Best practice transfer by public health nurses in Japan: actual conditions and related factors

BACKGROUND

The workload of public health nurses (PHNs) working for local governments has been increasing as health issues become more diverse and complicated. Even amidst the ongoing administrative and fiscal reforms, there is an urgent need to ensure how effectively and efficiently public health nurses can practice in health service development. The objective of this research was to clarify the actual conditions of best practice transfer (BPT) and its related factors.

METHODS

An anonymous postal and self-administered questionnaire survey was conducted among PHNs working at 334 sites, including the local government offices and health centers across Japan, and analysed mainly through logistic regression analysis.

RESULTS

One hundred eighty-five of the 334 institutions (55.4%) agreed to participate, and of the 966 questionnaire forms distributed, 709 forms (73.4%) were collected, of which 702 responses (72.7%) were valid. Although less than half (43.2%) have experience in BPT in health service development, more than 80% are willing to perform going forward. Significant factors for both the group with experience in BPT and the group with willingness to perform include an organizational culture that promotes BPT, as well as multiple elements of the workplace environment and facilitating factors related to knowledge and learning. The experienced group recognised the needs for criteria to evaluate the adaptability of best practice, while the willing group, to evaluate the quality of practice.

CONCLUSIONS

Through a nationwide survey, this research elucidated for the first time the actual conditions of BPT by PHNs in Japan and related factors. The results indicated the importance of developing a system to promote BPT at the workplace level, also highlighted the importance for practitioners and experts, including researchers, to work together to develop practical guidelines to ensure evidence-based practices. Urgent actions are needed for the national and local governments to develop a system to promote BPT from diverse perspectives, building on the findings of this research.

Traditional japanese diet score and the sustainable development goals by a global comparative ecological study

BACKGROUND

Reducing the environmental impact of the food supply is important for achieving Sustainable Development Goals (SDGs) worldwide. Previously, we developed the Traditional Japanese Diet Score (TJDS) and reported in a global ecological study that the Japanese diet is associated with reducing obesity and extending healthy life expectancy etc. We then examined the relationship between the TJDS and environmental indicators.

METHODS

The average food (g/day/capita) and energy supplies (kcal/day/capita) by country were obtained from the Food and Agriculture Organization of the United Nations Statistics Division database. The TJDS was calculated from eight food groups (beneficial food components in the Japanese diet: rice, fish, soybeans, vegetables, and eggs; food components that are relatively unused in the traditional Japanese diet: wheat, milk, and red meat) by country using tertiles, and calculated the total score from - 8 to 8, with higher scores meaning greater adherence to the TJDS. We used Land Use (m2), Greenhouse gas (GHG) emissions 2007/2013 (kg CO2eq), Acidifying emissions (g SO2eq), Eutrophying emissions (g PO43- eq), Freshwater (L), and water use (L) per food weight by Poore et al. as the environmental indicators and multiplied these indicators by each country's average food supply. We evaluated the cross-sectional and longitudinal associations between the TJDS and environmental indicators from 2010 to 2020. This study included 151 countries with populations ≥ 1 million.

RESULTS

Land use (β ± standard error; -0.623 ± 0.161, p < 0.001), GHG 2007 (-0.149 ± 0.057, p < 0.05), GHG 2013 (-0.183 ± 0.066, p < 0.01), Acidifying (-1.111 ± 0.369, p < 0.01), and Water use (-405.903 ± 101.416, p < 0.001) were negatively associated with TJDS, and Freshwater (45.116 ± 7.866, p < 0.001) was positively associated with TJDS after controlling for energy supply and latitude in 2010. In the longitudinal analysis, Land Use (β ± standard error; -0.116 ± 0.027, p < 0.001), GHG 2007 (-0.040 ± 0.010, p < 0.001), GHG 2013 (-0.048 ± 0.011, p < 0.001), Acidifying (-0.280 ± 0.064, p < 0.001), Eutrophying (-0.132 ± 0.062, p < 0.05), and Water use (-118.246 ± 22.826, p < 0.001) were negatively associated with TJDS after controlling for confounders.

CONCLUSIONS

This ecological study suggests that the traditional Japanese dietary pattern might improve SDGs except Fresh water.

Laser-based angle-resolved photoemission spectroscopy with micrometer spatial resolution and detection of three-dimensional spin vector

We have developed a state-of-the-art apparatus for laser-based spin- and angle-resolved photoemission spectroscopy with micrometer spatial resolution (µ-SARPES). This equipment is realized by the combination of a high-resolution photoelectron spectrometer, a 6 eV laser with high photon flux that is focused down to a few micrometers, a high-precision sample stage control system, and a double very-low-energy-electron-diffraction spin detector. The setup achieves an energy resolution of 1.5 (5.5) meV without (with) the spin detection mode, compatible with a spatial resolution better than 10 µm. This enables us to probe both spatially-resolved electronic structures and vector information of spin polarization in three dimensions. The performance of µ-SARPES apparatus is demonstrated by presenting ARPES and SARPES results from topological insulators and Au photolithography patterns on a Si (001) substrate.

Relationship between seasonal variation in isoprene emission and plant hormone profiles in the tropical plant Ficus septica

In Ficus septica, the short-term control of isoprene production and, therefore, isoprene emission has been linked to the hormone balance between auxin (IAA) and jasmonic acid (JA). However, the relationship between long-term changes in isoprene emission and that of plant hormones remains unknown. This study tracked isoprene emissions from F. septica leaves, plant hormone concentrations and signalling gene expression, MEP pathway metabolite concentrations, and related enzyme gene expression for 1 year in the field to better understand the role of plant hormones and their long-term control. Seasonality of isoprenes was mainly driven by temperature- and light-dependent variations in substrate availability through the MEP route, as well as transcriptional and post-transcriptional control of isoprene synthase (IspS). Isoprene emissions are seasonally correlated with plant hormone levels. This was especially evident in the cytokinin profiles, which decreased in summer and increased in winter. Only 4-hydroxy-3-methylbut-2-butenyl-4-diphosphate (HMBDP) exhibited a positive connection with cytokinins among the MEP metabolites examined, suggesting that HMBDP and its biosynthetic enzyme, HMBDP synthase (HDS), play a role in channelling of MEP pathway metabolites to cytokinin production. Thus, it is probable that cytokinins have potential feed-forward regulation of isoprene production. Under long-term natural conditions, the hormonal balance of IAA/JA-Ile was not associated with IspS transcripts or isoprene emissions. This study builds on prior work by revealing differences between short- and long-term hormonal modulation of isoprene emissions in the tropical tree F. septica.

Global Association between Traditional Japanese Diet Score and All-Cause, Cardiovascular Disease, and Total Cancer Mortality: A Cross-Sectional and Longitudinal Ecological Study

OBJECTIVE

Studies conducted on Japanese people have suggested that a traditional Japanese diet contributes to good health, longevity, and protection against several non-communicable diseases. However, it is unknown whether traditional Japanese dietary patterns are associated with all-cause mortality, cardiovascular disease, and cancer mortality globally. The purpose of this cross-sectional and longitudinal ecological study is to clarify the global association between the traditional Japanese diet score (TJDS) and all-cause, cardiovascular disease, and total cancer mortality.

METHODS

Data on food supply and all-cause mortality, cardiovascular disease mortality, total cancer mortality, and covariables by country were obtained from a relevant internationally available database. TJDS by country was calculated from eight food groups and the total score ranged from -8 to 8, with higher scores indicating greater adherence to a traditional Japanese diet. We evaluated the cross-sectional and 10-year longitudinal association between TJDS and all-cause, cardiovascular disease, and total cancer mortality using 2009 as the baseline in 142 countries with populations of more than one million. A cross-sectional analysis and a longitudinal analysis were performed using three general linear models or three linear mixed models with different covariables.

RESULTS

In cross-sectional models controlled for fully-adjusted covariables, TJDS was negatively associated with all-cause mortality (β ± standard error; -43.819 ± 11.741, p < 0.001), cardiovascular disease mortality (-22.395 ± 4.638, p < 0.001), and total cancer mortality (-3.893 ± 1.048, p < 0.001). In 10-year longitudinal models controlled for fully-adjusted covariables, TJDS was significantly negatively associated with all-cause mortality (-31.563 ± 7.695, p < 0.001), cardiovascular disease mortality (-16.249 ± 4.054, p < 0.001), and total cancer mortality (-3.499 ± 0.867, p < 0.001).

CONCLUSIONS

This cross-sectional and longitudinal ecological study suggests that the traditional Japanese diet is associated with lower all-cause mortality, cardiovascular disease mortality, and total cancer mortality, worldwide.

The Global Association between Egg Intake and the Incidence and Mortality of Ischemic Heart Disease-An Ecological Study

The relationship between egg consumption and ischemic heart disease (IHD) remains controversial as there is still no clear answer regarding the relationship, with research limited to a few geographical regions. In the current study, we conducted a longitudinal analysis of the association between egg intake and IHD incidence (IHDi) and mortality (IHDd) using 28 years of international data from 1990 to 2018. Egg intake (g/day/capita) by country was obtained from the Global Dietary Database. Age-standard IHDi and IHDd rates per 100,000 subjects in each country were obtained from the 2019 Global Burden of Disease database. The analysis included a total of 142 countries with populations of at least one million, for which all data were available from 1990 to 2018. Eggs are consumed worldwide, and regional differences in consumption are also shown. Utilizing IHDi and IHDd as objective variables and egg intake as an explanatory variable, the analysis was conducted using linear mixed models, which controlled for inter- and intra-country variation from year to year. The results showed a significant negative association between egg intake, and IHDi (-0.253 ± 0.117, p < 0.05) and IHDd (-0.359 ± 0.137, p < 0.05). The analysis was carried out using R 4.0.5. The results suggest that adequate egg intake might suppress IHDi and IHDd on a global scale.

Enhancement ofAcinetobacterbaumanniibiofilm growth by cephem antibiotics via enrichment of protein and extracellular DNAin thebiofilm matrices

AIMS

To determine the effects of subinhibitory concentrations of eight cephem and carbapenem antibiotics on thebiofilm formation ofAcinetobacterbaumanniicells and examine itseffect on pre-established biofilms.

METHODS AND RESULTS

Effects of antibiotics on biofilm formation were assayed using microtiter plates with polystyrene peg-lids.Cefmetazole, ceftriaxone, ceftazidime, and cefpirome increased the biomass of pre-established biofilms on pegs in the range of their sub-minimum inhibitory concentrations, whereas none increased biofilm formation by planktonic cells. Carbapenems had a negative effect.The constituents of antibiotic-induced biofilms were analyzed. Ceftriaxoneor ceftazidimetreatment markedly increased the matrix constituent amounts in the biofilms (carbohydrate, 2.7-fold; protein, 8.9-12.7-fold; lipid, 3.3-3.6-fold; DNA, 9.1-12.2-fold; outer membrane vesicles, 2.7-3.8-fold; and viable cells,6.8-10.1-fold).The antibiotic-enhanced biofilmshad increased outer membrane protein A and were resistant to the anti-biofilm effect of azithromycin.

CONCLUSIONS

Some cephems increased the biomass of pre-established biofilms in the ranges of their sub-minimum inhibitory concentrations.The antibiotic-enhanced biofilmspossessed more virulent characteristics than normal biofilms.

SIGNIFICANCE AND IMPACT OF THE STUDY

Incomplete administration of certain cephems followingbiofilm-related Ac.baumannii infectionscould adversely cause exacerbated and chronic clinical results.

Engineered extracellular vesicles antagonize SARS-CoV-2 infection by inhibiting mTOR signaling

Effective treatment approaches for patients with COVID-19 remain limited and are neither curative nor widely applicable. Activated specialized tissue effector extracellular vesicles (ASTEX) derived from genetically-enhanced skin fibroblasts, exert disease-modifying bioactivity in vivo in models of heart and lung injury. Here we report that ASTEX antagonizes SARS-CoV-2 infection and its pathogenic sequelae. In human lung epithelial cells exposed to SARS-CoV-2, ASTEX is cytoprotective and antiviral. Transcriptomic analysis implicated the mammalian target of rapamycin (mTOR) pathway, as infected cells upregulated mTOR signaling and pre-exposure to ASTEX attenuated it. The implication of mTOR signaling was further confirmed using mTOR inhibition and activation, which increased and decreased viral load, respectively. Dissection of ASTEX cargo identifies miRs including miR-16 as potential inhibitors of mTOR signaling. The findings reveal a novel, dual mechanism of action for ASTEX as a therapeutic candidate for COVID-19, with synergistic antiviral and cytoprotective benefits.

Plant hormone profile and control over isoprene biosynthesis in a tropical tree Ficus septica

Plant hormone signalling and the circadian clock have been implicated in the transcriptional control of isoprene biosynthesis. To gain more insight into the hormonal control of isoprene biosynthesis, the present study measured plant hormone concentrations in jasmonic acid (JA)-treated leaves of our previous model study, examined their relationship with gene expression of isoprene synthase (IspS) and hormone signalling transcription factors. Of the plant hormones, IAA and JA-Ile and their related transcription factors (MYC2 and SAUR21) were significantly correlated with IspS gene expression. Concentrations of cytokinins, isopentenyladenine (iP), trans-zeatin riboside (tZR) and cis-zeatin riboside (cZR), were similarly significantly correlated with IspS expression. However, there was no significant correlation between their related transcription factor (ARR-B) and IspS expression. The circadian clock-related gene PRR7, but not the transcription factor LHY, was highly correlated with IspS expression. These results suggest that the hormonal balance between JA-Ile and IAA plays a central role in transcriptional regulation of IspS through the transcription factors MYC2 and SAUR21, the early auxin responsive genes. The putative cis-acting elements for SAUR on the IspS promoter (TGTCNN and CATATG), in addition to the G-box for MYC2, support the above proposal. These results provide insightful information on the core components of plant hormone-related regulation of IspS under coordination with the circadian clock genes.

Association between the Mediterranean Diet Score and Healthy Life Expectancy: A Global Comparative Study

OBJECTIVES

Extending healthy life expectancy (HALE), defined as the average number of years that a person can expect to live in "full health" by taking into account years lived in less than full health due to disease and/or injury, is a common topic worldwide. This study aims to clarify the relationships between the Mediterranean diet score (MDS) and life expectancy (LE) and HALE globally using publicly available international data.

SETTING

Analyses were conducted on 130 countries with populations of 1 million or more for which all data were available. Individual countries were scored from 0 to 9 to indicate adherence to the Mediterranean diet according to the MDS scoring method. The supply of vegetables, legumes, fruits and nuts, cereals, fish, and olive oil per 1,000 kcal per country was calculated based on the Food and Agriculture Organization Corporate Statistical Database, with a score of 1 for above the median and 0 for below. The same method was used to calculate scores of presumed detrimental components (meat and dairy), with consumption below the median given a value of 1, and consumption above the median given a value of 0. For ethanol, a score of 1 was given for 10g to 50 g of consumption. We investigated the cross-sectional associations between the MDS and LE and HALE at birth in 2009, and the longitudinal associations between the MDS in 2009 and LE and HALE between 2009 and 2019, controlling for covariates at baseline using linear mixed models.

RESULTS

In the cross-sectional analysis, the MDS was significantly positively associated with LE (β=0.906 [95% confidence interval, 0.065-1.747], p=0.037) and HALE (β=0.875 [0.207-1.544], p=0.011) after controlling for all covariates. The longitudinal analysis also revealed significantly positive associations between the MDS and LE (0.621 [0.063-1.178], p=0.030) and HALE (0.694 [0.227-1.161], p=0.004) after controlling for all covariates.

CONCLUSION

The present study, based on an analysis using 10 years of international data, showed that countries with a higher MDS showed a positive association with HALE.

213Traditional Japanese Diet Score and healthy life expectancy - a longitudinal global study

Background

Traditional Japanese diets are considered to be health and longevity. We created a Traditional Japanese Diet Score (TJDS) and investigated the relationship between the TJDS and healthy life expectancy (HALE) longitudinally using global database.

Methods

Average food (g/day/capita) and energy supply (kcal/day/capita) by countries were identified by the Food and Agriculture Organization of the United Nations Statistics Division database. The sum of characterizing traditional Japanese foods supply (beneficial food components in Japanese diet; rice, fish, soybeans, vegetables, eggs, seaweeds, food components not use so much in Japanese diet; wheat, milk, and red meat) were divided as tertile (beneficial food components;-1, 0, 1, not use so much food components; 1, 0, -1). HALE values by country were derived from the Global Burden of Disease 2017 database. The longitudinal effects of TJDS on the rate of change in HALE from 1990 to 2013 were evaluated using a generalized mixed-effect model (GLMM), which takes into account the dependence of repeated observations within countries. The interaction between TJDS and survey year was applied to access the effects on HALE. This study covered 137 countries with populations of 1 million or greater.

Results

Longitudinal analysis controlled for covariates showed that smooth term of the interaction between TJDS and survey year was significant (p &lt; 0.001). The TJDS was negative associated with HALE in 1990, and in 1991, but positive associated after 2002.

Conclusions

The relationship between the TJDS as a healthy eating style and HALE is getting stronger since the 21st century.

Key messages

Well-balanced eating habits of traditional Japanese diets is supports healthy life expectancy.

265Global diabetes trends and associated socioeconomic, lifestyle and health indicators from 1990 to 2017

Background

This longitudinal ecological study was conducted to determine the global trends in the age-standardised prevalence of type 2 diabetes mellitus (T2DM) and its association with socioeconomic, lifestyle and health indicators.

Methods

Data pertaining to the age-standardised prevalence of T2DM (rates per 100,000) and socioeconomic, lifestyle and health indicators were obtained from several international databases. Data available from 1990 to 2017 for 139 countries with populations of 1 million or greater were analysed, followed by estimation of slopes for T2DM prevalence in each country. The longitudinal association between T2DM and the standardised variables of socioeconomic, lifestyle and health indicators was fitted using a generalised linear mixed-effects model with random intercept for each country and random slope for year.

Results

The country-specific age-standardised prevalence of T2DM decreased significantly in 9 countries, remained unchanged in 11 countries and increased significantly in 119 countries. The estimated standardised effect of age-standardised education for T2DM was the largest at − 524.5 (SE; 109.9), followed by − 514.8 (SE; 95.6) for physical activity and 398.8 (SE; 45.8) for body mass index (BMI) (P &lt; 0.0001 for all).

Conclusions

The factors strongly associated with global T2DM prevalence and trends were years of education, followed by physical activity and BMI. This study also provides a basis for investigating public health approaches to control the increase in global T2DM prevalence.

Key messages

The promotion of policies that reduce international educational disparities may have the potential to reduce the global increase in the number of patients with T2DM.

169Folic acid intake and dementia - a 27-year global longitudinal study

Background

Folate deficiency increases serum homocysteine and may cause cognitive impairment. However, there have been no international longitudinal studies that examined the association between folic acid intake and dementia. We investigated the longitudinal association between folate intake and the prevalence of dementia using global data during 27 years.

Methods

Prevalence of Alzheimer’s disease and other dementias and folic acid intake by country were obtained from the Global Burden of Disease (GBD) 2017 database. The longitudinal associations between folic acid intake and prevalence of dementia was examined using linear mixed effect model during 27 years from 1990 to 2017 in 151countries with populations of 1 million or greater. The effects of folic acid, year and interaction of folic acid and year were estimated controlling for covariates including socio-economic variables and life-style variables.

Results

Fixed effects of folic acid was highly significant (mean and SE; -33.1±7.1, p &lt; 0.001) and interaction of folic acid and survey year was also significant (0.90±0.13, p &lt; 0.001). Slope of folic acid for dementia prevalence was significant in 1990 and the slope has decreased with the year and has become not significant after 2011.

Conclusions

Folic acid was associated with the prevalence of dementia, but weakened over the years.

Key messages

Although folic acid intake has been associated with the of dementia, the risk of dementia may be increasingly related to factors other than nutrition.

64Traditional Japanese Diet Score and cancer incidence and mortality - a 23-year longitudinal global study

Background

Traditional Japanese diets are considered to be one cause of Japanese health and longevity. We created a Traditional Japanese Diet Score (TJDS) and investigated the relationship between the TJDS and cancer during more than 20 years using global database.

Methods

Total cancer incidence and mortality by country were identified from the Global Burden of Disease 2017 database. Average food supply (g/day/capita) and energy supply (kcal/day/capita) by country were obtained from the Food and Agriculture Organization of the United Nations database. The TJDS by country was calculated from nine food groups, the higher scores mean the more adherence to traditional Japanese diet. That is beneficial food groups (rice, fish, soybeans, vegetables, eggs, seaweed) gave positive points to high supply amount, and food groups not commonly used in the Japanese diet (wheat, milk, and red meat) gave minus points to high supply amount. The longitudinal associations between the TJDS and cancer incidence and mortality controlled for covariates were examined during 23 years from 1990 to 2013. The country covered by this study was 139 countries with populations of 1 million or greater.

Results

The TJDS was negatively associated with cancer incidence and mortality longitudinally in a linear mixed-effect model controlled for covariates.

Conclusions

These results suggest that greater adherence with the TJDS supressed cancer incidence and mortality worldwide.

Key messages

Well-balanced eating habits like traditional Japanese diets is important for suppressing cancer.

Global relationship between Mediterranean diet and the incidence and mortality of ischaemic heart disease

BACKGROUND

The purpose of this study was to clarify the global relationship between the Mediterranean diet score (MDS) and country-wise incidence and mortality of ischaemic heart disease (IHD) using an international database.

METHODS

We used population data from a global longitudinal database covering 137 countries with a population of over one million. MDS were evaluated based on the total score of the nine foods that comprise the Mediterranean diet. The incidence and mortality of IHD by country was derived from the Global Burden of Disease (GBD) database. Average food (g/day/capita) and energy supply (kcal/day/capita) by country, excluding loss between production and household, were obtained from the Food and Agriculture Organization of the United Nations Statistics Division database. Data from the GBD database were used for body mass index, current smoking rates, physical activity, years of education and percentage of the Muslim population. We identified the percentage of the population over 65 years of age (aging rate) and gross domestic product per capita (US$/capita) using the World Bank database. A linear mixed-effect model was used for evaluating the effects of MDS on incidence and mortality of IHD controlled for socioeconomic and lifestyle variables.

RESULTS

Analysis showed that MDS was significantly associated with IHD incidence after controlling for covariates (-1.01 ± 0.27, P < 0.001). Similarly, there was a significant association between MDS and IHD-related mortality after controlling for covariates (-0.73 ± 0.34, P < 0.05).

CONCLUSION

Analysis of 27 years of data suggests that a Mediterranean diet might have a preventive effect on IHD.

NF-kB decoy oligodeoxynucleotide preserves disc height in a rabbit anular-puncture model and reduces pain induction in a rat xenograft-radiculopathy model

While it is known that the degenerated intervertebral disc (IVD) is one of the primary reasons for low-back pain and subsequent need for medical care, there are currently no established effective methods for direct treatment. Nuclear factor-κB (NF-κB) is a transcription factor that regulates various genes' expression, among which are inflammatory cytokines, in many tissues including the IVD. NF-κB decoy is an oligodeoxynucleotide containing the NF-κB binding site that entraps NF-κB subunits, resulting in suppression of NF-κB activity. In the present preclinical study, NF-κB decoy was injected into degenerated IVDs using the rabbit anular-puncture model. In terms of distribution, NF-κB decoy persisted in the IVDs up to at least 4 weeks after injection. The remaining amount of NF-κB decoy indicated that it fit a double-exponential-decay equation. Investigation of puncture-caused degeneration of IVDs showed that NF-κB decoy injection recovered, dose-dependently, the reduced disc height that was associated with reparative cell cloning and morphological changes, as assessed through histology. Gene expression, by quantitative real-time polymerase chain reaction (qRT-PCR), showed that NF-κB decoy attenuated inflammatory gene expression, such as that of interleukin-1 and tumor necrosis factor-α, in rabbit degenerated IVDs. NF-κB decoy also reduced the pain response as seen using the "pain sensor" nude rat xenograft-radiculopathy model. This is the first report demonstrating that NF-κB decoy suppresses the inflammatory response in degenerated IVDs and restores IVD disc height loss. Therefore, the intradiscal injection of NF-κB decoy may have the potential as an effective therapeutic strategy for discogenic pain associated with degenerated IVDs.

Adlayer influence on Dirac-type surface state at W(110)

In a combined experimental and theoretical study, we investigated how Fe and Co adlayers on W(110) affect the Dirac-type surface state (DSS). Angle-resolved photoelectron spectroscopy data show an increase in binding energy of 75 meV and 107 meV for Fe and Co, respectively. In order to identify the origin of the energy shift we performed first-principles calculations of the surface electronic structure. The inward surface relaxation of the uncovered W(110) surface is lifted by the adlayers. This structural change is one reason of the energy shift of the DSS. Furthermore, the Fe and Co adlayers change the surface potential, which results in an additional energy shift of the DSS.

Experimental Observation and Spin Texture of Dirac Node Arcs in Tetradymite Topological Metals

We report the observation of a nontrivial spin texture in Dirac node arcs, i.e., novel topological objects formed when Dirac cones of massless particles extend along an open one-dimensional line in momentum space. We find that such states are present in all the compounds of the tetradymite M_{2}Te_{2}X family (M=Ti, Zr, or Hf and X=P or As) regardless of the weak or strong character of the topological invariant. The Dirac node arcs in tetradymites are thus the simplest possible textbook example of a type-I Dirac system with a single spin-polarized node arc.

Trends in age-standardised prevalence of type 2 diabetes mellitus according to country from 1990 to 2017 and their association with socioeconomic, lifestyle and health indicators: An ecological study

Background

There is a need for global public health strategies to effectively curb the ever-growing global diabetes population. This longitudinal ecological study was conducted to elucidate the country-specific trends of the age-standardised prevalence of type 2 diabetes mellitus (T2DM) and their association with socioeconomic, lifestyle and health indicators.

Methods

Data pertaining to the age-standardised prevalence of T2DM (rates per 100 000) and socioeconomic, lifestyle and health indicators were obtained from several international databases. Data available from 1990 to 2017 for 139 countries with populations of 1 million or greater were analysed, followed by estimation of slopes for T2DM prevalence in each country. The longitudinal association between T2DM and the standardised variables of socioeconomic, lifestyle and health indicators was fitted using a generalised linear mixed-effects model with random intercept for each country and random slope for year.

Results

The country-specific age-standardised prevalence of T2DM decreased significantly in 9 countries, remained unchanged in 11 countries and increased significantly in 119 countries. The estimated standardised effect of age-standardised education for T2DM was the largest at −524.5 (SE; 109.9), followed by −514.8 (SE; 95.6) for physical activity and 398.8 (SE; 45.8) for body mass index (BMI) (P < 0.0001 for all).

Conclusions

The factors largely associated with global T2DM prevalence and trends were years of education, followed by physical activity and BMI. This study also provides basic resources for examining public health approaches to curb the increase in global T2DM prevalence.

A longitudinal association between the traditional Japanese diet score and incidence and mortality of breast cancer-an ecological study

BACKGROUND

The traditional Japanese diet is considered one of the important factors of health and longevity in Japanese people. Breast cancer is the most common cancer among women in the world. However, the association between the traditional Japanese diet and breast cancer is unclear. The purpose of this study was to investigate the longitudinal association between the traditional Japanese diet score (TJDS) with the incidence and mortality of breast cancer in an ecological study.

METHODS

Food supply and breast cancer incidence and mortality by country were obtained from an international database. TJDS by country was calculated from nine food groups and the total score ranged from -9 to 9, with higher scores indicating greater adherence to a traditional Japanese diet. Longitudinal associations of interaction between TJDS and fiscal year on breast cancer incidence and mortality were investigated in 139 countries with populations of 1 million or greater. The longitudinal analysis was evaluated using four linear mixed-effect models with different adjustment covariables.

RESULTS

Many countries with high scores on TJDS had lower distributions of breast cancer incidence and mortality in 1990-2017. Longitudinal analysis using a linear mixed-effect model controlled for socio-economic and lifestyle covariables showed that the interaction between TJDS and fiscal year was significantly associated with incidence of breast cancer (-0.453 ± 0.138, p < 0.01) and mortality of breast cancer (-0.455 ± 0.135, p < 0.001).

CONCLUSIONS

This longitudinal analysis suggested that a traditional Japanese diet has been associated with lower breast cancer incidence and mortality worldwide in recent years.

Ventricular tachycardia in cardiac sarcoidosis -prognosis, characterization of ventricular substrates and outcomes of treatment-

Background

The prognosis, the underlying substrate and clinical outcomes of treatment are unclear in patients with cardiac sarcoidosis (CS)-related ventricular tachycardia (VT).

Objective

This study investigated the prognosis and the relationship between electroanatomical mapping (EAM) and imaging findings in patients with CS-related VT.

Methods

A total of 203 CS patients (Age 68.1±11.6 years, 87 males) were enrolled at two tertiary care medical centers between 2000 and 2018. All met the 2016 Japanese Circulation Society guidelines for diagnosis of CS. They were followed for a composite of major adverse cardiac events (MACE) including cardiac death, heart transplantation, unscheduled hospitalization for heart failure, and life-threatening ventricular arrhythmias. Distribution of late gadolinium enhancement (LGE) on cardiac MRI (CMR) and/or an abnormal myocardial 18F-fluorodeoxyglucose (FDG) uptake on positron emission tomography at diagnosis were examined. The relationship between EAM and the image findings were also analyzed in patients with radiofrequency ablation (RFA) for VT.

Results

During a median follow-up of 53 months, 87 of the 203 patients (43%) experienced a MACE. Baseline factors associated with MACE were presence of sustained VT (HR, 2.43, 95% CI 1.54–3.85, P&lt;0.001), left ventricular ejection fraction below 50% (HR, 1.95 95% CI 1.07–3.56, P=0.029), and abnormal myocardial FDG uptake (HR, 2.42 95% CI 1.04–5.61, P=0.039). Overall, 69 of the 203 patients (34%) experienced sustained VT. Abnormal myocardial FDG uptake was significantly more prevalent in patients with VT than in those without (92.7% vs. 78.5%, P=0.02). A total of 25 patients (9.9%) required RFA for CS-related VT (Age 64.0±8.7 years, 12 males, 1.32±0.56 RFAs per patient). Abnormal electrocardiograms (EGM) were observed in 22 of the 25 patients (88%). LGE was more frequent than abnormal FDG uptake in areas with an abnormal EGM (77% vs. 41%; P=0.002). Over a mean follow-up period of 67-months, 13 of the 25 patients with RFA (52%) remained free of VT episodes (Figure). VT recurred in nine of the 12 patients with RFA and in 17 of the 47 patients without RFA, but was suppressed by intensive pharmacologic therapy such as the combined use of amiodarone and sotalol. In patients with CS-related VT, survival without experiencing a MACE did not differ in participants with or without RFA.

Conclusions

In our 203 CS patients, sustained VT and abnormal FDG uptake were associated with worse cardiac outcomes. The prevalence of abnormal FDG uptake was significantly higher in patients with CS-related VT, LGE on CMR was more frequent within localized areas of an abnormal EGM, suggesting that both scar itself and the associated inflammation were involved in the pathogenesis of CS-related VT. Successful RFA of CS-related VT is still challenging, and recurrence is common. Preprocedural CMR can be useful in detecting abnormal EGMs that are potential targets for substrate ablation.

Funding Acknowledgement

Type of funding source: None

Cardiac function at diagnosis is important prognostic factor in patients with cardiac sarcoidosis -from Japanese nationwide questionnaire survey-

Background

Sarcoidosis is a systemic non-caseating granulomatous disease of unknown etiology. Cardiac involvement (cardiac sarcoidosis, CS) has been reported to be an important prognostic factor in this disease because of heart failure and/or ventricular arrhythmia, and corticosteroid therapy is usually prescribed to prevent cardiac events. However, little is known about the relationship of cardiac function and concomitant corticosteroid therapy on later cardiac events in CS.

Objective

We evaluated the relationship between prognosis and left ventricular ejection fraction (LVEF) at the time of diagnosis in CS patients from the Japanese nationwide questionnaire survey.

Methods

Total of 757 Japanese patients from 57 hospitals who diagnosed CS were examined. Patients who unsatisfied the criteria of the Japanese new guidelines, or who underwent cardiac transplantations were excluded, and 420 patients (287 females, mean age 60±13 years old, median follow-up periods 1864 days [interquartile range: 845–3159 days]) were analyzed. The relationship of adverse events (all-cause death, cardiovascular death, and appropriate ICD [Implantable Cardioverter Defibrillator] discharge) and LVEF (with corticosteroid 84%) (low LVEF: LVEF≤35% n=98 [with corticosteroid in 78%], moderate LVEF: LVEF 35–50% n=104 [with corticosteroid in 93%], normal LVEF: 50≤LVEF n=218 [with corticosteroid in 83%]) were evaluated respectively.

Results

89 CS patients developed all-cause death (n=50), cardiovascular death (n=30) or appropriate ICD discharge (n=48). The frequency of corticosteroid therapy was not different in the each LVEF group, but Kaplan-Meier analysis revealed that all-cause death, cardiovascular death, and all cardiovascular adverse events were more observed in lower LVEF group (log-rank p&lt;0.0001). Furthermore, multivariate Cox hazard analysis revealed that LVEF was a most important independent prognostic factor in CS.

Conclusion

This Japanese nationwide questionnaire survey data showed that initial LVEF was an independent and strong prognostic predictor in CS, therefore primary prevention would be needed even after starting corticosteroid in patients with decreased cardiac function.

Funding Acknowledgement

Type of funding source: None

Long time clinical course of cardiac sarcoidosis with corticosteroid therapy -from Japanese nationwide questionnaire survey-

Background

Sarcoidosis is a systemic inflammatory syndrome of unknown etiology and cardiac involvement has been reported to be an important prognostic factor in this disease. An autopsy study has reported that the frequency of this cardiac involvement (cardiac sarcoidosis: CS) varies in the different countries and races and very frequent in Japanese patients. We therefore performed the nationwide questionnaire survey and try to clarify the clinical characteristics and corticosteroid effect in CS, especially focused on arrhythmic events in this disease.

Methods

Total of 757 Japanese patients from 57 hospitals who diagnosed CS were examined. Patients who unsatisfied the criteria of the Japanese new guidelines, or who underwent cardiac transplantations were excluded, and 420 patients (287 females, median follow-up periods 1864 days [interquartile range: 845–3159 days]) were analyzed. The clinical outcome and corticosteroid effect were evaluated.

Results

Clinical characteristics at diagnosis was as follows: female dominant (68%), mean age of 60±13 years old, mean left ventricular ejection fraction was 49±16%. Arrhythmic events were very frequently observed as an initial cardiac manifestation in 263 patients (62%) of CS, of which atrioventricular block (AVB) in 174 (41%), ventricular tachycardia (VT) in 73 (17%) and AVB with VT in 17 (4%) (Figure 1A). Pacemaker was implanted in 166 patients (40%) and defibrillators was 137 patients (33%). Corticosteroid was prescribed in 144 (83%) of 174 patients with AVB and in 62 (85%) of 73 patients with VT. Initial dose was mean 47.9 mg and maintenance dose of mean 7.3 mg. Corticosteroid improved VT as good as AVB (27% vs. 29%). However, corticosteroid sometimes worsened VT events compared with AVB (10% vs. 2%) (Figure 1B). During the course of follow-up, 32 patients were needed to increase corticosteroid in 23 of AVB and 10 of VT cases. However, there were no difference in mortality between the groups, whether or not to increase corticosteroid. All survival rate was 92% (5-year mortality), 83% (10-year mortality) and free from all cause death and defibrillator charge was 81% (5 year), 71% (10 year).

Conclusion

Fatal arrhythmia is commonly observed in CS as a primary symptom. Corticosteroid sometimes worsen ventricular arrhythmia and appropriate defibrillator discharge was common. Thus, careful attention for activating ventricular arrhythmia would be needed during the follow-up period even after corticosteroid therapy.

Funding Acknowledgement

Type of funding source: None

Long-term follow up ventricular tachycardia patients with preserved cardiac function -from Japanese cardiac sarcoidosis nationwide questionnaire survey-

Background

Prior ventricular tachycardia (VT) and low left ventricular ejection fraction (LVEF) are the most important prognostic factors in cardiac sarcoidosis (CS). Recently diagnosis of CS was renewed according to Japanese new guidelines. Patients with preserved cardiac function often have VT events, thus new guidelines recommends to assess the implantable cardioverter defibrillator (ICD) implantation for CS patients with preserved LVEF (35%≤LVEF&lt;50%). However, the long-term prognosis of CS patients with preserved LVEF is unclear.

Objective

In CS patients with preserved LVEF, we evaluated the prognosis between VT manifestation and non-VT manifestation groups at CS diagnosis from Japanese nationwide questionnaire survey.

Methods

Total of 757 Japanese patients from 57 hospitals who diagnosed CS were examined. Patients who unsatisfied the criteria of the Japanese new guidelines, who had LVEF≤35%, LVEF&gt;50%, or who underwent cardiac transplantations were excluded. 104 patients with LVEF 35–50% (67 females, mean age 60±15 years old, median follow-up periods 2134 days [interquartile range: 758–2935 days]) were analyzed. The prognosis between VT manifestation and non-VT manifestation groups at CS diagnosis were evaluated.

Results

30 patients had VT manifestation at CS diagnosis and 24 patients (80%) received ICDs. 74 patients had no VT manifestation at CS diagnosis and 19 patients (44%) received ICDs during follow up period. All-cause mortality was not different between two groups (Figure). Appropriate ICD therapy of non-VT manifestation group was significantly lower compared with that of VT manifestation group (log-rank p=0.001), however considerable number (n=7, 15%) of non-VT manifestation group had appropriate ICD therapy event during follow-up period. Cox hazard analysis revealed that concomitant non-sustained VT (NSVT) with atrioventricular block (AVB) was a predictor of appropriate ICD therapy in non-VT manifestation group.

Conclusion

This nationwide survey showed that considerable number of CS patients with preserved LVEF had VT events, independent of VT manifestation. Concomitant NSVT with AVB was a predictor of VT events, and ICD implantation should be assessed.

Funding Acknowledgement

Type of funding source: None

Micro-embolic risks during radiofrequency and cryoballoon-ablation of atrial fibrillation -analysis from real-time carotid artery doppler monitoring-

Background

Catheter ablation of atrial fibrillation (AF) is associated with risks of silent cerebral events. However, the timing of intraprocedural micro-embolic events or differences between open-irrigated radiofrequency (RF) and cryoballoon (Cryo) ablation are unclear. Newly developed real-time carotid artery Doppler is a simple non-invasive method to detect micro-embolic signals (MESs) during ablation.

Objective

We investigated the timing of detecting MESs during RF and Cryo ablation of AF.

Methods

During the first pulmonary vein isolation (PVI) session of AF, MESs were monitored by real-time carotid artery Doppler monitoring throughout the procedure. The MES counts were collected and evaluated separately during the different steps of the procedure (Figure).

Results

Thirty-three AF patients (RF/Cryo: 22/11 cases, 9 females, 69.5±11.6 y.o) were included. PVI was successfully accomplished in all patients with no major complications. The MES count was significantly greater in the RF group than Cryo group (table). In both groups, left atrial (LA) access (interatrial puncture) and sheaths insertion to the LA generated a significant number of MESs (RF: 1690 of 9116 MESs [18.5% of the total MESs], Cryo: 793 of 2285 MESs [34.7%]). In the RF group, MESs were observed incessantly during PVI (Figure). The LA dwell time was significantly longer in the RF group than Cryo group (table). In the RF group, the MES count was significantly greater in the longer LA dwell time group (LA dwell time &gt;130min) than the shorter group (464.2±179.7 vs 302.6±138.2: P=0.049). During the cryo-applications in the Cryo group, the MESs were greatest during the first cryoballoon application (625 of 2285 MESs [27.4%]).

Conclusions

There were more MESs during RF ablation than cryoablation. MESs were recorded during a variety of steps throughout the procedure. In the RF group, most of MESs were recorded incessantly during radiofrequency ablation and greater number of MESs were recorded in patients with longer LA dwell time. In the Cryo group, most of MESs occurred during phases with a high probability of gaseous emboli.

Funding Acknowledgement

Type of funding source: None

The safety of catheter ablation of atrial fibrillation in elderly patients -analysis of the nationwide database in Japan, JROAD-DPC-

Background

“Age” is one of the major concerns and determinants of the indications for catheter ablation (CA) of atrial fibrillation (AF). There are little safety data on CA of AF according to the age. This study aimed to assess the safety of CA in elderly patients undergoing CA of AF.

Methods and results

We investigated the complication rate of CA of AF for the different age groups (&lt;60 years, 60–65, 65–70, 70–75, 75–80, 80–85, and ≥85) by a nationwide database (Japanese Registry Of All cardiac and vascular Diseases [JROAD]-DPC). The JROAD-DPC included 73,296 patients (65±11 years, 52,883 men) who underwent CA of AF from 516 hospitals in Japan. Aged patients had more comorbidities and a significantly increased CHADS2 score and higher rate of female according to a higher age. The overall complication rate was 2.6% and in-hospital mortality was 0.05%. By comparing each age group, complications occurred more frequently in higher aged groups. A multivariate adjusted hazard ratio revealed an increased age was independently and significantly associated with the overall complications (odds ratio was 1.25, 1.35, 1.72, 1.86, 2.76 and 3.13 respectively; reference &lt;60 years).

Conclusions

The frequency of complications was significantly higher according to a higher age. We should take note of the indications and procedure for CA of AF in aged patients.

Funding Acknowledgement

Type of funding source: Public Institution(s). Main funding source(s): Intramural Research Fund 17 (Kusano) for Cardiovascular Diseases of the National Cerebral and Cardiovascular Center

Differences in body composition and grip between Japanese and Thai older people living in Thailand

Background

Age-related muscle mass loss is one of the main risk factors for osteoporosis and fractures among older people. Thus, prevention of muscle mass loss in older people is an important issue. We examined ethnic group-related differences in body composition and grip strength among older people living in the same area.

Methods

We measured body composition and grip strength among local Thai older people living in Chiang Mai Province, as well as in Japanese older people who emigrated to Chiang Mai Province in their retirement. A self-reported questionnaire regarding socio-demographic status was also administered. Measurement items were averaged and compared by sex and ethnic group. Questionnaire items were also categorized by sex and ethnic group.

Results

A total of 119 older people participated, including 47 Japanese participants (26 men, 21 women) and 72 Thai participants (16 men, 56 women). The average age of Japanese participants was 71.1 years (standard deviation: 4.89), and the average age of Thai participants was 68.8 years (standard deviation: 5.61). Significant differences between ethnic groups were found in percentage of body fat in women (Japanese average: 32.9% vs. Thai average: 37.6%, p &lt; 0.05), skeletal muscle mass index (SMI) in men (Japanese average: 7.85 kg/m2 vs. Thai average: 7.31 kg/m2, p &lt; 0.05) and average grip strength in men (Japanese: 35.1 kg vs. Thai: 30.7 kg, p &lt; 0.05).

Conclusions

Our preliminary results suggest that Thai older people, particularly men, are weaker than Japanese older people. Decreased muscle mass is directly responsible for functional impairment, involving loss of strength, increased likelihood of falls, and loss of autonomy. Preventing muscle weakness among older people is important. In future studies, we plan to analyze and clarify the differences between Thai and Japanese older people to identify effective methods to prevent muscle mass decreases.

Key messages

There were significant differences in average % body fat between older Japanese and Thai women. There were significant differences in average SMI and grip strength between older Japanese and Thai men.

Nature of the Dirac gap modulation and surface magnetic interaction in axion antiferromagnetic topological insulator [Formula: see text]

Modification of the gap at the Dirac point (DP) in axion antiferromagnetic topological insulator [Formula: see text] and its electronic and spin structure have been studied by angle- and spin-resolved photoemission spectroscopy (ARPES) under laser excitation at various temperatures (9-35 K), light polarizations and photon energies. We have distinguished both large (60-70 meV) and reduced ([Formula: see text]) gaps at the DP in the ARPES dispersions, which remain open above the Neél temperature ([Formula: see text]). We propose that the gap above [Formula: see text] remains open due to a short-range magnetic field generated by chiral spin fluctuations. Spin-resolved ARPES, XMCD and circular dichroism ARPES measurements show a surface ferromagnetic ordering for the "large gap" sample and apparently significantly reduced effective magnetic moment for the "reduced gap" sample. These observations can be explained by a shift of the Dirac cone (DC) state localization towards the second Mn layer due to structural disturbance and surface relaxation effects, where DC state is influenced by compensated opposite magnetic moments. As we have shown by means of ab-initio calculations surface structural modification can result in a significant modulation of the DP gap.

Cubic Rashba Effect in the Surface Spin Structure of Rare-Earth Ternary Materials

Spin-orbit interaction and structure inversion asymmetry in combination with magnetic ordering is a promising route to novel materials with highly mobile spin-polarized carriers at the surface. Spin-resolved measurements of the photoemission current from the Si-terminated surface of the antiferromagnet TbRh_{2}Si_{2} and their analysis within an ab initio one-step theory unveil an unusual triple winding of the electron spin along the fourfold-symmetric constant energy contours of the surface states. A two-band k·p model is presented that yields the triple winding as a cubic Rashba effect. The curious in-plane spin-momentum locking is remarkably robust and remains intact across a paramagnetic-antiferromagnetic transition in spite of spin-orbit interaction on Rh atoms being considerably weaker than the out-of-plane exchange field due to the Tb 4f moments.

Switching of band inversion and topological surface states by charge density wave

Topologically nontrivial materials host protected edge states associated with the bulk band inversion through the bulk-edge correspondence. Manipulating such edge states is highly desired for developing new functions and devices practically using their dissipation-less nature and spin-momentum locking. Here we introduce a transition-metal dichalcogenide VTe2, that hosts a charge density wave (CDW) coupled with the band inversion involving V3d and Te5p orbitals. Spin- and angle-resolved photoemission spectroscopy with first-principles calculations reveal the huge anisotropic modification of the bulk electronic structure by the CDW formation, accompanying the selective disappearance of Dirac-type spin-polarized topological surface states that exist in the normal state. Thorough three dimensional investigation of bulk states indicates that the corresponding band inversion at the Brillouin zone boundary dissolves upon the CDW formation, by transforming into anomalous flat bands. Our finding provides a new insight to the topological manipulation of matters by utilizing CDWs' flexible characters to external stimuli.

Radial Spin Texture in Elemental Tellurium with Chiral Crystal Structure

The chiral crystal is characterized by a lack of mirror symmetry and inversion center, resulting in the inequivalent right- and left-handed structures. In the noncentrosymmetric crystal structure, the spin and momentum of electrons are expected to be locked in the reciprocal space with the help of the spin-orbit interaction. To reveal the spin textures of chiral crystals, we investigate the spin and electronic structure in a p-type semiconductor, elemental tellurium, with the simplest chiral structure by using spin- and angle-resolved photoemission spectroscopy. Our data demonstrate that the highest valence band crossing the Fermi level has a spin component parallel to the electron momentum around the Brillouin zone corners. Significantly, we have also confirmed that the spin polarization is reversed in the crystal with the opposite chirality. The results indicate that the spin textures of the right- and left-handed chiral crystals are hedgehoglike, leading to unconventional magnetoelectric effects and nonreciprocal phenomena.

Mismatch repair systems might facilitate the chromosomal recombination induced by N-nitrosodimethylamine, but not by N-nitrosodiethylamine, in Drosophila

Mismatch repair (MMR) systems play important roles in maintaining the high fidelity of genomic DNA. It is well documented that a lack of MMR increases the mutation rate, including base exchanges and small insertion/deletion loops; however, it is unknown whether MMR deficiency affects the frequency of chromosomal recombination in somatic cells. To investigate the effects of MMR on chromosomal recombination, we used the Drosophila wing-spot test, which efficiently detects chromosomal recombination. We prepared MMR (MutS)-deficient flies (spel1(-/-)) using a fly line generated in this study. The spontaneous mutation rate as measured by the wing-spot test was slightly higher in MutS-deficient flies than in wild-type (spel1(+/-)) flies. Previously, we showed that N-nitrosodimethylamine (NDMA)-induced chromosomal recombination more frequently than N-nitrosodiethylamine (NDEA) in Drosophila. When the wing-spot test was performed using MMR-deficient flies, unexpectedly, the rate of NDMA-induced mutation was significantly lower in spel1(-/-) flies than in spel1(+/-) flies. In contrast, the rate of mutation induced by NDEA was higher in spel1(-/-) flies than in spel1(+/-) flies. These results suggest that in Drosophila, the MutS homologue protein recognises methylated DNA lesions more efficiently than ethylated ones, and that MMR might facilitate mutational chromosomal recombination due to DNA double-strand breaks via the futile cycle induced by MutS recognition of methylated lesions.

P5655Efficacy of new-generation atrial antitachycardia pacing for atrial tachyarrhythmias in patients with left ventricular dysfunction

Background

The progression to persistent atrial fibrillation (AF) is associated with a worse clinical outcome in patients with previous atrial tachyarrhythmias. New-generation atrial antitachycardia pacing (ATP) (Reactive ATP) reduced the progression to persistent AF in patients with pacemaker and preserved left ventricular (LV) function. However, little is known about the efficacy of Reactive ATP in patients with cardiac implantable electronic devices (CIED) and LV dysfunction.

Purpose

We aimed to investigate the efficacy of Reactive ATP for atrial tachyarrhythmias in patients with LV dysfunction (LV ejection fraction [LVEF] <40%).

Methods

This study included 423 patients with CIED and previous atrial tachyarrthythmias. Reactive ATP was programmed in 284 patients (ATP group) and 139 were implanted with a dual-chamber device without ATP function (control group). The differences in the success rate of ATP and incidence of progression to persistent AF (≥7 days) between the ATP and control groups were evaluated in 108 patients with LVEF <40% (reduced LVEF) and 315 with LVEF ≥40% (preserved LVEF). Patients with persistent AF were excluded from this study.

Results

During 710±337 days of follow-up period, 16 patients (15%) with reduced LVEF and 51 (16%) with preserved LVEF progressed to persistent AF (p=0.88). The mean ATP success rate was lower in patients with reduced LVEF than in those with preserved LVEF, although not statistically significant (reduced LVEF: 27.2±19.4% and preserved LVEF: 35.1±29.2%, p=0.12). The incidence of progression to persistent AF was significantly lower in the ATP group than in the control group both in patients with reduced and preserved LVEF (log-rank, reduced LVEF: p=0.0070 and preserved LVEF: p<0.0001) (Figure). Multivariate analysis showed that use of Reactive ATP and smaller left atrium were associated with lower incidences of persistent AF, while LVEF was not predictive of progression to persistent AF (Reactive ATP: hazard ratio [HR] 0.28, 95% confidence interval [CI] 0.17–0.46, p<0.0001, left atrium diameter: HR 1.03, 95% CI 1.00–1.07, p=0.030).

Figure 1

Conclusions

Reactive ATP was effective in preventing AF progression in patients with LV dysfunction.

Effects of Music Therapy in Frail Elderlies: Controlled Crossover Study

Background: Music therapy (MT) may exert beneficial preventive effects in frail elderly individuals in psychophysiological health. Objectives: One hundred and fifteen frail elderly individuals (65–89 years old) participated. Methods: Subjects were randomly divided into 2 groups for a controlled crossover trial. The MT-first group participated in group sessions of 45–50 min conducted by a certified music therapist for 12 weeks, followed by a 12-week waiting period. The waiting-first group participated in the reverse order. Cognitive function was assessed by the Verbal Fluency Test (VFT) and Yamaguchi Kanji Symbol Substitution Test (YKSST). Physical function was assessed by the Timed Up and Go test (TUG). Psychophysical health was assessed by the Geriatric Depression Scale 15-item version (GDS-15), General Health Questionnaire 12-item version (GHQ-12), Instrumental Activity of Daily Living (IADL) scale, and Life Space Assessment (LSA) scale. We also evaluated the outcome of MT using the Clinical Global Impressions of Improvement (CGI-I) scale. Results: After 12 weeks of MT, significant improvements were observed in TUG, GDS-15, and GHQ-12 scores. However, no improvements were noted in other scores. CGI-I scores revealed the significant benefits of MT. Conclusions: MT may improve physical function, depressive mood, and quality of life in frail elderly individuals.

Traditional Japanese Diet Score - Association with Obesity, Incidence of Ischemic Heart Disease, and Healthy Life Expectancy in a Global Comparative Study

OBJECTIVES

We created a Traditional Japanese Diet Score (TJDS), and to clarify the relationship between TJDS and obesity, ischemic heart disease (IHD), and healthy life expectancy (HALE).

DESIGN

Ecological study.

SETTING

Food (g/day/capita) and energy (kcal/day/capita) supply was determined using the Food and Agriculture Organization of the United Nations Statistics Division database. The sum of characteristic traditional Japanese foods (beneficial food components in the Japanese diet: rice, fish, soybeans, vegetables, eggs, and seaweeds; food components rarely used in the Japanese diet: wheat, milk, and red meat) was divided as tertiles (beneficial food components: -1, 0, 1; rarely used food components: 1, 0, -1). Obesity rate was determined using the World Health Organization database. Incidence of IHD, HALE and smoking rate were determined using the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 database. Gross domestic product per capita, percentage of population > 65 years old, and health expenditure were determined using the World Bank database. Education years were obtained from the United Nations Educational, Scientific and Cultural Organization Institute for Statistics. Associations between TJDS and obesity, IHD and HALE were examined in 132 countries with a population of 1 million or greater using a general linear model controlled for co-variables.

RESULTS

TJDS was distributed from -6 to 7. TJDS was inversely correlated to obesity (β±SE; -0.70±0.19, p<0.001), IHD (-19.4±4.3, p<0.001), and positively correlated to HALE (0.40±0.14, p<0.01).

CONCLUSIONS

TJDS is a good indicator of a healthy diet, and applies to preventing obesity, IHD and extending HALE.

Dietary diversity and healthy life expectancy-an international comparative study

BACKGROUND/OBJECTIVES

The prolongation of healthy life expectancy (HALE) is a core issue of health policy in many countries. The purpose of this study is to clarify the relationship between dietary diversity and HALE using international databases.

MATERIALS/METHODS

HALE data by country were derived from the Global Burden of Disease (GBD) 2015 database. Average food supply (g/day/capita) and energy supply (kcal/day/capita) by country, excluding loss between production and household, were obtained from the Food and Agriculture Organization of the United Nations Statistics Division database. Each food was sorted across 12 food groups, and dietary diversity was obtained from food groups using the Quantitative Index for Dietary Diversity (QUANTIDD). The cross-sectional and longitudinal associations between QUANTIDD and HALE were examined in the countries with populations of one million or greater.

RESULTS

Cross-sectional analysis showed that HALE was significantly associated with QUANTIDD (β = 99.9 ± 11.4, p < 0.001) in the single regression model and in the multiple regression model controlled for covariates (β = 36.4 ± 11.3, p = 0.002). Longitudinal analysis showed that HALE increased with QUANTIDD during the 15-year study period (β = 46.4 ± 5.1, p < 0.001), and this association was also significant when controlled for covariates (β = 39.7 ± 5.1, p < 0.001). Longitudinal association of QUANTIDD with the percentage difference between life expectancy and HALE controlled for covariates was significantly negative (β = - 1.3 ± 0.5, p = 0.011).

CONCLUSIONS

After controlling for socioeconomic indicators, longer healthy life is enjoyed by populations of countries with greater dietary diversity.

Circular-polarized-light-induced spin polarization characterized for the Dirac-cone surface state at W(110) with C2v symmetry

The C_2v surface symmetry of W(110) strongly influences a spin-orbit-induced Dirac-cone-like surface state and its characterization by spin- and angle-resolved photoelectron spectroscopy. In particular, using circular polarized light, a distinctive k-dependent spin texture is observed along the \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\overline{{\boldsymbol{\Gamma }}{\boldsymbol{H}}}$$\end{document}ΓH¯ direction of the surface Brillouin zone. For all spin components P_x, P_y, and P_z, non-zero values are detected, while the initial-state spin polarization has only a P_y component due to mirror symmetry. The observed complex spin texture of the surface state is controlled by transition matrix element effects, which include orbital symmetries of the involved electron states as well as the geometry of the experimental set-up.