Differential activation of chicken gamma delta T cells from different tissues by Toll-like receptor 3 or 21 ligands

Gamma delta (γδ) T cells are highly enriched in mucosal barrier sites including intestinal tissues where microbial infections and tumors often originate in mammals. Human γδ T cells recognize stress antigens and microbial signals via their T cell receptor (TCR), natural killer (NK) receptors, and pattern recognition receptors. However, little is known about antigens or ligands capable of stimulating chicken γδ T cells. The results of the present study demonstrated that polyinosinic-polycytidylic acid (poly(I:C)), a Toll-like receptor (TLR)3 ligand, significantly induced upregulation of CD8α molecules on circulating and lung γδ T cells. Moreover, poly(I:C) stimulation induced interferon (IFN)-γ production from splenic and lung CD8α⁺ γδ T cells while Cytosine-phosphate-Guanine oligodeoxynucleotides (CpG-ODN) 2007, a TLR21 ligand, stimulation induced IFN-γ production by circulating γδ T cells. Neither poly(I:C) nor CpG-ODN 2007 stimulation elicited degranulation of γδ T cells. Additionally, the results revealed that CpG-ODN 2007 induced IFN-γ production from TCR-stimulated γδ T cells sorted from spleen. In our experiments, isopentenyl pyrophosphate (IPP), 4-hydroxy-3-methyl-but-2-enyl pyrophosphate (HMBPP), or zoledronate (Zol) stimulation did not induce IFN-γ production or degranulation in γδ T cells. Taken together, a combination of CpG-ODN 2007 and anti-CD3ε monoclonal antibodies (mAbs) can stimulate chicken γδ T cells and induce production of IFN-γ by these cells while IFN-γ production by γδ T cells induced by stimulation of poly(I:C) needs signals from other cells. These results suggest that chicken γδ T cells can sense invading pathogens via TLRs and produce IFN-γ as a first line of defense.

Genomic characterization of a fowl adenovirus serotype 4 strain isolated from a chicken with hydropericardium syndrome in Japan

Here, we report the genomic characterization of a fowl adenovirus serotype 4 strain isolated from a chicken with hydropericardium syndrome in Japan. The viral genome of FAdV-4 strain JP/LVP-1/96 was found to be 45,688 bp long. Amino acid substitutions at position 219 (G to D) in the fiber-2 protein and at position 188 (I to R) in the hexon protein, which are commonly found in virulent FAdV-4 strains, were also found in the JP/LVP-1/96 strain. Additional specific amino acid substitutions commonly found in virulent FAdV-4 strains were found in ORFs 4 and 43, which are present only in members of the species Fowl adenovirus C. Phylogenetic analysis based on complete hexon protein gene sequences showed that strain JP/LVP-1/96 belongs to a different genetic cluster from the strains circulating in neighboring countries.

Genetic Analysis of Avian Reovirus Isolated from Chickens in Japan

Sigma C protein-coding sequences have been used to phylogenetically classify avian reovirus (ARV) strains. However, the relationship between serotype and phylogenetic cluster classification of the five prototype serotype strains of ARV in Japan has not been established. Thus, we used sigma C protein-coding sequences to characterize avian reoviruses (ARVs) isolated from chickens with tendonitis in Japan together with the five prototype serotype strains of ARV in Japan. Phylogenetic analysis of ARVs based on the sigma C protein-coding sequences revealed that the five prototype serotype strains of ARV were each classified into different, independent clusters. Two field isolates (JP/Tottori/2016 and JP/Nagasaki/2017) that were isolated from chickens with arthritis/tenosynovitis were classified into different clusters. JP/Tottori/2016 was classified into cluster VI with the CS-108 strain, and JP/Nagasaki/2017 was classified into cluster I with strain TS-142. Serologically, JP/Tottori/2016 was well-neutralized by antisera against the CS-108 strain, whereas JP/Nagasaki/2017 cross-reacted with antisera against both the CS-108 and TS-142 strains. Embryo lethality test revealed that the two field isolates induced 80% and 67% embryo mortality, respectively, whereas the five prototype strains induced 0%-33% embryo mortality. Our findings will contribute to understanding the characteristics of ARV strains in Japan.

Fowl Adenoviruses Type 8b Isolated from Chickens with Inclusion Body Hepatitis in Japan

Fowl adenovirus (FAdV) type 8b isolated from chickens with inclusion body hepatitis (IBH) in Japan from 2018 to 2019 were characterized serologically and genetically. Serologically, all isolates were well neutralized by antisera against the FAdV-8b strain, but they were not neutralized by antisera against the FAdV-8a strain. Phylogenetic analysis of the part of the hexon protein gene that includes the L1 region revealed that these isolates were all identical. They were also identical to foreign strains such as the SD1356 strain isolated in China and belonged to FAdV-8b. Furthermore, the 2018-19 Japanese IBH 8b isolates were genetically identical to the SD1356 strain by phylogenetic analysis of fiber genes, but they were different from previous Japanese 8b strains. These findings suggest that the 2018-19 Japanese IBH isolates might have been introduced from other countries.

Immunity against a Japanese local strain of porcine reproductive and respiratory syndrome virus decreases viremia and symptoms of a highly pathogenic strain

Background

The type 2 highly pathogenic porcine reproductive and respiratory syndrome virus (HP-PRRSV) has spread throughout countries of southeast Asia, where it has caused severe economic losses. Even countries presently free of PRRSV are at high risk for infection and spread of this virus. Some of these countries, including Japan, have broad epidemics of the local type 2 PRRSV, creating chronic pathogenicity in the domestic pig population. The present study aimed to evaluate the protective efficacy of immunity by infection with a Japanese field isolate, EDRD1, against heterologous challenge with a Vietnamese HP-PRRSV field strain. To this end, four groups of PRRSV-negative crossbreed piglets were used for a challenge study. Groups 1 and 2 were inoculated with EDRD1 via the intranasal route. After 26 days, Groups 2 and 3 were inoculated with HP-PRRSV via the same route. Group 4 served as an uninfected control. Blood and oral fluid samples were taken every 3–4 days after HP-PRRSV challenge; on day 16 post-challenge, all pigs were euthanized, and examined pathologically.

Results

The nucleotide sequence analysis of nonstructural protein 2 gene of EDRD1 and comparison with Vietnamese HP-PRRSV showed that the 39 amino acid deletion sites of EDRD1 was nearly in the same region as the 29 amino acid deletion sites of HP-PRRSV. Immunity conferred by inoculation with EDRD1 dramatically reduced viral load in the sera and tissues besides viral shedding (Group 2) compared with those in pigs infected only with HP-PRRSV (Group 3). The clinical signs and rectal temperature were significantly reduced, and the average daily weight gain was significantly improved in the EDRD1-inoculated pigs (Group 2) compared with the Group 3 pigs. Notably, no viral RNA was detected in various organs of the Group 2 pigs 16 days post-infection with HP-PRRSV, except in one pig. Therefore, the immunity induced by EDRD1 and its genetically close field isolates may play a role in reducing viremia caused by HP-PRRSV.

Conclusions

The results of the present study demonstrate that pigs are highly protected against heterologous Vietnamese HP-PRRSV challenge by immunity against a Japanese local strain, EDRD1.

A potential system for the isolation and propagation of porcine deltacoronavirus using embryonated chicken eggs

Porcine deltacoronavirus (PDCoV) is a novel swine enteropathogenic coronavirus that leads to acute diarrhea/vomiting, dehydration, and mortality in seronegative neonatal piglets. As widely known, attempts to culture porcine enteropathogenic coronaviruses, such as PDCoV and porcine epidemic diarrhea virus, in cells have been proven to be difficult. This study aimed to establish an efficient and cost-effective culture system for PDCoV using embryonated chicken eggs (ECEs) to enable future vaccine production and efficient virus isolation from infected animals. The inoculation of samples into the allantoic cavity of 3- to 7-day-old ECEs yielded efficient virus propagation even from porcine fecal samples. Virus propagation in 2- and 8-day-old ECEs were confirmed in 30.0 % and 11.1 % of the samples, respectively. This indicates that susceptible cells rapidly develop in 2-day-old ECEs and differentiate to mature cells that are nonsusceptible to PDCoV in 8-day-old layer chicken ECEs. Furthermore, our study demonstrated that PDCoV can be passaged in 6-day-old ECEs with high viral replicative efficiency. This technique for propagating PDCoV using ECEs is a powerful tool that could be utilized for PDCoV vaccine development and virus isolation from poultry, livestock, and wild animals.

Genotyping of infectious bronchitis viruses isolated in Japan during 2008-2019

Seventeen isolates of infectious bronchitis virus (IBV) were obtained from various prefectures of Japan during 2008-2019 and genetically analyzed. The IBV isolates were classified into six genetic groups, based on phylogenetic analysis of the S1 gene. The S1 genotypes were distinguishable by a newly developed restriction fragment length polymorphism (RFLP) method using three endonucleases, Hae II, Hpa I, and Fok I. Moreover, the isolates were classified into four genetic groups, based on phylogenetic analysis of the S2 gene. However, novel genetic groups based on a combination of S1 and S2 genotypes, which were undetected previously, were confirmed in this study, indicating that various recombinant IBV strains were prevalent in poultry in Japan.

Identification of specific serotypes of fowl adenoviruses isolated from diseased chickens by PCR

We have developed a polymerase chain reaction (PCR) assay to facilitate detection of the major disease-associated serotypes of fowl adenovirus (FAdV) including serotypes 1, 2, 4, 8a and 8b; primers were designed based on serotype-specific sequences of the hexon gene. We tested field isolates from chickens diagnosed with inclusion body hepatitis, gizzard erosion and hydropericardium syndrome together with reference FAdV strains characterized in Japan. We found that the primers were serotype specific; appropriate amplification of serotype-specific hexon genes was confirmed by sequence analysis of the PCR products. This PCR assay will be useful for detection of FAdV and for differentiation between disease-associated serotypes.

Studies on heterologous protection between Japanese type 1 and type 2 porcine reproductive and respiratory syndrome virus isolates

The objective of the present study was to evaluate the cross-protective immunity between type 1 and type 2 porcine reproductive and respiratory syndrome virus (PRRSV) isolates in growing pigs. Japanese type 1 PRRSV, first isolated from a pig with respiratory disorders in a farm in 2009, exhibits unique genetic characteristics. The pathogenicity of a Japanese standard strain of type 2 PRRSV, EDRD1, in pigs immunized by the type 1 PRRSV isolate, Jpn EU 4-37 was determined by evaluating clinical signs, viremia, antibody response, and pathological lesions. Similarly, we evaluated the pathogenicity of Jpn EU 4-37 in pigs immunized by EDRD1 and compared the cross-protective immunity between these isolates. The EDRD1 challenge after Jpn EU 4-37 inoculation reduced viral clearance and shedding in pigs, compared to those treated with the EDRD1 single infection. On the other hand, the pathogenicity of Jpn EU 4-37 after EDRD1 infection did not differ significantly compared to non-immunized pigs treated with Jpn EU 4-37. Therefore, exposure to Jpn EU 4-37 could not induce enough immunity to reduce the viremia against subsequent infection by type 2 PRRSV. However, the immunity induced by Jpn EU 4-37 infection may play a role in reducing viremia caused by type 2 PRRSV. Moreover, the immunity induced by the EDRD1 and other genetically related viruses, which are broadly distributed in Japan, may not contribute to cross-protection against Jpn EU 4-37 as an emerging virus.

STMO-06 SMART CYBER OPERATING THEATER REALIZED BY INTERNET OF THINGS - RESULTS OF CLINICAL STUDY FOR 56 CASES

PURPOSE

Unlike conventional operating rooms that provide a sterilized space, we have developed a Smart Cyber Operating Theater (SCOT) in which the room itself performs treatment as a single medical device. We report the clinical results of 3 types of SCOT.

METHODS

Basic SCOT packaged with intraoperative MRI (0.4Tesla) was introduced in Hiroshima University in 2016. Standard SCOT networked with middleware OPeLiNK was introduced to Shinshu University in 2018, and Hyper SCOT introduced to Tokyo Women’s Medical University in 2019.

RESULTS

The average of all 56 patients was 44 years old. There were 38 brain tumors (68%), 11 functional diseases (19%), and 7 orthopedic diseases (13%). Basic SCOT is used for 41 cases (/56; 73%) with 22 gliomas, 10 epilepsies, 7 bone tumors, and 2 benign brain tumors. Standard SCOT with 20 networked devices is used for 14 cases (/56; 25%) with 6 gliomas including brain stem and thalamus, 6 pituitary tumors and 2 benign brain tumors. The strategy desk can display a variety of digital data synchronized in time, and the review and comment functions also operate. It is useful for remote advice through mutual communication via strategy desk. Hyper SCOT was used in February 2019 for the first case (1/56 cases; 2%). MRI images were taken with an average of 1.3 shots with good image quality. For 46/56 neoplastic lesions (82%), additional removal of residual tumor was performed in 31/46 cases (67%), and 26/46 cases (57%) were totally removed, with an average removal rate of 89.2%. There was no reoperation (0%) within 1 month in all cases.

CONCLUSIONS

Three types of SCOT contributed to planned surgical outcome including maximal tumor resection without serious related complications. We will proceed with verification of clinical effects, and develop robotized devices, and utilize AI for strategy desk at Hyper SCOT.

Transitions in morphological forms and rapid development of the asexual schizonts of Eimeria tenella through serial passaging in chicks

Attenuated strains of avian Eimeria parasites, generated by the selection of precocious lines through serial passaging in chicks, have been used widely as live vaccines. Detailed morphological transitions including their life cycle depending on the passages remain poorly understood. Here, we showed early development and acceleration of transitions in morphological forms of the asexual schizonts of E. tenella that had been attenuated for virulence by serial passaging. Our results may be helpful in understanding parasitism, facilitating further molecular analyses such as comparative genomic or transcriptomic tests.

Sonodynamic Therapy With Anticancer Micelles and High-Intensity Focused Ultrasound in Treatment of Canine Cancer

Sonodynamic therapy (SDT) is a minimally invasive anticancer therapy involving a chemical sonosensitizer and high-intensity focused ultrasound (HIFU). SDT enables the reduction of drug dose and HIFU irradiation power compared to those of conventional monotherapies. In our previous study, mouse models of colon and pancreatic cancer were used to confirm the effectiveness of SDT vs. drug-only or HIFU-only therapy. To validate its usefulness, we performed a clinical trial of SDT using an anticancer micelle (NC-6300) and our HIFU system in four pet dogs with spontaneous tumors, including chondrosarcoma, osteosarcoma, hepatocellular cancer, and prostate cancer. The fact that no adverse events were observed, suggests the usefulness of SDT.

Integrated datasets of normalized brain with functional localization using intra-operative electrical stimulation

PURPOSE

The purpose of this study was to transform brain mapping data into a digitized intra-operative MRI and integrated brain function dataset for predictive glioma surgery considering tumor resection volume, as well as the intra-operative and postoperative complication rates.

METHODS

Brain function data were transformed into digitized localizations on a normalized brain using a modified electric stimulus probe after brain mapping. This normalized brain image with functional information was then projected onto individual patient's brain images including predictive brain function data.

RESULTS

Log data were successfully acquired using a medical device integrated into intra-operative MR images, and digitized brain function was converted to a normalized brain data format in 13 cases. For the electrical stimulation positions in which patients showed speech arrest (SA), speech impairment (SI), motor and sensory responses during cortical mapping processes in awake craniotomy, the data were tagged, and the testing task and electric current for the stimulus were recorded. There were 13 SA, 7 SI, 8 motor and 4 sensory responses (32 responses) in total. After evaluation of transformation accuracy in 3 subjects, the first transformation from intra- to pre-operative MRI using non-rigid registration was calculated as 2.6 ± 1.5 and 2.1 ± 0.9 mm, examining neighboring sulci on the electro-stimulator position and the cortex surface near each tumor, respectively; the second transformation from pre-operative to normalized brain was 1.7 ± 0.8 and 1.4 ± 0.5 mm, respectively, representing acceptable accuracy.

CONCLUSION

This image integration and transformation method for brain normalization should facilitate practical intra-operative brain mapping. In the future, this method may be helpful for pre-operatively or intra-operatively predicting brain function.

Role of photodynamic therapy using talaporfin sodium and a semiconductor laser in patients with newly diagnosed glioblastoma

OBJECTIVE

In this study on the effectiveness and safety of photodynamic therapy (PDT) using talaporfin sodium and a semiconductor laser, the long-term follow-up results of 11 patients with glioblastoma enrolled in the authors' previous phase II clinical trial (March 2009-2012) and the clinical results of 19 consecutive patients with newly diagnosed glioblastoma prospectively enrolled in a postmarket surveillance (March 2014-December 2016) were analyzed and compared with those of 164 patients treated without PDT during the same period.

METHODS

The main outcome measures were the median overall survival (OS) and progression-free survival (PFS) times. Moreover, the adverse events and radiological changes after PDT, as well as the patterns of recurrence, were analyzed and compared between the groups. Kaplan-Meier curves were created to assess the differences in OS and PFS between the groups. Univariate and multivariate analyses were performed to identify the prognostic factors, including PDT, among patients with newly diagnosed glioblastoma.

RESULTS

The median PFS times of the PDT and control groups were 19.6 and 9.0 months, with 6-month PFS rates of 86.3% and 64.9%, respectively (p = 0.016). The median OS times were 27.4 and 22.1 months, with 1-year OS rates of 95.7% and 72.5%, respectively (p = 0.0327). Multivariate analyses found PDT, preoperative Karnofsky Performance Scale score, and IDH mutation to be significant independent prognostic factors for both OS and PFS. Eighteen of 30 patients in the PDT group experienced tumor recurrence, including local recurrence, distant recurrence, and dissemination in 10, 3, and 4 patients, respectively. Conversely, 141 of 164 patients in the control group experienced tumor recurrence, including 101 cases of local recurrence. The rate of local recurrence tended to be lower in the PDT group (p = 0.06).

CONCLUSIONS

The results of the present study suggest that PDT with talaporfin sodium and a semiconductor laser provides excellent local control, with few adverse effects even in cases of multiple laser irradiations, as well as potential survival benefits for patients with newly diagnosed glioblastoma.

Development concepts of a Smart Cyber Operating Theater (SCOT) using ORiN technology

Currently, networking has not progressed in the treatment room. Almost every medical device in the treatment room operates as a stand-alone device. In this project, we aim to develop a networked operating room called “Smart Cyber Operating Theater (SCOT)”. Medical devices are connected using Open Resource interface for the Network (ORiN) technology. In this paper, we describe the concept of the SCOT project. SCOT is integrated using the communication interface ORiN, which was originally developed for industry. One feature of ORiN is that the system can be constructed flexibly. ORiN creates abstracts of the same type of devices and increases the robustness of the system for device exchange. By using ORiN technology, we are developing new applications, such as decision-making navigation or a precision guided treatment system.

Imaging of Intracranial Gliomas

Combined use of contemporary radiological modalities, particularly integration of structural, metabolic, and functional imaging, provides optimal multifaceted information for detailed characterization of intracranial gliomas. It allows differentiation of the tumor from non-neoplastic pathology, its non-invasive histopathological typing and grading, prediction of patient prognosis and clinical course of the disease, detailed planning of surgical resection or biopsy, critical postoperative assessment of the residual lesion, effective surveillance during follow-up with evaluation of effectiveness of the adjuvant therapy and timely identification of recurrence, and even insights into molecular signatures of the neoplasms. Therefore, advanced neuroimaging is one of the most important cornerstones of the modern neuro-oncology.

Sonodynamic Therapy Based on Combined Use of Low Dose Administration of Epirubicin-Incorporating Drug Delivery System and Focused Ultrasound

Sonodynamic therapy (SDT) is currently considered as one of the promising minimally invasive treatment options for solid cancers. SDT is based on the combined use of a sonosensitizer drug and high-intensity focused ultrasound (HIFU) to produce cytotoxic reactive oxygen species (ROS) in and around neoplastic cells. Anthracycline drugs, including epirubicin (EPI), have been well known as effective sonosensitizers after interaction with focused ultrasound. Recently a new anticancer drug delivery system (DDS), NC-6300, has been developed that comprises EPI through an acid-labile hydrazone bond. In previous in vivo studies, NC-6300 showed basic drug safety and an excellent concentration property of EPI, and recently has been tested in clinical trials. For realizing minimally invasive cancer treatment, the present study demonstrated the effectiveness and feasibility of DDS-based SDT, which combined a small dose of NC-6300 and low energy of HIFU in mouse models of colon cancer and pancreatic cancer.

Threshold of the extent of resection for WHO Grade III gliomas: retrospective volumetric analysis of 122 cases using intraoperative MRI

OBJECTIVE WHO Grade III gliomas are relatively rare and treated with multiple modalities such as surgery, chemotherapy, and radiotherapy. The impact of the extent of resection (EOR) on improving survival in patients with this tumor type is unclear. Moreover, because of the heterogeneous radiological appearance of Grade III gliomas, the MRI sequence that best correlates with tumor volume is unknown. In the present retrospective study, the authors evaluated the prognostic significance of EOR. METHODS Clinical and radiological data from 122 patients with newly diagnosed WHO Grade III gliomas who had undergone intraoperative MRI-guided resection at a single institution between March 2000 and December 2011 were analyzed retrospectively. Patients were divided into 2 groups by histological subtype: 81 patients had anaplastic astrocytoma (AA) or anaplastic oligoastrocytoma (AOA), and 41 patients had anaplastic oligodendroglioma (AO). EOR was calculated using pre- and postoperative T2-weighted and contrast-enhanced T1-weighted MR images. Univariate and multivariate analyses were performed to evaluate the prognostic significance of EOR on overall survival (OS). RESULTS The 5-, 8-, and 10-year OS rates for all patients were 74.28%, 70.59%, and 65.88%, respectively. The 5- and 8-year OS rates for patients with AA and AOA were 72.2% and 67.2%, respectively, and the 10-year OS rate was 62.0%. On the other hand, the 5- and 8-year OS rates for patients with AO were 79.0% and 79.0%; the 10-year OS rate is not yet available. The median pre- and postoperative T2-weighted high-signal intensity volumes were 56.1 cm³ (range 1.3-268 cm³) and 5.9 cm³ (range 0-180 cm³), respectively. The median EOR of T2-weighted high-signal intensity lesions (T2-EOR) and contrast-enhanced T1-weighted lesions were 88.8% (range 0.3%-100%) and 100% (range 34.0%-100%), respectively. A significant survival advantage was associated with resection of 53% or more of the preoperative T2-weighted high-signal intensity volume in patients with AA and AOA, but not in patients with AO. Univariate analysis showed that preoperative Karnofsky Performance Scale score (p = 0.0019), isocitrate dehydrogenase 1 ( IDH1) mutation (p = 0.0008), and T2-EOR (p = 0.0208) were significant prognostic factors for survival in patients with AA and AOA. Multivariate analysis demonstrated that T2-EOR (HR 3.28; 95% CI 1.22-8.81; p = 0.0192) and IDH1 mutation (HR 3.90; 95% CI 1.53-10.75; p = 0.0044) were predictive of survival in patients with AA and AOA. CONCLUSIONS T2-EOR was one of the most important prognostic factors for patients with AA and AOA. A significant survival advantage was associated with resection of 53% or more of the preoperative T2-weighted high-signal intensity volume in patients with AA and AOA.

Genomic sequence and virulence evaluation of MN184A-like porcine reproductive and respiratory syndrome virus in Japan

In this study, a porcine reproductive and respiratory syndrome virus (PRRSV) that was isolated from a 9-week-old diseased pig on a farm in Japan with a high mortality rate during 2007-2008 was characterized. This unique isolate, designated as Jpn5-37, did not have a high nucleotide identity in open reading frame 5 against any Japanese isolates. Among all available type 2 PRRSV complete genome sequences, Jpn5-37 shared the highest nucleotide identity (93.6%) with virulent strain MN184A. The genomic characteristics of Jpn5-37 were highly conserved with respect to the virulent MN184A, including a continuous eight amino acid deletion in the nonstructural protein 2 region. Moreover, virus distribution, viremia and the gross and microscopic characteristics of lesions were investigated in pigs 10 days post-inoculation to elucidate the pathogenicity of the isolate. Intranasal inoculation was found to rapidly result in viremia and dissemination of the Jpn5-37 isolate to several tissues in a similar manner to EDRD1; however, the amounts of Jpn5-37 RNA in serum were significantly greater. Similarly, the quantities of Jpn5-37 viral RNA in all organs tested tended to be higher than with EDRD1 infection. Mean rectal temperatures were significantly higher in the Jpn5-37-inoculated than in the control group at 4 and 6 days post infection (dpi) and in the EDRD1-inoculated group at 6 and 8 dpi. These results suggest that the Jpn5-37 strain replicates and is more efficiently distributed to the organs than is EDRD1 under the same conditions.

An outbreak of duck hepatitis A virus type 1 infection in Japan

In June 2015, a highly fatal and acute disease broke out in a duckling farm in Hyogo Prefecture, Japan. The birds exhibited poor growth, reduced movement, lying in a dorsal recumbent position, depression, lethargy, ataxia and opisthotonus, with a high mortality rate of approximately 76%. By performing a reverse transcription-polymerase chain reaction (RT-PCR) using primers specific for duck hepatitis A virus type 1 (DHAV-1), we obtained the PCR products of a predicted size. The nucleotide sequences of the PCR products showed a >96% identity with that of the DHAV-1, HB02 strain, which was isolated in China. To our knowledge, this is the first time that the DHAV-1 virus has been isolated since its outbreak in Japan in 1963.

Efficacy of Type 2 porcine reproductive and respiratory syndrome virus (PRRSV) vaccine against the 2010 isolate of Vietnamese highly pathogenic PRRSV challenge in pigs

The efficacy of a commercial attenuated live type 2 porcine reproductive and respiratory syndrome (PRRS) vaccine was tested under experimental infection with a highly virulent Vietnamese virus isolated from a diseased pig affected with highly pathogenic PRRS (HP-PRRS) using specific pathogen-free (SPF) pigs. Twenty-five 4-week-old SPF pigs were divided into three groups as follows: pigs vaccinated with a single dose of the vaccine (Group 1, n=10), unvaccinated pigs (Group 2, n=10) and unvaccinated and non-infectious control pigs (Group 3, n=5). Four weeks later, Groups 1 and 2 were challenged with a 1 ml inoculum containing 1 × 10^5.5 50% tissue culture infectious dose (TCID₅₀)/ml of a Vietnamese HP-PRRS virus isolated in 2010 via the intranasal route. Animals were monitored during the subsequent two-week period post-challenge and necropsied for virological and pathological assays. Results showed a significant reduction in viral replication and shedding in vaccinated pigs compared to unvaccinated pigs. The non-vaccinated pigs showed severe pyrogenic and respiratory illness with marked systematic lesions including interstitial pneumonia and thymic atrophy. In contrast, vaccinated pigs recovered quickly from fever with only mild pathological manifestations. Therefore, although viral shedding was still noted, immunization with the live PRRS vaccine did indeed reduce viral replication and disease severity, suggesting its utility in minimizing outbreaks of HP-PRRS.

Difficulty in identification of the frontal language area in patients with dominant frontal gliomas that involve the pars triangularis

OBJECTIVE Identification of language areas using functional brain mapping is sometimes impossible using current methods but essential to preserve language function in patients with gliomas located within or near the frontal language area (FLA). However, the factors that influence the failure to detect language areas have not been elucidated. The present study evaluated the difficulty in identifying the FLA in dominant-side frontal gliomas that involve the pars triangularis (PT) to determine the factors that influenced failed positive language mapping. METHODS Awake craniotomy was performed on 301 patients from April 2000 to October 2013 at Tokyo Women's Medical University. Recurrent cases were excluded, and patients were also excluded if motor mapping indicated their glioma was in or around the motor area on the dominant or nondominant side. Eighty-two consecutive cases of primary frontal glioma on the dominant side were analyzed for the present study. MRI was used for all patients to evaluate whether tumors involved the PT and to perform language functional mapping with a bipolar electrical stimulator. Eighteen of 82 patients (mean age 39 ± 13 years) had tumors that showed involvement of the PT, and the detailed characteristics of these 18 patients were examined. RESULTS The FLA could not be identified with intraoperative brain mapping in 14 (17%) of 82 patients; 11 (79%) of these 14 patients had a tumor involving the PT. The negative response rate in language mapping was only 5% in patients without involvement of the PT, whereas this rate was 61% in patients with involvement of the PT. Univariate analyses showed no significant correlation between identification of the FLA and sex, age, histology, or WHO grade. However, failure to identify the FLA was significantly correlated with involvement of the PT (p < 0.0001). Similarly, multivariate analyses with the logistic regression model showed that only involvement of the PT was significantly correlated with failure to identify the FLA (p < 0.0001). In 18 patients whose tumors involved the PT, only 1 patient had mild preoperative dysphasia. One week after surgery, language function worsened in 4 (22%) of 18 patients. Six months after surgery, 1 (5.6%) of 18 patients had a persistent mild speech deficit. The mean extent of resection was 90% ± 7.1%. Conclusions Identification of the FLA can be difficult in patients with frontal gliomas on the dominant side that involve the PT, but the positive mapping rate of the FLA was 95% in patients without involvement of the PT. These findings are useful for establishing a positive mapping strategy for patients undergoing awake craniotomy for the treatment of frontal gliomas on the dominant side. Thoroughly positive language mapping with subcortical electrical stimulation should be performed in patients without involvement of the PT. More careful continuous neurological monitoring combined with subcortical electrical stimulation is needed when removing dominant-side frontal gliomas that involve the PT.

Cost-Effectiveness Analysis of Deep Brain Stimulation in Patients with Parkinson's Disease in Japan

OBJECTIVE

Deep brain stimulation (DBS) is an effective surgical option for treating Parkinson's disease (PD). DBS is invasive, with a high initial cost. In Japan, questions have been raised about its cost-effectiveness and the resulting improvements in outcome. The aim of this study was to evaluate the cost-effectiveness of DBS for PD in Japan, particularly whether early or late DBS is more cost-effective.

METHODS

We used a Markov cohort simulation to follow the clinical course of DBS for PD. We conducted a survey to capture QOL scores among healthy Japanese volunteers. Transition probabilities were estimated from randomized clinical trials. We determined direct medical costs from the perspective of the Japanese health care system. Outcomes were assessed as quality-adjusted life years. We conducted univariate and probabilistic sensitivity analyses.

RESULTS

DBS costs an additional 10.3 million Japanese yen (US$85,100; exchange rate on October 28, 2015 was 121 yen to $1) for a gain of 3.2 quality-adjusted life years. The incremental cost-effectiveness ratio was 3.1 million yen ($25,600). The incremental cost-effectiveness ratio was 8.5 million yen ($70,200) for early DBS, 3.1 million yen ($25,600) for intermediate DBS, and 3.3 million yen ($27,200) for late-stage DBS.

CONCLUSIONS

Our model suggests that DBS is cost-effective in the Japanese health care system. DBS is more cost-effective if performed in the intermediate rather than early or late stages of PD.

Proposed therapeutic strategy for adult low-grade glioma based on aggressive tumor resection

OBJECT There is no standard therapeutic strategy for low-grade glioma (LGG). The authors hypothesized that adjuvant therapy might not be necessary for LGG cases in which total radiological resection was achieved. Accordingly, they established a treatment strategy based on the extent of resection (EOR) and the MIB-1 index: patients with a high EOR and low MIB-1 index were observed without postoperative treatment, whereas those with a low EOR and/or high MIB-1 index received radiotherapy (RT) and/or chemotherapy. In the present retrospective study, the authors reviewed clinical data on patients with primarily diagnosed LGGs who had been treated according to the above-mentioned strategy, and they validated the treatment policy. Given their results, they will establish a new treatment strategy for LGGs stratified by EOR, histological subtype, and molecular status. METHODS One hundred fifty-three patients with diagnosed LGG who had undergone resection or biopsy at Tokyo Women's Medical University between January 2000 and August 2010 were analyzed. The patients consisted of 84 men and 69 women, all with ages ≥ 15 years. A total of 146 patients underwent surgical removal of the tumor, and 7 patients underwent biopsy. RESULTS Postoperative RT and nitrosourea-based chemotherapy were administered in 48 and 35 patients, respectively. Extent of resection was significantly associated with both overall survival (OS; p = 0.0096) and progression-free survival (PFS; p = 0.0007) in patients with diffuse astrocytoma but not in those with oligodendroglial subtypes. Chemotherapy significantly prolonged PFS, especially in patients with oligodendroglial subtypes (p = 0.0009). Patients with a mutant IDH1 gene had significantly longer OS (p = 0.034). Multivariate analysis did not identify MIB-1 index or RT as prognostic factors, but it did identify chemotherapy as a prognostic factor for PFS and EOR as a prognostic factor for OS and PFS. CONCLUSIONS The findings demonstrated that EOR was significantly correlated with patient survival; thus, one should aim for maximum tumor resection. In addition, patients with a higher EOR can be safely observed without adjuvant therapy. For patients with partial resection, postoperative chemotherapy should be administered for those with oligodendroglial subtypes, and repeat resection should be considered for those with astrocytic tumors. More aggressive treatment with RT and chemotherapy may be required for patients with a poor prognosis, such as those with diffuse astrocytoma, 1p/19q nondeleted tumors, or IDH1 wild-type oligodendroglial tumors with partial resection.

Pathogenicity of emerging Japanese type 1 porcine reproductive and respiratory syndrome virus in experimentally infected pigs

To clarify the pathogenicity of Japanese type 1 porcine reproductive and respiratory syndrome virus (PRRSV) isolate in experimentally infected pigs, we evaluated clinical signs and monitored viremia for 21 days post-inoculation (dpi). Lungs were mottled, tanned and reddish in appearance; had lesions predominantly in the cranial, middle and accessory lobes; and failed to collapse at 10 dpi. Although microscopic lesions of lungs were reproduced using the Japanese emerging type 1 PRRSV isolate under experimental conditions, no significant differences were noted between the challenge and control groups regarding mean rectal temperature and daily weight gain. These results provide useful insights into the limited pathogenicity of single infection with the Japanese type 1 PRRSV isolate in piglets, which differ from findings in reported field cases.

Development of Cutting and Suction Device with Twist Blade Screw for Minimally Invasive Surgery: Evaluation of Suction Performance

In this study, we aim to develop a narrow-diameter and long-bore device for minimally invasive surgery that achieves the simultaneous cutting and suction of body tissue such as the diseased part of an organ. In this paper, we propose a screw made of a thin metal plate, and we developed a prototype device using this screw. For smooth operation, the suction performance must be superior to the cutting performance. Therefore, we performed experiments and evaluated the suction performance of the developed device assuming the crushed tissue pieces correspond to a highly viscous fluid. From the results, we confirmed that the suction volume is almost proportional to the rotation speed of the screw in the low speed range, and the device has an upper limit of suction volume at a certain rotation speed. Considering practical use, its proportional speed range is suitable for the device controllability of cutting and suction volume, and the size of the device tip needs to be 1 mm or more. Based on these conditions, we are planning to examine the shape of the cutting edge for realizing efficient cutting and suction and we will complete the device.

An armrest is effective for reducing hand tremble in neurosurgeons

Experienced neurosurgeons reduce hand tremble by placing their hand beside the operative field when performing microneurosurgery conventionally. Another solution to reduce hand tremble is an armrest. However, the reduction of hand tremble by using an armrest or finger-placing technique has not been rigorously measured in microneurosurgery. This study was performed to provide a quantitative assessment of the efficacy of an armrest to reduce hand tremble in comparison with the finger-placing technique. Hand tremble was evaluated in 11 board-certified neurosurgeons in a simulated microneurosurgery. The loci of surgical forceps handled by neurosurgeons were measured by a three-dimensional optical coordinate measuring machine. A static task was performed under four conditions: with/without the finger-placing technique and/or an armrest. The radius of an imaginative sphere including 95% of each locus was calculated and reviewed according to the four conditions. Hand tremble was significantly larger when the finger-placing technique was not implemented compared to when the technique was used (P < 0.05). The armrest also reduced hand tremble (P < 0.05) similar to the finger-placing technique. Non-inferiority was retained between the finger-placing technique and the armrest. Concomitant use of the armrest and the finger-placing technique did not interfere with the efficacy of the technique to reduce neurosurgeon’s hand tremble. The finger-placing technique was confirmed to reduce hand tremble. Resting the neurosurgeon’s forearm on an armrest also reduced the hand tremble. An armrest is a device that reduces hand tremble in neurosurgeons like the finger-placing technique.

Real-time, noninvasive optical coherence tomography of cross-sectional living cell-sheets in vitro and in vivo

Cell sheet technology has a history of application in regenerating various tissues, having successfully completed several clinical trials using autologous cell sheets. Tomographic analysis of living cell sheets is an important tool in the field of cell sheet-based regenerative medicine and tissue engineering to analyze the inner structure of layered living cells. Optical coherence tomography (OCT) is commonly used in ophthalmology to noninvasively analyze cross-sections of target tissues at high resolution. This study used OCT to conduct real-time, noninvasive analysis of living cell sheet cross sections. OCT showed the internal structure of cell sheets in tomographic images synthesized with backscatter signals from inside the living cell sheet without invasion or damage. OCT observations were used to analyze the static and dynamic behaviors of living cell sheets in vitro and in vivo including (1) the harvesting process of a C2C12 mouse skeletal myoblast sheet from a temperature-responsive culture surface; (2) cell-sheet adhesion onto various surfaces including a culture surface, a synthetic rubber glove, and the dorsal subcutaneous tissue of rats; and (3) the real-time propagation of beating rat cardiac cells within cardiac cell sheets. This study showed that OCT technology is a powerful tool in the field of cell sheet-based regenerative medicine and tissue engineering.

Development and initial clinical testing of "OPECT": an innovative device for fully intangible control of the intraoperative image-displaying monitor by the surgeon

BACKGROUND

During surgery, various images as well as other relevant visual information are usually shown upon request with the help of operating staff. However, the lack of direct control over the display may represent a source of stress for surgeons, particularly when fast decision making is needed.

OBJECTIVE

To present the development and initial clinical testing of an innovative device that enables surgeons to have direct intangible control of the intraoperative image-displaying monitor with standardized free-hand movements.

METHODS

The originally developed intangible interface named "OPECT" is based on the commercially available gaming controller KINECT (Microsoft) and dedicated action-recognizing algorithm. The device does not require any sensors or markers fixed on the hands. Testing was done during 30 neurosurgical operations. After each procedure, surgeons completed the 5-item questionnaire for evaluation of the system performance, scaling several parameters from 1 (bad) to 5 (excellent).

RESULTS

During surgical procedures, OPECT demonstrated high effectiveness and simplicity of use, excellent quality of visualized graphics, and precise recognition of the individual user profile. In all cases, the surgeons were well satisfied with performance of the device. The mean score value of answers to the questionnaire was 4.7 ± 0.2.

CONCLUSION

OPECT enables the surgeon to easily have intangible control of the intraoperative image monitor by using standardized free-hand movements. The system has promising potential to be applied for various kinds of distant manipulations with the displaying visual information during human activities.

Application of a SYBR®Green one step real-time RT-PCR assay to detect type 1 porcine reproductive and respiratory syndrome virus

The emergence in Japan of field isolates of type 1 porcine reproductive and respiratory syndrome virus (PRRSV) suggests problems with control. We therefore developed a one-step real-time reverse transcription polymerase chain reaction (qRT-PCR) with improved sensitivity that detects as little as 1 × 10⁻² TCID₅₀/ml of viral RNA. We tested serum samples collected in January and September 2008, October 2009 and January 2011 from a farm with an outbreak and found infected pigs between January and September 2008, but not in January 2011. Further, between 2008 and 2011, we did not detect infection in pigs at 8 nearby farms or in 2,052 serum samples collected from pigs from 74 farms in 12 prefectures. This assay should help prevent future outbreaks.

Correlation between surgical manipulations and the variation of surgeon's heart rate in brain surgery: technical note

For improvement of surgical performance and safety, we record surgeries by video cameras. However, analysis of the video records is time consuming. To help this task, we are developing methods to automatically mark up significant time points in the surgery. As a possible mean for the marking, we focused on the surgeon's heart rate. During a craniotomy of an intracranial glioma, we recorded the surgeon's electrocardiogram using a telemeter and measured the R-to-R interval (RRI). We detected the stable state of heart rate as a peak-to-peak RRI of less than 5% of the mean of RRI data from 15 consecutive heartbeats. We also quantified the frequency of brain touches by the surgeon under the surgical microscope. We examined the association between the stability of surgeon's heart rate and the brain touches using a chi-square test. As the result, the stable state of surgeon's heart rate was associated with the brain touches (p < 0.05, odds ratio 5.1). We edited a one-minute digest video of the surgery based on only the heart rate data, and it was sufficient to understand how the surgery was preceded.

Concise and broadly applicable method for determining the genomic sequences of North-American-type porcine reproductive and respiratory syndrome viruses in various clusters

We developed a concise and broadly applicable method for accurate genomic sequencing of North American genotype (NA-type) porcine reproductive and respiratory syndrome viruses (PRRSVs) that overcomes high genetic variability of the viruses. The method, designated "combination of consensus oligonucleotide reverse transcription and multiple displacement amplification" (CORT-MDA), involves reverse-transcription of viral RNA followed by shotgun sequencing after amplification using only 11 degenerate oligonucleotide primers; these primers were designed against consensus regions within the open reading frames of the 124 NA-type PRRSV strains with reported full-length genomic sequences. Sequencing of the 192 shotgun clones generated per virus showed 80% to 94% coverage on the reported PRRSV genomic sequence, such that only 2 or 3 unread regions had to be resequenced after PCR amplification using custom primers. Direct sequencing of RT-PCR products confirmed absolute consistency between sequences determined by the CORT-MDA method and those from RT-PCR. These results suggest that our method is applicable to diverse NA-type viruses.

Intraoperative cortico-cortical evoked potentials for the evaluation of language function during brain tumor resection: initial experience with 13 cases

OBJECTIVES

The objective in the present study was to evaluate the usefulness of cortico-cortical evoked potentials (CCEP) monitoring for the intraoperative assessment of speech function during resection of brain tumors.

METHODS

Intraoperative monitoring of CCEP was applied in 13 patients (mean age 34 ± 14 years) during the removal of neoplasms located within or close to language-related structures in the dominant cerebral hemisphere. For this purpose strip electrodes were positioned above the frontal language area (FLA) and temporal language area (TLA), which were identified with direct cortical stimulation and/or preliminary mapping with the use of implanted chronic subdural grid electrodes. The CCEP response was defined as the highest observed negative peak in either direction of stimulation. In 12 cases the tumor was resected during awake craniotomy.

RESULTS

An intraoperative CCEP response was not obtained in one case because of technical problems. In the other patients it was identified from the FLA during stimulation of the TLA (7 cases) and from the TLA during stimulation of the FLA (5 cases), with a mean peak latency of 83 ± 15 msec. During tumor resection the CCEP response was unchanged in 5 cases, decreased in 4, and disappeared in 3. Postoperatively, all 7 patients with a decreased or absent CCEP response after lesion removal experienced deterioration in speech function. In contrast, in 5 cases with an unchanged intraoperative CCEP response, speaking abilities after surgery were preserved at the preoperative level, except in one patient who experienced not dysphasia, but dysarthria due to pyramidal tract injury. This difference was statistically significant (p < 0.01). The time required to recover speech function was also significantly associated with the type of intraoperative change in CCEP recordings (p < 0.01) and was, on average, 1.8 ± 1.0, 5.5 ± 1.0, and 11.0 ± 3.6 months, respectively, if the response was unchanged, was decreased, or had disappeared.

CONCLUSIONS

Monitoring CCEP is feasible during the resection of brain tumors affecting language-related cerebral structures. In the intraoperative evaluation of speech function, it can be a helpful adjunct or can be used in its direct assessment with cortical and subcortical mapping during awake craniotomy. It can also be used to predict the prognosis of language disorders after surgery and decide on the optimal resection of a neoplasm.