Ocular Inflammation Associated with Polymyalgia Rheumatica without Concomitant Giant-Cell Arteritis: A Report of Three Cases

PURPOSE

We report three cases of ocular inflammation and polymyalgia rheumatica without concomitant giant-cell arteritis.

METHODS

Report of three cases.

RESULTS

Polymyalgia rheumatica onset was at a mean age of 66.7 years, and ocular inflammation, which developed 7-21 months later, was bilateral in all patients. Ocular inflammation presented as episcleritis, scleritis, or anterior uveitis, and it emerged during the tapering of low-dose prednisolone prescribed for polymyalgia rheumatica in all patients. Recurrence of ocular inflammation was observed in two patients.

CONCLUSIONS

Ocular inflammation associated with polymyalgia rheumatica was often bilateral and occurred during steroid tapering. Although this presentation is relatively uncommon, polymyalgia rheumatica should be considered in the differential diagnosis of older patients presenting with ocular inflammation, especially those with proximal myalgia and elevated inflammatory markers.

Abstract P2-01-20: The non-invasive treatment for sentinel lymph node metastasis by photodynamic therapy using a verteporfin solubilized phospholipid polymer aggregate

Introduction:

Sentinel lymph node biopsy (SLNB) has become a standard procedure for axillary lymph node evaluation in clinically node-negative breast cancer patients. Recent trial suggested that patients with 1or 2 sentinel lymph nodes (SLNs) involvement could be treated with SLNB alone.

Although SLNB is much less invasive procedure comparing with axillary lymph node dissection (ALND), it is still associated with complications such as lymph edema, numbness and pain.

Photodynamic therapy (PDT) against cancer is a non-invasive optical therapeutic method in which the topical or systemic delivery of photosensitizing drugs is followed by its subsequent activation with broadband red light.

In this study, the usefulness of PDT for treating SLN metastasis was evaluated in murine model.

Materials and Methods:

Verteporfin, a hydrophobic photosensitizer (PS) forms a soluble conjugate in aqueous medium with a water-soluble and amphiphilic PMB polymer as a solubilizer. The PMB forms stable and well-dispersed molecular aggregate when its concentration is over 1.0 mg/mL based on the hydrophobic interactions among polymer chains. The verteporfin can form conjugate (PMB-vertepoffin) with hydrophobic domain in the PMB aggregate. The PMB-verteporfin was injected at dorsum manus of BALB/c nude mice. The concentrations of verteporfin in tissues were determined by measuring the fluorescence emitted at 700 nm (with excitation at 430 nm). To develop a murine SLN metastasis model, 5 x 105 human epidermoid carcinoma A431 cells with stable expression of GFP were injected to the forearm of BALB/c nude mice. Seven days after inoculation of cancer cells, 20 μL of PMB-verteporfin was injected at dorsum manus of BALB/c nude mice and 75 J of light energy was delivered using a 640 nm diode laser for a total treatment time of 1 min. Fifty-three mice were randomly assigned to the combination of PMB-verteporfin injection and light exposure (A), light exposure alone (B), PMB-verteporfin injection alone (C), and no treatment (D) groups. Ten days after PDT, brachial lymph nodes, which were considered as SLNs were harvested and evaluated by stereoscopic fluorescence microscope. And, DNA was extracted from harvested lymph node. Human Alu family sequence was detected by 7300 Real Time PCR system (Applied Biosystems, Carlsbad CA USA) to estimate metastatic volume.

Results:

The concentration of verteporfin in SLN was siginificantly higher than other organs including lung, liver, kidney and brachial skin.

The group A significantly reduced the SLN metastasis (13%) comparing with , group B (57%), group C (46%) and group D (52%).

The Ct value in a PCR of the combination of group A (Ct=29.17) significantly reduced the SLN metastasis comparing with group B (Ct=22.45, p=0.018), group C (Ct=25.58, p=0.018) and group D (Ct=25.54, p=0.005).

Conclusions:

These data suggested that PDT using PMB as a nanotransporter of verteporfin could be a minimally invasive treatment of SLN metastasis in breast cancer, and represent a potential alternative procedure to SLNB.

Citation Format: Shimada K, Matsuda S, Jinno H, Konno T, Ito A, Arai T, Ishihara K, Kitagawa Y. The non-invasive treatment for sentinel lymph node metastasis by photodynamic therapy using a verteporfin solubilized phospholipid polymer aggregate [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-01-20.

Abstract P5-02-04: Study on over-diagnosis of high-precision breast cancer screening ∼ Consideration from epidemiological point of view

<Introduction>

In breast cancer screening, it has been attempted to combine US with MMG. For relatively small breasts and dense breasts, there is the opinion that this combination is useful. On the other hand, the problem of over-diagnosis of breast cancer screening has been raised. We've been breast cancer screening with US/MMG combination method since 2005. The results were examined from the epidemiological point of view.

<Subjects and Methods >

Breast cancer discovery rate through US/MMG screening at our facility from 2005 to 2014 was considered. The medical examination was performed on 35,353 women.

Kagawa Prefecture, in which our facility is located has had 100 percent breast cancer registration for more than 10 years. We have compared the breast cancer registration of 2013 with our examination results.

<Results>

Asymptomatic breast cancer detection rate in our breast cancer screening was 0.6%. ４６% of the detected cancer was DCIS. Low-grade DCIS (Van Nuys 1 and 2) accounted for three-quarters of DCIS. In invasive carcinoma, 10 mm or less of luminal A type was 17%, other luminal types 19%, non-luminal types 5% and unclassified 6%. If our facility's highly precise breast cancer medical examination were performed throughout Kagawa Prefecture, DCIS would be found in 860 cases, 10 mm or less of luminal A type found in 276, other luminal type found in 320 and non-luminal type found in 70 cases per year.Compared to the Kagawa Prefecture breast cancer registered in 2013, DCIS was 6.6 times larger than the registered data, 10 mm or less of luminal A 2.9 times larger, other luminal types 1.1 times larger, and non-luminal types 1.2 times larger. The differences between the registered data and our findings for DCIS and 10mm or less of luminal A type are remarkable.

<Conclusion>

With the US/MMG combination method, the detection rate of DCIS and 10 mm or less of luminal A type have been excessive. Many type of DCIS and tiny luminal A type must exist latently. When performing a high-precision breast cancer screening, it is necessary to note such over-diagnosis. Furthermore, it is also necessary to re-examine the pathology diagnostic criteria of DCIS.

Citation Format: Takebe K, Arai T. Study on over-diagnosis of high-precision breast cancer screening ∼ Consideration from epidemiological point of view [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-02-04.

A ruthenium tellurocarbonyl (CTe) complex with a cyclopentadienyl ligand: systematic studies of a series of chalcogenocarbonyl complexes [CpRuCl(CE)(H2IMes)] (E = O, S, Se, Te)

The first tellurocarbonyl complex with a half-sandwich structure [CpRuCl(CTe)(H₂IMes)] was synthesized and compared with its CE (E = O, S, Se) analogs.

Sublingual immunotherapy for allergic rhinitis: subjective versus objective tools to evaluate its success

BACKGROUND

Biomarkers that enable objective evaluation of the clinical effects of immunotherapy for allergic rhinitis have yet to be identified.

METHODS

This study included 40 patients who were enrolled in a large randomized, double-blind, placebo-controlled, multicenter study examining the efficacy of sublingual immunotherapy (SLIT) using Japanese cedar (JC) pollen extract during two consecutive pollen seasons from 2010 to 2012. Based on changes in total nasal symptom medication score, patients in the SLIT and placebo groups were subdivided into two subgroups: good responders and poor responders. The levels of JC pollen-specific IL-10+Foxp3+ cells and specific Th2 cytokine-producing cells were measured and the association with the efficacy of SLIT was analysed.

RESULTS

The total nasal symptom medication score was significantly lower in the SLIT group compared with the placebo group. The number of JC pollen-specific Th2 cytokine-producing cells increased during the pollen season in the placebo group and in poor responders in the SLIT group; however, the increases were inhibited in the good responders in the SLIT group. The number of JC pollen-specific IL-10+Foxp3+ cells increased only in these good responders.

CONCLUSIONS

Changes in levels of allergen-specific Th2 cytokine-producing cells and IL-10+Foxp3+ cells could be objective biomarkers for SLIT.

Synthesis of 2-Butanol by Selective Hydrogenolysis of 1,4-Anhydroerythritol over Molybdenum Oxide-Modified Rhodium-Supported Silica

Rh-MoOx /SiO2 (Mo/Rh=0.13) is an effective catalyst for the hydrogenolysis of 1,4-anhydroerythritol (1,4-AHERY) and provides 2-BuOH in high yield of 51 %. This is the first report of the production of 2-BuOH from 1,4-AHERY by hydrogenolysis. 1,4-AHERY was more suitable as a starting material than erythritol because the 2-BuOH yield from erythritol was low (34 %). Based on the kinetics and comparison of reactivities of the related compounds using Rh-MoOx /SiO2 and Rh/SiO2 catalysts, the modification of Rh/SiO2 with MoOx leads to the high activity and high selectivity to 2-BuOH because of the generation of reactive hydride species and the strong adsorption of 1,4-AHERY on MoOx species. The reaction proceeds by main two routes, (I) the combination of single C-O hydrogenolysis with the desorption of intermediates, a usual route in hydrogenolysis, and (II) multiple C-O hydrogenolysis without the desorption of intermediates from the active site, and the reaction mechanism for Route (II) is proposed.

In vitro investigation of molecules involved in Lactobacillus gasseri SBT2055 adhesion to host intestinal tract components

AIMS

The adhesion ability of Lactobacillus gasseri SBT2055 was investigated in vitro by searching for its adhesion molecules.

METHODS AND RESULTS

Lactobacillus gasseri SBT2055 showed adherence to host components, including two commercially available mucins, Caco-2 epithelial-like cells and the extracellular matrix molecule fibronectin (Fn). Its adhesion rates to host components were generally higher than those of other Lactobacillus strains. We examined sortase-dependent proteins (SDPs) anchored by a sortase enzyme encoded by srtA1. The adhesion rates of an srtA1 disruptant were lower than those of Lact. gasseri SBT2055, and the relative adherences were as follows: two mucins, 43 and 40%; Caco-2, 66% and Fn, 28%. Seven additional gene disruptants were generated to determine the precise SDPs that contribute to adhesion to each component.

CONCLUSIONS

The adhesion ability of Lact. gasseri SBT2055 was superior to those of other Lactobacillus strains. Additionally, four adhesion molecules were newly identified from candidate SDPs.

SIGNIFICANCE AND IMPACT OF THE STUDY

Although the contribution of SDPs to adhesion has been reported using sortase gene disruptants, this is the first report to identify the precise SDPs that act as adhesion molecules. Our results will contribute to achieving better understanding of probiotic bacterial adherence.

Sublingual immunotherapy for allergic rhinitis: subjective versus objective tools to evaluate its success

BACKGROUND

Biomarkers that enable objective evaluation of the clinical effects of immunotherapy for allergic rhinitis have yet to be identified.

METHODS

This study included 40 patients who were enrolled in a large randomized, double-blind, placebo-controlled, multicenter study examining the efficacy of sublingual immunotherapy (SLIT) using Japanese cedar (JC) pollen extract during two consecutive pollen seasons from 2010 to 2012. Based on changes in total nasal symptom medication score, patients in the SLIT and placebo groups were subdivided into two subgroups: good responders and poor responders. The levels of JC pollen-specific IL-10+Foxp3+ cells and specific Th2 cytokine-producing cells were measured and the association with the efficacy of SLIT was analysed.

RESULTS

The total nasal symptom medication score was significantly lower in the SLIT group compared with the placebo group. The number of JC pollen-specific Th2 cytokine-producing cells increased during the pollen season in the placebo group and in poor responders in the SLIT group; however, the increases were inhibited in the good responders in the SLIT group. The number of JC pollen-specific IL-10+Foxp3+ cells increased only in these good responders.

CONCLUSIONS

Changes in levels of allergen-specific Th2 cytokine-producing cells and IL-10+Foxp3+ cells could be objective biomarkers for SLIT.

Abstract P4-03-07: Contribution of high-resolution ultrasonography in the diagnosis of non-palpable breast cancer with calcification

Background: In diagnosis of non-palpable calcificated breast cancer (NPCBC), stereo-guided mammotome (ST-MMT) serves as the standard. However, ultrasound resolution has improved dramatically recently. We hypothesized that through ultrasonography, it will become possible to diagnose NPCBC by US guided examination such as fine needle aspiration cytology (FNAC) and core needle biopsy (CNB) with much less invasion than ST-MMT.

Method: (Study1) The results of ultrasonic detection ability and US guided examination were studied among the benign lesions of 35 cases and 90 NPCBC patients histologically diagnosed in our facilities from 2010 to 2012. Of the 90 histological types, 74 (82%) were DCIS, and 16 (18%) were invasive carcinoma. (Study 2) The results of 193 progress observation cases from 2008 to 2012 with Birads Category 3 and 4a calcification were examined.

Result: (Study1) Using ultrasonography (Toshiba Aprio XG), calcification was detected in 88 of the 90 NPCBC lesions as echogenic foci. Two non-detectable lesions were DCIS of Van Nuys 1 and Van Nuys 2. The results of the FNAC were 80% positive and 20% indeterminate (there were no negative cases). In the 88 cases of possible calcified substance extracted through FNAC, 99% were confirmed under microscopic observation. (Study 2) 163 of 193 cases were able to be followed-up every six months for two to four years. An increase in calcification was observed in nine cases. Five of these cases were diagnosed with DCIS: Four were Van Nuys 1; one was Van Nuys 2. All five cases were of low-grade-malignancy.

Conclusion: The diagnostic method using FNAC to visualize calcification using high-resolution ultrasonography is an effective method to reduce the non-efficient, invasive breast cancer detecting method of ST-MMT. The diagnostic method is particularly useful in women of small breast size in Asian countries. The few low-grade DCIS cases included were not detected with ultrasound. However, we believe it is not a diagnostic error. As a result, we stopped using the ST-MMT from 2010. In spite of this, in the MMG screening performed in our facilities from 2010 to 2012, the detection rate of NPCBC without mass on MMG was 0.17 %. This detection rate is excellent in our country.

Citation Format: Arai T, Takebe K. Contribution of high-resolution ultrasonography in the diagnosis of non-palpable breast cancer with calcification. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-03-07.

Talaporfin sodium binding and photocytotoxicity of photosensitization reaction on myocardial cell under various albumin concentrations and temperature

To understand the efficiency change of the extracellular photosensitization reaction by the external factor in myocardium interstitial space, we studied the efficiency change of the extracellular photosensitization reaction caused by talaporfin sodium binding with serum proteins under various serum proteins concentrations and temperature conditions. Talaporfin sodium Q band absorbance was measured with various albumin concentrations and the cell survival rate was measured by WST assay in the same conditions. The talaporfin sodium binding ratio with albumin, high-density lipoprotein, and low-density lipoprotein were measured by talaporfin sodium absorbance measurement after the ultrafiltration. The albumin concentration affects the photocytotoxicity strongly when the albumin concentration was over 2.1 mg/ml in the case of the extracellular photosensitization reaction. It would be useful to measure the peak wavelength in Q band absorbance was suggested to know the albumin concentration and the photocytotoxicity efficiency to realize the safety treatment. The binding ratios with high-density lipoprotein and low-density lipoprotein were decreased with the solution temperature rise from 17°C to 37 °C and the photocytotoxicity was increased with temperature rise from 17°C to 37°C involving this binding ratio change. It would be important to maintain the target organ temperature during the photosensitization reaction to keep the photosensitization reaction efficiency.

Drug delivery of anti-restenosis agent by 40 - 60°C heating to porcine aortic smooth muscle cells in vitro

We investigated the uptake of anti-restenosis agent in vascular smooth muscle cells with heating observing the fluorescence intensity of Oregon green labeled paclitaxel in vitro. The heating temperature to porcine aortic smooth muscle cells was varied from 40 to 60°C in 5 s in order to simulate laser-mediated short-duration heating balloon. The cells were contacted with the agent from 1 to 30 min in 37°C after the heating. We measured the agent uptake characteristics on agent concentration and duration in 37°C as a reference. The uptake of the agent in the cells increased with increasing of both the concentration around the cells and contact duration in the case of 37°C. When the cells were heated with 40°C in 5 s and then contacted with the agent in 30 minutes, the uptake of the agent in the cells significantly increased. The uptake of the agent with 50°C or 60°C in 5 s did not show any increasing. We prospected that 40°C heating to the smooth muscle cells would promote the agent uptake ability of the cells because of homeostasis of the cells.

Prognostic impact of lymph node metastasis in distal cholangiocarcinoma

BACKGROUND

The aim of the study was to investigate the prognostic impact of lymph node metastasis in cholangiocarcinoma using three different classifications.

METHODS

Patients who underwent pancreaticoduodenectomy for distal cholangiocarcinoma in 24 hospitals in Japan between 2001 and 2010 were included. Survival was calculated by means of the Kaplan-Meier method and differences between subgroups were assessed with the log rank test. The Cox proportional hazards model was used to identify independent predictors of survival. χ(2) scores were calculated to determine the cut-off value of the number of involved nodes, lymph node ratio (LNR) and total lymph node count (TLNC) for discriminating survival.

RESULTS

Some 370 patients were included. The median (range) TLNC was 19 (3-59). Nodal metastasis occurred in 157 patients (42·4 per cent); the median (range) number of involved nodes and LNR were 2 (1-19) and 0·11 (0·02-0·80) respectively. Four or more involved nodes was associated with a significantly shorter median survival (1·3 versus 2·2 years; P = 0·001), as was a LNR of at least 0·17 (1·4 versus 2·3 years; P = 0·002). Involvement of nodes along the common hepatic artery, present in 21 patients (13·4 per cent), was also associated with a shorter survival (median 1·3 versus 2·1 years; P = 0·046). Multivariable analysis among 157 node-positive patients identified the number of involved nodes as an independent prognostic factor (risk ratio 1·87; P = 0·002).

CONCLUSION

The number of involved nodes was a strong predictor of survival in patients with distal cholangiocarcinoma.

Origin of the tetragonal-to-orthorhombic phase transition in FeSe: a combined thermodynamic and NMR study of nematicity

The nature of the tetragonal-to-orthorhombic structural transition at T_{s}≈90  K in single crystalline FeSe is studied using shear-modulus, heat-capacity, magnetization, and nuclear magnetic resonance measurements. The transition is shown to be accompanied by a large shear-modulus softening, which is practically identical to that of underdoped Ba(Fe,Co)_{2}As_{2}, suggesting a very similar strength of the electron-lattice coupling. On the other hand, a spin-fluctuation contribution to the spin-lattice relaxation rate is only observed below T_{s}. This indicates that the structural, or "nematic," phase transition in FeSe is not driven by magnetic fluctuations.

Immediate response and cytotoxicity effect on myocardial cells by extracellular photosensitization reaction varying irradiance

We investigated the extracellular photosensitization effect on myocardial cells using talaporfin sodium at various irradiance measuring cell lethality dependence on talaporfin sodium concentration and immediate response of intracellular Ca(2+) as a fundamental study of the application for tachyarrhythmia treatment. The myocardial cell lethality was measured 2 h after the photosensitization reaction by WST assay varying the irradiance from 0.12 to 0.66 W/cm(2). The intracellular Ca(2+) of myocardial cell was observed during and until 10 min after the extracellular photosensitization reaction using fluo-4 AM and a confocal microscope varying the irradiance. The linear increasing behavior of the myocardial cell lethality with talaporfin sodium concentration was similarly obtained in the case of 0.12 and 0.29 W/cm(2) in irradiance. The photocytotoxicity was not obtained in the case of 0.46 and 0.66 W/cm(2) in irradiance. The time response of necrosis occurrence after the beginning of the extracellular photosensitization reaction was decreased with the irradiance increasing. We prospect that it may be caused by oxygen depletion in our in vitro system using 96 well plate since the irradiance and talaporfin sodium concentration were higher comparing the in vitro conditions of the general PDT for cancer.