Epicardial adipose tissue density predicts the presence of atrial fibrillation and its recurrence after catheter ablation: three-dimensional reconstructed image analysis

Epicardial adipose tissue (EAT) induces inflammation in the atria and is associated with atrial fibrillation (AF). Several studies have examined the relationship between EAT volume (EAT-V) and density (EAT-D) and the presence of AF after catheter ablation. However, conclusions have been inconsistent. This study included 43 consecutive patients who underwent catheter ablation for AF and 30 control patients. EAT-V and EAT-D around the entire heart, entire atrium, left atrium (LA), and right atrium (RA) were measured in detail using reconstructed three-dimensional (3D) EAT images from dual-source computed tomography (CT). None of the measurements of EAT-V differed significantly between patients with AF and controls or between patients with recurrent AF and those without. On the other hand, all measurements of EAT-D were higher in patients with AF than in controls (entire atrium, p < 0.001; RA, p < 0.001; LA, p = 0.002). All EAT-D measurements were associated with the presence of AF. Among patients with AF who underwent ablation, all EAT-D measurements were higher in patients with recurrent AF than in those without. The difference was significant for EATRA-D (p = 0.032). All atrial EAT-D values predicted recurrent AF (EATRA-D: hazard ratio [HR], 1.208; 95% confidence interval [95% CI], 1.053-1.387; p = 0.007; EATLA-D: HR, 1.108; 95% CI 1.001-1.225; p = 0.047; EATatrial-D: HR, 1.174; 95% CI 1.040-1.325; p = 0.010). The most sensitive cutoffs for predicting recurrent AF were highly accurate for EATRA-D (area under the curve [AUC], 0.76; p < 0.01) and EATatrial-D (AUC = 0.75, p < 0.05), while the cutoff for EATLA-D had low accuracy (AUC, 0.65; p = 0.209). For predicting the presence of AF and recurrent AF after catheter ablation, 3D analysis of atrial EAT-D, rather than EAT-V, is useful.

[Usefulness of Electron Density Calculated from Dual Energy CT in Differential Diagnosis between Hepatocellular Carcinoma and Hepatic Hemangioma]

PURPOSE

The aim of this study were to compare electron density (ED), obtained by dual energy computed tomography (DECT), between hepatocellular carcinoma (HCC) and hemangioma, and to assess the differential diagnostic performance of ED between HCC and hemangioma.

METHODS

A total of 46 patients (27 men and 19 women; mean age, 65.7±14.0 years) diagnosed with HCC or hemangioma who underwent upper abdominal DECT between October 2021 and December 2022 were included. ED of each lesion was measured. Relative ED (rED), which is normalized by the ED of background liver parenchyma, was calculated. ED and rED of HCC and hemangioma were statistically analyzed.

RESULTS

The HCC group showed significantly higher ED (48.1±5.2) and rED (80.0±7.3) than the hemangioma group (43.7±4.1, 69.7±7.2, respectively) (p<0.01). The area under the curve of rED was greater than that of ED, but no significant difference was found (p=0.153).

CONCLUSION

ED may help in the differential diagnosis between HCC and hemangioma.

Contrast-enhanced computed tomography in the venous rather than the arterial phase is essential for the evaluation of the right phrenic nerve

BACKGROUND

Preprocedural detection of the running course of the right pericardiophrenic bundles (PBs) is considered to be useful in preventing phrenic nerve (PN) injury during catheter ablation for atrial fibrillation (AF). However, previous studies using the arterial phase of contrast-enhanced computed tomography (CT) reported a relatively low right PBs detection rate.

METHODS

This study included 63 patients with AF who underwent catheter ablation and preoperative contrast-enhanced CT imaging of the venous and arterial phases (66.7 ± 10.2 years; 44 male). The venous phase of contrast-enhanced CT significantly improved the detection rate of PBs compared to the arterial phase (96.8% vs. 60.3%, p < .001), and PBs were detected in the venous phase only in 23 (36.7%) patients. No significant differences were observed between the right PBs detection rate using non-contrast CT versus the arterial phase of contrast-enhanced CT (p = .37). Patients without visualization of the right PBs during the arterial phase had a higher frequency of chronic heart failure (p = .0083), lower left ventricular ejection fraction (p = .021), and a higher CHADS2 score (p = .048) than those with visualization. In five patients whose right PBs could only be detected during the venous phase of contrast-enhanced CT, the reconstructed running course of the right PBs corresponded with the PN generated by electrical high-output pacing.

CONCLUSION

Contrast-enhanced CT images of the venous phase, rather than the arterial phase, are useful in detecting the right PBs, especially in patients with heart failure or reduced left ventricular ejection fraction.

Liver fibrosis estimated using extracellular volume fraction obtained from dual-energy CT as a risk factor for hepatocellular carcinoma after sustained virologic response: A preliminary case-control study

PURPOSE

To assess hepatocellular carcinoma (HCC) risk after sustained virologic response (SVR) through clinical data analyses, including evaluation of liver fibrosis using the extracellular volume fraction (ECV) obtained from dual-energy computed tomography (DECT).

METHODS

Ninety-two patients (52 men and 40 women; mean age, 69.9 years) with hepatitis C virus infection after SVR underwent DECT of the liver (3-minute equilibrium-phase images) between January 2020 and March 2022. The ECV was calculated by measuring iodine density; fibrous markers, including ECV, fibrosis-4 index, aspartate aminotransferase to platelet ratio index, and platelet count, were statistically analyzed (p < 0.05). The risk factors associated with HCC were analyzed using univariate and multivariate logistic regression analyses.

RESULTS

The ECV (26.1 ± 4.6 %) in patients with HCC (n,21) was significantly larger than the ECV (20.7 ± 3.3 %) in patients without HCC (n = 71) (p < 0.001). The cutoff value for the ECV was 24.3 %. The area under the operating characteristic curve of the ECV was 0.857, which was higher than that of the serum fibrosis markers. Older age, SVR achieved with interferon, alpha-fetoprotein level (>5 ng/mL), advanced fibrosis before treatment (>F3), and ECV were associated with HCC according to the univariate analysis. Multivariate analyses showed that ECV was the only factor independently associated with HCC (odds ratio 0.619, 95 % confidence interval 0.482-0.795, p < 0.001).

CONCLUSION

Liver fibrosis estimated using ECV can be a predictive marker in patients with HCC after SVR.

Erratum: Search for Cosmic-Ray Boosted Sub-GeV Dark Matter Using Recoil Protons at Super-Kamiokande [Phys. Rev. Lett. 130, 031802 (2023)]

This corrects the article DOI: 10.1103/PhysRevLett.130.031802.

Multi-Institutional Fact-Finding Study: Association between Geriatric Assessment and Reduction in Intensity of Radiotherapy for Elderly Cancer Patients without Metastasis

PURPOSE/OBJECTIVE(S)

Vulnerable patients receive a low-intensity, palliative treatment rather than the standard treatment. Defining vulnerability in terms of standard or reduced radiation intensity can result in appropriate radiotherapy for elderly cancer patients without excessive adverse events and poor outcomes. However, it is difficult to define vulnerability, because radiation oncologists hesitate to include vulnerable patients in clinical trials involving radical radiotherapy. We hypothesized that for elderly cancer patients without metastasis, vulnerability scores, obtained by geriatric assessment (GA), could help in predicting the reduction in radiation intensity determined by radiation oncologists based on their experience.

MATERIALS/METHODS

In this multicenter prospective study, we enrolled cancer patients (70 years or older) without metastasis. The reduction in radiation intensity was categorized into 3 groups as follows: i) standard schedule of radiotherapy, but conversion of irradiation fields, ii) standard irradiation fields, but converted schedule of radiotherapy, and iii) conversion of radiotherapy schedule and irradiation fields. Standard radiotherapy was defined as recommended doses and radiation fields according to the guidelines for the primary tumors analyzed. GA was performed by calculating geriatric 8 (G8) and vulnerable elders survey (VES-13) scores before radiotherapy and 3-5 and 8-16 weeks after completion of radiotherapy. The primary endpoint was to evaluate the correlation between vulnerability assessed by G8 and change in radiation intensity.

RESULTS

Between November 2020 and February 2022, 317 patients were included in this study at 13 centers in Japan. The median age was 77 (range, 70-90) years. The primary cancer sites were head and neck, esophagus, lungs, breasts, pancreas, bladder, uterus, and prostate in 63, 22, 62, 48, 6, 5, 26, and 85 patients, respectively. High-precision radiotherapy was performed for 199 patients (63%). Of the 31 patients (10%) whose radiation intensity was reduced, 14, 9, and 8 patients were provided i, ii, and iii category, respectively. Planned radiotherapy was completed for 312 patients (98%). G8 and VES-13 vulnerability scores were obtained for 201 and 61 patients, respectively, before radiotherapy. The mean G8 and VES-13 scores were 13.3 ± 2.4 and 1.8 ± 1.8, 12.9 ± 2.6 and 2.0 ± 2.0, and 13.4 ± 2.4 and 2.0 ± 1.9 before radiotherapy and 3-5 and 8-16 weeks after completion of radiotherapy, respectively. Multivariate analysis revealed that reduction in radiation intensity was significantly associated with vulnerability assessed using VES-13 (p < 0.001) but not G8 (p = 0.06).

CONCLUSION

An excellent completion rate was obtained for planned radiotherapy, and vulnerability assessed using VES-13, not G8, was associated with the reduction in intensity of radiotherapy.

Measurements of neutrino oscillation parameters from the T2K experiment using 3.6×1021 protons on target

The T2K experiment presents new measurements of neutrino oscillation parameters using 19.7 ( 16.3 ) × 10 20 protons on target (POT) in (anti-)neutrino mode at the far detector (FD). Compared to the previous analysis, an additional 4.7 × 10 20 POT neutrino data was collected at the FD. Significant improvements were made to the analysis methodology, with the near-detector analysis introducing new selections and using more than double the data. Additionally, this is the first T2K oscillation analysis to use NA61/SHINE data on a replica of the T2K target to tune the neutrino flux model, and the neutrino interaction model was improved to include new nuclear effects and calculations. Frequentist and Bayesian analyses are presented, including results on sin 2 θ 13 and the impact of priors on the δ CP measurement. Both analyses prefer the normal mass ordering and upper octant of sin 2 θ 23 with a nearly maximally CP-violating phase. Assuming the normal ordering and using the constraint on sin 2 θ 13 from reactors, sin 2 θ 23 = 0 . 561 - 0.032 + 0.021 using Feldman-Cousins corrected intervals, and Δ m 32 2 = 2 . 494 - 0.058 + 0.041 × 10 - 3 eV 2 using constant Δ χ 2 intervals. The CP-violating phase is constrained to δ CP = - 1 . 97 - 0.70 + 0.97 using Feldman-Cousins corrected intervals, and δ CP = 0 , π is excluded at more than 90% confidence level. A Jarlskog invariant of zero is excluded at more than 2 σ credible level using a flat prior in δ CP , and just below 2 σ using a flat prior in sin δ CP . When the external constraint on sin 2 θ 13 is removed, sin 2 θ 13 = 28 . 0 - 6.5 + 2.8 × 10 - 3 , in agreement with measurements from reactor experiments. These results are consistent with previous T2K analyses.

Analysis of Urinary Retention Caused by Selective β 3-adrenoceptor Agonists Using the Japanese Adverse Drug Event Report Database (JADER)

Overactive bladder (OAB) is a frequent chronic disorder which impairs quality of life by frequent, uncontrollable urination. Newly developed selectiveβ 3-adrenoceptor agonists (sβ 3-agonists) have the same efficacy in treating OAB but significantly fewer side effects than the traditionally used anti-muscarinics. However, safety data on these compounds are scarce. In this study, we analysed the occurrence of adverse effects in patients taking sβ 3-agonists and their characteristics using the JADER database. The most frequently reported adverse effect associated with the use of sβ 3-agonists was urinary retention [mirabegron; crude reporting odds ratios (ROR): 62.1, 95% confidence interval (CI): 52.0-73.6, P<0.001, vibegron; crude ROR: 250, 95% CI : 134-483, P<0.001]. Data from patients with urinary retention were stratified by sex. In both men and women, the rate of urinary retention was higher when using the mirabegron/anti-muscarinic drug when compared to mirabegron monotherapy; its occurrence was higher in men with a history of benign prostatic hypertrophy than in those without. Weibull analysis showed that approximately 50% of sβ 3 agonist-induced urinary retention occurred within 15 days after initiation of treatment, and then gradually decreased. Although sβ 3-agonists are useful against OAB, they may induce several side effects, especially urinary retention, which can further evolve into more severe conditions. Urinary retention occurs more frequently in patients concomitantly taking medication that either increases urethral resistance or has organic factors that block the urethra. When using sβ 3-agonists, the concomitantly used medications and underlying diseases should be thoroughly reviewed, and safety monitoring should be instituted early during the treatment.

Extracellular volume fraction obtained by dual-energy CT depicting the etiological differences of liver fibrosis

PURPOSE

To assess etiological differences in extracellular volume fraction (ECV) and evaluate its influence on staging performance.

METHODS

A total of 166 patients with normal liver (n = 14) and chronic liver disease related to viral hepatitis (n = 71), alcohol (n = 44), and nonalcoholic steatohepatitis (NASH) (n = 37) underwent dual-energy CT (DECT) of the liver (5-min equilibrium-phase images) between January 2020 and July 2022. The iodine densities of the parenchyma and aorta were measured and ECV was calculated. Comparisons of ECV between each etiology and METAVIR fibrosis stage were statistically analyzed (p < 0.05).

RESULTS

ECV in each etiology and all patients significantly increased with higher fibrosis stage (p < 0.001) and showed a strong or moderate correlation with fibrosis stage (Spearman's ρ; all patients, 0.701; viral hepatitis, 0.638; alcoholic, 0.885; NASH, 0.791). In stages F2-F4, ECV in alcoholic liver disease was significantly larger than those for viral hepatitis and NASH (p < 0.05); however, no significant difference in stage F1 was found among the three etiologies. The cutoff values and areas under the receiver operating characteristic curve (AUC-ROCs) for discriminating fibrosis stage (≥ F1- ≥ F4) were higher for alcohol (cutoff values and AUC-ROC; 20.1% and 0.708 for ≥ F1, 23.8% and 0.990 for ≥ F2, 24.3% and 0.968 for ≥ F3, and 26.6% and 0.961 for ≥ F4, respectively) compared with those for the others.

CONCLUSION

ECV in alcoholic liver disease is higher than that in other etiologies in the advanced stages of fibrosis, and etiological differences in ECV affect the staging performance of fibrosis.

Search for Cosmic-Ray Boosted Sub-GeV Dark Matter Using Recoil Protons at Super-Kamiokande

We report a search for cosmic-ray boosted dark matter with protons using the 0.37  megaton×years data collected at Super-Kamiokande experiment during the 1996-2018 period (SKI-IV phase). We searched for an excess of proton recoils above the atmospheric neutrino background from the vicinity of the Galactic Center. No such excess is observed, and limits are calculated for two reference models of dark matter with either a constant interaction cross section or through a scalar mediator. This is the first experimental search for boosted dark matter with hadrons using directional information. The results present the most stringent limits on cosmic-ray boosted dark matter and exclude the dark matter-nucleon elastic scattering cross section between 10^{-33}cm^{2} and 10^{-27}cm^{2} for dark matter mass from 1  MeV/c^{2} to 300  MeV/c^{2}.

Arrhythmogenic superior vena cava manifesting after a right-sided pneumonectomy and mediastinal lymph node dissection

No case of AF ablation after right-sided pneumonectomy has been reported, presumably because the pneumonectomy renders the ablation procedure more difficult than lobectomy because of the marked mediastinal displacement. In the case of catheter ablation of AF after right-sided pneumonectomy, it is extremely important to insert a mapping catheter not only into the PV but also into the SVC to accurately diagnose the site of abnormal electrical activity.

DNA damage induced by radiation exposure from cardiac catheterization – an analysis in patients and operators

Background

The biological effects of low-dose radiation from cardiac imaging or intervention remain largely unknown. This study aimed to evaluate the effects of ionized radiation from cardiac catheterization on genomic DNA integrity and inflammatory cytokines in patients and operators.

Methods

Peripheral mononuclear cells (MNCs) were isolated from patients (n=52) and operators (n=35) before and after coronary angiography and/or percutaneous coronary intervention. Expression of gammaH2AX, a marker for DNA double-strand breaks, was measured by immunofluorescence. Dicentric chromosomes (DICs), a form of chromosome aberrations, were assayed using a fluorescent in situ hybridization technique.

Results

In the patient MNCs, the numbers of gammaH2AX foci and DICs increased after cardiac catheterization by 101±75% and 28±99%, respectively (P&lt;0.05 for both). The mRNA expressions of interleukin (IL)-1α, IL-1β, leukemia inhibitory factor (LIF) and caspase-1 were significantly increased by radiation exposure from cardiac catheterization. The increase in IL-1β was significantly correlated with that of gammaH2AX, but not with dose area product. In the operators, neither gammaH2AX foci nor DICs level was changed, but IL-1β mRNA was significantly increased. Protein expression of IkappaBα was significantly decreased in both groups.

Conclusions

DNA damage was increased in the MNCs of patients, but not of operators, who underwent cardiac catheterization. Inflammatory cytokines were increased both in the patients and operators, presumably through activation of NF-kappaB. Further efforts to reduce radiation exposure from cardiac catheterization are necessary both for patients and operators.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Grants-in-Aid for Scientific Research (KAKENHI)

CHEMORESISTANCE RELATED TO HYPOXIA ADAPTATION IN MESOTHELIOMA CELLS FROM TUMOR SPHEROIDS

BACKGROUND

Hypoxia has been noted as a key factor for induction and maintenance of cancer stemness thereby leading to therapy resistance. Three-dimensional (3D) spheroid models demonstrate a heterogeneity of hypoxic regions replicating the in vivo situation within tumors. Utilizing an established 3D spheroid model, we investigated whether extrinsic hypoxia reinforced chemoresistance in malignant pleural mesothelioma (MPM) spheroids.

MATERIALS AND METHODS

Tumor spheres were generated from Meso-1 (a typical human MPM cell line) cells having high spheroid-forming ability. To induce hypoxia condition, we utilized a hypoxia chamber with regulation of O2 and CO2 levels. Cell viability was estimated by a WST-8 assay. Real-time polymerase chain reaction and Western blot were performed to evaluate the expression at mRNA and protein levels.

RESULTS

Compared with cells cultured in the two-dimensional monolayer model, tumor sphere cells showed elevated mRNA levels of cancer stemness markers (CD26, CD44 and ABCG2) and protein levels of the stemness and hypoxia adaptation markers (ABCG2, ALDH1A1 and HIFs). Correlating with this, 3D spheroid cells were more resistant to permetrexed and topotecan than the two-dimensional cells, indicative of their potential for hypoxic adaptation. Furthermore, significantly stronger resistance to both chemotherapeutic agents was observed in spheroid cells upon hypoxic challenge compared to spheroid cells under normoxia.

CONCLUSION

From the present data, it is concluded that hypoxia adaptation of MPM cells from tumor spheres could enhance their chemoresistance.

Genetic diversity of Lactobacillus delbrueckii isolated from raw milk in Hokkaido, Japan

Lactic acid bacteria (LAB) play important roles in acid production and flavor formation in fermented dairy products. Lactic acid bacteria strains with distinct characteristics confer unique features to products. Diverse LAB have been identified in raw milk and traditional fermented milk prepared from raw milk. However, little is known about LAB in raw milk in Japan. To preserve diverse LAB as potential starters or probiotics for future use, we have isolated and identified various kinds of LAB from raw milk produced in Japan. In this study, we focused on Lactobacillus delbrueckii, one of the most important species in the dairy industry. We identified L. delbrueckii subspecies isolated from raw milk in Hokkaido, Japan, by analyzing intraspecific diversity using 4 distinct methods, hsp60 cluster analysis, multilocus sequence analysis, core-genome analysis, and whole-genome analysis based on average nucleotide identity. The subspecies distribution and a new dominant subset of L. delbrueckii from raw milk in Japan were revealed. The discovery of new strains with different genotypes is important for understanding the geographic distribution and characteristics of the bacteria and further their use as a microbial resource with the potential to express unconventional flavors and functionalities. The strains identified in this study may have practical applications in the development of fermented dairy products.

Development of retake support system for lateral knee radiographs by using deep convolutional neural network

INTRODUCTION

Lateral radiography of the knee joint is frequently performed; however, the retake rate is high owing to positioning errors. Therefore, in this study, to reduce the required number and time of image retakes, we developed a system that can classify the tilting directions of lateral knee radiographs and evaluated the accuracy of the proposed method.

METHODS

Using our system, the tilting directions of a lateral knee radiographs were classified into four direction categories. The system was developed by training the DCNN based on 50 cases of Raysum images and tested on three types test dataset; ten more cases of Raysum images, one case of flexed knee joint phantom images and 14 rejected knee joint radiographs. To train a deep convolutional neural network (DCNN), we employed Raysum images created via three-dimensional (3D) X-ray computed tomography (CT); 11 520 Raysum images were created from 60 cases of 3D CT data by changing the projection angles. Thereby, we obtained pseudo images attached with correct labels that are essential for training.

RESULTS

The overall accuracy on each test dataset was 88.5 ± 7.0% (mean ± standard deviation), 81.4 ± 11.2%, and 73.3 ± 9.2%. The larger the tilting degree of the knee joint, the higher the classification accuracy.

CONCLUSION

DCNN could classify the tilting directions of a knee joint from lateral knee radiographs. Using Raysum images made it possible to facilitate creating dataset for training DCNN. The possibility was indicated for using support system of lateral knee radiographs.

IMPLICATIONS FOR PRACTICE

The system may also reduce the burden on patients and increase the work efficiency of radiological technologists.

Juzentaihoto extract suppresses adipocyte hypertrophy and improves hyperglycemia in KKAy mice

Juzentaihoto is a herbal medicine with reported anti-inflammatory effects, and it is predicted to improve inflammation and insulin sensitivity within obesity. In the present study, juzentaihoto hot water extract (JTT) was administered to obese type 2 diabetic model mice (KKAy) for 56 days. In addition, the effects of JTT on the adipose tissue, glucose metabolism, and blood lipids were evaluated for examining its impact on insulin sensitivity and obesity. As a result of JTT administration, KKAy mice exhibited suppressed adipocyte hypertrophy, decreased the mRNA levels of tumor necrosis factor α, and increased the mRNA levels of adiponectin in epididymal fat tissue. In addition, fasting blood glucose levels, blood triglyceride, and total cholesterol decreased. In summary, these data indicated that JTT administration suppressed the production of inflammatory cytokines and increased adiponectin levels in the adipose tissue. Therefore, with improved insulin sensitivity, blood glucose, and lipid decreased.

East Asian variant aldehyde dehydrogenase Type 2 genotype exacerbates myocardial ischemia/reperfusion injury in men among patients with ST-segment elevation myocardial infarction -sex differences-

Background

Mitochondrial aldehyde dehydrogenase 2 (ALDH2) detoxifies toxic aldehydes including those generated during ischemia/reperfusion (I/R) injury in acute myocardial infarction. The deficient variant ALDH2 genotype (ALDH2*2) is prevalent among East Asians. We examined whether ALDH2*2 exacerbates I/R injury in Japanese patients with acute ST-segment elevation myocardial infarction (STEMI) utilizing Mendelian randomization.

Methods and results

The study subjects comprised 248 Japanese patients with STEMI (187 men and 61 women, mean age 67.1±11.5) who underwent successful primary percutaneous coronary intervention. Of these patients, 129 (52.0%) were the carriers of ALDH2*2 and 119 (48.0%) those of wild ALDH2*1/*1 on genotyping by direct application of the TaqMan polymerase chain system. There were no differences in clinical characteristics between the ALDH2*2 and ALDH2*1/*1 group except lower alcohol habit in the ALDH2*2 group. However, the peak plasma levels of creatine phosphokinase myocardial binding (CKMB), a marker of myocardial injury, were significantly higher (a median 234.0 vs 150.0 U/L, P&lt;0.001 in the ALDH2*2 group. Furthermore, the peak CKMB levels were higher in ALDH2*2 group in men (a median 2 75.0 vs 144.9 U/L, P&lt;0.001) but not in women (P=0.855) and there was a significant interaction between sex and ALDH2*2 on I/R injury (χ2=8.362, P=0.004).

Conclusions

The peak plasma levels of CKMB were higher in STEMI patients with ALDH2*2 than in those with ALDH2*1/*1 among men but not women. These findings identified deficient ALDH2 activity to be targeted for treatment of STEMI specifically in men with ALDH2*2.

Visual overview

Funding Acknowledgement

Type of funding source: None

Relationship between effects of riociguat and levels of methemoglobin in patients with chronic thromboembolic pulmonary hypertension

Background

Soluble guanyl cyclase (sGC) is a receptor for nitric oxide (NO) and plays an important role in vascular tonus. sGC stimulant is a therapeutic agent for pulmonary hypertension and an advantage of sGC stimulant over phosphodiesterase (PDE)-5 inhibitors is that sGC stimulant exerts its effect even when NO production is reduced. NO derived from vascular endothelial cells is immediately absorbed by hemoglobin (Hb), which leads to the production of methemoglobin (Met-Hb) when oxidized. Previous report has shown that the therapeutic effect of PDE-5 inhibitors was associated with levels of Met-Hb.

Purpose

In this study, we examined the relationship between the effect of riociguat and levels of Met-Hb in patients with chronic thromboembolic pulmonary hypertension (CTEPH).

Methods

The study population comprised 18 patients with CTEPH. Mean pulmonary artery pressure (mPAP) and pulmonary vascular resistance (PVR) were assessed before and after administration of riociguat, and changes in mPAP and PVR were defined as ΔmPAP and ΔPVR, respectively. Since the level of Met-Hb was obtained as the percentage of Hb (FMet-Hb), the amount of Met-Hb was calculated by following formula:

Met-Hb (mg/dL) = Hb (g/dL) × FMet-Hb (%) × 10.

Results

The amount of Met-Hb value before administration of riociguat was significantly correlated with the degree of improvement in mPAP and PVR after administration of riocigat (R=−0.502, P&lt;0.05 mPAP; R=−0.481, P&lt;0.05 PVR, respectively) as shown in figures.

Conclusion

Our findings suggest that the level of Met-Hb before treatment may predict the therapeutic effect of sGC stimulants in patients with CTEPH.

Funding Acknowledgement

Type of funding source: None

Search for Electron Antineutrino Appearance in a Long-Baseline Muon Antineutrino Beam

Electron antineutrino appearance is measured by the T2K experiment in an accelerator-produced antineutrino beam, using additional neutrino beam operation to constrain parameters of the Pontecorvo-Maki-Nakagawa-Sakata (PMNS) mixing matrix. T2K observes 15 candidate electron antineutrino events with a background expectation of 9.3 events. Including information from the kinematic distribution of observed events, the hypothesis of no electron antineutrino appearance is disfavored with a significance of 2.40σ and no discrepancy between data and PMNS predictions is found. A complementary analysis that introduces an additional free parameter which allows non-PMNS values of electron neutrino and antineutrino appearance also finds no discrepancy between data and PMNS predictions.

Effect of high ligation on survival of patients undergoing surgery for primary colorectal cancer and synchronous liver metastases

Background

Although R0 surgery is recommended for stage IV colorectal cancer, the degree of required lymphadenectomy has not been established. The aim of this study was to investigate the prognostic impact of high ligation (HL) of the feeding artery and the number of retrieved lymph nodes after R0 surgery for colorectal cancer and synchronous colorectal cancer liver metastasis (CRLM).

Methods

This was a multi‐institutional retrospective analysis of patients with colorectal cancer and synchronous CRLM who had R0 surgery between January 1997 and December 2007. Clinical and pathological features were compared in patients who underwent HL and those who had a low ligation (LL). Kaplan–Meier analysis was performed to estimate the effect of HL on overall survival (OS). The impact of several risk factors on survival was analysed using the Cox proportional hazards model.

Results

Of 549 patients, 409 (74·5 per cent) had HL. Median follow‐up was 51·4 months. HL significantly improved the 5‐year OS rate (58·2 per cent versus 49·3 per cent for LL; P = 0·017). Multivariable analysis revealed HL to be a significant prognostic factor compared with LL (5‐year mortality: hazard ratio (HR) 0·68, 95 per cent c.i. 0·51 to 0·90; P = 0·007). In subgroup analysis, the positive effect of HL on OS was greatest in patients with lymph node metastasis.

Conclusion

HL of the feeding artery was associated with improved OS in patients with colorectal cancer and synchronous CRLM after R0 surgery.

P3117Usefulness of cardiac magnetic resonance imaging for early detection of subclinical chemotherapy-related cardiac dysfunction in cancer patients

Background

Long-term prognosis of cancer patients has been improved along with the progress in chemotherapies. However, chemotherapy-related cardiac dysfunction (CTRCD) is emerging as a serious adverse effect as it worsens patients' outcome and quality of life. Thus, early detection of subclinical CTRCD is an important emerging issue in the management of cancer patients. Cardiac magnetic resonance (CMR) utilizes parametric mapping approach and strain analysis to provide detailed information about cardiac tissue and diastolic cardiac function.

Purpose

We examined whether the novel CMR imaging techniques are useful for early detection of CTRCD.

Methods and results

We performed both retrospective and prospective studies. (1) Retrospective study: We retrospectively enrolled 52 cancer patients (mean age 55.6±13 yrs., M/F=14/38) who had been treated with anthracyclines. We examined the usefulness of CMR for quantitative assessment of myocardial fibrosis caused by chemotherapies. We found that native T1 value was significantly prolonged in cancer patients compared with healthy controls (N=10) (1,279±56 vs. 1,240±34 msec, P=0.036). (2) Prospective study: A total of 99 consecutive female patients with breast cancer treated with chemotherapies were enrolled in this study from August 2017 to January 2019. To evaluate CTRCD in those patients, we performed CMR (at baseline and/or 6 months) and biomarkers analysis for cardiac troponin T (cTnT) and BNP at baseline and every 3 months during chemotherapies. In the 99 patients, 52 (mean age 53.0±12.7 yrs.) completed cardiac assessment at 6 months, and 6 (12%) developed CTRCD defined as a reduction in left ventricular ejection fraction (LVEF) >10% from baseline and below 53% without symptoms. In patients with CTRCD (CTRCD group, N=6), as compared with those without it (non-CTRCD group, N=46), native T1 value was significantly prolonged after chemotherapies (1,303±32 vs. 1,322±22 msec at 6 months, P=0.03). Plasma cTnT levels at 3 months were also significantly higher in the CTRCD group compared with the non-CTRCD group [0.022 (IQR 0.015–0.026) vs. 0.01 (0.006–0.014) ng/mL, P=0.024], whereas there was no difference in BNP values. In the 52 patients, 28 (mean age 56.3±12.3 yrs.) underwent CMR both before and 6 months after chemotherapies. In those patients, LVEF and global radial strain were significantly decreased at 6 months from baseline (LVEF, from 70.5±4.6 to 66.0±7.1%; global radial strain, from 70.0±22.5 to 61.1±22.6%, respectively, both P<0.05). In patients with elevated cTnT levels at 3 months, as compared with those without it, LVEF and extracellular volume fraction (ECV) at 6 months were significantly worse (LVEF, 59.0±6.0 vs. 62.7±2.6%, P=0.042; ECV, 32.3±2.9 vs. 30.2±2.3%, P=0.049, respectively).

Conclusions

These results indicate that novel CMR imaging techniques are useful for early detection of CTRCD among cancer patients treated with chemotherapies.

Smectic Liquid-Crystalline Structure of Skyrmions in Chiral Magnet Co_{8.5}Zn_{7.5}Mn_{4}(110) Thin Film

The organizing of magnetic skyrmions shows several forms similar to atomic arrays of solid states. Using Lorentz transmission electron microscopy, we report the first direct observation of a stable liquid-crystalline structure of skyrmions in chiral magnet Co_{8.5}Zn_{7.5}Mn_{4}(110) thin film, caused by magnetic anisotropy and chiral surface twist. Elongated skyrmions are oriented and periodically arranged only in the ⟨110⟩ directions, whereas they exhibit short-range order along the ⟨001⟩ directions, indicating a smectic skyrmion state. In addition, skyrmions possess anisotropic interaction with an opposite sign depending on the crystal orientation, in contrast to existing isotropic interaction.

Abstract P5-01-03: Comparison of mammography findings between dense and non dense breast in Japanese subjects: The potential limitation of routine mammography

Introduction

Recently “Dense breast” has attracted numerous attention because of diagnostic difficulty in mammography among those harboring dense breast, which is far more frequent in Asian than Caucasian women. Therefore, in this study, we retrospectively evaluated the risks of subsequent development of malignancy through comparing the detailed mammographic characteristics between Japanese subjects harboring dense and non dense breasts.

Methods

We retrospectively examined mammorgraphic findings taken from March 2013 to March 2016 at Nahanishi Clinic, Okinawa, Japan. We stratified its density according to the suggestion of the Japan Central Organization on Quality Assurance of Breast Cancer Screening, which was defined by the proportion of fat area as follows; extremely high dense:10-20%, heterogeneously dense:40-50%, scattered fatty:70-90%, fatty: almost all the breast fat. “Dense breast” includes extremely high and heterogeneous dense. We evaluated the detailed radiological findings of each phenotypes including the characteristics of the mass, calcification and focal asymmetric density(FAD) and architectural distortion. We also compared the rates of subsequent cancer development and sensitivity of detecting cancer between those harboring dense and non dense breasts.

Results

We reviewed the mammography findings of 7747 Japanese women including 857 with breast cancers. When adjusted for age, the rate of dense breast was significantly associated with age, 88.6% in women in their 20s(vs40s p&lt;0.001 OR3.402), with incremental decrease, 80.4% in 30s(P&lt;0.001 OR1.802), 69.5% in 40s, 55.9% in 50s(P&lt;0.001 OR0.512), 32.3% in 60s(P&lt;0.001 OR 0.108), 19.5% in 70s(P&lt;0.001 OR 0.106) and 5.3% in over 80s(P&lt;0.001 OR0.024). The rate of malignancies was 9.1% (385) in dense and 13.6% (472) in non dense breasts. We then compared the mammographic findings between dense and non dense breast. Abnormal calcifications were detected more frequent(7.6%vs5.3% P&lt;0.001 OR1.478) but masses less so(16.4%vs23.7% P&lt;0.001 OR 0.632) in dense breast, while no significant differences detected in FADs(4.9%vs4.6% P=0.35 OR1.074) and distortions(1.2%vs1.4% P=0.29 OR=0.859) between dense and non dense breast. The rate of carcinoma was less frequent in dense breast among those associated with mammographic calcification(19%vs27.3% P&lt;0.01 OR0.626) but more frequently in dense breast among those with masses (13%vs19% P&lt;0.001 OR0.628). The rate of carcinoma was not different between dense and non dense breast in those with FADs (21.6vs20.6% P=0.72 OR1.067) and distortions(71.7%vs74.7% P=0.64 OR0.857). In addition, among 37 breast cancer patients who did not harbor the mammographic findings above (26 dense and 11 non dense breasts), the average mass length was significantly larger in dense (13.6mm) than non-dense breast (9.9mm) (P=0.018 used Welch's t test), respectively.

Conclusion

Results of our present study did demonstrate that detection of malignancy in those with mammographic dense breast is more difficult. Therefore, in those harboring dense breast in mammography, addition of other modalities such as US could improve the detection of breast carcinoma.

Citation Format: Takigami N, Tamaki K, Kamada Y, Uehara K, Terukina S, Ishida T, Miyashita M, McNamara KM, Tamaki N, Sasano H. Comparison of mammography findings between dense and non dense breast in Japanese subjects: The potential limitation of routine mammography [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-01-03.

Quality control of hospital preparations: Establishment of a simple and rapid method for quantifying ulinastatin in vaginal suppositories

Ulinastatin vaginal suppositories, used to prevent threatened premature delivery, are frequently used in hospitals. However, there is no established method for quantifying ulinastatin contained in suppositories. Therefore, we investigated a simple and efficient method for quantifying ulinastatin contained in suppositories. Our analytical method involved removal of the base; optimising the enzyme inhibition reaction time and enzyme reaction time; and measuring the absorbance. The modified method was reproducible, operation time was significantly shortened, and cost was reduced to approximately 1/17 of that of the previously reported method. This simple and rapid quantitative method could contribute to the improvement of quality control of ulinastatin vaginal suppositories as an extemporaneous hospital preparation.

Search for CP Violation in Neutrino and Antineutrino Oscillations by the T2K Experiment with 2.2×10^{21} Protons on Target

The T2K experiment measures muon neutrino disappearance and electron neutrino appearance in accelerator-produced neutrino and antineutrino beams. With an exposure of 14.7(7.6)×10^{20} protons on target in the neutrino (antineutrino) mode, 89 ν_{e} candidates and seven anti-ν_{e} candidates are observed, while 67.5 and 9.0 are expected for δ_{CP}=0 and normal mass ordering. The obtained 2σ confidence interval for the CP-violating phase, δ_{CP}, does not include the CP-conserving cases (δ_{CP}=0, π). The best-fit values of other parameters are sin^{2}θ_{23}=0.526_{-0.036}^{+0.032} and Δm_{32}^{2}=2.463_{-0.070}^{+0.071}×10^{-3}  eV^{2}/c^{4}.