Morphologic changes in hepatitis virus-related liver cirrhosis: Relationship to hemodynamics of portal vein on dynamic contrast-enhanced CT

INTRODUCTION

The morphologic changes in the compensated stage of liver cirrhosis (cLC) are not diffuse atrophic changes. With cLC lobar or segmental changes combined with atrophy of the right lobe and medial segment together with hypertrophy of the caudate lobe and lateral segment are commonly seen. The purpose of this study was to evaluate the morphologic changes in hepatitis virus-related liver cirrhosis in relationship to haemodynamics of the portal vein on dynamic contrast-enhanced computed tomography (DCE-CT) METHODS: This study included 72 patients, 46 with hepatitis virus-related cirrhosis and 26 with a normally functioning liver, who underwent DCE-CT. In cirrhosis patients, the morphologic change index (MCI) of the liver was calculated and categorised into two groups, high-MCI (MCI ≥ 0.4) (n = 21) and low-MCI (MCI < 0.4) (n = 25). Cross-sectional areas of the main, right and left portal veins and the intra-portal distribution from splenic venous flow were evaluated for their relationships with the MCI and compared among three groups (normal-control, low MCI and high MCI).

RESULTS

There was a significant difference in the cross-sectional area of the left portal vein between the high-MCI group and the low-MCI group (p = 0.013) and the control group (p = 0.008). A significant correlation was identified between the cross-sectional area of the left portal vein and the MCI (r = 0.508, p < 0.001).

CONCLUSION

Cross-sectional area of the left portal vein may be a factor related to morphologic changes in hepatitis virus-related liver cirrhosis and could be a possible index of the left portal venous flow volume.

IMPLICATIONS FOR PRACTICE

This study may be useful for predicting the degree of hepatic morphologic changes and the condition of cirrhosis in association with regional hepatic morphologic changes.

Measuring mineralised tissue formation and resorption in a human 3D osteoblast-osteoclast co-culture model

In vitro tissue engineered bone constructs have been developed, but models which mimic both formation and resorption in parallel are still lacking. To be used as a model for the bone remodeling process, the formation and resorption of mineralised tissue volume over time needs to be visualised, localised and quantified. The goal of this study was to develop a human 3D osteoblast-osteoclast co-culture in which 1) osteoblasts deposit mineralised matrix, 2) monocytes differentiate into resorbing osteoclasts, and 3) the formation and resorption of mineralised matrix could be quantified over time using micro-computed tomography (μCT). Mesenchymal stromal cells were seeded on silk fibroin scaffolds and differentiated towards osteoblasts to create mineralised constructs. Thereafter, monocytes were added and differentiated towards osteoclasts. The presence of osteoblasts and osteoclasts was confirmed using immunohistochemistry. Osteoclastic activity was confirmed by measuring the increased release of osteoclast marker tartrate resistant acid phosphatase (TRAP), suggesting that osteoclasts were actively resorbing mineralised tissue. Resorption pits were visualised using scanning electron microscopy. Mineralised matrix formation and resorption were quantified using μCT and subsequent scans were registered to visualise remodelling. Both formation and resorption occurred in parallel in the co-culture. The resorbed tissue volume exceeded the formed tissue volume after day 12. In conclusion, the current model was able to visualise, localise and quantify mineralised matrix formation and resorption. Such a model could be used to facilitate fundamental research on bone remodeling, facilitate drug testing and may have clinical implications in personalised medicine by allowing the use of patient cells.

Frequency of cardiac arrhythmias in older adults: findings from the subclinical atrial fibrillation and risk of ischemic stroke (SAFARIS) study

Background

Prolonged monitoring of cardiac rhythm has been used in patients with symptomatic arrhythmias and to assess for atrial fibrillation (AF) after cryptogenic stroke, but not in the general population and especially in older adults.

Purpose

To evaluate the frequency of arrhythmias in a community-based cohort of older adults through 14-days continuous cardiac monitoring using a patch-based device.

Methods

Cardiac rhythm was analyzed in 533 participants free of AF and congestive heart failure (CHF) from the tri-ethnic (white, black, Hispanic) Subclinical Atrial Fibrillation and Risk of Ischemic Stroke (SAFARIS) study. AF, supraventricular tachycardia (SVT, defined as 4 beats or more), premature atrial (PACs) and ventricular (PVCs) contractions, ventricular tachycardia (VT, defined as 4 beats or more), sinus pauses (SP) and atrio-ventricular blocks (AVB) were analyzed. Gender, age and race-ethnic differences were examined.

Results

Mean age was 77.2±6.8 years (198 men, 335 women). Recording duration was over 10 days in 91%, and over 13 days in 84%. AF was present in 10 participants (1.9%), atrial flutter in 1 (0.2%). Other arrhythmias are reported in the Table. SP (1.9%) and high-degree AVB (Mobitz II: 0.6%; 3rd degree: 0.9%) were rare. No significant race-ethnic differences were observed.

Conclusion

In older adults without history of stroke or CHF, prolonged rhythm monitoring revealed moderate frequency of AF, but higher than expected frequencies of AF-predisposing conditions such as SVT and frequent PACs. VT episodes were relatively frequent, whereas SP and AVB were less frequent than commonly believed. Most arrhythmias were more frequent in the oldest; ventricular arrhythmias were more common in men than in women.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): NINDS R01 NS083874

Usefulness of lead delivery catheter system for true right ventricular septal pacing

Background

Right ventricular (RV) septal pacing is often selected to preserve a more physiologic ventricular activation. But the pacing leads are not always located in true septal wall, rather in hinge or free wall in some cases with the conventional stylet-guided lead implantation. In recent years, new guiding catheter systems has attracted attention as a solution to that problem.

Objective

The aim of this study is to investigate that true ventricular sepal pacing can be achieved by use of the new guiding catheter system for pacing lead.

Methods

We enrolled 198 patients who underwent RV septal lead implantation and computed tomography (CT) after pacemaker implantation. 16 cases were used delivery catheter (Delivery), and 182 cases were used stylet for targeting ventricular septum (Conventional). We analyzed the lead locations with CT, and evaluated capture thresholds, R-wave amplitudes, lead impedances and 12-lead electrocardiogram findings one month after implantation.

Results

All cases of delivery catheter group had true septal lead positions (Delivery; 100% vs Conventional; 44%, p&lt;0.01). Capture thresholds and lead impedances had not significant differences between between two groups (0.65±0.15V vs 0.60±0.15V, p=0.21, 570±95Ω vs 595±107Ω, p=0.39, respectively). R-wave amplitudes were significantly higher in delivery catheter group (13.0±4.8mV vs 10±4.6mV, p&lt;0.01). Paced QRS durations were shorter in delivery catheter group (128±16ms vs 150±21ms, p&lt;0.01).

Conclusions

The delivery catheter system designated for pacing lead can contribute to select the true ventricular septal sites and to attain the more physiologic ventricular activation.

Funding Acknowledgement

Type of funding source: None

Chronotropic incompetence and exercise capacity after mitral valve surgery: the importance of blood hemoglobin level

Background

Chronotropic incompetence (CI) is sometimes observed during exercise training of cardiac rehabilitation in patients with cardiac surgery, however, little is known concerning the differences between patients with mitral valve (MV) and aortic valve (AV) surgery.

Purpose

Because the possibility exists that cardiac sympathetic nerves might be impaired by left atrium incision, we hypothesized that the incidence of CI was higher in patients with MV surgery (Mitral Valve Replacement and Mitral Valvuloplasty) as compared with patients with AV surgery (Aortic Valve Replacement). And if so, which factor determines the exercise capacity of patients after MV surgery. We thus aimed this study to elucidate the hypothesis with cardiopulmonary exercise testing (CPX).

Methods

We performed CPX by ramp loading with ergometer exercise in total 61 patients who had undergone elective cardiac valve operation (25 patients with MV surgery, age 59.2±9.9 years; 36 patients with AV surgery, age 64.6±12.3 years). We analyzed chronotropic response index (CRI), peak oxygen uptake (peak VO2/W), anaerobic threshold (AT), and peak oxygen pulse (peak VO2/HR) with CPX, and blood hemoglobin concentration (Hb).

Results

The value of CRI was significantly decreased in the patients with MV surgery compared with those with AV surgery (MV; 0.19±0.10 vs. AV; 0.41±0.17, p&lt;0.001). Peak VO2, peak VO2/HR and Hb were not significantly different between patients with MV and those with AV surgery. Patients with MV surgery showed correlations between peak VO2 and Hb (r=0.45, p&lt;0.05), AT and Hb (r=0.52, p&lt;0.01), and a strong correlation between peak VO2 and peak VO2/HR (r=0.63, p&lt;0.001), but not in those with AV surgery.

Conclusions

The present study demonstrated that higher incidence of CI was shown in patients with MV surgery as compared with those with AV surgery. The exercise capacity of patients with MV surgery was determined by peak VO2/HR and Hb. These results suggest that 1) left atrium incision impairs cardiac sympathetic nerves and causes CI, 2) peak VO2/HR which is consisted of arterio-venous oxygen difference and Hb is critical indicator for exercise capacity in patients with MV surgery with CI.

Main results

Funding Acknowledgement

Type of funding source: None

Adipose extracellular signal-regulated kinase 2 protected from endothelial dysfunction and the oxidative stress of perivascular adipose tissue in obese mice

Introduction

Extracellular signal-regulated kinase (ERK) modulates differentiation and maturation of adipocyte and the hypertrophy and differentiation of adipocytes affected the vascular diseases in obese. Changes in characters of adipocytes could develope the oxidative stress and inflammations. Moreover, changes in perivascular adipose tissue (PVAT) could modulate vascular tonus in obesity. However, the role of adipose ERK2 in endothelial function and characters of PVAT in obese in vivo had not been clarified, yet.

Purpose

This study aims to elucidate the role of the adipose ERK2 in endothelial-dependent relaxation (EDR) in mice model of obesity. The role of PVAT in EDR was also assessed.

Methods and results

We created adipose-specific ERK2 knock out mice (AE2KO) by crossing fatty acid binding protein 4 Cre and ERK2 flox mice and fed them with normal diet (ND) or high fat/ high sucrose diet (HFHSD) for 24 weeks. AE2KO fed with HFHSD gained more weight and revealed the heterogeneity in sizes of adipocyte in subcutaneous fat (SF). Furthermore, the mRNA levels of lipoprotein lipase, hormone-sensitive lipase, and peroxisome proliferator-activated receptor γ, which was the master genes of adipocyte differentiation, were markedly down-regulated in SF. PVAT in AE2KO with HFHSD was markedly enlarged and the mRNA expression of inflammatory adipocytokines, such as IL-1β and leptin were up-regulated. Next, we assessed EDR by acetylcholine (ACh) -induced relaxation in aortic rings with or without PVAT. EDR without PVAT was modestly decreased in AE2KO with HFHSD compared with wild type mice (WT) with HFHSD. Aortic rings with PVAT increased EDR in WT with ND. PVAT modestly decreased EDR in WT with HFHSD and mostly eliminated EDR in AE2KO with HFHSD. To assess the contraction factors released from PVAT, the solutions incubated with PVAT (SIP) were transferred to the normal aortic rings. SIP from WT with HFHSD mildly increased vascular tone and SIP from AE2KO with HFHSD further increased it. Tempol, which was superoxide scavenger, restored endothelial dysfunction with PVAT and suppressed the contraction with SIP from AE2KO with HFHSD. Fluorescence intensity of dihydroethidium stain of aorta and PVAT, which indicated that aortic and adipose superoxide production were elevated in AE2KO with HFHSD, which were mostly eliminated with tempol.

Conclusions

Adipose ERK2 selectively modulated differentiation in SF, suppressed the aortic oxidative stress and protected from endothelial dysfunction in obese. Moreover, adipose ERK2 suppressed the hypertrophy, inflammation, and oxidative stress of PVAT in obese. The oxidative stress with the inflammation in PVAT released vasoconstriction factors, which contributed to endothelial dysfunction in obese mice.

Figure 1

Funding Acknowledgement

Type of funding source: None

The performance of resurfacing implants for focal cartilage defects depends on the degenerative condition of the opposing cartilage

BACKGROUND

Non-degradable resurfacing implants are being developed for treatment of focal cartilage defects. Performance of these implants has been investigated opposing intact cartilage. This study investigates whether implants would perform equally well when the opposing cartilage is fibrillated.

METHODS

Human osteochondral strips (~2x1x1 cm) with a smooth (n = 9) or fibrillated (n = 17) cartilage surface were obtained from human tibial plateaus excised during total knee arthroscopy. A custom-made pin-on-plate sliding indenter was used to apply simultaneous compression (0.75-3 MPa) and movement (4 mm/s over 6 mm). Either metal implants, polycarbonate-urethane or healthy porcine osteochondral plugs with a diameter of 6 mm were used as indenter.

FINDINGS

Cartilage roughness of the osteochondral strips was significantly higher for the fibrillated than the smooth group prior to sliding-indentation. Roughness of the indenters was not significantly altered by sliding indentation using either smooth or fibrillated cartilage. For all but one sample, sliding of smooth cartilage against any of the indenter surfaces did not cause damage. However, samples with fibrillated cartilage showed varied responses from seemingly unaffected to severe tissue wear as quantified by analysis of Indian ink staining and histology.

INTERPRETATION

This study demonstrates that the opposing cartilage quality is relevant for the clinical success of implanting an artificial implant in a focal cartilage defect. Therefore it is essential to test the efficacy of newly developed implants against arthritic joint surfaces, and care should be taken when interpreting in vivo studies in which implants are inserted in healthy joints.

Cryoneurotomy in the management of intractable trigeminal neuralgia

In this paper we describe the effects of peripheral cryoneurotomy on a consecutive series of patients with intractable trigeminal neuralgia (TN) who had been treated by a single surgeon over a ten-year period. The results of 55 patients who underwent a total of 102 cryoneurotomies were documented. The age at first cryofreeze was 64 (30-92) years with 24 males and 31 females. Thirty-five had primary TN and 20 secondary TN. The first cryofreeze resulted in 28.2 (5-144) pain free months. Twenty-nine had a second freeze which lasted 34 (2-100) pain-free months and 13 had a third cryofreeze which lasted 26 (1-108) pain free months. Two patients had further freezes. Thirty-four of the primary TN patients had prolonged freedom from pain with one dying perioperatively. The 20 patients with secondary TN had shorter period of pain relief (p<0.05) and one committed suicide. The procedure of peripheral cryoneurotomy is recommended for older, unwell patients with primary TN that is refractory to medical or neurosurgical treatments. It is less effective for dysaesthesia secondary to traumatic nerve injuries.

Diagnostic Value of Model-Based Iterative Reconstruction Combined with a Metal Artifact Reduction Algorithm during CT of the Oral Cavity

BACKGROUND AND PURPOSE

Metal artifacts reduce the quality of CT images and increase the difficulty of interpretation. This study compared the ability of model-based iterative reconstruction and hybrid iterative reconstruction to improve CT image quality in patients with metallic dental artifacts when both techniques were combined with a metal artifact reduction algorithm.

MATERIALS AND METHODS

This retrospective clinical study included 40 patients (men, 31; women, 9; mean age, 62.9 ± 12.3 years) with oral and oropharyngeal cancer who had metallic dental fillings or implants and underwent contrast-enhanced ultra-high-resolution CT of the neck. Axial CT images were reconstructed using hybrid iterative reconstruction and model-based iterative reconstruction, and the metal artifact reduction algorithm was applied to all images. Finally, hybrid iterative reconstruction + metal artifact reduction algorithms and model-based iterative reconstruction + metal artifact reduction algorithm data were obtained. In the quantitative analysis, SDs were measured in ROIs over the apex of the tongue (metal artifacts) and nuchal muscle (no metal artifacts) and were used to calculate the metal artifact indexes. In a qualitative analysis, 3 radiologists blinded to the patients' conditions assessed the image-quality scores of metal artifact reduction and structural depictions.

RESULTS

Hybrid iterative reconstruction + metal artifact reduction algorithms and model-based iterative reconstruction + metal artifact reduction algorithms yielded significantly different metal artifact indexes of 82.2 and 73.6, respectively (95% CI, 2.6-14.7; P < .01). The latter algorithms resulted in significant reduction in metal artifacts and significantly improved structural depictions(P < .01).

CONCLUSIONS

Model-based iterative reconstruction + metal artifact reduction algorithms significantly reduced the artifacts and improved the image quality of structural depictions on neck CT images.

Prevention of dental caries by eating vegetables at the beginning of a meal in Japanese children

Backgrounds

Dental caries is still a worldwide serious problem among children. Previous studies showed that higher consumption of vegetables prevents dental caries. Eating order habits, such as eating vegetables at the beginning of a meal, called “Vege-first”, may increase the amount of vegetable consumption, and in turn, prevent dental caries. We used cross-sectional data in our previous study to show the association between “Vege-first” and dental caries. However, the causal relationship of “Vege-first” on dental caries is not clear. The aim of this study to investigate the effect of “Vege-first” on dental caries, using cohort data of Japanese elementary students.

Methods

We used cohort data from 2015 to 2016 by the Adachi Child Health Impact of Living Difficulty (A-CHILD) study, a population-based study of all first- and Second- grade students in Adachi City, Tokyo, Japan. The number of DMFT (decayed, missed due to decay, and filled teeth) in 2016 was used as an outcome. Poisson regression analyses were applied to determine the independent association between keeping the “Vege-first” habit over one year and the number of DMFT in 2016 after controlling for the effects of a child's sex, parental marital status, socioeconomic status, and child's dental caries status in 2015.

Results

Of 3,164 valid participants, 45.0% had dental caries and 6.3% kept the “Vege-first” habit. Children who kept the “Vege-first” habit had fewer DMFTs in 2016 than children who did not (p &lt; 0.001). After controlled for covariates, children with having a continuous “Vege-first” habit were still significantly and independently decreased the number of DMFT in 2016 (Incidence-rate ratios=0.87 (95% confidential interval [0.75-0.98])).

Conclusions

This study showed that having the continuous “Vege-first” habit was associated with preventive dental caries even after accounting for socioeconomic status. Health policy introducing the “Vege-first” habit may be effective to prevent pediatric dental caries.

Key messages

The practice of eating vegetables at the beginning of a meal, called “Vege-first” may increase vegetable consumption and reduce dental caries. The continuous habit of 'Vege-first' was effective in preventing a child’s dental caries even if after accounting for socioeconomic status.

1320Effectiveness of atrial flutter ablation line selection using SOUNDSTAR catheter

Background

Cavotricuspid isthmus (CTI) ablation for atrial flutter (AFL) shows a high success rate and effective for patients. However, operators experience difficulties in CTI ablation in some cases and need additional ablation for repeated recurrence. We investigated whether the SOUNDSTAR® (Biosense. Webster, Diamond Barr, CA, USA) catheter would be effective to select a CTI line of high therapeutic effect.

Methods

We have investigated the anatomy of around CTI by SOUNDSTAR® catheter and decided the CTI line using the anatomical information in AFL ablation (Figure1). We assumed two CTI lines of medial and lateral line. Medial CTI (M-CTI) line was more common and shorter line. Lateral CTI (L-CTI) line was uncommon and slightly longer line. We use 3.5mm tip catheter with NxT steerable introducer. The target Ablation Index (AI) was 400, and the target VisTtag™ interval was 6 mm or less.

Results

A total 30 of AFL ablated cases were investigated retrospectively. We surveyed 15 cases in M-CTI group and 15 cases in L-CTI group. Comparing the length of CTI in all cases, the length of M-CTI line was shorter than L-CTI line (M-CTI 32.1 ± 6.6mm vs. L-CTI 38.4 ± 8.3mm, n = 30, p &lt;0.01). The atrial wall thickness of midsection and tricuspid valve (TV) side were thicker in M-CTI line (Midsection: M-CTI 4.0 ± 1.2mm vs. L-CTI 3.3 ± 0.8mm, n = 30, p &lt;0.05, TV side: M-CTI 5.4 ± 1.4mm vs. L-CTI 4.3 ± 1.1mm, n = 30, p &lt;0.05,). There was no difference in the required number of points to complete initial line (M-CTI 8.4 ± 1.6 vs. L-CTI 8.1 ± 1.7, n = 15, ns). Eustachian ridge in IVC side was thicker and higher in the M-CTI group (3.4 ± 3.3mm vs. 0.9 ± 1.9mm, n =30, p &lt;0.01) and ablation on the Eustachian ridge showed instability of catheter placement. A lot of RF delivery was required on Eustachian ridge in M-CTI (2.6 ± 0.6 vs. 2.1 ± 0.7, n =15, p &lt;0.05) and AI had resulted lower in M-CTI (351 ± 42.8 vs. 381 ± 27.1, n =15, p &lt;0.05). Recurrence is more common in M-CTI group (9/15, 60% vs. 3/15, 20%). Recurrence sites in M-CTI group were distributed ((IVC side 3/9 (33%), midsection 5/9 (56%), TV side 5/9 (56%)) and multiple recurrences occurred in 3/9 (33%). Recurrence sites in L-CTI were only midsection of CTI (3/3, 100%).

Conclusions

CTI ablation at the shorter distance M-CTI, which is commonly selected, resulted in more recurrences due to the unevenness including Eustachian ridge and the myocardium thickness. However, ablation at slightly longer L-CTI line showed lower recurrence and effective for CTI ablation.

Abstract Figure 1

739SERCA2 Cys674 modification lead to ventricular arrhythmia due to impaired sarcoplasmic reticulum Ca2+ handling

Background

Sarcoplasmic reticulum Ca2+-ATPase2 (SERCA2) plays an important role in intracellular Ca2+ handling. Under pathological conditions, oxidative stress leads to irreversible oxidation of Cys674 on SERCA2 which causes intracellular Ca2+ overload. Intracellular Ca2+ overload is known as the cause of ventricular arrhythmia, but the relation between SERCA2 function and ventricular arrhythmia remains unclear.

Purpose

To investigate the role of Cys674 on SERCA2 in the intracellular Ca2+ handling and the induction of ventricular arrhythmia.

Methods

We employed SERCA2 Cys674Ser heterozygote knock-in mice (SKI) which mimics oxidative modification of Cys674 on SERCA2. Continuous infusion of angiotensin (ANG) (3mg/kg/day) or distilled water were performed both in wild type mice (WT) and SKI for a week. After 1 week, electrophysiological study and intracellular Ca2+ transient measurement were performed.

Results

ANG elevated blood pressure and represented cardiac hypertrophy with fibrosis similarly both in WT and SKI. The mRNA expression of calcium/calmodulin-dependent protein kinase-II (CaMKII), ryanodine receptor (RyR) and sodium-calcium exchanger (NCX) was increased in SKI heart compared with WT. QTc interval was prolonged in SKI compared with WT, which was markedly prolonged with ANG infusion. Under programmed electrical stimulation, only SKI with ANG showed high incidence of pacing induced ventricular arrhythmia (0/11 in WT/SKI control, 0/14 in WT with ANG vs. 8/14 in SKI with ANG, P &lt; 0.01). In Ca2+ transient measurement, the peak Ca2+ transient amplitude (F/F0) was decreased (WT: 1.81 vs. SKI: 1.46, P &lt; 0.01) and the time to 50% of cytosolic Ca2+ extrusion (T50) was prolonged (WT: 152.6ms vs. SKI: 202.3ms, P &lt; 0.05) in SKI with ANG, suggesting decreased sarcoplasmic reticulum Ca2+ content and impaired SERCA2 activity in SKI with ANG. Intraperitoneal administration of dantrolene sodium (DAN) which inhibit Ca2+ leakage from RyR receptor normalized decreased F/F0 and prolonged T50 in SKI with ANG (Fig. 1 A, B). DAN also prevented QTc prolongation and decreased the incidence of ventricular arrhythmia in SKI with ANG (8/14 in SKI with ANG vs. 2/13 in SKI with ANG + DAN, P &lt; 0.05) (Fig. 2).

Conclusions

The loss of thiol on Cys674 under pathological condition resulted in impaired Ca2+ handling and high incidence of ventricular arrhythmia which were ameliorated by inhibition of Ca2+ leakage through RyR. Oxidative modification of Cys674 on SERCA2 might contribute to Ca2+ mishandling and arrhythmogenesis.

Abstract Figure.

FRI0166 HIGH FREQUENCY OF KIDNEY STONES AND/OR NEPHROCALCINOSIS IN PRIMARY SJOGREN’S SYNDROME MIGHT ACCELERATE CHRONIC RENAL DYSFUNCTION DUE TO TUBULOINTERSTITIAL DISEASE

Background:

The renal involvement of primary Sjögren’s syndrome (pSS) is characterized by distal renal tubular acidosis (RTA), tubulointerstitial nephritis (TIN), and/or glomerulonephritis [1,2]. Kidney stones and nephrocalcinosis are presumably caused by subclinical distal tubular acidosis, but its clinical significance has not been clarified.

Objectives:

This study aimed to clarify the frequency and clinical features of patients with pSS with kidney stones and/or nephrocalcinosis.

Methods:

We examined 59 patients with anti SS-A/Ro positive pSS who underwent abdominal computed tomography and/or ultrasound between 1998 and 2019 at Kanazawa University Hospital. We identified 2 groups of patients with primary Sjögren’s syndrome: 1) patients with kidney stones and/or nephrocalcinosis (group A: n=19) and 2) those without kidney stones and/or nephrocalcinosis (group B: n=40), and retrospectively analyzed their clinical features.

Results:

Kidney stones and/or nephrocalcinosis were confirmed in 19 of 59 (32%) patients with pSS. The patients comprised 4 males and 55 females with an average age of 60 years (range, 30 to 83 years) and mean observation period of 96 months (range 1 to 336 months). Estimated glomerular filtration rate (eGFR) at the time of diagnostic imaging (group A vs group B: 71.5 ml/min/1.73 m2vs 82.8 ml/min/1.73 m2; p=0.37) and eGFR at last follow up (group A vs group B: 59.3 ml/min/1.73 m2vs 74.7 ml/min/1.73 m2;p=0.03) of group A were lower than those of group B and urinary β2-microgloblin (group A vs group B: 7222 μg/mL vs 437 μg/mL; p=0.01) and urinary N-acetyl-β-D-glucosaminidase (group A vs group B: 5.8 U/L vs 3.9 U/L; p=0.22) of group A were higher than those of group B, while serum electrolytes (sodium, potassium, chloride, calcium, phosphorus), fractional excretion of calcium (group A vs group B: 1.2% vs1.5%; p=0.916), ESSDAI (group A vs group B: 7.6 vs 4.3; p=0.069), and eGFR decrease rate were not significantly different.

Conclusion:

32% patients with anti SS-A/Ro positive pSS had kidney stones and/or nephrocalcinosis in our cohort and their presence might accelerate chronic renal dysfunction due to tubulointerstitial disease (subclinical RTA or TIN).

References:

[1]Jain A et al. Renal involvement in primary Sjogren’s syndrome: a prospective cohort study. Rheumatol Int 2018; 38: 2251-62.

[2]Jasiek M et al. A multicentre study of 95 biopsy-proven cases of renal disease in primary Sjögren’s syndrome. Rheumatology 2017; 56: 362-70.

Acknowledgments:

We thank Mr. John Gelblum for critical reading of the manuscript.

Disclosure of Interests:

None declared

SAT0532 POSITIVE DISEASE-SPECIFIC AUTOANTIBODIES LOWER DIAGNOSTIC SENSITIVITY BUT HAVE LITTLE CLINICAL SIGNIFICANCE IN DIAGNOSING IgG4-RELATED DISEASE USING THE 2019 ACR/EULAR CLASSIFICATION CRITERIA IN DAILY CLINICAL PRACTICE

Background:

Recently, the 2019 ACR/EULAR classification criteria for IgG4-related disease (IgG4-RD) were published mainly to identify more homogeneous subjects for inclusion in clinical trials and observational studies [1]. However, although their high specificity is presumed to be useful to differentiate IgG4-RD from various mimickers, their value in daily clinical practice needs to be evaluated.

Objectives:

This study aimed to clarify the usefulness of the 2019 ACR/EULAR classification criteria for IgG4-RD and characteristics of false-negative patients in daily clinical practice.

Methods:

We retrospectively reviewed the medical records of 162 patients with IgG4-RD and 130 consecutive non-IgG4-RD patients (mimickers) diagnosed by experts whose serum IgG4 levels were measured at a single center in Japan. Using the collected data, we calculated sensitivity, specificity, and fulfillment rates for the entry criteria, exclusion criteria, and threshold of inclusion criteria points. In addition, to clarify the characteristics of false-negative cases in IgG4-RD, we performed an intergroup comparison of their clinical features including disease-specific autoantibodies.

Results:

Both the patients with IgG4-RD and mimickers were relatively old (66 and 65 years) with male predominance (67% and 60%). The final diagnoses of mimickers mainly consisted of cancer, lymphoma, vasculitis, sarcoidosis, multicentric Castleman’s disease, and atherosclerotic or infectious aortic aneurysm. The classification criteria had a sensitivity of 72.8% and a specificity of 100%. Of the 44 false-negative cases, one did not fulfill the entry criteria, 20 fulfilled one exclusion criterion, and 27 did not achieve sufficient inclusion criteria points. Compared with the true-positive cases, the false-negative cases had significantly fewer affected organs, lower serum IgG4 levels, higher serum CH50 levels, and lower prevalence of salivary/lacrimal gland and renal parenchymal lesions. They were also less likely to have had biopsies (61% vs 97%). Of note, positivity of disease-specific autoantibodies including SSA/Ro antibody, ANCA, ds-DNA antibody, and ACPA was the most common exclusion criterion fulfilled in 18 patients, only 2 of whom were diagnosed with a specific autoimmune disease (rheumatoid arthritis) complicated by IgG4-RD. The remaining 16 patients had no specific clinical symptoms related to such autoantibodies. In addition, compared with IgG4-RD patients without disease-specific autoantibodies, the 18 patients with them had almost equal serum IgG4 and complement levels, number of affected organs, and histopathology and immunostaining scores despite higher serum IgG and CRP levels.

Conclusion:

The present study suggests that the 2019 ACR/EULAR classification criteria for IgG4-RD has excellent diagnostic specificity and moderate sensitivity in daily clinical practice. Positive disease-specific autoantibodies alone, which lowered the sensitivity in this study, may have little clinical significance concerning the diagnosis of IgG4-RD.

References:

[1]Wallace ZS et al. The 2019 American College of Rheumatology/European League Against Rheumatism classification criteria for IgG4-related disease. Ann Rheum Dis. 2020 Jan;79(1):77-87.

Disclosure of Interests:

None declared

0491 Changes in Insomnia Symptoms are Associated with Improvements in Chronic Pain

Introduction

Depression and anxiety is known to associated with insomnia. Chronic pain is also well known to be associated with insomnia. However, relationship among insomnia and anxiety and depression is not well understood. Here We conducted a retrospective cohort study whether improvement insomnia could affect chronic pain release.

Methods

Patients with chronic pain suffering for more than three months, who first visited in our pain management clinic in Shiga University of Medical Science, Otsu, Japan during 09/25/2013-01/26/2017, were included in this study. Patients were asked to complete the same questionnaire at their first visit and six-month later.We designate pain release as 30% and over improvement in numerical rating scale (NRS) for pain release.We define improvement insomnia as subjects with Athene insomnia scale (AIS) ≥6 at the first visit became AIS &lt;6 six-month later.We also evaluated patients’ psychotic conditions by Questionnaires for anxiety and depression: HADS (Anxiety and depression) and PCS (Pain Catastrophizing score) for negative cognition, respectively. We conducted logistic regression analysis as for dependent variable was pain release.

Results

Characteristics data: n=47, mean age: 53.53±15.45, male rate: 45%, BMI: 22.81±3.49, NRS: 5.45±1.85, AIS: 8.94±2.73, HADSA: 6.04±2.57, HADSD: 6.06±2.64, PCS: 30.70±8.70, housemate rate: 81%, more than junior college graduated level: 53%, employment rate: 62%, annual income over 4oo million yen /year: 62%, antidepressant use; 26%, benzodiazepine use:11%.Logistic Regression odds ratio (OR) with 95% confidence intervals (95%CI) for relationship of improvement insomnia and not with chronic pain were unadjusted OR: 3.600 (95%CI: 1.007-12.865) and adjusted OR: 3.078 (95%CI 0.779-12.161) (adjust for PCS.)

Conclusion

We showed improvement in insomnia can affect pain release in the pain therapy, and PCS improvement may be also association with chronic pain release.

Support