Transversity Distributions and Tensor Charges of the Nucleon: Extraction from Dihadron Production and Their Universal Nature

We perform the first global quantum chromodynamics (QCD) analysis of dihadron production for a comprehensive set of data in electron-positron annihilation, semi-inclusive deep-inelastic scattering, and proton-proton collisions, from which we extract simultaneously the transversity distributions of the nucleon and π^{+}π^{-} dihadron fragmentation functions. We incorporate in our fits known theoretical constraints on transversity, namely, its small-x asymptotic behavior and the Soffer bound. We furthermore show that lattice-QCD results for the tensor charges can be successfully included in the analysis. This resolves the previously reported incompatibility between the tensor charges extracted from dihadron production data and lattice QCD. We also find agreement with results for the transversity and tensor charges obtained from measurements on single-hadron production. Overall, our work demonstrates for the first time the universal nature of all available information for the transversity distributions and the tensor charges of the nucleon.

Number Density Interpretation of Dihadron Fragmentation Functions

We present a new quantum field-theoretic definition of fully unintegrated dihadron fragmentation functions (DiFFs) as well as a generalized version for n-hadron fragmentation functions. We demonstrate that this definition allows certain sum rules to be satisfied, making it consistent with a number density interpretation. Moreover, we show how our corresponding so-called extended DiFFs that enter existing phenomenological studies are number densities and also derive their evolution equations. Within this new framework, DiFFs extracted from experimental measurements will have a clear physical meaning.

Masticatory Behavior Change with a Wearable Chewing Counter: A Randomized Controlled Trial

Because a relationship has been reported between masticatory behavior, obesity, and postprandial blood glucose, it is recommended to chew well and take a longer time to eat. The purpose of this study was to examine the possibility of changing masticatory behavior using a small ear-hung wearable chewing counter, which can monitor masticatory behavior without disturbing daily meals. In total, 235 healthy volunteers participated in a 4-wk randomized controlled trial and were divided into 3 groups. All participants were instructed about the importance of mastication at the first visit. During the intervention, group B used the chewing counter without an algorithm during each meal (notification of the number of chews after meal), and group C used the chewing counter with a masticatory behavior change algorithm (setting a target value and displaying the number of chews in real time). Group A was set as the control group. The number of chews and the meal time when consuming 1 rice ball (100 g) were measured before and after the intervention using the chewing counter, and the rate of change in these values was evaluated. Participants also provided a subjective evaluation of their changes in masticatory behavior. The number of chews and the meal time of 1 rice ball increased significantly in groups B and C compared with before the intervention, and the rate of change was significantly higher in group C than in group A and group B. In addition, the subjective evaluation of the change in the number of chews was highest in group C. Self-monitoring of masticatory behavior by providing a target value and the degree of achievement for the number of chews using a wearable chewing counter with a behavioral change algorithm could promote effective change in masticatory behavior and lead to an increased number of chews. (Trial ID: UMIN000034476).

MR Imaging Detection of CNS Lesions in Tuberous Sclerosis Complex: The Usefulness of T1WI with Chemical Shift Selective Images

BACKGROUND AND PURPOSE

CNS lesions of tuberous sclerosis complex are diagnosed mainly by T2WI, FLAIR, and sometimes T1WI with magnetization transfer contrast. The usefulness of T1WI with chemical shift selective images was recently reported in focal cortical dysplasia type IIb, which has histopathologic and imaging features similar to those of tuberous sclerosis complex. We investigated the usefulness of the T1WI with chemical shift selective images in detecting CNS lesions of tuberous sclerosis complex.

MATERIALS AND METHODS

We retrospectively reviewed 25 consecutive patients with tuberous sclerosis complex (mean age, 11.9 [SD, 8.9] years; 14 males) who underwent MR imaging including T1WI, T1WI with magnetization transfer contrast, T1WI with chemical shift selective, T2WI, and FLAIR images. Two neuroradiologists assessed the number of CNS lesions in each sequence and compared them in 2 steps: among T1WI, T1WI with magnetization transfer contrast and T1WI with chemical shift selective images, and among T2WI, FLAIR, and T1WI with chemical shift selective images. We calculated the contrast ratio of the cortical tubers and of adjacent normal-appearing gray matter and the contrast ratio of radial migration lines and adjacent normal-appearing white matter in each sequence and compared them.

RESULTS

T1WI with chemical shift selective images was significantly superior to T1WI with magnetization transfer contrast for the detection of radial migration lines and contrast ratio of radial migration lines. There was no significant difference between T1WI with chemical shift selective images and T1WI with magnetization transfer contrast for the detection of cortical tubers and the contrast ratio of the cortical tubers. Both T2WI and FLAIR were statistically superior to T1WI with chemical shift selective images for the detection of cortical tubers. T1WI with chemical shift selective images was significantly superior to T2WI and FLAIR for the detection of radial migration lines.

CONCLUSIONS

The usefulness of T1WI with chemical shift selective images in detecting radial migration lines was demonstrated. Our findings suggest that the combination of T1WI with chemical shift selective images, T2WI, and FLAIR would be useful to evaluate the CNS lesions of patients with tuberous sclerosis complex in daily clinical practice.

Isovector EMC Effect from Global QCD Analysis with MARATHON Data

We report the results of a Monte Carlo global QCD analysis of unpolarized parton distribution functions (PDFs), including for the first time constraints from ratios of ^{3}He to ^{3}H structure functions recently obtained by the MARATHON experiment at Jefferson Lab. Our simultaneous analysis of nucleon PDFs and nuclear effects in A=2 and A=3 nuclei reveals the first indication for an isovector nuclear EMC effect in light nuclei. We find that while the MARATHON data yield relatively weak constraints on the F_{2}^{n}/F_{2}^{p} neutron to proton structure function ratio and on the d/u PDF ratio, they suggest an enhanced nuclear effect on the d-quark PDF in the bound proton, questioning the assumptions commonly made in nuclear PDF analyses.

Global QCD Analysis of Pion Parton Distributions with Threshold Resummation

We perform the first global QCD analysis of pion valence, sea quark, and gluon distributions within a Bayesian Monte Carlo framework with threshold resummation on Drell-Yan cross sections at next-to-leading log accuracy. Exploring various treatments of resummation, we find that the large-x asymptotics of the valence quark distribution ∼(1-x)^{β_{v}} can differ significantly, with β_{v} ranging from ≈1 to >2.5 at the input scale. Regardless of the specific implementation, however, the resummation induced redistribution of the momentum between valence quarks and gluons boosts the total momentum carried by gluons to ≈40%, increasing the gluon contribution to the pion mass to ≈40  MeV.

Time Refraction of Spin Waves

We present an experimental study of time refraction of spin waves (SWs) propagating in microscopic waveguides under the influence of time-varying magnetic fields. Using space- and time-resolved Brillouin light scattering microscopy, we demonstrate that the broken translational symmetry along the time coordinate results in a loss of energy conservation for SWs and thus allows for a broadband and controllable shift of the SW frequency. With an integrated design of SW waveguide and microscopic current line for the generation of strong, nanosecond-long, magnetic field pulses, a conversion efficiency up to 39% of the carrier SW frequency is achieved, significantly larger compared to photonic systems. Given the strength of the magnetic field pulses and its strong impact on the SW dispersion relation, the effect of time refraction can be quantified on a length scale comparable to the SW wavelength. Furthermore, we utilize time refraction to excite SW bursts with pulse durations in the nanosecond range and a frequency shift depending on the pulse polarity.

Assessment of the 2015 cardiopulmonary resuscitation guidelines for patients with out-of-hospital cardiac arrest: results from the All-Japan Utstein registry

Background

The 2015 cardiopulmonary resuscitation (CPR) guidelines have stressed that high-quality CPR improves survival from cardiac arrest (CA). In particular, the guidelines recommended that it is reasonable for rescuers to perform chest compressions at a rate of 100 to 120/min in adult CA patients. However, it is unknown whether the 2015 guidelines contributed to favorable neurological outcome in adult CA patients. The present study aimed to clarify the effects of the 2015 guidelines in adult CA patients, using the data of the All-Japan Utstein Registry, a prospective, nationwide, population-based registry of out-of-hospital CA (OHCA).

Methods

From the data of this registry between 2011 and 2016, we included adult witnessed OHCA patients due to cardiac etiology, who had non-shockable rhythm as an initial rhythm. We excluded patients who received prehospital care in 2015 because it was difficult to distinguish prehospital care based on either 2010 CPR guidelines or 2015 CPR guidelines. We also excluded patients who received bystander CPR by citizens because we cannot assess the quality of bystander CPR in this registry. Study patients were divided into five groups based on different years (figure). The endpoint was the favorable neurological outcome at 30 days after OHCA. Potential confounding factors based on biological plausibility and previous studies were included in the multivariable logistic regression analysis. These variables included the age, sex (male, female), advanced airway or not, the administration of adrenaline or not, the administration of saline or not, instructed by dispatcher or not, and time interval from call EMS to scene.

Results

The figure showed favorable neurological outcomes at 30 days. In the multivariate analysis, the adjusted odds ratio for 30-day favorable neurological outcome in OHCA patients in 2016 as compared to in 2011 was 1.32 (95% CI: 1.04–1.68, p=0.022). On the other hands, there were no significant differences from 2011 to 2014.

Conclusion

In the OHCA patients with non-shockable rhythm, the 2015 guidelines were superior to the 2010 guidelines, in terms of neurological benefits.

Figure 1

Funding Acknowledgement

Type of funding source: None

Atrial Fibrillation is related with higher in-hospital morality in acute myocardial infarction (AMI) patients from K-ACTIVE registry

Background

The prognostic significance of atrial fibrillation (AF) on in-hospital mortality in acute myocardial infarction (AMI) patients is not fully understood in Japanese patients.

Methods

To elucidate the clinical significance of AF on in-hospital mortality in AMI patients, we analyzed the Japanese observational prospective multicenter registry of acute myocardial infarction (K-ACTIVE: Kanagawa ACuTe cardio Vacular rEgistry), which spans October 2016 to December 2019.

Results

A total of 3482 patients included 336 patients with AF and 3146 patients with sinus rhythm. Table 1 shows patient baseline characteristics. Patients with AF were significantly older than those with sinus rhythm (75 vs 67, P<0.0001). Prevalence of hypertension and hemodialysis were significantly greater in patients with AF than patients with sinus rhythm while prevalence of dyslipidemia and smoking were significantly less in patients with AF than patients with sinus rhythm. Table 2 shows characteristics of AMI. There were no significant difference in prevalence of STEMI, area of MI, Peak CK/CK-MB and prevalence of multivessel disease. However, patients with AF showed lower systolic blood pressure, faster heart rate, worse Killip category, greater prevalence of OHCA. Need of mechanical support including IABP/ECMO were greater in patients with AF than patients with sinus rhythm. In-hospital mortality was significantly higher in patients with AF than in patients with sinus rhythm (Figure, 10.4% versus 5.2%, P=0.0005). This trend didn't change even after adjustment with age and sex (Odds ratio 1.6 95% confidence interval 1.1–2.4, P=0.02).

Conclusion

AF was associated with higher in-hospital mortality in Japanese AMI patients.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): This work was supported by JSPS KAKENHI Grant Number JP15K09101.

MRI Findings of Immune Checkpoint Inhibitor-Induced Hypophysitis: Possible Association with Fibrosis

BACKGROUND AND PURPOSE

Hypophysitis is one of the well-known adverse effects of immune checkpoint inhibitors. Immune checkpoint inhibitor-induced hypophysitis frequently causes irreversible hypopituitarism, which requires long-term hormone replacement. Despite the high frequency and clinical significance, characteristic MR imaging findings of immune checkpoint inhibitor-induced hypophysitis have not been established. In the present study, we aimed to review and extract the MR imaging features of immune checkpoint inhibitor-induced hypophysitis.

MATERIALS AND METHODS

This retrospective international multicenter study comprised 20 patients with melanoma who were being treated with immune checkpoint inhibitors and clinically diagnosed with immune checkpoint inhibitor-induced hypophysitis. Three radiologists evaluated the following MR imaging findings: enlargement of the pituitary gland and stalk; homogeneity of enhancement of the pituitary gland; presence/absence of a well-defined poorly enhanced area and, if present, its location, shape, and signal intensity in T2WI; and enhancement pattern in contrast-enhanced dynamic MR imaging. Clinical symptoms and hormone levels were also recorded.

RESULTS

Enlargement of the pituitary gland and stalk was observed in 12 and 20 patients, respectively. Nineteen patients showed poorly enhanced lesions (geographic hypoenhancing lesions) in the anterior lobe, and 11 of these lesions showed hypointensity on T2WI. Thyrotropin deficiency and corticotropin deficiency were observed in 19/20 and 12/17 patients, respectively, which persisted in 12/19 and 10/12 patients, respectively, throughout the study period.

CONCLUSIONS

Pituitary geographic hypoenhancing lesions in the anterior lobe of the pituitary gland are characteristic and frequent MR imaging findings of immune checkpoint inhibitor-induced hypophysitis. They reflect fibrosis and are useful in distinguishing immune checkpoint inhibitor-induced hypophysitis from other types of hypophysitis/tumors.

New MRI Findings in Fukuyama Congenital Muscular Dystrophy: Brain Stem and Venous System Anomalies

BACKGROUND AND PURPOSE

Leptomeningeal glioneuronal heterotopia of the brain stem and cerebral migration abnormality were pathologically reported in Fukuyama congenital muscular dystrophy, but the radiologic assessments of the brain stem and cerebral venous system (which may be involved in the development of the anomaly) were insufficient. Here, we evaluated the brain stem and cerebral veins on MR imaging in patients with Fukuyama congenital muscular dystrophy.

MATERIALS AND METHODS

We retrospectively reviewed the MR imaging findings of 27 patients with Fukuyama congenital muscular dystrophy. We visually assessed the hypoplasia, superficial structures, and signal intensity of the brain stem on T2WI, FLAIR, and double inversion recovery images and the cerebral, superficial, and deep veins with and without hemorrhage on T2WI and SWI.

RESULTS

Brain stem fluffy structures were seen in 96.3% of the cases on T2WI. Superficial high signal intensity on T2WI and FLAIR images was seen in 96.3% and 92.6%, respectively. Abnormally located superficial vessels beneath the cortex were seen in 11.1% on T2WI. Hypoplasia of the superficial cerebral veins was noted in all patients who underwent SWI. Dilated and tortuous subependymal veins were seen in 40.0% on SWI. Hemorrhages were seen in 11.1% on T2WI and in 60.0% on SWI.

CONCLUSIONS

Superficial brain stem structural and signal abnormalities would be useful MR imaging findings to diagnose Fukuyama congenital muscular dystrophy as well as venous system abnormalities. Clinicians must keep in mind that this disease has a high risk of hemorrhage.

P17 In-hospital mortality and clinical features of Japanese patients with acute myocardial infarction diagnosed by universal definition in real world from kanagawa-acute cardiovascular registry (K-ACTIVE)

Background

Cardiac troponin (cTn) has been used as the preferred biomarker of myocardial injury for diagnosis of acute myocardial infraction (AMI) by universal definition. A large number of patients formerly classified by creatine kinase (CK) as unstable angina with the WHO criteria in Japan are now diagnosed by cTn as non-ST elevation myocardial infarction (NSTEMI). In this report, we aimed to understand its prevalence and clinical features of AMI diagnosed by using universal definition and the WHO criterial in real world. 

Method

This registry is a cross-sectional study of 53 facilities in Kanagawa prefecture of Japan. 4372 AMI patients were enrolled who received primary percutaneous coronary intervention (PCI) between October 1, 2015 and January 29, 2019. Patients were divided into 3 groups, 3268 patients with ST elevation myocardial infarction (STEMI), 628 patients with NSTEMI patients who satisfied the WHO criteria with CK elevation beyond twice upper limit of normal (NSTEMI + CK), and 476 patients with NSTEMI who didn’t satisfy the WHO criteria without CK elevation (NSTEMI-CK).

Result

Baseline clinical characteristics of the study patients are shown in Table 1. In-hospital mortality was significantly lower in patients with NSTEMI-CK (1.9%) than in STEMI (6.0%, P < 0.001) and NSTEMI + CK (5.3%, P < 0.004) (Figure 1). Kaplan-Meier analyses for 0-30 days of cardiac death are shown in Figure 2. From day 0, the Kaplan-Meier curves began to diverge in favor of NSTEMI-CK for up to 30 days.

Conclusion

AMI patients showed distinct clinical features depends on the type. We should be aware of the difference for the diagnosis of AMI by using universal definitions.

Table 1. 　 STEMI (n = 3268) NSTEMI + CK (n = 628) NSTEMI-CK (n = 476) STEMI vs NSTEMI + CK P value STEMI vs NSTEMI-CK P value NSTEMI + CK vs NSTEMI-CK P value Age(years) 68(59-77) 69(61-78) 70(61-79) 　 　 　 Male 76% 77% 75% 0.54 0.74 0.47 Concomitant diseases 　 　 　 　 　 　 Hypertention 65.4% 70.5% 69.3% 0.013 0.097 0.65 Diabetes 33.5% 36.5% 37.3% 0.15 0.11 0.78 Dyslipidemia 56.1% 61.2% 61.3% 0.018 0.03 0.96 Hemodialysis 2.3% 2.1% 6.8% 0.86 <0.001 0.01 Smoking 66.3% 63.1% 64.6% 0.13 0.48 0.62 Atrial fibrillation 9.6% 10.7% 14.4% 0.57 0.04 0.23 Previous MI 8.3% 17.3% 15.7% <0.001 <0.001 0.47 In-hospital mortality 6.0% 5.3% 1.9% 0.49 <0.001 0.004

Abstract P17 Figure 1. 2.

P278 Pharmacokinetics, pharmacodynamics and efficacy of OPC-61815, prodrug of tolvaptan for intravenous administration, in patients with congestive heart failure

Funding Acknowledgements

Otsuka Pharmaceutical Co. Ltd.

On Behalf

OPC-61815 phase II investigators

Background/Introduction: Tolvaptan, a vasopression V2-receptor antagonist, is effective for congestion in patients with congestive heart failure (CHF), and hyponatremia in patients with CHF and SIADH. But, this drug is not readily soluble in water and not suited for development as an injection. OPC-61815, a prodrug of tolvaptan having improved water solubility, is suitable for intravenous administration.

Purpose

The phase-II clinical study (ClinicalTrials.gov Identifier: NCT03254108) was conducted to investigate the dose for intravenous administration of OPC-61815 achieving tolvaptan exposure equivalent to that for oral administration of tolvaptan 15-mg tablet in CHF patients.

Methods

This study was a multicenter, a double-blind, randomized, active-controlled, parallel-group comparison clinical pharmacology trial. Sixty patients aged between 20 and 85 years with CHF with volume overload despite the use of conventional diuretics were randomly assigned to four treatment cohorts to receive OPC-61815 at doses of 2, 4, 8, 16 mg (i.v.) or tolvaptan at 15 mg (p.o.). Both drugs were administered once a day for 5 days. The primary endpoint was to assess the dose of OPC-61815 equivalent to tolvaptan at 15 mg using Cmax and AUC24h values after the first administration. Pharmacodynamics (urine volume, urine osmolality, serum electrolyte concentration, biomarkers), efficacy (body weight change, congestive symptoms) and safety were also evaluated.

Results

The mean Cmax and AUC of the metabolite tolvaptan increased dose-dependently following single intravenous administration of OPC-61815 at 2, 4, 8, and 16 mg. Tolvaptan exposure (Cmax and AUC24h) on Day 1 following single intravenous administration of OPC-61815 at 16 mg was the closest and similar to that following single administration of tolvaptan 15-mg tablet. OPC-61815 increased urine volume from baseline, leading to decrease in body weight and improvement of lower limb edema. The incidence of treatment-emergent adverse events was 54.2% (26/48 subjects) in the OPC-61815 2 to 16-mg, and 83.3% (10/12 subjects) in the tolvaptan 15-mg groups. No clinically relevant changes from baseline were found in laboratory parameters, vital signs, or ECG findings.

Conclusions

Tolvaptan exposure on Day 1 following single intravenous administration of OPC-61815 at 16 mg was the most similar to that following single administration of tolvaptan 15-mg tablet. There was no marked difference in tolerability between OPC-61815 at 16 mg and tolvaptan 15-mg tablet, and no clinically significant problems were observed.

4329Mega-studies in heart failure, effect dilution in examination of new therapies

Aims

All phase 3 studies in patients with acute heart failure (AHF) and HF with preserved ejection fraction (HFpEF) have failed in the last decades. We explore the likelihood that the negative results are due to chance and/or to study size and dilution of statistical power.

Methods and results

First, using simulations, we examined the probability that a positive finding in phase 2 would result in studying truly effective drugs in phase 3. We simulated phase 2 studies under six scenarios where the range of true relative risk (RR) for an outcome of interest varied from 0.5 (major benefit) to 1.15 (some harm). The proportion of simulated studies where the RR <0.8 (we assumed that a 20% or greater risk reduction reflects an effective drug) ranged from 6% to 42% across the six scenarios studied. To further simulate “real life” clinical research, we simulated a continuous surrogate outcome that was linearly related to the true RR in each simulation of each scenario. Regardless of criteria considered for a positive phase 2 trial, results suggest that even in our worst-case scenario, where overall only 6% of drugs taken into phase 2 are effective, roughly 20% of phase 3 studies, if appropriately powered, should have yielded positive results. Given this, we then explored study size in AHF research, as a potential explanation for the high failure rate in these studies. Comparison of published phase 2 and 3 clinical trials with registries in AHF suggest that populations in both large and small trials differ from “real life”. Meta-regression models suggest that both control event rates, and in the serelaxin program as an example, treatment effects, decline with increasing study size greatly reducing power (figure). This effect dilution might be explained by an increasing proportion of patients enrolled in studies who cannot benefit from the study drug.

Figure 1. Power at two-sided 0.05 significance level to detect an effect size of hazard ratio of 0.65 (left) or 0.8 (right) with a placebo event rate of 10% (top) and 20% (bottom) at N=100 at various treatment effect dilutions with increasing sample size.

Conclusion

These data suggest that it is unlikely that the very high rate of negative AHF phase III trials can be explained by chance alone. Potentially, our tendency to increase sample size does not necessarily increase statistical power, due to more heterogenous populations leading to reduced event rates and treatment effects.

P2666Association of out-of-hospital cardiac arrest occurrence time and the survival in all-Japan utstein registry: difference between international resuscitation guidelines 2005 and 2010

Background/Introduction

Previous studies have shown that out-of-hospital cardiac arrest (OHCA) occurring at night have poor outcomes compared with OHCA occurring during daytime. On the other hand, nationwide OHCA outcomes have gradually improved in Japan.

Purpose

We sought to examine whether one-month survival of OHCA differed between daytime and nighttime occurrences, and they differed between the periods of International Resuscitation Guidelines 2005 and 2010.

Methods

Using the All-Japan Utstein Registry between 2005 and 2015, adult OHCA patients whose collapse was witnessed by a bystander and the call-to-hospital admission interval was shorter than 120 min were included in this study. OHCA patients were divided by period of the International Resuscitation Guideline 2005 and 2010. Guideline 2005 included years from 2006 to 2010, while Guideline 2010 included years from 2011 to 2015. The primary outcome was one-month survival with favorable neurological outcome, defined as Cerebral Performance Category scale of 1 or 2. Daytime, evening, and night were defined as 0700 to 1459 h, 1500 to 2259 h, and 2300 to 0659 h, respectively.

Results

Among 479,046 cases, 20.3% revealed OHCA occurring at night. OHCA patients occurring at night had lower rate of bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator use than those occurring at both daytime and evening. In addition, of those who received bystander CPR, higher rate of patients received CPR by family members. OHCA patients occurring at night in both guideline periods had significantly worse one-month survival than those occurring during daytime (reference) (adjusted odds ratio, 0.69, 0.64; 95% confidence interval 0.65–0.72, 0.61–0.67; P<0.001, P<0.001, Guideline 2005 and 2010 respectively). OHCA patients occurring during daytime in Guideline 2010 had better one-month survival than those in Guideline 2005 (adjusted odds ratio, 1.29; 95% confidence interval 1.24–1.34; P<0.001).

Conclusions

One-month survival with favorable neurological outcome in OHCA patients occurring at night remains to be significantly worse than those occurring during daytime, even improved by the periods during daytime. CPR training for the family members should be more expanded and strengthened against the night time imperfection.

P6354Decreased beneficial effects of oral heart failure medications in patients with acute decompensated heart failure and hyperglycemia: results from an international observational cohort

Background

Hyperglycemia is common, regardless of diabetes mellitus (DM), and is associated with increased mortality in patients with acute heart failure (AHF). Current oral heart failure (HF) medications improve the outcome in patients with AHF. However, the relationships between HF medications, admission glucose levels, and prognosis in AHF patients remained unknown.

Purpose

This study sought to investigate the effect of oral HF medications on relationships between hyperglycemia at admission and 1-year all-cause mortality in patients with AHF.

Methods

From the GREAT (Global Research on Acute Conditions Team) registry, 13840 patients presenting with AHF whose admission glucose levels were available were included and followed up for 1-year all-cause mortality. Hyperglycemia was defined as a glucose levels of ≥7 mmol/L for patients without history of DM and ≥10 mmol/L for those with history of DM. Patients with hypoglycemia (defined as a glucose levels of ≤4 mmol/L, n=193, 1.4%) were excluded in this analysis.

Results

There were 6418 (%) patients with hyperglycemia and 7229 (%) patients with normoglycemia. One-year mortality was higher in patients with hyperglycemia than those with normoglycemia (1911 [30%] and 1821 [25%], respectively). Even after adjustment, the risk for 1-year mortality was significantly higher in hyperglycemia (HR 1.14, 95%-CI 1.04–1.26, P=0.008) compared with normoglycemia. Detrimental effects of hyperglycemia on 1-year mortality were more severe in de novo AHF patients than in patients with history of HF (p for interaction 0.004). Oral HF medications (beta blockers and/or angiotensin converting enzyme inhibitors/angiotensin receptor blockers) at discharge were effective in AHF patients with normoglycemia regardless of history of HF. Oral HF medications at discharge are very effective in de novo AHF patients with hyperglycemia and less effective in acute decompensated HF patients with hyperglycemia (Figure).

HF medications and 1-year mortality

Conclusions

Hyperglycemia at admission is associated with increased risk for 1-year mortality. Current oral HF medications are effective in most of subgroups, though they were less effective in patients with acute decompensated HF and hyperglycemia. These patients might need more aggressive therapies to improve outcomes.

Acknowledgement/Funding

This work was supported by a research fellowship from Japan Heart Foundation (E.A.)

P1701Sex-related difference in receiving bystander cardiopulmonary resuscitation and clinical outcome among out-of-hospital cardiac arrest patients

Background

Early studies from US and Europe have reported that female out-of-hospital cardiac arrest (OHCA) patients were less likely to receive bystander cardiopulmonary resuscitation (CPR). However, little is known about sex-related difference in receiving CPR and clinical outcome among adult OHCA patients in Japan.

Methods

This study was a nation-wide, population-based observational study of OHCA in Japan from 2011 to 2015. We included all adult cardiogenic OHCA patients. We excluded patients witnessed by emergency medical services (EMS) from the present analysis. To account for the age-related difference, we stratified by age category: 18–39, 40–64, 65–79, and ≥80. To examine the association between patient sex and neurological outcome at 30-day, we fitted multivariable logistic regression model with adjustment for age, bystander CPR status, first document rhythm, dispatcher instruction and EMS response time.

Results

There were 339,317 adult cardiogenic, not EMS-witnessed OHCA patients (median age, 80; female, 43.5%) in Japan from 2011 to 2015. Overall, 171,122 (50.4%) received CPR by citizen, 34,283 (10.1%) had initial shockable rhythm, and 11,421 (3.4%) had favorable neurological status at 30-day. Female patients were more likely to receive bystander CPR (vs. male; 53.8% vs. 47.8%), and were less likely to have initial shockable rhythm (5.2% vs. 13.9%) and favorable neurological status at 30-day (1.8% vs. 4.6%) (all; p<0.001). With stratification by age category, elderly female patients (aged ≥65) were more likely to received bystander CPR (P<0.001), whereas male patients were more likely to received bystander CPR among patients aged <40. Multivariable logistic regression analysis showed that female patients had a lower rate of favorable neurological status at 30-day, compared to male patients in all age categories (all; P<0.05).

Sex difference in bystander CPR Overall Male (n=191,672) Female (n=147,645) p-value All (n=339,317) 50.4% 47.8% 53.8% <0.001 Aged 18–39 (n=6,216) 56.0% 56.9% 53.5% 0.02 Aged 40–64 (n=50,320) 48.5% 48.5% 48.3% 0.69 Aged 65–80 (n=105,141) 46.5% 45.5% 48.3% <0.001 Aged ≥80 (n=177,640) 53.2% 49.0% 56.7% <0.001

OR for neurological outcome at 30-day

Conclusion

Unlike the situation in Europe and US, female OHCA patients, especially elderly female, were more likely to receive bystander CPR in Japan. However, female patients had worse clinical outcome after OHCA. Further investigations including in-hospital treatment are needed to clarify the sex-difference in clinical outcome after OHCA.

Acknowledgement/Funding

None

P2569Self-adhesive bi-layered dressing incorporating amnion-derived mesenchymal stromal cells for the treatment of heart failure: a pre-clinical proof of concept study

Introduction

Mesenchymal stromal cell (MSC) transplantation is a promising treatment to promote myocardial repair. Among various sources, the amnion has an advantage in mass production of high-quality MSCs due to its large initial cell-yield and prenatal nature of isolated cells. In addition to the powerful tissue-repair potential, amnion-derived MSCs (AMSCs) exhibit a robust immunomodulative ability, enabling allogeneic transplantation without immunosuppressive reagents. We here report a novel bioengineering technique to deliver AMSCs for myocardial repair by epicardial placement of self-adhesive, bi-layered, AMSC-incorporating dressings (AMSC-dressing), which is fabricable on-site (Figure A).

Methods and results

AMSC-dressing was fabricated by spreading AMSC suspension on the inner layer of a fibrin sealant film, composed of fibrinogen and thrombin. Due to the resulting adhesive AMSC-fibrin complex, the AMSC-dressing firmly adhered to the heart surface without the need for suture or additional glue. The outer collagen layer of the film facilitated the easy handling and also protected the AMSC-fibrin complex from external damage. We applied a 1 cm2 dressing containing 0, 1, 2 or 4 millions of rat AMSCs to a rat ischemic cardiomyopathy model (4 weeks post coronary artery ligation). Intramyocardial (IM) injection of 4 millions of AMSCs and sham treatment were also conducted. Echocardiography and catheterization consistently demonstrated that AMSC-dressing therapy improved cardiac function and reduced heart dilatation in a dose-dependent manner compared to the sham control. Furthermore, this therapeutic effect exceeded that of IM injection (Figure B). Histological analyses revealed that AMSC-dressing therapy resulted in augmented myocardial tissue repair (increased neovascularization, attenuated pathological fibrosis and reduced cardiomyocyte hypertrophy) compared to IM injection and sham groups. These effects were associated with increased upregulation of a range of tissue repair-related genes including Il10, Cxcl12, Igf1, Timp1, Hif1a, Tgfb, Mmp2, Hgf, Fgf2 and Vegf. Of note, it was elucidated that both initial retention and subsequent survival of donor AMSCs were enhanced by the dressing technique compared to IM injection. In addition, in vitro studies demonstrated that culturing in a fibrin glue not only enhanced upregulation of tissue-repair genes of AMSCs but also improved their survival against environmental stress through activating the Akt/PI3K cell-survival pathway.

Conclusion

AMSC-dressing therapy enhanced both quantity and quality of donor cell engraftment, leading to the augmented therapeutic efficacy, compared to the current method. Furthermore, this technique is user-friendly and requires no specialized equipment at the treating hospital, highlighting its great potential to be a widely-adopted, standard treatment for heart failure. Further development of this advanced cell therapy towards clinical application is justified.

Acknowledgement/Funding

British Heart Foundation, Heart Research UK, Japan Agency for Medical Research and Development, Kaneka Corporation

Domain Wall Based Spin-Hall Nano-Oscillators

In the last decade, two revolutionary concepts in nanomagnetism emerged from research for storage technologies and advanced information processing. The first suggests the use of magnetic domain walls in ferromagnetic nanowires to permanently store information in domain-wall racetrack memories. The second proposes a hardware realization of neuromorphic computing in nanomagnets using nonlinear magnetic oscillations in the gigahertz range. Both ideas originate from the transfer of angular momentum from conduction electrons to localized spins in ferromagnets, either to push data encoded in domain walls along nanowires or to sustain magnetic oscillations in artificial neurones. Even though both concepts share a common ground, they live on very different timescales which rendered them incompatible so far. Here, we bridge both ideas by demonstrating the excitation of magnetic auto-oscillations inside nanoscale domain walls using pure spin currents. This Letter will shed light on the current characteristic and spatial distribution of the excited auto-oscillations.

Radiologic and Pathologic Features of the Transmantle Sign in Focal Cortical Dysplasia: The T1 Signal Is Useful for Differentiating Subtypes

BACKGROUND AND PURPOSE

The transmantle sign is a characteristic MR imaging finding often seen in focal cortical dysplasia type IIb. The transmantle sign is typically hyperintense on T2WI and FLAIR and hypointense on T1WI. However, in some cases, it shows T1 high signal. We evaluated the imaging and pathologic findings to identify the causes of the T1 high signal in the transmantle sign.

MATERIALS AND METHODS

We retrospectively reviewed the preoperative imaging data of 141 consecutive patients with histologically proved focal cortical dysplasia. We selected 25 patients with focal cortical dysplasia with the transmantle sign and divided them into groups based on the pathologic focal cortical dysplasia subtype and T1 signal of the transmantle sign. We evaluated the clinical, radiologic, and pathologic findings, including the number of balloon cells and dysmorphic neurons and the severity of gliosis or calcifications and compared them among the groups.

RESULTS

Nine of the 25 patients had a T1-high-signal transmantle sign; the other 16 patients did not. All 9 patients with a T1-high-signal transmantle sign were diagnosed as type IIb (group A). Of the 16 patients with no T1-high-signal transmantle sign, 13 were diagnosed as having type IIb (group B), and the other 3 patients, as type IIa (group C). The number of balloon cells was significantly higher in group A than in the other groups, but there were no differences regarding dysmorphic neurons, the severity of gliosis, or calcifications.

CONCLUSIONS

Approximately 6% (9/141) of this patient series had a T1-high-signal transmantle sign, and all were type IIb. The signal may reflect a rich density of balloon cells. This finding could support the differentiation of subtypes, especially type IIb.

First Monte Carlo Global QCD Analysis of Pion Parton Distributions

We perform the first global QCD analysis of parton distribution functions (PDFs) in the pion, combining πA Drell-Yan data with leading neutron electroproduction from HERA within a Monte Carlo approach based on nested sampling. Inclusion of the HERA data allows the pion PDFs to be determined down to much lower values of x, with relatively weak model dependence from uncertainties in the chiral splitting function. The combined analysis reveals that gluons carry a significantly higher pion momentum fraction, ∼30%, than that inferred from Drell-Yan data alone, with sea quarks carrying a somewhat smaller fraction, ∼15%, at the input scale. Within the same effective theory framework, the chiral splitting function and pion PDFs can be used to describe the d[over ¯]-u[over ¯] asymmetry in the proton.

Prediction of major complications after hepatectomy using liver stiffness values determined by magnetic resonance elastography

BACKGROUND

Liver fibrosis is a risk factor for hepatectomy but cannot be determined accurately before hepatectomy because diagnostic procedures are too invasive. Magnetic resonance elastography (MRE) can determine liver stiffness (LS), a surrogate marker for assessing liver fibrosis, non-invasively. The aim of this study was to investigate whether the LS value determined by MRE is predictive of major complications after hepatectomy.

METHODS

This prospective study enrolled consecutive patients who underwent hepatic resection between April 2013 and August 2016. LS values were measured by imaging shear waves by MRE in the liver before hepatectomy. The primary endpoint was major complications, defined as Clavien-Dindo grade IIIa or above. Logistic regression analysis identified independent predictive factors, from which a logistic model to estimate the probability of major complications was constructed.

RESULTS

A total of 96 patients were included in the study. Major complications were observed in 15 patients (16 per cent). Multivariable logistic analysis confirmed that higher LS value (P = 0·021) and serum albumin level (P = 0·009) were independent predictive factors for major complications after hepatectomy. Receiver operating characteristic (ROC) analysis showed that the best LS cut-off value was 4·3 kPa for detecting major complications, comparable to liver fibrosis grade F4, with a sensitivity of 80 per cent and specificity of 82 per cent. A logistic model using the LS value and serum albumin level to estimate the probability of major complications was constructed; the area under the ROC curve for predicting major complications was 0·84.

CONCLUSION

The LS value determined by MRE in patients undergoing hepatectomy was an independent predictive factor for major complications.

Frequency-Domain Multiplexing Readout with a Self-Trigger System for Pulse Signals from Kinetic Inductance Detectors

We present the development of a frequency-domain multiplexing readout of kinetic inductance detectors (KIDs) for pulse signals with a self-trigger system. The KIDs consist of an array of superconducting resonators that have different resonant frequencies individually, allowing us to read out multiple channels in the frequency domain with a single wire using a microwave-frequency comb. The energy deposited to the resonators break Cooper pairs, changing the kinetic inductance and, hence, the amplitude and the phase of the probing microwaves. For some applications such as X-ray detections, the deposited energy is detected as a pulse signal shaped by the time constants of the quasiparticle lifetime, the resonator quality factor, and the ballistic phonon lifetime in the substrate, ranging from microseconds to milliseconds. A readout system commonly used converts the frequency-domain data to the time-domain data. For the short pulse signals, the data rate may exceed the data transfer bandwidth, as the short time constant pulses require us to have a high sampling rate. In order to overcome this circumstance, we have developed a KID readout system that contains a self-trigger system to extract relevant signal data and reduces the total data rate with a commercial off-the-shelf FPGA board. We have demonstrated that the system can read out pulse signals of 15 resonators simultaneously with about 10 Hz event rate by irradiating α particles from 241 Am to the silicon substrate on whose surface aluminum KID resonators are formed.

First Monte Carlo Global Analysis of Nucleon Transversity with Lattice QCD Constraints

We report on the first global QCD analysis of the quark transversity distributions in the nucleon from semi-inclusive deep-inelastic scattering (SIDIS), using a new Monte Carlo method based on nested sampling and constraints on the isovector tensor charge g_{T} from lattice QCD. A simultaneous fit to the available SIDIS Collins asymmetry data is compatible with g_{T} values extracted from a comprehensive reanalysis of existing lattice simulations, in contrast to previous analyses, which found significantly smaller g_{T} values. The contributions to the nucleon tensor charge from u and d quarks are found to be δu=0.3(2) and δd=-0.7(2) at a scale Q^{2}=2  GeV^{2}.

Estimation of the following Cardiac Output Using Sympathetic Tone and Hemodynamics for the Control of a Total Artificial Heart

A sympathetic neurogram is potentially useful for the development of a real time total artificial heart (TAH) control system. We used sympathetic tone and hemodynamic derivatives to estimate the following cardiac output in acute animal experiments using adult mongrel dogs. Moving averages of the mean left atrial pressure and mean aortic pressure were used as parameters of the preload and afterload, respectively. Renal sympathetic nerve activity (RSNA) was employed as a parameter of sympathetic tone. Equations for the following cardiac output were calculated using multiple linear regression analysis of the time series data. A significant correlation was observed between the estimated and following measured cardiac output. These results suggest the potential usefulness of the sympathetic neurogram for the real time TAH automatic control system.

Mayer Waves in Dogs with Total Artificial Heart

To assess the effect of a total artificial heart (TAH) on the autonomic nervous system a power spectral analysis of the hemodynamics in a TAH animal was done by the maximum entropy method. Two pneumatically driven sac-type ventricular assist devices were implanted as total biventricular bypass (BVB) in adult mongrel dogs to compare the differences between natural heart and TAH. Once the BVB was pumping, the natural heart was electrically fibrillated to constitute the BVB-type TAH model. In the arterial pressure waveform in animals with TAH, respiratory waves were not changed (97.7±24.6%) though Mayer waves were significantly decreased (47.5 ± 22.6%) compared with the animal with a natural heart. These results suggest that prosthetic hemodynamics in the TAH animal affect fluctuations in the cardiovascular system.

Abstract P3-13-06: Tailored neoadjuvant endocrine and chemo-endocrine therapy for postmenopausal patients with estrogen receptor-positive human epidermal growth factor receptor 2-negative primary breast cancer

Aims We investigated the efficacy and safety of initial neoadjuvant endocrine therapy with exemestane (EXE) alone followed by subsequent tailored treatment with EXE alone for responders or EXE plus oral metronomic cyclophosphamide (CPA) for non-responders.

Methods In this multicenter open-label phase II study, we enrolled postmenopausal patients with primary invasive estrogen receptor (ER)-positive, HER2-negative, stage I–IIIA (T1c–T3 N0–2 M0) breast cancer and Ki67 index ≤ 30%. Patients first received EXE 25mg/day for 12 weeks. Based on clinical response and change in Ki67 index in response to the initial therapy, patients who achieved complete response (CR), partial response (PR) with Ki67 index ≤5% after treatment, or stable disease (SD) with Ki67 index ≤5% both before and after treatment were defined as responders. Non-responders were defined as patients with PR and Ki67 index &gt;5% after treatment, or SD and Ki67 index &gt;5% before or after treatment. For the subsequent 24 weeks, responders continued the EXE monotherapy (continued EXE group), whereas non-responders switched to combination therapy with EXE plus CPA 50mg/day (EXE+CPA group). The primary endpoint was clinical response (CR and PR) at weeks 24 and 36.

Results A total of 59 patients (median age 69 years, range 53–86 years) were enrolled between January 2011 and July 2015. After exclusion of 3 (2 with progressive disease, 1 with an adverse event, AE) who discontinued treatment in the initial 12-week EXE monotherapy period, 56 remained enrolled to receive subsequent treatment. After 8–12 weeks of the initial EXE monotherapy, 14 patients were classified as responders (9 with PR and Ki67 index ≤5% after treatment; 5 with SD and Ki67 index ≤5% before and after treatment), whereas 42 were classified as non-responders (3 with PR and Ki67 index &gt;5% after treatment; 39 with SD and Ki67 index &gt;5% before or after treatment). Clinical response rates at weeks 24 and 36 were 85% (12/14, 95%CI 57.2–98.2%) and 76% (10/13, 95%CI 46.2–95.0%), respectively, in the continued EXE group, and 56% (23/41, 95%CI 39.7–71.5%) and 76% (30/39, 95%CI 60.7–88.9%), respectively, in the EXE+CPA group. At week 36, no significant difference was found in median Ki67 index between the continued EXE and EXE+CPA groups (3.5% and 4.0%, respectively). The proportion of patients with preoperative endocrine prognostic index (PEPI) 0 was also similar between the continued EXE and EXE+CPA groups (21.4% and 23.8%, respectively). The breast-conserving surgery rate was 71.4% and 69.0%, respectively. Grade 3 AEs were elevated liver enzymes (1 patient) in the continued EXE group, and gastritis, hypertriglyceridemia, and bone mineral density loss (1 patient each) in the EXE+CPA group.

Conclusion Switching from EXE monotherapy to EXE+CPA combination therapy based on clinical response and biological response (change in Ki67 index) to initial therapy improved subsequent clinical response in non-responders. Favorable clinical response to EXE alone was maintained in responders. Tailored neoadjuvant endocrine and chemo-endocrine therapy was shown to be effective in postmenopausal ER-positive breast cancer patients. (JBCRG-11CPA; UMIN000004751)

Citation Format: Masuda N, Sato N, Morimoto T, Ueno T, Kanbayashi C, Kaneko K, Yasojima H, Saji S, Sasano H, Morita S, Ohno S, Toi M. Tailored neoadjuvant endocrine and chemo-endocrine therapy for postmenopausal patients with estrogen receptor-positive human epidermal growth factor receptor 2-negative primary breast cancer [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 P3-13-06.

Diffusion with finite-helicity field tensor: A mechanism of generating heterogeneity

Topological constraints on a dynamical system often manifest themselves as breaking of the Hamiltonian structure; well-known examples are nonholonomic constraints on Lagrangian mechanics. The statistical mechanics under such topological constraints is the subject of this study. Conventional arguments based on phase spaces, Jacobi identity, invariant measure, or the H theorem are no longer applicable since all these notions stem from the symplectic geometry underlying canonical Hamiltonian systems. Remembering that Hamiltonian systems are endowed with field tensors (canonical 2-forms) that have zero helicity, our mission is to extend the scope toward the class of systems governed by finite-helicity field tensors. Here, we introduce a class of field tensors that are characterized by Beltrami vectors. We prove an H theorem for this Beltrami class. The most general class of energy-conserving systems are non-Beltrami, for which we identify the "field charge" that prevents the entropy to maximize, resulting in creation of heterogeneous distributions. The essence of the theory can be delineated by classifying three-dimensional dynamics. We then generalize to arbitrary (finite) dimensions.

Long-range Correlated Glucose Fluctuations in Diabetes

Objectives : Our objective is to investigate diabetes- related alteration of glucose control in diurnal fluctuations in normal daily life by detrended fluctuation analysis (DFA).

Methods : The fluctuations of glucose of 12 non-diabetic subjects and 15 diabetic patients were measured using a continuous glucose monitoring system (CGMS) over a period of one day. The glucose data was calculated by the DFA method, which is capable of revealing the presence of long-range correlations in time series with inherent non-stationarity.

Results : Compared with the non-diabetic subjects, the mean glucose level and the standard deviation are significantly higher in the diabetic group.

The DFA exponent α is calculated, and glucose time series are searched for the presence of negatively (0.5 < α <1.5) or positively (1.5 < α) correlated fluctuations. A crossover phenomenon, i.e. a change in the level of correlations, is observed in the non-diabetic subjects at about two hours; the net effects of glucose flux/reflux causing temporal changes in glucose concentration are negatively correlated in a “long-range" (> two hours) regime. However, for diabetic patients, the DFA exponent α = 1.65 ± 0.30, and in the same regime positively correlated fluctuations are observed, suggesting that the net effects of the flux and reflux persist for many hours.

Conclusions : Such long-range positive correlation in glucose homeostasis may reflect pathogenic mechanisms of diabetes, i.e., the lack of the tight control in blood glucose regulation. Using modern time series analysis methods such as DFA, continuous evaluation of glucose dynamics could promote better diagnoses and prognoses of diabetes and a better understanding of the fundamental mechanism of glucose dysregulation in diabetes.

MR Imaging Features of the Cerebellum in Adult-Onset Neuronal Intranuclear Inclusion Disease: 8 Cases

Neuronal intranuclear inclusion disease is a neurodegenerative disorder pathologically characterized by eosinophilic hyaline intranuclear inclusions. A high-intensity signal along the corticomedullary junction on DWI has been described as a specific MR imaging finding of the cerebrum in neuronal intranuclear inclusion disease. However, MR imaging findings of the cerebellum in neuronal intranuclear inclusion disease have not been fully evaluated. Here, we review MR imaging findings of the cerebellum in a series of 8 patients with pathologically confirmed neuronal intranuclear inclusion disease. The MR imaging results showed cerebellar atrophy (8/8 patients) and high-intensity signal on FLAIR images in the medial part of the cerebellar hemisphere right beside the vermis (the "paravermal area") (6/8) and in the middle cerebellar peduncle (4/8). The paravermal abnormal signals had a characteristic distribution, and they could be an indicator of the diagnosis of neuronal intranuclear inclusion disease even when using the results of past MR imaging examinations in which DWI findings were not examined.