Low-tube-voltage whole-body CT angiography with extremely low iodine dose: a comparison between hybrid-iterative reconstruction and deep-learning image-reconstruction algorithms

AIM

To evaluate arterial enhancement, its depiction, and image quality in low-tube potential whole-body computed tomography (CT) angiography (CTA) with extremely low iodine dose and compare the results with those obtained by hybrid-iterative reconstruction (IR) and deep-learning image-reconstruction (DLIR) methods.

MATERIALS AND METHODS

This prospective study included 34 consecutive participants (27 men; mean age, 74.2 years) who underwent whole-body CTA at 80 kVp for evaluating aortic diseases between January and July 2020. Contrast material (240 mg iodine/ml) with simultaneous administration of its quarter volume of saline, which corresponded to 192 mg iodine/ml, was administered. CT raw data were reconstructed using adaptive statistical IR-Veo of 40% (hybrid-IR), DLIR with medium- (DLIR-M), and high-strength level (DLIR-H). A radiologist measured CT attenuation of the arteries and background noise, and the signal-to-noise ratio (SNR) was then calculated. Two reviewers qualitatively evaluated the arterial depictions and diagnostic acceptability on axial, multiplanar-reformatted (MPR), and volume-rendered (VR) images.

RESULTS

Mean contrast material volume and iodine weight administered were 64.1 ml and 15.4 g, respectively. The SNRs of the arteries were significantly higher in the following order of the DLIR-H, DLIR-M, and hybrid-IR (p<0.001). Depictions of six arteries on axial, three arteries on MPR, and four arteries on VR images were significantly superior in the DLIR-M or hybrid-IR than in the DLIR-H (p≤0.009 for each). Diagnostic acceptability was significantly better in the DLIR-M and DLIR-H than in the hybrid-IR (p<0.001-0.005).

CONCLUSION

DLIR-M showed well-balanced arterial depictions and image quality compared with the hybrid-IR and DLIR-H.

Radiologic-histopathologic correlation of fatty island sign with fat necrosis in atypical lipomatous tumor and lipoma

AIM

This study aimed to assess the imaging features of atypical lipomatous tumors (ALTs) and lipoma with fat necrosis.

METHODS

This study included patients with histopathologically proven fat necrosis within adipocytic tumors who underwent preoperative imaging. Magnetic resonance imaging (MRI) and/or computer tomography (CT) findings of fat necrosis associated with lipomatous tumors were retrospectively reviewed, emphasizing the "fatty island sign (FIS)." FISs were defined as well-demarcated, focal fat-containing areas surrounded by more thickened septa compared with other intratumoral septa. Imaging findings of FIS were compared between ALT and lipoma.

RESULTS

Fat necrosis was histopathologically confirmed in 17 patients (6 ALTs and 11 lipomas). Among them, 18 FISs were observed in 10 lesions (59%). Multiple FISs within a lesion were observed in 4 (40%) patients. The median maximum diameter of the FISs was 37 mm. Hypointense areas within FISs relative to the subcutaneous fat on T1- and T2-weighted images were observed in 8 (80%) and 9 (90%), respectively, whereas hyperintense areas within FISs on fat-suppressed T2-weighted images were observed in 2 (20%). Nonfatty solid components within FISs were observed in 2 (20%). On CT, increased fat attenuation and pure fat attenuation within FISs were observed in 6 (86%) and 1 (14%), respectively. The imaging findings of FIS were not significantly different between ALT and lipoma.

CONCLUSION

FISs were observed in 59% of the histologically proven ALT and lipoma patients with fat necrosis. The hypointense areas relative to the subcutaneous fat on T1- and T2-weighted images and increased fat attenuation on CT were usually observed within FISs.

Quantitative measurement of airborne particles during endoscopic and microscopic ear surgery in the operating room

OBJECTIVE

This study aimed to quantitatively investigate airborne particle load in the operating room during endoscopic or microscopic epitympanectomy or mastoidectomy.

METHOD

In the transcanal endoscopic ear surgery group, drilling was performed underwater. A particle counter was used to measure the particle load before, during and after drilling during transcanal endoscopic ear surgery or microscopic ear surgery. The device counted the numbers of airborne particles of 0.3, 0.5 or 1.0 μm in diameter.

RESULTS

The particle load during drilling was significantly higher in the microscopic ear surgery group (n = 5) than in the transcanal endoscopic ear surgery group (n = 11) for all particle sizes (p < 0.01). In the transcanal endoscopic ear surgery group, no significant differences among the particle load observed before, during and after drilling were seen for any of the particle sizes.

CONCLUSION

Bone dissection carries a lower risk of airborne infection if it is performed using the endoscopic underwater drilling technique.

Effect of X-ray tube on image quality and pancreatic ductal adenocarcinoma conspicuity in pancreatic protocol dual-energy CT

AIM

To compare the radiation dose, image quality, and conspicuity of pancreatic ductal adenocarcinoma (PDAC) in pancreatic protocol dual-energy computed tomography (CT) between two X-ray tubes mounted in the same CT machine.

MATERIAL AND METHODS

This retrospective study comprised 80 patients (median age, 73 years; 45 men) who underwent pancreatic protocol dual-energy CT from January 2019 to March 2022 using either old (Group A, n=41) or new (Group B, n=39) X-ray tubes mounted in the same CT machine. The imaging parameters were completely matched between the two groups, and CT data were reconstructed at 70 and 40 keV. The CT dose-index volume (CTDIvol); CT attenuation of the abdominal aorta, pancreas, and PDAC; background noise; and qualitative scores for the image noise, overall image quality, and PDAC conspicuity were compared between the two groups.

RESULTS

The CTDIvol was lower in Group B than Group A (7.9 versus 9.2 mGy; p<0.001). The CT attenuation of all anatomical structures at 70 and 40 keV was comparable between the two groups (p=0.06-0.78). The background noise was lower in Group B than Group A (12 versus 14 HU at 70 keV, p=0.046; and 26 versus 30 HU at 40 keV, p<0.001). Qualitative scores for image noise and overall image quality at 70 and 40 keV and PDAC conspicuity at 40 keV were higher in Group B than Group A (p<0.001-0.045).

CONCLUSION

The latest X-ray tube could reduce the radiation dose and improve image quality in pancreatic protocol dual-energy CT.

Connection between Mechanical Relaxation and Equilibration Kinetics in a High-Entropy Metallic Glass

The slow transition from an out-of-equilibrium glass towards a supercooled liquid is a complex relaxation phenomenon. In this Letter, we study the correlation between mechanical relaxation and equilibration kinetics in a Pd_{20}Pt_{20}Cu_{20}Ni_{20}P_{20} high-entropy metallic glass. The evolution of stress relaxation with aging time was obtained with an unprecedented detail, allowing us to pinpoint new interesting features. The long structural relaxation towards equilibrium contains a wide distribution of activation energies, instead of being just associated to the β relaxation as commonly accepted. The stress relaxation time can be correlated with the equilibration rate and we observe a decrease of microstructural heterogeneity which contrasts with an increase of dynamic heterogeneity. These results significantly enhance our insight of the interplay between relaxation dynamics and thermodynamics in metallic glasses.

Vocal Fold Vibration of the Whistle Register Observed by High-Speed Digital Imaging

INTRODUCTION

Singers use a whistle register to sing at a fundamental frequency above 1000 Hz. In previous studies, vocal fold vibrations with or without complete closure and partial vocal fold vibrations were observed depending on the subject. However, the production mechanism of the whistle register is not yet clearly understood because of the limitations of the imaging device for the glottis and subjects.

OBJECTIVES

This study aims to examine vocal fold vibrations in a whistle register.

METHODS

The dynamic behavior of the glottis was recorded for six singers (four females and two males) using a high-speed digital imaging device with a frame rate above 10,000 fps. Audio signals were recorded simultaneously. The data were analyzed in the form of topography, glottal area waveforms, spectrograms, and phonovibrography to examine spatiotemporal patterns of glottal motion.

RESULTS

The vibratory motion of the vocal folds was classified into six patterns. The first pattern was the entire vocal fold vibration with complete closure during the closed phase. The second to fifth was the entire vocal fold vibration without complete closure, where a gap was observed for the full length of the vocal folds for the second, at the posterior part of the glottis for the third, at the anterior for the fourth, and at both ends for the fifth. In the sixth pattern, the vocal folds vibrated partially. Our results support the previous findings on the vibration of the vocal folds. In addition, we identified novel vibratory patterns in the vocal folds.

CONCLUSION

We conclude that the production of the whistle register is not just an extension of the falsetto register to the higher fundamental-frequency region; rather, the production mechanism of the whistle register appeared to be diverse as a means of vocalization.

Early Assessment of Radiation Treatment at Clinical Field Strength by D2O Administration and Deuterium MRI

PURPOSE/OBJECTIVE(S)

An accurate and non-invasive assessment of tumor response following treatment is essential. Traditional anatomical imaging techniques are insufficient before a significant morphological change can be observed. Metabolic imaging of molecular processes in the living body is also used. In recent years, deuterium magnetic resonance spectroscopic (MRS) imaging has been demonstrated as an alternative for cancer metabolic imaging by high-field (4-11T) MRI using deuterium-labeled molecules as a contrast agent. The study aim was to evaluate the feasibility of using deuterium MRI 1.5T for tumor visualization and early assessment of the efficacy of three anticancer treatment strategies (radiation and anticancer drugs) in pancreatic cancer model mice given heavy water (D2O) to induce deuterium (2H)-tissue labeling.

MATERIALS/METHODS

A MIA PaCa-2 pancreatic cancer model of six BALB/c-nu mice was prepared, and repeated deuterium MRI was performed during the first 10 days after starting free drinking of 30% D2O. We also evaluated 2H accumulation in the tumor after irradiation, bevacizumab administration, or gemcitabine administration of other 20 mice. Additional confirmatory proton MRI, ex vivo metabolic hyperpolarization 13C-MRS and histopathology were performed.

RESULTS

The mouse's whole-body distribution of 2H was visible 1 day after drinking, and the signal intensity increased daily. Although the tumor size did not change 1 and 3 days after irradiation, the amount of 2H in the tumor decreased significantly. The 2H image intensity of the tumor also significantly decreased after the administration of bevacizumab or gemcitabine. Metabolic hyperpolarization 13C-MRS, proton MRI and 2H-NMR spectroscopy confirmed the efficacy of the anticancer treatments.

CONCLUSION

Deuterium MRI at 1.5T proved feasibility to track 2H distribution throughout mouse tissues during D2O administration and revealed a higher 2H accumulation in the tumor xenografts. This research demonstrated a promising successful method for early assessment of radiotherapy and chemotherapy of pancreatic cancer.

Computed Tomography and 18F-Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography Imaging Biomarkers of Lung Invasive Non-mucinous Adenocarcinoma: Prediction of Grade 3 Tumour Based on World Health Organization Grading System

AIMS

To evaluate computed tomography (CT) and 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG-PET/CT) findings of invasive non-mucinous adenocarcinoma (INMA) of the lung as a predictor of histological tumour grade according to 2021 World Health Organization (WHO) classification.

MATERIALS AND METHODS

This retrospective study included consecutive patients with surgically resected INMA who underwent both preoperative CT and 18F-FDG-PET/CT. A three-tiered tumour grade was performed based on the fifth edition of the WHO classification of lung tumours. CT imaging features and the maximum standardised uptake value (SUVmax) were compared among the three tumour grades.

RESULTS

In total, 214 patients with INMA (median age 70 years; interquartile range 65-76 years; 123 men) were histologically categorised: 36 (17%) as grade 1, 102 (48%) as grade 2 and 76 (35%) as grade 3. Pure solid appearance was more frequent in grade 3 (83%) than in grades 1 (0%) and 2 (26%) (P < 0.001). The SUVmax of the entire tumour was higher in grade 3 than in grades 1 and 2 (P < 0.001). Multivariable analysis revealed that pure solid appearance (odds ratio = 94.0; P < 0.001), round/oval shape (odds ratio = 4.01; P = 0.001), spiculation (odds ratio = 2.13; P = 0.04), air bronchogram (odds ratio = 0.40; P = 0.03) and SUVmax (odds ratio = 1.45; P < 0.001) were significant predictors for grade 3 INMAs.

CONCLUSION

Pure solid appearance, round/oval shape, spiculation, absence of air bronchogram and high SUVmax were associated with grade 3 INMAs. CT and 18F-FDG-PET/CT were potentially useful non-invasive imaging methods to predict the histological grade of INMAs.

Investigation of in-line filter replacement intervals for infusion

BACKGROUND

In-line filters in peripheral and central venous catheters are used to remove bacterial cells mechanically. A recent study indicated an extension of the use of infusion sets to 7 days. There is no evidence regarding replacement intervals for in-line filters.

AIM

To test in-line filters that were used continuously for 7 days in order to investigate their ability to remove bacteria and assess the flow rate.

METHODS

Three different in-line filters were attached to an ELNEOPA-NF No. 2 premixed infusion bag of intravenous hyperalimentation, into which Staphylococcus epidermidis ATCC12228 or Escherichia coli ATCC25922 was inoculated. These experiments were compared with a control infusion. The infusion was dropped at a flow rate of 40 mL/h and replaced at 24-h intervals for 7 days. Samples were collected 24 h after drop initiation.

FINDINGS

S. epidermidis was not detected in droplets between Days 1 and 6, but In-line filters 1 and 2 showed droplets containing 6-10 colony-forming units/mL on Day 7. E. coli was not detected in any of the filters after 7 days of continuous use. Flow rates <40 mL/h were observed on Day 7 for In-line filter 3 in studies of S. epidermidis, and on Days 4 and 3 for In-line filters 2 and 3, respectively, in studies of E. coli.

CONCLUSION

This study revealed differences in bacterial removal and flow rates under high inoculation between the three in-line filters tested. It is suggested that in-line filters can be used continuously for a maximum of 6 days, and reductions in flow rate after 48 h of continuous use should be noted carefully.

Erratum: Intrinsic Correlation between the Fraction of Liquidlike Zones and the β Relaxation in High-Entropy Metallic Glasses [Phys. Rev. Lett. 129, 175501 (2022)]

This corrects the article DOI: 10.1103/PhysRevLett.129.175501.

Intrinsic Correlation between the Fraction of Liquidlike Zones and the β Relaxation in High-Entropy Metallic Glasses

Lacking the structural information of crystalline solids, the origin of the relaxation dynamics of metallic glasses is unclear. Here, we report the evolution of stress relaxation of high-entropy metallic glasses with distinct β relaxation behavior. The fraction of liquidlike zones, determined at each temperature by the intensity of stress decay, is shown to be directly related to both the aging process and the spectrum of relaxation modes obtained by mechanical spectroscopy. The results shed light on the intrinsic correlation between the static and dynamic mechanical response in high-entropy and conventional metallic glasses, pointing toward a sluggish diffusion high-entropy effect in the liquid dynamics.

Impact of Hospital Environmental Cleaning with a Potassium Peroxymonosulphate-Based Environmental Disinfectant and Antimicrobial Stewardship on the Reduction of Hospital-Onset Clostridioides difficile Infections

BACKGROUND

A 1% potassium peroxymonosulphate-based environmental disinfectant (PPED) produces sodium hypochlorite when combined with sodium chloride, which functions as a disinfectant. However, little is known about the impact of hospital cleaning with PPED on hospital-onset Clostridioides difficile infection (HO-CDI).

AIM

To reduce HO-CDI, we promote antimicrobial stewardship and hospital ward cleaning with PPED. This study was conducted to evaluate their impact.

METHODS

We began a promotion of post-prescription review with feedback for broad-spectrum antimicrobials and hospital ward cleaning with PPED. We reviewed the ratio of HO-CDI, PPED consumption, and days of therapy (DOT) of broad-spectrum antimicrobials between July 2014 and March 2018, dividing this time into the pre-promotion (July 2014 to June 2015) and post-promotion periods (July 2015 to March 2018).

FINDINGS

Using interrupted time series analysis, an immediate significant change in HO-CDI was observed after intervention (P = 0.03), although a downward trend was not observed over this period (P = 0.19). Trends in PPED consumption significantly changed over this period (P = 0.02). DOT of carbapenems decreased immediately after the intervention began (P < 0.01). A Poisson regression analysis showed that PPED consumption and DOT of carbapenems were independent factors affecting HO-CDI (P = 0.039 and 0.016, respectively).

CONCLUSION

We revealed that DOT of carbapenems and use of PPED were associated with the HO-CDI ratio and that both interventions reduced the rate of HO-CDI. This is the first report on the impact of hospital ward cleaning with PPED on the reduction of HO-CDI.

Recognition of pathogen-derived sphingolipids in Arabidopsis

In plants, many invading microbial pathogens are recognized by cell-surface pattern recognition receptors, which induce defense responses. Here, we show that the ceramide Phytophthora infestans-ceramide D (Pi-Cer D) from the plant pathogenic oomycete P. infestans triggers defense responses in Arabidopsis. Pi-Cer D is cleaved by an Arabidopsis apoplastic ceramidase, NEUTRAL CERAMIDASE 2 (NCER2), and the resulting 9-methyl-branched sphingoid base is recognized by a plasma membrane lectin receptor-like kinase, RESISTANT TO DFPM-INHIBITION OF ABSCISIC ACID SIGNALING 2 (RDA2). 9-Methyl-branched sphingoid base is specific to microbes and induces plant immune responses by physically interacting with RDA2. Loss of RDA2 or NCER2 function compromised Arabidopsis resistance against an oomycete pathogen. Thus, we elucidated the recognition mechanisms of pathogen-derived lipid molecules in plants.

Characteristics of the glycometabolic categories based on the oral glucose tolerance test results in Japanese adults without diabetes

OBJECTIVE

We aimed to classify Japanese adults without diabetes into different categories based on the oral glucose tolerance test (OGTT) and characterize their insulin sensitivity and insulin secretion.

PATIENTS AND METHODS

The OGTT was performed on 1,085 Japanese individuals without diabetes (aged 20-64 years); blood glucose and insulin levels were measured at 0, 30-, 60-, 90-, and 120-min. Fasting blood chemistry, hematology, and urine were analyzed. The participants were classified into four categories based on the following: (A) 30 min post-load plasma glucose levels < 157 mg/dL and/or (B) 120 min post-load plasma glucose levels < 126 mg/dL and Matsuda index > 4.97. Category 1 satisfied both conditions, category 2 satisfied condition A but not B, category 3 satisfied condition B but not A, and category 4 satisfied neither condition.

RESULTS

Overall, 46%, 21%, 13%, and 20% of the participants were classified into categories 1, 2, 3, and 4, respectively. Compared with category 1, the characteristics of the other categories were: 2, low insulin sensitivity and high blood glucose levels during the later period; 3, low insulin secretion and a rapid increase in blood glucose levels; and 4, combined characteristics of categories 2 and 3. Most blood test values besides glucose metabolism in category 4 were also worse than those in category 1. Categories 1 and 2 had a high proportion of females, whereas categories 3 and 4 had a low proportion.

CONCLUSIONS

Japanese adults without diabetes are classified into four categories with different insulin sensitivities and insulin secretion using OGTT results. Each category has different characteristics of age and sex distribution and clinical values besides glucose metabolism.

Massive calcification around large joints in a patient subsequently diagnosed with adult-onset hypophosphatasia

We report a 64-year-old Japanese woman with a history of progressive loss of motor function and painful swelling of large joints. At the age of 54, profound calcification appeared around the shoulder and hip joints, which did not heal after repeated surgical resections. Iliac bone biopsy revealed osteomalacic changes. Laboratory data showed low serum alkaline phosphatase (ALP) activity and a high urine phosphoethanolamine (PEA) concentration with normal serum calcium, phosphate, and fibroblast growth factor 23 (FGF23) levels. Subsequent genetic analysis of the ALPL gene confirmed the diagnosis of hypophosphatasia (HPP) with the identification of a heterozygous single nucleotide deletion, c.1559delT (p.Leu520ArgfsX86). We started a mineral-targeted enzyme replacement therapy, asfotase alfa (AA), to treat the patient's musculoskeletal symptoms. A follow-up bone biopsy after 12 months of AA treatment showed improvement of osteomalacia. Calcified deposits around the large joints were unchanged radiographically. To our knowledge, this is the first report of a patient with an adult-onset HPP who presented with profound calcification around multiple joints. Nonspecific clinical signs and symptoms in patients with adult-onset HPP often result in delayed diagnosis or misdiagnosis. We propose that bone biopsy and genetic analysis should be considered along with laboratory analysis for all patients with ectopic calcification around joints of unknown etiology for accurate diagnosis and better treatment.

Morphological differences in skulls and feeding apparatuses between Antarctic (Balaenoptera bonaerensis) and common (Balaenoptera acutorostrata) minke whales, and the implication for their feeding ecology

The differences in rorqual feeding ecology have been linked to the presence of different morphological markers. The Antarctic minke whale (Balaenoptera bonaerensis Burmeister, 1867) and the common minke whale (Balaenoptera acutorostrata Lacépède, 1804) are closely related species, but their morphological differences have not been fully investigated. In this study, we compared 21 skull and 11 feeding apparatus (baleen and mouth-related parts) measurement points between these two species using hundreds of individuals covering a wide range of body lengths in both sexes. Their engulfment capacities were estimated using these measurements. Our results show that Antarctic minke whales have (i) proportionally larger skulls to the body length, (ii) more dorsoventrally and laterally curved rostra, (iii) proportionally larger feeding apparatuses to the condylobasal length, and (iv) significantly larger engulfment capacity than common minke whales. These differences could indicate that Antarctic minke whales have developed a feeding strategy suitable for feeding on krill, which forms large schools. In contrast, common minke whales have adapted to prey on small pelagic fishes that are agile and form small schools.

Anti-PD-1 antibody monotherapy versus anti-PD-1 plus anti-CTLA-4 combination therapy as first-line immunotherapy in unresectable or metastatic mucosal melanoma: a retrospective, multicenter study of 329 Japanese cases (JMAC study)

Background

Anti-programmed cell death protein 1 (PD-1) antibody monotherapy (PD1) has led to favorable responses in advanced non-acral cutaneous melanoma among Caucasian populations; however, recent studies suggest that this therapy has limited efficacy in mucosal melanoma (MCM). Thus, advanced MCM patients are candidates for PD1 plus anti-cytotoxic T lymphocyte-associated antigen-4 (CTLA-4) combination therapy (PD1 + CTLA4). Data on the efficacy of immunotherapy in MCM, however, are limited. We aimed to compare the efficacies of PD1 and PD1 + CTLA4 in Japanese advanced MCM patients.

Patients and methods

We retrospectively assessed advanced MCM patients treated with PD1 or PD1 + CTLA4 at 24 Japanese institutions. Patient baseline characteristics, clinical responses (RECIST), progression-free survival (PFS), and overall survival (OS) were estimated using Kaplan–Meier analysis, and toxicity was assessed to estimate the efficacy and safety of PD1 and PD1 + CTLA4.

Results

Altogether, 329 patients with advanced MCM were included in this study. PD1 and PD1 + CTLA4 were used in 263 and 66 patients, respectively. Baseline characteristics were similar between both treatment groups, except for age (median age 71 versus 65 years; P < 0.001). No significant differences were observed between the PD1 and PD1 + CTLA4 groups with respect to objective response rate (26% versus 29%; P = 0.26) or PFS and OS (median PFS 5.9 months versus 6.8 months; P = 0.55, median OS 20.4 months versus 20.1 months; P = 0.55). Cox multivariate survival analysis revealed that PD1 + CTLA4 did not prolong PFS and OS (PFS: hazard ratio 0.83, 95% confidence interval 0.58-1.19, P = 0.30; OS: HR 0.89, 95% confidence interval 0.57-1.38, P = 0.59). The rate of ≥grade 3 immune-related adverse events was higher in the PD1 + CTLA4 group than in the PD1 group (53% versus 17%; P < 0.001).

Conclusions

First-line PD1 + CTLA4 demonstrated comparable clinical efficacy to PD1 in Japanese MCM patients, but with a higher rate of immune-related adverse events.

•

Anti-PD-1 plus anti-CTLA-4 antibody therapy (PD1 + CTLA4) is an option for patients with advanced mucosal melanoma (MCM).

•

Data on the efficacy of PD1 + CTLA4 compared with PD-1 monotherapy (PD1) for MCM, however, are limited.

•

We retrospectively analyzed data from 329 Japanese patients with advanced MCM treated with PD1 or PD1 + CTLA4.

•

No significant differences in objective response rate, progression-free survival, or overall survival were observed.

•

Immune-related adverse events resulting in treatment cessation were higher in the PD1 + CTLA4 group.

Deep-learning image-reconstruction algorithm for dual-energy CT angiography with reduced iodine dose: preliminary results

AIM

To evaluate the computed tomography (CT) attenuation values, background noise, arterial depiction, and image quality in whole-body dual-energy CT angiography (DECTA) at 40 keV with a reduced iodine dose using deep-learning image reconstruction (DLIR) and compare them with hybrid iterative reconstruction (IR).

MATERIAL AND METHODS

Whole-body DECTA with a reduced iodine dose (200 mg iodine/kg) was performed in 22 patients, and DECTA data at 1.25-mm section thickness with 50% overlap were reconstructed at 40 keV using 40% adaptive statistical iterative reconstruction with Veo (hybrid-IR group), and DLIR at medium and high levels (DLIR-M and DLIR-H groups). The CT attenuation values of the thoracic and abdominal aortas and iliac artery and background noise were measured. Arterial depiction and image quality on axial, multiplanar reformatted (MPR), and volume-rendered (VR) images were assessed by two readers. Quantitative and qualitative parameters were compared between the hybrid-IR, DLIR-M, and DLIR-H groups.

RESULTS

The vascular CT attenuation values were almost comparable between the three groups (p=0.013-0.97), but the background noise was significantly lower in the DLIR-H group than in the hybrid-IR and DLIR-M groups (p<0.001). The arterial depictions on axial and MPR images and in almost all arteries on VR images were comparable (p=0.14-1). The image quality of axial, MPR, and VR images was significantly better in the DLIR-H group (p<0.001-0.015).

CONCLUSION

DLIR significantly reduced background noise and improved image quality in DECTA at 40 keV compared with hybrid-IR, while maintaining the arterial depiction in almost all arteries.

Relationships between management factors in dairy production systems and mental health of farm managers in Japan

To facilitate sustainable dairy farming, it is essential to assess and support the mental health of dairy farm workers, which is affected more than that of workers in other industries, as indicated by the relatively few studies to date. In addition, the limited investigations on mental health in dairy workers minimize the opportunities to suggest practical approaches of improvement of their mental health. Therefore, further data acquisition and analysis is required. In the present study, we undertook quantitative surveys on 17 management factors and administered a mental health questionnaire to 81 dairy farm managers (80 male, 1 female) in Hokkaido, northern Japan. The management factors were categorized into 3 groups: production input, production output, and facility indicator; mental health was evaluated based on the Center for Epidemiologic Studies Depression Scale (CES-D). Principal component analysis assigned the factors into 2 groups: intensiveness factors of dairy production systems (PC1: livestock care cost, fat- and protein-corrected milk, stocking density, medical consultation fee per unit time per animal unit, nonfamily wages, fertilizer and pesticide expenses, and net agricultural income ratio) and basic dairy management factors (PC2: net agricultural income ratio, quantity of concentrate feed, and milk quality variable). The depression symptoms of dairy farm managers were not significantly associated with PC1 and milking methods; however, they were significantly negatively associated with PC2, which integrated 3 management factors, including factors related to finances, feeding, and milk quality. According to the findings of the present study, the efforts needed for stable economic farm management, adequate feed supply, and milk quality maintenance may increase the depression levels of dairy farm managers and negatively affect their mental health. These findings could be the basis for future studies on the relationship between the mental health of farm managers and sustainable dairy farm management and production.

Primary bone adult T cell lymphoma with multiple skeletal lesions and debilitating painful osteolysis: a case report

There have been only a limited number of reports on primary adult T cell lymphoma/leukemia (ATL) in the bone. This is a case report of a 75-year-old patient initially reporting multiple bone pains that were attributed to osteolytic ATL. The patient developed spontaneous chest/back pain and visited a local hospital. Laboratory tests showed high levels of alkaline phosphatase (ALP), and computed tomography (CT) revealed skeletal lesions with osteolysis. Although multiple myeloma was initially suspected, the results of bone marrow aspiration and bone biopsy were inconsistent. After he was referred to our hospital, mild hypercalcemia (10.4 mg/dL) with low-normal intact parathyroid hormone (PTH) (27 pg/mL), low parathyroid hormone-related protein (PTHrP), and elevated 1,25-dihydroxy vitamin D (1,25OH₂D) levels (136 pg/mL) narrowed the differential diagnosis down to lymphomatous and granulomatous diseases, and then, the high serum soluble IL-2 receptor (3,450 U/mL) and the flower cells recognized in the peripheral blood sample suggested the involvement of ATL. Finally, the reevaluation of the iliac bone biopsy sample led us to the histological diagnosis of ATL infiltration in the bone. The subsequent two courses of chemotherapy in addition to denosumab resulted in an objective partial metabolic response indicated in 18-fluorine-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT). Although very rare, the bone involvement of ATL could be used for the differential diagnosis for local osteolytic bone pain in addition to multiple myeloma and metastatic bone diseases.

Comparison of survival and perioperative outcome of the colonic stent and the transanal decompression tube placement and emergency surgery for left-sided obstructive colorectal cancer: a retrospective multi-center observational study "The CODOMO study"

PURPOSE

Advances in endoscopic technology have led to the reevaluation of self-expandable metallic stent (SEMS) placement as a bridge-to-surgery (BTS) in patients with obstructive colorectal cancer. In Japan, after inclusion of SEMS placement as a BTS in the medical insurance coverage in 2012, this procedure has been increasingly performed. However, a transanal decompression tube (TADT) placement has been used as a BTS. We aimed to retrospectively evaluate the optimal strategy for obstructive left-sided colorectal cancer (OLCRC) by comparing SEMS and TADT placement with emergency surgery.

METHODS

We included 301 patients with stage II and III OLCRC from 27 institutions. The study patients were divided into Surgery group (emergency surgery, n = 103), SEMS group (BTS by SEMS, n = 113), and TADT group (BTS by TADT, n = 85). We compared the survival and perioperative outcomes of patients in the Surgery group as a standard treatment with those in the SEMS and TADT groups.

RESULTS

The 3-year relapse-free survival rate in patients in the Surgery group was 74.8%, while that in patients in the SEMS group and TADT group were 69.0% (p = 0.39) and 55.3% (p = 0.006), respectively. The technical success rate was not statistically different, but the clinical success rate was significantly higher in the SEMS group than in the TADT group (p = 0.0040). With regard to postoperative complications after curative surgery, the SEMS group had significantly lower of complications (≥ grade 2) than the Surgery group (p = 0.022).

CONCLUSION

Patients who underwent SEMS placement for OLCRC had similar oncological outcomes to patients who underwent emergency surgery.

Hypothermic preservation of rat hearts using antifreeze glycoprotein

Antifreeze proteins are an effective additive for low-temperature preservation of solid organs. Here, we compared static hypothermic preservation with and without antifreeze glycoprotein (AFGP), followed by nonfreezing cryopreservation of rat hearts. The heart was surgically extracted and immersed in one of the cardioplegia solutions after cardiac arrest. Control rat hearts (n=6) were immersed in University of Wisconsin (UW) solution whereas AFGP-treated hearts (AFGP group) (n=6) were immersed in UW solution containing 500 ?g/ml AFGP. After static hypothermic preservation, a Langendorff apparatus was used to reperfuse the coronary arteries with oxygenated Krebs-Henseleit solution. After 30, 60, 90, and 120 min, the heart rate (HR), coronary flow (CF), cardiac contractile force (max dP/dt), and cardiac diastolic force (min dP/dt) were measured. Tissue water content (TWC) and tissue adenosine triphosphate (ATP) levels in the reperfused preserved hearts were also assessed. All the parameters were compared between the control and AFGP groups. Compared with the control group, the AFGP group had significantly (p<0.05) higher values of the following parameters: HR at 60, 90, and 120 min; CF at all four time points; max dP/dt at 90 min; min dP/dt at 90 and 120 min; and tissue ATP levels at 120 min. TWC did not differ significantly between the groups. The higher HR, CF, max dP/dt, min dP/dt, and tissue ATP levels in the AFGP compared with those in control hearts suggested that AFGP conferred superior hemodynamic and metabolic functions. Thus, AFGP might be a useful additive for the static/nonfreezing hypothermic preservation of hearts.

Practical and Safe Method of Long-Term Cryopreservation for Clinical Application of Human Adipose-Derived Mesenchymal Stem Cells Without a Programmable Freezer Or Serum

BACKGROUND

Adipose-derived mesenchymal stem cells (ADSCs) have emerged as a promising modality for cellular therapy. However, techniques of ADSC cryopreservation, which can facilitate their clinical application, haven't been established yet.

OBJECTIVE

To determine optimal conditions for ADSC cryopreservation.

MATERIALS AND METHODS

We used three cryoprotectants [serum containing 10% dimethyl sulfoxide; CP-1^TM (5% dimethyl sulfoxide, serum-free); Stem-CellBanker^TM (dimethyl sulfoxide and serum-free)], two storage temperatures (-80°C, -150°C) and two cell densities (1 × 10⁶, 7 × 10⁶ cells/mL). Storage was up to 18 months using cryovials. We didn't use a rate-controlled freezer or liquid nitrogen storage.

RESULTS

We found that CP-1^TM was a suitable cryoprotectant. Storage at -150°C and higher cell density (7×10⁶ cells/mL) kept the best viability of ADSCs, but storage at -80°C and a lower cell density (1×10⁶ cells/mL) is acceptable for up to 9 months. We also confirmed large quantities of ADSCs, stored with CP-1 in a cryobag, were still viable after -150°C cryopreservation for 24 months.

CONCLUSION

We have developed a safe, cost-effective way to cryopreserve ADSCs that could be used in the clinical setting.

The prognostic impact of right ventricular dysfunction in patients with septic cardiomyopathy

Background

Sepsis is a systemic condition of profoundly impaired health in which an infection leads to a dysregulated host response, and consecutively causes organ dysfunction, shock, and even death. Septic cardiomyopathy (SCM) is one of the multiple organ dysfunctions. SCM is typically defined as left ventricular (LV) dysfunction, presented by decreased LV ejection fraction (LVEF). However, it remains unclear about the detailed mechanism of cardiac dysfunction. In addition, the prognostic impact of right heart dysfunction in SCM patients has not been fully investigated.

Purpose

The purpose of this study was to investigate the prognostic impact of right heart dysfunction in patients with SCM.

Methods

We used the MIMIC-III (Medical Information Mart for Intensive Care III) critical care database, which is a large, freely-available database comprising deidentified health-related data associated with over forty thousand patients who stayed in critical care units of the Beth Israel Deaconess Medical Center between 2001 and 2012. We retrospectively analyzed data of patients with septic shock on admission to intensive care unit (ICU). Septic shock was defined as the presence of any suspected infections, the need for vasopressors, and the lactate level exceeding 2 mmol/L, based on the Sepsis-3 criteria. Patients were performed portable transthoracic echocardiography (TTE) during hospitalization. LVEF and right ventricular (RV) function were determined predominately by visual estimation in the parasternal long-axis view. SCM was defined as having a minimum LVEF of 50% or less during hospitalization. Patients with hyperdynamic motion of LVEF &gt;70% were excluded.

Results

In total, there were 2254 patients with septic shock. Of these, 604 patients who underwent TTE were enrolled, and 314 patients were diagnosed with SCM. At baseline, age, gender, Sequential Organ Failure Assessment (SOFA) score, maximum lactate levels, and maximum norepinephrine dosage were 70 [59–79] years, 194 males, 13 [11–15], 4.0 [2.7–6.2] mmol/L, and 0.20 [0.10–0.31] mcg/kg/min, respectively. All patients were treated with vasopressors. In Kaplan-Meier survival analysis, patients with SCM had increased 28-day mortality compared with those without SCM (log-rank, p=0.09). In addition, we divided SCM patients into two groups; SCM with and without RV dysfunction. SCM patients with RV dysfunction had significant increased 28-day mortality compared with those without RV dysfunction (log-rank, p=0.01) (Figure). In Cox proportional hazard regression analysis adjusted for age, male sex, SOFA score, and maximum lactate levels, RV dysfunction was an independent determinant of 28-day mortality (hazard ratio, 1.59; 95% confidence interval, 1.03–2.46; p=0.03).

Conclusions

The presence of RV dysfunction increased 28-day mortality in patients with SCM. It might be useful for predicting the prognosis of SCM to evaluate not only left heart function but also right heart function.

Kaplan-Meier survival curves

Funding Acknowledgement

Type of funding source: None

Efficacy of cardiac rehabilitation with motion assistance from wearable cyborg hybrid assistive limb in patients with chronic heart failure: a randomized controlled trial

Background

Recent Cochrane Systematic Review suggested that the participation in cardiac rehabilitation is associated with approximately 20% lower cardiovascular mortality and morbidity. Exercise therapy is the key component of cardiac rehabilitation programs. In recent years, innovative technologies have been introduced into the field of rehabilitation, and a typical example is the wearable cyborg Hybrid Assistive Limb (HAL). The wearable cyborg HAL provides motion assistance based on detection of bioelectrical signals on the skin surface when muscle forces are generated. The lumbar-type HAL is expected to expand the therapeutic options for severe cardiac patients who have difficulty in performing usual cardiac rehabilitation programs, such as bicycle pedaling or walking.

Purpose

We aim to compare the efficacy of exercise therapy performed with motion assistance from a lumbar-type HAL versus conventional training (sit-to-stand exercise without HAL) in patients with chronic heart failure.

Methods

This clinical trial is a randomized, non-blinded, and controlled study. Twenty-eight heart failure patients (73.1±13.8 years) who have difficulty in walking at the usual walking speed of healthy subjects were randomly assigned to 2 groups (HAL group or control group) with a 1:1 allocation ratio and performed sit-to stand exercise either with HAL or without HAL for 5 to 30 minutes once a day, and 6 to 10 days during the study period. The brain natriuretic peptide (BNP), isometric knee extensor strength, standing ability (30-seconds chair-stand test: CS-30), short physical performance battery (SPPB) and 6-minute walking distance (6MWD) were measured before and after the completion of cardiac rehabilitation. Cardiac events such as death, re-hospitalization, myocardial infarction and worsening of angina pectoris and heart failure during 1 year after discharge were evaluated.

Results

There was no significant difference in the number of days of exercise therapy between the two groups. BNP, SPPB and 6MWD were improved in both groups. In the HAL group, the isometric knee extensor strength (0.29±0.11 vs 0.35±0.11 kgf/kg, p=0.003) significantly improved and CS-30 (5.5±5.1 vs 8.2±5.3, p=0.054) tended to improve. However, in the control group, either the isometric knee extensor strength (0.35±0.11 vs 0.36±0.14 kgf/kg, p=0.424) or CS-30 (6.0±4.3 vs 9.2±6.2, p=0.075) did not significantly change. HAL group showed significantly more improvement in the isometric knee extensor strength than control group (p=0.045). Cardiac events occurred in 20% in the HAL group and 43% in the control group.

Conclusion

The improvement in isometric knee extensor strength with the assistance from lumbar-type HAL suggests that exercise therapy using this device may be useful in chronic heart failure patients with flail or sarcopenia, a strong poor prognostic factor in these patients.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): This work was supported in part by a grant-in-aid for Scientific Research from the Ministry of Education, Science, and Culture of Japan (JSPS KAKENHI grant number JP17K09485) and funded by the ImPACT Program of the Council for Science, Technology and Innovation (Cabinet Office, Government of Japan) (grant number 2017-PM05-03-01).

Associations between spleen volume and exercise capacity in advanced heart failure patients with left ventricular assist device

Background

The spleen has been recognized as an important organ with several functions such as a reservoir of blood volume, and an involvement in iron metabolism by processing of aged red blood cells and recycling iron. During exercise, spleen contracts, and red blood cells pooled in the spleen are recruited into the systemic circulation. So far, we reported that spleen size changed in advanced heart failure (HF) with left ventricular assist device (LVAD). In addition, spleen volume was related to pulmonary capillary wedge pressure (PCWP) or right atrial pressure (RAP) as parameters of cardiac preload. However, it remains unclear about the relationship between spleen volume and exercise capacity in advanced HF with LVAD.

Purpose

The purpose of this study was to investigate the associations between spleen volume and exercise capacity in advanced HF patients with LVAD.

Methods

We enrolled 27 HF patients (21 males, 45±12 years) with LVAD (HeartMate II™; Abbott, Chicago, IL, USA) for use as a bridge to heart transplantation. All patients underwent blood test, echocardiography, right heart catheterization, computed tomography (CT) and cardiopulmonary exercise testing (CPET). Spleen size was measured by CT volumetry. We excluded patients with splenic infarction or aortic valve closure surgery.

Results

At baseline, body mass index, blood brain natriuretic peptide levels, hemoglobin levels, left ventricular ejection fraction were 21.4±3.1 kg/m2, 73.8 (51.9–165.8) pg/mL, 12.1 (10.6–13.4) g/dL, 24.8±14.7%, respectively. Total cardiac output (CO), the sum of pump flow and CO of native heart was 4.6±0.9 L/min, and spleen volume was 184.9±48.8 mL. As for parameters of CPET, peak heart rate (HR), peak VO2, and peak O2 pulse were 128±25 beats/min, 14.2±3.3 mL/kg/min, and 6.6±1.9 mL/beat. At rest, there were significant correlations between spleen volume and PCWP (r=0.382, p=0.049), RAP (r=0.406, p=0.035) or pulsatility index (r=0.384, p=0.047), despite no correlations with total CO or pump flow. During exercise, there were significant interrelations of spleen volume with peak VO2 (r=0.451, p=0.018) and peak O2 pulse (r=0.427, p=0.026). Furthermore, peak VO2 was interrelated with peak HR (r=0.481, p=0.011) or hemoglobin levels (r=0.649, p&lt;0.001). Remarkably, spleen volume was significantly correlated with hemoglobin levels (r=0.391, p=0.043) (Figure). Interpreting these results based on Fick's formula, the proportion of native CO to total CO is very small at rest, but increases during exercise. The spleen during exercise may contribute to increased native CO, especially stroke volume. Moreover, the spleen may be related to both cardiac preload and oxygen carrying capacity, resulting in a significant association between spleen volume and peak VO2.

Conclusion

Spleen volume could be a useful predictor of exercise capacity in advanced HF patients with LVAD, reflecting splenic function to modulate cardiac preload and blood hemoglobin levels.

Spleen volume and exercise parameters

Funding Acknowledgement

Type of funding source: None

Efficacy of right ventricular dysfunction estimated by pulmonary artery pulsatility index in stable phased dilated cardiomyopathy

Background

Dilated cardiomyopathy (DCM) is characterized by a reduction in left and/or right ventricular myocardial contraction, dilatation of biventricular cavity and major cause of heart failure with high morbidity and mortality rates. Right ventricular dysfunction (RVD) recently have been received attention because of 34% of DCM had RVD and considered as a powerful predictor of impaired prognosis in DCM. Pulmonary Artery Pulsatility index (PAPi) is a novel hemodynamic index shown to predict RVD in advanced heart failure, however, it is unknown that even at early phase, PAPi can reflects latent right myocardial damage and predict long-term prognosis in stable DCM patients.

Methods

From April 2000 to March 2018, we enrolled 566 consecutive patients with cardiomyopathy. All patients underwent laboratory measurement, echocardiography, and cardiac catheterization to evaluate their general conditions. After excluded secondary cardiomyopathy, ischemic cardiomyopathy, and valvular heart disease, finally 162 DCM patients were enrolled. All enrolled patients had NYHA I/II/III and NYHA I/II were 150 patients (92.6%). PAPi was calculated as (systolic pulmonary artery pressure – diastolic pulmonary artery pressure (Pulmonary artery pulse pressure: PAPP)) / right atrial pressure. Median followed up for 4.85 years. In this study 149 patients were performed endomyocardial biopsy in order to exclude secondary cardiomyopathies and 95 patients were assessed using Sirius red staining. Myocardial fibrosis in biopsy specimen was assessed using Sirius red staining, and the positive region was quantified as the collagen volume fraction (CVF).

Results

The mean age and LV ejection fraction (EF) was 50.9±12.6 years and 30.5±8.3%, respectively. When divided into two groups by median PAPi value [PAPi &lt;3.06 (L-PAP) and PAPi ≥3.06 (H-PAP)], even though there were no significant difference in BNP, pulmonary vascular resistance and right ventricular stroke work index between two groups, the probability of cardiac event-survival was significantly higher in L-PAP than H-PAP by Kaplan-Meier analysis (P=0.012). Furthermore, cox proportional hazard regression analysis revealed that PAPi was independent predictor of cardiac events (hazard ratio: 0.624, P=0.025). In pathological analysis, there was no difference between H-PAPi and L-PAPi in CVF.

Conclusion

In the calculation of PAPi, PAPP reflects both RV contractility and left atrial filling pressure and this index considered as RV adaptive response to afterload. The denominator of the PAPP is defined by RA pressure, which serves as a marker of RV preload. Thus, PAPi reflect both preload and afterload of RV at the same time and even though estimated patients at early phase, RVD exists in DCM patients without severe myocardial fibrosis, and PAPi may help stratify DCM and predict cardiac events.

Kaplan-Meier analysis

Funding Acknowledgement

Type of funding source: None

Soil and vegetation sampling during the early stage of Fukushima Daiichi Nuclear Power Plant accident and the implication for the emergency preparedness for agricultural systems

After the Fukushima Daiichi Nuclear Power Plant (FDNPP) accident, immediate soil and vegetation sampling were conducted according to the action plan of nuclear emergency monitoring; however, analysing the monitoring dataset was difficult because the sampling protocols were not standardised. In this study, the sampling protocols applied just after the FDNPP accident were reviewed, and the monitoring data were analysed. The detailed protocols and results can provide a sound basis for guidelines of soil and vegetation sampling for nuclear emergency monitoring. The activity concentrations of ¹³⁷Cs and ¹³¹I in weed samples measured immediately after the FDNPP accident were related to the air dose rate at 1 m. Consequently, vegetation sampling is recommended when the additional dose rate (above background) is higher than 0.1 μSv/h. To enhance the efficiency of a protective response in the case of a nuclear accident, predetermined sampling points for soil and vegetation sampling should be considered in the preparedness plan for nuclear emergencies. Furthermore, sampling and analytical measurement capacities (time, people, cost) during the early phase after nuclear emergencies need to be considered in the preparedness and action plan, and sampling and measurement exercises are highly recommended.

Impact of nitrogen topdressing on the quality parameters of winter wheat (Triticum aestivum L.) yield

Scope of the study was to find more effective N fertilisation doses and applications to reach not only higher quantity but better quality grains as well as to be able to help preserving the continuity of feed and food quality improvement, since wheat is one of the most consumed crops all over the world.

Samples of winter wheat (Triticum aestivum L.) varieties harvested from the experimental field of the Szent István University in two consecutive crop seasons had been examined in the laboratory of the Crop Production Institute. Effects of nitrogen (N) application on the performance of grain protein were tested. Five high quality winter wheat varieties were studied regarding grain quality traits affected by applying undivided and split doses of N. The evaluated samples show that increasing doses of N topdressing and increasing time of application have beneficial effects on the yield and the value of protein content. Wheat grain protein value ranged between 9.9% of the untreated Mv Karéj and Alföld, where the 120+40 kg ha-1 N was applied resulting in the highest value of 16.0%. Similarly, the gluten values among untreated and N applied plots were in a wide range. Mv Karéj had the lowest wheat gluten value on untreated plot with 18.4% and Alfold had the highest value with 36.8% on the plot where the 120+40 kg ha-1 N was applied. There were no significant changes recorded on test weight and thousand kernel weight. In the case of baking quality, there were significant differences between varieties. The best records were obtained in the case of Mv Toborzö followed by Mv Karéj.

Effect of Copayment on Dental Visits: A Regression Discontinuity Analysis

Despite their prevalence and burdens, oral diseases are neglected in universal health coverage. In Japan, a 30% copayment (out of pocket) by the user and a 70% contribution by Japan’s universal health insurance (JUHI) are required for dental and medical services. From the age of 70 y, an additional 10% is offered by JUHI (copayment, 20%; JUHI, 80%). This study aimed to investigate the effect of cost on dental service use among older adults under the current JUHI system. A regression discontinuity quasi-experimental method was used to investigate the causal effect of the JUHI discount policy on dental visits based on cross-sectional data. Data were derived from the 2016 Japan Gerontological Evaluation Study. This analysis contained 7,161 participants who used JUHI, were aged 68 to 73 y, and responded to questions regarding past dental visits. Analyses were controlled for age, sex, number of teeth, and equalized household income. Mean ± SD age was 72.1 ± 0.79 y for the discount-eligible group and 68.9 ± 0.78 y for the noneligible group. During the past 12 mo, significantly more discount-eligible participants had visited dental services than noneligible participants (66.0% vs. 62.1% for treatment visits, 57.7% vs. 53.1% for checkups). After controlling for covariates, the effect of discount eligibility was significant on dental treatment visits (odds ratio [OR], 1.36; 95% CI, 1.32 to 1.40) and dental checkups (OR, 1.49; 95% CI, 1.44 to 1.54) in the regression discontinuity analysis. Similar findings were observed in triangular kernel-weighted models (OR, 1.38 [95% CI, 1.34 to 1.44]; OR, 1.52 [95% CI, 1.47 to 1.56], respectively). JUHI copayment discount policy increases oral health service utilization among older Japanese. The price elasticity for dental checkup visits appears to be higher than for dental treatment visits. Hence, reforming the universal health coverage system to improve the affordability of relatively inexpensive preventive care could increase dental service utilization in Japan.

AB0435 RISK OF SERIOUS INFECTION IN LUPUS NEPHRITIS AND RHEUMATOID ARTHRITIS MEASURED USING THE JAPANESE REAL WORLD HOSPITAL CLAIMS DATABASE

Background:

Patients with lupus nephritis (LN) and rheumatoid arthritis (RA) are at risk of serious infections (SIs) due to the impact of the disease itself and treatments that modulate immune system. Though the epidemiology of RA has been well-established by developing many targeted DMARDs (tDMARDs) including biologics and targeted synthesized DMARDs, LN is a very rare disease. Therefore, a large sample size with a significant number of cases is required to determine the exact risk of SIs in LN.

Objectives:

To compare the incidence rates of SIs resulting in an inpatient claim in adult patients with LN compared with RA with or without tDMARDs using hospital claims data in Japan.

Methods:

LN and RA were identified using claims data provided by Medical Data Vision Co., Ltd (Tokyo, Japan) between April 2008 and June 2019 which was extracted 5thSeptember 2019. Data between January 2010 and December 2018 was used for analysis. Patients with LN and RA were identified using modifications to algorithms developed before [1, 2]. LN patients were required to have continuous insurance claim for both systemic lupus erythematosus (SLE) and LN for ≥ 6 months after index date and then RA patients had continuous insurance claim for RA for ≥ 6 months after index date. First incident SIs were defined as those that resulted in an inpatient claim for a pre-specified set of ICD-10 code. Incidence rates (IRs) were calculated along with 95% confidence intervals (CI).

Results:

The LN, RA, RA treated with tDMARDs and RA treated without tDMARDs cohorts included 6,403, 108,317, 16,450, and 91,867 patients, respectively. As anticipated, the LN and RA cohorts were predominantly female and the RA cohort was generally older than the LN cohorts. IRs per 1,000 person-year(PY) [95% CI] for pneumocystis carini pneumonia were 28.2 [26.0-30.4] in LN, 8.5 [8.2-8.8] in RA, 12.6 [11.7-13.5] in RA with tDMARDs and 7.7 [7.4-8.0] in RA without tDMARDs. IRs per 1,000 PY for septicaemia infection were 23.3 [21.3-25.3] in LN, 12.1 [11.7-12.4] in RA, 13.3 [12.3-14.2] in RA with tDMARDs and 11.8 [11.5-12.2] in RA without tDMARDs. IRs per 1,000 PY for cytomegalovirus infection were 13.4 [11.9-14.9] in LN, 4.4 [4.2-4.6] in RA, 6.2 [5.6-6.8] in RA with tDMARDs and 4.1 [3.8-4.3] in RA without tDMARDs. IRs per 1,000 PY for tuberculosis were 7.2 [6.0-8.3] in LN, 6.7 [6.5-7.0] in RA, 18.2 [17.1-19.3] in RA with tDMARDs and 4.4 [4.2-4.7] in RA without tDMARDs.

Conclusion:

In this population-based analysis of claims data from Japan, the IRs of SI such as pneumocystis carini pneumonia, septicemia infection and cytomegalovirus infection were higher in LN than in RA. And also, the incidence of tuberculosis in RA treated with tDMARDs was highest among these cohorts. These findings demonstrate the relative contribution of age, immunosuppressive therapies and disease-related factors in LN and RA.

References:

[1]Pawar A, et al. Ann Rheum Dis. 2019 Apr;78(4):456-464. [2] ChibnikLB et al. Lupus, 2010. May;19(6):741-3.

Table 1.

Description of study population

LNRAtDMARDsNon tDMARDsN%N%N%N%Age (years) 18-34170026.690158.3182811.171877.8 35-44174327.21666215.4281617.11384615.1 45-54156324.42995527.7445227.12550327.8 55-64139721.85268548.6735444.74533149.3Gender Female538584.17841972.41265376.96576671.6 Male101815.92989827.6379723.12610128.4Table 2.

IRs per 1,000 PY [95% CI] of SI for LN and RA patients

LN total PY = 22065RA total PY = 365033tDMARDsNon tDMARDstotal PY = 60999total PY = 304034Pneumocystis carinipneumonia28.2 [26.0-30.4]8.5 [8.2-8.8]12.6 [11.7-13.5]7.7 [7.4-8.0]Septicaemia23.3 [21.3-25.3]12.1 [11.7-12.4]13.3 [12.3-14.2]11.8 [11.5-12.2]Cytomegalovirusinfection13.4 [11.9-14.9]4.4 [4.2-4.6]6.2 [5.6-6.8]4.1 [3.8-4.3]Tuberculosis7.2 [6.0-8.3]6.7 [6.5-7.0]18.2 [17.1-19.3]4.4 [4.2-4.7]Mycosis5.1 [4.1-6.0]2.7 [2.6-2.9]4.6 [4.1-5.1]2.4 [2.2-2.5]Aspergillosis4.7 [3.8-5.6]2.7 [2.5-2.9]2.1 [1.7-2.5]2.8 [2.6-3.0]Herpes3.3 [2.5-4.0]2.4 [2.2-2.6]2.9 [2.5-3.3]2.3 [2.1-2.5]

Disclosure of Interests:

Mariko Nio Employee of: Chugai Pharmaceutical Co., Ltd., Kosei Tajima Employee of: Chugai Pharmaceutical Co., Ltd., Naofumi Sugaya Employee of: Chugai Pharmaceutical Co., Ltd., Tomoyuki Ishiwata Employee of: Chugai Pharmaceutical Co., Ltd., Tatsuhiko Iwase Employee of: Chugai Pharmaceutical Co., Ltd., hiroyuki kato Employee of: Chugai Pharmaceutical Co., Ltd., Misato Hashizume Employee of: Chugai Pharmaceutical Co., Ltd.

Validation of Real-Time PCR Analyses for Line-Specific Quantitation of Genetically Modified Maize and Soybean UsingNew Reference Molecules

Novel analytical methods based on real-time quantitative polymerase chain reactions by use of new reference molecules were validated in interlaboratory studies for the quantitation of genetically modified (GM) maize and soy. More than 13 laboratories from Japan, Korea, and the United States participated in the studies. The interlaboratory studies included 2 separate stages: (1) measurement tests of coefficient values, the ratio of recombinant DNA (r-DNA) sequence, and endogenous DNA sequence in the seeds of GM maize and GM soy; and (2) blind tests with 6 pairs of maize and soy samples, including different levels of GM maize or GM soy. Test results showed that the methods are applicable to the specific quantitation of the 5 lines of GM maize and one line of GM soy. After statistical treatment to remove outliers, the repeatability and reproducibility of these methods at a level of 5.0% were &lt;13.7 and 15.9%, respectively. The quantitation limits of the methods were 0.50% for Bt11, T25, and MON810, and 0.10% for GA21, Event176, and Roundup Ready soy. The results of blind tests showed that the numerical information obtained from these methods will contribute to practical analyses for labeling systems of GM crops.