Association between Radon Hot Spring Bathing and Health Conditions: A Cross-Sectional Study in Misasa, Japan

No epidemiological studies have examined the health effects of daily bathing in radon hot springs. In this cross-sectional study, we investigated the associations between radon hot spring bathing and health conditions. The target population was 5,250 adults ≥ 20 years old in the town of Misasa, Japan. We collected information about the participants' bathing habits and alleviation of a variety of disease symptoms, and their self-rated health (SRH). Unadjusted and adjusted odds ratios (ORs) and 95% confidence intervals (CI) were calculated. In both the adjusted and unadjusted models of hypertension, significant associations between the > 1×/week hot spring bathing and the alleviation of hypertension symptoms were observed compared to the group whose hot spring bathing was <1×/week: adjusted model, OR 5.40 (95%CI: 1.98-14.74); unadjusted model, 3.67 (1.50-8.99) and for gastroenteritis: adjusted model, 9.18 (1.15-72.96); unadjusted model, 7.62 (1.59-36.49). Compared to the no-bathing group, higher SRH was significantly associated with both bathing < 1×/week: unadjusted model, 2.27 (1.53-3.37) and > 1×/week: adjusted model, 1.91 (1.15-3.19). These findings suggest that bathing in radon hot springs is associated with higher SRH and the alleviation of hypertension and gastroenteritis.

Effects of Custom-Designed Soft Contact Lenses on Irregular Astigmatism Correction in Patients with Keratoconus

Purpose

To evaluate the efficacy of YOUSOFT soft contact lenses in correcting irregular astigmatism and prescription results of patients with keratoconus.

Patients and Methods

The retrospective observational study included 55 eyes (mean age, 32.2 ± 10.6 years; 36 men and 6 women) of 42 patients with keratoconus who tried YOUSOFT for rigid gas permeable (RGP) lens intolerance. Average keratometry, corneal astigmatism, and maximum keratometry were 49.4 ± 5.2 diopters (D), 3.7 ± 2.1 D, and 57.3 ± 8.2 D, respectively. Patients were divided into YOUSOFT prescription and non-prescription cases, wherein the prescription rates were calculated. YOUSOFT visual acuity was compared with spectacle-corrected distance visual acuity (CDVA) and RGP lens-CDVA.

Results

YOUSOFT was prescribed to 28 out of 42 patients (prescription rate 67%). In the YOUSOFT prescription cases, YOUSOFT-CDVA (logMAR -0.04; 95% confidence interval [CI]: -0.08 to 0.00) was significantly better than spectacle-CDVA (logMAR 0.23; 95% CI: 0.08 to 0.38; P < 0.0001), whereas YOUSOFT-CDVA (logMAR -0.03; 95% CI: -0.08 to 0.03) did not significantly differ from the RGP lens-CDVA (logMAR -0.02; 95% CI: -0.08 to 0.04; P = 0.856).

Conclusion

YOUSOFT was effective in correcting irregular corneal astigmatism, suggesting that it is highly effective in patients with RGP lens intolerance.

Effects of low-dose/high-dose-rate X-irradiation on oxidative stress in organs following forced swim test and its combined effects on alcohol-induced liver damage in mice

The liver's susceptibility to oxidative stress after a combination of forced swim test (FST) and low-dose-rate γ-irradiation has been observed. Therefore, this study aims to clarify the effects of low-dose (0.1 and 0.5 Gy)/high-dose-rate (1.2 Gy/min) irradiation on combined oxidative stressors-liver damage associated with FST and alcohol administration. In addition, the effects of similar irradiation on FST-induced immobility, which induces psychomotor retardation, and antioxidative effects on the brain, lungs, liver and kidneys were investigated, and the results were compared with those of a similar previous study that utilized low-dose-rate irradiation. Low-dose/high-dose-rate (especially 0.5 Gy) irradiation temporarily worsened liver antioxidant function and hepatic function with FST- and alcohol administration-related oxidative damage; however, the damages improved soon after. In addition, the increase in total glutathione content in the liver contributed to the early improvement of hepatic functions. However, pre-irradiation did not suppress immobility during the FST. The results also suggested that the effects of low-dose/high-dose-rate irradiation on the antioxidant functions of each organ after the FST were different from those of low-dose/low-dose-rate irradiation. Overall, this study provides further insights into the effects of low-dose irradiation on exposure to a combination of different oxidative stressors. It will also contribute to the elucidation of dose rate effects on oxidative stress in the low-dose irradiation range.

Potential inhibitory effects of low-dose thoron inhalation and ascorbic acid administration on alcohol-induced hepatopathy in mice

Although thoron inhalation exerts antioxidative effects in several organs, there are no reports on whether it inhibits oxidative stress-induced damage. In this study, we examined the combined effects of thoron inhalation and ascorbic acid (AA) administration on alcohol-induced liver damage. Mice were subjected to thoron inhalation at 500 or 2000 Bq/m3 and were administered 50% ethanol (alcohol) and 300 mg/kg AA. Results showed that although alcohol administration increased the levels of glutamic oxaloacetic transaminase (GOT) and glutamic pyruvic transaminase (GPT) in the serum, the combination of thoron inhalation (500 Bq/m3) and AA administration 24 h after alcohol administration effectively inhibited alcohol-induced liver damage. The combination of thoron inhalation (500 Bq/m3) and AA administration 24 h after alcohol administration increased catalase (CAT) activity. Alcohol administration significantly decreased glutathione (GSH) levels in the liver. The GSH content in the liver after 2000 Bq/m3 thoron inhalation was lower than that after 500 Bq/m3 thoron inhalation. These findings suggest that the combination of thoron inhalation at 500 Bq/m3 and AA administration has positive effects on the recovery from alcohol-induced liver damage. The results also suggested that thoron inhalation at 500 Bq/m3 was more effective than that at 2000 Bq/m3, possibly because of the decrease in GSH content in the liver. In conclusion, the combination of thoron inhalation at 500 Bq/m3 and AA administration promoted an early recovery from alcohol-induced liver damage.

Changes in Sulfur Metabolism in Mouse Brains following Radon Inhalation

Therapy using hot springs, including the high-level radioactive gas "radon", is traditionally conducted as an alternative treatment for various diseases. Oxidative-stress-related diseases are inhibited by the enhancement of antioxidative functions following radon inhalation. We have reported that radon inhalation increased the level of anti-oxidants, such as glutathione (G-SH), in the brain and had a protective antioxidative effect against transient global cerebral ischemic injury. However, no studies have yet revealed the changes in G-SH associated substances after radon inhalation. In this study, we comprehensively analyzed several metabolites, focusing on G-SH. Mice were exposed to radon at concentrations of 200, 2000, or 20,000 Bq/m³ for 1, 3, or 10 days. We detected 27 metabolites in the mouse brains. The result showed that the L-methionine levels increased, whereas the levels of urea, glutathione, and sulfite ion decreased under any condition. Although the ratio of G-SH to oxidized glutathione (GS-SG) decreased, glutathione monosulfide (G-S-SH) and cysteine monosulfide (Cys-S-SH) increased after radon inhalation. G-S-SH and Cys-S-SH can produce a biological defense against the imbalance of the redox state at very low-dose irradiation following radon inhalation because they are strong scavengers of reactive oxygen species. Additionally, we performed an overall assessment of high-dimensional data and showed some specific characteristics. We showed the changes in metabolites after radon inhalation using partial least squares-discriminant analysis and self-organizing maps. The results showed the health effects of radon, especially the state of sulfur-related metabolites in mouse brains under the exposure conditions for radon therapy.

Immunomodulatory Effects of Radon Inhalation on Lipopolysaccharide-Induced Inflammation in Mice

Typical indications for radon therapy include autoimmune diseases such as rheumatoid arthritis (RA). We had previously reported that radon inhalation inhibits Th17 immune responses in RA mice by activating Th1 and Th2 immune responses. However, there are no reports on how radon inhalation affects the activated Th1 and Th17 immune responses, and these findings may be useful for identifying new indications for radon therapy. Therefore, in this study, we investigated the effect of radon inhalation on the lipopolysaccharide (LPS)-induced inflammatory response, focusing on the expression of related cytokines and antioxidant function. Male BALB/c mice were exposed to 2000 Bq/m³ radon for one day. Immediately after radon inhalation, LPS was administered intraperitoneally at 1.0 mg/kg body weight for 4 h. LPS administration increased the levels of Th1- and Th17-prone cytokines, such as interleukin-2, tumor necrosis factor-α, and granulocyte-macrophage colony-stimulating factor, compared to no treatment control (sham). However, these effects were suppressed by radon inhalation. IL-10 levels were significantly increased by LPS administration, with or without radon inhalation, compared to sham. However, radon inhalation did not inhibit oxidative stress induced by LPS administration. These findings suggest that radon inhalation has immunomodulatory but not antioxidative functions in LPS-induced injury.

Radon Solubility and Diffusion in the Skin Surface Layer

In specific situations such as bathing in a radon spa, where the radon activity concentration in thermal water is far higher than that in air, it has been revealed that radon uptake via skin can occur and should be considered for more precise dose evaluation. The primary aim of the present study was to numerically demonstrate the distribution as well as the degree of diffusion of radon in the skin, with a focus on its surface layer (i.e., stratum corneum). We developed a biokinetic model that included diffusion theory at the stratum corneum, and measured radon solubility in that tissue layer as a crucial parameter. The implementation of the model suggested that the diffusion coefficient in the stratum corneum was as low as general radon-proof sheets. After a 20-min immersion in water, the simulated depth profile of radon in the skin showed that the radon activity concentration at the top surface skin layer was approximately 103 times higher than that at the viable skin layer. The information on the position of radon as a radiation source would contribute to special dose evaluation where specific target cell layers are assumed for the skin.

Evaluation of the Relationship Between the Changes in the Corneal Biomechanical Properties and Changes in the Anterior Segment OCT Parameters Following Customized Corneal Cross-Linking

Purpose

Patients and Methods

Results

Conclusion

Mechanisms of action of radon therapy on cytokine levels in normal mice and rheumatoid arthritis mouse model

The typical indication of radon therapy is rheumatoid arthritis. Although there are several reports that radon therapy has regulation effects on Th17 cells, there has been no study reporting that radon inhalation affects the immune balance among Th1, Th2, and Th17. The purpose of this study is to examine the cytokine changes after radon inhalation. BALB/c mice inhaled radon at 2,000 Bq/m³ for 2 or 4 weeks. SKG/Jcl mice inhaled radon at 2,000 Bq/m³ for 4 weeks after zymosan administration. The results showed that radon inhalation for 4 weeks activated the immune response of Th1, Th2, and Th17. Moreover, the balance among them was not lost by radon inhalation. Radon inhalation for 4 weeks decreased superoxide dismutase activity and increased catalase activity in spleen. These findings suggest that an imbalance of oxidative stress may contribute to activate the immune response. Although zymosan administration activated Th17 immune response and decreased Th1 and Th2 immune response in SKG/Jcl mice, most cytokines related to Th1, Th2, and Th17 approached the normal level by radon inhalation. These findings suggested that radon inhalation has a different action between SKG/Jcl mice and normal BABL/c mice. This may indicate that radon inhalation has an immunomodulation function.

Radon inhalation decreases DNA damage induced by oxidative stress in mouse organs via the activation of antioxidative functions

Radon inhalation decreases the level of lipid peroxide (LPO); this is attributed to the activation of antioxidative functions. This activation contributes to the beneficial effects of radon therapy, but there are no studies on the risks of radon therapy, such as DNA damage. We evaluated the effect of radon inhalation on DNA damage caused by oxidative stress and explored the underlying mechanisms. Mice were exposed to radon inhalation at concentrations of 2 or 20 kBq/m3 (for one, three, or 10 days). The 8-hydroxy-2'-deoxyguanosine (8-OHdG) levels decreased in the brains of mice that inhaled 20 kBq/m3 radon for three days and in the kidneys of mice that inhaled 2 or 20 kBq/m3 radon for one, three or 10 days. The 8-OHdG levels in the small intestine decreased by approximately 20-40% (2 kBq/m3 for three days or 20 kBq/m3 for one, three or 10 days), but there were no significant differences in the 8-OHdG levels between mice that inhaled a sham treatment and those that inhaled radon. There was no significant change in the levels of 8-oxoguanine DNA glycosylase, which plays an important role in DNA repair. However, the level of Mn-superoxide dismutase (SOD) increased by 15-60% and 15-45% in the small intestine and kidney, respectively, following radon inhalation. These results suggest that Mn-SOD probably plays an important role in the inhibition of oxidative DNA damage.

Dosimetry of radon progeny deposited on skin in air and thermal water

It is held that the skin dose from radon progeny is not negligibly small and that introducing cancer is a possible consequence under normal circumstances as there are a number of uncertainties in terms of related parameters such as activity concentrations in air and water, target cells in skin, skin covering materials, and deposition velocities. An interesting proposal has emerged in that skin exposure to natural radon-rich thermal water as part of balneotherapy can produce an immune response to induce beneficial health effects. The goal of this study was to obtain generic dose coefficients with a focus on the radon progeny deposited on the skin in air or water in relation to risk or treatment assessments. We thus first estimated the skin deposition velocities of radon progeny in air and thermal water based on data from the latest human studies. Skin dosimetry was then performed under different assumptions regarding alpha-emitting source position and target cell (i.e. basal cells or Langerhans cells). Furthermore, the impact of the radon progeny deposition on effective doses from all exposure pathways relating to 'radon exposure' was assessed using various possible scenarios. It was found that in both exposure media, effective doses from radon progeny inhalation are one to four orders of magnitude higher than those from the other pathways. In addition, absorbed doses on the skin can be the highest among all pathways when the radon activity concentrations in water are two or more orders of magnitude higher than those in air.

Comparison of Corneal Biomechanical Properties and Corneal Tomography Between Customized and Accelerated Corneal Crosslinking in Eyes with Keratoconus

PURPOSE

To compare the changes in corneal biomechanical properties and corneal tomography between transepithelial customized corneal crosslinking (C-CXL) and epithelium-off accelerated corneal crosslinking (A-CXL) in eyes with keratoconus.

METHODS

Twenty eyes in 20 consecutive patients who underwent C-CXL (C-CXL group) and 20 eyes in 20 patients who underwent A-CXL (A-CXL group) were included in this retrospective comparative study. The corneal biomechanical properties were analyzed using a Scheimpflug-based tonometer, and all corneas were examined by anterior segment optical coherence tomography (AS-OCT) before and 3 months after surgery. The corneal biomechanical parameters analyzed were the maximum inverse radius, deformation amplitude (DA) ratio max (2 mm), stiffness parameter at applanation 1, and integrated radius. The AS-OCT parameters analyzed included average keratometry, corneal astigmatism, maximum keratometry reading (Kmax), higher-order irregularity, and asymmetry.

RESULTS

In the C-CXL group, there were significant improvements in biomechanical parameters, including the maximum inverse radius, the DA ratio max (2 mm), and the integrated radius after surgery (P = 0.037, P = 0.002, and P = 0.003, respectively). In the C-CXL group, there was a significant decrease in the Kmax, higher-order irregularity, and asymmetry components (P = 0.014, P = 0.008, and P = 0.016, respectively). The biomechanical properties and AS-OCT parameters did not change significantly in the A-CXL group after surgery. According to multiple regression analyses, C-CXL had a greater effect than A-CXL in improving the maximum inverse radius, DA ratio max (2 mm), integrated radius, Kmax, asymmetry component, and higher-order irregularity component.

CONCLUSIONS

C-CXL might improve the biomechanical properties and irregular shape of the cornea from the early postoperative period to a greater extent than A-CXL.

Evaluation of the redox state in mouse organs following radon inhalation

Radon inhalation activates antioxidative functions in mouse organs, thereby contributing to inhibition of oxidative stress-induced damage. However, the specific redox state of each organ after radon inhalation has not been reported. Therefore, in this study, we evaluated the redox state of various organs in mice following radon inhalation at concentrations of 2 or 20 kBq/m3 for 1, 3 or 10 days. Scatter plots were used to evaluate the relationship between antioxidative function and oxidative stress by principal component analysis (PCA) of data from control mice subjected to sham inhalation. The results of principal component (PC) 1 showed that the liver and kidney had high antioxidant capacity; the results of PC2 showed that the brain, pancreas and stomach had low antioxidant capacities and low lipid peroxide (LPO) content, whereas the lungs, heart, small intestine and large intestine had high LPO content but low antioxidant capacities. Furthermore, using the PCA of each obtained cluster, we observed altered correlation coefficients related to glutathione, hydrogen peroxide and LPO for all groups following radon inhalation. Correlation coefficients related to superoxide dismutase in organs with a low antioxidant capacity were also changed. These findings suggested that radon inhalation could alter the redox state in organs; however, its characteristics were dependent on the total antioxidant capacity of the organs as well as the radon concentration and inhalation time. The insights obtained from this study could be useful for developing therapeutic strategies targeting individual organs.

Confirmation of efficacy, elucidation of mechanism, and new search for indications of radon therapy

Indications of radon therapy include various diseases related to respiratory, painful, digestive, chronic degenerative, senile, etc. derived from reactive oxygen species, but most are based on empirical prescriptions. For this reason, we have evaluated the relation between the biological response caused by radon and the tissue/organ absorbed dose more quantitatively, and have promoted the elucidation of mechanisms related to the indication and searching newly. As a result, as a mechanism, a series of moderate physiological stimulative effects accompanying a small amount of oxidative stress by radon inhalation are being elucidated. That is, hyperfunction of anti-oxidation/immune regulation/damage repair, promotion of anti-inflammation/circulating metabolism/hormone secretion, induction of apoptosis/heat shock protein, etc. Also, new indications include inflammatory/neuropathic pain, hepatic/renal injury, colitis, type 1 diabetes, complication kidney injury, hyperuricemia, transient cerebral ischemia, and inflammatory edema. Furthermore, we examined the combined antioxidant effect of radon inhalation and antioxidants or therapeutic agents. As a result, it was clear that any combination treatment could enhance the suppression effect of disease. It can be expected that radon therapy can be used effectively by applying it in addition to usual treatment, since reduction in its dosage can also be expected by concomitant use for drugs with strong side effects.

Comparison of antioxidative effects between radon and thoron inhalation in mouse organs

Radon therapy has been traditionally performed globally for oxidative stress-related diseases. Many researchers have studied the beneficial effects of radon exposure in living organisms. However, the effects of thoron, a radioisotope of radon, have not been fully examined. In this study, we aimed to compare the biological effects of radon and thoron inhalation on mouse organs with a focus on oxidative stress. Male BALB/c mice were randomly divided into 15 groups: sham inhalation, radon inhalation at a dose of 500 Bq/m³ or 2000 Bq/m³, and thoron inhalation at a dose of 500 Bq/m³ or 2000 Bq/m³ were carried out. Immediately after inhalation, mouse tissues were excised for biochemical assays. The results showed a significant increase in superoxide dismutase and total glutathione, and a significant decrease in lipid peroxide following thoron inhalation under several conditions. Additionally, similar effects were observed for different doses and inhalation times between radon and thoron. Our results suggest that thoron inhalation also exerts antioxidative effects against oxidative stress in organs. However, the inhalation conditions should be carefully analyzed because of the differences in physical characteristics between radon and thoron.

X-Irradiation at 0.5 Gy after the forced swim test reduces forced swimming-induced immobility in mice

The forced swim test (FST) is a screening model for antidepressant activity; it causes immobility and induces oxidative stress. We previously reported that radon inhalation has antidepressant-like effects in mice potentially through the activation of antioxidative functions upon radon inhalation. This study aimed to investigate the effect of prior and post low-dose X-irradiation (0.1, 0.5, 1.0 and 2.0 Gy) on FST-induced immobility and oxidative stress in the mouse brain, and the differences, if any, between the two. Mice received X-irradiation before or after the FST repeatedly for 5 days. In the post-FST-irradiated group, an additional FST was conducted 4 h after the last irradiation. Consequently, animals receiving prior X-irradiation (0.1 Gy) had better mobility outcomes than sham-irradiated mice; however, their levels of lipid peroxide (LPO), an oxidative stress marker, remained unchanged. However, animals that received post-FST X-irradiation (0.5 Gy) had better mobility outcomes and their LPO levels were significantly lower than those of the sham-irradiated mice. The present results indicate that 0.5 Gy X-irradiation after FST inhibits FST-induced immobility and oxidative stress in mice.

Evaluation of apocynin in vitro on high glucose-induced oxidative stress on tenocytes

Aims

The purpose of this study was to evaluate the in vitro effects of apocynin, an inhibitor of nicotinamide adenine dinucleotide phosphate oxidase (NOX) and a downregulator of intracellular reactive oxygen species (ROS), on high glucose-induced oxidative stress on tenocytes.

Methods

Tenocytes from normal Sprague-Dawley rats were cultured in both control and high-glucose conditions. Apocynin was added at cell seeding, dividing the tenocytes into four groups: the control group; regular glucose with apocynin (RG apo+); high glucose with apocynin (HG apo+); and high glucose without apocynin (HG apo–). Reactive oxygen species production, cell proliferation, apoptosis and messenger RNA (mRNA) expression of NOX1 and 4, and interleukin-6 (IL-6) were determined in vitro.

Results

Expression of NOX1, NOX4, and IL-6 mRNA in the HG groups was significantly higher compared with that in the RG groups, and NOX1, NOX4, and IL-6 mRNA expression in the HG apo+ group was significantly lower compared with that in the HG apo– group. Cell proliferation in the RG apo+ group was significantly higher than in the control group and was also significantly higher in the HG apo+ group than in the HG apo– group. Both the ROS accumulation and the amounts of apoptotic cells in the HG groups were greater than those in the RG groups and were significantly less in the HG apo+ group than in the HG apo– group.

Conclusion

Apocynin reduced ROS production and cell death via NOX inhibition in high-glucose conditions. Apocynin is therefore a potential prodrug in the treatment of diabetic tendinopathy.

Cite this article:Bone Joint Res 2020;9(1):23–28.

Evaluation of Biomechanically Corrected Intraocular Pressure Measurements in Keratoconus and Forme Fruste Keratoconus

INTRODUCTION

Although biomechanically corrected intraocular pressure (bIOP) is available, the effectiveness of intraocular pressure (IOP) correction in keratoconus and forme fruste keratoconus (FFK) eyes has not been investigated.

OBJECTIVE

Evaluation of bIOP measurements in eyes with keratoconus and FFK.

METHODS

Forty-two eyes in 21 patients with keratoconus in one eye and FFK in the fellow eye were examined (KC/FFK group; mean age 24.62 ± 8.6 years; 16 males and 5 females). The control group consisted of 62 eyes in 31 unaffected subjects (mean age 26.26 ± 3.64 years; 15 males and 16 females). The bIOP was determined using a Scheimpflug-based tonometer (Corvis Scheimpflug Technology [Corvis ST®]) after measuring the IOP with a conventional non-contact tonometer (NIOP). The agreement between NIOP and bIOP values was examined using the Bland-Altman plot. The difference between NIOP and bIOP (bIOP correction amount) was compared between keratoconus and FFK eyes.

RESULTS

In the control group, there were no significant differences between right and left eyes in both NIOP and bIOP values (p = 0.975 and p = 0.224, respectively). In the KC/FFK group, NIOP values were significantly lower in the keratoconus eyes (9.93 ± 1.96 mm Hg) than in the FFK eyes (12.23 ± 3.03 mm Hg; p = 0.0003). There was no significant difference in bIOP values between the right and left eyes of the KC/FFK group (p = 0.168). The bIOP correction amount was significantly increased in keratoconus eyes (3.58 ± 2.12 mm Hg) compared to in FFK eyes (1.80 ± 3.32 mm Hg; p = 0.011).

CONCLUSIONS

For eyes with keratoconus and FFK, the bIOP method is effective to adjust IOP measurements based on corneal biomechanical properties.

Abstract P6-02-09: Diagnostic performance of dedicated breast PET for the prediction of pathological response after neoadjuvant chemotherapy

Background: Neoadjuvant chemotherapy (NAC) is a standard treatment for operable breast cancer. However, imaging methods for evaluating treatment response have not been established. Previous studies reported that ring-type dedicated breast positron emission tomography (DbPET) detected residual tumors following NAC more accurately than whole-body PET/CT. This study assessed DbPET parameters for predicting pathological complete response (pCR) in patients with breast cancer.

Patients and Methods: Among patients with breast cancer who underwent surgery after NAC, 61 were examined using ring-type DbPET before and after NAC. The maximum standardized uptake values (SUVmax) and tumor-to-normal-tissue ratio (TNR) were calculated before and after NAC (pre-SUVmax, pre-TNR, post-SUVmax and post-TNR, respectively). Moreover, the reduction rates (ΔSUVmax and ΔTNR) were determined. pCR was defined as complete remission of breast cancer.

Results: The median patient age was 52 years. Forty patients (65.6%) were estrogen receptor (ER)-positive, whereas 25 patients (41.0%) were HER2-positive. Fifteen patients (24.6%) achieved pCR after NAC. The calculated values for the parameters of DbPET are summarized in Table 1. The most promising parameters for predicting pCR were ΔSUVmax (area under the curve [AUC]: 0.506) and post-TNR (AUC: 0.640). Although neither of these two parameters reflected the pathological response to NAC in patients with ER-positive disease, post-TNR showed the highest AUC (i.e., AUC: 0.750) for pCR in patients with ER-negative disease. The sensitivity and specificity of post-TNR in the ER-positive group were 85.7% and 39.4%, respectively. In the ER-negative group, these values were 100% and 58.3%, respectively [Table 2]

Table 1.Diagnostic performance of dedicated breast positron-emission tomography for the prediction of pathological complete response after neoadjuvant chemotherapyParameterspCR Median (IQR)Non-pCR Median (IQR)PAUC (95% CI)Pre-SUVmax14.8 (9.2–17.7)14.4 (10.7–19.8)0.6040.454 (0.285–0.624)Post-SUVmax1.8(1.5–2.1)2.0 (1.6–3.4)0.2370.603 (0.460–0.746)ΔSUVmax (%)87.32 (81.5–91.8)88.6(82.8–91.8)0.9540.506 (0.329–0.682)Pre-TNR8.0 (5.3–9.2)7.3(5.9–10.2)0.7570.472 (0.297–0.647)Post-TNR1.7(1.0–1.1)1.2 (1.0–2.4)0.0980.640 (0.506–0.774)ΔTNR (%)87.3 (78.3–89.1)79.8 (62.7–86.7)0.1130.638 (0.472–0.803)pCR, pathological complete response; IQR, interquartile range; AUC, area under the curve; CI, confidence interval, SUV, standardized uptake value; TNR, tumor-to-normal-tissue ratio.Table 2.Diagnostic accuracy of post-TNR according to estrogen receptor status Sensitivity (%)Specificity (%)Accuracy (%)PPV (%)NPV (%)ER-positive85.739.447.523.192.9ER-negative10058.375.061.5100TNR, tumor-to-normal-tissue ratio; ER, estrogen receptor; PPV, positive predictive value; NPV, negative predictive value

Conclusion: In DbPET, ΔSUVmax and post-TNR were shown to be promising parameters for predicting pathological response to NAC. Post-TNR provided the highest sensitivity for predicting pCR in patients with ER-negative breast cancer.

Citation Format: Suzuki E, Sasada S, Sueoka S, Masumoto N, Goda N, Kajitani K, Emi A, Haruta R, Kadoya T, Kataoka T, Okada M. Diagnostic performance of dedicated breast PET for the prediction of pathological response after neoadjuvant chemotherapy [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-02-09.

The effects of high glucose condition on rat tenocytes in vitro and rat Achilles tendon in vivo

Objectives

The aim of this study was to investigate the effect of hyperglycaemia on oxidative stress markers and inflammatory and matrix gene expression within tendons of normal and diabetic rats and to give insights into the processes involved in tendinopathy.

Methods

Using tenocytes from normal Sprague-Dawley rats, cultured both in control and high glucose conditions, reactive oxygen species (ROS) production, cell proliferation, messenger RNA (mRNA) expression of NADPH oxidase (NOX) 1 and 4, interleukin-6 (IL-6), matrix metalloproteinase (MMP)-2, tissue inhibitors of matrix metalloproteinase (TIMP)-1 and -2 and type I and III collagens were determined after 48 and 72 hours in vitro. In an in vivo study, using diabetic rats and controls, NOX1 and 4 expressions in Achilles tendon were also determined.

Results

In tenocyte cultures grown under high glucose conditions, gene expressions of NOX1, MMP-2, TIMP-1 and -2 after 48 and 72 hours, NOX4 after 48 hours and IL-6, type III collagen and TIMP-2 after 72 hours were significantly higher than those in control cultures grown under control glucose conditions. Type I collagen expression was significantly lower after 72 hours. ROS accumulation was significantly higher after 48 hours, and cell proliferation after 48 and 72 hours was significantly lower in high glucose than in control glucose conditions. In the diabetic rat model, NOX1 expression within the Achilles tendon was also significantly increased.

Conclusion

This study suggests that high glucose conditions upregulate the expression of mRNA for NOX1 and IL-6 and the production of ROS. Moreover, high glucose conditions induce an abnormal tendon matrix expression pattern of type I collagen and a decrease in the proliferation of rat tenocytes.

Cite this article: Y. Ueda, A. Inui, Y. Mifune, R. Sakata, T. Muto, Y. Harada, F. Takase, T. Kataoka, T. Kokubu, R. Kuroda. The effects of high glucose condition on rat tenocytes in vitro and rat Achilles tendon in vivo. Bone Joint Res 2018;7:362–372. DOI: 10.1302/2046-3758.75.BJR-2017-0126.R2

Control-matched comparison of refractive and visual outcomes between small incision lenticule extraction and femtosecond laser-assisted LASIK

Purpose

This retrospective case-matched study aimed to compare visual and refractive outcomes between small incision lenticule extraction (SMILE) and LASIK.

Patients and methods

Patients who underwent SMILE (34 eyes of 23 patients) or LASIK (34 eyes of 24 patients) were enrolled and matched according to preoperative manifest refractive spherical equivalents. The mean preoperative manifest refractive spherical equivalent was −4.69±0.6 and −4.67±0.64 D in the SMILE and LASIK groups, respectively. The safety, efficacy, and predictability were compared 3 months after surgery. Changes in corneal refractive power from the center to peripheral points and their maintenance ratios were analyzed and compared between the two groups.

Results

In the SMILE and LASIK groups, 82.4% and 85.3% of patients, respectively, achieved 20/13 or better uncorrected distance visual acuity (p=1.00). There were no eyes that lost two or more lines of corrected distance visual acuity in either group. The maintenance ratios of corneal refractive power changes at the peripheral points in the SMILE group were significantly higher than those in the LASIK group (p<0.05).

Conclusion

Both groups achieved similar high efficacy and safety. SMILE surgery resulted in higher refractive power correction in the peripheral cornea than LASIK surgery.

Image Quality of the Coronary Angiography with Noise Reduction Technology to Decrease the Radiation Dose

We examined the effects of a reduced exposure dose on the quality of images from an angiography device augmented with a noise reduction algorithm. Before its clinical application, we compared the diameter of the discrimination limit of the hole with that in the conventional method by a visual evaluation with a contrast-detail (C-D) phantom imaged using the target dose. Based on the results, a reducible dose was determined and applied clinically. The sample population consisted of patients being followed up after percutaneous coronary intervention (PCI) for coronary artery disease; we evaluated the effects of the exposure reduction on image quality. A significant dose reduction was observed by the noise-reduction method compared to the conventional method; the radiation dose to the flat panel detector (FPD) could be reduced to 70 nGy per frame. Clinically, a dose reduction of approx. 40% was obtained while maintaining image quality almost equal to that of the conventional method.

Abstract P5-02-03: Evaluation of pathological malignancy grade and neoplastic progress of breast cancer using dedicated breast positron emission tomography

Background: Dedicated breast positron emission tomography (DbPET)provides detailed high resolution images of the breast and enables quantitative assessment using standard uptake values (SUVs). We aimed to determine whether DbPET can predict the pathological malignancy grade and neoplastic progress of breast cancer compared with whole body (WB) PET.

Methods: We investigated 196 consecutive patients with invasive breast cancerwho underwent concurrent Db- and WB-PET from January 2016 to March 2017. All Db- and WB-PET were quantified based on SUVs. We also investigated pathological features of breast cancer who had a ring-like uptake (RU) without central FDG accumulation on DbPET.

Results:

The associations between the SUVs for DB- and WB-PET and the pathological factors in breast cancerCharacteristicSUV WBPETDbPET Mean ± SDpMean ± SDpall3.6 ± 3.4 9.4±7.9 Tumor size    ≤2.0 cm2.2±1.6&lt;0.0016.5±5.2&lt;0.001&gt;2.0 cm5.5±4.1 13.3±9.2 LN    Negative3.1±3.3&lt;0.0018.4±7.8&lt;0.001Positive4.9±3.2 11.8±7.7 NG    1 or 22.4±2.1&lt;0.0016.6±5.9&lt;0.00135.1±4.0 12.7±8.7 Ki67    &lt; 201.8±1.1&lt;0.0015.2±3.3&lt;0.001≥ 204.4±3.7 11.4±8.6 ER    positive3.4±3.30.028.8±7.60.006negative5.2±3.6 13.5±8.6 HER-2    positive4.6±3.10.0911.8±7.60.04negative3.4±3.4 9.0±7.9 Sub type vs Lumnal A vs Lumnal ALuminal A1.8±1.1 5.2±3.3 Luminal B4.0±3.8&lt;0.00110.1±8.5&lt;0.001HER24.6±3.1&lt;0.00111.8±7.6&lt;0.001Triple negative5.3±3.8&lt;0.00113.8±9.2&lt;0.001

summarizes the association between SUVs for Db- and WB-PET and pathological factors inbreast cancer.SUVs on PET were significantly higher for the tumor size of &gt;2.0 cm than for tumor size ≤2.0 cm (p&lt;0.001), for LN-positive than for LN-negative (p&lt;0.001), for NG3 than for NG1-NG2 (p&lt;0.001), for higher Ki67 expression than for lower Ki67 expression (p&lt;0.001), and for ER-negative than for ER-positive (WBPET, p=0.02; DbPET, p=0.006). SUVs were significantly lower for Luminal A than for Luminal B, HER2, and triple-negative cancer (p&lt;0.001 for all three).SUVs for DbPET was significantly higher for HER2-positive than for HER2-negative (p=0.02).

The association between SUVs for breast cancer with and without RU on DbPETCharacteristicRU(-), nRU(+), npall17323 Tumor size   ≤2.0 cm1095&lt;0.001&gt;2.0 cm6418 LN   Negative1299&lt;0.001Positive4414 NG   1 or 210070.0237316 Ki67   &lt; 206130.03≥ 2011220 ER   positive152190.49negative214 HER-2   positive2620.38negative14721 Sub type  vs Lumnal ALuminal A493 Luminal B84150.02HER22620.81Triple negative1430.04

summarizes the association between SUVs for breast cancer with and without RU on DbPET. SUVs for breast cancer with RU on DbPET were significantly higher for the tumor size of &gt;2.0 cm than for tumor size ≤2.0 cm, for LN -positive than for LN-negative (p&lt;0.001), for NG3 than for NG1-2 (p=0.02), and for higher Ki67 expression than for lowerKi67 expression (p=0.03). SUVs were significantly lower for Luminal A than for Luminal B (p=0.02) and triple-negative cancer (p=0.04).

Conclusions: SUVs for DbPET were equal or superiorto WBPET in predicting the pathological malignancy grade and neoplastic progress in tumors. Furthermore, the presence of RU on DbPET can provide excellent predictive value for high-grade malignancy and might help to determine appropriate therapeutic strategies.

Citation Format: Masumoto N, Kadoya T, Nishina M, Kimura Y, Suzuki E, Sueoka S, Goda N, Sasada S, Kajitani K, Emi A, Haruta R, Kataoka T, Okada M. Evaluation of pathological malignancy grade and neoplastic progress of breast cancer using dedicated breast positron emission tomography [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 P5-02-03.

Abstract P6-03-08: Detection ability of dedicated breast positron emission tomography for small-sized breast cancer

Background: Whole body (WB) 18F-fluorodeoxyglucose positron emission tomography (PET) has a relatively poor spatial resolution (&gt;1 cm), which limits the capability to detect small lesions. Therefore, small-sized breast cancers (≤1 cm) may not be visible on WBPET. To overcome these limitations, dedicated breast PET (DbPET) has been developed to improve spatial resolution. DbPET enables detailed high-resolution images within the breast. We aimed to determine whether DbPET can detect small-sized breast cancer compared to WBPET.

Methods: We investigated 203 consecutive patients (217 tumors) (T1–3, N0–3a, M0) with breast cancer who underwent concurrent DbPET and WBPET between January 2016 and March 2017. All DbPET and WBPET images were semi-quantified based on standard uptake values. The diagnostic performance of each scanner was assessed in DbPET and WBPET. Tumors were classified based on pathological classification as follows: Tis, ductal carcinoma in situ (DCIS); T1a, ≤0.5 cm; T1b, 0.5–1 cm; and T1c, 1–2 cm; T2, 2–5 cm; T3, &gt;5 cm. The sensitivities of DbPET and WBPET were compared in each size group.

Results: Table 1 shows the detection rate of breast cancer in WBPET and DbPET

The detection rate of breast cancer in WB- and Db-PET DbPETWBPETpTumor sizeDetection (-) n(%)Detection (+) n(%)Detection (-) n(%)Detection (+) n(%) Tis6(14.6)35(85.4)18(43.9)23(56.1)0.0030T1a2(8)23(92)7(28)18(72)0.0594T1b2(6.5)29(93.5)10(32.3)21(67.7)0.0077T1c5(8.2)56(91.8)11(18)50(82)0.1038T20(0)57(100)1(1.8)56(98.2)0.2375T30(0)2(100)0(0)2(100)-total15(6.9)202(93.1)47(21.7)170(78.3)&lt;0.0001

. The overall detection rate in DBPET [93.1% (202/217)] was significantly higher than that of WBPET [78.3% (170/217)] (P &lt; 0.001). For smaller tumors, DbPET was more sensitive than WBPET: Tis (85.4% vs. 56.1%), T1a (92% vs. 72%), T1b (93.5% vs. 67.7%), T1c (91.8% vs. 82%), T2 (100% vs. 98.2%), and T3 (100% vs. 100%). The sensitivity of DbPET was significantly higher than that of WBPET in Tis (P = 0.003) and T1b (P = 0.008) and tended to be higher than that of WBPET in T1a (P = 0.059). Conversely, no significant differences were observed in T1c (P = 0.103) and T2 (P = 0.238).

Conclusion: The imaging sensitivity of DbPET was higher than that of WBPET. DbPET showed significant sensitivity in DCIS and tumors ≤1 cm, which is a weak point for WBPET. DbPET may serve as a new diagnostic modality to detect small-sized breast cancer.

Citation Format: Sueoka S, Masumoto N, Nishina M, Kimura Y, Suzuki E, Goda N, Sasada S, Kajitani K, Emi A, Haruta R, Kadoya T, Kataoka T, Okada M. Detection ability of dedicated breast positron emission tomography for small-sized breast cancer [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 P6-03-08.

Analysis of Progressive Ophthalmic Lesion in a Patient with Subacute Sclerosing Panencephalitis

Purpose

To evaluate the progressive lesions affecting the visual system in a patient with subacute sclerosing panencephalitis (SSPE).

Methods

The authors observed a 15-year-old boy with SSPE. Since the diagnosis was made before the appearance of ocular manifestations, the authors recorded the progressive ocular lesions using various ophthalmic examinations.

Results

The patient showed no ophthalmic abnormalities until he developed a left homonymous hemianopia with sudden bilateral disturbed visual acuity. Severe progressive macular lesions including a pigment epithelial window defect by fluorescein angiography, a marked decrease in foveal thickness by optical coherence tomography, and an extensive disorder mainly specific to cone cells in the central retina by electroretinography were demonstrated. Novel findings such as a transient relative afferent pupillary defect and an anterior uveitis were also observed.

Conclusions

Analyses over a long period of time showed progressive ophthalmic findings in a patient with SSPE.

Radon inhalation induces manganese-superoxide dismutase in mouse brain via nuclear factor-κB activation

Although radon inhalation increases superoxide dismutase (SOD) activities in mouse organs, the mechanisms and pathways have not yet been fully clarified. The aim of this study was to determine the details of SOD activation in mouse brain tissue following the inhalation of radon at concentrations of 500 or 2000 Bq/m3 for 24 h. After inhalation, brains were removed quickly for analysis. Radon inhalation increased the manganese (Mn)-SOD level and mitochondrial SOD activity. However, the differences were not significant. There were no changes in the Cu/Zn-SOD level or cytosolic SOD activity. Radon inhalation increased the brain nuclear factor (NF)-κB content, which regulates the induction of Mn-SOD, in the nuclear and cytosolic compartments. The level of inhibitor of nuclear factor κB kinase subunit β (IKK-β), which activates NF-κB, was slightly increased by radon inhalation. The expression of cytoplasmic ataxia-telangiectasia mutated kinase in mice inhaling radon at 500 Bq/m3 was 50% higher than in control mice. In addition, NF-κB-inducing kinase was slightly increased after inhaling radon at 2000 Bq/m3. These findings suggest that radon inhalation might induce Mn-SOD protein via NF-κB activation that occurs in response to DNA damage and oxidative stress.