Association between immunotherapy biomarkers and glucose metabolism from F-18 FDG PET

OBJECTIVE

To assess associations between parameters derived from F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) and mRNA expression levels of immune checkpoint biomarkers such as programmed death receptor 1 (PD-1), programmed death-ligand 1 (PD-L1), cytotoxic T-lymphocyte antigen 4 (CTLA-4) as well as tumor mutation burden (TMB) in non-small cell lung cancer (NSCLC) patients.

PATIENTS AND METHODS

Integrated data were downloaded from Genomic Data Common Data Portal. Clinical, mRNA-seq, and whole exome-seq data of lung adenocarcinoma and squamous cell carcinoma from The Cancer Genome Atlas (TCGA) database were analyzed. TMB was defined as the total number of somatic missense mutations per megabase of the genome examined. Expression levels of PD-1, PD-L1, CTLA4 mRNA and TMB were collected. Correlations between imaging parameters of glucose metabolism and the expression levels of genomic biomarkers from cancers were evaluated. Bonferroni correction (adjusted p<0.0027) was applied to reduce type 1 error.

RESULTS

Of 31 NSCLC cases, 11 cases were adenocarcinoma (LUAD) and 20 were squamous cell carcinoma (LUSC). In linear regression analysis, texture parameters such as low gray-level run emphasis (LGRE, R2=0.48, p<0.0001), short run low gray-level emphasis (SRLGE, R2=0.45, p<0.0001) and long run low gray-level emphasis (LRLGE, R2=0.41, p=0.0001) derived from gray-level run length matrix (GLRLM) showed remarkable correlation with PD-L1 mRNA expression. Expression of PD-1, CTLA-4, and TMB failed to show any significant correlation with parameters of the F-18 FDG PET/CT.

CONCLUSIONS

Texture parameters derived from PET, known to indicate glucose uptake distribution, were correlated with expression of PD-L1 mRNA but not with expression of PD-1, CTLA-4 and TMB. Thus, tumoral heterogeneity could be a surrogate marker for the identification of PD-L1 level in NSCLC.

Shape Coexistence at Zero Spin in ^{64}Ni Driven by the Monopole Tensor Interaction

The low-spin structure of the semimagic ^{64}Ni nucleus has been considerably expanded: combining four experiments, several 0^{+} and 2^{+} excited states were identified below 4.5 MeV, and their properties established. The Monte Carlo shell model accounts for the results and unveils an unexpectedly complex landscape of coexisting shapes: a prolate 0^{+} excitation is located at a surprisingly high energy (3463 keV), with a collective 2^{+} state 286 keV above it, the first such observation in Ni isotopes. The evolution in excitation energy of the prolate minimum across the neutron N=40 subshell gap highlights the impact of the monopole interaction and its variation in strength with N.

TEK is a novel prognostic marker for clear cell renal cell carcinoma

OBJECTIVE

Clear cell renal cell carcinoma (ccRCC) is the most common type of kidney cancer. However, effective therapeutics for ccRCC are lacking. Novel biomarkers could provide critical information when determining prognoses for patients with ccRCC. In this study, we sought to determine if the expression of receptor tyrosine kinase (TEK) could be a potential novel prognostic biomarker for ccRCC. TEK, originally identified as an endothelial cell-specific receptor, plays an important role in the modulation of vasculogenesis and remodeling. Altered TEK expression has been observed in tumor tissues (e.g., oral squamous cell carcinomas, leukemia) and breast, gastric and thyroid cancers. However, the role of TEK in ccRCC remains unknown.

PATIENTS AND METHODS

Differential TEK expression between non-metastatic (stage M0) and metastatic (stage M1) ccRCC patient cohorts was determined from The Cancer Genome Atlas (TCGA) and the International Cancer Genome Consortium (ICGC). Furthermore, TEK expression was assessed as a prognostic factor using the time-dependent area under the curve (AUC) of Uno's C-index, the AUC value of the receiver operating characteristics (ROC) at 5 years, Kaplan-Meier survival curves and multivariate analyses.

RESULTS

A Kaplan-Meier curve analysis revealed that the downregulation of TEK expression was associated with a poor prognosis for patients with ccRCC with good discrimination (p<0.0001 and p=0.0044 for the TGCA and ICGC cohorts, respectively). Analyses of C-indices and receiver operating characteristic AUC values further support this discriminative ability. Moreover, multivariate analyses showed the prognostic significance of TEK expression levels (p<0.001).

CONCLUSIONS

Although additional clinical investigations will be needed, our results suggest that TEK is a potential biomarker for ccRCC.

Vaginal compared with intramuscular progestogen for preventing preterm birth in high-risk pregnant women (VICTORIA study): a multicentre, open-label randomised trial and meta-analysis

OBJECTIVE

To compare the efficacy of two types of progestogen therapy for preventing preterm birth (PTB) and to review the relevant literature.

DESIGN

A multicentre, randomised, open-label, equivalence trial and a meta-analysis.

SETTING

Tertiary referral hospitals in South Korea.

POPULATION

Pregnant women with a history of spontaneous PTB or short cervical length (<25 mm).

METHODS

Eligible women were screened and randomised at 16-22 weeks of gestation to receive either 200 mg of vaginal micronised progesterone daily (vaginal group) or an intramuscular injection of 250 mg 17α-hydroxyprogesterone caproate weekly (IM group). Stratified randomisation was carried out according to participating centres and indications for progestogen therapy. This trial was registered at ClinicalTrials.gov (NCT02304237).

MAIN OUTCOME MEASURE

Preterm birth (PTB) before 37 weeks of gestation.

RESULTS

A total of 266 women were randomly assigned and a total of 247 women (119 and 128 women in the vaginal and IM groups, respectively) were available for the intention-to-treat analysis. Risks of PTB before 37 weeks of gestation did not significantly differ between the two groups (22.7 versus 25.8%, P = 0.571). The difference in PTB risk between the two groups was 3.1% (95% CI -7.6 to 13.8%), which was within the equivalence margin of 15%. The meta-analysis results showed no significant differences in the risk of PTB between the vaginal and IM progestogen treatments.

CONCLUSION

Compared with vaginal progesterone, treatment with intramuscular progestin might increase the risk of PTB before 37 weeks of gestation by as much as 13.8%, or reduce the risk by as much as 7.6%, in women with a history of spontaneous PTB or with short cervical length.

TWEETABLE ABSTRACT

Vaginal and intramuscular progestogen showed equivalent efficacy for preventing preterm birth before 37 weeks of gestation.

Limbal Metabolic Support Reduces Peripheral Corneal Edema with Contact-Lens Wear

Purpose

To assess the influence of limbal metabolic support on corneal edema during scleral-lens (SL) and soft-contact-lens (SCL) wear for healthy lens wearers.

Methods

A two-dimensional (2D) model of the cornea and sclera was designed on Comsol Multiphysics 5.4 along with SL and SCL architectures to mimic lens-wear induced hypoxia. The cornea is suffused with oxygen and metabolites from the limbus and aqueous humor. Air oxygen is supplied from and carbon dioxide is expelled to the atmosphere. Lens-oxygen permeability (Dk) was adjusted to investigate lens-wear safety against edema in different wear conditions. The 2D concentrations of oxygen, carbon dioxide, bicarbonate, lactate, sodium, chloride, glucose, and pH are quantified. Central-to-peripheral swelling of the cornea is determined by the change in stromal hydration caused by changing metabolite concentrations at the endothelium during hypoxia.

Results

The metabolic model assesses central-to-peripheral corneal swelling with different types of lenses, and oxygen Dks. Limbal metabolic support reduces edema from the periphery to approximately 1 mm away from the central cornea. Despite thicker lens designs, the peripheral cornea exhibits practically zero swelling due to limbal metabolic support.

Conclusions

The metabolic model accurately predicts central-to-peripheral corneal edema with various contact-lens designs, post-lens tear-film thicknesses, and lens oxygen Dk values. Despite the thicker periphery of most contact-lens designs, lactate and bicarbonate support from the limbus significantly reduces peripheral and mid-peripheral corneal edema, whereas oxygen has a lesser effect.

Translational Relevance

By utilizing metabolic kinetics, we provide a 2D computational tool to predict oxygenation safety across the entire cornea with various types and designs of contact lenses.

Correlating the size and cation inversion factor in context of magnetic and optical behavior of CoFe2O4 nanoparticles

Herein, the size dependent behavior of cobalt ferrite nanoparticles was investigated using synchrotron radiation based techniques. Scanning electron micrographs revealed the enhancement of particle/crystallite size with increase of annealing temperature. Moreover, the shape of these particles also changed with increase of crystallite size. Saturation magnetization increased with increase of crystallite size. The higher saturation magnetization for larger crystallite size nanoparticles was attributed to a cation distribution similar to that of bulk CoFe2O4. The optical band-gap of these nanoparticles decreased from 1.9 eV to 1.7 eV with increase of crystallite size. The enhancement of the optical band-gap for smaller crystallites was due to phenomena of optical confinement occurring in the nanoparticles. Fe L Co L-edge near edge extended X-ray absorption fine structure (NEXAFS) measurements showed that Fe and Co ions remain in the 3+ and 2+ state in these nanoparticles. The results obtained from Fe & Co K-edge X-ray absorption near edge structure (XANES)-imaging experiments further revealed that this oxidation state was possessed by even the crystallites. Extended X-ray absorption fine structure (EXAFS) measurements revealed distribution of Fe and Co ions among tetrahedral (A) and octahedral (B) sites of the spinel structure which corroborates the results obtained from Rietveld refinement of X-ray diffraction patterns (XRD). X-ray magnetic circular di-chroism (XMCD) measurements revealed negative exchange interaction among the ions situated in tetrahedral (A) and octahedral (B) sites. Theoretical and experimental calculated magnetic moments revealed the dominancy of size effects rather than the cation redistribution in the spinel lattice of CoFe2O4 nanoparticles.

Application of panoramic radiography with a multilayer imaging program for detecting proximal caries: a preliminary clinical study

OBJECTIVE

The aim of this study is to introduce a novel program of panoramic radiography that shows 41 multilayer images from the buccal to lingual aspects in a region of interest, and to evaluate the effectiveness of this program for detecting proximal caries.

METHODS

In total, 480 premolars and molars on 30 panoramic radiographs taken with the multilayer imaging program were included in this study. The presence or absence of caries in 960 proximal surfaces was assessed by three experienced oral and maxillofacial radiologists as a consensus-based gold-standard. Two general dentists evaluated and scored proximal caries on 980 surfaces on panoramic radiographs with and without the multilayer imaging program. The two general dentists' scores were compared with the gold-standard, and were analyzed for sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating characteristic (ROC) curve with and without using the program. The area under the ROC curve was analyzed using STATA/SE 13.1.

RESULTS

When the multilayer imaging program was used for panoramic radiography, the inter- and intraobserver agreement of the two general dentists improved. All values, including the area under the ROC curve, were higher when the multilayer imaging program was used than when it was not used. The area under the ROC curve showed a statistically significant improvement only in Observer 1, whose diagnostic ability was poorer than that of Observer 2.

CONCLUSIONS:O

This multilayer imaging program might help the inexperienced dentist to improve the diagnostic accuracy of proximal caries. If further studies would be performed in various clinical application, it could be useful when intraoral radiography taking is difficult for reasons such as mouth-opening limitations and the gag reflex of the patients.

Dose assessment in dental cone-beam computed tomography: Comparison of optically stimulated luminescence dosimetry with Monte Carlo method

The variety of cone-beam computed tomography (CBCT) machines and their applications has rapidly increased in recent years, making the dose evaluation of individual devices an important issue. Patient doses from CBCT were assessed with two different methods: optically stimulated luminescence dosimeter (OSLD) measurements and Monte Carlo (MC) simulations, in four different examination modes. Based on an analysis of the measurement process and the obtained values, a recommendation is made regarding which method is more practical and efficient for acquiring the effective dose of CBCT. Twenty-two OSLDs were calibrated and equipped in human phantoms of head and neck organs. They were exposed to radiation from two CBCT units—CS9300 (Carestream Dental LLC, Atlanta, Georgia) and RAYSCAN α+ (Ray Co. Ltd, Hwaseong-si, Korea)—using two different examination modes. The dose recorded using the OSLDs was used to calculate the organ dose and the effective dose for each unit in each examination mode. These values were also calculated using MC software, PCXMC (STUK, Helsinki, Finland). The organ doses and effective doses obtained using both methods were compared for each examination mode of the individual units. The OSLD-measured effective dose value was higher than that obtained using the MC method for each examination mode, except the dual jaw mode of CS9300. The percent difference of the effective dose between the two methods ranged from 4.0% to 14.3%. The dose difference between the methods decreased as the field of view became smaller. The organ dose values varied according to the method, although the overall trend was similar for both methods. The organs showing high doses were mostly consistent for both methods. In this study, the effective dose obtained by OSLD measurements and MC simulations were compared, and both methods were described in detail. As a relatively efficient and easy-to-perform method, we cautiously suggest using MC simulations for dose evaluations in the future.

Clinical features and prognosis of patients with idiopathic pulmonary fibrosis and chronic obstructive pulmonary disease

<sec> <title>BACKGROUND</title> Idiopathic pulmonary fibrosis (IPF) and chronic obstructive pulmonary disease (COPD) share common risk factors. They could therefore be expressed in a single patient. However, the prevalence, clinical characteristics and prognosis of individuals with comorbid IPF and COPD are not known. </sec> <sec> <title>METHOD</title> From 2003 to 2007, the Korean Interstitial Lung Disease Study Group created a register for idiopathic interstitial pneumonia using 2002 ATS/ERS (American Thoracic Society/European Respiratory Society) criteria. Of the 1546 IPF patients assessed, 143 had decreased lung function consistent with COPD (IPF-COPD). COPD was diagnosed based on age (≥40 years) and pulmonary function (forced expiratory volume in 1 sec [FEV₁]/forced vital capacity [FVC] ratio < 0.7). </sec> <sec> <title>RESULTS</title> The median age of the IPF-COPD group was 71.0 years (interquartile range 66.0-76.0); most patients were male (88.1%). FVC (%) was significantly higher in the IPF-COPD group; however, FEV₁ (%) was significantly lower in the IPF-COPD group (P < 0.001). Diffusing capacity of the lung for carbon monoxide (DL_CO) was not significantly different between the two groups. In survival analysis, age and FVC (%), but not COPD, were significantly associated with prognosis (respectively P = 0.003, 0.001 and 0.401). COPD severity was also not related to prognosis (P = 0.935). </sec> <sec> <title>CONCLUSION</title> The prevalence of IPF-COPD was estimated to be ∼9.2% among all IPF patients; prognosis of patients with IPF-COPD was not worse than those with IPF alone. </sec>.

Diagnostic signature of the compressibility of the inertial-confinement-fusion pusher

Carbon shell areal density measurements from many types of inertial confinement fusion implosions at the National Ignition Facility (NIF) demonstrate that the final state of the outside portion of the shell is set primarily by capsule coast time, the coasting period between main laser shut off and peak fusion output. However, the fuel areal density does not correlate with the increasing carbon compression. While two-dimensional (2D) radiation-hydrodynamic simulations successfully capture the carbon compression, energy must be added to the simulated fuel-ice layer to reproduce fuel areal density measurements. The data presented demonstrates that the degradation mechanisms that reduce the compressibility of the fuel do not reduce the compressibility of the ablator.

Alveolar bone height according to the anatomical relationship between the maxillary molar and sinus

Purpose

The aim of this study was to investigate the available alveolar bone height between the maxillary molars and the sinus floor according to their anatomical relationship using cone-beam computed tomographic (CBCT) images.

Methods

A total of 752 maxillary first (M1) and second molars (M2) on CBCT scans of 188 patients were selected. First, each maxillary molar was categorized as type 1, 2, 3, or 4 according to the relationship of the molar root with the maxillary sinus floor. The frequency distribution of each type was analyzed. Second, the shortest vertical distance (VD) of each molar was measured from the furcation midpoints of the roots to the lowest point of the sinus floor by 2 observers. Intraclass correlation coefficients and the t-test were calculated for the VD measurements.

Results

For M1, type 3 was the most frequent, followed by type 2. For M2, type 3 was the most common, followed by type 1. The VD measurements of type 1 were 9.51±3.68 mm and 8.07±2.73 mm for M1 and M2, and those of type 3 were 3.70±1.52 mm and 4.03±1.53 mm for M1 and M2, respectively. The VD measurements of M2 were significantly higher in female patients than in male patients.

Conclusions

Type 3 was the most frequent anatomical relationship in the maxillary molars, and showed the lowest alveolar bone height. This information will help clinicians to prevent complications related to the maxillary sinus during maxillary molar treatment and to predict the available bone height for immediate implant planning.

The Association of Gait Speed and Frontal Lobe among Various Cognitive Domains: The Korean Frailty and Aging Cohort Study (KFACS)

OBJECTIVE

The aim of this study was to determine how gait speed and frontal lobe functionsin community-dwelling older adults in Korea.

DESIGN

This was a cross-sectional study.

SETTING

The study used data from the Korean Frailty and Aging Cohort Survey (KFACS), a multi-center longitudinal study addressing 10 centers across urban, rural, and suburban communities in Korea, between 2016 and 2017.

PARTICIPANTS

A total of 1552 older adults who underwent both gait speed tests and cognitive functions tests during the investigation of the KFACS.

MEASUREMENTS

Gait speed was assessed by asking participants to walk from a starting point to a point 4 meters away at a normal gait. Cognitive functions were evaluated using various standardized cognitive functions tests.

RESULTS

Gait speed was slower when participants were older or less educated The percentage of women, higher BMI, people with lower incomes, singles, smokers, and drinkers was high in the slower gait group. Also, all cognitive function scores were low and depression score was high in the group with slower walking speed. The slower walking speed showed low physical activity score and high prevalence of hypertension, osteoarthritis and osteoporosis. Among the seven cognitive functions (MMSE, memory, TMT, Recall, Recognition, digit span, and Fab), only TMT showed no significant difference between different gait speed groups. The other six cognitive functions showed higher results in the fastest gait speed group (T3), Participants in middle gait speed group (T2) also showed higher results in five of the seven cognitive function scores as well (Memory, Recall, Recognition, digit span, and Fab).

CONCLUSION

In this study, we found correlation between the slower gait speeds and the decrease in cognitive function, and especially the frontal lobe dysfunction was most prominent of all cognitive dysfunctions.

Improved calibration of the OMEGA gas Cherenkov detector

Inertial fusion implosions are diagnosed using γ rays to characterize the implosion physics or measure basic nuclear properties, including cross sections. For the latter, previously reported measurements at laser facilities using gas Cherenkov detectors are limited by a large systematic uncertainty in the detector response. We present a novel in situ calibration technique using neutron inelastic scattering, which we apply to the new GCD-3 detector. The calibration accuracy is improved by ∼3× over the previous method.

Development of ICNP-based inpatient falls prevention catalogue

OBJECTIVES

The International Council of Nurses supports the development of International Classification for Nursing Practice® (ICNP®) catalogues to support the construction of electronic health records and evidence-based practice. Such a catalogue is needed for inpatient falls.

METHODS

The ICNP®-Based Inpatient Fall-Prevention Catalogue ('The Catalogue') was developed following the six steps recommended by the International Council of Nurses: (1) identifying inpatient falls as a priority, (2) gathering relevant concepts from 10 international guidelines and comparing locally defined sets of fall-prevention terms, (3) mapping the concepts to the ICNP® terminology, (4) identifying new concepts, (5) conducting a clinical face validation with a 12-member panel and finalizing The Catalogue and (6) setting a strategy for dissemination. The high-level structure of the International Classification for Patient Safety was used as a theoretical framework.

RESULTS

Eighteen nursing care elements and 141 terms were identified. A local vocabulary set had 89 terms (63.1%) that all corresponded to the identified terms. The exact and post-coordination mapping rates to the ICNP® were 75% and 40.6% for assessment/diagnosis/outcomes and interventions, respectively. The 54 new terms corresponded to 52 primitive concepts. An external review of The Catalogue showed that it had adequate understandability and validity. However, one-third of assessments/diagnoses/outcomes and one-fourth of interventions were not found in a tertiary hospital practice.

CONCLUSION

A fall-prevention catalogue has been developed based on evidence and a theoretical framework and also clinically validated.

IMPLICATION FOR NURSING AND HEALTH POLICY

The Catalogue is a standardized interface terminology and content subset in any electronic health records system that can directly deliver evidence on fall prevention. It can also be used as an informatics tool to aggregate, analyse, interpret and compare nursing data worldwide.

CT-like MRI using the zero-TE technique for osseous changes of the TMJ

OBJECTIVE

This study was conducted to assess the clinical usability of the zero-echo time (ZTE) technique of MRI for evaluating bone changes of the temporomandibular joint (TMJ) in comparison with CBCT.

METHODS

Twenty patients with TMJ disorder who underwent both CBCT and MRI were randomly selected. CBCT images were obtained with an Alphard 3030 device (Asahi Roentgen Ind., Co. Ltd, Kyoto, Japan). MRIs were obtained using a 3.0 T scanner (Pioneer; GE Healthcare, Waukesha, WI, USA) and a 21-channel head coil. An isotropic three-dimensional proton-density-weighted ZTE sequence was acquired. Two radiologists evaluated 40 joints of 20 patients for the presence of the following osseous changes: flattening, erosion, osteophyte and sclerosis of the condyle; and flattening, erosion and sclerosis of the articular fossa. CBCT and ZTE-MRI assessments were performed at a 2-month interval. The prevalence-adjusted and bias-adjusted κ statistic was used to analyse interexaminer and intraexaminer agreement and the agreement between ZTE-MRI and CBCT.

RESULTS

Intraexaminer and interexaminer agreement analyses of ZTE-MRI showed high reproducibility (κ>0.80), which was comparable to that of CBCT. Flattening, osteophyte and sclerosis of the condyle and all types of bone changes in the mandibular fossa showed nearly perfect agreement between CBCT and ZTE-MRI (κ = 0.80-0.90). Erosion of the condyle showed substantial agreement between both sets of images (κ = 0.65-0.70).

CONCLUSIONS

It is suggested that ZTE-MRI provides clinically reliable images for bone assessment in TMJ disorder. MRI may become a beneficial diagnostic tool for patients with both TMJ disc and bone pathology, with advantages involving medical costs and radiation dose.

Development of a New Type of Recombinant Hyaluronidase Using a Hexahistidine; Possibilities and Challenges in Commercialization

Hyaluronidases enhance therapeutic drug transport by breaking down the hyaluronan barrier to lymphatic and capillary vessels, facilitating their tissue absorption. Commercially available hyaluronidases are bovine in origin; however, they pose risks such as bovine spongiform encephalopathy. The present study aimed to develop a novel, highly active hyaluronidase and assess its function. Therefore, in order to find the most efficient active hyaluronidase, we produced several shortened hyaluronidases with partial removal of the N- or C-terminal regions. Moreover, we created an enzyme that connected six histidines onto the end of the hyaluronidase C-terminus. This simplified subsequent purification using Ni²⁺ affinity chromatography, making it feasible to industrialize this highly active recombinant hyaluronidase which exhibited catalytic activity equal to that of the commercial enzyme. Therefore, this simple and effective isolation method could increase the availability of recombinant hyaluronidase for research and clinical purposes.

Improved inertial confinement fusion gamma reaction history 12C gamma-ray signal by direct subtraction

The Gamma Reaction History (GRH) diagnostic located at the National Ignition Facility (NIF) measures time resolved gamma rays released from inertial confinement fusion experiments by converting the emitted gamma rays into Cherenkov light. Imploded capsules have a bright 4.4 MeV gamma ray from fusion neutrons inelastically scattering with carbon atoms in the remaining ablator. The strength of the 4.4 MeV gamma ray line is proportional to the capsule's carbon ablator areal density and can be used to understand the dynamics and energy budget of a carbon-based ablator capsule implosion. Historically, the GRH's four gas cells use the energy thresholding from the Cherenkov process to forward fit an estimation of the experiment's complete gamma ray spectrum by modeling the surrounding environment in order to estimate the 4.4 MeV neutron induced carbon gamma ray signal. However, the high number of variables, local minima, and uncertainties in detector sensitivities and relative timing had prevented the routine use of the forward fit to generate carbon areal density measurements. A new, more straightforward process of direct subtraction of deconvolved signals was developed to simplify the extraction of the carbon areal density. Beryllium capsules are used as a calibration to measure the capsule environment with no carbon signal. The proposed method is then used to appropriately subtract and isolate the carbon signal on shots with carbon ablators. The subtraction algorithm achieves good results across all major capsule campaigns, achieving similar results to the forward fit. This method is now routinely used to measure carbon areal density for NIF shots.

Site-specific and time-course changes of postmenopausal osteoporosis in rat mandible: comparative study with femur

Although the effects of osteoporosis on the skeleton are well studied, site-specific and long-term studies on the mandible are still lacking. This study investigated the time-course changes of the bone microarchitecture in the mandibular condyle in comparison to the corresponding changes in the alveolar bone, body of the mandible, and femur. Thirty-six 11-week-old female Sprague-Dawley rats were divided into ovariectomized (OVX) (24 rats) and sham (12 rats) groups. The right femur and mandible were obtained from 6 OVX rats and 3 sham rats at 8, 12, 26, and 36 weeks after surgery, respectively. The histomorphometric analysis was performed using micro-computed tomography and histologic assessments from the (1) distal femur; (2) the alveolar bone and (3) the body of the mandible; (4) the subchondral and (5) the central region of the condyle. The Brown-Forsythe test was used to verify the assumptions for statistical analysis, and the Mann-Whitney U test was then performed. The mandibular condyle showed increased trabecular bone in both the OVX and sham groups, while the bone density was reduced in the distal femur and the mandible interradicular septum and body. When comparing the OVX group to the sham group, only the central condyle showed a significant reduction in bone density at 36 weeks. Osteoporosis behaves in different manners in different parts of the skeleton, and clinicians should be aware that patients displaying osteoporotic changes in the mandible are expected to show severely advanced bone mineral density reduction in other bones, such as the femur.

P4393Current smoking and gender difference in South Korean AMI patients who underwent PCI with DES

Background

There is some debate on whether or not there is a gender difference is present between current smoking and cardiovascular disease.

Purpose

We decide to evaluate the impact of sex difference on the 2-year clinical outcomes in Korean acute myocardial infarction (AMI) patients who currently smoke and who underwent percutaneous coronary intervention (PCI) with drug-eluting stents (DES).

Methods

The data of this study was obtained from the Korea Acute Myocardial Infarction (KAMIR) registry. More than fifty high-volume universites or community hospitals with facilities for primary PCI and onsite cardiac surgery participated in this KAMIR registry. A total of 12565 current smoker AMI patients were enrolled and divided into the male (n=11767, 93.6%) or female (n=798, 6.4%) group. The clinical endpoint was the occurrence of major adverse cardiac events (MACE) defined as all-cause death, recurrent myocardial infarction (re-MI), and total repeat revascularization.

Results

Before risk adjustment, the cumulative incidences of MACE (7.2% vs. 10.0%, hazard ratio [HR], 1.419; 95% confidence interval [CI], 1.125–1.790; P=0.003), all-cause death (HR, 1.988; 95% CI, 1.417–2.789; P<0.001), and re-MI (HR, 1.885; 95% CI, 1.154–3.078; P=0.011) were significantly higher in the female group compared with the male group. However, after adjustment the cumulative incidences of MACE (adjusted HR, 1.047; 95% CI, 0.756–1.450; P=0.782), all-cause death, re-MI, total repeat revascularization, TLR, TVR, and non-TVR were similar between the two groups.

Clinical outcomes at 2-year Outcomes Cumulative Events at 2-year (%) Unadjusted Adjusted* Propensity-score adjusted Male Female Log-rank Hazard Ratio (95% CI) p value Hazard Ratio (95% CI) p value Hazard Ratio (95% CI) p value MACE 819 (7.2) 78 (10.0) 0.003 1.419 (1.125–1.790) 0.003 1.047 (0.756–1.450) 0.782 1.133 (0.871–1.473) 0.352 All-cause death 283 (2.5) 38 (4.8) <0.001 1.988 (1.417–2.789) <0.001 0.764 (0.457–1.279) 0.306 1.105 (0.744–1.641) 0.620 Cardiac death 224 (1.9) 25 (3.2) 0.016 1.654 (1.094–2.500) 0.017 0.512 (0.261–1.005) 0.052 0.822 (0.511–1.322) 0.419 Re-MI 142 (1.3) 18 (2.4) 0.010 1.885 (1.154–3.078) 0.011 1.741 (0.887–3.419) 0.107 1.835 (1.109–3.375) 0.062 Total revascularization 444 (4.0) 27 (3.6) 0.594 0.900 (0.610–1.327) 0.594 1.069 (0.654–1.748) 0.789 0.956 (0.627–1.458) 0.835 TLR 121 (1.1) 8 (1.1) 0.956 0.980 (0.479–2.004) 0.956 0.955 (0.366–2.497) 0.926 0.868 (0.395–1.910) 0.726 TVR 228 (2.1) 14 (1.9) 0.726 0.908 (0.529–1.558) 0.726 1.051 (0.518–2.135) 0.890 0.935 (0.519–1.684) 0.823 Non-TVR 223 (2.0) 13 (1.7) 0.602 0.862 (0.493–1.508) 0.602 1.060 (0.536–2.097) 0.867 0.942 (0.514–1.726) 0.847

Conclusion

Before risk adjustment, a gender difference was suggested in the female group compared with the male in these current smoker South Korean AMI patients during a 2-year follow-up period. However, after adjustment, gender difference was not observed in these AMI patients with a history of current smoking.

P2877The incidence, predictors, and long-term outcomes of new-onset ventricular tachycardia after cardiac surgery

Background

Incidence and outcomes of new-onset ventricular tachycardia (VT) after cardiac surgery are not fully evaluated.

Purpose

We retrospectively analyzed the occurrence of new-onset VTs after cardiac surgery, and their implications on short and long-term mortality.

Methods

Data of 11,004 adult patients who underwent cardiac surgery at our center from 2006 to 2016 were analyzed. VT was diagnosed when 3 or more consecutive wide QRS complexes (>100 bpm) were documented on ECG. The major study outcomes were in-hospital and 5-years overall mortality rates.

Results

During index hospitalization for cardiac surgery, clinical VTs were documented in 184 patients (1.7%), which included 74 sustained VTs (SusVT, ≥30 seconds) and 110 non-sustained VTs (NSVT). Those patients with SusVT and NSVT showed higher in-hospital mortality compared to those without VTs (31.1% vs. 24.5% vs. 2.0% for SusVT, NSVT, and no VT, respectively, P<0.001). During follow-up after discharge from index hospitalization, patients with SusVT showed higher 5-years mortality than those without VTs, while patients with NSVT did not showed significant differences (22.0% vs. 11.7% vs. 9.2%, P<0.001). In the subgroup of patients with sustained VT who were discharged from index hospitalization (n=51), those with recurrent VTs (>24 hours apart from initial episode) were at higher 5-years mortality rate compared to those without (40.7% vs. 15.8%, P=0.018).

Conclusion

Patients with SusVT and NSVT were at higher risk of in-hospital mortality, and patients with SusVT were associated with higher risk of long-term mortality. The mortality risk was even higher in those with recurrent episodes of VTs.

Acknowledgement/Funding

None

P4785Clinical characteristics and 1-year outcomes in atrial fibrillation patients with or without history of intracranial haemorrhage treated with edoxaban: snapshot analysis of the Global ETNA-AF program

Background

Patients with atrial fibrillation (AF) who survive an intracranial haemorrhage (ICH) are at high risk of stroke, death, and recurrent haemorrhage. Effectiveness and safety of the nonvitamin K antagonist oral anticoagulant (NOAC) edoxaban in this patient population has not been reported.

Purpose

This snapshot analysis from the global ETNA-AF program compared 1-year outcomes in AF patients with and without history of ICH treated with edoxaban from Europe, Japan, and Korea/Taiwan.

Methods

Global ETNA-AF (EU: NCT02944019, Japan: UMINehz745.116117011, Korea/Taiwan: NCT02951039) is a multinational, multicentre, prospective, noninterventional program of AF patients receiving edoxaban in regular clinical care. Demographics, baseline characteristics, and outcomes at 1-year follow-up were reported for 19416 patients with and without a history of ICH.

Results

Of the 19416 patients, 297 had a history of ICH. At 1-year follow-up, incidences of International Society on Thrombosis and Haemostasis (ISTH) major bleeding (including ICH) and clinically relevant nonmajor bleeding (CRNMB) were generally low. The rate of ischaemic stroke was higher in patients with a history of ICH than in those without prior ICH.

Europe (N=7672) Korea/Taiwan (N=1701) Japan (N=10043) History of ICH, n (%) Yes No Yes No Yes No 36 (0.5) 636 (99.5) 27 (1.6) 1674 (98.4) 234 (2.3) 9809 (97.7) Age, median (IQR) 75 (69, 78) 74 (68, 80) 70 (66, 76) 72 (66, 77) 76 (71, 82) 75 (68, 81) Gender, male % 72.2 57.4 70.4 59.9 60.7 59.3 Weight, median (IQR) kg 80.0 (75.0, 88.0) 80.0 (70.0, 92.0) 68.0 (54.0, 77.0) 65.0 (58.0, 73.0) 57.0 (50.0, 65.0) 59.0 (51.0, 68.0) CHA2DS2-VASc, mean (SD) 4.2 (1.44) 3.1 (1.38) 3.9 (1.63) 3.0 (1.43) 4.0 (1.56) 3.4 (1.64) HAS-BLED, mean (SD) 4.3 (1.23) 2.6 (1.12) 3.9 (1.55) 2.4 (10.7) 3.7 (1.07) 2.3 (1.12) CrCl [mL/min], median (IQR) 70.5 (58.8, 85.1) 70.4 (53.8, 90.1) 63.7 (45.8, 84.2) 61.6 (48.4, 78.1) 58.5 (46.0, 73.2) 60.2 (46.1, 77.0) Edoxaban 60/30 mg, % 83.3 / 16.7 77.1 / 22.9 55.6 / 44.4 50.2 / 49.8 21.8 / 78.2 27.8 / 72.2 1-year outcome, n (%/year)   Major bleeding (ISTH) 2 (5.94) 66 (0.92) 0 (0) 13 (0.82) 3 (1.92) 66 (0.96)   Intracranial haemorrhage 1 (2.91) 19 (0.26) 0 (0) 5 (0.32) 1 (0.64) 18 (0.26)   Major GI* bleeding 0 (0.00) 20 (0.28) 0 (0) 2 (0.13) 2 (1.28) 30 (0.43)   CRNMB 0 (0.00) 102 (1.43) 0 (0) 11 (0.70) 6 (3.82) 219 (3.20)   Ischaemic stroke 1 (2.93) 41 (0.57) 1 (4.04) 11 (0.70) 4 (2.57) 78 (1.13) *Gastrointestinal.

Conclusion

Our data underpin the need for effective stroke prevention. In AF patients with a history of ICH, data suggest that edoxaban can be safely and effectively administered in patients with and without prior ICH in regular clinical care.

Acknowledgement/Funding

Daiichi Sankyo

P1012Radiofrequency catheter ablation of accessory pathways at the site of prior valve surgery

Background

Radiofrequency catheter ablation (RFCA) for accessory pathways (APs) at the site of prior valve surgery remains challenging. We aimed to clarify the factors associated with successful RFCA for such APs.

Methods

Upon reviewing a RFCA registry and previous case reports, we included nine patients who underwent RFCA of APs at the site of prior valve surgery (total-VS group; age, 34.0 [24.5–45.0] years; men, 4/9) and 196 patients who underwent RFCA of APs with no history of valve surgery (no-VS group; age, 40.5 [23.0–54.0] years; men, 114/196). Electrophysiological features, procedural details, and outcomes were examined.

Results

AP exhibited decremental conduction in four of nine patients in the total-VS group. The number of RFCA attempts was significantly higher in the total-VS group than in the no-VS group (10.0 [4.5–14.5] vs 2.0 [1.0–3.0]; p<0.001). In four patients who underwent mitral valve surgery, successful RFCA was achieved using the transaortic approach, coronary sinus approach, or bipolar ablation. In three patients who underwent tricuspid valve surgery, successful RFCA was achieved using the above-prosthetics or trans-prosthetics approach. In two patients, RFCA failed. The trans-prosthetics approach and bipolar ablation technique were effective. The transaortic and coronary sinus approaches were occasionally effective. The transseptal approach was ineffective. Based on the success rate and accessibility, we suggest a stepwise approach to RFCA of APs at the site of prior mitral or tricuspid valve surgery (Figure).

Stepwise approach to AP at valve surgery

Conclusions

Successful RFCA of APs at the site of prior valve surgery can be achieved by detailed mapping of the areas both above and below the prosthetic valve, as well as by ensuring effective radiofrequency energy delivery using various catheter approaches and RFCA techniques.

P3452Differential implication of gender on future thromboembolic risk in patients with and without atrial fibrillation

Background

Gender difference in stroke risk by the presence of atrial fibrillation was not well evaluated.

Purpose

We hypothesized that the gender showed different impacts on future thromboembolic risk in patients with and without atrial fibrillation.

Methods

The study population comprised of 26,226 patients (mean 56.3 years old, 52.6% male) with (n=3147, 12.0%) or without (n=23079, 88.0%) atrial fibrillation who underwent cardiac evaluations consisted of electrocardiography, echocardiography, and holter monitoring in our center. The main study outcomes were thromboembolic events defined as composite of ischemic stroke and systemic embolism.

Results

During mean follow-up period of 2.8 years, thromboembolic event occurred in 610 patients (2.3%). In the overall population, the 3-year rate of thromboembolic event of female patients was lower than males (2.2% vs. 2.8%, P=0.011). However, when the population was divided according to the presence of AF, females showed higher rate of thromboembolic events in those with AF (6.7% vs 3.1%, P<0.001), whereas lower rate in those without AF (1.7% vs. 2.7%, P<0.001, P for interaction between gender and AF <0.001). After multivariable adjustment, female gender was at higher risk of future thromboembolic events in those with AF (HR 1.61, 95% CI 1.13–2.29, P<0.001), whereas at lower risk in those without AF (HR 0.75, 95% CI 0.62–0.91, P=0.003). The interaction between gender and AF was significant in those who had one or more components of CHA2DS2-VASc score other than gender (CHA2DS2-VA score ≥1, P for interaction = 0.001), but not in those without (P for interaction = 0.196)

Conclusion

Female gender demonstrated differential thromboembolic risk according to the presence of AF.

Acknowledgement/Funding

None

P1026Risk factors for the occurrence of stroke after atrial fibrillation ablation

Background

Risk factors for the occurrence of embolic stroke (ES) after atrial fibrillation (AF) ablation have not been fully elucidated. Our aim was to assess incidence of ES during long-term follow-up following AF ablation and to identify predicting factors associated with post-ablation ES.

Methods

We enrolled patients who experienced ES after AF ablation and body mass index-matched controls from AF ablation registries. Epicardial adipose tissue (EAT) was assessed using multislice computed tomography prior to ablation.

Results

A total of 3,464 patients who underwent AF ablation were recruited. During a mean follow-up of 47.2 months, ES occurred in 47 patients (1.36%) with a mean CHA2DS2-VAS score of 2.15 and overall incidence of ES was 0.34 per 100 patients/year. Compared with control group (n=190), ES group had more higher prior thromboembolic event and AF recurrence rates, larger LA size, lower creatinine clearance rate (CCr), and greater total and periatrial EAT volumes although no differences in AF type, CHA2DS2-VASc score, ablation extent, and anti-thrombotics use were found. On multivariate regression analysis, a prior history of thromboembolism, CCr, and periatrial EAT volume were independently associated with ES occurrence after AF ablation.

Cox regression analysis Risk factor Univariate Multivariate HR (95% CI) p value HR (95% CI) p value Age 1.017 (0.984–1.051) 0.31 Prior thromboembolism 2.488 (1.134–5.460) 0.023 2.916 (1.178–7.219) 0.021 CHA2DS2-VASc score 1.139 (0.899–1.445) 0.282 CCr 0.984 (0.970–0.999) 0.038 0.982 (0.996–0.998) 0.029 LA diameter (mm) 1.070 (1.012–1.130) 0.017 1.072 (0.999–1.150) 0.054 EAT_total (ml) 1.020 (1.010–1.029) <0.001 1.008 (0.993–1.023) 0.297 EAT_periatrial (ml) 1.085 (1.045–1.126) <0.001 1.065 (1.005–1.128) 0.032 PVI + additional ablation 0.846 (0.460–1.557) 0.592 No anticoagulant use 0.651 (0.346–1.226) 0.184 Recurrence 2.011 (1.007–4.013) 0.048 1.240 (0.551–2.793) 0.603 CCr, creatinine clearance rate; EAT, epicardial adipose tissue; LA, left atrium; PVI, pulmonary vein isolation.

K-M curve for stroke-free survival

Conclusions

Incidence of ES after AF ablation was lower than expected rate based on CHA2DS2-VASc score even though anticoagulants use was limited. Periatrial EAT volume, a prior thromboembolism event, and CCr were independent factors in predicting ES irrespective of AF recurrence and CHA2DS2-VASc score in patients who underwent AF ablation.

P833Two-year clinical outcomes between statin with ACE inhibitor or ARB in patients with ST-segment elevation myocardial infarction after successful PCI with DES

Background

Limited comparative data are available.

Purpose

We decided to compare 2-year major clinical outcomes between statin with ACEI and statin ARB therapy in patients with STEMI after PCI with drug-eluting stents (DES).

Methods

A total 11706 STEMI patients who underwent PCI with DES and who prescribed statin were enrolled and they were divided into two groups, the statin with ACEI group (n=8705) and the statin with ARB group (n=3001). The primary endpoint was the major adverse cardiac events (MACE) defined as all-cause death, recurrent myocardial infarction (re-MI), target lesion revascularization (TLR), target vessel revascularization (TVR), non-TVR. The secondary endpoints were the cumulative incidences of individual components of MACE and target vessel failure (TVF), a composite of death related to the target vessel, re-MI, or clinically driven TVR.

Results

Two PSM groups (2835 pairs, n=5670, C-statistic = 0.680) were generated. The relative risk of MACE was higher in the statin with ARB group compared to statin with ACEI groups after propensity score-matched (PSM) analysis (hazard ratio [HR]: 1.323, 95% confidence interval [CI]: 1.085–1.613, p=0.006). The relative risks of cardiac death (HR: 1.831, 95% CI: 1.199–2.740, p=0.005), total repeat revascularization (HR: 1.487, 95% CI: 1.133–1.950, p=0.004), and non-TVR (HR: 1.696, 95% CI: 1.122–2.564, p=0.012) were also higher in the statin with ARB group after PSM.

Outcomes Cumulative Events at 2-year (%) Hazard Ratio (95% CI) p value Statin + ACEI Statin + ARB Log-rank Propensity score matched Patients MACE 173 (6.5) 225 (8.5) 0.006 1.323 (1.085–1.613) 0.006 All-cause death 58 (2.2) 80 (3.0) 0.054 1.391 (0.992–1.950) 0.056 Cardiac death 35 (1.3) 63 (2.3) 0.004 1.831 (1.199–2.740) 0.005 Re-MI 39 (1.5) 44 (1.7) 0.548 1.141 (0.742–1.756) 0.548 Total repeat revascularization 88 (3.4) 128 (4.9) 0.004 1.487 (1.133–1.950) 0.004 TLR 26 (1.0) 40 (1.5) 0.075 1.561 (0.953–2.558) 0.077 TVR 53 (2.0) 71 (2.8) 0.086 1.364 (0.955–1.946) 0.088 Non-TVR 36 (1.4) 60 (2.3) 0.011 1.696 (1.122–2.564) 0.012 TVF 140 (5.3) 173 (6.6) 0.050 1.249 (1.000–1.561) 0.050

Conclusions

In this study, we suggest that the combination of statin with ACEI may be beneficial for reducing the cumulative incidences of MACE, total repeat revascularization rate, and non-TVR rather than the statin with ARB after PCI with DES in STEMI patients.

P5362Impact of statin therapy on long-term clinical outcomes between STEMI and NSTEMI after stent implantation

Background

Although European guideline recommends that statin should be given to all patients with acute myocardial infarction (AMI), irrespective of cholesterol concentration, limited studies were focused on the long-term effects of statin therapy between ST-segment elevation MI (STEMI) and non-ST-segment elevation MI (NSTEMI).

Purpose

The authors conducted the study to compare the relative beneficial role of statin on 2-year major clinical outcomes between STEMI and NSTEMI in patients who underwent successful PCI with DES.

Methods

Finally, a total of 26317 AMI patients who underwent stent implantation and who were prescribed the statin were enrolled and they were separated into two groups; the STEMI group (n=15002) and the NSTEMI group (n=11315). The clinical endpoint was the occurrence of major adverse cardiac events (MACE) defined as all-cause death, recurrent myocardial infarction (re-MI), total coronary revascularization (target lesion revascularization [TLR], target vessel revascularization [TVR], non-TVR) during 2-year follow-up period.

Results

After propensity score-matched (PSM) analysis, two PSM groups (7746 pairs, n=15492, C-statistic = 0.766) were generated. In the total study population, the cumulative incidences of MACE, all-cause death, and cardiac death were significantly higher in the NSTEMI group. However, after PSM, the cumulative incidence of all-cause death (Hazard ratio, 1.386; 95% CI, 1.133–1.696; p=0.002) was significantly higher in the NSTEMI group. The cumulative incidences of MACE, cardiac death, re-MI, total revascularization, TLR, TVR, and non-TVR were similar between the two groups (Table 1).

Outcomes Cumulative Events at 2-year (%) Hazard Ratio (95% CI) p value STEMI NSTEMI Log-rank Propensity score matched patients MACE 532 (7.2) 584 (8.1) 0.092 1.106 (0.984–1.244) 0.092 All-cause death 163 (2.2) 224 (3.1) 0.001 1.386 (1.133–1.696) 0.002 Cardiac death 121 (1.5) 148 (2.0) 0.088 1.232 (0.969–1.566) 0.089 Re-MI 117 (1.6) 107 (1.5) 0.545 0.922 (0.710–1.199) 0.545 Total revascularization 291 (4.1) 307 (4.4) 0.422 1.068 (0.910–1.254) 0.423 TLR 92 (1.3) 89 (1.2) 0.880 0.978 (0.731–1.309) 0.880 TVR 173 (2.4) 184 (2.6) 0.478 1.078 (0.876–1.327) 0.478 Non-TVR 123 (1.7) 130 (1.9) 0.593 1.070 (0.836–1.369) 0.539

Conclusion

The mortality reduction capability of statin was more prominent in the STEMI group compared with the NSTEMI group.

P5494Impact of the gender difference on long-term clinical outcomes in dyslipidemic South Korean AMI patients who underwent PCI with new-generation DES

Background

There are limited comparative data concerning long-term major clinical outcomes between male and female in dyslipidemic AMI patients after PCI with new-generation DES.

Purpose

We thought to investigate the impact of gender difference on the 2-year clinical outcomes.

Methods

Finally, a total of 2403 eligible dyslipidemic AMI patients who underwent PCI with new-generation DES were enrolled and they were separated into two groups; the male group (n=1800) and the female group (n=603). The primary endpoint was major adverse cardiac events (MACE) defined as all-cause death, recurrent myocardial infarction (re-MI), target lesion revascularization (TLR), and target vessel revascularization (TVR). The secondary endpoints were the incidence of the individual components of MACE and target vessel failure (TVF), a composite of death related to the target vessel, re-MI, or clinically driven TVR

Results

Two propensity score-matched (PSM) groups (422 pairs, n=844, C-statistic = 0.850) were generated. In the total study population, the cumulative incidences of MACE, all-cause death, re-MI, and TVF were significantly higher in the female group compared with the male group. However, after propensity score-matched (PSM) analysis, the cumulative incidences of MACE (HR, 0.971; 95% CI, 0.628–1.501; p=0.895), all-cause death (HR, 1.061; 95% CI, 0.536–2.100; p=0.865), re-MI (HR, 1.212; 95% CI, 0.433–2.907; p=0.813), and TVF (HR, 0.764; 95% CI, 0.474–1.229; p=0.267) were similar between the two groups. In addition, the cumulative incidences of cardiac death, TLR, TVR were not significantly different between the two groups (Table 1).

Outcomes Cumulative Events at 2-year (%) Hazard Ratio (95% CI) p value Male Female Log-rank Propensity score matched patients MACE 41 (10.4) 40 (10.3) 0.895 0.971 (0.628–1.501) 0.895 All-cause death 16 (4.0) 17 (4.2) 0.865 1.061 (0.536–2.100) 0.865 Cardiac death 13 (3.3) 9 (2.2) 0.391 0.691 (0.295–1.616) 0.393 Re-MI 8 (2.0) 9 (2.4) 0.813 1.212 (0.433–2.907) 0.813 TLR 7 (1.8) 6 (1.6) 0.781 0.857 (0.298–2.550) 0.781 TVR 16 (4.3) 10 (2.7) 0.236 0.623 (0.283–1.373) 0.241 TVF 39 (10.2) 30 (7.8) 0.265 0.764 (0.474–1.229) 0.267

Conclusion

The gender difference was not apparent in these dyslipidemic South Korean AMI patients who underwent PCI with new-generation DES during 2-year follow-up period.

Evaluation of fecal microbiomes associated with obesity in captive cynomolgus monkeys (Macaca fascicularis)

Microorganisms play important roles in obesity; however, the role of the gut microbiomes in obesity is controversial because of the inconsistent findings. This study investigated the gut microbiome communities in obese and lean groups of captive healthy cynomolgus monkeys reared under strict identical environmental conditions, including their diet. No significant differences in the relative abundance of Firmicutes, Bacteroidetes and Prevotella were observed between the obese and lean groups, but a significant difference in Spirochetes (p < 0.05) was noted. Microbial diversity and richness were similar, but highly variable results in microbial composition, diversity, and richness were observed in individuals, irrespective of their state of obesity. Distinct clustering between the groups was not observed by principal coordinate analysis using an unweighted pair group method. Higher sharedness values (95.81% ± 2.28% at the genus level, and 79.54% ± 5.88% at the species level) were identified among individual monkeys. This paper reports the association between the gut microbiome and obesity in captive non-human primate models reared under controlled environments. The relative proportion of Firmicutes and Bacteroidetes as well as the microbial diversity known to affect obesity were similar in the obese and lean groups of monkeys reared under identical conditions. Therefore, obesity-associated microbial changes reported previously appear to be associated directly with environmental factors, particularly diet, rather than obesity.

Human Lacrimal Production Rates from Modified Schirmer-Tear Test

SIGNIFICANCE

A simple methodology is presented to quantify basal tear production with a modified Schirmer-tear test.

PURPOSE

We introduce a simple clinical procedure to measure quantitative basal tear-production flowrates, QL, from a modified Schirmer-tear test (STT).

METHODS

Eight healthy subjects aged at least 18 years underwent modified STTs on both eyes for two visits each. Schirmer strips were sheathed with transparent tape before insertion. Topical anesthetic minimized reflex tearing. Wetting lengths were measured every 30 s for 5 min; QL was calculated from the linear slope of wetting length versus time. Determination of QL requires mass-balance equations on the tear prism and Schirmer strip with strip imbibition kinetics obeying Darcy and Young-Laplace laws.

RESULTS

Basal tear production rates varied from essentially 0 to about 2 μl/min. With some exceptions, right and left eyes showed similar tear production rates.

CONCLUSIONS

By following the modified STT, QL is established with minimal additional effort over a standard Schirmer test. We predict and observe four different subtypes of imbibition kinetics depending on how short or long the time is for first appearance of the wetting front and on how fast or slow is tear production. For slow lacrimal production rates, the standard 5-min wetting length does not correlate with basal tear production.

First Direct Measurement of Isotopic Fission-Fragment Yields of ^{239}U

A direct and complete measurement of isotopic fission-fragment yields of ^{239}U has been performed for the first time. The ^{239}U fissioning system was produced with an average excitation energy of 8.3 MeV in one-neutron transfer reactions between a ^{238}U beam and a ^{9}Be target at Coulomb barrier energies. The fission fragments were detected and isotopically identified using the VAMOS++ spectrometer at the GANIL facility. The measurement allows us to directly evaluate the fission models at excitation energies of fast neutrons, which are relevant for next-generation nuclear reactors. The present data, in agreement with model calculations, do not support the recently reported anomaly in the fission-fragment yields of ^{239}U, and they confirm the persistence of spherical shell effects in the Sn region at excitation energies exceeding the fission barrier by a few mega-electron volts.

Clinical evaluation of anesthesia for high-risk cesarean section at a tertiary medical center: retrospective study for 8 years (2009-2016)

Objective

The number of high-risk pregnancies is increasing in tertiary medical centers. Therefore, we investigated perioperative outcomes based on risk factors to ascertain proper maternal and neonatal management.

Methods

We reviewed the medical records of patients receiving cesarean sections over an 8-year period. Clinical parameters for anesthesia and the neonatal outcome were compared among high-risk groups after subdivision by the number of clinical risk factors. The groups were as follows: group A (one risk factor), group B (two risk factors), and group C (three or more risk factors).

Results

Patient age, estimated blood loss (EBL), and volume of transfused red blood cell (RBC) were higher in group B than group A. Birth weight, 1- and 5-minute Apgar scores, and gestational age were lower while the frequency of neonatal intensive care unit (NICU) admission was higher in group B than group A. Group C patients were significantly older than group A or B patients. Birth weight, 1- and 5-minute Apgar scores and gestational age were significantly lower while frequency of NICU admission was higher in group C than group A and B.

Conclusion

The number of maternal risk factors was positively associated with adverse outcomes in the neonates.

Search for a Dark Matter-Induced Annual Modulation Signal in NaI(Tl) with the COSINE-100 Experiment

We present new constraints on the dark matter-induced annual modulation signal using 1.7 years of COSINE-100 data with a total exposure of 97.7 kg yr. The COSINE-100 experiment, consisting of 106 kg of NaI(Tl) target material, is designed to carry out a model-independent test of DAMA/LIBRA's claim of WIMP discovery by searching for the same annual modulation signal using the same NaI(Tl) target. The crystal data show a 2.7  cpd/kg/keV background rate on average in the 2-6 keV energy region of interest. Using a χ-squared minimization method we observe best fit values for modulation amplitude and phase of 0.0092±0.0067  cpd/kg/keV and 127.2±45.9  d, respectively.

Microarchitectural changes in the mandibles of ovariectomized rats: a systematic review and meta-analysis

Background

This study aimed to examine radiologic microarchitectural changes in the mandibles of ovariectomized (OVX) rats through a systematic review and meta-analysis and to identify factors of the OVX rat model that influence on the bone microstructure.

Methods

Eligible articles were identified by searching electronic databases, including Embase, Medline, Web of Science, and KoreaMed, for articles published from January 1966 to November 2017. Two reviewers independently performed study selection, data extraction, and quality assessment. The pooled standardized mean difference (SMD) with 95% confidence intervals was calculated using a random-effects model. Subgroup analysis and meta-regression were performed to explore the effect of potential sources on the outcomes. The reliability of the results was assessed by sensitivity analysis and publication bias.

Results

Of 1160 studies, 16 studies (120 OVX and 120 control rats) were included in the meta-analysis. Compared to the control group, the OVX rats’ trabecular bone volume fraction (SMD = − 2.41, P < 0.01, I² = 81%), trabecular thickness (SMD = − 1.73, P < 0.01, I² = 73%) and bone mineral density (SMD = − 0.95, P = 0.01, I² = 71%) displayed the bone loss consistent with osteoporosis. The trabecular separation (SMD = 1.66, P < 0.01, I² = 51%) has widen in the OVX mandibular bone in comparison to the control group. However, the trabecular number showed no indication to detect the osteoporosis (SMD = − 0.45, P = 0.38, I² = 76%). The meta-regression indicated that longer post-OVX periods led to greater changes in bone mineral density (β = − 0.104, P = 0.017). However, the rats’ age at OVX was not linked to bone microstructure change.

Conclusions

Using meta-regression and sensitivity analysis techniques, heterogeneity across the micro CT studies of OVX-induced osteoporosis was found. The major factors of heterogeneity were the region of interest and post-OVX period. Our assessment can assist in designing experiments to maximize the usefulness of OVX rat model.

Human Lacrimal Production Rate and Wetted Length of Modified Schirmer's Tear Test Strips

Purpose

To assess and compare the wetting kinetics of sheathed and unsheathed Schirmer's tear test (STT) strips, and to determine the repeatability of 5-minute wetted length (WL) and basal tear production rate (BTPR).

Methods

Seventeen subjects underwent two sheathed and unsheathed STTs each for both eyes on four visits on separate days. After administration of topical anesthetic, WLs were measured every 30 seconds for 5 minutes, and BTPRs were calculated for sheathed strips. Limits of agreement (LoA), difference-versus-mean plots (DVM), and the coefficient of repeatability (CR) assessed WL and BTPR repeatabilities. Variance estimates were used to calculate sample sizes for future study.

Results

For the unsheathed STT, the mean (SD) difference in WLs between visits was 0.74 (5.05) mm, LoA were [−9.17, 10.64], and CR was 9.17 mm; for the sheathed STT, the mean (SD) intervisit difference was 0.16 (5.94) mm, LoA were [−11.49, 11.8], and CR was 10.53 mm. Eight of 48 sheathed STTs and 20 of 44 unsheathed STTs showed constant WL for the final 90 seconds of the test. The mean (SD) difference between repeated visits for BTPR was approximately 0.0 μL/min, LoA were [−1.82, 1.82], and CR was 1.91 μL/min.

Conclusions

Repeatability of sheathed and unsheathed 5-minute WL and BTPR is inadequate for measuring within-subject changes, but is sufficient for group studies with moderate sample sizes. Constant WL for the final 90 seconds with the eight sheathed STT measurements suggests varying BTPR, whereas constant WL with the unsheathed STT can be explained by balancing evaporation and BTPR.

Translational Relevance

Repeatability of the modified STT is evaluated clinically to establish quantitative BTPRs rather than inference from a strip WL.

First Direct Search for Inelastic Boosted Dark Matter with COSINE-100

A search for inelastic boosted dark matter (IBDM) using the COSINE-100 detector with 59.5 days of data is presented. This relativistic dark matter is theorized to interact with the target material through inelastic scattering with electrons, creating a heavier state that subsequently produces standard model particles, such as an electron-positron pair. In this study, we search for this electron-positron pair in coincidence with the initially scattered electron as a signature for an IBDM interaction. No excess over the predicted background event rate is observed. Therefore, we present limits on IBDM interactions under various hypotheses, one of which allows us to explore an area of the dark photon parameter space that has not yet been covered by other experiments. This is the first experimental search for IBDM using a terrestrial detector.

Abstract P6-09-09: Analysis of serial circulating tumor cell count during neoadjuvant systemic therapy in breast cancer patients

Background: We aimed to evaluate the clinical implication of circulating tumor cell (CTC) counts in correlation with prognosis and radiologic/pathologic response to therapy in locally advanced breast cancer patients undergoing preoperative systemic therapy.

Methods: From Feb 2014 to May 2017, 207 patients without distant metastasis were prospectively enrolled from AMC. CTC counts were analyzed before-during-after the therapy. CTC isolation was performed using a SMART BIOPSY™ SYSTEM Isolation kit (Cytogen, Inc., Seoul, Korea). Recurrence-free and overall survival was analyzed according to CTC counts.

Result: The mean follow-up period was 22.46 months and mean age was 46.48 years. One or more CTC was identified in 132 of 203 patients(65.0%) before NST, in 135 of 186 patients(72.0%) during NST and 103 of 171 patients(60.2%) after NST. Initial tumor burden at diagnosis -tumor size, lymph node metastasis- was not correlated with CTC positivity. Overall, CTC count ((≥1 CTC, ≥2 CTCs, and ≥5 CTCs) was not correlated with response to therapy. Using RECIST criteria, 86.5% (179/204) were responders (complete, partial response, CR/PR) and 12.1% (25/204) were non-responders (stable, progressive disease, SD/PD). 14.5% (30/207) showed a pathologic complete response (pCR), yet no association was found between CTC count/changes and radiologic/pathologic response to therapy. Also, CTC count was not correlated with prognosis among the whole population. However, HR+ tumors, CTC detection before NST was significantly associated with treatment response by RECIST criteria (responder vs. non-responder) (p=0.003, p=0.017 and p=0.023, respectively).

Conclusions: Our findings support limited value of CTC count for locally advanced breast cancers undergoing neoadjuvant systemic therapy.

Citation Format: Gwark S-C, Kim J, Kim YH, Kim MS, Park JY, Lee SB, Sohn G, Chung IY, Ko BS, Kim HJ, Lee JW, Son BH, Ahn SH. Analysis of serial circulating tumor cell count during neoadjuvant systemic therapy in breast cancer patients [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-09-09.

Tear dynamics under scleral lenses

PURPOSE

To evaluate post-lens tear dynamics at two different time points during scleral lens wear in two cohorts with 10 neophytes each.

METHODS

All subjects wore bilaterally scleral lenses for 5 h on 3 separate visits. Post-lens tear exchange was measured using Out-in method, which required 5 μL of 2% FITC-Dextran instilled on the bulbar conjunctiva during lens wear. Time taken to observe the first sign of fluorescence in post-lens tear reservoir was recorded with a stopwatch. Out-in measurements were collected at 5-hour  post-lens insertion in Group 1 and compared with those obtained at 20 min of lens wear in Group 2. Tear dynamics under the lens was observed in Group 2 with fluorogram using a modified slit-lamp technique (Tan et al., 2018) to monitor post-lens fluorescence intensity and with high-resolution spectral domain optical coherence tomography (ENVISU 2300; Bioptigen Inc.) to measure post-lens tear thickness (PoLTT) over 5 h of lens wear.

RESULTS

60% of subjects in Group 1 achieved Out-in times less than 5 min at 5-hour post-lens insertion, compared with 67% of subjects at 20-min lens wear (Tan et al., 2018). Using qualitative analysis on 60 series of data in Group 2 to compare the changes in fluorescence intensity and PoLTT with respect to lens-wearing time, 27% was due to lens settling, 13% was due to tear exchange and mixing while 60% indicated tear dynamics under scleral lenses was due to a combination of tear exchange, mixing, and lens settling.

CONCLUSION

Tear flow into tear reservoir under a scleral lens on subjects with healthy cornea occurred at 20 min and 5 h after lens insertion. After 5 h of lens wear, roughly one third of the subjects had no tear flow into post-lens reservoir, as the observed decline in post-lens tear fluorescence was predominately due to lens settling.

Intraoperative Management of a Patient With Impaired Cardiac Function Undergoing Simultaneous ABO-Compatible Liver and ABO-Incompatible Kidney Transplant From 2 Living Donors: A Case Report

BACKGROUND

Combined liver and kidney transplant is a very complex surgery. To date, there has been no report on the intraoperative management of patients with impaired cardiac function undergoing simultaneous ABO-compatible liver and ABO-incompatible kidney transplant from 2 living donors.

CASE REPORT

A 60-year-old man underwent simultaneous ABO-compatible liver and ABO-incompatible kidney transplant from 2 living donors because of IgA nephropathy and alcoholic liver cirrhosis. The preoperative cardiac findings revealed continuous aggravation, shown by large left atrial enlargement, severe left ventricular hypertrophy, a very prolonged QT interval, and a calcified left anterior descending coronary artery. Severe hypotension with very weak pulsation and severe bradycardia developed, with an irregular junctional rhythm noted immediately after the liver graft was reperfused. Although epinephrine was administered as a rescue drug, hemodynamics did not improve, and central venous pressure and mean pulmonary arterial pressure increased to potentially fatal levels. Emergency phlebotomy via the central line was performed. Thereafter, hypotension and bradycardia recovered gradually as the central venous pressure and mean pulmonary arterial pressure decreased. The irregular junctional rhythm returned to a sinus rhythm, but the QTc interval was slightly more prolonged. Because of poor cardiac capacity, the volume and rate of fluid infusion were increased aggressively to maintain appropriate kidney graft perfusion after confirming vigorous urine production of the graft.

CONCLUSIONS

A heart with impaired function due to both end-stage liver and kidney diseases may be less able to withstand surgical stress. Further study on cardiac dysfunction will be helpful for the management of patients undergoing complex transplant surgery.

Targeted killing of TNFR2-expressing tumor cells and Tregs by TNFR2 antagonistic antibodies in advanced Sézary syndrome

Sézary syndrome (SS) is a rare form of cutaneous T-cell lymphoma often refractory to treatment. SS is defined as adenopathy, erythroderma with high numbers of atypical T cells. This offers an opportunity for new interventions and perhaps antibody-based therapeutic by virtue of its high expression of the TNFR2 oncogene on the tumor cells and on T-regulatory cells (T_regs). Potent human-directed TNFR2 antagonistic antibodies have been created that preferentially target the TNFR2 oncogene and tumor-infiltrating TNFR2⁺ T_regs. Here we test the therapeutic potential of TNFR2 antagonists on freshly isolated lymphocytes from patients with Stage IVA SS and from healthy controls. SS patients were on a variety of end-stage multi-drug therapies. Baseline burden T_reg/T effector (T_eff) ratios and the responsiveness of tumor and infiltrating T_regs to TNFR2 antibody killing was studied. We show dose-escalating concentrations of a dominant TNFR2 antagonistic antibody killed TNFR2⁺ SS tumor cells and thus restored CD26^- subpopulations of lymphocyte cell numbers to normal. The abundant TNFR2⁺ T_regs of SS subjects are also killed with TNFR2 antagonism. Beneficial and rapid expansion of T_eff was observed. The combination of T_reg inhibition and T_eff expansion brought the high T_reg/T_eff ratio to normal. Our findings suggest a marked responsiveness of SS tumor cells and T_regs, to targeting with TNFR2 antagonistic antibodies. These results show TNFR2 antibodies are potent and efficacious in vitro.

Cherenkov detector analysis for implosions with multiple nuclear reactions

Nuclear reactions that produce γ rays occur in inertial fusion implosions and are commonly measured with Cherenkov detectors. Typically a detector is primarily sensitive to a single reaction, but in some implosions, multiple fusion reactions can occur and are combined in the data. We discuss an analysis technique using multiple thresholded detectors to reproduce the individual burn histories from reactions like DT and HT fusion, which is applicable to separated-reactant mix experiments. Requirements for this technique and resulting analysis uncertainties are quantified using synthetic data.

Pulse dilation gas Cherenkov detector for ultra-fast gamma reaction history at the NIF (invited)

The Cherenkov mechanism used in Gas Cherenkov Detectors (GCDs) is exceptionally fast. However, the temporal resolution of GCDs, such as the Gamma Reaction History diagnostic at the National Ignition Facility (NIF), has been limited by the current state-of-the-art photomultiplier tube technology to ∼100 ps. The soon-to-be deployed Pulse Dilation Photomultiplier Tube (PD-PMT) at NIF will allow for temporal resolution comparable to that of the gas cell or ∼10 ps. Enhanced resolution will contribute to the quest for ignition in a crucial way through precision measurements of reaction history and ablator areal density (ρR) history, leading to better constrained models. Features such as onset of alpha heating, shock reverberations, and burn truncation due to dynamically evolving failure modes may become visible for the first time. Test measurements of the PD-PMT at Atomic Weapons Establishment confirmed that design goals have been met. The PD-PMT provides dilation factors of 2 to 40× in 6 increments. The GCD-3 recently deployed at the NIF has been modified for coupling to a PD-PMT and will soon be making ultrafast measurements.

Progress on next generation gamma-ray Cherenkov detectors for the National Ignition Facility

Fusion reaction history and ablator areal density measurements for Inertial Confinement Fusion experiments at the National Ignition Facility are currently conducted using the Gamma Reaction History diagnostic (GRH_6m). Future Gas Cherenkov Detectors (GCDs) will ultimately provide ∼100x more sensitivity, reduce the effective temporal response from ∼100 to ∼10 ps, and lower the energy threshold from 2.9 to 1.8 MeV, relative to GRH_6m. The first phase toward next generation GCDs consisted of inserting the existing coaxial GCD-3 detector into a reentrant well which puts it within 4 m of the implosion. Reaction history and ablator gamma measurement results from this Phase I are discussed here. These results demonstrate viability for the follow-on Phases of (II) the use of a revolutionary new pulse-dilation photomultiplier tube to improve the effective measurement bandwidth by >10x relative to current PMT technology; and (III) the design of a NIF-specific "Super" GCD which will be informed by the assessment of the radiation background environment within the well described here.