Thigh intramuscular fat predicts the prognosis in patients in non-ischemic cardiomyopathy with reduced ejection fraction

Background

Skeletal muscle atrophy is an independent prognostic predictor for patients with chronic heart failure, and the concept of sarcopenia is drawing attention. Furthermore, the importance of not only muscle mass but also intramuscular fat (IMF) has been pointed out. However, there is a lack of consensus on the implications of ectopic fat for the prognosis in patients with non-ischemic cardiomyopathy.

Purpose

We investigated whether ectopic fat in the thigh affects the prognosis with non-ischemic cardiomyopathy.

Methods

We recruited 105 patients who were diagnosed with non-ischemic cardiomyopathy by cardiac catheterization and echocardiographic date between September 2017 and November 2019. Finally 73 patients with reduced EF (EF 40% or less) enrolled in this prospective study. Functional status was evaluated by using cardiopulmonary exercise test at baseline. All patients were measured quantity of epicardial fat and thigh IMF percentage (%IMF) using computed tomography scan. Demographic, laboratory and echocardiographic date were collected from the patients' medical records. Clinical endpoints were unexpected readmission.

Results

During the follow-up period 18 patients had adverse events. The %IMF was significantly higher in the group with adverse events than without (5.57±5.70 and 3.02±2.44%, respectively; p<0.01). Spearman correlation coefficient analysis showed a modest correlation between %IMF and lower limb extension strength (Spearman r=−0.280; p=0.0315), but there was no significant correlation between %IMF and exercise tolerance such as anaerobic threshold and peak oxygen uptake. Patients were divided into 2 groups according to the median values of %IMF. Kaplan-Meier analysis demonstrated that events were significantly higher in the high %IMF group (log-rank p=0.033). Multivariate Cox regression analysis adjusted for left ventricular end-diastolic diameter and peak ventricular oxygen consumption found %IMF as an independent factor of adverse events (hazard ratio 1.545; 95% confidential interval 1.151–2.087; p=0.004).

Conclusions

In non-ischemic cardiomyopathy patients with reduced EF, %IMF may have important adverse consequences such as increased cardiac-related events.

Kaplan-Meier curves

Funding Acknowledgement

Type of funding source: None

Regional muscle-adipose distribution is different in patients with heart failure with preserved or reduced ejection fraction

Background

Epicardial adipose tissue (EAT) has been recognized to contribute inflammatory activity and atherosclerosis. On the other hand, it has been reported that the volume of EAT is lower in non-ischemic heart failure (HF) patients than healthy individuals. However, the difference in regional muscle-adipose distribution including EAT between HF with preserved ejection fraction (HFpEF) and HF reduced ejection fraction (HFrEF) has not been investigated. In addition, we investigated whether distribution of body composition contributed to exercise capacity.

Methods

The study included 105 non-ischemic HF patients diagnosed by cardiac catheterization between September 2017 and November 2019. Epicardial, abdominal and thigh muscle and adipose tissue volume were measured by computed tomography (CT), and exercise tolerance was evaluated by symptom-limited cardiopulmonary exercise test.

Results

Patients were divided into 2 groups according to the left ventricular ejection fraction, ≥40% as HFpEF (n=28) or <40% as HFrEF (n=77). There was no significant difference comorbidity, including hypertension, dyslipidemia, chronic kidney disease, and body mass index. Plasma B-type natriuretic peptide level was significantly higher in HFrEF than HFpEF group (146.2 vs 393.2 pg/ml, p<0.01), whereas, high-sensitive troponin T level was not different between two groups. Although there was no significant difference in BMI between two groups, the volume of EAT was significantly higher in HFpEF than HFrEF group (81.8 vs 136.4 ml, p=0.01). On the other hand, HFpEF had more thigh adipose tissue compared with HFrEF group (54.6 vs 42.1 ml, p=0.03). There were negative correlations between EAT volume and parameters of exercise capacity such as anaerobic threshold (r=−0.42, p<0.01) and peak VO2 (r=−0.32, p<0.01). Muscle volume itself does not corelate with these parameters.

Conclusion

In patient with nonischemic HF, the pattern of regional adipose distribution may have important role in pathologically. HFpEF and HFrEF has different pattern despite similar body mass index. These differences may be related to impaired exercise tolerance in these 2 different types of HF.

Correlation between EAT and AT, peak VO2

Funding Acknowledgement

Type of funding source: None

Evaluation of neonatal withdrawal syndrome in neonates delivered by women taking psychotropic or anticonvulsant drugs: A retrospective chart review of the effects of multiple medications and breastfeeding

OBJECTIVES

Neonates delivered by women who were taking psychotropic or anticonvulsant drugs during pregnancy are at increased risk of developing neonatal withdrawal syndrome. We investigated the incidence of neonatal withdrawal symptoms and the effects of multiple maternal medications and breastfeeding on neonatal withdrawal symptoms.

STUDY DESIGN

This study examined the overall incidence of neonatal withdrawal symptoms in neonates delivered from 2004 to 2016 by women who were taking oral antipsychotics, antidepressants, anxiolytics, sedatives, or anticonvulsant drugs during pregnancy. Moreover, we compared the incidence of neonatal symptoms between mothers taking single drugs and multiple drugs, and between breastfed and formula-fed neonates. We scored the neonates according to the neonatal withdrawal syndrome checklist created by Isobe et al., which is widely used in Japan.

RESULTS

We examined 131 mothers and their 134 neonates. Withdrawal symptoms were found in 54.5 % of neonates. Symptoms were found in 32.4 % of neonates delivered by mothers taking single drugs and 62.9 % of neonates delivered by mothers taking two or more drugs (p = 0.0019). One or more withdrawal symptoms developed in 46.4 % of breastfed neonates and 66.1 % of formula-fed neonates (p = 0.034). Five infants had a score of 8 or more points on the withdrawal checklist, which is an indication to consider treatment with pharmacotherapy. All five of these neonates were mainly formula-fed, and their mothers were taking two or more drugs.

CONCLUSIONS

The incidence of withdrawal symptoms was high in neonates delivered by women taking psychotropic or anticonvulsant drugs; however, there were few serious cases. The risk increased when a mother was taking multiple drugs. Breastfeeding appeared to protect against withdrawal symptoms.

Aneuploid rescue precedes X-chromosome inactivation and increases the incidence of its skewness by reducing the size of the embryonic progenitor cell pool

STUDY QUESTION

Do monosomy rescue (MR) and trisomy rescue (TR) in preimplantation human embryos affect other developmental processes, such as X-chromosome inactivation (XCI)?

SUMMARY ANSWER

Aneuploid rescue precedes XCI and increases the incidence of XCI skewness by reducing the size of the embryonic progenitor cell pools.

WHAT IS KNOWN ALREADY

More than half of preimplantation human embryos harbor aneuploid cells, some of which can be spontaneously corrected through MR or TR. XCI in females is an indispensable process, which is predicted to start at the early-blastocyst phase.

STUDY DESIGN, SIZE, DURATION

We examined the frequency of XCI skewness in young females who carried full uniparental disomy (UPD) resulting from MR or TR/gamete complementation (GC). The results were statistically analyzed using a theoretical model in which XCI involves various numbers of embryonic progenitor cells.

PARTICIPANTS/MATERIALS, SETTING, METHODS

We studied 39 children and young adults ascertained by imprinting disorders. XCI ratios were determined by DNA methylation analysis of a polymorphic locus in the androgen receptor gene. We used Bayesian approach to assess the probability of the occurrence of extreme XCI skewness in the MR and TR/GC groups using a theoretical model of 1-12 cell pools.

MAIN RESULTS AND THE ROLE OF CHANCE

A total of 12 of 39 individuals (31%) showed skewed XCI. Extreme skewness was observed in 3 of 15 MR cases (20%) and 1 of 24 TR/GC cases (4.2%). Statistical analysis indicated that XCI in the MR group was likely to have occurred when the blastocyst contained three or four euploid embryonic progenitor cells. The estimated size of the embryonic progenitor cell pools was approximately one-third or one-fourth of the predicted size of normal embryos. The TR/GC group likely had a larger pool size at the onset of XCI, although the results remained inconclusive.

LIMITATIONS, REASONS FOR CAUTION

This is an observational study and needs to be validated by experimental analyses.

WIDER IMPLICATIONS OF THE FINDINGS

This study provides evidence that the onset of XCI is determined by an intrinsic clock, irrespectively of the number of embryonic progenitor cells. Our findings can also be applied to individuals without UPD or imprinting disorders. This study provides a clue to understand chromosomal and cellular dynamics in the first few days of human development, their effects on XCI skewing and the possible implications for the expression of X-linked diseases in females.

STUDY FUNDING/COMPETING INTEREST(S)

This study was supported by the Grants-in-aid for Scientific Research on Innovative Areas (17H06428) and for Scientific Research (B) (17H03616) from Japan Society for the Promotion of Science (JSPS), and grants from Japan Agency for Medical Research and Development (AMED) (18ek0109266h0002 and 18ek0109278h0002), National Center for Child Health and Development and Takeda Science Foundation. The authors declare no conflict of interest.

TRIAL REGISTRATION NUMBER

Not applicable.

Dopamine and beta-band oscillations differentially link to striatal value and motor control

Parkinson's disease is characterized by decreased dopamine and increased beta-band oscillatory activity accompanying debilitating motor and mood impairments. Coordinate dopamine-beta opposition is considered a normative rule for basal ganglia function. We report a breakdown of this rule. We developed multimodal systems allowing the first simultaneous, chronic recordings of dopamine release and beta-band activity in the striatum of nonhuman primates during behavioral performance. Dopamine and beta signals were anticorrelated over seconds-long time frames, in agreement with the posited rule, but at finer time scales, we identified conditions in which these signals were modulated with the same polarity. These measurements demonstrated that task-elicited beta suppressions preceded dopamine peaks and that relative dopamine-beta timing and polarity depended on reward value, performance history, movement, and striatal domain. These findings establish a new view of coordinate dopamine and beta signaling operations, critical to guide novel strategies for diagnosing and treating Parkinson's disease and related neurodegenerative disorders.

Cosmic-ray antinuclei as messengers of new physics: status and outlook for the new decade

The precise measurement of cosmic-ray antinuclei serves as an important means for identifying the nature of dark matter and other new astrophysical phenomena, and could be used with other cosmic-ray species to understand cosmic-ray production and propagation in the Galaxy. For instance, low-energy antideuterons would provide a "smoking gun" signature of dark matter annihilation or decay, essentially free of astrophysical background. Studies in recent years have emphasized that models for cosmic-ray antideuterons must be considered together with the abundant cosmic antiprotons and any potential observation of antihelium. Therefore, a second dedicated Antideuteron Workshop was organized at UCLA in March 2019, bringing together a community of theorists and experimentalists to review the status of current observations of cosmic-ray antinuclei, the theoretical work towards understanding these signatures, and the potential of upcoming measurements to illuminate ongoing controversies. This review aims to synthesize this recent work and present implications for the upcoming decade of antinuclei observations and searches. This includes discussion of a possible dark matter signature in the AMS-02 antiproton spectrum, the most recent limits from BESS Polar-II on the cosmic antideuteron flux, and reports of candidate antihelium events by AMS-02; recent collider and cosmic-ray measurements relevant for antinuclei production models; the state of cosmic-ray transport models in light of AMS-02 and Voyager data; and the prospects for upcoming experiments, such as GAPS. This provides a roadmap for progress on cosmic antinuclei signatures of dark matter in the coming years.

Intermittent pneumatic compression versus additional prophylaxis with enoxaparin for prevention of venous thromboembolism after laparoscopic surgery for gastric and colorectal malignancies: multicentre randomized clinical trial

Background

The role of antithrombotic chemoprophylaxis in prevention of venous thromboembolism (VTE) in laparoscopic surgery for gastric and colorectal malignancies is unknown. This study compared the addition of enoxaparin following intermittent pneumatic compression (IPC) with IPC alone in patients undergoing laparoscopic surgery for gastrointestinal malignancy.

Methods

In this multicentre RCT, eligible patients were older than 40 years and had a WHO performance status of 0 or 1. Exclusion criteria were prescription of antiplatelet or anticoagulant drugs and history of VTE. Patients were allocated to IPC or to ICP with enoxaparin in a 1 : 1 ratio. Stratification factors included sex, location of cancer, age 61 years and over, and institution. Enoxaparin was administered on days 1–7 after surgery. Primary outcome was VTE, evaluated by multidetector CT on day 7.

Results

Of 448 patients randomized, 208 in the IPC group and 182 in the IPC with enoxaparin group were evaluated. VTE occurred in ten patients (4·8 per cent) in the IPC group and six (3·3 per cent) in the IPC with enoxaparin group (P = 0·453). Proximal deep vein thrombosis and/or pulmonary embolism occurred in seven patients (3·4 per cent) in the IPC group and one patient (0·5 per cent) in the IPC with enoxaparin group (P = 0·050). All VTE events were asymptomatic and non‐fatal. Bleeding occurred in 11 of 202 patients in the IPC with enoxaparin group, and one patient needed a transfusion. All bleeding events were managed by discontinuation of the drug.

Conclusion

IPC with enoxaparin after laparoscopic surgery for gastric and colorectal malignancies did not reduce the rate of VTE. Registration number: UMIN000011667 ( https://www.umin.ac.jp/).

A randomized, open-label, controlled trial of monthly oral minodronate or semiannual subcutaneous injection of denosumab for bone loss by androgen deprivation in Asian men with prostate cancer: the PRevention of Osteopenia with Minodronate And DEnosumab (PROMADE) study

There is still a lack of evidence that minodronate or denosumab prevents bone loss due to androgen deprivation therapy (ADT) in non-Western patients. This study showed that both drugs significantly improved lumbar spine and total hip bone mineral density in Asian men with prostate cancer who received ADT.

INTRODUCTION

To evaluate whether monthly oral minodronate or semiannual subcutaneous injection of denosumab improves bone mineral density (BMD) in Asian men with prostate cancer (PCa) receiving ADT.

METHODS

A multicenter, open-label, randomized, controlled study including patients with hormone-sensitive PCa without bone metastasis receiving ADT was performed. Patients were randomized (1:1:1) to minodronate, denosumab, or no agent control groups. The primary end point was the mean percentage change in BMD at the lumbar spine at 12 months. Secondary end points were the mean percentage change in BMD at the femoral neck and total hip and changes in bone turnover markers. Statistical comparison was performed using analysis of covariance.

RESULTS

Of the 147 subjects enrolled in this study, 102 were randomly assigned into the minodronate (n = 36), denosumab (n = 36), and control (n = 30) groups. The percentage change in BMD at the lumbar spine was significantly improved in the minodronate (2.5%, p < 0.05) and denosumab groups (4.0%, p < 0.01) compared with that in the control group (- 0.1%). Denosumab increased BMD at the femoral neck and total hip at 12 months, whereas minodronate only increased BMD at the total hip compared with controls (all p < 0.05). The percentage change in bone turnover markers at 12 months was significantly lower in the minodronate and denosumab groups compared with that in the control group (both p < 0.01).

CONCLUSION

Minodronate or denosumab can be used for preventing bone loss related to ADT in Asian patients with PCa.

THU0324 CYTOMEGALOVIRUS REACTIVATION AND HIGH INITIAL SERUM CREATININE ARE SIGNIFICANT PROGNOSTIC FACTORS FOR SUBSEQUENT SEVERE INFECTIONS IN PATIENTS WITH ANCA-ASSOCIATED VASCULITIS

Background:

There are several reports that cytomegalovirus (CMV) reactivation resulted in more co-infections affecting survival in rheumatic disease, and CMV reactivation can lead to infections in granulomatosis with polyangiitis patients by inducing CD4+CD28- T cell and depressing naïve T cell populations.1-4Despite this evidence, the prognostic value of CMV reactivation for severe infections in patients with connective tissue disease are still unknown.

Objectives:

The aim of this study was to examine prognostic factors for severe infection during the early phase of treatment, especially in CMV reactivation, in patients with antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis (AAV) who received initial high dose corticosteroid therapy (prednisolone > 0.8mg/kg/day).

Methods:

We analyzed the data of 88 consecutive hospitalized patients newly diagnosed with AAV at our hospital from January 2006 to March 2019 in this retrospective cohort study. There were 32 patients with CMV reactivation during remission induction therapy compared to 56 patients without CMV reactivation. CMV reactivation was defined by the detection of CMV pp65 antigen in blood samples, and CMV positive cells ≥ 5 per 3.0 × 105polymorphonuclear neutrophils (PMNs). The variable for severe infections within 180 days with apvalue < 0.1 in univariate analysis were selected for multivariate analysis using the Cox regression model. The positive predictive value (PPV) and positive likelihood ratio (PLR) of CMV reactivation for subsequent severe infections were also analyzed.

Results:

Patients with CMV reactivation, compared to those without, had a higher prevalence of MPO-ANCA, renal manifestation and renal impairment at diagnosis, received hemodialysis (HD), higher revised five factor score (FFS), older age, higher Birmingham Vasculitis Activity Score at diagnosis, and higher initial doses of corticosteroids (CS) at baseline. Revised FFS ≥ 2, renal involvement, high initial serum creatinine (≥ 1.5 mg/dl) at diagnosis, received HD, and CMV reactivation were associated with severe infections in the univariate analysis, although receiving cyclophosphamide or rituximab was not. Among these variables, CMV reactivation (Hazard ratio [HR] 3.50; 95% confidence interval [CI]: 1.22-10.10;p= 0.02) and high initial serum creatinine at diagnosis (HR 8.09; 95%CI: 2.00-32.73;p< 0.01) were independent risk factors for severe infections within 180 days. (Table 1) The PPV and PLR of CMV reactivation for subsequent severe infections were 35% and 1.91. When including higher initial serum creatinine, PPV and PLR for subsequent severe infections was 67% and 7.26.

Table 1.

Cox regression analysis for severe infections within 180 days.

Univariate analysisMultivariate analysisPotential prognostic factorsHR (95% CI)P valueHR (95% CI)P valueAge ≥ 651.36 (0.48-3.71)0.580Male1.23 (0.50-3.04)0.648Past history of lung disease0.39 (0.11-1.36)0.140Past history of diabetes mellitus0.64 (0.15-2.77)0.550Lung involvement1.76 (0.67-4.62)0.254Renal involvement†3.68 (1.22-11.10)0.021Serum Cr ≥ 1.5 at diagnosis9.50 (3.40-26.49)< 0.0018.09 (2.00-32.73)0.003Hemodialysis4.85 (1.73-13.54)0.0030.96 (0.31-2.97)0.950BVAS ≥ 201.50 (0.59-3.81)0.393Revised FFS ≥ 24.40 (1.28-15.13)0.0180.83 (0.16-4.27)0.818MPSL pulse therapy1.16 (0.47-2.86)0.746Received CYC or RTX1.54 (0.55-4.27)0.409CMV reactivation5.10 (1.93-13.48)0.0013.50 (1.22-10.06)0.020

† “Renal involvement” was excluded in the multivariate analysis to avoid multicollinearity.

Conclusion:

Our study shows that there should be focus on subsequent severe infections when CMV reactivation is detected during early phase of treatment, especially in renal-impaired patients with ANCA-associated vasculitis.

References:

[1]Gardiner BJ et al. Rheumatol Int. 2019;39:1229-40

[2]Hung M et al. J Microbiol Immunol Infect. 2019;52:114-21.

[3]Hanaoka R et al. Mod Rheumatol. 2012;22:438-45.

[4]Morgan MD et al. Arthritis Rheum. 2011;63:2127-37.

Disclosure of Interests:

Daisuke Waki Speakers bureau: Mitsubishi Tanabe Pharma, AbbVie Inc, eisai Co,. Ltd, ONO PHARMACEUTICAL CO., LTD,, Keisuke Nishimura Speakers bureau: Mitsubishi Tanabe Pharma Corporation. Pfizer Inc. Kyowa Kirin Co., Ltd. Chugai Pharmaceutical Co., Ltd. ONO PHARMACEUTICAL CO., LTD. Japan Blood Products Organization. Kissei Pharmaceutical Co., Ltd. Astellas Pharma Inc. AYUMI Pharmaceutical Corporation. Eisai Co., Ltd. DAIICHI SANKYO COMPANY. Norvartis AG. Bayer AG. Sanofi K.K.

, Tomohiro Yoshida: None declared, Keiichiro Kadoba: None declared, Nozomi Tanaka: None declared, Hiroyuki Murabe: None declared, Toshihiko Yokota: None declared

AB0197 INCREASED CIRCULATING ADIPONECTIN IS AN INDEPENDENT DISEASE ACTIVITY MARKER IN PATIENTS WITH RHEUMATOID ARTHRITIS: A CROSS-SECTIONAL STUDY USING THE KURAMA DATABASE

Background:

Adiponectin is a major adipokine with pleiotropic effects on inflammatory conditions including rheumatoid arthritis (RA). Adiponectin generally has anti-atherogenic effects, and its serum level inversely correlates with body mass index (BMI) and visceral fat area (VFA). On the other hand, several studies have indicated a deleterious role of adiponectin in RA progression [1]. Recently, both low BMI and increased serum adiponectin have been reported as poor prognostic factors of RA [2, 3]. However, large-scale surveys have not been done focusing on both BMI and serum adiponectin, and it is unclear which factor provides further contribution to RA disease activity. In addition, the effects of biological disease-modifying antirheumatic drugs (bDMARDs) and Janus kinase (JAK) inhibitors on serum adiponectin are largely unknown.

Objectives:

To clarify the relationship among serum adiponectin, body composition, current disease activity and therapeutic agents of RA.

Methods:

We conducted a cross-sectional study in RA patients under treatment with agents including bDMARDs and JAK inhibitors. A total of 351 subjects from the Kyoto University RA Management Alliance cohort (KURAMA) were enrolled. We classified the participants into five body composition groups (overweight with or without visceral adiposity, normal with or without visceral adiposity, and underweight), according to the cut-off points for obesity and visceral fat used in Japan: BMI, 18.5 kg/m2for underweight and 25.0 kg/m2for obesity, and VFA, 100 cm2for visceral adiposity. Differences of continuous variables among the five groups were assessed by the Steel-Dwass test or one-way analysis of variance (ANOVA). We adopted a multiple standardized linear regression model to analyze effects of serum adiponectin level on DAS28-ESR.

Results:

Serum adiponectin levels (20.9±12.5 vs. 14.7±8.4 µg/ml, p < 0.001) and DAS28-ESR (3.04±1.0 vs. 2.63±0.9,p= 0.017) in the underweight group were significantly higher than those in the others. In multiple regression analysis, serum adiponectin level, but not BMI, was positively correlated with DAS28-ESR (estimate = 0.0127,p= 0.0258). Subanalysis also showed that the use of bDMARD or JAK inhibitor did not have an obvious influence on circulating adiponectin.

Conclusion:

In the multiple regression analysis we revealed a positive and independent correlation between serum adiponectin and DAS28-ESR in Japanese RA patients. Thus, serum adiponectin is an potential marker reflecting high disease activity of RA regardless of current medications.

References:

[1]Frommer KW, Zimmermann B, Meier FM, Schroder D, Heil M, Schaffler A, et al. Adiponectin-mediated changes in effector cells involved in the pathophysiology of rheumatoid arthritis. Arthritis Rheum. 2010;62(10):2886-99.

[2]Kaufmann J, Kielstein V, Kilian S, Stein G, Hein G. Relation between body mass index and radiological progression in patients with rheumatoid arthritis. Journal of Rheumatology. 2003;30(11):2350-5.

[3]Ebina K, Fukuhara A, Ando W, Hirao M, Koga T, Oshima K, et al. Serum adiponectin concentrations correlate with severity of rheumatoid arthritis evaluated by extent of joint destruction. Clin Rheumatol. 2009;28(4):445-51.

Acknowledgments:

We would like to thank to Ms. Sumie Nakagawa for management of blood specimens, Ms. Noriko Kitayama and Ms. Maki Yoneyama for support of the patients. We also thank Drs. Takao Fujii, Chicashi, Terao, Masahide Hamaguchi, Hiroyuki Yoshitomi, and Masahiro Ishikawa for their thoughtful comments.

Disclosure of Interests:

Masao Katsushima: None declared, Motomu Hashimoto Grant/research support from: Bristol-Myers Squibb, Eisai, and Eli Lilly and Company., Speakers bureau: Bristol-Myers Squibb and Mitsubishi Tanabe Pharma., Mirei Shirakashi: None declared, Tamami Yoshida: None declared, Wataru Yamamoto: None declared, Kosaku Murakami Speakers bureau: AbbVie, Eisai, and Mitsubishi Tanabe Pharma., Koichi Murata Grant/research support from: KMurata belong to a department that has been financially supported by four pharmaceutical companies (Mitsubishi-Tanabe, Chugai, AYUMI and UCB Japan)., Employee of: KMurata belong to a department that has been financially supported by four pharmaceutical companies (Mitsubishi-Tanabe, Chugai, AYUMI and UCB Japan)., Speakers bureau: KMurak has received speaking fees, and/or consulting fees from Eisai Co. Ltd, Chugai Pharmaceutical Co. Ltd., Pfizer Japan Inc, Bristol-Myers Squibb, Mitsubishi-Tanabe Pharma Corporation, UCB, Daiichi Sankyo Co. Ltd. and Astellas Pharma Inc., Kohei Nishitani Grant/research support from: KN belong to a department that has been financially supported by four pharmaceutical companies (Mitsubishi-Tanabe, Chugai, AYUMI and UCB Japan)., Masao Tanaka Grant/research support from: AbbVie, Asahi Kasei Pharma, Astellas Pharma, Ayumi Pharmaceutical, Chugai Pharmaceutical, Eisai, Mitsubishi Tanabe Pharma, Taisho Pharmaceutical, and UCB Japan.

Speakers bureau: AbbVie, Asahi Kasei Pharma, Astellas Pharma, Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Eli Lilly and Company, Janssen Pharmaceutical, Mitsubishi Tanabe Pharma, Novartis Pharma, Pfizer, Taisho Pharmaceutical, Takeda Pharmaceutical, and UCB Japan., Hiromu Ito: None declared, Shuichi Matsuda: None declared

Search for Electron Antineutrino Appearance in a Long-Baseline Muon Antineutrino Beam

Electron antineutrino appearance is measured by the T2K experiment in an accelerator-produced antineutrino beam, using additional neutrino beam operation to constrain parameters of the Pontecorvo-Maki-Nakagawa-Sakata (PMNS) mixing matrix. T2K observes 15 candidate electron antineutrino events with a background expectation of 9.3 events. Including information from the kinematic distribution of observed events, the hypothesis of no electron antineutrino appearance is disfavored with a significance of 2.40σ and no discrepancy between data and PMNS predictions is found. A complementary analysis that introduces an additional free parameter which allows non-PMNS values of electron neutrino and antineutrino appearance also finds no discrepancy between data and PMNS predictions.

Impact of technically qualified surgeons on laparoscopic colorectal resection outcomes: results of a propensity score-matching analysis

Background

The Endoscopic Surgical Skill Qualification System (ESSQS) was introduced in Japan to improve the quality of laparoscopic surgery. This cohort study investigated the short‐ and long‐term postoperative outcomes of colorectal cancer laparoscopic procedures performed by or with qualified surgeons compared with outcomes for unqualified surgeons.

Methods

All laparoscopic colorectal resections performed from 2010 to 2013 in 11 Japanese hospitals were reviewed retrospectively. The procedures were categorized as performed by surgeons with or without the ESSQS qualification and patients' clinical, pathological and surgical features were used to match subgroups using propensity scoring. Outcome measures included postoperative and long‐term results.

Results

Overall, 1428 procedures were analysed; 586 procedures were performed with ESSQS‐qualified surgeons and 842 were done by ESSQS‐unqualified surgeons. Upon matching, two cohorts of 426 patients were selected for comparison of short‐term results. A prevalence of rectal resection (50·3 versus 40·5 per cent; P < 0·001) and shorter duration of surgery (230 versus 238 min; P = 0·045) was reported for the ESSQS group. Intraoperative and postoperative complication and reoperation rates were significantly lower in the ESSQS group than in the non‐ESSQS group (1·2 versus 3·6 per cent, P = 0·014; 4·6 versus 7·5 per cent, P = 0·025; 1·9 versus 3·9 per cent, P = 0·023, respectively). These findings were confirmed after propensity score matching. Cox regression analysis found that non‐attendance of ESSQS‐qualified surgeons (hazard ratio 12·30, 95 per cent c.i. 1·28 to 119·10; P = 0·038) was independently associated with local recurrence in patients with stage II disease.

Conclusion

Laparoscopic colorectal procedures performed with ESSQS‐qualified surgeons showed improved postoperative results. Further studies are needed to investigate the impact of the qualification on long‐term oncological outcomes.

Early parenteral nutrition in neonates with congenital diaphragmatic hernia

BACKGROUND

The ideal nutritive strategy for a neonate with congenital diaphragmatic hernia (CDH) has not been elucidated. The purpose of this study was to investigate the efficacy of early parenteral nutrition (PN) in CDH neonates.

METHODS

Thirty-five CDH neonates admitted to a single hospital from January 2005 to December 2014 were retrospectively reviewed. For the first 4 years of the study period, neonates received non-early PN (n-EPN) (2005-2008, amino acids [AA] <1.0 g/kg/day, no lipids administered). After the transitional period (TP) (2009-2011, AA 1.0-2.5 g/kg/day, lipid 1.0 g/kg/day), early PN (EPN) (2011-2014, AA ≥3.0 g/kg/day, lipid 1.0 g/kg/day) was performed. We investigated the clinical effect of PN for growth-associated clinical variables and the outcomes.

RESULTS

The first day of AA administration was late in the n-EPN period (6.0 ± 4.6, 0.0 ± 0.8, 0.1 ± 0.3 ; n-EPN, TP, EPN: in order). The final day of PN (11.0 ± 3.7, 9.2 ± 4.0, 12.4 ± 3.9) and the first day of enteral feeding (4.5 ± 1.9, 4.3 ± 1.4, 4.5 ± 3.2), the first day of full milk feeding (100 mL/kg/day) (10.8 ± 5.4, 9.2 ± 2.3, 11.5 ± 3.5) were statistically equal in every period. The date and body weight at discharge showed no significant differences among the three groups, but the weight-gain rate from birth to discharge was higher in the EPN group than in the n-EPN group (P = 0.023). The rate of inhaled nitric oxide (NO) gas administration and the duration of ventilation showed no significant differences among the three groups. Severe PN-associated liver disease was not noted during the observation period.

CONCLUSIONS

Early PN for CDH neonates promotes weight gain in the neonatal intensive-care unit. The long-term efficacy and safety of EPN for CDH neonates should be elucidated by additional studies.

Band-dependent superconducting gap in SrFe2(As0.65P0.35)2 studied by angle-resolved photoemission spectroscopy

The isovalent-substituted iron pnictide compound SrFe₂(As_1−xP_x)₂ exhibits multiple evidence for nodal superconductivity via various experimental probes, such as the penetration depth, nuclear magnetic resonance and specific heat measurements. The direct identification of the nodal superconducting (SC) gap structure is challenging, partly because the presence of nodes is not protected by symmetry but instead caused by an accidental sign change of the order parameter, and also because of the three-dimensionality of the electronic structure. We have studied the SC gaps of SrFe₂(As_0.65P_0.35)₂ in three-dimensional momentum space by synchrotron and laser-based angle-resolved photoemission spectroscopy. The three hole Fermi surfaces (FSs) at the zone center have SC gaps with different magnitudes, whereas the SC gaps of the electron FSs at the zone corner are almost isotropic and k_z-independent. As a possible nodal SC gap structure, we propose that the SC gap of the outer hole FS changes sign around the Z-X [(0, 0, 2π) − (π, π, 2π)] direction.