Influence of the strain effect on magnetocrystalline anisotropy in Co2Fe0.4Mn0.6Si Heusler alloys

The perpendicular magnetocrystalline anisotropy, magnetoelastic properties as well as the Gilbert damping factor in Co2Fe0.4Mn0.6Si thin films were found to depend on a magnetic layer thickness, and they can be also tuned by the application of additional Ag buffer layer. The tetragonal distortion of a magnetic layer was found to increase with decreasing thickness, and after the application of an additional Ag buffer layer, the character of this distortion was changed from tensile to compressive in the plane of a film. A correlation between the tetragonal distortion and perpendicular magnetocrystalline anisotropy was found. However, the magnitude of the observed tetragonal distortion for most samples seems to be too small to explain alone the experimentally found large magnitude of the perpendicular magnetocrystalline anisotropy. For these samples, other mechanisms including both surface and volume effects must be taken into account.

Efficacy of repeated administration of intravenous acetaminophen for pain management after total knee arthroplasty

Intravenous acetaminophen is an integral component of multimodal postoperative pain management. This prospective study aims to assess the efficacy of the repeated administration of intravenous acetaminophen and the impact on postoperative patient satisfaction with postoperative pain management after total knee arthroplasty (TKA). We enrolled 98 patients scheduled for unilateral TKA. Patients were randomly assigned to receive either 1000 mg of intravenous acetaminophen at 6-hour intervals (AAP group) or not to receive intravenous acetaminophen (control group). All patients underwent single-shot femoral nerve block after general anesthesia, as well as intraoperative periarticular infiltration of analgesia prior to implantation. The primary outcome was the postoperative numerical rating scale (NRS) pain score at rest. The NRS score was measured just before the administration of study drugs, immediately after arrival in the ward (time 0), and at 6, 12, 18, 24, and 48 h (time 1 to time 5, respectively) postoperatively. We also evaluated the mean doses of rescue opioid use for 24 h postoperatively. At time 5, the AAP group had significantly improved mean NRS score than controls (3.0 vs. 4.0; P < 0.01). Rescue opioid use was significantly lower in the AAP group for 24 hours compared to controls (0.3 μg vs. 0.9 μg; P < 0.01). Repeated intravenous acetaminophen administration after TKA may provide better analgesia and reduce opioid use.

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

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

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

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

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

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

The orthostatic hypotension in patients with Stanford type A aortic dissection after surgery

Funding Acknowledgements

Type of funding sources: None.

Background

Orthostatic hypotension (OH) is sometimes observed during cardiac rehabilitation in patients with surgery for aortic dissection. However, little is known about the primary determinant of OH and influence of surgical range on incidence of OH.

Purpose

The aim of this study was to elucidate the incidence of OH in patients with surgery for aortic dissection, and compare it between the patients with ascending aortic replacement surgery (ascending group) and those with ascending aorta and hemiarch or total arch replacement surgery (arch group).

Methods

We analyzed 59 patients who underwent emergent surgery due to Stanford type A aortic dissection from January 2014 to March 2018, and compared the incidence of OH between ascending group (n = 28, age 69.8 ± 11.3 years) and arch group (n = 31, age 64.1 ± 13.0 years).

Results

The incidence of OH in total patients was 30.5%. There were no significant differences in patient characteristics including body tall, body weight, antihypertensive use and progress of rehabilitation between 2 groups. The arch group showed a significant higher incidence of OH as compared with ascending group (arch group: 46.4% vs. ascending group: 16.1%, p = 0.03). Moreover, the patients who occurred OH were significantly taller than those who did not occur OH.

Conclusions

OH was observed in about one third of patients with surgery for aortic dissection and it showed a close relationship with patient’s height and the range repaired by surgical operation. More careful cardiac rehabilitation is needed for tall patients with large area replacement of aorta.

Factors limiting quantitative phase retrieval in atomic-resolution differential phase contrast scanning transmission electron microscopy using a segmented detector

Quantitative differential phase contrast imaging of materials in atomic-resolution scanning transmission electron microscopy using segmented detectors is limited by various factors, including coherent and incoherent aberrations, detector positioning and uniformity, and scan-distortion. By comparing experimental case studies of monolayer and few-layer graphene with image simulations, we explore which parameters require the most precise characterisation for reliable and quantitative interpretation of the reconstructed phases. Coherent and incoherent lens aberrations are found to have the most significant impact. For images over a large field of view, the impact of noise and non-periodic boundary conditions are appreciable, but in this case study have less of an impact than artefacts introduced by beam deflections coupling to beam scanning (imperfect tilt-shift purity).

Clinical features and long-term prognosis of patients with congestive heart failure taking tolvaptan: a comparison between preserved and reduced left ventricular ejection fraction

Background

There were few reports which investigated the clinical benefit of long-term use of tolvaptan (TLV) for heart failure (HF). The purpose of this study was to evaluate the long-term prognosis of patients administrated TLV for more than 1 year in the HF patients with preserved ejection fraction (HFpEF) and reduced ejection fraction (HFrEF).

Method

In a total of 591 consecutive patients who were admitted to our hospital and administered TLV for HF between 2011 and 2018, we retrospectively enrolled 147 patients who were administered TLV for more than 1 year. The patients were classified into 2 groups, the HFpEF group (n=77, 52.4%) and the HFrEF group (n=70, 47.6%), and clinical backgrounds and long-term prognosis were examined. Furthermore, we performed stratified analysis based on the response to TLV defined by urine osmolality (The responder group n=40, the non-responder group n=52).

Results

The HFpEF group was significantly older (77.7±9.2 vs. 71.3±11.5 years, P&lt;0.01) and included more female (41.6 vs. 21.4%, P&lt;0.01) compared with the HFrEF group. Other baseline characteristics were not different between the two groups. During the average 2.7 years follow up, the HFpEF group showed significantly lower all-cause mortality and cardiovascular mortality compared to the HFrEF group (24.7 vs. 38.6%, Log-Rank P=0.014, 13.0 vs. 25.7%, Log-Rank P=0.007, respectively). Univariate analysis revealed that male, HFpEF, serum creatinine changes from baseline (ΔCre) were the factors correlated with all-cause mortality (HR 2.12, 95% CI 1.02 – 4.40, P=0.045, HR 0.48, 95% CI 0.26 - 0.87, P=0.016 and HR 1.50, 95% CI 1.00 - 2.24, P=0.049, respectively). According to multivariate analysis, HFpEF was the independent influencing factor of all-cause mortality (HR 0.44, 95% CI 0.23 - 0.86, P=0.017). Stratified analysis revealed that in the non-responder group all-cause mortality was significantly lower in the HFpEF group than in the HFrEF group (24.2% vs 48.3%, P=0.049).

Conclusion

Long-term administration of TLV maybe more beneficial for HFpEF compared with HFrEF. This tendency was remarkable at non-responder group.

Funding Acknowledgement

Type of funding sources: None.

Magnetoelastic interactions and magnetic damping in Co2Fe0.4Mn0.6Si and Co2FeGa0.5Ge0.5 Heusler alloys thin films for spintronic applications

Co₂Fe_0.4Mn_0.6Si (CFMS) and Co₂FeGa_0.5Ge_0.5 (CFGG) Heusler alloys are among the most promising thin film materials for spintronic devices due to a high spin polarization, low magnetic damping and giant/tunneling magnetoresistance ratios. Despite numerous investigations of Heusler alloys magnetic properties performed up to now, magnetoelastic effects in these materials remain not fully understood; due to quite rare studies of correlations between magnetoelastic and other magnetic properties, such as magnetic dissipation or magnetic anisotropy. In this research we have investigated epitaxial CFMS and CFGG Heusler alloys thin films of thickness in the range of 15-50 nm. We have determined the magnetoelastic tensor components and magnetic damping parameters as a function of the magnetic layer thickness. Magnetic damping measurements revealed the existence of non-Gilbert dissipation related contributions, including two-magnon scattering and spin pumping phenomena. Magnetoelastic constant B₁₁ values and the effective magnetic damping parameter α_eff values were found to be in the range of - 6 to 30 × 10⁶ erg/cm³ and between 1 and 12 × 10^-3, respectively. The values of saturation magnetostriction λ_S for CFMS Heusler alloy thin films were also obtained using the strain modulated ferromagnetic resonance technique. The correlation between α_eff and B₁₁, depending on magnetic layer thickness was determined based on the performed investigations of the above mentioned magnetic properties.

Chronotropic incompetence and exercise capacity after mitral valve surgery: the importance of blood hemoglobin level

Background

Chronotropic incompetence (CI) is sometimes observed during exercise training of cardiac rehabilitation in patients with cardiac surgery, however, little is known concerning the differences between patients with mitral valve (MV) and aortic valve (AV) surgery.

Purpose

Because the possibility exists that cardiac sympathetic nerves might be impaired by left atrium incision, we hypothesized that the incidence of CI was higher in patients with MV surgery (Mitral Valve Replacement and Mitral Valvuloplasty) as compared with patients with AV surgery (Aortic Valve Replacement). And if so, which factor determines the exercise capacity of patients after MV surgery. We thus aimed this study to elucidate the hypothesis with cardiopulmonary exercise testing (CPX).

Methods

We performed CPX by ramp loading with ergometer exercise in total 61 patients who had undergone elective cardiac valve operation (25 patients with MV surgery, age 59.2±9.9 years; 36 patients with AV surgery, age 64.6±12.3 years). We analyzed chronotropic response index (CRI), peak oxygen uptake (peak VO2/W), anaerobic threshold (AT), and peak oxygen pulse (peak VO2/HR) with CPX, and blood hemoglobin concentration (Hb).

Results

The value of CRI was significantly decreased in the patients with MV surgery compared with those with AV surgery (MV; 0.19±0.10 vs. AV; 0.41±0.17, p&lt;0.001). Peak VO2, peak VO2/HR and Hb were not significantly different between patients with MV and those with AV surgery. Patients with MV surgery showed correlations between peak VO2 and Hb (r=0.45, p&lt;0.05), AT and Hb (r=0.52, p&lt;0.01), and a strong correlation between peak VO2 and peak VO2/HR (r=0.63, p&lt;0.001), but not in those with AV surgery.

Conclusions

The present study demonstrated that higher incidence of CI was shown in patients with MV surgery as compared with those with AV surgery. The exercise capacity of patients with MV surgery was determined by peak VO2/HR and Hb. These results suggest that 1) left atrium incision impairs cardiac sympathetic nerves and causes CI, 2) peak VO2/HR which is consisted of arterio-venous oxygen difference and Hb is critical indicator for exercise capacity in patients with MV surgery with CI.

Main results

Funding Acknowledgement

Type of funding source: None

Histamine-2 receptor antagonists (H₂RA) may negatively impact ADL assessment in patients on a convalescent rehabilitation ward

Background/aim: In the convalescent rehabilitation ward, many elderly patients undergo rehabilitation. Histamine-2 receptor antagonists (H₂RA), which is a one of the acid secretion inhibitors, is frequently prescribed for the patients as a peptic ulcer prevention measure. At present, H₂RA are reported as being associated with factors that reduce cognitive function. However, little is known about the relationship H₂RA and rehabilitation outcome. Therefore, this study examined the relationship between H₂RA use and Functional Independence Measure (FIM) gain, which determines rehabilitation outcomes for patients admitted to the convalescent rehabilitation ward. Patients and methods: We retrospectively investigated FIM gain on discharge by both the administration group (H₂RA (+)) (n = 118) and non-administration group (H₂RA (-)) (n = 118). Results: The FIM gain scores of Motor FIM total, Cognition FIM total, and Total FIM were significantly lower in H₂RA (+) than in H₂RA (-) (Motor FIM total: 8.0 [4.0-16.0] [Inter-Quartile Range] vs. 12.0 [5.0-19.2], p =0.0217, Cognition FIM total: 3.0 [1.0-6.0] vs. 5.0 [2.0-7.0], p =0.0120, Total FIM: 11.5 [4.8-20.2] vs. 17.0 [8.0-27.0], p =0.0089). Conclusion: The administration of H₂RA to elderly patients undergoing rehabilitation may prevent cognitive function maintenance or recovery by rehabilitation.

Anticholinergic Load and Nutritional Status in Older Individuals

OBJECTIVES

The association between anticholinergic load-based Anticholinergic Risk Scale scores and nutritional status is unclear in Japanese patients. The aim of this study was to establish whether anticholinergic load affects the nutritional status of geriatric patients in convalescent stages.

DESIGN

Retrospective longitudinal cohort study.

SETTING

Convalescent rehabilitation wards.

PARTICIPANTS

Of the 1490 patients aged ≥65 years who were discharged from convalescent rehabilitation wards between July 2010 and October 2018, 908 patients met the eligibility criteria. They were categorized according to the presence or absence of increased anticholinergic load from admission to discharge.

MEASUREMENTS

Demographic data, laboratory data, the Functional Independence Measure were analyzed between the groups. The primary outcome was Geriatric Nutritional Risk Index (GNRI) at discharge. Multiple linear regression analysis was performed to analyze the relationship between anticholinergic load and GNRI at discharge.

RESULTS

Multiple linear regression analysis after adjusting for confounding factors revealed that anticholinergic load was independently and negatively correlated with GNRI at discharge. Particularly, the use of chlorpromazine, hydroxyzine, haloperidol, metoclopramide, risperidone, etc. increased significantly from admission to discharge.

CONCLUSION

Increased anticholinergic load during hospitalization may be a predictor of nutritional status in geriatric patients.

Determination of Walnut Protein in Processed Foods by Enzyme-Linked Immunosorbent Assay: Interlaboratory Study

Because food allergens from tree nuts, including walnuts, are a frequent cause of adverse food reactions for allergic patients, the labeling of foods containing ingredients derived from tree nuts is required in numerous countries. According to Japanese regulations, the labeling of food products containing walnuts is recommended. To ensure proper labeling, a novel sandwich ELISA kit for the determination of walnut protein in processed foods (Walnut Protein [2S-Albumin] Kit; Morinaga Institute of Biological Science, Inc.; walnut kit) has been developed. We prepared seven types of incurred samples (model processed foods: biscuits, bread, sponge cake, orange juice, jelly, chicken meatballs, and rice gruel) containing 10 g walnut soluble protein/g of food for use in interlaboratory evaluations of the walnut kit. The walnut kit displayed sufficient reproducibility relative standard deviations (interlaboratory precision: 5.89.9 RSDR) and a high level of recovery (81119) for all the incurred samples. All the repeatability relative standard deviation (RSDr) values for the incurred samples that were examined were less than 6.0. The results of this interlaboratory evaluation suggested that the walnut kit could be used as a precise and reliable tool for determination of walnut protein in processed foods.

Enzyme-Linked Immunosorbent Assay Kit for the Determination of Soybean Protein in Processed Foods: Interlaboratory Evaluation

The labeling of foods containing ingredients derived from soybean is recommended in Japan because of an increasing number of patients who are allergic to soybeans. To ensure proper labeling, a novel sandwich ELISA kit for the determination of soybean protein in processed foods (FASTKIT Ver. II, Soybean, Nippon Meat Packers, Inc.; soy kit) has been developed. Five types of incurred samples (model processed foods: rice gruel, sausage, sweet adzuki bean soup, sweet potato cake, and tomato sauce) containing 10 g soybean soluble protein/g food were prepared for use in interlaboratory evaluations of the soy kit. The soy kit displayed a sufficient RSDR value (interlaboratory precision: 9.313.4 RSDR) and a high level of recovery (97114) for all the incurred samples. The RSDr value for the incurred samples was mostly &lt;4.8. The results of this interlaboratory evaluation suggest that the soy kit can be used as a precise and reliable tool for the determination of soybean proteins in processed foods.

P628Association of outpatient cardiac rehabilitation with mortality and morbidities in patients with acute myocardial infarction

Background/Introduction

Outpatient cardiac rehabilitation (CR) is commonly recommended for patients with acute myocardial infarction (AMI). However, the survival benefit has recently been contested, especially with no survival benefit having been found in non-Western countries.

Purpose

To investigate whether outpatient CR, under current real-world clinical practice, is associated with lower mortality and morbidity risks in patients with AMI.

Methods

The retrospective cohort study was conducted from January 2011 to June 2016 (final date of follow-up: July 31, 2016) with a nation-wide administrative database for acute-care hospitals in Japan. Data for 7,411 patients were analyzed, with 5,654 fulfilling the inclusion criteria of being admitted for AMI and receiving both percutaneous coronary intervention and inpatient CR between January 2011 and December 2014. We compared patients who participated in outpatient CR at least once within 180 days of discharge and who did not. To account for measured baseline imbalances between outpatient CR participants and non-participants, 1:1 propensity-score matching was performed. The primary outcome was a composite of all-cause death and recurrence of AMI after the landmark time-point of day 180 after discharge. Secondary outcomes included all-cause death, recurrence of AMI, and heart failure.

Results

Among 5,654 patients (mean [SD] age, 66.8 [12.4] years; 21.2% female; median follow-up period [IQR] 1.44 [0.87 to 2.27] years), 730 (12.9%) received outpatient CR. Of 1,458 propensity-score matched patients, outpatient CR participants did not show a significantly lower risk of the primary outcome than non-participants (1.38 vs. 2.12 per 100 patient-years; hazard ratio [HR], 0.71 [95% CI, 0.32 to 1.61]). Similarly, outpatient CR participation was not associated with lower risks of all-cause death (0.68 vs. 1.31 per 100 patient-years; HR, 0.83 [95% CI, 0.25 to 2.73]), recurrence of AMI (0.69 vs. 0.88 per 100 patient-years; HR, 0.56 [95% CI, 0.19 to 1.66]) or heart failure (2.01 vs. 2.06 per 100 patient-years; HR, 0.89 [95% CI, 0.47 to 1.72]), respectively.

Conclusion

Among patients with AMI who received percutaneous coronary intervention and inpatient CR, outpatient CR was not associated with lower risks of mortality and morbidities. The survival benefit of outpatient CR should be reaffirmed under current real-world clinical practice, especially in non-Western countries.

P4334Effects of Asian dust on blood pressure and blood cell counts: a cross-sectional study of health check-up data

Introduction

Asian dust (AD) is one of the health care problems because AD increases risk for mortality, respiratory, and cardiovascular disease. Previous animal studies showed that particulate matter from AD induced oxidative stress and systemic inflammation, increased blood pressure and heart rate, and decreased cardiac contraction. However, few reports show association of AD with increased blood pressure in human healthy subjects.

Purpose

The aim of this study was to investigate effects of AD on blood pressure and blood cell counts in human.

Methods

Using generalized linear models, we estimated the association between short-term exposure to AD and systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR) and white blood cell (WBC) count in 296,168 participants aged 20 and older (men n=168,579, 56.9%) who underwent medical check-ups and had no anti-hypertensive agents between April 2005 and March 2015 in a health check-up center in Japan. AD days were the days on which AD events occurred, which were defined as decreased visibility (<10km) due to AD monitored by local meteorological observatory. Propensity score matching analysis was performed to reduce the effects of possible confounders such as age, sex, mean temperature, humidity. In multivariable generalized linear models, data of other air pollutant such as SO2, NO2, Ox or suspended particulate matter was used as covariate.

Results

During study period, 61 AD days were observed, and there were 4,670 participants undergoing medical check-ups on AD days. In the propensity score matched population (n=4,670, each), short-term exposure to AD was significantly associated with an increased risk of higher SBP, DBP, HR, or WBC count [β=1.303, 95% confidence interval (CI) 0.577 to 2.029 for SBP, β=0.630, 95% CI 0.122 to 1.138 for DBP, β=0.987, 95% CI 0.410 to 1.563 for HR, β=150.0, 95% CI 64.9 to 235.1 for WBC]. These significant associations were also observed in two-pollutant models. In subgroup analysis according to age, AD exposure had greater impact on SBP, DBP, and HR in younger people (20 to 40 years old), but WBC count in middle-high age (51 years and older).

GLM analysis according to age category

Conclusions

The present study showed that short-term exposure to AD was associated with higher SBP, DBP, HR and WBC count. Short-term exposure to AD may exacerbate sympathetic nervous system for the young and immune system for the elderly.

P884Short-term exposure to asian dust is associated with myocardial infarction with nonobstructive coronary arteries

Background

Asian dust (AD) is considered as one of air pollution that increases risk of acute myocardial infarction (AMI). However, it has not been elucidated whether AD might increase the risk of myocardial infarction with nonobstructive coronary arteries (MINOCA).

Methods

A time-stratified case-crossover design and conditional logistic regression models was used to investigate the association between short-term exposure to AD and admission of AMI during the spring months in a nationwide administrative Diagnostic Procedure Combination (DPC) database, the Japanese Of All cardiac and vascular Diseases (JROAD)-DPC, between April 2012 through March 2016. MINOCA was defined as AMI having angiography without revascularization and coronary atherosclerosis, whereas myocardial infarction with obstructive coronary artery disease (MI-CAD) was AMI with revascularization and/or coronary atherosclerosis. Data for AD events, air pollutants (PM2.5, Ox, NO2, SO2), and meteorological variables were obtained from the nearest monitoring station of the hospital.

Results

During the study period, 3,233 MINOCA and 27,202 MI-CAD patients were identified from 30,435 AMI patients. Although the occurrence of AD events 2 days before the admission was not associated with the admission of AMI and MI-CAD, the AD events was significantly associated with the admission of MINOCA with adjustment for meteorological variables and each air pollutant. In subgroup analysis of MINOCA, patients without low ADL was associated with higher risk of the admission due to AD exposure than those with low ADL, with significant interaction.

Conclusions

AD events might be more likely to trigger onset of MINOCA than MI-CAD.

Acknowledgement/Funding

None

Polarization control with an X-ray phase retarder for high-time-resolution pump-probe experiments at SACLA

Control of the polarization of an X-ray free-electron laser (XFEL) has been performed using an X-ray phase retarder (XPR) in combination with an arrival timing diagnostic on BL3 of the SPring-8 Angstrom Compact free-electron LAser (SACLA). To combine with the timing diagnostic, a pink beam was incident on the XPR crystal and then monochromated in the vicinity of samples. A high degree of circular polarization of ∼97% was obtained experimentally at 11.567 keV, which agreed with calculations based on the dynamical theory of X-ray diffraction. This system enables pump-probe experiments to be operated using circular polarization with a time resolution of 40 fs to investigate ultrafast magnetic phenomena.

Prepatterning of Papilio xuthus caterpillar camouflage is controlled by three homeobox genes: clawless, abdominal-A, and Abdominal-B

Color patterns often function as camouflage to protect insects from predators. In most swallowtail butterflies, younger larvae mimic bird droppings but change their pattern to mimic their host plants during their final molt. This pattern change is determined during the early fourth instar by juvenile hormone (JH-sensitive period), but it remains unclear how the prepatterning process is controlled. Using Papilio xuthus larvae, we performed transcriptome comparisons to identify three camouflage pattern-associated homeobox genes [clawless, abdominal-A, and Abdominal-B (Abd-B)] that are up-regulated during the JH-sensitive period in a region-specific manner. Electroporation-mediated knockdown of each gene at the third instar caused loss or change of original fifth instar patterns, but not the fourth instar mimetic pattern, and knockdown of Abd-B after the JH-sensitive period had no effect on fifth instar patterns. These results indicate the role of these genes during the JH-sensitive period and in the control of the prepatterning gene network.

Abstract P3-14-11: Comparative effectiveness of antiemetic regimens for highly emetogenic chemotherapy-induced nausea and vomiting: A systematic review and network meta-analysis

Background

The optimal choice of antiemetic therapy for chemotherapy-induced nausea and vomiting (CINV) needs to be clarified. This study assessed the efficacy and safety of antiemetic regimens for highly emetogenic chemotherapy (HEC).

Methods

Randomized trials that compared different antiemetic regimens were included from MEDLINE. Quality was assessed using the Cochrane risk-of-bias tool. We followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Data were pooled using random-effects models. We conducted indirect comparisons using network meta-analysis of a Bayesian model. The main outcomes were the odds ratio (OR) for overall complete response (CR [i.e., no emesis and no rescue]). Safety was assessed from the trial description. All statistical tests were two-sided.

Findings

We systematically reviewed 24 randomized control trials (12,104 participants), which compared 12 different antiemetic regimens. Palonosetron (PAL) 0·75 mg (PAL0·75) + dexamethasone (Dex); aprepitant (APR) + a serotonin-3 receptor antagonist (5HT3) + Dex; and APR + PAL (0·25 mg or 0·50 mg) + Dex were more favorable than the reference regimen (OR, 1·51; 95% credibility interval [95%CrI], 1·18-1·91; OR, 1·78; 95%CrI, 1·58-2·05; and OR, 2·28; 95%CrI, 1·66-3·18, respectively). The oral combination of netupitant and palonosetron (NEPA) was more effective than conventional regimens (OR, 2·39; CrI, 1·73-3·30). Olanzapine (OLZ)-containing regimens were apparently the most effective: the ORs of OLZ + 5HT3 + Dex, OLZ + PAL + Dex, and OLZ + APR + 5HT3 + Dex were 2·78, 2·58, and 4·98, respectively.

Interpretation

The regimens of PAL0·75 + Dex, APR + 5HT3 + Dex, and APR + PAL + Dex were more favorable in conventional regimens (i.e., regimens without NEPA or OLZ), which support the NCCN guideline strategy. NEPA could be a better choice than conventional regimens. OLZ-containing regimens could be an optimal choice; thus, more trials need to be accumulated.

Citation Format: Yokoe T, Hayashida T, Nagayama A, Seki T, Takahashi M, Takano T, Abe T, Kitagawa Y. Comparative effectiveness of antiemetic regimens for highly emetogenic chemotherapy-induced nausea and vomiting: A systematic review and network meta-analysis [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 P3-14-11.

Abstract P5-20-11: Comparative effectiveness of neoadjuvant therapy for HER2-Positive breast cancer: Addition of new clinical evidence to network meta-analysis and data update after 5 years

Background: It is becoming more popular to perform neoadjuvant chemotherapy including anti-HER2 agents to operable HER2-positive breast cancer patients. Increasing HER2-targeted treatment options urge us to define the best neoadjuvant therapy. In 2014, we reported the systematical assessment of the efficacy and safety of neoadjuvant therapy for HER2-positive breast cancer, using network meta-analysis based on Bayesian model (Nagayama et al., JNCI 2014). Network meta-analysis synthesizes information from a network of trials, which helps interpret the randomized evidence and can rank treatments from different trials. After five years from our first literature search, we decided to update our analysis due to accumulation of new clinical evidence.

Methods: We assessed odds ratio for pathological complete response (pCR), completion, and safety in seven treatment arms utilizing pooling effect sizes. The treatment arms included the combinations of chemotherapy (CT), trastzumab (tzmb), lapatinib (lpnb) and pertzumab (pzmb). All statistical tests were two-sided, and we followed Preferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA) guidelines.

Results: A database search identified 993 articles with 13 studies meeting the eligibility criteria, adding three studies (a trial of CT + tzmb vs CT + lpnb, and two trials of CT + tzmb vs CT + lpnb vs CT + tzmb + lpnb) to previous analysis. In direct comparison, CT + tzmb significantly achieved more pCR than CT + lpnb (OR=0.68, 95% CI = 0.52 to 0.89, p=.005) despite no statistical difference was found previously. In indirect comparison, treatment arms of dual anti-HER2 agents with CT achieved more pCR than other arms, reducing their credibility intervals against all other arms. This trend was stronger in CT + tzmb + lpnb arm (CT + tzmb + lpnb vs CT + tzmb, OR = 1.62, 95% CrI = 1.19 to 2.22, p = .003), which we added sufficient clinical evidence. Moreover, it exposed the need for additional clinical data for pzmb relative arms. Values of surface under the cumulative ranking (SUCRA) suggested that CT + tzmb + pzmb had the highest probability of being the best treatment arm for pCR (SUCRA = 0.95), followed by CT + tzmb + lpnb (SUCRA = 0.87), and CT + tzmb (SUCRA = 0.62), widening the gap and differentiating the top two dual blockade arms which were close in our previous report. All outcomes from our present analysis were consistent with our previous report and strengthened data solidity by reducing confidence or credibility intervals.

Conclusion: Consistent results in not only in pCR but also in completion rates and adverse events indicate that we are looking at the results which are close to the truth. Additional trials of lpnb relative regimens are not probable to change the results, but pzmb relative trials are required to improve evidence solidity. New clinical data established stronger evidence in network meta-analysis that combining two anti-HER2 agents with CT is most effective in the neoadjuvant setting for HER2-positive breast cancer.

Citation Format: Nakashoji A, Hayashida T, Yokoe T, Maeda H, Watanuki R, Kikuchi M, Seki T, Takahashi M, Abe T, Kitagawa Y. Comparative effectiveness of neoadjuvant therapy for HER2-Positive breast cancer: Addition of new clinical evidence to network meta-analysis and data update after 5 years [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 P5-20-11.

A red fluorophore comprising a borinate-containing xanthene analogue as a polyol sensor

A xanthene derivative containing a borinate moiety emitted red fluorescence with a high quantum yield. The interaction between the borinate and a sugar molecule induced a fluorescence change based on the change in the HOMO-LUMO gap. The response was pH-resistant in a wide range. In addition, catechol quenched through photoinduced electron transfer. The red fluorescence and polyol binding ability of dyes will pave the way for new biological applications of chemical sensors.

Abstract P2-01-37: Technical feasibility and validity of sentinel lymph node biopsy in patients with ipsilateral breast tumor recurrence

Background: The incidence of ipsilateral breast tumor recurrence (IBTR) was reported to be approximately 5-10% of breast cancer patients who had breast-conserving surgery. However, the role of sentinel lymph node biopsy (SLNB) in patients with IBTR still remains to be elucidated. The aim of this study wasto evaluate feasibility and validity of sentinel lymph node biopsy for ipsilateral breast tumor recurrence (second SLNB).

Patients and methods: A prospective database of 1607 patients with clinically node-negative breast cancer who underwent SLNB from January 2005 to May 2015 was analyzed and 46 patients with IBTR underwent SLNB. Lymphatic mapping was performed using a combined method of blue dye and radioisotope. ICG fluorescence imaging was performed in cases with failure of identification by blue dye and radioisotope.

Results: The median age was 52 (range: 36-82) years at the time of second SLNB and the mean size of recurrent tumor was 1.39 ± 0.63 cm. Thirty-one (67.4%) and 10 (21.7%) patients had a history of previous SLNB and axillary lymph node dissection (ALND), respectively. Another five (10.9%) patients had no previous axillary surgery for primary tumors. Preoperative lymphatic mapping by lymphoscintigraphy was successfully performed in 24 of 36 patients (66.7%). The identification rate by lymphoscintigraphy among patients with previous SLNB, ALND, and no axillary surgery was 64.0% (16/25), 66.6% (6/9) and 100% (2/2), respectively (P= 0.583). Overall, sentinel lymph nodes (SLNs) were successfully identified in 37 (80.4%) of 46 patients during surgery. The identification rate in patients with previous SLNB, ALND and no axillary surgery was 80.6% (25/31), 80.0% (8/10) and 80.0% (4/5), respectively (P=0.990). The aberrant lymphatic drainage to extra-ipsilateral axilla was found more frequently in patients with previous ALND compared with previous SLNB and no axillary surgery (40.0% vs. 6.5% vs. 0%, P=0.015).Among three (6.5%) patients with SLN metastases, one patient with previous SLNB had macrometastasis at the ipsilateral axilla and ALND found a positive non-SLN (1/21). The remaining two patients with previous SLNB and ALND had micrometastases at ipsilateral and contralateral axilla, respectively and both patients underwent no further axillary treatment. After second SLNB, systemic treatment including chemotherapy, endocrine therapy and trastuzumab was performed in 17 (37.0%), 36 (78.3%) and seven (15.2%) patients, respectively. No axillary recurrence was observed after a median follow-up time of 37.2 months from surgery for IBTR.

Conclusions: Second SLNB is technically feasible regardless of types of previous axillary surgery and may avoid complications from unnecessary ALND for IBTR. Furthermore, it could improve risk prediction for IBTR and provide valid information for deciding adjuvant therapy.

Citation Format: Matsumoto A, Jinno H, Yanagisawa T, Yoshikawa M, Takahashi Y, Seki T, Takahashi M, Hayashida T, Ikeda T, Kitagawa Y. Technical feasibility and validity of sentinel lymph node biopsy in patients with ipsilateral breast tumor recurrence [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 P2-01-37.

A pre-operative predictive score for the outcome of eccentric rotational acetabular osteotomy in the treatment of acetabular dysplasia and early osteoarthritis of the hip in adults

AIMS

The influence of identifiable pre-operative factors on the outcome of eccentric rotational acetabular osteotomy (ERAO) is unknown. We aimed to determine the factors that might influence the outcome, in order to develop a scoring system for predicting the prognosis for patients undergoing this procedure.

PATIENTS AND METHODS

We reviewed 700 consecutive ERAOs in 54 men and 646 women with symptomatic acetabular dysplasia or early onset osteoarthritis (OA) of the hip, which were undertaken between September 1989 and March 2013. The patients' pre-operative background, clinical and radiological findings were examined retrospectively. Multivariate Cox regression analysis was performed using the time from the day of surgery to a conversion to total hip arthroplasty (THA) as an endpoint. A risk score was calculated to predict the prognosis for conversion to THA, and its predictive capacity was investigated.

RESULTS

The congruity of the hip, age, the pre-operative minimum width of the joint space and range of abduction were identified as factors predicting conversion to THA. For three groups of patients (scoring 0 to 5, 6 to 7, and 8 to 9 points), the Kaplan-Meier event-free rates of survival at 15 years post-operatively for conversion to THA were 99.6%, 85.2% and 67.3%, respectively.

CONCLUSION

These four pre-operative factors are easily measured and predict the prognosis for patients following ERAO. They may be used for decision making when offering surgical treatment to patients with acetabular dysplasia and early onset osteoarthritis. Cite this article: Bone Joint J 2016;98-B:1326-32.

Comparison of oncological safety between nipple sparing mastectomy and total mastectomy using propensity score matching

INTRODCUTION

Although nipple sparing mastectomy (NSM) has attracted increased recognition as an alternative to traditional mastectomy approaches, its oncological safety is unclear. The purpose of this study was to compare the local recurrence rate between NSM and total mastectomy (TM).

METHODS

Between 2003 and 2013, 121 and 557 patients with stage 0-III breast cancer underwent NSM and TM respectively. Multivariate Cox regression and propensity score models were used to compare the two groups.

RESULTS

There was no significant difference in the five-year local recurrence rate between the NSM and TM groups (7.6% vs 4.9%, p=0.398). In multivariate analysis, NSM was not a risk factor for local recurrence (hazard ratio: 1.653, 95% confidence interval: 0.586-4.663, p=0.343). Propensity score matching found similar five-year local recurrence free survival rates between the two groups (92.3% vs 93.7%, p=0.655).

CONCLUSIONS

Our results suggest that NSM may provide oncological safety comparable with mastectomy for carefully selected patients.