Association between being at-risk of malnutrition and discontinued home medical care among older patients: a 1-year follow-up study

BACKGROUND

Both malnutrition and at-risk of malnutrition are prevalent among older patients receiving home medical care. Discontinuation of home medical care usually occurs when an older patient is admitted to a hospital or nursing home or dies. This study aimed to assess prospective associations between nutritional status and discontinuation of home medical care in older patients.

METHODS

Three hundred and thirty-three Japanese older patients receiving home-visit nursing care services were included in this study. Their nutritional status was assessed using the Mini Nutritional Assessment®-Short Form, and patients were classified into three groups (well-nourished, at-risk of malnutrition and malnourished). Outcomes were confirmed at the 1-year follow-up survey. Hazard ratios (HRs) and 95% confidence intervals (CIs) for discontinuation of home medical care based on nutritional status were calculated using a Cox proportional hazard model. Covariates included age, sex, living status, economic status, activities of daily living, comorbidities and dysphagia status.

RESULTS

In total, 297 patients (median age: 84 years) were analysed. At baseline, 48.5% of the patients were at-risk of malnutrition and 18.9% were malnourished. During the observation period of 1 year, 27.6% patients discontinued their home medical care. In the adjusted model, the HR for discontinuation of home medical care among those at-risk of malnutrition was 2.44 (95% CI: 1.34-4.45) times than that of the well-nourished group, although the malnourished group was not significantly associated with discontinuation of home medical care (HR: 1.69, 95% CI: 0.77-3.72; referent: well-nourished).

CONCLUSIONS

At-risk of malnutrition was associated with discontinuation of home medical care among older patients.

Establishment of indicator for screening of child abuse and neglect in primary school-age children

AIM

In Japan, elementary schools are committed to early discovery of child abuse and neglect. Under Japanese law, dentists are required to be involved in child welfare and early detection of child abuse. However, the extent to which dental practitioners cooperate for prevention of child abuse with schools remains limited to date. Therefore, we undertook a community-based project that aimed to develop screening indicators to identify potentially abused children based on their oral health condition and behavioural characteristics in education settings. We have already reported on the relationship between oral health condition and child abuse. The present study established an indicator that can facilitate identification and prevention of child abuse/neglect.

METHODS

Study design: Cross-sectional study. Questionnaires were given to teachers at an elementary school to ascertain behavioural characteristics observed in children who experienced abuse.

CONCLUSION

We developed a check sheet for proper assessment, which requires as little effort as possible, and an index for screening children in need based on teaching staff's observation of students' daily behaviour in school settings. Highly selected items are advantageous as they lead to a decrease in non-response or responses, which can help in improving the accuracy of the response to each question.

MR Imaging Findings of Carcinoma Ex Pleomorphic Adenoma Related to Extracapsular Invasion and Prognosis

BACKGROUND AND PURPOSE

MR imaging can reflect the pathologic progression of carcinoma ex pleomorphic adenoma (CXPA). This study aimed to identify the imaging findings related to extracapsular invasion of CXPA. Additionally, the pathologic background of these findings was investigated.

MATERIALS AND METHODS

This retrospective study included 37 patients with histologically confirmed CXPA. Three radiologists independently evaluated whether the CXPA showed the following characteristic MR imaging findings: border, capsule, the corona sign on fat-saturated T2WI and contrast-enhanced fat-saturated T1WI, and the black ring sign. The corona sign appeared larger on fat-saturated and/or contrast-enhanced fat-saturated T1WI than on T1WI. The black ring sign was defined as an intratumoral nodule with a thick low-intensity rim on T2WI. Interreader agreement of the visual assessment was performed using κ analysis, and MR imaging and histopathologic findings were also correlated. Kaplan-Meier survival and the log-rank test were used to estimate the 3-year disease-free survival.

RESULTS

MR imaging findings, especially peritumoral findings, showed a significant difference between invasive and noninvasive CXPA. The reliability was poor for the border and capsule. In contrast, it was good for the corona sign on fat-saturated and contrast-enhanced fat-saturated T1WI and the black ring sign. Pathologically, the corona sign reflected the invasiveness of the tumor and inflammatory cells, while the black ring sign reflected hyalinization or fibrosis. The corona sign also showed a significant difference in the 3-year disease-free survival.

CONCLUSIONS

MR imaging findings, including the corona and black ring signs, reliably differentiated invasive and noninvasive CXPA. The corona sign can be used as a prognostic factor for CXPA.

Discharge characteristics of steady-state high-density plasma source based on cascade arc discharge with hollow cathode

We developed a steady-state high-density plasma source by applying a hollow cathode to a cascade arc discharge device. The hollow cathode is made of a thermionic material (LaB₆) to facilitate plasma production inside it. The cascade arc discharge device with the hollow cathode produced a stationary plasma with an electron density of about 10¹⁶ cm^-3. It was found that the plasma source produces a strong pressure gradient between the gas feed and the vacuum chamber. The plasma source separated the atmospheric pressure (100 kPa) and a vacuum (100 Pa) when the discharge was performed with an argon gas flow rate of 5.0 l/min and a discharge current of 40 A. An analysis of the pressure gradient along the plasma source showed that the pressure difference between the gas feed and the vacuum chamber can be well described by the Hagen-Poiseuille flow equation, indicating that the viscosity of the neutral gas is the dominant factor for producing this pressure gradient. A potential profile analysis suggested that the plasma was mainly heated within cylindrical channels whose inner diameter was 3 mm. This feature and the results of the pressure ratio analysis indicated that the temperature, and, thus, viscosity, of the neutral gas increased with the increasing number of intermediate electrodes. The discharge characteristics and shape of the hollow cathode are suitable for plasma window applications.

Loss of IκBζ Drives Dentin Formation via Altered H3K4me3 Status

Enforced enrichment of the active promoter marks trimethylation of histone H3 lysine 4 (H3K4me3) and acetylation of histone H3 lysine 27 (H3K27ac) by inhibiting histone demethylases and deacetylases is positively associated with hard tissue formation through the induction of osteo/odontogenic differentiation. However, the key endogenous epigenetic modulator of odontoblasts to regulate the expression of genes coding dentin extracellular matrix (ECM) proteins has not been identified. We focused on nuclear factor (NF)-κB inhibitor ζ (IκBζ), which was originally identified as the transcriptional regulator of NF-κB and recently regarded as the NF-κB-independent epigenetic modulator, and found that IκBζ null mice exhibit a thicker dentin width and narrower pulp chamber, with aged mice having more marked phenotypes. At 6 mo of age, dentin fluorescent labeling revealed significantly accelerated dentin synthesis in the incisors of IκBζ null mice. In the molars of IκBζ null mice, marked tertiary dentin formation adjacent to the pulp horn was observed. Mechanistically, the expression of COL1A2 and COL1A1 collagen genes increased more in the odontoblast-rich fraction of IκBζ null mice than in wild type in vivo, similar to human odontoblast-like cells transfected with small interfering RNA for IκBζ compared with cells transfected with control siRNA in vitro. Furthermore, the direct binding of IκBζ to the COL1A2 promoter suppressed COL1A2 expression and the local active chromatin status marked by H3K4me3. Based on whole-genome identification of H3K4me3 enrichment, ECM and ECM organization-related gene loci were selectively activated by the knockdown of IκBζ, which consistently resulted in the upregulation of these genes. Collectively, this study suggested that IκBζ is the key negative regulator of dentin formation in odontoblasts by inhibiting dentin ECM- and ECM organization-related gene expression through an altered local chromatin status marked by H3K4me3. Therefore, IκBζ is a potential target for epigenetically improving the clinical outcomes of dentin regeneration therapies such as pulp capping.

Bayesian inference of ion velocity distribution function from laser-induced fluorescence spectra

The velocity distribution function is a statistical description that connects particle kinetics and macroscopic parameters in many-body systems. Laser-induced fluorescence (LIF) spectroscopy is utilized to measure the local velocity distribution function in spatially inhomogeneous plasmas. However, the analytic form of such a function for the system of interest is not always clear under the intricate factors in non-equilibrium states. Here, we propose a novel approach to select the valid form of the velocity distribution function based on Bayesian statistics. We formulate the Bayesian inference of ion velocity distribution function and apply it to LIF spectra locally observed at several positions in a linear magnetized plasma. We demonstrate evaluating the spatial inhomogeneity by verifying each analytic form of the local velocity distribution function. Our approach is widely applicable to experimentally establish the velocity distribution function in plasmas and fluids, including gases and liquids.

Measurements of radial profile of isotope density ratio using bulk charge exchange spectroscopy

A bulk charge exchange spectroscopy (BCXS) system using a grism (grating prism) spectrometer has been applied to measure the profile of the deuterium (D) fraction in deuterium and hydrogen (H) mixture plasma in the Large Helical Device. The observed spectrum can be fitted with four Gaussian functions successfully by reduction of free parameters for the least-squares fit. The plasma flow velocity and ion temperature profile measured by charge exchange spectroscopy using carbon impurity are used for estimation of the wavelength shift of hot components to reduce the free parameter. The ion temperature is used to estimate the apparent wavelength shift due to the energy dependent emission cross section only and is not used to set the Doppler width for H and D in the fitting. The sensitivity of the evaluated D fraction on the velocity is increased for a higher D fraction. The error of the D fraction is calculated from the error in the fitted parameter and sensitivity on the velocity of the hot component. The difference in the profile and time trace of the D fraction with D pellet and H pellet injection was observed clearly by BCXS using a grism spectrometer.

Conceptual design of heavy ion beam probes on the PLATO tokamak

Heavy ion beam probe (HIBP) systems have been designed for the new tokamak, PLATO [A. Fujisawa, AIP Conf. Proc. 1993, 020011 (2018)]. The designs have been completed, and the installations are in progress. Two HIBPs are being installed in toroidal sections 180° apart to investigate long-range correlations in the toroidal direction. Each HIBP consists of an injection beamline and a detection beamline as usual. Yet, one of the HIBPs is equipped with an additional detection beamline; the measurement positions of its two detection beamlines can be placed on almost the same magnetic surface yet at poloidal angles that differ by ∼180°. The use of three detection beamlines allows us to investigate spatial asymmetry and long-range correlations in both the toroidal and poloidal directions, simultaneously. The detected beam intensity is expected to be enough for turbulence measurements in almost the entire plasma region when the electron density is up to 1 × 10¹⁹ m^-3 by selecting appropriate ion species for the probe beam. Each detector has three channels 10 mm apart, allowing measurement of local structures of micro-scale turbulence. Therefore, using the HIBPs on the PLATO tokamak will enable both local and global properties of plasma turbulence to be investigated, simultaneously.

Ivermectin reduces in vivo coronavirus infection in a mouse experimental model

The objective of this study was to test the effectiveness of ivermectin for the treatment of mouse hepatitis virus (MHV), a type 2 family RNA coronavirus similar to SARS-CoV-2. Female BALB/cJ mice were infected with 6,000 PFU of MHV-A59 (group infected, n = 20) or infected and then immediately treated with a single dose of 500 µg/kg ivermectin (group infected + IVM, n = 20) or were not infected and treated with PBS (control group, n = 16). Five days after infection/treatment, the mice were euthanized and the tissues were sampled to assess their general health status and infection levels. Overall, the results demonstrated that viral infection induced typical MHV-caused disease, with the livers showing severe hepatocellular necrosis surrounded by a severe lymphoplasmacytic inflammatory infiltration associated with a high hepatic viral load (52,158 AU), while mice treated with ivermectin showed a better health status with a lower viral load (23,192 AU; p < 0.05), with only a few having histopathological liver damage (p < 0.05). No significant differences were found between the group infected + IVM and control group mice (P = NS). Furthermore, serum transaminase levels (aspartate aminotransferase and alanine aminotransferase) were significantly lower in the treated mice than in the infected animals. In conclusion, ivermectin diminished the MHV viral load and disease in the mice, being a useful model for further understanding this therapy against coronavirus diseases.

Scoring methods used in the dietary variety score survey to predict malnutrition among older patients receiving home care

BACKGROUND

The dietary variety score (DVS), a simple dietary survey method for older adults, investigates the weekly frequency of consumption of the 10 food groups in Japan. The DVS is also associated with nutritional status. The original scoring method applied only to community-dwelling older adults, not to older patients receiving home care, who have little dietary variety.

AIM

Using three different scoring methods for the DVS, we examined which method was most likely to reflect the nutritional status of older patients receiving home care.

METHODS

This cross-sectional study was carried out on older patients receiving home care. Participant characteristics, the DVS (evaluated using three different scoring methods), and the Mini Nutritional Assessment-Short Form (MNA^® -SF) survey were researched. A receiver operating characteristic (ROC) analysis was performed to find the cut-off value for the DVS. Multivariate analysis was performed, with malnutrition as the outcome, to investigate the extent to which the DVS is associated with malnutrition.

RESULTS

We studied 317 participants. The DVS could produce significant ROC curves using modified scoring methods A and B (p = .028 and .042) with nutritional status as the outcome. Cut-off value, sensitivity and specificity were 30 points, 60.9% and 55.9% in modified scoring method A and 5 points, 79.1%, and 35.6% in modified scoring method B. Results of the multivariate logistic regression analysis, in Model 1 dysphagia (odds ratio [95% confidence interval]: 3.85 [1.70-8.71]) and the DVS of modified scoring method A (2.00 [1.11-3.62]) were significant independent factors. In Model 2, dysphagia (3.57 [1.58-8.07]) and the DVS based on modified scoring method B (2.36 [1.24-4.47]) were significant independent factors.

CONCLUSIONS

Modified scoring method B was found to be most suitable for the dietary assessment of older patients receiving home care.

IMPLICATIONS FOR PRACTICE

Even in the absence of registered dietitians, any care staff member who is involved in providing nursing services during home-visits is capable of administering a dietary survey, when using the easy DVS scoring method.

Tomography system for two-dimensional observation of fluctuation in magnetized plasma

A tomography system is developed for observing local fluctuations, pursuing higher spatial resolution, over the entire plasma of a linear cylindrical plasma. The system is equipped with totally 126 lines-of-sight that are distributed equally to six sets of light guide arrays placed around the plasma. The system has succeeded in measuring the two-dimensional structure of plasma emission and resolving coherent fluctuation structures, with spatial resolution comparable to the ion Larmor radius.

Transition between Isotope-Mixing and Nonmixing States in Hydrogen-Deuterium Mixture Plasmas

The transition between isotope-mixing and nonmixing states in hydrogen-deuterium mixture plasmas is observed in the isotope (hydrogen and deuterium) mixture plasma in the Large Helical Device. In the nonmixing state, the isotope density ratio profile is nonuniform when the beam fueling isotope species differs from the recycling isotope species and the profile varies significantly depending on the ratio of the recycling isotope species, although the electron density profile shape is unchanged. The fast transition from nonmixing state to isotope-mixing state (nearly uniform profile of isotope ion density ratio) is observed associated with the change of electron density profile from peaked to hollow profile by the pellet injection near the plasma periphery. The transition from nonmixing to isotope-mixing state strongly correlates with the increase of turbulence measurements and the transition of turbulence state from TEM to ion temperature gradient is predicted by gyrokinetic simulation.

Measurements of radial profile of hydrogen and deuterium density in isotope mixture plasmas using bulk charge exchange spectroscopy

A bulk charge exchange spectroscopy system has been applied to measure the radial profiles of the hydrogen (H) and deuterium (D) density ratio in the isotope mixture plasma in a large helical device. Charge exchange lines of H_α and D_α are fitted by 4 Gaussian of H and D cold components and H and D hot components with 5 parameters by combining the measurement of plasma toroidal rotation velocity with carbon charge exchange spectroscopy. The radial profiles of the relative density of hydrogen and deuterium ions are derived from H and D hot components measured and the beam density calculated from beam attenuation calculation. A proof-of-principle experiment is performed by the H pellet and the D pellet injections into the H-D mixture plasma.

Intratumoural immune cell landscape in germinoma reveals multipotent lineages and exhibits prognostic significance

AIMS

Alterations in microenvironments are a hallmark of cancer, and these alterations in germinomas are of particular significance. Germinoma, the most common subtype of central nervous system germ cell tumours, often exhibits massive immune cell infiltration intermingled with tumour cells. The role of these immune cells in germinoma, however, remains unknown.

METHODS

We investigated the cellular constituents of immune microenvironments and their clinical impacts on prognosis in 100 germinoma cases.

RESULTS

Patients with germinomas lower in tumour cell content (i.e. higher immune cell infiltration) had a significantly longer progression-free survival time than those with higher tumour cell contents (P = 0.03). Transcriptome analyses and RNA in-situ hybridization indicated that infiltrating immune cells comprised a wide variety of cell types, including lymphocytes and myelocyte-lineage cells. High expression of CD4 was significantly associated with good prognosis, whereas elevated nitric oxide synthase 2 was associated with poor prognosis. PD1 (PDCD1) was expressed by immune cells present in most germinomas (93.8%), and PD-L1 (CD274) expression was found in tumour cells in the majority of germinomas examined (73.5%).

CONCLUSIONS

The collective data strongly suggest that infiltrating immune cells play an important role in predicting treatment response. Further investigation should lead to additional categorization of germinoma to safely reduce treatment intensity depending on tumour/immune cell balance and to develop possible future immunotherapies.

Lower dietary variety is a relevant factor for malnutrition in older Japanese home-care recipients: a cross-sectional study

Background

Nutritional status of the older people is affected by various life-style factors. Although dietary habit is one of the life-style factors, it is unknown which of older home-care recipients’ dietary habits are associated with malnutrition.

The purpose of this study was to examine the association of dietary variety, as an evaluation index for dietary habits, with malnutrition in Japanese older home-care recipients.

Methods

This cross-sectional study was conducted in a single city, Hyogo Prefecture, Japan between July and October 2016. Three hundred thirty-three community-dwelling older care recipients (aged 65 years or older who were receiving home-visit nursing care services) were enrolled. Their nutritional status (Mini Nutritional Assessment®-short form: MNA®-SF), dietary variety (Food frequency score [FFS]), socio-demographic characteristics (age, sex, marital status, etc.), health indicators (comorbidity [Charlson Comorbidity Index] and dysphagia status [Dysphagia Severity Scale]) were assessed. The participants were classified into two groups: malnourished (0–7 points) and non-malnourished (8–14 points), according to their MNA®-SF scores. Multivariate logistic regression analysis was used to examine the factors associated with malnutrition.

Results

A total of 317 participants were analyzed (118 men, 199 women, median age: 84 years). Compared to the fourth (highest) quartile of FFS, odds ratios (OR) (95% confidence intervals [CI]) of the third, second, and first (lowest) quartiles of FFS were 1.08 (0.42–2.80), 1.29 (0.56–2.98), and 2.30 (1.02–5.19), respectively (p for trend = 0.049). Higher Charlson Comorbidity Index score and the presence of dysphagia were also significantly associated with malnutrition (OR: 2.08, 95% CI: 1.08–4.00 and OR: 3.86, 95% CI: 2.08–7.17, respectively).

Conclusion

Lower dietary variety was significantly associated with malnutrition in Japanese older home-care recipients.

Abstract PD2-06: Preoperative diagnosis of sentinel lymph node metastasis using computed tomography lymphography for early breast cancer patients

Background: Sentinel lymph nodes (SLN) biopsy has been established as a standard of care in the treatment of early breast cancer. This technique represents a minimally invasive, highly accurate method of axillary staging and is an alternative to conventional axillary lymph node dissection. However, an indication of SLN navigation to metastatic disease may lead to misdiagnosis for staging. Recently, SLN identification using computed tomography lymphography (CTLG) has been reported in Japan. This study investigated the value of CTLG for preoperative prediction of SLN status in early breast cancer patients.

Patients and method: Between January 2013 and August 2016, 350 breast cancer patients without clinical evidence of lymph node metastasis were treated. On the day before the operation, CTLG was performed using 64-row multidetector helical CT scanner. Patients were placed in a supine position with their arms positioned in a cranial direction with CT guidelineattached to the skin at the axilla. We performed an intradermal injection in the periareolar area, using 4 ml of iopamidolwith 1 ml of local anesthetic. The contrasted lymph route and SLN were identified in reconstructed three-dimensional imaging. The SLN spot was indicated by CT laser light navigator system. We established typical pattern of the lymphography: stain defect of SLN, stagnation of lymphatic route for preoperative diagnosis of metastatic SLN. SLN biopsy was performed using the fluorescence imaging system, Photpdynamic Eye (pde-neo, Hamamatsu Photonics Co., Japan) referring to the point by axillary compression technique by plastic device. Intraoperative pathological analysis of SLN was examined, and an axillary lymph node dissection was performed in patients with SLN metastasis pathologically.

Results: The median age of the 350 patients was 59 (range 28 – 90) years old. One patient was male and others were female. CTLG were safely performed in all patients. CTLG could visualize lymphatic route and accurately identify SLN in 336 (96.0 %) and 343 (98.0 %) cases, respectively. Lymphatic routes of CTLG were completely consistent with those of fluorescence imaging. The mean number of SLN identified by CTLG was 1.1. Fifty of 350 patients had metastatic SLN pathologically, and 11 of them had micrometastases of SLNs. The accuracy for metastatic diagnosis of SLN using CTLG without micrometastasis was 84.1 %, sensitivity was 82.1 % and specificity was 84.3 %. The positive predictive value was 40.5 % and negative predictive value was 97.3 %. There were no complications associated with SLN identification.

Conclusion: CTLG in SLN biopsy has some advantages in that this method is simple and quite useful for obtaining accurate anatomic images of the SLN, lymph vessels, and tumor. CTLG could select the candidate with truly node negative cases in early breast cancer patients, because it predicts lymph node metastasis preoperatively from natural status of the lymphographic image.

Citation Format: Abe H, Teramoto A, Tanaka M, Yamasaki K, Yoneda K. Preoperative diagnosis of sentinel lymph node metastasis using computed tomography lymphography for early breast cancer patients [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr PD2-06.

A proposal of Fourier-Bessel expansion with optimized ensembles of bases to analyse two dimensional image

It is a critical issue to find the best set of fitting function bases in mode structural analysis of two dimensional images like plasma emission profiles. The paper proposes a method to optimize a set of the bases in the case of Fourier-Bessel function series, using their orthonormal property, for more efficient and precise analysis. The method is applied on a tomography image of plasma emission obtained with the Maximum-likelihood expectation maximization method in a linear cylindrical device. The result demonstrates the excellency of the method that realizes the smaller residual error and minimum Akaike information criterion using smaller number of fitting function bases.

Abstract P2-01-17: The combination of preoperative computed tomography lymphography and intraoperative fluorescence imaging navigation for sentinel lymph node biopsy of early breast cancer patients

Background: Sentinel lymph nodes (SLN) biopsy has been established as a standard of care in the treatment of early breast cancer. This technique represents a minimally invasive, highly accurate method of axillary staging and is an alternative to conventional axillary lymph node dissection. The combination of the radioisotope and dye-staining methods is the most accurate way to identify SLN. We had reported feasibility and safety of a new technique of SLN identification using fluorescence imaging of indocyanine green (ICG) injection without any need for training. Recently, SLN identification using computed tomography lymphography (CTLG) has been reported in Japan. This study investigated a usefulness of the combination of CTLG and fluorescence imaging for SLN biopsy of early breast cancer patients.

Patients and method: Between January 2013 and March 2016, 296 breast cancer patients without clinical evidence of lymph node metastasis were treated. On the day before the operation, CTLG was performed using 64-row multidetector CT. We performed an intradermal injection in the periareolar area, using 4 ml of contrast agent with 1 ml of local anesthetic. The contrasted lymph route and SLN were identified in reconstructed three-dimensional imaging. The SLN spot was indicated by CT laser light navigator system. We established typical pattern of the lymphography: stain defect of SLN, stagnation of lymphatic route for preoperative diagnosis of metastatic SLN. During the operation, fluorescence images were obtained using the fluorescence imaging system, Photpdynamic Eye (pde-neo, Hamamatsu Photonics Co., Japan). After 0.5 ml dye mixed indigocarmin and ICG was injected intradermally into the periareolar skin, lymphatic route was observed with fluorescence images. SLN biopsy was performed referring to the point by axillary compression technique by plastic device. Intraoperative pathological analysis of SLN was examined.

Results: The median age of the 296 patients was 59 (range 28 – 90) years old. One patient was male and others were female. CTLG and fluorescence imaging were safely performed in all patients. CTLG could visualize lymphatic route and accurately identify SLN in 284 (95.9 %) and 290 (98.0 %) cases, respectively, whereas fluorescence imaging identified successfully lymphatic route and SLN in all patients. Lymphatic routes of CTLG were completely consistent with those of fluorescence imaging. The number of SLN identified by CTLG was significantly lower than that by fluorescence imaging (1.1 vs. 1.6, p&lt;0.01). Thirty-nine of 296 patients had metastatic SLN pathologically, and 10 of them had micrometastases of SLNs. The accuracy for metastatic diagnosis of SLN using CTLG without micrometastasis was 83.9 %, sensitivity was 82.1 % and specificity was 84.1 %. The positive predictive value was 35.9 % and negative predictive value was 97.7 %.

Conclusion: The combination of CTLG and fluorescence imaging revealed easy and effective to detect SLN. The fluorescence imaging was more high detection rate and number of SLN than CTLG. Otherwise, preoperative diagnosis of SLN metastasis using CTLG would be useful to detect negative SLNs.

Citation Format: Abe H, Teramoto A, Yamasaki K, Yoneda K, Ogawa M, Kawasaki M, Kameyama M. The combination of preoperative computed tomography lymphography and intraoperative fluorescence imaging navigation for sentinel lymph node biopsy of early breast cancer patients [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-01-17.

The spectrophotometrical analysis of rhododendrol-induced leucoderma using a novel multispectral camera

BACKGROUND

Many users in Japan of skin brightening/lightening cosmetics containing rhododendrol (RD) have developed leucoderma. Leucoderma appears on skin areas repeatedly treated with RD-containing cosmetics. RD-induced leucoderma (RDIL) presents different degrees of well-defined hypopigmentation. It is crucial to determine the degree of hypopigmentation to differentiate RDIL from vitiligo vulgaris (VV).

OBJECTIVES

To quantitatively evaluate hypopigmentation of RDIL lesions and the recovery of pigmentation, and to compare the hypopigmentation with VV and normal skin.

MATERIALS AND METHODS

Sixteen cases of RDIL, nine cases of VV and 15 healthy controls were examined using a novel multispectral camera (MSC) that can simultaneously obtain the reflection intensity at 10-nm wavelength intervals from 400 to 760 nm of the photographed area. ∆Absorbance was calculated by subtracting the log of reflection intensity of the target area from that of a white reflection standard.

RESULTS

Most RDIL lesions showed lower ∆Absorbance than healthy skin and higher ∆Absorbance than VV lesions between 400 and 550 nm. Statistical comparison of the maximum ∆Absorbance from 420 to 460 nm (Max∆Absorbance) for VV, RDIL and control skin showed that the Max∆Absorbance of RDIL was significantly higher than that of VV and lower than that of control skin. The comparison of ∆Absorbance of the same sites in RDIL lesions between the initial visit and 6 months later showed significant improvement after 6 months.

CONCLUSIONS

These studies demonstrated quantitative changes in RDIL and its recovery phase and suggested the utility of a MSC in obtaining objective colour information of skin disorders.

Effectiveness of A School-Based Universal Prevention Program for Enhancing Self-Confiden Considering The Extended Effects Associated With Achievement of The Direct Purposes of The Program

Introduction

We have developed a group of school-based universal prevention programs for children's health and adjustment. The programs are characterized by new theories such as the somatic-marker hypothesis and enjoyable methods that utilize animated stories and games. This study adopted one of the programs for the development of self-confidence.

Objective

The aim was to examine the effectiveness of the program. In addition to the direct purposes of the program, children's adjustments at school and homeroom class were evaluated as extended effects.

Methods

Participants were third grade children in six public elementary schools in Japan. The final sample included 442 children (219 boys and 223 girls). The program was implemented weekly in one regular 45-minute class over 8 weeks. Participants completed a battery of three questionnaires three times, 1 month before the start of the program (T1), 1 week before the start of the program (T2), and during 1 week after the last class of the program (T3).

Results

Results showed that all of the main endpoints of the program significantly improved in the intervention condition (i.e., changes from T2 to T3), compared to the control condition (i.e., changes from T1 to T2). Moreover, children's adjustment at school and homeroom class increased in the intervention condition, compared to the control condition. However, implicit affect was unchanged.

Conclusion

This study suggests that the program is effective for enhancing self-confidence, along with adjustments at school and in class. Future research that examines the sustainability of the effectiveness of the program is planned.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Effects of implicit affect on emotional coping and school adjustment: A short-term longitudinal study with a school-based universal prevention program for enhancing emotional abilities

In recent years, affect and emotions are hot research topics in the domains of psychology and brain science. Moreover, an increasing number of studies have started to investigate the effects of implicit affect on health and adjustment. The purpose of this study was to examine the effects of implicit affect on explicit emotional coping with others’ emotions and school adjustment in children.

Methods

Participants were 5th- and 6th-grade children in two public elementary schools in Japan. The final samples were fifty-six children (25 boys and 31 girls). Participants completed a battery of three questionnaires just before (T1) and after (T2) an school-based universal prevention program for enhancing emotional coping abilities with others’ emotions, which was implemented in eight classes during one month. The questionnaires were utilized for assessing implicit positive and negative affect (IPA and INA), explicit emotional coping abilities to identify, understand, and regulate others’ emotions, and the adaptive status of children at school.

Results

Hierarchical regression analyses showed that higher IPA at T1 was associated with higher explicit emotional coping and motivation for learning at T2. Also, higher INA at T1 was related to better peer relationship at T2. Moreover, higher IPA and INA at T1 were concerned with higher scores of classroom climate and approval at T2.

Conclusion

This study suggested that higher IPA leads to higher explicit emotional coping with others’ emotions. Also, it suggested that higher implicit affectivity (i.e., both higher IPA and INA) causes more adaptive status of children at school.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Abstract P3-01-02: A comparison of significance with indocyanine green fluorescence imaging method and computed tomography-lymphography in sentinel lymph node identification for early breast cancer patients

Background: Sentinel lymph nodes (SLN) biopsy has been established as a standard of care in the treatment of early breast cancer. This technique represents a minimally invasive, highly accurate method of axillary staging and is an alternative to conventional axillary lymph node dissection. The combination of the radioisotope and dye-staining methods is the most accurate way to identify sentinel lymph nodes. We had reported feasibility and safety of a new technique of SLN identification using fluorescence imaging of indocyanine green (ICG) injection without any need for training. Recently, SLN identification using computed tomography-lymphography (CTLG) has been reported in Japan. This study investigated the comparison of significance with fluorescence imaging method and CTLG.

Patients and method: Between January 2013 and May 2015, 213 breast cancer patients without clinical evidence of lymph node metastasis were treated. On the day before the operation, CTLG was performed using 64-row multidetector CT. We performed an intradermal injection in the periareolar area, using 4 ml of contrast agent with 1 ml of local anesthetic. The contrasted lymph flow and SLN were identified in reconstructed three-dimensional imaging. The SLN spot was indicated by CT laser light navigator system. During the operation, fluorescence images were obtained using the fluorescence imaging system, Photpdynamic Eye (pde-neo, Hamamatsu Photonics Co., Japan). After 5 mg / 0.3ml ICG was injected intradermally in to the periareolar skin, lymphatic drainage was observed with fluorescence images. SLN biopsy was performed referring to the point by axillary compression technique by plastic device.

Results: The median age of the 213 patients was 59 (range 28 – 87) years old. CTLG and fluorescence imaging was safely performed in all patients. CTLG could visualize lymphatic flow and accurately identify SLN in 189 (89 %) and 196 (92 %) cases, respectively, whereas fluorescence imaging identified successfully lymphatic flow and SLN in all patients. Fluorescence imaging with axillary compression technique was visually easy to identify the location of SLN on the axillary skin even in obese patients. Lymphatic flows of CTLG were completely consistent with those of fluorescence imaging. The number of SLN identified by CTLG was significantly lower than that by fluorescence imaging (1.1 vs. 1.6, p&lt;0.01). Twenty seven patients (13%) were found to have lymph node metastases pathologically, and 7 of them had micrometastases of lymph node. In case of partial enhancement of SLN with CTLG, the rate of positive metastasis was significant higher compared to the cases of whole enhancement (p&lt;0.01), however, even if enhancement is poor, about 70 % cases without metastasis are present.

Conclusion: Both of fluorescence imaging and CTLG revealed easy and effective to detect SLN. The fluorescence imaging with fluorescence mapping showed strong fluorescence from all parts of the surgical field, which hindered identification of SLNs, and fluorescence imaging was more high detection rate of SLN.

Citation Format: Abe H, Yamasaki K, Teramoto A, Yoneda K, Ogawa M, Kawasaki M, Kameyama M. A comparison of significance with indocyanine green fluorescence imaging method and computed tomography-lymphography in sentinel lymph node identification for early breast cancer patients. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-01-02.

A combination of ultrasound-guided rectus sheath and transversus abdominis plane blocks is superior to either block alone for pain control after gynecological transumbilical single incision laparoscopic surgery

PURPOSE

To investigate the efficacy of the combination of ultrasound-guided rectus sheath (RS) and transversus abdominis plane (TAP) blocks compared with TAP or RS block alone in gynecological single-incision laparoscopic surgery (SILS).

MATERIALS AND METHODS

Bilateral TAP blocks (Group A, n = 12), TAP and RS blocks (Group B, n = 12), and RS blocks (Group C, n = 12) with 40 ml ropivacaine/patient were performed for ovarian tumor SILS. The analgesic effects were evaluated using a numerical rating scale (NRS) at zero, six, 12, 24, and 48 hours post-surgery.

RESULTS

Umbilical pain on completion of general anesthesia was significantly less frequent in Group B (1/12) than Group A (7/12) (p = 0.03). The postoperative NRS scores were significantly lower in Group B than Group A at zero (p = 0.02) and six (p = 0.03) hours and Group C at zero (p = 0.001), six (p = 0.02), and 12 (p = 0.004) hours.

CONCLUSION

The combination of RS and TAP blocks reduced early postoperative pain compared with RS or TAP block alone for gynecological SILS.

Establishment of a new cell line susceptible to Cyprinid herpesvirus 3 (CyHV-3) and possible latency of CyHV-3 by temperature shift in the cells

A new cell line named CCF-K104 predominantly consisting of fibroblastic cells showed optimal growth at temperatures from 25 °C to 30 °C. Serial morphological changes in the cells induced by Cyprinid herpesvirus 3 (CyHV-3) included cytoplasmic vacuolar formation, cell rounding and detachment. Mature virions were purified from CyHV-3-infected CCF-K104 cells by sucrose gradient ultracentrifugation and had a typical herpesvirus structure on electron microscopy. Infectious CyHV-3 was produced stably in CCF-K104 cells over 30 viral passages. Our findings showed that CCF-K104 is a useful cell line for isolation and productive replication of CyHV-3. A temperature shift from 25 °C to 15 °C or 35 °C did not allow serial morphological changes as observed at 25 °C for 14 days. Under the same conditions, real-time PCR showed that CyHV-3 was present with low viral DNA loads, suggesting that CyHV-3 may establish latent infection in CCF-K104 cells. Amplification of the left and right terminal repeat sequences of the CyHV-3 genome arranged in a head-to-tail manner was detected by nested PCR following an upshift in temperature from 25 °C to 35 °C. The PCR results suggested that the circular genome may represent a latent form of CyHV-3.