Long-Term Outcomes after Switching to Tenofovir Alafenamide in Patients with Chronic Hepatitis B

We sought to determine the long-term outcomes of chronic hepatitis B (CHB) cases switching to tenofovir alafenamide (TAF, n = 104, median age = 63.5 years). Data at switching to TAF (baseline) and those at 1, 2, 3, 4, and 5 years from switching to TAF were compared. At baseline, HB envelop antigen (HBeAg) seropositivity was found in 20 patients (19.2%), and undetectable HBV-DNA in 77 patients (74.0%). Percentage of detectable HBV-DNA significantly reduced at any time point. HB surface antigen (HBsAg) levels significantly reduced at 3, 4, and 5 years. The percentage of HBeAg seropositivity significantly reduced at 5 years. HB core related antigen levels did not significantly change. In patients with baseline HbeAg seropositivity, HbsAg levels significantly reduced at any time point, and a similar trend was found in patients without HBeAg seropositivity. In patients with baseline FIB4 index >1.85, HBsAg levels significantly reduced at 3, 4, and 5 years, and in patients with baseline FIB4 index <1.85, HBsAg levels significantly reduced at any time point. The estimated glomerular filtration rate significantly reduced only at 5 years. The discontinuation rate owing to the side effects of TAF was 0%. In conclusion, switching to TAF therapy in patients with CHB may be effective and safe at least up to 5 years.

Prognostic Nutritional Index Correlates with Liver Function and Prognosis in Chronic Liver Disease Patients

The Prognostic Nutritional Index (PNI) is widely recognized as a screening tool for nutrition. We retrospectively examined the impact of PNI in patients with chronic liver disease (CLD, n = 319, median age = 71 years, 153 hepatocellular carcinoma (HCC) patients) as an observational study. Factors associated with PNI < 40 were also examined. The PNI correlated well with the albumin-bilirubin (ALBI) score and ALBI grade. The 1-year cumulative overall survival rates in patients with PNI ≥ 40 (n = 225) and PNI < 40 (n = 94) were 93.2% and 65.5%, respectively (p < 0.0001). In patients with (p < 0.0001) and without (p < 0.0001) HCC, similar tendencies were found. In the multivariate analysis, hemoglobin (p = 0.00178), the presence of HCC (p = 0.0426), and ALBI score (p < 0.0001) were independent factors linked to PNI < 40. Receiver operating characteristic (ROC) curve analysis based on survival for the PNI yielded an area under the ROC curve of 0.79, with sensitivity of 0.80, specificity of 0.70, and an optimal cutoff point of 42.35. In conclusion, PNI can be a predictor of nutritional status in CLD patients. A PNI of <40 can be useful in predicting the prognosis of patients with CLD.

Association between the Suita Score and Body Composition in Japanese Adults: A Large Cross-Sectional Study

The purpose of this study was to clarify the relationship between the Suita score (a prediction model for the development of cardiovascular disease) and body composition in Japanese health check-up subjects (6873 men and 8685 women). The Suita score includes 8 items (age, gender, smoking, diabetes, blood pressure, low-density lipoprotein, high-density lipoprotein, and chronic kidney disease). Factors associated with the Suita score within body composition-related parameters (body mass index (BMI), waist circumference (WC), fat mass index, fat-free mass index, fat mass to fat-free mass ratio (F-FF ratio), and water mass index) as assessed by bioelectrical impedance analysis were examined. The mean age of subjects was 54.8 years in men and 52.8 years in women (p < 0.0001). The mean BMI was 23.9 kg/m2 in men and 21.8 kg/m2 in women (p < 0.0001). Diabetes mellitus was found in 1282 subjects (18.7%) among men and 816 subjects (9.4%) among women (p < 0.0001). The mean Suita score was 42.0 in men and 29.6 in women (p < 0.0001). In multivariate analysis, WC (p < 0.0001), F-FF ratio (p < 0.0001), and water mass index (p < 0.0001) were independent factors linked to the Suita score for both genders. In conclusion, body composition can be associated with the Suita score in Japanese adults receiving health check-ups.

Insulin Resistance: A Marker for Fat-to-Lean Body Composition in Japanese Adults

We sought to investigate the relationship between insulin resistance (IR) and body composition as assessed by bioelectrical impedance analysis in Japanese health check-up recipients (1186 men and 1441 women). IR was defined as a Homeostasis Model Assessment of IR (HOMA-IR) ≥ 2.5. In body-composition-related parameters, the fat mass index (F index) was defined as fat mass divided by the height squared (kg/m2). The fat-free mass index (FF index) was defined as fat-free mass divided by the height squared (kg/m2). The F index to FF index ratio (F-FF ratio) was defined as the F index divided by the FF index. Factors related to HOMA-IR were examined. The median HOMA-IR was 1.54 in men and 1.30 in women (p < 0.0001). The median F index was 4.9 kg/m2 in men and 6.1 kg/m2 in women (p < 0.0001). The median FF index was 18.2 kg/m2 in men and 15.1 kg/m2 in women (p < 0.0001). The median F-FF ratio was 0.272 in men and 0.405 in women (p < 0.0001). The F-FF ratio was an independent factor associated with HOMA-IR in the multivariate analysis in both genders, while the F index and FF index were not in both genders. In conclusion, fat and skeletal muscle balance can be controlled by IR in Japanese adults.

Body Composition Analysis in Patients with Metabolic Dysfunction-Associated Fatty Liver Disease

We sought to examine body composition using bioimpedance analysis in patients with metabolic dysfunction-associated fatty liver disease (MAFLD, 2014 males and 949 females). Factors linked to the fat-free mass index (FF index) were examined using univariate and multivariate analysis. An FF index < 18 kg/m2 in males and an FF index < 15 kg/m2 in females were defined as having decreased skeletal muscle mass. The median age and body mass index (BMI) were 55 years and 25.4 kg/m2 in males, and 57 years and 25.4 kg/m2 in females, respectively. The FF index strongly correlated with muscle mass index both in males (r = 0.999) and females (r = 0.999). The prevalence of patients with an FF index < 18 kg/m2 in males and an FF index < 15 kg/m2 in females was well stratified according to age, BMI, severity of FL, and FIB4 index. In the males, in the multivariate analysis, BMI (p < 0.0001), fat mass index (p < 0.0001), and waist circumference (p = 0.0050) were found to be significant factors linked to FF index. In the females, in the multivariate analysis, BMI (p < 0.0001) and fat mass index (p < 0.0001) were found to be significant. In conclusion, fat accumulation as reflected by BMI, which is an easily available marker, could be a useful indicator for the skeletal muscle mass in MAFLD.

Accurate SARC-F Score in Patients with Liver Disease

SARC-F is a well-accepted screening tool for sarcopenia. A SARC-F value of 1 point is reported to be more discriminating in identifying sarcopenia than 4 points (recommended cutoff point). The prognostic impact of the SARC-F score was investigated in patients with liver disease (LD, n = 269, median age = 71 years, 96 hepatocellular carcinoma (HCC) cases). Factors associated with SARC-F ≥ 4 points and SARC-F ≥ 1 point were also examined. In the multivariate analysis, age (p = 0.048), and Geriatric Nutritional Risk Index (GNRI) score (p = 0.0365) were significant factors linked to SARC-F ≥ 1 point. In our patients with LD, the SARC-F score is well correlated with the GNRI score. The 1-year cumulative overall survival ratio in patients with SARC-F ≥ 1 (n = 159) and SARC-F 0 (n = 110) was 78.3% and 90.1% (p = 0.0181). After excluding 96 HCC cases, similar tendencies were found (p = 0.0289). In the receiver operating curve (ROC) analysis based on the prognosis for the SARC-F score, the area under the ROC was 0.60. The sensitivity was 0.57, the specificity was 0.62, and the optimal cutoff point of the SARC-F score was 1. In conclusion, sarcopenia in LDs can be affected by nutritional conditions. A SARC-F score of ≥1 is more useful than a score of 4 in predicting the prognosis of patients with LD.

Effect of Seat Angle when Sleeping in a Car on Quality of Sleep and Its Impact on Calculation Performance the Following Day

The number of occasions to stay in a car overnight is increasing during disasters; however, the effects on sleep and the impact on daytime functioning are not well understood. We investigated the effect of seat angle when sleeping in a car and its impact on calculation performance the following day. Fifteen healthy males participated in three trials (sleeping in a car with the front seat angled at 45° and 60° in a laboratory and sleeping at home); sleep and calculation performance the following day were compared. Increased wake after sleep onset and decreased slow-wave sleep were observed in the 60° trial, that is, near-vertical, compared with the others. Subjective sleep quality and calculation performance in the 45° and 60° trials were poorer than those in the home trial. The effect of seat angle on sleep was confirmed objectively, but not subjectively, suggesting that a large seat angle might cause sleep impairment.

Usefulness and accuracy of segmental adrenal venous sampling on localisation and functional diagnosis of various adrenal lesions in primary aldosteronism

AIM

To clarify the usefulness and accuracy of segmental adrenal venous sampling (sAVS) on localisation and functional diagnosis of various adrenal lesions in primary aldosteronism.

MATERIALS AND METHODS

Consecutive patients (n=162) who underwent adrenalectomy and 138 patients indicated for medication following sAVS were analysed retrospectively. Based on immunohistopathological diagnosis, the positive predictive value (PPV) of computed tomography (CT)-detectable aldosterone-producing adenoma (APA) was calculated. Moreover, endocrinological and sAVS characteristics were analysed quantitatively and qualitatively among APA, CT-undetectable aldosterone-producing nodules (APNs), multiple aldosterone-producing micronodules (MAPM), and medication groups.

RESULTS

The PPV of APA by sAVS was 137/141 (97.1%; 95% confidence interval, 92.9-99.2%). Compared to the medication cases, the APA group showed stronger disease activity clinically and significant differences in adrenal hormones, such as a higher aldosterone level and aldosterone-to-cortisol ratio, and lower cortisol levels in the adrenal central vein and aldosterone maximum tributaries on the dominant side after cosyntropin stimulation. The APA group shows focal aldosterone hypersecretion, such as mean number of aldosterone elevated segments (1.7 ± 0.7 versus 2 ± 0.9, p=0.003) and presence of aldosterone-not-elevated segments (93% versus 41%, p<0.001). Clinically and in terms of sAVS, APN and MAPM showed similar characteristics to APA and to the medication cases, respectively.

CONCLUSION

sAVS can localise functionally active tissues of CT-detectable and CT-undetectable lesions enabling decisions on surgical or medical treatment.

Effect of an Electronic Alert System on Hepatitis B Virus Reactivation in Patients Receiving Immunosuppressive Drug Therapy

Hepatitis B virus (HBV) reactivation (HBVr) can occur in patients receiving immunosuppressive drug therapies, causing significant morbidity and mortality. Although the guidelines for HBVr have been proposed by several academic societies, some providers do not follow them, resulting in HBVr and death. As HBV-DNA levels increase before liver enzyme levels do, we previously constructed an electronic alert system that recommends the measurement of HBV-DNA. Here, we investigated whether this alert system improves the HBV-DNA measurement rate and elicits responses according to guidelines. A total of 5329 patients were divided into two groups, before and after the introduction of the alert system, and the HBV-DNA measurement rates in both groups were compared. Because of the introduction of the alert system, the HBV-DNA measurement rate among HBsAg-negative patients with anti-HBs and/or anti-HBc before immunosuppressive drug therapy improved significantly. The HBV-DNA monitoring rate within 3 months also improved significantly (p = 0.0034) in HBV-remission phase patients. HBVr was detected immediately, and the affected patients were treated with nucleotide analogs before severe hepatitis onset. The introduction of the alert system for HBVr improved the HBV-DNA measurement rates in patients receiving immunosuppressive drug therapy, leading to the rapid treatment of patients with HBVr.

Providing mammography in workplaces improved screening rates: cluster randomized controlled trial

Background

Despite sufficient evidence on the importance of breast cancer screening, the screening rate has remained less than 50% in Japan. To promote behavioral change of individuals, it is important to reduce barriers to taking screening. The purpose of this study was to examine the effect of an environmental approach providing opportunities for mammography (MMG) in workplaces.

Methods

Female employees aged 40 years or older were eligible. Supermarket stores were randomly assigned into two groups, the intervention arm (leaflet and MMG) and the control arm (leaflet). From May to July 2018, participants in the intervention arm were given a leaflet informing the subsidies for breast cancer screening and were provided the opportunity to have MMG in their workplace. Participants in the control group were given the same leaflet, but they had to take the screening outside the workplace as usual. The primary outcome was the breast cancer screening rate in 2018, evaluated using self-administered questionnaires. The odds ratio (OR) and 95% confidence intervals (CIs) for the screening rate in the intervention arm compared with the control arm was estimated using multilevel logistic regression.

Results

We analyzed 1624 participants (mean age was 53 years) from 25 supermarket stores (intervention: 578 patients in 8 stores, control: 1046 patients in 17 stores). The screening rate in the intervention arm was 312 (54%) and was 125 (12%) in the control arm. The OR (and 95% CIs) was 7.81 (5.03-12.12) in the final model adjusted store level effects (i.e., stores and screening rate in 2017 at each store) and individual age and current smoking.

Conclusions

In a worksite-based cluster-randomized controlled trial conducted in a Japanese population, an environmental approach providing MMG opportunities in workplaces significantly increased the self-reported breast cancer screening rate within one year. (UMIN000030465)

Key messages

Providing the opportunity of mammography in Japanese supermarket stores improved the breast cancer screening rate. An environmental approach reducing barriers to screening may be more effective than conventional approaches in improving breast cancer screening rate.

Classification of the colonic splenic flexure based on three-dimensional CT analysis

Background

Mobilization of the splenic flexure can be a challenging surgical step in colorectal surgery. This study aimed to classify the splenic flexure based on the three-dimensional (3D) coordinates of the splenic hilum and left renal hilum. This classification was used to compare splenic flexure mobilization during colorectal resection.

Methods

CT images of patients with colorectal cancer treated between April 2018 and December 2019 were analysed retrospectively. 3D mutual positioning of the splenic flexure from the ligament of Treitz to the splenic hilum or the left renal hilum was used to classify patients into three groups using cluster analysis. The difference in the procedure time between groups was also analysed in a subset of patients undergoing laparoscopic colectomy with complete splenic flexure mobilization.

Results

Of 515 patients reviewed, 319 with colorectal cancers were included in the study and categorized based on the 3D coordinates of the splenic hilum and left renal hilum as caudal (100 patients), cranial (118) and lateral (101) positions. Male sex (P < 0.001), older age (P = 0.004) and increased bodyweight (P = 0.043) were independent characteristics of the lateral group in multiple logistic regression analysis. Thirty-four patients underwent complete splenic flexure mobilization during the study period; this took significantly longer (mean 78.7 min) in the lateral group than in the caudal and cranial groups (41.8 and 43.2 min respectively; P = 0.006).

Conclusion

Locating the splenic flexure using 3D coordinates could be helpful in predicting a longer duration for mobilization of the splenic flexure.

Utility of computed tomography and 18 F-fluorodeoxyglucose with positron emission tomography/computed tomography for distinguishing appendiceal mucocele caused by mucinous adenocarcinoma from other pathologies

AIM

Differentiating appendiceal mucocele with mucinous adenocarcinoma from other pathologies before surgery is difficult. The objective of this study was to evaluate the utility of CT and ¹⁸ F-fluorodeoxyglucose (FDG) with positron emission tomography (PET)/CT for differentiating mucinous adenocarcinoma of appendiceal mucocele from other pathologies.

METHOD

The study included 25 patients who underwent surgery for clinically diagnosed appendiceal mucoceles detected on CT at the University of Tokyo Hospital. Among these patients, 19 underwent FDG-PET/CT preoperatively. We compared features of the CT imaging findings and maximum standard uptake values (SUV_max ) detected by FDG-PET/CT between mucocele with mucinous adenocarcinoma and other pathologies.

RESULTS

A total of 13 men (52%) and 12 women (48%) were included in this study, with a median age of 65 years (range 34-83). There were six patients (24%) with pathologically confirmed mucinous adenocarcinoma, 15 patients (60%) with appendiceal mucinous neoplasm and four patients (16%) with simple mucocele caused by chronic inflammation. On the CT findings, wall irregularity was the only significant feature for the two groups in this study (83.3% vs 0.0%, P < 0.01). There was a significant difference in the SUV_max levels on PET/CT between the two groups (100.0% vs 20.0%, P < 0.01).

CONCLUSION

Distinguishing between mucocele with mucinous adenocarcinoma and other pathologies using imaging modalities is challenging. Our results suggest that wall irregularity on CT and elevated SUV_max on PET/CT are useful factors that can be employed for such discrimination.

Effective reflection distance and its association with pressure augmentation index under a variety of acute hemodynamic perturbation

 

Effective reflection distance (ERD), a conceptual distance to a major reflection site from the aortic root, is associated with aging and pressure augmentation index (AIx) in clinical population. However, it is poorly understood how ERD varies and associates with AIx within a subject when the hemodynamic condition is changed extensively by acute pharmacological interventions.

Methods

In 13 anesthetized dogs, we measured aortic pressure (AP) and flow (AF) and femoral arterial flow (FF). Using AP, AF and FF, ERD based on an arterial model comprising a tube with frequency-dependent load (ERD_TL) was determined as a physiologically valid reference. ERD was also determined by wave separation (ERD_WSA) and pressure-only analyses (ERD_AW). Hemodynamic condition was changed by administrating zatebradine (bradycardic agent), nitroprusside, noradrenaline, dobutamine, and dextran.

Results

ERD_TL shortened significantly in response to infusion of nitroprusside or dobutamine. ERD_TL was significantly and negatively associated with AIx in multivariate analysis (Figure/Table). Changes in ERD_WSA or ERD_AW, and their association with AIx were not necessarily concordant with those observed in ERD_TL.

Conclusion

For the first time, we demonstrated that under diverse hemodynamic conditions, ERD_TL can change sensitively, and associates with AIx physiologically. This substantiates importance of tight attention to medication at clinical analysis of wave reflection phenomena. ERD_WSA or ERD_AW may not be a surrogate of ERD_TL.

Responses of ERD to drugs

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): Japan Society for the Promotion of Science (JSPS)

Pathological assessment of osimertinib-associated cardiotoxicity in EGFR-mutated non-small cell lung cancer patients

Background

Osimertinib, a third-generation epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI), inhibits both EGFR-TKI sensitizing mutations and resistant T790M mutations detected in non-small cell lung cancer (NSCLC) patients. Cardiac adverse events (AEs) induced by osimertinib are infrequent; however, cases of severe associated cardiac dysfunction have been reported and remain poorly understood.

Purpose

To assess pathogenesis of osimertinib-associated cardiac AEs, we analyzed myocardial specimens of three NSCLC cases with osimertinib-associated cardiac dysfunction.

Results

Analysis of LVEF prior to and after osimertinb administration in 36 NSCLC patients showed significant decrease of LVEF from 69% to 63%. Within this cohort, right ventricular (RV) biopsy was performed in 2 cases to further understand the pathophysiology of cardiac dysfunction. Case 1 was 78-year-old female with advanced NSCLC harboring an EGFR L858R mutation was treated with osimertinib as second line therapy. After 3 moths of osimetinib treatment, she presented with dyspnea, high NT-proBNP and troponin I, and significantly decreased left ventricular ejection fraction (LVEF) at 28%. RV biopsy showed moderate cardiomyocyte hypertrophy without inflammatory cell infiltration. Case 2 was 52-year-old female with advanced NSCLC harboring L858R mutation. She was treated with osimertinib as first line therapy. After 2 weeks of osimertinib, screening echocardiography revealed a reduction of LVEF from 63% to 41% without cardiac symptom. RV biopsy showed mild cardiomyocyte hypertrophy with infiltration of a few inflammatory cells in interstinum. We further analyzed death case of NSCLC. Case 3 was 63-year-old female with advanced NSCLC harboring EGFR ex. 19 del. and T790M mutations. After 6 months of osimertinib, she suffered from severe respiratory failure and severely reduced LVEF at 27%. She died on the 44th day after admission. Pathological autopsy revealed mild to moderate cardiomyocyte hypertrophy without inflammatory cell infiltration in both ventricles. These pathological findings may indicate neither myocyte injury nor myocarditis was induced by osimertinib in myocardium.

Conclusion

Although additional data collection of advanced NSCLC patients will be important in understanding the pathophysiology of cardiac AEs with osimertinib, osimertinib-associated cardiotoxicity may result from functional inhibition of myocyte contractility by osimertinib without induction of cell death or inflammation.

Funding Acknowledgement

Type of funding source: None

Donepezil markedly prevents the progression of chronic heart failure and renal dysfunction in renal artery stenosis-induced hypertensive rats

Introduction

Parasympathetic activation by donepezil has been shown to improve prognosis in chronic heart failure (CHF) rats following myocardial infarction. We examined whether donepezil is effective in the treatment of another CHF model complicated with renal artery stenosis (RAS)-induced hypertension.

Methods

RAS was created by ligating the left renal artery up to 50% in SD rats, at the same time, we implanted a blood pressure (BP) transmitter for confirming RAS-induced hypertension (7-week post-RAS: systolic BP = 154±7 mmHg; diastolic BP = 115±8 mmHg). In the 11th week after induction of RAS, surviving animals were randomly assigned to untreated (UT, n=10) or donepezil treated [DT, n=10, dissolved in drinking water (3mg/kg/day)] group. After a 6-week treatment, the effects of donepezil were evaluated by hemodynamics, blood levels of neurohumoral markers, and morphology.

Results

Compared with UT, DT significantly prevented the progression of the left kidney atrophy (2.38±0.13 vs. 1.51±0.34 g/kg, P&lt;0.05) and kidney fibrosis (left: −64%, P&lt;0.001; right: −55%, P&lt;0.01). DT also significantly prevented the progression of CHF, through suppressing cardiac hypertrophy (2.30±0.06 vs. 2.57±0.08 g/kg, P&lt;0.01), cardiac fibrosis (−70%, P&lt;0.01), and cardiac dysfunction [cardiac index: 102±3 vs. 86±3 ml/min/kg, P&lt;0.05; left ventricular (LV) end-diastolic pressure: 12±2 vs. 20±2 mmHg, P&lt;0.05; LV dp/dtmin: 5856±259 vs. 4924±227 mmHg/sec, P&lt;0.05]. DT not only decreased serum levels of creatinine (0.54±0.02 vs. 0.63±0.03 mg/dl, P&lt;0.05) and uric acid (1.4±0.2 vs. 1.9±0.2 mg/dl, P&lt;0.05); but also decreased plasma levels of norepinephrine (273±38 vs. 846±242, P&lt;0.01), AVP (2729±347 vs. 4783±695 pg/ml, P&lt;0.05), BNP (360±13 vs. 460±39 pg/ml, P&lt;0.05), angiotensin II and aldosteron, and suppressed the systemic inflammation.

Conclusions

Donepezil treatment markedly prevented the progression of CHF and renal dysfunction, and improved the neurohumoral markers in the CHF rat model complicated with RAS-induced hypertension, suggesting that donepezil may be used as a new pharmacotherapy for CHF patients complicated with RAS-induced hypertension.

Funding Acknowledgement

Type of funding source: None

A minimally-occlusive cuff method utilizing ultrasound vascular imaging for stress-free blood pressure measurement

Objective

Occlusive cuff inflation in ambulatory blood pressure (BP) monitoring disturbs the daily life of the user, and affects efficacy of monitoring. To overcome this limitation, we have developed a novel minimally-occlusive cuff method for stress-free measurement of BP. This study aimed to experimentally evaluate the reliability of this method, and improve the precision of this method by implementing a machine learning algorithm.

Methods

In this method, a thin-plate-type ultrasound probe (Size: 5.6mm-thickness × 28mm × 26mm; weight: 10g) is placed between the cuff and the skin, and used to measure the ultrasonic dimension of the artery (Figure 1). The cuff pressure (Pc), arterial dimension at systole (Ds) and diastole (Dd), systolic BP (SBP) and diastolic BP (DBP) during cuff inflation are theoretically related by the following equations,

SBP-Pc = P0·Exp[α·Ds]

DBP-Pc = P0·Exp[α·Dd]

Where P0 and α are constants, and α indicates arterial stiffness. Since multiple sets of the two equations can be defined over multiple cardiac beats while measuring Pc, Ds and Dd during mild cuff inflation (Pc is controlled less than 50 mmHg, Figure 1), it is possible to estimate SBP (SBPe) and DBP (DBPe) as solutions of the equations. In 6 anesthetized dogs, we attached the cuff and the probe to the right thigh to get SBPe and DBPe, which were one-time calibrated in each animal against reference SBP and DBP measured by using an intra-arterial catheter. We also determined the pulse arrival time (PAT), which is a commonly employed parameter in cuff-less BP monitoring. In all the dogs, BP was changed extensively by infusing noradrenaline or sodium nitroprusside.

Results

DBPe correlated tightly with DBP with a coefficient of determination (R2) of 0.85±0.08, and predicted DBP with error of 3.9±7.9 mmHg after one-time calibration (Figure 2). PAT correlated poorly with DBP (R2=0.49±0.17), and predicted DBP less accurately than this method. SBPe correlated well with SBP (R2=0.78±0.08) (Figure 3). However, even after one-time calibration, difference between SBPe and SBP was 2.6±18.9 mmHg, which was not acceptable. To improve the precision in SBP prediction, we used supervised machine learning approach with use of a support vector algorithm (Python, Scikit-learn), which regressed feature variables (SBPe, DBPe, Ds, Dd heart rate, and PAT) against teacher signal (reference SBP). The support vector algorithm, once trained, predicted SBP with acceptable accuracy with error of 0.7±6.9 mmHg (Figure 3).

Conclusions

This method reliably tracks BP changes without occlusive cuff inflation. Once calibrated, this method measures DBP accurately. With the aid of machine learning, precision in SBP prediction was greatly improved to an acceptable level. This method with machine learning approach has potential for stress-free BP measurement in ambulatory BP monitoring.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): Japan Society for the Promotion of Science

Liver dysfunction is associated with poor prognosis in patients after immune checkpoint inhibitor therapy

Immune-related adverse events (irAEs) are induced by immune checkpoint inhibitors (ICIs). Liver is one of the main target organs which irAEs occur and we investigated the influence of liver dysfunction on prognosis of patients after ICIs. From July 2014 to December 2018, 188 patients with diverse cancers who received ICIs (nivolumab or pembrolizumab) were enrolled. Twenty-nine patients experienced liver dysfunction of any grades after ICIs. Progression-free survival (PFS) was significantly shorter in the liver dysfunction-positive group than in the liver dysfunction-negative group, and a similar result was obtained for Overall survival (OS). Multiple logistic regression analysis revealed liver metastasis and alanine aminotransferase before ICIs were associated with a higher incidence of liver dysfunction after ICIs. Regardless of liver metastasis, PFS and OS were significantly shorter in the liver dysfunction-positive group. In conclusion, this study suggests liver dysfunction is associated with poor prognosis in patients after ICIs with diverse cancers.

Effects of preceding endoscopic treatment on laparoscopic surgery for early rectal cancer

AIM

Endoscopic treatment for rectal cancer, such as endoscopic mucosal resection and endoscopic submucosal dissection, causes inflammation, oedema and fibrosis in the surrounding tissue. However, little is known about the effect of these endoscopic therapies on salvage laparoscopic rectal surgery. The objective of this retrospective cohort study was to analyse the effect of preceding endoscopic treatment on the outcomes of laparoscopic surgery for rectal cancer.

METHOD

We analysed 53 patients who underwent laparoscopic surgery for rectal cancer with clinical Tis or T1 at our department between May 2011 and June 2019. Data from 30 patients who underwent laparoscopic surgery after preceding endoscopic treatment (Group E + S) were compared with those of 23 patients who underwent laparoscopic surgery alone (Group S).

RESULTS

There was no significant difference between the groups with respect to preoperative details. The mean operative time tended to be longer in Group E + S, and the volume of intra-operative blood loss was greater in Group E + S than in Group S (median 63 ml vs 10 ml, P = 0.049). There were no significant differences between the groups in other surgical parameters or oncological outcomes.

CONCLUSION

Laparoscopic surgery after endoscopic treatment for rectal cancer may be difficult due to an increased risk of intra-operative bleeding. Long-term prognosis after surgery was not affected by preceding endoscopic treatment in rectal cancer.

PD-L1+PD-L2+ monocytes from patients with hepatocellular carcinoma may be associated with a poor prognosis

The prognosis of patients with hepatocellular carcinoma (HCC) is poor. Anti–programmed death-1 (PD-1) antibodies (Abs) has been approved to treat HCC. Some PD-1 ligands (PD-L1 and PD-L2) negative tumors respond to anti–PD-1 Abs. This response may be caused by the expression of PD-1 ligands on non-tumor cells. PD-1 ligands were recently found to be expressed on monocytes (CD14+ cells) from diverse cancer patients. In this study, we investigate the expression of PD-1 ligands on CD14+ cells from HCC patients and the role of CD14+ cells in an antitumor response.

From October 2017 to June 2019, 67 patients with HCC were enrolled. The expression of PD-L1 and PD-L2 on CD14+ cells was analyzed by flow cytometry. Their prognosis was evaluated by overall survival (OS). Tumoricidal activities of both CD14+ and CD8+ cells were calculated by LDH release assay.

In the results, CD14+ cells from the patients expressed PD-L1 (4.5–95.5%) and PD-L2 (1.6–90.2%). We set cut-off values as the mean values of PD-L1 (50.2%) and PD-L2 (50.5%) expression. In addition, according to the cut-off value, we classified patients as those either with PD-L1+PD-L2+CD14+ cells or other types of CD14+ cells. The OS of patients with PD-L1+PD-L2+CD14+ cells was significantly shorter than that of patients with other types of CD14+ cells (p = 0.0145). The tumoricidal activity of CD8+ cells from patients with PD-L1+PD-L2+CD14+ cells was suppressed by co-cultivation with syngeneic CD14+ cells. Furthermore, anti–PD-1 Ab restored the tumoricidal activity of CD8+ cells.

In conclusions, some patients with HCC have PD-L1+PD-L2+CD14+ cells that suppress their antitumor response of CD8+ cells. These inhibitory functions of CD14+ cells may be associated with a poor prognosis in such patients.

Characterization of macrophages in the liver of total body irradiated mice

Two hepatic macrophage (MΦ) populations have been described in the inflamed liver: F4/80+CD11b+ cells and F4/80+CD68+ cells. In normal conditions, hepatic F4/80+CD11b+ cells are involved in host antibacterial resistance. However, these cells in total body irradiated mice (TBI mice) are unfunctional for the elimination of bacteria translocated from intestinal tracts. In this study, the properties of hepatic MΦ populations in TBI mice were characterized. Normal mice and mice 7 days after exposure to 4 Gy of X-rays were infected i.v. with 107 CFU/mouse of Enterococcus faecalis (E. faecalis). Three day after infection, F4/80+CD11b+ cells and F4/80+CD68+ cells isolated from the liver of these mice were cultured for 24 hrs, and culture fluids were assayed for IL-12, IL-10 and CCL1 by ELISA. NSG mice were inoculated i.v. with these MΦ preparations (2 × 105 cells/mouse), then infected i.v. with 5 × 104 CFU/mouse of E. faecalis. In the results, all TBI mice died within 2 weeks, while all normal mice survived. IL-12 was produced by F4/80+CD11b+ cells from normal mice, but not by both MΦ preparations from TBI mice. IL-10 was produced by F4/80+CD68+ cells from TBI mice (529.9 ± 272.6 pg/ml) and normal mice (445.8 ± 147.7 pg/ml). Large amounts of IL-10 (912.1 ± 103.7 pg/ml) was produced by F4/80+CD11b+ cells from TBI mice, and these cells produced CCL1 (327.5 ± 9.1 pg/ml), while other MΦ preparations did not. NSG mice inoculated with F4/80+CD11b+ cells from normal mice were resistant to infection; however, NSG mice inoculated with F4/80+CD11b+ cells from TBI mice did not. These results indicate hepatic F4/80+CD11b+ cells are polarized to M2bMΦ in response to total body irradiation, and these MΦ are involved in the decreased host antibacterial resistance in TBI mice.

Changes in the gut microbiota caused by ASBTi suppress intrahepatic steatosis and inflammation in a mouse model of non-alcoholic fatty liver disease (NAFLD)

Although the estimated prevalence of NAFLD is approximately 25%, an effective treatment has not been established. Recently, gut microbiota has been shown to affect the pathogenesis of NAFLD. In this study, the protective effect of Apical Sodium-dependent Bile acid Transporter inhibitor (ASBTi) against NAFLD was investigated in mice fed a high-fat diet for 12 weeks (HFD mice) via changing their gut microbiota. ASBTi mice were mice treated with ASBTi (2.5 μmol/kg/day) during HFD feeding. For fecal microbiota transplantation (FMT), stools were collected from HFD mice and ASBTi mice. Fecal materials obtained from HFD mice and ASBTi mice were transplanted to normal mice, fed HFD for 12 weeks, and designated as HFD-FMT mice and ASBTi-FMT mice, respectively. Microbiota in these groups of mice were analyzed by 16S rRNA gene sequencing. The degrees of hepatic steatosis and inflammation in these mice were determined pathologically. The shannon index of the microbiota from ASBTi mice (3.31±0.19) and ASBTi-FMT mice (3.29±0.18) was significantly high as compared to that from HFD mice (2.90±0.19) and HFD-FMT mice (2.89±0.16). Steatosis and inflammation in the liver of HFD mice and HFD-FMT mice were shown to be pathologically severe and NAFLD Activity Score (NAS) was 7.67±0.58 in HFD mice and 5.67±2.08 in HFD-FMT mice. However, those in the liver of ASBTi mice and ASBTi-FMT mice were improved and NAS was reduced in ASBTi mice (1.67±0.58) and in ASBTi-FMT mice (2.67±0.58). These results suggest that changes in the gut microbiota caused by ASBTi suppress intrahepatic steatosis and inflammation in NAFLD mice. Elobixibat can be expected to prevent fatty liver.

Vascular anatomy of the splenic flexure, focusing on the accessory middle colic artery and vein

AIM

Recently, the accessory middle colic artery (AMCA) has been recognized as the vessel that supplies blood to the splenic flexure. However, the positional relationship between the AMCA and inferior mesenteric vein (IMV) has not been evaluated. Herein, we aimed to evaluate the anatomy of the AMCA and the splenic flexure vein (SFV).

METHOD

Two hundred and five patients with colorectal cancer who underwent enhanced CT preoperatively were enrolled in the present study. The locations of the AMCA and IMV were evaluated, focusing on the positional relationship between the vessels and pancreas - below the pancreas or to the dorsal side of the pancreas.

RESULTS

The AMCA was observed in 74 (36.1%) patients whereas the SFV was found in 177 (86.3%) patients. The left colic artery (LCA) was the major artery accompanying the SFV in 87 (42.4%) of patients. The AMCA accompanied the SFV in 65 (32.7%) patients. In 15 (7.8%) patients, no artery accompanied the SFV. The origin of the AMCA was located on the dorsal side of the pancreas in 15 (20.3%) of these 74 patients. Similarly, the destination of the IMV was located on the dorsal side of the pancreas in 65 (31.7%) of patients.

CONCLUSION

The SFV was observed in most patients, and the LCA or AMCA was the common accompanying artery. In some patients these vessels were located on the dorsal side of the pancreas and not below it. Preoperative evaluation of this anatomy may be beneficial for lymph node dissection during left-sided hemicolectomy.

The slow earthquake spectrum in the Japan Trench illuminated by the S-net seafloor observatories

Investigating slow earthquake activity in subduction zones provides insight into the slip behavior of megathrusts, which can provide important clues about the rupture extent of future great earthquakes. Using the S-net ocean-bottom seismograph network along the Japan Trench, we mapped a detailed distribution of tectonic tremors, which coincided with very-low-frequency earthquakes and a slow slip event. Compiling these and other related observations, including repeating earthquakes and earthquake swarms, we found that the slow earthquake distribution is complementary to the Tohoku-Oki earthquake rupture. We used our observations to divide the megathrust in the Japan Trench into three along-strike segments characterized by different slip behaviors. We found that the rupture of the Tohoku-Oki earthquake, which nucleated in the central segment, was terminated by the two adjacent segments.

Incidence of and risk factors for lymphocele formation after lateral pelvic lymph node dissection for rectal cancer: a retrospective study

AIM

Pelvic lymphocele is a common complication that develops after pelvic lymph node dissection. The incidence of pelvic lymphocele formation has been reported to be 10.5-51% after gynaecological or urological procedures. However, no evidence has been reported thus far with regard to the development of pelvic lymphocele following lateral pelvic lymph node dissection (LPND) for low rectal cancer. The aim of this study was to investigate the incidence of and risk factors for lymphocele formation after LPND for low rectal cancer and to examine its clinical management.

METHOD

We retrospectively analysed the incidence of and risk factors for pelvic lymphocele formation after LPND for rectal cancer in our hospital between January 2012 and December 2017. We also compared the size of the lymphocele between asymptomatic and symptomatic patients by using CT volumetry and examined its clinical management.

RESULTS

A total of 30 out of 98 patients (30.8%) developed pelvic lymphocele after rectal LPND. The number of resected nodes was significantly higher in patients with a pelvic lymphocele (P < 0.01). The median volume was significantly higher in patients with symptomatic pelvic lymphocele (P = 0.011). Among the nine symptomatic patients, two underwent CT-guided drainage, one underwent transurethral ureteral stent placement and one underwent laparoscopic marsupialization.

CONCLUSION

It is essential to keep in mind the possibility of pelvic lymphocele formation during follow-up of patients who undergo LPND, and to consider an appropriate treatment when these patients are symptomatic.

Age-related and seasonal change in serum osmolarity and water intake in a healthy population

Background and aim

Few studies have clarified the seasonal and age-related change of serum osmolarity and water intake, which is thought to be associated with heat stroke and ischemic stroke. We investigated the association between them in a healthy population.

Methods

We conducted a cross-sectional study using database from Kobe Orthopedic and Biomedical Epidemiologic (KOBE) Study. Among 1138 healthy Japanese participants in the baseline survey, 1010 (women 704 and men 306) participants were eligible for the present study. Daily non-alcohol drink (NAD) intake was estimated according to food frequency questionnaire. Alcohol beverage and water in the meal or soup were excluded from the counting. Serum osmolarity (Osm/L) was calculated by Worthley’s formula: 2 (serum sodium (mEq/L)) + (blood urea nitrogen (mg/dL))/2.8 + (glucose (mg/dL))/18. The seasons the surveys were conducted were categorized into 4 groups, March-May (Spring), June-August (Summer), September-November (Autumn), and December-February (Winter). The association between serum osmolarity and daily NAD intake was analyzed using linear regression models.

Results

The seasonal change was observed in the serum osmolarity and daily NAD intake; serum osmolarity increased in spring and summer and daily NAD intake increased in summer. The serum osmolarity increased by aging in any seasons, while daily water intake didn’t. There was no significant association observed between serum osmolarity and the daily NAD intake, even after adjusting for sex, age, and season.

Conclusions

Serum osmolarity showed seasonal and age-related changes, but the serum osmolarity in subjects who had the daily habit of high NAD intake was not necessarily low.

Key messages

Serum osmolarity increased by aging and in spring and summer. Serum osmolarity was not associated with non-alcohol drink intake.

Presence of intimate family and cancer screening behavior: a cross-sectional study of 4237 workers

Background

Presence of intimate family is considered as one of the related factors of health behaviors. The study aim was to clarify the relationship between the presence of significant others and having a colorectal cancer screening.

Methods

This study used data of baseline survey of intervention study regarding breast cancer screening at worksites. A total of 6827 workers, aged 40 and over of the retail company, were required to fill out a self-administrated questionnaire related to cancer screening. the intimate family was defined as a person’s spouse or partner and children. Logistic regression analyses were performed to estimate odds ratios [ORs] and 95% confidence intervals [CIs] of undergoing an annual screening for colorectal cancer by the presence of spouse or partner adjusting for age. The same analysis was performed regarding the presence of children.

Results

Response rates were 70% in men and 71% in women. After excluding participants with a past history of cancer and lack of information about colorectal cancer screening or the presence of significant others, 4203 remained for the analyses. A total of 1777 participants reported that they had undergone screening for colorectal cancer within a year (42% in men and 42% in women). Screening rates of participants with/without a spouse were 45% and 30% in men, 44% and 38% in women. Screening rates of participants with/without children were 45% and 33% in men, 43% and 38% in women. ORs of undergoing annual colorectal cancer screening by the presence of spouse were 1.8 (1.3-2.5) in men and 1.3 (1.1-1.5) in women. ORs by the presence of children were 1.6 (1.2-2.1) in men and 1.1 (0.9-1.3) in women.

Conclusions

This study indicated that health behavior in cancer screening could be affected by having a spouse in both men and women. The presence of children positively related in men. Male workers with children might be under some pressure to keep their health, from a sense of responsibility of main income earner.

Key messages

Health behavior in cancer screening could be affected by having a spouse. Health behavior in cancer screening could be affected by having a child only in men.

P4605Landiolol, a beta-blocker, optimizes cardiac energetics and peripheral microhemodynamics better than ivabradine while reducing heart rate at hemodynamic resuscitation of experimental septic shock

Background

Septic shock is associated with sympathetic over-activation characterized by tachycardia, which is associated with poor survival. Though several kinds of drugs are available to reduce heart rate (HR), it is not clear which drug should be used to reduce HR effectively in initial hemodynamic resuscitation in septic shock.

Purpose

The aim of this study was to experimentally investigate comparative effects of landiolol (a β-blocker) and ivabradine (an If-channel inhibitor) on initial hemodynamic resuscitation in a canine model of endotoxin shock.

Methods

We used 19 anesthetized dogs. Seven dogs were allocated to control (CT) group, six dogs to landiolol (BB) group, and six dogs to ivabradine (IVA) group. In all the groups, endotoxin shock was induced by intravenous infusion of Escherichia coli lipopolysaccharide (4 mg/kg) over 1 h. After induction of endotoxin shock, we started hemodynamic resuscitation to restore mean arterial pressure (AP) and cardiac output (CO) by infusing noradrenaline (NA) and Ringer acetate solution (RiA). Dose of NA and RiA were automatically titrated with use of a computer-controlled drug infusion system that we developed previously. Hemodynamic resuscitation was continued for 4 h. During resuscitation, the BB group was given landiolol infusion at a low-dose range (1–10 μg/kg/min, manually titrated), while the IVA group was given ivabradine at 0.25 mg/kg bolus-injected every 2 h.

Results

The drug infusion system automatically restored AP to 70 mmHg and CO to greater than 90% of baseline level in all the groups. The restored AP and CO were not significantly different among the three groups (Figure A, B). There were no significant differences in the computer-controlled infusion rate of NA and cumulated volume of RiA infused among the three groups (Figure C). During the first 2 h of resuscitation, HR was significantly reduced in the BB and IVA groups in comparison to the CT group (Figure D). However, only in the BB group, cardiac oxygen consumption was significantly lower than that in the CT group (Figure E). Blood lactate level decreased significantly after hemodynamic resuscitation only within the BB group (Figure F).

Figure 1

Conclusions

In the initial hemodynamic resuscitation of septic shock, both low-dose landiolol infusion and ivabradine injection may be used to reduce HR. However, to optimize cardiac energetics and peripheral microhemodynamics, low-dose landiolol infusion may be preferable to ivabradine injection.

Acknowledgement/Funding

This work was supported by JSPS KAKENHI Grant Number 15K01307, 18K12126.

P6199Lipoprotein(a) and risk of chronic kidney disease among 4,235 Japanese hospitalized patients

Background

Lipoprotein (a) [Lp(a)] has been shown to be associated with the development of chronic kidney disease (CKD) among various ethnicities. In addition, recent Mendelian randomization studies have suggested that Lp(a) seems to be causally associated with CKD. However, few data exist regarding this issue among Japanese population.

Purpose

We aimed to investigate the association between serum Lp(a) and the CKD among Japanese population.

Methods

We retrospectively investigated 6,130 subjects whose serum Lp(a) had been measured for any reason (e.g. any operations which needs bed rest for a long duration, risk factors for atherosclerosis such as hypertension or diabetes) at our University Hospital from April 2004 to March 2014. We excluded 1,895 subjects due to the lack clinical data. We assessed their Lp(a), LDL cholesterol, HDL cholesterol, triglycerides, presence of hypertension, diabetes, chronic kidney disease, smoking, body mass index, presence of coronary artery disease (CAD), and presence of CKD (stage 3 or greater).

Results

When the study subjects were divided into 5 groups based on their CKD stage, there was a significant trend among their serum Lp(a) levels (P-trend = 2.7×10–13). Under these conditions, multiple regression analysis showed that Lp(a) was significantly associated with CKD [odds ratio (OR): 1.12, 95% confidence interval (CI): 1.08–1.17; p=1.3×10–7: per 10mg/dL)., independent of other classical risk factors, including age, gender, body mass index, hypertension, diabetes, smoking, LDL cholesterol and triglycerides. Under these conditions, Lp(a) was significantly associated with CAD [OR: 1.11, 95% CI: 1.06–1.16; p=1.7×10–6: per 10mg/dL), independent of the presence of CKD.

Conclusion

Serum Lp(a) was associated with the development of CKD independent of other classical risk factors among Japanese population as well.

Obstruction is associated with perineural invasion in T3/T4 colon cancer

AIM

Perineural invasion (PNI) is a risk factor for recurrence and metastasis and consequently leads to decreased survival in patients with various malignancies. Recent studies showed that stent placement in obstructive colon cancer increases the frequency of PNI. We hypothesized that mechanical stress including obstruction itself may be associated with PNI.

METHOD

We retrospectively reviewed 496 patients with pathological T3 or T4 colon cancer who did not receive preoperative treatment. Data were collected from medical charts and pathological findings. The relationships between PNI and other clinicopathological factors were analysed using univariate and multivariate analyses.

RESULTS

PNI was observed in 239 (48%) patients. Obstruction was markedly more frequent in PNI-positive cancer (39%) than in PNI-negative cancer (24%, P = 0.0003). Multivariate analyses identified obstruction as one of the significant factors associated with PNI (OR 1.68, P = 0.028). Moreover, in 414 patients without distant metastasis who underwent complete resection, PNI was an independent factor associated with poor recurrence-free survival (hazard ratio 2.35, P = 0.003). The coexistence of PNI and obstruction resulted in greater decreases in recurrence-free survival than PNI-negative and/or non-obstructive cases.

CONCLUSION

Our results suggest that obstruction is associated with PNI and consequently contributes to an increased postoperative recurrence in colon cancer.

Evidence for solitonic spin excitations from a charge-lattice-coupled ferroelectric order

Topological defects have been explored in different fields ranging from condensed matter physics and particle physics to cosmology. In condensed matter, strong coupling between charge, spin, and lattice degrees of freedom brings about emergent excitations with topological characteristics at low energies. One-dimensional (1D) systems with degenerate dimerization patterns are typical stages for the generation of topological defects, dubbed "solitons"; for instance, charged solitons are responsible for high electrical conductivity in doped trans-polyacetylene. Here, we provide evidence based on a nuclear magnetic resonance (NMR) study for mobile spin solitons deconfined from a strongly charge-lattice-coupled spin-singlet ferroelectric order in a quasi-1D organic charge-transfer complex. The NMR spectral shift and relaxation rate associated with static and dynamic spin susceptibilities indicate that the ferroelectric order is violated by dilute solitonic spin excitations, which were further demonstrated to move diffusively by the frequency dependence of the relaxation rate. The traveling solitons revealed here may promise the emergence of anomalous electrical and thermal transport.

Evaluation of the vascular anatomy of the left-sided colon focused on the accessory middle colic artery: a single-centre study of 734 patients

AIM

Surgery for colorectal cancer located in the splenic flexure is difficult to perform because of the complex anatomy. Recently, in addition to the middle colic artery and left colic artery (LCA), the accessory middle colic artery (AMCA) has been recognized as a feeding artery for the left-sided colon. This study aimed to evaluate the vascular anatomy of the splenic flexure focusing on the AMCA in a large number of patients.

METHOD

A total of 734 patients who underwent CT before surgery for colorectal cancer were enrolled. We retrospectively evaluated the vascular anatomy using both two- and three-dimensional CT angiography.

RESULTS

The AMCA existed in 36.4% of the cases (n = 267). In many cases, it originated from the superior mesenteric artery (n = 228, 85.4%). The AMCA had a common trunk with the transverse pancreatic artery in 54 patients (20.2%). The frequency of the presence of the AMCA was associated with the branching pattern of the LCA, and was more frequent when the LCA was absent (P < 0.001).

CONCLUSION

The presence of the AMCA is not rare and the AMCA has some branching patterns; therefore, recognizing it preoperatively and intra-operatively is important, being especially careful when the LCA is absent.

The preventive effect of the impaired liver function for antiemetic therapy against chemotherapy-induced nausea and vomiting in hepatocellular carcinoma patients

Transarterial chemoembolization and hepatic arterial infusion chemotherapy are recommended for the treatment in patients with intermediate stage of hepatocellular carcinoma. Impaired liver function was sometime observed in patients with hepatocellular carcinoma after transarterial chemoembolization or hepatic arterial infusion chemotherapy. However, what kinds of factors deeply influence in impaired liver function are not clear. A retrospective study was performed to evaluate the risk factors of impaired liver function in cisplatin-naïve patients treated with these therapies using cisplatin. Prior to and 2 months after these therapies, we analyzed the liver function by Child-Pugh score in these patients. For assessing the severity of chemotherapy-induced nausea and vomiting, we utilized the Common Terminology Criteria for Adverse Events ver. 4.0. In hepatocellular carcinoma patients received these therapies using cisplatin, the cancer stage and treatment without neurokinin-1 (NK₁) antagonist were found to be independent risk factors of the impaired liver function. The treatment with NK₁ antagonist was effective in reducing chemotherapy-induced nausea and vomiting and patients treated with NK₁ antagonist kept their liver functions after cisplatin-used these therapies. The treatment with NK₁ antagonist was effective in chemotherapy-induced nausea and vomiting and prevented the impaired liver function associated with cisplatin-used these therapies in hepatocellular carcinoma patients.

Photocatalyzed Site-Selective C(sp3)-H Functionalization of Alkylpyridines at Non-Benzylic Positions

Tetrabutylammonium decatungstate (TBADT)-photocatalyzed C-H functionalization of alkylpyridines was investigated. Unlike alkylbenzene counterparts, alkylation of α-C-H bonds did not proceed for the reaction of 2- and 4-alkylpyridines and reluctantly proceeded for 3-alkylpyridines, which allow site-selective C(sp³)-H functionalization at nonbenzylic positions. The observed nonbenzylic site selectivities are rationalized by the polar inductive effects of pyridyl groups in the S_H2 transition states. Consecutive γ-functionalization and α-bromofunctionalization were successfully carried out in selected cases.