Elderly onset atypical Lemierre's syndrome concurrent with a rheumatoid vasculitis sacral ulcer infection: a case report

BACKGROUND

Typical Lemierre's syndrome is usually secondary to an oropharyngeal infection. Recently, several cases following a primary infection site other than the oropharynx have been reported as atypical Lemierre's syndrome; although, these primary lesions are limited to the head and neck. This is the first case potentially sequential to infectious foci outside the head and neck.

CASE PRESENTATION

We describe an atypical Lemierre's syndrome in a 72-year-old woman with rheumatoid arthritis, which occurred during the treatment of Streptococcus anginosus bacteremia acquired from a sacral ulcer infection related to rheumatoid vasculitis. At first, the symptoms resolved after the initial administration of vancomycin for the bacteremia caused by methicillin-resistant Staphylococcus aureus and Streptococcus anginosus that entered via a sacral ulcer. On the 8th day, the patient developed a fever of 40 °C and unexpectedly required 10 L of oxygen due to rapid deterioration of oxygenation temporarily. Immediately contrast-enhanced computed tomography was performed to investigate systemic thrombosis including pulmonary embolism. Afterward, the newly formed thrombi at the right external jugular vein, bilateral internal jugular veins, and the right small saphenous vein were detected, and apixaban was started. On the 9th day, the patient again had an intermittent fever of 39.7 °C, and continuous Streptococcus anginosus bacteremia was revealed; subsequently, clindamycin was administered. On the 10th day, she developed a left hemothorax; consequently, apixaban was discontinued, and a thoracic drain was inserted. She repeatedly had an intermittent fever of 40.3 °C, and contrast-enhanced computed tomography detected an abscess formation at the left parotid gland, pterygoid muscle group, and masseter muscle. After Lemierre's syndrome was diagnosed in combination with the abovementioned jugular vein thrombus, clindamycin was replaced with meropenem, and vancomycin was increased. Swelling of the lower part of the left ear became prominent with delay and peaked at approximately the 16th day. The subsequent treatment course was favorable, and she was discharged on the 41st day.

CONCLUSION

Clinicians should consider Lemierre's syndrome as the differential diagnosis of internal jugular vein thrombosis occurring during sepsis, even though an antibiotic is administered or a primary infection site is anything besides the oropharynx.

Heterogeneous carotid plaque is associated with cardiovascular events after percutaneous coronary intervention

Background

The relationship between carotid artery ultrasound findings and clinical outcomes in percutaneous coronary intervention (PCI) patients has not been fully elucidated.

Purpose

To investigate the relationship between carotid artery ultrasound findings and cardiovascular risks in PCI patients.

Methods

This was a single-center retrospective study investigating 691 patients who underwent PCI and carotid ultrasound testing. Maximum carotid intima-media thickness (CIMT) was defined as the greatest CIMT at the maximally thick point among the common carotid artery, carotid bulb, and internal carotid artery. A carotid plaque was defined as vessel wall thickening with a CIMT ≥1.5 mm. The characteristics of carotid plaque (heterogeneity, calcification, or irregular/ulcerated surface) were evaluated visually. Patients were divided into those with and without heterogeneous carotid plaque (maximum CIMT ≥1.5 mm and heterogeneous texture). The endpoint was the incidence of a major adverse cardiovascular event (MACE) defined as a composite of cardiovascular death, myocardial infarction, and ischemic stroke.

Results

Among 691 patients, 312 were categorized as having a heterogeneous plaque. Patients with heterogeneous plaques were at a higher risk of MACE than those without (p=0.002). A heterogeneous plaque was independently associated with MACE after adjusting for covariates (hazard ratio [HR], 1.80; 95% confidence interval [CI], 1.06–3.04; p=0.03). Calcified or irregular/ulcerated plaques were correlated with a higher incidence of MACE but both were not independently associated with MACE (HR, 1.37; 95% CI, 0.70–2.67, p=0.36 and HR, 1.13; 95% CI, 0.66–1.93; p=0.66, respectively).

Conclusions

The presence of a heterogeneous carotid plaque in patients who underwent PCI predicted future cardiovascular events. These patients may require more aggressive medical therapy and careful follow-up.

Funding Acknowledgement

Type of funding sources: None.

Albuminuria predicts worsening renal function at 1 month after transcatheter aortic valve implantation

Background

Worsening renal function (WRF) at short term after transcatheter aortic valve replacement (TAVR) is reportedly associated with subsequent poor clinical outcomes. We previously reported preoperative albuminuria predicted mid-term WRF after TAVR. However, the impact of albuminuria on short-term WRF after TAVR is unknown.

Methods

Overall, 206 patients who underwent TAVR for severe aortic stenosis were investigated retrospectively. Patients were divided into two groups according to the preoperative urinary albumin-to-creatinine ratio (ACR): high (ACR ≥30 mg/g) and low (ACR <30 mg/g). The incidence of 1-month WRF, defined as a decrease in estimated glomerular filtration rate (eGFR) ≥10% from baseline after TAVR, was investigated.

Results

More than half of the examined patients (n=106/206 [51.5%]) had a high ACR. Patients with a high ACR had significantly lower eGFR at baseline than those with a low ACR (49.3 [32.5–57.8] vs. 51.4 [37.7–65.8] mL/min/1.73 m2, p=0.03). Patients with a high ACR more frequently had acute kidney injury (8.5% vs. 1.0%, p=0.01) and 1-month WRF than those with a low ACR (29.2% vs. 12.0%, p=0.002). Multivariate analysis showed a high ACR was independently associated with 1-month WRF (odds ratio, 3.72; 95% confidence interval, 1.72–8.08; p<0.001). Meanwhile, eGFR <60 mL/min/1.73 m2 was not an independent predictor of 1-month WRF (odds ratio, 0.48; 95% confidence interval, 0.22–1.04, p=0.06).

Conclusions

Patients with preoperative albuminuria (ACR ≥30 mg/g) more frequently developed AKI and 1-month WRF after TAVR. Albuminuria was independently associated with 1-month WRF, suggesting albuminuria to be a universal predictor of deterioration of renal function at various time points.

Funding Acknowledgement

Type of funding sources: None.

OP0112 THE EVER-LARGEST ASIAN GWAS FOR SYSTEMIC SCLEROSIS AND TRANS-POPULATION META-ANALYSIS IDENTIFIED SEVEN NOVEL LOCI AND A CANDIDATE CAUSAL SNP IN A CIS-REGULATORY ELEMENT OF THE FCGR REGION

Background

Genome-wide association studies (GWASs) have identified 29 disease-associated single nucleotide polymorphisms (SNPs) for systemic sclerosis (SSc) in non-human leukocyte antigen (HLA) regions (1-7). While these GWASs have clarified genetic architectures of SSc, study subjects were mainly Caucasians limiting application of the findings to Asians.

Objectives

The study was conducted to identify novel causal variants for SSc specific to Japanese subjects as well as those shared with European population. We also aimed to clarify mechanistic effects of the variants on pathogenesis of SSc.

Methods

A total of 114,108 subjects comprising 1,499 cases and 112,609 controls were enrolled in the two-staged study leading to the ever-largest Asian GWAS for SSc. After applying a strict quality control both for genotype and samples, imputation was conducted using the reference panel of the phase 3v5 1,000 genome project data combined with a high-depth whole-genome sequence data of 3,256 Japanese subjects. We conducted logistic regression analyses and also combined the Japanese GWAS results with those of Europeans (6) by an inverse-variance fixed-effect model. Polygenicity and enrichment of functional annotations were evaluated by linkage disequilibrium score regression (LDSC), Haploreg and IMPACT programs. We also constructed polygenic risk score (PRS) to predict SSc development.

Results

We identified three (FCRLA-FCGR, TNFAIP3, PLD4) and four (EOMES, ESR1, SLC12A5, TPI1P2) novel loci in Japanese GWAS and a trans-population meta-analysis, respectively. One of Japanese novel risk SNPs, rs6697139, located within FCGR gene clusters had a strong effect size (OR 2.05, P=4.9×10-11). We also found the complete LD variant, rs10917688, was positioned in cis-regulatory element and binding motif for an immunomodulatory transcription factor IRF8 in B cells, another genome-wide significant locus in our trans-ethnic meta-analysis and the previous European GWAS. Notably, the association of risk allele of rs10917688 was significant only in the presence of the risk allele of the IRF8. Intriguingly, rs10917688 was annotated as one enhancer-related histone marks, H3K4me1, in B cells, implying that FCGR gene(s) in B cells may play an important role in the pathogenesis of SSc. Furhtermore, significant heritability enrichment of active histone marks and a transcription factor C-Myc were found in B cells both in European and Japanese populations by LDSC and IMPACT, highlighting a possibility of a shared disease mechanism where abnormal B-cell activation may be one of the key drivers for the disease development. Finally, PRS using effects sizes of European GWAS moderately fit in the development of Japanese SSc (AUC 0.593), paving a path to personalized medicine for SSc.

Conclusion

Our study identified seven novel susceptibility loci in SSc. Downstream analyses highlighted a novel disease mechanism of SSc where an interactive role of FCGR gene(s) and IRF8 may accelerate the disease development and B cells may play a key role on the pathogenesis of SSc.

References

[1]F. C. Arnett et al. Ann Rheum Dis, 2010.

[2]T. R. Radstake et al. Nat Genet, 2010.

[3]Y. Allanore et al. PLoS Genet, 2011.

[4]O. Gorlova et al. PLoS Genet, 2011.

[5]C. Terao et al. Ann Rheum Dis, 2017.

[6]E. López-Isac et al. Nat Commun, 2019.

[7]W. Pu et al. J Invest Dermatol, 2021.

Disclosure of Interests

None declared

Estimation of Cerebral Hemodynamics and Oxygenation During Various Intensities of Rowing Exercise: An NIRS Study

Purpose

This study aimed to investigate changes in cerebral hemodynamics and oxygenation at moderate, heavy, maximal and supramaximal intensities of rowing exercise. It also examined whether these changes reflect alterations in sensation of effort and mood. We also aimed to examine the effects of peak pulmonary oxygen consumption (V.O_2peak) on cerebral oxygenation.

Methods

Eleven rowers, consisting out of six athletes and five recreational rowers [two female; age, 27 ± 9 years; height, 171 ± 7 cm, body mass, 67 ± 9 kg; V.O_2peak, 53.5 ± 6.5 mL min^–1 kg^–1] rowed a 13-min session separated by 10 and 3 min, at 70 (Ex_70%) and 80% of V.O_2peak (Ex_80%), respectively, on a rowing ergometer, followed by three sessions of 1-min supramaximal exercise (ExSp). After a warm-up at 60% of V.O_2peak (ExM), seven male rowers performed a 2,000 m all-out test (Ex₂₀₀₀). Cardiovascular and respiratory variables were measured. Cerebral oxygenation was investigated by near-infrared time-resolved spectroscopy (TRS) to measure cerebral hemoglobin oxygen saturation (ScO₂) and total hemoglobin concentration ([HbT]) in the prefrontal cortex (PFC) quantitatively. We estimated the relative changes from rest in cerebral metabolic rate for oxygen (rCMRO₂) using TRS at all intensities. During Ex_70% and Ex_80%, ratings of perceived exertion (RPE) were monitored, and alteration of the subject’s mood was evaluated using a questionnaire of Positive-and-Negative-Affect-Schedule after Ex_70% and Ex_80%.

Results

When exercise intensity changed from Ex_70% to Ex_80%, the sense of effort increased while ScO₂ decreased. [HbT] remained unchanged. After Ex_70% and Ex_80%, a negative mood state was less prominent compared to rest and was accompanied by increases in both ScO₂ and [HbT]. At termination of Ex₂₀₀₀, ScO₂ decreased by 23% compared to rest. Changes in ScO₂ correlated with V.O_2peak only during Ex₂₀₀₀ (r = −0.86; p = 0.01). rCMRO₂ did not decrease at any intensities.

Conclusion

Our results suggest that alterations in the sense of effort are associated with oxygenation in the PFC, while positive changes in mood status are associated with cerebral perfusion and oxygen metabolism estimated by TRS. At exhaustion, the cerebral metabolic rate for oxygen is maintained despite a decrease in ScO₂.

Association between the Mediterranean Diet Score and Healthy Life Expectancy: A Global Comparative Study

OBJECTIVES

Extending healthy life expectancy (HALE), defined as the average number of years that a person can expect to live in "full health" by taking into account years lived in less than full health due to disease and/or injury, is a common topic worldwide. This study aims to clarify the relationships between the Mediterranean diet score (MDS) and life expectancy (LE) and HALE globally using publicly available international data.

SETTING

Analyses were conducted on 130 countries with populations of 1 million or more for which all data were available. Individual countries were scored from 0 to 9 to indicate adherence to the Mediterranean diet according to the MDS scoring method. The supply of vegetables, legumes, fruits and nuts, cereals, fish, and olive oil per 1,000 kcal per country was calculated based on the Food and Agriculture Organization Corporate Statistical Database, with a score of 1 for above the median and 0 for below. The same method was used to calculate scores of presumed detrimental components (meat and dairy), with consumption below the median given a value of 1, and consumption above the median given a value of 0. For ethanol, a score of 1 was given for 10g to 50 g of consumption. We investigated the cross-sectional associations between the MDS and LE and HALE at birth in 2009, and the longitudinal associations between the MDS in 2009 and LE and HALE between 2009 and 2019, controlling for covariates at baseline using linear mixed models.

RESULTS

In the cross-sectional analysis, the MDS was significantly positively associated with LE (β=0.906 [95% confidence interval, 0.065-1.747], p=0.037) and HALE (β=0.875 [0.207-1.544], p=0.011) after controlling for all covariates. The longitudinal analysis also revealed significantly positive associations between the MDS and LE (0.621 [0.063-1.178], p=0.030) and HALE (0.694 [0.227-1.161], p=0.004) after controlling for all covariates.

CONCLUSION

The present study, based on an analysis using 10 years of international data, showed that countries with a higher MDS showed a positive association with HALE.

The effect of a decrease in stretch-shortening cycle function after cycling on subsequent running

OBJECTIVES

Increased cardiorespiratory responses and changes in muscle activity and running kinematics occur in running after cycling compared with isolated running. Nevertheless, little is known about the causes of these changes. Cycling exercise decreases the stretch-shortening cycle (SSC) function, which can influence subsequent running. This study aimed to clarify whether the decrease in SSC function after cycling causes cardiorespiratory and biomechanical changes in subsequent running.

DESIGN

Cross-sectional laboratory study. Participants were divided into two groups based on SSC function: an SSC dec group (those with decreased SSC function after cycling) and an SSC non-dec group (those without decreased SSC function after cycling).

METHODS

Eighteen participants (10 triathletes and 8 runners) completed maximal aerobic tests for running and cycling. After these sessions, a submaximal run-cycle-run test was performed to compare between control run (no preceding cycle) and transition run (preceded by cycling). A jump test was administered before and after the submaximal cycling. SSC function was calculated as the ratio of the jump height to the time spent in contact with the ground (reactive strength index). Gas exchange measures, heart rate, and gait parameters were collected throughout the test.

RESULTS

Oxygen uptake and ventilation were increased by cycling in the SSC dec group but not in the SSC non-dec group. In both groups, there were no significant differences in the gait parameters between control and transition runs.

CONCLUSIONS

The decrease in SSC function after cycling would increase cardiorespiratory responses in subsequent running.

AB0436 OUTCOMES OF DOSE-REDUCTION OR DISCONTINUATION OF TOCILIZUMAB IN PATIENTS WITH EARLY DIFFUSE CUTANEOUS SYSTEMIC SCLEROSIS

Background:

Potential efficacy and favorable safety profiles of tocilizumab (TCZ) have been demonstrated in patients with diffuse cutaneous systemic sclerosis (dcSSc) [1, 2]. However, clinical outcomes after dose-reduction or discontinuation of TCZ due to an improvement of skin thickness remain unclear.

Objectives:

To investigate the clinical outcomes after dose-reduction or discontinuation of TCZ in patients with dcSSc in a real-world setting.

Methods:

This is a single-center, retrospective, observational study using a database of consecutive SSc patients who visited our center between April 2014 and October 2020. For this study, we selected eligible patients from the database based on the following criteria: patients who (i) fulfilled the ACR/EULAR classification criteria, (ii) were classified as having dcSSc, (iii) had been treated with TCZ for at least 6 months, and (iv) were follow-up >6 months after TCZ introduction. Clinical information including demographic and clinical characteristics at TCZ introduction; dosing, administration route, and adherence of TCZ; and serial clinical parameters (modified Rondan total skin thickness score [mRSS], and percent predicted forced vital capacity [%FVC]), safety profiles, and outcomes after TCZ introduction regardless of TCZ continuation were extracted from the database.

Results:

Of 404 patients enrolled in the database, 13 dcSSc patients were eligible for this study. Baseline characteristics included a mean age of 51 ± 9 years, 85% female, disease duration of 27 ± 24 months, and mRSS of 19.5 ± 10.6. Seven patients (54%) had HRCT-confirmed ILD at baseline, and 9 (69%) were positive for anti-topoisomerase I antibody. Two (14%) and 11 (85%) were on mycophenolate mofetil and low-dose prednisolone (7.2 ± 6.0 mg/day), respectively. Seven patients (54%) each had active skin disease and elevated inflammatory markers defined in the phase III clinical trial [2], while only 4 (31%) fulfilled the inclusion criteria. TCZ was initially administered intravenously (8 mg/kg every 4 weeks) in 8 patients and subcutaneously in 5 (162 mg every 2 weeks in 4 and every week in one). At one year, mRSS was improved from 20.9 ± 11.4 to 10.7 ± 8.9 in 11 patients (p = 0.007), and %FVC was stable in 7 patients with ILD (76.8 ± 15.0 to 78.6 ± 16.1). During the observation period of 60.4 ± 26.7 months, 4 patients were treated with a stable dose of TCZ, while TCZ dose was reduced and/or discontinued in 9. Four of them discontinued TCZ due to adverse events (n = 2; acute lung injury and phlegmon) or prominent improvement of skin thickening (n = 2). Of 9 patients with dose reduction/discontinuation of TCZ, 4 patients who discontinued TCZ (n = 3) or received dose reduction of TCZ (n = 1) experienced a recurrence of progressive skin thickening together with inflammatory complications, including edematous induration of the skin, progression of ILD, polyarthritis, and/or pericarditis with increased inflammatory markers. The interval between dose-reduction/discontinuation of TCZ and clinical worsening ranged from 2 to 11 months. These manifestations were promptly improved by dose-escalation or resumption of TCZ in all patients except one who experienced progressive ILD and died of respiratory failure 27 months later.

Conclusion:

In dcSSc patients who experienced improvement of skin thickness during treatment with TCZ, dose-reduction or discontinuation of TCZ may result in a recurrence of the disease. Randomized comparative studies are necessary to examine optimal timing for dose-reduction or discontinuation of TCZ in dcSSc patients after improvement of skin thickness.

References:

[1]Khanna, D., et al., Safety and efficacy of subcutaneous tocilizumab in systemic sclerosis: results from the open-label period of a phase II randomised controlled trial (faSScinate). Ann Rheum Dis, 2018. 77(2):212-220.

[2]Khanna, D., et al., Tocilizumab in systemic sclerosis: a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Respir Med, 2020; 8(10): 963-974.

Disclosure of Interests:

Yohei Isomura: None declared, Yoshioki Yamasaki Speakers bureau: Boehringer-Ingelheim, Nippon Shinyaku, Bristol Myers, Yuichiro Shirai Speakers bureau: Janssen, Grant/research support from: Janssen, Masataka Kuwana Speakers bureau: Abbie, Astellas, Asahi Kasei Parma, Boehringer-Ingelheim, Chugai, Eisai, Janssen, MBL, Mochida, Nippon Shinyaku, Ono Pharmaceuticals, Pfizer, Tanabe-Mitsubishi, Consultant of: Boehringer-Ingelheim, Chugai, Corbus, MBL, Mochida, Grant/research support from: Boehringer-Ingelheim, Chugai, Eisai, MBL, Ono Pharmaceuticals, Tanabe-Mitsubishi

POS0861 EFFECTIVENESS AND SAFETY OF TOCILIZUMAB IN PATIENTS WITH SYSTEMIC SCLEROSIS: A PROPENSITY SCORE CONTROL MATCHED OBSERVATIONAL STUDY OF THE EUSTAR COHORT

Background:

Tocilizumab (TCZ) showed trends for improving skin fibrosis and prevented progression of lung fibrosis in patients with systemic sclerosis (SSc) in placebo-controlled randomised clinical trials (RCTs). However, safety and effectiveness of TCZ beyond these selected and enriched clinical trial populations in SSc is still unknown.

Objectives:

To assess safety and effectiveness of TCZ treatment compared to standard of care in SSc patients from the large, multicentre, observational, real-life EUSTAR network/database using propensity score matching.

Methods:

SSc patients from the EUSTAR network/database, who fulfilled the ACR/EULAR 2013 classification criteria, with a baseline and a follow-up visit at 12±3 months, receiving TCZ or standard of care (controls), were selected. The following variables were used for the propensity score matching (1:1): age at diagnosis, gender, disease subtype, baseline modified Rodnan skin score (mRSS), forced vital capacity (FVC), and diffusing capacity for carbon monoxide (DLCO), co-therapy with immunosuppressives, disease duration, and year of treatment. Primary endpoints were mRSS and FVC at 12±3 months follow-up compared between the groups, using paired t-tests. Secondary endpoints were the percentage of progressive/regressive patients for skin and lung at 12±3 months follow-up according to standard definitions (1,2). Sensitivity analyses assessed pre-processing decisions (selection of most recent vs. random observation for control patients with multiple suitable time intervals), as well as the matching method (optimal vs. exact matching). Missing values were addressed with 100-fold multiple imputation using chained equations. Safety data were analysed in all patients. The study including the statistical analysis plan was pre-registered at www.drks.de (DRKS-ID: DRKS00015537).

Results:

We identified 93 SSc patients treated with TCZ and 2370 SSc patients with standard of care who fulfilled the inclusion criteria. Forty nine (57.7%) of the TCZ treated patients were diffuse, eight patients were not classified, disease duration was (mean±SD) 6.35±5.40 years, their baseline mRSS was 15.05±10.85, and 76 (81.7%) received immunosuppressive therapy in addition to TCZ.Through multiple imputation and propensity score matching, 100 imputed sets of 93 pairs of TCZ/controls were generated. Comparison between groups showed consistent effects of TCZ across all pre-defined primary and secondary endpoints: mRSS was lower in the TCZ group (mean difference (95% confidence interval (CI)) -1.8 (-4.79 to 1.19), p=0.24, Figure 1A). Similarly, FVC % predicted was higher in the TCZ group mean difference (2.25, 95% CI -4.57 to 9.06), p=0.51, Figure 1B). Considering secondary endpoints, the percentage of skin progressors as well as lung progressors at follow up was lower in the TCZ group (odds ratio OR 0.67 (95% CI 0.07 to 6.41), p=0.74 and OR 0.53 (95% CI 0.16 to 1.7); p=0.2, respectively. Consistently, the percentage of regressors for skin (OR 1.6 (95% CI 0.56 to 4.54), p=0.38) and for lung (OR 1.74 (95% CI 0.66 to 4.58), p=0.26) was higher in TCZ. These results were robust regarding the sensitivity analyses. Safety analysis confirmed previously reported adverse event profiles.

Conclusion:

In this large, observational, controlled, real-life EUSTAR study, effectiveness of TCZ did not reach statistical significance compared to standard of care treatment but showed consistent positive effects of TCZ on skin and lung fibrosis across all pre-defined primary and secondary endpoints confirming data from recent RCTs.

References:

[1]Prediction of improvement in skin fibrosis in diffuse cutaneous systemic sclerosis: a EUSTAR analysis. Ann Rheum Dis 2016:1743-8.

[2]Progressive interstitial lung disease in patients with systemic sclerosis-associated interstitial lung disease in the EUSTAR database. Ann Rheum Dis 2021:219-227.

Disclosure of Interests:

Simon Kuster: None declared, Suzana Jordan: None declared, Muriel Daniele Elhai: None declared, Ulrike Held: None declared, Klaus Steigmiller: None declared, Cosimo Bruni: None declared, Florenzo Iannone: None declared, Serena Vettori: None declared, Elise Siegert: None declared, Simona Rednic: None declared, Veronica Codullo: None declared, Paolo Airò Consultant of: Dr. Airo’ reports personal fees (consultancies) from Bristol Myers Squibb, Bohringer Ingelheim, non-financial support from CSL Behring, SOBI, Janssen, Roche, Sanofi, Pfizer, Yolanda Braun-Moscovici: None declared, Nicolas Hunzelmann: None declared, Maria Joao Salvador: None declared, Valeria Riccieri: None declared, Ana Maria Gheorghiu: None declared, Juan Jose Alegre Sancho: None declared, Katarzyna Romanowska-Prochnicka: None declared, Ivan Castellví: None declared, Ina Koetter: None declared, Marie-Elise Truchetet Consultant of: Marie-Elise Truchetet has had consultancy relationships and/or has received research funding from Boehringer Ingelheim, Genentech/Roche, and Sanofi in the area of potential treatments of scleroderma and its complications., Grant/research support from: Marie-Elise Truchetet has had consultancy relationships and/or has received research funding from Boehringer Ingelheim, Genentech/Roche, and Sanofi in the area of potential treatments of scleroderma and its complications., Francisco J López-Longo: None declared, Pavel Novikov: None declared, Alessandro Giollo: None declared, Yuichiro Shirai: None declared, Laura Belloli: None declared, Elisabetta Zanatta: None declared, Eric Hachulla: None declared, Vanessa Smith: None declared, Christopher Denton: None declared, Ruxandra Ionescu: None declared, Tim Schmeiser: None declared, Jörg H.W. Distler: None declared, Armando Gabrielli: None declared, Anna-Maria Hoffmann-Vold Consultant of: AMHV has received research funding and/or consulting fees and/or other remuneration from Actelion, Boehringer Ingelheim, Roche, Bayer, Merck Sharp & Dohme, ARXX, Lilly and Medscape, Grant/research support from: AMHV has received research funding and/or consulting fees and/or other remuneration from Actelion, Boehringer Ingelheim, Roche, Bayer, Merck Sharp & Dohme, ARXX, Lilly and Medscape. Masataka Kuwana: None declared, Yannick Allanore: None declared, Oliver Distler Speakers bureau: Oliver Distler has/had consultancy relationship and/or has received research funding in the area of potential treatments for systemic sclerosis and its complications from (last three years): Abbvie, Acceleron Pharma, Amgen, AnaMar, Arxx Therapeutics, Baecon Discovery, Blade Therapeutics, Bayer, Boehringer Ingelheim, ChemomAb, Corbus Pharmaceuticals, CSL Behring, Galapagos NV, Glenmark Pharmaceuticals, GSK, Horizon (Curzion) Pharmaceuticals, Inventiva, iQvia, Italfarmaco, iQone, Kymera Therapeutics, Lilly, Medac, Medscape, Mitsubishi Tanabe Pharma, MSD, Novartis, Pfizer, Roche, Sanofi, Serodapharm, Topadur, Target Bioscience and UCB. Patent issued “mir-29 for the treatment of systemic sclerosis” (US8247389, EP2331143)., Consultant of: Oliver Distler has/had consultancy relationship and/or has received research funding in the area of potential treatments for systemic sclerosis and its complications from (last three years): Abbvie, Acceleron Pharma, Amgen, AnaMar, Arxx Therapeutics, Baecon Discovery, Blade Therapeutics, Bayer, Boehringer Ingelheim, ChemomAb, Corbus Pharmaceuticals, CSL Behring, Galapagos NV, Glenmark Pharmaceuticals, GSK, Horizon (Curzion) Pharmaceuticals, Inventiva, iQvia, Italfarmaco, iQone, Kymera Therapeutics, Lilly, Medac, Medscape, Mitsubishi Tanabe Pharma, MSD, Novartis, Pfizer, Roche, Sanofi, Serodapharm, Topadur, Target Bioscience and UCB. Patent issued “mir-29 for the treatment of systemic sclerosis” (US8247389, EP2331143)., Grant/research support from: The study was partially supported by a grant from Roche. Roche was not involved in analysis or interpretation of the results.

Stretch-Shortening Cycle Function of Lower Limbs After Cycling in Triathletes

Takahashi, K, Shirai, Y, and Nabekura, Y. Stretch-shortening cycle function of lower limbs after cycling in triathletes. J Strength Cond Res XX(X): 000-000, 2020-Impaired cardiorespiratory response and changes in biomechanical variables occur when running after cycling relative to isolated running. Nevertheless, little is known about the causes of these changes or the training to prevent them. This study aimed (a) to determine whether stretch-shortening cycle (SSC) function decreases after cycling exercise and (b) to determine whether the decreases in SSC function are related to brick training. Eleven male university triathletes performed hopping tests to measure SSC function before and after cycling (30 minutes of cycling at 110% ventilatory threshold). Stretch-shortening cycle function was calculated as the ratio of the jump height to the time spent in contact with the ground (reactive strength index [RSI]). Brick training was evaluated by the total experience of brick training. The RSI significantly decreased after the cycling exercise (-10.7%; p < 0.01), but changes in RSI after cycling did not significantly correlate with the total experience of brick training, despite a large effect size (p < 0.10; r = 0.62). These results suggest that SSC function decreases after cycling and that brick training is potentially useful for inhibiting decreases in SSC function after cycling.

P52714D-flow cardiac magnetic resonance analysis of left ventricular blood flow dynamics in mid-ventricular obstructive hypertrophic cardiomyopathy

Background

Mid-ventricular obstructive hypertrophic cardiomyopathy (MVO-HCM) has different blood flow dynamics from other phenotypes, but there are few detailed data on blood flow dynamics in the left ventricle.

Methods

4D-Flow MRI were performed at 1.5 T or 3 T with 9 MVO-HCM patients and 22 control patients (LVEF>50%, no wall motion abnormality). Myocardial infarction, severe valvular disease, HCM cases other than MVO were excluded. We calculated the cardiac function parameters and observed blood flow dynamics in the left ventricle using 4D-Flow MRI.

Results

LV mass was significantly higher in MVO-HCM group than in Control group (Control group; 73.3g vs MVO-HCM group; 109.5g, P=0.019). LVEF was higher in MVO-HCM group (Control group; 61.6% vs MVO-HCM group; 70.6%, P=0.026), but Stroke volume did not differ between the two groups (Control group; 68.8ml vs MVO-HCM group; 64.4ml, P=0.43).One or two vortices were observed in the left ventricle after opening the mitral valve. Two vortices were observed in 16 cases (72.7%) in the control group and 9 cases (100%) in the MVO-HCM group. Two vortices were formed on the anterior side and the posterior side. Blood flow pattern in which the vortex on the posterior side was formed to be the same size or larger than the vortex on the anterior side was observed only in the MVO-HCM group (Control group; 0% vs MVO-HCM group; 66.7%, P<0.001).

Streamline of MVO-HCM & Control

Conclusion

Characteristic blood flow patterns in the left ventricle of the MVO-HCM were revealed by using 4D-MRI. We thought that blood flow collides with the left ventricle wall due to the marked hypertrophy in the mid-ventricle, and normal vortex ring can not be formed in the MVO-HCM cases.

Traditional Japanese Diet Score - Association with Obesity, Incidence of Ischemic Heart Disease, and Healthy Life Expectancy in a Global Comparative Study

OBJECTIVES

We created a Traditional Japanese Diet Score (TJDS), and to clarify the relationship between TJDS and obesity, ischemic heart disease (IHD), and healthy life expectancy (HALE).

DESIGN

Ecological study.

SETTING

Food (g/day/capita) and energy (kcal/day/capita) supply was determined using the Food and Agriculture Organization of the United Nations Statistics Division database. The sum of characteristic traditional Japanese foods (beneficial food components in the Japanese diet: rice, fish, soybeans, vegetables, eggs, and seaweeds; food components rarely used in the Japanese diet: wheat, milk, and red meat) was divided as tertiles (beneficial food components: -1, 0, 1; rarely used food components: 1, 0, -1). Obesity rate was determined using the World Health Organization database. Incidence of IHD, HALE and smoking rate were determined using the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 database. Gross domestic product per capita, percentage of population > 65 years old, and health expenditure were determined using the World Bank database. Education years were obtained from the United Nations Educational, Scientific and Cultural Organization Institute for Statistics. Associations between TJDS and obesity, IHD and HALE were examined in 132 countries with a population of 1 million or greater using a general linear model controlled for co-variables.

RESULTS

TJDS was distributed from -6 to 7. TJDS was inversely correlated to obesity (β±SE; -0.70±0.19, p<0.001), IHD (-19.4±4.3, p<0.001), and positively correlated to HALE (0.40±0.14, p<0.01).

CONCLUSIONS

TJDS is a good indicator of a healthy diet, and applies to preventing obesity, IHD and extending HALE.

Knockout of histamine receptor H3 alters adaptation to sudden darkness and monoamine levels in the zebrafish

AIM

Histamine receptor H3 (HRH3) has substantial neuropharmacological potential. Currently, knockout models of this receptor have been investigated only in mice. We characterized the expression of this receptor in the zebrafish and generated a zebrafish HRH3 knockout line. Using this model, we studied the role of HRH3 in important behaviours. We also analysed the effect of HRH3 knockout on monoaminergic systems, which has not been thoroughly studied in any animal model.

METHODS

Generation of a mutant zebrafish line using the CRISPR-Cas9 system. Analysis of locomotor and social behaviour. Expression of HRH3 was characterized using in situ hybridization. Analysis of monoamine networks using HPLC, immunohistochemistry and quantitative PCR.

RESULTS

We found that HRH3 knockout zebrafish larvae showed a shorter period of increased locomotion after a sudden onset of darkness, while the knockout larvae had a wild-type-like acute response to sudden darkness. Adult knockout fish showed decreased swimming velocity, although locomotor activity of knockout larvae was unaltered. Additionally, levels of dopamine and serotonin were significantly decreased in the knockout fish, while monoamine-related gene expression and immunohistochemistry patterns were unchanged.

CONCLUSIONS

Our results show that HRH3 knockout larvae adapt faster to sudden darkness, suggesting a role for this receptor in regulating responses to changes in the environment. The decreased levels of dopamine and serotonin provide the first direct evidence that knockout of HRH3 alters these systems.

Caffeine and Bicarbonate for Speed. A Meta-Analysis of Legal Supplements Potential for Improving Intense Endurance Exercise Performance

A 1% change in average speed is enough to affect medal rankings in intense Olympic endurance events lasting ~45 s to 8 min which for example includes 100 m swimming and 400 m running (~1 min), 1,500 m running and 4000 m track cycling (~4 min) and 2,000 m rowing (~6-8 min). To maximize the likelihood of winning, athletes utilizes legal supplements with or without scientifically documented beneficial effects on performance. Therefore, a continued systematic evidence based evaluation of the possible ergogenic effects is of high importance. A meta-analysis was conducted with a strict focus on closed-end performance tests in humans in the time domain from 45 s to 8 min. These test include time-trials or total work done in a given time. This selection criterion results in a high relevance for athletic performance. Only peer-reviewed placebo controlled studies were included. The often applied and potentially ergogenic supplements beta-alanine, bicarbonate, caffeine and nitrate were selected for analysis. Following a systematic search in Pubmed and SportsDiscuss combined with evaluation of cross references a total of 7 (beta-alanine), 25 (bicarbonate), 9 (caffeine), and 5 (nitrate) studies was included in the meta-analysis. For each study, performance was converted to an average speed (km/h) from which an effect size (ES; Cohens d with 95% confidence intervals) was calculated. A small effect and significant performance improvement relative to placebo was observed for caffeine (ES: 0.41 [0.15–0.68], P = 0.002) and bicarbonate (ES: 0.40 [0.27–0.54], P < 0.001). Trivial and non-significant effects on performance was observed for nitrate (ES: 0.19 [−0.03–0.40], P = 0.09) and beta-alanine (ES: 0.17 [−0.12–0.46], P = 0.24). Thus, caffeine's and bicarbonate's ergogenic effect is clearly documented for intense endurance performance. Importantly, for all supplements an individualized approach may improve the ergogenic effect on performance.

Primary reattachment of avulsed skin flaps with negative pressure wound therapy in degloving injuries of the lower extremity

Large avulsed skin flaps of the lower extremity caused by degloving injuries eventually develop skin necrosis in most cases. The current treatment option involves excision of the degloved skin and reapplication as a full- or split-thickness skin graft. We considered that reattachment of avulsed skin flaps without excision would be theoretically beneficial, since some circulation may remain around the connected pedicle and thus facilitate graft take. Furthermore, securing the skin to the original anatomic position is much easier using retained landmarks. We treated a total of 12 patients (13 cases) with degloving injuries of the lower extremity. In all cases, the avulsed skin flap was defatted and sewn back to the original position, then negative-pressure wound therapy was applied over those grafts as a bolster for approximately 7 days. Most of the avulsed skin flap took excellently, particularly close to the connected pedicle. Nine cases did not need any additional surgical procedures. Four cases required secondary skin graft for a small area of open wound due to partial necrosis of the defatted skin, as well as the raw surface left by the primary skin defect in the initial operation. Primary reattachment of the avulsed skin flaps without excision is convenient and efficient to cover the open wound over the exposed fascia and periosteum in degloving injuries. This would potentially offer a better alternative to definitive wound closure.

Effect of hypoxia duration on the oxygen-dependent production of a recombinant protein, β-galactosidase, by an animal cell line, F6D2, with a hypoxia-inducible enhancer

Expression of specific genes is a strategy of animal cells for adaptation to oxygen deficiency and the mechanism underlying the hypoxic activation of gene expression may be useful for efficient production of recombinant proteins by animal cells, because oxygen is a limiting factor in animal cell cultures. We prepared an animal cell line harboring the plasmid in which expression of a reporter gene, β-galactosidase, is controlled by an enhancer responsible for the hypoxic activation of gene transcription. The purpose of this paper is to understand this hypoxic production of recombinant proteins quantitatively by a mathematical model originally developed based on the following hypotheses; 1 lacZ (the reporter gene) is transcribed after HIF-1 protein complex is bound to the hypoxic enhancer, 2. β-galactosidase synthesis rate is limited at the transcription of lacZ, 3. HIF-1 is an inactive form under a normal oxygen concentration, 4. Oxygen works as a repressor in the synthesis of HIF-1 protein, 5. Both β-galactosidase and HIF-1 are decomposed according to the first order reaction. The effects of hypoxic duration as well as oxygen concentration on the β-galactosidase production were successfully predicated by the model.

Two Cryptic Species of the Phytophagous Ladybird Beetle Epilachna vigintioctopunctata (Coleoptera: Coccinellidae) Detected by Analyses of Mitochondrial DNA and Karyotypes, and Crossing Experiments

Analyses of a part of mitochondrial cytochrome c oxidase I gene sequences (645 bp) for seventeen individuals of Epilachna vigintioctopunctata (Fabricius) from eight localities in east and southeast Asia revealed that the populations are divided into two genetically distinct groups (Chiba, Tokyo, Naha, Iriomote, Bangkok vs. Kuala Lumpur, Padang, Bogor). The number of nucleotide substitutions between sequences of different groups was 57-60, while that between sequences within each group was 1-8. Karyotypes of the two groups were also distinctly different. Crossing experiments showed that there exist strong postmating barriers between the two groups: eggs obtained from between-group crossings usually did not hatch, whereas more than 90% of eggs from within-group crossings hatched. It is concluded that E. vigintioctopunctata, a notorious pest of solanaceous crops in Asia and Australia, is composed of at least two reproductively isolated biological species that probably occupy different geographic ranges.

Changes in monoclonal antibody productivity of recombinant BHK cells immobilized in collagen gel particles

Animal cell perfusion high density culture is often adopted for the production of biologicals in industry. In high density culture sometimes the productivity of biologicals has been found to be enhanced. Especially in immobilized animal cell culture, significant increase in the productivity has been reported. We have found that the specific monoclonal antibody (MAb) productivity of an immobilized hybridoma cell is enhanced more than double. Several examples of enhancing productivities have been also shown by collagen immobilized cells. Immobilized cells involve some different points from non-immobilized cells in high density culture: In immobilized culture, some cells are contacted together, resulting in locally much higher cell concentration more than 10(8) cells/ml. Information originating from a cell can be easily transduced to the others in immobilized culture because the distance between cells is much nearer. Here we have performed collagen gel immobilized culture of recombinant BHK cells which produce a human IgG monoclonal antibody in a protein-free medium for more than three months. In this high density culture a stabilized monoclonal antibody production was found with around 8 times higher specific monoclonal antibody productivity compared with that in a batch serum containing culture. No higher MAb productivity was observed using a conditioned medium which was obtained from the high density culture, indicating that no components secreted from the immobilized cells work for enhancing monoclonal antibody production. The MAb productivity by the non-immobilized cells obtained by dissolving collagen using a collagenase gradually decreased and returned to the original level in the batch culture using a fresh medium. This suggests that the direct contact of the cells or a very close distance between the cells has something to do with the enhancement of the MAb productivity, and the higher productivity is kept for a while in each cell after they are drawn apart.

Gamma Titanium Aluminide Alloys

Extensive progress and improvements have been made in the science and technology of gamma titanium aluminide alloys within the last decade. In particular, our understanding of their microstructural characteristics and property/microstructurc relationships has been substantially deepened. Based on these achievements, various engineering two-phase gamma alloys have been developed and their mechanical and chemical properties have been assessed. Aircraft and automotive industries arc pursuing their introduction for various structural components. At the same time, recent basic studies on the mechanical properties of two-phase gamma alloys, in particular with a controlled lamellar structure have provided a considerable amount of fundamental information on the deformation and fracture mechanisms of the two-phase gamma alloys. The results of such basic studies are incorporated in the recent alloy and microstructure design of two-phase gamma alloys. In this paper, such recent advances in the research and development of the two-phase gamma alloys and industrial involvement are summarized.

Nitrification of ammonium-rich sanitary landfill leachate

The nitrification of ammonium-rich wastewater is considered challenging due to the substrate inhibition particularly in the form of free ammonia (FA) and free nitrous acid (FNA) in ammonia-oxidizing bacteria (AOB) and nitrite-oxidizing bacteria (NOB). The feasibility of the nitrifying activated sludge system to completely nitrify synthetic stabilized landfill leachate with N-NH(4)(+) concentration of 1452mg/L was tested in this study. The process started with 0.4kg N-NH(4)(+)/m(3)/day of nitrogen loading rate (NLR) in a fed-batch mode to avoid any accumulation of the FA and FNA in the system followed by increasing the nitrogen loading rate (NLR) gradually. Complete nitrification was achieved with a very high ammonium removal percentage (approximately 100%). The maximum specific and volumetric nitrification rate obtained were 0.49g N-NH(4)(+)/g VSS/day and 3.0kg N-NH(4)(+)/m(3)/day, respectively which were higher than those reported previously for ammonium-rich removal using activated sludge system. The nitrifying sludge exhibited good settling characteristics of up to 36mL/g VSS and a long SRT of more than 53 days which contributed to the success of the nitrification process. The coexistence and syntrophic association of the AOB and NOB was observed by using Fluorescence in situ hybridization (FISH) technique which supported the results on complete nitrification obtained in the system. These findings would be of prominent importance for further treatment of actual sanitary landfill leachate.

Measuring organic carbon, nutrients and heavy metals in rivers receiving leachate from controlled and uncontrolled municipal solid waste (MSW) landfills

Since landfilling is the common method of waste disposal in Malaysia, river water is greatly exposed to the risk of contamination from leachate unless proper leachate management is carried out. In this study, leachates from three different types of landfills, namely active uncontrolled, active controlled and closed controlled, were characterized, and their relationships with river water chemistry were examined monthly for a year. The influence of leachate on river water chemistry from each type of landfill depended on many factors, including the presence of a leachate control mechanism, leachate characteristics, precipitation, surface runoff and the applied treatment. The impact of leachate from an active uncontrolled landfill was the highest, as the organic content, NH(4)(+)-N, Cd and Mn levels appeared high in the river. At the same time, influences of leachate were also observed from both types of controlled landfills in the form of inorganic nitrogen (NH(4)(+)-N, NO(3)(-)-N and NO(2)(-)-N) and heavy metals (Fe, Cr, Ni and Mn). Improper treatment practice led to high levels of some contaminants in the stream near the closed controlled landfill. Meanwhile, the active controlled landfill, which was located near the coastline, was exposed to the risk of contamination resulting from the pyrite oxidation of the surrounding area.