Automation of etch pit analyses on solid-state nuclear track detectors with machine learning for laser-driven ion acceleration

Solid-state nuclear track detectors (SSNTDs) are often used as ion detectors in laser-driven ion acceleration experiments and are considered to be the most reliable ion diagnostics since they are sensitive only to ions and measure ions one by one. However, ion pit analyses require tremendous time and effort in chemical etching, microscope scanning, and ion pit identification by eyes. From a laser-driven ion acceleration experiment, there are typically millions of microscopic images, and it is practically impossible to analyze all of them by hand. This research aims to improve the efficiency and automation of SSNTD analyses for laser-driven ion acceleration. We use two sets of data obtained from calibration experiments with a conventional accelerator where ions with known nuclides and energies are generated and from actual laser experiments using SSNTDs. After chemical etching and scanning the SSNTDs with an optical microscope, we use machine learning to distinguish the ion etch pits from noises. From the results of the calibration experiment, we confirm highly accurate etch-pit detection with machine learning. We are also able to detect etch pits with machine learning from the laser-driven ion acceleration experiment, which is much noisier than calibration experiments. By using machine learning, we successfully identify ion etch pits ∼105 from more than 10 000 microscopic images with a precision of ≳95%. A million microscopic images can be examined with a recent entry-level computer within a day with high precision. Machine learning tremendously reduces the time consumption on ion etch pit analyses detected on SSNTDs.

Development of multichord ion Doppler spectroscopy system for toroidal flow measurement of field-reversed configuration

A double-chord ion Doppler spectroscopy (IDS) system was developed to measure the ion temperature and flow velocity of field-reversed configuration (FRC) plasmas in the FRC amplification via a translation-collisional merging (FAT-CM) device. Adopting a Czerny-Turner mount monochromator and 16-channel photomultiplier tube array, the developed IDS system achieves high wavelength resolution and fast time response. In addition, two vertically aligned optical paths share the optical system up to the monochromator and then branch just before the detector, successfully reducing crosstalk to <1%. The Doppler broadening was measured at two measurement points in the FAT-CM device, simultaneously, and ion temperatures of ∼50 eV were measured. Toroidal spin-up from 7 to 15 km/s and a steady flow velocity of ∼10 km/s were estimated from the Doppler shift obtained by the developed system. The observation of the toroidal flow velocity and the spatial profile of the ion temperature of the FRC plasma in the FAT-CM device were realized. These spectroscopic diagnostic's double chord capabilities will aid in understanding and improving the FRC plasmas.

Mass-resolved ion measurement by particle counting analysis for characterizing relativistic ion beams driven by lasers

Particle counting analysis is a possible way to characterize GeV-scale, multi-species ions produced in laser-driven experiments. We present a multi-layered scintillation detector to differentiate multi-species ions of different masses and energies. The proposed detector concept offers potential advantages over conventional diagnostics in terms of (1) high sensitivity to GeV ions, (2) realtime analysis, and (3) the ability to differentiate ions with the same charge-to-mass ratio. A novel choice of multiple scintillators with different ion stopping powers results in a significant difference in energy deposition between the scintillators, allowing accurate particle identification in the GeV range. Here, we report a successful demonstration of particle identification for heavy ions, performed at the Heavy Ion Medical Accelerator in Chiba. In the experiment, the proposed detector setup showed the ability to differentiate particles with similar atomic numbers, such as C⁶⁺ and O⁸⁺ ions, and provided an excellent energy resolution of 0.41%-1.2% (including relativistic effect, 0.51%--1.6%).

Spectroscopic observation of super-Alfvénic field-reversed configuration merging process by mixing of tracer ions

Visualization of the collisional merging formation process of field-reversed configuration (FRC) has been attempted. In the collisional merging formation process, two initial FRC-like plasmoids are accelerated toward each other by a magnetic pressure gradient. The relative speed of the collision reaches several times the typical ion sonic speed and Alfvénic speed. The magnetic structure of the initial-FRCs is disrupted in the collision process, but the FRC-like magnetic structure is reformed in ∼30 µs after the collision. Magnetic reconnection should occur in this process; however, general theoretical models in magnetohydrodynamics approximation cannot be applied to this process because of the high-beta nature of FRC and super-Alfvénic/sonic relative speed. In this work, the spectroscopic observation of the collisional merging FRC formation was conducted to evaluate the timescale and geometry of merging. A slight amount of tracer element (e.g., helium) was mixed into one of two initial-FRCs. Mixing of the tracer did not cause serious adverse effects on the performance of the initial-FRC in the collision and merging processes. The collision and merging processes were visualized successfully and observed using a fast-framing camera with a bandpass filter. The timescale of merging and the outflow speed in the collisional merging process of FRCs were optically evaluated for the first time.

Development of visible light tomographic imaging system for field-reversed configuration collisional merging experiment

A visible light tomographic imaging system has been developed for the collisional merging experiment of field-reversed configurations (FRCs) on the FRC Amplification via Translation-Collisional Merging device at Nihon University. Two FRCs formed by field-reversed theta-pinch translate at super-Alfvénic velocity and collide with each other. The translation and collision processes are completed in 20-30 µs, and a single FRC is reformed in ∼70 µs. To study these translation and collisional merging processes, the tomographic system, including fast response tomographic cameras and a reconstruction method assuming a Rigid-Rotor (RR) model, is developed. The developed tomographic cameras simply consist of 16 channels of multi-anode photomultipliers, a band-pass filter, a slit, and a cylindrical lens, which expands the viewing angle. Because the viewing angle is limited by the size of the viewports of the metal chamber, the iterative method assuming the RR model has been applied to reconstruct tomographic images from a small number of projections. The developed tomographic imaging system can estimate the behavior of FRCs. Four cameras are installed in the two cross sections near the collision point. The radial shift of each translated FRC can be calculated by this system. Details of the developed tomographic camera system and RR reconstruction method are reported.

A multi-stage scintillation counter for GeV-scale multi-species ion spectroscopy in laser-driven particle acceleration experiments

Particle counting analysis (PCA) with a multi-stage scintillation detector shows a new perspective on angularly resolved spectral characterization of GeV-scale, multi-species ion beams produced by high-power lasers. The diagnosis provides a mass-dependent ion energy spectrum based on time-of-flight and pulse-height analysis of single particle events detected through repetitive experiments. With a novel arrangement of multiple scintillators with different ions stopping powers, PCA offers potential advantages over commonly used diagnostic instruments (CR-39, radiochromic films, Thomson parabola, etc.) in terms of coverage solid angle, detection efficiency for GeV-ions, and real-time analysis during the experiment. The basic detector unit was tested using 230-MeV proton beam from a synchrotron facility, where we demonstrated its potential ability to discriminate major ion species accelerated in laser-plasma experiments (i.e., protons, deuterons, carbon, and oxygen ions) with excellent energy and mass resolution. The proposed diagnostic concept would be essential for a better understanding of laser-driven particle acceleration, which paves the way toward all-optical compact accelerators for a range of applications.

Hepatocellular carcinoma diagnosis using a novel electrochemiluminescence immunoassay targeting serum IgM-free AIM

BACKGROUND

Recent increases in the number of patients with non-alcoholic steatohepatitis (NASH) warrant the identification of biomarkers for early detection of hepatocellular carcinoma (HCC) associated with NASH (NASH-HCC). IgM-free apoptosis inhibitor of macrophage (AIM), which generally associates with IgM in blood and exerts its biological function by dissociation from IgM, may serve as an effective biomarker for NASH-HCC. Here, we established a fully automatic and high-throughput electrochemiluminescence immunoassay (ECLIA) to measure IgM-free AIM and investigated its efficacy in diagnosing NASH-HCC and viral HCC.

METHODS

IgM-free AIM levels were measured in 212 serum samples from patients with, or without, HCC related to NASH, hepatitis B virus, and hepatitis C virus, using ECLIA. We also developed an ECLIA for measuring both IgM-free and IgM-bound AIM and investigated the existing form of AIM in blood by size-exclusion chromatography.

RESULTS

IgM-free AIM levels were significantly higher in the HCC group than in the non-HCC group, regardless of the associated pathogenesis. Moreover, the area under the receiver operating curve for IgM-free AIM was greater than that for conventional HCC biomarkers, alpha-fetoprotein or des-γ-carboxy prothrombin, regardless of the cancer stage. ECLIA counts of IgM-free AIM derived from samples fractionated by size-exclusion chromatography were significantly higher in patients with NASH-HCC than in healthy volunteers and in patients with non-alcoholic fatty liver and NASH.

CONCLUSIONS

Serum IgM-free AIM may represent a universal HCC diagnostic marker superior to alpha-fetoprotein or des-γ-carboxy prothrombin. Our newly established ECLIA could contribute to further clinical studies on AIM and in vitro HCC diagnosis.

Development of a fast response neutron detector for the supersonic FRC collision process

The collisional merging experiments of the field-reversing configuration (FRC) at supersonic/Alfvénic velocities have been performed in the FRC Amplification via Translation-Collisional Merging device only in Japan. This experiment may excite shockwaves and cause particle acceleration. To obtain supporting evidence of particle acceleration by shockwaves, we have proposed to observe neutrons originating from the D-D fusion reaction of accelerated non-thermal particles. A plastic scintillation detector has been developed for the supersonic/Alfvénic collision/merging FRC experiment. The developed neutron detector has sufficient performance of neutron sensitivity and nanosecond response time. In the collisional merging process, we obtained a signal that could be considered a neutron, which is not predicted by the adiabatic compression process in the two-dimensional magnetohydrodynamics simulation.

MHD simulation of supersonic FRC merging corrected by non-invasive magnetic measurements

In this study, a newly developed correction method with external magnetic measurements for the magnetohydrodynamics (MHD) simulation of the collisional merging formation of a field-reversed configuration (FRC) realized the estimation of the internal structure of the FRCs without invasive internal measurements. In the collisional merging formation of FRCs, an FRC is formed via merging of two initial FRC-like plasmoids at supersonic/Alfvénic velocity. An invasive diagnostic may also interfere with the collisional merging formation process. A two-dimensional resistive MHD simulation was conducted to evaluate the global behavior and internal structure of FRCs in the collisional merging formation process without invasive measurements. This code simulated the initial formation and collisional merging processes of FRCs including discharge circuits. However, the translation velocity and the pressure of initial FRCs did not simultaneously agree with the experimental values because the magnetic pressure gradient in each formation region could not be reproduced without the artificial adjustment of the initial condition. The experimentally measured current distribution was given as the initial condition of the circuit calculation in the developed correction method. The initial FRCs were successfully translated at the translation velocity and plasma pressure in the corrected simulation, both of which were equivalent to the experiments. The properties of the merged FRCs in the experiments such as volume, total temperature, and average electron density were reproduced in the corrected simulation. The detailed radial profile of the internal magnetic field of the FRC was also measured and found to agree very well with the simulation results.

Multi-point density measurement of a collisional merging formation process of FRCs

Collisional merging formation of field-reversed configuration (FRC) plasmas at supersonic velocities was performed using the FRC amplification via translation-collisional merging device. Supersonic collisional merging formation is a novel technique to form an FRC that is long-lived compared to a conventional initial formation FRC; however, this technique requires measuring the plasma parameters at multiple points simultaneously because of the dynamic translation/merging process. Herein, we have developed a new interferometer and have observed the dynamic behavior of FRCs in the formation, translation, and merging processes simultaneously. In this study, as one of the performance evaluations of the developed simultaneous density measurement, collision/merging of FRCs have been conducted in the confinement section with and without background neutral gas. Comparing translation into deuterium gas vs translation into a vacuum environment prior to the collisional merging, we found that the background neutral particles were trapped in the merged FRC; moreover, a difference in the decay rate of the stored internal energy was observed.

Development of a Langmuir probe array for radial potential profile measurement in the collisional merging formation FRC

The radial electric field in a field-reversed configuration (FRC) plasma plays an important role in the global stability and confinement properties. Herein, we developed a new Langmuir probe array named "Skewered probe" employed in measuring the radial potential profile in the collisional merging formation of an FRC in the FAT-CM (FRC Amplification via Translation - Collisional Merging) device. Because an FRC has a strong toroidal flow, the skewered probe consists of alternately skewered ring electrodes and ceramic beads on a thin stainless-steel tube to neutralize the effect of plasma flow. The developed array has nine electrodes, one every 2 cm from r = 9-25 cm, and it measures the FRC boundary in the case when the radius of the excluded flux ranges from 10 to 20 cm. The skewered probe also has one additional electrode that measures the potential near the chamber wall as a reference for the other electrodes. The radial potential profile of the FRC formed by the collisional merging method in the FAT-CM device was measured using the probe, and the results showed that the region of negative potential gradually changed to a positive potential after merging the FRCs. It was also shown that a strong outward electric field is formed near the separatrix at n = 2 rotational instability.

Internal magnetic measurement in collisional-merging process of a field-reversed configuration

An internal magnetic probe array has been developed to observe the three components of the magnetic field simultaneously in the vicinity of the collision surface of two colliding plasmoids at supersonic/Alfvénic velocity. Collisional-merging formation of a field-reversed configuration (FRC) has been conducted in the (FRC Amplification via Translation-Collisional Merging) device at Nihon University. Significant plasma heating and an increase in trapped poloidal magnetic flux have been observed during/after the collisional-merging process in the FAT-CM device. In this dynamic formation process, two FRC-like plasmoids formed by a field-reversed theta-pinch method collide in the middle of the confinement chamber at a relative speed of 200-400 km/s. Therefore, the excited shockwave is considered as one of the heating mechanisms. The developed probe array installed in the middle of the confinement chamber observes the internal structure of the magnetic field. The probe consists of 12 sets of three-axis chip inductors arranged at intervals of 40 mm. The measurement position can be varied in the radial direction. In the single translation and collisional-merging experiment, the internal magnetic probe measures the magnetic field's radial distribution with a high time resolution under noise.

Impact of body mass index on the clinical outcomes in heart failure patients undergoing cardiac rehabilitation

Background

Increased body mass index (BMI) has recently shown to have a favorable effect on the prognosis in heart failure (HF) patients. However, the impact of BMI on clinical events and mortality in HF patients who underwent cardiac rehabilitation (CR) remains unclear.

Purpose

This study aimed to investigate whether the obesity paradox is present in HF patients who have undergone CR.

Methods

This study enrolled 238 consecutive HF patients who had undergone CR at our university hospital between November 2015 and October 2017. The clinical characteristics and anthropometric data of these patients, including BMI, were collected at the beginning of the CR. The major adverse cardiovascular event (MACE) was defined as a composite of all-cause mortality and unplanned hospitalization for HF. Follow-up data regarding the primary endpoints were collected until November 2018.

Results

Patients (mean age 68.7 years, male 61%) were divided into four groups as per BMI quartiles. More patients in the highest BMI group were women, were significantly younger, and had a higher prevalence of hypertension, dyslipidemia, and diabetes mellitus; however, no significant differences were observed in the prevalence of chronic kidney disease, left ventricular ejection fraction, and brain natriuretic peptide levels of the four groups. During a median follow-up duration of 583 days, 28 patients experienced all-cause mortality, and 42 were hospitalized for HF. Kaplan–Meier analysis showed that patients in the highest BMI quartiles had lower rates of MACE (Log-rank P&lt;0.05) (Figure 1). After adjusting for confounding factors, Cox regression multivariate analysis revealed that BMI was negatively and independently associated with the incidence of MACE (hazard ratio: 0.89, 95% confidence interval: 0.83–0.96, P&lt;0.05).

Conclusion

Increased BMI was associated with better clinical prognosis even in HF patients who have undergone CR Therefore, BMI assessment may be useful for risk stratification in HF patients who have undergone CR.

Figure 1. Kaplan-Meier survival curve

Funding Acknowledgement

Type of funding source: None

Physical vapor deposition using a coaxial ion acceleration method

A novel physical vapor deposition method involving electromagnetic acceleration using a set of coaxial electrodes has been developed. In this study, the coaxial ion acceleration method is applied for a diamond-like carbon (DLC) thin film formation. In the developed method, the central electrode made of the deposition material is sputtered by the noble gas plasma current and accelerated toward the deposition chamber. Because the sputtered ions are accelerated by the Lorentz self-force, the ion injection energy can be controlled separately from the plasma temperature. In addition, the gaseous hydrocarbon, which is commonly used for DLC formation, is not required since a noble gas is used as the discharge gas.

Clinical relevance of increased serum preneoplastic antigen in hepatitis C-related hepatocellular carcinoma

BACKGROUND

The prognosis of hepatocellular carcinoma (HCC) patients remains poor despite advances in treatment modalities and diagnosis. It is important to identify useful markers for the early detection of HCC in patients. Preneoplastic antigen (PNA), originally reported in a rat carcinogenesis model, is increased in the tissues and serum of HCC patients.

AIM

To determine the diagnostic value of PNA for discriminating HCC and to characterize PNA-positive HCC.

METHODS

Patients with hepatitis C virus (HCV)-related hepatic disorders were prospectively enrolled in this study, which included patients with hepatitis, with cirrhosis, and with HCC. A novel enzyme-linked immunosorbent assay was developed to measure serum PNA concentrations in patients.

RESULTS

Serum PNA concentrations were measured in 89 controls and 141 patients with HCV infections (50 hepatitis, 44 cirrhosis, and 47 HCC). Compared with control and non-HCC patients, PNA was increased in HCC. On receiver operating characteristic curve analysis, the sensitivity of PNA was similar to the HCC markers des-γ-carboxy-prothrombin (DCP) and α-fetoprotein (AFP), but the specificity of PNA was lower. There was no correlation between PNA and AFP and a significant but weak correlation between PNA and DCP in HCC patients. Importantly, the correlations with biochemical markers were completely different for PNA, AFP, and DCP; glutamyl transpeptidase was highly correlated with PNA, but not with AFP or DCP, and was significantly higher in PNA-high patients than in PNA-low patients with HCV-related HCC.

CONCLUSION

PNA may have the potential to diagnose a novel type of HCC in which glutamyl transpeptidase is positively expressed but AFP or DCP is weakly or negatively expressed.

P5410Combination assessment of renal and hepatic dysfunction improves the predictability of prognosis in patients with acute decompensated heart failure

Background

Renal dysfunction is associated with poor mortality in patients with heart failure (HF). Hepatic dysfunction, assessed by Fibrosis-4 (FIB4) index, has also prediction ability in acute decompensated HF (ADHF) patients. We investigated whether the assessment of the combination of FIB4 index and renal dysfunction improves predictability in patients with ADHF.

Methods

We retrospectively enrolled consecutive 758 patients who admitted due to ADHF from January 2011 to February 2018 and followed up for one year. FIB4 index on admission was calculated by the formula: age (yrs) × AST[U/L] / (platelets [103/μL] × (ALT[U/L])1/2). Study subjects were divided into high FIB4 index (>3.25) and low FIB4 index (≤3.25), furthermore each group were classified by the presence/absence of CKD (estimated glomerular filtration rate <60 ml/min/1.73m). We have generated four groups; low FIB4/without CKD (n=154), low FIB4/with CKD (n=294), high FIB4/without CKD (n=56), and high FIB4/with CKD (n=254). The primary outcome was defined as all-cause mortality in one year. We performed Kaplan-Meyer analysis and multivariable Cox regression models. Furthermore, we evaluated the incremental value with C-index, net reclassification improvement (NRI) and integrated discrimination improvement (IDI) when FIB4 index and renal dysfunction added to a baseline model.

Results

In total, 106 patients died in one year. High FIB4 index and CKD showed significantly higher 1-year mortality (high FIB4 index: 19.7% vs 10.3%, p<0.001, CKD: 17.0% vs 6.7%, p<0.001, respectively). Kaplan-Meyer analysis shows that high FIB4 index with CKD showed statistically higher mortality than the others (vs low FIB4/without CKD, p<0.001, vs high FIB4/without CKD, p=0.031, vs low FIB4/with CKD, p<0.001, respectively).

Multivariate Cox regression model revealed that both high FIB4 index and CKD were an independent risk predictor of 1-year mortality (FIB4 index: p<0.001, HR 1.06, 95% CI 1.035–1.087, CKD: p=0.004, HR 1.834, 95% CI 1.213–2.773, respectively) in patients with ADHF.

A baseline model for prediction of 1-year mortality was determined by multivariable logistic regression including age, body mass index, systolic blood pressure, and serum albumin (C-index: 0.688). Adding high FIB4 index and CKD to the baseline model, all of C-index (0.738, p=0.04), NRI (0.122, p=0.067), and IDI (0.024, p=0.004) were improved.

Receiver operating characteristic curves

Conclusions

Combination assessment of renal and hepatic dysfunction could improve the predictability of prognosis in patients with ADHF.

Acknowledgement/Funding

None

P4551Prognostic utility of Palliative Prognostic Index for prediction of 30-day and 1-year outcome in patients with acute decompensated heart failure

Background

The prognosis of heart failure remains poor similar to the terminal cancer patients, although recent progress in medical treatment. Palliative Prognostic Index (PPI) is a widely used prognostic index for terminal cancer patients (PPI includes: Palliative Performance Scale, oral intake, oedema, dyspnea at rest and delirium), suggesting the short-term prognostic marker of terminal cancer patients.

Purpose

The purpose of this study was to evaluate the impact of PPI on 30-day mortality, 1-year mortality and 1-year events (including all-cause mortality, readmission due to heart failure and new onset of cerebral infarction after hospital discharge) among acute decompensated heart failure (ADHF) patients.

Method

Study subjects comprised of consecutive 764 patients who admitted due to ADHF and followed up for 1-year. PPI were calculated at the time of hospital admission. Study subjects were divided into two groups based on the PPI: L-PPI (PPI<6) and H-PPI (6≤PPI). We calculated the C-index, net reclassification improvement (NRI) and the integrated discrimination improvement (IDI) to evaluate the improvement of prediction ability on 30-day mortality.

Result

H-PPI showed significantly higher 30-day mortality than L-PPI [7.9% vs 2.0%, log rank p<0.001, Hazard retio (HR): 1.26, 95% confidential interval(CI): 1.14–1.37, p<0.001], 1-year mortality [20.0% vs 12.7%, log rank p=0.022, HR 1.15, 95% CI 1.09–1.21, p<0.001]and 1-year events [45.5% vs 31.1%, log rank p<0.001, HR 1.13, 95% CI 1.09–1.17, p<0.001]. Multivariate cox proportional hazard models adjusted with several covariates revealed that PPI was an independent predictor of 30-day mortality (HR: 1.23, 95% CI: 1.10–1.36, p<0.001), 1-year mortality (HR: 1.10, 95% CI: 1.04–1.16, p<0.001) and 1-year events (HR: 1.11, 95% CI: 1.07–1.15, p<0.001), respectively.

A reference model for prediction of 30-day mortality was determined including left ventricular ejection fraction and serum albumin concentration by multivariable logistic regression analysis. (P<0.05) (C-index: 0.720) Adding PPI to the reference model (C-index: 0.773) significantly improved both NRI (0.458, p=0.038) and IDI (0.046, p=0.007), respectively.

Conclusion

We suggest that assessment of PPI showed good prognostic ability for 30-day and 1-year outcome, while PPI provided additional prognostic information in patients with ADHF.

P4660Lipoprotein particle profiles compared with standard lipids in the association with sub-clinical aortic valve calcification in apparently healthy Japanese men

Introduction

Calcific aortic valve disease (CAVD) is one of the most common heart diseases worldwide, and its prevalence has increased in developed countries along with aging populations. Subclinical CAVD is characterized by aortic valve calcification (AVC) that may lead to aortic stenosis. AVC shares the same risk factors with atherosclerotic disease. Recently, nuclear magnetic resonance (NMR)-based lipoprotein particles, low-density and high-density lipoprotein particles (LDL-p, HDL-p) in particular, have emerged as novel markers of atherosclerotic disease. It has been unclear, however, whether NMR-based particles are associated with AVC.

Purpose

To examine cross-sectional association of NMR-based lipoprotein particles, standard lipids with AVC, and compare their strengths of association.

Methods

We studied a community-based random sample of Japanese men aged 40–79 years examined in 2006–08 in Japan. We excluded participants with history of myocardial infarction, stroke, aortic valve surgery, serum triglyceride concentration ≥400 mg/dl, estimated glomerular filtration rate (eGFR) <30 (ml/min/1.73m2), and use of lipid-lowering medication. We scored the degree of AVC according to Agatston's method, and defined prevalent AVC as the score >0. Lipoprotein particles were measured using NMR spectroscopy.

In our main analysis, we obtained multivariable-adjusted odds ratios (ORs) and 95% confidence intervals (95% CI) of prevalent AVC in the top quartile (Q4) for each lipid index in reference to the lowest quartile (Q1). Adjusting covariates include age, smoking, drinking, systolic blood pressure, glycated hemoglobin, medications for hypertension and/or for diabetes, eGFR, C-reactive protein. For sensitivity analysis, we repeated similar analyses presenting ORs per 1 standard deviation (SD) higher NMR-lipoproteins particles or standard lipids.

Results

Of 874 participants we analyzed, 153 (17.5%) men had AVC. The average (SD) age was 63.3 (10.0) years. Those with AVC tended to be older, likely to have clustering of atherosclerotic risk factors. Multivariable-adjusted ORs of prevalent AVC for Q4 versus Q1 were significantly positive for LDL-p [OR, 2.21 (95% CI: 1.24, 3.95] and low-density lipoprotein cholesterol (LDL-c) [2.17 (1.24, 3.80)]. In contrast, neither HDL-p nor high-density lipoprotein cholesterol (HDL-c) was significantly associated with AVC. In sensitivity analyses, however, the corresponding ORs per 1SD higher lipids/lipoprotein particles were smaller in LDL-p [1.33 (1.09, 1.63)] than LDL-c [1.41 (1.15, 1.73)]. The association of HDL-p became significant [1.28 (1.02, 1.61)] (per 1SD decrement) in the sensitivity analysis.

Conclusion

The overall associations of AVC with NMR-based lipoprotein particles (i.e. LDL-p, HDL-p) are comparable to those of standard lipids. This finding is parallel to the association between atherosclerotic cardiovascular diseases with NMR-based lipoproteins.

P2434Digital zoom decreases radiation exposure dose up to 30% in percutaneous coronary intervention

Background

Interventional cardiology is gaining greater popularity worldwide with each passing year. Reduction of exposure dose is a very imminent and an important issue in cardiology procedure. Although a newer radiation reduction technique, device and procedure are very valuable and expected, we should consider about therapy technique, radiation technique, devices, and the way to protection. Digital zoom digitally enlarges images in real time by up to 2.5-fold at lower doses than those used with traditional field of view changes. In our phantom examination the average dose reduction of digital zoom was 27%.

Methods and results

This study is designated as single-center, retrospective, not-randomized, observation study. 2101 eligible cases were collected. We assigned the cases of PCI without the use of Digital zoom to the Conventional group and those involving the use of Digital zoom to the Digital zoom group. There were 806 patients in the Conventional group and 1195 in the Digital zoom group. Because we had begun using Digital zoom from January 2015 onwards, all patients in the Conventional group had undergone PCI from January 2013 to December 2014 and all patients in the Digital zoom group had undergone PCI from January 2015 to December 2016. In addition, we calculated the RAK/minute and DAP/minute for an accurate assessment. To minimize the difference of characteristics between two groups, propensity score including all baseline variables was performed. Furthermore, Predictors of radiation exposure were investigated using multivariable least square methods. Inter group differences were observed in DAP, RAK, DAP/min, and RAK/min (Digital zoom group vs conventional group: DAP, 16000 cGy cm2 [from 1st quartile to 3rd quartile; 10300–24400] vs 20700 [13400–29500], p<0.001; DAP/min, 557 cGy cm2/min [392–737] vs 782 [571–1010], p<0.01; RAK, 1590 Gy [990–2410] vs 1850 [1220–2720], p<0.01; RAK/min, 54.7 Gy/min [38.5–73.2] vs 71.2 [51.5–93.0], p<0.01). Even after propensity score matching, intergroup differences in DAP (810 cases), DAP/min (811 cases), RAK (746 cases), and RAK/min (744 cases) persisted. Furthermore, the least squares method showed that Digital zoom is an important predictor of DAP (β=0.17, p<0.01) and RAK (β=0.12, p<0.01).

Conclusion

Digital zoom is an old and cost-free technique, but one of most powerful reduction of exposure method. Propensity score adjustment and least square methods show that digital zoom is one of independent effective method.

Efficacy of a new blood pressure monitor (inflationary non-invasive blood pressure, iNIBP™): a randomised controlled study

The inflationary non-invasive blood pressure monitor (iNIBP™) uses a new measurement method, whereby the cuff is slowly inflated whilst simultaneously sensing oscillations, to determine the diastolic blood pressure first and then the systolic pressure. It may measure blood pressure more quickly than the conventional non-invasive blood pressure monitor. We studied 66 patients undergoing general anaesthesia, comparing the time taken to measure the blood pressure between the two monitors at times when there were marked changes (increases or decreases by 30 mmHg or greater) in the systolic blood pressure. The median (IQR) [range]) time was significantly longer for the non-invasive blood pressure monitor (38.8 (31.5-44.7) [18.0-130.0] s) than for the iNIBP (14.6 (13.7-16.4) [11.5-35.5] s), p = 0.001, 95%CI for difference 22-25 s). We also studied 30 volunteers to evaluate the accuracy of the iNIBP, comparing it with the mercury sphygmomanometer. There was good agreement between the two monitors, with a mean difference of 0 (95% limit of agreement -12 to 11) mmHg for the systolic blood pressure. We also compared the degree of pain during cuff inflation between the automated non-invasive blood pressure and iNIBP monitors. Pain was significantly more for the non-invasive blood pressure monitor (22 of 30 volunteers had less pain with the iNIBP). We have shown that the iNIBP measured the blood pressure quicker than the conventional non-invasive blood pressure monitor and the speed of measurement was not significantly affected by marked changes in the blood pressure.

Development of a tracer-containing compact-toroid injection system

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

Fast-framing camera based observations of spheromak-like plasmoid collision and merging process using two magnetized coaxial plasma guns

We have been conducting compact toroid (CT) collision and merging experiments by using two magnetized coaxial plasma guns. As is well known, an actual CT/plasmoid moves macroscopically in a confining magnetic field. Therefore, three-dimensional measurements are important in understanding the behavior of the CTs. To observe the macroscopic process, we adopted a fast-framing camera (ULTRA Cam HS-106E) developed by NAC Image Technology. The characteristics of this camera are as follows: a CCD color sensor, capable of capturing 120 images during one sequence with a frame rate of up to 1.25 MHz. Using this camera, we captured the global motion of a CT inside the magnetic field and the collision of two CTs at the mid-plane of the experimental device. Additionally, by using a color sensor, we captured the global change in the plasma emission of visible light during the CT collision/merging process. As a result of these measurements, we determined the CT's global motion and the changes in the CT's shape and visible emission. The detailed system setup and experimental results are presented and discussed.

Internal magnetic field measurements of translated and merged field-reversed configuration plasmas in the FAT-CM device

Field-reversed configuration (FRC) Amplification via Translation-Collisional Merging (FAT-CM) experiments have recently commenced to study physics phenomena of colliding and merged FRC plasma states. Two independently formed FRCs are translated into the confinement region of the FAT-CM device, collided near the mid-plane of the device with a relative speed of up to ∼400 km/s, and a final merged FRC plasma state is achieved. To measure internal magnetic field profiles of the translated and merged FRC plasmas as well as to understand its collisional-merging process, an internal magnetic probe array, developed by TAE Technologies, has been installed in the mid-plane of the FAT-CM device. Initial magnetic field measurements indicate that both the translated and the merged FRC plasma states exhibit a clear field-reversed structure, which is qualitatively in good agreement with 2D MHD simulation. It is found and verified that a sufficient mirror field in the confinement region is required for colliding FRCs to be fully merged into a single FRC plasma state.

Application of a Hall sensor for pulsed magnetic field measurement in the FAT-CM FRC experiments

Collisional merging experiments of a field-reversed configuration (FRC) plasma at the super-Alfvénic velocity have been conducted in the FAT (FRC Amplification via Translation)-CM (Collisional Merging) device. In the experiments, two FRCs are collided and merged in a confinement section with a quasi-static confinement magnetic field. Therefore, it is necessary to measure the high-frequency pulsed magnetic field superposed on a quasi-stationary signal. The magnetic field is generally measured by a magnetic coil probe in the pulse discharge experiments; however, in such measurements, errors arise in the low-frequency band in the conducted FRC experiments. Therefore, a Hall sensor has been applied for low-frequency magnetic field measurements in the FAT-CM experiments. Calibration of the Hall sensor involves confirming that the sensor has a sufficient response speed and linear characteristics for the magnetic field with a rising time of approximately 240 µs and that its output voltage does not saturate up to a magnetic field of 0.7 T. Combination of the Hall sensor and the magnetic coil probe ensures a comprehensive measurement of the magnetic field in the range of FAT-CM experiments. In this study, accurate magnetic measurements were performed in a collisional merging experiment in the FAT-CM device by using a combined magnetic diagnostic system.

Activation of apoptosis inhibitor of macrophage is a sensitive diagnostic marker for NASH-associated hepatocellular carcinoma

BACKGROUND

A diagnostic marker is needed enabling early and specific diagnosis of hepatocellular carcinoma (HCC) associated with non-alcoholic steatohepatitis (NASH). Our recent findings have indicated that circulating apoptosis inhibitor of macrophage (AIM), which usually associates with IgM pentamer in the blood, is activated by its dissociation from IgM. We investigated the serum levels of IgM-free AIM for AIM activation and its possible relationship with development of HCC in NASH.

METHODS

Serum levels of IgM-associated and IgM-free AIM were evaluated in patients with non-alcoholic fatty liver, NASH, and NASH-HCC using enzyme-linked immunosorbent assays and immunoblots. Liver biopsy specimens were graded and staged using Brunt's classification.

RESULTS

Forty-two patients with fatty liver, 141 with NASH, and 26 with NASH-HCC were evaluated. Patients with stage 4 or grade 3 NASH (with or without HCC) exhibited significantly higher levels of both IgM-free and total AIM than those with fatty liver, whereas the ratio of IgM-free-to-total AIM was equivalent in these groups. Among patients with the same fibrosis stage of NASH, those with HCC had significantly higher IgM-free but not total AIM levels, resulting in a proportional increase in the IgM-free/total AIM ratio. Analysis of the areas under the receiver operating characteristic curves indicated the high sensitivity of the IgM-free AIM for NASH-HCC.

CONCLUSIONS

Our observations suggest the activation of AIM in blood in the presence of NASH-HCC, with a significant increase in IgM-free AIM levels. IgM-free AIM serum levels appear to be a sensitive diagnostic marker for NASH-HCC.

A case of a rare variant of Klinefelter syndrome, 47,XY,i(X)(q10)

Klinefelter syndrome is a condition in which a male patient has one Y chromosome and one or more extra X chromosomes. It is the most common sex chromosome disorder. Klinefelter syndrome is distinguished by many clinical features, such as infertility, high gonadotropin and low testosterone levels, increased height, and sparse body and facial hair. We report the case of a 32-year-old man who visited our hospital complaining of male infertility. Semen analysis showed azoospermia, and chromosomal analysis revealed a 47,XY,i(X)(q10) karyotype, which is a rare variant of Klinefelter syndrome. No spermatozoon was found on microdissection testicular sperm extraction, and the testis biopsy histology showed only Sertoli cells and hyalinised seminiferous tubules. 47,XY, i(X)(q10) has an additional isochromosome made of the long arm of the X chromosome, which shares some features of classical Klinefelter syndrome in many aspects, but patients are usually shorter than average height and have normal intelligence. In addition, to the best of our knowledge, no successful sperm extractions from 47,XY, i(X)(q10) patients were reported in the literature. The reports of patients who have undergone microdissection testicular sperm extraction are very rare. Further reports and studies of this chromosomal abnormality are needed.

Super-Alfvénic translation of a field-reversed configuration into a large-bore dielectric chamber

An experimental device to demonstrate additional heating and control methods for a field-reversed configuration (FRC) has been developed. The newly developed device, named FRC Amplification via Translation (FAT), has a field-reversed theta-pinch plasma source and a low-elongation dielectric (transparent quartz) confinement chamber with quasi-static confinement field. In the initial experiments on the FAT device, FRC translation and trapping were successfully demonstrated. Although the typical elongation of the trapped FRC in the confinement region was roughly three, no disruptive global instability, such as tilt, was observed. The FAT device increases the latitude to perform translation-related experiments, such as those concerning inductive current drive, equivalent neutral beam injection effects, and wave applications.

Perioperative respiratory complications: current evidence and strategy discussed in 2017 JA symposium

Respiratory management during general anesthesia aims to safely secure the airway and maintain adequate ventilation to deliver oxygen to the vital organs, maintaining homeostasis even during surgery. Despite its clinical importance, anesthesiologists often encounter difficulties in properly managing respiration during the perioperative period, leading to severe respiratory complications. In this year's JA symposium, 5 editorial board members of Journal of Anesthesia (JA) who are experts in the field of respiratory management in anesthesia discussed the following topics: quitting smoking before surgery: exposure to passive smoke is damaging to children, ventilator-associated pneumonia, high inspiratory oxygen concentration and lung injury, aspiration pneumonia, and postoperative respiratory management strategy in patients with obstructive sleep apnea. We hope that this special article regarding this year's JA symposium may be useful for JA readers to manage clinical anesthesia on a daily basis.

Loss of p300 accelerates MDS-associated leukemogenesis

The role that changes in DNA methylation and histone modifications have in human malignancies is poorly understood. p300 and CREB-binding protein (CBP), two distinct but highly homologous lysine acetyltransferases, are mutated in several cancers, suggesting their role as tumor suppressors. In the current study, we found that deletion of p300, but not CBP, markedly accelerated the leukemogenesis ofNup98-HoxD13 (NHD13) transgenic mice, an animal model that phenotypically copies human myelodysplastic syndrome (MDS). p300 deletion restored the ability of NHD13 expressing hematopoietic stem and progenitor cells (HSPCs) to self-renew in vitro, and to expand in vivo, with an increase in stem cell symmetric self-renewal divisions and a decrease in apoptosis. Furthermore, loss of p300, but not CBP, promoted cytokine signaling, including enhanced activation of the MAPK and JAK/STAT pathways in the HSPC compartment. Altogether, our data indicate that p300 has a pivotal role in blocking the transformation of MDS to acute myeloid leukemia, a role distinct from that of CBP.

Characterization of compact-toroid injection during formation, translation, and field penetration

We have developed a compact toroid (CT) injector system for particle refueling of the advanced beam-driven C-2U field-reversed configuration (FRC) plasma. The CT injector is a magnetized coaxial plasma gun (MCPG), and the produced CT must cross the perpendicular magnetic field surrounding the FRC for the refueling of C-2U. To simulate this environment, an experimental test stand has been constructed. A transverse magnetic field of ∼1 kG is established, which is comparable to the C-2U axial magnetic field in the confinement section, and CTs are fired across it. On the test stand we have been characterizing and studying CT formation, ejection/translation from the MCPG, and penetration into transverse magnetic fields.

Development of a magnetized coaxial plasma gun for compact toroid injection into the C-2 field-reversed configuration device

A compact toroid (CT) injector was developed for the C-2 device, primarily for refueling of field-reversed configurations. The CTs are formed by a magnetized coaxial plasma gun (MCPG), which consists of coaxial cylindrical electrodes and a bias coil for creating a magnetic field. First, a plasma ring is generated by a discharge between the electrodes and is accelerated by Lorenz self-force. Then, the plasma ring is captured by an interlinkage flux (poloidal flux). Finally, the fully formed CT is ejected from the MCPG. The MCPG described herein has two gas injection ports that are arranged tangentially on the outer electrode. A tungsten-coated inner electrode has a head which can be replaced with a longer one to extend the length of the acceleration region for the CT. The developed MCPG has achieved supersonic CT velocities of ∼100 km/s. Plasma parameters for electron density, electron temperature, and the number of particles are ∼5 × 10(21) m(-3), ∼40 eV, and 0.5-1.0 × 10(19), respectively.

Sales of veterinary antimicrobial agents for therapeutic use in food-producing animal species in Japan between 2005 and 2010

The use of veterinary antimicrobial agents in animals can result in the emergence and selection of resistant bacteria in food-producing animals. This study elucidated the use of veterinary antimicrobial agents in Japan in terms of milligrams of active ingredient sold per kilogram of biomass between 2005 and 2010. Data on sales of antimicrobial agents and on the biomass of the target animal species were compiled from statistics published bythe Japanese Ministry of Agriculture, Forestry and Fisheries. The quantities of antimicrobials used varied between animal species: the highest usage was observed in pigs (392 to 423 mg/ kg), followed by beef cattle (45 to 67 mg/kg), broiler chickens (44 to 63 mg/kg) and dairy cattle (33 to 49 mg/kg). For the animal species combined, usage of third- and fourth-generation cefalosporins, fluoroquinolones and macrolides ranged from 0.10 to 0.14 mg/kg biomass, 1.1 to 1.3 mg/kg biomass and 7.8 to 10.6 mg/kg biomass, respectively.

Lichen Planus Annularis: An Immunohistochemical Study

Lichen planus annularis is a relatively rare skin manifestation of lichen planus. The mechanisms in the formation of annular lesions are not fully understood. We reported here a 57-year-old female with this disease. The eruption initially occurred as lichen-papules, then enlarged (bean-sized, umbilicated small plaques), and finally developed annular manifestations. We performed immunohistochemical examinations of specimens taken from different types of eruptions. In all specimens, HLA-DR was expressed in the focal keratinocytes adjacent to the dermal HLA-DR positive cell infiltration. Both in the initial papule and in the final annular lesion, expression of ICAM-1 was present only in the keratinocytes above the dermal cell infiltration, similar to HLA-DR. It is of interest that, in the umbilicated small plaques, the peripheral epidermis other than the central site extensively reacted to ICAM-1. LFA-1 expression was most prominent in the mononuclear cells impinging on the dermo-epidermal junction in all specimens. In addition, in the periphery of the umbilicated small plaques, which showed no bandlike dense cell infiltration nor degeneration of basement membrane, TNF-alpha, but not LFA-1, was positive in the infiltrated cells of the upper dermis. These results suggest that expressions of ICAM-1 and TNF-alpha in the peripheral keratinocytes and dermal infiltrated cells are important molecular events in the mechanisms of formation of the annular lesions.

Efficiency of Dual-Cured Resin Cement Polymerization Induced by High-Intensity LED Curing Units Through Ceramic Material

Objective

This study aimed to evaluate the ability of high-intensity light-emitting diode (LED) and other curing units to cure dual-cured resin cement through ceramic material.

Methods

A halogen curing unit (Jetlite 3000, Morita), a second-generation LED curing unit (Demi, Kerr), and two high-intensity LED curing units (PenCure 2000, Morita; Valo, Ultradent) were tested. Feldspathic ceramic plates (VITABLOCS Mark II, A3; Vita Zahnfabrik) with thicknesses of 1.0, 2.0, and 3.0 mm were prepared. Dual-cured resin cement samples (Clearfil Esthetic Cement, Kuraray Noritake Dental) were irradiated directly or through one of the ceramic plates for different periods (5, 10, 15, or 20 seconds for the high-intensity LED units and 20, 40, 60, or 80 seconds for the others). The Knoop hardness test was used to determine the level of photopolymerization that had been induced in the resin cement. Data were analyzed by one-way analysis of variance and Dunnett's post-hoc test to identify test-control (maximum irradiation without a ceramic plate) differences for each curing unit (p&lt;0.05).

Results

For all curing units, the curing conditions had a statistically significant effect on the Knoop hardness numbers (KHNs) of the irradiated cement samples (p&lt;0.001). In general, the KHN decreased with increasing plate thickness and increased as the irradiation period was extended. Jetlite 3000 achieved control-level KHN values only when the plate thickness was 1.0 mm. At a plate thickness ≥2.0 mm, the LED units (except for PenCure 2000 at 3.0 mm) were able to achieve control-level KHN values when the irradiation time was extended. At a plate thickness of 3.0 mm, irradiation for 20 seconds with the Valo or for 80 seconds with the Demi were the only methods that produced KHN values equivalent to those produced by direct irradiation.

Conclusion

Regardless of the type of curing unit used, indirect irradiation of dual-cured resin cement through a ceramic plate resulted in decreased KHN values compared with direct irradiation. When the irradiation period was extended, only the LED units were able to achieve similar KHN values to those observed under direct irradiation in the presence of plates ≥2.0-mm thick. High-intensity LED units require a shorter irradiation period than halogen and second-generation LED curing units to obtain KHN values similar to those observed during direct irradiation.