Akira (France)

Abstract Quantitative morphometry (QM) is crucial to accurately diagnose and perform follow-up of vertebral fractures. Although the semiquantitative technique by Genant is prevalent, its accuracy and reproducibility are low. This study combines an AI model that identifies the position of each vertebral body from thoracic and lumbar lateral X-ray images with another AI model that determines vertebral body height ratios required for QM to develop a software for automatic evaluations. The learning data set comprised 3,082 vertebrae annotated by an orthopedic specialist. Thereafter, the correlation and concordance were evaluated between the specialist in the validation set and external evaluators in the test set. The software required approximately 6 s to read one image. For the validation set, Spearman’s correlation coefficient (rs) was 0.605, 0.721, and 0.798 for C/A, C/P, and A/P, respectively. Bland–Altman analysis indicated that the percentage within the limits of agreement (LOA) was 96.8%, 95.7%, and 94.9%, respectively, which decreased as the vertebral body compression increased. For the test set, rs were between 0.519–0.589, 0.558–0.647, and 0.735–0.770, respectively, and the correlations between the external evaluators were similar. Additionally, LOAs were almost above 95%. The proposed software is expected to improve the diagnosis of vertebral fractures and osteoporosis, enabling appropriate treatment.

Background: While overall obesity remains a major risk factor for cardiometabolic diseases, the location of stored fat is also thought to play a role. In addition to fat storage in ectopic sites, the density of fat, a marker of fat quality, is emerging as a novel risk factor for cardiometabolic diseases. Previous studies have focused primarily on visceral (VAT) and abdominal subcutaneous (SAT) adipose tissue density and in predominantly white cohorts; however, studies in populations of African ancestry who are at higher risk of cardiometabolic diseases are lacking. Additionally, information is lacking on associations of density of other relevant ectopic fat depots, such as intermuscular adipose tissue (IMAT), with cardiometabolic risk factors. Methods: We investigated whether VAT, SAT, or thigh IMAT densities were associated with cardiometabolic measures in 648 black men aged 50-91 years (mean age 63.6 years, mean BMI 27.7 kg/m 2 ). Adipose tissue volume (cm 3 ) and density (Hounsfield units, HU) was measured in the abdomen (between L4 and L5) and mid-thigh from computed tomography scans. Cardiometabolic measures, including blood pressure, fasting serum glucose and insulin homeostasis, and serum lipids (N=476), were transformed as needed and used as outcomes in multiple linear regression models adjusting for age, lifestyle factors, medication use (antihypertensive, antidiabetic, or lipid-lowering), and corresponding fat depot volume. Results: After adjustment (Table), VAT, SAT, and IMAT densities were significantly associated with fasting insulin, insulin resistance, and lipids. Results remain similar after adjustment for BMI instead of fat volume and in a sensitivity analysis excluding those taking relevant medications. Conclusion: As reported in other studies, in our study among African ancestry individuals VAT and SAT were associated with several cardio-metabolic risk factors. Importantly, our findings suggest that thigh IMAT density may be a novel predictor of cardiometabolic risk in African ancestry men.

Introduction: Recently, the balance between sodium and potassium intake, i.e. sodium-to-potassium (Na/K) ratio, has received a lot of attention for prevention of hypertension. Previous studies reported that the positive association between 24-hour urinary Na/K (uNa/K) ratio and hypertension. However, no studies have evaluated the relationship between uNa/K ratio measured by casual urine measurement and home hypertension in large populations. We aimed to clarify whether casual uNa/K ratio using the self-monitoring device was associated with home hypertension in general population. In addition, we assessed whether multiple days measurement of uNa/K ratio by casual urine increase the accuracy of the prediction of home hypertension compared with casual urine collected in a single day. Hypothesis: We assessed the hypothesis that multiple measurement of uNa/K ratio was positively associated with home hypertension, and increase the prediction of home hypertension compared with a single measurement. Methods: The subjects were over 20 years old who participated in The Tohoku Medical Megabank Project Cohort Study. Of these participants, we targeted 2,551 subjects who borrowed home blood pressure monitors (HEM-7080IC) and uNa/K ratio monitors (HEU-001F) for continuous 10 days. To assess the relationship between casual uNa/K ratio and home hypertension, we performed multiple logistic regression analyses and calculated aOR with 95% CI. We included covariate factors as age, sex, BMI and drinking status. In addition, to compare the prediction of home hypertension in multiple measurement with that in a single measurement, we calculated area under the ROC curve (AUROC) of uNa/K ratio. Home hypertension was defined as a SBP ≥ 135 mmHg and/or a DBP ≥ 85 mmHg. Results: Among 849 subjects had home hypertension (33.3%). Although uNa/K ratio was even positively associated with home hypertension by a single day (P for trend <0.01, aOR of home hypertension increase per quartile =1.11), the relationship between uNa/K ratio of multiple measurement and home hypertension was more robust (aOR of more than 5 days: 1.23 to 1.25). Similarly, AUROC of uNa/K ratio measurement for home hypertension in 5 days was larger than that in a single day. Conclusions: In conclusion, even single measurement of uNa/K ratio was positively associated with hypertension, the multiple measurement of uNa/K ratio strongly related with home hypertension. We suggested that multiple measurement of uNa/K ratio is desirable for assessing home hypertension because long term measurement of uNa/K ratio might reflect participants’ dietary balance of Na/K ratio.

Background: Dietary salt intake is associated with the risk of raised blood pressure and cardiovascular diseases (CVD). In Asian countries, a major source of salt intake is seasoning or table salt from cooking at home. However, little is known about the relationship between salt intake level of the entire household and CVD mortality risk. Objective: We aimed to investigate the relationship between household salt level and mortality from all-causes, CVD, stroke and subtypes of stroke in a 24-year follow-up study of a Japanese representative population (NIPPON DATA80). Methods: NIPPON DATA80 is a cohort study based on the National Nutrition Survey and the National Survey on Circulatory Disorders conducted by Japanese government in 1980. A total of 8,702 individuals (56% women) who were living with someone such as family were included in this analysis. Participants were 30-79 years old and none had a history of myocardial infarction or stroke. Household salt level was evaluated as the amount of salt consumption (g) per 1000 kcal of total energy intake in each household. The amount of salt consumption and total energy intake were evaluated using 3-day weighed food records at baseline. We used Cox proportional hazards models to evaluate the effect of household salt level for each mortality. Multivariable-adjusted hazard ratios (HRs) and confidence intervals (CIs) for a salt increment of 2g/1000 kcal (1 standard deviation) were calculated after adjusting for sex, age, body mass index, smoking status, drinking status, daily physical activity level, household-based potassium, household-based saturated fatty acid and household-based long-chain n-3 polyunsaturated fatty acid. Results: In 186,186 person-years of follow-up, there were 27.1% (2360 of 8702) deaths, among which CVD were 787 (9.0%), and stroke were 361 (4.1%). Household salt level was 6.25 (±2.02) mg/1000 kcal. Multivariable-adjusted HRs for a 2g/1000 kcal increment in household salt level were 1.07 (1.02-1.11) for all-causes mortality, 1.11 (1.03-1.19) for CVD mortality and 1.12 (1.00-1.25) for stroke mortality. In the analysis for subtypes of stroke, the relative risk of mortality from cerebral hemorrhage was significantly increased (p for trend = 0.024); the HR (95%CI) for a 2g/1000 kcal increment of household salt level was 1.28 (1.03-1.59). However, the association for mortality from cerebral infarction was not significant (HR 1.05; 95% CI 0.91-1.22). Conclusion: Household salt level was associated with long-term risk of all-cause, CVD and stroke mortality in a representative population of Japanese men and women. The association was stronger for mortality risk from cerebral hemorrhage.

Capillary refill time(CRT) is a non-invasive method to assess tissue perfusion, routinely performed in pediatric practice. Current methods to measure CRT have limitations in objectivity and reproducibility. The measurement depends on clinician’s assessment. New analytic approach using pulse oximeter waveform has been developed. Hypothesis: CRT measured by pulse oximeter device and clinicians(critical care/anesthesiologist attending physicians) were different across skin color and finger thickness. Method: Children(1-12 yr) with different skin color tones (Fitzpatrick scale 1-2:fair, 3-4:medium, 5-6:dark) were recruited. Subjects were randomized to a pulse oximeter either on index/middle finger, and had a total 10 CRT measurements (5 with device, 5 with clinician’s visual assessment, alternating). Waveform analysis was performed with quick compression and release on the pulse oximetry device by clinician. The difference between device and clinician measured CRT was calculated. ANOVA for difference in CRT across 3 skin color categories and across 4 finger thickness. Result: 64 subjects(skin color fair 33, medium 16, dark 15) were recruited (median age 72 m, IQR 42-123m). Out of 640 CRT measurements, 300 pairs had measurable CRTs in both device and clinician. Based on clinician’s measurement, 114 CRTs were >2s and 26 CRTs > 4s. The overall CRT difference was mean 0.97±1.32s. The CRT difference by skin color was fair 0.86±1.35s, medium 0.90±1.31s, dark 1.26±1.22s, p=0.095. Pearson correlation coefficient was all 0.49 (fair 0.31, medium 0.67, and dark 0.41, all p<0.001). There was no significant difference in CRT difference among 4 finger thickness categories(thin to thick); 1.21±1.48s, 0.94±1.48s, 1.12±1.20s, 0.75±1.20s, p=0.108. Conclusion: The difference between device and clinician measured CRT did not vary across the different patient skin color or finger thickness. Device measured CRT may be a helpful indicator for peripheral perfusion.

Contingency planning in the area of animal health is all about preparing for threats and outbreaks of exotic disease, i.e. a disease not present in the country. The objective of contingency planning is to encourage livestock keepers, producers and manufacturers of food and feed, veterinarians in the private and public sector and relevant governmental institutions to think about major contingencies and possible response. The planning involves the development of contingency plans based on the four pillars: prevention, preparation, response and recovery and the conduct of simulation exercises.This report presents an overview of contingency planning related to animal diseases, preparedness for natural disasters, experiences gained from outbreaks of African swine fever in Baltic and Eastern European countries and contains the Memorandum of Understanding on a Nordic-Baltic Animal Health Emergency Reserve and on Nordic- Baltic Veterinary Contingency Planning Studies.

Introduction: Cardioembolic stroke related to atrial fibrillation (AF) is associated with a high recurrence rate and high mortality and morbidity. Catheter ablation for AF is effective in reducing AF burden, while the impact of AF ablation on a recurrence of stroke remains to be elucidated. Methods: We performed a retrospective multicenter cohort study of patients who were diagnosed with AF. A total of 1792 patients with AF (age 67±10, male 67%, 47% paroxysmal AF) were analyzed. Six hundred thirty-three patients underwent AF ablation. Patients with a history of transient ischemic attack (TIA) or ischemic stroke (IS) were listed. The association between a recurrence of TIA/IS, and AF ablation was evaluated. Results: There were 282 patients with a history of TIA/IS (104 ablation, 178 no-ablation). Ablation group had more patients with heart failure than no-ablation group. Besides this, there were similar about CHADS2 score in both group. Fifty-six recurrences were observed. AF ablation was associated with a lower incidence of recurrences (Hazard ratio 0.30; 95% CI 0.11 - 0.85; p=0.02). Independent predictors of recurrences of TIA/IS were, not undergoing AF ablation, aging, and a presence of hypertension. Conclusion: Our results suggested that AF ablation could reduce the recurrence of TIA/IS.

Kawasaki disease (KD; MIM611775) is a systemic vasculitis syndrome with unknown etiology which predominantly affects infants and children. Recent findings of susceptibility genes for KD have suggested up-regulation of Ca2+/NFAT pathway as one of the main pathophysiological processes in KD. In this study, we focused on ORAI1, a gene for a channel involved in store operated Ca2+ entry located on 12q24 where positive linkage signal was seen in our previous sib pair study of KD, and conducted a genetic association study. By re-sequencing 17.4kb of ORAI1 region for 94 subjects, we identified 37 variants with minor allele frequencies larger than 0.05. After selecting 9 tagging SNPs which represent 37 variants we performed an association study using 730 KD cases and 1315 controls. As a result, one tagging SNP located within exon2 showed nominal association (rs3741596; OR = 1.19, 95%CI 1.02~1.40, P = 0.028). The same trend of association was observed in an independent case control panel (1813 KD cases and 1097 controls, OR=1.22, 95% CI 1.06-1.40, P = 0.0056) and a significant P value was observed in a meta-analysis (OR = 1.21, 95%CI 1.09~1.34, P = 0.00041). Furthermore, we also found a rare 6 base-pair insertion polymorphism which cause elongation of proline repeat within N-terminal cytoplasmic domain of the ORAI1 protein was overrepresented in KD cases (rs78448924; OR = 3.91, 95%CI 1.30~11.80, P=0.010). These data indicate altered ORAI1 function confers susceptibility of KD and further highlight importance of the Ca2+/NFAT pathway in the disease pathogenesis.

Background and Purpose: Neovascularization of carotid plaques is associated with plaque vulnerability. However, the role of neovascularization in the development of intraplaque hemorrhage (IPH) and the clinical contribution of neovascularization to IPH and symptomatic presentation remain undetermined. Methods: Consecutive patients with moderate to severe carotid atherosclerosis who underwent carotid endarterectomy were prospectively analyzed from 2010 to 2014. The neovessel appearance was categorized into three groups based on dynamic intraoperative indocyanine green videoangiography: neovessels derived from the endothelium (NVe), neovessels derived from the vasa vasorum (NVv), and no neovessels. Each neovessel pattern was evaluated with respect to clinical, radiological, and pathological findings. Results: Of 57 patients, 13 exhibited NVe, 33 exhibited NVv, and 11 exhibited no neovessels. There were no significant differences in baseline characteristics among the three groups with the exception of a higher percentage of symptomatic presentations among patients with NVe. Moreover, patients with NVe exhibited larger infarctions than did those with NVv (P=0.04). Pathologically, patients with NVe had more severe IPH (P=0.002), hemosiderin spots (P=0.04), neovessels (P=0.11) and inflammation (P=0.26), all of which were correlated with hyperintensity on time-of-flight magnetic resonance imaging. Interestingly, inflammation was significantly correlated with neovessel formation (R=0.43, P=0.008), hemosiderin spots (R=0.62, P<0.0001), and IPH (R=0.349, P=0.0097), suggesting that inflammation may be a key factor in plaque vulnerability. Conclusions: Luminal neovascular sprouting with inflammation and lumen communication could clinically contribute to IPH and symptomatic presentation in patients with carotid stenosis. This condition may thus be a key therapeutic target against neovessel formation and inflammation.

Several studies have indicated that treatment with dipeptidyl peptidase-4 (DPP-4) inhibitors decreases blood pressure. We aimed to examine the effects of vildagliptin, a specific DPP-4 inhibitor, on blood pressure and its dipping pattern in Dahl salt-sensitive (DSS) rats. Male DSS rats were treated with a high salt (8% NaCl) diet and vehicle (0.5% carboxymethylcellulose) or vildagliptin (3 or 10 mg/kg, twice daily, p.o.) for 7 days (n = 7 per group). Mean arterial pressure (MAP) was measured by telemetry. High salt diet for 7 days significantly increased MAP with an extreme dipping pattern of blood pressure in DSS rats. Vildagliptin dose-dependently inhibited DPP-4 enzymatic activity and increased plasma GLP-1 levels. Furthermore, vildagliptin dose-dependently attenuated the development of salt-induced hypertension. Interestingly, vildagliptin significantly increased urine sodium excretion and normalized the dipping pattern. In anesthetized high salt-diet DSS rats, acute intra-cerebroventricular infusion of vildagliptin (50, 500 or 2500 μg in 10 μl solution) did not alter MAP or heart rate (n = 4). These data suggest that treatment with the DPP-4 inhibitor, vildagliptin, attenuates the extreme dipping pattern of blood pressure and development of salt sensitive hypertension by increasing urinary sodium excretion. These effects of vildagliptin may not be mediated through the central nervous system.