Mushroom intake and risk of incident disabling dementia: the Circulatory Risk in Communities Study (CIRCS)

It is uncertain whether dietary intake of mushrooms rich in dietary fibre and several antioxidants is associated with a lower risk of dementia. We sought to examine prospectively the association between mushroom intake and the risk of disabling dementia. We performed a prospective study involving 3750 people aged 40 to 64 years residing in three communities who participated in an annual cardiovascular risk survey from 1985 to 1999. Cases of incident disabling dementia were surveyed from 1999 to 2020. We calculated the hazard ratios (HR) and 95 % CI for incident total dementia according to mushroom intake among participants with or without a history of stroke. During a mean 16·0 years' follow-up in 3739 eligible participants, 670 people developed disabling dementia. For women, mushroom intake was inversely associated with the risk of total dementia and the association was confined to dementia without a history of stroke. The multivariable HR (95 % CI) for total dementia in women were 0·81 (0·62, 1·06) for mushroom intake of 0·1-14·9 g/d and 0·56 (0·42, 0·75) for mushroom intake above 15·0 g/d (Pfor trend = 0·003) compared with no intake. The corresponding HR (95 % CI) for dementia without a history of stroke were 0·66 (0·47, 0·93) and 0·55 (0·38, 0·79) (Pfor trend = 0·01). In men, no associations were observed between mushroom intake and the risk of disabling dementia. Among Japanese women, dietary mushroom intake was associated with a lower risk of disabling dementia.

Association between smoking and height loss in Japanese workers: A retrospective study

Height loss is reported to be an independent risk factor for all-cause and cardiovascular mortality. Smoking, which is responsible for a considerable proportion of deaths due to any cause, is also associated with lumbar disc degeneration, a major risk factor for height loss. Therefore, smoking could be an independent risk factor for height loss. To clarify the association between smoking status and height loss, a retrospective study with 8,984 (5,518 men and 3,466 women) Japanese workers was conducted. The present study population comprised 9,681 workers aged 40-74 years who participated in annual medical examinations between 2011 and 2017 (baseline). Subjects without a height measurement during 2012-2018 (endpoint) were excluded from the analysis (n = 697). Height loss was defined as being in the highest quartile of annul height decrease (1.48 mm/year for men and 1.79 mm/year for women). Independent of known cardiovascular risk factors, smoking was positively associated with height loss among men but not among women. With never smokers as the referent group, the adjusted odds ratio (95% confidence interval) was 1.15 (0.98, 1.35) for former smokers and 1.24 (1.05, 1.46) for current smokers among men, respectively. Among women, the corresponding values were 0.98 (0.79, 1.21) and 0.90 (0.71, 1.16), respectively. Since height loss and smoking are independent risk factors for all-cause and cardiovascular mortality, these results help clarify the mechanisms underlying the association between height loss and mortality risk.

HbA1c and height loss among Japanese workers: A retrospective study

Evaluating the risk of height loss could be an efficient way to evaluate endothelial health, which might be associated with all-cause and cardiovascular mortality. Diabetes is an established risk factor both for intervertebral disk degeneration and osteoporosis-related fractures, which are major risk factors for height loss among adults. Therefore, hemoglobin A1c (HbA1c), as an indicator of the presence of diabetes, could be positively associated with height loss. A retrospective study of 10,333 workers aged 40 to 74 years was conducted. Height loss was defined as being in the highest quintile of height decrease per year. HbA1c in the normal range was positively associated with height loss. The known cardiovascular risk factors-adjusted odds ratio (OR) and 95% confidence interval (CI) for height loss with a 1-standard deviation (SD) increase in HbA1c (0.38% for both men and women) was 1.06 (1.02, 1.10) for men and 1.15 (1.07, 1.23) for women, respectively. When limit those analysis among those without diabetes, the magnitude was slightly higher; the fully adjusted OR and 95% CI for height loss with a 1-SD increase in HbA1c was 1.19 (1.11, 1.28) for men and 1.32 (1.20, 1.44) for women, respectively. Even when HbA1c is within the normal range, higher HbA1c is a significant risk factor for height loss among workers.

Risk Factors for Hyperuricemia or Gout in Men and Women: The Circulatory Risk in Communities Study (CIRCS)

AIM

We aimed to examine sex-specific risk factors for hyperuricemia or gout in Japanese cohorts.

METHODS

We followed up 3,188 men (mean age, 55.6 years) and 6,346 women (mean age, 54.1 years) without hyperuricemia, gout, or elevated liver enzymes at baseline from 1986 to 1990 for a median of 14.6 years. The participants were considered as having hyperuricemia or gout if their serum uric acid levels were ≥ 7.0 mg/dL or they were receiving treatment for hyperuricemia or gout during annual health checkups. The sex-specific multivariable hazard ratios (HRs) of hyperuricemia or gout incidence were calculated after adjustment for smoking and drinking status, body mass index, hypertension, diabetes, hypercholesterolemia, and hypertriglyceridemia using the Cox proportional-hazard model.

RESULTS

During follow-up, 733 men and 355 women had hyperuricemia or gout. Among men, the multivariable HRs (95% confidence intervals) of hyperuricemia or gout were 1.23 (1.00-1.52) and 1.41 (1.13-1.75) for drinkers of ＜46 and ≥ 46 g ethanol/day, respectively, compared with non-drinkers; 1.00 (0.81-1.24) and 1.18 (0.93-1.50) for smokers of 1-19 and ≥ 20 cigarettes/day, respectively, compared with never smokers; and 1.41 (1.20-1.65) for hypertensive compared with non-hypertensive participants. The HRs for women were 1.02 (0.70-1.48), 1.66 (1.05-2.63), and 1.12 (0.88-1.42) for current drinkers, current smokers, and hypertensive participants, respectively. For both men and women, body mass index, diabetes, hypercholesterolemia, and hypertriglyceridemia were not associated with hyperuricemia or gout incidence.

CONCLUSIONS

Hypertension and alcohol drinking are risk factors for hyperuricemia or gout among men and smoking among women.

Association between serum albumin levels and height loss in Japanese workers: a retrospective study

BACKGROUND

Height loss starting in middle age was previously shown to be associated with high cardiovascular mortality in later life. However, the factors associated with height loss remain unknown. Since low serum albumin levels are reported to be associated with high mortality caused by cardiovascular disease, they may also contribute to height loss.

METHODS

To clarify the association between serum albumin and height loss, we conducted a retrospective study of 7637 Japanese workers who participated in general health check-ups from 2008 to 2019. Height loss was defined as the highest quartile of height loss per year.

RESULTS

Individual with high serum concentration of albumin possess beneficial influence on preventing incidence of height loss. In both men and women, serum albumin level was significantly inversely associated with height loss. After adjustment for known cardiovascular risk factors, the adjusted odd ratio (OR) and 95% confidence interval (CI) for height loss per 1 standard deviation of albumin (0.2 g/dL for both men and women) were 0.92 (0.86, 0.98) in men and 0.86 (0.79, 0.95) in women. Even when the analysis was limited to participants without hypoalbuminemia, essentially same association was observed, with fully adjusted corresponding ORs (95%CI) of 0.92 (0.86, 0.98) in men and 0.86 (0.78, 0.94) in women.

CONCLUSION

Independent of known cardiovascular risk factors, higher serum albumin levels may prevent height loss among Japanese workers. While several different diseases cause hypoalbuminemia, they may not be the main reasons for the association between serum albumin and height loss. Though further research is necessary, this finding may help clarify the mechanisms underlying the association between height loss and higher mortality in later life.

Association between anti-thyroid peroxidase antibody and thyroid stimulating hormone: a cross-sectional study

To maintain normal level of thyroid hormone, especially for free thyroxine (FT4), individuals with latent thyroid gland damage might have required higher thyroid stimulating hormone (TSH) than those without latent thyroid gland damage. Anti-thyroid peroxidase antibody (TPO-Ab) is a main cause of auto-immune thyroiditis, and therefore euthyroid individuals positive for TPO-Ab might have latent damage to the thyroid gland. Therefore, the association between TSH values and TPO-Ab positivity may be useful to determine the influence of latent thyroid gland damage on requirement of TSH. Furthermore, because latent damage of thyroid might elevate TSH level but not FT4 level, those associations should be observed independent from FT4. This cross-sectional study analyzed 1431 Japanese with normal ranges of free triiodothyronine (FT3) and FT4. Since TPO-Ab is associated with atherosclerosis in euthyroid individuals, cardiovascular risk factors might underlie the association between TPO-Ab and TSH values. After adjusting for FT4 and known cardiovascular risk factors, the adjusted odds ratio (95% confidence interval) of TPO-Ab positivity for logarithmic value of TSH was 1.53 (1.20, 1.95). Essentially the same association was observed when the analysis was restricted to individuals without subclinical hypothyroidism (1.54 [1.15, 2.13]). Euthyroid individuals with latent thyroid gland damage might have increased the requirement of TSH.

Serum Concentration of Growth Differentiation Factor 15 and Atherosclerosis among General Older Japanese Individuals with Normal Weight

Growth differentiation factor 15 (GDF-15), which modulates cellular energy balance, is reported to be positively associated with cardiovascular disease. However, there have been no reports about the association between serum GDF-15 concentration and atherosclerosis as evaluated by carotid intima-media thickness (CIMT) among the general population. A cross-sectional study of 536 Japanese individuals aged 60 to 69 years was conducted. To avoid the influence of abnormal cellular energy balance, this study only included participants who had a normal body mass index (BMI) and normal thyroid hormone (free thyroxine and free triiodothyronine) levels. A significant positive association between serum GDF-15 concentration and atherosclerosis was observed. In the sex- and age-adjusted model (Model 1), the odds ratio (OR) (95% confidence interval (CI)) for the logarithmic value of GDF-15 and atherosclerosis was 2.62 (1.67, 5.87). This association remained after adjusting for thyroid function and renal function (Model 2) and further adjusting for known cardiovascular risk factors (Model 3). The corresponding values were 2.61 (1.15, 5.93) for Model 2 and 2.49 (1.08, 5.71) for Model 3, respectively. Serum GDF-15 concentrations could help us to estimate the risk of atherosclerosis by indicating the status of cellular energy balance, which is related to mitochondrial activity among comparative healthy older individuals.

Strong chū-hai, a Japanese ready-to-drink high-alcohol-content beverage, and hazardous alcohol use: A nationwide cross-sectional study

BACKGROUND

A new ready-to-drink premixed high-alcohol-content beverage, called strong chū-hai, was launched in Japan, and more recently, in Taiwan and Australia. We aimed to examine the popularity and association of strong chū-hai with individual alcohol use, both of which remained unclear.

METHODS

We conducted a cross-sectional study using data from the Japan "Society and New Tobacco" Internet Survey conducted from February 1 to 28, 2022, in Japan. We enrolled 27,993 respondents (aged 15 to 81 years; male 48.5%), including 15,083 current alcohol users. Using inverse probability weighting of data from the 2016 Comprehensive Survey of Living Conditions on Health and Welfare, we estimated the weighted proportions of strong chū-hai users among all respondents and constructed multivariable logistic regression models to estimate the weighted odds ratios (OR) and 95% confidence intervals (CI) of strong chū-hai use for hazardous and harmful alcohol use, defined as a score ≥8 of the Alcohol Use Disorder Identification Test, among current alcohol users.

RESULTS

Among all respondents, 56.2% (weighted proportions: past, 35.9%; and current, 20.3%) drank strong chū-hai. Among drinkers, both past and current strong chū-hai use, compared to never use, were associated with hazardous and harmful alcohol use (past, OR 1.73, 95% CI 1.42 to 2.12; current, OR 2.19, 95% CI 1.79 to 2.69).

CONCLUSIONS

Our study found that more than half of the respondents experienced strong chū-hai consumption, suggesting that it is widely used in Japan. In addition, both past and current strong chū-hai use were associated with hazardous and harmful alcohol use among current alcohol users.

Relationships of habitual daily alcohol consumption with all-day and time-specific average glucose levels among non-diabetic population samples

BACKGROUND

Alcohol consumption is a prevalent behavior that is bi-directionally related to the risk of type 2 diabetes. However, the effect of daily alcohol consumption on glucose levels in real-world situations in the general population has not been well elucidated. This study aimed to clarify the relationship between alcohol consumption and all-day and time-specific glucose levels among non-diabetic individuals.

METHODS

We investigated 913 non-diabetic males and females, aged 40-69 years, during 2018-2020 from four communities across Japan. The daily alcohol consumption was assessed using a self-report questionnaire. All-day and time-specific average glucose levels were estimated from the interstitial glucose concentrations measured using the Flash glucose monitoring system for a median duration of 13 days. Furthermore, we investigated the association between all-day and time-specific average glucose levels and habitual daily alcohol consumption levels, using never drinkers as the reference, and performed multiple linear regression analyses after adjusting for age, community, and other diabetes risk factors for males and females separately.

RESULTS

All-day average glucose levels did not vary according to alcohol consumption categories in both males and females. However, for males, the average glucose levels between 5:00 and 11:00 h and between 11:00 and 17:00 h were higher in moderate and heavy drinkers than in never drinkers, with the difference values of 4.6 and 4.7 mg/dL for moderate drinkers, and 5.7 and 6.8 mg/dL for heavy drinkers. Conversely, the average glucose levels between 17:00 and 24:00 h were lower in male moderate and heavy drinkers and female current drinkers than in never drinkers; the difference values of mean glucose levels were -5.8 for moderate drinkers, and -6.1 mg/dL for heavy drinkers in males and -2.7 mg/dL for female current drinkers.

CONCLUSIONS

Alcohol consumption was associated with glucose levels in a time-dependent biphasic pattern.

Eating speed and height loss in relation to overweight: A retrospective study

Fast eating is an independent risk factor for weight gain. Our previous study involving Japanese workers revealed that overweight (body mass index ≥ 25.0 kg/m2) is an independent risk factor for height loss. However, no studies have clarified the association between eating speed and height loss in relation to overweight status. A retrospective study of 8,982 Japanese workers was conducted. Height loss was defined as being in the highest quintile of height decrease per year. Compared with slow eating, fast eating was revealed to be positively associated with overweight; the fully adjusted odds ratio (OR) and 95% confidence interval (CI) was 2.92 (2.29, 3.72). Among non-overweight participants, fast eaters had higher odds of height loss than slow eaters. Among overweight participants, fast eaters had lower odds of height loss; the fully adjusted OR (95% CI) was 1.34 (1.05, 1.71) for non-overweight individuals and 0.52 (0.33, 0.82) for overweight individuals. Since overweight was significantly positively associated with height loss [1.17(1.03, 1.32)], fast eating is not favorable for reducing the risk of height loss among overweight individuals. Those associations indicate that weight gain is not the main cause of height loss among Japanese workers who eat fast.

VEGF Polymorphism rs3025039 and Human T-Cell Leukemia Virus 1 (HTLV-1) Infection among Older Japanese Individuals: A Cross-Sectional Study

Previous studies have reported a close correlation between vascular endothelial growth factor (VEGF), which plays an important role in angiogenesis, and human T-cell leukemia virus 1 (HTLV-1). However, an association between genetic characteristics related to VEGF and HTLV-1 infection has not yet been reported. Because the VEGF polymorphism rs3025039 is inversely associated with serum concentrations of VEGF, we focus on rs3025039 in the present study. To clarify the association between the VEGF polymorphism rs3025039 and HTLV-1 infection, a cross-sectional study of 1924 Japanese individuals aged 60–79 years who participated in general health check-ups was conducted. Using logistic regression, odds ratios (ORs) and 95% confidence intervals (CIs) for HTLV-1 infection in relation to rs3025039 genotype were calculated with adjustment for known confounders. Compared with rs3025039 CC-homozygotes, (T) allele carriers had a significantly lower OR for HTLV-1 infection. The adjusted OR and 95% CI for HTLV-1 infection was 0.70 (0.54–0.91) (p = 0.009). Genetic characteristics related to lower angiogenesis activity might be associated with a lower chance of establishing HTLV-1 infection. Although further investigation is necessary, angiogenesis might play a crucial role in the establishment of HTLV-1 infection.

Loneliness and Increased Hazardous Alcohol Use: Data from a Nationwide Internet Survey with 1-Year Follow-Up

We aimed to examine the association between loneliness and developing alcohol dependence or hazardous alcohol use. A cohort study was conducted utilizing data from a nationwide internet survey in 2021 and 2022 in Japan. A total of 15,854 follow-up participants (55% men, with a mean age of 52.8 years) were divided based on AUDIT scores: nondrinkers (AUDIT: 0), low-risk drinkers (AUDIT: 1-7), medium-risk drinkers (AUD: 8-14), high-risk drinkers (AUDIT: 15-19), and probable alcohol dependence (AUDIT: 20-40). The University of California, Los Angeles Loneliness Scale (Version 3), a short-form three-item scale, was used to assess loneliness (high loneliness score of ≥6). The prevalence of high loneliness was higher in nondrinkers than that in low- and medium-risk drinkers, i.e., 22%, 18%, and 17%, respectively, as well as in high-risk drinkers (32%) and those with probable alcohol dependence (43%) compared to non-high-risk drinkers (19%). After adjusting for various factors (sociodemographic, social isolation, psychological distress, and smoking), non-high-risk drinkers (AUDIT: 0-14) with high loneliness were more likely to become high-or-over-risk drinkers (AUDIT: 15-40) than those without high loneliness, with adjusted risk ratios of 1.45 (95% confidence interval: 1.08-1.96) through multivariable binary logistic regression. Among non-high-risk drinkers, people with high loneliness scores at baseline were associated with increased high-risk drinking patterns with probable alcohol dependence.

Problem drinkers and high risk-taking behaviors under the stay-at-home policy of the COVID-19 emergency declaration

Background

To the best of the authors’ knowledge, this is the first study to examine whether problem drinkers have had high risk-taking behaviors during the stay-at-home policy (e.g., dining out at a bar) under the COVID-19 emergency declaration.

Methods

We investigated data from Japan COVID-19 and Society Internet Survey(JACSIS)study—a web-based nationwide survey, conducted from August to September 2020. From a total of 12,076 current drinkers, problem drinkers were detected by Cut, Annoyed, Guilty, and Eye-opener (CAGE) questions. A CAGE score of 4 showed potential alcohol use disorder and scores of 2 to3 showed potential alcohol abuse; individuals with these scores were regarded as problem drinkers compared to light-or-no-risk drinkers, with a CAGE score of 0 to 1. The outcome assessed the presence of 18 behaviors against the stay-at-home policy, such as dining out at a bar, meeting people, or going to crowded places. All these behaviors were limited in Japan during the first declaration of emergency between April and May 2020.

Results

Based on the multivariable logistic regression, the participants with potential alcohol use disorder demonstrated 16 out of the 18 risk-taking behaviors, such as dining out at a bar (adjusted odds ratio (aOR): 2.08; 95% confidence interval (CI): 1.56–2.79), dining out at a restaurant (aOR: 1.79; 95% CI:1.37–2.35), visiting friends (aOR: 1.81; 95% CI: 1.34–2.44), going to karaoke (1.97; 95% CI: 1.26–3.10), and riding on a crowded train (aOR: 1.46; 95% CI: 1.07–1.99), compared to light-or-no risk drinkers with a CAGE score of 0 to 1. Additionally, participants with potential alcohol abuse (CAGE score of 2 to 3) had 10 out of 18 behaviors against the stay-at-home policy: the corresponding aORs for the aforementioned behaviors were 1.45 (95% CI: 1.25–1.67), 1.27 (95% CI: 1.12–1.44), 1.17 (95% CI: 1.01–1.36), 1.49 (95% CI: 1.17–1.90), and 1.19 (95% CI: 1.03–1.38), respectively. Problem drinkers had a significant association with being men, a higher income and job position, smoking, sleep deprivation, depression, and other mental diseases.

Conclusions

Overall, problem drinkers were more likely to have higher risk-taking behaviors against the stay-at-home policy, compared to light-or-no-risk drinkers.

Low Amino Acid Score of Breakfast is Associated with the Incidence of Cognitive Impairment in Older Japanese Adults: A Community-Based Longitudinal Study

BACKGROUND

The protein digestibility-corrected amino acid score (PDCAAS) represents the degree of utilizable dietary protein, namely the protein quality. The PDCAAS of a diet is required to be evaluated on a meal-by-meal basis, as food digestion and absorption occur with each meal intake. Although a positive association between protein intake and cognitive function has been reported, no study has investigated the association between PDCAAS of a diet and cognitive function.

OBJECTIVES

To investigate the relationship between PDCAAS of a diet and cognitive impairment in older adults.

DESIGN

Longitudinal epidemiological study.

SETTING

Community-based setting.

PARTICIPANTS

We analyzed 541 community-dwellers who participated in both baseline and follow-up survey. They were 60-83 years of age without cognitive impairment at baseline.

MEASUREMENTS

Cognitive impairment was defined as a Mini-Mental State Examination (MMSE) score ≤27. Individual PDCAASs were calculated for each of three regular meals from the 3-day dietary records at baseline. Participants were classified into two groups according to the sex-specific tertiles (T1-T3) of the PDCAAS for each meal (i.e., T1 as the low score group and T2-T3 as the medium and high score group). The dependent variable was cognitive impairment observed after 4 years, and the explanatory variables were the PDCAAS groups for each meal (the medium and high group as the reference) and covariates (sex, age, body mass index, education, depressive symptoms, medical history, protein intake at each meal, and the MMSE score at baseline). Multivariable logistic regression analysis was performed to evaluate the low PDCAAS group for cognitive impairment after 4 years.

RESULTS

A significant association was observed only between a low PDCAAS of breakfast and the incidence of cognitive impairment (the adjusted odds ratios [95% confidence intervals] of low PDCAAS for cognitive impairment for breakfast, lunch, and dinner were 1.58 [1.00-2.50], 0.85 [0.54-1.34], and 1.08 [0.71-1.65], respectively).

CONCLUSION

A lower PDCAAS of breakfast, i.e., a diet with poor quality of protein, was associated with the incidence of cognitive impairment in older adults of the community.

Percentage of income spent on tobacco and intention to quit: a cross-sectional analysis of the JASTIS 2020 study

BACKGROUND

Existing indicators for the ease of purchasing tobacco did not reflect the actual amount smoked and individual income, and did not assess heated tobacco products (HTPs). This study assessed the percentage of income spent on tobacco, including combustible cigarettes and/or HTPs, at the individual level and its relation to quit intention.

METHODS

An internet-based self-reported questionnaire survey was conducted in 2020 as a part of the Japan Society and New Tobacco Internet Survey. A total of 954 smokers aged 15-72 years were analyzed. We calculated the percentage of income spent on tobacco according to income levels. A high percentage implies that tobacco is not easy to purchase. The odds ratios for quit intention according to three categories of percentage of income spent on tobacco (<1%, 1-5%, >5%) were calculated by multivariable logistic regression.

RESULTS

The percentage of income spent on tobacco was higher as income level was lower, especially for dual cigarette and HTP users; the percentages in the lowest/highest income group were 7.1%/1.2% for exclusive combustible cigarette smokers; 6.5%/1.1% for exclusive HTPs users; and 9.2%/1.3% for dual users. The adjusted odds ratios (95% confidence intervals) of quit intention among the >5% of income spent on tobacco group compared with the <1% spent group were 0.43 (0.18-1.03) for exclusive combustible cigarette smokers, 0.71 (0.20-2.54) for exclusive HTPs users, and 0.11 (0.02-0.77) for dual users.

CONCLUSIONS

Higher tobacco expenditure was not associated with quit intention for all categories of tobacco product users, probably due to the low price of tobacco in Japan.

Height and Mortality from Aortic Aneurysm and Dissection

AIMS

Reports on the association between height and aortic disease have been modest, and there are only a few studies investigating the association between height and mortality from specific aortic disease types or by sex.

METHODS

We conducted the Japan Collaborative Cohort Study, a prospective study of 99,067 Japanese (41,730 men and 57,337 women) aged 40-79 years old. Height was self-reported, and the participants were followed up from 1988-1989 to the end of 2009. Sex-specific hazard ratios (95% confidence intervals) of mortality from aortic disease type according to sex-specific quartiles of height were analyzed using the Cox proportional hazards model.

RESULTS

During the median follow-up period of 19.1 years, the numbers of deaths due to aortic aneurysm, thoracic aortic aneurysm, abdominal aortic aneurysm, and aortic dissection were 87, 29, 48, and 56 among men and 35, 17, 15, and 65 among women, respectively. The sex-specific multivariate hazard ratios (95% confidence intervals) and p for trend for the highest versus lowest quartiles of height were 1.10 (0.66-1.83), p=0.58 among men and 1.54 (0.85-2.79), p=0.06 among women for total aortic disease; 1.85 (0.80-4.28), p=0.16 among men and 5.67 (0.90-35.77), p=0.08 among women for abdominal aortic aneurysm; and 1.13 (0.48-2.64), p=0.65 among men and 1.70 (0.82-3.50), p=0.04 among women for aortic dissection. The positive association was observed for both sexes, albeit more prominent among women. No association was found between height and mortality from thoracic aortic aneurysms.

CONCLUSIONS

As per our findings, we were able to determine that height was positively associated with mortality from abdominal aortic aneurysm in the Japanese population.

Hemoglobin and adult height loss among Japanese workers: A retrospective study

Height loss starting in middle age is reported to be associated with increased all-cause and cardiovascular mortality later in life. However, the mechanisms underlying this association are unclear. Hypoxia and oxidative stress, which are known causes of cardiovascular disease, could be reduced by hemoglobin. Therefore, hemoglobin could be inversely associated with height loss. However, high body mass index (BMI) is a known risk factor for intervertebral disc disorder, a known cause of height loss in adults. High BMI might confound the association between hemoglobin and height loss. Therefore, we performed analyses stratified by BMI status. To clarify the association between hemoglobin and height loss, we conducted a retrospective study of Japanese workers (6,471 men and 3,180 women) aged 40–74 years. Height loss was defined as being in the highest quintile of height decrease per year. In men overall and men with BMI <25 kg/m², hemoglobin was significantly inversely associated with height loss; but no association was observed for men with high BMI (BMI ≥25 kg/m²) and for women. For men, after adjusting for known cardiovascular risk factors, adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for height loss with each 1 standard deviation (SD) increase in hemoglobin (1.0 g/dL for men and 0.8g/dL for women) were 0.89 (0.83, 0.95) for men overall, 0.82 (0.75, 0.89) for men who do not have high BMI, and 1.01 (0.92, 1.12) for men with high BMI. For women, the corresponding values were 0.97 (0.89, 1.06), 0.98 (0.89, 1.09), and 0.93 (0.75, 1.15) respectively. Hemoglobin is significantly inversely associated with height loss in men who do not have high BMI, but not in men with high BMI or women. These results help clarify the mechanisms underlying height loss, which has been reported to be associated with a higher risk of mortality in adults.

The Association between Dietary Amino Acid Intake and Cognitive Decline 8 Years Later in Japanese Community-Dwelling Older Adults

OBJECTIVES

Previous studies have reported a relationship between low protein intake and cognitive decline and have suggested that this association may be related to specific amino acid intake. However, the effects of amino acid intake on the maintenance of cognitive function have yet to be clarified. We examined the longitudinal association between dietary amino acid intake and cognitive function in community-dwelling older adults.

DESIGN

Longitudinal epidemiological study.

SETTING

Community-based setting.

PARTICIPANTS

This study comprised 427 study participants aged 60-82 years with no cognitive decline, defined as a Mini-Mental State Examination (MMSE) score of >27 at baseline, who also participated in a follow-up. The average and standard deviation of the follow-up period was 8.2 ± 0.3 years.

MEASUREMENTS

Dietary intake was assessed using three-day dietary records at baseline. Participants were classified into quartiles (Q1-Q4) based on the intake of 19 amino acids for males and females. Next, we classified participants into Q1 and Q2-Q4 groups. Cognitive function was assessed using the MMSE both at baseline and at follow-up. Multivariable logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between the Q1 group and cognitive decline (MMSE ≤27), using the Q2-Q4 group as a reference group. Covariates were age, sex, body mass index, years of education, severity of depressive symptoms, history of lifestyle diseases (hypertension, dyslipidemia, diabetes mellitus, stroke, and ischemic heart disease), energy intake (kcal/d), protein intake (g/d), and MMSE score at baseline.

RESULTS

Cognitive decline was present in 133 (31.1%) participants. After adjustment for covariates, including total protein intake, the ORs (95% CIs) for cognitive decline were 2.40 (1.21-4.75) for lysine, 2.05 (1.02-4.09) for phenylalanine, 2.18 (1.09-4.34) for threonine, and 2.10 (1.06-4.15) for alanine.

CONCLUSION

The results suggest that lysine, phenylalanine, threonine, and alanine intake is important for the maintenance of cognitive function in older people, independent of total protein intake.

Newly diagnosed disease and job loss: a nationwide longitudinal study among middle-aged Japanese

OBJECTIVES

Since previous studies have only used past or current medical history of disease, there is no information on newly diagnosed disease in relation to job loss. Our objective was therefore to investigate whether newly diagnosed chronic disease increased job loss among middle-aged Japanese.

METHODS

We analysed data on 31 403 Japanese workers aged 50-59 years from a nationally representative longitudinal study. We defined two types of job loss; later job loss (within 1 year of disease diagnosis) and concurrent/later job loss (at around the time of diagnosis and within 1 year of diagnosis). Generalised estimating equation models were used to calculate ORs for job loss among current workers after a new-diagnosis of chronic disease (diabetes, hypertension, hyperlipidaemia, heart disease, stroke and cancer), using a discrete-time design and adjusting for demographic, socioeconomic and health behavioural factors. We used inverse probability weighting to account for non-response at follow-up.

RESULTS

ORs for concurrent/later job loss were 1.17 (95% CI 1.03-1.31) for diabetes, 1.01 (95% CI 0.93-1.09) for hypertension, 1.01 (95% CI 0.94-1.09) for hyperlipidaemia, 1.21 (95% CI 1.06-1.40) for heart disease, 1.48 (95% CI 1.21-1.81) for stroke and 1.38 (95% CI 1.17-1.62) for cancer diagnosed patients. The corresponding ORs for later job loss were 1.14 (95% CI 0.96-1.35), 1.00 (95% CI 0.90-1.12), 0.98 (95% CI 0.88-1.08), 1.24 (95% CI 1.02-1.49), 1.16 (95% CI 0.86-1.55) and 1.39 (95% CI 1.11-1.73).

CONCLUSIONS

New diagnosis of diabetes, heart disease, cancer and stroke increased the risk of job loss; loss was concurrent for diabetes mellitus and stroke, and concurrent/later for cancer and heart disease. Our results provide fundamental information for employment support for patients with chronic disease.

Conduction gaps after pulmonary vein isolation due to high contact force ablation in patients with atrial fibrillation

Background

Catheter ablation for atrial fibrillation (AF) with high contact force (CF) has been reported to lead to the gaps after pulmonary vein isolation (PVI), and the appearance of the gaps depends on the site in the left atrium (LA).

Purpose

The aim of this study is to clarify the relationship between the gaps appearance and high CF.

Methods

In the clinical study, 74 consecutive patients (39 males, age 71±9, 46 with paroxysmal AF) underwent conventional PVI with a point-by-point radiofrequency (RF) ablation using a CF sensing catheter (TactiCath SETM). RF energy (J), number of RF point, Lesion index (LSI), force-time integral (FTI), average CF (g), and the degree of LA depression with high CF were evaluated. In the experimental study (figure), the relationship between the ablation area and the degree of depression with high CF using bovine left ventricular wall.

Results

In the clinical study, the gaps were found in 175 of 1182 sites after first path PVI ablation. The CF in the gap sites was higher than without the gap sites in RPV roof, anterior RSPV and anterior RPV carina (18.9±6.8 vs 15.0±5.7g p=0.0262, 26.4±11.6 vs 19.5±6.0g p=0.0029, 22.7±6.4 vs 19.1±5.5g, p=0.0161). Meanwhile, there were no differences in RF energy, number of RF point, LSI, FTI. High CF (≥30g) showed a depression of 3 mm or more in only RPV roof and anterior RPV (figure). In the experimental study, the ablation range narrowed as the indentation deepened with more than 30g CF (r=0.6417, p=0.0625).

Conclusion

Catheter ablation for AF with high contact force might lead to the gaps in RPV roof and anterior RPV site by the reduction of the ablation area due to depression caused by the pressure.

Extension of each contact force

Funding Acknowledgement

Type of funding source: None

Body Mass Index and Mortality From Aortic Aneurysm and Dissection

AIMS

Reports on an association between body mass index and aortic disease, which remains controversial. This study investigated the association between body mass index and mortality from aortic disease.

METHODS

We conducted the Japan Collaborative Cohort Study, a prospective study of 103,972 Japanese men and women aged 40-79 years. Body mass index was calculated on the basis of self-reported height and weight, and the participants were followed up from 1988-89 through 2009. Sex-specific hazard ratios (95% confidence intervals) of mortality from aortic disease according to quintiles of body mass index were analyzed using the Cox proportional hazards model.

RESULTS

During the median 18.8 years of follow-up, we documented 139 deaths due to aortic aneurysm (including 51 thoracic and 74 abdominal aortic aneurysms) and 134 deaths due to aortic dissection. We observed positive associations of body mass index with mortality from aortic aneurysm among men: the multivariable hazard ratios (95% confidence intervals) for highest versus lowest quintiles of body mass index were 4.48 (2.10-9.58), P for trend ＜0.0001 for aortic aneurysm; 6.52 (1.33-32.02), P=0.005 for thoracic aortic aneurysm; 3.81 (1.39-10.49), P=0.01 for abdominal aortic aneurysm; and 2.71 (1.59-4.62), P=0.001 for total aortic disease. No association was found for aortic dissection. Among ever-smokers (men ≥ 90%) but not never-smokers (women ≥ 84%), an association between body mass index and aortic disease mortality was observed regardless of sex, which may explain the sex difference (P for sex-interaction=0.046).

CONCLUSIONS

We found a positive association between body mass index and mortality from aortic aneurysm among Japanese men and smokers.

Green tea consumption and risk of hematologic neoplasms: the Japan Collaborative Cohort Study for Evaluation of Cancer Risk (JACC Study)

PURPOSE

Experimental studies suggested that green tea may have an anticancer effect on hematologic neoplasms. However, few prospective studies have been conducted.

METHODS

A total of 65,042 individuals aged 40-79 years participated in this study and completed a self-administered questionnaire about their lifestyle and medical history at baseline (1988-1990). Of these, 52,462 individuals living in 24 communities with information on incident hematologic neoplasms available in the cancer registry, who did not have a history of cancer and provided valid information on frequency of green tea consumption, were followed through 2009. Hazard ratios (HRs) and 95% confidence intervals (CIs) for the incidence of hematologic neoplasms according to green tea consumption were analyzed.

RESULTS

The incidence of hematologic neoplasms during a median follow-up of 13.3 years was 323. Compared with the never-drinkers of green tea, the multivariate HRs and 95% CIs for total hematologic neoplasms in green tea drinkers of ≤ 2 cups/day, 3-4 cups/day, and ≥ 5 cups/day were 0.65 (0.42-1.00), 0.73 (0.47-1.13), and 0.63 (0.42-0.96), respectively. The association was more prominent for acute myeloid leukemias and follicular lymphomas.

CONCLUSIONS

The present cohort study suggests a protective effect of green tea against hematologic neoplasms, especially acute myeloid leukemias.

Abstract P3-03-21: Usefulness of sentinel lymph node biopsy by indocyanine green fluorescence method for cN0 breast cancer patients

Background. Indocyanine green (ICG) fluorescence method (ICG-f) has been recently widely used in sentinel lymph node (SLN) detection. The advantages of ICG-f are no radiation exposure, no limitation to use in high-volume medical centers without radioactive facility, and to confirm lymph flow as a real-time image from outside the body. ICG-f identified an average of 2.3-3.4 SLNs and the detection rate was 99%, compared to 1.7-2 SLNs by RI methods. Long-term observation after SNB using ICG-f has not been reported, including arm lymphedema as the complication of this method.We evaluate the usefulness of SLN biopsy (SNB) for cN0 breast cancer patients from data of multicenter cohort study on long-term results after negative SNB by ICG-f.

Methods. Eleven hundred and thirty-two women were enrolled who had histologically proved clinical stage T1-4, pN0, M0 primary invasive breast cancer with SNB using ICG-f (ICG alone or combination of RI/blue dye method) sparing axillary lymph node dissection from May 2007 to December 2015. This study is retrospective, multicenter cohort study conducted at 6 centers in Japan. Primary endpoint is axillary recurrence rate. We analyzed the correlation with the axillary recurrence and adjuvant systemic therapy, adjuvant radiotherapy, and the clinicopathological characteristics. Secondary endpoint is lymphedema.

Results and Discussion. The median follow-up time was 41 (range 21-117) months, and axillary recurrence was found in 6 patients (0.53%). Five out of 6 patients were not received standard adjuvant systemic therapy or adjuvant radiation therapy after breast conserving surgerybecause of patient's preference or old age. Lymphedema was identified only 4 patients in 632 patients. It is reported that axillary recurrence after SNB was 0.3-1.65%, which was consistent with our result. Lymphedema was not frequent in patients received SNB using ICG-f, because SLNs are removed along with lymphatic ducts in the limited area of axillary adipose tissue.

Conclusion.Axillary recurrence after negative SNB using ICG-f was comparable to RI or blue dye method. It might be important to perform appropriate adjuvant medication or radiation therapy for preventing axillary recurrence after SNB using ICG-f.

Next, ICG-f after neoadjuvant chemotherapy is to be investigated, because itis reported that removing more than 2 SLNs were associated with a lower likelihood of false negative ratio in patients with clinically node-positive disease converted to clinically node-negative after chemotherapy, and ICG-f might overcome this issue.

Citation Format: Maeshima Y, Takahara S, Yamauchi A, Yamagami K, Sugie T, Yamashiro H, Kato H, Torii M, Takada M, Torii M. Usefulness of sentinel lymph node biopsy by indocyanine green fluorescence method for cN0 breast cancer patients [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-03-21.

Abstract P6-01-02: Machine learning-based structural analysis and oxygen saturation measurement of tumor-associated vessels in breast cancer using a photoacoustic tomography system

Introduction

Breast cancer induces angiogenesis, one of the primary factors responsible for tumor progression. Therefore, the ability to visualize angiogenesis at a higher resolution is crucial. Photoacoustic tomography is a noninvasive method of visualizing angiogenesis involving light absorption and ultrasonic wave emission. If the irradiation light wavelength is adjusted for hemoglobin, vascular imaging is possible. Furthermore, using two wavelengths for oxidized and reduced hemoglobin, “S-factor,” can be calculated, which nearly corresponds to oxygen saturation. Therefore, photoacoustic imaging allows the assessment of breast lesions from vascular structural and functional viewpoints.

Objectives

This study aimed to demonstrate the possible utility of photoacoustic tomography for clinical application focusing on the morphologic features and oxygen saturation status of breast tumor-related vessels.

Methods

For the morphological analysis, we applied a machine learning-based method for automatic vessel extraction, and for the functional analysis we evaluated hemoglobin oxygen saturation calculating signals obtained at two wavelengths. In our system, a 3D ultrasound image was simultaneously acquired as a volume image of a tumor, which helped analyze the positional relationship between the vessels and the tumor.

Results

On morphological analysis, the fine structure of tumor-related vessels was rendered in high resolution. In our system, the blood vessels branched toward the tumor 2-3 more times more frequently than observed on contrast-enhanced MRI, illustrating a finer level of blood vessels near the tumor on our system than on MRI. Next, we analyzed the six morphologic features of vessels (radius, volume, curvature, contraction, maximum angle and vessel branch number) that are associated with the pathologic condition in neuroscience. We determined that the feature distribution of vessels located close to the tumor differed from that located away from the tumor. For example, vessels near the tumor had higher curvature, which means they are more tortuous than healthy vessels. The difference in the distribution of all six features was statistically significant on the Kolmogorov-Smirnov test.

On functional analysis, S-factor measurement of the healthy human breast demonstrated clearly demarcated arteries and veins. The S-factor of any artery was nearly 100%, while that of the veins inside the breast cancer tended to be a little higher (approximately 5%) compared to that in the healthy part. This tendency of veins was not recognized in benign tumors. This could show arteriovenous shunt in cancer microenvironment. We found low saturation signals emerging in the tumor tissue following bevacizumab-containing chemotherapy, indicating the possibility that our system reveals microenvironment changes.

Discussion

If our system can identify the structure or oxygen saturation characteristics unique to tumor-associated vasculature, it could contribute to the improved accuracy of breast cancer diagnosis and allow the observation of tumor vessel normalization because of the drug treatment. An earlier grasp of the therapeutic effect could lead to the provision of individualized medicine.

Citation Format: Matsumoto Y, Gu L, Bise R, Asao Y, Sekiguchi H, Yoshikawa A, Ishii T, Takada M, Kataoka M, Sakurai T, Yagi T, Sato I, Togashi K, Shiina T, Toi M. Machine learning-based structural analysis and oxygen saturation measurement of tumor-associated vessels in breast cancer using a photoacoustic tomography system [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-01-02.

Abstract PD2-07: Real-time navigation for sentinel lymph node biopsy in breast cancer patients using projection mapping with indocyanine green fluorescence

Background)

Sentinel lymph node (SLN) biopsy using indocyanine green fluorescence (fICG) method showed equal or better identification rate compared with blue dye or radioisotope (RI) method. In the fICG method, lymphatic vessels which drain into the SLNs can be seen through skin or subcutaneous tissue using near infrared camera (Photodynamic Eye®: PDE), and we can easily find the SLNs. However, whenever we observe the fluorescence images, we have to hold the PDE, turn off the operating light, and look at a monitor because fluorescence images cannot be seen directly. Medical imaging projection system (MIPS) is a new device which detects fluorescent emission from the organ and projects their images on the location of the fluorescence emission (Panasonic Connected Solutions Company, Japan). Projected images can be adjusted following the body movement or deformation of the organ. Therefore, MIPS could provide an option for real-time navigation for the SLN biopsy. The aim of this study was to evaluate the clinical utility of the MIPS.

Patients and methods)

Patients with clinically node-negative primary breast cancer underwent the fICG SLN biopsy using MIPS. Primary endpoint was identification rate of the fICG method using MIPS. At first, the study was conducted as an interventional study because the MIPS was the unapproved medical device. After approval of the MIPS, this study was conducted as an observational study. The study protocol was approved by the institutional review board at Kyoto University Hospital. All patients provided informed consent to participate in this study.

Results)

Between March 2016 and May 2017, 39 patients (40 procedures) underwent the fICG method SLN biopsy using MIPS. The median age was 55 years (range 32–74 years), and the median body mass index was 20.4 kg/m2 (range 17.7–27.7 kg/m2). About half had tumor stage T1 (58%) and 8 (20.0%) had DCIS. 8 procedures (20%) were performed after preoperative systemic therapy (PST). As MIPS itself can illuminate the operating field, SLN biopsy using MIPS was successfully performed without operating light in all procedures. At least one SLN was detected using MIPS for all procedures and the identification rate was 100% (95% CI: 91–100%). Median number of SLNs detected by MIPS was 3 (range 1–9) for all procedures, and 3 (range 2–8) for procedures after PST. Two pathologically positive SLNs and one SLN which included isolated tumor cells were detected by MIPS. In 25 procedures, RI was also used. 62 of 97 SLNs detected by MIPS (64%) were also detected by RI. However, no SLNs were detected only by RI.

Conclusions)

Although we still may not be able to avoid RI method because 25/40 (62.5%) procedures required the combined use of RI method, the fICG methods SLN biopsy using MIPS, which showed comparable identification rate of SLN with the conventional methods, could be useful tool with a view of allowing us to perform a real-time navigation surgery.

Acknowledgements)

This study was supported by Acceleration Transformative research for Medical innovation, Japan Agency for Medical Research and Development (AMED).

Citation Format: Takada M, Takeuchi M, Suzuki E, Sato F, Matsumoto Y, Torii M, Sakita-Kawaguchi N, Nakayama Y, Okuda T, Nishino H, Seo S, Hatano E, Toi M. Real-time navigation for sentinel lymph node biopsy in breast cancer patients using projection mapping with indocyanine green fluorescence [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr PD2-07.

Label-free photoacoustic imaging of human palmar vessels: a structural morphological analysis

We analysed the vascular morphology of the palm using a photoacoustic tomography (PAT) instrument with a hemispherical detector array. The three-dimensional (3D) morphology of blood vessels was determined noninvasively. Overall, 12 females and 11 males were recruited as healthy volunteers. Their ages were distributed almost evenly from 22 to 59 years. In all cases, many vascular networks were observed just beneath the skin and were determined to be veins anatomically. To analyse the major arteries, the layer containing the subcutaneous venous network was removed from the image. The analysis focused on the common and proper palmar digital arteries. We used the curvature of these arteries as a parameter to analyse their morphologies. There was no significant difference in the curvature between genders when comparing the subjects as a whole. The blood vessel curvature increased with age. Good agreement was found between the 3D numerical analysis results and the subjective evaluation of the two-dimensional (2D) projection image. The PAT system enabled visualization of the 3D features of blood vessels in the palm and noninvasive analysis of arterial tortuousness.

Beneficial effects of Lactobacillus casei strain Shirota on academic stress-induced sleep disturbance in healthy adults: a double-blind, randomised, placebo-controlled trial

The present study examined whether Lactobacillus casei strain Shirota (LcS) improves sleep quality under psychological stress. A double-blind, placebo-controlled trial was conducted in healthy 4^th year medical students exposed to academic examination stress. The trial was repeated over two consecutive years in different groups of students, and the data were pooled. For 8 weeks prior to and 3 weeks after a national standardised examination, a total of 48 and 46 subjects received a daily dose of 100 ml of LcS-fermented milk or non-fermented placebo milk, respectively. Study measures included subjective anxiety, overnight single-channel electroencephalography (EEG) recordings, and the Oguri-Shirakawa-Azumi (OSA) sleep inventory scores of subjective sleep quality. Total OSA scores were significantly lower than baseline on the day before the exam and recovered after the exam, indicating a stress-induced decline in sleep quality. There was a significant positive effect of LcS treatment on OSA factors for sleepiness on rising and sleep length. Sleep latency measured by EEG lengthened as the exam approached in the placebo group but was significantly suppressed in the LcS group. The percentage of stage 3 non-REM (N3) sleep decreased in the placebo group as the exam approached, whereas it was maintained in the LcS group throughout the trial. Delta power during the first sleep cycle, measured as an index of sleep intensity, increased as the exam approached in the LcS group and was significantly higher than in the placebo group. These findings suggest that daily consumption of LcS may help to maintain sleep quality during a period of increasing stress. The observed retention of N3 sleep and increased delta power in the LcS group may have contributed to higher perceived sleep satisfaction.

Abstract P4-21-24: Development of mathematical prediction models to identify disease-free survival events for HER2-positive primary breast cancer patients treated by neoadjuvant chemotherapy and trastuzumab

Background)

The addition of trastuzumab to standard neoadjuvant chemotherapy (NAC) doubles the pathological complete response (pCR) rate in patients with HER2-positive primary breast cancer. Patients who achieved pCR after NAC with trastuzumab showed a better prognosis compared to those without pCR. However, it is still difficult to predict the likelihood of recurrence after surgery at an individual patient-level. The aim of this study was to develop a mathematical model to predict disease-free survival (DFS) events such as recurrence for patients treated with NAC and trastuzumab. Because brain metastasis (BM) often occurs in HER2-positive cancer patients and it is a particular event for those, we planned to develop a specific model for BM as well.

Patients and Methods)

Data of 776 HER2-positive primary breast cancer patients from the multicenter cohort study (JBCRG-C03) were used in the analysis. All patients had received NAC plus trastuzumab between 2001 and 2010. Two prediction models using a machine learning method (alternating decision tree algorithm) were developed using age, body-mass index, menopausal status, clinical stage, histological type, ER/PgR status, histological/nuclear grade, type of surgery, pathological response, adjuvant radiation therapy, and adjuvant hormonal therapy. The model A (DFS) predicted the probability of any disease recurrence, death by any cause, or secondary malignancy within 5 years after starting treatment. The model B (BM) predicted the probability of occurrence of BM within the 5 years. First, bias-controlled virtual datasets were generated for the training of the models using a resampling method. Second, the models were optimized by cross-validation (CV). Finally, the developed models were validated using the original dataset. The area under the receiver operating characteristics curve (AUC) was calculated to assess the discrimination ability of the models.

Results)

The DFS and BM event was observed in 118 and 30 patients, respectively. The AUC values for the model A and model B were 0.833 (95% CI, 0.798–0.868, P &lt; 0.001) and 0.927 (95% CI, 0.905–0.949, P &lt; 0.001), respectively. The sensitivity and specificity at the cut-off value of 50% were 72.0% and 78.4% for the model A, and 100% and 83.7% for the model B, respectively. Patients predicted as “low-risk” by the model A showed a significantly better 5-year DFS rate than “high-risk” patients (91.2% vs 53.8%, P &lt; 0.001). Patients predicted as “low-risk” by the model B showed a significantly better 5-year BM-free survival rate than “high-risk” patients (100% vs 76.1%, P &lt; 0.001). The discrimination ability of these models were maintained for both ER/PgR-positive and ER/PgR-negative subgroups, and also for both pCR and non-pCR subgroups.

Conclusions)

Our models showed high accuracy for predicting DFS events and BM in HER2-positive primary breast cancer patients treated with NAC and trastuzumab. These two models would help to realize accurate prediction of DFS events and to optimize the postoperative surveillance plan. The identification of high-risk patients for recurrence including BM may be useful for selecting a patient-subpopulation who requires new therapeutic approach.

Citation Format: Takada M, Sugimoto M, Masuda N, Iwata H, Kuroi K, Yamashiro H, Ohno S, Ishiguro H, Inamoto T, Toi M. Development of mathematical prediction models to identify disease-free survival events for HER2-positive primary breast cancer patients treated by neoadjuvant chemotherapy and trastuzumab [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-21-24.

Abstract P4-01-10: Development of photoacoustic vascular imaging system for breast cancer

Background:

Tumor angiogenesis and hypoxia are associated with breast cancer growth and metastasis. Photoacoustic (PA) tomography is an optical imaging technology that visualizes distribution and oxygenation status of hemoglobin with high spatial resolution. Initially we developed a photoacoustic mammography (PAM) having a flat-shaped scanning detector that could detect breast tumors. Nevertheless, the flat-shaped detector array has the drawback of a limited view. Here we developed a novel PAM system with a hemispherical-shaped detector array (HDA), which enables us to identify microvasculatures non-invasively and allow the collection of nearly spatially isotropic three-dimensional reconstructed image of blood vessels. This non-invasive vascular imaging system may be able to characterize tumor angiogenesis and analyze the status of microcirculation. The aim of this study was to analyze the imaging findings of tumor-related vasculature in breast cancer patients.

Patients and method:

A PAM system with HDA has been generated in a cooperation project between Canon Inc., Japan, and Kyoto University. Twenty-two primary breast cancer patients, including 5 patients with non-invasive cancer and 17 patients with invasive cancer, diagnosed between December 2014 and December 2015 underwent the PAM imaging analysis. We also applied the breast deformation algorithm from the breast shape in a MRI image to that in a PA image in order to create a fusion image of the two modalities for the analysis. Features of peri- and intra-tumoral vasculature, and their oxygenation status were evaluated. The study protocol was approved by the institutional review board at Kyoto University Hospital (UMIN000012251). All patients provided informed consent to participate in this study.

Results:

The abnormal peri-tumoral vasculature was detected in 86% of all non-invasive and invasive disease cases. In invasive cancer cases, most tumor-related blood vessels were centripetally directed toward the tumor, and 93% of centripetal blood vessels appeared to be disrupted or rapidly narrowed at the tumor boundary. The centripetal blood vessel structure was frequently observed in invasive cancer compared with non-invasive cancer (61% vs 35%). PA images before and after preoperative chemotherapy were obtained in one case, where intra-tumoral blood vessels became finer after chemotherapy, reflecting normalization of intra-tumoral microcirculation induced by chemotherapy.

Conclusions:

A PAM system with HDA has provided a high-resolution vascular images of primary breast cancers. The morphological differences of peri-tumoral vasculature were observed between invasive disease and non-invasive disease. These results suggest the potential of PA imaging as a non-invasive tool to analyze tumor vasculature of human breast cancers and maybe be helpful for breast cancer diagnosis.

(Acknowledgements)

This work was partially supported by the Innovative Techno-Hub for Integrated Medical Bio-imaging Project of the Special Coordination Funds for Promoting Science and Technology from the Ministry of Education, Culture, Sports, Science, and Technology, Japan.

Citation Format: Toi M, Asao Y, Takada M, Kataoka M, Endo T, Kawashima M, Yamaga I, Nakayama Y, Tokiwa M, Fakhrejahani E, Torii M, Kawaguchi-Sakita N, Kanao S, Matsumoto Y, Yagi T, Sakurai T, Togashi K, Shiina T. Development of photoacoustic vascular imaging system for breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-01-10.

Visualization of tumor-related blood vessels in human breast by photoacoustic imaging system with a hemispherical detector array

Noninvasive measurement of the distribution and oxygenation state of hemoglobin (Hb) inside the tissue is strongly required to analyze the tumor-associated vasculatures. We developed a photoacoustic imaging (PAI) system with a hemispherical-shaped detector array (HDA). Here, we show that PAI system with HDA revealed finer vasculature, more detailed blood-vessel branching structures, and more detailed morphological vessel characteristics compared with MRI by the use of breast shape deformation of MRI to PAI and their fused image. Morphologically abnormal peritumoral blood vessel features, including centripetal photoacoustic signals and disruption or narrowing of vessel signals, were observed and intratumoral signals were detected by PAI in breast cancer tissues as a result of the clinical study of 22 malignant cases. Interestingly, it was also possible to analyze anticancer treatment-driven changes in vascular morphological features and function, such as improvement of intratumoral blood perfusion and relevant changes in intravascular hemoglobin saturation of oxygen. This clinical study indicated that PAI appears to be a promising tool for noninvasive analysis of human blood vessels and may contribute to improve cancer diagnosis.

Impact of thoracic radiotherapy timing in limited-stage small-cell lung cancer: usefulness of the individual patient data meta-analysis

BACKGROUND

Chemotherapy (CT) combined with radiotherapy is the standard treatment of 'limited-stage' small-cell lung cancer. However, controversy persists over the optimal timing of thoracic radiotherapy and CT.

MATERIALS AND METHODS

We carried out a meta-analysis of individual patient data in randomized trials comparing earlier versus later radiotherapy, or shorter versus longer radiotherapy duration, as defined in each trial. We combined the results from trials using the stratified log-rank test to calculate pooled hazard ratios (HRs). The primary outcome was overall survival.

RESULTS

Twelve trials with 2668 patients were eligible. Data from nine trials comprising 2305 patients were available for analysis. The median follow-up was 10 years. When all trials were analysed together, 'earlier or shorter' versus 'later or longer' thoracic radiotherapy did not affect overall survival. However, the HR for overall survival was significantly in favour of 'earlier or shorter' radiotherapy among trials with a similar proportion of patients who were compliant with CT (defined as having received 100% or more of the planned CT cycles) in both arms (HR 0.79, 95% CI 0.69-0.91), and in favour of 'later or longer' radiotherapy among trials with different rates of CT compliance (HR 1.19, 1.05-1.34, interaction test, P < 0.0001). The absolute gain between 'earlier or shorter' versus 'later or longer' thoracic radiotherapy in 5-year overall survival for similar and for different CT compliance trials was 7.7% (95% CI 2.6-12.8%) and -2.2% (-5.8% to 1.4%), respectively. However, 'earlier or shorter' thoracic radiotherapy was associated with a higher incidence of severe acute oesophagitis than 'later or longer' radiotherapy.

CONCLUSION

'Earlier or shorter' delivery of thoracic radiotherapy with planned CT significantly improves 5-year overall survival at the expense of more acute toxicity, especially oesophagitis.

Neutron emission and dose distribution from natural carbon irradiated with a 12 MeV amu-1 12C5+ ion beam

Measured neutron energy distribution emitted from a thick stopping target of natural carbon at 0°, 30°, 60° and 90° from nuclear reactions caused by 12 MeV amu^-1 incident ¹²C⁵⁺ ions were converted to energy differential and total neutron absorbed dose as well as ambient dose equivalent H ^*(10) using the fluence-to-dose conversion coefficients provided by the ICRP. Theoretical estimates were obtained using the Monte Carlo nuclear reaction model code PACE and a few existing empirical formulations for comparison. Results from the PACE code showed an underestimation of the high-energy part of energy differential dose distributions at forward angles whereas the empirical formulation by Clapier and Zaidins (1983 Nucl. Instrum. Methods 217 489-94) approximated the energy integrated angular distribution of H ^*(10) satisfactorily. Using the measured data, the neutron doses received by some vital human organs were estimated for anterior-posterior exposure. The estimated energy-averaged quality factors were found to vary for different organs from about 7 to about 13. Emitted neutrons having energies above 20 MeV were found to contribute about 20% of the total dose at 0° while at 90° the contribution was reduced to about 2%.

CHARACTERIZATION OF A THIN SILICON SENSOR FOR ACTIVE NEUTRON PERSONAL DOSEMETERS

A thin silicon sensor has been developed for active neutron personal dosemeters for use by aircrews and first responders. This thin silicon sensor is not affected by the funneling effect, which causes detection of cosmic protons and over-response to cosmic neutrons. There are several advantages to the thin silicon sensor: a decrease in sensitivity to gamma rays, an improvement of the energy detection limit for neutrons down to 0.8 MeV and an increase in the sensitivity to fast neutrons. Neutron response functions were experimentally obtained using 2.5 and 5 MeV monoenergy neutron beams and a (252)Cf neutron source. Simulation results using the Monte Carlo N-Particle transport code agree quite well with the experimental ones when an energy deposition region shaped like a circular truncated cone is used in place of a cylindrical region.

Probiotic Lactobacillus casei strain Shirota relieves stress-associated symptoms by modulating the gut-brain interaction in human and animal models

BACKGROUND

This study aimed to examine the effects of Lactobacillus casei strain Shirota (LcS) on gut-brain interactions under stressful conditions.

METHODS

Three double-blind, placebo-controlled trials were conducted to examine the effects of LcS on psychological and physiological stress responses in healthy medical students under academic examination stress. Subjects received LcS-fermented milk or placebo daily for 8 weeks prior to taking a national standardized examination. Subjective anxiety scores, salivary cortisol levels, and the presence of physical symptoms during the intervention were pooled and analyzed. In the animal study, rats were given feed with or without LcS for 2 weeks, then submitted to water avoidance stress (WAS). Plasma corticosterone concentration and the expression of cFos and corticotropin releasing factor (CRF) in the paraventricular nucleus (PVN) were measured immediately after WAS. In an electrophysiological study, gastric vagal afferent nerve activity was monitored after intragastric administration of LcS to urethane-anesthetized rats.

KEY RESULTS

Academic stress-induced increases in salivary cortisol levels and the incidence rate of physical symptoms were significantly suppressed in the LcS group compared with the placebo group. In rats pretreated with LcS, WAS-induced increases in plasma corticosterone were significantly suppressed, and the number of CRF-expressing cells in the PVN was reduced. Intragastric administration of LcS stimulated gastric vagal afferent activity in a dose-dependent manner.

CONCLUSIONS & INFERENCES

These findings suggest that LcS may prevent hypersecretion of cortisol and physical symptoms under stressful conditions, possibly through vagal afferent signaling to the brain and reduced stress reactivity in the PVN.

Fermented milk containing Lactobacillus casei strain Shirota prevents the onset of physical symptoms in medical students under academic examination stress

This pilot study investigated the effects of the probiotic Lactobacillus casei strain Shirota (LcS) on psychological, physiological, and physical stress responses in medical students undertaking an authorised nationwide examination for promotion. In a double-blind, placebo-controlled trial, 24 and 23 healthy medical students consumed a fermented milk containing LcS and a placebo milk, respectively, once a day for 8 weeks until the day before the examination. Psychophysical state, salivary cortisol, faecal serotonin, and plasma L-tryptophan were analysed on 5 different sampling days (8 weeks before, 2 weeks before, 1 day before, immediately after, and 2 weeks after the examination). Physical symptoms were also recorded in a diary by subjects during the intervention period for 8 weeks. In association with a significant elevation of anxiety at 1 day before the examination, salivary cortisol and plasma L-tryptophan levels were significantly increased in only the placebo group (P<0.05). Two weeks after the examination, the LcS group had significantly higher faecal serotonin levels (P<0.05) than the placebo group. Moreover, the rate of subjects experiencing common abdominal and cold symptoms and total number of days experiencing these physical symptoms per subject were significantly lower in the LcS group than in the placebo group during the pre-examination period at 5-6 weeks (each P<0.05) and 7-8 weeks (each P<0.01) during the intervention period. Our results suggest that the daily consumption of fermented milk containing LcS may exert beneficial effects preventing the onset of physical symptoms in healthy subjects exposed to stressful situations.

Abstract P4-03-03: Detection of the tumor vasculature and the hypoxic status of breast lesions using second-generation photoacoustic mammography: An exploratory study

Background: Tumor angiogenesis and hypoxia are associated with breast cancer growth and metastasis. Photoacoustic mammography (PAM) non-invasively visualizes hemoglobin distribution inside the breast by detecting thermoelastic waves from hemoglobin generated by the irradiation of a near-infrared laser pulse. Oxygen saturation (SO2) can be calculated using photoacoustic (PA) signals obtained by two laser pulses of different wavelengths. We further improved the spatial resolution of PAM by approximately 1 mm and enhanced detectability by using a high-sensitivity detector. This new PAM technique can obtain both PAM images and ultrasonography (US) images simultaneously. The aim of this study was to explore the clinical usefulness of this PAM technique.

Patients and methods: Women who had breast lesions were eligible for this study. The participants' lesions were measured using the new PAM technique before they began treatment. The PAM images were evaluated by 5 physicians. First, the lesions were identified using only the PAM images. Second, we used US or contrast-enhanced magnetic resonance images (CE-MRI) to identify the locations of the lesions. Next, we evaluated the photoacoustic (PA) signals based on their locations. Peri-tumoral PA signals were defined as linear signals that congregated in the peri-tumoral area, boundary PA signals were defined as peri-tumoral signals that were disrupted at the lesion's boundaries, and intra-tumoral PA signals were defined as any significant PA signals inside the tumor. SO2 was illustrated using a color scale. The study protocol was approved by the institutional review board at Kyoto University Hospital, Japan (UMIN000007464).

Results: PAM was performed on 48 breast lesions in 45 patients, including 36 invasive carcinoma lesions, 8 ductal carcinoma in situ (DCIS) lesions, and 4 benign lesions. Evaluations of PA signals according to the locations of the lesion, with confirmation from US or CE-MRI, were successfully performed for 38 lesions. Peri-tumoral PA signals were detected in 33 lesions (87%), disrupted boundary PA signals were detected in 30 lesions (79%), and intra-tumoral PA signals were detected in 25 lesions (66%). The detection rates for peri-tumoral, boundary and intra-tumoral PA signals were 94%, 87%, and 65% for invasive carcinoma, and 60%, 40%, and 80% for DCIS, respectively. Intra-tumoral PA signals tended to be weaker than peri-tumoral PA signals in invasive carcinoma lesions, and they often displayed a spotty rather than a linear shape. Intra-tumoral PA signals were observed to have lower SO2 levels than peri-tumoral PA signals in 95% of invasive carcinoma lesions and in 75% of DCIS lesions. Although peri-tumoral and boundary PA signals were also detected in a 38-mm fibroadenoma, the intra-tumoral PA signals displayed a diffuse pattern.

Conclusions: We demonstrated that high spatial resolution and use in combination with US and CE-MRI facilitate the region-specific evaluation of PAM imaging. PAM could become a useful tool for the evaluation of the hypoxic status of tumors by enhancing its sensitivity.

Citation Format: Takada M, Kawashima M, Kataoka M, Kanao S, Yamaga I, Torii M, Tokiwa M, Fakhrejahani E, Sakurai T, Asao Y, Haga H, Shiina T, Togashi K, Toi M. Detection of the tumor vasculature and the hypoxic status of breast lesions using second-generation photoacoustic mammography: An exploratory study. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-03-03.