Association between outpatient cardiac rehabilitation and all-cause mortality after cardiovascular surgery: A propensity score-matched analysis

Objectives

Cardiac rehabilitation (CR) is a class I recommendation in the treatment guidelines for cardiovascular disease; however, its postoperative prognostic effects after surgery are not fully understood. Therefore, this study aimed to examine the effect of multidisciplinary outpatient CR on postdischarge all-cause mortality in patients who underwent cardiovascular surgery.

Methods

This retrospective cohort study included consecutive patients who underwent elective cardiovascular surgery between April 2015 and March 2021. Patients were categorized into CR and non-CR groups. The primary outcome measure was all-cause mortality. Propensity score-matching analysis was performed to minimize selection bias and differences in clinical characteristics. The propensity score for each patient was produced using logistic regression analysis, with the CR group and the subsequent 27 variables as the dependent and independent variables, respectively.

Results

In our cohort (n = 1095), 51 patients (4.7%) died during the follow-up period (mean, 1042 days). The CR group had a significantly lower mortality rate than the non-CR group (hazard ratio, 0.45; 95% CI, 0.21-0.95; P = .036). After propensity score matching adjusted for confounders, the association between CR and reduced risk of all-cause mortality remained (hazard ratio, 0.35; 95% CI, 0.14-0.85; P = .02).

Conclusions

Postdischarge multidisciplinary outpatient CR in patients who underwent cardiovascular surgery was associated with a substantial survival benefit, which persisted after adjusting for variables, including age, operative factors, physical and cognitive functions, and nutritional status.

Metabolic Oscillations and Glycolytic Phenotypes of Cancer Cells

Cancer cells show several metabolic phenotypes depending on the cancer types and the microenvironments in tumor tissues. The glycolytic phenotype is one of the hallmarks of cancer cells and is considered to be one of the crucial features of malignant cancers. Here, we show glycolytic oscillations in the concentrations of metabolites in the glycolytic pathway in two types of cancer cells, HeLa cervical cancer cells and DU145 prostate cancer cells, and in two types of cellular morphologies, spheroids and monolayers. Autofluorescence from nicotinamide adenine dinucleotide (NADH) in cells was used for monitoring the glycolytic oscillations at the single-cell level. The frequencies of NADH oscillations were different among the cellular types and morphologies, indicating that more glycolytic cancer cells tended to exhibit oscillations with higher frequencies than less glycolytic cells. A mathematical model for glycolytic oscillations in cancer cells reproduced the experimental results quantitatively, confirming that the higher frequencies of oscillations were due to the higher activities of glycolytic enzymes. Thus, glycolytic oscillations are expected as a medical indicator to evaluate the malignancy of cancer cells with glycolytic phenotypes.

Efficacy and safety of dexamethasone-based mouthwash to prevent chemotherapy-induced stomatitis in women with breast cancer: A multicenter, open-label, randomized phase II study

12103

Background: Stomatitis, a frequent adverse event in patients undergoing chemotherapy, can lead to pain, ulcers, bleeding, and malnutrition due to reduced oral intake, which not only deteriorates quality of life but may also result in dose reduction or interruption of chemotherapy. However, there is currently no standard approach for preventing chemotherapy-induced stomatitis. Therefore, this study aimed to assess the efficacy and safety of a dexamethasone-based mouthwash for preventing chemotherapy-induced stomatitis in patients with early breast cancer. Methods: We conducted a multicenter, randomized, controlled phase II trial. Patients with early-stage breast cancer scheduled for epirubicin and cyclophosphamide (EC) or docetaxel and cyclophosphamide (TC) therapies were allocated in a 1:1 ratio to the intervention and control groups. The sample size was set to 120 cases based on the following assumptions: stomatitis incidence of 50% in the control group and 30% in the intervention group, alpha error of 0.2, one-sided power of 0.9, and dropout proportion of 10%. The intervention group received chemotherapy, oral care, and a dexamethasone-based mouthwash (10 mL, 0.1 mg/mL; swish for 2 min and spit, 4 times daily for 9 weeks), and the control group received chemotherapy and oral care. The primary endpoint was the incidence of stomatitis that was compared between the two groups. Results: There were 60 patients in the control group and 61 in the intervention group. One patient in the control group and two in the study group withdrew consent; one patient in the control group was excluded because of discontinuation of the first cycle of chemotherapy and unavailability of data related to the incidence of stomatitis. Finally, the data of 58 patients in the control group and 59 in the intervention group were analyzed. There were no differences in age and chemotherapy regimens between the groups. The incidence of stomatitis was 55% in the control group and 38% in the intervention group (risk ratio 0.68; 80% confidence interval, 0.52 – 0.88; p = 0.052). The grade of stomatitis (0/1/2/3) was significantly lower in the study group (intervention group vs. control group: 37/13/7/2 vs. 26/16/7/9, p = 0.03). There were no differences in the duration of stomatitis between the groups. Moreover, the percentage of patients who adhered to the mouthwash regimen was 87% (range, 14% – 100%). There were no significant differences in the occurrence of other adverse events between the groups, and only one case of oral candidiasis was observed in the intervention group. Conclusions: Dexamethasone-based mouthwash safely reduced the incidence and severity of stomatitis in patients receiving chemotherapy (EC/TC) for early breast cancer. Clinical trial information: UMIN000030489.

Direct visualization of the three-dimensional shape of skyrmion strings in a noncentrosymmetric magnet

Magnetic skyrmions are topologically stable swirling spin textures that appear as particle-like objects in two-dimensional (2D) systems. Here, utilizing scalar magnetic X-ray tomography under applied magnetic fields, we report the direct visualization of the three-dimensional (3D) shape of individual skyrmion strings in the room-temperature skyrmion-hosting non-centrosymmetric compound Mn_1.4Pt_0.9Pd_0.1Sn. Through the tomographic reconstruction of the 3D distribution of the [001] magnetization component on the basis of transmission images taken at various angles, we identify a skyrmion string running through the entire thickness of the sample, as well as various defect structures, such as the interrupted and Y-shaped strings. The observed point defect may represent the Bloch point serving as an emergent magnetic monopole, as proposed theoretically. Our tomographic approach with a tunable magnetic field paves the way for direct visualization of the structural dynamics of individual skyrmion strings in 3D space, which will contribute to a better understanding of the creation, annihilation and transfer of these topological objects.

Khorana score at an initial chemotherapy is effective on predicting death in patients with gastrointestinal cancer

Background

The Khorana risk score (KRS) has been recommended for predicting an incidence of cancer-associated thrombosis (CAT). On the other hand, KRS is that the specific gravity of score for the primary tumor is too high and the prevalence of severe obesity is low, so there are some reports that the KRS is not effective in predicting CAT but is effective in predicting death.

Purpose

The purpose of this retrospective cohort study was to evaluate the efficacy of KRS on predicting CAT and all-cause death at an initial chemotherapy in patients with gastrointestinal cancer.

Methods

260 consecutive patients with no history of thrombosis who started an initial chemotherapy for gastrointestinal cancer during a 2-year period from January 2017 to December 2018 in our hospital were divided into 3 groups according to KRS and observed until December 2019 (122 patients (46.9%) in the low-risk group (0 points), 114 patients (43.8%) in the intermediate-risk group (1–2 points), and 24 patients (9.2%) in the high-risk group (3–6 points)). The incidence of CAT and all-cause death was compared among 3 groups.

Results

The median age of the patients was 67 (60–75) years, and 63.5% of them were male. CAT was observed in 61 patients (23.5%), and 84 patients (32.3%) died during the observation period. There was no difference in the incidence rate of CAT among 3 groups (Log-rank P=0.6), but all-cause death was a significant difference among 3 groups (high risk group: 54.2%, intermediate risk group: 36.0%, low risk group: 24.6%, p value=0.0023). After adjustment for multivariate analysis, the KRS high risk group was still significantly associated with death (HR: 2.83, 95% CI: 1.37–5.83, p value =0.0049), but not with CAT.

Conclusion

The Khorana score at an initial of chemotherapy in patients with gastrointestinal cancer is useful in predicting prognosis, but not CAT.

Funding Acknowledgement

Type of funding sources: None.

Obesity May Not Be a Risk of Non-Target Lesion Revascularization in the Elderly Patients

Obesity is assumed to be one of the robust risk factors for coronary artery disease. However, the effects of obesity on the progression of atherosclerosis in patients in different age groups after percutaneous coronary intervention (PCI) remain unclear. This study aimed to examine the effect of obesity on prognosis in different age groups.Consecutive patients who underwent urgent or elective PCI were surveyed for this study and were then divided into the elderly group and middle-aged group with a cut-off age of 70 years. All patients underwent coronary angiography or coronary computed tomography angiography 1 year after PCI to examine the progression of atherosclerosis. The primary endpoint was revascularization for a new lesion within 2 years after PCI. In addition, the main effects and correlations between obesity and age were examined. Multivariate logistic regression analysis was conducted to identify independent predictors of non-target lesion revascularization (non-TLR).Of the 711 patients who met the criteria and were available for follow-up analysis, the incidence of non-TLR within 2 years was 97/711 (13.6%). The higher incidence of non-TLR in patients with obesity was observed only in the middle-aged group. Furthermore, in the multivariate analysis, obesity was independently associated with non-TLR only in the middle-aged group.The findings of the present study would enable us to construct the hypothesis that obesity in elderly patients may not be an independent predictor of the incidence of non-TLR, indicating that the management to prevent non-TLR may vary depending on the age of the patient.

Methotrexate-induced Transient Encephalopathy in an Adolescent and Young Adult Patient with Acute Lymphoblastic Leukemia

A 17-year-old girl was diagnosed with acute lymphoblastic leukemia (ALL). After the administration of high-dose methotrexate (MTX) or intrathecal MTX, the patient experienced transient hemiparesis and motor aphasia. Diffusion-weighted magnetic resonance imaging showed a high-intensity lesion in the bilateral centrum semiovale, and a vasospasm was detected in the proximal segment of bilateral A1 on magnetic resonance angiography. Edaravone was administered, and leucovorin rescue treatment was continued; eventually, the patient's neurological symptoms completely resolved. This finding suggested that vasospasm might be a mechanism underlying MTX-induced transient encephalopathy in adolescent and young adult patients with ALL.

Clinical Outcomes of Subcutaneous and Visceral Adipose Tissue Characteristics Assessed in Patients Underwent Transcatheter Aortic Valve Replacement

BACKGROUND

Adipose tissue (AT) characteristics are considered to be a marker for predicting clinical outcomes. This study aimed to investigate the prognostic value of subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) computed tomography (CT) assessment in patients who underwent transcatheter aortic valve replacement (TAVR).

METHODS

We used the Japanese multicentre registry data of 1372 patients (age: 84.5 ± 5.0 years, women: 70.6%) who underwent TAVR. The SAT and VAT were assessed according to the preprocedural CT area and density. Baseline characteristics and clinical outcomes were compared based on the differences in AT characteristics. The independent associations with all-cause mortality after TAVR were evaluated according to the CT area and density of AT.

RESULTS

Low-volume area of SAT and VAT was associated with worse clinical outcomes compared with high-volume area of SAT and VAT in patients who underwent TAVR (log-rank test P = 0.016 and P = 0.014). High CT density of SAT and VAT was associated with increasing mortality in comparison with low CT density of SAT and VAT (log-rank test P < 0.001 and P = 0.007). The Cox regression multivariate analysis demonstrated the independent association of increased all-cause mortality in the high SAT and VAT density (hazard ratio [HR]: 1.41, 95% confidence interval [CI]: 1.06-1.88, P = 0.019, and HR: 1.34, 95% CI: 1.03-1.76, P = 0.031, respectively), but not in the low SAT and VAT area (HR: 0.85, 95% CI: 0.74-1.29, P = 0.85, and HR: 0.78, 95% CI: 0.60-1.03, P = 0.085, respectively).

CONCLUSIONS

CT-derived AT characteristics, particularly the qualitative assessments, were useful for predicting the prognosis in patients after TAVR.

Clinical implication of symptom for long-term outcomes after elective percutaneous coronary intervention

Background

The appropriate treatment for silent myocardial ischemia (SMI) is controversial. The prognosis of asymptomatic patients after percutaneous coronary intervention (PCI) is unknown. Asymptomatic patients might be sicker and have delay of diagnosis when they have coronary events in clinical course. We, thus, hypothesized SMI are associate with the poor outcomes after PCI for stable coronary artery disease (CAD).

Purpose

The present study compared the long-term outcomes of patients with SMI vs. stable angina pectoris (SAP) after elective PCI.

Methods

Our prospective registry database included 923 consecutive patients with CAD who underwent PCI from October 2015 to August 2018. Patients with emergent PCI, acute coronary syndrome at admission, or chronic total occlusion patients were not included. A total 613 patients (71.4±11.2 years, 75.7% male) who underwent elective PCI were studied. The end points included all-cause mortality, non-fatal myocardial infarction, and repeat revascularization.

Results

They were divided into 2 groups according to symptom status: SMI (n=392) and SAP (n=221). SMI patients were predominantly men, and more frequently had diabetes mellitus (197 [50.4%] vs. 91 [41.2%], p=0.028), previous myocardial infarction (44 [11.3%] vs. 8 [3.6%], p=0.001) and heart failure hospitalization.Echocardiography showed SMI groups had reduced ejection fraction (56.9±12.6 vs 63.3±9.1, P&lt;0.001), extended left ventricular internal dimension in diastole (48.5±6.2 vs 47.4±5.8, p=0.048) and left ventricular diameter at end systole (32.8±7.6 vs 30.5±7.5, p=0.001). Mean duration of follow-up was 20.9±10.6 months. The incidence of non-fatal myocardial infarction and repeat revascularization was similar between the 2 groups (10 [2.6%] vs. 5 [2.3%], p=0.82, and 50 [12.8%] vs. 30 [13.6%], p=0.77, respectively). The incidence of all-cause and cardiovascular mortality was more frequent in SMI patients (26 [6.6%] vs. 6 [2.7%], p=0.036, and 9 [3.1%] vs 1 [0.5%], p=0.035, respectively). Kaplan-Meier survival curves indicated that SMI patients had significantly higher all cause-mortality than SAP patients (log-rank, p=0.0184, Hazard ratio 1.24 (1.05–1.47), p=0.013). In multivariable analysis, SMI was an independent predictor of all cause-mortality (Hazard-ratio 5.17, 95% CI 1.35–34.29, p=0.014).

Conclusion

In patients with stable CAD undergoing elective PCI, SMI was associated with an increase in mortality. Optimal care for SMI patients after PCI should be clarified in future studies.

Funding Acknowledgement

Type of funding source: None

Safety and efficacy of a hyperaemic agent, intracoronary nicorandil 4mg, for invasive physiological assessments during fractional flow reserve measurement

Background

Fractional flow reserve (FFR) is one of most reliable index for the determining the functional severity coronary artery stenosis. Adenosine is the most commonly used agent for maximal hyperaemia. However, adenosine can cause chest discomfort, bronchial hyper-reactivity, and atrioventricular block. The aim of this study is to evaluate the safety and efficacy of intracoronary nicorandil as an alternative hyperaemic agent for FFR.

Methods and results

We enrolled consecutive 82 patients (87 lesions) who underwent FFR measurement in our center from Nov. 2018. We compared three groups; intravenous infusion of adenosine (150 μg/kg/min); and adenosine added intracoronary nicorandil 2mg; and intracoronary nicorandil 4mg. Mean FFR value was 0.83±0.09, 0.82±0.09, 0.82±0.08, There was a strong correlation among three groups (R2&gt;0.9). Mean cyclic change in FFR was 0.026±0.023, 0.019±0.010, 0.016±0.014, respectively, cyclic change was smallest in intracoronary nicorandil 4mg group (vs ATP; p&lt;0.001, vs ATP + nicorandil 2mg; p&lt;0.001). By Wilcoxon test, mean FFR value of nicorandil 4mg was significant lower than ATP (p=0.0021), and equal to ATP + nicorandil 2mg (p=0.98).

Conclusions

Intracoronary nicorandil 4mg is a simple, safe, and effective way to induce steady-state hyperaemia for FFR.

Figure 1

Funding Acknowledgement

Type of funding source: None

Changes in nutritional status by recovery phase interventions would be a powerful determinant of cardiovascular prognosis in heart failure patients

Background

Adequate nutrition has been proposed for better cardiovascular prognosis as well as fitness, although the impact of the “changes” in nutrition and fitness at recovery phase on the future prognosis has been unclear.

Purpose

We aimed to examine whether the change in nutritional level as a result of dietary intervention combined with exercise would determine patients' cardiovascular prognosis.

Methods

This study involved 398 consecutive patients who participated in phase II comprehensive cardiac rehabilitation (CCR) for at least three months. All patients underwent cardiopulmonary exercise test (CPX) at the initial and completion periods of CCR. Individual dietary guidance was periodically performed with exercise. Peak oxygen uptake (PVO2) was measured through CPX to evaluate the fitness level, whereas nutritional status was evaluated using the geriatric nutritional risk index (GNRI). Patients were divided in two groups according to the baseline GNRI and the change in GNRI (ΔGNRI) by the median, respectively, to compare their prognosis between groups. Then they were classified into four categories according to the median values of the changes in GNRI (ΔGNRI) and PVO2 (ΔPVO2) during CCR: “Both improved”, “Only GNRI improved”, “Only PVO2 improved” and “Both NOT improved”, to compare MACCE-free rate between categories.

Results

The rate of MACCE showed significant difference between categories (14%, 18%, 19% and 36%, p&lt;0.001), which was approximately 2 times higher in “Both NOT improved” than the others. Kaplan-Meier analysis showed that according to the level of ΔGNRI, “higher ΔGNRI group” showed significantly higher in MACCE-free survival rate than “lower ΔGNRI group” (log rank p=0.010), whereas there was no significant difference according to the baseline GNRI (see figure). According to the categories divided by ΔGNRI and ΔPVO2, MACCE-free rate was significantly lower in “Both NOT improved” (log rank p&lt;0.001) compared to the other categories. Cox proportional hazard regression analysis revealed that “both NOT improved” was an independent predictor of MACCE (hazard ratio, 2.1, 95% confident interval, 1.344–3.175, p&lt;0.001).

Conclusion

Changes in nutritional level would determine patients' cardiovascular prognosis rather than the baseline nutritional level. Non-responders who showed no improvement in nutritional or fitness by interventions may result in a poor cardiovascular outcome.

Funding Acknowledgement

Type of funding source: None

Smoking status and unruptured intracranial aneurysm among brain health check-up examinees: a cross-sectional study in Japan

Objective: Although it is well known that smoking is a risk factor for subarachnoid hemorrhage, the association between smoking and unruptured intracranial aneurysms remains unclear. The aim of the present study was to investigate whether smoking status was associated with unruptured intracranial aneurysms among Japanese brain health check-up examinees.

Materials and Methods: We conducted a cross-sectional study of 1,496 adults (aged 26–90 years) undergoing brain health check-ups at a single community medical support hospital in Akita, Japan between 2009 and 2013. In Japan, people can discretionarily undergo a brain health check-up for early detection of unruptured intracranial aneurysms or subarachnoid hemorrhages. Participants responded to a questionnaire on lifestyle, such as smoking status, and were classified into three groups: never, former, and current smoker. The evaluation of unruptured intracranial aneurysms detected by magnetic resonance angiography was performed by an expert physician. Multiple logistic regression models were used to estimate the odds ratio for unruptured intracranial aneurysms. We performed statistical analyses by age, sex, and family history of stroke.

Results: The number of participants with unruptured intracranial aneurysms was 43 (2.9%). The mean age (standard deviation) and proportion of males was 55.8 (9.5) years and 53.3%, respectively. The adjusted odds ratios (95% confidence intervals) for unruptured intracranial aneurysms of 1.21 (0.48–3.08) among former smokers and 2.88 (1.10–7.50) among current smokers were compared to those of never smokers (p-trend = 0.041). After stratifying by age, sex, and family history of stroke, no interactions were found.

Conclusion: This cross-sectional study conducted in Japan showed that smoking was positively associated with unruptured intracranial aneurysms among brain health check-up examinees.

Motion tracking of 80-nm-size skyrmions upon directional current injections

Nanometer-scale skyrmions are prospective candidates for information bits in low-power consumption devices owing to their topological nature and controllability with low current density. Studies on skyrmion dynamics in different classes of materials have exploited the topological Hall effect and current-driven fast motion of skyrmionic bubbles. However, the small current track motion of a single skyrmion and few-skyrmion aggregates remains elusive. Here, we report the tracking of creation and extinction and motion of 80-nm-size skyrmions upon directional one-current pulse excitations at low current density of the order of 109 A m-2 in designed devices with the notched hole. The Hall motion of a single skyrmion and the torque motions of few-skyrmion aggregates have been directly revealed. The results exemplify low-current density controls of skyrmions, which will pave the way for the application of skyrmions.

Endovascular Stenting Following Stereotactic Radiosurgery for Meningioma Involving the Superior Sagittal Sinus

Objective

Surgical removal of meningiomas that have partially invaded the superior sagittal sinus (SSS) is difficult because it requires reconstruction of the SSS, which can lead to SSS occlusion and venous infarction. The present report details the case of an SSS-involved meningioma treated by stereotactic radiosurgery (SRS) and stenting.

Case Presentation

A 60-year-old woman was admitted to the hospital with blurred vision and papilledema. Lumbar puncture showed markedly increased intracranial pressure (ICP; 340 mm H2O). Gadolinium-enhanced T1-weighted imaging revealed a 1-cm meningioma located mainly in the SSS. Digital subtraction angiography revealed severe stenosis, at the posterior part of the SSS, and no collateral flow. The ICP was considered a result of the stenosis caused by the meningioma. A combined therapy comprising transarterial embolization (for tumor growth suppression), endovascular stenting of the SSS (for intracranial hypertension improvement), and SRS (for tumor control) was planned. SRS was performed first to avoid interference by the metal artifacts caused by the stent. After placement of a self-expanding stent, partial recanalization was achieved. Two months after stenting, SSS stenosis improved and MRI results showed shrinkage of the meningioma. Thirty months after the treatment, no tumor recurrence was observed.

Conclusion

The treatment strategy of SRS followed by stenting was successful for a SSS-involved meningioma. ICP and a pressure gradient between the pre- and post-stenotic segments should be considered indications for stenting.

An fMRI Study of the Brain Network Involved in Teeth Tapping in Elderly Adults

Cortical activity during jaw movement has been analyzed using various non-invasive brain imaging methods, but the contribution of orofacial sensory input to voluntary jaw movements remains unclear. In this study, we used functional magnetic resonance imaging (fMRI) to observe brain activities during a simple teeth tapping task in adult dentulous (AD), older dentulous (OD), and older edentulous subjects who wore dentures (OEd) or did not wear dentures (OE) to analyze their functional network connections. (1) To assess the effect of age on natural activation patterns during teeth tapping, a comparison of groups with natural dentition—AD and OD—was undertaken. A general linear model analysis indicated that the major activated site in the AD group was the primary sensory cortex (SI) and motor cortex (MI) (p < 0.05, family wise error corrected). In the OD group, teeth tapping induced brain activity at various foci (p < 0.05, family wise error corrected), including the SI, MI, insula cortex, supplementary motor cortex (SMC)/premotor cortex (PMA), cerebellum, thalamus, and basal ganglia in each group. (2) Group comparisons between the OD and OEd subjects showed decreased activity in the SI, MI, Brodmann’s area 6 (BA6), thalamus (ventral posteromedial nucleus, VPM), basal ganglia, and insular cortex (p ¡ 0.005, uncorrected). This suggested that the decreased S1/M1 activity in the OEd group was related to missing teeth, which led to reduced periodontal afferents. (3) A conjunction analysis in the OD and OEd/OE groups revealed that commonly activated areas were the MI, SI, cerebellum, BA6, thalamus (VPM), and basal ganglia (putamen; p < 0.05, FWE corrected). These areas have been associated with voluntary movements. (4) Psychophysiological interaction analysis (OEd vs OE) showed that subcortical and cortical structures, such as the MI, SI, DLPFC, SMC/PMA, insula cortex, basal ganglia, and cerebellum, likely function as hubs and form an integrated network that participates in the control of teeth tapping. These results suggest that oral sensory inputs are involved in the control of teeth tapping through feedforward control of intended movements, as well as feedback control of ongoing movements.

Final overall survival results of WJTOG3405, a randomized phase III trial comparing gefitinib versus cisplatin with docetaxel as the first-line treatment for patients with stage IIIB/IV or postoperative recurrent EGFR mutation-positive non-small-cell lung cancer

BACKGROUND

Primary analysis of the phase III study WJTOG 3405 demonstrated superiority of progression-free survival (PFS) for gefitinib (G) in patients treated with the epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) gefitinib compared with cisplatin plus docetaxel (CD) as the first-line treatment of stage IIIB/IV or postoperative recurrent EGFR mutation-positive non-small-cell lung cancer. This report presents final overall survival (OS) data.

PATIENTS AND METHODS

Patients were randomized between G (250 mg/day orally) and cisplatin (80 mg/m2 intravenously) plus docetaxel (60 mg/m2 i.v.), administered every 21 days for three to six cycles. After the exclusion of 5 patients, 172 patients (86 in each group, modified intention-to-treat population) were included in the survival analysis. OS was re-evaluated using updated data (data cutoff, 30 September 2013; median follow-up time 59.1 months). The Kaplan-Meier method and the log-rank test were used for analysis, and hazard ratios (HRs) for death were calculated using the Cox proportional hazards model.

RESULTS

OS events in the G group and CD group were 68 (79.1%) out of 86 and 59 (68.6%) out of 86, respectively. Median survival time for G and CD were 34.9 and 37.3 months, respectively, with an HR of 1.252 [95% confidence interval (CI): 0.883-1.775, P = 0.2070]. Multivariate analysis identified postoperative recurrence and stage IIIB/IV disease as independent prognostic factors, with an HR of 0.459 (95% CI: 0.312-0.673, P < 0.001). Median survival time (postoperative recurrence versus stage IIIB/IV disease) were 44.5 and 27.5 months in the G group and 45.5 and 32.8 months in the CD group, respectively.

CONCLUSION

G did not show OS benefits over CD as the first-line treatment. OS of patients with postoperative recurrence was better than that of stage IIIB/IV disease, even though both groups had metastatic disease.This study was registered with UMIN (University Hospital Medical Information Network in Japan), number 000000539.

P2528Responsiveness to nutritional intervention would impact on future cardiovascular prognosis in poor fitness patients

Purpose

Nutritional improvement has been proposed for long-term cardiovascular prognosis as well as fitness recovery. We aimed to examine whether “responsiveness” to nutritional and exercise interventions would impact patients' cardiovascular prognosis even patients in low baseline fitness level.

Methods

We included 254 consecutive patients who participated in the phase II comprehensive cardiovascular rehabilitation (CCR) for at least three months. All patients underwent cardiopulmonary exercise test (CPX) at the initial and completion phases of CCR. Nutritional guidance was periodically performed individually during CCR. Peak oxygen uptake (PVO2) was measured through CPX to evaluate the fitness level, whereas nutritional status was evaluated using the geriatric nutritional risk index (GNRI). Patients were divided into “low fitness” and “normal fitness” groups based on the median of baseline PVO2. Each group was further classified into four categories according to the changes in VO2 and GNRI during CCR: “Both NOT improved”, “Only GNRI improved”, “Only PVO2 improved”, and “Both improved”.

Results

Cox proportional regression analysis showed that the category of “both NOT improved” was an independent predictor for cardiovascular risk among the baseline low fitness group (Hazard ratio: 4.5, p=0.007); whereas no significant difference among the normal fitness group. Kaplan-Meier analysis revealed that the event-free survival rate was significantly lower in the “both NOT improved” category (log rank p=0.002) among the baseline low fitness group (figure); whereas no significant difference among the normal fitness group.

GNRI/PVO2 improvement vs. prognosis

Conclusion

Responsiveness to nutritional and exercise intervention could be a predictive factor of cardiovascular prognosis even in low fitness patients.

Diagnostic utility of CD205 in breast cancer: Simultaneous detection of myoepithelial cells and dendritic cells in breast tissue by CD205

BACKGROUND

CD205 can be used to detect myoepithelial cells (MECs) and dendritic cells (DCs) in breast tissue. However, the usefulness of CD205 immunostaining in the pathological diagnosis of breast tumors is not fully understood. The objective of this study was to re-evaluate CD205 co-expression with other MEC markers, such as p63 and CD10, in nonneoplastic and neoplastic breast tissue and to evaluate its pathological diagnostic utility in these types of breast cancer.

MATERIAL AND METHODS

Nonneoplastic breast tissue samples with a terminal duct lobular unit and duct were obtained from fibroadenoma and mastopathy patients. Neoplastic breast tissue samples included ductal carcinoma in situ (DCIS) (n=43) and invasive ductal carcinoma (IDC) (n=60), including the tubule-forming type (n=20). These specimens were investigated by CD205, p63, and CD10 immunostaining.

RESULTS

In addition to p63 and CD10, CD205 was expressed on MECs in nonneoplastic breast and DCIS tissue samples; CD205 was simultaneously detected on DCs that had infiltrated DCIS and IDC tumor nests. CD205 was expressed on cancer cells themselves in only 7.3% of the breast cancer samples. The number of intratumoral CD205⁺ DCs in tubular IDC was significantly higher than that in DCIS (P<0.01).

CONCLUSION

Because CD205 was simultaneously detected on MECs and DCs in the same breast tissue sections, it may be useful for distinguishing tubular IDC from DCIS.

Comparison of posterior alveolar canal location measured on computer tomography scan with cadaveric measurement of posterior superior alveolar foramen in Japanese samples

The aim of this study was to analyse anatomical characteristics of the most posterior alveolar canal (PAC) on computed tomography (CT) images and the posterior superior alveolar foramen (PSAF) physically identified in cadaveric samples, to avoid injuring the posterior superior alveolar artery (PSAA) during surgery in the maxillary tuberosity region. The study included 125 hemi-heads of 64 Japanese cadavers. Simple CT data of the maxillary bone region of the samples were obtained and analysed using measurement software. The alveolar crest (AC) and the PAC were identified to calculate the shortest distance between the AC and the PAC (AC-PAC). Then the samples were dissected to measure physically the shortest distance between the AC and the PSAF (AC-PSAF). The data were analysed statistically. The mean value and standard deviation were 20.7±4.2mm for AC-PAC and 20.7±4.3mm for AC-PSAF. The intraclass correlation coefficient between AC-PAC and AC-PSAF was 0.98. The CT-measured PAC locations were found to be almost identical to the PSAF positions identified physically in the samples. Preoperative CT localization of the PAC aids in avoiding injury to PSAA, while preoperative CT evaluation is important for each case due to significant individual variability in the anatomical PAC and PSAF locations.

Differential expression of estrogen receptor-α on follicular dendritic cells from patients with grade 1-2 and grade 3 follicular lymphoma

Hormone therapy has been used for patients with estrogen receptor alpha (ERα)–positive breast cancers. Recently, some studies reported the expression of ERα on neoplastic cells from B‐cell lymphomas. However, there has been only one report of ERα expression on the follicular dendritic cells (FDCs) that structurally and functionally support the microenvironment of follicular lymphomas (FLs). The objective of this study was to investigate the frequency of ERα expression on FDCs in nonneoplastic reactive lymphoid tissues and to compare the frequency of ERα expression on FDCs in the axillary lymph nodes between patients with and without antiestrogen therapy and among patients with grades 1‐3 of FL. Reverse transcription–polymerase chain reaction was performed to detect ERα mRNA in FL. In nonneoplastic germinal centers (GCs) from patients with tonsillitis or reactive lymphadenitis, ERα was expressed in the light zone. ERα‐positive cells strongly correlated with the width of GCs (r_s = 0.81, P < 0.01) and the CD21‐positive (r_s = 0.69, P < 0.01) and CD23‐positive (r_s = 0.83, P < 0.01) FDC meshwork. The axillary lymph nodes had fewer ERα‐positive cells, smaller GCs, and a looser CD21‐ and CD23‐positive FDC meshwork with hormone therapy than without hormone therapy (P < 0.01). Neoplastic follicles of G1‐2 FL had more ERα‐positive cells and a larger CD23⁺ FDC meshwork than those of G3 FL (P < 0.01). ERα mRNA was detected in both G1‐2 FL and G3 FL by reverse transcription–polymerase chain reaction. In conclusion, these results suggested that antiestrogen hormone therapy may decrease the number of ERα‐positive FDCs and that the responses mediated by the estrogen‐ERα interaction on FDCs may differ between G1‐2 FL and G3 FL.

Modeling studies of heterogeneities in glycolytic oscillations in HeLa cervical cancer cells

Previous experiments demonstrated that a population of HeLa cells starved of glucose or both glucose and serum exhibited a strong heterogeneity in the glycolytic oscillations in terms of the number of oscillatory cells, periods of oscillations, and duration of oscillations. Here, we report numerical simulations of this heterogeneous oscillatory behavior in HeLa cells by using a newly developed mathematical model. It is simple enough that we can apply a mathematical analysis, but capture the core of the glycolytic pathway and the activity of the glucose transporter (GLUT). Lognormal distributions of the values of the four rate constants in the model were obtained from the experimental distributions in the periods of oscillations. Thus, the heterogeneity in the periods of oscillations can be attributed to the difference in the rate constants of the enzymatic reactions. The activity of GLUT is found to determine whether the HeLa cells were oscillatory or non-oscillatory under the same experimental conditions. Simulation with the log-normal distribution of the maximum uptake velocity of glucose and the four randomized rate constants based on the log-normal distributions successfully reproduced the time-dependent number of oscillatory cells (oscillatory ratios) under the two starving conditions. The difference in the initial values of the metabolites has little effect on the simulated results.

Gigantic mammary Paget's disease of a very elderly woman

Background

Recently, surgical stress due to breast cancer has been reduced, more so for elderly patients. However, an expanded resection is still required in some situations.

Case presentation

We present a case of a 90-year-old woman with a 15 × 15 cm² erythema and localized skin ulceration with hemorrhage in her right breast. A punch biopsy indicated mammary Paget’s disease. Computed tomography showed that the tumor was only located on the surface of the breast with no metastasis, including of the axillar lymph nodes. We decided to perform surgery with sufficient informed consent. We performed muscle-sparing mastectomy with sampling of an axillar lymph node, adding two stress-relaxation sutures to avoid diastasis. The patient’s postoperative course was good. A histological examination revealed mammary Paget’s disease without invasion and no evidence of a residual tumor of the entire stumps. Her quality of life was improved after surgery.

Conclusion

Mammary Paget’s disease has a relatively good prognosis. However, advanced mammary Paget’s disease leads to a decrease of quality of life with symptoms such as skin ulcer and bleeding. Surgery should be performed in such cases, considering the risks and benefits, even in older patients with comorbidities.

Effect of Perioperative Neuromuscular Electrical Stimulation in Patients Undergoing Cardiovascular Surgery: A Pilot Randomized Controlled Trial

A randomized, controlled trial was conducted to examine the effects of perioperative neuromuscular electrical stimulation on muscle proteolysis and physical function using blinded assessment of physical function. Consecutive patients undergoing cardiovascular surgery were screened for eligibility as study subjects. Participants were randomly assigned to receive either neuromuscular electrical stimulation or the usual postoperative mobilization program. The intervention group received neuromuscular electrical stimulation on bilateral legs 8 times before and after surgery. The primary outcomes were the mean 3-methylhistidine concentration corrected for urinary creatinine content from baseline to postoperative day 6, and knee extensor isometric muscle strength on postoperative day 7. Secondary outcomes were usual walking speed and grip strength. Physical therapists blinded to patient allocation performed measurements of physical function. Of 498 consecutive patients screened for eligibility, 119 participants (intervention group, n = 60; control group, n = 59) were enrolled. In the overall subjects, there were no differences in any outcomes between the intervention and control groups. The results demonstrated no significant effects of neuromuscular electrical stimulation on muscle proteolysis and physical function after cardiovascular surgery, suggesting the need to explore indications for neuromuscular electrical stimulation and to clarify the effects in terms of the dose-response relationship.

Thermal behavior, structure, dynamic properties of aqueous glycine solutions confined in mesoporous silica MCM-41 investigated by x-ray diffraction and quasi-elastic neutron scattering

Differential scanning calorimetry, X-ray diffraction, and quasi-elastic neutron scattering (QENS) measurements of aqueous glycine solutions confined in mesoporous silica (MCM-41) were performed at different glycine concentrations, pH, and loading ratio (=mass of glycine solution/mass of dry MCM-41) in the temperature range from 305 to 180 K to discuss the confinement effect on the thermal behavior, the structure, and the dynamic properties of the solutions. The freezing points of the confined glycine solutions decreased, compared with those of the bulk solutions. The corresponding exothermic peak due to ice formation became broader with an increase in the glycine concentration. By subtracting X-ray diffraction patterns of dry MCM-41 from those of glycine solution-loaded MCM-41, information about the structure of the confined glycine solutions was obtained. The radial distribution functions of the confined glycine solutions showed that the peaks assigned to the interaction between glycine molecules and the surface silanol (Si-OH) groups of MCM-41 at pH = 5 were observed, in contrast to the case at pH = 2. The QENS data on H/D substituted aqueous glycine solutions gave the translational diffusion coefficients and the residence time of glycine and water molecules confined in MCM-41 individually. The activation energy of the diffusion coefficient of a glycine molecule at pH = 5 was larger than that at pH = 2. These results imply that glycine molecules locate near the pore surface of MCM-41 due to the formation of hydrogen bonding between glycine molecules and the silanol group of the MCM-41 wall at pH = 5.

Importance of Geriatric Nutritional Risk Index assessment in patients undergoing transcatheter aortic valve replacement

BACKGROUND

Nutritional condition is one marker of patients' frailty. The Geriatric Nutritional Risk Index (GNRI) is a well-known marker of nutritional status. This study sought to assess the clinical outcomes of GNRI after transcatheter aortic valve replacement (TAVR).

METHODS

We evaluated the GNRI value of 1,613 patients who underwent TAVR using data from a Japanese multicenter registry. According to baseline GNRI, patients were classified into 3 groups: GNRI ≥92 (n = 1,085; 67.3%), GNRI 82-92 (n = 396; 24.6%), and GNRI ≤82 (n = 132; 8.2%). Baseline characteristics, procedural outcomes, and cumulative mortality rates were compared. In addition, GNRI correlations with other frailty components (gait speed, grip strength, and Clinical Frailty Scale) and Society of Thoracic Surgeons (STS) score were also evaluated.

RESULTS

Significantly increased mortality rates were observed across the 3 groups at 30 days (0.9%, 2.3%, and 6.8%, respectively; P < .001) and 1 year (6.5%, 16.4%, and 36.4%, respectively; P < .001). Both GNRI 82-92 and GNRI ≤82 (as a reference for GNRI ≥92) were independently associated with increased midterm mortality in the Cox regression multivariate model (hazard ratio: 1.97, 3.60; 95% confidence interval: 1.37-2.84, 2.30-5.64; P < .001, P < .001, respectively). The GNRI value was significantly correlated with gait speed (Spearman ρ = -0.15, P < .001), grip strength (ρ = 0.25, P < .001), Clinical Frailty Scale (ρ = -0.24, P < .001), and STS score (ρ = -0.29, P < .001).

CONCLUSIONS

GNRI is related to both frailty components and the STS score and is an important surrogate marker for predicting worse clinical outcomes after TAVR. Assessment of the GNRI may be considered when deciding on TAVR.

Activation of NLRP3 inflammasome in macrophages by mycoplasmal lipoproteins and lipopeptides

The NLRP3 inflammasome, an intracellular sensor consisting of the nucleotide-binding oligomerization domain-like receptor family, pyrin domain containing 3 (NLRP3), the adaptor protein apoptosis-associated speck-like protein containing a caspase-recruitment domain (ASC), and procaspase-1, plays critical roles in host defense against microbial pathogens by inducing production of interleukin-1β (IL-1β) and IL-18. Mycoplasma salivarium and Mycoplasma pneumoniae cells activated murine bone marrow-derived macrophages (BMMs) to induce production of IL-1α, IL-1β, and IL-18. The IL-1β production-inducing activities of these mycoplasmas toward BMMs from Toll-like receptor 2 (TLR2)-deficient mice were significantly attenuated compared with those from C57BL/6 mice (B6BMMs). This result suggests the possibility that their lipoproteins as TLR2 agonists are involved in the activity. Lipoproteins of M. salivarium and M. pneumoniae (MsLP and MpLP), and the M. salivarium-derived lipopeptide FSL-1 induced IL-1β production by B6BMMs, but not by BMMs from caspase-1-, NLRP3- or ASC-deficient mice. The activities of MsLP and MpLP were not downregulated by the proteinase K treatment, suggesting that the active sites are their N-terminal lipopeptide moieties. B6BMMs internalized the mycoplasmal N-terminal lipopeptide FSL-1 at least 30 min after incubation, FSL-1-containing endosomes started to fuse with the lysosomes around 2 hours, and then FSL-1 translocated into the cytosol from LAMP-1⁺ endosomes. The artificial delivery of FSL-1 into the cytosol of B6BMMs drastically enhanced the IL-1β production-inducing activity. FSL-1 as well as the representative NLRP3 inflammasome activator nigericin induced the NLRP3/ASC speck, but FSL-1 located in a compartment different from the NLRP3/ASC speck.

Promotion and inhibition of synchronous glycolytic oscillations in yeast by chitosan

Synchronous rhythmic activities play crucial roles in diverse biological systems. Glycolytic oscillations in yeast cells have been studied for 50 years with the aim of elucidating the mechanisms underlying the intracellular oscillations and their synchronization. We investigated the effects of chemical disturbances on the individual and collective glycolytic oscillations in yeast cells encapsulated in alginate microparticles, and demonstrated that the addition of chitosan, an antimicrobial agent, decreased the duration of these oscillations. In contrast, the periods and the synchronicity states showed two different responses to the chitosan treatments. The periods were shown to be prolonged following the treatment with 5-50 mg·L^-1 and shortened at 75 mg·L^-1 of chitosan. Collective oscillations became more synchronized at 5 mg·L^-1 of chitosan, and desynchronized at 25-75 mg·L^-1 of this compound. These findings can be explained by the balance between two chitosan features, increasing cell membrane permeability and acetaldehyde scavenging. At low concentrations, chitosan presumably acts as a synchronization promoter that does not mediate the synchronization itself but induces an increase in intercellular coupling. We believe that our findings may provide new insights into the synchronous rhythmic activities in biological systems.

Liquid-like thermal conduction in intercalated layered crystalline solids

As a generic property, all substances transfer heat through microscopic collisions of constituent particles ¹ . A solid conducts heat through both transverse and longitudinal acoustic phonons, but a liquid employs only longitudinal vibrations^2,3. As a result, a solid is usually thermally more conductive than a liquid. In canonical viewpoints, such a difference also serves as the dynamic signature distinguishing a solid from a liquid. Here, we report liquid-like thermal conduction observed in the crystalline AgCrSe₂. The transverse acoustic phonons are completely suppressed by the ultrafast dynamic disorder while the longitudinal acoustic phonons are strongly scattered but survive, and are thus responsible for the intrinsically ultralow thermal conductivity. This scenario is applicable to a wide variety of layered compounds with heavy intercalants in the van der Waals gaps, manifesting a broad implication on suppressing thermal conduction. These microscopic insights might reshape the fundamental understanding on thermal transport properties of matter and open up a general opportunity to optimize performances of thermoelectrics.

Low-Field Bi-Skyrmion Formation in a Noncentrosymmetric Chimney Ladder Ferromagnet

The real-space spin texture and the relevant magnetic parameters were investigated for an easy-axis noncentrosymmetric ferromagnet Cr_{11}Ge_{19} with Nowotny chimney ladder structure. Using Lorentz transmission electron microscopy, we report the formation of bi-Skyrmions, i.e., pairs of spin vortices with opposite magnetic helicities. The quantitative evaluation of the magnetocrystalline anisotropy and Dzyaloshinskii-Moriya interaction (DMI) proves that the magnetic dipolar interaction plays a more important role than the DMI on the observed bi-Skyrmion formation. Notably, the critical magnetic field value required for the formation of bi-Skyrmions turned out to be extremely small in this system, which is ascribed to strong easy-axis anisotropy associated with the characteristic helix crystal structure. The family of Nowotny chimney ladder compounds may offer a unique material platform where two distinctive Skyrmion formation mechanisms favoring different topological spin textures can become simultaneously active.

Effects of ionic liquids on the nanoscopic dynamics and phase behaviour of a phosphatidylcholine membrane

Ionic liquids (ILs) are potential candidates for new antimicrobials due to their tunable antibacterial and antifungal properties that are required to keep pace with the growing challenge of bacterial resistance. To a great extent their antimicrobial actions are related to the interactions of ILs with cell membranes. Here, we report the effects of ILs on the nanoscopic dynamics and phase behaviour of a dimyristoylphosphatidylcholine (DMPC) membrane, a model cell membrane, as studied using neutron scattering techniques. Two prototypical imidazolium-based ILs 1-butyl-3-methylimidazolium tetrafluoroborate (BMIM[BF4]) and 1-decyl-3-methylimidazolium tetrafluoroborate (DMIM[BF4]), which differ only in terms of the alkyl chain length of cations, have been used for the present study. Fixed Elastic Window Scan (FEWS) shows that the incorporation of ILs affects the phase behaviour of the phospholipid membrane significantly and the transition from a solid gel to a fluid phase shifts to lower temperature. This is found to be consistent with our differential scanning calorimetry measurements. DMIM[BF4], which has a longer alkyl chain cation, affects the phase behaviour more strongly in comparison to BMIM[BF4]. The pressure-area isotherms of the DMPC monolayer measured at the air-water interface show that in the presence of ILs, isotherms shift towards higher area-per lipid molecule. DMIM[BF4] is found to shift the isotherm to a greater extent compared to BMIM[BF4]. Quasielastic neutron scattering (QENS) data show that both ILs act as a plasticizer, which enhances the fluidity of the membrane. DMIM[BF4] is found to be a stronger plasticizing agent in comparison to BMIM[BF4] that has a cation with a shorter alkyl chain. The incorporation of DMIM[BF4] enhances not only the long range lateral motion but also the localised internal motion of the lipids. On the other hand, BMIM[BF4] acts weakly in comparison to DMIM[BF4] and mainly alters the localised internal motion of the lipids. Any subtle change in the dynamical properties of the membrane can profoundly affect the stability of the cell. Hence, the dominant effect of the IL with the longer chain length on the dynamics of the phospholipid membrane might be correlated with its cytotoxic activity. QENS data analysis has provided a quantitative description of the effects of the two imidazolium-based ILs on the dynamical and phase behaviour of the model cell membrane, which is essential for a detailed understanding of their action mechanism.

An Energy-Efficient Antenna Impedance Detection Using Electrical Balance for Single-Step On-Chip Tunable Matching in Wearable/Implantable Applications

A low-power impedance detection method using a hybrid transformer and its analysis are presented. A balun is reused for the hybrid transformer to achieve area-efficiency. The complex impedance detection enables faster optimization on a tunable matching network and its calibration technique increases the detection accuracy. The proposed impedance detection method fabricated in a 40-nm CMOS process consumes only 0.83 mW and demonstrates the accuracy of less than 18° and 0.1 on the Γ detection up to of 0.5 in ISM2.4 GHz band. After single-step matching network tuning, PA power and RX noise figure are improved by up to 1.2 dB and 1.3 dB, respectively.

Accuracy of self-reported height, weight and waist circumference in a Japanese sample

Objective

Inconsistent results have been found in prior studies investigating the accuracy of self‐reported waist circumference, and no study has investigated the validity of self‐reported waist circumference among Japanese individuals. This study used the diagnostic standard of metabolic syndrome to assess the accuracy of individual's self‐reported height, weight and waist circumference in a Japanese sample.

Methods

Study participants included 7,443 Japanese men and women aged 35–79 years. They participated in a cohort study's baseline survey between 2007 and 2011. Participants' height, weight and waist circumference were measured, and their body mass index was calculated. Self‐reported values were collected through a questionnaire before the examination.

Results

Strong correlations between measured and self‐reported values for height, weight and body mass index were detected. The correlation was lowest for waist circumference (men, 0.87; women, 0.73). Men significantly overestimated their waist circumference (mean difference, 0.8 cm), whereas women significantly underestimated theirs (mean difference, 5.1 cm). The sensitivity of self‐reported waist circumference using the cut‐off value of metabolic syndrome was 0.83 for men and 0.57 for women.

Conclusions

Due to systematic and random errors, the accuracy of self‐reported waist circumference was low. Therefore, waist circumference should be measured without relying on self‐reported values, particularly in the case of women.

Electrical magnetochiral effect induced by chiral spin fluctuations

Chirality of matter can produce unique responses in optics, electricity and magnetism. In particular, magnetic crystals transmit their handedness to the magnetism via antisymmetric exchange interaction of relativistic origin, producing helical spin orders as well as their fluctuations. Here we report for a chiral magnet MnSi that chiral spin fluctuations manifest themselves in the electrical magnetochiral effect, i.e. the nonreciprocal and nonlinear response characterized by the electrical resistance depending on inner product of current and magnetic field. Prominent electrical magnetochiral signals emerge at specific temperature-magnetic field-pressure regions: in the paramagnetic phase just above the helical ordering temperature and in the partially-ordered topological spin state at low temperatures and high pressures, where thermal and quantum spin fluctuations are conspicuous in proximity of classical and quantum phase transitions, respectively. The finding of the asymmetric electron scattering by chiral spin fluctuations may explore new electromagnetic functionality in chiral magnets.

The magnetism-induced chirality in electron transportation is of fundamental importantance in condensed matter physics but the origin is still unclear. Here the authors demonstrate that the asymmetric electron scattering by chiral spin fluctuations can be the key to the electrical magnetochiral effect in MnSi.

Primordial oscillations in life: Direct observation of glycolytic oscillations in individual HeLa cervical cancer cells

We report the first direct observation of glycolytic oscillations in HeLa cervical cancer cells, which we regard as primordial oscillations preserved in living cells. HeLa cells starved of glucose or both glucose and serum exhibited glycolytic oscillations in nicotinamide adenine dinucleotide (NADH), exhibiting asynchronous intercellular behaviors. Also found were spatially homogeneous and inhomogeneous intracellular NADH oscillations in the individual cells. Our results demonstrate that starved HeLa cells may be induced to exhibit glycolytic oscillations by either high-uptake of glucose or the enhancement of a glycolytic pathway (Crabtree effect or the Warburg effect), or both. Their asynchronous collective behaviors in the oscillations were probably due to a weak intercellular coupling. Elucidation of the relationship between the mechanism of glycolytic dynamics in cancer cells and their pathophysiological characteristics remains a challenge in future.