Lateral Mass Intrapedicular Screw Fixation for Subaxial Cervical Spines: A Short- to Medium-Term Retrospective Follow-Up Study of 20 Cases

BACKGROUND

 Lateral mass intrapedicular screw(LMIS) fixation was introduced in 2021 as an alternative method for the fixation of subaxial cervical spines for the treatment of various cervical spine disease. The objective of this study is to provide a short- to medium-term result of the 20 patients who underwent cervical spine fixation using LMIS.

METHODS

 Twenty patients with varying cervical spine pathology who underwent cervical spine fixation using LMIS in a 21-month period were included in the study. Postoperative computed tomography (CT) imaging was used to evaluate the screw placement.

RESULTS

 A total of 105 screws were used. The average screw size used was 3.5 × 14 mm. The average screw angle in the axial plane was 18 degrees. Five screws had breached the inner cortex of the vertebral canal. None of the patients had any postsurgical neurologic deficit. Fifteen screws did not reach the pedicle. Intraoperative fixation was excellent and no screw showed signs of loosening in the subsequent follow-up imaging.

CONCLUSION

 LMIS is a good alternative to the commonly used methods for subaxial cervical spine fixation and is worth considering in many patients.

Enhancing Fingertip Tactile Sensitivity by Vibrotactile Noise and Cooling Skin Temperature Effect

This article discusses a method to enhance fingertip tactile sensitivity by applying a vibrotactile noise at the wrist. This is an application of stochastic resonance to the field of haptics. We consider that the tactile sensitivity of the fingertip improves when a sufficiently large noise is propagated to it from the wrist. However, fingertip tactile sensitivity decreases when a large noise that humans can perceive is applied to the wrist. Therefore, in this article, we cool the wrist skin to reduce the wrist's tactile sensitivity to noise. This allows us to apply noise that is large, but still imperceptible, at the wrist and thus to propagate it to the fingertip. On the basis of these procedures, we propose a method to enhance fingertip tactile sensitivity. Further, we carry out several experiments and confirm that the proposed method improves fingertip tactile sensitivity.

Research protocol for a pragmatic randomized controlled effectiveness and cost effectiveness study of Well Parent Japan (WPJ) for Japanese mothers of children with ADHD: The TRaining And Nurturing Support FOR Mothers TRANSFORM study (Preprint)

Background

Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder associated with numerous functional deficits and poor long-term outcomes. Internationally, behavioral interventions are recommended as part of a multimodal treatment approach for children with ADHD. Currently, in Japan, there are limited interventions available to target ADHD. Well Parent Japan (WPJ), a new hybrid parent-training program, provides a culturally acceptable and effective way to help support Japanese children with ADHD and their parents.

Objective

This pragmatic multicenter randomized controlled trial aims to provide preliminary evidence about the effectiveness and cost-effectiveness of WPJ evaluated against treatment as usual (TAU) within routine Japanese mental health services.

Methods

Mothers of children (aged 6-12 years) diagnosed with ADHD were recruited from child and adolescent mental health care services at three hospital sites across Japan (Fukui, Fukuoka, and Okinawa). The mothers were randomized to receive immediate treatment or TAU. The effectiveness and cost-effectiveness of WPJ over TAU at the end of the intervention and at 3-month follow-up will be evaluated. The primary outcome is maternal parent domain stress in the parenting role. The following secondary outcomes will be explored: child behavior, including severity of ADHD symptoms; parenting practices; emotional well-being; and the parent-child relationship and maternal child domain parenting stress. Data analysis will follow intention-to-treat principles with treatment effects quantified through analysis of covariance using multilevel modeling. An incremental cost-effectiveness ratio will be used to analyze the cost-effectiveness of the WPJ intervention.

Results

Study funding was secured through a proof-of-concept grant in July 2018. Approval by the institutional review board for the data collection sites was obtained between 2017 and 2019. Data collection began in August 2019 and was completed in April 2022. Participant recruitment (N=124) was completed in May 2021. Effectiveness and cost-effectiveness analyses are expected to be completed by July 2022 and December 2022, respectively. These timelines are subject to change owing to the COVID-19 pandemic.

Conclusions

This is the first multisite pragmatic trial of WPJ based on the recruitment of children referred directly to routine clinical services in Japan. This multisite randomized trial tests the effectiveness of WPJ in children and families by comparing WPJ directly with the usual clinical care offered for children diagnosed with ADHD in Japan. We also seek to assess and compare the cost-effectiveness of WPJ with TAU in Japan.

Trial Registration

International Standard Randomised Controlled Trial Number ISRCTN66978270; https://www.isrctn.com/ISRCTN66978270

International Registered Report Identifier (IRRID)

DERR1-10.2196/32693

Lateral mass intra-pedicular screw fixation for subaxial cervical spines - An alternative surgical technique

Background:

Lateral mass screw (LMS) and transpedicular screw (TPS) techniques are the two major options for performing posterior cervical fusion of the subaxial cervical spine. Although these two techniques can cover the vast majority of patients who require posterior fixation of the cervical spine, they are not without their limitations.

Objective:

The objective of this study is to introduce a novel technique, lateral mass intrapedicular screw (LMIS) fixation, for posterior subaxial cervical spine (C3–C6) fixation.

Materials and Methods:

The starting point of the screw is defined as the midpoint of the lateral mass. In the axial plane, the screw is angled at 20–25 with respect to the midline of the spinous process. In the sagittal plane, the screw is directed toward the rostral quarter (zone 1) of the vertebral body and placed within the pedicle. A preliminary, proof-of-concept experiment was performed using a bone model created with synthetic bone and computed tomography images before performing the operation on a patient.

Results:

During the preliminary experiment, insignificant breaching of the inner cortex of the pedicle was observed with one of the screws. However, no other screws breached the inner cortex in the same manner during the preliminary experiment or during the operation, and the intraoperative fixation was strong.

Conclusion:

LMIS is a relatively simple and safe technique that can be performed for the fixation of subaxial cervical spines with screws that are longer than those used in LMS. We believe that this technique may join the two existing techniques to become a common alternative technique, particularly for patients with poor bone quality.

[A Case of a Massive Retropharyngeal Hematoma Associated with Traumatic Cervical Cord Injury]

Retropharyngeal hematomas are uncommon, but they may rarely cause occlusion of the upper airway and threaten life. Retropharyngeal hematomas often occur due to head or neck injury;they rarely occur due to iatrogenic causes such as insertion of a gastric tube or anticoagulant therapy. It has been found that patients receiving anticoagulant therapy are more likely to experience potentially severe retropharyngeal hematomas. We report the case of a patient with retropharyngeal hematoma with cervical cord damage. A 75-year-old man was transferred to our hospital after he sustained a fall and damaged his face. CT showed a massive retropharyngeal hematoma, but he did not complain of any breathing issues. Therefore, we selected conservative therapy. However, after approximately 4 hours, he suddenly complained of breathing problems and suffered from loss of consciousness. We performed intubation and provided sedation. After one week, his condition clearly improved and he was extubated.

THU0225 INTEGRATIVE PLASMA METABOLOME AND TRANSCRIPTOME ANALYSIS REVEALED THE IMPORTANCE OF HISTIDINE HOMEOSTASIS IN SLE PATHOGENESIS WITH POTENTIAL FOR IMPROVED SLE PATIENTS STRATIFICATION

Background:

Recently, immunometabolism has gathered attention of many immunologists. It has been widely recognized that metabolic reprogramming in each immune cell brings different effects on different cells and is important for regulating their functions. Along with the progress of statistical genetics, serum metabolites were shown to be under genetic regulations1). Metabolic changes are now considered not only to be mere phenotypes of cells but also to be key factors for controlling immune cell differentiation, proliferation and function through regulating gene expressions eventually. Although genome-wide association studies have brought deep insights into SLE pathogenesis, the precise pathway from genome to metabolome has been largely unknown, and vice versa.

Objectives:

The aim of this study is to investigate metabolomic regulation in SLE in relation to gene expressions by integrating plasma metabolome data and transcriptome data.

Methods:

We collected plasma samples from patients with SLE (n=57) who met the 1997 American College of Rheumatology criteria for SLE. Gender- and age-matched healthy controls (HCs) (n=56) were recruited. Metabolic profiles focusing on 39 amino acids were analyzed with liquid chromatography (LC)-mass spectrometry. Transcriptome data of SLE patients were obtained from our RNA-sequencing data of each immune cell subset (total 19 subsets). Whole-genome sequencing was also performed.

Results:

Our previous experiment showed that about 160 peaks were detected from comprehensive LC-TOFMS and amino acids were useful for distinguishing SLE patients from HCs. Both partial least squares discriminant analysis (PLS-DA) and random forest, a machine learning algorithm, revealed the importance of histidine (His), one of the essential amino acids, to classify SLE patients from HCs, whose plasma level was lower in SLE patients. In addition, inverse correlation between His level and titer of ds-DNA as well as damage index (SDI) was detected. His level was correlated neither with PSL dosage nor with type I interferon (IFN) signature. Receiver operating characteristic (ROC) analysis showed the best predictability for SLE with the combination of specific amino acids including His. Our transcriptome analysis has revealed the significance of oxidative phosphorylation (OXPHOS) in B cells for SLE pathogenesis. Interestingly, OXPHOS signature was inversely correlated with His level in SLE B cells.

Conclusion:

His may be an important factor for SLE pathogenesis especially in B cells independently from IFN signal. SLC15A4, a transporter of His on lysosome, is one of the SLE GWAS SNPs and has been reported to play an important role in IFN production in B cells through regulation of TLR7/9 activation 2). We also identified that SLE patients with risk allele of SLC15A4 had tendency to show higher plasma His level, indicating His homeostasis could become a novel treatment target for SLE. Moreover, the inverse correlation of His level to SDI as well as OXPHOS signature suggests that His might play a key role for promoting organ damages in SLE.

References:

[1]Nat Genet.2017;49:568. 2)Immunity. 2014;41:375. 3)Semin Arthritis Rheum.2019;48:1142

Disclosure of Interests: :

Yukiko Iwasaki: None declared, Yusuke Takeshima: None declared, Masahiro Nakano: None declared, Mineto Ota: None declared, Yasuo Nagafuchi: None declared, Akari Suzuki: None declared, Yuta Kochi: None declared, Tomohisa Okamura: None declared, Takaho Endo: None declared, Ichiro Miki: None declared, Kazuhiro Sakurada: None declared, Kazuhiko Yamamoto Grant/research support from: Astellas, BMS, MitsubishiTanabe, Pfizer, Ayumi, Takeda, Chugai, Eisai, Taisho Toyama, UCB, and ImmunoFuture, Keishi Fujio Grant/research support from: Astellas, BMS, MitsubishiTanabe, Pfizer, Ayumi, Takeda, Chugai, Eisai, Taisho Toyama, Eli Lilly, Sanofi, and UCB

Differences in fetal fractional limb volume changes in normal and gestational diabetic pregnancies: an exploratory observational study

OBJECTIVE

Fetal fractional limb volume has been proposed as a useful measure for quantifying fetal soft tissue development. The aim of this study was to investigate the growth of fractional arm volume (AVol) and fractional thigh volume (TVol) of fetuses with maternal gestational diabetes (GDM) compared with those of fetuses with normal glucose tolerance (NGT). We hypothesised fetal fractional limb volume would be larger in the GDM group than in the NGT group in late gestation.

DESIGN

Exploratory observational study.

SETTING

Saitama Municipal Hospital.

SAMPLE

A total of 165 (125 NGT and 40 GDM) singleton Japanese pregnant women.

METHODS

AVol and TVol were assessed between 20 and 37 weeks' gestation as cylindrical limb volumes based on 50% of the fetal humeral or femoral diaphysis length. Women were diagnosed as GDM based on the criteria of the Japan Society of Obstetrics and Gynecology.

MAIN OUTCOME MEASURES

AVol and TVol were compared between women with NGT and those with GDM at each gestational age period (2-week intervals from 20 to 37 weeks' gestation).

RESULTS

Overall, 287 ultrasound scans were performed (NGT group, 205 scans; GDM group, 82 scans). There was no significant difference of AVol between the groups before 32 weeks' gestation. AVol was significantly larger in the GDM group than in the NGT group after 32 weeks' gestation (P < 0.05). TVol was not statistically different between the groups across gestation.

CONCLUSIONS

Detection of variations in fetal AVol may provide greater insight into understanding the origins of altered fetal body proportion in GDM.

TWEETABLE ABSTRACT

AVol, but not TVol, is significantly larger in fetuses with GDM than in those with NGT after 32 weeks' gestation.

Relationship between changes in the 7-day urticaria activity score after treatment with omalizumab and the responsiveness of basophils to FcεRI stimulation in patients with chronic spontaneous urticaria

Background

About one-half of all patients with chronic spontaneous urticaria have low or less reactivity of the basophils to FcεRI stimulation. However, the differences in the clinical characteristics between patients who show normal and attenuated basophil reactivities to FcεRI stimulation are still unclear. Furthermore, it also remains unknown as to what factors induce the poor reactivity of basophils to FcεRI stimulation.

Objective

The aim of the study is to investigate the differences in the clinical characteristics between patients who show normal and attenuated basophil reactivities to FcεRI stimulation.

Methods

We compared the clinical characteristics, including the autologous serum skin test-positive rates, serum concentrations of anti-IgE and anti-FcεRIα autoantibodies, and the FcεRI-crosslinking ability of these autoantibodies between patients with a negative basophil activation test (BAT) (≤10% CD203c^high basophils, n = 9) and positive BAT (>10% CD203c^high basophils, n = 13). We also monitored the changes in the 7-day urticaria activity scores after treatment with omalizumab, as compared to the score at the baseline, between the BAT-positive and BAT-negative patients.

Results

The BAT-negative patients showed a significantly higher urticaria control test score than the BAT-positive patients (p = 0.01). There were no significant differences in the autologous serum skin test-positive rates, concentrations of anti-IgE and anti-FcεRIα autoantibodies, and the FcεRI-crosslinking ability of these autoantibodies between the 2 groups. After treatment with omalizumab for 35 days, the score decreased to under 15 (corresponding to controlled or mild chronic spontaneous urticaria) in all of the BAT-negative patients, whereas in 6 out of the 13 BAT-positive patients, the scores remained over 16 (corresponding to moderate or severe chronic spontaneous urticaria).

Conclusions

The weak reactivity of basophils to FcεRI stimulation may not be due to the desensitization of basophils by anti-IgE or anti-FcεRIα autoantibodies. The time to response to omalizumab might differ between BAT-negative and BAT-positive patients with chronic spontaneous urticaria.

P856Incidence and Outcomes of irregular protrusion after stent implantation in patients with acute myocardial infarction: An in in vivo optical coherence tomography study

Background

Irregular protrusion, a protrusion of material with an irregular surface into the lumen of the vessel after stent implantation, can only be identified by optical coherence tomography (OCT). A previous study demonstrated that irregular protrusion after stent implantation was an independent predictor of 1-year major adverse cardiac events (MACE) in CAD patients. However, the true incidence and prognostic significance of irregular protrusion after stenting in patients with ST-segment elevation myocardial infarction (STEMI) have not previously examined.

Aims

The aims of this study were the following: 1) to evaluate the incidence of irregular protrusion detected by OCT in STEMI patients after stenting; and 2) to compare the long-term outcomes between patients with and without irregular protrusion.

Methods and results

A total of 210 STEMI patients who had post-procedure OCT imaging after coronary stenting within 12 hours after symptom onset were studied. We divided them into two groups: those with irregular protrusion (n=159) and those without (n=51) after stenting. There were no significant differences in baseline characteristics between the 2 groups except that peak CK-MB levels were higher in patients with irregular protrusion than those without (289 (137–563) vs. 260 (63–349) U/L, p<0.05). During mean follow-up period of 298 days, the overall incidence of MACE defined as cardiac death, target vessel-related myocardial infarction, and target lesion revascularization was 15.3%. Kaplan-Meier curve showed that the incidence of MACE did not differ between patients with and without irregular protrusion (14.7% vs. 17.7%, p=0.53 by Log-rank).

Conclusions

Irregular protrusion after stent implantation was detected in three-fourth of STEMI patients. Although patients with irregular protrusion had a greater myocardial damage, it did not influence clinical outcomes.

Acknowledgement/Funding

Donation course from Abbott Japan

P2810Clinical outcomes 1 year after filter protection during percutaneous coronary intervention in patients with attenuated plaque identified by intravascular ultrasound

Background

In the VAMPIRE 3 (VAcuuM asPIration thrombus REemoval 3) trial, we have previously shown that selective use of distal filter protection during percutaneous coronary intervention (PCI) decreased the incidence of no-reflow phenomenon and was associated with fewer in-hospital serious adverse cardiac events than conventional PCI in patients with attenuated plaque ≥5mm. However, whether the early efficacy of distal embolic protection translate into long term clinical benefit is unknown.

Methods

Patients with acute coronary syndrome (ACS) with attenuated plaque ≥5mm were assigned to distal protection (DP) (n=98) or conventional treatment (CT) (n=96). The primary end point of the incidence of no-reflow phenomenon during PCI and the secondary end point of in-hospital serious adverse cardiac events has been reported previously. The rate of a major adverse events, a composite of death from any cause, non-fatal myocardial infarction, or unplanned target vessel revascularization (TVR) at 1 year was the prespecified secondary end point of the trial. All clinical endpoint events were adjudicated by an independent Clinical Event Committee.

Results

Major adverse events at 1 year occurred in 12 patients (12.2%) in the DP group and in 3 patients (3.1%) in the CT group (P=0.029). The difference was driven by a higher risk of TVR (11 [11.2%] vs. 2 [2.1%], p=0.018) in the DP group compared with the CT group. In patients treated with bare metal stents (n=42), major adverse events occurred in 25.0% of the patients in the DP group and in none of the patients in the CT group (P=0.029), whereas in patients treated with drug eluting stents (n=152), rates of major adverse events were similar between the groups (8.1% vs. 3.9%, p=0.32). Rates of cardiac death were not significantly different (1.0% vs. 1.0%, p=1.00). No definite stent thrombosis was observed in either group.

Conclusions

In the VAMPIRE 3 trial of patients with ACS with attenuated plaque ≥5mm, the 1-year rates of major adverse events in the distal protection group were higher than in the conventional treatment group. This effect could be mitigated by the use of drug eluting stents.

Acknowledgement/Funding

This work was supported in part by a grant from Nipro, Boston Scientific Corporation, and Japan Lifeline.

Differentiation between control subjects and patients with chronic spontaneous urticaria based on the ability of anti-IgE autoantibodies (AAbs) to induce FcεRI crosslinking, as compared to anti-FcεRIα AAbs

BACKGROUND

The reported prevalences of IgG autoantibodies (AAbs) to FcεRIα and IgE in sera from patients with chronic spontaneous urticaria (CSU) have varied, and these AAbs are also often observed in healthy control subjects. Regarding the histamine release activity of purified IgG from patients with CSU, the number of examined patients has been small. Thus, we sought to determine the prevalence and FcεRI crosslinking ability of these AAbs in a large number of patients with CSU and non-atopic control (NC) subjects.

METHODS

We compared the concentrations of anti-IgE and anti-FcεRIα AAbs and the abilities of these AAbs to cause FcεRI aggregation in patients with CSU (n = 134) and NC subjects (n = 55) using ELISA and an in vitro elicitation test, respectively.

RESULTS

The concentration of anti-IgE AAbs was significantly different between the NC subjects and the CSU patients (P < 0.0001, cutoff value: 0.558 μg/mL), whereas the concentration of anti-FcεRIα AAbs was not. A significant difference in the duration of illness was noted between patients with lower and those with higher concentrations of anti-IgE AAbs relative to the cutoff value. The abilities of anti-IgE AAbs, but not anti-FcεRIα AAbs, to induce FcεRI crosslinking were significantly higher in CSU patients than in NC subjects (P = 0.0106).

CONCLUSIONS

In the Japanese population of CSU patients studied, the ability of the anti-IgE AAbs to induce FcεRI crosslinking differed significantly between NC subjects and CSU patients, suggesting the involvement of anti-IgE AAbs in the pathogenesis of CSU in the Japanese population.

Prognostic nutritional index and early mortality with percutaneous endoscopic gastrostomy

BACKGROUND

Although percutaneous endoscopic gastrostomy (PEG) is a well-accepted and less invasive method of feeding tube placement in patients with swallowing difficulties, complications and early death after PEG have been reported.

AIM

This study aimed to evaluate predictive factors associated with 30-day mortality after PEG, and to assess the utility of nutritional supporting period before PEG in reducing early mortality following PEG.

DESIGN

An observational study.

METHODS

We retrospectively analyzed 268 patients who underwent PEG at Sapporo Shirakaba-dai Hospital from 2006 to 2010, using clinical and laboratory data to analyze predictive factors associated with early death after PEG. Then, we prospectively assessed 152 consecutive patients assessed for eligibility for PEG from 2011 to 2014. We assessed the patients' nutritional condition using Onodera's prognostic nutritional index (PNI), and supported nutrition for more than 10 days before PEG in patients with a poor nutritional index (PNI < 37).

RESULTS

In both univariate and multivariate analyses in the retrospective study, Onodera's PNI of less than 37 was the only predictive factor for early mortality. In the second study, among the 115 patients who finally underwent PEG, early mortality rates improved to 1.7% from 5.2% in the first study. Conversely, 32% of patients with malnutrition who did not undergo PEG died within 30 days.

CONCLUSION

Nutritional status might be a predictive factor for early mortality after PEG. In patients with poor nutritional status, nutritional supporting period before PEG might improve the outcomes and reduce unnecessary PEG.

In Vitro and in Vivo Antigen-Induced Release of High-Molecular Weight Neutrophil Chemotactic Activity from Human Nasal Tissue

High molecular weight neutrophil chemotactic activity has been identified in resected human nasal polyps, inferior turbinates, and nasal secretions following antigen challenge. The estimated molecular weight, by gel filtration chromatography, was approximately 600,000. However, a heterogeneity of molecular weight in some patients was recognized. Our results suggest a possible role for high molecular weight-neutrophil chemotactic activity in the pathogenesis of hypersensitivity in the human nasal cavity.

Regulation of mitosis-meiosis transition by the ubiquitin ligase β-TrCP in male germ cells

The mitosis-meiosis transition is essential for spermatogenesis. Specific and timely downregulation of the transcription factor DMRT1, and consequent induction of Stra8 expression, is required for this process in mammals, but the molecular mechanism has remained unclear. Here, we show that β-TrCP, the substrate recognition component of an E3 ubiquitin ligase complex, targets DMRT1 for degradation and thereby controls the mitosis-meiosis transition in mouse male germ cells. Conditional inactivation of β-TrCP2 in male germ cells of β-TrCP1 knockout mice resulted in sterility due to a lack of mature sperm. The β-TrCP-deficient male germ cells did not enter meiosis, but instead underwent apoptosis. The induction of Stra8 expression was also attenuated in association with the accumulation of DMRT1 at the Stra8 promoter in β-TrCP-deficient testes. DMRT1 contains a consensus β-TrCP degron sequence that was found to bind β-TrCP. Overexpression of β-TrCP induced the ubiquitylation and degradation of DMRT1. Heterozygous deletion of Dmrt1 in β-TrCP-deficient spermatogonia increased meiotic cells with a concomitant reduction of apoptosis. Collectively, our data indicate that β-TrCP regulates the transition from mitosis to meiosis in male germ cells by targeting DMRT1 for degradation.

Task-Space Synchronization of Networked Mechanical Systems With Uncertain Parameters and Communication Delays

This paper addresses the adaptive synchronization problem of networked mechanical systems in task space with time-varying communication delays, where both kinematic and dynamic uncertainties are considered and the information flow in the networks is represented by a directed graph. Based on a novel coordination auxiliary system, we first extend existing feedback architecture to achieve synchronization of networked mechanical systems in task space with slow-varying delays. Given that abrupt turns arise for the delays sometimes, we then propose a delay-independent adaptive synchronization control scheme which removes the requirement of the slow-varying condition. Both of the two control schemes are established with time-domain approaches by using Lyapunov-Krasovskii functions. Simulation results are provided to demonstrate the effectiveness of the proposed control schemes.

Abstract P4-01-10: Development of photoacoustic vascular imaging system for breast cancer

Background:

Tumor angiogenesis and hypoxia are associated with breast cancer growth and metastasis. Photoacoustic (PA) tomography is an optical imaging technology that visualizes distribution and oxygenation status of hemoglobin with high spatial resolution. Initially we developed a photoacoustic mammography (PAM) having a flat-shaped scanning detector that could detect breast tumors. Nevertheless, the flat-shaped detector array has the drawback of a limited view. Here we developed a novel PAM system with a hemispherical-shaped detector array (HDA), which enables us to identify microvasculatures non-invasively and allow the collection of nearly spatially isotropic three-dimensional reconstructed image of blood vessels. This non-invasive vascular imaging system may be able to characterize tumor angiogenesis and analyze the status of microcirculation. The aim of this study was to analyze the imaging findings of tumor-related vasculature in breast cancer patients.

Patients and method:

A PAM system with HDA has been generated in a cooperation project between Canon Inc., Japan, and Kyoto University. Twenty-two primary breast cancer patients, including 5 patients with non-invasive cancer and 17 patients with invasive cancer, diagnosed between December 2014 and December 2015 underwent the PAM imaging analysis. We also applied the breast deformation algorithm from the breast shape in a MRI image to that in a PA image in order to create a fusion image of the two modalities for the analysis. Features of peri- and intra-tumoral vasculature, and their oxygenation status were evaluated. The study protocol was approved by the institutional review board at Kyoto University Hospital (UMIN000012251). All patients provided informed consent to participate in this study.

Results:

The abnormal peri-tumoral vasculature was detected in 86% of all non-invasive and invasive disease cases. In invasive cancer cases, most tumor-related blood vessels were centripetally directed toward the tumor, and 93% of centripetal blood vessels appeared to be disrupted or rapidly narrowed at the tumor boundary. The centripetal blood vessel structure was frequently observed in invasive cancer compared with non-invasive cancer (61% vs 35%). PA images before and after preoperative chemotherapy were obtained in one case, where intra-tumoral blood vessels became finer after chemotherapy, reflecting normalization of intra-tumoral microcirculation induced by chemotherapy.

Conclusions:

A PAM system with HDA has provided a high-resolution vascular images of primary breast cancers. The morphological differences of peri-tumoral vasculature were observed between invasive disease and non-invasive disease. These results suggest the potential of PA imaging as a non-invasive tool to analyze tumor vasculature of human breast cancers and maybe be helpful for breast cancer diagnosis.

(Acknowledgements)

This work was partially supported by the Innovative Techno-Hub for Integrated Medical Bio-imaging Project of the Special Coordination Funds for Promoting Science and Technology from the Ministry of Education, Culture, Sports, Science, and Technology, Japan.

Citation Format: Toi M, Asao Y, Takada M, Kataoka M, Endo T, Kawashima M, Yamaga I, Nakayama Y, Tokiwa M, Fakhrejahani E, Torii M, Kawaguchi-Sakita N, Kanao S, Matsumoto Y, Yagi T, Sakurai T, Togashi K, Shiina T. Development of photoacoustic vascular imaging system for breast cancer [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 P4-01-10.

Visualization of tumor-related blood vessels in human breast by photoacoustic imaging system with a hemispherical detector array

Noninvasive measurement of the distribution and oxygenation state of hemoglobin (Hb) inside the tissue is strongly required to analyze the tumor-associated vasculatures. We developed a photoacoustic imaging (PAI) system with a hemispherical-shaped detector array (HDA). Here, we show that PAI system with HDA revealed finer vasculature, more detailed blood-vessel branching structures, and more detailed morphological vessel characteristics compared with MRI by the use of breast shape deformation of MRI to PAI and their fused image. Morphologically abnormal peritumoral blood vessel features, including centripetal photoacoustic signals and disruption or narrowing of vessel signals, were observed and intratumoral signals were detected by PAI in breast cancer tissues as a result of the clinical study of 22 malignant cases. Interestingly, it was also possible to analyze anticancer treatment-driven changes in vascular morphological features and function, such as improvement of intratumoral blood perfusion and relevant changes in intravascular hemoglobin saturation of oxygen. This clinical study indicated that PAI appears to be a promising tool for noninvasive analysis of human blood vessels and may contribute to improve cancer diagnosis.

Nutritional assessment using stable isotope ratios of carbon and nitrogen in the scalp hair of geriatric patients who received enteral and parenteral nutrition formulas

BACKGROUND & AIMS

The δ¹³C and δ¹⁵N values in the scalp hair of geriatric patients in Japan who received the enteral or parenteral nutrition formula were measured to assess nutritional status.

METHODS

The relations among δ¹³C, δ¹⁵N, calorie intake, BMI, albumin concentration, total cholesterol (T-CHO) and geriatric nutritional risk index (GNRI) in the patients were investigated. Furthermore, the enrichment of δ¹³C and δ¹⁵N from the nutrients to the hair was investigated.

RESULTS

The δ¹³C values in the hair of patients who received enteral nutrition decreased with decreases in the calories received, while the δ¹⁵N values increased, suggesting malnutrition in some patients with a low calorie intake due to a negative nitrogen balance. The distribution of patients with a low calorie intake (below 20 kcal/kg/day) when δ¹³C was plotted against δ¹⁵N differed from that of control subjects, but the distribution of patients with a high calorie intake (above 20 kcal/kg/day) was similar to that of control subjects. No significant differences were observed in BMI, albumin concentration, T-CHO or GNRI between the low and high calorie groups. The enrichment of δ¹³C and δ¹⁵N from the enteral nutrients to the hair were inversely correlated with the δ¹³C and δ¹⁵N in the enteral nutrients. The enrichment levels of δ¹³C and δ¹⁵N tended to be higher and lower, respectively, in the high calorie group. On the other hand, the δ¹³C and δ¹⁵N values in the hair of patients who received parenteral nutrition were higher and lower than those in the control subjects and in the patients who received enteral nutrition, respectively, reflecting the higher δ¹³C and lower δ¹⁵N contents of the parenteral nutrients.

CONCLUSIONS

The δ¹³C and δ¹⁵N values in the hair of patients who received enteral nutrition may be effective indicators for evaluating the long-term nutritional status of geriatric patients. A calorie intake of 20 kcal/kg/day may be a cut-off value for malnutrition in Japanese geriatric patients receiving enteral nutrition. However, caution is necessary when dealing with patients switching from parental nutrition as parenteral nutrition resulted in different changes in δ¹³C and δ¹⁵N. The enrichment levels of δ¹³C and δ¹⁵N from the enteral nutrients to the hair may be inversely correlated with the δ¹³C and δ¹⁵N values of enteral nutrients and vary according to the calorie intake.

Development of a cascade arc discharge source for an atmosphere-vacuum interface device

To realize a novel vacuum-atmosphere interface that does not require a large differential pumping system, a robust cascade arc discharge source called a plasma window is constructed and tested for long-term operation. By modifying a test plasma with a direct current discharge, a vacuum interface with a high gas pressure ratio of 1/407 between the discharge and expansion sections is demonstrated for currents as high as 20 A. No significant damage to the electrodes is observed during the operation. Analysis of the visible emission spectra reveals that a stationary, stable argon plasma having a temperature of 1 eV and a density of 1.5 × 10(16) cm(-3) is generated in the plasma channel.

MR Imaging of Hippocampal Sulcus Remnant: Age-Related Differences

The hippocampal sulcus remnant (HSR) is often observed at the medial temporal lobe on MR images. In the present study, we made a retrospective assessment of the frequency and age-related differences in HSR in routine brain MR examinations of 1000 patients, 494 females and 506 males. Cases with one or several spots that were hypointense on T1-weighted and FLAIR images and hyperintense on T2-weighted images were defined as positive for HSR. Abnormal spots with the same intensity as cerebrospinal fluid were observed in 210 out of 506 males and in 193 out of 494 females. No significant sex-related differences were observed in the frequency of HSR. The HSR was seen more frequently with age in both males and females. Patients with hypertension had a significantly higher frequency of HSR.

Measurement and comparison of individual external doses of high-school students living in Japan, France, Poland and Belarus-the 'D-shuttle' project

Twelve high schools in Japan (of which six are in Fukushima Prefecture), four in France, eight in Poland and two in Belarus cooperated in the measurement and comparison of individual external doses in 2014. In total 216 high-school students and teachers participated in the study. Each participant wore an electronic personal dosimeter 'D-shuttle' for two weeks, and kept a journal of his/her whereabouts and activities. The distributions of annual external doses estimated for each region overlap with each other, demonstrating that the personal external individual doses in locations where residence is currently allowed in Fukushima Prefecture and in Belarus are well within the range of estimated annual doses due to the terrestrial background radiation level of other regions/countries.