardiac fibrosis. MiR-21 can be the therapeutic target in NICM.

5945Single nucleotide polymorphisms of PAR2 gene is associated with subclinical myocardial damage in the general population

Introduction

The protease activated receptor (PAR) 2 is a G protein-coupled receptor and expressed in cardiomyocytes, vascular cells, and leukocytes. Experimental studies demonstrated that PAR2 signaling is associated with adverse cardiac remodeling, heart failure, vascular inflammation and atherosclerosis. Recently, we and others demonstrated that subclinical myocardial damage is associated with cardiovascular mortality in general population. However, the impact of single nucleotide polymorphisms (SNPs) of PAR2 gene on subclinical myocardial damage in general population is unclear.

Purpose

The aim of this study was to investigate whether SNPs of PAR2 gene is associated with subclinical myocardial damage in general population.

Methods

The present study included 2,926 apparently healthy subjects (aged ≥40) who participated in a community-based health checkup. We investigated 639 SNPs and measured serum heart-type fatty acid binding protein (H-FABP) as markers of subclinical myocardial damage.

Results

We found the association of SNPs rs616235 within a PAR2 gene with subclinical myocardial damage. The homozygous A-allele (AA), heterozygous (AG), and homozygous G-allele (GG) carriers of rs616235 were identified in 2084 (71%), 791 (27%), and 51 (2%) subjects, respectively. The prevalence rates of subclinical myocardial damage were 29% in AA carriers, 23% in AG carriers, and 18% in GG carriers. Multivariate logistic analysis showed that the homozygous (AA) of rs616235 was independently associated with subclinical myocardial damage (odds ratio: 1.330, 95% confidence interval: 1.077–1.641, P=0.0080) after adjustment for conventional cardiovascular risk factors.

Conclusions

Genetic variant of PAR2 gene was independently associated with subclinical myocardial damage in the general population.

P6379The impact of coronary artery evaluation and intervention to predict mortality and neurological outcome in out-of-hospital cardiac arrest patients with extra corporeal cardiopulmonary resuscitation

Background

Refractory cardiac arrest (CA), as defined by the absence of a return of spontaneous circulation (ROSC) is associated with poor prognosis. Current guidelines advocate the use of extracorporeal cardiopulmonary resuscitation (ECPR) for selected patients with CA. Although previous studies have reported the association of survival with some prognostic factors such as age, bystander CPR attempt, low-flow duration or lactate serum level, the impact of the evaluation of coronary artery by coronary angiography (CAG) and the revascularization of coronary artery stenosis have not been sufficiently elucidated.

Purpose

We sought to investigate impact of the CAG and the revascularization of coronary artery stenosis to predict mortality and neurological outcome at 30 days in out-of-hospital CA (OHCA) patients resuscitated by ECPR.

Methods

1382 out-of-hospital cardiac arrest patients were transferred to our critical care center, of which 899 patients with refractory CA at the emergency department were extracted from the institutional consecutive database between January 2015 and December 2018. Among those patients, we performed ECPR for 85 patients, who were successfully resuscitated. To predict mortality in hospital and neurological outcome at 30 days, we investigated basic patients' characteristics, pre-hospital information, and post-hospital care including CAG and coronary revascularization.

Results

Among those who had first resuscitated by ECPR, 20 patients (23.5%) survived and 10 patients (11.8%) achieved good neurological outcome (cerebral-performance-category (CPC) =1 or 2) at 30 days. We performed CAG for 40 patients (47.1%) and revascularization by percutaneous coronary intervention for 25 patients (29.4%). Younger age (P=0.037), CAG (P=0.001), PCI (P=0.001), and hypothermia therapy (P<0.001) were associated with low mortality. In the multivariate analysis, age (Odds ratio (OR) 0.95; 95% confidence interval (CI) 0.91–0.99; P=0.0025), PCI (OR 4.5; 95% CI 1.15–17.6; P=0.031), and hypothermia therapy (OR 13.7; 95% CI 1.52–124; P=0.020) were independent predictors of 30-days survival. Without diabetes mellitus (P=0.024), CAG (P<0.001), PCI (P=0.006), and hypothermia therapy (P=0.038) were associated with good neurological outcome. PCI (OR 7.39; 95% CI 1.73–31.6; P<0.001) was independently predictive for good neurological outcome.

Conclusions

Successful PCI was an independent predictor of 30-days survival and good neurological outcome in OHCA patients who were resuscitated by ECPR.

P2672Coronary artery calcification on the whole body computed tomography predicts coronary artery disease and mortality in patients with out-of-hospital cardiac arrest

Introduction

Coronary artery disease (CAD) is the most frequent cause of out-of-hospital cardiac arrest (OHCA). Although the prompt evaluation of coronary artery in OHCA patients is recommended, it is not easy to identify the CAD by coronary artery angiography (CAG) because OHCA patients often exhibit unstable systemic condition after the return of spontaneous circulation (ROSC). The Agatston score, which is a popular calcium scoring of coronary artery calcification by computed tomography (CT), is useful for the risk stratification in patients suspected CAD. The impact of coronary artery calcification to predict the existence of CAD in OHCA patients has not been sufficiently elucidated. The usefulness of coronary artery calcification to predict mortality has also been unclear.

Purpose

We sought to assess the impact of evaluating the Agatston score to predict the existence of coronary artery stenosis and patients' mortality at 30 days in OHCA.

Method

A total of 748 OHCA patients were transferred to our critical care center, of which 126 cardiovascular arrest patients achieving the ROSC were extracted from the institutional database from January 2017 to December 2018. Among those patients, we performed the whole-body CT scanning in Emergency Department (ED) for 101 patients and evaluated coronary artery by CAG for 82 patients. We assessed their coronary artery calcifications on CT findings, calculating the Agatston score. We investigated the usefulness of the Agatston score to predict the existence of coronary artery stenosis on CAG findings, and patients' mortality at 30 days.

Result

Both the whole-body CT scanning and CAG were performed in 70 patients. Among those patients, 31 (44.3%) patients had any coronary artery stenosis on CAG findings. The Agatston score was significantly higher in those who had any coronary artery stenosis (p<0.01). The optimal cut off value of the Agatston score to predict the existence of coronary artery stenosis was 9.9 ((Area under the curve (AUC) 0.75; 95% Confidence interval (CI) 0.63 - 0.87). The positive predictive value to predict coronary artery stenosis was 72.5%. In the present study, 101 patients were eligible to be calculated the Agatston score. The Agatston score was significantly higher in those who was dead at 30 days (p=0.04). The optimal cut off value of the Agatston score to predict the 30-days mortality was 15.1 ((Area under the curve (AUC) 0.62; 95% Confidence interval (CI) 0.51 - 0.73). Among the patients who had lower Agatston score (<15.1), 22 (50%) patients survived at 30 days.

Conclusion

The Agatston score calculated by the whole-body CT scanning in ED is helpful to predict the existence of coronary artery stenosis in OHCA patients. And evaluating the Agatston score is useful to predict mortality in OHCA patients.

P2266The predictor of mortality and neurological outcome in out-of-hospital cardiac arrest patients with non-ST-segment elevation

Background

The prognosis of patients with out-of-hospital cardiac arrest (OHCA) remains poor. Coronary artery disease (CAD) is the most frequent cause of OHCA. The prompt evaluation and revascularization for coronary artery in OHCA patients with ST-segment elevation are recommended because they often have CAD. However, OHCA patients without ST-segment elevation also have any coronary stenosis in the non-negligible proportion. The predictor of mortality and neurological outcome in OHCA patients with no ST-segment elevation has not been sufficiently elucidated.

Purpose

We sought to investigate the predictor of mortality and neurological outcome at 30 days in OHCA patients without ST-segment elevation.

Methods

A total of 1382 out-of-hospital cardiac arrest patients were transferred to our critical care center, of which 252 cardiovascular arrest patients achieving the return of spontaneous circulation (ROSC) were extracted from the institutional consecutive database between January 2015 and December 2018. Among those patients, 183 patients' electrocardiogram after ROSC were without ST-segment elevation. We performed coronary angiography (CAG) for 103 patients, who were eligible for final analysis. To predict mortality in hospital and neurological outcome at 30 days, we investigated basic patients' characteristics, pre-hospital information, post-hospital care.

Results

Any coronary stenosis was founded in 50 patients (48.5%). Male (P=0.007), older age (P<0.001), past history of coronary artery disease (CAD) (P=0.037) and diabetes mellitus (P=0.087) were associated with coronary artery stenosis on CAG findings. Age (OR 1.05; 95% confidence interval (CI) 1.02–1.08; P<0.001), male (OR 5.33; 95% CI 1.37–20.7; P<0.001) were independent predictors of coronary artery stenosis. Among those who had stenosis, 34 patients (68.0%) survived and 27 patients (54.0%) achieved good neurological outcome (cerebral-performance-category (CPC) =1 or 2) at 30 days. Successful revascularization by percutaneous coronary intervention (PCI) was not associated with low mortality (P=0.77). Past history of CAD (P=0.014) and high Syntax score (P=0.030) were associated with mortality. Bystander cardiopulmonary resuscitation (CPR) (P-0.021), pre-hospital ROSC (P<0.001) was more frequent in patients with good neurological outcome. Pre-hospital ROSC (OR 14.7; 95% CI 3.1–69.3; P<0.001) was independently predictive for good neurological outcome.

Conclusions

Successful PCI for OHCA patients with no ST-segment elevation was not a predictor of mortality. CAD past history and complex CAD was associated with mortality. Pre-hospital information such as pre-hospital ROSC was important to achieve good neurological outcome.

P2462Left atrial appendage wall velocity evaluated by transthoracic echocardiography is a feasible parameter for predicting cardiac prognosis in patients with heart failure

Background

It was reported that left atrial (LA) remodeling is occurred in patients with heart failure (HF), and increased LA volume index (LAVI) is a feasible predictor for poor prognosis of HF. It was reported that LA remodeling is associated with LA appendage (LAA) dysfunction. We previously reported that LAA wall motion velocity (LAWV) obtained by transthoracic echocardiography (TTE) can noninvasively evaluate LAA dysfunction. However, it remains to be determined whether LAWV is useful for predicting poor prognosis in patients with HF.

Purpose

We investigated whether LAA dysfunction assessed by LAWV is associated with poor prognosis in patients with HF.

Methods

We performed TTE at discharge in 217 consecutive patients who hospitalized for HF (126 males, 71±13 years) and prospectively followed them up. LAWV was measured using Doppler tissue imaging at the LAA tip from the parasternal short-axis view on TTE imaging.

Results

There were 86 patients with cardiac events including 14 cardiac deaths and 72 rehospitalizations for HF during a median follow-up period of 404 days (interquartile range 168–748 days). LAWV was significantly lower in patients with cardiac events than in those without. LAWV was significantly decreased with advancing left ventricular diastolic dysfunction grade. Kaplan-Meier analysis demonstrated that significantly higher cardiac event rate was observed in patients with low LAWV (log-rank test, P=0.004). Cox multivariate hazard analysis revealed that LAWV was an independent predictor for cardiac events after adjusting for confounding factors (hazard ratio 0.57, 95% confidence interval 0.40–0.82, P<0.05). Further, we categorized the patients into 3 groups based on the median of LAWV and left atrial volume index (LAVI), and Kaplan-Meier analysis showed that patients with both low LAWV and high LAVI had the highest rate of cardiac events among 3 groups (log-rank test, P<0.001; Figure).

Figure 1

Conclusion

LAWV may be a feasible parameter for predicting cardiac prognosis in patients with HF.

P1919The assessment of the application and the efficacy of pulmonary vein isolation with cryoballoon for non-paroxysmal atrial fibrillation

Background

Pulmonary vein isolation (PVI) using second generation cryoballoon (CB) ablation has become an established treatment for paroxysmal atrial fibrillation (PAF) patients. On the other hand, PVI with radiofrequency (RF) has been an established treatment for non-PAF patients, in addition to PAF patients.

Purpose

The data on second generation CB ablation for non-PAF patients is limited. We assessed the application of PVI with CB for non-PAF patients and compared the outcomes of success rate, radiational time, and procedural time.

Methods

A total of 2632 AF patients (age 64±10; 1873 males) underwent initial PVI from September 2014 to June 2018. Second-generation CB was employed to 1587 patients (CB-PAF: 80%, CB-non-PAF: 20%) and RF using irrigation-tip catheter was employed to other 1045 patients (RF-PAF: 40%, RF-non-PAF: 60%). In CB group, PV touch-up ablation with RF was needed for 113 patients (7%) (CB-PAF: 6%, CB-non-PAF: 13%; p<0.001). After PVI, additional ablation for non-PV foci was undergone after the induction by using ISP infusion and rapid atrial pacing.

Results

AF free survival rate was almost equivalent in both non-PAF group (2-years Kaplan-Meir event rate, CB-non-PAF 66.3%, RF-non-PAF 69.8%; log-rank p=0.297). There was significantly difference in procedural time (CB-non-PAF 132±56min, RF-non-PAF: 189±52min, p<0.001), and radiation time (CB-non-PAF: 47±40min, RF-non-PAF: 75±31min, p<0.001). The percentage of patients with non-PV foci was significantly higher in CB group (CB-non-PAF 41%, RF-non-PAF 54%, p<0.001), and after excluding the patients with non-PV foci, AF free survival rate was almost equivalent in both group (2-years Kaplan-Meier event rate, CB-non-PAF 75.4%, RF-non-PAF 78.8%; log-rank p=0.577). On the other hand, in patients in CB, AF free survival rate was significantly superior in PAF group (2-years Kaplan-Meir event rate, CB-PAF 83.3%, CB-non-PAF 65.2%; log-rank p<0.001). There was significantly difference in procedural time (CB-PAF: 117±47min, CB-non-PAF: 132±56min, p<0.001), and radiation time (CB-PAF: 38±22min, CB-non-PAF: 46±27min, p<0.001). The percentage of patients with non-PV foci was significantly higher in non-PAF group (CB-PAF 30%, CB-non-PAF 41%, p<0.001), and after excluding the patients with non-PV foci, AF free survival rate was also significantly superior in PAF group (2-years Kaplan-Meier event rate, CB-PAF 85.1%, CB-non-PAF 69.8%; log-rank p<0.001).

Conclusions

For non-PAF patients with PV triggers, PVI with CB might be non-inferior to PVI with RF. Our study showed the efficacy of CB in terms of the shortening of procedural time, and the reduction of radiational exposure. PVI with CB for non-PAF patients was inferior to that for PAF patients.

P1615HECT-Type Ubiquitin E3 Ligase ITCH attenuates cardiac hypertrophy by suppressing Wnt signaling pathway

Background

The homologous to the E6-AP carboxyl terminus (HECT)–type ubiquitin E3 ligase ITCH is an enzyme that plays an important role in ubiquitin proteasomal protein degradation. Dishevelled proteins (Dvl1, Dvl2 and Dvl3), which are involved in canonical Wnt/β catenin signaling pathway, play a role in cardiac hypertrophy.

Purpose

The aim of this study was to examine whether ITCH interacts with Dvls and prevents cardiac hypertrophy induced by pressure overload.

Methods and results

We confirmed the protein interaction between ITCH and Dvls in cardiomyocytes. Overexpression of ITCH decreased protein expression levels of Dvls, phospho-GSK3β and β-catenin. Conversely, knockdown of ITCH using small interfering RNA augmented canonical Wnt/β catenin signaling pathway. Thoracic transverse aortic constriction (TAC) was performed in transgenic mice with cardiac-specific overexpression of ITCH (ITCH-Tg) and wild-type (WT) mice. The canonical Wnt/β catenin signaling pathway was inhibited and cardiac hypertrophy was attenuated in ITCH-Tg mice compared with WT mice after TAC.

Overexpression of ITCH in cardiomyocytes

Conclusion

We demonstrated that ITCH targets Dvls for ubiquitin-proteasome degradation in cardiomyocytes and ameliorates cardiac hypertrophy by suppressing canonical Wnt/β catenin signaling pathway.

First Detection of Photons with Energy beyond 100 TeV from an Astrophysical Source

We report on the highest energy photons from the Crab Nebula observed by the Tibet air shower array with the underground water-Cherenkov-type muon detector array. Based on the criterion of a muon number measured in an air shower, we successfully suppress 99.92% of the cosmic-ray background events with energies E>100  TeV. As a result, we observed 24 photonlike events with E>100  TeV against 5.5 background events, which corresponds to a 5.6σ statistical significance. This is the first detection of photons with E>100  TeV from an astrophysical source.

Emerging investigator series: investigation of mercury emission sources using Hg isotopic compositions of atmospheric mercury at the Cape Hedo Atmosphere and Aerosol Monitoring Station (CHAAMS), Japan

This study conducted mercury (Hg) isotopic analysis, which has been expected as a new indicator for understanding the behavior of atmospheric Hg. The dominant atmospheric Hg species, namely gaseous elemental mercury (GEM, Hg0), were collected at the Cape Hedo Atmosphere and Aerosol Monitoring Station (CHAAMS) in Okinawa, Japan, for evaluating possible source(s) and transformation process(es) of Hg. The Hg isotopic compositions of GEM samples showed that the mass-dependent fractionation (MDF) of δ202Hg and the mass-independent fractionation (MIF) of Δ199Hg ranged from -2.15‰ to 0.79‰ and from -0.32‰ to 0.00‰, respectively. The results were classified into two groups: (1) negative δ202Hg and near-zero Δ199Hg in summer and (2) near-zero δ202Hg and negative Δ199Hg in the other season. According to the NOAA Hybrid Single-Particle Lagrangian Integrated Trajectory (HYSPLIT) model, the dominant air masses traveled from East Asia during winter and South and East Asia during summer. However, the air masses also traveled from mainland Japan and rotated around Okinawa before reaching CHAAMS. In contrast, clear positive correlations between δ202Hg values and CO and PM2.5 concentrations were observed during summer. A small peak of Ox concentration was observed at three atmospheric monitoring stations, namely Nago, Naha, and Miyako Island during summer. Since Miyako Island is located ∼370 km southwest of CHAAMS, the main emission source of GEM transported to CHAAMS was not from mainland Okinawa but traveled from the southwest during summer.