Effects of gait intervention using the draw-in maneuver on knee joint function and the thoracic kyphosis angle in knee osteoarthritis

BACKGROUND

To evaluate whether the knee adduction moment (KAM) could be reduced by a short instruction in the Draw-in (DI) maneuver in healthy adults, and whether knee joint function would improve with a longer DI gait intervention in patients with knee osteoarthritis (OA).

METHOD

In Study 1, healthy adults received 10 minutes supervised instruction in DI gait in and then practiced the gait independently for 10 minutes. Three-dimensional motion analysis measurement was performed in each phase. In Study 2, patients with OA performed a 20-minute DI gait intervention daily for 6 weeks. At baseline and after 6 weeks, knee pain, the Knee injury and Osteoarthritis Outcome Score, the MOS 8 item Short-Form Health Survey, thoracic kyphosis angle, knee joint range of motion, knee extension muscle strength, hip abduction muscle strength, and activity level were evaluated.

RESULTS

In Study 1, the DI gait to decrease KAM could be learning following only 10 minutes of instruction and 10 minutes of self-practice in healthy adults. In Study 2, knee pain was reduced by 19 % and the thoracic kyphosis angle was reduced by 2.6° after 6 weeks. No significant changes in other parameters were detected, and the implementation rate was 86 ± 14 %.

SIGNIFICANCE

In healthy adults, DI gait instruction for 10 minutes of instruction and 10 minutes of self-practice reduced the KAM. In patients with knee OA, 20 minutes of DI gait per day for 6 weeks may reduce knee pain and thoracic kyphosis.

A Nomogram Based on Pretreatment Radiomics and Dosiomics Features for Predicting Overall Survival for Esophageal Squamous Cell Cancer: Multi-Institutional Study

PURPOSE/OBJECTIVE(S)

The current study aims to propose a nomogram-based 2- and 3-years survival prediction model for esophageal squamous cell carcinoma treated by definitive radiotherapy using pretreatment computed tomography (CT), positron emission tomography (FDG PET) radiomic features and dosiomics features in addition to the common clinical factors using multi-institution data.

MATERIALS/METHODS

Data of 112 patients from one institution and 28 patients from the other institution were retrospectively collected. Radiomics and dosiomics features were extracted using five segmentations on CT and PET images and dose distribution. The least absolute shrinkage and selection operator (LASSO) with logistic regression was used to select radiomics and dosiomics features by calculating the radiomics and dosiomics scores (Rad-score and Dos-score), respectively, in the training model. The predictive clinical factors, Rad-score, and Dos-score were identified to develop a nomogram model.

RESULTS

We extracted 15219 features from the radiomics and dosiomics analysis. By LASSO Cox regression analysis, 13 CT-based radiomics features, 11 PET-based radiomics features, and 19 dosiomics features were selected. Clinical factors of T-stage, N-stage, and clinical stage were selected as significant prognostic factors by univariate Cox regression analysis. A predictive nomogram for prognosis in was established using these factors. In the external validation cohort, the C-index of the combined model of CT-based radiomics, PET-based radiomics, and dosiomics features with clinical factors were 0.74, 0.82, and 0.92, respectively. Moreover, we divided the cohort into high-risk and low-risk groups using the median nomogram score. Significant differences in overall survival (OS) in the combine model of CT-based radiomics, PET-based radiomics, and dosiomics features with clinical factors were observed between the high-risk and low-risk groups (P = 0.019, P = 0.038, and 0.014, respectively).

CONCLUSION

The current study established and validated 2- and 3-year survival prediction models based on radiomics and dosiomics features with clinical factors. The prediction model with dosiomics analysis could better predict OS than CT- and PET-based radiomics analysis in esophageal cancer patients treated with radiotherapy.

Laryngo-Esophageal Dysfunction Free Survival of Chemoradiation for Cervical Esophageal Cancer

PURPOSE/OBJECTIVE(S)

Chemoradiotherapy is often the treatment of choice for cervical esophageal cancer due to the invasiveness of surgery. However, toxicity after chemoradiotherapy often affects the quality of life related to swallowing and speech. This study evaluated laryngoesophageal dysfunction-free survival (LEDFS) in patients with cervical esophageal cancer, which has recently been used in head and neck cancer.

MATERIALS/METHODS

We analyzed 59 patients with cervical esophageal cancer without distant metastases other than supraclavicular lymph node metastases who received radical chemoradiotherapy with 5-fluorouracilplus platinum between 2002 and 2018. Loco-regional control (LRC), overall survival (OS), LEDFS, metachronous esophageal cancer incidence rates, and late toxicities were evaluated. LEDFS events were defined as death, local recurrence, total or partial laryngectomy, tracheostomy for more than 2 years, and feeding tube use for more than 2 years, as recommended by the Larynx Preservation Consensus Panel. The Kaplan-Meier method was used to calculate survival rates. The generalized Wilcoxon test was used to compare the two groups. The Common Terminology Criteria for Adverse Events v5.0 was used to assess toxicities.

RESULTS

The median age was 66 years (range, 38-83). There were 13 women and 46 men. Stage I, II, III, IVA, and IVB disease according to UICC 8th staging were 15, 9, 9, 10, and 16 patients, respectively. 22 received conventional radiotherapy and 37 received volumetric modulated arc therapy. The median total irradiation dose was 66 Gy. Platinum plus 5-fluorouracil chemotherapy was administered to all patients. The median follow-up for survivors was 87.5 months. The 5-year LRC, OS, and LEDFS rates were 54.2%, 48.9%, and 41.9%, respectively. The prognostic factors for OS were performance status (PS), hypopharyngeal extension, and clinical stage in univariate analysis and only clinical stage (hazard ratio [HR] 3.87, 95% Confidence interval [CI]: 1.52-9.87, p<0.01) in multivariate analysis; the prognostic factors for LEDFS were PS, hypopharyngeal extension and clinical stage in univariate analysis and hypopharyngeal extension (HR 2.38, 95% CI: 1.12-5.03, p = 0.02) and clinical stage (HR 4.07, 95% CI: 1.48-11.06, p<0.02) in multivariate analysis. Metachronous esophageal cancer was observed in 28.6% of patients at 5 years. As severe late toxicities, grade 3 pneumonitis, esophageal stricture, esophageal fistula, laryngeal stricture, and laryngeal edema were observed in 1 (2%), 1 (2%) and 4 (7%), 1 (2%) and 1 (2%), respectively. Grade 2 hypothyroidism was observed in 31 (53%) patients.

CONCLUSION

Chemoradiation for cervical esophageal cancer showed good results. The prognostic factors for LEDFS were pharyngeal extension and clinical stage. Late esophageal and laryngeal toxicity, hypothyroidism, and metachronous esophageal cancer should be noted.

Impact of the G8 Score on Treatment Strategies and Outcome in Definitive Radiotherapy for the Elderly Esophageal Cancer Patients

PURPOSE/OBJECTIVE(S)

Although chemoradiotherapy (CRT) is widely used as a curative treatment for esophageal cancer, it is often difficult to perform standard CRT for the elderly in the real world. This study aimed to investigate the impact of the Geriatric 8 (G8) score on treatment strategies and outcome in definitive radiotherapy (RT) for elderly esophageal cancer patients.

MATERIALS/METHODS

We analyzed 81 esophageal cancer patients aged ≥65 years who received definitive RT between 2018 and 2021. The G8 score was acquired at the first visit to the radiation oncology department. The treatment strategy was decided by a multi-disciplinary conference, and the G8 score was not used to determine the treatment strategy. Standard treatment (standard CRT) was defined as RT with elective nodal irradiation and a total dose ≥50 Gy, and chemotherapy with two cycles of platinum (70 mg/m2) and 5FU (700 mg/m2 for 4 days) concurrently. The Kaplan-Meier method was used to generate actual survival curves. The Common Terminology Criteria for Adverse Events (CTCAE) version 5.0 was used to assess toxicities. The Mann-Whitney U test was used to compare the two groups, and statistical significance was set at p<0.05. The Receiver Operating Characteristic (ROC) curve was used to calculate the cutoff value.

RESULTS

The Median follow-up time was 30 months (range: 8-51) for survivors. The mean G8 scores by treatment strategy were 13.9 (range: 9-17) for standard CRT group (n = 26), 12.1 (range: 7-16) for reduced CRT group (n = 30), and 9.7 (range: 4.5-14) for RT alone group (n = 25). G8 score was significantly higher for standard CRT (p = 0.017) and significantly lower for RT alone (p<0.01). The cut-off value of the G8 score for standard treatment, calculated by the ROC curve, was 12.5 points. In the non-standard treatment group, the cut-off value of the G8 score for RT alone, calculated by the ROC curve, was 10.5 points. The 2-year overall survival (OS) rates for standard CRT, reduced CRT and RT alone were 74%, 71% and 35%, respectively, and significantly lower in RT alone (p<0.001). The 2-years OS rates for G8 score >10.5 points and ≤10.5 points were 69% and 48%, respectively (p = 0.039). Grade 3 or higher acute toxicities were observed in 33 patients (41%); 14 (54%) in standard CRT, 17 (57%) in reduced CRT and 2 (8%) in RT alone. Grade 5 acute toxicity was not observed. G8 scores tended to be higher in the patients with grade 3 or higher acute toxicities, but the difference was not statistically significant (p = 0.057). Grade 3 or higher late toxicities were observed in 7 patients.

CONCLUSION

Our results suggest that there is an association between the G8 score and clinicians' treatment decisions. Although RT alone could be safely performed even in patients with low G8 scores, administration of chemotherapy strongly affected prognosis. These results suggest the importance of developing less toxic systemic therapy regimens for patients with low G8 scores.

Predictive Modeling of Radiation Pneumonitis Induced by Chemoradiotherapy for Locally Advanced Non-Small Cell Lung Cancer Using Radiomics and Clinical Features

PURPOSE/OBJECTIVE(S)

The purpose of this study is to establish a prediction model for the development of grade 2 or higher radiation pneumonitis (RP) using radiomics analysis of pretreatment CT images, PET images, and dose distribution, in addition to clinical factors, in patients with locally advanced non-small cell lung cancer (NSCLC) treated with radical chemoradiotherapy.

MATERIALS/METHODS

We retrospectively evaluated 128 cases of locally advanced NSCLC treated with radical radiotherapy at our institution from 2008 to 2021. Clinical factors included age, sex, performance status (PS), KL-6, smoking history, histological type, clinical stage, and total radiation dose. Radiomics analysis was performed by analyzing treatment planning CT images, PET images, and dose distribution, and Rad-score (Radiomics-score) was calculated for the extracted features using Lasso-Cox regression. Rad-score (Radiomics-score) was calculated by Lasso-Cox regression for the extracted features. Risk factors were selected by univariate/multivariate analysis of clinical factors and Rad-score. Three models for predicting RP were developed from the identified risk factors using Nomogram: Clinical, Rad-score, and Combined model. The model was evaluated using area under the curve (AUC) based on receiver operating characteristic (ROC) curves and concordance index (C-index). RP was evaluated using the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. The cumulative incidence of Grade 2 or higher RP was evaluated using the Kaplan-Meier method.

RESULTS

Of the 128 cases, grade 2 or higher RP was observed in 50 cases (39%). Regarding clinical factors, gender, smoking status, and histology were selected as significant predictors of RP. Lasso-Cox analysis of radiomics features selected 11 features from CT images, 7 features from PET images, and 16 features from dose distribution as predictors of RP, yielding a total of 34 factors. The combined model (C-index: 0.96, AUC: 0.92) showed the best discrimination performance compared to the clinical model (C-index: 0.73, AUC: 0.56) and the Rad-score model (C-index: 0.87, AUC: 0.92). Risk classification using the combined model showed that the 1-year cumulative incidence of grade 2 or higher RP was 65% in the high-risk group, significantly higher than 15% in the low-risk group (p<0.001).

CONCLUSION

The combined model with Rad-score and clinical factors can predict grade 2 or higher RP in NSCLC patients with high accuracy.

High-power laser experiment forming a supercritical collisionless shock in a magnetized uniform plasma at rest

We present an experimental method to generate quasiperpendicular supercritical magnetized collisionless shocks. In our experiment, ambient nitrogen (N) plasma is at rest and well magnetized, and it has uniform mass density. The plasma is pushed by laser-driven ablation aluminum (Al) plasma. Streaked optical pyrometry and spatially resolved laser collective Thomson scattering clarify structures of plasma density and temperatures, which are compared with one-dimensional particle-in-cell simulations. It is indicated that just after the laser irradiation, the Al plasma is magnetized by a self-generated Biermann battery field, and the plasma slaps the incident N plasma. The compressed external field in the N plasma reflects N ions, leading to counterstreaming magnetized N flows. Namely, we identify the edge of the reflected N ions. Such interacting plasmas form a magnetized collisionless shock.

Common Features and Intra-Species Variation of Cutibacterium modestum Strains, and Emended Description of the Species

Cutibacterium modestum is a new species coined in 2020 as the fifth species of genus Cutibacterium, which includes Cutibacterium acnes. The species is predicted as a minor but common member of skin microbiome and includes a group tentatively named as “Propionibacterium humerusii”. The description of the species has been provided only with a single strain. To establish the characteristics of C. modestum and search for possible disease-related subtypes, we investigated the biochemical characteristics of eight live strains and performed in silico comparison of nine genomes. The common features, which included the morphology of Gram-stain positive short rods, the negativity of phenylalanine arylamidase, and several unique MALDI-TOF MS spectral peaks, were considered useful in laboratory identification. Pairwise comparisons of the genomes by in silico DNA–DNA hybridization showed similarity values of 98.1% or larger, which were far higher than the subspecies cutoff of 79–80%. The 16S rRNA gene sequences of thirteen isolates and genomes were identical. Their recA gene sequences were identical except for two strains, HM-510 (HL037PA2) and Marseille-P5998, which showed unique one-nucleotide polymorphisms. The biochemical features using API kits were slightly different among the isolates but far closer than those of the nearest other species, C. acnes and Cutibacterium namnetense. Spectra of MALDI-TOF mass spectrometry showed slight differences in the presence of m/z 10,512 (10 kD chaperonin GroS) and three other peaks, further clustering the eight isolates into three subtypes. These results indicated that these isolates did not separate to form subspecies-level clusters, but subtyping is possible by using recA gene sequences or MALDI-TOF mass spectrometry spectra. Moreover, this work has confirmed that a group “P. humerusii” is included in C. modestum.

What Do We See in Spectra?: Assignment of High-Intensity Peaks of Cutibacterium and Staphylococcus Spectra of MALDI-TOF Mass Spectrometry by Interspecies Comparative Proteogenomics

Matrix-assisted laser-desorption/ionization time-of-flight (MALDI–TOF) mass spectrometry is a widely used and reliable technology to identify microbial species and subspecies. The current methodology is based on spectral fingerprinting, analyzing protein peaks, most of which are yet to be characterized. In order to deepen the understanding of these peaks and to develop a more reasonable identification workflow, we applied proteogenomic approaches to assign the high-intensity peaks of MALDI–TOF spectra of two bacterial genera. First, the 3–22 kD proteomes of 5 Cutibacterium strains were profiled by UPLC–MS/MS, and the amino acid sequences were refined by referring to their genome in the public database. Then, the sequences were converted to m/z (x-axis) values based on their molecular masses. When the interspecies comparison of calculated m/z values was well-fitted to the observed peaks, the peak assignments for the five Cutibacterium species were confirmed. Second, the peak assignments for six Staphylococcus species were performed by using the above result for Cutibacterium and referring to ribosomal subunit proteins coded on the S10-spc-alpha operon (the S10-GERMS method), a previous proteomics report by Becher et al., and comprehensive genome analysis. We successfully assigned 13 out of 15 peaks for the Cutibacterium species and 11 out of 13 peaks for the Staphylococcus species. DNA-binding protein HU, the CsbD-like protein, and 50S ribosomal protein L7/L12 were observed in common. The commonality suggests they consist of high-intensity peaks in the MALDI spectra of other bacterial species. Our workflow may lead to the development of a more accurate species identification database of MALDI–TOF mass spectrometry based on genome data.

Electron Beam Irradiation of Lead Halide Perovskite Solar Cells: Dedoping of Organic Hole Transport Materials despite Hardness of the Perovskite Layer

Organic-inorganic lead halide perovskite solar cells (PSCs) are highly efficient, flexible, lightweight, and even tolerant to radiation, such as protons, electron beams (EB), and γ-rays, all of which makes them plausible candidates for use in space satellites and spacecrafts. However, the mechanisms of radiation damage of each component of PSC [an organic hole transport material (HTM), a perovskite layer, and an electron transport material (ETM)] are not yet fully understood. Herein, we investigated the EB irradiation effect (100 keV, up to 2.5 × 10¹⁵ cm^-2) on binary-mixed A site cations and halide perovskite (MA_0.13FA_0.87PbI_2.61Br_0.39, MA:methylammonium cation and FA:formaminidium cation), a molecular HTM of doped SpiroOMeTAD, and an inorganic ETM of mesoporous TiO₂. Despite the decreased power conversion efficiency of PSCs upon EB exposure, the photoconductivities of the perovskite, HTM, and ETM layers remained intact. In contrast, significant dedoping of HTM was observed, as confirmed by steady-state conductivity, photoabsorption, and X-ray photoelectron spectroscopy measurements. Notably, this damage could be healed by exposure to short-wavelength light, leading to a partial recovery of the PSC efficiency. Our work exemplifies the robustness of perovskite against EB and the degradation mechanism of the overall PSC performance.

A phase III, 52-week, open-label study to evaluate the safety and efficacy of 5% sofpironium bromide (BBI-4000) gel in Japanese patients with primary axillary hyperhidrosis

A long‐term study was conducted in Japanese patients with primary axillary hyperhidrosis who completed the preceding 6‐week phase III, confirmatory study of 5% sofpironium bromide gel (hereinafter referred to as sofpironium) to evaluate the safety and efficacy of 52‐week treatment with sofpironium. In the long‐term study, 185 patients who completed the confirmatory study (94 and 91 patients in the vehicle and sofpironium groups, respectively) started to receive sofpironium (switching and extension groups, respectively), and all these patients were included in both the full analysis set (FAS) and the safety analysis set (SAF). In the FAS, there were more females than males (73.0% vs. 27.0%), and median age was 38.0 years. A total of 161 patients (86 and 75 patients in the switching and extension groups, respectively) completed the study at week 52. The proportions of patients with hyperhidrosis disease severity score of 1 or 2 and a 50% or more reduction in total gravimetric weight of sweat were 57.4% in the switching group and 58.2% in the extension group at week 52. The proportions of patients who achieved this efficacy end‐point in the long‐term study were similar to that (53.9%) in the sofpironium group in the confirmatory study. In the SAF, the incidences of adverse events (AEs) were 80.9% in the switching group and 83.5% in the extension group, and the incidences of adverse drug reactions were 39.4% and 45.1%, respectively. AEs that occurred in at least 20% of patients in both treatment groups were application site dermatitis (25.5% and 33.0%, respectively) and nasopharyngitis (31.9% and 23.1%, respectively). Reported AEs were generally mild, and there were no deaths. Serious AEs occurred in three patients, but none were considered related to the study drug. In this study, the efficacy of sofpironium was maintained during 52‐week treatment, and no new safety risk was observed.

Relationship between vancomycin-associated nephrotoxicity and the number of combined nephrotoxic agents

Vancomycin is associated with nephrotoxicity; however, the influence of the number of combined nephrotoxic agents on the incidence of vancomycin nephrotoxicity has not been clarified. We investigated patient backgrounds in 148 inpatients who received vancomycin treatment. The patients were divided into nephrotoxicity (n=35) and non-nephrotoxicity (n=113) groups. A comparison of the patient backgrounds in the two groups revealed significant differences in weight, changes in serum creatinine before vancomycin administration, blood urea nitrogen to serum creatinine ratio, length of vancomycin therapy, vancomycin trough concentration, and number of combined nephrotoxic agents. Multiple logistic regression analysis using these six factors as autonomous variables showed that the highest vancomycin trough concentration (odds ratio, 1.080; 95% confidence interval, 1.030-1.140; p = 0.003) and the number of combined nephrotoxic agents (odds ratio, 1.590; 95% confidence interval, 1.120-2.260; p = 0.010) were significantly related to nephrotoxicity.

Impact of Proteinuria and Low eGFR on Lifetime Risk of Cardiovascular Disease Death: A Pooled Analysis of Data From the Evidence for Cardiovascular Prevention From Observational Cohorts in Japan Study

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): H20–Junkankitou [Seishuu]–Ippan–013; H23–Junkankitou [Seishuu]–Ippan–005; H26-Junkankitou [Seisaku]-Ippan-001; H29–Junkankitou–Ippan–003 and 20FA1002

OnBehalf

EPOCH-JAPAN

Introduction

Absolute risk of Lifetime risk (LTR) is useful estimate for risk communication compared with short term risk or relative risk especially for young people. Proteinuria is leading cause of end-stage kidney disease (ESKD) and independent risk factor for cardiovascular disease (CVD). Although nonproteinuric renal disease is global burden of ESKD, it has been poorly focused. To date, there have been no reports of impact of proteinuria and low eGFR on LTR with the outcome of CVD death in Asian population.

Purpose

We aimed to estimate LTR of CVD death stratified by the status of proteinuria and low eGFR.

Methods

We used modified Kaplan-Meier approach to estimate the remaining lifetime risk of cardiovascular death based on EPOCH-JAPAN(Evidence for Cardiovascular Prevention From Observational Cohorts in Japan) database. LTR was estimated at each index age starting from 40 years for those with proteinuria and without proteinuria stratified by low eGFR, which is defined as eGFR &lt;60 ml/min/1.73 m². Participants were classified into three groups, which were those with proteinuria (Proteinuria (+)), those without proteinuria with low eGFR (Proteinuria (-)/Low eGFR (+)), those without proteinuria without low eGFR (Proteinuria (-)/Low eGFR (-)).

Results

A total of 47,292 participants from 9 cohorts was included in the analysis. Mean follow-up period was 14.6 years with 690,463 person years and total CVD death was 1,075 in men and 1,193 in women. The LTRs at the index age of 40 years were as follows: 17.7% (95% confidence interval: 15.4 – 19.0%) in Proteinuria (-)/Low eGFR (-) group, 26.2% (20.2 – 31.1%) in Proteinuria (-)/low eGFR (+) group, 24.5% (15.1 – 29.3%) in Proteinuria (+) group for men; 15.3%(13.7 – 16.5%), 29.9%(14.7 – 46.8%) , 28.3%(19.4 – 34.7%) for women.

Conclusions

We observed that those without proteinuria with low eGFR have equivalently high LTR with those with proteinuria. These results indicate that even in the absence of proteinuria, low eGFR has high impact on LTR. Lifestyle modification from young age is necessary to prevent from renal dysfunction.

A phase 3, multicenter, randomized, double-blind, vehicle-controlled, parallel-group study of 5% sofpironium bromide (BBI-4000) gel in Japanese patients with primary axillary hyperhidrosis

A phase 3 study was conducted to verify the efficacy and safety of 5% sofpironium bromide (BBI‐4000) gel (hereinafter referred to as sofpironium) administrated for 6 weeks in Japanese patients with primary axillary hyperhidrosis. The primary efficacy end‐point was the proportion of patients who satisfied both criteria of a Hyperhidrosis Disease Severity Score (HDSS) of 1 or 2 at the end of 6‐week treatment and a 50% or more reduction in total gravimetric weight of sweat at the end of treatment relative to baseline. A total of 281 patients were randomized to receive 5% sofpironium (141 patients) or vehicle (140 patients), and all patients were included in the full analysis set (FAS). In the FAS, 70.1% of patients were female, and the median age was 35.0 years. The proportion of patients who achieved the primary efficacy end‐point was 53.9% in the sofpironium group and 36.4% in the vehicle group, with a statistically significant difference of 17.5% (95% confidence interval, 6.02–28.93) between these two groups (P = 0.003). The incidence of adverse events was 44.0% in the sofpironium group and 30.7% in the vehicle group, and the incidence of adverse drug reactions was 16.3% in the sofpironium group and 5.0% in the vehicle group. Reported adverse events were generally mild or moderate in severity. In the sofpironium group, common events (incidence, ≥5%) were nasopharyngitis (14.2%) and dermatitis/erythema at the application site (8.5%/5.7%), with no serious adverse events reported. This study demonstrated the efficacy and safety of 5% sofpironium.

Topological metastability supported by thermal fluctuation upon formation of chiral soliton lattice in [Formula: see text]

Topological magnetic structure possesses topological stability characteristics that make it robust against disturbances which are a big advantage for data processing or storage devices of spintronics; nonetheless, such characteristics have been rarely clarified. This paper focused on the formation of chiral soliton lattice (CSL), a one-dimensional topological magnetic structure, and provides a discussion of its topological stability and influence of thermal fluctuation. Herein, CSL responses against change of temperature and applied magnetic field were investigated via small-angle resonant soft X-ray scattering in chromium niobium sulfide ([Formula: see text]). CSL transformation relative to the applied magnetic field demonstrated a clear agreement with the theoretical prediction of the sine-Gordon model. Further, there were apparent differences in the process of chiral soliton creation and annihilation, discussed from the viewpoint of competing between thermal fluctuation and the topological metastability.

Cutibacterium modestum sp. nov., isolated from meibum of human meibomian glands, and emended descriptions of Cutibacterium granulosum and Cutibacterium namnetense

An anaerobic and aerotolerant bacterium, strain M12^T, was isolated from the meibum of inflamed human meibomian glands. Cells of the strain was Gram-stain-positive, non-spore-forming and non-motile rods. Growth on trypticase soy agar plates supplemented with 5 % sheep blood was fastest at 30-37 °C under anaerobic conditions. The 16S rRNA gene sequence of the strain revealed that it belongs to the genus Cutibacterium with a 98.0 % similarity value to the closest species, Cutibacterium acnes. Genome analysis of the strain with type strains of the other Cutibacterium species resulted in digital DNA-DNA hybridization values of 32.3-22.3% and average nucleotide identity (OrthoANI) values of 86.7-73.6 %. Biochemical and physiological analyses using API rapid ID 32A and API Coryne kits revealed relatively low reactivity of the strain compared with C. acnes and Cutibacterium namnetense. The most abundant major cellular fatty acid was iso-C_15 : 0. Fermentation end-products from glucose were propionate, lactate, succinate and acetate. The diagnostic diamino acid of the peptidoglycan was meso-diaminopimelic acid. Major menaquinones were MK-9(H₄), MK-9(H₂) and MK-9. The major peaks of the MALDI-TOF mass spectrometry spectrum were at 3493, 3712, 6986 and 7424 Da. The DNA G+C content was 59.9 mol%. Based on these findings, we propose a novel species, Cutibacterium modestum. The type strain of C. modestum is M12^T (=JCM 33380^T=DSM 109769^T). On the basis of further genomic analysis, we also provide emended descriptions of Cutibacterium granulosum (Prévot 1938) Scholz and Kilian 2016 and Cutibacterium namnetense (Aubin et al. 2016) Nouioui et al. 2018.

Phase I/II study of adding intraperitoneal paclitaxel in patients with pancreatic cancer and peritoneal metastasis

BACKGROUND

Intraperitoneal chemotherapy using paclitaxel is considered an experimental approach for treating peritoneal carcinomatosis. This study aimed to determine the recommended dose, and to evaluate the clinical efficacy and safety, of the combination of intravenous gemcitabine, intravenous nab-paclitaxel and intraperitoneal paclitaxel in patients with pancreatic cancer and peritoneal metastasis.

METHODS

The frequencies of dose-limiting toxicities were evaluated, and the recommended dose was determined in phase I. The primary endpoint of the phase II analysis was overall survival rate at 1 year. Secondary endpoints were antitumour effects, symptom-relieving effects, safety and overall survival.

RESULTS

The recommended doses of intravenous gemcitabine, intravenous nab-paclitaxel and intraperitoneal paclitaxel were 800, 75 and 20 mg/m² respectively. Among 46 patients enrolled in phase II, the median time to treatment failure was 6·0 (range 0-22·6) months. The response and disease control rates were 21 of 43 and 41 of 43 respectively. Ascites disappeared in 12 of 30 patients, and cytology became negative in 18 of 46. The median survival time was 14·5 months, and the 1-year overall survival rate was 61 per cent. Conversion surgery was performed in eight of 46 patients, and those who underwent resection survived significantly longer than those who were not treated surgically (median survival not reached versus 12·4 months). Grade 3-4 haematological toxicities developed in 35 of 46 patients, whereas non-haematological adverse events occurred in seven patients.

CONCLUSION

Adding intraperitoneal paclitaxel had clinical efficacy with acceptable tolerability.

P224 Valvuloplasty treatment and three-dimensional analysis for isolated cleft of the anterior mitral valve leaflet: a case report

Introduction: Isolated cleft of the anterior mitral valve leaflet is a very rare congenital disease and a cause of mitral regurgitation

not associated with atrioventricular septal defect. In this case, we report our experience in valvuloplasty treatment for mitral regurgitation with this rare aetiology.

Case description

23-year-old Russian women. Although cardiac murmur was pointed out in her childhood and she was diagnosed as mitral regurgitation, she refused treatment. After getting married with a Japanese man and moving to Japan, her symptoms had worsened and she visited our hospital for treatment. Preoperative transthoracic echocardiography (TTE) had indicated the regurgitation from the central part of the mitral valve. Preoperative transoesophageal echocardiography (TOE) had pointed out the isolated cleft of the anterior mitral valve.

Surgical mitral valvuloplasty was scheduled, and the TOE after anaesthetic induction showed the isolated cleft of the anterior mitral valve the same as in the preoperative period and pointed out the posterior leaflet billowing. The operative finding was also similar to TOE: the largely bisected central anterior mitral valve and billowing, P2 billowing, shortening of P1 and P3, P2-3 cleft. There were no chords at the anterior cleft. The valvuloplasty was performed including five-time pump runs in total: 1) Continuous suture for the anterior cleft and ring annuloplasty were performed, and the regurgitation was seemed to be almost controlled at the water-leak test and the ink test; 2) Artificial chordae and leaflet plications were added to residual regurgitation from the posterior region; 3)The residual regurgitation was controlled to Mild but it became a lateral jet toward the ring; 4)Mild remnant flow was pointed out: the regurgitation seemed to be from the posterior cleft, where immediately below the ring suture; 5) Pericardium patch was added and the remnant flow was almost eliminated. The pump was weaned and the operation was finished without any problems.

Discussion

The cause of difficulty in this valvuloplasty was thought to be caused by the difficulty in evaluating the mitral valve morphology. It was evident that the anterior leaflet of the mitral valve was largely bisected. However, it was difficult to evaluate the coaptation line and area due to the absence of chordal cords in the anterior cleft and the billowing or shortening of the posterior leaflet. Although preoperative three-dimensional analysis helped evaluating the isolated cleft and the regurgitation was almost controlled in the evaluation in the operation field, nevertheless, a residual regurgitation occurred and indicated in the TOE after re-beating.

Conclusion

It is important and necessary to use fine evaluation of coaptation is needed in valvuloplasty for isolated cleft of the anterior mitral valve leaflet; not only apply three-dimensional analysis but also apply two-dimensional echocardiogram.

Abstract P224 Figure.

P662 Synchrony between the right and left heart systems is recovered after TAVI in patients with severe aortic stenosis

Funding Acknowledgements

Young Investigator Grant of Japanese Society of Cardiovascular Anesthesia

Background / Introduction

Evidences have shown that cardiac function decline and systolic phase change are caused by massive afterload of the stenosed aortic valve in patients with severe aortic valve stenosis. As a result of the reduction of the left ventricular afterload by valve replacement, the cardiac function recovers. However, it has not been clarified yet how the changes in cardiac function affect the relationship between the right and left heart systems, as well as the systole phase.

TAPSE and MAPSE are known as indices of simple cardiac function evaluation by measuring the movement distance of the atrioventricular annulus. We obtained these indices (i.e. TAPSE, MAPSE) within the same heartbeat using speckle tracking analysis of the atrioventricular annulus and evaluated the changes in cardiac function and phase between the right and left heart systems.

Purpose

To reveal the relationship of cardiac function and time phase between the right and left heart systems by evaluating the maximum movement distance and time of the atrioventricular annulus within the same heartbeat and the same view in patients with severe aortic valve stenosis before and after TAVI.

Methods

A prospective cohort study was conducted. We recruited and analyzed 44 patients with severe aortic valve stenosis who received TAVI treatment, able to record baseline before treatment and follow-up 6 months and 12 months after treatment at our hospital from March 2017 to May 2019. Patients were excluded if more than 2 degree of atrioventricular valve regurgitation or incomplete data. The apical four-chamber view was used for speckle tracking analysis with the origin of the apical extension and region of interest (ROI) of the mitral annulus and tricuspid annulus. For each patient before treatment, at 6 months and 12 months after treatment, the maximum contraction distance (DM), maximum contraction time (TM) of the mitral valve annulus, maximum contraction distance (DT) and maximum contraction time (TT) of the tricuspid annulus were measured. Maximum contraction distance ratio (DM/ DT) and maximum contraction time ratio (TM/ TT) were calculated. For statistical analysis, t-test and ANOVA were used, and a significance threshold of p &lt;0.05 was applied.

Results

TM/ TT decreased at 12 months after TAVI, and DM/ DT increased significantly at 6 months and 12 months after TAVI when compared to baseline before treatment.

Conclusions

In patients with severe aortic valve stenosis, the correction of cardiac function difference between the right and left heart systems occurs from 6 months after TAVI. Moreover, the correction of contraction phase difference between the right and left heart systems at 12 months after TAVI. Thus, the synchrony between the right and left heart system is recovered 12 months after TAVI.

Abstract P662 Figure.

Curative Criteria After Endoscopic Resection for Superficial Esophageal Squamous Cell Carcinomas

BACKGROUND

According to the Japanese Esophageal Society (JES) guidelines, risk factors for lymph node (LN) metastasis in the muscularis mucosa (MM)/submucosa to a depth of up to 200 μm (SM1) in cases of esophageal squamous cell carcinomas (ESCCs) include the presence of lymphatic invasion (ly), venous invasion (v), infiltration pattern (INF)c, and SM1. The long-term prognoses of these patients are unclear, and there are very few reports on the validation of the curative criteria for MM/SM1 ESCCs.

AIMS

To examine the long-term prognoses of these patients and the risk factors for LN metastasis of MM/SM1 ESCCs after endoscopic resection (ER).

METHODS

This study included patients with MM/SM1 ESCCs who underwent ER at Hiroshima University Hospital from December 1990 to November 2016. We evaluated the clinicopathological characteristics of 98 patients and overall survival, disease-specific survival, recurrence-free survival, and recurrence rates in the e-curative and non-e-curative groups.

RESULTS

The mean observation period was 75 months. There was no significant difference in disease-specific survival rate between the e-curative and non-e-curative groups (100 vs. 98%). There was no significant difference in disease-specific survival rates between the groups (100 vs. 98%). In contrast, the LN recurrence-free survival rate in patients with INFa, ly(-), and v(-) was significantly higher than that in patients with INFb/c, ly(+), or v(+) (100 and 87%, P < 0.05).

CONCLUSION

Contrary to the JES guidelines, our findings suggest that new criteria (MM/SM1, INFa, negative vertical margin (VM0), ly[-], and v[-]) may be associated with curative ER without additional treatment.