Postoperative Changes of Spinopelvic Sagittal Parameters After Cervical Laminoplasty for Cervical Spondylotic Myelopathy

STUDY DESIGN

A retrospective analysis of prospectively collected data.

OBJECTIVE

To investigate postoperative changes of spinopelvic sagittal parameters after laminoplasty for cervical spondylotic myelopathy (CSM) accompanying postoperative cervical kyphotic deformity or cervical regional sagittal imbalance.

SUMMARY OF BACKGROUND DATA

To the best of our knowledge, no study has been reported concerning postoperative changes of spinopelvic sagittal parameters accompanying postoperative deterioration of cervical sagittal alignment or balance after cervical laminoplasty.

METHODS

Forty-five CSM patients without preoperative cervical kyphosis who underwent laminoplasty were included. None of the 45 patients had a medical history of previous spine surgery, hip joint surgery, or knee joint surgery. The patients were divided into 2 groups (kyphosis and lordosis groups) according to postoperative C2-7 angle, and they were also divided into 2 other groups (imbalance and balance groups) according to postoperative C1-7 sagittal vertical axis. Postoperative changes (Δ) of T1 slope (T1S), thoracic kyphosis, thoracolumbar kyphosis (TLK), lumbar lordosis (LL), Pelvic tilt, and C7 sagittal vertical axis were measured comparing lateral radiographs of the whole spine in the standing position taken at 1 year postoperatively with those before surgery.

RESULTS

Both T1S and TLK significantly decreased after cervical laminoplasty in the kyphosis group compared with the lordosis group. On the other hand, both T1S and TLK increased significantly, and LL significantly decreased after surgery in the imbalance group compared with the balance group.

CONCLUSIONS

At 1 year after laminoplasty for CSM, both T1S and TLK significantly decreased accompanying postoperative cervical kyphotic deformity as a compensatory action for postoperative cervical kyphosis to maintain the global sagittal balance of the spine, whereas both T1S and TLK increased significantly, and LL significantly decreased accompanying postoperative cervical reginal sagittal imbalance which resulted in postoperative forward inclination of the whole spine.

Numb Chin Syndrome as the Initial Presentation of Mandibular Metastasis of Colorectal Cancer: A Case Report

Numb chin syndrome (NCS) is hypesthesia of the mandible and lower lip caused by damage to the inferior alveolar or mandibular nerves, commonly due to dental treatment or osteomyelitis, but occasionally caused by malignant tumors. We report the case of a male in his 60s. He came to our hospital with a chief complaint of mandibular pain and paresthesia in the right side of the mental region. He had noticed swelling of the left mandible one month before the initial visit and strong hypesthesia of the right side of the mental region one week before the initial visit. Panoramic radiographs showed slight osteosclerosis of the left side mandible at the initial visit. Blood tests showed only a slight inflammatory reaction. The diagnosis of mandibular osteomyelitis and numb chin syndrome was made, and a contrast-enhanced CT scan was performed to investigate the possibility of neoplastic lesions, but no obvious cause was found. Osteosclerosis was minimal. A tissue biopsy was recommended, but the patient did not consent. Considering the possibility of NCS due to a hematologic disorder, the patient was referred to a hematologist, but no cause could be identified at the initial visit. With time, the markedly severe pain worsened, and the possibility of a neoplastic lesion was again suspected. Blood tests were performed, which revealed abnormally high levels of CA19 and CEA. He consulted a gastroenterologist, who found a tumor in the ileocecal region on contrast-enhanced CT, and multiple systemic metastases were found on a PET-CT scan the next day. Systemic chemotherapy was administered for multiple metastatic unresectable colorectal cancer (cT4N1aMc2 stage IVc).

Primary Oral Mixed Neuroendocrine-Non-neuroendocrine Neoplasm (MiNEN): A Rare Case Report and Review of the Literature

Mixed neuroendocrine-non-neuroendocrine neoplasms (MiNENs) are rare tumors recently characterized by the presence of both neuroendocrine and non-neuroendocrine components within the same tumor tissue. Although MiNEN found their place in the WHO classification for various organs, this composite tumor in the head and neck region remains exceptionally rare. We present a case of primary oral MiNEN in a 64-year-old male located on the left side of lower gingiva. Biopsy raised suspicion of neuroendocrine carcinoma (NEC) and the patient underwent partial mandibulectomy. The resected specimen showed two distinct components of NEC and squamous cell carcinoma (SCC) with the confirmation of immunohistochemical markers. There has been no sign of recurrence nor metastasis 6 years after the surgery. In addition, we have conducted a review of published cases with potential relevance to this entity, resulting in five cases. The diverse terminology reinforces the need for a standardized classification system of oral/head and neck MiNENs.

Docetaxel administered through a novel lymphatic drug delivery system (LDDS) improved treatment outcomes for lymph node metastasis

Recently, sentinel lymph nodes (LNs) have been recognized as a starting point of hematogenous metastasis; thus, an increase in the control rate of LN metastasis is expected to improve the survival rate. Although surgical treatment and radiation therapy are commonly used for the radical treatment of LNs, these treatments are associated with lymphedema, pain, and an extended hospital stay. In a recent mouse study, activation of metastatic tumors in distant organs was reported after removing LNs, with or without metastasis to the LNs. Thus, there is the necessity for cancer treatment that can replace LN removal. Here, we evaluated the treatment efficacy of lymphatic drug delivery system (LDDS) with osmotic pressure and viscosity escalated Docetaxel at the early stage of LN metastasis. MXH10/Mo/lpr mice were inoculated with mouse breast cancer cells into Subiliac LN to create the metastatic mouse model. Docetaxel was injected into mouse mammary carcinoma cells inoculated LN as a single shot (SS) or double shot (DS) to understand the therapeutic mechanism of a single shot or double shot intervention using an in vivo imaging system, histology, and qPCR. The results showed that the DS administration of docetaxel at 1,960 kPa (12 mPa∙s) had better therapeutic outcomes with increased complete response and improved survival with reduced adverse events. The results also revealed that administration of a DS of docetaxel enhances differentiation of T helper cells, and improves survival and therapeutic outcomes. From a safety perspective, LDDS-administered DS of low-concentration docetaxel without any other anticancer treatments to LNs a novel approach to cancer management of LN metastasis. We emphasize that LDDS is a groundbreaking method of delivering anticancer drugs specifically to cancer susceptible LNs and is designed to enhance the effectiveness of cancer treatment while minimizing side effects.

Microvascular reconstruction for oral cancer in older adult patients: the impact of age on surgical outcomes

OBJECTIVE

Flap complications continue to be a challenge in microsurgical reconstruction for older adults. We aimed to evaluate the impact of age on surgical outcomes after microvascular reconstruction.

STUDY DESIGN

We retrospectively investigated 103 patients with oral squamous cell carcinoma who had undergone microvascular reconstruction surgery to compare microsurgical reconstruction, common postoperative complications, and flap success rates in geriatric (>75 years) and non-geriatric (<75 years) patients. We also evaluated differences based on the American Society of Anesthesiologists Physical Status score.

RESULTS

We found no significant differences between the geriatric and non-geriatric groups in peri-operative, postoperative, or general complications. Conversely, we found that delirium and aspiration pneumonia were significantly more likely to occur in geriatric patients and that multiple medical complications were significantly more likely to occur in geriatric patients with a high American Society of Anesthesiologists score.

CONCLUSION

Microvascular reconstruction can be performed effectively and without excessive complications in geriatric patients, and age should not be considered a contraindication for this procedure. Comorbidities play a stronger role in the prediction of adverse events.

Bimodal artificial intelligence using TabNet for differentiating spinal cord tumors-Integration of patient background information and images

We proposed a bimodal artificial intelligence that integrates patient information with images to diagnose spinal cord tumors. Our model combines TabNet, a state-of-the-art deep learning model for tabular data for patient information, and a convolutional neural network for images. As training data, we collected 259 spinal tumor patients (158 for schwannoma and 101 for meningioma). We compared the performance of the image-only unimodal model, table-only unimodal model, bimodal model using a gradient-boosting decision tree, and bimodal model using TabNet. Our proposed bimodal model using TabNet performed best (area under the receiver-operating characteristic curve [AUROC]: 0.91) in the training data and significantly outperformed the physicians' performance. In the external validation using 62 cases from the other two facilities, our bimodal model showed an AUROC of 0.92, proving the robustness of the model. The bimodal analysis using TabNet was effective for differentiating spinal tumors.

Simultaneous Recognition of Over- and Under-Expressed MicroRNAs Using Nanopore Decoding

This paper describes a strategy for simultaneous recognition of over- and under-expressed microRNAs (miRNAs) using the method of signal classification-based nanopore decoding. MiRNA has attracted attention as a promising biomarker for cancer diagnosis owing to its cancer-type-specific expression patterns. While nanopore technology has emerged as a simple and label-free method to detect miRNAs and their expression patterns, recognizing patterns involving simultaneous over/under-expression is still challenging due to the inherent working principles. Here, inspired by the sequence design for DNA computation with nanopore decoding, we designed diagnostic DNA probes targeting two individual over/under-expressed miRNAs in the serum of oral squamous cell carcinoma. Through nanopore measurements, our designed probes exhibited characteristic current signals depending on the hybridized miRNA species, which were plotted on the scatter plot of duration versus current blocking ratio. The classified signals reflected the relative abundance of target miRNAs, thereby enabling successful pattern recognition of over/under-expressed miRNAs, even when using clinical samples. We believe that our method paves the way for miRNA-targeting simple diagnosis as a liquid biopsy.

Identification of Neck Lymph Node Metastasis-Specific microRNA-Implication for Use in Monitoring or Prediction of Neck Lymph Node Metastasis

MicroRNAs (miRNAs) have attracted attention as non-invasive cancer biomarkers in various cancers; however, they have not been adequately investigated in oral squamous cell carcinoma (OSCC). This study investigated the diagnostic performance of serum-derived miRNAs at initial diagnosis for primary neck lymph node metastasis and the predictive performance for late neck lymph node metastasis based on long-term (up to approximately 8 years) follow-up of patients with OSCC. The expression of miRNAs in 40 patients with OSCC was quantified using real-time PCR (qPCR), and a comprehensive statistical analysis of the correlation of miRNA expression for primary and late neck lymph node metastases was performed. For the diagnosis of primary neck lymph node metastases, miR-423 and miR-125 were accurate. The miRNA index for primary metastasis diagnosis (miR-PM) calculated by regression analysis showed high diagnostic accuracy. The miR-5100 was useful for predicting late neck lymph node metastases. The miRNA index for late metastasis prediction (miR-LM) calculated using regression analysis showed high prediction accuracy. MiRNAs were useful for diagnosing primary neck lymph node metastases in OSCC and predicting late neck lymph node metastases. It may help to consider individualized treatment, including follow-up, surgical methods, and postoperative management.

Heterogeneity of management practices surrounding operable gallbladder cancer - results of the OMEGA-S international HPB surgical survey

BACKGROUND

Gallbladder cancer (GBC) is an aggressive, uncommon malignancy, with variation in operative approaches adopted across centres and few large-scale studies to guide practice. We aimed to identify the extent of heterogeneity in GBC internationally to better inform the need for future multicentre studies.

METHODS

A 34-question online survey was disseminated to members of the European-African Hepatopancreatobiliary Association (EAHPBA), American Hepatopancreatobiliary Association (AHPBA) and Asia-Pacific Hepatopancreatobiliary Association (A-PHPBA) regarding practices around diagnostic workup, operative approach, utilization of neoadjuvant and adjuvant therapies and surveillance strategies.

RESULTS

Two hundred and three surgeons responded from 51 countries. High liver resection volume units (>50 resections/year) organised HPB multidisciplinary team discussion of GBCs more commonly than those with low volumes (p < 0.0001). Management practices exhibited areas of heterogeneity, particularly around operative extent. Contrary to consensus guidelines, anatomical liver resections were favoured over non-anatomical resections for T3 tumours and above, lymphadenectomy extent was lower than recommended, and a minority of respondents still routinely excised the common bile duct or port sites.

CONCLUSION

Our findings suggest some similarities in the management of GBC internationally, but also specific areas of practice which differed from published guidelines. Transcontinental collaborative studies on GBC are necessary to establish evidence-based practice to minimise variation and optimise outcomes.

Protocol for a multicentre, prospective observational study of elective neck dissection for clinically node-negative oral tongue squamous cell carcinoma (END-TC study)

INTRODUCTION

In early-stage oral tongue squamous cell carcinoma (OTSCC), elective neck dissection (END) is recommended when occult lymph node metastasis is suspected; however, there is no unanimous consensus on the risks and benefits of END in such cases. The management of clinically node-negative (cN0) OTSCC remains controversial. This study, therefore, aimed to evaluate the efficacy of END and its impact on the quality of life (QoL) of patients with cN0 OTSCC.

METHODS AND ANALYSIS

This is a prospective, multicentre, nonrandomised observational study. The choice of whether to perform END at the same time as resection of the primary tumour is based on institutional policy and patient preference. The primary endpoint of this study is 3-year overall survival. The secondary endpoints are 3-year disease-specific survival, 3-year relapse-free survival and the impact on patient QoL. Propensity score-matching analysis will be performed to reduce selection bias.

ETHICS AND DISSEMINATION

This study was approved by the Clinical Research Review Board of the Nagasaki University. The protocol of this study was registered at the University Hospital Medical Information Network Clinical Trials Registry. The datasets generated during the current study will be available from the corresponding author on reasonable request. The results will be disseminated internationally, through scientific and professional conferences and in peer-reviewed medical journals.

TRIAL REGISTRATION NUMBER

UMIN000027875.

P-153 Oocytes with narrow perivitelline space have poor fertilization and developmental potentials after ICSI

Study question

Do oocytes with narrow perivitelline space have poor clinical outcomes after ICSI?

Summary answer

After ICSI, oocytes with narrow perivitelline space have an increased degeneration rate and decreased rates of 2PN and embryo development.

What is known already

Several studies reported that oocytes with dysmorphologies, such as zona pellucida (ZP) abnormalities and cytoplasmic inclusions (vacuoles, smooth endoplasmic reticulum cluster, refractile bodies), have poor developmental potential in IVF/ICSI. In research on perivitelline space (PVS), many studies have focused on the PVS with fragmentation as well as large PVS. On the other hand, oocytes with narrow perivitelline space (narrow PVS oocytes) are considered to have an immature cytoplasm, but there are few reports on the relationship between narrow PVS oocytes and clinical outcomes. In this study, we retrospectively analyzed the effect of narrow PVS oocytes on ICSI outcomes.

Study design, size, duration

This retrospective single-center study analyzed 11149 MII oocytes that underwent ICSI between January 2018 and October 2021. We observed the PVS of MII oocytes during ICSI, and oocytes with sufficient PVS between the ZP and cytoplasm were determined to be non-narrow PVS oocytes. Oocytes without sufficient PVS from any angle (PVS was observed only around the first polar body) were defined as narrow PVS oocytes.

Participants/materials, setting, methods

After ICSI, oocytes were cultured in ONESTEP medium (NakaMedical, Tokyo, Japan). Embryos that developed into blastocysts were used for single vitrified-warmed blastocyst transfer (SVBT). We compared the rates of degeneration, 2PN, cleavage, blastocyst formation, good-grade (Gardner’s criteria ≥BB) blastocyst, top-grade blastocyst (Gardner’s criteria=AA), and clinical pregnancy (presence of a gestational sac) between oocytes with narrow and non-narrow PVS. Logistic regression analysis with consideration of patient age, BMI, and basal AMH was performed for each outcome.

Main results and the role of chance

Of the 11149 MII oocytes, 570 and 10579 were determined to be narrow and non-narrow PVS oocytes, respectively. Narrow PVS oocytes showed significantly higher degeneration rates (aOR: 1.52, 95% CI: 1.12–2.06, p&lt;0.01) and lower 2PN rates (aOR: 0.77, 95% CI: 0.64–0.93, p&lt;0.01) after ICSI compared to non-narrow PVS oocytes. Furthermore, rates of cleavage (aOR: 0.52, 95% CI: 0.31–0.87, p&lt;0.05), blastocyst formation (aOR: 0.56, 95% CI: 0.45–0.70, p&lt;0.01), good-grade blastocyst formation (aOR: 0.59, 95% CI: 0.46–0.76, p&lt;0.01), and top-grade blastocyst formation (aOR:0.625, 95% CI:0.45–0.86, p&lt;0.01), were significantly lower in the narrow PVS oocytes.

Of the blastocysts developed, 32 and 1439 blastocysts from narrow PVS oocytes and non-narrow PVS oocytes, respectively, were used for SVBT. The clinical pregnancy rate was not significantly different between blastocysts developed from narrow (aOR: 0.52, 95% CI, 0.22–1.22, p = 0.131) and non-narrow PVS oocytes. However, in blastocysts developed from narrow PVS oocytes, clinical pregnancy was confirmed only in top-grade blastocysts (58.8% [10/17]), and blastocysts of other grades did not result in pregnancy (0% [0/15]).

Limitations, reasons for caution

The limitation of this study is that it was a retrospective analysis conducted at a single IVF center. It is necessary to confirm the reproducibility at other facilities because the evaluation of PVS differs among embryologists and IVF centers. Therefore, a prospective multicenter study is needed.

Wider implications of the findings

We found that the narrow PVS oocytes showed poor outcomes after ICSI. While a good pregnancy rate could be expected if a top-grade blastocyst from such oocytes was obtained and transferred, the embryonic development rate of narrow PVS oocytes is low.

Trial registration number

Not applicable

P-395 Use of a granulocyte-macrophage colony-stimulating factor (GM-CSF)-containing medium for poor-grade blastocyst transfer increases the clinical pregnancy and live birth rates

Study question

Does the post-thaw use of a GM-CSF-containing medium improve blastocyst transfer outcomes in all blastocysts in a frozen-thawed embryo transfer cycle?

Summary answer

The use of a GM-CSF-containing medium at post-thawing especially improves the live birth (LB) rate of morphologically poor blastocysts in a frozen-thawed embryo transfer cycle.

What is known already

GM-CSF, a cytokine secreted by the epithelial cells of the female reproductive tract, plays an important role in embryonic development, implantation, and subsequent development in humans and animals. In humans, GM-CSF increases the blastocyst developmental rate and decreases the chances of miscarriage. Previously, we reported that the use of a GM-CSF-containing medium for blastocyst recovery culture after thawing improves the clinical pregnancy (CP) rate in a frozen-thawed blastocyst transfer cycle (ESHRE, 2019). However, it is unclear whether GM-CSF improves embryo transfer outcomes in all blastocysts. In addition, it is necessary to accumulate information regarding its effects on neonatal outcomes.

Study design, size, duration

We performed a retrospective observational study to compare two groups: a GM-CSF group (GM-CSF-containing medium; SAGE-1step GM-CSF, Cooper Surgical) and a control group (GM-CSF-free medium; ONE STEP Medium, NAKA Medical). We analyzed 566 blastocyst transfer cycles in patients aged 30–39 years who underwent frozen-thawed single embryo transfer at Takahashi Women’s Clinic (Japan) from February 2018 to February 2019. Chromosomal analysis was not performed.

Participants/materials, setting, methods

We used a control medium for blastocyst culture and a Cryotop safety kit for blastocyst vitrification. After thawing, we cultured blastocysts in a GM-CSF-containing medium or control medium for 3–5 h until transfer. Embryo transfer outcomes were compared. We performed the multivariate logistic regression analysis(MVRA) to adjust confounding bias. A subgroup analysis was also performed of morphological grade according to Gardner’s criteria (excellent: ≥AA, good: blastocysts containing B, poor: blastocysts containing C).

Main results and the role of chance

There were no difference in patient background between the two groups. The CP and LB rates in the GM-CSF group and control group were 54.3% vs. 42.6% and 42.9% vs. 31.1%. The MVRA adjusted by confounding factors(patient age, BMI, basal AMH, blastocyst grade, day of vitrification, number of previous failed ETs, and assisted hatching) demonstrated that CP (p = 0.0193; adjusted odds ratio [aOR], 1.55) and LB rate (p = 0.0080; aOR, 1.67) were significantly higher in GM-CSF group than that of control group. Moreover, the CP and LB rates of the GM-CSF group and control group were: excellent-blastocysts at 62.0% vs. 58.8% (p = 0.5955; OR, 1.14), 52.7% vs. 45.6% (p = 0.2466, aOR:1.33), good-blastocysts 52.1% vs. 37.6% (p = 0.0561; OR, 1.80), 38.0% vs. 26.6% (p = 0.1072; OR, 1.69), and poor-blastocysts 38.9% vs. 17.9% (p = 0.0115; OR, 2.92), 25.9% vs. 9.0% (p = 0.0164; OR, 3.56). A GM-CSF-containing medium significantly improved the CP and LB rates of poor-grade blastocysts. There were no significant differences between the GM-CSF group and control group in the male ratio (52.7％ vs. 51.0%, p = 0.8057), pregnancy duration (38.8±1.4 weeks vs. 38.5±1.8 weeks, p = 0.2558), cesarean section rate (38.2% vs. 40.8%, p = 0.6979), birth weight (3133±466g vs. 3037±437g, p = 0.1281), and congenital anomaly rate (0.91% vs. 2.04％, p = 0.6026).

Limitations, reasons for caution

This was a single-center, retrospective study. Chromosomal abnormalities in embryos were not considered; however, the LB rate among babies was analyzed. The basic chemical composition of the culture medium (salt concentration, glucose concentration, etc.) used in the control group was different from that of the GM-CSF-containing medium.

Wider implications of the findings

We found that the use of a GM-CSF-containing medium improved the clinical pregnancy and live birth rates of poor-grade blastocysts without affecting the babies. This may be an effective therapeutic strategy for some patients as it may allow for the effective use of poor-grade euploid blastocysts.

Trial registration number

not applicable

Responsiveness of the Zurich Claudication Questionnaire, the Oswestry Disability Index, the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire, the 8-Item Short Form Health Survey, and the Euroqol 5 dimensions 5 level in the assessment of patients with lumbar spinal stenosis

PURPOSE

To assess the responsiveness of the Zurich Claudication Questionnaire (ZCQ), the Oswestry Disability Index, the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire, the visual analog scale (VAS), the 8-Item Short Form Health Survey (SF-8), and the EuroQol 5 dimensions 5 level as methods of assessing outcomes of surgery for lumbar spinal stenosis.

METHODS

We analyzed 218 patients who had undergone lumbar surgery for spinal stenosis and completed one year of follow-up. The internal responsiveness of each questionnaire and any domains was assessed by the effect size and standardized response mean. External responsiveness was assessed by the Spearman rank correlation coefficient and the receiver operating characteristics (ROC) curve.

RESULTS

The most responsive assessments were "symptom severity" and "physical function" on the ZCQ, "walking ability" on the JOABPEQ, "leg pain" on the VAS, and "social function" on the JOABPEQ. The moderately responsive assessments were the physical component summary on the SF-8, the ODI, the EQ5D-5L, "low back pain" on the JOABPEQ, and "leg numbness" on the VAS. The least responsive assessments were "low back pain" on the VAS, "mental health" and "lumbar function" on the JOABPEQ, and the mental component summary on the SF-8.

CONCLUSIONS

Because of its high responsiveness, "symptom severity" on the ZCQ is recommended as a primary tool for assessing outcome when designing prospective studies for lumbar spinal stenosis.

Detecting Early-Stage Oral Cancer from Clinically Diagnosed Oral Potentially Malignant Disorders by DNA Methylation Profile

Simple Summary

Clinically, early-stage oral cancers are difficult to distinguish from oral potentially malignant disorders (OPMDs) because they show a variety of mucosal pathologies. Therefore, invasive tissue biopsies should be performed to determine the treatment strategy. Previously, we focused on gargle fluid as a noninvasive testing method and reported aberrant methylation in gargle fluid in patients with oral cancer. In this study, we successfully identified aberrantly methylated genes in early-stage oral cancer and reported that a combination of methylation of six genes could distinguish early-stage oral cancer from OPMDs, with high diagnostic performance. In addition, the methylation panel more accurately reflected the presence of early-stage oral cancer than cytology testing. Our results suggest that the methylation panel using gargle fluid has the potential to be used as a noninvasive screening tool to diagnose early-stage cancer.

Abstract

Clinically, early-stage oral cancers are difficult to distinguish from oral potentially malignant disorders (OPMDs), and invasive tissue biopsy should be performed to determine a treatment strategy. Previously, we focused on gargle fluid as a noninvasive testing method and reported aberrant methylation in gargle fluid in patients with oral cancer. This study aimed to distinguish early-stage oral cancer from clinically diagnosed OPMDs using gargle fluid samples. We collected gargle fluid samples from 40 patients who were clinically diagnosed with OPMDs in the training set; among them, 9 patients were pathologically diagnosed with oral cancer. Methylation levels of 25 tumor suppressor genes were analyzed using the methylation-specific multiplex ligation-dependent probe amplification (MS-MLPA) method. We found that a combination of six genes (TP73, CASP8, RARB, KLLN, GSTP1, and CHFR) could distinguish oral cancer from clinically diagnosed OPMDs with high diagnostic performance (area under the curve [AUC], 0.885; sensitivity, 77.8%; and specificity, 87.1%). Additionally, the panel comprised of the six methylated genes was validated in the test set. Furthermore, when compared with cytology testing, the panel could accurately detect oral cancer. The present methylated gene panel may serve as a novel biomarker for oral cancer.

Effects of immune checkpoint inhibitor therapy resumption in patients with malignant tumors after moderate-to-severe immune-related adverse events

BACKGROUND AND AIMS

Immune checkpoint inhibitors (ICIs) are used to treat several cancers, but they sometimes induce immune-related adverse events (irAEs). Patients with irAEs often have improved antitumor responses, but discontinuation of ICIs after irAEs is considered necessary. Resuming the use of ICIs after irAEs is preferable, but few studies have investigated the safety of ICI resumption after irAEs. Therefore, we evaluated the factors associated with the recurrence of irAEs after ICI resumption to investigate the safety of this approach.

METHODS

In this observational study, we enrolled patients treated with ICIs from September 2014 to March 2020 at our institution. Patient characteristics, ICIs, grades of irAEs, ICI discontinuation or resumption rates, and recurrence rates of irAEs after ICI therapy were analysed.

RESULTS

Two-hundred eighty-seven patients were included in the present study, and 76 patients experienced grade 2 or higher irAEs. Forty-two patients underwent ICI resumption after recovering from irAEs, and 13 of them had a recurrence of irAEs. Among those 13 patients, six had a recurrence of the same irAE, and seven experienced other irAEs. Ten of the 13 patients had grade ≥2 irAEs, and none had fatal irAEs. In the grade 2 or higher irAE group, more patients had irAEs associated with multiple organs and of initial grade ≥2 than those in the grade 1 and no recurrent irAEs group.

CONCLUSIONS

Patients with initial multisystemic irAEs and irAEs of grade ≥2 were more likely to experience relapse or develop new grade ≥2 irAEs after ICI resumption.

Early Fusion Status After Posterior Lumbar Interbody Fusion With Cortical Bone Trajectory Screw Fixation or Traditional Trajectory Screw Fixation: A Comparison Between the Titanium-coated Polyetheretherketone Cage and the Same Shape Polyetheretherketone Cage

STUDY DESIGN

A retrospective analysis of prospectively collected data.

OBJECTIVE

The aim was to examine whether posterior lumbar interbody fusion with cortical bone trajectory screw fixation (CBT-PLIF) is inferior to PLIF using traditional trajectory screw fixation (TT-PLIF) regarding early fusion status and whether the titanium-coated polyetheretherketone (PEEK) cage (TP cage) improves early fusion status compared with the same shape pure PEEK cage (P cage).

SUMMARY OF BACKGROUND DATA

We recently reported that the fusion rate was relatively lower after CBT-PLIF than after TT-PLIF, although no significant difference was found and that compared with the carbon PEEK cage, the TP cage significantly reduced the incidence of vertebral endplate cysts (cyst signs) and slightly improved the early fusion rate at 1 year after CBT-PLIF.

MATERIALS AND METHODS

The subjects were 37 patients undergoing TT-PLIF using P cages (TT-P group), 24 patients undergoing CBT-PLIF using P cages (CBT-P group), 32 patients undergoing TT-PLIF using TP cages (TT-TP group), and 20 patients undergoing CBT-PLIF using TP cages (CBT-TP group). On multiplanar reconstruction computed tomography at 6 months after surgery, cyst signs were evaluated and classified into diffuse or local cysts. Early fusion status was assessed using both dynamic plain radiographs and multiplanar reconstruction computed tomography at 1-year postoperatively.

RESULTS

The incidence of the diffuse cyst was 27.0% in the TT-P group, 29.2% in the CBT-P group, 25.0% in the TT-TP group and 25.0% in the CBT-TP group (P>0.05). The early fusion rate was 75.7% in the TT-P group, 75.0% in the CBT-P group, 71.9% in the TT-TP group and 75.0% in the CBT-TP group (P>0.05).

CONCLUSIONS

These results indicate that CBT-PLIF resulted in the equivalent early fusion status to TT-PLIF and that compared with the same shape P cage, the TP cage did not improve early fusion status after both TT-PLIF and CBT-PLIF.

Epidemiology of symptomatic ossification of the posterior longitudinal ligament: a nationwide registry survey

BACKGROUND

Ossification of the posterior longitudinal ligament (OPLL) is radiographically detectable in 3-6% of Asian individuals, although not all detectable OPLL cases lead to myelopathy. To date, it is unknown how many patients suffer from neurological symptoms due to OPLL. The purpose of this study was to investigate the epidemiology of symptomatic OPLL using Japan's national registry database.

METHODS

We examined the registry data of patients with OPLL who held a certificate of medical subsidy from the Japanese Ministry of Health, Labor and Welfare. The study period was from January 1, 2011 to December 31, 2012.

RESULTS

Registry data revealed that the incidence and the period prevalence of symptomatic OPLL were 0.005% (5 per 100,000 population) and 0.027% (27 per 100,000 population), respectively. OPLL occurred twice as often in men as in women. The peak age for onset of symptoms was 60-69 years. The mean Japanese Orthopedic Association (JOA) score was 9 points. Ninety percent of OPLL patients underwent surgery, and 90% of these surgeries were performed with a posterior approach. The most common indication for surgery was a JOA score of 11 points.

CONCLUSIONS

According to registry data, the prevalence of symptomatic OPLL was less than one-hundredth of that of radiographically detected OPLL. This indicates that most cases of radiographically detectable OPLL may be asymptomatic.

Influences of smoking on central blood pressure in hypertensive subjects

Background/Introduction

Smoking is known to induce systemic vascular damage, leading to cardiovascular diseases. Recent studies demonstrated that central blood pressure has a greater impact on cardiovascular events than brachial blood pressure.

Purpose

We investigated influences of habitual smoking on central systolic blood pressure (CSBP) in hypertensive subjects.

Methods

A total of 5630 subjects (male = 2622, 51.7±12.0 year-old at baseline), who visited our hospital for a physical check-up at least twice during the last 10 years and underwent CSBP measurement at each visit, were enrolled, and they were divided into three groups; normotensive (n=4634), non-treated hypertensive (n=91) and treated hypertensive subjects (n=905). Then, the influences of smoking on the average and yearly changes of CSBP (median follow-up 5 years) were analyzed. Brachial blood pressure (oscillometer) and radial artery pressure waveforms (tonometer) were recorded using an automated device, and the pressure corresponding to the second systolic peak of radial pressure waveforms was taken as CSBP (HEM-9000AI, Omron Healthcare, Kyoto). Hypertension was defined as brachial BP ≥140/90mmHg or the use of antihypertensive medications. A yearly change in CSBP was calculated in each subject by linear regression analysis using longitudinal data.

Results

The average CSBP was higher in habitual smokers than in non-smokers when analyzed in normotensive (109.1±11.7 vs. 107.6±12.8 mmHg, p&lt;0.001) and non-treated hypertensive subjects (150.7±14.8 vs. 142.8±16.7 mmHg, p&lt;0.05), whereas in hypertensive subjects under medication the average CSBP was lower in smokers than in non-smokers (124.6±12.4 vs. 127.8±13.6 mmHg, p&lt;0.01). Smoking status did not affect yearly changes of CSBP in normotensive (habitual smokers vs. non-smokers; 1.38±6.00 vs. 1.44±6.04 mmHg/year), treated hypertensive (−0.16±7.08 vs. −0.66±8.24 mmHg/year), and non-treated hypertensive subjects (4.09±15.1 vs. −0.53±10.3 mmHg/year).

Conclusions

Habitual smoking increases CSBP, however, antihypertensive medications counteract the unfavorable effects of smoking on CSBP. These results imply a new pathway underlying the development of cardiovascular diseases in smokers. Unfavorable changes in the cardiovascular system caused by smoking may quite slowly progress that short period of observation in the present study could not have detected enhanced yearly increases of CSBP by smoking.

Funding Acknowledgement

Type of funding sources: None.

Relationship between year-to-year blood pressure variability and target organ damage in the general population

Background/Introduction

Visit-to-visit blood pressure variability (BPV) is a strong predictor of cardiovascular events as well as target organ damage (TOD) in hypertension. However, effects of year-to-year BPV on the development of TOD have not been investigated in the general population.

Purpose

The present study was designed to investigate a possible relationship between year-to-year BPV and TOD in the general population.

Methods

Consecutive 5542 subjects (male=3771, 58.6±10.7 yea-old) who visited our hospital for an annual physical check-up for 5 years in a row during 2008 and 2013 were enrolled. The average, standard deviation (SD), coefficient of variation (CV), and average real variability (ARV) of systolic blood pressure (SBP) were calculated using data during the period. Other baseline data were obtained in 2013; left ventricular hypertrophy (LVH; Sokolow-Lyon voltage &gt;3.8 mV and/or Cornell product &gt;2440 mm ms) and kidney impairment (estimated glomerular filtration rate; eGFR&lt;60) were taken as TOD. Then, subjects without TOD at baseline (2013) (n=3801, male=2584, 57.4±10.4 yea-old) were followed up until 2019 (median = 5 years) and the impact of BPV on the development of TOD was investigated.

Results

The average, SD, CV and ARV of SBP were 123.8 mmHg, 8.04 mmHg, 6.50%, and 9.19 mmHg, respectively. At baseline, these parameters were higher in subjects with TOD than those without TOD (Table 1-A). During the follow-up of subjects without TOD at baseline, LVH and kidney impairment developed in 425 and 623 subjects (24.7 and 35.8 per 1000 person-year), respectively. In retrospective analysis, the average, SD, and ARV were higher in subjects with than without future TOD (Table 1-B). Although some indices of year-to-year BPV predicted future development of TOD in univariate Cox-hazard analysis, only the average of SBP predicted incident TOD after adjustment.

Conclusions

Year-to-year BPV is a marker of the incident TOD in the general population. However, these indices do not independently predict the onset of TOD and, thus, there may be unknown pathway that links TOD and BPV.

Funding Acknowledgement

Type of funding sources: None. Table 1. BP variability and TODTable 2. Cox-hazard analyses

Surgical outcomes after posterior lumbar interbody fusion using traditional trajectory screw fixation or cortical bone trajectory screw fixation: A comparative study between the polyetheretherketone cage and the same shape titanium-coated polyetheretherketone cage

OBJECTIVE

To investigate whether or not the fusion rate after posterior lumbar interbody fusion with cortical bone trajectory screw fixation (CBT-PLIF) is lower than after PLIF using traditional trajectory screw fixation (TT-PLIF) and whether or not the titanium-coated polyetheretherketone (PEEK) cage (TiP cage) improves fusion status compared to the same shape uncoated PEEK cage (P cage).

METHODS

The subjects were 37 patients undergoing TT-PLIF using P cages (P-TT group), 24 patients undergoing CBT-PLIF using P cages (P-CBT group), 32 patients undergoing TT-PLIF using TiP cages (TiP-TT group), and 20 patients undergoing CBT-PLIF using TiP cages (TiP-CBT group). All patients from the 4 groups underwent our unified PLIF procedure (total facetectomy, subtotal discectomy, and the same bone graft technique using the same shape cages) except for the screw trajectories and the surface materials of the cages. Clinical symptoms were assessed using the Japanese Orthopedic Association (JOA) score before surgery and at 2-year postoperatively. None of age at the time of surgery, gender, fused segment and preoperative JOA score showed significant differences among the 4 groups. On multiplanar reconstruction computed tomography (MPR-CT) at 6months after surgery, vertebral end plate cysts were evaluated and classified into local or diffuse cysts. Fusion status was assessed using both dynamic plain radiographs and MPR-CT at postoperative 2-year.

RESULTS

Neither the mean JOA score nor the mean recovery rate of the JOA score at 2-year after surgery showed significant differences among the 4 groups. The incidence of the diffuse cyst (a known predictor of non-union) was 27.0% in the P-TT group, 29.2% in the P-CBT group, 25.0% in the TiP-TT group and 25.0% in the TiP-CBT group (P > 0.05). The fusion rate was 89.2% in the P-TT group, 91.7% in the P-CBT group, 90.6% in the TiP-TT group and 90.0% in the TiP-CBT group (P > 0.05).

CONCLUSIONS

After our unified PLIF procedure except for the screw trajectories and the surface materials of the cages, CBT-PLIF resulted in the equivalent fusion rate to TT-PLIF and the TiP cage did not lead to the improved fusion rate compared to the same shape P cage.

P–145 usefulness of morphokinetic data to predict pregnancy rates of day–6 blastocyst transfers

Study question

Can a scoring model based on morphokinetic data developed to predict pregnancy rates of day–5 blastocyst transfers (KIDSCORE™D5) predict pregnancy rates of day–6 blastocyst transfers?

Summary answer

KIDSCORE™D5 was able to predict the clinical pregnancy rates of embryo transfers done on day 6 with an area under the curve (AUC) of 0.72.

What is known already

KIDSCORE™D5 is a scoring model based on morphokinetic data developed to predict the pregnancy rates of day–5 blastocysts. In 2019, Regnier et al. reported that the AUC of KIDSCORE™D5 for predicting clinical pregnancy rates of day–5 blastocyst transfers was 0.6. However, as KIDSCORE™D5 is constructed based on morphological characteristics and developmental dynamics of day–5 blastocysts, it is unclear whether KIDSCORE™D5 can predict pregnancy rates of day–6 blastocyst transfers. Since there are many cases of day–6 blastocyst transfers, it is important to know if KIDSCORE™D5 can predict pregnancy rates of day–6 blastocyst transfers.

Study design, size, duration

This retrospective single-center study, which included 162 day–5 and 72 day–6 blastocyst transfers, respectively, was conducted at Takahashi Women’s clinic from January to December 2019. Blastocysts derived from 146 patients who underwent intracytoplasmic sperm injection. All blastocysts were cryopreserved and were transferred singly.

Participants/materials, setting, methods

We used EmbryoScope+™ (Vitrolife) for in-vitro culture and calculated KIDSCORE™D5 (ver.3) using Embryoviewer™ (Vitrolife). Blastocyst scoring was done from 1.0 to 9.9. Clinical pregnancy was defined as the presence of a gestational sac confirmed by transvaginal ultrasonography. Statistical analysis was performed with JMP Pro 15.00 (SAS). The relationship between KIDSCORE™D5 and clinical pregnancy was evaluated by the AUC using ROC curve analysis and multivariate analysis adjusted for patient age.

Main results and the role of chance

The mean KIDSCORE™D5 of day–5 and day–6 blastocysts was 7.1±1.7 and 3.7±1.5, respectively. KIDSCORE™D5 of day–6 blastocysts was significantly lower than that of day–5 blastocysts (p &lt; 0.0001, Wilcoxon test). ROC curve analysis showed that the KIDSCORE™D5 could predict clinical pregnancy rates with an AUC of 0.62 for day–5 blastocysts and 0.72 for day–6 blastocysts. The cut-off values for KIDSCORE™D5 were 5.7 and 4.9 for day–5 and day–6 blastocysts, respectively. Blastocysts above the cut off value on both day–5 and day–6 had a significantly higher pregnancy rate than those below the cut off value (day–5: 61.9% vs. 33.3%(p = 0.0023), day–6: 47.4% vs. 7.6%(p = 0.0003)). Multivariate analysis adjusted for patient age showed that KIDSCORE™D5 correlated with clinical pregnancy rates of days 5 and 6 of blastocyst transfer with AUCs of 0.66 and 0.73, respectively.

Limitations, reasons for caution

This study had a small sample size, and it was a retrospective single-center study. In addition, the relationship between KIDSCORE™D5 and clinical pregnancy rates may vary among facilities. Therefore, a prospective multicenter validation is necessary.

Wider implications of the findings: Our study results indicated that KIDSCORE™D5 predicted clinical pregnancy and that morphokinetic parameters related to clinical pregnancy were similar between day–5 and day–6 blastocysts. Hence, morphokinetic evaluation can serve as a criterion for deciding which of multiple day–6 blastocysts can be transferred.

Trial registration number

Not applicable

Major hepatectomy with combined vascular resection for perihilar cholangiocarcinoma

Background

Hepatectomy with vascular resection (VR) for perihilar cholangiocarcinoma (PHCC) is a challenging procedure. However, only a few reports on this procedure have been published and its clinical significance has not been fully evaluated.

Methods

Patients undergoing surgical resection for PHCC from 2002–2017 were studied. The surgical outcomes of VR and non-VR groups were compared.

Results

Some 238 patients were included. VR was performed in 85 patients. The resected vessels were hepatic artery alone (31 patients), portal vein alone (37 patients) or both (17 patients). The morbidity rates were almost the same in the VR (49.4 per cent) and non-VR (43.8 per cent) groups (P = 0.404). The mortality rates of VR (3.5 per cent) and non-VR (3.3 per cent) were also comparable (P > 0.999). The median survival time (MST) was 45 months in the non-VR group and 36 months in VR group (P = 0.124). Among patients in whom tumour involvement was suspected on preoperative imaging and whose carbohydrate antigen 19-9 (CA19-9) value was 37 U/ml or less, MST in the VR group was significantly longer than that in the non-VR group (50 versus 34 months, P = 0.017). In contrast, when the CA19-9 value was greater than 37 U/ml, MST of the VR and non-VR groups was comparable (28 versus 29 months, P = 0.520).

Conclusion

Hepatectomy with VR for PHCC can be performed in a highly specialized hepatobiliary centre with equivalent short- and long-term outcomes to hepatectomy without VR.

Colorectal Cancer Patients Have Four Specific Bacterial Species in Oral and Gut Microbiota in Common-A Metagenomic Comparison with Healthy Subjects

Simple Summary

The incidence of colorectal cancer (CRC) has been increasing in recent years, and the gut microbiota is nowadays considered to be involved in the progression of CRC. Recent studies have investigated the involvement of the oral microbiota in CRC development using saliva and stool samples. However, the details regarding how oral bacteria alter the gut microbiota and affect CRC carcinogenesis remain unclear. In the present study, we identified four bacterial species that may affect the carcinogenesis and progression of CRC. These microorganisms may be potential biomarkers in saliva for diagnosing CRC.

Abstract

Oral microbiota is reportedly associated with gut microbiota and influences colorectal cancer (CRC) progression; however, the details remain unclear. This study aimed to evaluate the role of oral microbiota in CRC progression. Fifty-two patients with CRC and 51 healthy controls were included. Saliva and stool samples were collected, and microbiota were evaluated using 16S rRNA analysis and next-generation sequencing. Comparative analysis was performed on both groups. Linear discriminant analysis effect size (LEfSe) revealed the presence of indigenous oral bacteria, such as Peptostreptococcus, Streptococcus, and Solobacterium spp., at a significantly higher relative abundance in saliva and stool samples of CRC patients compared with controls. Next, CRC patients were divided into early stage (Stage I, II; n = 26; 50%) and advanced stage (Stage III, IV; n = 26; 50%) disease. LEfSe revealed that S. moorei was present at a significantly higher relative abundance in the advanced-stage group compared with the early-stage group, again consistent for both saliva and stool samples. Among bacterial species with significantly higher relative abundance in CRC patients, P. stomatis, S. anginosus, S. koreensis, and S. moorei originated from the oral cavity, suggesting indigenous oral bacteria may have promoted initiation of CRC carcinogenesis. Furthermore, S. moorei may influence CRC progression.

Does Atherosclerosis Have Negative Impacts on Early Adjacent Segment Degeneration After Posterior Lumbar Interbody Fusion?

STUDY DESIGN

Retrospective study.

OBJECTIVE

To examine whether atherosclerosis has negative impacts on early adjacent segment degeneration (ASD) after posterior lumbar interbody fusion using traditional trajectory pedicle screw fixation (TT-PLIF).

METHODS

The subjects were 77 patients who underwent single-level TT-PLIF for degenerative lumbar spondylolisthesis. Using dynamic lateral radiographs of the lumbar spine before surgery and at 3 years postoperatively, early radiological ASD (R-ASD) was examined. Early symptomatic ASD (S-ASD) was diagnosed when neurologic symptoms deteriorated during postoperative 3-year follow-up and the responsible lesions adjacent to the fused segment were also confirmed on magnetic resonance imaging. According to the scoring system by Kauppila et al, the abdominal aortic calcification score (AAC score: a surrogate marker of systemic atherosclerosis) was assessed using preoperative lateral radiographs of the lumbar spine.

RESULTS

The incidence of early R-ASD was 41.6% at the suprajacent segment and 8.3% at the subjacent segment, respectively. Patients with R-ASD had significantly higher AAC score than those without R-ASD. The incidence of early S-ASD was 3.9% at the suprajacent segment and 1.4% at the subjacent segment, respectively. Patients with S-ASD had higher AAC score than those without S-ASD, although there was no significant difference.

CONCLUSIONS

At 3 years after surgery, the advanced AAC had significantly negative impacts on early R-ASD after TT-PLIF. This result indicates that impaired blood flow due to atherosclerosis can aggravate degenerative changes at the adjacent segments of the lumbar spine after PLIF.

Association of Oral Hypofunction with Frailty, Sarcopenia, and Mild Cognitive Impairment: A Cross-Sectional Study of Community-Dwelling Japanese Older Adults

Oral hypofunction is a new concept that addresses the oral function of older adults. Few studies have investigated the relationship between oral hypofunction and general health conditions such as frailty, sarcopenia, and mild cognitive impairment. This paper explores these relationships in a large-scale, cross-sectional cohort study. The relationships of oral hypofunction with frailty, sarcopenia, and mild cognitive impairment were examined using data from 832 individuals who participated in the 2018 health survey of the residents of Tarumizu City, Kagoshima Prefecture, Japan. Individuals with frailty, sarcopenia, and mild cognitive impairment had significantly higher rates of oral hypofunction. Frailty was independently associated with deterioration of the swallowing function (odds ratio 2.56; 95% confidence interval, 1.26-5.20), and mild cognitive impairment was independently associated with reduced occlusal force (odds ratio 1.48; 95% confidence interval, 1.05-2.08) and decreased tongue pressure (odds ratio 1.77; 95% confidence interval, 1.28-2.43). There was no independent association found between sarcopenia and oral function. In conclusion, early intervention for related factors such as deterioration of the swallowing function in frailty, reduced occlusal force, and decreased tongue pressure in mild cognitive impairment could lead to the prevention of general hypofunction in older adults.

Utility of remnant liver volume for predicting posthepatectomy liver failure after hepatectomy with extrahepatic bile duct resection

BACKGROUND

Hepatectomy with extrahepatic bile duct resection is associated with a high risk of posthepatectomy liver failure (PHLF). However, the utility of the remnant liver volume (RLV) in cholangiocarcinoma has not been studied intensively.

METHODS

Patients who underwent major hepatectomy with extrahepatic bile duct resection between 2002 and 2018 were reviewed. The RLV was divided by body surface area (BSA) to normalize individual physical differences. Risk factors for clinically relevant PHLF were evaluated with special reference to the RLV/BSA.

RESULTS

A total of 289 patients were included. The optimal cut-off value for RLV/BSA was determined to be 300 ml/m2. Thirty-two patients (11.1 per cent) developed PHLF. PHLF was more frequent in patients with an RLV/BSA below 300 ml/m2 than in those with a value of 300 ml/m2 or greater: 19 of 87 (22 per cent) versus 13 of 202 (6.4 per cent) (P < 0.001). In multivariable analysis, RLV/BSA below 300 ml/m2 (P = 0.013), future liver remnant plasma clearance rate of indocyanine green less than 0.075 (P = 0.031), and serum albumin level below 3.5 g/dl (P = 0.015) were identified as independent risk factors for PHLF. Based on these risk factors, patients were classified into three subgroups with low (no factors), moderate (1-2 factors), and high (3 factors) risk of PHLF, with PHLF rates of 1.8, 14.8 and 63 per cent respectively (P < 0.001).

CONCLUSION

An RLV/BSA of 300 ml/m2 is a simple predictor of PHLF in patients undergoing hepatectomy with extrahepatic bile duct resection.

Clinical features, risk factors, and prognosis of anthracycline-induced cardiotoxicity in patients with malignant lymphoma who received a CHOP like regimen

Background

Anthracycline-induced cardiotoxicity is a serious complication in patients with malignant lymphoma (ML) who received chemotherapy, which threatens life prognosis and quality of life of patients. However, incidence and risk factors of cardiotoxicity in patients with ML who undergo intensive chemotherapy which aims complete remission is not clarified. Furthermore, prognosis after cardiotoxicity and that after recovery from cardiotoxicity have not been elucidated.

Method

We screened 443 ML patients who received either rituximab (R)-CHOP or CHOP regimen between January 2008 and December 2017 at Nagoya City University Hospital. Two handled forty-four patients who underwent echocardiography before and after chemotherapy were enrolled and data were analyzed retrospectively. Cardiotoxicity was defined as a decline in left ventricular ejection fraction (LVEF) of 10% or greater and an LVEF was below 50%. Partial recovery was defined as a 5% or more of increase in LVEF and an LVEF was ≥50% after cardiotoxicity. Complete recovery was defined as an increase in LVEF became more than 95% of the baseline value. Patient's basic characteristics, chemotherapeutic regimen, laboratory data, echocardiographic data, and prognosis were collected from the medical records by two cardiologists and two hematologists.

Result

At baseline, the median age was 71 years, the median cumulative dose of doxorubicin was 302 mg/m2 and the median LVEF was 69%. During the follow-up period, cardiotoxicity was observed in 52 out of 244 patients (21%), 30 patients (12%) had a symptomatic heart failure, and 5 patients died from cardiovascular cause. Thirty-five patients developed cardiotoxicity during the first year of chemotherapy. Multivariate analysis identified that only the baseline LVEF (HR 0.949, 95% CI 0.919–0.981, p=0.002) was an independent risk factor for cardiotoxicity. In our study, patients who received more than 200 mg/m2 of doxorubicin developed cardiotoxicity frequently. Among 52 patients who experienced cardiotoxicity, partial recovery and full recovery were observed in 18 (35%) and 4 (8%) patients, respectively. Four patients without recovery died due to heart failure and 1 patient with partial recovery died suddenly. Six out of 18 patients with partial recovery developed re-cardiotoxicity.

Conclusion

ML patients who undergo more than 200 mg/m2 of doxorubicin need a watchful follow-up. Only a baseline LVEF was an independent risk factor for cardiotoxicity. one third of patients with partial recovery developed re-cardiotoxicity.

Funding Acknowledgement

Type of funding source: None

Effect of advancing age on dietary salt intakes: a 10-year follow-up study

Background/Introduction

The National Nutrition Survey in Japan indicated that dietary salt intake of the Japanese is gradually decreasing for the last several decades, while salt intakes are higher in elderly than young people. There is no survey on the alteration of salt intakes with advancing age in individuals.

Purpose

The present study investigated effects of aging on salt intakes in individuals.

Methods

A total of 2600 subjects (men; 1787, age; 30 to 79 years-old at 2008) who participated in our physical check-up program both in 2008 and 2018 were enrolled. Individual dietary salt intakes in 2008 and 2018, which were estimated using a spot urine by a previously reported method, were compared.

Results

The mean age and salt intakes at 2008 were 53.9±10.0 years and 12.2±3.2 g/day in men and 54.4±9.2 years and 8.3±2.1 g/day in women, respectively. Salt intake increased to 13.2±3.3 g/day in men and 8.8±2.2 g/day in women during the 10 years. Salt intakes were higher in hypertensive than normotensive subjects both at 2008 and 2018, but changes of blood pressure category were not associated with those of salt intakes during the 10 years (table). Changes in salt intakes in each decade are shown in Figure. Salt intakes in each decade increased with advancing age both in men and women until their 70s. Salt intakes in people in their 60s and 70s at 2018 were higher than those at 2008. Similar results were obtained in subjects without any anti-hypertensive medications (n=1667) (data not shown).

Conclusions

The observational follow-up study revealed that salt intakes in each individual increased after the interval of 10 years in both men and women. The results suggest that the sense of taste changes with advancing age in young adults as well as elderly persons, which may be related with alterations of lifestyle.

Age difference in changes of salt intake

Funding Acknowledgement

Type of funding source: None

What is the optimal blood pressure level for kidney in the general population?

Background/Introduction

Hypertension induces kidney dysfunction, and vice versa. Furthermore, kidney dysfunction can be a risk factor for cardiovascular diseases as well as end-stage of kidney disease. Although blood pressure (BP) control is necessary to prevent deterioration of kidney function, strict BP control may deteriorate kidney function.

Purpose

The present observational study investigated effects of BP levels on the incidence of chronic kidney disease (CKD) in the general population.

Methods

A total of 12,753 subjects with normal kidney function (estimated glomerular filtration rate [eGFR] ≥60 mL/min per 1.73 m2) (male 7,707, mean age 51.8 years) who visited our hospital for an annual physical check-up from April 2010 to March 2018 were enrolled. After baseline examination, subjects were followed up until March 2019 (median 1769 days) with the endpoint being the development of CKD (eGFR&lt;60 mL/min per 1.73 m2). The modified MDRD formula for Japanese was used to calculate eGFR. Hypertension was defined as BP ≥140/90mmHg or the use of antihypertensive medication.

Results

During the follow-up period, 1,604 subjects developed CKD (26.9 per 1,000 person-years) with the incidence being more frequent in hypertensive (n=3,098) than normotensive (n=9,655) subjects at enrollment (44.2 vs. 21.5 per 1,000 person-years, respectively; hazard ratio [95% confidence interval] from multivariate Cox proportional analysis 1.205 [1.061–1.369]). Hazard ratio of systolic BP at baseline was 1.006 [1.002–1.010] in a multivariate Cox proportional hazard regression model adjusted for possible risk factors. The incidence was lower in subjects without hypertension throughout the follow-up period (normotension group, n=7,866) than those who were diagnosed as having hypertension at least once during the period (hypertension group, n=4,887) (23.1 vs. 32.3 per 1,000 person-years, p&lt;0.001). In the normotension group, subjects with average BP &lt;120/80mmHg had lower incidence of CKD than in those with BP ≥120/80mmHg (17.2 vs. 36.1 per 1,000 person-years, p&lt;0.001). In contrast, in the hypertension group, the incidences of CKD in subjects with average BP &lt;120/80, 120–139/80–89 and ≥140/90mmHg were 34.3, 25.8, and 54.4 per 1,000 person-years, respectively (p&lt;0.001). Moreover, in hypertensive subjects under medication (n=2,002) with average BP &lt;120/80, 120–139/80–89 and ≥140/90mmHg, the incidence of CKD was 65.5, 41.3, and 64.3 per 1,000 person-years, respectively (p&lt;0.01).

Conclusions

The incidence of CKD was higher in hypertensive than in normotensive subjects. The lower BP was associated with the lower incidence of CKD in normotensive subjects, while strict BP control may increase the risk of CKD in hypertensive subjects.

Funding Acknowledgement

Type of funding source: None

Excessive salt intake is a significant predictor for future development of metabolic syndrome in the general population

Background/Introduction

Dietary salt consumption is one of the most important modifiable factors in our lifestyle and restriction of dietary salt results in the reduction of blood pressure in previous studies. Excessive salt intake causes cardiovascular diseases independently of its effects on blood pressure. Since metabolic syndrome also increases a risk of cardiovascular disease, there may be some association between salt intake and metabolic syndrome.

Purpose

The present study was designed to investigate a possible relationship between salt intake and future development of metabolic syndrome in the general population.

Methods

Consecutive 12,256 subjects without metabolic syndrome (male=7,053, 52.1±12.3 year-old) who visited our hospital for an annual physical check-up from April 2010 to March 2018 were enrolled. After baseline examination, subjects were followed up until March 2019 (median 1,582 days) with the endpoint being the development of metabolic syndrome. Metabolic syndrome was diagnosed according to the Japanese criteria (2005). Individual salt intake was estimated using a spot urine by a previously reported method.

Results

Salt intake was 11.9±3.0 g/day in male and 8.2±2.1 g/day in female subjects at baseline. During the follow-up period, 1,669 subjects developed metabolic syndrome (29.9 per 1,000 person-year) with the incidence being more frequent in male than female subjects (41.8 vs. 14.2 per 1,000 person-year). Non-adjusted hazard ratio (HR) (95% confidence interval [CI]) of salt intake for the development of metabolic syndrome was 1.157 (1.142–1.173). In analysis where subjects were divided into gender-specific quartiles according to the baseline salt intake, Kaplan-Meyer curve analysis revealed that the incidence of metabolic syndrome were increased across the quartiles (20.6, 25.0, 32.4, and 42.7 per 1,000 person-years; logrank p&lt;0.001). Multivariate Cox proportional hazard analysis adjusted for age, gender, body mass index, systolic blood pressure, heart rate, serum creatinine, uric acid, fasting plasma glucose, low-density lipoprotein cholesterol, triglyceride, hemoglobin and current smoking habit at baseline revealed that salt intake predicted the new onset of metabolic syndrome (HR: 1.036, 95% CI: 1.019–1.054).

Conclusions

Excessive salt intake is significantly associated with the new development of metabolic syndrome in the general population. The results suggest that salt restriction prevents metabolic syndrome as well as hypertension leading to cardiovascular diseases.

Funding Acknowledgement

Type of funding source: None

Arterial stiffness could reflect increased cardiac load and reduced pulmonary function in the general population

Background

Pulmonary function is known to decrease with age and reduced pulmonary function has been reported to be associated with all-cause mortality and cardiovascular death. The association between pulmonary impairment and atherosclerosis was reported previously but has not been investigated sufficiently in the general population.

Purpose

We hypothesized that arterial stiffness could reflect increase of cardiac load and reduced pulmonary function. The present study aimed to investigate whether increased cardiac load and reduced pulmonary function could affect arterial stiffness in the general population.

Methods

Subjects undergoing their health check-up were enrolled. Plasma B-type natriuretic peptide (BNP) levels and serum high-sensitivity cardiac troponin I (hs-cTnI) levels were measured to evaluate cardiac load and myocardial damage. Radial augmentation index (rAI) was measured to investigate arterial stiffness using HEM-9000AI device. Subjects with an ST-T segment abnormality on the electrocardiogram, renal insufficiency, cancer, active inflammatory disease, or a history of cardiovascular events and pulmonary disease were excluded. Pulmonary function was assessed using spirometry by calculating forced vital capacity (FVC) as a percentage of predicted value (FVC%-predicted), forced expiratory volume in 1 second (FEV1) as a percentage of predicted value (FEV1%-predicted), and the ratio of FEV1 to FVC (FEV1/FVC).

Results

A total of 1100 subjects aged 57 years were enrolled and their median values of BNP and hs-cTnI were 15.5 and 2.3 pg/ml. The levels of rAI were significantly associated with the levels of BNP after adjustment for possible confounders in multivariate regression analysis, but were not with the levels of hs-TnI. While the parameters of pulmonary function were inversely associated with the levels of rAI and hs-cTnI after adjustment for possible confounders in the multivariate regression analysis, but not with the levels of BNP. The other multivariate regression analyses where BNP, hs-cTnI, parameters of pulmonary function, and the other possible factors were simultaneously included as independent variables revealed that the BNP levels and the FVC%-predicted or FEV1%-predicted, besides age, gender, smoking status, body mass index, blood pressure, heart rate, creatinine, fasting plasma glucose, and triglyceride, were significantly associated with the levels of rAI.

Conclusions

The significant associations of rAI with BNP and pulmonary function were revealed in the general population. These findings support that arterial stiffness could reflect increased cardiac load and reduced pulmonary function, in apparently healthy individuals.

Funding Acknowledgement

Type of funding source: None

Development of prediction models for the sensitivity of oral squamous cell carcinomas to preoperative S-1 administration

S-1 is an anticancer agent that is comprised of tegafur, gimeracil, and oteracil potassium, and is widely used in various carcinomas including oral squamous cell carcinoma (OSCC). Although an established prediction tool is not available, we aimed to develop prediction models for the sensitivity of primary OSCC cases to the preoperative administration of S-1.

We performed DNA microarray analysis of 95 cases with OSCC. Using global gene expression data and the clinical data, we developed two different prediction models, namely, model 1 that comprised the complete response (CR) + the partial response (PR) versus stable disease (SD) + progressive disease (PD), and model 2 that comprised responders versus non-responders. Twelve and 18 genes were designated as feature genes (FGs) in models 1 and 2, respectively, and, of these, six genes were common to both models. The sensitivity was 96.3%, the specificity was 91.2%, and the accuracy was 92.6% for model 1, and the sensitivity was 95.6%, the specificity was 85.2%, and the accuracy was 92.6% for model 2. These models were validated using receiver operating characteristic analysis, and the areas under the curves were 0.967 and 0.949 in models 1 and 2, respectively. The data led to the development of models that can reliably predict the sensitivity of patients with OSCC to the preoperative administration of S-1. The mechanism that regulates S-1 sensitivity remains unclear; however, the prediction models developed provide hope that further functional investigations into the FGs will lead to a greater understanding of drug resistance.

Multimodality imaging evaluation of saphenous vein graft peri-stent contrast staining enlargement

A patient with Takayasu arteritis who underwent CABG using a saphenous vein graft (SVG) experienced ventricular fibrillation due to total SVG occlusion. A drug-eluting stent was implanted; however, follow-up CAG demonstrated an advanced expansion of peri-stent contrast staining. Coronary computed tomography angiography revealed contrast media extending around the SVG. An intravascular ultrasound indicated a worsening stent malapposition and a significant positive remodeling.

Anterior selective stabilization combined with laminoplasty for cervical myelopathy due to massive ossification of the posterior longitudinal ligament: report of early outcomes in 14 patients

OBJECTIVE

Surgical management of massive ossification of the posterior longitudinal ligament (OPLL) is challenging. To reduce surgical complications, the authors have performed anterior selective stabilization combined with laminoplasty (antSS+LP) for massive OPLL since 2012. This study aimed to elucidate the short-term outcome of the antSS+LP procedure.

METHODS

The authors' analysis was based on data from 14 patients who underwent antSS+LP for cervical myelopathy caused by massive OPLL and were followed up for at least 2 years after surgery (mean follow-up duration 3.3 years). Clinical outcome was evaluated preoperatively, at 6 months and 1 year postoperatively, and at the final follow-up using the Japanese Orthopaedic Association (JOA) scoring system for cervical myelopathy and the recovery rate of the JOA score. The following radiographic parameters were measured preoperatively, immediately after surgery, at 1 year after surgery, and at the final follow-up: the C2-7 angle, measured on lateral plain radiographs, and the segmental lordosis angle (SLA), measured on sagittal CT scans. The correlation between radiographic parameters and clinical outcomes was evaluated.

RESULTS

The mean JOA score increased from 10.4 before surgery to 13.6 and 13.8 at 6 months and 1 year after surgery, respectively; at the final follow-up the mean score was 13.4. This postoperative recovery was significant (p = 0.004) and was maintained until the final follow-up. No patient required revision surgery due to postoperative neurological deterioration. However, the C2-7 angle gradually deteriorated postoperatively. Similarly, the SLA was significantly increased immediately after surgery, but the improvement was not maintained. The recovery rate at the final follow-up correlated positively with the change in C2-7 angle (r = 0.60, p = 0.03) and the change in SLA (r = 0.72, p < 0.01).

CONCLUSIONS

AntSS+LP is safe and effective and may be an alternative to anterior decompression and fusion for the treatment of patients with massive OPLL. No postoperative neurological complications or significant postoperative exacerbation of neck pain were observed in our case series. Not only reducing intervertebral motion and decompressing the canal at the maximal compression level but also acquiring segmental lordosis at the maximal compression level are crucial factors for achieving successful outcomes of antSS+LP.

Early cephalad adjacent segment degeneration after posterior lumbar interbody fusion: a comparative study between cortical bone trajectory screw fixation and traditional trajectory screw fixation

OBJECTIVE

Cortical bone trajectory (CBT) screw insertion through a caudomedial starting point provides advantages in limiting dissection of the superior facet joints and reducing muscle dissection and the risk of superior-segment facet violation by the screw. These advantages of the cephalad CBT screw can result in lower rates of early cephalad adjacent segment degeneration (ASD) after posterior lumbar interbody fusion (PLIF) with CBT screw fixation (CBT-PLIF) than those after PLIF using traditional trajectory screw fixation (TT-PLIF). Here, the authors investigated early cephalad ASD after CBT-PLIF and compared these results with those after TT-PLIF.

METHODS

The medical records of all patients who had undergone single-level CBT-PLIF or single-level TT-PLIF for degenerative lumbar spondylolisthesis (DLS) and with at least 3 years of postsurgical follow-up were retrospectively reviewed. At 3 years postoperatively, early cephalad radiological ASD changes (R-ASD) such as narrowing of disc height (> 3 mm), anterior or posterior slippage (> 3 mm), and posterior opening (> 5°) were examined using lateral radiographs of the lumbar spine. Early cephalad symptomatic adjacent segment disease (S-ASD) was diagnosed when clinical symptoms such as leg pain deteriorated during postoperative follow-up and the responsible lesion suprajacent to the fused segment was confirmed on MRI.

RESULTS

One hundred two patients underwent single-level CBT-PLIF for DLS and were followed up for at least 3 years (CBT group). As a control group, age- and sex-matched patients (77) underwent single-level TT-PLIF for DLS and were followed up for at least 3 years (TT group). The total incidence of early cephalad R-ASD was 12.7% in the CBT group and 41.6% in the TT group (p < 0.0001). The incidence of narrowing of disc height, anterior slippage, and posterior slippage was significantly lower in the CBT group (5.9%, 2.0%, and 4.9%) than in the TT group (16.9%, 13.0%, and 14.3%; p < 0.05). Early cephalad S-ASD developed in 1 patient (1.0%) in the CBT group and 3 patients (3.9%) in the TT group; although the incidence was lower in the CBT group than in the TT group, no significant difference was found between the two groups.

CONCLUSIONS

CBT-PLIF, as compared with TT-PLIF, significantly reduced the incidence of early cephalad R-ASD. One of the main reasons may be that cephalad CBT screws reduced the risk of proximal facet violation by the screw, which reportedly can increase biomechanical stress and lead to destabilization at the suprajacent segment to the fused segment.

Digital zoom is a useful, simple, and cost-effective method of reducing radiation exposure in percutaneous coronary intervention

Reducing radiation exposure is a very important issue in interventional cardiology techniques such as percutaneous coronary intervention. Although novel techniques to reduce radiation exposure are valuable, we should also reconsider older techniques. Digital zoom has been available in Japan from 2005. Digital zoom enlarges an 8-inch field of view (FOV) by 1.2 times, allowing visualization of a 6.7-inch FOV without FOV switching. We identified 2101 suitable cases of percutaneous intervention (PCI) and divided them into two groups according to the use of digital zoom; 1195 patients were included in the digital zoom group and 906 patients in the conventional group. We collected data regarding the reference air kerma (RAK) and dose-area product (DAP). We calculated RAK and DAP per minute fluoroscope time (RAK/min, DAP/min, respectively). There were intergroup differences in RAK, DAP, RAK/min, and DAP/min (digital zoom group vs conventional group; RAK, 1590 mGy [990-2410] vs 1850 [1220-2720], p < 0.01, RAK/min; 54.7 mGy/min [38.5-73.2] vs 71.2 [51.5-93.0], p < 0.01; DAP, 16,000 cGy × cm² [10,300-24,400] vs 20,700 [13,400-29,500], p < 0.001; DAP/min, 557 cGy × cm²/min [392-737] vs 782 [571-1010], p < 0.01, respectively). Because of baseline differences between the two groups, we performed propensity score matching. Even after score matching, there were intergroup differences in DAP, DAP/min, RAK, and RAK/min. Furthermore, the least squares method showed that digital zoom is a significant predictor of RAK (β = 0.14, p < 0.01) and DAP (β = 0.20, p < 0.01). Digital zoom is an older cost-effective technique that can significantly reduce radiation exposure in PCI.

P743 Right ventricular function is important for exercise capacity in patients at risk of heart failure

Background and Purpose

It is important to evaluate exercise capacity to detect the development of heart failure (HF) in patients with heart disease. The pathology of exercise capacity is multi-factorial, and cardiac function is recognized as one of the most important determinants. However, the correlation between right ventricular (RV) function and exercise capacity is not fully understood in the subjects without HF. Therefore, we assessed the relationship between RV function and exercise capacity, both in patients with HF (HF+) and in patients with heart disease but not developed HF (HF-).

Methods

Two hundred and fifty-two patients with heart disease who underwent both Doppler echocardiography at rest and cardio-pulmonary exercise testing (CPET) for the assessment of heart function were enrolled (HF+: n = 142, HF-: n = 110). We measured left ventricular ejection fraction (LVEF), peak early diastolic transmitral flow velocity (E), peak late diastolic transmitral flow velocity (A), early diastolic mitral annular velocity (e’), left atrial volume (LAV), and tricuspid annular plane systolic excursion (TAPSE) by echocardiography. After echocardiographic examination, symptom-limited exercise testing was performed with simultaneous respiratory gas analysis, and peak oxygen consumption (pVO2) was determined. Blood examination including hemoglobin (Hb) and brain natriuretic peptide (BNP) was done on the same day.

Results

There were significant relationships between pVO2 and LVEF (r = 0.16, p = 0.005), e" (r = 0.51, p &lt; 0.0001), E/e" (r=-0.47, p &lt; 0.0001), LAV (r=-0.21, p = 0.0002), and TAPSE (r = 0.33, p &lt; 0.0001) in the whole subjects. In the multiple regression analyses, age, Hb, E/e" and TAPSE were selected as significant determinants for pVO2 both in HF+ (R²=0.39, p &lt; 0.0001) and HF- (R²=0.33, p &lt; 0.0001).

Conclusion

RV function is the prime determinant of exercise capacity in patients at risk of HF, as well as in patients with HF.

Abstract P743 Figure.

P196 Effect of tofogliflozin on systolic and diastolic cardiac function in type 2 diabetic patients

Funding Acknowledgements

None

Background

Recent studies have shown that sodium glucose cotransporter 2 (SGLT2) inhibitors have a favorable effect on cardiovascular events in diabetic patients. However, the underlying mechanism associated with favorable outcome has not been clearly identified.

Purpose

The purpose of this study was to investigate the effect of tofogliflozin, SGLT2 inhibitor, on systolic and diastolic cardiac function in patients with type 2 diabetes mellitus (T2DM).

Methods

We enrolled 26 consecutive T2DM out-patients on glucose-lowering drugs who initiated tofogliflozin and underwent echocardiogram before and ≥ 6 months after tofogliflozin administration. During this period, we also enrolled 162 T2DM out-patients taking other glucose-lowering drugs as a control group. Propensity score analysis was performed to match the patient characteristics. As a result, 40 patients (tofogliflozin group: 20 patients and control group: 20 patients) were finally used for analysis. Left ventricular systolic function was assessed by measuring 2D-echocardiographic left ventricular ejection fraction (LVEF) and diastolic cardiac function by pulsed wave Doppler derived early diastolic velocity (E/e’).

Results

There were no significant differences in patient characteristics and echocardiographic parameters at baseline. Follow-up E/e’ was significantly improved in tofogliflozin compared to control (11.7 ± 3.5 vs. 14.4 ± 4.5, p = 0.037). Moreover, the change in LVEF from baseline to follow up was 5.8± 7.2% in tofogliflozin group and 1.2 ± 6.9% in control group; difference significant: p = 0.047.

Conclusions

In addition to conventional oral glucose-lowering drugs, additional tofogliflozin administration had a favorable effect on left ventricular systolic and diastolic function in patients with T2DM.

Prognostic role of the length of tumour-vein contact at the portal-superior mesenteric vein in patients having surgery for pancreatic cancer

BACKGROUND

The length of tumour-vein contact between the portal-superior mesenteric vein (PV/SMV) and pancreatic head cancer, and its relationship to prognosis in patients undergoing pancreatic surgery, remains controversial.

METHODS

Patients diagnosed with pancreatic head cancer who were eligible for pancreatoduodenectomy between October 2002 and December 2016 were analysed. The PV/SMV contact was assessed retrospectively on CT. Using the minimum P value approach based on overall survival after surgery, the optimal cut-off value for tumour-vein contact length was identified.

RESULTS

Among 491 patients included, 462 underwent pancreatoduodenectomy for pancreatic head cancer. PV/SMV contact with the tumour was detected on preoperative CT in 248 patients (53·7 per cent). Overall survival of patients with PV/SMV contact exceeding 20 mm was significantly worse than that of patients with a contact length of 20 mm or less (median survival time (MST) 23·3 versus 39·3 months; P = 0·012). Multivariable analysis identified PV/SMV contact longer than 20 mm as an independent predictor of poor survival, whereas PV/SMV contact greater than 180° was not a predictive factor. Among patients with a PV/SMV contact length exceeding 20 mm on pretreatment CT, those receiving neoadjuvant therapy had significantly better overall survival than patients who had upfront surgery (MST not reached versus 21·6 months; P = 0·002).

CONCLUSION

The length of PV/SMV contact predicts survival, and may be used to suggest a role for neoadjuvant therapy to improve prognosis.

First Observation of the Directed Flow of D^{0} and D^{0}[over ¯] in Au+Au Collisions at sqrt[s_{NN}]=200 GeV

We report the first measurement of rapidity-odd directed flow (v_{1}) for D^{0} and D^{0}[over ¯] mesons at midrapidity (|y|<0.8) in Au+Au collisions at sqrt[s_{NN}]=200  GeV using the STAR detector at the Relativistic Heavy Ion Collider. In 10-80% Au+Au collisions, the slope of the v_{1} rapidity dependence (dv_{1}/dy), averaged over D^{0} and D^{0}[over ¯] mesons, is -0.080±0.017(stat)±0.016(syst) for transverse momentum p_{T} above 1.5  GeV/c. The absolute value of D^{0} meson dv_{1}/dy is about 25 times larger than that for charged kaons, with 3.4σ significance. These data give a unique insight into the initial tilt of the produced matter, and offer constraints on the geometric and transport parameters of the hot QCD medium created in relativistic heavy-ion collisions.

P5410Combination assessment of renal and hepatic dysfunction improves the predictability of prognosis in patients with acute decompensated heart failure

Background

Renal dysfunction is associated with poor mortality in patients with heart failure (HF). Hepatic dysfunction, assessed by Fibrosis-4 (FIB4) index, has also prediction ability in acute decompensated HF (ADHF) patients. We investigated whether the assessment of the combination of FIB4 index and renal dysfunction improves predictability in patients with ADHF.

Methods

We retrospectively enrolled consecutive 758 patients who admitted due to ADHF from January 2011 to February 2018 and followed up for one year. FIB4 index on admission was calculated by the formula: age (yrs) × AST[U/L] / (platelets [103/μL] × (ALT[U/L])1/2). Study subjects were divided into high FIB4 index (>3.25) and low FIB4 index (≤3.25), furthermore each group were classified by the presence/absence of CKD (estimated glomerular filtration rate <60 ml/min/1.73m). We have generated four groups; low FIB4/without CKD (n=154), low FIB4/with CKD (n=294), high FIB4/without CKD (n=56), and high FIB4/with CKD (n=254). The primary outcome was defined as all-cause mortality in one year. We performed Kaplan-Meyer analysis and multivariable Cox regression models. Furthermore, we evaluated the incremental value with C-index, net reclassification improvement (NRI) and integrated discrimination improvement (IDI) when FIB4 index and renal dysfunction added to a baseline model.

Results

In total, 106 patients died in one year. High FIB4 index and CKD showed significantly higher 1-year mortality (high FIB4 index: 19.7% vs 10.3%, p<0.001, CKD: 17.0% vs 6.7%, p<0.001, respectively). Kaplan-Meyer analysis shows that high FIB4 index with CKD showed statistically higher mortality than the others (vs low FIB4/without CKD, p<0.001, vs high FIB4/without CKD, p=0.031, vs low FIB4/with CKD, p<0.001, respectively).

Multivariate Cox regression model revealed that both high FIB4 index and CKD were an independent risk predictor of 1-year mortality (FIB4 index: p<0.001, HR 1.06, 95% CI 1.035–1.087, CKD: p=0.004, HR 1.834, 95% CI 1.213–2.773, respectively) in patients with ADHF.

A baseline model for prediction of 1-year mortality was determined by multivariable logistic regression including age, body mass index, systolic blood pressure, and serum albumin (C-index: 0.688). Adding high FIB4 index and CKD to the baseline model, all of C-index (0.738, p=0.04), NRI (0.122, p=0.067), and IDI (0.024, p=0.004) were improved.

Receiver operating characteristic curves

Conclusions

Combination assessment of renal and hepatic dysfunction could improve the predictability of prognosis in patients with ADHF.

Acknowledgement/Funding

None

P4551Prognostic utility of Palliative Prognostic Index for prediction of 30-day and 1-year outcome in patients with acute decompensated heart failure

Background

The prognosis of heart failure remains poor similar to the terminal cancer patients, although recent progress in medical treatment. Palliative Prognostic Index (PPI) is a widely used prognostic index for terminal cancer patients (PPI includes: Palliative Performance Scale, oral intake, oedema, dyspnea at rest and delirium), suggesting the short-term prognostic marker of terminal cancer patients.

Purpose

The purpose of this study was to evaluate the impact of PPI on 30-day mortality, 1-year mortality and 1-year events (including all-cause mortality, readmission due to heart failure and new onset of cerebral infarction after hospital discharge) among acute decompensated heart failure (ADHF) patients.

Method

Study subjects comprised of consecutive 764 patients who admitted due to ADHF and followed up for 1-year. PPI were calculated at the time of hospital admission. Study subjects were divided into two groups based on the PPI: L-PPI (PPI<6) and H-PPI (6≤PPI). We calculated the C-index, net reclassification improvement (NRI) and the integrated discrimination improvement (IDI) to evaluate the improvement of prediction ability on 30-day mortality.

Result

H-PPI showed significantly higher 30-day mortality than L-PPI [7.9% vs 2.0%, log rank p<0.001, Hazard retio (HR): 1.26, 95% confidential interval(CI): 1.14–1.37, p<0.001], 1-year mortality [20.0% vs 12.7%, log rank p=0.022, HR 1.15, 95% CI 1.09–1.21, p<0.001]and 1-year events [45.5% vs 31.1%, log rank p<0.001, HR 1.13, 95% CI 1.09–1.17, p<0.001]. Multivariate cox proportional hazard models adjusted with several covariates revealed that PPI was an independent predictor of 30-day mortality (HR: 1.23, 95% CI: 1.10–1.36, p<0.001), 1-year mortality (HR: 1.10, 95% CI: 1.04–1.16, p<0.001) and 1-year events (HR: 1.11, 95% CI: 1.07–1.15, p<0.001), respectively.

A reference model for prediction of 30-day mortality was determined including left ventricular ejection fraction and serum albumin concentration by multivariable logistic regression analysis. (P<0.05) (C-index: 0.720) Adding PPI to the reference model (C-index: 0.773) significantly improved both NRI (0.458, p=0.038) and IDI (0.046, p=0.007), respectively.

Conclusion

We suggest that assessment of PPI showed good prognostic ability for 30-day and 1-year outcome, while PPI provided additional prognostic information in patients with ADHF.

1415Dose antihypertensive medication improve accelerated age-dependent decline of GFR in hypertension?

Background/Introduction

An impairment of kidney function is a risk not only for end stage renal disease but also for cardiovascular events. Hypertension is known to accelerate an age-dependent decline in glomerular filtration rate (GFR).

Purpose

Effects of antihypertensive medications on yearly changes of estimate GFR (eGFR) in hypertensive patients were investigated.

Methods

Consecutive 5110 subjects (male=3196, 52.3±11.3 year-old) who participated in our physical check-up program during 2010 and 2012 were enrolled and followed up for 5 years. The average and the yearly change of eGFR during the 5 years were calculated in each individual and the both values were compared in hypertensive and normotensive subjects. Effect of antihypertensive medication on eGFR was also investigated. The modified Modification of Diet in Renal Disease study formula for the Japanese population was used for calculating eGFR.

Results

In hypertensive subjects (n=1408), the baseline and the average of eGFR were smaller (74.8±14.6 vs. 80.4±13.6, p<0.001 and 72.1±13.2 vs. 77.9±11.9 mL/min per 1.73 m2, p<0.001, respectively) and the yearly decline of eGFR was greater (0.96±1.41 vs. 0.84±1.19 mL/min per 1.73 m2 per year, p<0.01) than in normotensive subjects (n=3702). The baseline and the average of eGFR were smaller in hypertensive patients with (n=1234) than without (n=174) antihypertensive medication (74.3±14.6 vs. 78.3±13.8, p<0.001 and 71.7±13.2 vs. 74.9±12.7 mL/min per 1.73 m2, p<0.01, respectively). Although the yearly decline of eGFR in hypertensive patients with medication tended to be smaller than the decline in those without medication (0.94±1.41 vs. 1.09±1.42 mL/min per 1.73 m2 per year), this did not reach a statistical significance (p=0.213). Neither the number, classes of antihypertensive medications nor systolic blood pressure during the follow-up period did affect the average or yearly decline of eGFR in hypertensive patients.

Conclusions

As compared to normotensive subjects, eGFR was reduced and a yearly decrease in eGFR during the 5 years was accelerated in hypertensive patients. Although antihypertensive medication may reduce an accelerated age-dependent decline of kidney function in hypertension, observational period in this study was too short to clarify such beneficial effects of antihypertensive medications.

Abdominal Aortic Calcification Is a Significant Poor Prognostic Factor for Clinical Outcomes After Decompressive Laminotomy for Lumbar Spinal Canal Stenosis

STUDY DESIGN

Retrospective study.

OBJECTIVE

To examine whether the presence of chronic kidney disease (CKD) or advanced abdominal aortic calcification (AAC) negatively affects clinical outcomes after decompression surgery for lumbar spinal canal stenosis (LSCS).

METHODS

The subjects comprised 143 patients who underwent decompressive laminotomy for LSCS and were followed for ≥2 years. Fifty-five patients had CKD (Stage 3-4). Clinical outcome was assessed using the Japanese Orthopaedic Association (JOA) score before surgery and at 2-year postoperatively. According to the scoring system by Kauppila et al, the AAC score (a surrogate marker of systemic atherosclerosis) was assessed using preoperative lateral radiographs of the lumbar spine.

RESULTS

Patient age had weak but significantly negative correlations with both the preoperative JOA score and the JOA score at 2 years after surgery, but did not have a significant correlation with the recovery rate of the JOA score at 2 years postoperatively. The JOA score before surgery, the JOA score at 2-year follow-up, and the recovery rate of the JOA score were slightly lower in the CKD patients than in those without CKD, although there were no significant differences between the 2 groups. On the contrary, the AAC score had a weak but significantly negative correlation with the preoperative JOA score, and had relatively strong and significantly negative correlations with both the JOA score at 2 years after surgery and the recovery rate of the JOA score.

CONCLUSIONS

At 2 years after surgery, advanced AAC was a significant poor prognostic factor for clinical outcomes of decompression surgery for LSCS.

P5301Impacts of lifestyle behavior and shift Work on visceral fat accumulation and progression of atherosclerosis in middle-aged workers

Background

Work style, and particularly shift work, can affect an individual's health through disrupting circadian rhythms. Moreover, lifestyle habits including dietary and exercise routines might be altered by irregular shift hours. We thus hypothesized that an individual's lifestyle including working habits could influence the prevalence of visceral fat obesity and the progression of atherosclerosis.

Purpose

The present study investigated how lifestyle and shift work affect the accumulation of visceral fat and the progression of subclinical atherosclerosis in middle-aged workers.

Methods

This study enrolled employees undergoing their periodic health check-up (n=10883). The Cardio-Ankle Vascular Index (CAVI) was measured to assess arterial stiffness, followed by ultrasound examination and computed tomography imaging to measure carotid intima-media thickness (IMT) and visceral fat area (VFA), respectively. Lifestyle was evaluated by the following items: 1) eating breakfast, 2) nighttime eating, 3) regular exercise, 4) habitual drinking, 5) habitual smoking, 6) sleeping hours, and 7) working hours. With regard to work factors, subjects were categorized into fixed daytime workers or shift workers (including subjects working with an irregular schedule, outside of daytime hours, or at nighttime).

Results

Among all subjects enrolled, 6820 subjects were fixed daytime workers and 4063 subjects were shift workers. Most of the employees engaged in fixed daytime work were clerical workers, while the employees engaged in shift work were mainly physical workers in this company. Fixed daytime workers had significantly greater VFA than shift workers, but the prevalence of metabolic syndrome, CAVI values, and carotid IMT were similar between groups. Reduced regular exercise, long sleeping hours, and fixed daytime work were independently associated with visceral fat accumulation by both multivariate regression and logistic regression analyses. However, the logistic regression analysis with the presence of metabolic syndrome as the endpoint revealed that skipping breakfast, reduced regular exercise, long sleeping hours, and short working hours were independent determinants of metabolic syndrome. On the other hand, univariate and multivariate regression analysis showed that habitual smoking, but not shift work, were significantly associated with CAVI and carotid IMT. Logistic regression analysis with the endpoint of carotid atherosclerosis (presence of plaque) showed that habitual smoking was an independent determinant of carotid atherosclerosis.

Conclusions

Reduced regular exercise, long sleeping hours, and fixed daytime work were significantly associated with visceral fat accumulation, while habitual smoking has a consistent association with the progression of atherosclerosis. These findings support the concept that unhealthy lifestyles should be modified before considering intervention in work styles.

P1545Predictve factor for major adverse cardiovascular events in health check-up participants

Background/Introduction

Health check-up has been carried out for individual health management. One of its main objectives is the early detection and prevention of major adverse cardiovascular event (MACE).

Purpose

We investigated predictive factors for MACE among clinical test items in health check-up program.

Methods

A total of 13522 subjects (male=8140, 52.8±12.3 year-old at baseline), who visited our hospital for a health check-up between 2008 and 2015, were enrolled. After the baseline examination, they were followed up until December 2016 (median 1827 days) with the endpoint being the incident of MACE. The outcome was confirmed using a questionnaire at health check-up, medical record, telephone, or letter. Possible association between MACE and clinical test items including gender, age, waist circumference, blood pressure, kidney function, fasting plasma glucose, lipid profile, hemoglobin, electrocardiogram (ECG), smoking habit and alcohol consumption was investigated.

Results

During the follow-up period, MACE occurred in 196 subjects (3.03 per 1000 person-year), with the incidence being more frequent in male than female subjects (4.07 vs. 1.42 per 1000 person-year). Multivariate Cox-hazard analysis demonstrated that male gender (hazard ratio [HR] = 2.457, 95% confidence intervals [CI] = 1.498–4.028), age (HR = 1.056, 95% CI = 1.040–1.071), waist circumference (HR = 1.023, 95% CI = 1.004–1.042), systolic blood pressure (HR = 1.015, 95% CI = 1.005–1.024), hemoglobin (HR = 0.868, 95% CI = 0.758–0.994) and Sokolow–Lyon voltage in the ECG (HR = 1.227, 95% CI = 1.033–1.458) were significant predictors for MACE. However, in a model where B-type natriuretic peptide (BNP) was also added as an independent variable, BNP (HR = 2.593, 95% CI = 1.602–4.196) was the strongest predictor for MACE.

Conclusions

In participants underwent health check-up, systolic blood pressure and hemoglobin as well as age and gender were the risk factors of MACE. Appropriate control of blood pressure and treatment of anemia may be useful for the prevention of MACE. Measurement of BNP may give us additional important information associated with future MACE.

P2434Digital zoom decreases radiation exposure dose up to 30% in percutaneous coronary intervention

Background

Interventional cardiology is gaining greater popularity worldwide with each passing year. Reduction of exposure dose is a very imminent and an important issue in cardiology procedure. Although a newer radiation reduction technique, device and procedure are very valuable and expected, we should consider about therapy technique, radiation technique, devices, and the way to protection. Digital zoom digitally enlarges images in real time by up to 2.5-fold at lower doses than those used with traditional field of view changes. In our phantom examination the average dose reduction of digital zoom was 27%.

Methods and results

This study is designated as single-center, retrospective, not-randomized, observation study. 2101 eligible cases were collected. We assigned the cases of PCI without the use of Digital zoom to the Conventional group and those involving the use of Digital zoom to the Digital zoom group. There were 806 patients in the Conventional group and 1195 in the Digital zoom group. Because we had begun using Digital zoom from January 2015 onwards, all patients in the Conventional group had undergone PCI from January 2013 to December 2014 and all patients in the Digital zoom group had undergone PCI from January 2015 to December 2016. In addition, we calculated the RAK/minute and DAP/minute for an accurate assessment. To minimize the difference of characteristics between two groups, propensity score including all baseline variables was performed. Furthermore, Predictors of radiation exposure were investigated using multivariable least square methods. Inter group differences were observed in DAP, RAK, DAP/min, and RAK/min (Digital zoom group vs conventional group: DAP, 16000 cGy cm2 [from 1st quartile to 3rd quartile; 10300–24400] vs 20700 [13400–29500], p<0.001; DAP/min, 557 cGy cm2/min [392–737] vs 782 [571–1010], p<0.01; RAK, 1590 Gy [990–2410] vs 1850 [1220–2720], p<0.01; RAK/min, 54.7 Gy/min [38.5–73.2] vs 71.2 [51.5–93.0], p<0.01). Even after propensity score matching, intergroup differences in DAP (810 cases), DAP/min (811 cases), RAK (746 cases), and RAK/min (744 cases) persisted. Furthermore, the least squares method showed that Digital zoom is an important predictor of DAP (β=0.17, p<0.01) and RAK (β=0.12, p<0.01).

Conclusion

Digital zoom is an old and cost-free technique, but one of most powerful reduction of exposure method. Propensity score adjustment and least square methods show that digital zoom is one of independent effective method.

Polarization of Λ (Λ[over ¯]) Hyperons along the Beam Direction in Au+Au Collisions at sqrt[s_{NN}]=200 GeV

The Λ (Λ[over ¯]) hyperon polarization along the beam direction has been measured in Au+Au collisions at sqrt[s_{NN}]=200  GeV, for the first time in heavy-ion collisions. The polarization dependence on the hyperons' emission angle relative to the elliptic flow plane exhibits a second harmonic sine modulation, indicating a quadrupole pattern of the vorticity component along the beam direction, expected due to elliptic flow. The polarization is found to increase in more peripheral collisions, and shows no strong transverse momentum (p_{T}) dependence at p_{T} greater than 1  GeV/c. The magnitude of the signal is about 5 times smaller than those predicted by hydrodynamic and multiphase transport models; the observed phase of the emission angle dependence is also opposite to these model predictions. In contrast, the kinematic vorticity calculations in the blast-wave model tuned to reproduce particle spectra, elliptic flow, and the azimuthal dependence of the Gaussian source radii measured with the Hanbury Brown-Twiss intensity interferometry technique reproduce well the modulation phase measured in the data and capture the centrality and transverse momentum dependence of the polarization signal.