Anterior Ankle Impingement Syndrome With Spur Fragmentation: Is It an Os Talotibiale?

Background

Bone fragments are often found in ankles with anterior bony impingement. However, whether they are detached osteophytes or accessory bones remains unknown.

Methods

Among the 66 continuously enrolled cases of ankles with anterior bony impingement, 32 had a fragment located at the anterior margin of the tibia. The cases of posterior impingement, lateral instability, osteochondral lesions, or free bodies simultaneously treated were excluded. The enrolled subjects were classified into 2 groups: ankles without (group A) and with remarkable spurs (group B). The patients' backgrounds, location of the fragments, clinical scores, and other parameters required to resume sports were compared. The Japanese Society for Surgery of the Foot (JSSF) ankle rating scale was used to evaluate preoperative and postoperative ankle conditions, and the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) was used to evaluate postoperative sports abilities.

Results

Eight (seven subjects) and 11 ankles were classified into groups A and B, respectively, and the mean age of the 18 patients was 25.4 (range, 16-37) years. No statistical differences in patient backgrounds or fragment sizes between the groups existed. In group A, the fragments were located on the lateral plateau in 7 of the 8 ankles, whereas in group B, their locations varied. The patients were followed up for a median of 48 months (range, 24-168). No complications were observed. The postoperative JSSF and SAFE-Q sports activity scores were significantly higher in group A than in group B (P <.01 and <.001, respectively). The postoperative term to return to their original sports activities was significantly shorter in group A (P < .05).

Conclusion

Anterior bony fragments of the ankle without a remarkable spur were located at a specific site, and the results of arthroscopic treatment were better than in those with remarkable spurs. Such a fragment may be called an os talotibiale.

Level of Evidence

Level III, retrospective cohort study.

In situthermal noise measurements under nanoindentation of suspended graphene

We demonstrated thermal noise measurement under the nanoindentation of monolayer and bilayer graphene nanodrums. The resonant oscillation of the cantilever excited only by a thermal energy is detectable even in the case of contact with a suspended graphene. The contact resonance fRequency can be obtained in 1 millisecond intervals during the force curve measurement by optimizing the parameters of a real-time spectrum analyzer. The pretension value of the graphene nanodrum is evaluated by the minimum frequency just when the applied force of the cantilever becomes zero. The simultaneous measurement of the force and the resonant frequency with respect to the deformation of the graphene nanodrum enables us to determine the value of InvOLS (inverse optical lever sensitivity) more accurately in each measurement. From the analysis scheme, force curve measurements of the graphene nanodrums with the same diameters show good reproducibility. We also revealed that the effective spring constant of the graphene nanodrums consists of a weak sample-dependent pretension factor and a deformation-dependent factor proportional to the number of graphene layers.

Protein-Ligand Interaction Analyses with Nuclear Magnetic Resonance Spectroscopy Enhanced by Dissolution Triplet Dynamic Nuclear Polarization

Solution-state nuclear magnetic resonance spectroscopy (NMR) is a powerful method for the analysis of intermolecular interactions within a biomolecular system. However, low sensitivity is one of the major obstacles of NMR. We improved the sensitivity of solution-state ¹³C NMR for the observation of intermolecular interactions between protein and ligand using hyperpolarized solution samples at room temperature. Eutectic crystals composed of ¹³C-salicylic acid and benzoic acid doped with pentacene were hyperpolarized by dynamic nuclear polarization using photoexcited triplet electrons, and a ¹³C nuclear polarization of 0.72 ± 0.07% was achieved after dissolution. The binding of human serum albumin and ¹³C-salicylate was observed with several hundred times sensitivity enhancement under mild conditions. The established ¹³C NMR was applied for pharmaceutical NMR experiments by observation of the partial return of the ¹³C chemical shift of salicylate by competitive binding with other non-isotope-labeled drugs.

Relationship between the morphology of osteophytes and cartilage lesions in anterior ankle impingement in athletes: a cross-sectional study

BACKGROUND

The present study aimed to describe the frequency and severity of tram-track lesions in anterior ankle impingement in athletes and to evaluate the association between osteophyte morphology and severity of tram-track lesions, the distinctive cartilage lesions associated with tibial osteophytes in anterior ankle impingement syndrome.

METHODS

We evaluated 34 athletes who underwent arthroscopic osteophyte resection for anterior ankle impingement between January 2017 and March 2021.

RESULTS

We found tram-track lesions in 26 athletes (76.5%). Arthroscopic findings revealed the distribution of the International Cartilage Repair Society grades of tram-track lesions (grade 0, eight; grade 1, seven; grade 2, ten; grade 3, nine; grade 4, zero). These findings indicate that athletes with anterior ankle impingement syndrome may have more severe cartilage lesions than non-athletes. There was a positive correlation between the International Cartilage Repair Society grade and osteophyte size (r = 0.393, p = 0.021). We divided athletes into two groups according to the presence or absence of osteophyte protrusion into the joint space. Osteophyte protrusion was present in 14 athletes (41.2%). All athletes in the protrusion-type group had tram-track lesions; seven (50%) had International Cartilage Repair Society grade 3. The protrusion-type group's International Cartilage Repair Society grade was significantly higher than that of the non-protrusion-type group (p = 0.008). The osteophyte sizes in the two groups were not significantly different (p = 0.341).

CONCLUSIONS

Based on these findings, osteophyte protrusion should be assessed when an indication of arthroscopic treatment for anterior ankle impingement syndrome is considered, particularly in athletes.

Effectiveness of patient and staff cohorting to reduce the risk of vancomycin-resistant enterococcus (VRE) acquisition: a retrospective cohort study during a VRE outbreak in Japan

BACKGROUND

Patient and staff cohorting is part of a bundle approach in the response to multi-drug-resistant organisms, but its effectiveness is not fully clarified. This study compared the risks of acquiring vancomycin-resistant Enterococcus faecium (VREfm) at a hospital during a VREfm outbreak based on contact characteristics in order to better understand the effectiveness of cohorting.

METHODS

Exposure came from contact with patients with VREfm (infectors), including existing patients with VREfm and patients who acquired VREfm during the study period. Contact was defined as length of contact time, degree of sharing space, and care by the same nurses as those caring for infectors between January and March 2018. The outcome was VREfm acquisition as determined through monthly stool or rectal screening cultures. Incidence rates were calculated based on contact patterns, and incidence rate ratios (IRRs) were compared.

FINDINGS

Among 272 inpatients (4038 patient-days), 43 patients acquired VREfm with the same or similar pulsotype. Incidence rates were 8.45 per 1000 patient-days when susceptible inpatients were on the same ward as an infector but cared for by different nurses (reference), 16.96 when susceptible inpatients were on the same ward as an infector and cared for by the same nurses [IRR 2.01, 95% confidence interval (CI) 0.62-10.28], and 52.91 when susceptible inpatients shared a room with an infector (IRR 6.26, 95% CI 1.61-35.40).

CONCLUSION

Compared with susceptible inpatients in a different room from infectors and not being cared for by the same nurses, the risk of VREfm acquisition could be six times higher for susceptible inpatients who are in the same room as infectors, and could be double for susceptible inpatients cared for by the same nurses as infectors.

AB1140 IMPACT OF COVID-19 NEWS SOURCES ON RHEUMATOID ARTHRITIS PATIENTS’ LIFESTYLE AND THEIR DISEASE ACTIVITY FROM NINJA 2020 COHORT STUDY

Background

One of the problems with the COVID-19 epidemic is infodemic. Insufficient and inaccurate information can be confusing and hinder treatment. In Japan, tabloid TV show might be an easily accessible source of information, but its reliability is low and it has a harmful effect on patients’ mental status and lifestyle. There are no reports to examine what is the source of COVID-19 news for patients with rheumatoid arthritis and how these information affect patients’ daily lives and disease activity. By using NinJa, Japanese largest database of rheumatoid arthritis, it may be possible to examine them in detail.

Objectives

To investigate the impact of the COVID—19 news sources on rheumatoid arthritis patients’ lifestyle and their disease activity using NinJa 2020 cohort study.

Methods

At the timing of collection of patients’ data of NinJa2020, questionnaire about their lifestyle and news source of COVID-19 was given. Questionnaire includes questions about frequency of scheduled visit, going out and exercise, weakness and news source.

Results

6677 patients out of 15553 patients answered questionnaire. Most patients did not change the interval of scheduled visit. The frequency of hospital visits was “unchanged” in 85.8%, “longer” in 13.6%, and “shortened” in 0.6%. The chances of going out were “unchanged” at 14.4%, “significantly decreased” at 57.5%, “slightly decreased” at 27.8%, and “increased” at 0.3%. 42.6% answered that the amount of exercise did not change, 30.2% answered that it decreased considerably, 26.1% answered that it decreased a little, and 1.1% answered that it increased. Regarding muscular strength and physical strength, 46.0% answered “no change”, 19.9% ​​answered “significantly dropped”, 33.5% answered “slightly dropped”, and 0.6% answered “increased”.

The media used as information sources are “newspaper (86.4%)”, “tabloid show (54.5%)”, “family, acquaintances and friends (43.7%)”, and “official web of Ministry of Health, Labor and Welfare and academic societies (9.4. %)”. Respondents often referred to multiple media and 30.6% of them listed three sources (Figure 1). There was a positive correlation between the decrease in frequency of going out and the number of information sources, and a negative correlation between age and the number of information sources. We also found a negative correlation with age for muscle weakness.

No correlation was found between the number of information sources and SDAI, CDAI, HAQ-DI, EQ-5D, HADS (A), HADS (D).

Figure 1.

Conclusion

The more sources of information, the less chance of going out. About 80% of the patients refrained from going out, the opportunity for exercise decreased in more than 50% of the patients, and the decrease in physical fitness was also noticed in nearly 50% of the patients. Newspapers, tabloid shows, and acquaintances were the most common sources of medical information, and relatively few patients used official sources.

He provision of accurate information about COVID-19 was important to avoid infodemic. From this questionnaire, more practical information delivery system was required in Japan.

Disclosure of Interests

None declared

AB0200 COMPARISON OF TREATMENT AND DISEASE ACTIVITY OF BETWEEN EORA AND YORA PATIENTS IN A NATIONWIDE DATABASE OF RHEUMATOID ARTHRITIS IN JAPAN “NINJA”

Background

Elderly-onset rheumatoid arthritis (EORA) has different characteristics from younger-onset RA (YORA), however, few reports have conducted large-scale and long-term comparisons of treatment and disease activity between EORA and YORA.

Objectives

To compare the changes in treatment and disease activity of between EORA and YORA patients and to examine the characteristics of patients who achieved remission between them using data of a real-world database in Japan.

Methods

Analysis was performed using data from 2010, 2013, 2016, and 2019 of the National Database of Rheumatic Diseases in Japan (NinJa). Patients were grouped according to age of disease onset into G1: <65 years (divided into G1a <65 years and G1b ≧65 years by the age at analysis), G2: 65-74 years, and G3:≧75 years.

Results

MTX usage rate decreased over time in G2 (58.3% in 2013→55.1% in 2016→54.4% in 2019) and G3 group (41.1→39.5→37.9%). Biologics/JAKi usage rate increased (G1b:24.4→28.2→ 33.3%, G2:19.1→20.3→23.7%, G3:12.3→14.5→19.1%) and steroid usage rate decreased (G1b:49.1→41.8→35.1%, G2:42.2→36.8→29.5%, G3:50.9→45.9→39.2%) in all groups. TNFi usage rate decreased (G1b:19.5→18.0→17.3%, G2:15.4→ 14.1→12.7%, G3:6.2→4.3→5.1%) but IL-6i usage rate increased (G1b:5.2→7.4→9.5%, G2:4.1→4.3→5.9%, G3:2.7→3.4→3.3%) except for the G3 group. CTLA-4Ig usage rate also increased (G1b:3.7→5.3→6.7%, G2:2.7→5.5→5.9%, G3:3.6→6.5→8.1%) in all groups.

The SDAI remission rate was increased over time in all groups (G1a:34.4→41.2→44.6%, G1b:25.1→31.4→35.2%, G2:33.1→37.1→42.2%, G3:30.0→35.9→39.3%) and EORA showed similar rate of remission with YORA. In the analysis stratified by SDAI using NinJa 2019, the positive rate of RF and ACPA decreased (ex RF. G3: 71.0→64.5→53.2%, ACPA. G3: 66.4→56.2→46.5%) and the proportion of male increased (ex G3: 23.0→30.3→35.1%) as the disease activity decreased (moderate / high → low → remission) in all groups. Also, the proportion of patients using two or more DMARDs decreased (ex G3: 43.8→35.2→22.4%) and the usage rate of steroid decreased (ex G3:52.5→37.9→30.2%). Furthermore, in a comparison of remission patients in each group, MTX usage rate (G1b:62.9→G2:61.7→G3:40.9%) and biologics/JAKi usage rate decreased (32.5→23.6→15.3%) as the age of onset increased, but the steroid usage rate increased (20.3→20.6→30.2%).

Conclusion

Disease activity improved over time, regardless of age of onset. EORA showed the same remission achievement rate as YORA, but the treatment content of those who achieved remission differed greatly depending on the age of onset.

Disclosure of Interests

Toshihiro Matsui Speakers bureau: Abbvie, Asahi Kasei, Ono, Chugai, Eli lilly, Pfizer, Grant/research support from: Abbvie, Asahi Kasei, Chugai, Shigeto Tohma: None declared

POS0614 THE RELATIONSHIP BETWEEN DISEASE ACTIVITY AND FINANCIAL TOXICITY IN PATIENTS WITH RHEUMATOID ARTHRITIS ON BIOLOGICS: A CROSS-SECTIONAL STUDY USING THE JAPANESE RHEUMATOID ARTHRITIS REGISTRY

Background

As the number of rheumatoid arthritis (RA) patients using biologics increases, the health financial issues posed by biologics become more important. The health financial issues posed by biologics have been discussed using health economic indicators such as incremental cost-effectiveness ratios (ICERs), but have not been evaluated using the financial burden of medical expenses (financial toxicity). In the field of malignancies, evaluations using financial burden have been conducted and have shown that the stage of malignancy is associated with financial toxicity. It is not known whether disease activity and financial toxicity are similarly associated in RA patients.

Objectives

This study aims to evaluate the relationship between RA activity and financial toxicity in RA patients using biologics, who are especially likely to feel the financial burdens.

Methods

We conducted a cross-sectional study of biologic users enrolled in NinJa2020, a database of rheumatoid arthritis patients in Japan collected from April 1, 2020 to March 31, 2021. We defined the users of TNF inhibitor, IL-6 receptor antagonists, T-cell costimulation blocker, Janus kinase inhibitor and biosimilar as biologic users. The main exposure was the disease activity of RA and was measured using DAS28-CRP. Outcome measure was a financial toxicity and was measured using COmprehensive Score for financial Toxicity (COST). This scale is a patient-reported outcome measure (PROM) consisting of 11 items. The responses are recorded on 5-point Likert Scales (ranging from 0 = strongly disagree to 4 = strongly agree). The score by domains ranges from 0 to 44. Higher scores indicated better results and lower financial toxicity. Multiple linear regression models adjusted for age, sex, disease duration, co-payments for anti-rheumatic drugs, work status, financial support systems were conducted to assess the relationship between the disease activity of RA and financial toxicity. As a secondary analysis, we excluded patients with zero copayments and performed the same analysis as in the main analysis. We used multiple imputation to deal with missing values.

Results

Among 15553 cases in the NinJa database, 649 cases for which RA disease activity and COST were available were included. The median age of the patients was 70 (interquartile range [IQR],56 -77), 83.7% were female. The median copayment amount was ¥12978 per month (IQR 637.2 to 24204.1). The median DAS28-CRP was 1.99 (IQR, 1. - 2.72). The median financial toxicity (COST score) was 21 (IQR 0-27) (Figure 1). In the main analysis using multiple linear regression, COST significantly decreased with disease activity of RA (per 1-pt DAS28-CRP, -1.16 [95% CI -2.04 - -0.28]). In the secondary analysis, COST significantly decreased with disease activity of RA (per 1-pt DAS28-CRP, -1.69 [95% CI -2.29 - -1.10]). Statistical significance was defined as a two-sided p-value < 0.05. All statistical analyses were conducted using STATA 17.0 (Stata Corp LP, College Station, TX). The National Hospital Organization’s research ethics committees evaluated and authorized the NinJa study.

Conclusion

High disease activity of RA was associated with high financial toxicity in biologic users. We reaffirmed the importance of financial considerations and empathy for RA patients using biologics, and suggested a potential demand for more financial support for RA patients who are refractory to treatment.

Disclosure of Interests

None declared

Two-Dimensional Superconductivity of Ca-Intercalated Graphene on SiC: Vital Role of the Interface between Monolayer Graphene and the Substrate

Ca-intercalation has enabled superconductivity in graphene on SiC. However, the atomic and electronic structures that are critical for superconductivity are still under discussion. We find an essential role of the interface between monolayer graphene and the SiC substrate for superconductivity. In the Ca-intercalation process, at the interface a carbon layer terminating SiC changes to graphene by Ca-termination of SiC (monolayer graphene becomes a bilayer), inducing more electrons than a free-standing model. Then, Ca is intercalated in between the graphene layers, which shows superconductivity with the updated critical temperature (T_C) of up to 5.7 K. In addition, the relation between T_C and the normal-state conductivity is unusual, "dome-shaped". These findings are beyond the simple C₆CaC₆ model in which s-wave BCS superconductivity is theoretically predicted. This work proposes a general picture of the intercalation-induced superconductivity in graphene on SiC and indicates the potential for superconductivity induced by other intercalants.

Comparison of symptomatic unstable ankle with and without os subfibulare

BACKGROUND

This study aimed to compare the patients background, clinical scores, condition of the lateral ligament, mechanical instabilities, and chondral lesions in ankles with symptomatic os subfibulare compared to those in ankles with chronic lateral instability without os subfibulare.

METHODS

Of the 212 ankles with a chronic lateral instability that were surgically treated, 72 ankles had an os subfibulare. All ankles were examined by arthroscopy during surgery. Age, sex, preoperative American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale scores, remnant condition of the lateral ligaments, and chondral lesions were compared between ankles with symptomatic os subfibulare and ankles with chronic lateral instability without os subfibulare.

RESULTS

There were no statistically significant differences between the groups in terms of the sex ratio (males: females, 35:37 vs. 53:87, n.s.) and the AOFAS Ankle-Hindfoot Scale scores (median; 75 vs. 77, n.s.). There were statistically significant differences in patient age (median: 20 vs. 24.5 years, p < 0.01), talar tilt angle (median: 9.0° vs 12.0°, p < 0.01), anterior drawer distance (6.2 vs. 7.0 mm, p < 0.01), chondral lesions (G0:G1:G2:G3, 35:21:66:5 vs. 40:44:27:29, p < 0.01), condition of the anterior talofibular ligament (intact: repairable remnant: poor remnant, 0:70:2 vs. 1:112:27, p < 0.01), and condition of the calcaneofibular ligament (intact: repairable remnant: poor remnant, 44:26:2 vs. 77:35:28, p < 0.01) between the groups.

CONCLUSION

This study suggests that the condition of the lateral ligaments including mechanical instability and cartilage of the ankle were less severe in the ankles with symptomatic os subfibulare than in those with chronic lateral instability without os subfibulare. The patients' age was lower in the ankles with symptomatic os subfibulare than in those with chronic lateral instability without os subfibulare. The clinical scores and gender ratio were not statistically different between the group.

[Preoperative Esophageal Decompression and Enteral Nutrition Using a W-ED Tube in Patients with Esophagogastric Junction Cancer-A Case Report]

The patient was a 67-year-old male diagnosed with adenocarcinoma of the esophagogastric junction. The esophagus was markedly dilated due to severe stenosis, and aspiration pneumonia was observed. Therefore, he was treated with a W- ED tube for simultaneous esophageal decompression and enteral nutrition. Two weeks of W-ED tube placement improved esophageal dilatation and pneumonia while maintaining nutritional status; thus, he underwent proximal gastrectomy, lower esophagectomy and combined resection of distal pancreas, spleen and left crus of diaphragm with jejunal interposition reconstruction. His postoperative course was uneventful, and he was discharged 16 days after surgery without any postoperative infectious complications such as pneumonia, anastomotic leakage, pancreatic fistula and enterocolitis. In the preoperative management for patients with esophagogastric junction cancer with severe stenosis, simultaneous esophageal decompression and enteral nutrition using a W-ED tube is very useful because it can improve aspiration pneumonia, reduce the risk of anastomotic leakage by improving esophageal edema, and prevent disuse atrophy of small intestinal villi.

[A Case of Gastric Carcinoma with Lymphoid Stroma That Was Difficult to Diagnose Preoperatively]

A 71-year-old man was referred to our hospital because of a gastric submucosal tumor. Gastrointestinal stromal tumor (GIST)was diagnosed in the antrum of the stomach and local resection was undergone. At this time, upper gastrointestinal endoscopy found the gastric submucosal tumor with a size of about 5 mm on the posterior wall of the fundus, but it was followed up. The lesion had grown to a size of about 10 mm by endoscopy 2 years later, and a biopsy was performed. Gastric mucosa associated lymphoid tissue(MALT)lymphoma was diagnosed by pathological examination, and Helicobacter pylori eradication therapy was performed. Endoscopy after treatment further increased the size of the lesion to about 20 mm, and ulceration was also observed. A biopsy was performed again, and a diagnosis of poorly differentiated adenocarcinoma was made, and laparoscopic proximal gastrectomy was undergone. It was the diagnosis of gastric carcinoma with lymphoid stroma(GCLS), pT3N0M0, pStage ⅡA in the postoperative pathological examination. GCLS is a rare disease with a frequency of about 1 to 4% of all gastric cancers, and preoperative diagnosis is difficult. From the morphology and histology, the differential diagnosis from submucosal tumors and lymphomas becomes problems.

Large-Scale Prospective Genome-Wide Association Study of Oxaliplatin in Stage II/III Colon Cancer and Neuropathy

IMPORTANCE

The severity of oxaliplatin (L-OHP)-induced peripheral sensory neuropathy (PSN) exhibits substantial interpatient variability, and some patients suffer from long-term, persisting PSN.

OBJECTIVE

To identify single-nucleotide polymorphisms (SNPs) predicting L-OHP-induced PSN using a genome-wide association study (GWAS) approach.

DESIGN, SETTING, PARTICIPANTS

A large prospective GWAS including 1,379 patients with stage II/III colon cancer who received L-OHP-based adjuvant chemotherapy (mFOLFOX6/CAPOX) under the phase II (JOIN/JFMC41) or the phase III (ACHIVE/JFMC47) trial.

MAIN OUTCOMES AND MEASURES

First, GWAS comparison of worst grade PSN (grade 0/1 vs. 2/3) was performed. Next, to minimize the impact of ambiguity in PSN grading, extreme PSN phenotypes were selected and analyzed by GWAS. SNPs that could predict time to recovery from PSN were also evaluated. In addition, SNPs associated with L-OHP-induced allergic reactions (AR) and time to disease recurrence were explored.

RESULTS

No SNPs exceeded the genome-wide significance (p < 5.0 × 10^-8) in either GWAS comparison of worst grade PSN, extreme PSN phenotypes, or time to recovery from PSN. Association study focusing on AR or time to disease recurrence also failed to reveal any significant SNPs.

CONCLUSION AND RELEVANCE

Our results highlight the challenges of utilizing SNPs for predicting susceptibility to L-OHP-induced PSN in daily clinical practice.

Effect of Ankle Motion and Tensile Stress at the Achilles Tendon on the Contact Pressure Between the Achilles Tendon and the Calcaneus

Impingement between the Achilles tendon and the posterosuperior prominence of the calcaneus is considered to be a cause of insertional Achilles tendinopathy. The corresponding treatment intends to reduce tensile stress from calf muscles and avoid hyper-dorsiflexion of the ankle joint for decreasing the contact pressure; however, no study has reported on whether these treatments can decrease impingement. Thus, this study investigated the hypothesis that the tensile stress of the Achilles tendon and ankle motion affect the contact pressure between the Achilles tendon and the posterosuperior prominence of the calcaneus. Six fresh-frozen cadaveric lower leg specimens were procured. Each specimen was set to a custom foot-loading frame and loaded with a ground reaction force of 40 N and a tensile load of 70 N along the Achilles tendon. The contact pressure between the Achilles tendon and the posterosuperior prominence of the calcaneus was measured using a miniature pressure sensor under different tensile loadings of the Achilles tendon at the neutral ankle position. Similarly, the contact pressures during the ankle motion from a neutral position to maximum dorsiflexion were measured. The tensile load of the Achilles tendon and ankle motion affected the contact pressure between the Achilles tendon and the posterosuperior prominence of the calcaneus. The contact pressure increased with tensile load or ankle dorsiflexion. Conditions with increasing the tensile load of the Achilles tendon or under ankle dorsiflexion increase the contact pressure between the Achilles tendon and the posterosuperior prominence of the calcaneus.

POS0286 INCIDENCE OF MALIGNANCIES IN JAPANESE PATIENTS WITH RHEUMATOID ARTHRITIS: DATA FROM A LARGE JAPANESE NATIONAL REGISTRY

Background:

Patients (pts) with rheumatoid arthritis (RA) have an increased risk of some malignancies vs the general population, and this can vary by region/race.1,2 Data on the epidemiology and impact of biological (b)DMARDs and targeted synthetic (ts)DMARDs, such as Janus kinase (JAK) inhibitors, on the incidence of malignancies in Japanese pts with RA are limited. The National Database of Rheumatic Diseases in Japan (NinJa) is one of the largest RA registries in Japan.

Objectives:

To evaluate the incidence of malignancies in Japanese pts with RA using NinJa registry data.

Methods:

This retrospective observational study analysed NinJa registry data for Japanese pts with RA aged ≥18 years with ≥1 data entry between 2013 (first JAK inhibitor approval for RA in Japan) and 2018. The overall cohort included all pts with RA, and two sub-cohorts were analysed: pts exposed and unexposed to bDMARDs (exposure defined as ≥1 bDMARD reported in database). Crude incidence rates (IRs) for malignancies (including non-melanoma skin cancer) were calculated as the number of events per 100 pt-years of follow-up (time between start of follow-up or the date of first bDMARD exposure [for bDMARD-exposed pts] and end of observation period, or withdrawal from database). The most recent data for incidence of malignancy in the Japanese general population (2013–2017 data from the National Cancer Center, Japan) were used to calculate standardised incidence ratios (SIRs) and age- and sex-adjusted standardised rates (ASRs) for malignancies. Cross-sectional (per calendar year) and cumulative analyses were performed for the overall cohort. Cumulative rates were calculated for sub-cohorts, and all cumulative analyses were repeated excluding pts exposed to JAK inhibitors (ie ≥1 JAK inhibitor reported in database).

Results:

Data were collected for 26 607 Japanese pts with RA from 2013–2018. In the cross-sectional analysis (Table 1), the SIR and ASR for malignancies in all pts with RA were generally consistent from 2013–2018. In the cumulative analysis, the SIR (95% CI) for malignancies from 2013–2018 was 0.97 (0.91, 1.03) in all pts with RA, and 0.93 (0.82, 1.04) and 0.99 (0.92, 1.07) in pts exposed and unexposed to bDMARDs, respectively (Figure 1). Adjusting for age/sex, the cumulative ASR (95% CI) for malignancies from 2013–2018 was 0.83 (0.76, 0.90) in all pts with RA, and 0.82 (0.69, 0.95) and 0.86 (0.77, 0.96) in pts exposed and unexposed to bDMARDs, respectively (Figure 1). In all cohorts, the cumulative SIR and ASR were similar when pts exposed to JAK inhibitors were excluded (Figure 1).

Table 1.

Cross-sectional analysis of the incidence of malignancies in Japanese pts with RA from 2013–2018

All RA2013 (N=13 423)2014 (N=15 584)2015 (N=15 751)2016 (N=16 107)2017 (N=15 994)2018(N=15 003)Total follow-up, PY13 35314 86614 82914 97014 74814 898Pts with events, n140164174168161211Crude IRa(95% CI)1.05(0.89, 1.24)1.10(0.95, 1.29)1.17(1.01, 1.36)1.12(0.97, 1.31)1.09(0.94, 1.27)1.42(1.24, 1.62)ASRa,b(95% CI)0.76(0.60, 0.93)0.76(0.62, 0.90)0.90(0.68, 1.11)0.88(0.68, 1.07)0.80(0.62, 0.98)0.88(0.74, 1.01)SIRb(95% CI)0.97(0.82, 1.14)1.01(0.86, 1.17)1.02(0.87, 1.18)0.88(0.75, 1.02)0.86(0.73, 1.00)1.10(0.95, 1.25)

aIR/ASR were calculated as number of events per 100 PY of follow-up

bData from a Japanese general population database of malignancy incidence from 2013–2017, provided by the Center for Cancer Control and Information Services, National Cancer Center, Japan

PY, pt-years

Conclusion:

The incidence of malignancies in Japanese pts with RA, registered in the NinJa database from 2013–2018, was similar to that in the Japanese general population. The SIR and ASR for malignancies were comparable in pts exposed and unexposed to bDMARDs. In all cohorts, rates did not increase when pts exposed to JAK inhibitors were included.

References:

[1] Dougados et al. Ann Rheum Dis 2014; 73: 62-68.

[2] Parikh-Patel et al. Cancer Causes Control 2009; 20: 1001-1010.

Acknowledgements:

Study sponsored by Pfizer Inc. Medical writing support was provided by Christina Viegelmann, CMC Connect, and funded by Pfizer Inc.

Disclosure of Interests:

Toshihiro Matsui Speakers bureau: Astellas, Ayumi, Chugai, Daiichi-Sankyo, Eli Lilly, Ono, Pfizer Inc, Takeda, Tanabe-Mitsubishi, Consultant of: Pfizer Inc, Grant/research support from: Chugai, Naonobu Sugiyama Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Shigeyuki Toyoizumi Employee of: Pfizer R&D Japan, Fujio Matsuyama Consultant of: Pfizer Inc, Employee of: CRECON Medical Assessment Inc, Tatsunori Murata Consultant of: Pfizer Inc, Employee of: CRECON Medical Assessment Inc, Yukitomo Urata Speakers bureau: Asahi Kasei, Chugai, Eli Lilly, Pfizer Inc, Consultant of: AbbVie, Asahi Kasei, Chugai, Pfizer Inc, Kimito Kawahata Speakers bureau: Pfizer Inc, Consultant of: Pfizer Inc, Grant/research support from: Pfizer Inc, Shigeto Tohma Speakers bureau: Astellas, Ayumi, Chugai, Ono, Pfizer Inc, Takeda, Consultant of: Pfizer Inc

[A Case of Gastric Cancer with Extensive Lymph Node Metastasis Causing Stenosis Symptoms in the Primary pCR after Preoperative Chemotherapy]

A 65‒year‒old man was found with a circumferential type 2 tumor in the gastric antrum by upper gastrointestinal endoscopy, and biopsy revealed poorly a differentiated adenocarcinoma and HER2‒negative results. According to imaging examinations and laparoscopy, he was diagnosed with an advanced gastric cancer, classified as cT4a(SE)N3M0 and cStage Ⅲ. He underwent neoadjuvant chemotherapy(SOX regimen)because of the bulky N finding. After 2 courses of the treatment, marked reductions in the primary gastric lesion and metastatic lymph nodes were observed, although stenosis appeared at the gastric tumor site. The W‒ED tube was used to depressurize the stomach and to manage his nutrition, and the patient's surgery was conducted under good general conditions. We performed a distal gastrectomy(D2 dissection)and cholecystectomy. Histopathological examination showed no viable tumor cells in the primary gastric lesion(Grade 3). Two metastases were found in the dissected lymph nodes, although only a few cancer cells persisted. We report a case of gastric cancer in which pCR was obtained in the primary lesion, although stenosis appeared after the neoadjuvant chemotherapy.

A false-pouch closure technique with an intact superior peroneal retinaculum for recurrent dislocation of the peroneal tendon

Purpose

To evaluate the usefulness of the false-pouch closure technique with an intact superior peroneal retinaculum (SPR).

Methods

From 2016 to 2020, 30 patients with recurrent dislocation of the peroneal tendon were treated with the current procedure. Clinical outcomes, including the time to resume running, the rate and time to return to sports, and the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hind Foot score, were evaluated preoperatively and at the last follow-up.

Results

The rate of return to the pre-injury level of sports activity was 93.3%, and the mean duration to return to running and sports was 8.0 ± 2.8 weeks (range: 3–12 weeks) and 14.4 ± 3.2 weeks (range: 10–24 weeks), respectively. The mean preoperative AOFAS score was 79.7 ± 9.6 points (range: 41–90), which improved significantly to 98.9 ± 3.2 (87–100) postoperatively (p < 0.01).

Conclusion

The false-pouch closure technique with suture tape and anchors had a reliable clinical outcome and can enable the early return of patients to their sports activities.

Level of evidence

IV, Case series

The therapeutic strategy for advanced gastric cancer with pyloric stenosis and liver metastasis; successfully treated by gastro-jejunal bypass and chemotherapy first, followed by curative R0 resection

Background

The indication of surgical resection for liver metastasis from gastric cancer (GC) is still limited and controversial because of its more aggressive oncological characteristics than liver metastasis from colorectal cancer. Pyloric stenosis causes an inadequate oral intake and malnutrition in GC patients. We herein report a case of GC with these two factors that was successfully treated by the combination of gastro-jejunal bypass and chemotherapy, followed by curative R0 resection.

Case presentation

A 60-year-old man was diagnosed with type 2 GC with liver metastasis and pyloric stenosis, which was confirmed as the HER2-positive type. He underwent gastrojejunostomy and received capecitabine and cisplatin (XP) + trastuzumab chemotherapy. After three courses of the XP + trastuzumab regimen, shrinkage of the primary lesion and liver metastasis was confirmed and his nutritional parameters markedly improved with a stable oral intake after bypass surgery. He underwent curative R0 resection by distal gastrectomy with D2 lymphadenectomy and partial hepatectomy. Histologically, viable tumor cells were observed in less than one-third of the primary lesion, and only scar tissue without viable cancer cells was noted in the resected liver specimen. His postoperative course was uneventful, and recurrence has not been detected in the 30 months after surgery without adjuvant chemotherapy.

Conclusion

The present case report describes a successful strategy for advanced GC with pyloric stenosis and liver metastasis.

[A Surgical Case Report of Gastric Cancer Patient with Severe COPD Successfully Controlled by Preoperative Pulmonary Rehabilitation]

A 72-year-old man with a history of chronic obstructive pulmonary disease(COPD)was diagnosed with type 3 gastric cancer at the posterior wall of the gastric body. Although there was no distant metastasis in preoperative imaging tests, pulmonary function test revealed severe obstructive ventilatory impairment, suggesting that the patient had high risks of perioperative pulmonary complications. After treatment for COPD and preoperative pulmonary rehabilitation under hospitalization for 2 weeks, laparoscopic distal gastrectomy plus D2 lymphadenectomy plus Roux-en-Y reconstruction was performed. The patient showed stable respiratory condition postoperatively, and was discharged from hospital on postoperative day 12 without serious postoperative complications. It was suggested that preoperative pulmonary rehabilitation reduced postoperative pulmonary complications and allowed safe surgery in patients with severe COPD.

SAT0124 RISK OF SERIOUS INFECTION, MALIGNANCY, OR DEATH IN JAPANESE RHEUMATOID ARTHRITIS PATIENTS TREATED WITH A COMBINATION OF ABATACEPT AND TACROLIMUS: A RETROSPECTIVE COHORT STUDY

Background:

Both Abatacept (ABT) and Tacrolimus (Tac) suppress T cell immunity, but it is unknown whether combinations of these will increase the risk of adverse events.

Objectives:

To evaluate whether combining ABT and Tac increases the risk of infection and malignancy compared to their individual use in Japanese rheumatoid arthritis (RA) patients.

Methods:

We conducted a retrospective cohort study of RA patients using the multicenter database in Japan (NinJa). The dataset was clinical information at a certain point within each year, and the point was any point selected by a registered physician. RA was clinically diagnosed in the dataset. (1)

We analyzed the data from RA patients registered in NinJa during the period from April 2010 to March 2019. In this study, we compared three groups who received Tac, ABT or a combination of both. We included patients who had just begun initiating treatment with ABT or Tac, and we excluded patients who used TNF inhibitors, IL-6 inhibitors, and Jak inhibitors in the first year. The primary outcome was defined the composite events including infections that require hospitalization, newly diagnosed malignancy, and death from any cause after initiation of ABT or Tac. We assessed whether the combination contributed to increase the risk of outcome by performing a Cox regression analysis.

Results:

Among the 27032 RA patients in the registry, 2009 patients were included. The Tac, ABT and combination groups consisted of 1328, 563 and 118 patients, respectively. (Figure 1) (Table 1) Primary outcomes occurred in 149 (13.4%), 62 (13.5%), 14 (13.9%) patients, of the Tac, ABT and combination groups, respectively. The incidence between groups was not significantly different (p= 0.638). (Figure 2) A Cox regression analysis was adjusted for the following parameters: age, sex, disease duration, modified health assessment questionnaire, disease activity score 28-CRP, CRP, use of prednisolone, and use of methotrexate. The analysis revealed no significant differences between groups. The hazard ratio (95% confidence interval) was as follows: Tac 1.00 (Ref), ABT 1.02 (0.74-1.40), and combination 1.15 (0.65-2.05).

Table 1.

baseline characteristics

TacrolimusAbataceptCombinationp valueN (person-year)1328 (2505)563 (944)118 (193)age (median [IQR])69.00 [60.00, 76.00]70.00 [61.00, 76.00]67.00 [59.00, 74.00]0.169*sex female (%)1038 (78.2)468 (83.1)97 (82.2)0.039†disease duration (yr) (median [IQR])9.00 [4.00, 18.00]11.00 [5.00, 21.00]11.00 [7.00, 20.00]0.002*Steinbrocker stage (%)I285 (23.5)82 (15.6)12 (12.1)<0.001†II361 (29.8)125 (23.8)25 (25.3)III232 (19.1)150 (28.5)31 (31.3)IV334 (27.6)169 (32.1)31 (31.3)mHAQ (median [IQR])0.25 [0.00, 0.75]0.38 [0.00, 1.00]0.50 [0.00, 1.13]<0.001*DAS28CRP (median [IQR])2.58 [1.88, 3.40]2.77 [2.09, 3.62]3.01 [2.27, 3.98]<0.001*CRP (mg/dL) (median [IQR])0.30 [0.10, 1.02]0.35 [0.13, 1.10]0.30 [0.14, 0.82]0.590*RF positivity (%)708/895 (79.1)331/400 (82.8)57/71 (80.3)0.314†Tacrolimus (mg/d) (median [IQR])1.50 [1.00, 2.00]0.00 [0.00, 0.00]2.00 [1.00, 2.50]<0.001*MTX use (%)619 (46.6)264 (46.9)32 (27.1)<0.001†PSL use (%)749 (56.4)299 (53.1)71 (60.2)0.253†

Abbreviations: anti-CCP, anti-cyclic citrullinated peptide; mHAQ, modified Health Assessment Questionnaire; MTX, methotrexate; PSL, prednisolone; RF, rheumatoid factor * Kruskal-Wallis test; † chi square test; ‡ analysis of variance (ANOVA)

Conclusion:

The combination of ABT and Tac does not increase the risk of adverse events in patients with rheumatoid arthritis in Japan when compared to the use ABT or Tac alone. Further evaluation is needed.

References:

[1]Matsui T, et al. Ann Rheum Dis 2007;66:1221–6.

Disclosure of Interests:

Kenichiro Tokunaga: None declared, Kunihiko Matsui: None declared, Hideto Oshikawa: None declared, Toshihiro Matsui Paid instructor for: Chugai Pharmaceutical Co., LTD., Janssen Pharmaceutical K,K,, Shigeto Tohma: None declared

Randomized clinical trial of extensive intraoperative peritoneal lavage versus standard treatment for resectable advanced gastric cancer (CCOG 1102 trial)

BACKGROUND

A survival benefit of extensive intraoperative peritoneal lavage (EIPL) has been reported in patients with gastric cancer with positive peritoneal cytology. The hypothesis of this study was that EIPL may reduce peritoneal recurrence in patients with advanced gastric cancer who undergo surgery with curative intent.

METHODS

This was an open-label, multi-institutional, randomized, phase 3 trial to assess the effects of EIPL versus standard treatment after curative gastrectomy for resectable gastric cancer of T3 status or above. The primary endpoint was disease-free survival (DFS); secondary endpoints were overall survival, peritoneal recurrence-free survival and incidence of adverse events.

RESULTS

Between July 2011 and January 2014, 314 patients were enrolled from 15 institutions and 295 patients were analysed (145 and 150 in the EIPL and no-EIPL groups respectively). The 3-year DFS rate was 63·9 (95 per cent c.i. 55·5 to 71·2) per cent in the EIPL group and 59·7 (51·3 to 67·1) per cent in the control group (hazard ratio (HR) 0·81, 95 per cent c.i. 0·57 to 1·16; P = 0·249). The 3-year overall survival rate was 75·0 (67·1 to 81·3) per cent in the EIPL group and 73·7 (65·9 to 80·1) per cent in the control group (HR 0·91, 0·60 to 1·37; P = 0·634). Peritoneal recurrence-free survival was not significantly different between the two groups (HR 0·92, 0·62 to 1·36; P = 0·676). No intraoperative complications related to EIPL were observed.

CONCLUSION

EIPL did not improve survival or peritoneal recurrence in patients who underwent gastrectomy for advanced gastric cancer. Registration number: 000005907 (http://www.umin.ac.jp/ctr/index.htm).

Recurrent Dislocation of the Tibialis Posterior Tendon Treated With Suture Tape: A Case Report of an Innovative Operative Procedure

Dislocation of the tibialis posterior tendon (PTT) is a rare traumatic injury, and treatment is often delayed. Conservative treatment is ineffective for recurrent dislocation of the PTT; however, a reference standard procedure has not yet been established. In the present case report, we describe an innovative pseudo-pouch closing procedure with suture tape and a suture anchor for recurrent PTT dislocation. The patient returned to preoperative levels of activity at 21 weeks postoperatively and was asymptomatic at the 1-year follow-up examination.

Bartonella henselae DNA in Seronegative Patients with Cat-Scratch Disease

We used real-time PCR to detect Bartonella henselae DNA in 7.9% (5/63) of blood specimens from seronegative patients in Japan suspected of having cat-scratch disease. The combined use of serologic tests and real-time PCR to analyze blood specimens is recommended for the prompt, noninvasive laboratory diagnosis of cat-scratch disease.

Si-based Mach-Zehnder wavelength/mode multi/demultiplexer for a WDM/MDM transmission system

We propose and experimentally demonstrate a low-loss and low-crosstalk Mach-Zehnder mode/wavelength multi/demultiplexer for WDM/MDM transmission based on a Si-photonics platform. A broadband 3-dB mode divider, which is also newly devised here, makes it possible to compose a Mach-Zehnder filter for "mode" and "wavelength" simultaneously. Transmission characteristics of fabricated 3-dB mode dividers are in excellent agreement with theoretical results. Mach-Zehnder filters using the 3-dB mode divider with a free spectral range (FSR) of 20 and 1 nm are also fabricated and the modal crosstalk is less than -24 dB in the 40-nm wavelength range for the MZ filter with an FSR of 20 nm. The tuning of the peak wavelength position by the TiN heater is also demonstrated.

Honeycomb micro-textures for light trapping in multi-crystalline silicon thin-film solar cells

The liquid phase crystallization (LPC) of silicon is an emerging technology for fabricating 10 - 20 µm thin multi-crystalline silicon layers on glass. LPC silicon solar cells exhibit similar electronic performance to multi-crystalline wafer-based devices. Due to the reduced absorber thickness, however, effective measures for light trapping have to be taken. We present tailor-made micro-structures for light trapping at the LPC silicon back-side, whereby a nano-imprinted resist layer serves as a three-dimensional etching mask in subsequent reactive ion etching. Contrary to state-of-the-art random pyramid textures produced by wet-chemical etching, this method allows to produce tailor-made textures independent of grain orientation. Differently shaped micro-textures were replicated in LPC silicon. Absorptance and external quantum efficiency of periodic honeycomb patterns and random pyramids were found to be equivalent. Thus, the method enables the potential to further optimize light trapping in LPC silicon solar cells.

Pathophysiological characteristics of non-alcoholic steatohepatitis-like changes in cholesterol-loaded type 2 diabetic rats

Spontaneously Diabetic Torii (SDT) fatty rats, a new obese diabetic model, reportedly presented with features of non-alcoholic steatohepatitis (NASH) after 32 weeks of age. We tried to accelerate the onset of NASH in SDT fatty rats using dietary cholesterol loading and noticed changes in the blood choline level which is expected to be a NASH biomarker. Body weight and biochemical parameters were measured from 8 to 24 weeks of age. At 16, 20, 24 weeks, pathophysiological analysis of the livers were performed. Hepatic lipids, lipid peroxides, and the expression of mRNA related to triglyceride (TG) synthesis, inflammation, and fibrosis were evaluated at 24 weeks. Hepatic fibrosis was observed in SDT fatty rats fed cholesterol-enriched diets (SDT fatty-Cho) from 16 weeks. Furthermore, hepatic lipids and lipid peroxide were significantly higher in SDT fatty-Cho than SDT fatty rats fed normal diets at 24 weeks. Hepatic mRNA expression related to TG secretion decreased in SDT fatty-Cho, and the mRNA expression related to inflammation and fibrosis increased in SDT fatty-Cho at 24 weeks. Furthermore, SDT fatty-Cho presented with increased plasma choline, similar to human NASH. There were no significant changes in the effects of feeding a cholesterol-enriched diet in Sprague-Dawley rats. SDT fatty-Cho has the potential to become a valuable animal model for NASH associated with type 2 diabetes and obesity.

Early results of a randomized two-by-two factorial phase II trial comparing neoadjuvant chemotherapy with two and four courses of cisplatin/S-1 and docetaxel/cisplatin/S-1 as neoadjuvant chemotherapy for locally advanced gastric cancer

Background

Neoadjuvant chemotherapy (NAC) is a promising method of improving the survival of resectable gastric cancer. Cisplatin/S-1 (CS) and docetaxel/cisplatin/S-1 (DCS) are both effective against metastatic gastric cancer. This report clarified the impact of these regimens on early endpoints, including the pathological responses, chemotherapy-related toxicities, and surgical results.

Methods

Patients with M0 and either T4 or T3 in case of junctional cancer or scirrhous type received two or four courses of cisplatin (60 mg/m2 at day 8)/S-1 (80 mg/m2 for 21 days with 1 week rest) or docetaxel (40 mg/m2 at day 1)/cisplatin (60 mg/m2 at day 1)/S-1 (80 mg/m2 for 14 days with 2 weeks rest) as NAC. Patients then underwent D2 gastrectomy and adjuvant S-1 chemotherapy for 1 year. The primary endpoint was the 3-year overall survival.

Results

Between October 2011 and September 2014, 132 patients were assigned to receive CS (n = 66; 33 in 2 courses and 33 in 4 courses) or DCS (n = 66; 33 in 2 courses and 33 in 4 courses). The respective major grade 3 or 4 hematological toxicities (CS/DCS) were leukocytopenia (14.1%/26.2%), neutropenia (29.7%/47.7%), anemia (14.1%/12.3%), and platelet reduction (3.1%/1.5%). The rate of pathological response, defined as a complete response or < 10% residual cancer remaining, was 19.4% in the CS group and 15.4% in the DCS group, and 15.6% in the two-course group and 19.0% in the 4-course group. The R0 resection rate was 72.7% in the CS group and 81.8% in the DCS group and 80.3% in the two-course group and the 74.2% in the four-course group. No treatment-related deaths were observed.

Conclusions

Our results do not support three-drug therapy with a taxane over two-drug therapy, or any further treatment beyond two cycles as an attractive candidate for the test arm of NAC.

Type-1 polarised dendritic cells are a potent immunogen against Mycobacterium tuberculosis

OBJECTIVE

Application of immunotherapy using dendritic cells (DCs) is considered an effective treatment strategy against persistent Mycobacterium tuberculosis infection. With the goal of developing improved therapeutic vaccination strategies for patients with tuberculosis (TB), we tested the ability of ex vivo-generated DCs to induce an effective TB antigen-specific type-1 immune response.

METHODS

Monocyte-derived DCs from TB patients were induced to mature using a 'standard' cytokine cocktail (interleukin [IL] 1β, tumour necrosis factor alpha [TNF-α], IL-6 and prostaglandin E2) or a type 1-polarised DC (DC1) cocktail (IL-1β, TNF-α, interferon [IFN] α, IFN-γ and polyinosinic:polycytidylic acid), and were loaded with the established TB antigen 6-kDa early secretory antigenic target protein (ESAT-6).

RESULTS

Although DC1s from TB patients expressed the same levels of multiple co-stimulatory molecules (CD83, CD86, CD80 and CD40) as the standard DCs (sDCs), DC1s secreted substantially higher levels of IL-12p70. Furthermore, when DCs pulsed with or without ESAT-6 were cultured with lymphocytes from the same patients, DC1s induced much higher numbers of ESAT-6-specific IFN-γ-producing T-cells than sDCs, as manifested by their superior induction of natural killer cell activation and antigen-independent suppression of regulatory T-cells.

CONCLUSION

TB antigen-loaded DC1s are potent inducers of antigen-specific T-cells, which could be used to develop improved immunotherapies of TB.

Significance of measurement of serum trough level and anti-drug antibody of adalimumab as personalised pharmacokinetics in patients with Crohn's disease: a subanalysis of the DIAMOND trial

BACKGROUND

Significance of monitoring adalimumab trough levels and anti-adalimumab antibodies (AAA) for disease outcome in Crohn's disease (CD) patients remained unclear.

AIM

To evaluate the association of adalimumab trough levels and AAA at week 26 with clinical remission at week 52, the effect of azathiopurine on AAA and factors influencing trough levels in CD patients in the DIAMOND trial.

METHODS

We performed this study using adalimumab trough levels, AAA at week 26 and 6-thioguanine nucleotide (TGN) in red blood cells at week 12. A multiple regression model and receiver operating analysis was performed to identify factors influencing adalimumab trough levels and AAA, and adalimumab thresholds for predicting disease activity.

RESULTS

There was a significant difference of adalimumab trough level at week 26 between patients with disease remission and without at week 52 (7.7 ± 3.3 μg/mL vs 5.4 ± 4.3 μg/mL: P <.001). Adalimumab trough level of 5.0 μg/mL yielded optimal sensitivity and specificity for remission prediction (80.2% and 55.6%, respectively). AAA development at week 26 significantly affected remission at week 52 (P = .021), which was strongly associated with adalimumab trough levels. Female gender and increasing body weight were independently associated with low adalimumab trough levels, and female gender was associated with AAA development. A cut-off 6TGN level of >222.5 p mol/8 ×10⁸ RBCs yielded sensitivity (100%) and specificity (60.6%) for AAA negativity.

CONCLUSION

Adalimumab trough levels and AAA occurrence were significantly associated with clinical remission. Higher 6TGN affected AAA negativity. The combination therapy is beneficial in some relevant aspects for CD patients. (UMIN Registration No. 000005146).

Heterogeneous expression of glycoconjugates in the primary olfactory centre of the Japanese sword-tailed newt (Cynops ensicauda)

Histochemical organization of the Caudata olfactory system remains largely unknown, despite this amphibian order showing phylogenetic diversity in the development of the vomeronasal organ and its primary centre, the accessory olfactory bulb. Here, we investigated the glycoconjugate distribution in the olfactory bulb of a semi-aquatic salamander, the Japanese sword-tailed newt (Cynops ensicauda), by histochemical analysis of the lectins that were present. Eleven lectins showed a specific binding to the olfactory and vomeronasal nerves as well as to the olfactory glomeruli. Among them, succinylated wheat germ agglutinin (s-WGA), soya bean agglutinin (SBA), Bandeiraea simplicifolia lectin-I (BSL-I) and peanut agglutinin showed significantly different bindings to glomeruli between the main and accessory olfactory bulbs. We also found that s-WGA, SBA, BSL-I and Pisum sativum agglutinin preferentially bound to a rostral cluster of glomeruli in the main olfactory bulb. This finding suggests the presence of a functional subset of primary projections to the main olfactory system. Our results therefore demonstrated a region-specific glycoconjugate expression in the olfactory bulb of C. ensicauda, which would be related to a functional segregation of the olfactory system.

Impacts of aerosol-monsoon interaction on rainfall and circulation over Northern India and the Himalaya Foothills

The boreal summer of 2008 was unusual for the Indian monsoon, featuring exceptional heavy loading of dust aerosols over the Arabian Sea and northern-central India, near normal all-India rainfall, but excessive heavy rain, causing disastrous flooding in the Northern Indian Himalaya Foothills (NIHF) regions, accompanied by persistent drought conditions in central and southern India. Using NASA Unified-physics Weather Research Forecast (NUWRF) model with fully interactive aerosol physics and dynamics, we carried out three sets of 7-day ensemble model forecast experiments: 1) control with no aerosol, 2) aerosol radiative effect only and 3) aerosol radiative and aerosol-cloud-microphysics effects, to study the impacts of aerosol-monsoon interactions on monsoon variability over the NIHF during the summer of 2008. Results show that aerosol-radiation interaction (ARI), i.e., dust aerosol transport, and dynamical feedback processes induced by aerosol-radiative heating, plays a key role in altering the large-scale monsoon circulation system, reflected by an increased north-south tropospheric temperature gradient, a northward shift of heavy monsoon rainfall, advancing the monsoon onset by 1-5 days over the HF, consistent with the EHP hypothesis (Lau et al. 2006). Additionally, we found that dust aerosols, via the semi-direct effect, increase atmospheric stability, and cause the dissipation of a developing monsoon onset cyclone over northeastern India/northern Bay of Bengal. Eventually, in a matter of several days, ARI transforms the developing monsoon cyclone into meso-scale convective cells along the HF slopes. Aerosol-Cloud-microphysics Interaction (ACI) further enhances the ARI effect in invigorating the deep convection cells and speeding up the transformation processes. Results indicate that even in short-term (up to weekly) numerical forecasting of monsoon circulation and rainfall, effects of aerosol-monsoon interaction can be substantial and cannot be ignored.