The impact of rare cancer and early-line treatments on the benefit of comprehensive genome profiling-based precision oncology

BACKGROUND

Comprehensive genome profiling (CGP) serves as a guide for suitable genomically matched therapies for patients with cancer. However, little is known about the impact of the timing and types of cancer on the therapeutic benefit of CGP.

MATERIALS AND METHODS

A single hospital-based pan-cancer prospective study (TOP-GEAR; UMIN000011141) was conducted to examine the benefit of CGP with respect to the timing and types of cancer. Patients with advanced solid tumors (>30 types) who either progressed with or without standard treatments were genotyped using a single CGP test. The subjects were followed up for a median duration of 590 days to examine therapeutic response, using progression-free survival (PFS), PFS ratio, and factors associated with therapeutic response.

RESULTS

Among the 507 patients, 62 (12.2%) received matched therapies with an overall response rate (ORR) of 32.3%. The PFS ratios (≥1.3) were observed in 46.3% (19/41) of the evaluated patients. The proportion of subjects receiving such therapies in the rare cancer cohort was lower than that in the non-rare cancer cohort (9.6% and 17.4%, respectively; P = 0.010). However, ORR of the rare cancer patients was higher than that in the non-rare cancer cohort (43.8% and 20.0%, respectively; P = 0.046). Moreover, ORR of matched therapies in the first or second line after receiving the CGP test was higher than that in the third or later lines (62.5% and 21.7%, respectively; P = 0.003). Rare cancer and early-line treatment were significantly and independently associated with ORR of matched therapies in multivariable analysis (P = 0.017 and 0.004, respectively).

CONCLUSION

Patients with rare cancer preferentially benefited from tumor mutation profiling by increasing the chances of therapeutic response to matched therapies. Early-line treatments after profiling increase the therapeutic benefit, irrespective of tumor types.

Development of a Reverse-Yield Factor Database Disaggregating Japanese Composite Foods into Raw Primary Commodity Ingredients Based on the Standard Tables of Food Composition in Japan

The reverse-yield factor (RF) database was developed for qualitatively and quantitatively disaggregating Japanese composite foods into raw primary commodity (RPC) ingredients. Representative equations for four types (dried, salted, fermented and mixed foods) were developed to calculate RFs using the food content and composition data for composite foods listed in the Standard Tables of Food Composition in Japan-2020-(STFCJ), published by the Ministry of Education, Culture, Sports, Science and Technology of Japan. Out of 1150 composite foods identified in the STFCJ, RFs for 54 dried, 41 salted, 40 fermented and 818 mixed foods were obtained. RFs for 197 mixed foods could not be calculated because these foods were produced from ingredients with no specified information and/or through complex processing. The content and composition of Japanese composite foods would be interpreted representatively by RFs in the developed database.

How can we promote vaccination of the mass population?-Lessons from the COVID-19 vaccination defaults

While vaccines are pivotal in combating COVID-19, concerns about side effects and complex procedures have hindered complete vaccination. Prior studies suggest that individuals defaulted to opt-out exhibit higher COVID-19 vaccination rates compared to those in opt-in systems. However, these studies were conducted in countries with a tolerant attitude towards vaccination and default changes, targeting specific age groups, and did not address potential deterrents like the increase in cancellation rates on the day, discomfort towards changing defaults, or the possibility of the opt-out effect being a one-time occurrence. Under the hypothesis that the default nature of the COVID-19 vaccination system influences attitudes towards vaccination even in countries conservative about vaccination and default changes like in Japan, we aimed to examine the differences in the first and second dose vaccination rates, cancellation rates, and the number of complaints between the opt-in and opt-out systems for COVID-19 vaccination. An email survey was conducted in 10 cities in A Prefecture, Japan. The results showed not only higher COVID-19 vaccination rates across all comparable age groups in the opt-out group but also a notably smaller decrease in the second-dose vaccination rate compared to the opt-in group, all achieved without any complaints about the system's introduction. Consequently, it can be inferred that the potential inhibiting factors were largely overcome. Despite some limitations, such as regional specificity, the study suggests that opt-out systems might increase COVID-19 vaccination coverage without leading to significant cancellations or complaints, presenting a promising strategy to facilitate vaccination efforts.

Recommendations for the use of next-generation sequencing in patients with metastatic cancer in the Asia-Pacific region: a report from the APODDC working group

INTRODUCTION

Next-generation sequencing (NGS) diagnostics have shown clinical utility in predicting survival benefits in patients with certain cancer types who are undergoing targeted drug therapies. Currently, there are no guidelines or recommendations for the use of NGS in patients with metastatic cancer from an Asian perspective. In this article, we present the Asia-Pacific Oncology Drug Development Consortium (APODDC) recommendations for the clinical use of NGS in metastatic cancers.

METHODS

The APODDC set up a group of experts in the field of clinical cancer genomics to (i) understand the current NGS landscape for metastatic cancers in the Asia-Pacific (APAC) region; (ii) discuss key challenges in the adoption of NGS testing in clinical practice; and (iii) adapt/modify the European Society for Medical Oncology guidelines for local use. Nine cancer types [breast cancer (BC), gastric cancer (GC), nasopharyngeal cancer (NPC), ovarian cancer (OC), prostate cancer, lung cancer, and colorectal cancer (CRC) as well as cholangiocarcinoma and hepatocellular carcinoma (HCC)] were identified, and the applicability of NGS was evaluated in daily practice and/or clinical research. Asian ethnicity, accessibility of NGS testing, reimbursement, and socioeconomic and local practice characteristics were taken into consideration.

RESULTS

The APODDC recommends NGS testing in metastatic non-small-cell lung cancer (NSCLC). Routine NGS testing is not recommended in metastatic BC, GC, and NPC as well as cholangiocarcinoma and HCC. The group suggested that patients with epithelial OC may be offered germline and/or somatic genetic testing for BReast CAncer gene 1 (BRCA1), BRCA2, and other OC susceptibility genes. Access to poly (ADP-ribose) polymerase inhibitors is required for NGS to be of clinical utility in prostate cancer. Allele-specific PCR or a small-panel multiplex-gene NGS was suggested to identify key alterations in CRC.

CONCLUSION

This document offers practical guidance on the clinical utility of NGS in specific cancer indications from an Asian perspective.

Individual Learning Needs of Japanese Public Health Dietitians by Years of Experience in Health Promotion

Lifelong education for dietitians in Japan is based mainly on competencies according to years of experience. Because learning content differs depending on the desired position and specialty, training programs that reflect the individual learning needs of public health dietitians are needed. This study aimed to assess the individual learning needs of public health dietitians via years of experience in health promotion. In 2021, an online survey of public health dietitians involved in health promotion in prefectures, designated cities, and other municipalities throughout Japan was conducted. Years of experience in health promotion were categorized as early (<10 years), mid-career (10-19 years), and leadership (≥20 years) periods. To ascertain individual learning needs, the survey asked about respondents' desired final position, career path, and skills they felt they needed to improve in the future. Of the 1649 public health dietitians analyzed, all administrative categories preferred to work as public health generalists in mid-career or leadership periods rather than in the early period. In municipalities, more public health dietitians across all experience categories selected "professional competence", such as knowledge in specialized areas and nutritional guidance techniques. It was suggested that public health dietitians in the mid-career and leadership periods have individual learning needs, in both nutrition specialists and public health generalists.

The vision for public health dietitians' skill improvement over the next 10 years in Japan: A qualitative study

Objectives

To obtain the basis for developing a new human resource development program. We examined the association between their position type and their vision for skill improvement in the profession in the next 10 years.

Study design

This was a qualitative study.

Methods

In 2021, we conducted an exhaustive survey of Japanese public health dietitians working in Japanese local governments. Using qualitative content analysis, we analyzed the participants' descriptions of how the profession could improve their skills over the next 10 years.

Results

Regardless of the participants' organization of employment or their target position type, seven common categories were extracted; [goals], [health promotion activities], [organizational activities], [evaluation from others], [cooperation], [skills to be acquired], and [means for improving skills]. Depending on the organization type, 35-40 subcategories were extracted from those who wanted to be staff, 35-38 subcategories from those who wanted to be supervisors, and 20-37 subcategories from those who wanted to be managers. Different subcategories were extracted to describe the difference between specialists and generalists in [goals]. Participants described challenges with [evaluation from others] and [collaboration], regardless of the target position type or [goals].

Conclusion

The vision for Japanese public health dietitians' skill improvement to achieve in the next 10 years describes challenges with business evaluation and collaborative work. However, participants differed across what skills they wanted to improve based on the direction of their careers. To offer public health dietitians learning content that connects with their desired direction, a new human resource development program needs to be considered.

Online training of Covid-19 infection prevention and control for healthcare workers in psychiatric institutes

BACKGROUND

This study aimed to develop a unique online infection prevention and control (IPC) training on Covid-19 for healthcare workers in psychiatric institutes in Japan and to examine its efficacy based on its impact on the knowledge, attitude, and confidence about IPC for Covid-19 among the healthcare workers.

METHOD

This quasi-experimental study was conducted using online training on Covid-19 IPC for healthcare workers in various psychiatric institutes from April 2021 to March 2022. An online training video on Covid-19 IPC was developed. Voluntary healthcare workers in psychiatric institutes located in five prefectures in Japan were recruited to participate in this training. The participants then completed 30 min of online training and surveys about knowledge, attitude, and confidence were conducted pre, post, and three months after the training. The video training and surveys were contextually validated by the experts, but not by any previous study.

RESULTS

A total of 224 participants were included, of which 108 (54.0%) were men. The mean (standard deviation (SD)) age and the mean occupational experience were 47.4 (9.5) and 18.0 (12.6) years, respectively. Among the participants, 190 (84.8%) completed the post-training, and 131 (58.5%) completed the three-month-later training surveys. The total score on the quizzes in the post-training (+ 31.1%, SD 15.7, p-value < 0.01) and three-month-later training (+ 14.9%, SD 16.8, p-value < 0.01) surveys had significantly increased from that in the pre-training survey. In contrast, the total score in the three-month-later training had significantly decreased from that in the post-training survey (-16.1%, SD 16.7, p-value < 0.01).

CONCLUSION

Thirty minutes of online training about IPC for Covid-19 had improved knowledge, confidence, and attitude among psychiatric healthcare workers. Regular online training would help in preventing the transmission or formation of clusters of Covid-19 in psychiatric healthcare institutes.

A Food Consumption-Based Diet Quality Score and Its Correlation With Nutrient Intake Adequacy Among Japanese Children

OBJECTIVE

Diet quality indices reflect overall dietary patterns better than single nutrients or food groups. Focusing on the needs of children, this study developed a measure of adherence to the Japanese Food Guide Spinning Top (JFGST), which was developed by the Ministry of Health, Labour and Welfare and Ministry of Agriculture, Forestry and Fisheries, Japan, and determined the correlation between index scores and nutrient intake.

RESEARCH METHODS AND PROCEDURES

This cross-sectional study was conducted among 48 children between six and nine years of age from a coastal town in the Kinki region of Japan. Data were collected between August 2012 and March 2013, including the 12-day diet records (three days over four seasons) of each participant. For children, adherence to the JFGST entails the consumption of five core food groups, including grain, fish and meat, vegetables, milk, and fruits (total possible score of 50). Spearman's correlation coefficients were calculated to identify any correlations between JFGST scores and nutrient intake.

RESULTS

The mean participant JFGST score was 25 ± 10. Higher JFGST scores were correlated with higher intake of monounsaturated fatty acids, n-6 polyunsaturated fatty acids, dietary fiber, potassium, calcium, magnesium, phosphorus, zinc, copper, vitamin A, vitamin D, riboflavin, pantothenate, and vitamin C. JFGST scores were also positively correlated with nutrient adequacy for calcium, magnesium, iron, zinc, copper, vitamin A, thiamine, riboflavin, vitamin B₆, vitamin B₁₂, folate, and vitamin C.

CONCLUSION

The index employed in this study may adequately express diet quality among Japanese children.

POS1482-HPR PAIN CATASTROPHIZING IS ASSOCIATED WITH RESIDUAL PAIN AFTER REACHING IMPROVED CONDITIONS OF SWOLLEN/TENDER JOINTS AND SERUM C-REACTIVE PROTEIN LEVEL

Background:

It has long been recognized that immune-mediated inflammatory diseases, such as rheumatoid arthritis (RA), are prone to coexist with depression due to the effects of cytokines, and that these two illnesses lead to an elevation in patients’ pain. However, we often encounter patients with RA who suffer from residual pain despite an improvement in disease activity and inflammation. The specific psychological factors associated with residual pain have not yet been clarified. In addition to the traditional psychological factors, such as depression and anxiety, we focused on pain catastrophizing due to the distortion of pain perception and explored its association with residual pain.

Objectives:

To examine whether psychological factors, such as pain catastrophizing, depression, and anxiety, are associated with self-reported pain visual analogue scale (pain-VAS) scores in RA patients with 1 or less on 28joints- swollen/tender counts (SJC/TJC) and CRP.

Methods:

This was a cross-sectional study of 290 RA outpatients (85% of whom were women) with scores of less than 1 on SJC, TJC, and CRP, with a median (IQR) age of 66 (57–73) years. The participants completed questionnaires, including pain VAS (0–100 mm), Pain Catastrophizing Scale (PCS, 0–52 scale), and Hospital Depression and Anxiety Scale (HADS, 0–42 scale). Using linear regression analyses, we analysed whether PC (PCS ≥30), depression (HADS-D ≥11), and anxiety (HADS-A ≥11) (independent variables) were associated with pain VAS scores (dependent variable). After univariate regression analysis, multivariate analysis adjusted for confounding factors was performed.

Results:

Patients reported a wide range of pain severity with a median (range) pain VAS score of 9 (0–96mm). The prevalence of anxiety and depression were 5.5% and 5.9%, respectively. Meanwhile, 24.1% of the patients experienced pain catastrophizing. Pain catastrophizing was associated with pain VAS scores in univariate and multivariate analyses (Table 1). The presence of anxiety and depression was not associated with pain VAS scores in any model. Multivariate analysis of other covariates showed that age, disease duration, and presence of SJC/TJC of joints other than the 28 joints were positively correlated with pain VAS scores.

Table 1.

Univariate and multivariate regression analysis for independent variables associated with pain-VAS scores

UnivariateMultivariate independent variablesModel 1*Model 2**Pain catastrophizingEstimate3.74.13.695%CI 0.7 to 6.61.1 to 7.00.5 to 6.6p-value0.0150.0060.021AnxietyEstimate3.74.40.595%CI -1.9 to 9.2 -1.0 to 9.9 -3.5 to 7.9p value0.1980.1080.453DepressionEstimate3.54.23.995%CI -1.9 to 8.9 -1.1 to 9.5 -1.9 to 8.7p-value0.2040.1190.210

The covariates in multivariate analysis are as follows: age, sex, body mass index, disease duration, Steinbrocker’s Stage, prednisolone dosage, biologic agents use, and presence of swollen joint counts/tender joint counts of joints other than the 28 joints.

*Model 1: each psychological independent variable and the above covariates.

**Model 2: all psychological independent variables and the above covariates.

Conclusion:

Pain catastrophizing was associated with pain VAS scores in RA patients with 1 or less on 28joints-SJC/TJC and CRP, emphasising that residual pain in the patients should be treated in a biopsychosocial framework focussing on pain catastrophizing.

Disclosure of Interests:

Tamami Yoshida: None declared, Motomu Hashimoto Speakers bureau: Mitsubishi Tanabe Pharma Corporation; Bristol-Myers Squibb; Eisai Co., Ltd.; and Eli Lilly and Company., Grant/research support from: Mitsubishi Tanabe Pharma Corporation; Bristol-Myers Squibb; Eisai Co., Ltd.; and Eli Lilly and Company., Kosaku Murakami Speakers bureau: Eisai Co., Ltd.; Chugai Pharmaceutical Co., Ltd.; Pfizer Inc.; Bristol-Myers Squibb; Mitsubishi Tanabe Pharma Co; UCB Japan Co., Ltd.; Daiichi Sankyo Co., Ltd.; and Astellas Pharma Inc., Consultant of: Eisai Co., Ltd.; Chugai Pharmaceutical Co., Ltd.; Pfizer Inc.; Bristol-Myers Squibb; Mitsubishi Tanabe Pharma Co; UCB Japan Co., Ltd.; Daiichi Sankyo Co., Ltd.; and Astellas Pharma Inc., Koichi Murata Speakers bureau: Eisai Co., Ltd. and Astellas Pharma Inc., Consultant of: Eisai Co., Ltd. and Astellas Pharma Inc., Kohei Nishitani Grant/research support from: Asahi-Kasei Pharma., Ryu Watanabe Speakers bureau: Mitsubishi Tanabe Pharma Co; Pfizer Inc.; Sanofi S.A.; AbbVie GK; Asahi Kasei Pharma; Eisai Co., Ltd.; Eli Lilly and Company; Bristol-Myers Squibb; and Janssen Pharmaceutical K.K., Teruhide Koyama: None declared, Ritei Uehara: None declared, Masao Tanaka Speakers bureau: AbbVie GK, Asahi Kasei Pharma., Astellas Pharma Inc., Ayumi Pharmaceutical Co., Chugai Pharmaceutical Co., Ltd., Eisai Co., Ltd., Eli Lilly Japan K.K., Janssen Pharmaceutical K.K., Mitsubishi Tanabe Pharma Co., Novartis Pharma K.K., Pfizer Inc., Taisyo Pharma., Ltd., UCB Japan Co., Ltd., Grant/research support from: AbbVie GK, Asahi Kasei Pharma., Astellas Pharma Inc., Ayumi Pharmaceutical Co., Chugai Pharmaceutical Co., Ltd., Eisai Co., Ltd., Eli Lilly Japan K.K., Janssen Pharmaceutical K.K., Mitsubishi Tanabe Pharma Co., Novartis Pharma K.K., Pfizer Inc., Taisyo Pharma., Ltd., UCB Japan Co., Ltd., Hiromu Ito Grant/research support from: Bristol-Myers Squibb, Eisai Co, Taisyo Pharma., and Mochida., Shuichi Matsuda: None declared

Pathological assessment of osimertinib-associated cardiotoxicity in EGFR-mutated non-small cell lung cancer patients

Background

Osimertinib, a third-generation epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI), inhibits both EGFR-TKI sensitizing mutations and resistant T790M mutations detected in non-small cell lung cancer (NSCLC) patients. Cardiac adverse events (AEs) induced by osimertinib are infrequent; however, cases of severe associated cardiac dysfunction have been reported and remain poorly understood.

Purpose

To assess pathogenesis of osimertinib-associated cardiac AEs, we analyzed myocardial specimens of three NSCLC cases with osimertinib-associated cardiac dysfunction.

Results

Analysis of LVEF prior to and after osimertinb administration in 36 NSCLC patients showed significant decrease of LVEF from 69% to 63%. Within this cohort, right ventricular (RV) biopsy was performed in 2 cases to further understand the pathophysiology of cardiac dysfunction. Case 1 was 78-year-old female with advanced NSCLC harboring an EGFR L858R mutation was treated with osimertinib as second line therapy. After 3 moths of osimetinib treatment, she presented with dyspnea, high NT-proBNP and troponin I, and significantly decreased left ventricular ejection fraction (LVEF) at 28%. RV biopsy showed moderate cardiomyocyte hypertrophy without inflammatory cell infiltration. Case 2 was 52-year-old female with advanced NSCLC harboring L858R mutation. She was treated with osimertinib as first line therapy. After 2 weeks of osimertinib, screening echocardiography revealed a reduction of LVEF from 63% to 41% without cardiac symptom. RV biopsy showed mild cardiomyocyte hypertrophy with infiltration of a few inflammatory cells in interstinum. We further analyzed death case of NSCLC. Case 3 was 63-year-old female with advanced NSCLC harboring EGFR ex. 19 del. and T790M mutations. After 6 months of osimertinib, she suffered from severe respiratory failure and severely reduced LVEF at 27%. She died on the 44th day after admission. Pathological autopsy revealed mild to moderate cardiomyocyte hypertrophy without inflammatory cell infiltration in both ventricles. These pathological findings may indicate neither myocyte injury nor myocarditis was induced by osimertinib in myocardium.

Conclusion

Although additional data collection of advanced NSCLC patients will be important in understanding the pathophysiology of cardiac AEs with osimertinib, osimertinib-associated cardiotoxicity may result from functional inhibition of myocyte contractility by osimertinib without induction of cell death or inflammation.

Funding Acknowledgement

Type of funding source: None

Overall nutrient and total fat intake among Japanese people: The INTERLIPID Study Japan

BACKGROUND AND OBJECTIVES

Total fat intake is linked to the intake of other nutrients. Little data are available on the extent to which total fat affects diet quality in Japanese people. We investigated the relationship between total fat intake and other nutrient intake using INTERLIPID/ INTERMAP data on Japanese people living in Japan.

METHODS AND STUDY DESIGN

The participants included 371 men and 401 women with a healthy body mass index and between the ages of 40 and 59 from 4 population samples in Japan. Nutrient intake data were based on four in-depth 24-hour dietary recalls per person.

RESULTS

Analysis of covariance adjusted for age revealed that total fat intake was positively related to intakes of calcium, thiamine, riboflavin, meat, eggs, and milks and dairy products for both sexes. Total fat intake was inversely associated with carbohydrate and cereals intake for both sexes. On average, men with total fat intake between 25.0 and 27.4% of total energy had saturated fatty acids above 7%, which is the upper limit recommended for preventing lifestyle-related diseases. Men with total fat intake less than 20% of total energy had a higher risk of not meeting the Dietary Reference Intakes for Japanese (2015) for some nutrients.

CONCLUSIONS

Total fat intake was positively associated with calcium, thiamine, and riboflavin intakes and inversely associated with carbohydrate intake. Our results suggest that in 40-59-year-old men with a healthy body mass index, total fat intake between 20 and 27% of total energy may best support adequate intake of other nutrients.

Anomalous Temperature Behavior of the Chiral Spin Helix in CrNb_{3}S_{6} Thin Lamellae

Using Lorentz transmission electron microscopy and small-angle electron scattering techniques, we investigate the temperature-dependent evolution of a magnetic stripe pattern period in thin-film lamellae of the prototype monoaxial chiral helimagnet CrNb_{3}S_{6}. The sinusoidal stripe pattern appears due to formation of a chiral helimagnetic order (CHM) in this material. We found that as the temperature increases, the CHM period is initially independent of temperature and then starts to shrink above the temperature of about 90 K, which is far below the magnetic phase transition temperature for the bulk material T_{c} (123 K). The stripe order disappears at around 140 K, far above T_{c}. We argue that this cascade of transitions reflects a three-stage hierarchical behavior of melting in two dimensions.

Relationship between the administration of nicardipine hydrochloride and the development of delirium in patients on mechanical ventilation

A history of hypertension is a known risk factor for delirium in patients in intensive care units, but the effect of antihypertensive agents on delirium development is unclear. Nicardipine, a calcium channel blocker, is widely used in ICU as a treatment agent for hypertensive emergency. This study investigated the relationship between the administration of nicardipine hydrochloride and delirium development in patients under mechanical ventilation. We conducted a medical chart review of 103 patients, who were divided into two groups according to the use of nicardipine hydrochloride. The prevalence of delirium was compared with respect to factors such as age, sex, laboratory data, and medical history, by multivariate analysis. 21 patients (20.4 %) were treated with nicardipine hydrochloride in 103 patients. The treatment and non-treatment groups differed significantly in age (72 vs. 65 years) and history of high blood pressure (57% vs. 11%). Multivariate analysis revealed that patients in the treatment group developed delirium significantly less often than those in the non-treatment group (19% vs. 48%). These results suggested that treatment of high blood pressure with nicardipine hydrochloride is a possible method for preventing the development of delirium.

Element Selectivity in Second-Harmonic Generation of GaFeO_{3} by a Soft-X-Ray Free-Electron Laser

Nonlinear optical frequency conversion has been challenged to move down to the extreme ultraviolet and x-ray region. However, the extremely low signals have allowed researchers to only perform transmission experiments of the gas phase or ultrathin films. Here, we report second harmonic generation (SHG) of the reflected beam of a soft x-ray free-electron laser from a solid, which is enhanced by the resonant effect. The observation revealed that the double resonance condition can be met by absorption edges for transition metal oxides in the soft x-ray range, and this suggests that the resonant SHG technique can be applicable to a wide range of materials. We discuss the possibility of element-selective SHG spectroscopy measurements in the soft x-ray range.

Microscopic Investigation into the Electric Field Effect on Proximity-Induced Magnetism in Pt

Electric field effects on magnetism in metals have attracted widespread attention, but the microscopic mechanism is still controversial. We experimentally show the relevancy between the electric field effect on magnetism and on the electronic structure in Pt in a ferromagnetic state using element-specific measurements: x-ray magnetic circular dichroism (XMCD) and x-ray absorption spectroscopy (XAS). Electric fields are applied to the surface of ultrathin metallic Pt, in which a magnetic moment is induced by the ferromagnetic proximity effect resulting from a Co underlayer. XMCD and XAS measurements performed under the application of electric fields reveal that both the spin and orbital magnetic moments of Pt atoms are electrically modulated, which can be explained not only by the electric-field-induced shift of the Fermi level but also by the change in the orbital hybridizations.

Familial pulmonary thromboembolism with a prothrombin mutation and antithrombin resistance

We describe the case of a 45-year-old man with congenital thrombophilia induced by antithrombin resistance. He had recurrent venous thrombosis without traditional risk factors or abnormal coagulation function and had a family history of venous thrombosis which included his mother, brother, and nephew. We suspected the association of hereditary antithrombin resistance, which has been reported in some cases of familial venous thromboses due to prothrombin mutations. Although prothrombin abnormality typically shows a bleeding tendency, variations of arginine at position 596 in the gene encoding prothrombin have been reported to conversely cause thrombosis. Therefore, we tested and detected antithrombin resistance in the patient's plasma. We also performed genetic analysis for his second filial generation, and found a missense mutation (c.1787G>A), resulting in a substitution of arginine for glutamine at position 596 (p.Arg596Gln) in the gene encoding prothrombin (called prothrombin Belgrade). The Gln596 substitution caused the susceptibility to thrombosis. This variation is the same as one previously reported in Serbia and India, and it is the third report in Japan. <Learning objective: Venous thrombosis is caused by multiple factors. However, approximately 20% of the patients with venous thrombosis of unknown cause have no risk factors. The present case had no known risk factors, rather he has a family history of thrombosis. Therefore, we suspected an association with inherited thrombophilia. Although several gene mutations have been found in some families with inherited thrombophilia, many mutations remain to be detected.>.

Relationship of Consumption of Meals Including Grain, Fish and Meat, and Vegetable Dishes to the Prevention of Nutrient Deficiency: The INTERMAP Toyama Study

A Japanese-style diet consists of meals that include grain (shushoku), fish and meat (shusai), and vegetable dishes (fukusai). Little is known about the association of such meals (designated well-balanced meals hereafter) with nutrient intake. We therefore examined the frequency of well-balanced meals required to prevent nutrient deficiency. Participants were Japanese people, ages 40 to 59 y, from Toyama, recruited for INTERMAP, in an international population-based study. Each person provided 4 in-depth 24-h dietary recalls (149 men, 150 women). The prevalence of risk ratios of not meeting the Dietary Reference Intakes for Japanese (2015) was calculated. Well-balanced diets were assessed by the Japanese Food Guide Spinning Top. We counted the frequencies of meals in which participants consumed 1.0 or more servings of all 3 dishes categories. We divided the frequency of consumption of well-balanced meals into the following 4 groups: <1.00 time/d, 1.00-1.49 times/d, 1.50-1.74 times/d, and ≥1.75 times/d. Compared with participants in the highest frequency group for well-balanced meals, those who consumed well-balanced meals less than once a day had a higher risk of not meeting the adequate intake for potassium and the recommended dietary allowance for vitamin A. Those who consumed well-balanced meals on average less than 1.50 times per day had a higher risk of not meeting the recommended dietary allowance for calcium and vitamin C. Our results suggest that individuals should on average consume well-balanced meals more than 1.5 times per day to prevent calcium and vitamin C deficiencies.