Impacts of workplace verbal aggression classified via text mining on workers' mental health

BACKGROUND

Exposure to workplace aggression adversely affects workers' health; however, little is known regarding the impact of specific types of verbal content.

AIMS

We aimed to examine the relationship between exposure to several types of aggressive words at work and the victim's depressive symptoms and sleep disturbance using text mining.

METHODS

We conducted a longitudinal survey with 800 workers in wholesale and retail companies; of which, 500 responded to the follow-up survey. The Centre for Epidemiologic Studies-Depression Scale and Pittsburgh Sleep Quality Index were filled out by the participants, and their responses were analysed by logistic regression to evaluate the risk of depression or sleep problems. We collected exact aggressive words encountered at work over the past year as a dependent variable and classified it into four types using text mining, such as words criticizing one's performance.

RESULTS

The follow-up rate was 63%. Exposure to words threatening one's life showed a significant relationship with the risk of depression (odds ratio [OR] = 13.94, 95% confidence interval [CI] = 1.76-110.56). The exposure to words criticizing one's job performance is significantly related to the risk of sleep disturbance (OR = 5.56, 95% CI = 2.08-14.88).

CONCLUSIONS

These findings suggest that different contents of verbal aggression can have different impacts on workers' health. This indicates that not only overtly threatening and abusive language but also words related to one's performance can be a risk factor for workers, depending on how they are delivered. To mitigate the adverse effects, promoting effective communication and cultivating psychological detachment from work may be beneficial.

The impact of rare cancer and early-line treatments on the benefit of comprehensive genome profiling-based precision oncology

BACKGROUND

Comprehensive genome profiling (CGP) serves as a guide for suitable genomically matched therapies for patients with cancer. However, little is known about the impact of the timing and types of cancer on the therapeutic benefit of CGP.

MATERIALS AND METHODS

A single hospital-based pan-cancer prospective study (TOP-GEAR; UMIN000011141) was conducted to examine the benefit of CGP with respect to the timing and types of cancer. Patients with advanced solid tumors (>30 types) who either progressed with or without standard treatments were genotyped using a single CGP test. The subjects were followed up for a median duration of 590 days to examine therapeutic response, using progression-free survival (PFS), PFS ratio, and factors associated with therapeutic response.

RESULTS

Among the 507 patients, 62 (12.2%) received matched therapies with an overall response rate (ORR) of 32.3%. The PFS ratios (≥1.3) were observed in 46.3% (19/41) of the evaluated patients. The proportion of subjects receiving such therapies in the rare cancer cohort was lower than that in the non-rare cancer cohort (9.6% and 17.4%, respectively; P = 0.010). However, ORR of the rare cancer patients was higher than that in the non-rare cancer cohort (43.8% and 20.0%, respectively; P = 0.046). Moreover, ORR of matched therapies in the first or second line after receiving the CGP test was higher than that in the third or later lines (62.5% and 21.7%, respectively; P = 0.003). Rare cancer and early-line treatment were significantly and independently associated with ORR of matched therapies in multivariable analysis (P = 0.017 and 0.004, respectively).

CONCLUSION

Patients with rare cancer preferentially benefited from tumor mutation profiling by increasing the chances of therapeutic response to matched therapies. Early-line treatments after profiling increase the therapeutic benefit, irrespective of tumor types.

Observation of New Isotopes in the Fragmentation of ^{198}Pt at FRIB

Five previously unknown isotopes (^{182,183}Tm, ^{186,187}Yb, ^{190}Lu) were produced, separated, and identified for the first time at the Facility for Rare Isotope Beams (FRIB) using the Advanced Rare Isotope Separator (ARIS). The new isotopes were formed through the interaction of a ^{198}Pt beam with a carbon target at an energy of 186  MeV/u and with a primary beam power of 1.5 kW. Event-by-event particle identification of A, Z, and q for the reaction products was performed by combining measurements of the energy loss, time of flight, magnetic rigidity Bρ, and total kinetic energy. The ARIS separator has a novel two-stage design with high resolving power to strongly suppress contaminant beams. This successful new isotope search was performed less than one year after FRIB operations began and demonstrates the discovery potential of the facility which will ultimately provide 400 kW of primary beam power.

Impact of deep learning on radiologists and radiology residents in detecting breast cancer on CT: a cross-vendor test study

AIM

To investigate the effect of deep learning on the diagnostic performance of radiologists and radiology residents in detecting breast cancers on computed tomography (CT).

MATERIALS AND METHODS

In this retrospective study, patients undergoing contrast-enhanced chest CT between January 2010 and December 2020 using equipment from two vendors were included. Patients with confirmed breast cancer were categorised as the training (n=201) and validation (n=26) group and the testing group (n=30) using processed CT images from either vendor. The trained deep-learning model was applied to test group patients with (30 females; mean age = 59.2 ± 15.8 years) and without (19 males, 21 females; mean age = 64 ± 15.9 years) breast cancer. Image-based diagnostic performance of the deep-learning model was evaluated with the area under the receiver operating characteristic curve (AUC). Two radiologists and three radiology residents were asked to detect malignant lesions by recording a four-point diagnostic confidence score before and after referring to the result from the deep-learning model, and their diagnostic performance was evaluated using jackknife alternative free-response receiver operating characteristic analysis by calculating the figure of merit (FOM).

RESULTS

The AUCs of the trained deep-learning model on the validation and test data were 0.976 and 0.967, respectively. After referencing with the result of the deep learning model, the FOMs of readers significantly improved (reader 1/2/3/4/5: from 0.933/0.962/0.883/0.944/0.867 to 0.958/0.968/0.917/0.947/0.900; p=0.038).

CONCLUSION

Deep learning can help radiologists and radiology residents detect breast cancer on CT.

Discovery of ^{39}Na

The new isotope ^{39}Na, the most neutron-rich sodium nucleus observed so far, was discovered at the RIKEN Nishina Center Radioactive Isotope Beam Factory using the projectile fragmentation of an intense ^{48}Ca beam at 345  MeV/nucleon on a beryllium target. Projectile fragments were separated and identified in flight with the large-acceptance two-stage separator BigRIPS. Nine ^{39}Na events have been unambiguously observed in this work and clearly establish the particle stability of ^{39}Na. Furthermore, the lack of observation of ^{35,36}Ne isotopes in this experiment significantly improves the overall confidence that ^{34}Ne is the neutron dripline nucleus of neon. These results provide new key information to understand nuclear binding and nuclear structure under extremely neutron-rich conditions. The newly established stability of ^{39}Na has a significant impact on nuclear models and theories predicting the neutron dripline and also provides a key to understanding the nuclear shell property of ^{39}Na at the neutron number N=28, which is normally a magic number.

Impact of transcatheter aortic valve implantation on coronary flow reserve by transthoracic Doppler echocardiography 1-year after the intervention in severe aortic stenosis patients

Background

Coronary flow reserve (CFR) which is one of indexes reflecting coronary microcirculation in patients without significant epicardial coronary lesions can be impaired in patients with severe aortic stenosis (AS). It has been shown that CFR is an independent predictor for future cardiovascular events in AS patients. Transcatheter aortic valve implantation (TAVI) has rapidly become widespread and is becoming the standard treatment for severe AS. This procedure may have a good effect on CFR due to reduction of severe afterload in patients with severe AS. Although the recent reports evaluated change in CFR immediately and 6 months after TAVI, it has not been evaluated whether impaired CFR improves 1-year after TAVI in AS patients with preserved left ventricular ejection fraction (LVEF).

Purpose

The purpose of the present study was to investigate whether impaired CFR improves 1-year after TAVI in severe AS patients with preserved LVEF.

Methods

The study population consists of consecutive 105 patients with severe AS undergoing TAVI. Exclusion criteria were atrial fibrillation, old myocardial infarction, history of coronary artery bypass grafting, significant lesions in the left anterior descending artery (LAD), moderate or severe mitral valve disease, history of valve replacement, LVEF <50% and preoperative CFR >2.2. CFR was obtained from coronary flow velocity by transthoracic echocardiography at rest and maximal hyperemia in LAD before, immediately and 1-year after TAVI. We compared CFR between before and after TAVI in the study patients who did not meet the exclusion criteria.

Results

After exclusion of 76 patients who met the exclusion criteria, the final study patients consist of 29 patients (8 male, 84.9±5.2 years). There was no significant difference in LVEF (61.3±3.4% vs 61.6±4.4%, P=0.667) and LV end-diastolic volume (LVEDVI; 58.2±9.2 mL/m2 vs 55.8±9.0 mL/m2, P=0.089) between before and immediately after TAVI. LVEF (61.0±2.8%, P=0.721) and LVEDVI (58.0±9.1 mL/m2, P=0.949) 1-year after TAVI were similar to those before TAVI. There was no significant difference in coronary flow velocity at rest between before and immediately after TAVI (27.4±8.9 vs 24.4±7.0 cm/s, P=0.051) and between before and 1-year after TAVI (25.9±8.3 cm/s, P=0.396). Coronary flow velocity at maximal hyperemia 1-year after TAVI significantly increased compared with that before TAVI (from 48.8±13.9 to 67.9±21.0 cm/s, P<0.001) while there was no significant difference between before and immediately after TAVI (52.0±12.0 cm/s, P=0.186). Impaired CFR before TAVI (1.82±0.28) increased immediately (2.03±0.39, P=0.009) and 1-year after TAVI (2.69±0.57, P<0.001).

Conclusions

The present results suggest that impaired CFR in patients with preserved LVEF improves 1-year after TAVI. TAVI may have a good effect on CFR in severe AS patients with preserved LVEF.

Funding Acknowledgement

Type of funding sources: None.

Diagnostic Accuracy of Diastolic Fractional Flow Reserve for Functional Evaluation of Coronary Stenosis

Background

In the resting conditions, narrowing the window of coronary pressure measurements from the whole cardiac cycle to diastole improves diagnostic performance of coronary pressure–derived physiological index. However, whether this also applies to the hyperemic conditions has not yet been thoroughly evaluated.

Objectives

The purpose of this study was to assess whether diastolic fractional flow reserve (diastolic FFR) has better diagnostic performance in identifying ischemia-causing coronary lesions than conventional FFR in a prospective, multicenter, and independent core laboratory–based environment.

Methods

In this prospective multicenter registry at 29 Japanese centers, we compared the diagnostic performance of FFR, diastolic FFR, resting distal to aortic coronary pressure (Pd/Pa), and diastolic pressure ratio (dPR) using myocardial perfusion scintigraphy (MPS) as the reference standard in 378 patients with single-vessel coronary disease.

Results

Inducible myocardial ischemia was found on MPS in the relevant myocardial territory of the target vessel in 85 patients (22%). In the receiver-operating curve analyses, diastolic FFR had comparable area under the curve (AUC) compared with FFR (AUC_{diastolic FFR}: 0.66; 95% confidence interval [CI]: 0.58-0.73, vs AUC_FFR: 0.66; 95% CI: 0.58-0.74, P = 0.624). FFR and diastolic FFR showed significantly larger AUCs than resting Pd/Pa (0.62; 95% CI: 0.54-0.70; P = 0.033 and P = 0.046) but did not show significantly larger AUCs than dPR (0.62; 95% CI: 0.55-0.70; P = 0.102 and P = 0.113).

Conclusions

Diastolic FFR showed a similar diagnostic performance to FFR as compared with MPS. This result reaffirms the use of FFR as the most accurate invasive physiological lesion assessment. (Diagnostic accuracy of diastolic fractional flow reserve (d-FFR) for functional evaluation of coronary stenosis; UMIN000015906)

Gefitinib induction followed by chemoradiotherapy in EGFR-mutant, locally advanced non-small-cell lung cancer: LOGIK0902/OLCSG0905 phase II study

Background

The role of epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) induction coupled with standard concurrent chemoradiotherapy (CRT) is unclear in unresectable, stage III, EGFR-mutant non-small-cell lung cancer (NSCLC). Therefore, a phase II trial was conducted to evaluate the efficacy and safety of gefitinib induction followed by CRT in this disease setting.

Patients and methods

Patients with unresectable, EGFR-mutant, stage III NSCLC were administered gefitinib monotherapy (250 mg/day) for 8 weeks. Subsequently, patients without disease progression during induction therapy were administered cisplatin and docetaxel (40 mg/m² each) on days 1, 8, 29, and 36 with concurrent radiotherapy at a total dose of 60 Gy. The primary endpoint was the 2-year overall survival (OS) rate, which was hypothesized to reach 85%, with a threshold of the lower limit of 60%.

Results

Twenty patients (median age: 66 years; male/female: 9/11; histology: 20 adenocarcinoma; stage IIIA/IIIB: 9/11; and exon 19/21: 10/10) were enrolled. The 2-year OS rate was 90% (90% confidence interval: 71.4% to 96.8%), indicating that this trial met the primary objective. The overall response rate and 1- and 2-year progression-free survival rates were 85.0%, 58.1%, and 36.9%, respectively. Grade ≥3 adverse events (>10%) included hepatic toxicity during the induction phase and neutropenia and febrile neutropenia in the CRT phase. Radiation pneumonitis grade ≥3 or treatment-related death did not occur.

Conclusions

This is the first prospective study to demonstrate the favorable efficacy and safety of EGFR-TKI induction followed by standard CRT in EGFR-mutant, stage III NSCLC. Further confirmatory studies are needed.

•

This is the first prospective study evaluating gefitinib induction followed by CRT in EGFR-mutated, locally advanced NSCLC.

•

The 2-year OS rate was 90% (90% confidence interval: 71.4% to 96.8%), indicating that this trial met the primary objective.

•

The objective response rate throughout the treatment protocol was 85.0% (17 of 20).

•

The safety findings were consistent with the known safety profiles of all agents administered.

•

Our results might raise a critical point that needs to be evaluated in further studies to improve the cure rate.

High sensitivity cardiac troponin T is a useful biomarker for predicting prognosis of the patients with sarcoidosis

Background

Cardiac involvement is one of the most significant prognostic factors for the patients with sarcoidosis. In spite of the advancement of diagnostic tools, such as cardiac magnetic resonance imaging or 18F-fluoro-2-deoxyglucose positron emission tomography, there is still significant room for improvement in cardiac screening and prognostic prediction.

Purpose

To evaluate the prognostic factors for the patients with sarcoidosis.

Methods and results

We prospectively studied 133 patients with sarcoidosis and evaluated clinical data including biomarkers. The mean age at diagnosis was 62.1±12.8 years. During a mean follow up period of 5.6±4.1 years, nine patients died and 27 patients suffered from cardiac events (cardiac death, heart failure admission, arrhythmic event). We divided patients into two groups according to cardiac events, event group had high serum high-sensitivity cardiac troponin T (hs-cTnT) (0.028±0.017 vs. 0.015±0.011 ng/ml, p<0.001), high BNP (409.2±634.0 vs. 122.4±195.8 pg/ml, p<0.001), low EF (43.1±16.4 vs. 59.2±15.5%, p<0.001). This was observed even if those patients were not diagnosed with cardiac involvement at the enrollment. On the other hand, there were no significant differences in the values of angiotensin-converting enzyme, lysozyme, soluble interleukin-2 receptor, or calcium in both groups. Multivariate analysis revealed that hs-cTnT was an independent biomarker to predict cardiac events (hs-cTnT >0.014 ng/ml: HR 3.2, 95% CI 1.02 to 10.19, p=0.046).

Conclusion

Hs-cTnT was a useful biomarker for predicting cardiac events for the patients with sarcoidosis even if cardiac involvement was not detected at initial evaluation.

Figure 1

Funding Acknowledgement

Type of funding source: None

Baseline clinical features in a large-scale registration survey of patient with hypertrophic cardiomyopathy throughout Japan: J-HCM registry study

Background

Hypertrophic cardiomyopathy (HCM) is a most prevalent primary myocardial disorder with heterogeneous clinical features. However, there have been few studies on clinical features of HCM as a prospective cohort. In 2015, we established a large-scale registration survey of patients with HCM throughout Japan, named J-HCM registry study.

Purpose

The aim of this study was to clarify the clinical features of Japanese patients with HCM.

Methods

J-HCM registry study is a prospective, multicenter investigation, consisting of 24 hospitals. This time, we present the baseline clinical characteristics in this survey.

Results

Total 1484 patients were registered. The ages at registration and at diagnosis were 65±15 and 56±17 years, respectively, and 806 patients (54%) were men. Majority of the patients (95%) was NYHA class I or II. With regard to subtypes of HCM, there were 526 patients (36%) in the HCM with left ventricular (LV) outflow tract obstruction, 126 patients (8%) in the mid-ventricular obstruction, 57 patients (4%) in the end-stage phase characterized by LV ejection fraction <50%, and 197 patients (14%) in apical HCM. At registration, 80 patients (6%) had prior successful recovery from sustained ventricular tachycardia or ventricular fibrillation, 162 patients (11%) suffered from heart failure hospitalization, and 64 patients (4%) had history of embolic event. Regarding invasive treatment, 160 patients (10%) had prior septal reduction therapy and 162 patients (11%) had ICD implantation. According to the 2014 European Society of Cardiology Guidelines on sudden cardiac death (SCD) prevention, the study patients were divided into 3 categories by the HCM Risk-SCD calculator: patients distribution, 4% in the high risk group (≥6% calculated HCM Risk-SCD at 5 years), 7% in the intermediate risk group (4% to <6%), 69% in the low risk group (<4%), and 16% in the patients with extreme characteristics (Figure 1).

Conclusions

In this multicenter registration survey of patients with HCM, the baseline clinical characteristics were almost similar to several retrospective large-scale cohorts in Western countries except older age and less symptomatic state. This study will provide important knowledge regarding management of HCM.

Figure 1

Funding Acknowledgement

Type of funding source: None

Prognostic impact of atrial fibrillation in patients with hypertrophic cardiomyopathy in a community-based Japanese cohort: results from Kochi RYOMA study

Background

The prognostic impact of atrial fibrillation (AF) in patients with hypertrophic cardiomyopathy (HCM) is not fully elucidated.

Purpose

The aim of this study was to examine the prevalence and prognostic impact of AF in a prospectively assembled community-based HCM patient cohort in an aged Japanese community.

Methods

In 2004, we established a cardiomyopathy registration network in Kochi Prefecture, Japan, consisting of 9 hospitals, and finally 293 patients with HCM were followed.

Results

The ages at registration and at diagnosis were 63±14 and 56±16 years, respectively, and 197 patients (67%) were men. 86 patients (29%) showed AF. During follow-up period of 6.1±3.2 years, 44 patients died. In those patients, HCM-related deaths occurred in 23 patients with an annual mortality rate of 1.3%. Regarding HCM-related adverse events including HCM-related deaths, appropriate ICD discharge, heart failure admission and hospitalization for embolic events, a total of 77 cardiovascular events in 70 patients occurred. Multivariate analysis revealed that presence of AF, left ventricular (LV) outflow obstruction, NYHA functional class III, and lower LV fractional shortening at registration were significant predictors of these adverse events. During the follow-up period, additional 31 patients (11%) developed new-onset AF. Importantly, the incidence of HCM-related adverse events was significantly higher in patients with new AF observed from its onset compared with those with AF at registration (log-rank p=0.029) (Figure 1).

Conclusions

In an unselected HCM registry in an aged Japanese community, presence of AF, particularly new-onset AF, was associated with unfavorable clinical outcomes. AF is not just a marker of the disease stage but an important trigger of HCM-related adverse events.

Figure 1

Funding Acknowledgement

Type of funding source: None

Mapping of a New Deformation Region around ^{62}Ti

We performed the first direct mass measurements of neutron-rich scandium, titanium, and vanadium isotopes around the neutron number 40 at the RIKEN RI Beam Factory using the time-of-flight magnetic-rigidity technique. The atomic mass excesses of ^{58-60}Sc, ^{60-62}Ti, and ^{62-64}V were measured for the first time. The experimental results show that the two-neutron separation energies in the vicinity of ^{62}Ti increase compared to neighboring nuclei. This shows that the masses of Ti isotopes near N=40 are affected by the Jahn-Teller effect. Therefore, a development of Jahn-Teller stabilization appears below the Cr isotopes, and the systematics in Sc, Ti, and V isotopes suggest that ^{62}Ti is located close to the peak of the Jahn-Teller effect.

How Different is the Core of ^{25}F from ^{24}O_{g.s.} ?

The structure of a neutron-rich ^{25}F nucleus is investigated by a quasifree (p,2p) knockout reaction at 270A  MeV in inverse kinematics. The sum of spectroscopic factors of π0d_{5/2} orbital is found to be 1.0±0.3. However, the spectroscopic factor with residual ^{24}O nucleus being in the ground state is found to be only 0.36±0.13, while those in the excited state is 0.65±0.25. The result shows that the ^{24}O core of ^{25}F nucleus significantly differs from a free ^{24}O nucleus, and the core consists of ∼35% ^{24}O_{g.s.}. and ∼65% excited ^{24}O. The result may infer that the addition of the 0d_{5/2} proton considerably changes neutron structure in ^{25}F from that in ^{24}O, which could be a possible mechanism responsible for the oxygen dripline anomaly.

Halo Structure of the Neutron-Dripline Nucleus ^{19}B

The heaviest bound isotope of boron ^{19}B has been investigated using exclusive measurements of its Coulomb dissociation, into ^{17}B and two neutrons, in collisions with Pb at 220  MeV/nucleon. Enhanced electric dipole (E1) strength is observed just above the two-neutron decay threshold with an integrated E1 strength of B(E1)=1.64±0.06(stat)±0.12(sys)  e^{2} fm^{2} for relative energies below 6 MeV. This feature, known as a soft E1 excitation, provides the first firm evidence that ^{19}B has a prominent two-neutron halo. Three-body calculations that reproduce the energy spectrum indicate that the valence neutrons have a significant s-wave configuration and exhibit a dineutronlike correlation.

Fragmentation of Single-Particle Strength around the Doubly Magic Nucleus ^{132}Sn and the Position of the 0f_{5/2} Proton-Hole State in ^{131}In

Spectroscopic factors of neutron-hole and proton-hole states in ^{131}Sn and ^{131}In, respectively, were measured using one-nucleon removal reactions from doubly magic ^{132}Sn at relativistic energies. For ^{131}In, a 2910(50)-keV γ ray was observed for the first time and tentatively assigned to a decay from a 5/2^{-} state at 3275(50) keV to the known 1/2^{-} level at 365 keV. The spectroscopic factors determined for this new excited state and three other single-hole states provide first evidence for a strong fragmentation of single-hole strength in ^{131}Sn and ^{131}In. The experimental results are compared to theoretical calculations based on the relativistic particle-vibration coupling model and to experimental information for single-hole states in the stable doubly magic nucleus ^{208}Pb.

P1518 Relationship between post-operative asymptomatic status and reverse remodeling of large left atrium in patients with aortic stenosis who underwent aortic valve replacement

Introduction

Recently, we have reported that large left atrial volume (minimum left atrial volume index : LAVImin ≥30ml/m²) at end-diastole determined by direct exposure of left ventricular (LV) end-diastolic pressure can predict post-operative symptomatic status after aortic valve replacement (AVR) in aortic stenosis (AS) patients with high sensitivity and modest specificity. Reverse remodeling of large LAVImin after AVR may contribute to false positive for the prediction of post-operative symptomatic status in patients with AS.

Purpose

The purpose of this study was to evaluate relationship between post-operative symptomatic status and reverse remodeling of large LAVImin in patients with AS who underwent AVR.

Methods

The study population consisted of 75 patients with AS who underwent AVR and were followed up for 600 days after AVR, after the exclusion of the followings; atrial fibrillation, significant coronary artery disease, significant mitral valve disease, pacemaker rhythm, and inadequate echocardiographic images. We measured LAVImin by biplane Simpson"s method before and after AVR. Preoperative large LAVImin (≥30ml/m²) according to the previous study was observed in 32 (43%) of 75 patients. We divided these 32 patients into two groups according to the post-operative symptomatic status during the follow-up period.

Results

There was no significant difference in pre-operative LAVImin between patients with and without post-operative symptom (46.5 ± 13.4 vs 40.4 ± 8.6 ml/m²). On the other hand, post-operative LAVImin in patients without post-operative symptom was significantly smaller than that in patients with post-operative symptom (31.5 ± 8.6 vs 54.8 ± 14.0 ml/m², p < 0.01). While significant regression in LAVImin after AVR was observed in patients without post-operative symptom (40.4 ± 8.6 to 31.5 ± 8.6 ml/m², p < 0.05), no regression in LAVImin after AVR was observed in patients with post-operative symptom (46.5 ± 13.4 to 54.8 ± 14.0 ml/m²).

Conclusions

Reverse remodeling of large LAVmin in patients with AS who underwent AVR was observed in post-operative asymptomatic group, but not in symptomatic group. These results suggest that reverse remodeling of large LAVImin after AVR could contribute to the post-operative asymptomatic status in patients with AS who underwent AVR.

P91 Prognostic value of tissue-tracking mitral annular displacement by speckle-tracking echocardiography in asymptomatic patients with aortic stenosis with preserved left ventricular ejection fraction

Background

  Management of asymptomatic severe aortic stenosis (AS) patients with preserved left ventricular (LV) ejection fraction (EF) remains controversial. Recent studies using have shown that decreased LV longitudinal deformation assessed by global longitudinal strain analysis can predict adverse cardiac events in AS patients with preserved EF. Tissue-tracking mitral annular displacement (TMAD) by speckle-tracking echocardiography provides rapid and simple assessment of LV longitudinal deformation even when the acoustic window is poor (Fig.1).

Purpose

 The purpose of this study was to examine the value of TMAD to predict occurrence of the cardiac events in asymptomatic severe AS patients with preserved EF.

Methods

  We studied 103 patients with severe AS and preserved EF [aortic velocity >4m/s or aortic valve area (AVA) <1.0 cm2, EF >50%]in whom TMAD was measured, and a total of 44 patients were included in the final data setaccording to the exclusion criteria. Using TMAD analysis software, the base-to-apex displacement of automatically defined mid-point of mitral annular line in four-chamber view was quickly assessed, and the percentage of its displacement to LV length at end-diastole (%TMAD) was calculated (Fig.1). We investigated the association between %TMAD and the cardiac events including implementation of hospitalization due to heart failure, decreased EF (< 50%), aortic valve replacement or transcatheter aortic valve implantation due to appearance of symptoms and cardiac death, 

Results

 In all the final study patients, %TMAD was successfully and quickly (within 10 seconds) evaluated. During a follow-up, the cardiac events developed in 16 (36%) of 44 patients. Tableshows echocardiographic parameters in patients with and without the cardiac events. %TMAD was significantly impaired in patients with the cardiac events compared with those without the cardiac events (9.6 ± 0.6 vs 12.1 ± 0.4%, p= 0.002). The other parameters were not involved in the event occurrence; age, LV mass index, EF, aortic velocity, AVA, tricuspid regurgitation pressure gradient (TR-PG), early diastolic /atrial filling velocity (E/A), early diastolic velocity of the mitral valve annulus (e’) and E/e’. In multiple variable analysis, %TMAD was an independentpredictor of the cardiac events (HR; 12.1, p= 0.001). ROC analysis revealed that the area under the curve of %TMAD was 0.81 for the cardiac events. Kaplan-Meier analysis showed %TMAD (cut-off: 11.9) provides a significant difference in the cardiac event (Fig. 2). Conclusions.  The present results suggests that TMAD easily and rapidly estimated by speckle-tracking echocardiography can be used as a simple method to predict occurrence of the cardiac events in asymptomatic severe AS patients with preserved EF.

Abstract P91 Figure 1,2 and Table

Cross-section measurement in the reactions of 136Xe on proton, deuteron and carbon

The isotopic production cross sections for the reactions of 136Xe induced by proton, deuteron and carbon at 168 MeV/u were obtained by using the inverse kinematics technique at RIKEN Radioactive Isotope Beam Factory. The target dependence of the cross sections was investigated systematically. It was found that for the light-mass products, the cross sections on carbon are larger than those on deuteron and proton. The measured cross sections on proton were compared with the previous data at higher reaction energies to study the energy dependence. The experimental results were compared with the theoretical calculations including both the intranuclear cascade and evaporation processes using PHITS and with the EPAX and SPACS empirical parameterizations.

Near misses and presenteeism among paramedics

BACKGROUND

Paramedics need to be in good physical health to be able to respond to emergencies. We hypothesized that near misses by paramedics and unanticipated incidents that cause no harm may be associated with presenteeism during emergency rescues.

AIMS

To examine the association between presenteeism and near misses among paramedics.

METHODS

A cross-sectional study was conducted among 254 paramedics using a self-administered questionnaire. Presenteeism was measured using the work functioning impairment scale (WFun).

RESULTS

Twelve per cent of respondents experienced high work function impairment indicating presenteeism. The rate of near-miss experiences steadily increased with increasing work function impairment among paramedics (WFun score category: middle, odds ratio (OR) 3.62, 95% confidence interval (CI) 1.62-8.11; high, OR 4.36, 95% CI 1.37-13.84; very high, OR 8.62, 95% CI 2.09-35.48).

CONCLUSIONS

This study demonstrated a positive relationship between impaired work function indicating presenteeism and near misses among paramedics. This suggests that presenteeism may be associated with errors that have the potential to cause serious accidents. Improved access to treatment for frequent health problems may reduce the number of incidents among paramedics.

Location of the Neutron Dripline at Fluorine and Neon

A search for the heaviest isotopes of fluorine, neon, and sodium was conducted by fragmentation of an intense ^{48}Ca beam at 345  MeV/nucleon with a 20-mm-thick beryllium target and identification of isotopes in the large-acceptance separator BigRIPS at the RIKEN Radioactive Isotope Beam Factory. No events were observed for ^{32,33}F, ^{35,36}Ne, and ^{38}Na and only one event for ^{39}Na after extensive running. Comparison with predicted yields excludes the existence of bound states of these unobserved isotopes with high confidence levels. The present work indicates that ^{31}F and ^{34}Ne are the heaviest bound isotopes of fluorine and neon, respectively. The neutron dripline has thus been experimentally confirmed up to neon for the first time since ^{24}O was confirmed to be the dripline nucleus nearly 20 years ago. These data provide new keys to understanding the nuclear stability at extremely neutron-rich conditions.

P3536Prevalence and clinical impact of social frailty in elderly patients hospitalized for acute decompensated heart failure: a multicenter prospective cohort study

Purpose

The aim of this study was to investigate clinical characteristics of socially frail patients and an association with social frailty and short-term rehospitalization for worsening heart failure.

Methods

We analyzed 169 elderly patients (≥65 years old) hospitalized for acute decompensated heart failure (ADHF) between June 2017 and August 2018 in our prospective HF registry in Japan. The patients with activities of daily living dependence and without data of social frailty and outcome were excluded. Social frailty was determined based on their responses to the 5 questions (living alone, eating alone, going out less frequently, rarely visiting friends, not helpful to friends or family). Patients with none of these components were considered social non-frailty; those with one component were considered social prefrailty; those with two or more components were considered social frailty. The outcome was rehospitalization for worsening HF within 6 months after discharge.

Results

The mean age was 79±8 years old. Social frailty in 86 patients (50.8%), social prefrailty in 41 patients (24.3%), and social non-frailty in 42 patients (24.9%) were observed. Age, body mass index, geriatrics nutritional risk index, Hasegawa dementia rating scale-revised score, gait speed, and handgrip strength values were significantly different among the these three groups (all Ps for trend <0.01). Left ventricular ejection fraction, brain natriuretic peptide values, and the proportion of the patients with the symptom of New York Heart Association class III/IV did not vary significantly between the groups. Kaplan-Meier analysis revealed that higher prevalence of rehospitalization for worsening HF within 6 months in the social frailty group compared to that in the social non-frailty group (Log-rank p<0.05). In a Cox proportional hazard model after adjusting covariates, patients with social frailty (hazard ratio 4.77; 95% CI 1.61–14.12, p<0.005) and social prefrailty (hazard ratio 3.73; 95% CI 1.12–12.41, p<0.05) had an increased risk of rehospitalization for worsening HF within 6 months compared with those with social non-frailty.

Conclusion

This study revealed that social frailty was common in elderly patients hospitalized for ADHF, and social frailty was an independent predictor of rehospitalization for worsening HF within 6 months after discharge.

P1252Diagnostic performance of quantitative flow ratio from coronary angiography versus fractional flow reserve from computed tomography

Background

QFR and FFRCT are recently developed, less-invasive techniques for functional assessment of coronary artery disease.

Objectives

We compared the diagnostic performance between fractional flow reserve derived from computed tomography (FFRCT) and quantitative flow ratio (QFR) derived from coronary angiography, using FFR as the standard reference.

Methods

We measured FFRCT, QFR and FFR in 152 patients (233 vessels) with stable coronary artery disease.

Results

QFR was highly correlated with FFR (r=0.78, p<0.001), while FFRCT was moderately correlated with FFR (r=0.63, p<0.001). Both QFR and FFRCT showed good agreements with FFR, presenting small values of mean difference and root-mean-squared deviation (FFR -QFR: 0.02±0.09 and FFR -FFRCT: 0.03±0.11). The AUC of QFR was significantly greater than that of 3D-QCA-derived %DS (0.93 vs. 0.78; difference: 0.15; 95% CI: 0.09 to 0.20; p<0.001). The AUC of FFRCTwas significantly greater than that of CCTA-derived %DS (0.82 vs. 0.70; difference: 0.12; 95% CI: 0.05 to 0.19; p<0.001). The AUC of QFR was significantly greater than that of FFRCT (0.93 vs. 0.82; difference: 0.11; 95% CI: 0.05 to 0.16; p<0.001). The sensitivity, specificity, positive predictive value, and negative predictive valueof QFR ≤0.80 for predicting FFR ≤0.80 were 90%, 82%, 81%, and 90%, respectively. Those of FFRCT ≤0.80 for predicting FFR ≤0.80 were 82%, 70%, 70%, and 82%, respectively. The diagnostic accuracy of QFR ≤0.80 for predicting FFR ≤0.80 was 85% [95% confidence interval: 81% to 89%], while that of FFRCT≤0.80 for predicting FFR ≤0.80was 76% [95% confidence interval: 70% to 80%].

Figure 1. Comparison of FFR ≤0.80 predictors

Conclusions

Both QFR and FFRCTpossessed the ability to accurately evaluate the functional severity of coronary stenosis.

P2700Impact of instantaneous wave-free ratio on graft failure after coronary artery bypass graft surgery

Background

It has been reported that preoperative fractional flow reserve (FFR) is associated with graft patency after coronary artery bypass graft (CABG) and the patency is excellent when a bypass graft is anastomosed on a vessel with positive FFR. However, the association with graft patency has not yet been investigated in its novel counterpart, instantaneous wave-free ratio (iFR), and iFR sometimes contradicts FFR results.

Purpose

The purpose of this study is to assess an impact of preoperative iFR on a graft failure after CABG in patients with coronary arteries showing positive FFR (≤0.80).

Methods

We retrospectively identified patients who had undergone preoperative coronary angiography in conjunction with resting and hyperemic intra-coronary pressure measurements, CABG, and graft evaluation by coronary computed tomography angiography. After excluding vessels with negative FFR (>0.80), vessels were divided into two groups: negative iFR group (iFR >0.89) and positive iFR group (iFR ≤0.89). The rate of graft failure within 1 year after CABG was compared between the two groups.

Results

We analyzed 131 vessels in 89 patients (35 vessels in the negative iFR group and 96 vessels in the positive iFR group). The negative iFR group showed significantly higher iFR (0.92±0.02 vs. 0.74±0.13, P<0.0001) and FFR (0.72±0.06 vs. 0.63±0.09, P<0.0001) than the positive iFR group, although percent diameter stenosis (%DS) was comparable (57±10 vs. 56±9, P=0.47). The graft failure significantly often occurred in the negative iFR group than in the positive iFR group (28.6% vs. 8.3%, P=0.0029). In order to reduce the imbalance in the baseline characteristics except for iFR, 70 vessels were selected by using propensity score matching (n=35 in each group). The propensity score matched vessels also demonstrated significantly higher rate of graft failure in the negative iFR group than in the positive iFR group (28.6% vs. 5.7%, p=0.026) despite much more balanced FFR (0.72±0.06 vs. 0.69±0.07, p=0.02) and %DS (57±10 vs. 57±9, p=1.000).

Conclusions

Even when FFR is positive, the graft failure is likely to occur when a bypass graft is anastomosed on a vessel with negative iFR compared to a vessel with positive iFR.

Acknowledgement/Funding

None

P3387Cholesterol crystals in superficial plaque layer detected by optical coherence tomography as a new morphological feature for plaque rupture

Background

While plaque rupture (PR) is the leading cause of acute myocardial infarction (AMI), other etiologies are also involved in the onset of AMI. Cholesterol crystals (CCs) are usually present abundantly in atherosclerotic plaques, especially in the culprit site of AMI. However, the relationship between in vivo CCs and PR is unclear. Optical coherence tomography (OCT) is a high-resolution imaging technique that allows for the in vivo identification of various plaque characteristics including PR and CCs.

Purpose

The aim of this study was to investigate prevalence and distribution of CCs between patients with AMI with PR, AMI without PR, and SAP.

Method

This study consisted of 146 patients with coronary artery disease (AMI with PR; n=64, AMI without PR; n=41, and SAP; n=41) who underwent OCT prior to percutaneous coronary intervention. Plaque characteristics in OCT images were assessed according to the consensus document. We classified the distribution of CCs as follows; superficial type CCs were defined by any of the CCs invading the fibrous cap and remaining CCs as deep type CCs.

Result

There was no statistical difference in clinical characteristics among the three groups. The % diameter stenosis was significantly smaller in the SAP group than others (AMI with PR 91±12% vs. AMI without PR 86±13% vs. SAP 65±9%, p<0.001). The prevalence of CCs was significantly higher in the AMI with PR group than others (AMI with PR 78% vs. AMI without PR 41% vs. SAP 39%, p<0.001). The prevalence of superficial type CCs was significantly different among the groups (AMI with PR 72% vs. AMI without PR 24% vs. SAP 7%, p<0.001). Multivariable logistic analysis demonstrated that lipid plaque (OR 84.5, 95% CI [6.30–11332.33], p<0.001) and superficial type CC (OR 9.5, 95% CI [2.61–34.89], p<0.001) were independent predictors of PR.

Conclusion

Plaque with CCs invading the fibrous cap is frequently associated with PR in patients with AMI, suggesting. In vivo CC detection is a new morphological feature for plaque rupture.

Acknowledgement/Funding

This study was supported by a grant from JSPS KAKENHI (17K09557).

P3365Relationship between early diastolic intra-ventricular pressure gradient shortly after aortic valve closure estimated by vector flow mapping and left ventricular diastolic untwisting rate in humans

Background

Early diastolic suction is an important determinant of early diastolic function. Previous studies using color Doppler M-mode and speckle-tracking echocardiography have shown left ventricular (LV) early diastolic LV untwisting rate is directly related to LV intra-ventricular pressure gradient (IVPG) between LV base and apex during early diastole. Recent introduction of vector flow mapping (VFM) using combination of color Doppler and speckle-tracking echocardiography provides noninvasive and feasible assessment of early diastolic IVPG shortly after aortic valve closure including isovolmic relaxation period (ED-IVPG) in humans. However, relationship between VFM–derived ED-IVPG and early diastolic LV untwisting rate has not been well investigated.

Purpose

The purpose of this study was to examine relationship between ED-IVPG estimated by VFM and LV untwisting rate by speckle-tracking echocardiography.

Methods

The study population consists of 66 patients without segmental wall motion abnormality, significant valvular diseases, and atrial fibrillation who underwent echocardiography for evaluation of LV function (age: 60±15 years, LVEF: 49±16%). From the apical long-axis views by color Doppler echocardiography, we analyzed peak ED-IVPG between LV base and apex just after aortic valve closure (figure) using commercially available VFM analysis software (DAS-RS1, Hitachi). We assessed peak early diastolic LV untwisting rate and LV torsion from LV basal and apical short-axis view by speckle-tracking echocardiography. We evaluated correlation between ED-IVPG and LV untwisting rate. We also evaluated correlation between ED-IVPG and peak systolic LV torsion, LV end-diastolic (EDV) and end-systolic volumes (ESV), ejection fraction (EF), early diastolic velocity (E) of LV inflow, average early diastolic velocity (e') of mitral annulus, and average E/e'.

Results

In all the study patients, ED-IVPG was successfully and quickly evaluated. 1) ED-IVPG correlated well with peak LV untwisting rate (r=0.64, p<0.0001). 2) ED-IVPG significantly correlated with LV torsion, LVEDV, LVESV, and LVEF (r=0.47, r=−0.48, r=−0.46, and r=0.48, respectively, p<0.001). 3) There were no significant correlations between ED-IVPG and other indexes including E, average e', and average E/e'. According to receiver operating characteristic analysis, the best cut-off value of ED-IVPG for determining impaired LV untwisting rate (<80 degrees/s) was found at 0.42 mmHg (sensitivity 81%, specificity 76%, and area under the curve 0.86)

ED-IVPG measurement by VFM

Conclusions

The present results showed that noninvasive VFM-derived peak ED-IVPG shortly after aortic valve closure is related to early diastolic peak LV untwisting rate. ED-IVPG easily and quickly estimated by VFM may be used as an additional index for LV diastolic function.

P2453Value of pre-operative left atrial minimum volume as a surrogate for post-operative symptoms in patients with aortic stenosis who underwent aortic valve replacement

Background

Previous reports have shown that symptoms after aortic valve replacement (AVR) are not uncommon depending on severity of myocardial fibrosis in patients with severe aortic stenosis (AS). Pre-operative minimum left atrial volume (LAVmin) at end-diastole determined by direct exposure of left ventricular end-diastolic pressure may be used as a surrogate for post-operative symptoms in patients with severe AS undergoing AVR.

Purpose

The purpose of this study was to examine the value of pre-operative echocardiographic LAVmin index (LAVImin) to predict post-operative symptomatic status after AVR in patients with severe AS.

Methods

The study population consisted of 219 patients with severe AS who underwent AVR and were followed up for 1000 days after AVR. Pre-operative maximum LAV index (LAVImax), LAVImin, LA emptying fraction (LAEF), LV volume indexes, LV ejection fraction (LVEF) by biplane Simpson's method, aortic valve area index (AVAI), mean aortic valve pressure gradient (mAV-PG), E/A, mean E/e' from LV inflow and mitral annular velocity, and pulmonary artery systolic pressure (PASP) were evaluated by Doppler echocardiography.

Results

After exclusion of 136 patients who met the exclusion criteria (atrial fibrillation, significant coronary artery disease, significant mitral valve diseases, pacemaker rhythm, and inadequate echocardiographic images), the final study population consisted of 75 patients (75±7 years old, 46 female). During a follow-up, 19 patients (25%) complained post-operative symptoms. There were no significant differences in pre-operative serum hemoglobin, creatinine, BNP, chronic obstructive pulmonary disease, hypertension, diabetes, LV volume indexes, LVEF, AVA, mAV-PG between patients with and without post-operative symptoms. There were significant differences in pre-operative LAVImax, LAVImin, and LAEF between patients with and without post-operative symptoms. (60±15 vs 47±15 ml/m2, 45±15 vs 28±1 ml/m2, and 29±12 vs 42±11 ml/m2, respectively). E/A, mean E/e', and PASP in patients with symptoms were significantly greater compared with patients without symptoms (1.0±0.3 vs 0.7±0.2, 25±3 vs 18±2, 44±17 vs 32±9 mmHg, respectively). In the multivariate analysis, pre-operative LAVImin was the independent predictor of the post-operative symptomatic status after AVR (odds ratio: 1.11, 95% confidence interval: 1.04 - 1.18). Receiver operating characteristic analysis revealed that area under the curve (AUC) of LAVImin (cutoff: 30ml/m2) for post-operative symptoms was the largest (0.84) among the other echocardiographic parameters, and significantly larger than that of mean E/e' (0.67, *p<0.01) and LVEF (0.53, **p<0.05) (figure).

Figure 1. ROC analysis

Conclusions

The present results suggest that pre-operative echocardiographic LAVImin may be used as a surrogate for post-operative symptomatic status after AVR in patients with severe AS.

102Diagnosis of coronary plaque rupture, plaque erosion, and calcified nodule by using near-infrared spectroscopy intravascular ultrasound

Objectives

This study sought to investigate the ability of near-infrared spectroscopy intravascular ultrasound (NIRS-IVUS) to differentiate among plaque rupture (PR), plaque erosion (PE), and calcified nodule (CN) in acute myocardial infarction (AMI) using an optical coherence tomography (OCT) diagnosis as a reference standard.

Background

In vivo, precise differentiation among PR, PE and CN is a major challenge for intravascular imaging.

Methods

The study enrolled 156 AMI patients who had a de novo culprit lesion in a native coronary artery. The culprit lesions were assessed by both NIRS-IVUS and OCT.

Results

OCT identified 112 PR, 29 PE, and 15 CN. IVUS-detected plaque ulceration showed a high specificity (100%) to identify OCT-PR although the sensitivity (62%) was intermediate. IVUS-detected convex calcium showed a high sensitivity (93%) and specificity (100%) to identify OCT-CN. In NIRS, the maximum lipid core burden index in 4 mm (maxLCBI4mm) was greatest in OCT-PR (values are median [interquartile range]) (671 [530 to 853]), followed by OCT-CN (355 [303 to 432]) and OCT-PE (283 [89 to 357]) (p<0.001). MaxLCBI4mm of <422 was the best cut-off to discriminate OCT-PE from OCT-PR and OCT-CN. The NIRS-IVUS classification algorithm using plaque ulceration, convex calcium, and maxLCBI4mm <422 showed a sensitivity and specificity of 96% and 95% for identifying OCT-PR, 93% and 95% for OCT-PE, and 93% and 100% for OCT-CN, respectively.

NIRS-IVUS classification algorism

Conclusion

Lipid component assessed by NIRS-IVUS was different among OCT-PR, OCT-PE and OCT-CN. The NIRS-IVUS classification algorism was highly sensitive and specific for differentiating these unstable lesion types in AMI.

Acknowledgement/Funding

None

P4349Simple and rapid estimation of left ventricular longitudinal deformation by tissue-tracking mitral annular displacement in single apical view

Background

Noninvasive assessment of left ventricular (LV) deformation using global longitudinal strain (GLS) has prognostic value in patients with and without preserved ejection fraction (EF). Application of speckle-tracking technology to the mitral annulus provides rapid and easy assessment of displacement of septal and lateral mitral annulus and mid-point of mitral annular line in single apical view (TMAD) even in poor echo-image quality. TMAD may be used as a simple index of LV longitudinal deformation in patients with and without preserved EF (Figure).

Purpose

The purpose of this study was to examine whether TMAD can be used as a simple index of LV longitudinal deformation in patients with and without preserved EF.

Methods

The study population consists of 95 patients without segmental wall motion abnormality, significant valvular diseases, and atrial fibrillation in whom both TMAD and GLS measurements were applied by QLAB software (Philips). We estimated GLS from apical 4- and 2-chamber views and apical longitudinal views, and TMAD from apical 4-chamber view. TMAD was automatically and quickly evaluated as the base-to-apex displacement of septal (TMADsep), lateral (TMADlat), and mid-point of annular line (TMADmid) (Figure). The percentage of M-TMAD to LV length from the mid-point of mitral annuls to the apex at end-diastole (%TMADmid) was also calculated. We compared each TMAD values with GLS values by linear regression analysis, and evluated TMAD values by a receiver operating characteristic (ROC) analysis to detect impaired LV longitudinal deformation (|GLS|<12.0%).

Results

TMAD was successfully assessed in 94 of 95 patients (99%) while GLS was measured in 84 of 95 patients (87%, p=0.0082 vs TMAD). There were good correlations between each TMAD index and |GLS| (TMADsep:r=0.77, TMADlat:r=0.81, TMADmid:r=0.82, %TMADmid:r=0.87). According to ROC curve, the best cut-off values for TMADsep, TMADlat, TMADmid, and %TMADmid in determining LV longitudinal deformation were 6.8mm, 8.0mm, 7.8mm, and 9.5% respectively (Table).

Conclusions

The present results suggest that rapid and easy assessment of TMAD in single apical view may be used as a simple index of LV longitudinal deformation.

Improved Value for the Gamow-Teller Strength of the ^{100}Sn Beta Decay

A record number of ^{100}Sn nuclei was detected and new isotopic species toward the proton dripline were discovered at the RIKEN Nishina Center. Decay spectroscopy was performed with the high-efficiency detector arrays WAS3ABi and EURICA. Both the half-life and the β-decay end point energy of ^{100}Sn were measured more precisely than the literature values. The value and the uncertainty of the resulting strength for the pure 0^{+}→1^{+} Gamow-Teller decay was improved to B_{GT}=4.4_{-0.7}^{+0.9}. A discrimination between different model calculations was possible for the first time, and the level scheme of ^{100}In is investigated further.

Proton Shell Evolution below ^{132}Sn: First Measurement of Low-Lying β-Emitting Isomers in ^{123,125}Ag

The β-delayed γ-ray spectroscopy of neutron-rich ^{123,125}Ag isotopes is investigated at the Radioactive Isotope Beam Factory of RIKEN, and the long-predicted 1/2^{-} β-emitting isomers in ^{123,125}Ag are identified for the first time. With the new experimental results, the systematic trend of energy spacing between the lowest 9/2^{+} and 1/2^{-} levels is extended in Ag isotopes up to N=78, providing a clear signal for the reduction of the Z=40 subshell gap in Ag towards N=82. Shell-model calculations with the state-of-the-art V_{MU} plus M3Y spin-orbit interaction give a satisfactory description of the low-lying states in ^{123,125}Ag. The tensor force is found to play a crucial role in the evolution of the size of the Z=40 subshell gap. The observed inversion of the single-particle levels around ^{123}Ag can be well interpreted in terms of the monopole shift of the π1g_{9/2} orbitals mainly caused by the increasing occupation of ν1h_{11/2} orbitals.

First Observation of ^{20}B and ^{21}B

The most neutron-rich boron isotopes ^{20}B and ^{21}B have been observed for the first time following proton removal from ^{22}N and ^{22}C at energies around 230  MeV/nucleon. Both nuclei were found to exist as resonances which were detected through their decay into ^{19}B and one or two neutrons. Two-proton removal from ^{22}N populated a prominent resonancelike structure in ^{20}B at around 2.5 MeV above the one-neutron decay threshold, which is interpreted as arising from the closely spaced 1^{-},2^{-} ground-state doublet predicted by the shell model. In the case of proton removal from ^{22}C, the ^{19}B plus one- and two-neutron channels were consistent with the population of a resonance in ^{21}B 2.47±0.19  MeV above the two-neutron decay threshold, which is found to exhibit direct two-neutron decay. The ground-state mass excesses determined for ^{20,21}B are found to be in agreement with mass surface extrapolations derived within the latest atomic-mass evaluations.

Interleukin-18 is associated with the presence of interstitial lung disease in rheumatoid arthritis: a cross-sectional study

OBJECTIVE

Serum interleukin-18 (IL-18) levels are increased in patients with interstitial lung disease (ILD). In addition, IL-18 levels are increased in patients with rheumatoid arthritis (RA) and are associated with arthritis activity. We determined whether increased IL-18 levels are associated with ILD in RA.

METHOD

RA patients were enrolled using an RA cohort database. Plasma IL-18 levels were measured by enzyme-linked immunosorbent assay. ILD was determined by a pulmonologist and a radiologist based on chest radiography and computed tomography findings. IL-18 levels for RA with ILD and RA without ILD were compared. Associations between ILD and various markers including IL-18 and confounding factors (e.g. smoking history) were investigated by logistic regression analysis. Diagnostic values of IL-18 for the presence of ILD were investigated using receiver operating characteristics curve analysis.

RESULTS

ILD was complicated in 8.2% (n = 26) of the study population (N = 312). Plasma IL-18 levels were higher for RA patients with ILD than for RA patients without ILD (721.0 ± 481.4 vs 436.8 ± 438.9 pg/mL, p < 0.001). IL-18, Krebs von den Lungen-6, and anti-cyclic citrullinated peptide antibody titre and glucocorticoid doses were independently associated with the presence of ILD during multivariate logistic regression analysis. Sensitivity and specificity of IL-18 levels for the detection of ILD in RA patients were 65.3% and 76.3%, respectively (area under the curve = 0.73).

CONCLUSION

Plasma IL-18 levels were higher for RA patients with ILD than for those without ILD. Increased IL-18 levels were associated with the presence of ILD.

Extraction of the Landau-Migdal Parameter from the Gamow-Teller Giant Resonance in ^{132}Sn

The key parameter to discuss the possibility of the pion condensation in nuclear matter, i.e., the so-called Landau-Migdal parameter g^{'}, was extracted by measuring the double-differential cross sections for the (p,n) reaction at 216  MeV/u on a neutron-rich doubly magic unstable nucleus, ^{132}Sn with the quality comparable to data taken with stable nuclei. The extracted strengths for Gamow-Teller (GT) transitions from ^{132}Sn leading to ^{132}Sb exhibit the GT giant resonance (GTR) at the excitation energy of 16.3±0.4(stat)±0.4(syst)  MeV with the width of Γ=4.7±0.8  MeV. The integrated GT strength up to E_{x}=25  MeV is S_{GT}^{-}=53±5(stat)_{-10}^{+11}(syst), corresponding to 56% of Ikeda's sum rule of 3(N-Z)=96. The present result accurately constrains the Landau-Migdal parameter as g^{'}=0.68±0.07, thanks to the high sensitivity of the GTR energy to g^{'}. In combination with previous studies on the GTR for ^{90}Zr and ^{208}Pb, the result of this work shows the constancy of this parameter in the nuclear chart region with (N-Z)/A=0.11 to 0.24 and A=90 to 208.