Nationwide trends of gatekeeper to invasive coronary angiography in suspected coronary artery disease

Funding Acknowledgements

Type of funding sources: None.

Background and Objectives

Real-world trends in the utility and type of gatekeeping studies in invasive coronary angiography (ICA) requires further investigation.

Methods

We identified outpatients who underwent noninvasive cardiac tests or directly ICA for suspected coronary artery disease (CAD) from the nationwide Korea Health Insurance Review and Assessment Service-National Patient Sample database between 2012 and 2018.

Results

Among 71,401 patients, the percentage of patients who were evaluated for suspected CAD was 34.7% for treadmill test (TMT), 4.2% for single-photon emission computed tomography (SPECT), 24.2% for coronary computed tomography angiography (CCTA), 1.6% for multiple gatekeepers, and 32.3% for directly ICA without noninvasive studies (Figure 1). The proportion of CCTA as a gatekeeper showed linear increase, (18.6% in 2012 and 28.8% in 2018; p < 0.001), while those of TMT, SPECT, and direct ICA have decreased (p < 0.001, p = 0.03, and p < 0.001, respectively). The overall incidence of downstream ICA after gatekeeper was 13.8% (6,662/48,346), and SPECT showed higher ICA rate in pairwise comparison with TMT and CCTA (p < 0.001). Patients who performed gatekeepers before ICA showed higher rate of subsequent PCI (34.7% vs. 32.3%; p < 0.001) and CABG (3.5% vs. 1.0%; p < 0.001), compared to those who directly underwent ICA, and CCTA was associated with higher revascularization rate after ICA in pairwise comparison with TMT and SPECT (p < 0.001).

Conclusion

Nationwide database demonstrated that CCTA is utilized increasingly as a gatekeeper for ICA and is associated with high revascularization rate after ICA in outpatients with suspected CAD.

Assessment of aortic valve area on cardiac computed tomography and doppler echocardiography: differences and clinical significance in symptomatic bicuspid aortic stenosis

Backgrounds

This study aimed to investigate the differences and clinical significance of effective orifice area (EOA) on Doppler echocardiography and geometric orifice area (GOA) on cardiac computed tomography (CT) in bicuspid aortic stenosis (AS).

Methods

One-hundred sixty-three consecutive patients (age 64±10 years, 56.4% men) with symptomatic bicuspid AS who were referred for surgery and underwent both cardiac CT and echocardiography within 3 months were studied. For the aortic valve area, GOACT was measured by multiplanar CT planimetry, and EOAEcho was calculated by continuity equation with Doppler echocardiography. The associations of GOACT and EOAEcho with the patients' symptom scale, biomarkers, and left ventricular (LV) functional variables were comprehensively analyzed.

Results

There was a significant but modest correlation between EOAEcho and GOACT (r=0.604, p<0.001). Both EOAEcho and GOACT revealed significant correlations with mean pressure gradient and peak transaortic velocity and the coefficients were higher in EOAEcho than GOACT. EOAEcho of 1.05 cm2 and GOACT of 1.25 cm2 correspond to the hemodynamic cut-off values for diagnosing severe AS. EOAEcho was well correlated with patients' symptom scale and log NT-pro BNP, but GOACT was not. In addition, EOAEcho showed higher correlation coefficient with estimated LV filling pressure and LV global longitudinal strain than GOACT.

Conclusions

Both EOAEcho and GOACT can be used to evaluate the severity of bicuspid AS, however, the threshold for GOACT for diagnosing severe AS should be applied higher than that for EOAEcho. EOAEcho tends to be more correlated with the patients' symptom degree, biomarkers, and LV functional variables than GOACT.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): The Korean Cardiac Research Foundation

Characteristics and clinical implications of premature summation of early and late diastolic filling in patients without tachycardia

Backgrounds

The summation of early (E) and late diastolic filling (A) on mitral inflow Doppler even in the absence of tachycardia is often found during assessments of left ventricular (LV) diastolic function. We evaluated the echocardiographic characteristics and clinical implications of premature E-A summation.

Methods

We identified 1,014 subjects who showed E-A summation and normal LV ejection fraction between January 2019 and June 2021 in two tertiary hospitals. Among these, 105 (10.4%) subjects showed premature E-A summation at heart rates less than 100 beats per minute (bpm). The conventional echocardiographic parameters and LV global longitudinal strain (GLS) were compared with 1:1 age, sex, and heart rate matched controls without E-A summation.

Results

The premature E-A summation group had a heart rate of 96.4±3.7 bpm. Only 4 (3.8%) subjects were classified as having LV diastolic dysfunction according to the current guidelines. That group showed prolonged isovolumic relaxation time (107.2±25.3 vs. 61.6±15.6 msec, p<0.001), increased Tei index (0.76±0.19 vs. 0.48±0.10, p<0.001), lower LVEF (63.8±7.0 vs. 67.3±5.6%, p<0.001) and lower absolute LV GLS (|LV GLS|) (17.0±4.2 vs. 19.7±3.3%, p<0.001) than controls. As the E-A summation occurred at lower heart rate, the |LV GLS| was also lower (p for trend=0.002).

Conclusions

The premature E-A summation at heart rates less than 100 bpm is associated with subclinical LV dysfunction. Time-based indices and LV GLS are helpful for evaluating this easily overlooked population.

Funding Acknowledgement

Type of funding sources: None.

Performance of an impedance-variable pulsed high-power electron-beam accelerator based on energy efficient transmission

Versatile high-power pulsed electron-beam accelerators that meet the requirements of pulsed high-power specifications are needed for appropriate applications in medical industry, defense, and other industries. The pulsed electron beam accelerator comprising a Marx generator and Blumlein pulse forming line (PFL) is designed to accelerate the electron beams at the level of 1 MeV when electrostatically discharging. The performance specifications of Marx generators consisting of a 100 kV DC power supply, R-L-C circuit, and high voltage switch are at a maximum 800 kV. At this time, by using the capacitance mismatching principle between the Marx generator and the Blumlein PFL under the law of preserving the amount of charge, it is possible to generate a high voltage in the form of a square pulse up to about 1.1 MV, as much as 1.37 times the charged voltage of the Marx generator. As a result, energy transmission from the Marx generator with a high efficiency of about 85% to the Blumlein PFL is possible. The aim of this study is that the pulsed high-power electron-beam accelerator can be used to change the diode impedance, and the energy of the accelerated electron beam reaches a level of 1 MeV with the square pulse width of about 100 ns at the flat-top in the range of relativistic electron beam generation. Performance tests were securely carried out by installing a dummy load based on CuSO₄ solution varying the diode impedance to deter damage to the circuit by preventing reflected waves from being generated in the load.

Development of ICNP-based inpatient falls prevention catalogue

OBJECTIVES

The International Council of Nurses supports the development of International Classification for Nursing Practice® (ICNP®) catalogues to support the construction of electronic health records and evidence-based practice. Such a catalogue is needed for inpatient falls.

METHODS

The ICNP®-Based Inpatient Fall-Prevention Catalogue ('The Catalogue') was developed following the six steps recommended by the International Council of Nurses: (1) identifying inpatient falls as a priority, (2) gathering relevant concepts from 10 international guidelines and comparing locally defined sets of fall-prevention terms, (3) mapping the concepts to the ICNP® terminology, (4) identifying new concepts, (5) conducting a clinical face validation with a 12-member panel and finalizing The Catalogue and (6) setting a strategy for dissemination. The high-level structure of the International Classification for Patient Safety was used as a theoretical framework.

RESULTS

Eighteen nursing care elements and 141 terms were identified. A local vocabulary set had 89 terms (63.1%) that all corresponded to the identified terms. The exact and post-coordination mapping rates to the ICNP® were 75% and 40.6% for assessment/diagnosis/outcomes and interventions, respectively. The 54 new terms corresponded to 52 primitive concepts. An external review of The Catalogue showed that it had adequate understandability and validity. However, one-third of assessments/diagnoses/outcomes and one-fourth of interventions were not found in a tertiary hospital practice.

CONCLUSION

A fall-prevention catalogue has been developed based on evidence and a theoretical framework and also clinically validated.

IMPLICATION FOR NURSING AND HEALTH POLICY

The Catalogue is a standardized interface terminology and content subset in any electronic health records system that can directly deliver evidence on fall prevention. It can also be used as an informatics tool to aggregate, analyse, interpret and compare nursing data worldwide.

P997Improving left atrial appendage occluder size determination by using 3-dimensional printing model of the left atrial appendage

Introduction

Given the complexity of left atrial appendage (LAA) structure, current 2D based LAA occluder (LAAO) size prediction system using transesophageal echocardiography (TEE) has limitations.

Objective

To assess the accuracy of LAAO size determination method by implantation simulation using a 3D printed model compared with a conventional method based on TEE.

Methods

We retrospectively reviewed 57 cases with percutaneous LAAO using Amplatzer Cardiac Plug and Amulet from 2014 to 2018. We excluded cases without cardiac CT (21 cases) or with peri-device leakage or inappropriate position of the device on six months follow up TEE (6 cases), or with paroxysmal atrial fibrillation (2 cases). We finally included 28 cases with anatomically and physiologically properly implanted LAAO, using the final size of the implanted devices as a standard for the size prediction accuracy. We generated 3D printing model from cardiac CT images. LAAO size was determined with device implantation simulation using 3D printing model and occluder devices (Figure C), and conventional 2D TEE measurements by two experienced cardiologists who were blinded to the size of the finally implanted device.

Results

The accuracy in size of 3D printed left atrium (LA) models, compared with CT image sources, were validated by measuring the distance between artifacts which were intentionally implanted to LA model during image processing. There was minimal bias (−0.11 mm) between 3D images and printed LA models (Figure A). As plotted in Figure B, LAAO sizing by implantation simulation with 3D printing model showed excellent agreement with actually implanted LAAO size (r=0.927; bias=0.7±2.5), while LAAO sizing by 2D TEE measurements remained poor (r=0.544; bias 2.3±6.7).

Conclusions

LAAO size determination by using 3D printing model of LAA showed excellent accuracy. A prospective study to evaluate the clinical utility of this method should be done in future.

P604Clinical feasibility assessment of a novel Quantitative Multi-contrast Atherosclerosis Characterization (qMATCH) sequence for carotid plaque quantification

Background

Conventional protocol contrast MRI (cMRI) for evaluating carotid artery atherosclerosis is clinically under-utilized due to complex scanning procedures and long scan time. Recently, the Quantitative Multi-contrast Atherosclerosis Characterization (qMATCH) has been proposed, which allows comprehensive and quantitative assessment of atherosclerosis including MRA, dark-blood vessel wall morphology, and T1/T2 mapping with an 8-minute single scan (Figure1). However, the diagnostic accuracy and feasibility of qMATCH has not been validated in clinical circumstances.

Purpose

To evaluate the diagnostic accuracy of quantitative plaque analysis of qMATCH compared with cMRI

Method

We prospectively enrolled 43 patients who have carotid plaques diagnosed by carotid ultrasound. cMRI was performed along with qMATCH scan. All imaging data were acquired with a clinical 3T scanner using a 64-channel head & neck coil. In the current analysis, we evaluated the diagnostic accuracy of qMATCH in the quantitative assessment of carotid plaque. Plaque area measurements using dark-blood wall images with qMATCH were compared with corresponding cross-sectional T1/T2-weighted images with cMRI as references values (Figure 2). These inter-technique comparisons included linear regression with Pearson correlation and Bland-Altman analyses to assess the mean inter-technique differences (biases) and limits of agreements.

Result

Among 90 segments, mean plaque areas measured by cMRI and qMATCH were 43.83±21.21 mm2 and 42.47±19.23mm2, respectively (mean differences, −1.36±8.12mm2; p for a paired t-test, 0.073). Correlation coefficient showed excellent correlation between plaque areas measured by cMRI and qMATCH (r=0.943, p<0.001) (Figure 3). Bland-Altman plot showed excellent agreement in plaque areas between the two methods (Figure 4).

Conclusion

Quantitative carotid plaque burden analysis by a novel sequence with qMATCH is feasible and accurate compared with conventional MRI. Given that qMATCH can reduce scan time and allow quantitative relaxometry mapping, fast and accurate carotid plaque analysis would be feasible. Further studies to evaluate the accuracy of qualitative plaque analysis should be performed to confirm the “all-in-one” assessment of carotid atherosclerosis using qMATCH.

P5350Atrial fibrillation prediction using P wave signal-averaged ECG in patients with embolic stroke of undetermined source

Background

Approximately 10–25% of ischemic strokes are of unknown origin. Determining their potential association with subclinical atrial fibrillation (SCAF) is important for proper secondary prevention. We investigated whether SCAF can be predicted by assessing the atrial substrate with signal-averaged electrocardiography (SAECG).

Methods

Between April 2015 and February 2018, we recruited 125 consecutive patients with embolic stroke of undetermined source (ESUS) and 125 patients with paroxysmal atrial fibrillation (AF) patients as control. All participants underwent P wave SAECG at baseline and ESUS patients were followed up with ECG and Holter ECG, at baseline, 3, 6, and 12 months after discharge, and every 12 months thereafter.

Results

In the ESUS group (69 males, 68.4±12.1 years), 32 (25.6%) patients were diagnosed with SCAF during follow-up. There were no significant differences between both groups in terms of P wave duration [PWD] (ESUS vs. AF, P=0.321). PWD demonstrated a significant predictive efficacy for SCAF detection during follow-up (C-index of standard PWD=0.657, 95% confidence interval (CI) 0.552–0.761, P=0.008).

Stroke recurrence occurred in 22 patients (17.6%) and was significantly associated with PWD but not SCAF (odds ratio 2.756, 95% CI 1.061–7.161, P=0.037).

Conclusion

PWD, an ECG biomarker associated with atrial substrate directly contributes to AF and ESUS, is useful for predicting SCAF. The potential for using this simple ECG biomarker for screening for SCAF amongst ESUS patients merits further exploration.

Dosimetric analysis of stereotactic rotational versus static intensity-modulated radiation therapy for pancreatic cancer

PURPOSE

Stereotactic body radiation therapy is a promising treatment modality for locally advanced pancreatic cancer. To determine the optimal radiation treatment, we compared the plan characteristics of volumetric-modulated arc therapy and intensity-modulated radiation therapy when administered with stereotactic body radiation therapy to treat pancreatic cancer.

PATIENTS AND METHODS

Fifteen patients with locally advanced pancreatic cancer were treated by stereotactic body radiation therapy at a dose of 24-32Gy in four fractions with marker-guided gated volumetric-modulated arc therapy. Four dimensional-computed tomography scans were used to assess the target and surrounding normal organs. The same images, contours, and dose constraints were used for dual-arc volumetric-modulated arc therapy and 9-field intensity-modulated radiation therapy planning. Plans were compared using dosimetric parameters and treatment performance.

RESULTS

Volumetric-modulated arc therapy required significantly lower monitor units (1726 vs. 4188; P<0.001) and shorter treatment delivery time in comparison with intensity-modulated radiation therapy (22.5min vs. 52.4min; P<0.001). Regarding target volume coverage, both modalities demonstrated comparable results (V_95%, 99.3% vs. 99.4%; P=0.796). Both modalities satisfied the dosimetric determinants for duodenal toxicity and the maximum and mean doses administered to normal organ were also statistically similar.

CONCLUSION

In comparison with 9-field intensity-modulated radiation therapy, volumetric-modulated arc therapy significantly reduces the number of monitoring units and treatment delivery times while administering similar dosimetric quality. Based on these results, volumetric-modulated arc therapy might be an appropriate treatment for locally advanced pancreatic cancer when combined with stereotactic body radiation therapy.

Estimation of the medical need for carbon-ion radiotherapy in Korea

The Korea Heavy Ion Medical Accelerator project focuses on the development of medical accelerator facilities for delivering carbon-ion beams to cancer patients. The purpose of the present study was to estimate the clinical need for carbon-ion therapy in Korea. Seven tumor sites, namely head and neck, liver, lung, colon and rectum, prostate, bone and soft tissue, and pancreas were selected as eligible sites for receiving carbon-ion radiotherapy (RT) by radiation oncologists of the Korea Institute of Radiological and Medical Sciences. Cancer incidence data for the selected tumor sites were obtained from the Korea National Cancer Incidence Database in order to estimate the potential medical need for carbon-ion RT. The carbon-ion RT adaption rate was assessed based on the clinical experience of other carbon-ion therapy facilities. An estimation model was constructed for estimating the medical need for carbon-ion RT, and from this, 25 606 patients were deemed to be potential candidates for carbon-ion RT. This estimated potential need corresponded to 10% of newly diagnosed cancer patients in Korea. The realistic estimation was calculated as ranging between 4000 and 6300 patients, depending on the carbon-ion RT adaptation rate. This estimated medical need corresponded to 2-3% of newly diagnosed cancer patients in Korea. Taken together, our findings suggest that there is a clear medical need for carbon-ion RT in Korea, with at least 4000 potential patients per year.

Protein Arginine Methyltransferase PRMT1 Is Essential for Palatogenesis

Cleft palate is among the most common birth defects. Currently, only 30% of cases have identified genetic causes, whereas the etiology of the majority remains to be discovered. We identified a new regulator of palate development, protein arginine methyltransferase 1 (PRMT1), and demonstrated that disruption of PRMT1 function in neural crest cells caused complete cleft palate and craniofacial malformations. PRMT1 is the most highly expressed of the protein arginine methyltransferases, enzymes responsible for methylation of arginine motifs on histone and nonhistone proteins. PRMT1 regulates signal transduction and transcriptional activity that affect multiple signal pathways crucial in craniofacial development, such as the BMP, TGFβ, and WNT pathways. We demonstrated that Wnt1-Cre;Prmt1 ^fl/fl mice displayed a decrease in palatal mesenchymal cell proliferation and failure of palatal shelves to reach the midline. Further analysis in signal pathways revealed that loss of Prmt1 in mutant mice decreased BMP signaling activation and reduced the deposition of H4R3me2a mark. Collectively, our study demonstrates that Prmt1 is crucial in palate development. Our study may facilitate the development of a better strategy to interrupt the formation of cleft palate through manipulation of PRMT1 activity.

Expansion microscopy

Super-resolution optical microscopy techniques have revolutionized how we see and understand biology. In recent past, a new super-resolution optical microscopy technique called expansion microscopy (ExM) was developed. Unlike other pre-existing super-resolution imaging techniques, this technique achieves super-resolution by physically expanding biological specimens via a swellable hydrogel. After the development of ExM, various techniques based on ExM but with improved performance in various aspects, have been developed. In this review, we introduce the basic principles of ExM and its variants. and compare the advantages and disadvantages of these techniques. In addition, we present the applications of ExM techniques in various fields.

Education, Practice, and Research in Nursing Terminology: Gaps, Challenges, and Opportunities

Objectives To provide an overview of nursing terminology education, research, and clinical use, to identify and analyze any gaps therein, and to propose ways to close those gaps.

Methods We conducted an extensive Internet and literature search to establish the current status of nursing terminology education, research, and clinical use. We also surveyed 40 experts in nursing terminology from 15 countries to obtain more detailed information on nursing terminology education and clinical use.

Results We found that there are gaps in nursing terminology education, research, and use, with the area of research being the most advanced. Nursing terminology is not taught widely in either informatics or nursing programs. Where it is taught, it constitutes only up to several hours of an informatics or nursing course. Research into nursing terminology has been very active, focusing mainly on the development and evaluation/validation of nursing terminology, using reference terminology models, and mapping between these and nursing terminologies. However, little research has been carried out on the use of nursing terminologies in clinical information systems. In addition, there are very few systems in which a standardized nursing terminology has been implemented.

Conclusion In order to close the gaps in nursing terminology education, research, and clinical use, qualified personnel are required to educate potential users as to the importance of terminology-based information systems for semantic interoperability. In addition, more research is required into the implementation of nursing terminologies in information systems, and we must demonstrate the usefulness and effectiveness of nursing terminology-based information systems.

Mechanisms for SU5416 as a radiosensitizer of endothelial cells

Endothelial cells (ECs), that comprise the tumor vasculature, are critical targets for anticancer radiotherapy. The aim of this work was to study the mechanism by which SU5416, a known anti-angiogenesis inhibitor, modifies the radiation responses of human vascular ECs. Two human endothelial cell lines (HUVEC and 2H11) were treated with SU5416 alone, radiation alone, or a combination of both. In vitro tests were performed using colony forming assays, FACS analysis, western blotting, immunohistochemistry, migration assay, invasion assays and endothelial tube formation assays. The combination of radiation and SU5416 significantly inhibited cell survival, the repair of radiation-induced DNA damage, and induced apoptosis. It also caused cell cycle arrest, inhibited cell migration and invasion, and suppressed angiogenesis. In this study, our results first provide a scientific rationale to combine SU5416 with radiotherapy to target ECs and suggest its clinical application in combination cancer treatment with radiotherapy.

Effective generation of the spread-out-Bragg peak from the laser accelerated proton beams using a carbon-proton mixed target

Conventional laser accelerated proton beam has broad energy spectra. It is not suitable for clinical use directly, so it is necessary for employing energy selection system. However, in the conventional laser accelerated proton system, the intensity of the proton beams in the low energy regime is higher than that in the high energy regime. Thus, to generate spread-out-Bragg peak (SOBP), stronger weighting value to the higher energy proton beams is needed and weaker weighting value to the lower energy proton beams is needed, which results in the wide range of weighting values. The purpose of this research is to investigate a method for efficient generating of the SOBP with varying magnetic field in the energy selection system using a carbon-proton mixture target. Energy spectrum of the laser accelerated proton beams was acquired using Particle-In-Cell simulations. The Geant4 Monte Carlo simulation toolkit was implemented for energy selection, particle transportation, and dosimetric property measurement. The energy selection collimator hole size of the energy selection system was changed from 1 to 5 mm in order to investigate the effect of hole size on the dosimetric properties for Bragg peak and SOBP. To generate SOBP, magnetic field in the energy selection system was changed during beam irradiation with each beam weighting factor. In this study, our results suggest that carbon-proton mixture target based laser accelerated proton beams can generate quasi-monoenergetic energy distribution and result in the efficient generation of SOBP. A further research is needed to optimize SOBP according to each range and modulated width using an optimized weighting algorithm.

Evaluation of a Korean version of a tool for assessing the incorporation of human factors into a medication-related decision support system: the I-MeDeSA

OBJECTIVE

The Instrument for Evaluating Human-Factor Principles in Medication-Related Decision Support Alerts (I-MeDeSA) was developed recently in the US with a view towards improving considerations of human-factor principles when designing alerts for clinical decision support (CDS) systems. This study evaluated the generalizability of this tool, in cooperation with its authors, across cultures by applying it to a Korean system. We also examined opportunities to promote user acceptance of the system.

METHODS

We developed a Korean version of the I-MeDeSA (K-I-MeDeSA) and used it to evaluate drug-drug interaction alerts in a large academic tertiary hospital in Seoul. We involved four reviewers (A, B, C, and D). Two (A and B) conducted the initial independent scoring, while the other two (C and D) performed a final review and assessed feedback from the initial reviewers. The obtained scores were compared with those from 13 previously reported CDS systems. The feedback was summarized qualitatively.

RESULTS

The translation of the I-MeDeSA had excellent interrater agreement in terms of face validity (scale-level content validity index = 0.95). The system's K-I-MeDeSA score was 10 out of 26, with a good agreement between reviewers (κ = 0.77), which showed a lack of human-factor considerations. The reviewers readily identified two of the nine principles that needed primary improvement: prioritization and text-based information. The reviewers also expressed difficulty judging the following four principles: alarm philosophy, visibility, color, and learnability and confusability.

CONCLUSION

The K-I-MeDeSA was semantically and operationally equivalent to the original tool. Only minor cultural problems were identified, leading the reviewers to suggest the need for clarification of certain words plus a more detailed description of the tool's rationale and exemplars. Further evaluation is needed to empirically assess whether the implementation of changes in an electronic health record system could improve the adoption of CDS alerts.

IL-22-producing CD4+ cells are depleted in actively inflamed colitis tissue

T helper type (Th17) cytokines such as interleukin (IL)-17A and IL-22 are important in maintaining mucosal barrier function and may be important in the pathogenesis of inflammatory bowel diseases (IBDs). Here, we analyzed cells from the colon of IBD patients and show that Crohn's disease (CD) patients had significantly elevated numbers of IL-17+, CD4+ cells compared with healthy controls and ulcerative colitis (UC) patients, but these numbers did not vary based on the inflammatory status of the mucosa. By contrast, UC patients had significantly reduced numbers of IL-22+ cells in actively inflamed tissues compared with both normal tissue and healthy controls. There was a selective increase in mono-IL-17-producing cells from the mucosa of UC patients with active inflammation together with increased expression of transforming growth factor (TGF)-β and c-Maf. Increasing concentrations of TGF-β in lamina propria mononuclear cell cultures significantly depleted Th22 cells, whereas anti-TGF-β antibodies increased IL-22 production. When mucosal microbiota was examined, depletion of Th22 cells in actively inflamed tissue was associated with reduced populations of Clostridiales and increased populations of Proteobacteria. These results suggest that increased TGF-β during active inflammation in UC may lead to the loss of Th22 cells in the human intestinal mucosa.

Risk factors for double primary malignancies and their clinical implications in patients with sporadic gastric cancer

AIMS

We carried out a large scale study to identify the risk factors for double primary malignancy (DPM) development in gastric cancer patients and to evaluate the clinical implications for these patients.

METHODS

A total of 2593 patients who underwent gastrectomy for primary gastric cancer from January 2005 to November 2010 were reviewed with regard to DPM. We compared the clinicopathological characteristics, risk factors for developing DPM, and prognosis between the DPM+ group and the DPM- group.

RESULTS

Of the 2593 patients, 152 (5.9%) were diagnosed with DPM. The most common accompanying malignancies were colorectal, lung and thyroid. Multivariate analysis indicated that age (p = 0.016) and MSI status (p = 0.002) were associated with a higher frequency of DPM. 30.3% of patients were diagnosed with DPM within 1 year around perioperative period and 53.3% of patients had DPM detected during 5 years of post-operative follow up periods. Although there was no significant difference in overall survival between the DPM+ and DPM- group, DPM+ patients had a worse prognosis than DPM- patients in stage I gastric cancer.

CONCLUSIONS

Gastric cancer patients over the age of 60 or with a MSI-high status had an increased risk for developing DPM. Further, in stage I gastric cancer, the presence of DPM was associated with a worse prognosis. Therefore, careful pre- and postoperative surveillance is especially important in these patients.

18F-FDG PET/CT findings in patients with Kikuchi disease

PURPOSE

Kikuchi disease (KD) is a benign and self-limited syndrome characterized by cervical lymphadenopathy. This study evaluated 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) findings in patients with KD and analyzed their imaging features.

PATIENTS, MATERIAL, METHODS

We evaluated the FDG PET/CT findings of 22 patients (14 men, 8 women) with KD, ranging in age from 9 to 73 years. All patients had been diagnosed based on the pathological findings of biopsy. We examined the locations, metabolic activity and size of hypermetabolic lymph nodes (LNs) on FDG PET/CT imaging with medical history including laboratory results.

RESULTS

Among the 22 patients, we identified 619 hypermetabolic LNs which had maximum standard uptake value (SUVmax) above 3.0. The 16 patients were studied with FDG PET/CT to identify the cause of fever, another 5 patients for their neck masses, and the remaining patient for his left inguinal mass. Hypermetabolic LNs were noted in neck (18 bilaterally, 2 right, 1 left) of 21 patients, axilla of 10, mediastinum of 9, abdomen of 17, pelvis of 6, and inguinal area of 3. The SUVmax of FDG uptake in affected LNs by patient base analysis were 6.2-29.4. Of the 619 hypermetabolic LNs identified, 440 LNs (71.1%) were less than 10 mm in their short axis determined by CT, and were occasionally aggregated. No patient showed solid organ hypermetabolic lesion in FDG PET/CT.

CONCLUSION

Kikuchi disease could present multiple hypermetabolic LNs in body on FDG PET/CT. Based on the physical findings, consideration of the generalized distribution of the relatively small-sized hypermetabolic LNs, FDG PET/CT may be useful as a diagnostic tool in cases of Kikuchi disease.

Evaluation of hybrid PET/CT gastrography in gastric cancer

AIM

With the recent advances in multidetector-row CT, a fusion of functional PET with three dimensional (3D) CT gastrography may provide enhanced diagnostic capability and help surgeons during preoperative planning. The diagnostic value of hybrid PET/CT gastrography was compared with that of conventional PET/CT alone in gastric cancer staging.

PATIENTS, METHODS

Patients with gastric cancer (n = 101) confirmed by endoscopic biopsy specimens underwent conventional PET/CT and regional PET with contrast enhanced CT, followed by gastrectomy with lymphadenectomy at our institution from November 2007 to November 2008. These images were fused into a hybrid PET/CT gastrography using the cardiac IQ fusion software. Conventional PET/CT and hybrid PET/CT gastrography were evaluated for staging of gastric cancer. After gastrectomy, these were compared with pathologic reports respectively.

RESULTS

Gastric cancer was diagnosed as 50 early gastric cancer (EGC) and 51 advanced gastric cancer (AGC) on pathologic examination. In EGC, hybrid PET/CT gastrography and PET/CT identified 36 (72%) and 7 (14%) tumours, respectively. Hybrid PET/CT gastrography correctly delineated the subtype of 25 EGC. In AGC, all 51 (100%) tumours were identified on the hybrid PET/CT gastrography compared to 39 (76.5%) tumours on PET/CT. Hybrid PET/CT gastrography correctly classified the morphology of 42 AGC using the Bormann classification. Additionally, depth of invasion was correctly presented in 38 of 51 AGC. Hybrid PET/CT gastrography for regional lymph node (LN) metastasis in the EGC and AGC showed the sensitivity of 75% and 83.9%, and specificity 90.5% and 55%, respectively.

CONCLUSION

Hybrid PET/CT gastrography is the more intuitive and comprehensive method for the preoperative evaluation of gastric cancer than conventional PET/CT.

Cloning of a Family 11 Xylanase Gene from Bacillus amyloliquefaciens CH51 Isolated from Cheonggukjang

Bacillus amyloliquefaciens CH51, an isolate from cheonggukjang, Korean fermented soyfood, secretes several enzymes into culture medium. A gene encoding 19 kDa xylanase was cloned by PCR. Sequencing showed that the gene encoded a glycohydrolase family 11 xylanase and named xynA. xynAHis, xynA with additional codons for his-tag, was overexpressed in Escherichia coli BL21(DE3) using pET-26b(+). XynAHis was purified using HisTrap affinity column. Km and Vmax of XynAHis were 0.363 mg/ml and 701.1 μmol/min/mg, respectively with birchwood xylan as a substrate. The optimum pH and temperature were pH 4 and 25 °C, respectively. When xynA was introduced into Bacillus subtilis WB600, active XynA was secreted into culture medium.

Changes in collagen fibril pattern and adhesion force with collagenase-induced injury in rat Achilles tendon observed via AFM

The Achilles tendon consists mainly of type I collagen fibers that contain collagen fibrils. When the Achilles tendon is injured, it is inflamed. The collagenase-induced model has been widely used to study tendinitis. The major advantages of atomic force microscopy (AFM) over conventional optical and electron microscopy for bio-imaging include its non-requirement of a special coating and vacuum, and its capability to perform imaging in all environments. AFM force-distance measurements have become a fundamental tool in the fields of surface chemistry, biochemistry and materials science. Therefore, the changes in the ultrastructure and adhesion force of the collagen fibrils on the Achilles tendons of rats with Achilles tendinitis were observed using AFM. The changes in the structure of the Achilles tendons were evaluated based on the diameter and D-banding of the collagen fibrils. Collagenase-induced Achilles tendinitis was induced with the injection of 30 microl crude collagenase into 7-week-old male Sprague-Dawley rats. The animals were each sacrificed on the first, second, third, fifth and seventh day after the collagenase injection. The normal and injured Achilles tendons were fixed in 4% buffered formalin and dehydrated with increasing concentrations of ethanol. AFM was performed using the non-contact mode at the resolution of 512 x 512 pixels, with a scan speed of 0.8 line/sec. The adhesion force was measured via the force-distance curve that resulted from the interactions between the AFM tip and the collagen fibril sample using the contact mode. The diameter of the collagen fibrils in the Achilles tendons significantly decreased (p < 0.05) after the collagenase injection, and the pattern of the D-banding of the collagen fibrils was similar to that of the diameter changes. The adhesion force decreased until the fifth day after the collagenase injection, but increased on the seventh day after the collagenase injection (p < 0.0001).

Education, practice, and research in nursing terminology: gaps, challenges, and opportunities

OBJECTIVES

To provide an overview of nursing terminology education, research, and clinical use, to identify and analyze any gaps therein, and to propose ways to close those gaps.

METHODS

We conducted an extensive Internet and literature search to establish the current status of nursing terminology education, research, and clinical use. We also surveyed 40 experts in nursing terminology from 15 countries to obtain more detailed information on nursing terminology education and clinical use.

RESULTS

We found that there are gaps in nursing terminology education, research, and use, with the area of research being the most advanced. Nursing terminology is not taught widely in either informatics or nursing programs. Where it is taught, it constitutes only up to several hours of an informatics or nursing course. Research into nursing terminology has been very active, focusing mainly on the development and evaluation/validation of nursing terminology, using reference terminology models, and mapping between these and nursing terminologies. However, little research has been carried out on the use of nursing terminologies in clinical information systems. In addition, there are very few systems in which a standardized nursing terminology has been implemented.

CONCLUSION

In order to close the gaps in nursing terminology education, research, and clinical use, qualified personnel are required to educate potential users as to the importance of terminology-based information systems for semantic interoperability. In addition, more research is required into the implementation of nursing terminologies in information systems, and we must demonstrate the usefulness and effectiveness of nursing terminology-based information systems.

Search for exclusive gammagamma production in Hadron-Hadron collisions

We have searched for exclusive gammagamma production in proton-antiproton collisions at sqrt[s]=1.96 TeV, using 532 pb(-1) of integrated luminosity taken by the run II Collider Detector at Fermilab. The event signature requires two electromagnetic showers, each with transverse energy E(T)>5 GeV and pseudorapidity |eta|<1.0, with no other particles detected in the event. Three candidate events are observed. We discuss the consistency of the three events with gammagamma, pi(0)pi(0), or eta eta production. The probability that other processes fluctuate to >or=3 events is 1.7x10(-4). An upper limit on the cross section of pp-->p + gammagamma + p production is set at 410 fb with 95% confidence level.

Observation of the Heavy Baryons Sigma b and Sigma b*

We report an observation of new bottom baryons produced in pp collisions at the Tevatron. Using 1.1 fb(-1) of data collected by the CDF II detector, we observe four Lambda b 0 pi+/- resonances in the fully reconstructed decay mode Lambda b 0-->Lambda c + pi-, where Lambda c+-->pK* pi+. We interpret these states as the Sigma b(*)+/- baryons and measure the following masses: m Sigma b+=5807.8 -2.2 +2.0(stat.)+/-1.7(syst.) MeV/c2, m Sigma b- =5815.2+/-1.0(stat.)+/-1.7(syst.) MeV/c2, and m(Sigma b*)-m(Sigma b)=21.2-1.9 +2.0(stat.)-0.3+0.4(syst.) MeV/c2.

Search for chargino-neutralino production in pp collisions at sq rt[s] = 1.96 TeV

We present a search for associated production of the chargino and neutralino supersymmetric particles using up to 1.1 fb{-1} of integrated luminosity collected by the CDF II experiment at the Tevatron pp collider at sq rt[s]=1.96 TeV. We analyze events with a large transverse momentum imbalance and either three charged leptons or two charged leptons of the same electric charge. The numbers of observed events are consistent with standard model expectations. Upper limits on the production cross section are derived in different theoretical models.

Precise measurement of the top-quark mass in the lepton+jets topology at CDF II

We present a measurement of the mass of the top quark from proton-antiproton collisions recorded at the CDF experiment in Run II of the Fermilab Tevatron. We analyze events from the single lepton plus jets final state (tt-->W(+)bW(-)b-->lnubqq'b). The top-quark mass is extracted using a direct calculation of the probability density that each event corresponds to the tt final state. The probability is a function of both the mass of the top quark and the energy scale of the calorimeter jets, which is constrained in situ by the hadronic W boson mass. Using 167 events observed in 955 pb(-1) of integrated luminosity, we achieve the single most precise measurement of the top-quark mass, 170.8+/-2.2(stat.)+/-1.4(syst.) GeV/c(2).

Search for new physics in high-mass electron-positron events in pp[over] collisions at square root s = 1.96 TeV

We report the results of a search for a narrow resonance in electron-positron events in the invariant mass range of 150-950 GeV/c(2) using 1.3 fb(-1) of pp[over] collision data at square root s = 1.96 TeV collected by the CDF II detector at Fermilab. No significant evidence of such a resonance is observed and we interpret the results to exclude the standard-model-like Z' with a mass below 923 GeV/c(2) and the Randall-Sundrum graviton with a mass below 807 GeV/c(2) for k/M[over](pl) = 0.1, both at the 95% confidence level. Combining with diphoton data excludes the Randall-Sundrum graviton for masses below 889 GeV/c(2) for k/M[over](pl) = 0.1.

Search for high-mass diphoton states and limits on Randall-Sundrum gravitons at CDF

We have performed a search for new particles which decay to two photons using 1.2 fb(-1) of integrated luminosity from pp[over] collisions at square root s = 1.96 TeV collected using the CDF II detector at the Fermilab Tevatron. We find the diphoton mass spectrum to be in agreement with the standard model expectation, and set limits on the cross section times branching ratio for the Randall-Sundrum graviton, as a function of diphoton mass. We subsequently derive lower limits for the graviton mass of 230 GeV/c(2) and 850 GeV/c(2), at the 95% confidence level, for coupling parameters (k/M[over](Pl)) of 0.01 and 0.1, respectively.