Search for Boosted Dark Matter in COSINE-100

We search for energetic electron recoil signals induced by boosted dark matter (BDM) from the galactic center using the COSINE-100 array of NaI(Tl) crystal detectors at the Yangyang Underground Laboratory. The signal would be an excess of events with energies above 4 MeV over the well-understood background. Because no excess of events are observed in a 97.7  kg·yr exposure, we set limits on BDM interactions under a variety of hypotheses. Notably, we explored the dark photon parameter space, leading to competitive limits compared to direct dark photon search experiments, particularly for dark photon masses below 4 MeV and considering the invisible decay mode. Furthermore, by comparing our results with a previous BDM search conducted by the Super-Kamionkande experiment, we found that the COSINE-100 detector has advantages in searching for low-mass dark matter. This analysis demonstrates the potential of the COSINE-100 detector to search for MeV electron recoil signals produced by the dark sector particle interactions.

Effects of the beta-blocker carvedilol on arrhythmia and long-term clinical outcomes in benign prostate hypertrophy patients

Benign prostatic hypertrophy (BPH) is associated with autonomic dysfunction and sympathetic nervous system mediated by the alpha receptor. However, limited data exist regarding the effects of the beta-blocker (BB) carvedilol on arrhythmia and urologic outcomes in BPH patients. Our database of patients diagnosed with BPH from 2015 to 2020 was used to obtain echocardiography and electrocardiogram data. Inclusion criteria were BPH patients taking BBs. International Prostate Symptom Score questionnaire were used to evaluate the urinary symptoms and quality of life. Among 448 patients with BPH (69.2 ± 10.9 years) taking BBs, 219 patients took carvedilol (48.9%) and 229 patients took a non-carvedilol BB (51.1%; bisoprolol, 184 patients, 80% or nebivolol, 45 patients, 20%). Difference in the baseline characteristics was not observed. During the median 36-month follow-up, a lower incidence of arrhythmic events (P = .029), total urologic events (P < .001), and less use of additive alpha-blocker was observed in the carvedilol group (P = .022). In multivariate analysis, less carvedilol use (P = .019), heart failure (P < .001), stroke (P < .001), and cardiomyopathy (P = .046) were independent risk factors for arrhythmic events. In addition, less carvedilol use (P = .009) and older age (P = .005) were independent risk factors for urologic events based on BB type at the median 36-month follow-up. The use of carvedilol was associated with less arrhythmic events in BPH patients with palpitation and decreased the incidence of urologic events in BPH compared with the use of non-carvedilol BBs in long-term follow-up.

Decadal stability in coral cover could mask hidden changes on reefs in the East Asian Seas

Coral reefs in the Central Indo-Pacific region comprise some of the most diverse and yet threatened marine habitats. While reef monitoring has grown throughout the region in recent years, studies of coral reef benthic cover remain limited in spatial and temporal scales. Here, we analysed 24,365 reef surveys performed over 37 years at 1972 sites throughout East Asia by the Global Coral Reef Monitoring Network using Bayesian approaches. Our results show that overall coral cover at surveyed reefs has not declined as suggested in previous studies and compared to reef regions like the Caribbean. Concurrently, macroalgal cover has not increased, with no indications of phase shifts from coral to macroalgal dominance on reefs. Yet, models incorporating socio-economic and environmental variables reveal negative associations of coral cover with coastal urbanisation and sea surface temperature. The diversity of reef assemblages may have mitigated cover declines thus far, but climate change could threaten reef resilience. We recommend prioritisation of regionally coordinated, locally collaborative long-term studies for better contextualisation of monitoring data and analyses, which are essential for achieving reef conservation goals.

Rhinitis associated with asthma is distinct from rhinitis alone: The ARIA-MeDALL hypothesis

Asthma, rhinitis and atopic dermatitis (AD) are interrelated clinical phenotypes that partly overlap in the human interactome. The concept of "one-airway-one-disease", coined over 20 years ago, is a simplistic approach of the links between upper- and lower-airway allergic diseases. With new data, it is time to reassess the concept. This article reviews (i) the clinical observations that led to Allergic Rhinitis and its Impact on Asthma (ARIA), (ii) new insights into polysensitisation and multimorbidity, (iii) advances in mHealth for novel phenotype definition, (iv) confirmation in canonical epidemiologic studies, (v) genomic findings, (vi) treatment approaches and (vii) novel concepts on the onset of rhinitis and multimorbidity. One recent concept, bringing together upper- and lower-airway allergic diseases with skin, gut and neuropsychiatric multimorbidities, is the "Epithelial Barrier Hypothesis". This review determined that the "one-airway-one-disease" concept does not always hold true and that several phenotypes of disease can be defined. These phenotypes include an extreme "allergic" (asthma) phenotype combining asthma, rhinitis and conjunctivitis. Rhinitis alone and rhinitis and asthma multimorbidity represent two distinct diseases with the following differences: (i) genomic and transcriptomic background (Toll-Like Receptors and IL-17 for rhinitis alone as a local disease; IL-33 and IL-5 for allergic and non-allergic multimorbidity as a systemic disease), (ii) allergen sensitisation patterns (mono- or pauci-sensitisation versus polysensitisation), (iii) severity of symptoms and (iv) treatment response. In conclusion, rhinitis alone (local disease) and rhinitis with asthma multimorbidity (systemic disease) should be considered as two distinct diseases, possibly modulated by the microbiome, and may be a model for understanding the epidemics of chronic and auto-immune diseases.

Postoperative effects of bariatric surgery on heart rate recovery and heart rate variability

Background: Several studies have reported associations between obesity and autonomic dysfunction. However, little research has investigated the effect of bariatric surgery on heart rate recovery (HRR) in the treadmill test and heart rate variability (HRV) in 24-hour Holter monitoring. We investigated the effects of bariatric surgery on HRR and HRV, which are parameters related to autonomic dysfunction. Methods: We retrospectively investigated patients who underwent bariatric surgery in 2019. The treadmill test, 24-hour Holter monitoring, and echocardiography were performed before and 6 months after surgery. We compared the changes in HRR in the treadmill test and HRV parameters such as the time domain and spectral domain in 24-hour Holter monitoring before and after surgery. Results: Of the 40 patients who underwent bariatric surgery, 25 patients had the treadmill test or 24-hour Holter monitoring both before and after surgery. Body weight and body mass index significantly decreased after surgery (112.86±24.37 kg vs. 89.10±20.26 kg, p<0.001; 39.22±5.69 kg/m2 vs. 31.00±5.09 kg/m2, p<0.001, respectively). HRR significantly increased (n=23; 43.00±20.97 vs. 64.29±18.49, p=0.001). The time domain of HRV parameters increased (n=21; standard deviation of the N-N interval 123.57±28.05 vs. 152.57±39.49, p=0.002 and mean N-N interval 791.57±88.84 vs. 869.05±126.31, p=0.002).Conclusions: Our data showed that HRR after exercise and HRV during 24-hour Holter monitoring improved after weight reduction with bariatric surgery through improved cardiac autonomic function.

Liposomal irinotecan plus fluorouracil/leucovorin versus FOLFIRINOX as the second-line chemotherapy for patients with metastatic pancreatic cancer: a multicenter retrospective study of the Korean Cancer Study Group (KCSG)

Background

There is no clear consensus on the recommended second-line treatment for patients with metastatic pancreatic cancer who have disease progression following gemcitabine-based therapy. We retrospectively evaluated the clinical outcomes of liposomal irinotecan (nal-IRI) plus fluorouracil/leucovorin (FL) and FOLFIRINOX (fluorouracil, leucovorin, irinotecan, and oxaliplatin) in patients who had failed on the first-line gemcitabine-based therapy.

Patients and methods

From January 2015 to August 2019, 378 patients with MPC who had received nal-IRI/FL (n = 104) or FOLFIRINOX (n = 274) as second-line treatment across 11 institutions were included in this retrospective study.

Results

There were no significant differences in baseline characteristics between groups, except age and first-line regimens. With a median follow-up of 6 months, the median progression-free survival (PFS) was 3.7 months with nal-IRI/FL versus 4.6 months with FOLFIRINOX (P = 0.44). Median overall survival (OS) was 7.7 months with nal-IRI/FL versus 9.7 months with FOLFRINOX (P = 0.13). There was no significant difference in PFS and OS between the two regimens in the univariate and multivariate analyses. The subgroup analysis revealed that younger age (<70 years) was associated with better OS with FOLFIRINOX. In contrast, older age (≥70 years) was associated with better survival outcomes with nal-IRI/FL. Adverse events were manageable with both regimens; however, the incidence of grade 3 or higher neutropenia and peripheral neuropathy was higher in patients treated with FOLFIRINOX than with nal-IRI/FL.

Conclusions

Second-line nal-IRI/FL and FOLFIRINOX showed similar effectiveness outcomes after progression following first-line gemcitabine-based therapy. Age could be the determining factor for choosing the appropriate second-line therapy.

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This multicenter retrospective study investigated nal-IRI/FL and FOLFIRINOX outcomes after gemcitabine-based therapy.

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We found no significant differences in outcome between nal-IRI/FL and FOLFIRINOX treatment.

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Both regimens were well tolerated; however, neutropenia and peripheral neuropathy were more frequent with FOLFIRINOX.

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Age (cut-off, 70 years) showed differential efficacy between chemotherapy regimens.

Association of dipping status of blood pressure, visual field defects, and retinal nerve fiber layer thickness in patients with normotensive glaucoma

The aim of this study was to evaluate the association between dipping status of blood pressure (BP), visual field defects (VFDs), and retinal nerve fiber layer (RNFL) thickness in patients with normotensive glaucoma (NTG). Our University echocardiography, electrocardiogram, 24-hour BP monitor and glaucoma database were reviewed from 2016 to 2018 to identify patients with NTG and hypertension (HTN). These NTG patients were followed for a mean 26.4 ± 13.6 months and were divided into 2 groups according to the absence or presence of VFDs. Among the 110 patients with NTG, 55 (50%) patients had VFDs. There were no differences of baseline characteristics between 2 groups. In univariate analysis, extreme dipper status at night in the 24-hour BP monitoring, HTN, age, diabetes mellitus, and hyperlipidemia were significantly associated with VFDs. In multivariate analysis, extreme dipper status at night in the 24-hour BP monitoring (odds ratio [OR] 4.094; P = .045) and HTN (OR 2.368; P = .048) were independent risk factors for VFDs at 2-year follow-up. Moreover, the RNFL thickness was thinner in NTG patients with VFDs (P < .001). VFDs group had more increased fluctuation of systolic and diastolic BP in 24-hour BP monitoring and that the extreme dipper status at night in the 24-hour BP monitoring and HTN itself were also associated with higher incidence of VFDs and thinning changes of the RNFL in patients with NTG, suggesting that more intensive medical therapy with close clinical follow-up will be required for these patients.

Changes in QRS Duration Are Associated with a Therapeutic Response to Sacubitril-valsartan in Heart Failure with Reduced Ejection Fraction

BACKGROUND

Recent studies have demonstrated that angiotensin receptor neprilysin inhibitors (ARNIs) can reverse the cardiac remodeling effects that occur in heart failure with reduced ejection fraction (HFrEF). These studies have also suggested that ARNIs have favorable effects on ventricular dyssynchrony. We assessed the changes in QRS duration associated with ARNIs in patients with HFrEF.

METHODS

We retrospectively investigated patients with HFrEF (defined by a left ventricular ejection fraction [LVEF] ≤ 35%) who were treated with ARNIs for at least six months. We divided the patients into QRS shortening and non-QRS shortening groups according to their electrocardiogram (ECG) findings. We also compared changes in echocardiographic parameters between the groups.

RESULTS

A total of 68 patients with HFrEF were included (mean age: 62.5 years, 74.6% male). Twenty-one patients had significant ischemic heart disease (IHD). Thirty-five patients exhibited QRS-duration shortening on follow-up ECGs (mean change: −7.8 msec), and 33 patients showed no changes or increased QRS duration (mean change: 5.1 msec). The QRS shortening group exhibited significant improvement in LVEF (12.5 ± 15.3% vs. 1.7 ± 9.5%; p < 0.001) when compared with the non-QRS shortening group. The QRS shortening group also had significantly lower LV end-diastolic dimension (LVEDD), LV end-systolic dimension (LVESD) and LV mass index (LVMI) than did the non-QRS shortening group. The change in QRS duration was significantly correlated with the change in LVEF (r = -0.329, p = 0.011) and LVESD (r = 0.298, p = 0.022).

CONCLUSIONS

Among patients with HFrEF treated with ARNIs, the QRS shortening group showed favorable LV systolic function recovery, and reversal of cardiac remodeling compared to those of the non-QRS shortening group. Change in the QRS duration, which reflects LV synchrony, may be associated with response to ARNIs in patients with HFrEF.

The effect of myocardial injury on the clinical course of snake envenomation in South Korea

CONTENT

This study investigated the incidence, progression and clinical course of myocardial injury-related snake envenomation in South Korea. In addition, this study evaluated whether antivenom guidelines are appropriate to control envenomation in patients with myocardial injury.

METHODS

The study included 198 patients who received antivenom after a snakebite, and they were divided into two groups according to evidence of myocardial injury (defined as elevated troponin I or ischemic change on electrocardiogram) at presentation. Data including serial troponin I, echocardiogram/coronary angiogram findings, the clinical course, and treatment were collected and analyzed.

RESULTS

The incidence of myocardial injury at presentation was 15.2%. The troponin I level was 0.11 (0.07-0.56) ng/ml at presentation and tended to decrease over 24 h. Echocardiograms revealed neither regional wall motion abnormalities nor left ventricular dysfunction in 15 of 17 patients, while two patients showed signs of coronary artery stenosis on echocardiograms and coronary angiograms. However, compared with patients without myocardial injury, patients with myocardial injury had a higher frequency of systemic envenomation complications, including bleeding, respiratory failure, hypotension, acute kidney injury, thrombocytopenia and venom-induced consumption coagulopathy (VICC). The patients with myocardial injury at presentation needed significantly more frequent and larger doses of antivenom than indicated by the initial severity of envenomation. Multivariate analysis showed that myocardial injury was associated with the need for additional antivenom administration after initial administration.

DISCUSSION AND CONCLUSION

Myocardial injury is not uncommon after snake envenomation in Korea. Although myocardial injury itself seems to be benign, the clinical course of patients with myocardial injury is complicated, and myocardial injury is associated with the need for additional antivenom administration. The optimal use of antivenom to control envenomation in patents with myocardial injury after snake envenomation in South Korea should be established.

Correlation between work impairment, scores of rhinitis severity and asthma using the MASK-air® App

BACKGROUND

In allergic rhinitis, a relevant outcome providing information on the effectiveness of interventions is needed. In MASK-air (Mobile Airways Sentinel Network), a visual analogue scale (VAS) for work is used as a relevant outcome. This study aimed to assess the performance of the work VAS work by comparing VAS work with other VAS measurements and symptom-medication scores obtained concurrently.

METHODS

All consecutive MASK-air users in 23 countries from 1 June 2016 to 31 October 2018 were included (14 189 users; 205 904 days). Geolocalized users self-assessed daily symptom control using the touchscreen functionality on their smart phone to click on VAS scores (ranging from 0 to 100) for overall symptoms (global), nose, eyes, asthma and work. Two symptom-medication scores were used: the modified EAACI CSMS score and the MASK control score for rhinitis. To assess data quality, the intra-individual response variability (IRV) index was calculated.

RESULTS

A strong correlation was observed between VAS work and other VAS. The highest levels for correlation with VAS work and variance explained in VAS work were found with VAS global, followed by VAS nose, eye and asthma. In comparison with VAS global, the mCSMS and MASK control score showed a lower correlation with VAS work. Results are unlikely to be explained by a low quality of data arising from repeated VAS measures.

CONCLUSIONS

VAS work correlates with other outcomes (VAS global, nose, eye and asthma) but less well with a symptom-medication score. VAS work should be considered as a potentially useful AR outcome in intervention studies.

Female reproductive factors and the risk of dementia: a nationwide cohort study

BACKGROUND AND PURPOSE

The aim was to investigate whether female reproductive factors are associated with dementia.

METHODS

In all, 4 696 633 post-menopausal women without dementia were identified using the Korean National Health Insurance System database. Data on reproductive factors were collected using a self-administered questionnaire. Dementia was determined using dementia diagnosis codes and anti-dementia drug prescription. Cox proportional hazards regression was conducted to assess the hazard ratio (HR) for dementia according to reproductive factors.

RESULTS

During a median follow-up of 5.74 years, there were 212 227 new cases of all-cause dementia (4.5%), 162 901 cases of Alzheimer's disease (3.5%) and 24 029 cases of vascular dementia (0.5%). The HR of dementia was 1.15 [95% confidence interval (CI) 1.03-1.16] for menarcheal age ≥17 years compared with menarcheal age 13-14 years, 0.79 (0.77-0.81) for menopausal age ≥55 years compared with menopausal age <40 years, and 0.81 (0.79-0.82) for fertility duration ≥40 years compared with fertility duration <30 years. Whilst being of parity one (HR 0.89, 95% CI 0.85-0.94) and breastfeeding <6 months (HR 0.92, 95% CI 0.88-0.95) was associated with lower risk of dementia, being of parity two or more (HR 1.04, 95% CI 0.99-1.05) and breastfeeding ≥12 months (HR 1.14, 95% CI 1.01-1.07) was associated with a higher risk of dementia than women without parity or breastfeeding history. Use of hormone replacement therapy and oral contraceptives independently reduced the dementia risk by 15% and 10%, respectively.

CONCLUSIONS

Female reproductive factors are independent risk factors for dementia incidence, with higher risk associated with shorter lifetime endogenous estrogen exposure.

A systematic review of automated feeder detection software for locoregional treatment of hepatic tumors

PURPOSE

The purpose of this study was to perform a systematic review of current literature describing the efficacy and technical outcomes of transarterial liver therapies using automated feeder detection (AFD) software.

MATERIALS AND METHODS

This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. A structured search was performed in the PubMed, SCOPUS, and Embase databases of patients undergoing locoregional therapy of liver tumors utilizing AFD software. Demographic data, procedure data (including radiometrics) and tumor response rate were recorded. Where available, performance of AFD was compared to conventional digital subtraction angiography (DSA) and cone-beam CT (CBCT) without AFD.

RESULTS

A total of 14 full-text manuscripts met inclusion criteria, comprising 1042 tumors in 604 patients (305 men, 156 women; mean age, 68.6±6.0 [SD] years), including 537 patients with hepatocellular carcinoma, 8 with metastases from neuroendocrine tumors, and 59 patients without reported etiology. Reported sensitivity of AFD ranged between 86% and 98.5%, compared to DSA alone (38% - 64%) or DSA in combination with CBCT (69% - 81%). Three studies reported tumor response by modified response evaluation criteria in solid tumors (mRECIST) guidelines, with complete response in the range of 60% - 69%.

CONCLUSION

AFD is a promising new technology for the identification of intrahepatic and extrahepatic tumor-feeding arteries and should be considered a useful adjunct to conventional DSA and CBCT in the treatment of liver tumors.

P1882Association between acute hepatitis B flare and long-term clinical outcomes in patients with atrial fibrillation

Background

Relationship between AF and inflammation was shown in previous studies. However, there was limited data about the association between the acute hepatitis B flare (AVHF-B) and AF in the long-term follow-up.

Purpose

The aim of this study was to evaluate the association of AVHF-B and long-term clinical outcomes in patients with AF.

Methods

Our University echocardiography, electrocardiogram (ECG) and hepatitis B database were reviewed from 2008 to 2017 to identify patients with AF and AVHF-B. Patients were followed for a mean 26.4±0.9 months and were divided into two groups according to the absence or presence of AVHF-B with AF.

Results

Among 280 patients with AF, 100 (35.7%) patients had AVHF-B. Total any event rates were significantly higher in patients with AVHF-B compared to those without AVHF-B (P<0.001). Arrhythmias including AF, atrial tachycardia,APC, VT, and VPC also occurred in 54 (19.3%) patients, with a significantly higher incidence in patients with AVHF-B than in those without AVHF-B (P<0.001). In univariate analysis, CHA2DS2 VASc, Left atrial diameter (LAD), E/E' (the peak mitral flow velocity of the early rapid filling wave/early diastolic mitral annulus velocity) and AVHF-B were significantly associated with arrhythmic events and total any events including thromboembolic events, arrhythmic events, re-hospitalizations and mortality. In multivariate analysis, AVHF-B was independent risk factors for arrhythmic events (P=0.031) at the long-term follow-up.

Conclusion

The patients with AVHF-B were associated with higher arrhythmic events and total any events, suggesting more intensive medical therapy with close clinical follow-up will be required.

Acknowledgement/Funding

None

P3617Systolic blood pressure, glycemic control and clinical outcome in diabetic patients with acute myocardial infarction

Background

Recent blood pressure guidelines recommend intensive blood pressure control in diabetic patients with cardiovascular disease.

Purpose

We sought to investigate combined impact of intensive blood glucose lowering and blood pressure control on clinical outcome in diabetic patients with acute myocardial infarction (AMI) has not been fully investigated yet.

Method

Korean Acute Myocardial Infarction Registry (KAMIR) – National Institute of Health (NIH) database included 12,179 patients (9,046 men; mean age = 63.6±12.6 year-old) who were discharged alive. Among them, 3,430 (28.2%) had a diabetes mellitus (DM). MACCEs were defined as a composition of all cause death, non-fatal MI, repeat revascularizations including repeated percutaneous coronary intervention and coronary bypass grafting, cerebrovascular accident and rehospitalizations at 1 year. This research was supported by a fund by Research of Korea Centers for Disease Control and Prevention.

Result

We determined cut-off value of discharge systolic blood pressure (SBP) to predict 1-year MACCE in DM and non-DM patients. Discharge SBP of less than 130mmHg was associated with a lower MACCE at 1 year compared to SBP level of 130mmHg or greater (10.8% versus 15.4%; log-rank p=0.001) in DM patients, whereas discharge SBP cut-off level was 140mmHg to discriminate 1-year MACCE in non-DM patients (6.4% versus 8.5%, log-rank p=0.045). In DM patients, there were no significant difference in 1-year MACCEs between patients with HbA1c less than 7% versus 7% or greater (12.0% versus 10.7%; log-rank p=0.325). DM patients were categorized into 4 groups; discharge SBP <130mmHg and HbA1c <7% (Group 1); discharge SBP <130mmHg and HbA1c ≥7% (Group 2); discharge SBP ≥130mmHg and HbA1c <7% (Group 3); discharge SBP ≥130mmHg and HbA1c ≥7% (Group 4). Intensive BP control was associated lower 1-year MACCEs in patients with good glycemic control (Group 1 & 3; 10.7% versus 16.7%; log-rank p=0.009). However, in patients with poor glycemic control, intensive BP control did not improve 1-year MACCEs (Group 2 & 4; 10.6% versus 11.1%; log-rank p=0.761).

Conclusion

Strict BP control is more important than glycemic control to improve short-term clinical outcome in DM patients with AMI. However, in patients with poor glycemic control, strict BP control did not improve clinical outcome.

P3583Optimal procedural strategy to improve clinical outcome in primary percutaneous coronary intervention

Background

Current guideline recommends potent antiplatelet agents and transradial intervention. However, it is uncertain whether routine use of IVUS, thrombus aspiration and glycoprotein IIB-IIIA inhibitor is beneficial for improving clinical outcome in patients with ST-segment elevation myocardial infarction (STEMI).

Purpose

The aim of this study was to investigate optimal procedural strategy to improve clinical outcome.

Methods

A total of 6,046 patients who underwent primary percutaneous coronary intervention (PCI) for STEMI were analyzed from the Korean Acute Myocardial Infarction Registry (KAMIR) – National Institute of Health (NIH) database. MACCEs were defined as a composition of all cause death, non-fatal MI, repeat revascularizations including repeated percutaneous coronary intervention and coronary bypass grafting, cerebrovascular accident and rehospitalizations. This research was supported by a fund by Research of Korea Centers for Disease Control and Prevention.

Results

During the primary PCI, potent antiplatelet agents such as prasugrel and ticagrelor were used in 2342 (38.4%). PCI was performed through transradial approach in 1490 (25.2%). Thrombus aspiration and intravascular ultrasound (IVUS) examination was done in 2204 (36.1%) and 1079 (18.1%), respectively. Glycoprotein IIB-IIIA inhibitor was administered in 1295 (21.7%). Among them, potent antiplatelet agents, transradial intervention, IVUS, and thrombus aspiration significantly reduced MACCEs at 1 year. Glycoprotein IIB-IIIA inhibitor was not effective to improved clinical outcome. In Cox-proportional hazards model, potent antiplatelet agents (hazard ratio 0.82, 95% confidence interval 0.67–0.99; p=0.045) and transradial intervention (hazard ratio 0.61, 95% confidence interval 0.47–0.78; p<0.001) was an independent predictor of MACCEs after adjusting for confounding variables. Combined use of potent antiplatelet agents and transradial intervention (hazard ratio 0.54; 95% confidence interval 0.37–0.80; p=0.002) substantially reduced MACCEs at 1 year.

Conclusion

Among evidence based procedures during the primary PCI, combined use of potent antiplatelet agents and transradial intervention was optimal procedural strategy to improve clinical outcome.

P6253Electrocardiographic characteristics for prediction of irreversible fulminant hepatitis in patients with acute hepatic failure

Background

There was limited data about the association between the electrocardiographic characteristics and irreversible fulminant hepatitis (IFH) in patients with acute hepatic failure (AHF) in the long-term follow up.

Purpose

The aim of this study was to analysis the electrocardiographic characteristics for prediction of IFH in patients with AHF.

Methods

Our University echocardiography, electrocardiogram (ECG) and viral hepatitis database were reviewed from 2008 to 2017 to identify patients with AHF. Patients were followed for a mean 32.0±0.8 months and were analyzed to find out the predictors for IFH.

Results

Among 202 patients with AHF, 23 (11.4%) patients had IFH. In our study, there are 118 (58.7%) viral hepatitis patients (hepatitis A, 83 patients, 41.3%; hepatitis B, 19 patients, 9.5%; hepatitis C, 15 patients, 7.5%) and alcoholic hepatitis patients (83 patients, 41.3%). Based on the ROC curve, we set the corrected QT interval (QTc) cutoff value of 425 msec for prediction of IFH, which gave a sensitivity of 66.7% and a specificity of 66.0% (P=0.002). In univariate analysis, age, QTc, diabetes mellitus (DM), heavy alcoholics, labile INR, hemoglobin, albumin, total bilirubin, sodium, and c-reactive protein were significantly associated with IFH. In multivariate analysis, age, QTc, DM, heavy alcoholics, and total bilirubin were independent risk factors for IFH at the long-term follow-up.

Conclusion

Longer QTc (>425msec) in patients with AHF was associated with higher IFH, suggesting close clinical and electrocardiographic follow-up will be required.

Acknowledgement/Funding

None

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.

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 P3-03-31: Is sentinel lymph node biopsy necessary in all patients with early breast cancer?

Background and objectives : Since the results of the American College of Surgeons Oncology Group Z0011 published, the criteria for applying axillary lymph node (ALN) dissection was relaxed among early breast cancer patients who were scheduled for breast conserving surgery, adjuvant chemotherapy therapy, and adjuvant radiation therapy. SLNB criteria may be established if pathologic nodal status can be predicted. The aim of this study was to develop a nomogram for preoperative prediction of axillary node metastasis.

Methods: The records of 1650 patients with T1, T2 primary invasive breast cancer who were treated between January 2013 and September 2016 were selected from the medical database of Yonsei University (Seoul, South Korea). Those whom a preoperative diagnosis of axillary node metastases were excluded. Two nomogram that predicted three or more axillary metastasis and one or more axillary metastasis were developed using a binary logistic regression model with a training cohort. Internal validation was carried out adopting bootstrap method by validation cohort 500 times resampling.

Result: A total of 82 (4.8%) patients had three or more ALNs metastasis. Three hundred seventy five (17.4%) patients had one or more ALNs metastasis. Axillary metastasis was associated with Preoperative ALN suspicious image findings, clinical tumor size, Number of neoplastic foci, estrogen receptor status, Ki-67 expression, tumor marker. The nomogram was developed based on the clinical and statistically significant predictors. It had good discrimination performance (AUC 0.79, 95% CI, 0.73–0.85), (AUC 0.71, 95% CI, 0.67–0.74) and calibration fit.

Conclusion:Our nomogram might help predict the ALN metastasis in breast cancer patients. Patients with a low probability of ALN metastasis could be spared SLNB.

Citation Format: Yoon KH, Lee KB, Lee H, Lee J, Kim JY, Park HS, Park S, Kim SI, Cho YU, Park B-W. Is sentinel lymph node biopsy necessary in all patients with early breast cancer? [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 P3-03-31.

Abstract OT2-01-03: A prospective pilot study of simultaneous robotic assisted nipple sparing mastectomy and immediate reconstruction

Endoscopic breast surgery was expected to be an adequate technique to complete cancer clearance and preservation of the patient's body image. However, this technique has limitations including incomplete internal movements and unstable vision of a two dimensional camera due to inflexible endoscopic instruments especially during the skin flap formation. High resolution, ten-fold image magnification, and three-dimensional optics of robotic surgery help overcome the limitations of endoscopic surgery, and thus robotic surgery has been adopted in a wide range of intracorporeal procedures including breast surgery. However, few studies have evaluated feasibility and safety of robotic assisted nipple sparing mastectomy (RANSM) and immediate breast reconstruction (IBR) for the treatment of breast cancer. There were not any investigation to assess patients' satisfaction of cosmetic effect after performing RANSM and IBR. This study is aim to verify the feasibility and the safety of RANSM and IBR and to analyze cosmetic effect of the procedure and satisfaction of patients. The target number of enrollments is 15 patients. Patients who are diagnosed with early breast cancer or BRCA 1/2 mutation carriers are enrolled. Female patients over 20 years old who are candidates to preserve nipple areolar complex and considered to perform reconstruction with implants are prospectively collected. Written informed consents are mandatory. Patients who are considered the high possibility of postoperative radiation therapy according to preoperative stage are not included in this study. We exclude patients who want to undergo other methods of breast reconstruction than breast reconstruction with implants. Patients will undergo RANSM and IBR through a single axillary skin incision simultaneously. Regular follow-up at 1 month and 6 months after RANSM and IBR is scheduled to record recovery of a patient, amount of a drain, date of drain removal, and postoperative complications. Patient satisfaction questionnaire will be completed on the last follow-up day. To evaluate the safety of robotic assisted surgery, the oncologic safety (margin status of nipple areolar complex), postoperative recovery of a patient, and postoperative complications are investigated. We compare preoperative and postoperative 6 month photographs of patients and estimate the surgical outcome by objective indicators to evaluate the cosmetic grading by plastic surgeons. Patients' satisfaction are assessed by questionnaire (BREAST-Q) at the 6-month visit.

Citation Format: Lee J, Park HS, Kim JH, Lee DW, Song SY, Lew DH, Kim JY, Kim SI, Cho YU, Lee H, Lee KB, Yoon KH. A prospective pilot study of simultaneous robotic assisted nipple sparing mastectomy and immediate reconstruction [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 OT2-01-03.

Predictive value of a fragmented QRS complex in diagnosing patients with myocardial ischemia

Background

A fragmented QRS complex (fQRS) is caused by conduction abnormalities of the ventricle secondary to myocardial ischemia and/or scar in patients with myocardial infarction. However, the implications of the fQRS in the development of coronary artery disease with myocardial ischemia in those without a scar remain unknown.

Methods

We studied electrocardiograms (ECGs) obtained from 150 patients (60.5 ± 8.5 years, 102 men) with myocardial ischemia, which was confirmed by performing both, a nuclear exercise stress test and coronary angiography. We also studied ECGs obtained from 601 patients (58.5 ± 10.0 years, 315 men) who showed a negative nuclear exercise stress test (control group). Patients in whom the nuclear exercise stress test showed a myocardial scar were excluded.

Results

An fQRS was more commonly observed in patients with myocardial ischemia (n = 48, 32.0%) than in the control group (n = 133, 22.1%) (P = 0.011). The sensitivity, specificity, positive, and negative predictive values of fQRS in diagnosing myocardial ischemia were 32.0, 77.9, 26.5, and 82.1%, respectively. The fQRS (odds ratio 1.580, 95% confidence interval 1.020‐2.446, P = 0.040) was an independent predictor of myocardial ischemia after adjusting for age, sex, current smoking habits, ST‐T changes on ECG, as well as histories of hypertension, diabetes, and dyslipidemia. Moreover, the fQRS showed an incremental prognostic value over conventional risk factors (χ² = 5, P = 0.032) and over a combination of conventional factors and ST‐T changes (χ² = 9, P = 0.014).

Conclusions

The fQRS is a moderately sensitive and independent predictor of myocardial ischemia.

Claudin-1 expression decreases with increasing pathological grade in actinic keratosis and may be a marker of high-risk actinic keratosis

BACKGROUND

Actinic keratosis (AK) is a common sun-induced skin disorder that can progress to invasive squamous cell carcinoma. However, there is still no reliable method to predict high-risk AK.

AIM

To identify markers that reflect the biological behaviour of AK and to understand the pathogenesis of AK.

METHODS

In total, 52 patients with AK and 17 site-matched healthy controls (HCs) were enrolled. We evaluated solar elastosis and immunohistochemical features using antibodies to p53, vitamin D receptor (VDR), claudin-1 and Langerin (CD207). Comparisons between AK and HC skin were performed and analyses carried out according to the pathological grade of AK.

RESULTS

We found that in both patients and HCs, solar elastosis increased and Langerhans cell (LC) density decreased with ageing. Solar elastosis and p53 expression were higher and VDR expression was lower in patients than in HCs; however, there was no statistical difference between them in relation to the pathological grade of AK. Claudin-1 expression gradually decreased from HC skin to severe AK, and particularly decreased in areas with epidermal atypia. LC density in severe AK was significantly lower than in HC skin and mild AK, while there was no difference in LC density between HC skin, mild AK and moderate AK.

CONCLUSIONS

Claudin-1 could be a useful marker of the pathological severity of AK. In addition, p53 increases and VDR decreases in AK, not in a gradual manner but in the early steps of carcinogenesis. LC density is relatively maintained in AK until it reaches severe dysplasia.

Femtosecond X-Ray Diffraction Studies of the Reversal of the Microstructural Effects of Plastic Deformation during Shock Release of Tantalum

We have used femtosecond x-ray diffraction to study laser-shocked fiber-textured polycrystalline tantalum targets as the 37-253 GPa shock waves break out from the free surface. We extract the time and depth-dependent strain profiles within the Ta target as the rarefaction wave travels back into the bulk of the sample. In agreement with molecular dynamics simulations, the lattice rotation and the twins that are formed under shock compression are observed to be almost fully eliminated by the rarefaction process.

Depth extraction with offset pixels

Numerous depth extraction techniques have been proposed in the past. However, the utility of these techniques is limited as they typically require multiple imaging units, bulky platforms for computation, cannot achieve high speed and are computationally expensive. To counter the above challenges, a sensor with Offset Pixel Apertures (OPA) has been recently proposed. However, a working system for depth extraction with the OPA sensor has not been discussed. In this paper, we propose the first such system for depth extraction using the OPA sensor. We also propose a dedicated hardware implementation for the proposed system, named as the Depth Map Processor (DMP). The DMP can provide depth at 30 frames per second at 1920 × 1080 resolution with 31 disparity levels. Furthermore, the proposed DMP has low power consumption as for the aforementioned speed and resolution it only requires 290.76 mW. The proposed system makes it an ideal choice for depth extraction systems in constrained environments.

Abstract P2-05-07: Whole exome sequencing of extreme responders reveals low mutation burden in metastatic breast cancer

Background: Extreme responders to anticancer therapy are rarely encountered in the treatment of advanced breast cancer patients, but their treatment response have not been investigated on the whole exome level. We performed whole exome analysis to characterize genomic landscape of extreme responders in metastatic breast cancer patients.

Methods: Clinical samples were obtained from patients who showed exceptional response to anti-HER2 therapy or hormonal therapy. Non-responders were selected among those who did not respond. Matched breast tumor tissue (somatic DNA) and blood samples (germline DNA) were collected from a total of 18 responders (12 ER+, 6 HER2+) and 8 non-responders (6 ER+, 1 HER2+, 1 TNBC). Whole exome sequencing using Illumina HiSeq2500 was performed on the 26 patients (52 samples). Somatic single nucleotide variants (SNVs), indels and copy number variants (CNVs) were identified for each patient genome. Group specific somatic variants and mutation burden were statistically analyzed.

Findings: Cancer exomes were characterized by 1,455 somatic single-nucleotide variants (1,327 missense, 80 nonsense, 36 splice-site, 12 start/stop-lost), 149 insertions/deletions (108 frameshift, 41 inframe), with a median of 1 mutations per Mb (0.2 to 2.7 mutations per Mb) in all patients. Responders harbored a significantly lower non-synonymous mutation burden than non-responders (median, 27 vs. 90.5, P=0.01), and copy number variation burden was also lower (median 23 vs. 31, P=0.14). Multivariate analyses of factors influencing progression-free survival showed that high mutation burden and visceral metastases were significantly related with progression.

Interpretation: Extreme responders of metastatic breast cancer are characterized by low nonsynonymous mutational burden.

Citation Format: Sohn J, Lim SM, Kim E, Kim S, Koo JS, Kim SI, Park S, Park HS, Kwon N-J, Kim GM, Kim S. Whole exome sequencing of extreme responders reveals low mutation burden in metastatic breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-05-07.

Abstract OT2-01-03: A prospective randomized study comparing surgery using electrosurgical bipolar sealing devices and surgery using conventional electro-cautery

Background: Seroma and lymphorrhea are the most common complication following mastectomy and/or axillary lymph node dissection (ALND). The manifestation of seroma accelerates complications such as post-operative bleeding, wound infection, prolonged recovery period. Sealing blood vessels and lymph drainages adequately during mastectomy and/or ALND may play a main role in reducing complication. Therefore, adequate sealing vessels and lymphatics during the surgery is important to reduce seroma and lymphorrhea related complications in patients with breast cancer. Objective: This study aims to show that electrosurgical bipolar sealing device for mastectomy could provide clinical benefit in reducing seroma formation. Design: ELBCE (ELectrosurgical Bipolar Devices VS Convention Electronicautery, NCT03166384)is a prospective, randomized, two-arm assignment controlled trial of application of electrosurgical bipolar sealing device for mastectomy in patients with breast cancer. Patients is randomized in 1:1 ratio to conventional suture and tie group or electrosurgical bipolar sealing devices group. Randomization is performed using opening sealed envelope before enrollment. The primary end point is to compare the total drainage volume until drain tube removal. The time to drain removal is also measured. The secondary end points is the total amount of aspiration from seroma after drain tube removal, and the frequency of seroma aspiration. Statistical consideration: A sample size 44 subjects per each arm was planned to provide a 90% power to detect a 25% decrease of the total amount of drainage fluid after surgery by using an electrosurgical bipolar sealing device when compared to a conventional suture and tie technique. In our experience, the average total volume of fluid after conventional suture and tie technique is 220 mL, with a standard deviation of 80. Eligibility criteria:Inclusion criteria are patients older than 20 years and those who planned to undergo total mastectomy and/or ALND. Exclusion criteria are bilateral breast cancer patients, male patients, patients who underwent ipsilateral axillar surgery or radiation therapy, recurrent breast cancer patients, patients without drain catheter, and patients with ductal carcinoma in situ who have not undergone ipsilateral sentinel lymph node biopsy or ALND.Present accrual and target accrual:ELSEBA study has an accrual target of 88 patients. To date, 8 patients have been randomized. Contact information:Dr. Hyung Seek Park, E-mail: hyungseokpark.md@gmail.com; imgenius@yuhs.ac, Telephone: +82-2-2228-2100

Citation Format: Yoon KH, Park HS, Kim JH, Kim JY, Lim SM, Kim SI, Cho YU. A prospective randomized study comparing surgery using electrosurgical bipolar sealing devices and surgery using conventional electro-cautery [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT2-01-03.

Abstract P6-11-13: Not presented

This abstract was not presented at the symposium.

Differential Expression Patterns of Irf3 and Irf7 in Pediatric Lymphoid Disorders

Interferon regulatory factors (IRFs) are multifunctional transcriptional factors. To define the role of IRFs in lymphoid disorders, we determined the expression patterns of IRF3 and IRF7 by immunohistochemistry in 5 normal lymph nodes, 12 reactive hyperplastic lymph nodes, and 27 pediatric lymphomas. IRF3 was prominently expressed in the nuclei of the histiocytes, and was expressed very weakly in the cytoplasm of most of the lymphocytes of the normal lymph nodes. However, IRF7 was expressed strongly in the nuclei of over 50% of the lymphocytes throughout the normal lymph nodes, but the histiocytes and fibroblasts were spared. In the reactive hyperplastic lymph nodes, the number of IRF3- and IRF7-positive cells in the nuclei was elevated. In the lymphomas, the number of IRF3-positive cells in the nucleus appeared to have decreased, and the cells were scattered throughout the lymphoma tissue in no specific pattern. However, in most cases the number of IRF7-positive cells was elevated.

These results suggested that IRF3 was activated principally in the histiocytes and T cells under inflammatory conditions, but IRF3 activation was attenuated in cases of lymphoma. However, the number of IRF7-positive cells was found to be elevated in the reactive hyperplastic lymph nodes and pediatric lymphoma.

Sterile Neutrino Search at the NEOS Experiment

An experiment to search for light sterile neutrinos is conducted at a reactor with a thermal power of 2.8 GW located at the Hanbit nuclear power complex. The search is done with a detector consisting of a ton of Gd-loaded liquid scintillator in a tendon gallery approximately 24 m from the reactor core. The measured antineutrino event rate is 1976 per day with a signal to background ratio of about 22. The shape of the antineutrino energy spectrum obtained from the eight-month data-taking period is compared with a hypothesis of oscillations due to active-sterile antineutrino mixing. No strong evidence of 3+1 neutrino oscillation is found. An excess around the 5 MeV prompt energy range is observed as seen in existing longer-baseline experiments. The mixing parameter sin^{2}2θ_{14} is limited up to less than 0.1 for Δm_{41}^{2} ranging from 0.2 to 2.3 eV^{2} with a 90% confidence level.

Abstract P5-16-25: Serum 25-hydroxyvitamin D levels and oncologic outcomes of breast cancer patients receiving neoadjuvant chemotherapy

Background:According to prior studies, the role of serum vitamin D3 has been inconsistentand clinical implications of 25-hyrdoxyvitamin D (25-OHD) have been little studiedin breast cancer patients receiving neoadjuvant chemotherapy (NCT).

Objectives: The aims of study were to investigate changes in 25-OHD levels before and after NCT and to determine the association of 25-OHD and oncologic outcomes including pathological complete response (pCR) in breast cancer patients.

Patients and Materials: From January 2010 to December 2013, serum 25-OHD levels at pre- and post-NCT were measured in 377 breast cancer patients. The association of serum 25-OHD levels with clinicopathological data including breast cancer subtypes, pCR and survival were retrospectively analysed. Delta 25-OHD was calculated as serum 25-OHDlevels before minus after NCT.

Results: Mean ageof study population was 48.7 yearsand mean follow-up periods were 35.9months.Mean baseline serum 25-OHD concentration was 14.60 ng/mL (standard deviation, 7.44) and more than 80% of patients showed insufficient 25-OHD levels. The mean 25-OHDat post-NCT was 12.16 ng/mL (standard deviation, 6.87).There was a significant decrease in serum 25-OHD after NACT (p&lt;0.001).The pCR rates were 25.7% among study cohort.However, 25-OHD levels at baseline and post-NCT were not related to pCR and survival outcomes. No associations were found between pCR and delta 25-OHD. According to stratification by breast cancer subtypes, however, patients with ≥ -2.67 (median value) of delta 25-OHD revealed a trend of higher achievement of pCR and better survival in luminal A subtype. No associations were found among the other subtypes.

Conclusions: Many Korean breast cancer patients showed insufficient serum 25-OHD levels at diagnosis of malignancy and a significant decrease in serum vitamin D3 after NACT was observed.No significant association of 25-OHD 3 with pCR and survival was found. Therefore, correction or maintenance of appropriate serum 25-OHD levels should be focused for bone health as comprehensive management of breast cancer during NCT.In addition, possible oncological aspects of 25-OHD should further researched individually considering breast subtypes.

Citation Format: Park S, Lee JS, Kim JH, Lim SM, Park HS, Kim SI. Serum 25-hydroxyvitamin D levels and oncologic outcomes of breast cancer patients receiving neoadjuvant chemotherapy [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-16-25.

Abstract OT2-04-01: Study on the usefulness of the skin wound therapeutic agent 'Neo dermal activator' in breast cancer surgery

Background : Wound infection after breast cancer surgery is considered to be factors that increase the discomfort of the patient and increase of the extension and the use of antibiotics in the treatment time period, in particular breast cancer postoperative wound infection resulting slow the implementation of adjunctive therapy such as radiation therapy or chemotherapy after surgery can cause, it is important to effectively prevent, there has been a development of a variety of skin wound therapeutic agent to reduce them. The purpose of this study was to evaluate the effects of the wound dressing with existing wound dressing Neo dermal activator compared to the patients receiving preoperative chemotherapy.

Methods : A total of 54 breast cancer patients who recieved BCS & mastectomy devided two group(each 27 patients) through the random assignment between Jan, 2016 and June, 2016. Day one weeks after surgery to examine the wound infection rate (surgical site infection, SSI rate). After six months of outpatient surgery visits to check the wounds of patients, using the VAS records the scar of the wound satisfaction. For patients who underwent radiation therapy, check out the time it took to begin radiation therapy after surgery.

All tests were two-sided. All statistical analyses were performed using SPSS version 20.0 (SPSS Inc., Chicago, Illinois, USA).

Eligbility criteria is :

- one side breast cancer

- not inflammatory breast cancer

- recieved BCS and mastectomy only (without immediate reconstruction surgery)

- stage IV breast cancer.

Citation Format: Kim JH, Lim SM, Kim SI, Park SH, Park HS, Kim JY. Study on the usefulness of the skin wound therapeutic agent 'Neo dermal activator' in breast cancer surgery [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr OT2-04-01.

Abstract P6-07-23: The ELK3 expression is positively associated with interferon signaling molecules in triple-negative breast cancer

This abstract was withdrawn by the authors.

Improved Diagnostic Accuracy Using Arterial Phase CT for Lateral Cervical Lymph Node Metastasis from Papillary Thyroid Cancer

BACKGROUND AND PURPOSE

Contrast-enhanced CT protocols for papillary thyroid cancer are yet to be optimized. Our aim was to compare the diagnostic accuracy of arterial phase CT and delayed-phase CT protocols for lateral cervical lymph node metastasis from papillary thyroid carcinoma by using the lymph node tissue attenuation.

MATERIALS AND METHODS

This retrospective study included 327 lateral cervical lymph nodes (177 metastatic and 150 benign) from 131 patients with papillary thyroid carcinoma (107 initially diagnosed and 24 recurrences). Patients underwent CT by using 1 of 3 protocols: a 70-second (A) or a 35-second (B) delay with 100 mL of iodinated IV contrast or a 25-second delay with 75 mL of IV contrast (C). Two readers independently measured and compared lymph node tissue attenuation between metastatic and benign lymph nodes. An area under the receiver operating characteristic curve analysis was performed to differentiate metastatic and benign lymph nodes after multiple comparison correction for clustered data and was compared across the protocols.

RESULTS

The difference in mean lymph node tissue attenuation between metastatic and benign lymph nodes was maximum in protocol C (P < .001 for both readers). Protocol C showed the highest diagnostic performance (area under the receiver operating characteristic curve, 0.88-0.92) compared with protocol A (area under the receiver operating characteristic curve, 0.73-0.74, P < .001 for both readers) and B (area under the receiver operating characteristic curve, .63-0.65, P < .01 for both readers). The sensitivity, specificity, positive predictive value, and negative predictive value of lymph node tissue attenuation by using a 99-HU cutoff value were 83%-87%, 93.7%-97.9%, 95.1%-97.3%, and 81.2%-87%.

CONCLUSIONS

A combination of 25-second delay CT and 75 mL of iodinated IV contrast can improve the diagnostic accuracy for lateral lymph node metastasis from papillary thyroid carcinoma compared with a combination of a 35- or 70-second delay with 100-mL of iodinated IV contrast.

ARIA 2016: Care pathways implementing emerging technologies for predictive medicine in rhinitis and asthma across the life cycle

The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative commenced during a World Health Organization workshop in 1999. The initial goals were (1) to propose a new allergic rhinitis classification, (2) to promote the concept of multi-morbidity in asthma and rhinitis and (3) to develop guidelines with all stakeholders that could be used globally for all countries and populations. ARIA—disseminated and implemented in over 70 countries globally—is now focusing on the implementation of emerging technologies for individualized and predictive medicine. MASK [MACVIA (Contre les Maladies Chroniques pour un Vieillissement Actif)-ARIA Sentinel NetworK] uses mobile technology to develop care pathways for the management of rhinitis and asthma by a multi-disciplinary group and by patients themselves. An app (Android and iOS) is available in 20 countries and 15 languages. It uses a visual analogue scale to assess symptom control and work productivity as well as a clinical decision support system. It is associated with an inter-operable tablet for physicians and other health care professionals. The scaling up strategy uses the recommendations of the European Innovation Partnership on Active and Healthy Ageing. The aim of the novel ARIA approach is to provide an active and healthy life to rhinitis sufferers, whatever their age, sex or socio-economic status, in order to reduce health and social inequalities incurred by the disease.

Exploration of Biomarkers for Amoxicillin/Clavulanate-Induced Liver Injury: Multi-Omics Approaches

To explore potential biomarkers for amoxicillin/clavulanate‐induced liver injury (AC‐DILI), we conducted a clinical trial in 32 healthy subjects based on multi‐omics approaches. Every subject was administered amoxicillin/clavulanate for 14 days. The liver‐specific microRNA‐122 (miR‐122) level increased prior to and correlated well with the observed alanine aminotransferase (ALT) level increase. This result indicates its potential as a sensitive early marker for AC‐DILI. We also identified urinary metabolites, such as azelaic acid and 7‐methylxanthine, with levels that significantly differed among the groups classified by ALT elevation level on day 8 after drug administration (P < 0.05). Lymphocyte proliferation in response to the drug was also observed. These findings demonstrate sequential changes in the process of AC‐DILI, including metabolic changes, increased miR‐122 level, increased liver enzyme activity, and enhanced lymphocyte proliferation after drug administration. In conclusion, this study provides potential biomarkers for AC‐DILI based on currently known mechanisms using comprehensive multi‐omics approaches.

Scaled laboratory experiments explain the kink behaviour of the Crab Nebula jet

The remarkable discovery by the Chandra X-ray observatory that the Crab nebula's jet periodically changes direction provides a challenge to our understanding of astrophysical jet dynamics. It has been suggested that this phenomenon may be the consequence of magnetic fields and magnetohydrodynamic instabilities, but experimental demonstration in a controlled laboratory environment has remained elusive. Here we report experiments that use high-power lasers to create a plasma jet that can be directly compared with the Crab jet through well-defined physical scaling laws. The jet generates its own embedded toroidal magnetic fields; as it moves, plasma instabilities result in multiple deflections of the propagation direction, mimicking the kink behaviour of the Crab jet. The experiment is modelled with three-dimensional numerical simulations that show exactly how the instability develops and results in changes of direction of the jet.

The periodical change of the Crab nebula's jet direction challenges our understanding of astrophysical jet dynamics. Here the authors use high-power lasers to create a jet that can be directly compared to the Crab nebula's, and report the detection of plasma instabilities that mimic kink behaviour.

Atypia of undetermined significance on thyroid fine needle aspiration - risk factors for malignancy

OBJECTIVES

This study is designed to determine the clinical predictors of malignancy in the atypia of undetermined significance (AUS) category resulted from thyroid fine needle aspiration (FNA).

DESIGN

Retrospective cohort study.

SETTING

Dong-A University Medical Center, Busan, Korea.

PARTICIPANTS

Sixty-two patients who underwent thyroid surgery from January 2010 to December 2013, following a diagnosis of AUS from preoperative thyroid FNA.

MAIN OUTCOME MEASURES

We investigated the age, gender, maximum size and site of the nodules, ultrasonographic findings, cytological features, BRAF gene mutation, surgical method, number of AUS on repeated FNA and final pathologic results.

RESULTS

Forty-one of sixty-two patients underwent total thyroidectomy and the rest had lobectomy. The final pathologic results were 41 malignancies and 21 benign diseases. Nodules less than 1.5 cm, ultrasonographic findings suggestive of malignancy were risk factors for malignancy on univariated analysis (P < 0.001). Multivariated analysis showed that nodules less than 1.5 cm, ultrasonographic findings suggestive of malignancy and more than 2 results of atypia from repeated FNAs were significant risk factors for malignancy (P < 0.001). A BRAF gene mutation analysis was performed in 38 patients, and 13 patients had the mutation. All patients with the BRAF gene mutation had been diagnosed with papillary thyroid cancer (P > 0.05).

CONCLUSIONS

We recommend close observation or diagnostic surgery in patients with nodules <1.5 cm and with two or more malignant ultrasound feature and a BRAF mutation, or with two or more AUS findings on repeated FNAs.

Treatment Strategy for Persistent Sciatic Artery and Novel Classification Reflecting Anatomic Status

BACKGROUND

Persistent sciatic artery (PSA) is a relatively rare congenital variant of the lower limb vasculature and can have highly variable clinical presentations. The purpose of this study was to analyze the relationship between PSA anatomy and clinical presentation, and to suggest an optimal management strategy.

METHODS

Between 2001 and 2014, 24 PSAs in 19 patients were diagnosed by computed tomography and referred to the vascular surgery department. Patient demographics, types of PSA and femoral artery, aneurysmal changes, symptoms, and treatment methods were assessed. Additionally, all English literature from 1964 to 2014 was reviewed and compared using the PubMed database (224 PSAs in 171 patients).

RESULTS

PSA was diagnosed in 10 men (52.6%) and nine women (47.4%). PSAs were bilateral in five patients (26.3%) and symptomatic in 12 patients, while in seven patients PSA was found incidentally. According to the Pillet-Gauffre classification, Type 2a was the most common variant (n = 15/24, 62.5%), with unclassifiable types in two limbs. Compared with cases in the literature, the PSA occlusion rate in this study was higher (n = 10/24, 41.7% vs. n = 54/224, 27.5%), but aneurysm incidence was higher in the literature cases (n = 5/24, 20.8% vs. n = 112/224; 50.7%). In this study, 16 limbs (66.6%) were treated conservatively, and six limbs were treated by open surgery, including four bypasses, one amputation, and one thrombo-embolectomy. Endovascular coil embolization was performed in one limb, and a hybrid procedure with stent graft was performed in one limb with PSA aneurysm. Based on the present series and the literature review, a new classification system and treatment option is proposed according to the anatomic status and the presence of aneurysm. According to the new classification, class III was the most common in both the present study (18/24; 75%) and the literature review, and the presence of aneurysm was the most important determinant of surgical treatment.

CONCLUSIONS

The new classification system is simple and provides guidance for management. Limb anatomy of the femoral artery system and the presence of PSA aneurysm should be considered when selecting the optimal treatment. The risk of embolism from the presence of aneurysm is an important factor for treatment, and bypass surgery is mostly required in classes III and IV.

Relationship between underweight, bone mineral density and skeletal muscle index in premenopausal Korean women

AIM

Osteoporosis and sarcopenia are common health problems in postmenopausal women. However, studies of these issues in premenopausal women are limited. Our present study aimed to investigate relationship the between underweight, bone mineral density (BMD) and skeletal muscle index (SMI) in a representative sample of premenopausal Korean women.

METHODS

We used data from the Korea National Health and Nutrition Examination Surveys (2009-2010). Participants included 1767 healthy, ≥ 20-year-old, non-obese premenopausal women. Underweight was defined as BMI< 18.5 kg/m(2) and normal weight was defined as 18.5 ≤ BMI< 23 kg/m(2) . We analysed anthropometric measurements, BMD and SMI with a DXA scanner. Multiple logistic regression analysis was performed to assess the relationship between underweight, BMD and SMI after adjusting for confounding factors.

RESULTS

The prevalence of low BMD and low SMI in underweight women was 23.9% and 18.4%, respectively, compared with 9.4% and 1.7% in normal weight women. Low BMD and/or low SMI were present in 36.7% of underweight women compared with 10.7% of normal weight women. After adjustments, underweight women exhibited a higher odds ratio for low BMD (OR, 3.41; 95% CI, 2.31-5.05), low SMI (OR, 11.61; 95% CI, 6.17-21.88) and combined low BMD and low SMI (OR, 23.82; 95% CI, 8.92-63.58) when compared with normal weight women.

CONCLUSION

Underweight premenopausal women are at a higher risk of low bone mass and low skeletal muscle. Educational efforts that promote a normal weight in premenopausal women should be reinforced.

Trends in type 2 diabetes prevalence according to income levels in Korea (1998-2012)

There was no significant association between diabetes prevalence and income levels for either sex in 1998. However, the high income level in men and the low income level in women positively related to the odds of diabetes in 2011-2012. Preventive strategies for diabetes should consider the gender-specific economic discrepancy.

Spontaneous Polarization and Bulk Photovoltaic Effect Driven by Polar Discontinuity in LaFeO_{3}/SrTiO_{3} Heterojunctions

Structurally coherent and chemically abrupt interfaces formed between polar and nonpolar perovskite oxides provide an ideal platform for examining the purely electronic reconstruction known as the polar catastrophe and the emergence of mobile or bound charges at the interface. The appearance of mobile charges induced by the polar catastrophe is already established in the LaAlO_{3}/SrTiO_{3} heterojunctions. Although not experimentally verified, the polar catastrophe can also lead to the emergence of spontaneous polarization. We report that thin films of originally nonpolar LaFeO_{3} grown on SrTiO_{3} are converted to polar as a consequence of the polar catastrophe. The induced spontaneous polarization evokes photovoltaic properties distinct from conventional p-n junctions, such as a switching of the photocurrent direction by changing the interfacial atomic sequence. The control of the bulk polarization by engineering the interface demonstrated here will expand the possibilities for designing and realizing new polar materials with photovoltaic functions.

Abstract P1-15-04: Irriversible chemotherapy-induced alopecia in breast cancer patient

Introduction

Patients with breast cancer who received chemotherapy have distressing side effects such as mucositis, alopecia, gastritis, and BM suppression. Chemotherapy-induced alopecia(CIA) is one of considerable psychological events in self-esteem in patients with breast cancer, but the possibility of irreversible alopecia is often overlooked by physician.

We investigated clinical characteristics of CIA and prevalence of irreversible severe hair loss in patient with breast cancer who received chemotherapy.

Methods

We conducted a survey to collect demographic information about CIA with 150 breast cancer patients who had passed at least 6 months since their last day of chemotherapy from February 2015 to May 2015 in Yonsei Cancer Center. We obtained clinical information as age, elapsed time from end of chemotherapy, chemotherapy regimen, and other adjuvant therapy using their electrical medical records. We compared irreversible CIA characters between anthracycline and cyclophosphamide (AC) and taxane based regimen groups. The severe alopecia was defined as the hair density loss over 50% compared to the hair density before chemotherapy.

Results

The mean age at chemotherapy was 48 years old (±17.3) and the mean elapsed time after chemotherapy was 37 months (±9.5) in total patients.

Remnant alopecia was reported in 71 patients (47.3%). Wig or hat were used in 39 patients (26.0%).

The mean satisfaction score with a five-point scale was 4 in patients without alopecia or hair character change and 2.2 in patients with irreversible alopecia (p&lt;0.001). The severe irreversible hair loss was complained by the 12 (8.2%) patients.

AC and taxane based chemotherapy were carried out in 65 and 85 patients, respectively. In AC group, remnant alopecia was shown in 18 patients (27.7%), and more than a half of patients in taxane group, 53 patients (62.4%), showed remnant alopecia (p&lt;0.001). While only five patients (7.8%) in AC group suffered for severe hair loss, 26 patients (31.3%) in taxane group were affected by severe hair loss (p=0.001). The mean satisfaction level of hair status in patients in taxane group was 2.5 as compared to 3.6 in those in AC group (p&lt;0.001).

Conclusion

Contrary to general expectation, About a half of breast cancer patients who received chemotherapy complained of irreversible hair loss even though at least 6 months has elapsed since the end of chemotherpy. In particular, patients with taxane based chemotherapy had more irreversible and severe alopecia than those with AC chemotherapy.

Citation Format: Kim S, Park HS, Kim JY, Nam S, Kim GM, Sohn JH, Kim SI. Irriversible chemotherapy-induced alopecia in breast cancer patient. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-15-04.

Structure and Stability of the Dimeric Triosephosphate Isomerase from the Thermophilic Archaeon Thermoplasma acidophilum

Thermoplasma acidophilum is a thermophilic archaeon that uses both non-phosphorylative Entner-Doudoroff (ED) pathway and Embden-Meyerhof-Parnas (EMP) pathway for glucose degradation. While triosephosphate isomerase (TPI), a well-known glycolytic enzyme, is not involved in the ED pathway in T. acidophilum, it has been considered to play an important role in the EMP pathway. Here, we report crystal structures of apo- and glycerol-3-phosphate-bound TPI from T. acidophilum (TaTPI). TaTPI adopts the canonical TIM-barrel fold with eight α-helices and parallel eight β-strands. Although TaTPI shares ~30% sequence identity to other TPIs from thermophilic species that adopt tetrameric conformation for enzymatic activity in their harsh physiological environments, TaTPI exists as a dimer in solution. We confirmed the dimeric conformation of TaTPI by analytical ultracentrifugation and size-exclusion chromatography. Helix 5 as well as helix 4 of thermostable tetrameric TPIs have been known to play crucial roles in oligomerization, forming a hydrophobic interface. However, TaTPI contains unique charged-amino acid residues in the helix 5 and adopts dimer conformation. TaTPI exhibits the apparent T_d value of 74.6°C and maintains its overall structure with some changes in the secondary structure contents at extremely acidic conditions (pH 1–2). Based on our structural and biophysical analyses of TaTPI, more compact structure of the protomer with reduced length of loops and certain patches on the surface could account for the robust nature of Thermoplasma acidophilum TPI.