Factors associated with adherence to recommendations for medical visits following annual health checkups among Japanese employees: A prospective cohort study

There are growing concerns in Japanese workplaces that many employees do not follow recommendations to visit medical institutions for further examinations following annual health checkups. Although previous studies have shown that job- and health-related factors affect adherence to such recommendations, these longitudinal associations are unknown. We examined the longitudinal associations between job- and health-related factors and visiting medical institutions after annual health checkups among Japanese employees. We conducted a prospective cohort study in a food-related company in fiscal year 2019. Participants completed a self-administered questionnaire to assess job- and health-related factors. Of 2914 employees who completed the questionnaire, 615 received recommendations to visit medical institutions following annual health checkups in fiscal year 2020; these employees comprised our sample. We used logistic regression analysis to examine the associations between each factor and medical institution visits. Of participants, 474 (77.1 %) were men, 432 (70.2 %) were aged over 40 years, and 293 (47.6 %) visited a medical institution. Logistic regression analysis showed that participants with a primary doctor and those with obesity were more likely to visit medical institutions. In Japanese workplaces, having a primary doctor may be important in increasing adherence to medical visit recommendations following annual health checkups. However, more focus is also needed on employees without obesity who may be more confident about their health and so less likely to follow recommendations. Further intervention studies focusing on these factors are needed to identify effective interventions to improve adherence to medical recommendations.

Real-world evidence of trifluridine/tipiracil plus bevacizumab in metastatic colorectal cancer using an administrative claims database in Japan

BACKGROUND

Trifluridine/tipiracil (FTD/TPI) and regorafenib (REG) are standard therapies for refractory metastatic colorectal cancer (mCRC). No results of large real-world data directly comparing FTD/TPI + bevacizumab (BEV) with FTD/TPI or REG monotherapy have been reported. We evaluated the efficacy and safety of FTD/TPI + BEV in a real-world setting.

MATERIALS AND METHODS

This retrospective study used a Japanese claims database provided by Medical Data Vision Co., Ltd. (Tokyo, Japan). Eligible patients were aged 20 years and over with a diagnosis of mCRC, and received their first dose of FTD/TPI or REG from 2014 to 2021. The primary endpoint was overall survival (OS) in a propensity score matching (PSM) population in which PSM was carried out by matching using a 1 : 1 ratio for the FTD/TPI + BEV group and the control group (FTD/TPI or REG) by propensity score. To enhance robustness, sensitivity analyses of OS were carried out using the inverse probability treatment weighted (IPTW) approach and the analysis in the all eligible population. Secondary endpoints included time to treatment discontinuation (TTD), incidence of adverse events, and post-treatment.

RESULTS

Eligible population was 2369 for the FTD/TPI + BEV group and 9318 for the control group. The PSM population was 1787 for each group. Median OS (mOS) was longer in the FTD/TPI + BEV group compared to the control group [17.0 versus 11.6 months, hazard ratio (HR) = 0.70, P < 0.001] in the PSM population. Similarly, mOS was longer for the FTD/TPI + BEV group compared to that for the control group in IPTW analyses and in the all eligible population (both HRs = 0.68). Median TTD was 3.3 months for the FTD/TPI + BEV group and 1.8 months for the control group in the PSM population (P < 0.001).

CONCLUSIONS

Real-world data showed that FTD/TPI + BEV was significantly associated with OS and TTD compared to FTD/TPI or REG. In clinical practice, FTD/TPI + BEV can be a favorable regimen for refractory mCRC.

Intervention studies to encourage HPV vaccination using narrative: A scoping review

OBJECTIVE

This review aimed to provide an overview of intervention studies that aimed to encourage HPV vaccination using narratives.

METHODS

We searched MEDLINE, CINAHL, PsycINFO, and PsycARTICLES for English language articles that quantitatively examined the persuasive effect of narratives on encouraging HPV vaccination through interventions.

RESULTS

A total of 25 studies were identified. Most studies were conducted in the United States of America, adopted a convenient sampling of university students, measured vaccination intention as the primary outcome, and used text messages in the interventions. A minority of the studies measured vaccination behavior and examined the long-term effects of persuasion. Narratives were as effective as didactics and statistics in encouraging HPV vaccination in most included studies. The findings were mixed or scarce for the effect of combining narratives and statistics, and the person (the first vs. third), narrator, framing, and content of narratives.

CONCLUSION

More findings from a broader range of well-designed studies are needed to determine which narratives can encourage HPV vaccination across different populations.

PRACTICE IMPLICATIONS

Findings indicated using narratives can be a part of repertoire of messages encouraging HPV vaccination.

Using patient storytelling to improve medical students' empathy in Japan: a pre-post study

BACKGROUND

Empathy for patients is now internationally accepted as one of the competencies of physicians for patient-centered medical practice and an essential component of medical education. Recently, "patient storytelling" has attracted attention in empathy education for medical students to understand patients' experiences, feelings, and perspectives. This study aimed to quantitatively evaluate how patient storytelling enhanced undergraduate medical students' empathy in Japan to the extent that they sustained it for six months.

METHODS

Participants were 159 fourth-year undergraduate medical students in Tokyo in academic years 2018 and 2019. The questionnaire surveys were conducted three times: at the beginning of the class, immediately after the class, and six months after the class. The Japanese version of the Jefferson Scale of Empathy-Student Version was used in this study. Gender, age, and clinical orientation were also obtained through the self-reported questionnaire. We invited a male patient storyteller who was diagnosed with chronic kidney disease to the classes on "Professionalism." The title of his storytelling was "The Power of Medical Professionals' Words."

RESULTS

JSE-S scores improved significantly immediately after listening to patient storytelling. The scores remained improved six months after the class. Interest of specialty was significantly positively associated with an immediate change in JSE-S scores. However, gender had no significant association with changes in JSE-S scores either immediately or six months after education.

CONCLUSIONS

Our findings may suggest that patient storytelling would be useful to cultivate empathy among undergraduate medical students. It is to be expected that more medical schools will use patient storytelling to educate medical students in humanistic and communication education.

Anticipated Affect That Encourages or Discourages Human Papillomavirus Vaccination: A Scoping Review

We reviewed studies that examined the anticipated affects associated with human papillomavirus (HPV) vaccination to identify gaps in the literature and the currently available practice implications for encouraging HPV vaccination. We systematically searched MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, PsycINFO, PsycArticles, Academic Search Complete, Scopus, and Web of Science to find English articles that quantitatively and qualitatively examined anticipated affects associated with HPV vaccination. A total of twenty-one studies were identified. Seventeen studies examined the anticipated inaction regret (i.e., not being vaccinated). Most of the included studies reported that anticipated inaction regret had a significantly positive association with HPV vaccination outcomes, such as vaccination behavior, intention, willingness, and acceptability. Furthermore, seven studies reported that anticipated inaction regret had a significantly positive and stronger association with vaccination outcomes than cognitive beliefs, such as vaccine effectiveness and safety, and perceived susceptibility and severity. The present review indicated that the stronger the participants' anticipated inaction regret, the more likely they were to receive the HPV vaccine. Messages targeting the anticipated affect may be as effective as or more effective than messages targeting cognitive beliefs in encouraging HPV vaccination among people. However, most of the studies included in the present review adopted a cross-sectional design with vaccination intention and willingness as outcomes. Therefore, future studies should examine the influence of anticipated affects on the utilization of HPV vaccines using experimental designs to accumulate stronger evidence.

Encouraging COVID-19 vaccination via an evolutionary theoretical approach: A randomized controlled study in Japan

OBJECTIVE

We aimed to examine the effect of a message that target the fundamental human motive of kin care on COVID-19 vaccination recommendations among participants with young children, based on an evolutionary theoretical approach.

METHODS

Participants with young children (n = 969) were randomly assigned either to a group that received an intervention message that targeted the fundamental motive of kin care, or that targeted the fundamental motive of disease avoidance, or a control message. Intention to receive COVID-19 vaccination was assessed both before and after reading the messages. A one-way ANOVA with Tukey's or Games-Howell test was conducted.

RESULTS

An intervention message targeting the fundamental motive of kin care and disease avoidance significantly increased intention of vaccination versus a control message (p < 0.001, respectively).

CONCLUSION

The evolutionary theoretical approach that focuses on fundamental human motives has the potential to extend the communication strategy for COVID-19 vaccination recommendations.

PRACTICE IMPLICATIONS

Health professionals should deliver messages that target the fundamental motive of kin care as well as messages about the susceptibility and severity of COVID-19 and vaccine efficacy (e.g., "Get vaccinated against COVID-19 for your child's sake, because if you are infected, you will be unable to care for your child.").

Encouragement of cervical cancer screening via an evolutionary theoretical approach: a randomized controlled study in Japan

•

This is the first study of evolutionary approaches to encourage cancer screening.

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We tested the effect of a message targeting the fundamental human motive of kin care.

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Kin care messages are such as “get cervical cancer screening for future childbirth.”

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A message targeting the fundamental motive of disease avoidance was also tested.

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The kin care message was as effective as the disease avoidance message.

The introduction of an evolutionary perspective into public health research has received attention in recent years. We aimed to examine the effects of messages that target the fundamental human motive of kin care (i.e., childbirth and parenting) on cervical cancer screening recommendations, based on an evolutionary theoretical approach. A randomized controlled study was conducted in Japan. Female participants (n = 969) were randomly assigned either to a group that received an intervention message that targeted the fundamental motive of kin care (recommending cervical cancer screening for future childbearing), or that targeted the fundamental motive of disease avoidance, or a control message. Intention to obtain cervical cancer screening was assessed both before and after reading the messages. A one-way ANOVA with Tukey’s or Games–Howell test was conducted. Each of the intervention message targeting the fundamental motive of kin care and of the message targeting disease avoidance significantly increased intention to obtain cervical cancer screening versus a control message (M = 0.76 vs. M = 0.17, p < 0.001; M = 0.74 vs. M = 0.17, p < 0.001, respectively). A message that targeted the fundamental motive of kin care was as effective as one targeting the fundamental motive of disease avoidance. Health professionals should add messages that target the fundamental motive of kin care to their repertoire to encourage cervical cancer screening among women who wish future childbirth and parenting (e.g., “Delayed detection of cervical cancer may prevent your future childbirth and parenting. So let’s obtain cervical cancer screening regularly for your future childbirth and parenting.”)

Encouraging HPV Vaccination via an Evolutionary Theoretical Approach: A Randomized Controlled Study in Japan

In recent years, researchers have discussed the introduction of an evolutionary perspective into public health and health behavior research. We aimed to examine the effects of messages that target the fundamental human motive of kin care on HPV vaccination recommendations among mothers with daughters, based on an evolutionary theoretical approach. This study consisted of a three-arm parallel-group single-blinded randomized controlled study. A web-based survey was conducted from 7 to 8 October 2021 in Japan. Mothers with daughters (n = 969) were randomly assigned either to a group that received an intervention message that targeted the fundamental motive of kin care, or that targeted the fundamental motive of disease avoidance, or a control message. Intention to have daughter(s) receive HPV vaccination was assessed both before and right after reading the messages. A one-way ANOVA with Tukey’s or Games−Howell test was conducted. An intervention message targeting the fundamental motive of kin care and disease avoidance significantly increased intention of vaccination versus a control message (p < 0.001, respectively). There was no significant difference between the two intervention groups. The evolutionary theoretical approach that focuses on fundamental human motives may have the potential to extend the communication strategy for HPV vaccination recommendations. Health professionals may be recommended to deliver messages that target the fundamental motive of kin care as well as messages about the susceptibility and severity of cervical cancer and vaccine efficacy (e.g., “Getting cervical cancer can prevent childbirth. To protect your daughter and your future grandchildren, get your daughter vaccinated against HPV”). However, the present study only evaluated HPV vaccination intentions in Japanese mothers with daughters. Future studies should evaluate vaccination behavior in a wider range of subjects to confirm that the evolutionary theoretical approach promotes HPV vaccination.

Types of anticipated affect that encourage and discourage vaccination: a scoping review protocol

INTRODUCTION

Various cognitive behavioural models and theories have been used to address vaccine hesitancy. However, those models and theories have been criticised for focusing on cognitive influences on health behaviours at the expense of affective influences. Recent studies have highlighted the importance of affective elements as complementary predictors of health behaviours. Anticipated affect (ie, an expectation of one's affective response to the target behaviour) has received the most scrutiny. This scoping review will analyse studies of anticipated affect that aimed to encourage vaccination and organise implications for future research and practice in vaccine communication. Our report will focus on exploring the usefulness of affective influence in terms of a comparison with the cognitive influence on vaccination.

METHODS AND ANALYSIS

We will search several databases (MEDLINE, CINAHL, PsycINFO, PsycARTICLES, Academic Search Complete, Embase, Scopus, Web of Science and Google Scholar) and identify additional literature by searching the reference lists of eligible studies. Eligible studies are those that quantitatively or qualitatively examined anticipated affect and aimed to encourage vaccination. Only papers written in English will be included. We will include all eligible publications from database inception up to the date of the final database search. Two independent reviewers will screen the titles, abstracts and full texts of all identified studies. Two independent reviewers will share responsibility for data extraction and verification. Discrepancies will be resolved through discussion to reach consensus. We will extract data such as study characteristics, type of vaccine, type of anticipated affect, participant characteristics, methodology and main results. Data will be extracted using a customised extraction template on Covidence. The findings will be synthesised in a descriptive, narrative review.

ETHICS AND DISSEMINATION

This work does not warrant any ethical or safety review. This scoping review will be presented at a relevant conference and published in a peer-reviewed journal.

Effect of batch size on the granule properties in planetary centrifugal granulation

A granulation method using a planetary centrifugal mixer, called planetary centrifugal granulation, has been developed for small-scale production, such as extemporaneous preparation in pharmacies. Although the impact of its operational parameters on granulation is described, the scale effect has not been investigated. Therefore, we aimed to reveal the effects of vessel size and vessel filling rate on granule properties. In this study, ibuprofen 20% granules consisting of lactose, cornstarch, sodium carmellose, and talc were used as model granules. Granulation was performed using geometrically similar containers, 6-58 mL, with a filling rate of 20-70%. After granulation, we monitored the granule properties, for example, median diameter (d50), span of particle size distribution, and sphericity. At filling rates of 40% and 50% in the 58-mL vessel, the granules grew larger in diameter, and at a rate of 30%, the granules showed a higher sphericity. When the filling rate was 30%, d50 became larger and the span decreased as the vessel size increased. The yields of the granules were higher than 95% when using the 12-58 mL vessel. Lastly, the drug content uniformity and drug dissolution behavior of the granules produced in different vessel size were examined. The granules showed similar drug consistencies and drug dissolution profiles. In conclusion, the quality of the products was not affected by changes in vessel size. Thus, pharmacists could prepare and compound the granule formulations with high yield and appropriate quality using an adequate vessel in the same manner.

Associations between job and workplace factors, health and physical factors, personal factors, and presenteeism among general employees in Japan: A longitudinal study

OBJECTIVE

Presenteeism is gaining attention as an occupational health issue in Japan. However, few studies have longitudinally examined the associations between work- and health-related factors and presenteeism using validated instruments in Japan. Drawing on a theoretical framework, we aimed to examine longitudinal associations between job and workplace factors, health and physical factors, personal factors, and presenteeism among Japanese general employees. We also aimed to use the findings to identify educational factors to reduce presenteeism in the Japanese occupational field.

METHODS

We conducted two surveys (T1: conducted 2019; T2: conducted 2020) in a Japanese food-related company using a self-administered questionnaire. Presenteeism was assessed using a work functioning impairment scale (WFun). We used multiple linear regression analysis to examine the associations between each factor at T1 and presenteeism at T2.

RESULTS

A total of 2914 employees completed the T1 survey (response rate: 55.7%) and 1467 completed the T2 survey. Thus, we analyzed data for 1467 employees. Of these, 1038 (70.8%) were men and 886 (60.4%) were aged over 40 years at T1. The mean presenteeism score at T2 was 15.06 (standard deviation: 6.22). Multiple linear regression analysis showed that job demands, self-rated health status, dietary choices, and health literacy were associated with presenteeism after 1 year.

CONCLUSIONS

The findings suggest that job demands, self-rated health status, dietary habits, and health literacy were associated with higher degree of presenteeism in future. Further intervention studies focusing on these factors are needed to develop and examine effective interventions to reduce presenteeism in Japan.

The effectiveness of strict low-density lipoprotein cholesterol management in secondary prevention of Japanese patients

Background

In Japanese guidelines, target value of low-density lipoprotein cholesterol (LDL-C) &lt;100mg/dL is recommended as standard management for secondary prevention of coronary artery disease. On the other hand, the guidelines also state that LDL-C targeting &lt;70mg/dL should be considered in high-risk patients. However, the effectiveness of strict LDL-C management in the prevention of long-term coronary event recurrence in Japanese patients remains unclear.

Purpose

The purpose of the present study was to evaluate whether the strict management of LDL-C targeting &lt;70 mg/dL was effective to prevent recurrence of acute coronary syndrome (ACS) than standard management in patients with previous percutaneous coronary intervention (PCI).

Methods

From January 2007 to August 2020, we performed coronary angiography in 359 patients with previous PCI who were suspected of having signs of recurrent cardiac ischemia. Patients were stratified into three groups according to achieved LDL-C value; &lt;70mg/dL (n=57), 70 to &lt;100mg/dL (n=135) and ≥100mg/dL (n=167). In addition, patients who had previous ACS and/or diabetes mellitus were defined as high-risk group, and sub-analysis by their achieved LDL-C values was performed in high-risk group and non-high-risk group. Endpoint was recurrence of ACS. Moreover, risk factors associated with recurrent-ACS were examined in patients with LDL-C &lt;100 mg/dL.

Results

After follow-up (median 6.1 years), 99 patients (28%) had recurrent-ACS. Recurrent-ACS was significantly lower in patients with LDL-C &lt;70mg/dL than LDL-C 70 to &lt;100mg/dL and LDL-C ≥100mg/dL (p&lt;0.01 and p&lt;0.001, respectively). In sub-analysis, high-risk group with LDL-C &lt;70 mg/dL had lower incidence of recurrent-ACS than LDL-C 70 to &lt;100 mg/dL (p=0.03). Similar tendency was found in non-high-risk group (p=0.08). There was no difference of recurrent-ACS between high-risk group and non-high-risk group in patients with LDL-C &lt;70mg/dL (p=0.41). Moreover, in patients with achieved LDL-C &lt;100mg/dL (n=192), multivariate analysis identified that LDL-C (HR: 1.032, p&lt;0.01) and HbA1c (HR: 1.330, p&lt;0.01) were independent predictors of recurrent-ACS. In these patients, whether or not they were in the high-risk group was not a significant predictor (p=0.61).

Conclusions

Strict management of LDL-C targeting &lt;70 mg/dL should be considered for a wider range of Japanese patients as well as for Westerners to prevent recurrence of ACS in secondary prevention.

Funding Acknowledgement

Type of funding sources: None. Probability of freedom from ACS

Impact of the 12-gene recurrence score assay on deciding adjuvant chemotherapy for stage II and IIIA/B colon cancer: the SUNRISE-DI study

BACKGROUND

Recent advances in adjuvant chemotherapy for early colon cancer have widened physicians' recommendations on the regimen and duration (3 or 6 months) of the treatment. We conducted this prospective study to evaluate whether the 12-gene recurrence score (12-RS) assay affected physicians' recommendations on adjuvant treatment selection.

PATIENTS AND METHODS

Patients with stage IIIA/IIIB or stage II colon cancer were enrolled. After the patients discussed adjuvant treatment with their treating physicians, the physicians filled in the questionnaire before assay indicating the treatment recommendation. When the 12-RS assay results were available, the physicians again filled in the questionnaire after assay. The primary endpoint was the rate of change in treatment recommendations from before to after the assay, with a threshold rate of change being 20%. Patients with stage IIIA/B to II were enrolled in a ratio of 2 : 1.

RESULTS

Overall, the treatment recommendations changed in 40% of cases after obtaining 12-RS assay results. Recommendations were changed in 45% (80/178; 95% confidence interval, 37% to 53%; P < 0.001) and 30% (29/97; 95% confidence interval, 21% to 40%; P < 0.001) of patients with stage IIIA/B and II colon cancer, respectively. Patients with stage IIIA/B cancer had significantly more change than those with stage II cancer (P = 0.0148). From before to after the 12-RS assay, the percentage of patients whose physicians reported being confident in their treatment recommendations significantly increased from 54% to 81% in stage IIIA/B (P < 0.001) and from 65% to 83% in stage II (P < 0.001).

CONCLUSION

Our study confirmed the usefulness of the 12-RS assay in aiding the physician-patient decision-making process for tailoring adjuvant chemotherapy for stage IIIA/B colon cancer.

Effectiveness of more strict managements after achievement of standard target value of low-density lipoprotein cholesterol in secondary prevention of Japanese patients

Background

In secondary prevention of coronary artery disease, target value of low-density lipoprotein cholesterol (LDL-C) &lt;100 mg/dL is recommended as standard management in Japanese guideline. The guideline also stated that strict management of LDL-C targeting &lt;70 mg/dL is considered in some high risk patients. However, in Japanese patients, effectiveness of more strict management of LDL-C lowering therapy for prevention of long-term cardiovascular events remains unclear.

Purpose

The purpose of the present study was to evaluate whether the strict management of LDL-C targeting &lt;70 mg/dL was effective to prevent recurrence of long-term coronary events than standard management in patients with previous percutaneous coronary intervention (PCI).

Methods

We investigated 344 patients with previous PCI who underwent late coronary angiography to examine recurrence of cardiac ischemia beyond the early phase of restenosis from January 2007 to August 2019. Patients were stratified into three groups according to achieved LDL-C value; LDL-C &lt;70mg/dL (n=53), 70 to &lt;100mg/dL (n=130) and ≥100mg/dL (n=161). Endpoints of this study were recurrence of cardiac ischemia presenting as acute coronary syndrome (recurrence-ACS) and any late coronary revascularization.

Results

During average 7.1 years follow-up, 200 patients (58%) underwent any late coronary revascularization. In 94 of those patients, recurrence-ACS was observed. The incidence of recurrence-ACS was significantly lower in patients with achieved LDL-C &lt;70mg/dL than in those with LDL-C 70 to &lt;100mg/dL and LDL-C ≥100mg/dL (p=0.009 and p=0.001, respectively), however, there was no difference between patients with LDL-C 70 to &lt;100mg/dL and LDL-C ≥100mg/dL (p=0.140). Any late revascularization was significantly lower in patients with achieved LDL-C &lt;70mg/dL and in those with LDL-C 70 to &lt;100mg/dL than in those with LDL-C ≥100mg/dL (p=0.002 and p&lt;0.001, respectively), however, no difference was found between patients with LDL-C &lt;70mg/dL and LDL-C 70 to &lt;100mg/dL (p=0.119). Moreover, in patients with achieved LDL-C &lt;100mg/dL (n=183), multivariate analysis identified that LDL-C (HR 1.035, p=0.007) and HbA1c (HR 1.338, p=0.001) were independent predictors of recurrence-ACS. In contrast, only using statins (HR 0.461, p=0.009) was an independent predictor of recurrence-ACS in patients with achieved LDL-C ≥100mg/dL.

Conclusions

LDL-C was the important residual risk of recurrence-ACS even after recommended standard LDL-C lowering management had been achieved. More strict management of LDL-C targeting to &lt;70mg/dL should be considered to prevent recurrence-ACS for wider range of Japanese patients in secondary prevention.

Incidence of late coronary events

Funding Acknowledgement

Type of funding source: None

AB0106 THE SERUM N-ACETYLGLUCOSAMINE CONCENTRATIONS IN RHEUMATOID ARTHRITIS PATIENTS ARE ASSOCIATED WITH JOINT DESTRUCTION AND RELATED METABOLISM MORE THAN INFLAMMATORY CONDITION

Background:

In rheumatoid arthritis (RA) patients, synovitis causes severe articular cartilage damage. N-acetylglucosamine (NAc-Glc) is a component of gluglucosaminoglycans (GAG) such as hyaluronic acid (HA) and keratan sulfate (KS), heparan sulfate (HS). NAc-Glc concentration in plasma is thought to reflect the balance between biosynthesis and destruction of articular cartilage, however, few studies had examined the relationship between plasma NAc-Glc conncentration and RA activity.

Objectives:

NAc-Glc concentrations in RA patients were measured, and association with clinical indicators was assessed.

Methods:

A cross-sectional study was carried out including 60 RA cases. Using N-acetylglucosamine-d3 as standard, the serum of subjects were deproteinized by protein precipitation method with acetonitrile, then concentration of NAc-Glc was measured with high-speed liquid chromatography mass spectrometer (LC-MS / MS). Clinical evaluation items: basic metabolism, presence or absence of exercise habit, Larsen score of knee and wrist joint, therapeutic agents (csDMARDs, biologics and PSL), DAS28, CRP, MMP-3, modified HAQ score (mHAQ). Statically analyzed by Spearman non parametric test.

Results:

The age of 60 RA cases was 59.7±16.4 years, and the duration of the disease was 10.4±8.7 years. Biologics were used in 29 cases (TNF inhibitors in 16 cases, IL-6 inhibitors in 4 cases, Abatacept in 9 cases), MTX in 32 cases, and prednisolone in 15 cases.

Plasma NAc-Glc concentration was 113±41 (ng/dl), DAS28CRP was 3.04±1.2, and mHAQ was 0.863±891. Plasma NAc-Glc concentration showed positive correlation with age (correlation coefficient 0.644), knee joint destruction (0.425), HAQ score (0.340), BUN (0.412), and RF (0.287). Plasma NAc-Glc concentrations also negatively correlated with eGFR (-0.597), MTX use (-0.389), basal metabolism (-0.313), and sex difference (-0.272). There was no correlation between plasma NAc-Glc concentration and body weight, BMI, DAS28, CRP, MMP-3, NTX, serum creatinine, hand joint disease, and transaminase.In this study, plasma NAc-Glc concentration had increased with age, and had have a negative correlation with basal metabolism. Considering these results, it is unlikely that NAc-Glc is released into plasma as a metabolite of synthesis promotion. Further, since NAc-Glc had a negative correlation (-0.389) with MTX as a folic acid inhibitor, it was supposed to be affected by protein synthesis reduction. Because no correlation between NAc-Glc and inflammation or bone metabolism markers was observed, NAc-Glc may represent removal of GAG from the cell membrane (shedding).

In previous GAGs studies, in RA patients, HA, KS, CRP, DAS28, was very associated with arthritis, such as MMP-3.The concentration of NAc-Glc in plasma was more relevant to dysfunctions such as destruction and HAQ due to arthritis such as HAQ than inflammatory indicators such as DAS28, MMP-3 and CRP. It is appearing in the plasma by destruction by shedding, as an index to see the joint destruction, it was presumed to be a better indicator than the GAGs. It was also thought that there is a possibility that MTX affects cartilage substrate metabolism.

Conclusion:

Serum NAc-Glc concentration in rheumatoid arthritis patients may represent cartilage metabolism and joint destruction.

References:

[1]Y.Matsuura. et al.Ann.Rheum.Dis. 2018;77: 1219-1225

[2]T D Spector.et al. Ann.Rheum.Dis. 1992;51: 1134-1137

Disclosure of Interests:

None declared

P1520 Aortic flow reversal caused by aortic regurgitation deteriorates renal function

Background

Chronic kidney disease is a growing public health problem. Renal dysfunction is known as a strong risk factor for cardiovascular disease and end-stage renal failure. The presence of pan-diastolic flow reversal in the abdominal aorta is a very specific sign of severe aortic regurgitation (AR). A higher aortic reverse/forward flow ratio is associated with lower intrarenal forward flow. However, the influence of AR on renal function has been poorly understood. We hypothesized that the aortic flow reversal reduces the renal artery forward flow and accordingly leads to renal dysfunction in patients with severe AR.

Methods

The study consisted of 21 consecutive patients (mean age 69 ± 11 years) with severe AR who underwent aortic valve replacement (AVR). We compared echocardiographic indices and the glomerular filtration rate (GFR) before and 603 ± 541 days after AVR.

Results

Blood pressure was 122 ± 16/54 ± 8 mmHg before AVR and 123 ± 16/76 ± 11 mmHg after AVR. After AVR, left ventricular (LV) end-diastolic dimension decreased from 57 ± 9 to 44 ± 5 mm and LV ejection fraction increased from 58 ± 12 to 60 ± 11 %. Estimated GFR significantly increased from 62.9 ± 18.9 to 71.8 ± 18.1 mL/min per 1.73 m2 after AVR (p = 0.003).

Conclusions An increase in aortic flow reversal caused by severe AR reduces forward flow into the kidney and thereby deteriorates renal function. This study demonstrated a key mediating role of central hemodynamic factors, particularly an exaggerated aortic flow reversal in renal dysfunction and severe AR.

P642What is the most important residual risk after achievement of appropriate low-density lipoprotein cholesterol lowering therapy in secondary prevention of Japanese patients?

Background

In secondary prevention of coronary artery disease, target value of low-density lipoprotein cholesterol (LDL-C) <100mg/dL with using statins is recommended as standard therapy in Japanese guideline. However, impact of residual risks after achievement of standard LDL-C lowering therapy was not fully examined. Furthermore, there is little information whether more strict management of LDL-C lowering is effective to prevent long-term cardiovascular events than standard management.

Purpose

The purpose of this study was to evaluate the relationship between residual risks after achievement of standard LDL-C lowering therapy and long-term coronary events in secondary prevention of Japanese patients.

Methods

From January 2007 to August 2018, 333 patients with previous percutaneous coronary intervention underwent late coronary angiography to examine recurrence of cardiac ischemia beyond the early phase of restenosis. We defined appropriate LDL-C lowering therapy as achieved LDL-C <100mg/dL with using statins. Patients whose achieved LDL-C was <100mg/dL with using statins were classified as Appropriate-group (n=139), and patients who were not using statins or whose achieved LDL-C was ≥100mg/dL were classified as Inappropriate-group (n=194). Endpoints of the study were recurrence of cardiac ischemia as acute coronary syndrome (recurrence-ACS) and any late coronary revascularization.

Results

During average 7.1 years follow-up, 195 patients (59%) underwent any late coronary revascularization. In 91 of those patients, clinical presentation of recurrence-ACS was observed. Kaplan-Meier curve analysis revealed that the incidence of recurrence-ACS and any late coronary revascularization were significantly lower in Appropriate-group than in Inappropriate-group (p=0.017 and p<0.001, respectively). In Appropriate-group, recurrence-ACS was significantly lower in patients with achieved LDL-C <70mg/dL than in those with LDL-C 70 to <100mg/dL (p=0.042), however, any late revascularization was not different between the two groups. On the other hand, in Inappropriate-group, recurrence-ACS was significantly lower in patients with using statins than in those without using statins (p=0.038), and any late revascularization was less frequent in patients with achieved LDL-C <100mg/dL than in those with LDL-C ≥100mg/dL (p=0.035). Moreover, multivariate analysis identified that only LDL-C was an independent predictor of recurrence-ACS in Appropriate-group (HR: 1.047, p=0.006), in contrast, LDL-C (HR: 1.008, p=0.020), using statins (HR: 0.555, p=0.034) and triglyceride (HR: 1.003, p=0.038) were independent predictors of recurrence-ACS in Inappropriate-group.

Conclusions

LDL-C was the most important residual risk of recurrence-ACS even after recommended standard therapy has been achieved. More strict management of LDL-C targeting to <70mg/dL should be considered in secondary prevention of Japanese patients.

REVERCE: a randomized phase II study of regorafenib followed by cetuximab versus the reverse sequence for previously treated metastatic colorectal cancer patients

BACKGROUND

The objective of this randomized phase II trial was to evaluate efficacy and safety of the therapeutic sequence of regorafenib followed by cetuximab, compared with cetuximab followed by regorafenib, as the current standard sequence for metastatic colorectal cancer patients.

PATIENTS AND METHODS

Patients with KRAS exon 2 wild-type metastatic colorectal cancer after failure of fluoropyrimidine, oxaliplatin, and irinotecan were randomized to receive sequential treatment with regorafenib followed by cetuximab ± irinotecan (R-C arm), or the reverse sequence [cetuximab ± irinotecan followed by regorafenib (C-R arm)]. The primary end point was overall survival (OS). Key secondary end points included progression-free survival (PFS) with initial treatment (PFS1), PFS with second treatment (PFS2), safety, and quality of life. Exploratory end points included serial biomarker analyses, including oncogenic alterations from circulating tumor DNA or multiple serum or plasma proteins.

RESULTS

One-hundred one patients were randomized and eligible for efficacy analysis. Sequential treatment was successful in 86% patients in both arms. Median OS for R-C and C-R was 17.4 and 11.6 months, respectively (P = 0.0293), with a hazard ratio (HR) of 0.61 for OS [95% confidence interval (CI) 0.39-0.96]. The HR for PFS1 (regorafenib in R-C versus cetuximab in C-R) was 0.97 (95% CI 0.61-1.54), and PFS2 (C in R-C versus R in C-R) was 0.29 (95% CI 0.17-0.50). No unexpected safety signals were observed. The quality of life scores during the entire treatment period was not significantly different between the two arms. Circulating biomarker analyses showed emerging oncogenic alterations in RAS, BRAF, EGFR, HER2, and MET, which were more commonly detected after cetuximab than after regorafenib.

CONCLUSIONS

The therapeutic sequence of regorafenib followed by cetuximab suggests a longer OS than the current standard sequence.

Correction to: Age-related normative values of trabecular bone score (TBS) for Japanese women: the Japanese Population-based Osteoporosis (JPOS) study

I have, as the Principal Investigator of this study, identified an error in the computation of TBS values in the JPOS cohort, which resulted in the publication of incorrect TBS absolute values [1]. This error was linked to the calibration process for calculating standardized TBS values in the R&D TBS.

PCR-based clonality analysis of antigen receptor gene rearrangements in canine cutaneous plasmacytoma

Plasmacytomas are discrete, B cell-derived, round cell tumours that sometimes are difficult to distinguish from canine cutaneous histiocytomas or T cell lymphosarcomas (lymphomas). Diagnosis of plasmacytomas relies on morphological observations and immunohistochemistry for multiple myeloma oncogene-1 (MUM-1) and cluster of differentiation 3 (CD3). Clonality testing often is used as an adjunct diagnostic tool to examine lymphoproliferative diseases. In this study, the sensitivity of PCR-based clonality analysis of antigen receptor gene rearrangements in canine cutaneous plasmacytomas was determined. Formalin-fixed paraffin-embedded sections of 29 canine plasmacytomas, 23 diffuse large B cell lymphomas (DLBCLs) and 23 lymph nodes without lymphoma were used for clonality analysis. New oligonucleotide primers for the framework (FR)2 and FR3 regions of the immunoglobulin heavy chain (IGH) V gene subgroup 3 were designed and used with previously reported FR3 primers. Although plasma cells are of B cell lineage, the detected frequency of IGH clonality in plasmacytoma was 0-34.5% with the seven primers used, whereas in DLBCLs it was 8.7-78.3%. In 23 lymph nodes without lymphoma, IGH clonality was detected in only one case with two out of the seven primers used. Sequence analysis of PCR products from plasmacytomas revealed mismatches in the annealing region of the FR3 primers. The sensitivity of detecting IGH clonality in canine plasmacytomas was lower than in DLBCLs. The low detection rate of IGH clonality in canine plasmacytoma may be due to somatic hypermutation of the variable region.

Evaluation of the molecular lipid organization in millimeter-sized stratum corneum by synchrotron X-ray diffraction

BACKGROUND

The aim of this study was to investigate whether the lamellar and lateral structure of intercellular lipid of stratum corneum (SC) can be evaluated from millimeter-sized SC (MSC) by X-ray diffraction.

MATERIALS AND METHODS

A 12 mm × 12 mm SC sheet from hairless mouse was divided into 16 pieces measuring 3 mm × 3 mm square. From another sheet, 4 pieces of ultramillimeter-sized SC (USC:1.5 mm × 1.5 mm square) were prepared. Small and wide-angle X-ray diffraction (SAXD and WAXD) measurements were performed on each piece. For MSC and USC, changes in the lamellar and lateral structure after the application of d-limonene were measured.

RESULTS

The intensity of SAXD peaks due to the lamellar phase of long periodicity phase (LPP) and WAXD peaks due to the lateral hydrocarbon chain-packing structures varied in MSC and USC pieces, although over the 12 mm × 12 mm SC sheet. These results indicated that the intercellular lipid components and their proportion appeared nearly uniform. Application of d-limonene on MSC and USC piece with strong peaks in SAXD and the WAXD resulted in the disappearance of peaks due to the lamellar phase of LPP and decrease in peak intensity for the lateral hydrocarbon chain-packing structures. These changes are consistent with normal-sized sample results.

CONCLUSION

We found that the selection of a sample piece with strong diffraction peaks due to the lamellar and lateral structure enabled evaluation of the SC structure in small-sized samples by X-ray diffraction.

Gallbladder Agenesis in 17 Dogs: 2006-2016

Background

Gallbladder agenesis (GBA) is extremely rare in dogs.

Hypothesis/Objectives

To describe the history, clinical signs, diagnosis, treatment, and outcomes of dogs with GBA.

Animals

Seventeen client‐owned dogs with GBA.

Methods

Medical records from 2006 through 2016 were retrospectively reviewed. Dogs were included when GBA was suspected on abdominal ultrasonography and confirmed by gross evaluation. Signalment, clinical signs, clinicopathological data, diagnostic imaging, histopathology, treatment, and outcome were recorded.

Results

Dogs were of 6 different breeds, and Chihuahuas (10 of 17) were most common. Median age at presentation was 1.9 (range, 0.7–7.4) years. Clinical signs included vomiting (5 of 17), anorexia (2 of 17), ascites (2 of 17), diarrhea (1 of 17), lethargy (1 of 17), and seizures (1 of 17). All dogs had increased serum activity of at least 1 liver enzyme, most commonly alanine aminotransferase (15 of 17). Fifteen dogs underwent computed tomography (CT) cholangiography; common bile duct (CBD) dilatation was confirmed in 12, without evidence of bile duct obstruction. Gross evaluation confirmed malformation of the liver lobes in 14 of 17 dogs and acquired portosystemic collaterals in 5 of 17. Ductal plate malformation was confirmed histologically in 16 of 17 dogs. During follow‐up (range, 4–3,379 days), 16 of 17 dogs remained alive.

Conclusions and Clinical Importance

Dogs with GBA exhibit clinicopathological signs of hepatobiliary injury and hepatic histopathological changes consistent with a ductal plate abnormality. Computed tomography cholangiography was superior to ultrasound examination in identifying accompanying nonobstructive CBD distention. Computed tomography cholangiography combined with laparoscopic liver biopsy is the preferable approach to characterize the full disease spectrum accompanying GBA in dogs.