A case of plastic bronchitis with a remarkable response to steroids

Plastic bronchitis can cause fatal airway obstruction. An 85-year-old woman with no medical history presented to the emergency department of our hospital with progressing respiratory failure and hemoptysis. Bronchoscopy revealed a fibrin-type cast thrombus in the trachea, and plastic bronchitis was diagnosed. Initial treatment involved airway thrombus removal, and the patient survived. However, bleeding persisted for 6 days, and respiratory status showed slight improvement despite ventilatory management. Steroids were administered for concomitant acute respiratory distress syndrome, and there was marked improvement in both airway hemorrhage and respiratory failure. The patient was extubated, the steroid dose was reduced, and no rebleeding was observed. The patient was discharged from the hospital 1 month after the onset of symptoms. Blood tests were positive for the myeloperoxidase-anti-neutrophil cytoplasmic antibody; however, no biopsy was performed, and no specific symptoms were observed. A definitive diagnosis was therefore not reached. The causes of plastic bronchitis are numerous, and there are no standardized diagnostic criteria or treatment guidelines for this condition. The present case suggests that steroids may be effective in some patients with plastic bronchitis.

Deshima 2.0: Rapid Redshift Surveys and Multi-line Spectroscopy of Dusty Galaxies

We present a feasibility study for the high-redshift galaxy part of the Science Verification Campaign with the 220-440 GHz deshima 2.0 integrated superconducting spectrometer on the ASTE telescope. The first version of the deshima 2.0 chip has been recently manufactured and tested in the lab. Based on these realistic performance measurements, we evaluate potential target samples and prospects for detecting the [CII] and CO emission lines. The planned observations comprise two distinct, but complementary objectives: (1) acquiring spectroscopic redshifts for dusty galaxies selected in far-infrared/mm-wave surveys; (2) multi-line observations to infer physical conditions in dusty galaxies.

Are fructophilic lactic acid bacteria (FLAB) beneficial to humans?

Fructophilic lactic acid bacteria (FLAB) are heterofermentative and related to the genera Fructilactobacillus, Convivina, Leuconostoc, Oenococcus and Weissella. Although they generally prefer fructose above glucose, obligate heterofermentative species will ferment glucose in the presence of external electron acceptors such as pyruvate and fructose. Little is known about the presence of FLAB in the human gut, let alone probiotic properties. In this review we discuss the possible role FLAB may have in the human gastro-intestinal tract (GIT) and highlight the advantages and disadvantages these bacteria may have in individuals with a diet high in fructose.

Successful Coil Embolization Using Percutaneous Cardiopulmonary Support in a Patient with Refractory Out-of-hospital Cardiac Arrest Caused by Aneurysmal Subarachnoid Hemorrhage

In recent years, extracorporeal cardiopulmonary resuscitation (ECPR) has been reported to be an effective alternative to conventional CPR for treating patients with reversible causes of cardiac arrest. Nevertheless, the definite indication for ECPR and also surgical interventions during ECPR treatment have not been established, especially in patients with out-of-hospital cardiac arrest (OHCA) caused by subarachnoid hemorrhage (SAH). We treated a comatose 50-year-old woman with refractory cardiac arrest due to aneurysmal SAH-induced takotsubo cardiomyopathy (TCM). The initial cardiac rhythm was ventricular fibrillation. This is the first case report on coil embolization being successfully performed on a patient undergoing ECPR and therapeutic hypothermia (TH) while the patient was still in cardiac arrest, which resulted in complete social rehabilitation. Moreover, the success of this treatment suggests that ECPR and endovascular therapy should be considered for highly selected patients when cardiopulmonary and neurological functions are potentially reversible even in the setting of SAH.

The effectiveness of strict low-density lipoprotein cholesterol management in secondary prevention of Japanese patients

Background

In Japanese guidelines, target value of low-density lipoprotein cholesterol (LDL-C) <100mg/dL is recommended as standard management for secondary prevention of coronary artery disease. On the other hand, the guidelines also state that LDL-C targeting <70mg/dL should be considered in high-risk patients. However, the effectiveness of strict LDL-C management in the prevention of long-term coronary event recurrence in Japanese patients remains unclear.

Purpose

The purpose of the present study was to evaluate whether the strict management of LDL-C targeting <70 mg/dL was effective to prevent recurrence of acute coronary syndrome (ACS) than standard management in patients with previous percutaneous coronary intervention (PCI).

Methods

From January 2007 to August 2020, we performed coronary angiography in 359 patients with previous PCI who were suspected of having signs of recurrent cardiac ischemia. Patients were stratified into three groups according to achieved LDL-C value; <70mg/dL (n=57), 70 to <100mg/dL (n=135) and ≥100mg/dL (n=167). In addition, patients who had previous ACS and/or diabetes mellitus were defined as high-risk group, and sub-analysis by their achieved LDL-C values was performed in high-risk group and non-high-risk group. Endpoint was recurrence of ACS. Moreover, risk factors associated with recurrent-ACS were examined in patients with LDL-C <100 mg/dL.

Results

After follow-up (median 6.1 years), 99 patients (28%) had recurrent-ACS. Recurrent-ACS was significantly lower in patients with LDL-C <70mg/dL than LDL-C 70 to <100mg/dL and LDL-C ≥100mg/dL (p<0.01 and p<0.001, respectively). In sub-analysis, high-risk group with LDL-C <70 mg/dL had lower incidence of recurrent-ACS than LDL-C 70 to <100 mg/dL (p=0.03). Similar tendency was found in non-high-risk group (p=0.08). There was no difference of recurrent-ACS between high-risk group and non-high-risk group in patients with LDL-C <70mg/dL (p=0.41). Moreover, in patients with achieved LDL-C <100mg/dL (n=192), multivariate analysis identified that LDL-C (HR: 1.032, p<0.01) and HbA1c (HR: 1.330, p<0.01) were independent predictors of recurrent-ACS. In these patients, whether or not they were in the high-risk group was not a significant predictor (p=0.61).

Conclusions

Strict management of LDL-C targeting <70 mg/dL should be considered for a wider range of Japanese patients as well as for Westerners to prevent recurrence of ACS in secondary prevention.

Funding Acknowledgement

Type of funding sources: None. Probability of freedom from ACS

Effectiveness of more strict managements after achievement of standard target value of low-density lipoprotein cholesterol in secondary prevention of Japanese patients

Background

In secondary prevention of coronary artery disease, target value of low-density lipoprotein cholesterol (LDL-C) <100 mg/dL is recommended as standard management in Japanese guideline. The guideline also stated that strict management of LDL-C targeting <70 mg/dL is considered in some high risk patients. However, in Japanese patients, effectiveness of more strict management of LDL-C lowering therapy for prevention of long-term cardiovascular events remains unclear.

Purpose

The purpose of the present study was to evaluate whether the strict management of LDL-C targeting <70 mg/dL was effective to prevent recurrence of long-term coronary events than standard management in patients with previous percutaneous coronary intervention (PCI).

Methods

We investigated 344 patients with previous PCI who underwent late coronary angiography to examine recurrence of cardiac ischemia beyond the early phase of restenosis from January 2007 to August 2019. Patients were stratified into three groups according to achieved LDL-C value; LDL-C <70mg/dL (n=53), 70 to <100mg/dL (n=130) and ≥100mg/dL (n=161). Endpoints of this study were recurrence of cardiac ischemia presenting as acute coronary syndrome (recurrence-ACS) and any late coronary revascularization.

Results

During average 7.1 years follow-up, 200 patients (58%) underwent any late coronary revascularization. In 94 of those patients, recurrence-ACS was observed. The incidence of recurrence-ACS was significantly lower in patients with achieved LDL-C <70mg/dL than in those with LDL-C 70 to <100mg/dL and LDL-C ≥100mg/dL (p=0.009 and p=0.001, respectively), however, there was no difference between patients with LDL-C 70 to <100mg/dL and LDL-C ≥100mg/dL (p=0.140). Any late revascularization was significantly lower in patients with achieved LDL-C <70mg/dL and in those with LDL-C 70 to <100mg/dL than in those with LDL-C ≥100mg/dL (p=0.002 and p<0.001, respectively), however, no difference was found between patients with LDL-C <70mg/dL and LDL-C 70 to <100mg/dL (p=0.119). Moreover, in patients with achieved LDL-C <100mg/dL (n=183), multivariate analysis identified that LDL-C (HR 1.035, p=0.007) and HbA1c (HR 1.338, p=0.001) were independent predictors of recurrence-ACS. In contrast, only using statins (HR 0.461, p=0.009) was an independent predictor of recurrence-ACS in patients with achieved LDL-C ≥100mg/dL.

Conclusions

LDL-C was the important residual risk of recurrence-ACS even after recommended standard LDL-C lowering management had been achieved. More strict management of LDL-C targeting to <70mg/dL should be considered to prevent recurrence-ACS for wider range of Japanese patients in secondary prevention.

Incidence of late coronary events

Funding Acknowledgement

Type of funding source: None

Classification of HFrEF based on echocardiography using machine learning to predict future HFrecEF events

Background

In recent years, there have been sporadic reports of heart failure with recovered ejection fraction (HFrecEF), wherein the left ventricular EF (LVEF) has been improved by considering temporal changes in the LVEF. Although patients with HFrecEF are known to have a better prognosis than other groups, the type of heart failure associated with reduced EF (HFrEF) that subsequently transitions to HFrecEF is yet to be determined.

Purpose

In this study, we examined whether it is possible to predict future HFrecEF events by stratifying the HFrEF using machine learning based on previously recorded echocardiographic indices.

Methods

For 162 patients, with HFrEF and a history of hospitalization owing to heart failure, who underwent echocardiography in a stable hemodynamic state, stratification was performed via machine learning. Regarding temporal changes in the LVEF, 73 patients who underwent another echocardiography under stable conditions were investigated (52 with continued HFrEF and 21 with HFrecEF, with a median follow up of 397 days). HFrEF was defined as a condition for patients with an LVEF of less than 50%, and HFrecEF was defined as a condition for patients who initially had an LVEF of less than 50% but later improved. Patients with severe valvular disease, acute myocardial infarction, acute myocarditis, acute pulmonary embolism, post-cardiac surgery, and pericardial disease were excluded from this group. The random forest method was used as a classification method for machine learning.

Results

When 162 patients with HFrEF were stratified using machine learning, 63 were classified into Cluster 1 and 99 into Cluster 2. Cluster 1 patients showed a significantly higher tendency to transition to HFrecEF than Cluster 2 patients (p=0.001). The Gini coefficient was calculated to identify echocardiographic indices that are important for the purpose of stratification. As a result, LVEF, left ventricular endo-diastolic volume (LVEDV), the thickness of interventricular septum (IVSth), E/A ratio, and the maximum diameter of the inferior vena cava were found to be particularly important. Compared to Cluster 2 patients, Cluster 1 patients exhibited a significantly higher LVEF (41.5±5.9% vs 27.0±7.6%, p<0.001), lower LVEDV (93.6±36.8 mL vs 141.1±51.7 mL, p<0.001), and a higher IVSth (10.8±2.6 mm vs 9.4±2.5 mm, p<0.001).

Conclusion

Stratifying HFrEF via machine learning based on echocardiographic indices can help predict temporal changes in the LVEF and deduce the echocardiographic indices useful for improving LVEF.

Funding Acknowledgement

Type of funding source: None

Age and geographic dependence of Zika virus infection during the outbreak on Yap island, 2007

Intensive surveillance of Zika virus infection conducted on Yap Island has provided crucial information on the epidemiological characteristics of the virus, but the rate of infection and medical attendance stratified by age and geographical location of the epidemic have yet to be fully clarified. In the present study, we reanalyzed surveillance data reported in a previous study. Likelihood-based Bayesian inference was used to gauge the age and geographically dependent force of infection and age-dependent reporting rate, with unobservable variables imputed by the data augmentation method. The inferred age-dependent component of the force of infection was suggested to be up to 3-4 times higher among older adults than among children. The age-dependent reporting rate ranged from 0.7% (5-9 years old) to 3.3% (50-54 years old). The proportion of serologically confirmed cases among total probable or confirmed cases was estimated to be 44.9%. The cumulative incidence of infection varied by municipality: Median values were over 80% in multiple locations (Gagil, Tomil, and Weloy), but relatively low values (below 50%) were derived in other locations. However, the possibility of a comparably high incidence of infection was not excluded even in municipalities with the lowest estimates. The results suggested a high degree of heterogeneity in the Yap epidemic. The force of infection and reporting rate were higher among older age groups, and this discrepancy implied that the demographic patterns were remarkably different between all infected and medically attended individuals. A higher reporting rate may have reflected more severe clinical presentation among adults. The symptomatic ratio in dengue cases is known to correlate with age, and our findings presumably indicate a similar tendency in Zika virus disease.

Epidemiological features after emergency declaration in Hokkaido and report of 15 cases of COVID-19 including 3 cases requiring mechanical ventilation

The ongoing spread of coronavirus disease (COVID-19) is a worldwide crisis. Hokkaido Prefecture in Japan promptly declared a state of emergency following the rapid increase of COVID-19 cases, and the policy became an example to mitigate the spread of COVID-19. We herein report 15 cases of COVID-19 including 3 cases requiring mechanical ventilation. Based on review of our cases, among patients over 50 years of age with underlying diseases such as hypertension and diabetes mellitus, and those who required oxygen administration tended to deteriorate. These cases highlight the importance of understanding the background and clinical course of severe cases to predict prognosis.

Histamine-2 receptor antagonists (H₂RA) may negatively impact ADL assessment in patients on a convalescent rehabilitation ward

Background/aim: In the convalescent rehabilitation ward, many elderly patients undergo rehabilitation. Histamine-2 receptor antagonists (H₂RA), which is a one of the acid secretion inhibitors, is frequently prescribed for the patients as a peptic ulcer prevention measure. At present, H₂RA are reported as being associated with factors that reduce cognitive function. However, little is known about the relationship H₂RA and rehabilitation outcome. Therefore, this study examined the relationship between H₂RA use and Functional Independence Measure (FIM) gain, which determines rehabilitation outcomes for patients admitted to the convalescent rehabilitation ward. Patients and methods: We retrospectively investigated FIM gain on discharge by both the administration group (H₂RA (+)) (n = 118) and non-administration group (H₂RA (-)) (n = 118). Results: The FIM gain scores of Motor FIM total, Cognition FIM total, and Total FIM were significantly lower in H₂RA (+) than in H₂RA (-) (Motor FIM total: 8.0 [4.0-16.0] [Inter-Quartile Range] vs. 12.0 [5.0-19.2], p =0.0217, Cognition FIM total: 3.0 [1.0-6.0] vs. 5.0 [2.0-7.0], p =0.0120, Total FIM: 11.5 [4.8-20.2] vs. 17.0 [8.0-27.0], p =0.0089). Conclusion: The administration of H₂RA to elderly patients undergoing rehabilitation may prevent cognitive function maintenance or recovery by rehabilitation.

P1520 Aortic flow reversal caused by aortic regurgitation deteriorates renal function

Background

Chronic kidney disease is a growing public health problem. Renal dysfunction is known as a strong risk factor for cardiovascular disease and end-stage renal failure. The presence of pan-diastolic flow reversal in the abdominal aorta is a very specific sign of severe aortic regurgitation (AR). A higher aortic reverse/forward flow ratio is associated with lower intrarenal forward flow. However, the influence of AR on renal function has been poorly understood. We hypothesized that the aortic flow reversal reduces the renal artery forward flow and accordingly leads to renal dysfunction in patients with severe AR.

Methods

The study consisted of 21 consecutive patients (mean age 69 ± 11 years) with severe AR who underwent aortic valve replacement (AVR). We compared echocardiographic indices and the glomerular filtration rate (GFR) before and 603 ± 541 days after AVR.

Results

Blood pressure was 122 ± 16/54 ± 8 mmHg before AVR and 123 ± 16/76 ± 11 mmHg after AVR. After AVR, left ventricular (LV) end-diastolic dimension decreased from 57 ± 9 to 44 ± 5 mm and LV ejection fraction increased from 58 ± 12 to 60 ± 11 %. Estimated GFR significantly increased from 62.9 ± 18.9 to 71.8 ± 18.1 mL/min per 1.73 m2 after AVR (p = 0.003).

Conclusions An increase in aortic flow reversal caused by severe AR reduces forward flow into the kidney and thereby deteriorates renal function. This study demonstrated a key mediating role of central hemodynamic factors, particularly an exaggerated aortic flow reversal in renal dysfunction and severe AR.

P642What is the most important residual risk after achievement of appropriate low-density lipoprotein cholesterol lowering therapy in secondary prevention of Japanese patients?

Background

In secondary prevention of coronary artery disease, target value of low-density lipoprotein cholesterol (LDL-C) <100mg/dL with using statins is recommended as standard therapy in Japanese guideline. However, impact of residual risks after achievement of standard LDL-C lowering therapy was not fully examined. Furthermore, there is little information whether more strict management of LDL-C lowering is effective to prevent long-term cardiovascular events than standard management.

Purpose

The purpose of this study was to evaluate the relationship between residual risks after achievement of standard LDL-C lowering therapy and long-term coronary events in secondary prevention of Japanese patients.

Methods

From January 2007 to August 2018, 333 patients with previous percutaneous coronary intervention underwent late coronary angiography to examine recurrence of cardiac ischemia beyond the early phase of restenosis. We defined appropriate LDL-C lowering therapy as achieved LDL-C <100mg/dL with using statins. Patients whose achieved LDL-C was <100mg/dL with using statins were classified as Appropriate-group (n=139), and patients who were not using statins or whose achieved LDL-C was ≥100mg/dL were classified as Inappropriate-group (n=194). Endpoints of the study were recurrence of cardiac ischemia as acute coronary syndrome (recurrence-ACS) and any late coronary revascularization.

Results

During average 7.1 years follow-up, 195 patients (59%) underwent any late coronary revascularization. In 91 of those patients, clinical presentation of recurrence-ACS was observed. Kaplan-Meier curve analysis revealed that the incidence of recurrence-ACS and any late coronary revascularization were significantly lower in Appropriate-group than in Inappropriate-group (p=0.017 and p<0.001, respectively). In Appropriate-group, recurrence-ACS was significantly lower in patients with achieved LDL-C <70mg/dL than in those with LDL-C 70 to <100mg/dL (p=0.042), however, any late revascularization was not different between the two groups. On the other hand, in Inappropriate-group, recurrence-ACS was significantly lower in patients with using statins than in those without using statins (p=0.038), and any late revascularization was less frequent in patients with achieved LDL-C <100mg/dL than in those with LDL-C ≥100mg/dL (p=0.035). Moreover, multivariate analysis identified that only LDL-C was an independent predictor of recurrence-ACS in Appropriate-group (HR: 1.047, p=0.006), in contrast, LDL-C (HR: 1.008, p=0.020), using statins (HR: 0.555, p=0.034) and triglyceride (HR: 1.003, p=0.038) were independent predictors of recurrence-ACS in Inappropriate-group.

Conclusions

LDL-C was the most important residual risk of recurrence-ACS even after recommended standard therapy has been achieved. More strict management of LDL-C targeting to <70mg/dL should be considered in secondary prevention of Japanese patients.

EVALUATIONS OF INVENTORY AND ACTIVITY CONCENTRATION OF RADIOCESIUM IN SOIL AT A RESIDENTIAL HOUSE 3 YEARS AFTER THE FUKUSHIMA NUCLEAR ACCIDENT

Soil samples from the surface to a 5 cm depth were collected at a residential house in Koriyama City, Fukushima Prefecture using a scraper plate every three months from March 2014 to September 2014 to evaluate the vertical distribution profiles and inventories of 134Cs and 137Cs in soil. The vertical distribution profiles of radiocesium (134Cs and 137Cs) in soil showed that greater than 86% of the total radiocesium was absorbed in the upper 2 cm 3 years after the accident. Radiocesium in the surface layer seems to move to the lower layer over time. The migration of radiocesium in surface layer might be influenced by the ground surface runoff by rainfall. Radiocesium inventories in June increased significantly over the short period between March and June. In contrast, the radiocesium inventories in September did not increase significantly compared to the values in June. Radiocesium resuspension and deposition caused by decontamination work and meteorological events might be one possible reason for the increased radiocesium inventories observed in June.

P684Long-term outcomes in patients with cancer undergoing percutaneous coronary intervention: analysis from a Japan multicenter registry

Background

Cancer and cardiovascular disease (CVD) is the most common cause of death in developed countries, and substantial overlap exist in their medical care. However, the detailed and updated information on outcome of cancer patients with cardiovascular disease (CVD), particularly in clinically significant coronary artery disease (CAD) remain unknown.

Purpose

We sought to describe the prevalence and long-term outcomes of cancer patients undergoing percutaneous coronary intervention (PCI), which has become a coronerstone in the management of CVD.

Methods

Patient data extracted from a regional prospectiveprocedure-based multicenter registry for PCI was analyzed. A total of 4,455 patients who underwent PCI at 15 hospitals within metropolitan Tokyo from September 2008 to 2012 were followed for 2 years. “Active” cancer patient was defined as having a history of cancer not cured or in remission. We analyzed in acute and stable presentation.The occurrence of clinical outcomes was assessed via Kaplan-Meier survival curve, and Cox-regression hazard model to adjust for known clinical predictors.

Results

Within the studied patients, 173 (3.9%) had a concomitant “active” cancer at the time of intervention. There was a significant difference between the patients with and without active cancer in each situation. In stable presentation, cancer group were older, lower BMI, frequently had silent ischemia, COPD and cerebrovascular/peripheral disease, and less often had dyslipidemia compared with non-cancer group. In acute presentation, cancer group were older, frequently had COPD, CKD, peripheral disease and history of HF compared with non-cancer group. The prescription rate of RAAS inhibitor was lower in the cancer group than in the non-cancer group in acute presentation. Notably, in both acute and stable presentation, these patients had significantly higher risk of all-cause mortality (HR 8.01: 95%, p<0.001 and HR5.53: 95%, p<0.001, respectively), and they were also at higher risk of major cardo- and cerebrovascular events (MACCE; HR2.38, p<0.001, HR2.33, p=0.001), when referenced to non-cancer patients after 2 year of follow-up.

Conclusion

Cancer patient was present in 3.9% of all PCI patients and was strongly associated with both non-cardiac and cardiac adverse events.

P2478Prognostic impact and severity assessment of combinational elastography in heart failure patients

Background

Heart failure (HF) causes liver congestion, which is thought to increase liver stiffness. Elastography is a noninvasive method of measuring organ stiffness that was originally developed to evaluate fibrosis caused by liver diseases such as cirrhosis. There are two main techniques of elastography: shear wave imaging and strain imaging. Shear wave imaging varies significantly due to the influence of not only fibrosis but also congestion, inflammation, and jaundice. In contrast, strain imaging in chronic liver disease reflects only the progression of liver fibrosis. We previously presented a method that is measuring both shear wave and strain imaging (combinational elastography) for assessing liver congestion. This study demonstrates the prognostic impact and severity assessment of combinational elastography in HF patients.

Methods

This study included 144 HF patients (age 76.4±12.3, men 67). The velocity of shear wave (Vs) values was measured with shear wave imaging. Fibrosis index (F Index) was calculated by measuring both shear wave and strain imaging.

Results

During a median follow-up of 161 days, 14 deaths or hospitalization for HF was observed. A multivariable cox regression analysis demonstrated that high vs values was dependently correlated with higher mortality rate and HF hospitalization (hazard ratio: 2.31; 95% confidence interval: 1.09–4.89; p=0.029). The Kaplan-Meier analysis demonstrated that high vs (>1.87 m/s) was associated with higher hospitalization rates for HF compared with low vs (≤1.87 m/s, log rank test, p<0.001). F index showed graded elevation as stage of HF progressed (stage A or B, C, D: 1.19±0.43, 1.38±0.56, 2.8±1.32; p<0.001).

Conclusion

Combinational elastography can predict the severity of HF.

The ICRU Proposal for New Operational Quantities for External Radiation

Report Committee 26 of the ICRU proposes a set of operational quantities for radiation protection for external radiation, directly based on effective dose and for an extended range of particles and energies. It is accompanied by quantities for estimating deterministic effects to the eye lens and the local skin. The operational quantities are designed to overcome the conceptual and technical shortcomings of those presently in use. This paper describes the proposed operational quantities, and highlights the improvements with respect to the present, legal monitoring quantities.

Outcomes of patients receiving a massive transfusion for major trauma

BACKGROUND

The benefits of high transfusion ratios (plasma to red blood cells and platelets to red blood cells) on survival in injured patients who receive massive transfusions remain uncertain. This study aimed to assess the association between transfusion ratios and adverse events and survival in patients undergoing massive transfusion for major trauma.

METHODS

A retrospective observational study was conducted on patients who had major trauma using a Japanese national administrative database. The associations between transfusion ratios and outcomes (in-hospital mortality and incidence of adverse events) were analysed using a non-linear logistic generalized additive model (GAM). In a logistic generalized estimating equation model, adjusted for patient and hospital-level confounders, transfusion ratios were included as continuous or categorical variables (low, transfusion ratio 0·75 or less; intermediate, over 0·75 to 1·25; high, over 1·25).

RESULTS

Some 1777 patients were included in the analysis, of whom 602 died in hospital. GAM plots of the transfusion ratios for in-hospital mortality demonstrated a downward convex unimodal curve. In-hospital mortality was similar with increasing transfusion ratios for plasma (adjusted odds ratio (OR) 1·13, 95 per cent c.i. 0·82 to 1·55; P = 0·446) and platelets (adjusted OR 0·84, 0·66 to 1·08; P = 0·171). Both plasma to red blood cell ratio (adjusted OR 1·77, 1·32 to 2·37; P < 0·001) and platelet to red blood cell ratio (adjusted OR 1·71, 1·35 to 2·15; P < 0·001) were significantly associated with a higher incidence of adverse events. No significant differences in in-hospital mortality were observed between the three transfusion categories (low, medium and high).

CONCLUSION

In this study, transfusion strategies with high plasma to red blood cell and platelet to red blood cell ratios did not have survival benefits, but were associated with an increase in adverse events.

ICRP Publication 133: The ICRP computational framework for internal dose assessment for reference adults: specific absorbed fractions

Dose coefficients for assessment of internal exposures to radionuclides are radiological protection quantities giving either the organ equivalent dose or effective dose per intake of radionuclide following ingestion or inhalation. In the International Commission on Radiological Protection’s (ICRP) Occupational Intakes of Radionuclides (OIR) publication series, new biokinetic models for distribution of internalised radionuclides in the human body are presented as needed for establishing time-integrated activity within organs of deposition (source regions). This series of publications replaces Publications 30 and 68 (ICRP, 1979, 1980, 1981, 1988, 1994b). In addition, other fundamental data needed for computation of the dose coefficients are radionuclide decay data (energies and yields of emitted radiations), which are given in Publication 107 (ICRP, 2008), and specific absorbed fraction (SAF) values – defined as the fraction of the particle energy emitted in a source tissue region that is deposited in a target tissue region per mass of target tissue. This publication provides the technical basis for SAFs relevant to internalised radionuclide activity in the organs of Reference Adult Male and Reference Adult Female as defined in Publications 89 and 110 (ICRP, 2002, 2009). SAFs are given for uniform distributions of mono-energetic photons, electrons, alpha particles, and fission-spectrum neutrons over a range of relevant energies. Electron SAFs include both collision and radiative components of energy deposition. SAF data are matched to source and target organs of the biokinetic models of the OIR publication series, as well as the Publication 100 (ICRP, 2006) Human Alimentary Tract Model and the Publication 66 (ICRP, 1994a) Human Respiratory Tract Model, the latter as revised within Publication 130 (ICRP, 2015). This publication further outlines the computational methodology and nomenclature for assessment of internal dose in a manner consistent with that used for nuclear medicine applications. Numerical data for particle-specific and energy-dependent SAFs are given in electronic format for numerical coupling to the respiratory tract, alimentary tract, and systemic biokinetic models of the OIR publication series.

Superconducting Coplanar Waveguide Filters for Submillimeter Wave On-Chip Filterbank Spectrometers

We show the first experimental results which prove that superconducting NbTiN coplanar-waveguide resonators can achieve a loaded Q factor in excess of 800 in the 350 GHz band. These resonators can be used as narrow band pass filters for on-chip filter bank spectrometers for astronomy. Moreover, the low-loss coplanar waveguide technology provides an interesting alternative to microstrip lines for constructing large scale submillimeter wave electronics in general.

Cryogenically-cooled Yb:YGAG ceramic mode-locked laser

This work reports on a liquid-nitrogen-cooled, SESAM mode-locked Yb:YGAG (Yb:Y(3)Ga(2)Al(3)O(12)) ceramic laser. The Yb:YGAG has a similar structure to Yb:YAG, but its emission spectrum at low temperature remains much broader, which is suitable for ultrashort pulse generation and amplification. A stable pulse train with 119-MHz repetition rate was obtained at a wavelength of 1026 nm. The measured pulse duration is 2.4 ps, which is more than four times shorter than that achieved with a cryogenically-cooled Yb:YAG. Furthermore, laser performance of the Yb:YGAG ceramics in continuous-wave operation and wavelength tunability at 80 K was investigated.

CO2 adsorption–desorption performance of mesoporous zirconium hydroxide with robust water durability

The present study demonstrates for the first time, the development of mesoporous zirconium hydroxide with high CO₂ capacity and sustainable adsorption–desorption performance within a broad range of pressures (100–3000 kPa).

Elevated receptor for activated C kinase 1 expression is involved in intracellular Ca2+ influx and potentially associated with compromised regulatory T cell function in patients with asthma

BACKGROUND

Regulatory T cells (T(regs)) are activated during anergy in response to T cell receptor (TCR) activation and functional immune suppression. Anergy of paediatric T(regs) is partially dependent on intracellular calcium mobility; following TCR activation, T(regs) do not exhibit increased intracellular Ca(2+) concentration ([Ca(2+) ](i)).

OBJECTIVE

We determined whether [Ca(2+) ](i) in adult T(regs) defined their anergy, if intracellular Ca(2+) movement was linked to regulatory functions, whether [Ca(2+)](i) was indicative of asthma pathology, and the potential molecular mechanism responsible for Ca(2+) movement in T(regs).

METHODS

T(regs) were purified by the magnetic bead method, and their regulatory functions were assessed by monitoring carboxyfluorescein succinimidyl ester-labelled responder T cell proliferation. The Ca(2+) response of Fura-2-labelled cells was measured using a video image analysis system. To analyse the functions of T(regs) at the molecular level, we generated Jurkat Tet-On(®) clones with doxycycline (Dox)-induced forkhead box P3 (FOXP3) protein expression.

RESULTS

CD4(+) CD25(+) CD127(-/low) T(regs) from participants without asthma did not elicit Ca(2+) influx in response to TCR activation, exhibited little proliferation and suppressed proliferation of CD4(+) CD25(-) T cells. In contrast, under similar conditions, T(regs) from patients with asthma exhibited increased [Ca(2+)](i) and robust proliferation with partial loss of regulatory functions. FOXP3 protein levels in Tet-On(®) clones were high after both 2- and 5-day Dox treatment; however, 5-day cells were comparable with T(regs) from patients with asthma, whereas 2-day cells were similar to T(regs) from participants without asthma. Increasing [Ca(2+)](i) induced a high level of receptor for activated C kinase 1 (RACK1) expression in 5-day cells.

CONCLUSIONS AND CLINICAL RELEVANCE

We confirmed that T(regs) in patients with asthma are functionally impaired and that the abnormal regulatory functions of these cells can be analysed by [Ca(2+)](i) following TCR engagement. Furthermore, the impaired functioning of T(regs) evident in patients with asthma may be due to a high level of RACK1.

Two γ-ray bursts from dusty regions with little molecular gas

Long-duration γ-ray bursts are associated with the explosions of massive stars and are accordingly expected to reside in star-forming regions with molecular gas (the fuel for star formation). Previous searches for carbon monoxide (CO), a tracer of molecular gas, in burst host galaxies did not detect any emission. Molecules have been detected as absorption in the spectra of γ-ray burst afterglows, and the molecular gas is similar to the translucent or diffuse molecular clouds of the Milky Way. Absorption lines probe the interstellar medium only along the line of sight, so it is not clear whether the molecular gas represents the general properties of the regions where the bursts occur. Here we report spatially resolved observations of CO line emission and millimetre-wavelength continuum emission in two galaxies hosting γ-ray bursts. The bursts happened in regions rich in dust, but not particularly rich in molecular gas. The ratio of molecular gas to dust (<9-14) is significantly lower than in star-forming regions of the Milky Way and nearby star-forming galaxies, suggesting that much of the dense gas where stars form has been dissipated by other massive stars.

The pharmacokinetics and safety profiles of belimumab after single subcutaneous and intravenous doses in healthy Japanese volunteers

WHAT IS KNOWN AND OBJECTIVES

Belimumab is a recombinant human monoclonal antibody that binds and antagonizes the biological activity of soluble B-lymphocyte stimulator (BLyS) protein. BLyS appears to play a role in the pathogenesis of systemic lupus erythematosus, and the biological profile of belimumab suggests that it may have a therapeutic benefit in the treatment for the disease. In this healthy Japanese subjects study, we investigated the pharmacokinetics and safety of a single subcutaneous and intravenous injection of belimumab administered as a 200 mg/mL liquid formulation.

METHODS

This was an open-label, randomized, parallel-group, single-dose study in healthy Japanese subjects. Each subject received a single intravenous infusion or a subcutaneous injection of 200 mg belimumab. The pharmacokinetic parameters and safety parameters including local tolerance (injection site), biomarkers, immunogenicity and adverse events were evaluated up to 70 days post-dosing.

RESULTS

After a single intravenous or a subcutaneous administration of 200 mg belimumab, all 16 subjects completed the study. There were no serious adverse events or adverse events related to injection site reactions. All seven adverse events were considered mild or moderate in intensity and deemed unrelated to belimumab except for cellulitis following intravenous administration. The bioavailability of the single subcutaneous dose of 200 mg belimumab in the subjects was estimated to be 77·5%. Time to the maximum serum concentration after subcutaneous injection was 6·5 days (median). The geometric mean terminal half-life was comparable between the two administration routes (17·7 days intravenous and 15·9 days subcutaneous). Serum immunoglobulin G level decreased slightly after each treatment. No subjects were found to produce antibelimumab antibodies.

WHAT IS NEW AND CONCLUSIONS

A favourable absolute bioavailability in healthy Japanese subjects was seen following a subcutaneous injection of 200 mg belimumab. Considering the intersubject variability, exposures were consistent with those previously observed in healthy non-Japanese subjects. Safety and biomarker data were also consistent with previous non-Japanese clinical studies.

The effect of growth media and physical treatments on the adhesion properties of canine probiotics

AIMS

The manufacturing processes have been reported to influence the properties of probiotics with potential impact on health properties. The aim was to investigate the effect of different growth media and inactivation methods on the properties of canine-originated probiotic bacteria alone and in combination mixture.

METHODS AND RESULTS

Three established dog probiotics, Lactobacillus fermentum VET9A, Lactobacillus plantarum VET14A and Lactobacillus rhamnosus VET16A, and their combination mixture were evaluated for their adhesion to dog mucus. The effect of different growth media, one reflecting laboratory and the other manufacturing conditions, and inactivation methods (95°C, 80°C and UV irradiation) on the mucus adhesion of the probiotic strains was characterized. Evaluation of dog probiotics was supported by cell visualization using transmission electron microscopy (TEM). Higher adhesion percentage was reported for probiotic strains growing in laboratory rather than in manufacturing conditions (P < 0.05). Inactivation by heat (95°C, 80°C) decreased the adhesion properties when strains were cultivated in soy-based growth media compared with those grown in MRS broth (P < 0.05). TEM observations uncovered differences in cell-surface components in nonviable forms of probiotic strains as compared with their viable forms.

CONCLUSIONS

Manufacturing process conditions such as growth media and pretreatment methods may significantly affect the adhesive ability of the tested strains.

SIGNIFICANCE AND IMPACT OF THE STUDY

Growth conditions, growth media, pretreatment methods and different probiotic combinations should be carefully considered for quality control of existing probiotics and for identification of new probiotics for dogs. These may also have an impact on health benefits for the host.

Dose indices in dental cone beam CT and correlation with dose-area product

OBJECTIVES

In the 2011 project "Safety and efficacy of a new and emerging dental X-ray modality (SEDENTEXCT)", it was suggested that dose index (DI) and dose-area product (DAP) could be easily measured and used as diagnostic reference levels (DRLs), which would help in the management of radiation doses to patients in optimum exposure settings. Such indices could be directly related to effective dose. The purposes of this study, therefore, were to measure and calculate the DI and DAP in cone beam CT (CBCT) machines and to evaluate the correlation between the two.

METHODS

Dose measurements were performed on three-dimensional cone beam CT (3D-CBCT) machines [3D Accuitomo (J. Morita Mfg. Corp., Kyoto, Japan), Veraviewepocs (J. Morita Mfg. Corp.) and CS9300 (Carestream, New York, NY)] by exposing a cylindrical poly-methyl methacrylate (PMMA) phantom using a CT ionization chamber. These dose measurements were used for the calculation of Dose Indices 1 and 2, according to the methodology suggested by SEDENTEXCT. The DAP was measured using a DAP meter that was attached to the detector to cover the entire irradiated area.

RESULTS

The DI1 ranged from 53.6 mR to 216.6 mR, the DI2 ranged from 77.1 mR to 325.0 mR and the DAP ranged from 101.1 mGy cm(2) to 457.9 mGy cm(2), depending on the machines and exposure settings. Index 2 had a better correlation with the DAP than Index 1.

CONCLUSIONS

The DIs and DAP proposed by SEDENTEXCT may be useful for establishing DRLs for dental CBCT machines; however, further studies are necessary to determine which of these indices provide accurate dose estimates proportionally relating to the effective dose.

A preliminary study to determine the diagnostic reference level using dose-area product for limited-area cone beam CT

OBJECTIVES

The aim of this study was to measure the dose-area product (DAP) of limited-area cone beam CT (CBCT) units used by dental offices, and to evaluate the rationale of the DAP with an aid of optically stimulated luminescence (OSL) dosemeter in measuring radiation dose.

METHOD

The DAPs of 21 CBCT units used in the dental offices of Tokyo and the surrounding areas from five different manufacturers were measured using OSL nanoDot dosemeter. An assembly of OSL dosemeters with an X-ray film was exposed by CBCT units at exposure parameters commonly used in each dental office. DAP values were then calculated as expressed in mGy cm(2).

RESULTS

DAP values ranged from 126.7 mGy cm(2) to 1476.9 mGy cm(2), depending on the units used.

CONCLUSION

OSL dosemeter coupled with film can be utilized for a large-scale study to measure DAP. The DAP values for individual CBCT units depend not only on the field of view, but also on the exposure parameters adapted by the dental offices.

Image quality assessment of three cone beam CT machines using the SEDENTEXCT CT phantom

OBJECTIVES

The SEDENTEXCT Project proposed quality assurance (QA) methods and introduced a QA image quality phantom. A new prototype was recently introduced that may be improved according to previous reports. The purpose of this study is to evaluate image quality in various protocols of three cone beam CT (CBCT) machines using the proposed QA phantom.

METHODS

Using three CBCT machines, nine image quality parameters, including image homogeneity (noise), uniformity, geometrical distortion, pixel intensity value, contrast resolution, spatial resolution [line pair (LP) chart, point spread function (PSF) and modulation transfer function (MTF)] and metal artefacts, were evaluated using a QA phantom proposed by SEDENTEXCT. Exposure parameters, slice thickness and field of view position changed variously, and the number of total protocols was 22.

RESULTS

Many protocols showed a uniform gray value distribution except in the minimum slice thickness image acquired using 3D Accuitomo 80 (Morita, Kyoto, Japan) and Veraviewepocs 3Df (Morita). Noise levels differed among the protocols. There was no geometric distortion, and the pixel intensity values were correlated with the CT value. Low contrast resolution differed among the protocols, but high contrast resolution performed well in all. Many protocols showed that the maximum line pair was larger than 1 LP mm(-1) but smaller than 3 LP mm(-1). PSF and MTF did not correlate well with the pixel size. The measured metal artefact areas varied for each device.

CONCLUSIONS

We studied the image quality of three CBCT machines using the SEDENTEXCT phantom. Image quality varied with exposure protocols and machines.

Ruthenium(II) complexes containing quinone based ligands: synthesis, characterization, catalytic applications and DNA interaction

1,2-Naphthaquinone reacts with amines such as semicarbazide, isonicotinylhydrazide and thiosemicarbazide in high yield procedure with the formation of tridentate ligands HL(n) (n=1-3). By reaction of ruthenium(II) starting complexes and quinone based ligands HL(n) (n=1-3), a series of ruthenium complexes were synthesized and characterized by elemental and spectroscopic methods (FT-IR, electronic, (1)H, (13)C, (31)P NMR and ESI-MS). The ligands were coordinated to ruthenium through quinone oxygen, imine nitrogen and enolate oxygen/thiolato sulfur. On the basis of spectral studies an octahedral geometry may be assigned for all the complexes. Further, the catalytic oxidation of primary, secondary alcohol and transfer hydrogenation of ketone was carried out. The DNA cleavage efficiency of new complexes has also been tested.

Radiation transport calculations for cosmic radiation

The radiation environment inside and near spacecraft consists of various components of primary radiation in space and secondary radiation produced by the interaction of the primary radiation with the walls and equipment of the spacecraft. Radiation fields inside astronauts are different from those outside them, because of the body's self-shielding as well as the nuclear fragmentation reactions occurring in the human body. Several computer codes have been developed to simulate the physical processes of the coupled transport of protons, high-charge and high-energy nuclei, and the secondary radiation produced in atomic and nuclear collision processes in matter. These computer codes have been used in various space radiation protection applications: shielding design for spacecraft and planetary habitats, simulation of instrument and detector responses, analysis of absorbed doses and quality factors in organs and tissues, and study of biological effects. This paper focuses on the methods and computer codes used for radiation transport calculations on cosmic radiation, and their application to the analysis of radiation fields inside spacecraft, evaluation of organ doses in the human body, and calculation of dose conversion coefficients using the reference phantoms defined in ICRP Publication 110.

Organ doses from environmental exposures calculated using voxel phantoms of adults and children

This paper presents effective and organ dose conversion coefficients for members of the public due to environmental external exposures, calculated using the ICRP adult male and female reference computational phantoms as well as voxel phantoms of a baby, two children and four adult individual phantoms--one male and three female, one of them pregnant. Dose conversion coefficients are given for source geometries representing environmental radiation exposures, i.e. whole body irradiations from a volume source in air, representing a radioactive cloud, a plane source in the ground at a depth of 0.5 g cm⁻², representing ground contamination by radioactive fall-out, and uniformly distributed natural sources in the ground. The organ dose conversion coefficients were calculated employing the Monte Carlo code EGSnrc simulating the photon transport in the voxel phantoms, and are given as effective and equivalent doses normalized to air kerma free-in-air at height 1 m above the ground in Sv Gy(-1). The findings showed that, in general, the smaller the body mass of the phantom, the higher the dose. The difference in effective dose between an adult and an infant is 80-90% at 50 keV and less than 40% above 100 keV. Furthermore, dose equivalent rates for photon exposures of several radionuclides for the above environmental exposures were calculated with the most recent nuclear decay data. Data are shown for effective dose, thyroid, colon and red bone marrow. The results are expected to facilitate regulation of exposure to radiation, relating activities of radionuclides distributed in air and ground to dose of the public due to external radiation as well as the investigation of the radiological effects of major radiation accidents such as the recent one in Fukushima and the decision making of several committees.

Characterization of optically stimulated luminescence dosemeters to measure organ doses in diagnostic radiology

OBJECTIVE

The aim of this study was to assess the characteristics of an optically stimulated luminescence dosemeter (OSLD) for use in diagnostic radiology and to apply the OSLD in measuring the organ doses by panoramic radiography.

METHODS

The dose linearity, energy dependency and angular dependency of aluminium oxide-based OSLDs were examined using an X-ray generator to simulate various exposure settings in diagnostic radiology. The organ doses were then measured by inserting the dosemeters into an anthropomorphic phantom while using three panoramic machines.

RESULTS

The dosemeters demonstrated consistent dose linearity (coefficient of variation<1.5%) and no significant energy dependency (coefficient of variation<1.5%) under the applied exposure conditions. They also exhibited negligible angular dependency (≤ 10%). The organ doses of the X-ray as a result of panoramic imaging by three machines were calculated using the dosemeters.

CONCLUSION

OSLDs can be utilized to measure the organ doses in diagnostic radiology. The availability of these dosemeters in strip form proves to be reliably advantageous.

Reliability of a multiplex PCR assay for the identification of the major Campylobacter taxa

The primer pair (C412F/C1228R) constructed previously for the polymerase chain reaction (PCR) identification of the genus Campylobacter using an approximate 800 base pair (bp) 16S rRNA gene target segment proved to be useful for the identification of a total of 49 Campylobacter lari isolates including urease-positive thermophilic Campylobacter (UPTC) organisms (n=25). When the primer pair (CLF/R) developed previously for the PCR identification of C. lari species using an approximate 250 bp glyA segment was employed, 27 C. lari isolates, including all the UPTC isolates, were identified to be PCR-negative (55%). Therefore, this PCR procedure developed for the molecular identification of C. lari was shown to be unreliable for C. lari identification. Nucleotide sequencing analysis clarified the reason(s) why PCR-negative examples occurred in many C. lari isolates, including UPTC isolates. The primer pair target sequences in the C. lari-specific PCR-negative isolates apparently varied at the 3' end region, as compared with C. lari-specific PCR-positive isolates. Thus, the multiplex PCR assay developed previously was shown to be unreliable for the molecular identification of C. lari subspecies organisms.

Development of a web-based CT dose calculator: WAZA-ARI

A web-based computed tomography (CT) dose calculation system (WAZA-ARI) is being developed based on the modern techniques for the radiation transport simulation and for software implementation. Dose coefficients were calculated in a voxel-type Japanese adult male phantom (JM phantom), using the Particle and Heavy Ion Transport code System. In the Monte Carlo simulation, the phantom was irradiated with a 5-mm-thick, fan-shaped photon beam rotating in a plane normal to the body axis. The dose coefficients were integrated into the system, which runs as Java servlets within Apache Tomcat. Output of WAZA-ARI for GE LightSpeed 16 was compared with the dose values calculated similarly using MIRD and ICRP Adult Male phantoms. There are some differences due to the phantom configuration, demonstrating the significance of the dose calculation with appropriate phantoms. While the dose coefficients are currently available only for limited CT scanner models and scanning options, WAZA-ARI will be a useful tool in clinical practice when development is finalised.