Association of Mechanical Energy and Power with Postoperative Pulmonary Complications in Lung Resection Surgery: A Post Hoc Analysis of Randomized Clinical Trial Data

BACKGROUND

Mechanical power (MP), the rate of mechanical energy (ME) delivery, is a recently introduced unifying ventilator parameter consisting of tidal volume, airway pressures, and respiratory rates, which predicts pulmonary complications in several clinical contexts. However, ME has not been previously studied in the perioperative context, and neither parameter has been studied in the context of thoracic surgery utilizing one-lung ventilation.

METHODS

The relationships between ME variables and postoperative pulmonary complications were evaluated in this post hoc analysis of data from a multicenter randomized clinical trial of lung resection surgery conducted between 2020 and 2021 (n = 1,170). Time-weighted average MP and ME (the area under the MP time curve) were obtained for individual patients. The primary analysis was the association of time-weighted average MP and ME with pulmonary complications within 7 postoperative days. Multivariable logistic regression was performed to examine the relationships between energy variables and the primary outcome.

RESULTS

In 1,055 patients analyzed, pulmonary complications occurred in 41% (431 of 1,055). The median (interquartile ranges) ME and time-weighted average MP in patients who developed postoperative pulmonary complications versus those who did not were 1,146 (811 to 1,530) J versus 924 (730 to 1,240) J (P < 0.001), and 6.9 (5.5 to 8.7) J/min versus 6.7 (5.2 to 8.5) J/min (P = 0.091), respectively. ME was independently associated with postoperative pulmonary complications (ORadjusted, 1.44 [95% CI, 1.16 to 1.80]; P = 0.001). However, the association between time-weighted average MP and postoperative pulmonary complications was time-dependent, and time-weighted average MP was significantly associated with postoperative pulmonary complications in cases utilizing longer periods of mechanical ventilation (210 min or greater; ORadjusted, 1.46 [95% CI, 1.11 to 1.93]; P = 0.007). Normalization of ME and time-weighted average MP either to predicted body weight or to respiratory system compliance did not alter these associations.

CONCLUSIONS

ME and, in cases requiring longer periods of mechanical ventilation, MP were independently associated with postoperative pulmonary complications in thoracic surgery.

EDITOR’S PERSPECTIVE

Comparison of Load-Sharing Responses Between Graded Posterior Cervical Foraminotomy and Conventional Fusion Using Finite Element Modeling

Following the diagnosis of unilateral cervical radiculopathy and need for surgical intervention, anterior cervical diskectomy and fusion (conventional fusion) and posterior cervical foraminotomy are common options. Although patient outcomes may be similar between the two procedures, their biomechanical effects have not been fully compared using a head-to-head approach, particularly, in relation to the amount of facet resection and internal load-sharing between spinal segments and components. The objective of this investigation was to compare load-sharing between conventional fusion and graded foraminotomy facet resections under physiological loading. A validated finite element model of the cervical spinal column was used in the study. The intact spine was modified to simulate the two procedures at the C5-C6 spinal segment. Flexion, extension, and lateral bending loads were applied to the intact, graded foraminotomy, and conventional fusion spines. Load-sharing was determined using range of motion data at the C5-C6 and immediate adjacent segments, facet loads at the three segments, and disk pressures at the adjacent segments. Results were normalized with respect to the intact spine to compare surgical options. Conventional fusion leads to increased motion, pressure, and facet loads at adjacent segments. Foraminotomy leads to increased motion and anterior loading at the index level, and motions decrease at adjacent levels. In extension, the left facet load decreases after foraminotomy. Recognizing that foraminotomy is a motion preserving alternative to conventional fusion, this study highlights various intrinsic biomechanical factors and potential instability issues with more than one-half facet resection.

Facial Dermatoses Associated With Mask-Wearing in the COVID-19 Era: A Nationwide, Cross-Sectional, Multicenter, Questionnaire-based Study

BACKGROUND

Daily usage of facial masks during coronavirus disease 2019 pandemic influenced on facial dermatoses.

OBJECTIVE

This study investigated the impact of mask-wearing habits on facial dermatoses.

METHODS

A nationwide, observational, questionnaire-based survey was conducted from July through August 2021, involving 20 hospitals in Korea.

RESULTS

Among 1,958 facial dermatoses, 75.9% of patients experienced aggravation or development of new-onset facial dermatoses after wearing masks. In aggravated or newly developed acne patients (543 out of 743), associated factors were healthcare provider, female gender, and a long duration of mask-wearing. Irritating symptoms, xerosis, and hyperpigmentation were more frequently observed in this group. Aggravated or newly developed rosacea patients (515 out of 660) were likely to be female, young, and have a long duration of mask-wearing per day. Seborrheic dermatitis patients who experienced aggravation or de novo development (132 out of 184) were younger, and they more frequently involved the chin and jaw in addition to the nasolabial folds and both cheeks. Contact dermatitis patients (132 out of 147) with aggravation or de novo development tended to be female, involve both cheeks, and complain of pruritus. Aggravated or newly developed atopic dermatitis patients (165 out of 224) were more likely to be female, and had a higher baseline investigator global assessment score before mask-wearing.

CONCLUSION

Clinical features and factors related to aggravation were different according to the types of facial dermatoses.

A Comprehensive Review of the Acne Grading Scale in 2023

Acne is a common skin inflammatory condition that can significantly affect the patient's quality of life. Therefore, accurate assessment scales are very important for treatment and management of acne vulgaris. This review article issues a comprehensive review of various acne severity assessment scales. In this text, the authors review the acne grading scales, such as the Pillsbury scale, Cook's acne grading scale, Leeds acne grading system, Global Acne Grading System, and investigator's global assessment, etc. And we delve into the characteristics, advantages, limitations, and applicability of these scales. The acne grading scale to be developed in the future should be objective, accurate, comprehensive, easy to use, and applicable in a variety of clinics and research settings. Current technologies, such as artificial intelligence, could potentially contribute to the development of ideal acne grading scales that meet unmet needs.

Specificity of tilt illusion reduction through perceptual learning

Human perceptual ability can be improved by perceptual learning through repeated exposure or training. Perceptual learning studies have focused on achieving accurate perception of stimuli by improving perceptual sensitivity. However, eliminating illusions can also be one of the ways of accurate perception. To determine whether the illusion can be attenuated by perceptual learning, the current study used a tilt illusion where the orientation of the grating presented in the center (central grating) was misperceived because of the orientation of the grating presented in the periphery (surrounding grating). In Experiment 1, participants were trained either in the illusion training condition, in which they trained with illusory stimuli presenting both surrounding and central gratings together, or in the control training condition, where only the central grating was presented. The results confirmed that the tilt illusion was reduced only in the illusion training condition. Experiment 2 tested the transfer effect of learning, which is not often observed in perceptual learning. During training, the orientation of the surrounding grating was fixed to see whether the elimination of the illusion also occurred in the surrounding grating with an orientation that was not used during training. A decrease in the illusion was found only in the case of a surrounding grating with trained orientations, and not in the case of surrounding gratings with untrained orientations. These results suggest that the reduction in tilt illusion through training is due to perceptual learning.

Evaluation of soil pesticide leaching to groundwater using undisturbed lysimeter: development of the pesticide groundwater leaching scoring system (PLS)

Groundwater pesticide safety management is essential for providing consistently safe water for humans, but such management is limited globally. In this study, we developed an accurate and convenient exposure assessment method for the safety management of pesticides in groundwater by conducting a lysimeter experiment to evaluate the leaching of 11 pesticides into groundwater. During the experimental period, flutoalanil and oxadiazon had the highest cumulative leaching amounts, 603.7 and 83.5 ng, respectively. Comparative analysis of existing groundwater exposure prediction indices, including the GUS, LEACH, modified LEACH, Hornsby index, and GLI showed no correlations with the measured data (p > 0.05). To enhance the accuracy of the assessment method, we used lysimeter data and principal component analysis to determine the main factors affecting groundwater leaching, and developed the "pesticide groundwater leaching scoring system" (PLS). The soil and water half-life, which had the greatest positive impact on groundwater leaching, was set as a 10-point indicator, whereas log P was set as a 1-point indicator. In contrast, solubility in water was determined as a 5-point indicator, and organic carbon partition coefficient and vapor pressure were determined as 2.5-point indicators owing to their negative relationship. The correlation coefficient was 0.670, indicating a significant correlation with the lysimeter data (p < 0.05). Using our scoring system, we ranked 376 pesticides. As an exposure assessment method developed using actual data, the PLS is expected to be applicable to groundwater safety management.

Consensus Report on Truncal Acne: The Korean Acne and Rosacea Society Experts Panel

BACKGROUND

More than half of acne patients have truncal acne on their chest, back, and shoulders. However, since most studies on acne have focused on the face, data on clinical characteristics and proper management for truncal acne are insufficient.

OBJECTIVE

To establish a Korean Acne Rosacea Society (KARS) consensus for experts' perception and treatment patterns of truncal acne.

METHODS

We conducted two rounds of the Dephi technique to gather expert opinion and reach a consensus on truncal acne. The first round comprised 48 questionnaires focusing on various aspects such as epidemiology, clinical features, diagnosis, treatment, prognosis and more, while second rounds consisted of 26 questionnaires.

RESULTS

A total of 36 dermatologists (36/38 KARS members, 94.7%) completed this survey. In the first-round survey, consensus was reached on 20 out of the 48 questions (41.7%). In the second-round questionnaire, consensus was achieved on 9 of the 26 questions (34.6%). The most unresponsive lesion to truncal acne treatment was scars (atrophic/hypertrophic). The most commonly used treatments for each non-inflammatory and inflammatory truncal acne lesions were selected to use topical retinoids (78.1% of the responders) and oral antibiotics (93.8% of the responders).

CONCLUSION

Our study has yielded valuable insights into the epidemiology, clinical manifestations, diagnosis, treatment, and quality of life of patients with truncal acne. We anticipate that this study will inspire further comprehensive research for individuals with truncal acne.

Low household income increases the risk of tuberculosis recurrence: a retrospective nationwide cohort study in South Korea

OBJECTIVES

We assessed the impact of household income on tuberculosis (TB) recurrence and the long-term impact of TB on household income.

STUDY DESIGN

This was a retrospective nationwide cohort study of patients with drug-susceptible TB (DS-TB) and TB recurrence.

METHODS

Using the South Korean national TB cohort database, we identified a sub-set cohort of patients with newly diagnosed drug-susceptible TB between 2013 and 2016 and tracked their TB recurrence and longitudinal income data from 2007 to 2018. Income levels were evaluated as 'Medical aid' and quintile categories. To assess risk factors associated with TB recurrence, we used a sub-distribution hazard model, adjusting for the competing risks of death.

RESULTS

Of 66,690 patients successfully treated with DS-TB, 2095 (3.1 %) experienced recurrence during a median follow-up of 39 months. The incidence of TB recurrence was 982.1/100,000 person-years, with 50.3 % of the recurrences occurring within 1 year of treatment completion. The risk of TB recurrence increased with decreasing income levels, with the highest risk observed in the lowest income group. The effect of income on TB recurrence was prominent in males but not in females. Overall, patients with TB recurrence experienced a linear decline in income levels, compared with those without recurrence.

CONCLUSIONS

Household income during the initial TB episode was an important risk factor for TB recurrence, particularly in males.

Is There a Difference in the Incidence of Depression between Radiation and Surgical Treatments in Patients with Prostate Cancer?

PURPOSE

Patients with cancer have a high risk of depression. However, a few studies have assessed differences in the incidence of depression among patients with prostate cancer (PC) based on whether they received radiotherapy (RTx) or surgical treatment.

MATERIALS AND METHODS

We analyzed data from the National Health Insurance Sharing Service database regarding the entire Korean adult population with PC (n=210,924) between 2007 and 2017. The adjusted hazard ratios (HRs) of depression associated with treatment were estimated using propensity score-matched Cox proportional hazards models and Kaplan-Meier survival analyses.

RESULTS

Our final cohort comprised 9,456 patients with PC; of which, 8,050 men underwent surgery. During a mean follow-up duration of 7.1 years, 503 (5.3%) patients were newly diagnosed with depression. A significant difference in the incidence of depression was noted between the RTx and surgery groups (RTx vs. surgery: 5.55% vs. 5.28%; p=0.011) in the unmatched cohort. In the matched cohort, older age (≥70 years, HR: 1.596, p<0.001) and poor Charlson comorbidity index scores (HR: 1.232, p=0.039) were correlated with the risk of depression. In addition, the adjusted HR for depression in the surgery group was 0.843 (p=0.221) compared with that in the RTx group. Kaplan-Meier analyses revealed that no significant difference in the cumulative probability of persistent depression was detected between the RTx and surgery groups in matched cohort (p=0.3386).

CONCLUSIONS

In this nationwide population-based study, no significant differences in the risk of depression were observed between the surgical and RTx groups.

Prophylactic effect of pilocarpine on acute sialadenitis following radioactive iodine therapy in thyroid cancer patients

Purpose: Our aim was to evaluate the effect of prophylactic pilocarpine on acute salivary symptoms after radioactive iodine (RAI) therapy in patients with differentiated thyroid cancer. Methods: We enrolled 88 patients (76 women and 12 men; mean age: 47 years; range: 20-74 years) with differentiated thyroid cancer who received RAI. Patients were divided into pilocarpine (51 patients) and control (37 patients) groups. Pilocarpine was given orally, at a dose of 5 mg three times a day, from 2 days before and 12 days after RAI therapy. Symptoms and signs of acute sialadenitis within 3 months of RAI therapy were recorded. Results: During the 3 months after RAI therapy, 13 of the 88 patients (14.7%) developed acute symptomatic sialadenitis (swelling or pain of salivary glands). Acute salivary symptoms were reported by 4 (7.8%) and 9 (24.3%) patients in the pilocarpine and control groups, respectively. Acute salivary symptoms were less frequent in the pilocarpine than control group (p = 0.04), but did not differ by age, sex, or RAI dose (p = 0.3357, p = 0.428, and p = 0.2792). Conclusions: Pilocarpine reduced the likelihood of acute sialadenitis after RAI therapy in patients with differentiated thyroid cancer.

Surgical experiences in pediatric pilomatricoma: punch incision and elliptical excision

BACKGROUND

As pilomatricoma is a common adnexal skin tumor often occurring in exposed areas, dermatologists focus on minimizing postsurgical scarring.

METHODS

This retrospective study included patients aged < 19 years who underwent surgical treatment for pilomatricoma at a single university hospital from 2015 to 2021. Patient demographics, tumor characteristics, and surgical outcomes were analyzed according to the surgical methods including punch incision and elliptical excision.

RESULTS

Overall, 75 patients and 79 lesions were included in the study. The mean age of the patients was 8.4 years, and 48 patients (64.0%) were females. The face was the most common site of pilomatricoma (51.9%), and within the face, the cheeks were the most common sites. No recurrence was observed in the elliptical excision group, while one case of recurrence (4.5%) was observed in the punch incision group. The mean length of the wound was 2.00 cm in the elliptical excision group, which was longer than that in the punch incision group (0.49 cm; p < .001).

CONCLUSIONS

Considering that surgery is the gold standard treatment for pilomatricoma, punch incision may be useful as an alternative surgical option for pilomatricoma in children.

Pigmented contact dermatitis and hair dyes: A retrospective case-control multicentre study in Korea

BACKGROUND

Pigmented contact dermatitis (PCD), a rare variant of non-eczematous contact dermatitis, is clinically characterized by sudden-onset brown or grey pigmentation on the face and neck. It is hypothesized to be caused by repeated contact with low levels of allergens.

OBJECTIVES

This study evaluated the risk of using hair dyes in patients with PCD in Korea.

METHODS

A total of 1033 PCD patients and 1366 controls from 31 university hospitals were retrospectively recruited. We collected and analysed the data from the patient group, diagnosed through typical clinical findings of PCD and the control group, which comprised age/sex-matched patients who visited the participating hospitals with pre-existing skin diseases other than current allergic disease or PCD.

RESULTS

Melasma and photosensitivity were significantly more common in the control group, and a history of contact dermatitis was more common in the PCD group. There were significantly more Fitzpatrick skin type V participants in the PCD group than in the control group. There was no significant difference in sunscreen use between the groups. Using dermatologic medical history, Fitzpatrick skin type and sunscreen use as covariates, we showed that hair dye use carried a higher PCD risk (odds ratio [OR] before adjustment: 2.06, confidence interval [CI]: 1.60-2.65; OR after adjustment: 2.74, CI: 1.88-4.00). Moreover, henna users had a higher risk of PCD (OR before adjustment: 5.51, CI: 4.07-7.47; OR after adjustment: 7.02, CI: 4.59-10.74), indicating a significant increase in the risk of PCD with henna dye use. Contact dermatitis history was more prevalent in henna users than in those using other hair dyes in the PCD group (17.23% vs. 11.55%).

CONCLUSION

Hair dye use is a risk factor for PCD. The risk significantly increased when henna hair dye was used by those with a history of contact dermatitis.

Pyoderma gangrenosum developed from aggravated pemphigus foliaceous after dog bite

Dear Editor, Pyoderma gangrenosum(PG) is a rare neutrophilic dermatosis that causes the development of painful ulcers on the skin, initially starting with nodules or abscesses, and quickly progressing at the peripheral regions into ulcers.1 The exact cause is not yet known, and 20-30% of patients are said to experience a pathergy phenomenon in which lesions occur in the sites of previous trauma.2 In addition, pyoderma gangrenosum is accompanied by systemic diseases, such as Crohn's disease or inflammatory colitis, rheumatoid arthritis, and hyperthyroidism.3 Although numerous reports indicate that pyoderma gangrenosum is associated with systemic diseases,4 case reports on the association of pyoderma gangrenosum with skin diseases, especially blistering disorders, are very rare. [...]

Disruption of redox balance in glutaminolytic triple negative breast cancer by inhibition of glutamate export and glutaminase

In triple-negative breast cancer (TNBC) that relies on catabolism of amino acid glutamine, glutaminase (GLS) converts glutamine to glutamate, which facilitates glutathione synthesis by mediating the enrichment of intracellular cystine via xCT antiporter activity. To overcome chemo resistant TNBC, we have tested a strategy of disrupting cellular redox balance by inhibition of GLS and xCT by CB839 and Erastin, respectively. Key findings of our study include: 1. Dual metabolic inhibition (CB839+Erastin) led to significant increases of cellular superoxide level in both parent and chemo resistant TNBC cells, but superoxide level was distinctly lower in resistant cells. 2. Dual metabolic inhibition combined with doxorubicin or cisplatin induced significant apoptosis in TNBC cells and is associated with high degrees of GSH depletion. In vivo , dual metabolic inhibition plus cisplatin led to significant growth delay of chemo resistant human TNBC xenografts. 3. Ferroptosis is induced by doxorubicin (DOX) but not by cisplatin or paclitaxel. Addition of dual metabolic inhibition to DOX chemotherapy significantly enhanced ferroptotic cell death. 4. Significant changes in cellular metabolites concentration preceded transcriptome changes revealed by single cell RNA sequencing, underscoring the potential of capturing early changes in metabolites as pharmacodynamic markers of metabolic inhibitors. Here we demonstrated that 4-(3-[ 18 F]fluoropropyl)-L-glutamic acid ([ 18 F]FSPG) PET detected xCT blockade by Erastin or its analog in mice bearing human TNBC xenografts. In summary, our study provides compelling evidence for the therapeutic benefit and feasibility of non-invasive monitoring of dual metabolic blockade as a translational strategy to sensitize chemo resistant TNBC to cytotoxic chemotherapy.

Subaxial Cervical Spine Motion With Different Sizes of Head-supported Mass Under Accelerative Forces

INTRODUCTION

The evolution of military helmet devices has increased the amount of head-supported mass (HSM) worn by warfighters. HSM has important implications for spine biomechanics, and yet, there is a paucity of studies that investigated the effects of differing HSM and accelerative profiles on spine biomechanics. The aim of this study is to investigate the segmental motions in the subaxial cervical spine with different sizes of HSM under Gx accelerative loading.

METHODS

A three-dimensional finite element model of the male head-neck spinal column was used. Three different size military helmets were modeled and incorporated into head-neck model. The models were exercised under Gx accelerative loading by inputting low and high pulses to the cervical vertebra used in the experimental studies. Segmental motions were obtained and normalized with respect to the non-HSM case to quantify the effect of HSM.

RESULTS

Segmental motions increased with an increase in velocity at all segments of the spine. Increasing helmet size resulted in larger motion increases. Angulations ranged from 0.9° to 9.3° at 1.8 m/s and from 1.3° to 10.3° at 2.6 m/s without a helmet. Helmet increased motion between 5% to 74% at 1.8 m/s. At 2.6 m/s, the helmet increased segmental motion anywhere from 10% to 105% in the subaxial cervical spine. The greatest motion was seen at the C5-C6 level, followed by the C6-C7 level.

CONCLUSIONS

The subaxial cervical spine experiences motion increases at all levels at both velocity profiles with increasing HSM. Larger helmet and greater impact velocity increased motion at all levels, with C5-C6 demonstrating the largest range of motion. HSM should be minimized to reduce the risk of cervical spine injury to the warfighter.

Whole Regional Lymph Node Area Delineation with Deep Learning Model for Total Marrow and Lymphoid Irradiation

PURPOSE/OBJECTIVE(S)

Total body irradiation (TBI) has been performed for conditioning before hematopoietic stem cell transplantation. However, TBI can be related to diverse adverse events including radiation pneumonitis and cataract. Efforts to reduce these events include the total marrow irradiation (TMI) and total marrow and lymphoid irradiation (TMLI). Compared to TMI, TMLI requires more target delineations with lymph nodes which can be labor-intensive and time-consuming. However, with the TMI plans, the coverage to lymph node might be lower than TMLI and its clinical significance is unknown. In the current study, we aimed to develop a deep learning model for automatic delineation of whole regional lymph nodes area and assess the dose coverage of lymph nodes with TMI plans.

MATERIALS/METHODS

Whole regional lymph nodes (cervical, axillary, mediastinal, para-aortic, common iliac, external iliac, internal iliac, obturator, presacral, inguinal lymph nodes) were manually contoured by 3 radiation oncologists in 26 patients having whole body computed tomography (CT) images. Twenty patients were designated as the training/validation set and 6 patients as the testing set, and model was developed using the 'nnUNET' framework. The trained model was evaluated with dice coefficient score (DCS), precision, and recall. In addition, dose coverage of the automatically or manually delineated lymph nodes in TMI plans was calculated.

RESULTS

The mean value of DCS, precision, and recall of the trained model was 0.76, 0.81, and 0.74, respectively. Dose parameters for manually delineated lymph nodes in previously treated TMI plans showed the mean value of V100% (the percentage of volume receiving 100% of the prescribed dose), V95%, and V90% to be 46.50%, 62.12%, and 73.68%, respectively. The highest V90% was observed in presacral (93.61%), axillary (90.40%), obturator (88.78%), and internal iliac lymph nodes (84.67%). In contrast, the lowest V90% was identified in inguinal (47.95%), cervical (61.69%), and para-aortic (65.75%) and external iliac lymph nodes (68.97%). For automatically delineated lymph nodes, the mean value of V100%, V95%, and V90% of TMI plan was 38.35%, 55.06%, and 67.84%, respectively. The difference with dose coverage of lymph node between delineated manually and automatically was not statistically significant.

CONCLUSION

Automatic delineation of lymph node using deep learning showed the potential to reduce the labor-intensive process of TMLI. When treated with TMI, the coverage of inguinal, cervical, para-aortic and external iliac lymph nodes was lower than expected.

Mapping the Anatomical Distribution of MRI-Identified Locoregional Recurrence following Robotic-Assisted Laparoscopic Prostatectomy for Prostate Adenocarcinoma

PURPOSE/OBJECTIVE(S)

The pattern of locoregional recurrence specifically after robotic-assisted laparoscopic prostatectomy (RALP) for prostate adenocarcinoma is still unknown. In this study, we reviewed pelvic magnetic resonance images (MRI) after postoperative biochemical recurrence (BCR) and drew a map of locoregional recurrence to support evidence of determining the optimal target volume of salvage radiotherapy in a post-RALP BCR scenario.

MATERIALS/METHODS

We have retrospectively searched 7,583 prostate adenocarcinoma patients who have received RALP in our institution between January 2010 and December 2021, and found a pool of highly selected patients with gross tumor recurrence confirmed by post-BCR pelvic MRIs and did not have other histories of malignancy. BCR was defined as the serum PSA more or equal to 0.2 ng/mL, or three consecutive increases. Patients with serum PSA nadir more or equal to 0.2 ng/mL on the 90th postoperative day (POD 90) were excluded to guarantee successful tumor removal. We have reviewed serum PSA levels using R codes, MRI and pathological reports using Excel, and descriptive statistics using SPSS 25. The gross lesions were contoured on the correlating MRIs using MIM Maestro 7.1. The RT structure DICOM files were merged into a map using MATLAB 2022b. In addition, we have conducted Fisher exacted test, Mann-Whitney U test, and logistic regression to identify risk factors for regional recurrence.

RESULTS

A total of 173 patients were identified with locoregional recurrence from post-BCR pelvic MRIs, and 139 (80.3%) patients were in the high-risk group or very-high-risk group according to the NCCN guidelines: 57 (32.9%) patients with histological grade group 5, 50 (28.9%) patients with initial PSA over 20 ng/mL, 114 (65.9%) patients with extracapsular extension, 55 (31.8%) patients with seminal vesicle invasion, and 15 (9%) patients with pN1. The median follow-up was 4.7 (IQR 2.8-6.9) years for pelvic MRIs and 5.8 (IQR 4.0-8.6) years for serum PSA. The BCF survival was median of 10.7 (IQR 4.6-19.1) months, and the locoregional recurrence-free survival was median of 24.6 (IQR 9.7-49.4) months for this subgroup of patients. At first locoregional recurrence, 148 (85.5%) patients were local only, 20 (11.6%) patients were regional only, and 5 (2.9%) patients were both local and regional. Out of the 25 patients with regional recurrence, the incidence of gross tumor recurrence differed by nodal sites: 3 (12%) in perirectal space, 5 (20%) in internal iliac, 7 (28%) in obturator, 13 (52%) in external iliac, and 6 (24%) in common iliac lymph nodes.

CONCLUSION

We have found 173 patients and were able to map reliable gross tumor recurrence sites after RALP and confirmed by pelvic MRIs following BCR. The map supports evidence of using the existing consensus pelvic clinical target volume of salvage radiotherapy, in a post-RALP BCR scenario.

Analysis of Factors Affecting Postoperative Opioid Requirement in Pediatric Patients Undergoing Pectus Excavatum Repair with Multimodal Analgesic Management

Children with pectus excavatum are treated with surgical repair in a procedure known as minimally invasive repair of pectus excavatum (MIRPE). MIRPE causes considerable postoperative pain, resulting in the administration of a substantial dose of opioids. This study aimed to identify perioperative factors that influence the requirement for opioids in children undergoing MIRPE. Retrospective data from children who underwent MIRPE were analyzed. A multimodal analgesic protocol was implemented with a continuous wound infiltration system and administration of non-opioid analgesics. Intravenous opioid analgesics were administered if the pain score was greater than 4. The cumulative opioid use was assessed by calculating the morphine equivalent dose at 6, 24, and 48 h after surgery. Perioperative factors affecting the postoperative opioid use were identified with multiple linear regression analyses. This study included 527 children aged 3-6 years, with a mean age of 3.9 years. Symmetrically depressed chest walls, a lower Haller index, and a lower revised depression index were found to be associated with decreased postoperative opioids. Boys required higher opioid doses than girls. Longer pectus bars (10 inches versus 9 inches) were associated with increased opioid use. Severity indices, gender, and the length of pectus bars influence postoperative opioid requirement in children undergoing MIRPE surgery with multimodal analgesia.

Simultaneous analytical method for 296 pesticide multiresidues in root and rhizome based herbal medicines with GC-MS/MS

A method for the simultaneous analysis of pesticide multiresidues in three root/rhizome-based herbal medicines (Cnidium officinale, Rehmannia glutinosa, and Paeonia lactiflora) was developed with GC-MS/MS. To determine the concentrations of pesticide residues, 5 g of dried samples were saturated with distilled water, extracted with 10 mL of 0.1% formic acid in acetonitrile/ethyl acetate (7:3, v/v), and then partitioned using magnesium sulfate and sodium chloride. The organic layer was purified with Oasis PRiME HLB plus light, followed by a cleanup with dispersive solid-phase extraction containing alumina. The sample was then injected into GC-MS/MS (2 μL) using a pulsed injection mode at 15 psi and analyzed using multiple reaction monitoring (MRM) modes. The limit of quantitation for the 296 target pesticides was within 0.002-0.05 mg/kg. Among them, 77.7-88.5% showed recoveries between 70% and 120% with relative standard deviations (RSDs) ≤20% at fortified levels of 0.01, and 0.05 mg/kg. The analytical method was successfully applied to real herbal samples obtained from commercial markets, and 10 pesticides were quantitatively determined from these samples.

Uptake of Fungicide Fluopyram from Soil by Scallions during Greenhouse Cultivation

Unintentional pesticide contamination in rotational crops, often caused by soil contamination from pesticide use in the preceding crops, is a major concern in a positive list system. The residue and dissipation pattern of fluopyram in soil and scallions were investigated to evaluate the uptake of fluopyram from the soil by scallions. In addition, the management concentration in soil (MC_soil) was calculated based on bioconcentration factors (BCFs) and the maximum residue limit (0.2 mg/kg) in leaf-and-stem vegetables. In a field experiment, plots in two different trials, A and B, were treated with 0.06 g fluopyram/m² and maintained for 30 days according to OECD guidelines. Scallion seedlings were cultivated for 48 days. Soil samples were taken at three different time points: DAP (Days after planting) 0, 34, and 48. Scallion samples were collected at five different time points: DAP 20, 27, 34, 41, and 48. The initial amounts of fluopyram in soil at DAP 0 were 0.94 ± 0.03 and 0.96 ± 0.04 mg/kg in trials A and B, respectively. The half-life of fluopyram in the soil was 87-231 days. Fluopyram uptake by the roots increased over time, but fluopyram residue in the scallions decreased due to the dilution effect caused by an increase in plant weight. The residues in the scallions at DAP 48 were 0.22 ± 0.01 and 0.15 ± 0.01 mg/kg in trials A and B, respectively. The BCFs of scallions for fluopyram were 0.21-0.24 (trial A) and 0.14-0.18 (trial B). The MC_soil was proposed as 0.8 mg/kg, and may be utilized as a safe management guideline for precautionary practices to cultivate safe rotational crops.

Effectiveness of fosfomycin-based antimicrobial prophylaxis for transrectal ultrasound-guided prostate biopsy: A Korean multicenter study

PURPOSE

Recent studies have highlighted increasing infectious complications due to fluoroquinolone (FQ)-resistant organisms in men undergoing transrectal ultrasound-guided prostate biopsy (TRUSPB). This study investigated whether fosfomycin (FM)-based antibiotic prophylaxis reduces infections after TRUSPB and identified risk factors for infective complications.

MATERIALS AND METHODS

A multicenter study was conducted in the Republic of Korea from January 2018 to December 2021. Patients undergoing prostate biopsy with FQ or FM-based prophylaxis were included. The primary outcome was the post-biopsy infectious complication rate after FQ (group 1) or FM-based antibiotic prophylaxis with FM alone (group 2) or FQ and FM (group 3). Risk factors for infectious complications after TRUSPB were secondary outcomes.

RESULTS

Patients (n=2,595) undergoing prostate biopsy were divided into three groups according to the type of prophylactic antibiotics. Group 1 (n=417) received FQ before TRUSPB. Group 2 (n=795) received FM only and group 3 (n=1,383) received FM and FQ before TRUSPB. The overall post-biopsy infectious complication rate was 1.27%. The infectious complication rates were 2.4%, 1.9%, and 0.5% in groups 1, 2, and 3, respectively (p=0.002). In multivariable analysis, predictors of post-biopsy infectious complications included an association with health care utilization (adjusted odds ratio [OR], 4.66; 95% confidence interval [CI], 1.74-12.4; p=0.002) and combination antibiotic prophylaxis (FQ and FM) (adjusted OR, 0.26; 95% CI, 0.09-0.69; p=0.007).

CONCLUSIONS

In comparison with monotherapy with FM or FQ, combination antibiotic prophylaxis (FQ and FM) showed a lower rate of infectious complications after TRUSPB. Utilization of health care was an independent risk factor for infectious complications after TRUSPB.

LC-MS/MS Method Minimizing Matrix Effect for the Analysis of Bifenthrin and Butachlor in Chinese Chives and Its Application for Residual Study

The matrix effect refers to the change in the analytical signal caused by the matrix in which the sample is contained, as well as the impurities that are co-eluted with the target analyte. In crop sample analysis using LC-MS/MS, the matrix effect can affect the quantification results. Chinese chives are likely to exhibit a strong matrix effect when co-extracted with bifenthrin and butachlor due to the presence of phytochemicals and chlorophyll. A novel analytical method was developed to reduce the matrix effects of bifenthrin and butachlor to a negligible level in Chinese chives. The established method had a limit of quantitation of 0.005 mg/kg and correlation coefficients greater than 0.999 within the range of 0.005-0.5 mg/kg. Matrix effects were found to be negligible, with values ranging from -18.8% to 7.2% in four different sources of chives and two leafy vegetables. Compared to conventional analytical methods for the LOQ and matrix effect, the established method demonstrated improved performances. The analytical method was further applied in a residual study in chive fields. The active ingredient of butachlor 5 granule (GR) was not detected after soil admixture application, while that of bifenthrin 1 emulsifiable concentrate (EC) showed a range from 1.002 to 0.087 mg/kg after foliar spraying. The dissipation rate constant (k) of bifenthrin was determined to be 0.115, thus its half-life was calculated to be 6.0 days. From the results, PHI and safety use standards of both pesticides were suggested. The developed analytical method can be applied to accurately determine bifenthrin and butachlor residues in Chinese chives and provides a foundation for further research on the fate and behavior of these pesticides in the environment.

SAMHD1-induced endosomal FAK signaling promotes human renal clear cell carcinoma metastasis by activating Rac1-mediated lamellipodia protrusion

Human sterile α motif and HD domain-containing protein 1 (SAMHD1) has deoxyribonucleoside triphosphohydrolase (dNTPase) activity that allows it to defend against human immunodeficiency virus type I (HIV-1) infections and regulate the cell cycle. Although SAMHD1 mutations have been identified in various cancer types, their role in cancer is unclear. Here, we aimed to investigate the oncogenic role of SAMHD1 in human clear cell renal cell carcinoma (ccRCC), particularly as a core molecule promoting cancer cell migration. We found that SAMHD1 participated in endocytosis and lamellipodia formation. Mechanistically, SAMHD1 contributed to the formation of the endosomal complex by binding to cortactin. Thereafter, SAMHD1-stimulated endosomal focal adhesion kinase (FAK) signaling activated Rac1, which promoted lamellipodia formation on the plasma membrane and enhanced the motility of ccRCC cells. Finally, we observed a strong correlation between SAMHD1 expression and the activation of FAK and cortactin in tumor tissues obtained from patients with ccRCC. In brief, these findings reveal that SAMHD1 is an oncogene that plays a pivotal role in ccRCC cell migration through the endosomal FAK-Rac1 signaling pathway.

18F-Fluciclovine PET Imaging of Glutaminase Inhibition in Breast Cancer Models

Aggressive cancers such as triple-negative breast cancer (TNBC) avidly metabolize glutamine as a feature of their malignant phenotype. The conversion of glutamine to glutamate by the glutaminase enzyme represents the first and rate-limiting step of this pathway and a target for drug development. Indeed, a novel glutaminase inhibitor (GLSi) has been developed and tested in clinical trials but with limited success, suggesting the potential for a biomarker to select patients who could benefit from this novel therapy. Here, we studied a nonmetabolized amino acid analog, ¹⁸F-fluciclovine, as a PET imaging biomarker for detecting the pharmacodynamic response to GLSi. Methods: Uptake of ¹⁸F-fluciclovine into human breast cancer cells was studied in the presence and absence of inhibitors of glutamine transporters and GLSi. To allow ¹⁸F-fluciclovine PET to be performed on mice, citrate in the tracer formulation is replaced by phosphate-buffered saline. Mice bearing triple-negative breast cancer (TNBC) xenografts (HCC38, HCC1806, and MBA-MD-231) and estrogen receptor-positive breast cancer xenografts (MCF-7) were imaged with dynamic PET at baseline and after a 2-d treatment of GLSi (CB839) or vehicle. Kinetic analysis suggested reversible uptake of the tracer, and the distribution volume (V_D) of ¹⁸F-fluciclovine was estimated by Logan plot analysis. Results: Our data showed that cellular uptake of ¹⁸F-fluciclovine is mediated by glutamine transporters. A significant increase in V_D was observed after CB839 treatment in TNBC models exhibiting high glutaminase activity (HCC38 and HCC1806) but not in TNBC or MCF-7 exhibiting low glutaminase. Changes in V_D were corroborated with changes in GLS activity measured in tumors treated with CB839 versus vehicle, as well as with changes in V_D of ¹⁸F-(2S,R4)-fluoroglutamine, which we previously validated as a measure of cellular glutamine pool size. A moderate, albeit significant, decrease in ¹⁸F-FDG PET signal was observed in HCC1806 tumors after CB839 treatment. Conclusion: ¹⁸F-fluciclovine PET has potential to serve as a clinically translatable pharmacodynamic biomarker of GLSi.

Driving pressure-guided ventilation and postoperative pulmonary complications in thoracic surgery: a multicentre randomised clinical trial

BACKGROUND

Airway driving pressure, easily measured as plateau pressure minus PEEP, is a surrogate for alveolar stress and strain. However, the effect of its targeted reduction remains unclear.

METHODS

In this multicentre trial, patients undergoing lung resection surgery were randomised to either a driving pressure group (n=650) receiving an alveolar recruitment/individualised PEEP to deliver the lowest driving pressure or to a conventional protective ventilation group (n=650) with fixed PEEP of 5 cm H₂O. The primary outcome was a composite of pulmonary complications within 7 days postoperatively.

RESULTS

The modified intention-to-treat analysis included 1170 patients (mean [standard deviation, sd]; age, 63 [10] yr; 47% female). The mean driving pressure was 7.1 cm H₂O in the driving pressure group vs 9.2 cm H₂O in the protective ventilation group (mean difference [95% confidence interval, CI]; -2.1 [-2.4 to -1.9] cm H₂O; P<0.001). The incidence of pulmonary complications was not different between the two groups: driving pressure group (233/576, 40.5%) vs protective ventilation group (254/594, 42.8%) (risk difference -2.3%; 95% CI, -8.0% to 3.3%; P=0.42). Intraoperatively, lung compliance (mean [sd], 42.7 [12.4] vs 33.5 [11.1] ml cm H₂O^-1; P<0.001) and Pa_o2 (median [inter-quartile range], 21.5 [14.5 to 30.4] vs 19.5 [13.5 to 29.1] kPa; P=0.03) were higher and the need for rescue ventilation was less frequent (6.8% vs 10.8%; P=0.02) in the driving pressure group.

CONCLUSIONS

In lung resection surgery, a driving pressure-guided ventilation improved pulmonary mechanics intraoperatively, but did not reduce the incidence of postoperative pulmonary complications compared with a conventional protective ventilation.

CLINICAL TRIAL REGISTRATION

NCT04260451.

Development of novel Escherichia coli cell-based biosensors to monitor Mn(II) in environmental systems

Escherichia coli uses manganese [Mn(II)] as an essential trace element; thus, it has a genetic system that regulates cellular Mn(II) levels. Several genes in the mnt-operon of E. coli respond to intercellular Mn(II) levels, and transcription is regulated by a transcription factor (MntR) that interacts with Mn(II). This study aimed to develop Mn(II)-sensing biosensors based on mnt-operon genetic systems. Additionally, the properties of biosensors developed based on the promoter regions of mntS, mntH, and mntP were investigated. MntR represses the transcription of MntS and MntH after binding with Mn(II), while it induces MntP transcription. Thus, Mn(II) biosensors that decrease and increase signals could be obtained by fusing the promoter regions of mntS/mntH and mntP, with egfp encoding an enhanced green fluorescent protein. However, only the biosensor-based mntS:egfp responded to Mn(II) exposure. Further, E. coli harboring P mntS :egfp showed a concentration-dependent decrease in fluorescence signals. To enhance the sensitivity of the biosensor toward Mn(II), E. coli containing a deleted MntP gene that encodes Mn(II) exporter, was used as a host cell for biosensor development. The sensitivity toward Mn(II) increased by two times on using E. coli-mntP, and the biosensor could quantify 0.01-10 μM of Mn(II). Further, the applicability of Mn(II) in artificially contaminated water samples was quantified and showed >95% accuracy. The newly developed Mn(II) biosensors could detect and quantify the residual Mn(II) from mancozeb in soil samples, with the quantification accuracy being approximately 90%. To the best of our knowledge, this is the first Mn (II)-specific bacterial cell-based biosensor that serves as a valuable tool for monitoring and assessing the risks of Mn(II) in environmental systems.

Morphometry of lumbar muscles in the seated posture with weight-bearing MR scans

Conventional imaging studies of human spine are done in a supine posture in which the axial loading of the spine is not considered. Upright images better reveal the interrelationships between the various internal structures of the spine. The objective of the current study is to determine the cross-sectional areas, radii, and angulations of the psoas, erector spinae, and multifidus muscles of the lumbar spine in the sitting posture. Ten young (mean age 31 ± 4.8 years) asymptomatic female subjects were enrolled. They were seated in an erect posture and weight-bearing T1 and T2 MRIs were obtained. Cross-sectional areas, radii, and angulations of the muscles were measured from L1-L5. Two observers repeated all the measurements for all parameters, and reliability was determined using the inter- and intra-class coefficients. The Pearson product moment correlation was used for association between levels, while level differences were used using a linear regression model. The cross-sectional areas of the psoas and multifidus muscles increased from L1 to L5 (1.9 ± 1.1 to 12.1 ± 2.5 cm2 and 1.8 ± 0.3 to 5.7 ± 1.4 cm2). The cross-sectional area of the erector spinae was greatest at the midlevel (13.9 ± 2.2 cm2) and it decreased in both directions. For the angle, the range for psoas muscles was 75-105°, erector spinae were 39-46° and multifidus was 11-19°. Correlations magnitudes were inconsistent between levels and muscle types. These quantitated data improve our understanding of the geometrical properties in the sitting posture. The weight-bearing MRI-quantified morphometrics of human lumbar spine muscles from this study can be used in biomechanical models for predicting loads on spinal joints under physiological and traumatic situations.

Simultaneous Determination of Pyrethroid Insecticides in Foods of Animal Origins Using the Modified QuEChERS Method and Gas Chromatography-Mass Spectrometry

Pyrethroid insecticides are used in agriculture to treat parasites in livestock. This study developed a simultaneous residue analysis method to measure seventeen pyrethroid insecticides in foods of animal origin, including beef, pork, chicken, milk, and eggs. The method, which comprises instrumental analysis using gas chromatography-tandem mass spectrometry and a modified QuEChERS (quick, easy, cheap, effective, rugged, and safe) method for pretreatment, was optimized to verify the applicability of the method. A mixture of acetonitrile, ethyl acetate, and original salt (MgSO4 4 g, NaCl 1 g) was used as the extraction solvent and salt. MgSO4 (150 mg) primary secondary amine (25 mg) and graphitized carbon black (25 mg) were selected for dispersive solid phase extraction (d-SPE). The method limit of quantitation was 0.01 mg/L, and the linearity of the matrix-matched calibration curves was reasonable (R2 > 0.99). Recovery tests were performed at three concentrations (LOQ, 10 LOQ, and 50 LOQ). Good recoveries (75.2109.8%) and reproducibility (coefficient of variation <10%) were obtained. The matrix effects were in the range of −35.8 to 56.0%. The established method was fully validated and can be used as an official analytical method for quantifying pyrethroid insecticides in animal commodities.

Search for Dark Matter Axions with CAST-CAPP

The CAST-CAPP axion haloscope, operating at CERN inside the CAST dipole magnet, has searched for axions in the 19.74 μeV to 22.47 μeV mass range. The detection concept follows the Sikivie haloscope principle, where Dark Matter axions convert into photons within a resonator immersed in a magnetic field. The CAST-CAPP resonator is an array of four individual rectangular cavities inserted in a strong dipole magnet, phase-matched to maximize the detection sensitivity. Here we report on the data acquired for 4124 h from 2019 to 2021. Each cavity is equipped with a fast frequency tuning mechanism of 10 MHz/ min between 4.774 GHz and 5.434 GHz. In the present work, we exclude axion-photon couplings for virialized galactic axions down to g_aγγ = 8 × 10⁻¹⁴ GeV⁻¹ at the 90% confidence level. The here implemented phase-matching technique also allows for future large-scale upgrades.

Haloscopes aim at detecting axions by converting them into photons using high-quality resonant cavities, where the cavity resonance should be tuned with the unknown axion mass. Here, the authors improve exclusion limits using four phase-matched resonant cavities and a fast frequency scanning technique.

The association between cardiovascular risk factors and coronary CT angiography findings for predicting obstructive coronary artery disease in Korean patients with stable chest pain

Background/Introduction

The 2019 European Society of Cardiology (ESC) guidelines currently recommend the use of coronary computed tomography angiography (CCTA) as the initial test for diagnosing coronary artery disease (CAD) in symptomatic patients in whom obstructive CAD cannot be excluded by clinical assessment alone.

Purpose

The purpose of this study is to identify the prevalence of obstructive CAD in patients with stable chest pain, and the correlation between several clinical cardiovascular disease (CVD) risk factors and CCTA findings presented by Coronary Artery Disease Reporting and Data System (CAD-RADS).

Methods

The present study is a single-center retrospective cross-sectional study. A total of 1,892 patients with stable chest pain who underwent CCTA were enrolled in this study. Diamond-Forrester classification, Framingham risk score (FRS), atherosclerotic CVD (ASCVD) 10-year risk score, coronary artery calcium score (CACS) and CAD-RADS category were obtained from every patient.

Results

Among 1,892 patients (mean age, 60.5±8.6 years; men, 59.3%), 356 (18.8%) had obstructive CAD according to CCTA. Patients with high and intermediate ASCVD 10-year risk score had 2.59 times (aOR 2.59, 95% CI; 1.58 to 4.23) and 1.66 times (aOR 1.66, 95% CI; 1.04 to 2.65) higher odds of having obstructive CAD than patients with low ASCVD 10-year risk score, respectively (adjusted for Diamond-Forrester classification and CACS group). Higher ASCVD risk scores were significantly associated with higher CAD-RADS category (p&lt;0.001), and patients with CAD-RADS category 3 had ASCVD 10-year risk score of 20.1±12.7. CACS showed the highest discrimination in presence of obstructive CAD, followed by ASCVD 10-year risk score, FRS, and Diamond-Forrester classification (AUC: 0.821 [95% CI; 0.797–0.845]; 0.711 [95% CI; 0.683–0.740]; 0.675 [95% CI; 0.646–0.704]; 0.600 [95% CI; 0.569–0.632], respectively).

Conclusion

This is the first study of CCTA findings in stable chest pain patients in Korea. The prevalence of obstructive CAD in patients with stable chest pain was 18.8%. Higher ASCVD score is significantly associated with presence of obstructive CAD and higher CAD-RADS category. As coronary stenosis of 50%-69% had a mean ASCVD score of 20.1, we should consider CCTA for identifying obstructive CAD in patients with ASCVD score over 20 with stable chest pain.

Funding Acknowledgement

Type of funding sources: None.

Inhibition of lysyl oxidase‑like 2 ameliorates folic acid‑induced renal tubulointerstitial fibrosis

Tubulointerstitial fibrosis is characterized by accumulation of the extracellular matrix in the interstitium. Lysyl oxidase-like 2 (LOXL2), a member of the lysyl oxidase family, is known for promoting cancer metastasis, invasion and stromal fibrosis in various organs. Our previous study demonstrated expression of LOXL2 in kidney podocytes and tubular epithelial cells, and the association between elevated LOXL2 and tubulointerstitial fibrosis. The present study evaluated the effect of LOXL2 inhibition using an inhibitory monoclonal antibody (AB0023) on tubulointerstitial fibrosis in a folic acid-induced tubulointerstitial fibrosis mouse model. The association of LOXL2 with epithelial-mesenchymal transformation-related molecules was also evaluated in vitro using HK-2 cells. The present data demonstrated that AB0023 prevented the progression of tubulointerstitial fibrosis significantly, as determined by trichrome and picro-sirius red staining, as well as the total collagen assay. The mean expression of phosphorylated Smad2 and Smad4 was lower in the AB0023-treated group although it was not statistically significant. Following transforming growth factor-β (TGF-β) challenge, LOXL2-deficient HK-2 cells exhibited significantly lower expression of the mesenchymal markers vimentin and fibronectin than control HK-2 cells. In conclusion, LOXL2 inhibition ameliorates renal fibrosis through the TGF-β/Smad signalling pathway.

DWI Metrics Differentiating Benign Intraductal Papillary Mucinous Neoplasms from Invasive Pancreatic Cancer: A Study in GEM Models

KPC (KrasG12D:Trp53R172H:Pdx1-Cre) and CKS (KrasG12D:Smad4L/L:Ptf1a-Cre) mice are genetically engineered mouse (GEM) models that capture features of human pancreatic ductal adenocarcinoma (PDAC) and intraductal papillary mucinous neoplasms (IPMN), respectively. We compared these autochthonous tumors using quantitative imaging metrics from diffusion-weighted MRI (DW-MRI) and dynamic contrast enhanced (DCE)-MRI in reference to quantitative histological metrics including cell density, fibrosis, and microvasculature density. Our results revealed distinct DW-MRI metrics between the KPC vs. CKS model (mimicking human PDAC vs. IPMN lesion): the apparent diffusion coefficient (ADC) of CKS tumors is significantly higher than that of KPC, with little overlap (mean ± SD 2.24±0.2 vs. 1.66±0.2, p<10−10) despite intratumor and intertumor variability. Kurtosis index (KI) is also distinctively separated in the two models. DW imaging metrics are consistent with growth pattern, cell density, and the cystic nature of the CKS tumors. Coregistration of ex vivo ADC maps with H&E-stained sections allowed for regional comparison and showed a correlation between local cell density and ADC value. In conclusion, studies in GEM models demonstrate the potential utility of diffusion-weighted MRI metrics for distinguishing pancreatic cancer from benign pancreatic cysts such as IPMN.

Ingestion and egestion of polystyrene microplastic fragments by the Pacific oyster, Crassostrea gigas

Marine microplastics (MPs) pose a risk to human health through accumulation in maricultural organisms, particularly bivalves. Various studies have reported the presence of MP particles in Pacific oysters (Crasostrea gigas). In this study, we investigated the size-specific ingestion and egestion of polystyrene (PS) MPs by Pacific oysters. The cultivation density of C. gigas was maintained at 1 L of filtered seawater per oyster (n = 5) during the MP ingestion and egestion experiments. On exposure to 300 n/L of PS MP fragments for 7 d, 60.4% of the PS was ingested within 6 h (7.25 × 10² ± 1.36 × 10² n/indv.), and the ingestion was saturated at 12 h (1.2 × 10³ ± 2.2 × 10² n/indv.) in C. gigas. The maximum MP ingestion capacity (Ig_max) of a single Pacific oyster was 73.0 ± 16.3 n/g wet weight. Further, 62.9% of the PS MP particles were egested for 7 d from the saturated single C. gigas. Ingestion and egestion varied according to the PS MP size. In the case of <50 μm PS MP, ingestion rate was low but MP amount and net-ingestion efficiency was significantly higher than other PS MP sizes. In addition, egestion, egestion rate, and net-egestion efficiency for <50 μm PS MPs were significantly higher than other PS MP sizes. Therefore, smaller MPs (<50 μm) normally exhibit the highest ingestion and egestion rates; therefore, the 50-300 μm size fraction exhibited the highest residual possibility (particles >1000 μm were excluded). Additionally, considering the net-egestion efficiency, the most economical and efficient depuration period was 24 h. This study clarifies the size-specific MP accumulation in oysters, and the egestion results suggest that the potential risk of MPs to human health through the intake of maricultural products could be reduced by depuration.

The Effect of Opioid-Free Anesthesia on the Quality of Recovery After Gynecological Laparoscopy: A Prospective Randomized Controlled Trial

Purpose

Opioid-free anesthesia (OFA) is an emerging technique that eliminates intraoperative use of opioids and is associated with lower postoperative opioid consumption and reduced adverse postoperative events. The present study investigated the effect of OFA on the quality of recovery in patients undergoing gynecological laparoscopy.

Patients and Methods

Seventy-five adult patients undergoing elective gynecological laparoscopy were randomly assigned to the OFA group with dexmedetomidine and lidocaine or the remifentanil-based anesthesia (RA) group with remifentanil. Patients, surgeons, and medical staff members providing postoperative care and assessing outcomes were blinded to group allocation. The anesthesiologist performing general anesthesia could not be blinded due to the different drug administration protocols by groups. The primary outcome was the quality of recovery measured using the Quality of Recovery-40 (QoR-40) questionnaire. Secondary outcomes were postoperative pain score, intraoperative and postoperative adverse events, and stress hormones levels.

Results

The patients in both groups had comparable baseline characteristics. The QoR-40 score on postoperative day 1 was significantly higher in the OFA group than in the RA group (155.9 ± 21.2 in the RA group vs 166.9 ± 17.8 in the OFA group; mean difference: −11.0, 95% confidence interval: −20.0, −2.0; p = 0.018). The visual analog scale score at 30 min after surgery was significantly lower in the OFA group than in the RA group (6.3 ± 2.3 in the RA group vs 4.1 ± 2.1 in the OFA group; p < 0.001). The incidences of nausea and shivering in the post-anesthetic care unit were also significantly lower in the OFA group (p = 0.014 and 0.025; respectively). Epinephrine levels were significantly lower in the OFA group (p = 0.002).

Conclusion

OFA significantly improved the quality of recovery in patients undergoing gynecological laparoscopy.

Perioperative Inflammatory Response and Cancer Recurrence in Lung Cancer Surgery: A Narrative Review

While surgical resection is the gold standard treatment for solid tumors, cancer recurrence after surgery is common. Immunosurveillance of remnant tumor cells is an important protective mechanism. Therefore, maintenance of anti-tumor cell activity and proper levels of inflammatory mediators is crucial. An increasing body of evidence suggests that surgery itself and perioperative interventions could affect these pathophysiological responses. Various factors, such as the extent of tissue injury, perioperative medications such as anesthetics and analgesics, and perioperative management including transfusions and methods of mechanical ventilation, modulate the inflammatory response in lung cancer surgery. This narrative review summarizes the pathophysiological mechanisms involved in cancer recurrence after surgery and perioperative management related to cancer recurrence after lung cancer surgery.

Simultaneous determination of nereistoxin insecticides in foods of animal origins by combining pH-dependent reversible partitioning with hydrophilic interaction chromatography-mass spectrometry

Although nereistoxin insecticides (NIs) are banned for animal husbandry operations, they are still used because of their high insecticidal activities. Therefore, a reliable residue analysis method for the simultaneous detection of cartap, bensultap, thiocyclam, and nereistoxin in foods of animal origins, including beef, pork, chicken, milk, and eggs, was developed using hydrophilic interaction liquid chromatography-mass spectrometry (HILIC-LC-MS/MS). The NIs were extracted with an acidic cysteine and formate buffer solution and hydrolyzed to nereistoxin. The molarity and pH of the buffer were optimized at 20 mM and 3, respectively, to keep the pH of the extracts at 4-5. pH-dependent acid-base partitioning coupled with salting-out-assisted liquid-liquid extraction using acetonitrile was performed for purification and for the direct introduction of the extracts to LC. The optimal pH values were 5 and 9 for the acid-base partitioning. Nereistoxin quantitation was achieved with consistent column retention (RSD < 0.6%) and a high degree of separation (N > 10⁶). The matrix-dependent method limit of quantitation was 2 μg nereistoxin/kg, and the calibration curve showed good linearity (R² > 0.998). The recovery efficiencies were in the range of 89.2-109.9% with relative standard deviations less than 10%, and matrix effects did not exceed ± 10%, which satisfied the criteria outlined in the European SANTE/12682/2019 guidelines.

POS1443 IDENTIFYING THE NEW EMERGENCE OF RACIAL DISPARITIES IN GOUT OVER THE PAST 3 DECADES – US NATIONAL SURVEY AND PROSPECTIVE COHORT DATA

Background

Several studies published after 2010 reported a higher frequency of gout and hyperuricemia among US Blacks than Whites.1-4 However, Blacks (in the US and Africa) were previously thought to suffer gout less often than Whites.5 We hypothesized that the racial disparity in Blacks emerged over the past several decades, with flipped prevalence between the two races.

Objectives

To assess trends in racial differences in gout prevalence in the US using both national survey and cohort study data over the past 3 decades.

Methods

Using data from the NHANES (National Health and Nutrition Examination Survey) III (1988-1994) and latest decade (2007-2016), and data from 5 examination periods in the ARIC (Atherosclerosis Risk in Communities) Study between 1988 through 2013, we compared age- and sex-adjusted prevalences and odds ratios (OR) to determine the trend of racial differences in gout prevalence between Blacks and Whites. A time-race interaction term was used to assess differences in the rate of change between the two races.

Results

Among Whites, the sex- and age-standardised prevalence of gout in the NHANES rose from 2.8% (95% CI: 2.4 to 3.2) in 1988-94 to 3.7% (3.2 to 4.1) in 2007/16. Prevalence of gout among Blacks was lower than Whites in 1988-94 (2.6% [2.2 to 3.0]) but rose more sharply over the subsequent decades (p for race-time interaction=0.003), and in 2007/16 came to exceed that of Whites (5.0% [4.4 to 5.6]).

Corresponding age-sex-adjusted ORs for gout in Blacks vs. Whites were 0.93 (0.73 to 1.17) in 1988-94, increasing to 1.46 (1.22 to 1.74) in 2007/16 (Table 1). This disproportionate rise in gout prevalence among Blacks tended to be more prominent among women (OR 1.81 [1.29 to 2.53]) than men (OR 1.26 [1.02 to 1.55]; p for race-time interactions of 0.002 and 0.01, respectively). Similar trends were observed in the ARIC cohort, where the OR for gout among Blacks vs. Whites rose progressively from 0.82 (0.65 to 1.02) in 1987-89 to 1.81 (1.49 to 2.19) in 2011-13.

Table 1.

Temporal Trend of Racial Disparity in Gout Prevalence in NHANES Survey and the ARIC Study Cohort, overall and by sex

Odds Ratio (95% CI) for Gout Among Blacks vs. WhitesOVERALLNHANES1988-19942007-2016Age- and sex-adjusted0.93(0.73 to 1.17)1.46(1.22 to 1.74)ARICVisit 1: 1987-89Visit 2: 1990-92Visit 3: 1993-95Visit 4: 1996-98Visit 5: 2011-13Age- and sex-adjusted0.82(0.65 to 1.02)0.99(0.81 to 1.22)1.24(1.03 to 1.50)1.60(1.35 to 1.90)1.81(1.49 to 2.19)WOMENNHANES1988-19942007-2016Age-adjusted0.98(0.65 to 1.47)1.81(1.29 to 2.53)ARICVisit 1: 1987-89Visit 2: 1990-92Visit 3: 1993-95Visit 4: 1996-98Visit 5: 2011-13Age-adjusted0.92(0.64 to 1.32)1.14(0.82 to 1.59)1.45 (1.07 to 1.96)1.89 (1.45 to 2.46)2.28(1.73 to 3.01)MENNHANES1988-19942007-2016Age-adjusted0.91(0.68 to 1.21)1.26 (1.02 to 1.55)ARICVisit 1: 1987-89Visit 2: 1990-92Visit 3: 1993-95Visit 4: 1996-98Visit 5: 2011-13Age-adjusted0.73 (0.54 to 0.97)0.87 (0.66 to 1.14)1.03(0.79 to 1.33)1.29(1.02 to 1.64)1.34(1.00 to 1.78)

Conclusion

Gout prevalence tended to be lower in Blacks than Whites until late 80’s, then rose and surpassed that of Whites over the past several decades. These trends closely parallel the worsening obesity epidemic during this period,6 particularly in Blacks, partly due to enhanced Western lifestyle. Gout risk genetic profile change would not contribute to this emergence of racial differences, particularly among the same individuals in ARIC, although it remains to be clarified whether Blacks carry genetic profiles that enhance the effect of lifestyle risk factors for gout.

References

[1]PMID 22225548 (2012)

[2]PMID 24330409 (2013)

[3]PMID 24335384 (2014)

[4]PMID: 30618180 (2019)

[5]NEJM PMID: 15014177

[6]JAMA PMID: 12365955

Disclosure of Interests

Natalie McCormick: None declared, Leo Lu: None declared, Chio Yokose: None declared, Amit Joshi: None declared, Yuqing Zhang: None declared, Hyon Choi Consultant of: Ironwood, Selecta, Horizon, Takeda, Kowa, and Vaxart., Grant/research support from: Ironwood and Horizon

POS0280 EXCESS RISK OF ALL-CAUSE AND CARDIOVASCULAR MORTALITY IN FEMALES WITH GOUT – A PROSPECTIVE COHORT STUDY OF 105,502 WOMEN

Background

Despite the disproportionately worsening disease burden of female gout in recent years1 and its frequent associations with key cardiovascular risk factors (more often than male gout2,3), there remains a paucity of specific data about female gout, particularly about its impact on mortality and fatal coronary heart disease (CHD).

Objectives

To prospectively examine the relation of female gout and risk of all-cause and cardiovascular and coronary heart disease-specific deaths.

Methods

Using data from the Nurses’ Health Study (NHS), an ongoing prospective cohort study in which female nurses in the United States completed detailed mailed questionnaires regarding their medical history, lifestyle, and other risk factors at baseline and every two years thereafter, we prospectively analyzed the relation between gout status at baseline and during the follow-up period and the risk of all-cause and cardiovascular mortality using Cox proportional hazards regression to adjust for cardiovascular risk factors such as comorbidities, body mass index, postmenopausal status, medication use, and dietary factors.

Results

The analysis included 105,502 women without gout and 1602 women with gout. Women with gout at baseline in 1982 tended to be older (mean age 54 vs. 50 years), and more likely to report a history of hypertension (44% vs. 22%), hypercholesterolemia (17% vs. 8%), and diabetes (11% vs. 6%). During 24 years of follow-up, we documented 15,255 deaths from all causes, including 3,128 deaths from cardiovascular disease (CVD) and 1,405 deaths from coronary heart disease (CHD). Compared to women without history of gout or CHD at baseline, the multivariable relative risks (RRs) among women with history of gout at baseline were 1.33 (95% CI, 1.21 to 1.46) for total mortality, 1.40 (95% CI, 1.17 to 1.67) for CVD deaths, and 1.49 (95% CI, 1.17 to 1.91) for fatal CHD (Table 1). The corresponding RRs for gout at baseline and during the follow-up were 1.33 (95% CI, 1.23 to 1.44), 1.43 (95% CI, 1.24 to 1.66), and 1.34 (95% CI, 1.08 to 1.66), respectively.

Table 1.

Relative Risks of Death from All-Causes, Cardiovascular Disease, and Coronary Heart Disease According to Gout Status at Baseline in 1982 in the Nurses’ Health Study

No CHDNo GoutGoutDeaths from all causesCases, n14,810445Age-adjusted RR (95% CI)1.01.58 (1.43, 1.73)Multivariable-adjusted* RR (95% CI)1.01.33 (1.21, 1.46)All cardiovascular deathsCases, n3,001127Age-adjusted RR (95% CI)1.02.06 (1.72, 2.46)Multivariable-adjusted* RR (95% CI)1.01.40 (1.17, 1.67)Fatal CHDCases, n1,33570Age-adjusted RR (95% CI)1.02.53 (1.99, 3.22)Multivariable-adjusted* RR (95% CI)1.01.49 (1.17, 1.91)

*Adjusted for age (continuous), history of hypertension, history of hypercholesterolemia, history of diabetes, aspirin use (yes, no), diuretic use (yes, no), smoking (never, past, current <15, current ≥15 cigarettes/day), body mass index (<23, 23-24.9, 25-29.9, 30-34.9, ≥35), physical activity (quintile), alcohol intake (nondrinker, <5, 5-9, 10-29, ≥30g/day), family history of MI (yes, no), menopausal status (premenopause, post menopause), hormone replacement therapy use (premenopause, never user, current user, past user). total energy intake (quintile), trans fat (quintile), dietary cholesterol (quintile), protein (quintile), linoleic fatty acid (quintile), and ratio of polyunsaturated fat/saturated fat.

CHD = coronary heart disease; CI = confidence interval; RR = relative risk.

Conclusion

These prospective data indicate that women with gout have a higher risk of all-cause mortality, which is primarily driven by higher risk of CVD deaths. These findings closely agree with the UK general population data of both sexes that showed unclosing mortality gap over the past two decades.4 Together, these findings provide support for rigorous cardiovascular risk factor modification specifically in female gout to help curtail the rising disease burden of gout worldwide.1

References

[1]Xia et al., PMID 31624843

[2]Puig et al., PMID 2012455

[3]Harrold et al., PMID 16644784

[4]Fisher et al., PMID 28122760

Disclosure of Interests

Chio Yokose: None declared, Natalie McCormick: None declared, Na Lu: None declared, Amit Joshi: None declared, Gary Curhan Consultant of: AstraZeneca, Allena Pharmaceuticals, Shire/Takeda, Dicerna, and Orfan, Grant/research support from: Decibel Therapeutics, Employee of: Chief Medical Officer at OM1, Inc., Hyon Choi Consultant of: Ironwood, Selecta, Horizon, Takeda, Kowa, and Vaxart, Grant/research support from: Ironwood and Horizon

POS0155 WHAT DRIVES RACIAL DISPARITIES IN GOUT IN THE US? – POPULATION-BASED, SEX-SPECIFIC, CASUAL MEDIATION ANALYSIS

Background

Traditionally viewed as a disease of White men, global frequency and disability burden of female gout are rising disproportionately to male gout.1 Moreover, emerging US cohort data suggest gout and hyperuricemia impart larger burdens on Black adults than Whites.2 These racial disparities may be largely attributable to differences in non-genetic, mainly modifiable gout risk factors e.g., BMI, diet,3,4 and chronic kidney disease (CKD). However, national-level, general population data on racial differences in burden of gout, and potential mediators, are lacking.

Objectives

To determine and quantify sex-specific mediators of racial disparities in gout prevalence among a nationally representative sample of US adults.

Methods

Using recent decadal data (2007-2016) on physician-diagnosed gout and hyperuricemia from the National Health and Nutrition Examination Survey, we compared contemporary sex- and race-specific prevalences and conducted sequential causal mediation analysis (adjusting for upstream mediators following causal pathways)5 to determine the proportion of the racial differences attributable to 7 potentially mediating social and clinical factors (see DAG in Figure 1): low education, poverty, body mass index (BMI), alcohol, poor quality diet (poor DASH adherence), diuretic use, and CKD (eGFR <60 mL/min, using the latest equations that do not include a coefficient for Black race6, per National Kidney Foundation and American Society of Nephrology recommendations.7)

Results

Age standardised prevalence of gout was 3.5% and 2.0% in Black and White women, respectively (age-adjusted OR =1.8 [95% CI: 1.3 to 2.5]), and 7.0% and 5.4% in Black and White men (age-adjusted OR =1.3 [1.0 to 1.6]). Most risk factors were more frequent/elevated in Blacks than Whites, except alcohol consumption, which was lower in Blacks (both sexes). BMI levels and poverty were higher in Black women, but similar between Black and White men.

Largest mediating factor of excess gout cases among Black women was excess BMI, accounting for 56% of the racial difference (independent of education, poverty, diet, and alcohol), followed by CKD (24%), poverty (17%), and poor diet (12%) (see Table 1).

Table 1.

Indirect (mediation) effects of potential mediators, using sequential mediation analysis, for the association between Black race and odds of gout in US women and men.

WOMENMENEffect Estimate (OR), 95% CIProportion Mediated, %Effect Estimate (OR), 95% CIProportion Mediated, %Indirect (Mediation) EffectEducation (high school or less)1.01 (0.98 to 1.03)2.4%1.01 (0.98 to 1.03)3.3%Poverty1.07 (1.04 to 1.10)16.9%1.00 (0.99 to 1.00)0.53%Alcohol consumption (# drinks/week, continuous)0.99 (0.96 to 1.01)-3.4%0.99 (0.98 to 1.00)-4.5%DASH diet score (continuous; higher scores = ↓ adherence)1.05 (0.96 to 1.01)12.0%1.05 (1.01 to 1.10)19.8%Body mass index (continuous)1.25 (1.14 to 1.37)55.9%1.03 (1.02 to 1.04)11.9%Diuretic use1.03 (1.01 to 1.05)7.6%1.04 (1.02 to 1.06)14.2%Chronic kidney disease1.10 (1.04 to 1.16)23.9%1.12 (1.08 to 1.17)45.6%Direct Effect0.94 (0.68 to 1.30)a−15.2%1.02 (0.83 to 1.26)b9.2%Total Effect1.49 (1.12 to 1.98)100%1.29 (1.05 to 1.57)100%

DASH=Dietary Approaches to Stop Hypertension;

ap=0.52,

bp=0.83

Among men, CKD was the largest mediator (46%), followed by poor diet (20%) and diuretic use (14%). BMI (12%) and poverty (0.5%) mediated smaller proportions of the racial difference among men compared to women. Mediators of racial differences in hyperuricemia closely agreed with gout results.

Conclusion

Contrasting with historical views, gout is more frequent among Black adults in the US than their White counterparts, especially women (two-times greater in Black women vs. White). Culturally informed efforts to reduce these disparities should focus on excess adiposity, diet quality, and kidney disease while recognising the impact of poverty in female gout.

References

[1]Xia; PMID 31624843

[2]PMID 24335384

[3]Rai BMJ PMID 28487277

[4]Yokose JAMA IM (2022)

[5]VanderWeele; PMID 25580377

[6]NEJM PMID 34554658

[7]JASN PMID 34556489

Disclosure of Interests

Natalie McCormick: None declared, Leo Lu: None declared, Chio Yokose: None declared, Amit Joshi: None declared, Tony Merriman: None declared, Kenneth Saag Consultant of: Arthrosi, Atom Bioscience, Horizon Therapeutics, LG Pharma, Mallinkrodt, SOBI, Takeda, Grant/research support from: Horizon Therapeutics, SOBI, Shanton, Yuqing Zhang: None declared, Hyon Choi Consultant of: Ironwood, Selecta, Horizon, Takeda, Kowa, and Vaxart.

Grant/research support from: Ironwood, Horizon