Factors Associated With Changes in Objectively Measured Moderate to Vigorous Physical Activity in Patients After Percutaneous Coronary Intervention: A Prospective Cohort Study

BACKGROUND

This study aimed to clarify factors affecting changes in moderate to vigorous physical activity (MVPA) in patients 1 to 3 months after undergoing percutaneous coronary intervention (PCI).

METHODS

In this prospective cohort study, we enrolled patients aged <75 years who underwent PCI. MVPA was objectively measured using an accelerometer at 1 and 3 months after hospital discharge. Factors associated with increased MVPA (≥150 min/wk at 3 mo) were analyzed in participants with MVPA < 150 minutes per week at 1 month. Univariate and multivariate logistic regression analyses were performed to explore variables potentially associated with increasing MVPA, using MVPA ≥ 150 minutes per week at 3 months as the dependent variable. Factors associated with decreased MVPA (<150 min/wk at 3 mo) were also analyzed in participants with MVPA ≥ 150 minutes per week at 1 month. Logistic regression analysis was performed to explore factors of declining MVPA, using MVPA < 150 minutes per week at 3 months as the dependent variable.

RESULTS

We analyzed 577 patients (median age 64 y, 13.5% female, and 20.6% acute coronary syndrome). Increased MVPA was significantly associated with participation in outpatient cardiac rehabilitation (odds ratio 3.67; 95% confidence interval, 1.22-11.0), left main trunk stenosis (13.0; 2.49-68.2), diabetes mellitus (0.42; 0.22-0.81), and hemoglobin (1.47, per 1 SD; 1.09-1.97). Decreased MVPA was significantly associated with depression (0.31; 0.14-0.74) and Self-Efficacy for Walking (0.92, per 1 point; 0.86-0.98).

CONCLUSIONS

Identifying patient factors associated with changes in MVPA may provide insight into behavioral changes and help with individualized PA promotion.

Dynamic changes in RAS gene status in circulating tumour DNA: a phase II trial of first-line FOLFOXIRI plus bevacizumab for RAS-mutant metastatic colorectal cancer (JACCRO CC-11)

Background

Few prospective studies have used liquid biopsy testing in RAS-mutant metastatic colorectal cancer (mCRC), and its clinical significance remains unknown. Therefore, this study aimed to carry out a biomarker analysis by liquid biopsy using updated data of the phase II trial of FOLFOXIRI plus bevacizumab as first-line chemotherapy for RAS-mutant mCRC.

Materials and methods

A total of 64 patients who received modified FOLFOXIRI regimen (irinotecan 150 mg/m², oxaliplatin 85 mg/m², levofolinate 200 mg/m², and fluorouracil 2400 mg/m²) plus bevacizumab biweekly were enrolled. The primary endpoint was the objective response rate (ORR). Plasma samples were collected at pre-treatment, 8 weeks after treatment, and progression in participants included in the biomarker study. The levels of circulating tumour DNA (ctDNA) and specific KRAS and NRAS variants were evaluated using real-time PCR assays.

Results

There were 62 patients (median age: 62.5 years, 92% performance status 0, 27% right side) who were assessable for efficacy and 51 for biomarker analysis. ORR was 75.8% (95% confidence interval 65.1% to 86.5%). The median progression-free survival was 12.1 months, and the median overall survival (OS) was 30.2 months. In 78% of patients, RAS mutations disappeared in the ctDNA at 8 weeks after treatment; these patients tended to have better outcomes than those with RAS mutations. Interestingly, RAS mutations remained undetectable during progression in 62% of patients. Survival analysis indicated that the median OS from progression was significantly longer in patients with RAS mutation clearance than in those with RAS mutation in the ctDNA at disease progression (15.1 versus 7.3 months, hazard ratio: 0.21, P = 0.0046).

Conclusions

Our biomarker study demonstrated no RAS mutations in ctDNA at disease progression in 62% of patients with RAS-mutant mCRC. Both OS and post-progression survival were better in patients with clearance of RAS mutations in ctDNA after triplet-based chemotherapy.

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First-line FOLFOXIRI plus bevacizumab is effective for RAS-mutant mCRC with comparable efficacy in elderly patients.

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RAS mutations disappeared in ctDNA after intensive chemotherapy in 62% of patients with mCRC with RAS-mutant tumours.

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Survival time was longer in patients with RAS mutation clearance than in those with RAS mutations in ctDNA.

Related factors and changes of angiopoietin-like protein 2 with chronic heart failure patients participating in phase III cardiac rehabilitation

Funding Acknowledgements

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): the research grant D2 from Kansai Medical University

Objectives

Angiopoietin-like protein 2 (ANGPTL2) is a protein, whose structure is similar to that of angiopoietin, but binds to a different receptor. Overexpression of ANGPTL2 promotes chronic inflammation and relates to the development of aging-related diseases. ANGPTL2 has been reported to be mainly secreted by adipose tissue. Although ANGPTL2 has been implicated in the pathogenesis of heart failure, there are no studies about serum ANGPTL2 levels in patients with heart failure participating in cardiac rehabilitation program. The aim of this study was to investigate the characteristics, related factors and changes of ANGPTL2 in patients with chronic heart failure during phase III of cardiac rehabilitation program.

Methods

The subjects included 57 patients (70.1 ± 10.2 years old; 46 men) with chronic heart failure whose serum ANGPTL2 levels were measured during the maintenance phase of cardiac rehabilitation program. Furthermore, we classified 25 patients (70.6 ± 7.5 years old; 23 men) from the 6-month course into a reduced group and an unchanged group to characterize change in ANGPTL2. We excluded patients who were admitted or discharged within 3 months of the evaluation of serum ANGPTL2. We evaluated exercise tolerance using the cardiopulmonary exercise test, grip strength, body composition using a body composition analyzer, blood examinations, and echocardiography. Serum ANGPTL2 was measured by solid-phase sandwich enzyme-linked immunosorbent assay (ELISA).

Results

The median value of ANGPTL2 was 4.05 ng/ml. ANGPTL2 was positively correlated with body weight, body mass index, body fat mass, body fat percentage, C-reactive protein (CRP) and total protein (TP) levels, and negatively correlated with skeletal muscle mass percentage and anaerobic threshold (AT). From the result of the logistic regression analysis, AT (OR=0.68, 95% CI:0.47-0.97and TP (OR=20.1, 95% CI:2.52-160.63) were extracted as independent factors related to the level of ANGPTL2. In addition, overall serum ANGPTL2 levels decreased significantly after 6 months. Changes in ANGPTL2 in the reduced group showed a positive correlation between baseline peak VO2, left ventricular ejection fraction and skeletal muscle rate, and a negative correlation with baseline ANGPTL2, CRP, body fat mass. In an unchanged group, HbA1c increased, but no significant change was observed in other factors.

Conclusions

Exercise tolerance in patients with chronic heart failure during maintenance phase might be related to the inflammation marker ANGPTL2. Serum ANGPTL2 levels with stable chronic heart failure patients decreased significantly 6 months after continued cardiac rehabilitation.

POS0887 TRANSCRANIAL ELECTRICAL STIMULATION IS SAFE AND EFFICIENT IN PATIENTS WITH SYSTEMIC AUTOIMMUNE MYOPATHIES

Background:

There is currently few information regarding rehabilitation in patients with systemic autoimmune myopathies (SAMs). Transcranial direct current stimulation (tDCS) has shown promising results for the motor performance of healthy individuals as for patients with, e.g., post-stroke hemiparetic limbs.

Objectives:

The present study was aimed to assessing the safety and efficiency of tDCS in patients with SAMs.

Methods:

This study is a prospective, randomized, sham controlled, double blind, and clinical trial with ethical approval. Eighteen adult patients with dermatomyositis, polymyositis, antisynthetase syndrome or immune-mediated necrotizing myopathies in remission or with minimal disease activity were enrolled from 2018 to 2019. Patients were allocated randomly in two groups to receive sham or active tDCS with 2mA amplitude submitted for 20 minutes for three consecutive days. The 5x7cm sponge-electrodes were positioned with the anode over the left (C1) or right (C2) - contralateral to the dominant limb, whereas the cathode over the FP2 or FP3, respectively (10-10 EEG electrodes placement). The groups were evaluated in four moments: pre-stimulation, and 30 minutes, 3 weeks and 8 weeks post-tDCS. They were evaluated in the different moments with International Myositis Assessment and Clinical Studies Group set scores, Short-Form health survey (SF-36), state-trait anxiety inventory (STAI), Beck depression inventory (BDI), timed up-and-go test (TUG), time-stands test (TST), isokinetic extension and flexion testing of bilateral knee and elbow. A specific security questionnaire for tDCS was used after the active or sham stimulation in all patients.

Results:

The demographic data, kind of myositis, disease duration, and disease status (all with low disease activity) were comparable between both active and sham tDCS groups. After interventions, there was improvement of values of patient’s VAS (P=0.042) and serum levels of creatine phosphokinase (P=0.005), independent of the group. Moreover, in active tDCS group, the physical aspects of SF-36 in week 8 (P<0.001), mean and better TST at each evaluation (P<0.001), absolute peak tork (P<0.001) and peak tork adjusted for body weight values (P<0.001) of stimulated inferior limb extension also improved. No differences were observed in the STAI, BDI, or TUG in both groups. The patients’ adherence to the protocol was 100% and no adverse event was reported, including disease relapsing.

Conclusion:

This unprecedented study evidences the safety of tDCS, besides the potential efficiency in improving rehabilitation of tDCS in SAMs. More studies with a large samples and period of tDCS sessions are necessaries to corroborate with the present study.

References:

[1]Lundberg IE, et al. 2017 European league against rheumatism/ American College of Rheumatology classification criteria for adult and juvenile idiopathic inflammatory myopathies and their major subgroups. Arthritis Rheum. 2017;69:2271-82.

[2]Tanaka S, et al. Single session of transcranial direct current stimulation transiently increases knee extensor force in patients with hemiparetic stroke. Neurorehabil Neural Repair. 2011;25:565-9.

Acknowledgements:

This work was supported by the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) 303.379/2018-9, Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) 2019/11776-6, Faculdade de Medicina da USP/SP to SKS.

Disclosure of Interests:

None declared

Environmental factors and physical activity among youth in rural Japan: a 1-year prospective study

Background

Although moderate-to-vigorous physical activity (MVPA) has multiple health benefits, current global activity levels among children are quite low. Environmental influences on MVPA levels among children and adolescents in rural areas are unclear. The present study examined if environmental factors were associated with MVPA in children and adolescents in rural Japan.

Methods

Two school-based serial surveys were conducted in 2017 and 2018 for 1,461 children and adolescents (10-14 years old) in Unnan City, Japan. If meeting the WHO recommended MVPA levels: at least 60 minutes/day was assessed via the Japanese translation of the WHO Health Behaviour in School-aged Children survey questionnaire. Environmental factors, namely habitable land area, population size, and population density were calculated for each individuals' residential town, and categorized into three levels (small, medium, and large). Logistic regression was used to determine odds ratios (OR) and 95% confidence intervals (CI) of engaging in the recommended level of MVPA after 1 year by each environmental factor, adjusting for sex, school grades, body mass index, screen time, preference for PA, and MVPA level at baseline.

Results

Only 22.4% of children and adolescents were engaging in the recommended MVPA levels in 2018. Engaging in the recommended level of MVPA after 1 year was significantly associated with medium (OR = 1.63; 95%CI, 1.08-2.46) and large (OR = 1.69; 95%CI, 1.15-2.47) compared to small habitable areas, and with medium (OR = 1.01; 95%CI, 0.61-1.67) and large (OR = 1.75; 95%CI, 1.09-2.81) compared to small population size. Population density was not associated with MVPA.

Conclusions

This prospective study found that habitable area and population size were positively associated with MVPA at 1-year follow-up in rural Japan. In rural areas, habitable land areas and population size itself may be a better predictor for MVPA among children than population density.

Key messages

Habitable area and population size was positively associated with physical activity among children and adolescents in rural Japan. Population density as an environmental factor was not associated with physical activity.

Synaptotagmin XIII expression and peritoneal metastasis in gastric cancer

BACKGROUND

Peritoneal metastasis is a frequent cause of death in patients with gastric cancer. The aim of this study was to identify molecules responsible for mediating peritoneal metastasis of gastric cancer.

METHODS

Transcriptome and bioinformatics analyses were conducted to identify molecules associated with peritoneal metastasis. The therapeutic effects of intraperitoneally administered small interfering (si) RNA were evaluated using mouse xenograft models. Expression of mRNA and protein was determined in gastric tissues from patients with gastric cancer.

RESULTS

Synaptotagmin XIII (SYT13) was expressed at significantly higher levels in patients with peritoneal recurrence, but not in those with hepatic or distant lymph node recurrence. Inhibition of SYT13 expression in a gastric cancer cell line transfected with SYT13-specific siRNA (siSYT13) was associated with decreased invasion and migration ability of the cells, but not with proliferation and apoptosis. Intraperitoneal administration of siSYT13 significantly inhibited the growth of peritoneal nodules and prolonged survival in mice. In an analysis of 200 patients with gastric cancer, SYT13 expression in primary gastric cancer tissues was significantly greater in patients with peritoneal recurrence or metastasis. A high level of SYT13 expression in primary gastric cancer tissues was an independent risk factor for peritoneal recurrence.

CONCLUSION

SYT13 expression in gastric cancer is associated with perioneal metatases and is a potential target for treatment.

Geographic distribution and environmental control of vertebral count in Ammodytes spp. along the northern Pacific coast of Japan

To examine species composition and population structures in sand lance (Ammodytidae) along the northern Pacific coast of Japan, genetic analysis were carried out for specimens collected in 2014 from Otsuchi Bay, Iwate, Ishinomaki Bay, Miyagi, off Soma, Fukushima and Ise-Mikawa Bays, Aichi. The samples consisted of Ammodytes japonicus and Ammodytes heian, of which the latter is a recently described species. Neither species exhibited significant genetic differences among localities. Only A. japonicus was found in the most southern locality at Aichi, but it decreased northward to <90% in Miyagi and Fukushima and the two species occurred almost evenly in Iwate suggesting a latitudinal cline in their species composition along the northern Pacific coast of Japan, off Tohoku. The vertebral counts differed between A. japonicus and A. heian with modes of 65 and 63, respectively, but this characteristic did not differ significantly within a locality (Iwate). This suggests that the vertebral counts of Ammodytes spp. in Japanese waters are probably strongly determined by the environment than by a species-specific genetic trait.

Children with nocturnal enuresis have posture and balance disorders

INTRODUCTION

Integration of the neuromuscular system is required for maintaining balance and adequate voiding function. Children with enuresis have delayed maturation of the motor cortex, with changes in the sensory and motor systems. Along with various alterations, including the genetic, hormonal, behavioral, and sleep disturbances, and neuromotor and sensory deficits associated with nocturnal enuresis (NE) in children and adults, a consistent alteration in the posture of children with NE has been observed in the current practice. Because posture and the balance control system are strongly connected, this study aimed to investigate posture and balance in children and teenagers with NE.

MATERIAL AND METHODS

A total of 111 children with enuresis were recruited to the enuretic group (EG) and 60 asymptomatic children made up the control group (CG). The participants were divided into two age subgroups: (A) 7-11 years old, N = 77 for EG/A, N = 38 for CG/A; and (B) 12-16 years old, N = 34 for EG/B, N = 22 for CG/B. Balance was assessed using an electronic force plate (100 Hz) to calculate the area of the center of pressure (COP) displacement. The COP is the point that results from the action of vertical forces projected onto the force plate. Sensory integration was analyzed using a 60-s trial with the subject standing under four conditions: (1) eyes open, stable surface; (2) eyes closed, stable surface; (3) eyes open, unstable surface; (4) eyes closed, unstable surface. Posture was assessed by placing reflective anatomical landmarks on the anterior superior iliac spine, the posterior superior iliac spine, the greater trochanter, and lateral malleolus. A photograph was taken while the subject stood quietly. The angles were obtained from landmark connections using software to assess the following posture variables: pelvic ante/retroversion and pelvic ante/retropulsion.

RESULTS

The EG showed a greater area of COP displacement compared with the CG under all four sensory conditions and both subgroups, except for EG/B in condition 3. Regarding posture, EG showed higher pelvic anteversion angles than CG.

CONCLUSIONS

Enuretic children showed forward inclination of the pelvis and had worse balance compared with control children.

Salvage pharyngolaryngectomy with total esophagectomy following definitive chemoradiotherapy

Historically, total pharyngolaryngectomy with total esophagectomy has been the standard radical surgical treatment for synchronous cancer of the thoracoabdominal esophagus and pharyngolaryngeal region, and for cancer of the cervical esophagus that has invaded as far as the thoracic esophagus. Although definitive chemoradiotherapy that enables preservation of the larynx has often been the first choice of treatment for cancers involving the cervical esophagus, total pharyngolaryngectomy with total esophagectomy is required as a salvage therapy for cases involving failure of complete remission or locoregional recurrence after chemoradiotherapy. However, salvage esophageal surgery after definitive high-dose chemoradiotherapy is generally associated with high morbidity and mortality. The aim of this study was to examine the short-term outcome of salvage total pharyngolaryngectomy with total esophagectomy. From 2001 to 2014, nine patients underwent salvage total pharyngolaryngectomy with total esophagectomy at the Department of Gastroenterological Surgery, Nagoya University. The mortality and morbidity rates were high at 22% and 89%, respectively. Four patients (44%) developed tracheal necrosis, which in two patients eventually led to lethal hemorrhage. Salvage total pharyngolaryngectomy with total esophagectomy is an uncommon and highly demanding surgical procedure that should be carefully planned and conducted in selected centers of excellence. Measures must be taken to preserve the tracheal blood supply, thus avoiding fatal complications.

Preparation and Properties of Optically Clear Poly[(Arylenedioxy)(Diphenylsilylene)]s and Poly[(Alkylenedioxy)(Diphenylsilylene)]

Several types of poly[(arylenedioxy)(diphenylsilylene)]s and poly[(alkylenedioxy)(diphenylsilylene)] were synthesized from various diols and dichlorodiphenylsilane by the step polymerization method. The thermal properties, solubility in organic solvents and optical properties of the obtained polymers were investigated by focusing on the chemical structures of their repeating structural units. The weight-average molecular weight ( Mw) of the obtained polymers based on polystyrene ranged from 43000 to 194000. High molecular weight, ductile materials with a high degree of optical clarity were obtained. These polymers display glass transition temperatures ( Tg) between 96 and 130°C. The obtained poly[(arylenedioxy) (diphenylsilylene)]s and poly[(alkylenedioxy)(diphenylsilylene)] were soluble in chloroform and toluene. The refractive index ( nd) was 1.64 for a biphenol-based poly[(arylenedioxy)(diphenylsilylene)] and 1.61 for a bisphenol-A based poly[(arylenedioxy)(diphenylsilylene)]. The poly[(arylenedioxy)(diphenylsilylene)]s and poly[(alkylenedioxy)(diphenylsilylene)] display very low birefringence (Δ n) between 0.0005 and 0.0022. The 70 μm thick film transmission of bicyclohexanol-based poly[(alkylenedioxy)(diphenylsilylene)] was 91% at a 350 nm wavelength.

[The Detectability of Iterative CT Reconstruction for Low-contrast Lesions in Hyperacute Cerebral Infarction: Assessment with Newly Developed Dedicated Head Phantoms]

Iterative reconstruction techniques, such as adaptive statistical iterative reconstruction (ASiR), improve the contrast-to-noise ratio of computed tomography (CT) images; however, underlying anatomical structures may nevertheless hamper detectability of low-contrast areas in clinical situations, despite using such a technique. We therefore conducted a phantom study to investigate the efficacy of ASiR in improving the detectability of low-contrast areas in the presence of brain anatomical structures. We developed dedicated head phantoms simulating hyperacute cerebral infarction and confirmed that their CT numbers were sufficiently reproducible and that observer performance in detecting low-contrast areas using these phantoms more closely resembled that in clinical situations than that using a simple phantom. The efficacy of ASiR in improving low-contrast detectability was evaluated via receiver operating characteristics analysis. The mean area under the curve (AUC) values at ASiR blend rates of 0%, 30%, 60%, and 100% were 0.57, 0.57, 0.59, and 0.59 at 200 mA; 0.83, 0.84, 0.84, and 0.90 at 500 mA; and 0.79, 0.77, 0.76, and 0.79 at 800 mA, respectively. No significant differences were noted in AUC values among ASiR blend rates at any mA setting, suggesting that ASiR does not improve the detectability of subtle low-contrast lesions seen in hyperacute cerebral infarction in clinical situations.

An internally and externally validated nomogram for predicting the risk of irinotecan-induced severe neutropenia in advanced colorectal cancer patients

Background:

In Asians, the risk of irinotecan-induced severe toxicities is related in part to UGT1A1*6 (UGT, UDP glucuronosyltransferase) and UGT1A1*28, variant alleles that reduce the elimination of SN-38, the active metabolite of irinotecan. We prospectively studied the relation between the UGT1A1 genotype and the safety of irinotecan-based regimens in Japanese patients with advanced colorectal cancer, and then constructed a nomogram for predicting the risk of severe neutropenia in the first treatment cycle.

Methods:

Safety data were obtained from 1312 patients monitored during the first 3 cycles of irinotecan-based regimen in a prospective observational study. In development of the nomogram, multivariable logistic regression analysis was used to test the associations of candidate factors to severe neutropenia in the first cycle. The final nomogram based on the results of multivariable analysis was constructed and validated internally using a bootstrapping technique and externally in an independent data set (n=350).

Results:

The UGT1A1 genotype was confirmed to be associated with increased risks of irinotecan-induced grade 3 or 4 neutropenia and diarrhoea. The final nomogram included type of regimen, administered dose of irinotecan, gender, age, UGT1A1 genotype, Eastern Cooperative Oncology Group performance status, pre-treatment absolute neutrophil count, and total bilirubin level. The model was validated both internally (bootstrap-adjusted concordance index, 0.69) and externally (concordance index, 0.70).

Conclusions:

Our nomogram can be used before treatment to accurately predict the probability of irinotecan-induced severe neutropenia in the first cycle of therapy. Additional studies should evaluate the effect of nomogram-guided dosing on efficacy in patients receiving irinotecan.

Longitudinal changes in objectively measured sedentary behaviour and their relationship with adiposity in children and adolescents: systematic review and evidence appraisal

This review aimed to determine longitudinal changes in objectively measured overall sedentary behaviour, and to examine their associations with adiposity in children and adolescents. A search for longitudinal studies was performed using several electronic databases. Of 161 potentially eligible papers, 10 for change in sedentary behaviour and 3 for longitudinal associations with change in adiposity were included. Weighted mean increase in daily sedentary behaviour per year was 5.7% for boys and 5.8% for girls. Only one paper included preschool children, and it showed a decrease in sedentary behaviour. Nine studies were from Western countries. Null associations were reported between sedentary behaviour and adiposity in two studies, the other found that increases in sedentary behaviour were associated with increases in adiposity, but only in those with body mass index above the 50th percentile. There was consistent evidence that sedentary behaviour increases with age in school-age children and adolescents, by approximately 30 min extra daily sedentary behaviour per year. There was little evidence on the influence of changes in sedentary behaviour on changes in adiposity. There is a need for more longitudinal research, for more evidence from outside the Western world, and for more studies that examine 'dose-response' associations between changes in sedentary behaviour and changes in adiposity.

Feasibility and accuracy of relative electron density determined by virtual monochromatic CT value subtraction at two different energies using the gemstone spectral imaging

Background

Recent work by Saito (2012) has demonstrated a simple conversion from energy-subtracted computed tomography (CT) values (ΔHU) obtained using dual-energy CT to relative electron density (RED) via a single linear relationship. The purpose of this study was to investigate the feasibility of this method to obtain RED from virtual monochromatic CT images obtained by the gemstone spectral imaging (GSI) mode with fast-kVp switching.

Methods

A tissue characterization phantom with 13 inserts made of different materials was scanned using the GSI mode on a Discovery CT750 HD. Four sets of virtual monochromatic CT images (60, 77, 100 and 140 keV) were obtained from a single GSI acquisition. When we define Δ HU in terms of the weighting factor for the subtraction α, Δ HU ≡ (1 + α)H - αL (H and L represent the CT values for high and low energy respectively), the relationship between Δ HU and RED is approximated as a linear function, a × Δ HU/1000 + b (a, b = unity). We evaluated the agreement between the determined and nominal RED. We also have investigated reproducibility over short and long time periods.

Results

For the 13 insert materials, the RED determined by monochromatic CT images agreed with the nominal values within 1.1% and the coefficient of determination for this calculation formula was greater than 0.999. The observed reproducibility (1 standard deviation) of calculation error was within 0.5% for all materials.

Conclusions

These findings indicate that virtual monochromatic CT scans at two different energies using GSI mode can provide an accurate method for estimating RED.

The effects of repetitive haemarthrosis on postural balance in children with haemophilia

Sensory information from visual, vestibular and proprioceptive systems is necessary to control posture and balance. Impairment in proprioception due to repetitive joints bleeding may lead to a deficit in postural balance which, in turn, leads to high joint stress and risk of bleeding recurrence. Despite the increase in attention in this field during the past few years, the data concerning to how bleeds can affect postural control in children with haemophilia (CWH) remain scarce. This study aimed to evaluate the postural balance in CWH. Twenty CWH Haemophilia Group (HG) and 20 age-matched children Control Group (CG) were recruited to this study. A force plate was used to record centre of pressure (COP) displacement under four different postural conditions during quiet standing: eyes open on firm surface, eyes open on foam surface, eyes closed on firm surface and eyes closed on a foam surface. Variables of COP as sway area and mean velocity and in anterior-posterior (y) medio-lateral (x) direction were processed and for each variable sensory, quotients were calculated and compared between groups. No differences were found in visual and vestibular quotients variables between groups. A higher value was found in sway area variable on proprioception quotient in the HG when compared with CG (P = 0.042). CWH with repetitive joint bleed on lower limbs showed differences in postural balance when compared with non-haemophiliac children. The identification of early balance impairments in CWH can help us understand better the effects of bleeds inside joints on postural control and plan a more effective preventive and rehabilitative treatment.

High-resolution inventory of Japanese anthropogenic mercury emissions

Heavy metals like mercury that are emitted into the environment remain there indefinitely, posing a long-term threat to both the environment and human health. Elemental mercury is volatile and is in gaseous form, and because of the long residence time, transported over long distances. Comprehensive control of mercury emissions therefore remains an important international issue. The crucial steps for designing effective approaches for such control include the quantification of mercury emissions by sources and the identification of geographical characteristics of the emissions. In this study a detailed, high-resolution inventory of Japanese mercury emissions in 2005 was developed to improve understanding of their geographical distribution. Proceeding from a national emissions inventory per source category, emissions were spatially allocated with increasing geographical resolution in a stepwise procedure using statistics from geographic information resources, yielding mercury emissions per prefecture, per municipality and per grid cell of approximately 1 × 1 km. The five prefectures with the highest emissions were Fukuoka, Yamaguchi, Hyogo, Oita, and Hokkaido, accounting for 35.2% of all emissions. In each prefecture a small number of municipalities account for a major share of emissions. Distribution by grid cell is characterized by a concentration of 50% of all emissions in a mere 32 of the 255 954 grid cells over which emissions are distributed in this study. It was also quantitatively confirmed that use of larger grid cells leads to greater uncertainty in emissions distribution. Problems with data collection are clarified and measures to improve the accuracy of future estimation are proposed.

Role of L1 cell adhesion molecule in gastric carcinoma

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Background: L1 cell adhesion molecule (L1) is a 200-220 kDa transmembrane glycoprotein of the immunoglobulin super family initially identified in neural cells. L1 was detected in ovarian cancer in a stage-dependent manner, was found exclusively in the invasion front of colorectal cancer, and has been considered a stem cell marker in glioma. The authors have shown that mRNA expression of L1 was a significant prognostic factor in gastric cancer (Kodera et al. Gastrointestinal Cancer Symposium 2009, abst 37). Its role in gastric cancer was further investigated.

Methods: Expression of L1 was observed by immunostaining in 72 surgically resected pT4A-stage gastric cancer specimens. The association of L1 with peritoneal seeding and prognosis was elucidated. mRNA expression of L1-expressing gastric cancer cell line, KATO3, was suppressed using siRNA (KATO3 L1-). Microarray was used to indentify molecules that differ in expression between KATO3 L1- and the parental cell line.

Results: L1 was scarcely stained in non-cancerous epithelial cells and intestinal metaplastic cells. L1 was detected mainly in the cell surface membrane of cancer cells in 15 of 72 specimens, more often in the intestinal type cancer. No correlation was found between L1 expression and detection of cancer cells in the peritoneal washes or development of peritoneal carcinomatosis. Nevertheless, the prognosis of L1-positive cancer was significantly inferior (p = 0.024). Prognosis was particularly poor among 6 cases where L1 was expressed in cancer cells at the invasive front (median survival time 149 days). Of 40,000 genes evaluated in the microarray, mRNA expression of 50 genes were amplified by > 4-fold whereas the expression of 20 genes were attenuated to less than 1/4. Of these, expression of DYRK1A that induces apoptosis in conjunction with p53 was markedly suppressed to less than 1/8. Suppression of DYRK1A in the KATO3 L1- in comparison with the parental cell line was confirmed by RT-PCR.

Conclusions: L1 affects prognosis of gastric cancer, particularly when it is expressed in cancer cells at the invasion front. Its role in the biology of gastric cancer has began to be elucidated.

No significant financial relationships to disclose.

[Noninvasive assessment of coronary artery with substantial contrast volume reduction using 320-detector row computed tomography: a feasibility study]

The recently introduced 320-detector row computed tomography (320-row CT) allows very fast volumetric acquisition of the entire heart. Because the total amount of contrast agent required for CT coronary angiography (CTCA) depends directly on the acquisition time, 320-row CTCA would substantially reduce the contrast agent dose. The objective of this retrospective study was to evaluate the feasibility of contrast volume reduction on 320-row CTCA compared with 64-detector row CTCA (64-row CTCA). We retrospectively reviewed consecutive 320- and 64-row CTCA data (16 eligible cases for each; administrated contrast volume, 20-24 ml for the former and 50-65 ml for latter) from a homogeneous patient population (age ≤ 81, body weight ≤ 67 kg, and heart rate ≤ 69 bpm). The two types of CTCA data were compared with respect to the successful rate of adequate intravascular contrast enhancement defined as the number of segments with attenuations of more than 250 HU divided by total number of coronary segments evaluated. Our dataset provided mean intravascular attenuation values of 320 and 404 HU on the 320- and 64-row CTCA, respectively. Although the attenuation values were statistically lower for the 320-row CTCA (P < 0.001), there was no significant difference in the successful rates of adequate intravascular contrast enhancement (rate of 0.98 for each; P > 0.05). We therefore conclude that 320-row CTCA is a feasible method of diagnostic imaging and is superior to 64-row CTCA because it uses less of the contrast medium.