Deep learning-based vessel automatic recognition for laparoscopic right hemicolectomy

BACKGROUND

In laparoscopic right hemicolectomy (RHC) for right-sided colon cancer, accurate recognition of the vascular anatomy is required for appropriate lymph node harvesting and safe operative procedures. We aimed to develop a deep learning model that enables the automatic recognition and visualization of major blood vessels in laparoscopic RHC.

MATERIALS AND METHODS

This was a single-institution retrospective feasibility study. Semantic segmentation of three vessel areas, including the superior mesenteric vein (SMV), ileocolic artery (ICA), and ileocolic vein (ICV), was performed using the developed deep learning model. The Dice coefficient, recall, and precision were utilized as evaluation metrics to quantify the model performance after fivefold cross-validation. The model was further qualitatively appraised by 13 surgeons, based on a grading rubric to assess its potential for clinical application.

RESULTS

In total, 2624 images were extracted from 104 laparoscopic colectomy for right-sided colon cancer videos, and the pixels corresponding to the SMV, ICA, and ICV were manually annotated and utilized as training data. SMV recognition was the most accurate, with all three evaluation metrics having values above 0.75, whereas the recognition accuracy of ICA and ICV ranged from 0.53 to 0.57 for the three evaluation metrics. Additionally, all 13 surgeons gave acceptable ratings for the possibility of clinical application in rubric-based quantitative evaluations.

CONCLUSION

We developed a DL-based vessel segmentation model capable of achieving feasible identification and visualization of major blood vessels in association with RHC. This model may be used by surgeons to accomplish reliable navigation of vessel visualization.

Artificial intelligence for the recognition of key anatomical structures in laparoscopic colorectal surgery

To prevent intraoperative organ injury, surgeons strive to identify anatomical structures as early and accurately as possible during surgery. The objective of this prospective observational study was to develop artificial intelligence (AI)-based real-time automatic organ recognition models in laparoscopic surgery and to compare its performance with that of surgeons. The time taken to recognize target anatomy between AI and both expert and novice surgeons was compared. The AI models demonstrated faster recognition of target anatomy than surgeons, especially novice surgeons. These findings suggest that AI has the potential to compensate for the skill and experience gap between surgeons.

Effect of common sedation agents on feline splenic size determined via ultrasonography

AIMS

To evaluate the effect of IM administration of three sedative drugs, acepromazine, alfaxalone and dexmedetomidine, in combination with morphine, on the size of the feline spleen using ultrasonography.

METHODS

Twenty-four client-owned cats undergoing elective de-sexing or minor procedures were recruited for a focused ultrasonographic examination of the spleen prior to and at 10, 20 and 30 minutes following administration of one of three randomly assigned IM sedation protocols: 0.05 mg/kg acepromazine (ACE group), 3 mg/kg alfaxalone (ALF group), or 10 μg/kg dexmedetomidine (DEX group), in combination with 0.5 mg/kg morphine. B-mode images of the spleen were collected and measured following a standardised protocol. Cardiorespiratory parameters and sedation score were also recorded. Mean thickness of the head, body and tail of the spleen for each group at 10, 20 and 30 minutes after drug administration was compared to baseline.

RESULTS

Mean splenic thickness increased over time in the ACE group (thickness of body at T0 = 8.9 (SE 2.1) mm and at T30 = 10.5 (SE 2.0) mm; p = 0.001) and the ALF group (thickness of body at T0 = 8.8 (SE 1.0) mm and at T30 = 10.3 (SE 1.7) mm; p = 0.022) but not in the DEX group (thickness of body at T0 = 8.6 mm (1.2) and at T30 = 8.9 mm (0.6); p = 0.67). Mean arterial blood pressure in the DEX group was significantly higher than in the other groups (p = 0.002). Sedation scores in the DEX group were consistently high for the entire period. However, the sedation score in the ACE group increased over 30 minutes (p = 0.007). Sedation score in the ALF group was highest at 10 minutes but gradually decreased over the following 20 minutes (p = 0.003).

CONCLUSIONS

Sedation with IM dexmedetomidine and morphine did not change splenic size, whereas acepromazine or alfaxalone and morphine increased it regardless of the degree of sedation.

CLINICAL RELEVANCE

Where splenomegaly is identified in a cat sedated with acepromazine or alfaxalone, the effects of the sedation protocol could be considered as a possible cause.

PEg TRAnsfer Workflow recognition challenge report: Do multimodal data improve recognition?

BACKGROUND AND OBJECTIVE

In order to be context-aware, computer-assisted surgical systems require accurate, real-time automatic surgical workflow recognition. In the past several years, surgical video has been the most commonly-used modality for surgical workflow recognition. But with the democratization of robot-assisted surgery, new modalities, such as kinematics, are now accessible. Some previous methods use these new modalities as input for their models, but their added value has rarely been studied. This paper presents the design and results of the "PEg TRAnsfer Workflow recognition" (PETRAW) challenge with the objective of developing surgical workflow recognition methods based on one or more modalities and studying their added value.

METHODS

The PETRAW challenge included a data set of 150 peg transfer sequences performed on a virtual simulator. This data set included videos, kinematic data, semantic segmentation data, and annotations, which described the workflow at three levels of granularity: phase, step, and activity. Five tasks were proposed to the participants: three were related to the recognition at all granularities simultaneously using a single modality, and two addressed the recognition using multiple modalities. The mean application-dependent balanced accuracy (AD-Accuracy) was used as an evaluation metric to take into account class balance and is more clinically relevant than a frame-by-frame score.

RESULTS

Seven teams participated in at least one task with four participating in every task. The best results were obtained by combining video and kinematic data (AD-Accuracy of between 93% and 90% for the four teams that participated in all tasks).

CONCLUSION

The improvement of surgical workflow recognition methods using multiple modalities compared with unimodal methods was significant for all teams. However, the longer execution time required for video/kinematic-based methods(compared to only kinematic-based methods) must be considered. Indeed, one must ask if it is wise to increase computing time by 2000 to 20,000% only to increase accuracy by 3%. The PETRAW data set is publicly available at www.synapse.org/PETRAW to encourage further research in surgical workflow recognition.

Deep-learning-based semantic segmentation of autonomic nerves from laparoscopic images of colorectal surgery: an experimental pilot study

BACKGROUND

The preservation of autonomic nerves is the most important factor in maintaining genitourinary function in colorectal surgery; however, these nerves are not clearly recognisable, and their identification is strongly affected by the surgical ability. Therefore, this study aimed to develop a deep learning model for the semantic segmentation of autonomic nerves during laparoscopic colorectal surgery and to experimentally verify the model through intraoperative use and pathological examination.

MATERIALS AND METHODS

The annotation data set comprised videos of laparoscopic colorectal surgery. The images of the hypogastric nerve (HGN) and superior hypogastric plexus (SHP) were manually annotated under a surgeon's supervision. The Dice coefficient was used to quantify the model performance after five-fold cross-validation. The model was used in actual surgeries to compare the recognition timing of the model with that of surgeons, and pathological examination was performed to confirm whether the samples labelled by the model from the colorectal branches of the HGN and SHP were nerves.

RESULTS

The data set comprised 12 978 video frames of the HGN from 245 videos and 5198 frames of the SHP from 44 videos. The mean (±SD) Dice coefficients of the HGN and SHP were 0.56 (±0.03) and 0.49 (±0.07), respectively. The proposed model was used in 12 surgeries, and it recognised the right HGN earlier than the surgeons did in 50.0% of the cases, the left HGN earlier in 41.7% of the cases and the SHP earlier in 50.0% of the cases. Pathological examination confirmed that all 11 samples were nerve tissue.

CONCLUSION

An approach for the deep-learning-based semantic segmentation of autonomic nerves was developed and experimentally validated. This model may facilitate intraoperative recognition during laparoscopic colorectal surgery.

Deep Learning-Based Seminal Vesicle and Vas Deferens Recognition in the Posterior Approach of Robot-Assisted Radical Prostatectomy

OBJECTIVE

To develop a convolutional neural network to recognize the seminal vesicle and vas deferens (SV-VD) in the posterior approach of robot-assisted radical prostatectomy (RARP) and assess the performance of the convolutional neural network model under clinically relevant conditions.

METHODS

Intraoperative videos of robot-assisted radical prostatectomy performed by the posterior approach from 3 institutions were obtained between 2019 and 2020. Using SV-VD dissection videos, semantic segmentation of the seminal vesicle-vas deferens area was performed using a convolutional neural network-based approach. The dataset was split into training and test data in a 10:3 ratio. The average time required by 6 novice urologists to correctly recognize the SV-VD was compared using intraoperative videos with and without segmentation masks generated by the convolutional neural network model, which was evaluated with the test data using the Dice similarity coefficient. Training and test datasets were compared using the Mann-Whitney U-test and chi-square test. Time required to recognize the SV-VD was evaluated using the Mann-Whitney U-test.

RESULTS

From 26 patient videos, 1 040 images were created (520 SV-VD annotated images and 520 SV-VD non-displayed images). The convolutional neural network model had a Dice similarity coefficient value of 0.73 in the test data. Compared with original videos, videos with the generated segmentation mask promoted significantly faster seminal vesicle and vas deferens recognition (P < .001).

CONCLUSION

The convolutional neural network model provides accurate recognition of the SV-VD in the posterior approach RARP, which may be helpful, especially for novice urologists.

POS0728 ASSOCIATION BETWEEN TREATMENT GOAL ACHIEVEMENT AND GRIT PERSONALITY CHARACTERISTICS OF ATTENDING PHYSICIAN IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS: A MULTICENTER CROSS-SECTIONAL STUDY

Background

In clinical practice for systemic lupus erythematosus (SLE), the concept of “treat to target” has been introduced with an established goal of reducing glucocorticoid dose as much as possible while controlling disease activity. Although it has been shown that various personality characteristics of patients with SLE affect their disease activity and damage, it is not clear whether the personality characteristics of attending physicians affect the outcomes of patients with SLE. Grit is a personality trait characterized by perseverance and passion for achieving long-term goals.

Objectives

This study aims to evaluate the relationship between attending physicians’ grit personality characteristics and treatment goal achievements in patients with SLE.

Methods

A cross-sectional study was conducted on 386 patients with SLE in five referral hospitals in Japan. The main exposure was the “perseverance” and “consistency” (scores 1-5) of the attending physicians, as measured by the Short Grit Scale, and the primary outcome was the achievement of the Lupus Low Disease Activity Score (LLDAS). Considering the clustering of achievement of LLDAS by each attending physician, the association between attending physician’s personality and LLDAS was analyzed by logistic regression with cluster robust variance estimation. Odds ratios to assess the relationship between perseverance and consistency and LLDAS were estimated with adjustment for confounders (age, sex, disease duration, hydroxychloroquine use, immunosuppressant use, and Systemic Lupus International Collaborating Clinics-Damage Index). We used multiple imputation to handle the uncertainty caused by missing values of potential confounders on the assumption of missing at random.

Results

The median age of the patients was 45 years (interquartile range[IQR],36-56), 88% were female, and the median disease duration was 152 months(IQR, 80-240). Thirty-seven doctors were in charge of the patients (1-79 patients/each doctor). The median age of the attending physicians was 40 years (IQR, 35-43), and 19% were female. The median perseverance and consistency scores of attending physicians were 3.1 (IQR, 3.0-3.5) and 3.3 (IQR, 2.8-3.8), respectively. Of the enrolled patients, 154 (40%) had achieved LLDAS. The attending physicians with a lower consistency score of <3 were more frequent in the patients who achieved LLDAS (40% vs. 29%, p=0.026). The lower consistency score of attending physicians was still related to LLDAS independently (adjusted odds ratio 1.63, 95% confidential interval 1.17-2.27). There was no association between the achievement of LLDAS and perseverance.

Conclusion

The grit personality characteristics of the attending physician may affect the achievement of treatment goals in patients with SLE.

Disclosure of Interests

KEN-EI SADA Speakers bureau: I received speaker’s fees from Glaxo Smith Kline K.K., Grant/research support from: I received a research grant from Pfizer Inc., Yoshia Miyawaki: None declared, Kenta Shidahara: None declared, Shoichi Nawachi: None declared, Yu Katayama: None declared, Yosuke ASANO: None declared, Keigo Hayashi: None declared, Keiji Ohashi: None declared, Eri Katsuyama: None declared, Takayuki Katsuyama: None declared, Mariko Narazaki: None declared, Yoshinori Matsumoto: None declared, Nao Oguro: None declared, Yuichi Ishikawa: None declared, Natsuki Sakurai: None declared, Chiharu Hidekawa: None declared, Ryusuke Yoshimi: None declared, Takanori Ichikawa: None declared, Dai Kishida: None declared, Yasuhiro Shimojima: None declared, Noriaki Kurita: None declared, Nobuyuki Yajima: None declared

POS1404 SHARED DECISION MAKING AND INTERNET USE FOR GATHERING HEALTH INFORMATION IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS: A MULTICENTER CROSS-SECTIONAL STUDY

Background

It is well known that providing appropriate health information to patients with systemic lupus erythematosus (SLE) has an advantage in the treatment decision making process. In modern information society the growing popularity of smartphones and social networking services, patients have more access to online health information. However, there are concerns that Internet use may inversely affect the shared decision making (SDM) process with their attending physicians if they receive inaccurate information.

Objectives

This study aimed to investigate how online information gathering behavior affects SDM with their attending physicians.

Methods

In this cross-sectional study, information of 386 patients with SLE, which were enrolled from five Japanese institutions between June 2020 and August 2021, were analyzed. The main exposure was time spent on the Internet per day (excluding time used for working). It was divided into four categories (none, <1 hour, 1-2 hours, > 2 hours). Patients were asked to select the source of health care information they would like to access first and were categorized into physicians, the Internet, and other media sources (family and friends, healthcare professionals other than physicians, or TV and radio, etc.). Outcome was shared decision making measured via the 9-item Shared Decision Making Questionnaire (SDM-Q-9 [scores 0-100]). To assess the relationship between the time of Internet use and SDM, we fitted general linear models adjusted for age, gender, education level, household income, marital status, history of cancer, disease duration, and disease activity. Chained equations were used to impute missing values of covariates.

Results

This study ultimately employed 334 patients whose mean age and female ratio were 45.3 years (standard deviation 13.8) and 87.7%, respectively. 68.9% of the patients indicated that they would like to access their physicians first, and 19.5% indicated that they would like to access the Internet first. Compared to patients who chose their physician as their first access to health information, there was no difference in SDM-Q-9 among patients who chose the Internet, but patients who chose other media had significantly lower SDM-Q-9 (-7.7 point, 95% confident interval [CI] -14.4 to -0.92, P=0.026). Besides, SDM-Q-9 scores were significantly lower in patients who did not use the Internet compared to those who used it for more than two hours except for their work activities (-9.6, 95%CI -18.9 to -0.26, P=0.044).

Conclusion

The present study suggests that SDM between physicians and patients is positively rather than adversely associated with online information-gathering behavior. Rheumatologists also need to be aware that how patients prefer to access health information to establish a good physician-patient relationship for SDM. In addition, rheumatologists may need to introduce their patients to websites offering appropriate health information.

Disclosure of Interests

None declared

OP0112 THE EVER-LARGEST ASIAN GWAS FOR SYSTEMIC SCLEROSIS AND TRANS-POPULATION META-ANALYSIS IDENTIFIED SEVEN NOVEL LOCI AND A CANDIDATE CAUSAL SNP IN A CIS-REGULATORY ELEMENT OF THE FCGR REGION

Background

Genome-wide association studies (GWASs) have identified 29 disease-associated single nucleotide polymorphisms (SNPs) for systemic sclerosis (SSc) in non-human leukocyte antigen (HLA) regions (1-7). While these GWASs have clarified genetic architectures of SSc, study subjects were mainly Caucasians limiting application of the findings to Asians.

Objectives

The study was conducted to identify novel causal variants for SSc specific to Japanese subjects as well as those shared with European population. We also aimed to clarify mechanistic effects of the variants on pathogenesis of SSc.

Methods

A total of 114,108 subjects comprising 1,499 cases and 112,609 controls were enrolled in the two-staged study leading to the ever-largest Asian GWAS for SSc. After applying a strict quality control both for genotype and samples, imputation was conducted using the reference panel of the phase 3v5 1,000 genome project data combined with a high-depth whole-genome sequence data of 3,256 Japanese subjects. We conducted logistic regression analyses and also combined the Japanese GWAS results with those of Europeans (6) by an inverse-variance fixed-effect model. Polygenicity and enrichment of functional annotations were evaluated by linkage disequilibrium score regression (LDSC), Haploreg and IMPACT programs. We also constructed polygenic risk score (PRS) to predict SSc development.

Results

We identified three (FCRLA-FCGR, TNFAIP3, PLD4) and four (EOMES, ESR1, SLC12A5, TPI1P2) novel loci in Japanese GWAS and a trans-population meta-analysis, respectively. One of Japanese novel risk SNPs, rs6697139, located within FCGR gene clusters had a strong effect size (OR 2.05, P=4.9×10-11). We also found the complete LD variant, rs10917688, was positioned in cis-regulatory element and binding motif for an immunomodulatory transcription factor IRF8 in B cells, another genome-wide significant locus in our trans-ethnic meta-analysis and the previous European GWAS. Notably, the association of risk allele of rs10917688 was significant only in the presence of the risk allele of the IRF8. Intriguingly, rs10917688 was annotated as one enhancer-related histone marks, H3K4me1, in B cells, implying that FCGR gene(s) in B cells may play an important role in the pathogenesis of SSc. Furhtermore, significant heritability enrichment of active histone marks and a transcription factor C-Myc were found in B cells both in European and Japanese populations by LDSC and IMPACT, highlighting a possibility of a shared disease mechanism where abnormal B-cell activation may be one of the key drivers for the disease development. Finally, PRS using effects sizes of European GWAS moderately fit in the development of Japanese SSc (AUC 0.593), paving a path to personalized medicine for SSc.

Conclusion

Our study identified seven novel susceptibility loci in SSc. Downstream analyses highlighted a novel disease mechanism of SSc where an interactive role of FCGR gene(s) and IRF8 may accelerate the disease development and B cells may play a key role on the pathogenesis of SSc.

References

[1]F. C. Arnett et al. Ann Rheum Dis, 2010.

[2]T. R. Radstake et al. Nat Genet, 2010.

[3]Y. Allanore et al. PLoS Genet, 2011.

[4]O. Gorlova et al. PLoS Genet, 2011.

[5]C. Terao et al. Ann Rheum Dis, 2017.

[6]E. López-Isac et al. Nat Commun, 2019.

[7]W. Pu et al. J Invest Dermatol, 2021.

Disclosure of Interests

None declared

AB0474 IMPACT OF HEALTH LITERACY ON TRUST IN PHYSICIANS AMONG PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS: THE TRUMP2-SLE PROJECT

Background

Information technology has expanded the gap in patient health literacy (HL), and HL has various implications on the trust in patient-doctor relationship. Previously, only functional HL, the ability to interpret health information through reading and writing skills, has been studied in patients with SLE (1).

Objectives

We examined how trust in physicians is affected by the broader concept of HL, including communicative HL, the ability to extract health information from communication to use, and critical HL, the ability to discern and use such information (2).

Methods

This cross-sectional study enrolled 362 SLE patients at 5 sites between June 2020 and August 2021. Three domains of HL (i.e., functional HL, communicative HL, and critical HL) were assessed using the 14-item FCCHL scale (range: 1-4 points for each domain). The outcomes were patients’ trust in their physicians and physicians in general and were measured using the Japanese version of the 5-item Wake Forest Physician Trust scales (range: 0-100 points for each scale). General linear models adjusted for age, gender, education, income, SLEDAI, disease duration, depression, and hours of Internet use were conducted. Subsequently, a series of general linear models were then fit to each of the three domains of HL to examine whether or not it was associated with the aforementioned covariates.

Results

The median age of the patients was 45 (interquartile range [IQR],34-55), 88% were female. The median value of SLEDAI was 4 ([IQR], 2-8), Trust in one’s physician was 80 ([IQR], 70-95) and trust in physicians generally was 65 ([IQR], 50-80). Trust in one’s physician increased with higher functional and communicative HL (per 1-pt increase, 3.2 [95%CI 0.7 to 5.9]; 5.4 [95%CI 1.6 to 9.3]). Trust in doctors generally increased with higher communicative HL and decreased with higher critical HL (per 1-pt increase, 6.8 [95% CI 2.0 to 12]; -6.7 [95% CI -12 to -1.9]). Lower functional HL was associated with older age and depression, while higher HL was associated with higher educational level. Higher communicative HL and critical HL were each associated with longer Internet use.

Conclusion

In patients with SLE, higher trust in one’s physician was associated with both functional and communicative HL, while higher trust in physicians generally was associated with higher communicative HL and lower critical HL. Our findings suggest that trusting relationships may be fostered by the encouragement of rheumatologists to cultivate patients’ ability to share their health problems with their physicians and family members and to obtain useful health information (i.e., communicative HL), rather than to improve their ability to discern health information (i.e., critical HL).

References

[1]Maheswaranathan M, Cantrell S, Eudy AM, Rogers JL, Clowse MEB, Hastings SN, et al. Investigating Health Literacy in Systemic Lupus Erythematosus: a Descriptive Review. Curr Allergy Asthma Rep. 2020;20(12):79.

[2]Ishikawa H, Takeuchi T, Yano E. Measuring functional, communicative, and critical health literacy among diabetic patients. Diabetes Care. 2008;31(5):874-9.

Disclosure of Interests

Nao Oguro: None declared, Nobuyuki Yajima: None declared, Yoshia Miyawaki: None declared, Ryusuke Yoshimi: None declared, Yasuhiro Shimojima: None declared, KEN-EI SADA Speakers bureau: He received speaker’s fees from Glaxo Smith

Kline K.K., Grant/research support from: He received a research grant from Pfizer Inc.,, Keigo Hayashi: None declared, Kenta Shidahara: None declared, Natsuki Sakurai: None declared, Chiharu Hidekawa: None declared, Dai Kishida: None declared, Takanori Ichikawa: None declared, Yuichi Ishikawa: None declared, Noriaki Kurita: None declared

Immunoglobulin A vasculitis post‐severe acute respiratory syndrome coronavirus 2 vaccination and review of reported cases

Immunoglobulin (Ig)A vasculitis/nephropathy is a systemic immune complex‐mediated vasculitis. Although severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) vaccination is widely recommended in individuals without specific allergy to the vaccine components, it is arguable whether vaccination is advisable for patients with IgA vasculitis or for predisposed individuals. We and others have presented cases of IgA vasculitis occurring after SARS‐CoV‐2 vaccination. In total, these 19 cases, including ours, involved predominantly female patients, and half of them were suffering from de novo vasculitis onset. The most frequent manifestation was gross hematuria (89.5%) while skin lesions were relatively infrequent, occurring in only five cases (26.3%), of which three (15.8%) were confirmed to be IgA vasculitis. Taken together, these cases suggest that SARS‐CoV‐2 vaccination might be a trigger for development/deterioration of IgA vasculitis/nephropathy.

Precise Measurement of Differential Cross Sections of the Σ^{-}p→Λn Reaction in Momentum Range 470-650 MeV/c

The differential cross sections of the Σ^{-}p→Λn reaction were measured accurately for the Σ^{-} momentum (p_{Σ}) ranging from 470 to 650  MeV/c at the J-PARC Hadron Experimental Facility. Precise angular information about the Σ^{-}p→Λn reaction was obtained for the first time by detecting approximately 100 reaction events at each angular step of Δcosθ=0.1. The obtained differential cross sections show a slightly forward-peaking structure in the measured momentum regions. The cross sections integrated for -0.7≤cosθ≤1.0 were obtained as 22.5±0.68 [statistical error(stat.)] ±0.65 [systematic error(syst.)] mb and 15.8±0.83(stat)±0.52(syst)  mb for 470<p_{Σ}(MeV/c)<550 and 550<p_{Σ}(MeV/c)<650, respectively. These results show a drastic improvement compared with past measurements of the hyperon-proton scattering experiments. They will play essential roles in updating the theoretical models of the baryon-baryon interactions.

Bone density in youth with prediabetes: results from the National Health and Nutrition Examination Survey, 2005-2006

Youth with type 2 diabetes might have suboptimal peak bone mass, but it is unknown whether similar effects are evident in youth with prediabetes. Results from this study suggest that diabetes-related effects on peak bone mass likely occur before disease onset, and involve the muscle-bone unit.

INTRODUCTION

Type 2 diabetes might adversely influence bone health around the age of peak bone mass, but it is unknown whether diabetes-related effects on areal bone mineral density (aBMD) are evident in youth with prediabetes. We compared age-related trends in aBMD and associations between lean body mass (LBM) and aBMD between children and adolescents with prediabetes vs. normal glucose regulation.

METHODS

Cross-sectional analysis of data from the National Health and Nutrition Examination Survey (2005-2006) in youth ages 12-20 years (49% female, 34% black) with prediabetes (n = 267) and normal glucose regulation (n = 1664). Whole body aBMD and LBM were assessed via DXA. LBM index (LBMI) and Z-scores for aBMD and LBMI were computed.

RESULTS

Unadjusted between-group comparisons revealed greater mean weight and LBMI Z-scores in youth with prediabetes vs. normal glucose regulation, but similar bone Z-scores between the two groups. While accounting for differences in BMI Z-score, there was a significant interaction between prediabetes status and age with respect to whole body aBMD Z-score (P < 0.05), such that children with prediabetes tended to have increased aBMD but adolescents and young adults with prediabetes tended have lower aBMD. Furthermore, the positive association between LBMI and whole body aBMD was moderated in youth with prediabetes (P < 0.001), who had slightly lower whole body aBMD for a given LBMI (P = 0.068). Lumbar spine bone measures did not differ between the two groups.

CONCLUSIONS

Type 2 diabetes-related threats to peak bone mass might occur prior to disease onset, therefore potentially impacting a considerable proportion of US youth.

X ray spectroscopy on 𝚵− atoms (J-PARC E03, E07 and future)

X-ray spectroscopy of hadronic atoms is a powerful method to study strong interaction between hadrons and nuclei. At J-PARC, we have conducted two experiments, J-PARC E07 and E03, for hadronic atoms with a doubly strange hyperon, Ξ−, aiming at the world-first detection of their X-rays. The first measurement is performed as a byproduct of J-PARC E07 experiment with the hybrid emulsion technique. The second one, J-PARC E03, is a dedicated experiment for detection of Ξ− Fe atom X rays. The preliminary results and the present status of E07 and E03 are shown in this article. Future prospects of Ξ−-atomic X-ray spectroscopy are also discussed. A new measurement has been proposed for detecting Ξ− C atom X rays, where a novel Ξ− tracking method will be applied to realize an improved signal to noise ratio.

Results of the 𝚵− atomic X-ray measurement in J-PARC E07

Ξ− atomic X-ray spectroscopy is one of the most useful methods for investigation of the Ξ-nucleus strong interaction. A serious problem in the measurement is the significant background coming from in-flight Ξ− decay. For the first Ξ− atomic X-ray spectroscopy experiment, a novel method of identifying stopped Ξ− events using nuclear emulsion was developed to reject background photons from in-flight Ξ− decay. We succeeded in reducing the background to 1/170 by this method employing coincidence measurements using the nuclear emulsion and X-ray detectors.

Recent progress and future prospects of hyperon nucleon scattering experiment

A new hyperon-proton scattering experiment, dubbed J-PARC E40, was performed to measure differential cross sections of the Σ+p, Σ−p elastic scatterings and the Σ−p → Λn scattering by identifying a lot of Σ particles in the momentum ranging from 0.4 to 0.8 GeV/c produced by the π±p → K+Σ± reactions. We successfully measured the differential cross sections of these three channels with a drastically improved accuracy with a fine angular step. These new data will become important experimental constraints to improve the theories of the two-body baryon-baryon interactions. Following this success, we proposed a new experiment to measure the differential cross sections and spin observables by using a highly polarized Λ beam for providing quantitative information on the ΛN interaction. The results of three Σp channels and future prospects of the Λp scattering experiment are described.

Is steroid pulse therapy a suitable treatment for drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms? A systematic review of case reports in patients treated with corticosteroids in Japan

Drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms is a life-threatening severe cutaneous adverse reaction, characterized by multiple organ involvement and reactivation of herpes viruses. Although the mainstay of treatment is a high dosage of corticosteroids delivered by pulse therapy or conventional oral administration, it remains debatable which mode is better. To clarify this issue, we reviewed publications in Japan of 299 cases of drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms treated with corticosteroids, to evaluate safety concerns with regards to these two modes of treatment. As a result, we found that patients treated with pulse therapy more frequently suffered cytomegalovirus reactivation, persistency, and high mortality but less frequently experienced herpesvirus 6 reactivation or type 1 diabetes compared with those undergoing conventional treatment, suggesting that the administration mode may differentially modulate inflammatory responses toward distinct consequences. This is the first statistical analysis revealing that steroid pulse therapy frequently resulted in severe sequelae with high mortality. In terms of the risk of serious consequences, we consider that steroid pulse therapy should be eschewed for the treatment of drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms.

Observation of Coulomb-Assisted Nuclear Bound State of Ξ^{-}-^{14}N System

In an emulsion-counter hybrid experiment performed at J-PARC, a Ξ^{-} absorption event was observed which decayed into twin single-Λ hypernuclei. Kinematic calculations enabled a unique identification of the reaction process as Ξ^{-}+^{14}N→_{Λ}^{10}Be+_{Λ}^{5}He. For the binding energy of the Ξ^{-} hyperon in the Ξ^{-}-^{14}N system a value of 1.27±0.21  MeV was deduced. The energy level of Ξ^{-} is likely a nuclear 1p state which indicates a weak ΞN-ΛΛ coupling.

TLR4/MD-2 is a receptor for extracellular nucleophosmin 1

Nucleophosmin 1 (NPM1) primarily localizes to the nucleus and is passively released into the extracellular milieu by necrotic or damaged cells, or is secreted by monocytes and macrophages. Extracellular NPM1 acts as a potent inflammatory stimulator by promoting cytokine production [e.g., tumor necrosis factor-α (TNF-α)], which suggests that NPM1 acts as a damage-associated molecular pattern. However, the receptor of NPM1 is unknown. Evidence indicates that DAMPs, which include high mobility group box 1 and histones, may bind Toll-like receptors (TLRs). In the present study, it was shown that NPM1 signaling was mediated via the TLR4 pathway, which suggests that TLR4 is an NPM1 receptor. TLR4 binds myeloid differentiation protein-2 (MD-2), which is essential for intracellular signaling. Furthermore, the TLR4 antagonist, LPS-Rhodobacter sphaeroides (an MD-2 antagonist) and TAK-242 (a TLR4 signaling inhibitor) significantly inhibited NPM1-induced TNF-α production by differentiated THP-1 cells as well as reducing ERK1/2 activation. Far-western blot analysis revealed that NPM1 directly bound MD-2. Thus, the results of the present study provide compelling evidence that TLR4 binds NPM1, and it is hypothesized that inhibiting NPM1 activity may serve as a novel strategy for treating TLR4-related diseases.

Safety and feasibility of retrograde inoue balloon for balloon aortic valvuloplasty without rapid ventricular pacing during transcatheter aortic valve implantation

Background

Although rapid ventricular pacing (RVP) is commonly performed for preparation of transcatheter aortic valve implantation (TAVI). It has been reported that multiple and / or prolonged RVP is associated with adverse clinical outcomes of TAVI. Retrograde Inoue-Balloon was designed for balloon aortic valvuloplasty (BAV) without RVP to prevent slip of balloon by way of central waist during biphasic inflation.

Purpose

The purpose of this study was to evaluate safety and feasibility of Retrograde Inoue-Balloon for TAVI preparation.

Methods

From December 2013 to December 2019, 427 consecutive patients who performed TAVI for severe aortic valve stenosis, were retrospectively enrolled in Iwate Medical University. Of them, 227 (53%) patients (mean age 83±5 years, male 41%), underwent retrograde BAV before prosthetic valve implantation, comprised this study population. Retrograde BAV procedures were divided into two groups; patients used Inoue-Balloon without RVP and those did conventional balloon with RVP. The primary endpoint was defined as combined adverse events of 30-day mortality, cerebral infarction, and critical complications after BAV (aortic dissection, aortic rupture and cardiopulmonary arrest). The secondary endpoint was set as prolonged hypotension after BAV.

Result

Inoue-Balloon (IB) and conventional balloon (CB) were used for 73 patients (32%) and 154 (68%) patients, respectively. Both balloons were succeeded to through and expand of aortic valve in all cases. In the CB group, cardiopulmonary arrest occurred in 2.0% after BAV, cerebral infarction was observed in 3.9%, and 30-day death in 3.3%. On the other hand, no major complications were observed except one aortic dissection in the IB group. In logistic regression analysis adjusted by sex and age, the incidence of combined adverse events was significantly lower in the IB group (OR 0.17, 95% CI 0.009–0.917, P=0.037). Furthermore, the IB group had significantly a lower incidence of prolonged hypotension following BAV compared with CB group (4.1% vs 19.5%, p=0.002).

Conclusion

Balloon aortic valvuloplasty using retrograde Inoue-balloon without rapid ventricular pacing is safe and feasible, and may improve clinical outcomes of TAVI.

Funding Acknowledgement

Type of funding source: None

Impact of east Japan earthquake disaster with massive tsunami for prevalence of Takotsubo syndrome – a multicenter regional registry before and after east Japan earthquake disaster

Background

Previous studies demonstrated Takotsubo syndrome (TS) was easy provoked by earthquake disaster. However, a previous other regional report demonstrated TS was not increased after 2011 east Japan earthquake disaster. The purpose of this study was to clarify incidence of TS after the earthquake disaster in Iwate prefecture during long term period.

Method

Consecutive hospitalized TS patients were registered during 8 years between 2009 and 2016 in our medical university and five Iwate prefecture hospitals. Moreover, patients were divided into two groups, i.e., those with the inland and those with tsunami-stricken area groups. Prevalence of TS were calculated by standard incidence ratio (SIR) before and after the earthquake disaster. Moreover, long-term prognosis in the both groups was compared using Kaplan-Meier analysis.

Results

A total of 112 TS (male 25 and female 87) were registered from acute coronary syndrome registry in each hospital (n=4,163). Averaged age was 75.3 year-old. A total number of TS just after the two months of the earthquake (March and April 2011) was nine and significance monthly variation was observed comparing with the other months (p=0.029). SIR before and after the disaster is as following Figure. There were no significant differences for long-term prognosis between the two groups (p=0.20).

Conclusion

Incidence of TS was increased in acute phase after east Japan earthquake disaster. However, significance increases were maintained during long-term period, although number of TS was decreased after acute phase. TS is increased not only acute but also chronic phase after the serious earthquake disaster.

Standard incidence ratio

Funding Acknowledgement

Type of funding source: None

Dynamic nuclear polarization and ESR hole burning in As doped silicon

We present an experimental study of the Dynamic Nuclear Polarization (DNP) of ²⁹Si nuclei in silicon crystals of natural abundance doped with As in the temperature range 0.1-1 K and in a strong magnetic field of 4.6 T. This ensures a very high degree of electron spin polarization, extremely slow nuclear relaxation and optimal conditions for realization of Overhauser and resolved solid effects. We found that the solid effect DNP leads to the appearance of a pattern of holes and peaks in the ESR line, separated by the super-hyperfine interaction between the donor electron and ²⁹Si nuclei closest to the donor. On the contrary, the Overhauser effect DNP mainly affects the remote ²⁹Si nuclei having the weakest interaction with the donor electron. This leads to the appearance of a very narrow (≈3 mG wide) hole in the ESR line. We studied relaxation of the holes after burning, which is caused by the nuclear spin diffusion. Analyzing the dynamics of the hole in the spectrum with a simple one-dimensional diffusion model leads to a value of the diffusion coefficient D = 8(3) × 10^-9 G² s^-1. Our data indicate that the spin diffusion is not completely prevented even in the frozen core near the donors. The emergence of the narrow hole after the Overhauser DNP may be explained by a partial "softening" of the frozen core caused by decoupling of the donor electron and remote ²⁹Si nuclei.

A candidate-SNP retrospective cohort study for fracture risk in Japanese Thoroughbred racehorses

Fractures are medical conditions that compromise the athletic potential of horses and/or the safety of jockeys. Therefore, the reduction of fracture risk is an important horse and human welfare issue. The present study used molecular genetic approaches to determine the effect of genetic risk for fracture at four candidate SNPs spanning the myostatin (MSTN) gene on horse chromosome 18. Among the 3706 Japanese Thoroughbred racehorses, 1089 (29.4%) had experienced fractures in their athletic life, indicating the common occurrence of this injury in Thoroughbreds. In the case/control association study, fractures of the carpus (carpal bones and distal radius) were statistically associated with g.65809482T/C (P = 1.17 x 10^-8 ), g.65868604G/T (P = 2.66 x 10^-9 ), and g.66493737C/T (P = 6.41 x 10^-8 ). In the retrospective cohort study using 1710 racehorses born in 2000, the relative risk (RR) was highest for male horses at g.65868604G/T, based on the dominant allele risk model (RR = 2.251, 95% confidence interval 1.407-3.604, P = 0.00041), and for female horses at g.65868604G/T, based on the recessive allele risk model (RR = 2.313, 95% confidence interval 1.380-3.877, P = 0.00163). Considering the association of these SNPs with racing performance traits such as speed, these genotypes may affect the occurrence of carpus fractures in Japanese Thoroughbred racehorses as a consequence of the non-genetic influence of the genotype on the distance and/or intensity of racing and training. The genetic information presented here may contribute to the development of strategic training programs and racing plans for racehorses that improve their health and welfare.

Development of a tracer-containing compact-toroid injection system

The accumulation and behavior of impurities is one of the most important subjects in the development of magnetically confined fusion reactors because impurities can potentially cause cooling and worsen the confinement of the hot core plasma. Tracer-encapsulated solid pellets (TESPELs) have demonstrated some results for impurity injection for fusion-reactor plasma studies [N. Tamura et al., J. Phys. Conf. Ser. 823, 012003 (2017)]. However, the TESPEL technique has several shortcomings, for example, the penetration depth and the amounts of tracer impurities. In the present study, we have developed a tracer-containing, compact-toroid (TCCT) injection system that utilizes a magnetized coaxial plasma gun (MCPG). The discharge current through the MCPG sputters and ionizes the electrode material, and the Lorenz self-force accelerates it as a plasmoid. The MCPG easily accelerates a magnetized plasmoid to speeds greater than the ion thermal velocity of several tens of kilometers per second. The accelerated and ejected plasmoid that contains the tracer ions is itself a warm, ionized plasma. Therefore, a TCCT can potentially be injected into the core region of a target plasma with less adverse effect.