Genetic Diagnosis of Adult Hemodialysis Patients With Unknown Etiology

Introduction

Kidney disease of unknown etiology accounts for 1 in 10 adult end-stage renal disease (ESRD) cases worldwide. The aim of this study is to clarify the genetic background of patients with chronic kidney disease (CKD) of unknown etiology who initiated renal replacement therapy (RRT) in adulthood.

Methods

This is a multicenter cross-sectional cohort study. Of the 1164 patients who attended 4 dialysis clinics in Japan, we first selected patients who started RRT between the ages of 20 and 49 years. After excluding patients with apparent causes of CKD (e.g., diabetic nephropathy, polycystic kidney disease (PKD) with family history, patients who underwent renal biopsy), 90 patients with CKD of unknown cause were included. The 298 genes associated with CKD were analyzed using capture-based targeted next-generation sequencing.

Results

Of the 90 patients, 10 (11.1%) had pathogenic variants in CKD-causing genes and 17 (18.9%) had variant of unknown significance (VUS). Three patients had PKD1 pathogenic variants, and 1 patient had PKD1 and COL4A4 pathogenic variants. In addition, 2 patients were diagnosed with atypical hemolytic uremic syndrome (aHUS) due to C3 or CFHR5. One patient each was diagnosed with Alport syndrome due to COL4A4 and COL4A3 variants, nephronophthisis due to NPHP1 variants, Fabry disease due to GLA variants, and autosomal-dominant tubulointerstitial kidney disease due to UMOD variants. Genetic diagnoses were not concordant with clinical diagnoses, except for patients with PKD1 variant.

Conclusion

This largest study on genetic analysis in hemodialysis-dependent adults revealed the presence of undiagnosed inherited kidney diseases.

Infantile outcome at 3 years of age among monochorionic twins with Type-II or -III selective fetal growth restriction with isolated oligohydramnios who underwent fetoscopic laser photocoagulation

OBJECTIVE

This study aimed to examine infantile outcomes at 3 years of age with selective fetal growth restriction (sFGR) Types II and III with isolated oligohydramnios who underwent fetoscopic laser photocoagulation (FLP).

METHODS

This multicenter prospective cohort study included monochorionic diamniotic twins who underwent FLP for sFGR between 16 and 25 weeks of gestation. The indication for performing FLP was in cases of sFGR Type II or III with oligohydramnios, where the maximal vertical pocket was ≤2 cm among twins with FGR. This was done in the absence of a typical twin-twin transfusion syndrome diagnosis. The primary outcome was the intact survival (IS) rate of infants at the corrected age of 40 weeks and 3 years. IS at the corrected age of 40 weeks was defined as survival without grade III or IV intraventricular hemorrhage or cystic periventricular leukomalacia, and IS at 3 years of age was defined as survival without neurodevelopmental morbidity, including cerebral palsy, neurodevelopmental impairment with a total developmental quotient of ≤70, bilateral deafness, or bilateral blindness.

RESULTS

Among 45 patients with sFGR, 30 (66.7%) were classified as having Type II and 15 (33.3%) as Type III sFGR. The prevalence of IS at the corrected age of 40 weeks was 51.1% (n=23) in FGR twins and 95.5% (n=42) in larger twins. The prevalence of IS at 3 years of age was 46.7% (n=21) in FGR twins and 86.4% (n=38) in larger twins. Among the 24 FGR twins who were not diagnosed with IS at 3 years of age, 91.7% (22 of 24 cases) suffered fetal or infantile demise other than miscarriage and neurodevelopmental impairment. All larger twins who were not diagnosed with IS at 3 years of age (n=6, 13.6%) had neurological morbidity, in addition to one case of miscarriage.

CONCLUSIONS

FGR twins and larger twins, when subjected to FLP due to sFGR coupled with umbilical artery Doppler abnormalities and isolated oligohydramnios, exhibit low rates of neurological morbidity and low mortality, respectively. Therefore, FLP for Type II or III sFGR with oligohydramnios may be a feasible and preferable management option. This article is protected by copyright. All rights reserved.

Measurement of Direct-Photon Cross Section and Double-Helicity Asymmetry at sqrt[s]=510 GeV in p[over →]+p[over →] Collisions

We present measurements of the cross section and double-helicity asymmetry A_{LL} of direct-photon production in p[over →]+p[over →] collisions at sqrt[s]=510  GeV. The measurements have been performed at midrapidity (|η|<0.25) with the PHENIX detector at the Relativistic Heavy Ion Collider. At relativistic energies, direct photons are dominantly produced from the initial quark-gluon hard scattering and do not interact via the strong force at leading order. Therefore, at sqrt[s]=510  GeV, where leading-order-effects dominate, these measurements provide clean and direct access to the gluon helicity in the polarized proton in the gluon-momentum-fraction range 0.02<x<0.08, with direct sensitivity to the sign of the gluon contribution.

Capillary-driven horseshoe vortex forming around a micro-pillar

HYPOTHESIS

Horseshoe vortices are known to emerge around large-scale obstacles, such as bridge pillars, due to an inertia-driven adverse pressure gradient forming on the upstream-side of the obstacle. We contend that a similar flow structure can arise in thin-film Stokes flow around micro-obstacles, such as used in textured surfaces to improve wettability. This could be exploited to enhance mixing in microfluidic devices, typically limited to creeping-flow regimes.

EXPERIMENTS

Numerical simulations based on the Navier-Stokes equations are carried out to elucidate the flow structure associated with the wetting dynamics of a liquid film spreading around a 50 μm diameter micro-pillar. The employed multiphase solver, which is based on the volume of fluid method, accurately reproduces the wetting dynamics observed in current and previous (Mu et al., Langmuir, 2019) experiments.

FINDINGS

The flow structure within the liquid meniscus forming at the foot of the micro-pillar evinces a horseshoe vortex wrapping around the obstacle, notwithstanding that the Reynolds number in our system is extremely low. Here, the adverse pressure gradient driving flow reversal near the bounding wall is caused by capillarity instead of inertia. The horseshoe vortex is entangled with other vortical structures, leading to an intricate flow system with high-potential mixing capabilities.

Utility of a modified Controlling Nutritional Status score in mortality risk assessment of patients on hemodialysis

PURPOSE

Malnutrition is common among hemodialysis patients. A nutritional index may be important for their prognosis prediction. We examined the use of a modified version of the Controlling Nutritional Status (CONUT) score as a predictor of mortality in hemodialysis patients and investigated whether statin use modified the association.

METHODS

We conducted a retrospective cohort study in 1130 adults (mean age 67.7 years, 35.0% women) on maintenance hemodialysis at four outpatient dialysis clinics in Japan. The exposure of interest was modified CONUT scores calculated by one-time data of serum albumin and total cholesterol at baseline, or mean data of these measures using multiple blood test results. The primary outcome was all-cause mortality. We examined the association between modified CONUT groups (low-risk, middle-risk, and high-risk) and mortality using multivariate Cox proportional hazard regression and logistic regression models in overall patients and by statin use.

RESULTS

During a median follow-up of 6.6 years, 525 (46.5%) patients died. Analysis using both one-time and mean data showed increased mortality risk in the high-risk modified CONUT score group as compared to the low-risk group (mean data: HR 2.52, 95% CI 1.96, 3.24); when stratified by statin use, the effect appeared stronger among users (mean data: HR 5.84, 95% CI 2.98, 11.44). Strong predictive ability was observed, particularly for mortality risk at 5 year follow-up using mean data (AUC = 0.842).

CONCLUSION

Our results suggest that the modified CONUT score may be useful in helping clinicians quickly identify hemodialysis patients with poorer prognosis who may benefit from close monitoring and interventions.

Epitaxial growth of an atom-thin layer on a LiNi0.5Mn1.5O4 cathode for stable Li-ion battery cycling

Transition metal dissolution in cathode active material for Li-based batteries is a critical aspect that limits the cycle life of these devices. Although several approaches have been proposed to tackle this issue, this detrimental process is not yet overcome. Here, benefitting from the knowledge developed in the semiconductor research field, we apply an epitaxial method to construct an atomic wetting layer of LaTMO₃ (TM = Ni, Mn) on a LiNi_0.5Mn_1.5O₄ cathode material. Experimental measurements and theoretical analyses confirm a Stranski-Krastanov growth, where the strained wetting layer forms under thermodynamic equilibrium, and it is self-limited to monoatomic thickness due to the competition between the surface energy and the elastic energy. Being atomically thin and crystallographically connected to the spinel host lattices, the LaTMO₃ wetting layer offers long-term suppression of the transition metal dissolution from the cathode without impacting its dynamics. As a result, the epitaxially-engineered cathode material enables improved cycling stability (a capacity retention of about 77% after 1000 cycles at 290 mA g^-1) when tested in combination with a graphitic carbon anode and a LiPF₆-based non-aqueous electrolyte solution.

Effect of porous structural properties on lithium-ion and sodium-ion storage: illustrated by the example of a micro-mesoporous graphene1-x (MoS2) x anode

In this work, we synthesized micro-mesoporous graphene1-x (MoS2) x with different compositional ratios via co-reduction of graphite oxide and exfoliated MoS2 platelets. We systematically studied the performance of the micro-mesoporous graphene1-x (MoS2) x as anodes in lithium-ion batteries and sodium-ion batteries. The results show that the specific surface areas of the composites decrease with introducing MoS2. The irreversible capacitance, which is related to the formation of solid electrolyte interphases, also decreases. Besides specific surface area, we found that micropores can benefit the lithiation and sodiation. We demonstrated that a specific charge capacity of 1319.02 mA h g-1 can be achieved at the 50th cycle for the graphene½(MoS2)½ anode in lithium-ion batteries. Possible relationships between such a high specific capacity and the micro-mesoporous structure of the graphene1-x (MoS2) x anode are discussed. This work may shed light on a general strategy for the structural design of electrode materials in lithium-ion batteries and sodium-ion batteries.

Probing Gluon Spin-Momentum Correlations in Transversely Polarized Protons through Midrapidity Isolated Direct Photons in p^{↑}+p Collisions at sqrt[s]=200 GeV

Studying spin-momentum correlations in hadronic collisions offers a glimpse into a three-dimensional picture of proton structure. The transverse single-spin asymmetry for midrapidity isolated direct photons in p^{↑}+p collisions at sqrt[s]=200  GeV is measured with the PHENIX detector at the Relativistic Heavy Ion Collider (RHIC). Because direct photons in particular are produced from the hard scattering and do not interact via the strong force, this measurement is a clean probe of initial-state spin-momentum correlations inside the proton and is in particular sensitive to gluon interference effects within the proton. This is the first time direct photons have been used as a probe of spin-momentum correlations at RHIC. The uncertainties on the results are a 50-fold improvement with respect to those of the one prior measurement for the same observable, from the Fermilab E704 experiment. These results constrain gluon spin-momentum correlations in transversely polarized protons.

MO656CORRELATION BETWEEN CHANGES IN THE BODY FLUID VOLUME CALCULATED BY THE URIC ACID KINETIC MODEL AND CHANGES IN THE BODY WEIGHT*

Background and Aims

Uric acid (UA) is a solute unable to cross the cell membranes in general tissues by any of simple diffusion, facilitated diffusion or active transport. These facts imply that UA distribution volume (UDiV) equals to the extracellular fluid volume (ECFV). We have developed a method for calculating UDiV from serum uric acid levels before and after hemodialysis based on a uric acid kinetic model (Shinzato T, Int J Artif Organs 2020). Urea is evenly distributed throughout the body fluids. Therefore, the total body fluid volume (TBFV) can be calculated by using the same method as the calculation of UDiV for the serum urea level. The remaining body fluid volume, which is TBFV minus UDiV, is considered to reflect the intracellular fluid volume (ICFV). In this study, we clarified the relationship between the amount of change over time in UDiV and ICFV calculated by the uric acid kinetic model and the amount of change over time in the actual body weight of hemodialysis patients.

Method

Subjects were 1,101 patients with chronic maintenance hemodialysis. UDiV and ICFV before and after dialysis were calculated for two time points, December 2019 and June 2020.

Results

The amount of change in UDiV per body during the dialysis session showed a very good correlation with the amount of body weight change during the same dialysis (UDiV change = 0.950 x body weight change - 0.158, R-square 0.90, p &lt; 0.0001). The amount of change in ICFV during the 6 months from December 2019 to June 2020 showed a good correlation with the amount of change in post-dialysis body weight during the same period (ICFV change = 0.270 x post-dialysis body weight change + 0. 240, R-square 0.21, p &lt;0.0001).

Conclusion

These results suggest that the body fluid volume calculated by the uric acid kinetic model has high accuracy.

MO781THE CATIONIC CELLULOSE BASED PAD REDUCE THE HEMOSTATIC TIME AFTER HEMODIALYSIS

Background and Aims

In case of prolonged bleeding at the vascular access site after hemodialysis, a nurse must compress the bleeding site longer than usual. This situation causes the risk of intravascular thrombosis and consumes valuable time of both patients and staff. Therefore, effective hemostatic agents are desired. Nowadays, chitosan is considered as one of the strongest hemostatic substance. Nipro Corporation and Artisan-lab co., Ltd found the cationic cellulose could clot blood faster than chitosan in the activated clotting time (Figure). After carefully examining its safety and efficacy, it was approved as medicine by the Japanese Ministry of Health, Labor and Welfare. Then, a trial to verify its clinical efficacy as a hemostat was conducted in the Toshin Clinic. In our clinic, the timer is set on the hemodialysis machine after the needles are removed and pressure is started after hemodialysis. We examined how long the timer should be set to be able to sufficiently stop bleeding in case cationic-cellulose pads are used.

Method

Of the 150 hemodialysis patients treated at the Toshin clinic; patients who agreed to this trial were enrolled. We set a timer for 5 minutes initially using cationic-cellulose pads for hemostasis, and was shortened in the next trial by 1 minute if the bleeding had been stopped. If the patient did not consent, the timer was not shortened further. from April 15th to December 31st in 2020. We checked the bleeding evidence of the puncture sites at the timing of immediately after relieving their compression. At their following hemodialysis session, we also checked the existence of adverse effects at their puncture sites, such as contact dermatitis or infection.

Results

Ten patients (9 men and 1 woman, Age 58.5y ±13.1) agreed to participate in this study. In the case of stable hemostasis, we continued to shorten the time by 1 minute each time, and added 1 minute in case of bleeding. After searching for the shortest time to achieve stable hemostasis, we confirmed hemostasis an average of 14.2 times in all cases. The average time to set for the timer was 3.0 ± 0.94 minutes (2-5 minutes). Two patients refused to shorten the time set for the timer, the hemostasis time were 5 and 4minutes respectively. The hemostasis time in all the other cases was equal or less than 3 minutes. In one case, the hemostasis time was reduced to 3 minutes with a cationic cellulose pad, compared to 30 minutes with The Neoplaster hemostatic pad (Nipro Corporation) which is made with the carboxymethyl cellulose. Of the 142 case compressions performed, 1 case resulted in bleeding and required 2 minutes of additional compressions. All cases did not have any adverse effects such as redness, itching or pain of their hemostatic pad attached sites.

Discussion

This study showed that the average time to set for the timer, when using cationic cellulose pad was 3 minutes on average, without any adverse effects. Cationic cellulose pads can stop bleeding safely, quickly and stably. At present, clinically available strong hemostatic agents are too expensive to be applied for many patients. But the cost to get the cationic-cellulose to make hemostatic pads may be reduced enough to be distributed to many hemodialysis patients because this material is mass-produced for hair conditioner, shampoo, and toothpaste.

Conclusion

The average time set for the timer was estimated around 3 minutes using the cationic cellulose pad. The cationic cellulose pad can save precious time and efforts of both patients and staff through its quick hemostasis.

Erratum: Evolution of π^{0} Suppression in Au+Au Collisions from sqrt[s_{NN}]=39 to 200 GeV [Phys. Rev. Lett. 109, 152301 (2012)]

This corrects the article DOI: 10.1103/PhysRevLett.109.152301.

A green strategy for the preparation of a honeycomb-like silicon composite with enhanced lithium storage properties

The high-performance silicon (Si) composite electrodes are being widely developed due to their considerable theoretical capacity. Coating with carbon-based materials is an efficient way to solve the common issues of Si-based materials. Currently, most of the reported strategies are complicated, pollutive, or uneconomic, which hamper their practical applications. Herein, a honeycomb-like Si-based composite was prepared to address these issues via a facile and green reduction approach at room temperature. The pre-anchored Si nanoparticles could be packed and interconnected through a three-dimensional graphene network to further enhance the electrochemical properties of the active materials. As an electrode, this composite shows good rate capabilities upon lithium storage and cycling stability. The continued cycling measurement delivers a -0.049% capacity decay rate per cycle within 600 cycles. A direct comparison further exhibits the obviously improved performance between the as-designed Si-based composite and naked Si, suggesting a potential application of this convenient strategy for other high-performance electrode materials.

P1088BRAND NEW METHOD TO CALCULATE THE VOLUME OF EXTRA CELLULAR FLUID IN HEMODIALYSIS PATIENT ONLY FROM REGULAR BLOOD TEST

Background and Aims

Uric acid is a small molecule with molecular weight 168, but has an electrical pole which enables pass through the phospholipid bilayers of cell membranes by simple diffusion. Urate transport proteins of cell membranes (URAT1, GLUT9, OAT, MRP4, MCT9, NPT4, ABCG2) are expressed only in uric acid-excreting tissues. These findings suggest that uric acid does not pass through the cell membrane, either by diffusion or active transport. Since uric acid does not pass through cell membranes, the uric acid distribution volume (UDiV) would reflect the extracellular volume (ECV). At ASN 2018, we reported that UDiV significantly correlated with ECV predicted by the bio-impedance method measured by InBody, S 20 (Biospace Co., Ltd, Korea). However, both data were correlated, there was a large fixed error. This time, we examined the correlation with the UDiV again using the Fresenius BCM (Fresenius Medical Care, Bad Homberg, Germany), which is trusted worldwide.

Method

We calculated UDiV from regular blood test results by uric acid kinetic modeling.

This study was performed in Yokohama Minami Clinic. One hundred nine patient under hemodialysis was consented and enrolled in this study. The HD patients were 59males and 50females. 68.0±10.9years old.

We performed UDiV calculation from blood samples obtained before and after hemodialysis. Then, after the hemodialysis session, 30minutes interval was made to measure the BIA-ECV using BCM. Then, we compared UDiV with BIA-ECV .

We used least squares regression analysis and Bland–Altman analysis to compare the UDiV method and the BIA-ECV method, and the Steel test for multiple comparisons of UDiV and symptoms. All analyses were performed using JMP 9.0.2 (SAS Institute, Inc., Cary, NC, USA).

Results

There was a significant correlation between UDiV(x) and BIA-ECFV (y): (y = 0.70x +3.02, r-square = 0.61, p &lt; 0.0001, Figure 1a). The regression line closely coincided with the line of identity. Bland–Altman analysis showed a systematic error for UDiVvs. BIA-ECV (Figure 1b). There was a significant difference between UDiVand BIA-ECV (mean difference 1.32 L, 95% CI -2.6 to 5.2 L).

Conclusion

UdiV could be a viable alternative marker of BIA-ECV for the assessment of hydration status of patients with HD.

Search for η^{'} Bound Nuclei in the ^{12}C(γ,p) Reaction with Simultaneous Detection of Decay Products

We measured missing mass spectrum of the ^{12}C(γ,p) reaction for the first time in coincidence with potential decay products from η^{'} bound nuclei. We tagged an (η+p) pair associated with the η^{'}N→ηN process in a nucleus. After applying kinematical selections to reduce backgrounds, no signal events were observed in the bound-state region. An upper limit of the signal cross section in the opening angle cosθ_{lab}^{ηp}<-0.9 was obtained to be 2.2  nb/sr at the 90% confidence level. It is compared with theoretical cross sections, whose normalization ambiguity is suppressed by measuring a quasifree η^{'} production rate. Our results indicate a small branching fraction of the η^{'}N→ηN process and/or a shallow η^{'}-nucleus potential.

Fetal echocardiographic assessment of cardiovascular impact of prolonged support on EXTrauterine Environment for Neonatal Development (EXTEND) system

OBJECTIVE

EXTrauterine Environment for Neonatal Development (EXTEND) is a system to support ongoing fetal growth and organ development in an extrauterine environment, utilizing a pumpless low-resistance oxygenator circuit. The aim of this study was to evaluate hemodynamics and cardiac function in fetal sheep sustained on the EXTEND system.

METHODS

This was a prospective study of fetal sheep supported for a minimum of 3 weeks on EXTEND. Hemodynamic parameters were assessed weekly and included heart rate, mean arterial pressure (MAP), Doppler-echocardiography-derived cardiac output (CO), pulsatility indices (PIs) of the fetal middle cerebral artery (MCA), umbilical artery (UA) and ductus venosus and cardiac function, as assessed by speckle-tracking-derived global longitudinal strain and strain rate in the right (RV) and left (LV) ventricles. Parameters were compared at 0 days and 1, 2 and 3 weeks following placement on EXTEND.

RESULTS

Of 10 fetal sheep enrolled, seven survived for 3 weeks and were included in the analysis. Median gestational age at cannulation was 107 (range, 95-109) days. Heart rate decreased and MAP increased significantly, but within acceptable ranges, during the study period. The quantities and relative ratios of right and left CO remained stable within the anticipated physiological range throughout the study period. Vascular tracings and PIs appeared to be similar to those seen normally in the natural in-utero state, with MCA-PI being higher than UA-PI. UA tracings demonstrated maintained abundant diastolic flow despite the absence of placental circulation. In both the RV and LV, strain decreased significantly at 1 and 2 weeks relative to baseline but returned to baseline values by week 3.

CONCLUSIONS

The EXTEND mechanical support system replicates natural physiology and creates a stable and sustainable cardiovascular construct that supports growth over a 3-week period. However, there is a period of depressed contractility within the first week with subsequent improvement by week 3. This may reflect a period of physiological accommodation that warrants further investigation. This study lays the foundation for further exploration as the EXTEND system moves towards human application. © 2019 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.

418 Ultrasound molecular imaging of the role of von willebrand factor-mediated platelet adhesion in atherogenesis

Funding Acknowledgements

JSPS Overseas Research Fellowship

Background

Platelets are known to be both pro-inflammatory and pro-mitogenic. However, the role of platelet-endothelial interactions in the initiation and growth of atherosclerotic lesions is not well understood.

Purpose

We used contrast-enhanced ultrasound (CEU) molecular imaging of the arterial endothelium to test the hypothesis that platelet attachment to endothelial Von Willebrand Factor (VWF) promotes atherogenesis.

Methods

We studied wild-type mice (WT), low-density lipoprotein deficient mice fed western diet to produce atherosclerosis (LDLR-/-), and LDLR-/- mice also deficient for ADAMTS-13 (LDLR-/-ADAMTS13-/-) which is the enzyme responsible for proteolytic cleavage of endothelial-associated VWF. Mice were studied at 20 weeks and 30 weeks of age. A subset of LDLR-/- mice were treated with recombinant ADAMTS13 1 hr prior to study. Proximal aortic CEU molecular imaging of P-selectin, vascular cell adhesion molecule (VCAM)-1, von Willebrand factor (VWF), and platelet GPIbα was performed. Aortic distensibility was assessed using high-frequency (30 MHz) transthoracic echocardiography and tail cuff blood pressure systems. NF-κB of aorta was assessed by ELISA kit. Plaque size and composition were assessed by histology. Platelets and macrophage immunohistochemistry were also performed on confocal microscopy.

Results

Aortic molecular imaging signal for P-selectin, VCAM-1, VWF, and platelet adhesion was significantly higher in LDLR-/- than WT mice, and increased by 2-fold between 20 and 30 wks of age. Signal for VWF and platelet adhesion was abolished 1 h after administration of ADAMTS13, confirming that platelet adhesion was VWF-mediated. At 20 and 30 wks of age, molecular imaging signal for all targets was 2-fold higher (p &lt; 0.01) in LDLR-/-ADAMTS13-/- versus LDLR-/- mice. The LDLR-/-ADAMTS13-/- mice also had lower aortic distensibility (p &lt; 0.05), had a 2-fold higher NF-κB signal (p &lt; 0.05), and had a 2-fold greater total plaque area (p &lt; 0.01). Fluorescent immunohistochemistry confirmed that the LDLR-/-ADAMTS13-/- mice also had greater platelets (p &lt; 0.05) and increased macrophage content (p &lt; 0.05) than LDLR-/- mice in aortic plaque.

Conclusion

In early to mid-stage atherosclerosis, abnormal regulation of endothelial-associated VWF results in platelet adhesion and secondary up-regulation of endothelial inflammatory adhesion molecules, thereby promoting atherosclerotic plaque progression. These results indicate an important role of platelet-endothelial interactions in early atherogenesis.

Abstract 418 Figure

P3448Influence of severity of pectus excavatum as indicated by the Haller Index on actual heart compression and ECG findings

Background

Pectus excavatum (PEX) is a depression of the sternum relative to the costal cartilages. The Haller index (HI) is an anatomical indicator of the severity of PEX that is calculated from CT.

Purpose

We evaluated the influence of anatomical severity of PEX as indicated by HI on the severity of actual heart compression and ECG findings

Methods

A total of 28 patients (23 males; 20±19 years) with PEX underwent unenhanced CT and ECG. On CT, HI and degree of compression of right (RA) and left atria (LA) were evaluated simultaneously.

Results

As indicated by CT, the mean HI was 5.80±2.34. We observed 7, 15, 5, and 1 patient with none, mild, moderate, or severe RA compression, respectively. In addition, we observed 8, 13, 4, and 3 patients with none, mild, moderate, or severe LA compressions, respectively. The mean HI was calculated as 4.28±0.92, 5.40±2.01, 6.85±1.81, and 9.61±0.00 in patients with none, mild, moderate, or severe RA, respectively, and the findings were significant (P=0.021). The mean HI was calculated as 4.17±0.91, 5.97±2.23, 5.95±1.51, and 6.69±2.93 in patients with none, mild, moderate, or severe LA compression, respectively, although the findings were not significant (P=0.145). On ECG, a P wave with a negative portion >1 mm in depth and >40 ms in duration in the V1 lead, complete or incomplete right bundle branch block (RBBB), sinus arrhythmia, or right-axis deviation of a QRS wave were diagnosed in 23, 10, 8, and 6 patients, respectively. The HI between patients with (n=23) and without (n=5) a negative portion of the P wave in the V1 lead showed a significant difference (6.45±2.43 vs. 4.62±1.68; P<0.05). The correlation coefficient between absolute values of the maximum negative portion of the P wave in the V1 lead and HI was 0.36 (n=28). The HI between patients with and without a complete or incomplete RBBB showed a significant difference (6.98±2.43 vs. 5.14±2.07; P<0.05). The HI between patients with and without a sinus arrhythmia did not show a significant difference (5.45±2.66 vs. 5.94±2.25). The HI between patients with and without a right axis deviation on a QRS wave also did not show a significant difference (4.76±1.53 vs. 6.08±2.64). The inter-observer agreement of HI between the two observers was 0.978.

Haller index and heart compression on CT

Conclusion

In patients with PEX, compression of RA on CT, a negative portion of the P wave in V1, complete or incomplete RBBB, sinus arrhythmia, and a right axis deviation on a QRS wave are common. The degree of compression of RA on CT, negative portion of the P wave in the V1 lead and complete or incomplete RBBB on ECG are associated with anatomical severity as indicated by the HI. However, our results showed that HI severity was unrelated to either the degree of compression of LA on CT, or sinus arrhythmia and right-axis deviation of the QRS wave on ECG. These observations may be due to variation of location of maximum sternum depression, such as high- or low-positioned dominant-type compressions.

Nuclear Dependence of the Transverse Single-Spin Asymmetry in the Production of Charged Hadrons at Forward Rapidity in Polarized p+p, p+Al, and p+Au Collisions at sqrt[s_{NN}]=200 GeV

We report on the nuclear dependence of transverse single-spin asymmetries (TSSAs) in the production of positively charged hadrons in polarized p^{↑}+p, p^{↑}+Al, and p^{↑}+Au collisions at sqrt[s_{NN}]=200  GeV. The measurements have been performed at forward rapidity (1.4<η<2.4) over the range of transverse momentum (1.8<p_{T}<7.0  GeV/c) and Feynman x (0.1<x_{F}<0.2). We observed positive asymmetries for positively charged hadrons in p^{↑}+p collisions, and significantly reduced asymmetries in p^{↑}+A collisions. These results reveal a nuclear dependence of TSSAs for charged-hadron production in a regime where perturbative techniques are applicable. These results provide new opportunities to use p^{↑}+A collisions as a tool to investigate the rich phenomena behind TSSAs in hadronic collisions and to use TSSAs as a new handle in studying small-system collisions.

Beam Energy and Centrality Dependence of Direct-Photon Emission from Ultrarelativistic Heavy-Ion Collisions

The PHENIX collaboration presents first measurements of low-momentum (0.4<p_{T}<3  GeV/c) direct-photon yields from Au+Au collisions at sqrt[s_{NN}]=39 and 62.4 GeV. For both beam energies the direct-photon yields are substantially enhanced with respect to expectations from prompt processes, similar to the yields observed in Au+Au collisions at sqrt[s_{NN}]=200. Analyzing the photon yield as a function of the experimental observable dN_{ch}/dη reveals that the low-momentum (>1  GeV/c) direct-photon yield dN_{γ}^{dir}/dη is a smooth function of dN_{ch}/dη and can be well described as proportional to (dN_{ch}/dη)^{α} with α≈1.25. This scaling behavior holds for a wide range of beam energies at the Relativistic Heavy Ion Collider and the Large Hadron Collider, for centrality selected samples, as well as for different A+A collision systems. At a given beam energy, the scaling also holds for high p_{T} (>5  GeV/c), but when results from different collision energies are compared, an additional sqrt[s_{NN}]-dependent multiplicative factor is needed to describe the integrated-direct-photon yield.

Pseudorapidity Dependence of Particle Production and Elliptic Flow in Asymmetric Nuclear Collisions of p+Al, p+Au, d+Au, and ^{3}He+Au at sqrt[s_{NN}]=200 GeV

Asymmetric nuclear collisions of p+Al, p+Au, d+Au, and ^{3}He+Au at sqrt[s_{NN}]=200  GeV provide an excellent laboratory for understanding particle production, as well as exploring interactions among these particles after their initial creation in the collision. We present measurements of charged hadron production dN_{ch}/dη in all such collision systems over a broad pseudorapidity range and as a function of collision multiplicity. A simple wounded quark model is remarkably successful at describing the full data set. We also measure the elliptic flow v_{2} over a similarly broad pseudorapidity range. These measurements provide key constraints on models of particle emission and their translation into flow.

Measurements of Multiparticle Correlations in d+Au Collisions at 200, 62.4, 39, and 19.6 GeV and p+Au Collisions at 200 GeV and Implications for Collective Behavior

Recently, multiparticle-correlation measurements of relativistic p/d/^{3}He+Au, p+Pb, and even p+p collisions show surprising collective signatures. Here, we present beam-energy-scan measurements of two-, four-, and six-particle angular correlations in d+Au collisions at sqrt[s_{NN}]=200, 62.4, 39, and 19.6 GeV. We also present measurements of two- and four-particle angular correlations in p+Au collisions at sqrt[s_{NN}]=200  GeV. We find the four-particle cumulant to be real valued for d+Au collisions at all four energies. We also find that the four-particle cumulant in p+Au has the opposite sign as that in d+Au. Further, we find that the six-particle cumulant agrees with the four-particle cumulant in d+Au collisions at 200 GeV, indicating that nonflow effects are subdominant. These observations provide strong evidence that the correlations originate from the initial geometric configuration, which is then translated into the momentum distribution for all particles, commonly referred to as collectivity.

Nuclear Dependence of the Transverse-Single-Spin Asymmetry for Forward Neutron Production in Polarized p+A Collisions at sqrt[s_{NN}]=200 GeV

During 2015, the Relativistic Heavy Ion Collider (RHIC) provided collisions of transversely polarized protons with Au and Al nuclei for the first time, enabling the exploration of transverse-single-spin asymmetries with heavy nuclei. Large single-spin asymmetries in very forward neutron production have been previously observed in transversely polarized p+p collisions at RHIC, and the existing theoretical framework that was successful in describing the single-spin asymmetry in p+p collisions predicts only a moderate atomic-mass-number (A) dependence. In contrast, the asymmetries observed at RHIC in p+A collisions showed a surprisingly strong A dependence in inclusive forward neutron production. The observed asymmetry in p+Al collisions is much smaller, while the asymmetry in p+Au collisions is a factor of 3 larger in absolute value and of opposite sign. The interplay of different neutron production mechanisms is discussed as a possible explanation of the observed A dependence.

Prevalence of rear seat belt use among pregnant women in a suburban area of Japan

AIM

The aim of this study was to clarify the prevalence and influencing factors of rear seat belt use among pregnant women.

METHODS

Questionnaires were given to 1546 pregnant women who visited obstetrics clinics and hospitals for prenatal checkups from October to December 2013. A total of 1494 pregnant women (96.6%) agreed to participate in this study and completed the questionnaire.

RESULTS

Fewer than 20% of the rear-seat passengers 'always' used seat belts before and during pregnancy, whereas a third 'never' used a seat belt before or during pregnancy. There was no significant decrease in seat belt use by rear-seat passengers during compared to before pregnancy. Multivariate analysis revealed that age, knowledge of how to use a seat belt during pregnancy, belief in the compulsory use of a rear seat belt and driver behavioral characteristics before pregnancy were associated with rear seat belt use during pregnancy.

CONCLUSIONS

The prevalence of fastening seat belts was substantially low. The provision of information regarding proper seat belt use and its role in protecting the fetus may increase use.

CXorf48 is a potential therapeutic target for achieving treatment-free remission in CML patients

Although the introduction of tyrosine kinase inhibitors (TKIs) has improved overall survival of patients with chronic myeloid leukemia (CML), about half of the patients eventually relapse after cessation of TKIs. In contrast, the remainder of the patients maintain molecular remission without TKIs, indicating that the patients' immune system could control proliferation of TKI-resistant leukemic stem cells (LSCs). However, the precise mechanism of immunity against CML-LSCs is not fully understood. We have identified a novel immune target, CXorf48, expressed in LSCs of CML patients. Cytotoxic T cells (CTLs) induced by the epitope peptide derived from CXorf48 recognized CD34⁺CD38^- cells obtained from the bone marrow of CML patients. We detected CXorf48-specific CTLs in the peripheral blood mononuclear cells from CML patients who have discontinued imatinib after maintaining complete molecular remission for more than 2 years. Significantly, the relapse rate of CXorf48-specific CTL-negative patients was 63.6%, compared to 0% in CXorf48-specific CTL-positive patients. These results indicate that CXorf48 could be a promising therapeutic target of LSCs for immunotherapy to obtain durable treatment-free remission in CML patients.

Comparison of reduction products from graphite oxide and graphene oxide for anode applications in lithium-ion batteries and sodium-ion batteries

Hydrazine-reduced graphite oxide and graphene oxide were synthesized to compare their performances as anode materials in lithium-ion batteries and sodium-ion batteries. Reduced graphite oxide inherits the layer structure of graphite, with an average spacing between neighboring layers (d-spacing) of 0.374 nm; this exceeds the d-spacing of graphite (0.335 nm). The larger d-spacing provides wider channels for transporting lithium ions and sodium ions in the material. We showed that reduced graphite oxide as an anode in lithium-ion batteries can reach a specific capacity of 917 mA h g^-1, which is about three times of 372 mA h g^-1, the value expected for the LiC₆ structures on the electrode. This increase is consistent with the wider d-spacing, which enhances lithium intercalation and de-intercalation on the electrodes. The electrochemical performance of the lithium-ion batteries and sodium-ion batteries with reduced graphite oxide anodes show a noticeable improvement compared to those with reduced graphene oxide anodes. This improvement indicates that reduced graphite oxide, with larger interlayer spacing, has fewer defects and is thus more stable. In summary, we found that reduced graphite oxide may be a more favorable form of graphene for the fabrication of electrodes for lithium-ion and sodium-ion batteries and other energy storage devices.

Interface electronic structure at the topological insulator-ferrimagnetic insulator junction

An interface electron state at the junction between a three-dimensional topological insulator film, Bi₂Se₃, and a ferrimagnetic insulator film, Y₃Fe₅O₁₂ (YIG), was investigated by measurements of angle-resolved photoelectron spectroscopy and x-ray absorption magnetic circular dichroism. The surface state of the Bi₂Se₃ film was directly observed and localized 3d spin states of the Fe³⁺ in the YIG film were confirmed. The proximity effect is likely described in terms of the exchange interaction between the localized Fe 3d electrons in the YIG film and delocalized electrons of the surface and bulk states in the Bi₂Se₃ film.

Understanding Performance Differences from Various Synthesis Methods: A Case Study of Spinel LiCr0.2Ni0.4Mn1.4O4 Cathode Material

High voltage (5-V class) spinel LiCr_0.2Ni_0.4Mn_1.4O₄ is one of the most promising cathode materials to meet the energy requirements of lithium-ion batteries for electric vehicles and hybrid electric vehicles. For the mass production of this material (1 kg or higher), different synthesis routes will lead to different electrochemical performances, even with similar morphology and similar crystal structure obtained from laboratory X-ray diffraction, and the reason for this issue is still not clear. Herein, we have investigated the reasons for the different electrochemical performances resulting from three common synthesis routes (spray pyrolysis, coprecipitation, and sol-gel). Taking advantage of the high-resolution X-ray beam in synchrotron X-ray diffraction, we find that varying phase composition and the generated impurities, rather than the particle distribution, are likely to be the main reasons for the detected electrochemical variations. A higher amount of impurities will result in greater charge transfer resistance, inferior cycling stability, and more oxygen/lithium vacancies. Therefore, it is very important to obtain a deeper understanding with the help of higher-resolution X-rays and to provide better guidance for mass production of this cathode material for practical applications.

Centrality-Dependent Modification of Jet-Production Rates in Deuteron-Gold Collisions at √[s(NN)]=200 GeV

Jet production rates are measured in p+p and d+Au collisions at sqrt[s_{NN}]=200  GeV recorded in 2008 with the PHENIX detector at the Relativistic Heavy Ion Collider. Jets are reconstructed using the R=0.3 anti-k_{t} algorithm from energy deposits in the electromagnetic calorimeter and charged tracks in multiwire proportional chambers, and the jet transverse momentum (p_{T}) spectra are corrected for the detector response. Spectra are reported for jets with 12<p_{T}<50  GeV/c, within a pseudorapidity acceptance of |η|<0.3. The nuclear-modification factor (R_{dAu}) values for 0%-100% d+Au events are found to be consistent with unity, constraining the role of initial state effects on jet production. However, the centrality-selected R_{dAu} values and central-to-peripheral ratios (R_{CP}) show large, p_{T}-dependent deviations from unity, challenging the conventional models that relate hard-process rates and soft-particle production in collisions involving nuclei.

Depression-like episodes in mice harboring mtDNA deletions in paraventricular thalamus

Depression is a common debilitating human disease whose etiology has defied decades of research. A critical bottleneck is the difficulty in modeling depressive episodes in animals. Here, we show that a transgenic mouse with chronic forebrain expression of a dominant negative mutant of Polg1, a mitochondrial DNA (mtDNA) polymerase, exhibits lethargic behavioral changes, which are associated with emotional, vegetative and psychomotor disturbances, and response to antidepression drug treatment. The results suggested a symptomatic similarity between the lethargic behavioral change that was recurrently and spontaneously experienced by the mutant mice and major depressive episode as defined by DSM-5. A comprehensive screen of mutant brain revealed a hotspot for mtDNA deletions and mitochondrial dysfunction in the paraventricular thalamic nucleus (PVT) with similar defects observed in postmortem brains of patients with mitochondrial disease with mood symptoms. Remarkably, the genetic inhibition of PVT synaptic output by Cre-loxP-dependent expression of tetanus toxin triggered de novo depression-like episodes. These findings identify a novel preclinical mouse model and brain area for major depressive episodes with mitochondrial dysfunction as its cellular mechanism.

Advantage of tacrolimus/mycophenolate mofetil regimen for cytotoxic T cell-mediated defence and its inhibition by additive steroid administration in high-risk liver transplant recipients

Our previous work revealed that the recipients with the highest pre-existing numbers of CD8(+) effector T cells (TE ) [hyperparathyroidism (HPT)E recipients] occupied approximately 30% of adult transplant recipients performed in our hospital. HPTE recipients demonstrated very poor clinical outcome compared with the remaining 70% of recipients with the lowest pre-existing TE (LPTE recipient). This study aimed to clarify the best combined immunosuppressive regimen related to function of cytotoxic T lymphocytes (CTLs) for HPTE recipients. Eighty-one HPTE recipients were classified into three types, according to the immunosuppressive regimens: type 1, tacrolimus (Tac)/glucocorticoid (GC); type 2, Tac/mycophenolate mofetil (MMF)/GC; and type 3, Tac/MMF. Frequencies of severe infection, rejection and hospital death were the highest in types 1 and 2, whereas the lowest occurred in type 3. The survival rate in type 3 was the highest (100%) during follow-up until post-operative day 2000. Regarding the immunological mechanism, in type 1 TE perforin and interferon (IFN)-γ were generated through the self-renewal of CD8(+) central memory T cells (TCM ), but decreased in the early post-transplant period due to marked down-regulation of interleukin (IL)-12 receptor beta-1 of TCM. In type 2, the self-renewal TCM did not develop, and the effector function could not be increased. In type 3, in contrast, the effectors and cytotoxicity were correlated inversely with IL-12Rβ1(+) TCM levels, and increased at the highest level around the pre-transplant levels of IL-12Rβ1(+) TCM . However, the immunological advantage of Tac/MMF therapy was inhibited strongly by additive steroid administration.