Transabdominal levatorplasty technique in laparoscopic mesh rectopexy for rectal prolapse

Rectal prolapse is characterized by a full-thickness intussusception of the rectal wall and is associated with a spectrum of coexisting anatomic abnormalities. We developed the transabdominal levatorplasty technique for laparoscopic rectopexy, inspired by Altemeier's procedure. In this method, following posterior mesorectum dissection, we expose the levator ani muscle just behind the anorectal junction. Horizontal sutures, using nonabsorbable material, are applied to close levator diastasis associated with rectal prolapse. The aim of the transabdominal levatorplasty is to (i) reinforce the pelvic floor, (ii) narrow the anorectal hiatus, and (iii) reconstruct the anorectal angle. We report a novel transabdominal levatorplasty technique during laparoscopic rectopexy for rectal prolapse. The laparoscopic mesh rectopexy with levatorplasty technique was performed in eight cases: six underwent unilateral Orr-Loygue procedure, one modified Wells procedure, and one unilateral Orr-Loygue procedure combined with sacrocolpopexy for uterine prolapse. The median follow-up period was 178 (33-368) days, with no observed recurrences. Six out of seven patients with fecal incontinence experienced symptomatic improvement. Although the sample size is small and the follow-up period is short, this technique has the potential to reduce the recurrence rate and improve functional outcomes, as with levatorplasty of Altemeier's procedure. We believe that this technique may have the potential to become an option for rectal prolapse surgery.

Pathological findings in enucleated eyes of patients with neurofibromatosis type 1: report of a case with 15-year follow-up and review of 14 patients in the literature

BACKGROUNDS

Iris nodules are frequently noted as clinical manifestations of neurofibromatosis type 1 but the other intraocular manifestations are rare. The purpose of this study is to present a patient with a phthisic eye who underwent enucleation for a cosmetic reason after 15-year follow-up and also to review 14 patients with enucleation described in the literature.

CASE PRESENTATION

A 17-year-old man with neurofibromatosis type 1 from infancy underwent the enucleation of phthisic left eye and also had the resection of eyelid subcutaneous mass lesions on the left side for a cosmetic reason. He had undergone four-time preceding surgeries for eyelid and orbital mass reduction on the left side in childhood and had developed total retinal detachment 10 years previously. Pathologically, the enucleated eye showed massive retinal gliosis positive for both S-100 and glial fibrillary acidic protein (GFAP) in the area with involvement of the detached retinal neuronal layer, together with a more fibrotic lesion along the choroid which were, in contrast, negative for both S-100 and GFAP. The choroid, ciliary body, and iris did not show apparent neurofibroma while episcleral neurofibroma was present.

LITERATURE REVIEW

In review of enucleated eyes of 14 patients in the literature, buphthalmic eyes with early-onset glaucoma on the unilateral side was clinically diagnosed in 9 patients who frequently showed varying extent of hemifacial neurofibromatosis which involved the eyelid and orbit on the same side. Pathologically, neurofibromas in varying extent were found in the choroid of 12 patients. One patient showed choroidal malignant melanoma on the left side and fusiform enlargement of the optic nerve on the right side suspected of optic nerve glioma. The phthisic eye in another patient showed massive retinal gliosis similar to the present patient.

CONCLUSIONS

In summary of the 15 patients with neurofibromatosis type 1, including the present patient, buphthalmic or phthisic eyes with no vision were enucleated for cosmetic reasons and showed choroidal neurofibroma in most patients and massive retinal gliosis in two patients including the present patient.

Histological Observation of Helmet Development in the Treehopper Poppea capricornis (Insecta: Hemiptera: Membracidae)

The treehoppers (Hemiptera, Membracidae) are known for possessing a large three-dimensional structure called a helmet. Although some ecological functions of the helmet have already been elucidated, the developmental mechanisms underlying the complex and diverse morphology of the helmet are still largely unknown. The process of helmet formation was first described in Antianthe expansa, which possesses a simple roof-shaped helmet. However, the developmental process in species with more complex helmet morphologies remains largely unexplored. Hence, in this study, we used Poppea capricornis, which possesses a more complex helmet structure than A. expansa, to investigate the helmet development using paraffin sections, micro-CT, and scanning electronic microscopy. Our focus was on the overall helmet developmental process common to both species and formation of structures unique to Poppea and its comparison to Antianthe. As a result, we discovered that miniature structures were also formed in Poppea, similar to Antianthe, during the helmet formation. Common structures that were shared between the two species were discernible at this stage. Additionally, we observed that suprahumeral horns and posterior horns, two morphological traits specific to the Poppea helmet that are apparently similar anatomically, are formed through two distinctly different developmental mechanisms. The suprahumeral horns appeared to be formed by utilizing the nymphal suprahumeral bud as a mold, while we could not detect any nymphal structures potentially used for a mold in the posterior horns formation. Our findings suggest that the helmet formation mechanisms of Antianthe and Poppea employ a common mechanism but form species-specific structures by multiple mechanisms.

Advances in treatment of alveolar soft part sarcoma: an updated review

Alveolar soft part sarcoma is a rare neoplasm of uncertain histogenesis that belongs to a newly defined category of ultra-rare sarcomas. The neoplasm is characterized by a specific chromosomal translocation, der (17) t(X; 17)(p11.2;q25), that results in ASPSCR1-TFE3 gene fusion. The natural history of alveolar soft part sarcoma describes indolent behaviour with slow progression in deep soft tissues of the extremities, trunk and head/neck in adolescents and young adults. A high rate of detection of distant metastasis at presentation has been reported, and the most common metastatic sites in decreasing order of frequency are the lung, bone and brain. Complete surgical resection remains the standard treatment strategy, whereas radiotherapy is indicated for patients with inadequate surgical margins or unresectable tumours. Although alveolar soft part sarcoma is refractory to conventional doxorubicin-based chemotherapy, monotherapy or combination therapy using tyrosine kinase inhibitors and immune checkpoint inhibitors have provided antitumor activity and emerged as new treatment strategies. This article provides an overview of the current understanding of this ultra-rare sarcoma and recent advancements in treatments according to the clinical stage of alveolar soft part sarcoma.

Architecture, construction, retention, and repair of faecal shields in three tribes of tortoise beetles (Coleoptera, Chrysomelidae, Cassidinae: Cassidini, Mesomphaliini, Spilophorini)

Animal constructions are the outcomes of complex evolutionary, behavioural, and ecological forces. A brief review of diverse animal builders, the materials used, and the functions they provide their builders is provided to develop approaches to studying faecal-based constructions and faecal-carrying in leaf beetles (Coleoptera: Chrysomelidae). Field studies, rearing, dissections, photography, and films document shields constructed by larvae in two species in two tribes of the subfamily Cassidinae, Calyptocephalaattenuata (Spaeth, 1919) (Spilophorini), and Cassidasphaerula Boheman, 1853 (Cassidini). Natural history notes on an undetermined Cassidini species and Stolascucullata (Boheman, 1862) (Tribe Mesomphaliini) outline the life cycle of tortoise beetles and explain terms. Commonly, the cassidine shield comprises exuviae onto which faeces are daubed, producing a pyramidal-shaped shield that can cover most of the body (up to the pronotum). In Cal.attenuata the larval shield comprises only exuviae, while in Cass.sphaerula, instar 1 initiates the shield by extending its telescopic anus to apply its own faeces onto its paired caudal processes; at each moult the exuvia is pushed to the caudal process base but remains attached, then more faeces are applied over it. The larva's telescopic anus is the only tool used to build and repair the shield, not mouthparts or legs, and it also applies chemicals to the shield. Pupae in Cal.attenuata retain part of the exuviae-only shield of instar VI, while pupae in Cass.sphaerula retain either the entire 5th instar larval shield (faeces + all exuviae) or only the 5th larval exuvia. The caudal processes are crucial to shield construction, shield retention on the body, and as materials of the central scaffold of the structure. They also move the shield, though the muscular mechanism is not known. Altogether the faecal + exuviae shields may represent a unique morpho-behavioural synapomorphy for the crown-clade Cassidinae (10 tribes, ~ 2669 species) and may have been a key innovation in subsequent radiation. Defensive shields and domiciles may help explain the uneven radiation of chrysomelid subfamilial and tribal clades.

Butterfly wing color made of pigmented liquid

A previously undescribed mechanism underlying butterfly wing coloration patterns was discovered in two distantly related butterfly species, Siproeta stelenes and Philaethria diatonica. These butterflies have bright green wings, but the color pattern is not derived from solid pigments or nanostructures of the scales or from the color of the cuticular membrane but rather from a liquid retained in the wing membrane. Wing structure differs between the green and non-green areas. In the non-green region, the upper and lower cuticular membranes are attached to each other, whereas in the green region, we observed a space of 5-10 μm where green liquid is held and living cells are present. A pigment analysis and tracer experiment revealed that the color of the liquid is derived from hemolymph components, bilin and carotenoid pigments. This discovery broadens our understanding of the diverse ways in which butterfly wings obtain their coloration and patterns.

Retroperitoneal Solid Pseudopapillary Tumor Mimicking Adrenal Malignant Tumor in a 67-Year-Old Man

Solid pseudopapillary tumor (SPT) is a low-grade malignant tumor of the pancreas. SPT typically affects women and can occur in ectopic pancreatic region; however, it also occurs rarely in retroperitoneum. The tumor may be bulky at the time of diagnosis since there is no specific clinical manifestation. Here we present an older male case with retroperitoneal SPT. A 67-year-old man consulted for intermittent fever and lumbago. His basal hormonal profile screened out a functional tumor. Computed tomography (CT) showed a gigantic mass in his left adrenal region. A normal left adrenal gland was not identified, and the tumor's feeding artery was recognized as the left adrenal artery by the contrast-enhanced CT. Adrenal malignant tumor was suspected, and tumor resection was performed. The resected tumor size was 15 × 10 × 9 cm. Histologically, epithelial-like cells with round nuclei and a small amount of eosinophilic cytoplasm proliferated in papillary (around the blood vessels) or uniformly solid form. By immunostaining, tumor cells were vimentin, CD56, cytokeratin AE1/AE3, CD10, β-catenin in the nucleus, cyclin D1, and PgR positive. These findings led to the diagnosis of SPT. Although rare, SPT should be considered as a differential diagnosis in cases of a mass arising from the adrenal region.

Utility of Comprehensive Genomic Profiling for Precise Diagnosis of Pediatric-Type Diffuse High-Grade Glioma

In the current World Health Organization classification of central nervous system tumors, comprehensive genetic and epigenetic analyses are considered essential for precise diagnosis. A 14-year-old male patient who presented with a cerebellar tumor was initially diagnosed with glioblastoma and treated with radiation and concomitant temozolomide chemotherapy after resection. During maintenance temozolomide therapy, a new contrast-enhanced lesion developed in the bottom of the cavity formed by the resection. A second surgery was performed, but the histological findings in specimens from the second surgery were different from those of the first surgery. Although genome-wide DNA methylation profiling was conducted using frozen tissue for a precise diagnosis, the proportion of tumor cells was insufficient and only normal cerebellum was observed. We then performed comprehensive genetic analysis using formalin-fixed paraffin-embedded sections, which revealed MYCN amplification without alteration of IDH1, IDH2, or Histone H3. Finally, the patient was diagnosed with pediatric-type diffuse high-grade glioma, H3-wildtype and IDH-wildtype. In conclusion, comprehensive genetic and epigenetic analysis should be considered in pediatric brain tumor cases.

Three Cases of Down Syndrome with Transient Abnormal Myelopoiesis who Underwent Liver Biopsy before Induction of Low-Dose Cytarabine

Among patients with transient abnormal myelopoiesis (TAM) associated with Down syndrome, approximately 20% die within 6 months from multiorgan failure, especially liver fibrosis. We experienced three children with TAM who had low white blood cell counts but increased bilirubin levels. Here, we discuss the detailed clinical courses of these patients, including the pathological findings of liver biopsies. Our cases, together with previous literature, suggest that liver biopsy can be performed safely and provides useful information, especially regarding disease activities, and that low-dose cytarabine is a reasonable option to prevent early death in TAM patients with liver dysfunction.

A Clinical Case of Insulinoma Presenting with Postprandial Hypoglycemia in a Patient with a History of Gastric Bypass Surgery

A 61-year-old man with a history of total gastrectomy for cancer with Roux-en-Y reconstruction showed severe postprandial hypoglycemia accompanied by endogenous hyperinsulinemia. Abdominal ultrasonography and contrast-enhanced computed tomography showed no abnormal findings in the pancreas. A selective arterial secretagogue injection test showed the marked induction of serum immunoreactive insulin when calcium was injected into the splenic artery. A pathological analysis following distal pancreatectomy with splenectomy revealed a pancreatic neuroendocrine microadenoma containing insulin-producing cells in the resected pancreas. This case highlights the importance of carefully evaluating refractory and severe hypoglycemia in patients with a history of gastric surgery to exclude insulinoma.

Reflection on the proposed changes to dose quantities-an industrial perspective

In 2021, the ICRP initiated the revision of the general recommendations of the system of radiation protection, and part of it will focus on dose quantities. The recently published ICRP Publication 147 and ICRU Report 95 have described the extent of the proposed modifications and paved the way for the strategy to be adopted. These revisions would seek to simplify, improve the accuracy and extend the field of use of dose quantities. While the Radiological Protection Working Group of the World Nuclear Association recognises the notable improvement in the estimation of the protection quantities and the usefulness of such changes for the medical and research sector, the benefits of the proposed new system seem very limited for the nuclear industry and industries involving naturally occurring radioactive materials. The complexity associated with changing a long-standing and robust system and the risk incurred by the human factor seem unjustified, bearing in mind the likely cost.

Acute circumflex coronary artery occlusion; dilemma in diagnosis and management

Background

Acute coronary syndrome (ACS) with occlusion of the circumflex coronary artery (LCX) poses diagnostic dilemma that may lead to a delay in reperfusion.

Purpose

We sought to assess the diagnostic significance of initial electrocardiography (ECG) changes in patients with acute LCX occlusion in relation to its clinical characteristics and the management.

Methods

From consecutive 1269 patients with ACS who were admitted to our institution during a 5-year period (2015–2019), 138 patients with ACS due to LCX occlusion were analyzed for clinical, ECG and angiographic presentation, and the door-to-balloon (DTB) time. ECG changes were classified into 4 different patterns: 1) ST-elevation in inferior/lateral leads (ST-E); 2) ST-depression in V1-V4 (ST-D); 3) no significant ST changes (No-ST); and 4) others.

Results

(1) No-ST pattern was found in 47 patients (34%), ST-E in 47 patients (34%), ST-D in 25 patients (18%) and others in 19 patients (14%). (2) Occlusion site: Proximal LCX; 16 patients with No-ST (34%), 6 patients with ST-E (13%), 13 patients with ST-D (52%). Distal LCX; 28 patients with No-ST (60%), 35 patients with ST-E (74%), 11 patients with ST-D (44%) (p=0.007). (Table) (3) Echocardiographic identification of left ventricular asynergy; 31 patients with No-ST (66%), 38 patients with ST-E (81%), 22 patients with ST-D (88%). (4) No-ST group was associated with longer DTB time; 245 min (170–562 min), compared to 93 min (83–121 min) in ST-E group and 97 min (70–129 min) in ST-D group (p<0.0001). DTB time ≤90 min was significantly uncommon in No-ST group (11%), compared to ST-E group (46%) and ST-D group (43%) (p=0.0004). (Figure)

Conclusion

One-third of the patients with LCX-ACS showed no ST changes, resulting in significantly longer DTB time. Improving diagnostic accuracy with anticipation for LCX-ACS and the use of echocardiographic examination and also the possible application of posterior leads (V7-V9) recording is challenging but critical to avoid delayed reperfusion and to improve outcomes in these patients without ECG changes.

Funding Acknowledgement

Type of funding sources: None.

Immunoglobulin G4-related Disease Accompanied by Peripheral Neuropathy: A Report of Two Cases

Due to its rarity and the limited literature, the clinicopathological characteristics of peripheral nerve involvement in immunoglobulin G4 (IgG4)-related disease are unknown. We present two cases of IgG4-related disease, accompanied by peripheral neuropathy, presenting as unilateral ptosis (case 1) and sclerosing cholangitis (case 2), respectively. In both cases, sural nerve biopsy indicated vasculitis as the underlying pathophysiology; the peripheral neuropathy was refractory to corticosteroid therapy. In contrast to the previously proposed pathomechanism of IgG4-related neuropathy (direct lymphoplasmacytic infiltration), the pathological findings in our cases suggest that vasculitis occurs secondary to systemic autoimmune conditions.

Endoscopic ultrasonography findings of pancreatic parenchyma for predicting subtypes of intraductal papillary mucinous neoplasms

BACKGROUND AND AIMS

The subtypes of intraductal papillary mucinous neoplasms (IPMNs) are closely associated with the clinicopathological behavior and recurrence after surgical resection. However, there are no established non-invasive methods to confirm the subtypes of IPMNs without surgery. The aim of this study is to predict the subtypes of IPMNs using the findings of endoscopic ultrasonography (EUS).

METHODS

Sixty-two consecutive patients with IPMNs who underwent EUS before surgery were retrospectively reviewed. The following EUS findings were analyzed and their relationship with the subtypes was evaluated: diameter of the main pancreatic duct, cyst size, number of cysts, height of mural nodule, early chronic pancreatitis (CP) finding, fatty parenchyma and atrophic parenchyma.

RESULTS

The subtypes of IPMNs were as follows: gastric (G)-type 38 (61%), intestinal (I) -type 14 (23%) and pancreatobiliary (PB) -type 10 (16%). Fatty parenchyma was significantly associated with G-type (P < 0.0001). Early CP findings ≥2 and atrophic parenchyma were significantly correlated with I-type (P < 0.0001). PB-type was significantly associated with pancreatic parenchyma without early CP findings or fatty degeneration in comparison to the other subtypes (P < 0.0001). Using the above characteristic EUS findings, the sensitivity, specificity, and accuracy were as follows: 63%, 92% and 74%, respectively, in G-type, 57%, 96% and 87% in I-type, and 90%, 94% and 94% in PB-type.

CONCLUSIONS

The evaluation of EUS findings, especially focused on the pancreatic parenchyma, has the potential to predict the subtypes of IPMN.

Description of the male of Xystromutilla bucki Suárez, 1960 (Hymenoptera, Mutillidae), including new information on the biology of the genus

The male of Xystromutillabucki Suárez, 1960 is described and associated with the female based on couples reared from trap-nests occupied by Auplopussubaurarius Dreisbach, 1963 (Hymenoptera: Pompilidae). Information on the diapause of X.bucki and Pseudomethocanr.chontalensis (Cameron, 1895) (Hymenoptera: Mutillidae) is presented. Seasonal and annual variation in the abundance of X.turrialba Casal, 1969 are also given.

Optimal phase analysis of electrocardiogram-gated computed tomography angiography in patients with Stanford type A acute aortic dissection

Objective

To determine the phase that facilitates flap observation of the ascending aorta in Stanford type A acute aortic dissection with perfused false lumen.

Methods

We reconstructed retrospective Electrocardiogram-gated Computed Tomography Angiography images of the ascending aorta of all 20 patients to 20 phases of curved-multiplanar reconstruction in 5% increment. One radiologist created and randomized 10 cross-sectional images of each phase for every patient and two radiologists scored these images on a 5-point scale depending on the degree of flap stoppage. We calculated the average score for each phase of each case and compared them among the three groups.

Results

Image scores were significantly better in the 65 %-100 % R-R interval group than those in the 5%-30 % (p < 2e-16) and 35 %-60 % R-R interval groups(p = 7.2e-10). Similar scores were observed in the Heart Rate > 70 group (p = 0.00039, 2.2e-14). Moreover a similar tendency was observed in the arrhythmia group (p = 0.0035, 0.294). No difference was found in the degree of flap stoppage in the 65 %-100 % R-R interval group between the Heart Rate > 70 and Heart Rate ≤ 70 groups (p = 0.466) and between the arrhythmia and non-arrhythmia groups (p = 0.1240).

Conclusion

In observing the ascending aorta, We obtained a good image at 65 %-100 % R-R interval and similar tendency was observed in the patients with arrhythmia.

One side makes you taller: a mushroom–eating butterfly caterpillar (Lycaenidae) in Costa Rica

Electrostrymon denarius is the first mushroom-feeding butterfly caterpillar discovered in the New World. It belongs to the Calycopidina, a subtribe of lycaenid butterflies whose caterpillars eat detritus and seeds in the leaf litter. Electrostrymon denarius has not been reared previously, and we illustrate and briefly describe the biology and morphology of its caterpillar and pupa. The significance of this discovery is that it increases the range of organic leaf litter substrates that Calycopidina caterpillars will eat. Increased diet breadth may decrease the likelihood of species extinction.

Pneumococcal perihepatitis due to hematogeneous dissemination

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Perihepatitis can occur via hematogeneous dissemination of Streptococcus pneumoniae.

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A blood culture is useful for clarifying the infection route and pathogens in perihepatitis.

Perihepatitis is mainly caused by a direct extension of pelvic inflammatory disease, in which the causative pathogen is typically Neisseria gonorrhoeae or Chlamydia trachomatis. We herein discuss the case of a 61-year-old female patient who presented with a fever and right upper quadrant pain. Perihepatitis was diagnosed by contrast-enhanced computed tomography. She had no previous history of sexual activity, genital symptoms, remarkable physical findings or examination results indicative of pelvic inflammatory disease or other diseases. A blood culture detected Streptococcus pneumoniae, leading to the suspicion of hematogeneous dissemination. The patient was therefore treated with the appropriate antimicrobials. While invasive pneumococcal disease mainly results in bacteremic pneumonia, meningitis or endocarditis, the present case showed that it can also lead to perihepatitis; a blood culture is therefore useful for clarifying the infection route and pathogens in perihepatitis if the patient has no past history of sexual activity, genital symptoms or physical or other findings indicative of pelvic inflammatory disease.

SAT0010 ANTI-CD30 IMMUNOTHERAPY AMELIORATES BONE AND CARTILAGE DESTRUCTION IN EXPERIMENTAL MODEL OF RHEUMATOID ARTHRITIS IN MICE

Background:

CD30 is a member of the TNF-receptor family and commonly expressed on lymphocytes of Hodgkin lymphoma and anaplastic large cell lymphoma. It has been reported that levels of soluble CD30 in serum and joint fluid is significantly elevated in rheumatoid arthritis (RA). Although RA patients may develop lymphoproliferative disorders (LPD) as a result of immunosuppression by MTX or bDMARDs, safety medications after the regression of LPD for RA have not yet been established.

Objectives:

To explore the potential of CD30 targeting therapy for RA.

Methods:

(1) Immuno-histological staining of CD30 was performed for fresh synovial tissues of RA and osteoarthritis (OA). In addition, double immunofluorescence staining of CD30 with CD3, CD20, CD68, CD138 were performed on RA synovial tissue. (2) Brentuximab vedotin (BV) is an anti-CD30 antibody conjugated with monomethyl auristatin E, designed to induce apoptosis of CD30 expressing cells. A multiple myeloma cell line (RPMI8226) was used as a non-lymphoma cell line and plasma cell-like cell line. Immuno-cytological staining for CD30 was performed on RPMI8226. Cells were cultured and harvested on days 0, 1, and 3 to evaluate the effects of BV (50 μl / ml per well). Cytospin specimens were stained by May-Grunwald-Giemsa (MGG) staining for cell counting and by FIFC-terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining for detection of apoptosis. (3) Collagen antibody induced arthritis (CAIA) was induced in DBA/1 mice by arthritogenic cocktail of monoclonal antibodies against type II collagen. BV was administered to the treatment groups (30mg/kg and 70mg/kg n=4 each) and evaluated clinical score, histological findings and levels of SAA, IL-6, and TNFα in serum by ELISA. Student’st-test (two-tailed) was used to determine statistical significance for analysis of synovial tissues and cell line assay. Two way ANOVA with Dunnett’s post hoc analysis was used for multiple comparisons of mice model.

Results:

(1) The number of CD30-positive cells was significantly higher in RA synovial tissue than in OA synovial tissue (p<0.01) (Fig. 1). CD30-positive cells were detected around the lymphoid follicles. Double immunofluorescence showed CD30 and CD138 double-positive cells in the synovial tissue of RA, suggesting CD30 is predominantly expressed by plasma cells. (2) RPMI8226 cells expressed CD30. BV caused apoptosis of RPMI8226 cells, and the number of cells treated with BV decreased to 95% compared to controls. (3) All control mice (n=4) developed severe arthritis, and their scores reached a peak (score: 13.3) on day 10. In the mice of treatment group of 30 mg/kg, paw swelling was slightly decreased, their clinical score reached a peak (score: 9.3) on day 10. In contrast, paw swelling was significantly reduced in the 70 mg/kg treatment group. The peak of the clinical score was 4.3 on day 10 (Fig.2). Histological score evaluated synovitis with infiltration of inflammatory cells, pannus formation, and erosion of bone and cartilage. Histological score of hind paws were 3.0 ± 0.8 for the control group, 2.7 ± 1.0 for 30 mg/kg group, and 0.7 ± 1.1 for 70 mg/kg group (p<0.01), respectively. The serum levels of SAA and IL-6 of treatment group were lower than those of no treatment group (p<0.01).

Conclusion:

We showed the expression of CD30 on synovial tissue of RA and the expression of CD30 on plasma cells. In addition, the current study provides the first evidence that BV depletion of CD30-positive cells suppressed arthritis and osteochondral destruction in CAIA mice. Our results may provide an important clue for the development of an effective treatment for RA with iatrogenic immunodeficiency-related LPD.

Disclosure of Interests:

Minami Matsuhashi: None declared, Keiichiro Nishida Grant/research support from: K. Nishida has received scholarship donation from CHUGAI PHARMACEUTICAL Co., Eisai Co., Mitsubishi Tanabe Pharma and AbbVie GK., Speakers bureau: K. Nishida has received speaking fees from CHUGAI PHARMACEUTICAL Co., Eli Lilly, Janssen Pharmaceutical K.K., Eisai Co. and AYUMI Pharmaceutical Corporation., Yoshihisa Nasu: None declared, Ryuichi Nakahara: None declared, Masahito Watanabe: None declared, Yoshifumi Hotta: None declared, Toshifumi Ozaki: None declared

SAT0068 THE RECENT INCIDENCE OF SURGICAL SITE INFECTION AND DELAYED WOUND HEALING AFTER ELECTIVE ORTHOPAEDIC SURGERIES FOR PATIENTS WITH RHEUMATOID ARTHRITIS WHO TREATED WITH B/TSDMARDS

Background:

In Japan, Methotrexate (MTX) has been approved in 1999, the first biologic DMARD (bDAMRD) in 2003, and the Janus kinase (JAK) inhibitors have been used since 2013. Although it is expected that the recent advancement of drug therapy would contribute the decrease in the incidence of orthopaedic surgeries by preventing structural damages1, 2), we are still facing a considerable number of patients who require surgical interventions3).

Objectives:

To investigate the recent trends of patient’s background who underwent the orthopaedic surgery for rheumatoid arthritis, number of orthopaedic intervention, and the type of the surgery.

Methods:

We reviewed the records of 1569 patients with RA who underwent orthopedic surgeries between 2004 and 2019 in our institution. The mean age of patients was 62.8 (22-88) years-old with disease duration of 20.9 (0.5-64) years. Data of these patients such as age, disease duration, medication (Glucocorticoid; GC, MTX, b/tsDMARD), type of surgeries (total joint replacement; TJR, hand surgery, foot surgery, spine surgery, and others), and preoperative serum CRP level were collected. We analyzed the annual change of these demographic and clinical data. Then, we compared them between CRP negative (<1.5g/l) and CRP positive group. Cochran-Armitage trend test,χ square test, or unpaired T-test was performed for statistical analysis. P <0.05 was considered significant.

Results:

Among all cases, 426 cases (27.2%) were treated with b/tsDMARDs at the time of operation. MTX and GC were used in 937 cases (59.7%) and 1015 cases (64.7%), respectively. The mean age and disease duration of RA showed an increasing trend, although the CRP level was dramatically decreased during the study period. While the rate of MTX use has not changed significantly (p=0.102), the number of cases treated by b/ts DMARD increased significantly to 46.7% (p<0.001). In contrast, the rate of GC use dicreased significantly (p<0.001). Although the annual number of surgeries have not changed, the proportion of cases who performed TJR decreased dramatically (59.6% in 2011, 29.5% in 2019), and the surgeries for hand and foot increased significantly (p<0.001) (Fig 1). The annual mean preoperative CRP level also decreased from 18.8±1.95 to 4.89±0.81 (Fig2). Compared to CRP positive group (n=1,113), the patients in CRP negative group (n=446) showed significantly younger age(p<0.001), shorter disease duration (p=0.031), lower late of GC use, and a higher rate of b/tsDAMRD use. The proportion of patients who underwent TJR was significantly higher in CRP positive group (p<0.001).

Conclusion:

Along with the increasing use of b/tsDMARD, the preoperative disease control of RA, as well as the type of demanded surgeries have dramatically changed.

References:

[1] Yamanaka H, Tanaka E, Nakajima A, et al. A large observational cohort study of rheumatoid arthritis, IORRA: Providing context for today’s treatment options.Mod Rheumatol2020;30:1-6.

[2] Matsumoto T, Nishino J, Izawa N, et al. Trends in Treatment, Outcomes, and Incidence of Orthopedic Surgery in Patients with Rheumatoid Arthritis: An Observational Cohort Study Using the Japanese National Database of Rheumatic Diseases.J Rheumatol2017;44:1575-82.

[3] Momohara S, Tanaka S, Nakamura H, et al. Recent trends in orthopedic surgery performed in Japan for rheumatoid arthritis.Mod Rheumatol2011;21:337-42.

Disclosure of Interests:

Yoshifumi Hotta: None declared, Yoshihisa Nasu: None declared, Keiichiro Nishida Grant/research support from: K. Nishida has received scholarship donation from CHUGAI PHARMACEUTICAL Co., Eisai Co., Mitsubishi Tanabe Pharma and AbbVie GK., Speakers bureau: K. Nishida has received speaking fees from CHUGAI PHARMACEUTICAL Co., Eli Lilly, Janssen Pharmaceutical K.K., Eisai Co. and AYUMI Pharmaceutical Corporation., Minami Matsuhashi: None declared, Masahito Watanabe: None declared, Ryuichi Nakahara: None declared, Toshifumi Ozaki: None declared

SAT0023 THE ROLE OF ADAM12 UPREGULATED PROLIFERATION OF SYNOVIAL MEMBRANE IN RHEUMATOID ARTHRITIS

Background:

ADAM12 is a member of a disintegrin and metalloproteinase family and has been reported to participate in the development of a variety of tumors by degrading ECM and shed precursors, thus promoting cell proliferation, invasion, and metastasis1). Additionally, ADAM12 is involved in chondrocyte differentiation from osteoarthritis (OA) patients by regulation of TGFβ1-induced IGF-1 and RUNX-2 expressions2). However, there is no report on the role of ADAM12 for rheumatoid arthritis (RA).

Objectives:

To investigate the expression and role of ADAM12 in the synovial tissue of RA.

Methods:

(1) The expression of ADAM12 in synovial tissues from RA (18 cases), OA (5 cases) and healthy control (HC) (3 cases) was examined by immunohistochemistry. The synovial tissues of HC were obtained during surgery of hemiarthroplasty for bone tumors. Three researchers evaluated the positive cell ratio. The samples were scored according to the percentage of positive staining: 0 points (weak positive, positive expression was less than 5%), 1 point (moderate positive, positive expression was between 5% and 50%) and 2 points (strong positive, positive expression was greater than 50%). In addition, the samples were scored according to the staining intensity: 0 points (weak intensity), 1 point (moderate intensity) and 2 points (high intensity). (2) The cultured synovial fibroblasts obtained from RA patients at the surgery (RASF) were stimulated by TNFα (1, 5, 10 ng/mL), TGFβ1 (1, 5, 10 ng/mL), PDGF-BB (1, 5, 10 ng/mL) and TNFα+TGFβ1+PDGF-BB (all 10 ng/mL), and the expression levels of ADAM12 relative mRNA was examined by real-time PCR. (3) siADAM12 was transfected in RASF, and the proliferation was examined by WST-1 assay, and the expression of ADAM12 protein was examined by western blotting.

Results:

(1) ADAM12 positive cells were found in synovial lining cells, plasma cells, and vascular endothelial cells. ADAM12 was highly expressed in RA synovial tissues. The immunostaining scores of RA, OA, and HC were 3.9±0.01, 1.9±0.27, and 0.8±0.18, respectively. (2) Stimulation by TNFα, TGFβ1, and PDGF-BB resulted in the upregulation of the expression of ADAM12 relative mRNA in RASF, and TGFβ1 stimulation notably tended to increase the expression by about 5 to 6 times. (3) siADAM12 successfully suppressed the expression of ADAM12 protein and simultaneously suppressed the proliferation of RASF.

Conclusion:

ADAM12 might be involved in the pathogenesis of RA, promoting the cell proliferation of RASF.

References:

[1] Kyeiborg M, Albrechtsen R, Couchman J, et al., Cellular roles of ADAM12 in health and disease, Int J Biochem Cell Biol, 2008

[2] Masahiro H, Keiichiro N, Joe H, et al., Involvement of ADAM12 in Chondrocyte Differentiation by Regulation of TGF-beta1-Induced IGF-1 and RUNX-2 Expressions, Calcif Tissue Int, 2019

Disclosure of Interests:

Masahito Watanabe: None declared, Keiichiro Nishida Grant/research support from: K. Nishida has received scholarship donation from CHUGAI PHARMACEUTICAL Co., Eisai Co., Mitsubishi Tanabe Pharma and AbbVie GK., Speakers bureau: K. Nishida has received speaking fees from CHUGAI PHARMACEUTICAL Co., Eli Lilly, Janssen Pharmaceutical K.K., Eisai Co. and AYUMI Pharmaceutical Corporation., Yoshihisa Nasu: None declared, Ryuichi Nakahara: None declared, Minami Matsuhashi: None declared, Yoshifumi Hotta: None declared, Toshifumi Ozaki: None declared

AB1172 IMPROVEMENT OF DEPRESSION BY JOINT SURGERY IN ESTABLISHED RHEUMATOID ARTHRITIS; RESULTS FROM MULTICENTER PROSPECTIVE COHORT STUDY FOR EVALUATION OF JOINT SURGERY ON PATIENT’S REPORTED OUTCOME

Background:

Total management including reconstructive joint surgery and rehabilitation should be needed for further improvements of physical function for long-standing RA patients. In these days, it is very important to evaluate the effectiveness of joint surgery as well as drug therapy based on patient-reported outcome (PRO)

Objectives:

The purpose of this study is to explore the relationship among depression, clinical variables and other PROs including physical function and to explore whether joint surgery can improve the depression.

Methods:

Multicenter prospective observational cohort study was conducted among patients who underwent elective joint surgery for RA from April 2012 to March 2016 (Study registration: UMIN000012649). In this study, we collected data at baseline and at 6 or 12 months after the surgery. These data were as follow; age, sex, disease duration, drug therapies, and disease activity (DAS), TUG, and patient-reported outcome [HAQ-DI, EQ-5D (QOL), pain and BDI-II (depression)]. Correlation between BDI-II and other variables were determined using multiple liner regression analysis.

Results:

Totally, 346 patients before elective joint surgery were analyzed cross-sectionally. Mean age, disease duration, pain VAS, DAS28, HAQ-DI, EQ-5D and BDI-II were 64.2 years, 17.0 years, 36.2 mm, 3.02, 1.11, 0.641 and 13.0, respectively. 52.6% of elective joint surgeries were in upper limbs and 47.4% were in lower limbs. Multiple liner regression analysis showed that HAQ-DI [B:-0.099 (95%CI:-0.117- -0.08) β:-0.48] pain VAS [B:-0.002 (95%CI:-0.002- -0.001) β:-0.26] and BDI-II [B:-0.003 (95%CI:-0.005- -0.002) β:-0.19] had significant impact on EQ-5D. Furthermore, HAQ-DI [B:3.78 (95%CI:2.54- 5.06) β: 0.33] and pain VAS [B: 0.062 (95%CI: 0.023- 0.101) β 0.17] had significant impact on BDI-II. Especially, walking and eating were independent factors for BDI-II in HAQ-DI categories. These results were confirmed in longitudinal analyses using results from joint surgery in lower limbs (LL; n=138) and upper limbs (UL; n=165), respectively. BDI-II was remarkably improved from 12.1 (mean) to 10.5 in LL and from 14.2 (mean) to 11.9 in UL. Change in HAQ-DI had significant impact on that in BDI-II [LL; B:3.183 (95%CI:0.301- 6.065) β:0.229, and UL; B:2.55 (95%CI:0.19- 4.92) β:0.19] while that in painVAS did not. Especially, the improving in walking category by LL [B:1.38 (95%CI:0.06- 2.70) β:0.18] and in hygiene category by UL [B:2.11 (95%CI:0.79- 3.42) β:0.24] were relevant factors for improving of BDI-II.

Conclusion:

Depression is an important patient-reported outcome for QOL in established RA patients. Improving of physical function with joint surgery in both lower and upper limbs caused improving of depression status. Rheumatologists should take the joint surgery into consideration as effective intervention for treatment of established RA patients with treatment.

Acknowledgments:

This study was funded by a grant from the Ministry of Health, Labour and Walfare (h2424YN002-00) to Naoki Ishiguro.

We thank Drs Tanaka S, Haga N, Yukioka M, Hashimoto J, Miyahara H, Niki Y, Kimura T, Oda H, Funahashi K for their contribution to this study and all medical staff members of each institute for their data collection efforts for their data collection efforts.

Disclosure of Interests:

Toshihisa Kojima Grant/research support from: Chugai, Eli Lilly, Astellas, Abbvie, and Novartis, Consultant of: AbbVie, Speakers bureau: AbbVie, Astellas, Bristol-Myers Squibb, Chugai, Daiichi-Sankyo, Eli Lilly, Janssen, Mitsubishi Tanabe, Pfizer, and Takeda, Masayo Kojima: None declared, Hajime Ishikawa: None declared, Keiichiro Nishida Grant/research support from: K. Nishida has received scholarship donation from CHUGAI PHARMACEUTICAL Co., Eisai Co., Mitsubishi Tanabe Pharma and AbbVie GK., Speakers bureau: K. Nishida has received speaking fees from CHUGAI PHARMACEUTICAL Co., Eli Lilly, Janssen Pharmaceutical K.K., Eisai Co. and AYUMI Pharmaceutical Corporation., Shuji Asai Speakers bureau: AbbVie, Astellas, Bristol-Myers Squibb, Chugai, Daiichi-Sankyo, Eisai, Janssen, Takeda, and UCB Japan, Naoki Ishiguro Grant/research support from: AbbVie, Asahi Kasei, Astellas, Chugai, Daiichi-Sankyo, Eisai, Kaken, Mitsubishi Tanabe, Otsuka, Pfizer, Takeda, and Zimmer Biomet, Consultant of: Ono, Speakers bureau: Astellas, Bristol-Myers Squibb, Daiichi-Sankyo, Eli Lilly, Pfizer, and Taisho Toyama