Evaluation of anti-ribosomal P protein immunoassay in Japanese patients with connective tissue diseases: comparison with an indirect immunofluorescence assay

OBJECTIVES

To investigate the prevalence of anti-ribosomal P protein (anti-P) antibodies in Japanese patients with connective tissue diseases (CTDs) using enzyme-linked immunosorbent assays (ELISAs) and western blotting (WB) and to evaluate the indirect immunofluorescence (IIF) staining patterns of anti-P-positive sera.

METHODS

Anti-P antibodies were measured by two different commercially available ELISA kits and WB in 239 outpatients, 99 with systemic sclerosis (SSc), 73 with systemic lupus erythematosus (SLE), 45 with dermatomyositis (DM), and 22 with Sjögren's syndrome (SjS). Sera positive for anti-P antibodies by WB were analysed by IIF.

RESULTS

The frequency of positive WB findings in SLE (18/73, 25%) was higher than in other diseases. ELISA kits A and B for anti-P antibodies showed 21% and 43% sensitivity, and 93% and 88% specificity, respectively, for diagnosing SLE, based on the manufacturer's cut-off values. Receiver operating characteristic (ROC) curve analysis, based on positive WB findings, determined a new cut-off threshold but revealed that both ELISA kits still had good diagnostic characteristics. In IIF assays on anti-P antibody positive sera, typical anti-P antibody cytoplasmic staining patterns (n=8) were seen less frequently than other staining patterns (n=17).

CONCLUSIONS

Routine screening for anti-P antibodies by IIF has low sensitivity. ELISAs using cut-off values established by individual facilities are suitable for detecting anti-P antibodies and provide a tool with good diagnostic characteristics, on a parity with WB.

Percutaneous radiofrequency lung ablation combined with transbronchial saline injection: an experimental study in swine

To evaluate the efficacy of radiofrequency lung ablation with transbronchial saline injection. The bilateral lungs of eight living swine were used. A 13-gauge bone biopsy needle was inserted percutaneously into the lung, and 1 ml of muscle paste was injected to create a tumor mimic. In total, 21 nodules were ablated. In the saline injection group (group A), radiofrequency ablation (RFA) was performed for 11 nodules after transbronchial saline injection under balloon occlusion with a 2-cm active single internally cooled electrode. In the control group (group B), conventional RFA was performed for 10 nodules as a control. The infused saline liquid showed a wedge-shaped and homogeneous distribution surrounding a tumor mimic. All 21 RFAs were successfully completed. The total ablation time was significantly longer (13.4 +/- 2.8 min vs. 8.9 +/- 3.5 min; P = 0.0061) and the tissue impedance was significantly lower in group A compared with group B (73.1 +/- 8.8 Omega vs. 100.6 +/- 16.6 Omega; P = 0.0002). The temperature of the ablated area was not significantly different (69.4 +/- 9.1 degrees C vs. 66.0 +/- 7.9 degrees C; P = 0.4038). There was no significant difference of tumor mimic volume (769 +/- 343 mm(3) vs. 625 +/- 191 mm(3); P = 0.2783). The volume of the coagulated area was significantly larger in group A than in group B (3886 +/- 1247 mm(3) vs. 2375 +/- 1395 mm(3); P = 0.0221). Percutaneous radiofrequency lung ablation combined with transbronchial saline injection can create an extended area of ablation.

Soy sauce allergy

BACKGROUND

Soy sauce is well-known as a Japanese traditional seasoning, namely shoyu. Usually, shoyu means sauce made from soy. Shoyu does have not only benefits but also adverse effects. Soy sauce allergy which is not caused by soy or wheat allergy is rare.

PATIENTS

Our four patients developed cellulites and dermatitis around lips with irritation after a meal with shoyu. The age of the patients was 10, 35, 46 and 51 years; they were all female.

OBJECTIVES

These inflammations can be developed by two causes; first it can be caused by allergic reactions to shoyu; the second, it can be caused by histamine poisoning. It is important to determine whether inflammation is caused by allergic reactions or histamine poisoning.

METHODS

We determined the volume of histamine in some sauces and performed prick test and laboratory tests.

RESULTS

Four patients had positive reactions by prick test after using some sauces. We suspected that histamine caused their symptoms, but nine normal volunteers had negative reactions. Patient's specific IgE score to soy and wheat was class 0. The results showed that the sauce made from soybean and broad bean contained histamine, but histamine in other sauces was not detected.

CONCLUSIONS

In this study, we confirmed by prick test, four cases of soy sauce allergy, which was caused by some products during brewing. When patients with inflammations around mouth, after a meal containing or using soy sauce, are examined, it should be considered whether dermatitis or cellulites were developed by allergic reaction or by histamine poisoning.

The applicability of chimney grafts in the aortic arch

AIM

Proximal fixation is often limiting for thoracic endovascular aortic repair (TEVAR) and the stent graft may need to cover the origin of the arch branch vessels. Chimney grafts have been proposed to preserve flow into over stented branches during urgent TEVAR. The aim of this report is to share our initial experience of this technique.

METHOD

Eleven patients underwent urgent TEVAR combined with a chimney graft between January 2004 and April 2009. The indications included acute complicated type B dissection (N. = 2), ruptured aneurysms of the aortic arch (1) and descending aorta (2), traumatic aortic transaction (1), aortoesophageal fistula (1) and accidental over stenting of the left carotid artery during TEVAR (4). Chimney grafts were implanted into the innominate (N. = 3), left carotid (7) and left subclavian (1) arteries. Mean length of follow up was 20 months.

RESULTS

All chimney grafts were successfully implanted. Two patients developed a primary proximal type I endoleak: one leak was successfully coil embolized, the other awaits treatment. One paraplegia was reversed by spinal drainage but two months later, this patient presented with a contained rupture and underwent successful conversion to open repair. No other postoperative aneurysm expansion has occurred and the chimney grafts remain patent. The only aneurysm related death occurred in a patient with an unrecognized chronic occlusion of his right carotid artery who received a left carotid chimney graft and suffered from a lethal stroke.

CONCLUSION

Chimney grafts in the supra-aortic branches seem feasible and may facilitate urgent TEVAR in patients with an inadequate proximal neck.

Scoring of reflux symptoms associated with scleroderma and the usefulness of rabeprazole

OBJECTIVE

The high frequency of gastroesophageal reflux disease (GERD) as a complication of scleroderma (systemic sclerosis, SSc) calls for treatment with powerful acid suppressants such as proton pump inhibitors (PPI). The present study used a GERD-specific questionnaire to assess the symptoms of GERD in SSc patients, and examine the effectiveness of rabeprazole (RPZ) for treating the symptoms of GERD.

METHODS

The Frequency Scale for the Symptoms of GERD (FSSG), a medical questionnaire developed in Japan for evaluating GERD, and the Visual Analogue Scale (VAS) were used to evaluate GERD symptoms and the degree of pain, respectively, in 151 SSc subjects. These tools were also used to assess the effect of 8 weeks' treatment with the PPI RPZ (10 mg/day).

RESULTS

Data on age and gender, and FSSG and VAS scores before treatment and after 4 and 8 weeks' RPZ treatment, were available for 84 subjects. The mean FSSG score was 13.9+/-9.7 before treatment, 8.3+/-8.1 after 4 weeks of treatment, and 7.0+/-7.0 after 8 weeks of treatment; the score reduction was significant (p<0.001) indicating the effectiveness of RPZ in improving subjective GERD symptoms. The VAS scores revealed a significant improvement in pain after both 4 and 8 weeks compared with baseline scores. Six subjects experienced adverse effects and five discontinued the analysis during the period.

CONCLUSION

Administration of RPZ 10 mg/day is effective for the control of the symptoms of GERD associated with SSc. In addition to assessing the symptoms of GERD, the FSSG questionnaire can be used to evaluate the therapeutic effect of drugs.

An evaluation of the efficacy of the toe brachial index measuring vascular involvement in systemic sclerosis and other connective tissue diseases

OBJECTIVE

The ankle and toe brachial indices (ABI and TBI) are calculated as the ankle and toe systolic blood pressures divided by the highest brachial systolic pressure, respectively. We sought to evaluate the efficacy of ABI and TBI as an objective, non-invasive assessment of vascular involvement in patients with systemic sclerosis (SSc) and to investigate the clinical significance of TBI in SSc.

METHODS

ABI and TBI were measured using an oscillometric method in 136 outpatients, including 77 with SSc, 29 with systemic lupus erythematosus (SLE), 16 with primary Sjögren's syndrome (SjS), and 14 with dermatomyositis (DM). We also analyzed 21 healthy controls.

RESULTS

The mean ABI and frequency of reduced ABI values (%1.0) did not differ significantly between disease groups. TBI values in patients with SSc and lSSc were significantly lower than in those with SjS and DM, respectively (p%0.01). Patients with SSc and lSSc had significantly lower TBI values than healthy controls (p%0.05). Reduced TBI values (%0.6) were significantly more common in patients with SSc, including both dSSc and lSSc, than in those with SLE (p%0.05). Similarly, the frequency of decreased TBI was higher in patients with SSc and dSSc than in those with SjS or healthy controls (p%0.05). Skin ulcers (p=0.041) or overlap with rheumatoid arthritis (p=0.018) were associated with reduced TBI values by logistic regression analysis.

CONCLUSION

The TBI value is a useful, non-invasive tool to evaluate vascular involvement in SSc.

Predicted trends in the supply and demand of veterinarians in Japan

Currently in Japan, there are 32,000 active veterinarians, mainly engaged in small and large animal practice and public animal health and public health services. In the face of the notable increase in recent years in the proportion of female students enrolled in veterinary schools and in the number of households with companion animals, a model was developed to predict the supply and demand of veterinarians toward 2040 in Japan. Surveys were conducted on sampled households and veterinarians to estimate input variables used in the supply and demand model. From this data it is predicted that there might be somewhere between a shortage of 1,000 to an over-supply of 3,700 veterinarians engaged in small animal practice in 2040. This, however, will depend on possible changes in the number of visits made to veterinarians by small animal owners and the efficiency of practices in the future. The model also predicts that there will be a shortage of around 1,100 veterinarians in large animal practice in 2040. Considering the many assumptions made to estimate the input variables used in the model, the results of this study do not provide definitive conclusions, but provide a base for discussions on what will be needed in the veterinary profession in the future.

High concomitance of disease marker autoantibodies in anti-DFS70/LEDGF autoantibody-positive patients with autoimmune rheumatic disease

Autoantibodies against dense fine speckles 70 (DFS70) are found in 10% of healthy individuals, but only in a tiny population of patients with autoimmune rheumatic disease. The antibody may thus be a marker of autoimmune rheumatic disease negativity. To investigate this possibility, we examined the presence of various disease-marker autoantibodies in anti-DFS70 antibody-positive patients with autoimmune rheumatic disease. Serum samples from 500 patients with various types of autoimmune rheumatic disease were examined for anti-DFS70 antibodies by indirect immunofluorescence and immunoblotting. Various disease-marker autoantibodies were measured by enzyme-linked immunosorbent assay. Twenty-two patients were positive for anti-DFS70 antibodies. Eighteen patients also had disease-marker autoantibodies including anti-double stranded DNA, anti-cardiolipin, anti-SS-A, or other antibodies. In one patient with Sjögren syndrome and two patients with dermatomyositis, no disease-marker antibodies were found; however, one patient with dermatomyositis had a concomitant anti-cytoplasmic antibody. All seven systemic lupus erythematosus patients fulfilled the classification criteria for this disease even if anti-nuclear antibody-positive findings were excluded. One patient with morphea had high-titer anti-single stranded DNA antibody. According to this and previous studies, patients with only anti-DFS70 antibody are rarely diagnosed as having autoimmune rheumatic disease. Recognizing dense fine speckle patterns in anti-nuclear antibodies tests is, thus, very important for analysis of laboratory results in rheumatology clinics.

Anti-cyclic citrullinated peptide antibody in systemic sclerosis

OBJECTIVES

To determine if anti-cyclic citrullinated peptide (anti-CCP) antibody titers can distinguish the overlap syndrome of systemic sclerosis and rheumatoid arthritis (SSc-RA) in patients with systemic sclerosis (SSc) and to investigate the clinical significance of anti-CCP antibodies in SSc.

METHODS

Serum levels of anti-CCP antibodies were measured by enzyme-linked immunosorbent assay in 159 outpatients: 114 with SSc, 14 with rheumatoid arthritis, 7 with SSc-RA overlap syndrome, and 24 with Sjögren's syndrome. In patients with SSc and SSc-RA, we also measured serum levels of matrix metalloproteinase-3 and anti-agalactosyl IgG antibody.

RESULTS

Elevated serum levels of anti-CCP antibodies were observed in 3 of 114 patients (2.6%) with SSc, 9 of 14 patients (64%) with RA, 6 of 7 patients (86%) with SSc-RA, and only 1 of 24 patients (4.2%) with SjS. In patients with SSc-RA, serum anti-CCP antibody levels were significantly higher than those seen in SSc (p<0.001). The sensitivity, specificity, and predictive values of elevated anti-CCP titers for SSc-RA were higher than either matrix metalloproteinase-3 and anti-agalactosyl IgG antibodies as markers. In addition, almost all SSc-RA and SSc patients with elevated serum levels of anti-CCP antibodies exhibited arthralgias and interstitial pneumonia.

CONCLUSIONS

Anti-CCP antibody titers are a reliable marker of SSc-RA facilitating its distinction from SSc alone.

Effect of hyperosmotic stimulation on aquaporins gene expression in chick kidney

Birds can produce hyperosmotic urine, but their renal morphology differs from that of mammals. Recent studies in mammals, suggested that various aquaporins (AQPs) are present in the kidney and play crucial roles in urine production. To elucidate the role of AQPs in the avian kidney, we first examined for the presence of AQP1, 2, 3, 4, 7 and 9 mRNAs in the chick (Gallus gallus) kidney by RT-PCR analysis. Next, we quantified variations of AQPs mRNAs levels in chick kidney after hyperosmotic stimulation (water-deprivation or salt-loading) by real-time RT-PCR analysis. Our study showed that in addition to AQP1, 2, 3, 4 and 7, chick kidney also expressed AQP9 and that hyperosmotic stimulation induced changes in AQPs expression. In particular, water-deprivation increased AQP2 and AQP3 mRNAs levels, whereas salt-loading induced a significant increase in AQP1, AQP2 and AQP9 mRNAs levels. AQP4 and AQP7 mRNA levels were not affected by any hyperosmotic stimulation. Taken together, these results indicated that the presence of AQPs in chick kidney is similar to that in mammals, that the chick kidney has an additional AQP9 and that AQP1, 2, 3 and 9 may play a crucial but different role in water permeability in this organ.

Rescue of Akabane virus (family Bunyaviridae) entirely from cloned cDNAs by using RNA polymerase I

Reverse-genetic systems are often used to study different aspects of the viral life cycle. To date, three rescue systems have been developed for the family Bunyaviridae. These systems use T7 RNA polymerase, which is generally used in rescue systems for Mononegavirales. In the present study, we describe a rescue system for Akabane virus (family Bunyaviridae) that uses cDNAs and RNA polymerase I instead of T7 RNA polymerase. The utility of this system was demonstrated by the generation of a mutant with a deletion of the non-structural protein (NSs) on the S RNA segment. These results offer a new option for bunyavirus rescue.

Validity of positron emission tomography using fluoro-2-deoxyglucose for the preoperative evaluation of endometrial cancer

To clarify the validity of positron emission tomography using fluoro-2-deoxyglucose (FDG-PET) for the preoperative evaluation of endometrial cancer, we analyzed the preoperative FDG-PET images of both primary and metastatic lesions of 30 patients with endometrial cancer, and compared them with computed tomography (CT) and/or magnetic resonance imaging (MRI) images and the results of postoperative pathologic findings. As to the primary lesions, FDG-PET could easily identify the cancer, and the sensitivity was 96.7%, which tended to be higher than that of 83.3% by CT/MRI. As to the evaluation of retroperitoneal lymph node metastasis, FDG-PET could detect none of five cases of lymph node metastatic lesions of up to 0.6 cm in diameter but had higher specificity (100%) compared with CT/MRI (85.7%). The sensitivity of FDG-PET for detection of extrauterine lesions excluding retroperitoneal lymph nodes was 83.3% and was superior to that of CT/MRI (66.7%), although there was no difference in the specificity between the modalities (100%). The diagnostic ability of FDG-PET was limited if used alone, but FDG-PET gave additional information especially with regard to the extrauterine lesions whose significance could not be determined on CT/MRI. However, we also found that FDG-PET could not identify any lymph node metastasis less than 1 cm in diameter; therefore, a negative finding of lymph node metastasis on FDG-PET should not be interpreted as a reason for omitting retroperitoneal lymph node dissection for the precise surgical staging of endometrial cancer.

Results of the Health Assessment Questionnaire for Japanese patients with systemic sclerosis--measuring functional impairment in systemic sclerosis versus other connective tissue diseases

OBJECTIVE

To evaluate the physical functional impairment in patients with systemic sclerosis (SSc) using the Health Assessment Questionnaire (HAQ) and to estimate the correlation of HAQ scores with the severity of SSc.

METHODS

One hundred and twenty-four outpatients with connective tissue disease, including 50 patients with SSc, were evaluated using the HAQ. Twelve patients were classified as having diffuse cutaneous SSc (dSSc) and 38 limited cutaneous SSc (lSSc). The severity classification and the guidelines for treatment (2004) were applied to Japanese SSc patients in order to evaluate the relationship between HAQ scores and disease activity in patients with multiple organ involvement.

RESULTS

In dSSc the HAQ category scores for eating, walking, grip, activity and the HAQ-disability index (HAQ-DI) showed the greatest deficits in all disease groups. The severity of disease activity correlated significantly with the scores for walking, reach, and the HAQ-DI. The severity of joint, heart, and pulmonary hypertension were correlated independently with the HAQ-DI score by multiple linear regression analysis.

CONCLUSION

Patients with dSSc suffer greater functional impairment than patients with other connective tissue diseases, and improvements in hand use and walking represent very important targets for both drug development and rehabilitation. As improvement in organ involvement (joints, heart as well as pulmonary hypertension) can lead to reduced functional impairment, they constitute an important target for therapy in SSc.

Comparison of Akabane virus isolated from sentinel cattle in Japan

Adult cows, ewes, and goats infected with Akabane virus (AKAV) of the genus Orthobunyavirus of the family Bunyaviridae do not present any clinical signs; however, in utero infections may result in abortion, premature birth, stillbirth, and congenital deformities such as arthrogryposis-hydranencephaly syndrome in cattle, sheep, and goats. In contrast, the Iriki strain, a variant of AKAV isolated from a calf with nervous signs and encephalitis, causes encephalitis in experimentally inoculated calves. Two AKAV field isolates, named Okayama2001 and Okayama2004, were isolated from blood specimens of sentinel calves and characterized by cross-neutralization testing, genetic analyses of the S and M RNA segments, and experimental intraperitoneal infection in mice. Although a genetic relationship was established between Okayama2001 and the Iriki strain, their antigenic characteristics differ. Okayama2001 was avirulent in mice, as was the OBE-1 strain, which was isolated from an aborted bovine fetus. In contrast, Okayama2004 was antigenically and genetically related to the OBE-1 strain, but was virulent in mice, similar to the Iriki strain. These results indicate that the isolates mutated antigenically or pathogenically and suggest that AKAV mutates frequently in the field. Although attenuated and inactivated vaccines have been developed for disease prevention, an outbreak may occur due to variant viruses arising from mutation.

Response of Japan to the introduction of exotic animal diseases

The response of Japan to the introduction of exotic animal diseases is used as an example of methods used to control these diseases. Japan had been free from the major animal exotic diseases for many years until outbreaks of foot and mouth disease (FMD) occurred in 2000, highly pathogenic avian influenza (HPAI) in 2004 and bovine spongiform encephalopathy (BSE) was detected in 2001. In spring 2000, four outbreaks of FMD were recorded. In early 2004, four outbreaks of HPAI were recorded. Without resorting to vaccination, both diseases were eradicated in several months through depopulation of infected farms, movement controls, surveillance and other measures. The first case of BSE was detected in September 2001. Since then, 23 additional cases were detected by the end of March 2006, despite a strict ban on the use of meat-and-bone meal for feed and other eradication measures. The authors describe how these diseases occurred or were detected in Japan and discuss how Japan responded to them. Details are given on how they were introduced into Japan, the impact on Japanese farming and society and the lessons learned.

Lactoferrin expression in the canine uterus during the estrous cycle and with pyometra

The expression of lactoferrin, a non-specific antimicrobial defence, in the canine uterus during the normal estrous cycle and in bitches with pyometra was examined. Using polymerase chain reaction analysis, lactoferrin gene transcripts were detected in the endometrium at all stages of the estrous cycle, with the highest levels in estrus. In normal bitches, endometrial lactoferrin mRNA increased from proestrus to estrus (P<0.05). Thereafter, it dramatically decreased from estrus to Day 10 of diestrus (P<0.05), and stayed low at Day 35 of diestrus and anestrus; this was consistent with blood estrogen concentrations. Levels of lactoferrin mRNA were higher in bitches with pyometra than in normal diestrus (P<0.05). With immunohistochemistry, distinct staining of lactoferrin was detected in the luminal and glandular epithelial cells of the endometrium at proestrus and estrus, but little staining was detected at Day 10 of diestrus. At Day 35 of diestrus and anestrus, a partial and weak reaction was present in the same region. In bitches with pyometra, the glandular epithelial cells and many cells in the uterine stroma were strongly stained. Staining cells in the stroma were morphologically similar to neutrophils. No lactoferrin staining was seen in the uterine stromal cells or myometrium in any section. These results suggest that, in the canine uterus, lactoferrin expression is related to the blood concentration of estrogen, and that the dramatic reduction in lactoferrin observed at the early stage of diestrus may impair antimicrobial defense. Also, enhanced expression of lactoferrin mRNA in the endometrium with pyometra may be associated with neutrophil invasion into the uterus to combat the infection.