Differential impact of glomerular and tubule-interstitial histological changes on kidney outcome between non-proteinuric and proteinuric diabetic nephropathy

BACKGROUND

Studies on kidney function and histological findings in diabetic nephropathy (DN) with low urinary protein (UP) are few. We examined the differential impact of histological changes on kidney outcomes between non-proteinuric and proteinuric DN.

METHODS

Patients diagnosed with DN by renal biopsy during 1981-2014 were divided into non-proteinuric (UP ≤ 0.5 g/day) and proteinuric (UP > 0.5 g/day) DN. The Cox proportional hazard model was used to examine the association of glomerular lesions (GLs) and interstitial fibrosis and tubular atrophy (IFTA) with end-stage kidney disease (ESKD) development after adjusting for relevant confounders.

RESULTS

The non-proteinuric and proteinuric DN groups included 197 and 199 patients, respectively. During the 10.7-year median follow-up period, 16 and 83 patients developed ESKD in the non-proteinuric and proteinuric DN groups, respectively. In the multivariable Cox hazard model, hazard ratios (HRs) [95% confidence intervals (CIs)] of GL and IFTA for ESKD in proteinuric DN were 2.94 [1.67-5.36] and 3.82 [2.06-7.53], respectively. Meanwhile, HRs [95% CIs] of GL and IFTA in non-proteinuric DN were < 0.01 [0-2.48] and 4.98 [1.33-18.0], respectively. IFTA was consistently associated with higher incidences of ESKD regardless of proteinuria levels (P for interaction = 0.49). The prognostic impact of GLs on ESKD was significantly decreased as proteinuria levels decreased (P for interaction < 0.01).

CONCLUSIONS

IFTA is consistently a useful predictor of kidney prognosis in both non-proteinuric and proteinuric DN, while GLs are a significant predictor of kidney prognosis only in proteinuric DN.

Utility of serum β2-microglobulin for prediction of kidney outcome among patients with biopsy-proven diabetic nephropathy

AIM

To examine whether serum β2-microglobulin (β2-MG) could improve the prediction performance for kidney failure with replacement therapy (KFRT) among patients with diabetic nephropathy (DN).

METHODS

Patients with biopsy-proven DN at Nara Medical University Hospital were included. The exposure of interest was log-transformed serum β2-MG levels measured at kidney biopsy. The outcome variable was KFRT. Multivariable Cox regression models and competing-risk regression models, with all-cause mortality as a competing event, were performed. Model fit by adding serum β2-MG levels was calculated using the Akaike information criterion (AIC). The net reclassification improvement (NRI) and integrated discrimination improvement (IDI) indexes were used to evaluate the improvement of predictive performance for 5-year cumulative incidence of KFRT by serum β2-MG levels.

RESULTS

Among 408 patients, 99 developed KFRT during a median follow-up period of 6.7 years. A higher serum β2-MG level (1-unit increase in log-transformed serum β2-MG level) was associated with a higher incidence of KFRT, even after adjustments for previously known clinical and histological risk factors (hazard ratio [95% confidence interval {CI}]: 3.30 [1.57-6.94] and subdistribution hazard ratio [95% CI]: 3.07 [1.55-6.06]). The addition of log-transformed serum β2-MG level reduced AIC and improved the prediction of KFRT (NRI and IDI: 0.32 [0.09-0.54] and 0.03 [0.01-0.56], respectively).

CONCLUSIONS

Among patients with biopsy-proven DN, serum β2-MG was an independent predictor of KFRT and improved prediction performance. In addition to serum creatinine, serum β2-MG should probably be measured for DN.

Role of kicking action in front crawl: the inter-relationships between swimming velocity, hand propulsive force and trunk inclination

This study aimed to investigate the essential role of the kicking action in front crawl. To achieve this objective, we examined the relationships of the hand propulsive force and trunk inclination with swimming velocity over a wide range of velocities from 0.75 m·s-1 to maximum effort, including the experimental conditions of arm stroke without a pull buoy. Seven male swimmers performed a 25 m front crawl at various speeds under three swimming conditions: arm stroke with a pull buoy, arm stroke without a pull buoy (AWOB) and arm stroke with a six-beat kick (SWIM). Swimming velocity, hand propulsive force and trunk inclination were calculated using an underwater motion-capture system and pressure sensors. Most notably, AWOB consistently exhibited greater values than SWIM for hand propulsive force across the range of observed velocities (p < 0.05) and for trunk inclination below the severe velocity (p < 0.05), and these differences increased with decreasing velocity. These results indicate that 1) the kicking action in front crawl has a positive effect on reducing the pressure drag acting on the trunk, thereby allowing swimmers to achieve a given velocity with less hand propulsive force, and 2) this phenomenon is significant in low-velocity ranges.

Trace proteinuria detected via dipstick test is associated with kidney function decline and new-onset overt proteinuria: the Japan Specific Health Checkups (J-SHC) Study

BACKGROUND

Microalbuminuria is associated with mortality, cardiovascular disease, and end-stage kidney disease. The association between trace proteinuria (detected via dipstick test) and kidney outcomes is unclear.

METHODS

This nationwide longitudinal study used data from the Japan Specific Health Checkups Study conducted during 2008-2014. The frequency of trace proteinuria (detected via dipstick test) during first two visits was used as an exposure variable (TrUP 0/2, no trace proteinuria; TrUP 1/2, detected once; TrUP 2/2, detected twice), and kidney outcomes were evaluated. The association between the frequency of trace proteinuria and incidence of 1.5-fold increase in serum creatinine levels and overt proteinuria was analyzed using Cox regression analysis. Trajectories of estimated glomerular filtration rate (eGFR) were compared using a mixed-effect model.

RESULTS

Among 306,317 participants, 3188 and 17,461 developed a 1.5-fold increase in serum creatinine levels and new-onset overt proteinuria, respectively, during the median follow-up period of 36.2 months. The adjusted hazard ratio (HR) and 95% confidence interval (CI) for 1.5-fold increase in serum creatinine level in the TrUP 1/2 and TrUP 2/2 groups, compared to TrUP 0/2 group, were 1.23 (1.07-1.42) and 1.39 (1.01-1.92), respectively, and the adjusted HR (95% CI) for overt proteinuria were 2.94 (2.83-3.06) and 5.14 (4.80-5.51), respectively. The eGFR decline rates in the TrUP 1/2 and TrUP 2/2 groups were higher than that in the TrUP 0/2 group (p for interaction < 0.001).

CONCLUSIONS

Trace proteinuria (detected via dipstick test) was associated with subsequent kidney function decline and overt proteinuria in the general population.

Association of triglycerides to high-density lipoprotein cholesterol ratio with incident cardiovascular disease but not end-stage kidney disease among patients with biopsy-proven diabetic nephropathy

Increased triglycerides (TG) and decreased high-density lipoprotein cholesterol (HDL-C) are dyslipidemias characteristic of diabetes. Here, we aimed to examine associations of TG/HDL-C ratio with cardiovascular disease (CVD) and kidney dysfunction among patients with diabetic nephropathy. This retrospective observational study consists of patients with biopsy-proven diabetic nephropathy at Nara Medical University Hospital. Exposure of interest was TG/HDL-C ratio measured at kidney biopsy. Outcome variables were kidney histological findings, incident CVD and end-stage kidney disease (ESKD). Multivariable logistic regression models and Cox proportional hazard models were used to examined these associations. A total of 353 subjects were divided into quartiles based on TG/HDL-C ratio: Quartile 1 (reference), <1.96; Quartile 2, 1.96-3.10; Quartile 3, 3.11-4.55; and Quartile 4, ≥4.56. TG/HDL-C ratio was not a predictor of any histological findings in fully adjusted models. During median follow-up periods of 6.2 and 7.3 years, 152 and 90 subjects developed CVD and ESKD, respectively. Higher TG/HDL-C ratio was independently associated with higher incidences of CVD even after adjustments for potential confounders (hazard ratio [95% confidence interval] for Quartile 3 vs. reference; 1.73 [1.08-2.79] and Quartile 4 vs. reference; 1.86 [1.10-3.17]). Although there was a weak association between TG/HDL-C ratio and ESKD in the univariable model, the association was not significant in fully adjusted models. In conclusion, among patients with biopsy-proven diabetic nephropathy, higher TG/HDL-C ratio was independently associated with higher incidences of CVD but not with kidney outcomes, suggesting different impact of TG/HDL-C ratio on cardiorenal outcomes.

Cardiac Dysfunction Due to Thiamine Deficiency after Hemodialysis for Biguanide-related Lactic Acidosis

Biguanide is an ideal drug for the treatment of type 2 diabetes mellitus. When used appropriately, the incidence of lactic acidosis is reported to be very low. Risk factors associated with biguanide-related lactic acidosis include chronic kidney disease, congestive heart failure, alcohol use, severe dehydration, shock, hypoxic states, sepsis, and advanced age. We herein report a case of cardiac dysfunction due to thiamine deficiency after hemodialysis in a patient with suspected biguanide-related lactic acidosis. Patients who develop severe lactic acidosis while taking biguanides should be given a large dose of thiamine without delay, given the possibility of thiamine deficiency as a complication.

Novel Method for Estimating Propulsive Force Generated by Swimmers' Hands Using Inertial Measurement Units and Pressure Sensors

Propulsive force is a determinant of swimming performance. Several methods have been proposed to estimate the propulsive force in human swimming; however, their practical use in coaching is limited. Herein, we propose a novel method for estimating the propulsive force generated by swimmers' hands using an inertial measurement unit (IMU) and pressure sensors. In Experiment 1, we use a hand model to examine the effect of a hand-mounted IMU on pressure around the hand model at several flow velocities and water flow directions. In Experiment 2, we compare the propulsive force estimated using the IMU and pressure sensors (FIMU) via an underwater motion-capture system and pressure sensors (FMocap). Five swimmers had markers, pressure sensors, and IMUs attached to their hands and performed front crawl swimming for 25 m twice at each of nine different swimming speeds. The results show that the hand-mounted IMU affects the resultant force; however, the effect of the hand-mounted IMU varies with the flow direction. The mean values of FMocap and FIMU are similar (19.59 ± 7.66 N and 19.36 ± 7.86 N, respectively; intraclass correlation coefficient_(2,1) = 0.966), and their waveforms are similar (coefficient of multiple correlation = 0.99). These results indicate that the IMU can estimate the same level of propulsive force as an underwater motion-capture system.

AB0763 IGG4-RELATED CORONARY PERIARTERITIS: SYSTEMATIC LITERATURE REVIEW WITH OUR CASE SERIES

Background:

Coronary periarteritis is one of the clinical manifestations of IgG4-related disease. It can cause serious conditions such as angina and ruptured aneurysms. Therefore, it is important to recognize the clinical and radiological characteristics, which was little known.

Objectives:

We report four patients with IgG4-related coronary periarteritis with a systematic literature review.

Methods:

We identified four patients with IgG4-related coronary periarteritis at the St. Luke’s International Hospital in Tokyo, Japan from 2014 to 2020. A systematic literature review was conducted for English articles on IgG4-related coronary periarteritis cases with a full text or abstract available. We summarized patient demographics, IgG and IgG4 titers, the site and morphological type of coronary lesion, and other organ involvements.

Results:

Our 4 cases and 38 cases identified by the literature review were assessed. Coronary artery lesions were detected by a coronary CT in all but two cases. Wall thickening was the most common type of the lesion. Moreover, there were 32 (76.1%) patients with other organ involvements. The commonest other lesion was peri-aortitis in 21 (50.0%) patients. In cases with peri-aortitis, IgG and IgG4 titers were significantly higher than those without peri-aortitis (IgG4; 1540 [705.0, 2570.0] vs 246.0 [160.0, 536.3]; p = 0.001, IgG; 3596.5 [2838.3, 4260.0] vs 1779.0 [1288.3, 1992.8]; p =0.040). In addition, 15 (71.4%) patients of them had three or more IgG4 related organ involvements.

Conclusion:

Coronary CT was a useful imaging modality for the diagnosis of IgG4-related coronary periarteritis, and wall thickening was the most common lesion. Moreover, about half cases coexisted with peri-aortitis. Peri-aortitis and other organ involvements should be screened in those with higher IgG and IgG4.

Table 1.

Characteristics of our cases and the literature review cases.

RCA: right coronary artery, LAD: left anterior descending artery, LCx: left circumflex artery

Disclosure of Interests:

None declared

Deletion of the Golgi Ca2+-ATPase PMR1 gene potentiates antifungal effects of dodecanol that depend on intracellular Ca2+ accumulation in budding yeast

One strategy for overcoming infectious diseases caused by drug-resistant fungi involves combining drugs rendered inactive by resistance with agents targeting the drug resistance mechanism. The antifungal activity of n-dodecanol disappears as incubation time passes. In Saccharomyces cerevisiae, anethole, a principal component of anise oil, prolongs the transient antifungal effect of dodecanol by downregulating genes of multidrug efflux pumps, mainly PDR5. However, the detailed mechanisms of dodecanol's antifungal action and the anethole-induced prolonged antifungal action of dodecanol are unknown. Screening of S. cerevisiae strains lacking genes related to Ca2+ homeostasis and signaling identified a pmr1Δ strain lacking Golgi Ca2+-ATPase as more sensitive to dodecanol than the parental strain. Dodecanol and the dodecanol + anethole combination significantly increased intracellular Ca2+ levels in both strains, but the mutant failed to clear intracellular Ca2+ accumulation. Further, dodecanol and the drug combination reduced PMR1 expression and did not lead to specific localization of Pmr1p in the parental strain after 4-h treatment. By contrast with the parental strain, dodecanol did not stimulate PDR5 expression in pmr1Δ. Based on these observations, we propose that the antifungal activity of dodecanol is related to intracellular Ca2+ accumulation, possibly dependent on PMR1 function, with anethole enabling Ca2+ accumulation by restricting dodecanol efflux.

FRI0535 NEWLY DETECTED HYPERTHYROIDISM WITH THERAPEUTIC INDICATIONS IN RHEUMATIC DISEASE PATIENTS AND HEALTHY CONTROLS IN JAPAN: A RETROSPECTIVE COHORT STUDY

Background:

Thyroid disorders are known as common comorbidities of rheumatic diseases(RD) [1]. However, data regarding prevalence of hyperthyroidism with treatment indication in RD patients are limited.

Objectives:

This study aims to reveal and compare the frequency of newly developed hyperthyroidism with treatment indication between RD patients and healthy controls (HC), and identify risk factors to identify patients whose thyroid function should be followed up carefully.

Methods:

We retrospectively reviewed charts of RD patients and HC who had thyroid stimulating hormone (TSH) measured at least once between 2004 and 2018 from immuno-rheumatology center and preventive medicine center in St. Luke’s International Hospital, Japan. We compared frequency of hyperthyroidism requiring treatment (TSH ≦ 0.1μU/mL or for which physicians started treatment) with Kaplan-Meier curve and log rank test. Cox regression multivariate analysis was performed to reveal risk factors for the new onset of hyperthyroidism with treatment indication in participants without treatment-indicated hyperthyroidism at initial assessments.

Results:

Overall, 2307 RD patients and 78251 HC were included. Newly detected hyperthyroidism with treatment indication were significantly more frequent in RD patients at initial assessment (1.3% vs 0.5 %, p < 0.001) and in total (2.9% vs 1.7%, p<0.001) (Table 1, Figure 1). Cox regression multivariate analysis revealed systemic lupus erythematosis (SLE), polymyositis dermatomyositis (PMDM), mixed connective tissue disease (MCTD) as significant risk factors of new developments of hyperthyroidism during follow up after adjusting confounders. (Table 2)

Table 1.

Patients characteristics and results of hyperthyroidism

Rheumatic Disease (n = 2307)Control (n = 78251)p.valueAge(yr)53.7 (16.2)46.1 (11.9)<0.001Female (%)1826 (79.2)38632 (49.4)<0.001 Rheumatoid arthritis (%)1091 (47.3)-NA Spondyloarthritis161 (7.0)-NA ANA associated disease (%)944 (40.9)-NA  SLE(%)363 (15.7)-NA  SS (%)396 (17.2)-NA  PMDM(%)104 (4.5)-NA  SSc (%)222 (9.6)-NA  MCTD (%)43 (1.9)-NA Vasculitis (%)202 (8.8)-NA Others (%)244 (10.6)-NATimes of TSH measurement2.0 [1.0, 5.0]5.0 [3.0, 9.0]<0.001Follow up of TSH (days)258.00 [0, 1315]1992 [958, 3632]<0.001Baseline TSH (μU/mL)2.28 (3.21)2.15 (4.07)0.137 ≦0.45 μU/mL (%)86 (3.7)1371 (1.8)<0.001 ≦0.1 μU/mL (%)29 (1.3)389 (0.5)<0.001Baseline FreeT4 (μU/mL)1.16 (0.24)1.30 (0.20)<0.001≧1.65 μU/mL (%)17 (0.8)2355 (3.0)<0.001TSH level in follow up ≦0.45 μU/mL (%)231 (0.0)3926 (5.0)<0.001 ≦0.1 μU/mL (%)84 (3.6)1388 (1.8)<0.001Newly detected hyperthyroidism with treatment indication (%)68 (2.9)1350 (1.7)<0.001 At initial assessment (%)29 (1.3)389 (0.5)<0.001 In follow up (%)39 (1.6)961 (1.2)<0.001Treatment for hyperthyroidism (%)21 (0.9)325 (0.4)0.002Figure 1.

Hyperthyroidism with treatment indication in rheumatic patients and control

Table 2.

Risk factors for newly detected hyperthyroidism with treatment indication

Adjusted HRp valueAge0.99 (0.98-0.99)< 0.001Female2.68 (2.31-3.12)< 0.001BMI1.04 (1.02-1.06)< 0.001Baseline TSH ≦ 0.455.71 (4.47-7.30)< 0.001Baseline Free T4 ≧ 1.651.16 (0.79-1.69)0.45Rheumatoid arthritis1.05 (0.50-2.21)0.90ANA associated diseases-- SLE2.29 (1.11-4.71)0.025 SS1.91 (0.91-4.01)0.089 PMDM12.90 (5.50-30.22)< 0.001 SSc0.67 (0.18-2.43)0.541 MCTD8.02 (2.62-24.51)< 0.001Vasculitis1.44 (0.35-5.92)0.610Spondyloarthritis3.04 (0.74-12.52)0.120Others1.98 (0.67-5.81)0.214

Conclusion:

Hyperthyroidism with therapeutic indications are considerably more frequent in RD patients (particularly with SLE, PMDM and MCTD) both at initial assessment and during follow up. We recommend routine screening at initial assessment and careful follow up of thyroid function test in those patients.

References:

[1] Rev Bras Rheumatol 2012;52(3):417-430

Disclosure of Interests:

None declared

AB0533 ANTI-NEUTROPHIL CYTOPLASMIC ANTIBODY (ANCA) IN GENERAL POPULATION WITHOUT ANCA ASSOCIATED VASCULITIS

Background:

Currently it is hypothesized that many systemic autoimmune diseases occur due to environmental risk factors in addition to genetic risk factors. Anti-Neutrophil Cytoplasmic Antibody (ANCA) is mainly associated with three systemic autoimmune disease including granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), eosinophilic granulomatosis with polyangiitis (EGPA). It is known that ANCA can be positive before clinical symptoms in patients with known diagnosis of GPA and ANCA titers rise before clinical manifestations appear. However, prevalence of ANCA among general population is not well known. It has not been described as well how many of people with positive ANCA eventually develop clinical manifestations of ANCA associated Vasculitis.

Objectives:

This study aims to estimate prevalence of ANCA in general population without ANCA associated Vasculitis. It also describes natural disease course of people with positive ANCA without ANCA associated Vasculitis. Risk factors for positive ANCA are also analyzed.

Methods:

This is a single center retrospective study at Center for Preventive Medicine of St. Luke’s International Hospital in Tokyo. ANCA was checked among the patients who wished to between 2018 and 2019. St. Luke’s Health Check-up Database (SLHCD) was utilized to collect the data. The patients whose serum was measured for ANCA were identified. The data for basic demographics, social habits, dietary habits and laboratory data were extracted. The charts of the patients with positive ANCA were reviewed.

Results:

Sera of total 1204 people were checked for ANCA. Of these 1204 people, 587 (48.8%) are male and the mean age was 55.8 years (32.6 to 79). There were total 11 patients with positive ANCA. Myeloperoxidase ANCA (MPO-ANCA) was positive for 3 patients and proteinase 3 ANCA (PR3-ANCA) was positive for 8 patients. Of these 11 patients, 5 were male (45.5%) and the mean age was 54.6 years. Two patients had history of autoimmune disease (primary biliary cirrhosis and ulcerative colitis). Five patients were evaluated by rheumatologists with the median follow-up period of 274 days. None of them developed clinical signs and symptoms of ANCA associated Vasculitis. Four out of five patients had ANCA checked later, two of which turned negative. The prevalence of ANCA in this cohort was 0.9% (95% confidence interval [95% CI]: 0.5% to 1.6%). Univariate analysis was performed to identify risk factors of positive ANCA. The variables analyzed include age, gender, body mass index (BMI), smoking habits, alcohol intake, dietary habits (fruits, fish, red meat), hypertension, dyslipidemia, and laboratory data. None of these variables demonstrated statistically significant differences except for positive rheumatoid factor (ANCA positive group: 33 % vs ANCA negative group: 9.1%, p value = 0.044).

Conclusion:

The prevalence of ANCA in this cohort was 0.9% (95% CI: 0.5% to 1.6%). None of them who had a follow-up developed ANCA associated Vasculitis during the follow-up period. Longer follow-up and more patients are necessary to determine natural course of people with positive ANCA.

Disclosure of Interests:

None declared

SAT0525 EFFICACY AND SAFETY OF MZR FOR IgG4-RELATED DISEASE

Background:

IgG4-Related Disease (IgG4RD) is known to cause multiple organ lesions with infiltration of IgG4-positive plasma cells, and patients often have relapses with tapering treatments despite an initial good response to glucocorticoids therapy. Mizoribine (MZR) is an immunosuppressant working as an inhibitor of purine synthesis, which mechanism of action is similar to mycophenolate mofetil. Data regarding the efficacy and safety of MZR on IgG4RD is limited although some previous case reports1showed effectiveness for IgG4RD.

Objectives:

This study aims to assess the efficacy and safety of MZR in patients with IgG4RD.

Methods:

We retrospectively reviewed charts of IgG4RD patients who used MZR between January 2004 and December 2019 at Immuno-Rheumatology Center in St. Luke’s International Hospital, Tokyo, Japan. We investigated basic demographics, involved organs, results of blood tests including IgG and IgG4 titer, and medications used including glucocorticoid and other immunosuppressants (IS). We followed IgG4 titer, dose of glucocorticoid, flare of disease and retention of MZR at the beginning, 6 and 12months after starting MZR. We compared changes in PSL (prednisolone) doses and IgG4 titers over time using Friedman test with Bonferroni correction. We also checked adverse events during follow up.

Results:

Twenty-two patients with IgG4RD who used MZR were included. Median age was 62 years old, and 15 (68.2%) patients are male. Lacrimal and salivary glands, pancreatitis and retroperitoneal fibrosis were common lesions. All patients were initially treated with glucocorticoids. Flare was observed in 5 (22.7 %) patients before initiation of MZR. The number of patients who continued MZR without flare are 19 (86.4 %) at 6 months, and 14 (73.7 %) at 12 months. IgG4 titer significantly declined at 6 and 12 months from baseline although significant consecutive decrease in PSL dose (Figure 1, 2). Liver dysfunctions are commonest adverse events (n=16, 72.7%) but mild (grade1; n=15, 68.2%) and most cases are apparently due to other reasons. Serious infection (SI) occurred in 3 (13.6%) patients in total follow up, however no SI were observed during 1 year after MZR treatment.

Conclusion:

MZR can be safely used in patients of IgG4RD with high retention rate, and seemed to have steroid-sparing effect. Prospective comparative studies are needed.

References:

[1]Nanke Y, Kobashigawa T, Yago T, Kamatani N, Kotake S. A case of Mikulicz’s disease, IgG4-related plasmacytic syndrome, successfully treated by corticosteroid and mizoribine, and then by mizoribine alone. Intern Med 49: 1449-1453, 2010.

Table 1.

Patient characteristics

    Table 2.

Disease and treatment status before and after initiation of MZR

    Figure 1.

Serum IgG4 level changes

Figure 2.

Changes in the PSL dose over time

Disclosure of Interests:

None declared

AB0198 SMOKING AND POSITIVITY OF RHEUMATOID FACTOR AND ANTI-CYCLIC CITRULLINATED PEPTIDE ANTIBODY IN THE GENERAL POPULATION

Background:

It is well known that rheumatoid arthritis (RA) occurs due to environmental risk factors in addition to genetic risk factors. Rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibody (ACPA) are strongly associated with RA, and these biomarkers could turn to be positive before development of clinical symptoms. While smoking, particularly Brinkman index (BI) is well known as a risk factor for RA and ACPA positivity, it is still unclear whether smoking intensity or smoking duration contribute more to positive RF and ACPA.

Objectives:

This study aims to evaluate risk factors for RF and ACPA positivity in the general population. It also describes whether smoking intensity, duration, and BI are significant.

Methods:

This is a cross-sectional, observational, single center study. We reviewed the baseline characteristics of the general population who checked RF and ACPA at Preventive Medicine Center in St. Luke’s International Hospital, Tokyo, Japan from January 2004 to December 2018.

The data for basic demographics, dietary habit, smoking intensity, smoking duration, BI, and blood tests including RF and ACPA were extracted. The data was analyzed statistically.

Results:

A total of 127472 people who checked RF are included. Of these 127472 people, 64504 (50.6%) are male and the mean age was 44.9 years. RF was positive in 11477 people (9.0%). Among these, 1667 (1.2%) were checked for ACPA, and 21 people (1.3%) had positive ACPA. None of variables demonstrated significant association with RF positivity. In contrast, BI and smoking duration was significantly associated with an increased risk of ACPA positivity (13.3 years vs 7.49 years, p value = 0.023), although the number of cigarettes smoked was not. The smoking duration for 10 years or more was associated with an increased risk of ACPA positivity even after adjusted for age and sex (adjusted hazard ratio: 2.47 [95% confidence interval: 1.04-5.87]; p=0.04).

Conclusion:

In this study, no significant risk factor for positive RF was found. Even smoking was not associated with RF positivity. On the other hand, smoking duration, not smoking intensity was significantly associated with an increased risk of ACPA positivity.

References:

[1]Verpoort KN. Association of smoking with the constitution of the anti-cyclic citrullinated peptide response in the absence of HLA-DRB1 shared epitope alleles. Arthritis Rheum 2007;56:29138.

Table 1.

Patient characteristics with RF and ACPA positivity

RF positive (n=11477)RF negative (n=115995)p valueACPA positive (n=21)ACPA negative (n=1646)p valueAge44.86 (12.32)44.94 (12.47)0.5437.90 (9.07)45.26 (12.58)0.008Male (%)5659 (49.3)57309 (49.4)0.84511 (52.4)834 (50.7)1Body Mass Index22.33 (3.38)22.35 (3.40)0.52121.64 (3.28)22.34 (3.37)0.346Smoker, total (%)4509 (39.3)45738 (39.4)0.77212 (57.1)642 (39.0)0.115Current smoker (%)1959 (17.1)20483 (17.7)0.1148 (38.1)277 (16.8)0.017Previous smoker (%)2550 (22.2)25255 (21.8)0.2714 (19.0)365 (22.2)1Brinkman index144.8 (299.3)145.2 (313.8)0.897280.9 (409.7)145.3 (300.3)0.041Number of cigarettes (/day)17.7 (18.5)17.4 (13.3)0.16619.8 (12.0)17.4 (12.1)0.511Smoking Duration (years)7.43 (11.68)7.45 (11.66)0.85113.33 (14.11)7.49 (11.68)0.023Alcohol Drinker (%)6972 (60.7)70010 (60.4)0.41810 (47.6)1005 (61.1)0.261Alcohol Intake (g/day)13.67 (21.88)13.58 (21.32)0.67616.70 (26.89)14.06 (22.16)0.59Exercise ≧3 times/week (%)2792 (24.3)28293 (24.4)0.8825 (23.8)402 (24.4)1White blood cell (103/μL)5.32 (1.46)5.35 (1.50)0.135.59 (2.05)5.37 (1.54)0.52Hemoglobin (g/dL)13.82 (1.44)13.82 (1.45)0.75314.12 (1.03)13.83 (1.43)0.36Creatinine (mg/dL)0.73 (0.20)0.73 (0.25)0.1940.76 (0.16)0.73 (0.18)0.586AST (U/L)21.89 (9.39)21.93 (11.65)0.78220.95 (6.02)21.68 (8.29)0.69LDL cholesterol (mg/dL)115.41 (30.90)115.48 (30.77)0.815112.62 (33.26)115.36 (31.03)0.688Triglyceride (mg/dL)97.63 (78.46)97.70 (80.36)0.929100.57 (63.40)97.85 (78.37)0.874Uric Acid (mg/dL)5.32 (1.42)5.33 (1.42)0.6235.76 (1.34)5.34 (1.42)0.172

Disclosure of Interests:

None declared

The Efficacy of Sonazoid-enhanced Ultrasonography in Decision-making for Liver Abscess Treatment

Objective The usefulness of contrast-enhanced ultrasonography (CEUS) for making decisions in the treatment of liver abscess is unknown. Methods We evaluated the internal blood flow in the arterial-predominant phase by CEUS using Sonazoid^® in 21 patients. The stain area rate was evaluated in maximum parting plane of abscess in CEUS. Patients were divided into two groups: the vascular phase enhancement (VE) group, in which ≥50% of the abscess cavity was enhanced (12 patients), and the vascular phase non-enhancement (VNE) group, in which <50% of the abscess cavity was enhanced (9 patients). The rate of patients who were cured by conservative treatment alone was examined in both groups. The defect rate of all liver abscesses in the post-vascular phase was also evaluated. Results In the VE group, improvement by conservative treatment alone was obtained in 11 out of 12 patients (91.7%), while in the VNE group, improvement by conservative treatment alone was obtained in only 1 out of 9 patients (11.1%), a significant difference (p<0.001). In the VE group, one patient did not improve with conservative treatment alone because the abscess ruptured near the liver surface. In the VE group, the abscess size was smaller than in the VNE group. By examining the defect rate in the post-vascular phase, it was found that 16 out of 21 patients (76.2%) showed 71% or more defects. Conclusion The enhancement rate in the arterial-predominant phase of CEUS was considered useful for determining the treatment approach for liver abscess.

Concerns and Side Effects of Azathioprine During Adalimumab Induction and Maintenance Therapy for Japanese Patients With Crohn's Disease: A Subanalysis of a Prospective Randomised Clinical Trial [DIAMOND Study]

BACKGROUND

Combining a thiopurine with the human anti-tumour necrosis factor-α monoclonal antibody adalimumab for Crohn's disease [CD] treatment is controversial with regard to efficacy and safety. By conducting a subanalysis of a multicentre, randomised, prospective, open-label trial [the DIAMOND study, UMIN registration number 000005146], we studied the risk of discontinuation of thiopurine in combination with adalimumab.

METHODS

In the preceding DIAMOND study, we analysed the: [i] timing and reasons for dropout in the monotherapy group and combination group; [ii] risk factors for dropout in the combination group.

RESULTS

There was no significant difference in the dropout rate up to Week 52 between the monotherapy group and combination group [p = 0.325]. The main reason for study dropout was active CD in the monotherapy group, whereas it was adverse effects in the combination group [Fisher's exact test, p <0.001]. Kaplan-Meier analyses revealed significantly earlier dropout in the combination group [log-rank test, p = 0.001]. Multivariable analysis revealed low body weight to be a risk for dropout due to adverse effects in the combination group.

CONCLUSIONS

Combination of azathioprine with adalimumab resulted in dropout in the early stage of the study due to side effects of azathioprine, in comparison with late dropout due to active CD in the adalimumab monotherapy group.

Shochu slop is an excellent medium for Escherichia coli K-12

We found that shochu slop, the residue generated during the production of distilled shochu liquor, which must be treated as industrial waste, can be used as an excellent medium for Escherichia coli culture. LB medium is generally used in laboratories for culturing E. coli. However, it is not the optimal medium for E. coli culture because the bacterial cells cannot grow to very high densities in LB medium. On the other hand, E. coli can grow to higher densities in Terrific broth and this medium is used when researchers want to grow E. coli to high density or to obtain a protein with high yield. In this study, we removed solid matter from shochu slop, adjusted the pH of the mixture to 7 and subsequently used the slop for E. coli culture. The ability of shochu slop to support E. coli growth was compared with those of LB Miller medium and Terrific broth. The results indicate that sweet potato shochu slop as culture medium for E. coli is comparable to Terrific broth and much better than LB Miller medium in terms of supporting cell proliferation, and plasmid and enzyme production. SIGNIFICANCE AND IMPACT OF THE STUDY: Shochu manufacturers incur a cost to dispose shochu slop, which is recognized as food manufactural residues. Escherichia coli has been used in laboratories and in industry. However, culture media used in the laboratories are expensive and those used in industry are expensive because of their large scale. We found that sweet potato shochu slop is an excellent culture medium for E. coli. This finding is not only useful for laboratories and industry, but also beneficial to the effective utilization of this renewable resource to create a sustainable society.

Efficacy of 1.2 L polyethylene glycol plus ascorbic acid for bowel preparations

BACKGROUND

A low-volume polyethylene glycol (PEG) solution that combines ascorbic acid with PEG-based electrolyte solution (PEG-ASC) is gaining mainstream acceptance for bowel preparation due to reduced volume and improved taste. Although several reports showed that bowel preparation with PEG-ASC volume lower than 2.0 L with laxative agents could be an alternative to traditional preparation regimen, the cleansing protocols have not been fully investigated.

AIM

To evaluate the cleansing efficacy of 1.2 L PEG-ASC solution comparing with 2.0 L PEG electrolyte (PEG-ELS) for bowel preparations.

METHODS

A randomized, single-blinded, open-label, single-center, non-inferiority study was conducted. In total, 312 Japanese adult patients (aged > 18 years) who underwent colonoscopy were enrolled. Patients were randomly allocated to bowel lavage with either 1.2 L of PEG-ASC solution with at least 0.6 L of an additional clear fluid (1.2 L PEG-ASC group) or 2.0 L of PEG-ELS (PEG-ELS group). Then, 48 mg of sennoside was administered at bedtime on the day before colonoscopy, and the designated drug solution was administered at the hospital on the day of colonoscopy. Bowel cleansing was evaluated using the Boston Bowel Preparation Scale (BBPS). The volume of fluid intake and required time for bowel preparation were evaluated. Furthermore, compliance, patient tolerance, and overall acceptability were evaluated using a patient questionnaire, which was assessed using a visual analog scale.

RESULTS

In total, 291 patients (1.2 L PEG-ASC group, 148; PEG-ELS group, 143) completed the study. There was no significant difference in successful cleansing, defined as a BBPS score ≥ 2 in each segment, between the two groups (1.2 L PEG-ASC group, 91.9%; PEG-ELS group, 90.2%; 95%CI: -0.03-0.09). The required time for bowel preparation was significantly shorter (164.95 min ± 68.95 min vs 202.16 min ± 68.69 min, P < 0.001) and the total fluid intake volume was significantly lower (2.23 L ± 0.55 L vs 2.47 L ± 0.56 L, P < 0.001) in the 1.2 L PEG-ASC group than in the PEG-ELS group. Palatability, acceptability of the volume of solution, and overall acceptability evaluated using a patient questionnaire, which was assessed by the visual analog scale, were significantly better in the 1.2 L PEG-ASC group than in the PEG-ELS group (7.70 cm ± 2.57 cm vs 5.80 cm ± 3.24 cm, P < 0.001). No severe adverse event was observed in each group.

CONCLUSION

The 1.2 L PEG-ASC solution was non-inferior to the 2.0 L PEG-ELS solution in terms of cleansing efficacy and had better acceptability among Japanese patients.

Low-Frequency Electrical Stimulation of Denervated Skeletal Muscle Retards Muscle and Trabecular Bone Loss in Aged Rats

Electrical stimulation (ES)-induced muscle contraction has multiple effects; however, mechano-responsiveness of bone tissue declines with age. Here, we investigated whether daily low-frequency ES-induced muscle contraction treatment reduces muscle and bone loss and ameliorates bone fragility in early-stage disuse musculoskeletal atrophy in aged rats. Twenty-seven-month-old male rats were assigned to age-matched groups comprising the control (CON), sciatic nerve denervation (DN), or DN with direct low-frequency ES (DN+ES) groups. The structural and mechanical properties of the trabecular and cortical bone of the tibiae, and the morphological and functional properties of the tibialis anterior (TA) muscles were assessed one week after DN. ES-induced muscle contraction force mitigated denervation-induced muscle and trabecular bone loss and deterioration of the mechanical properties of the tibia mid-diaphysis, such as the stiffness, but not the maximal load, in aged rats. The TA muscle in the DN+ES group showed significant improvement in the myofiber cross-sectional area and muscle force relative to the DN group. These results suggest that low-frequency ES-induced muscle contraction treatment retards trabecular bone and muscle loss in aged rats in early-stage disuse musculoskeletal atrophy, and has beneficial effects on the functional properties of denervated skeletal muscle.

Transcranial Static Magnetic Field Stimulation over the Primary Motor Cortex Induces Plastic Changes in Cortical Nociceptive Processing

Transcranial static magnetic field stimulation (tSMS) is a novel and inexpensive, non-invasive brain stimulation (NIBS) technique. Here, we performed non-invasive modulation of intra-epidermal electrical stimulation-evoked potentials (IES-EPs) by applying tSMS or sham stimulation over the primary motor (M1) and somatosensory (S1) cortices in 18 healthy volunteers for 15 min. We recorded EPs after IES before, right after, and 10 min after tSMS. The IES-EP amplitude was significantly reduced immediately after tSMS over M1, whereas tSMS over S1 and sham stimulation did not affect the IES-EP amplitude. Thus, tSMS may affect cortical nociceptive processing. Although the results of intervention for experimental acute pain in healthy subjects cannot be directly translated into the clinical situation, tSMS may be a potentially useful NIBS method for managing chronic pain, in addition to standard of care treatments.

Cortical Oxyhemoglobin Elevation Persists After Moderate-Intensity Cycling Exercise: A Near-Infrared Spectroscopy Study

Near-infrared spectroscopy (NIRS) can measure cortical activity during gross motor tasks based on the cerebral hemodynamic response. Although some reports suggest that cycling exercise improves cortical oxygenation, its after-effects are unknown. We examined the after-effects of low- and moderate-intensity cycling exercise on cortical oxygenation. Ten healthy volunteers (mean age 21.3 ± 0.7 years; 4 women) underwent cycle ergometer exercise at 30% or 50% of VO₂peak for 20 min, followed by an 8-min post-exercise rest (PER). O₂Hb levels of the supplementary motor area (SMA) and sensorimotor cortex (SMC) were recorded using a near-infrared spectroscopy system. Skin blood flow (SBF) and mean arterial pressure (MAP) were continuously measured. The peak values of O₂Hb between exercise and PER were compared. The O₂Hb, SBF, and MAP increased in the exercise phase. SBF degraded over time, and MAP decreased immediately after exercise. The O₂Hb decreased immediately and increased again in the PER. There were no significant differences between exercise and PER in the SMC in the 30% VO₂peak experiment or in the SMA and SMC in the 50% VO₂peak experiment. The O₂Hb in the motor-related area was elevated during both exercise and PER especially in the 50% VO₂peak experiment.

Effects of Streptomycin Administration on Increases in Skeletal Muscle Fiber Permeability and Size Following Eccentric Muscle Contractions

The purpose of this study was to investigate the preventive effect of streptomycin (Str) administration on changes in membrane permeability and the histomorphological characteristics of damaged muscle fibers following eccentric contraction (ECC ). Eighteen 7-week-old male Fischer 344 rats were randomly assigned to three groups: control (Cont), ECC, and ECC with Str (ECC + Str). The tibialis anterior (TA) muscles in both ECC groups were stimulated electrically and exhibited ECC. Evans blue dye (EBD), a marker of muscle fiber damage associated with increased membrane permeability, was injected 24 hr before TA muscle sampling. The number of EBD-positive fibers, muscle fiber cross-sectional area (CSA), and roundness were determined via histomorphological analysis. The ECC intervention resulted in an increased fraction of EBD-positive fibers, a larger CSA, and decreased roundness. The fraction of EBD-positive fibers was 79% lower in the ECC + Str group than in the ECC group. However, there was no difference in the CSA and roundness of the EBD-positive fibers between the two ECC groups. These results suggest that Str administration can reduce the number of myofibers that increase membrane permeability following ECC, but does not ameliorate the extent of fiber swelling in extant EBD-positive fibers. Anat Rec, 301:1096-1102, 2018. © 2018 Wiley Periodicals, Inc.

Changes in Cerebral Oxyhaemoglobin Levels During and After a Single 20-Minute Bout of Moderate-Intensity Cycling

Aerobic exercise produces changes in cerebral oxyhaemoglobin (O₂Hb) concentration; however, the effects of exercise on O₂Hb during the post-exercise period remain to be established. The aim of the present study was to evaluate O₂Hb levels during and after a 20-min bout of moderate-intensity cycling exercise. After a 3-min rest period, 12 healthy volunteers (9 women, 3 men) cycled for 20 min at an intensity corresponding to 50% of their VO₂max, after which they were monitored during a 15-min post-exercise rest period. O₂Hb levels in the right (R-PFC) and left prefrontal cortices (L-PFC), right (R-PMA) and left premotor areas (L-PMA), supplementary motor area (SMA), and primary motor cortex (M1) were measured using near-infrared spectroscopy. A one-way repeated-measures analysis of variance (ANOVA) was performed to compare mean pre-exercise O₂Hb levels with O₂Hb levels during the last 5 min of exercise and the last 5 min of the post-exercise rest period. O₂Hb levels increased significantly (p < 0.01) between the pre-exercise rest period and the last 5 min of the exercise session for each region of interest (range: 0.040-0.085 mM·cm). O₂Hb levels did not return to pre-exercise values during the 15-min post-exercise rest period. O₂Hb levels during the last 5 min of the post-exercise rest period were significantly higher than pre-exercise values in the L-PFC, L-PMA, SMA, and M1 (p < 0.01). Our results indicate that cortical oxygenation persists for at least 15 min following a 20-min bout of moderate-intensity cycling, and that aerobic exercise may facilitate neuroplasticity.

Hand-Foot Syndrome and Post-Progression Treatment Are the Good Predictors of Better Survival in Advanced Hepatocellular Carcinoma Treated with Sorafenib: A Multicenter Study

OBJECTIVE

To determine the relationship between treatment outcomes and hand-foot syndrome (HFS), and the relationship between survival rate and post-progression treatment after sorafenib therapy.

METHODS

The study assessed 314 patients with advanced hepatocellular carcinoma (HCC) treated with sorafenib at 5 general hospitals in Kagawa Prefecture, Japan.

RESULTS

At the start of sorafenib therapy, 23.6% of the patients had HCC of a Child-Pugh class other than A. The initial sorafenib dose was 800 mg in 9.2% of the patients and 400 mg in 64.3%. Time to progression was 129 days (95% CI: 87.3-170.7) and the median overall survival (OS) was 392 days (95% CI: 316.0-468.0). The OS of the patients with Child-Pugh class A HCC was significantly better than that of the patients with Child-Pugh class B HCC (p < 0.0001). The survival curves for Child-Pugh class A-5 points and class A-6 points were significantly different, with that for class A-5 points being better (p < 0.0001). A significant difference was observed between the patients who exhibited HFS and those who did not, with the former exhibiting a better survival rate (p < 0.001). In addition, the survival rate of the patients who received post-progression treatment after sorafenib therapy was significantly better than that of the patients who did not (p < 0.001).

CONCLUSION

In sorafenib therapy, patients with HFS and those who received post-progression treatment exhibited good OS.

Time-Dependent Changes in the Structure of Calcified Fibrocartilage in the Rat Achilles Tendon-Bone Interface With Sciatic Denervation

The enthesis transmits a physiological load from soft to hard tissue via fibrocartilage. The histological alterations induced by this physiological loading remain unclear. This study was performed to examine the histomorphological alterations in the collagen fiber bundle alignment and depth of collagen interdigitation between the calcified fibrocartilage and the bone. We examined the Achilles enthesis of rats with sciatic denervation to explore the mechanical effects of structural changes in the enthesis. The parallelism of the collagen fiber bundles was significantly reduced 8 weeks after denervation. However, the depth of collagen interdigitation significantly increased at 2 and 4 weeks after denervation and then significantly decreased 8 weeks after denervation. In conclusion, a lack of muscle loading induced structural alterations in the distal calcified fibrocartilage. These findings suggest that while structural changes in the enthesis are necessary for the development of physiological loading, structural deformities are required in the long term. Anat Rec, 300:2166-2174, 2017. © 2017 Wiley Periodicals, Inc.

Decrease in short-latency afferent inhibition during corticomotor postexercise depression following repetitive finger movement

INTRODUCTION

This study aimed to clarify cortical circuit mechanisms contributing to corticomotor excitability during postexercise depression (PED) following repetitive nonfatiguing movement. We investigated changes in short-latency afferent inhibition (SAI) and short-interval intracortical inhibition (SICI) by paired-pulse transcranial magnetic stimulation (TMS) during PED.

METHODS

A total of 16 healthy subjects performed repetitive abduction movements of the right index finger at 2.0 Hz for 6 min at 10% maximum voluntary contraction. We measured SAI evoked by pairing ulnar nerve stimulation with TMS (interstimulus interval, 22 ms) before and during PED (n = 10, experiment 1). We also measured SICI evoked by paired TMS (interstimulus interval, 2 ms) at 80% resting motor threshold (n = 10, experiment 2), and at 80% active motor threshold (n = 8, experiment 3) before and during PED.

RESULTS

Single motor evoked potential amplitude significantly decreased 1-2 min after the movement task in all experiments, indicating reliable PED induction. In experiment 1, SAI significantly decreased (disinhibited) 1-2 min during PED, whereas in experiments 2 and 3, SICI showed no significant change during PED.

CONCLUSION

This study suggests that cholinergic inhibitory circuit activity decreases during PED following repetitive nonfatiguing movement, whereas GABA_A circuit activity remains stable.

Articular chondrocyte alignment in the rat after surgically induced osteoarthritis

[Purpose] Chondrocytes in articular cartilage are aligned as columns from the joint surface. Notably, loss of chondrocyte and abnormalities of differentiation factors give rise to osteoarthritis (OA). However, the relationship between chondrocyte alignment and OA progression remains unclear. This study was performed to investigate temporal alterations in surgically-induced OA rats. [Subjects and Methods] Thirteen-week-old Wistar rats (n=30) underwent destabilized medial meniscus surgery in their right knee and sham surgery in their left knee. Specimens (n=5) were collected at 0, 1, 2, 4 and 8 weeks after surgery. Histological analysis with Osteoarthritis Research Society International (OARSI) scores, cell density ratios, cell alignments and correlation between OARSI scores and cell density/alignment was performed. [Results] OARSI scores were significantly higher at 1, 2, 4 and 8 weeks in the DMM group than in the control. Cell density ratios were decreased significantly in the DMM group at 2, 4 and 8 weeks compared with the control. Chondrocyte alignment was decreased significantly in the DMM group at 4 and 8 weeks. There were negative correlations between OA severity and cell density / cell alignment. [Conclusion] The results suggest a relationship between chondrocyte alignment and cartilage homeostasis, which plays an important role in OA progression.

Electrical Stimulation of Denervated Rat Skeletal Muscle Ameliorates Bone Fragility and Muscle Loss in Early-Stage Disuse Musculoskeletal Atrophy

We tested whether daily muscle electrical stimulation (ES) can ameliorate the decrease in cortical bone strength as well as muscle and bone geometric and material properties in the early stages of disuse musculoskeletal atrophy. 7-week-old male F344 rats were randomly divided into three groups: age-matched control group (Cont); a sciatic denervation group (DN); and a DN + direct electrical stimulation group (DN + ES). Denervated tibialis anterior (TA) muscle in the DN + ES group received ES with 16 mA at 10 Hz for 30 min/day, 6 days/week. Micro CT, the three-point bending test, and immunohistochemistry were used to characterize cortical bone mechanical, structural, and material properties of tibiae. TA muscle in the DN + ES group showed significant improvement in muscle mass and myofiber cross-sectional area relative to the DN group. Maximal load and stiffness of tibiae, bone mineral density estimated by micro CT, and immunoreactivity of DMP1 in the cortical bone tissue were also significantly greater in the DN + ES group than in the DN group. These results suggest that daily ES-induced muscle contraction treatment reduced the decrease in muscle mass and cortical bone strength in early-stage disuse musculoskeletal atrophy and is associated with a beneficial effect on material properties such as mineralization of cortical bone tissue.

Diagnostic performance of a new endoscopic scraper for malignant biliary strictures: a multicenter prospective study

BACKGROUND AND AIMS

The efficacy of ERCP for histologic diagnosis of malignant biliary strictures is disappointingly low. The aim of this study was to investigate the diagnostic performance of a newly developed endoscopic device with scraping loops in combination with conventional biopsy forceps.

METHODS

We performed a multicenter single-arm prospective study. Between February 2013 and December 2014, 123 patients with suspected malignant biliary strictures were enrolled in the study. The new device and conventional biopsy forceps were applied for histologic diagnosis by ERCP. The primary outcome was to evaluate cancer detectability by biopsy forceps, the new device, and their combined use.

RESULTS

Of the 123 patients, 119 were diagnosed with a malignant stricture. Sufficient samples were collected in 83.7% (103/123), 93.5% (115/123), and 95.9% (118/123) of patients using biopsy forceps, the new device, and their combination, respectively. Cancer detectability of forceps biopsy, the new device, and their combination were 51.3% (61/119), 64.7% (77/119), and 74.8% (89/119), respectively. The new device had a significantly higher sample yield and cancer detectability than biopsy forceps (P < .01 and P = .018, respectively, McNemar test). Complementary use of the new device with biopsy forceps demonstrated a significantly additive effect in both sample yield and cancer detection (P < .01 each, McNemar test). The new device detected 48.3% (28/58) of cancers that were not diagnosed as malignant by biopsy forceps.

CONCLUSIONS

The new endoscopic scraper demonstrated a large sample yield and high cancer detectability. It could be a first-line tissue-sampling device for biliary strictures. (University Hospital Medical Information Network Clinical Trial Registry [UMIN-CTR] (http://www.umin.ac.jp/ctr/index.htm) registration number: UMIN000009895.).

Difference in Cortical Relay Time Between Intrinsic Muscles of Dominant and Nondominant Hands

The authors aimed to calculate and compare cortical relay time (CRT) between intrinsic hand muscles and between homonymous muscles of dominant and nondominant hands. The participants comprised 22 healthy volunteers. The CRT for long-latency reflexes (LLRs) was calculated by subtracting the peak latency of somatosensory evoked potentials of component N20 and the onset latency of motor evoked potentials from the onset latency of LLRs. CRT was significantly shorter for the first dorsal interosseous muscle than for the abductor pollicis brevis muscle, regardless of hand dominance. CRT for the abductor pollicis brevis muscle was significantly shorter in the dominant hand than in the nondominant hand. Evaluation of CRT for intrinsic muscles might be beneficial in the understanding of individuated finger functions.

Prediction of Embolization Area after Conventional Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma Using SYNAPSE VINCENT

PURPOSE

Transcatheter arterial chemoembolization (TACE) is one of the most effective therapeutic options for hepatocellular carcinoma (HCC) and it is important to protect residual liver function after treatment as well as the effect. To reduce the liver function deterioration, we evaluated the automatic software to predict the embolization area of TACE in 3 dimensions.

MATERIALS AND METHODS

Automatic prediction software of embolization area was used in chemoembolization of 7 HCCs. Embolization area of chemoembolization was evaluated within 1 week CT findings after TACE and compared simulated area using automatic prediction software.

RESULTS

The maximal diameter of these tumors is in the range 12-42 mm (24.6 ± 9.5 mm). The average time for detecting tumor-feeding branches was 242 s. The total time to detect tumor-feeding branches and simulate the embolization area was 384 s. All cases could detect all tumor-feeding branches of HCC, and the expected embolization area of simulation with automatic prediction software was almost the same as the actual areas, as shown by CT after TACE.

CONCLUSION

This new technology has possibilities to reduce the amount of contrast medium used, protect kidney function, decrease radiation exposure, and improve the therapeutic effect of TACE.

Non-invasive modulation of somatosensory evoked potentials by the application of static magnetic fields over the primary and supplementary motor cortices

This study was performed to investigate the possibility of non-invasive modulation of SEPs by the application of transcranial static magnetic field stimulation (tSMS) over the primary motor cortex (M1) and supplementary motor cortex (SMA), and to measure the strength of the NdFeB magnetic field by using a gaussmeter. An NdFeB magnet or a non-magnetic stainless steel cylinder (for sham stimulation) was settled on the scalp over M1 and SMA of 14 subjects for periods of 15 min. SEPs following right median nerve stimulation were recorded before and immediately after, 5 min after, and 10 min after tSMS from sites C3′ and F3. Amplitudes of the N33 component of SEPs at C3′ significantly decreased immediately after tSMS over M1 by up to 20%. However, tSMS over the SMA did not affect the amplitude of any of the SEP components. At a distance of 2–3 cm (rough depth of the cortex), magnetic field strength was in the range of 110–190 mT. Our results that tSMS over M1 can reduce the amplitude of SEPs are consistent with those of low-frequency repeated TMS and cathodal tDCS studies. Therefore, tSMS could be a useful tool for modulating cortical somatosensory processing.

Inhibitory effect of intensity and interstimulus interval of conditioning stimuli on somatosensory evoked magnetic fields

Magnetoencephalography (MEG) recordings were performed to investigate the inhibitory effects of conditioning stimuli with various types of interstimulus intervals (ISIs) or intensities on somatosensory evoked magnetic fields (SEFs) using a 306-ch whole-head MEG system. Twenty-three healthy volunteers participated in this study. Electrical stimuli were applied to the right median nerve at the wrist. Six pulse trains with ISIs of 500 ms were presented in Experiment 1. A paired-pulse paradigm with three kinds of conditioning stimulus (CON) intensities, 500 ms before the test stimulus (TS), was applied in Experiment 2. Finally, three CONs 500 or 1000 ms before TS were presented in Experiment 3. Three main SEF deflections (N20m, P35m, and P60m) were observed, and the source activities of P35m and P60m significantly decreased after the 2nd pulse of a six pulse trains. These source activities also significantly decreased with increasing intensity of CON. In addition, these attenuations of source activities were affected by CON-CON or CON-TS intervals. These results indicated that the source activities were modulated by the intensity and ISIs of CONs. Furthermore, P35m after the stimulation were very sensitive to CONs; however, the attenuation of P60m after the stimulation lasted for a longer period than that of P35m. Our findings suggest that the conditioning stimulation had inhibitory effects on subsequent evoked cortical responses for more than 500 ms. Our results also provide important clues about the nature of short-latency somatosensory responses in human studies.

Do Differences in Levels, Types, and Duration of Muscle Contraction Have an Effect on the Degree of Post-exercise Depression?

We conducted two experiments to determine how differences in muscle contraction levels, muscle contraction types, and movement duration affect degree of post-exercise depression (PED) after non-exhaustive, repetitive finger movement. Twelve healthy participants performed repetitive abduction movements of the right index finger at 2 Hz. In experiment 1, we examined the effects of muscle contraction levels at 10, 20, and 30% maximum voluntary contraction and the effects of muscle contraction types at isotonic and isometric contraction. In experiment 2, we examined the effects of movement duration at 2 and 6 min. Motor-evoked potentials (MEPs) were recorded from the right first dorsal interosseous muscle before movement tasks and 1–10 min after movement tasks. MEP amplitudes after isotonic contraction tasks were significantly smaller than those after isometric contraction tasks and decreased with increasing contraction levels, but were independent of movement duration. This study demonstrated that the degree of PED after non-exhaustive repetitive finger movement depended on muscle contraction levels and types. Thus, the degree of PED may depend on the levels of activity in the motor cortex during a movement task. This knowledge will aid in the design of rehabilitation protocols.

Correlation Between the Cerebral Oxyhaemoglobin Signal and Physiological Signals During Cycling Exercise: A Near-Infrared Spectroscopy Study

Near-infrared spectroscopy (NIRS) is a widely used noninvasive method for measuring human brain activation based on the cerebral haemodynamic response. However, systemic changes can influence the signal's parameters. Our study aimed to investigate the relationships between NIRS signals and skin blood flow (SBF) or blood pressure during dynamic movement. Nine healthy volunteers (mean age, 21.3 ± 0.7 years; 6 women) participated in this study. The oxyhaemoglobin (O2Hb) signal, SBF, and mean arterial pressure (MAP) were measured while the volunteers performed multi-step incremental exercise on a bicycle ergometer, at workloads corresponding to 30, 50, and 70 % of peak oxygen consumption (VO2peak) for 5 min. The Pearson's correlation coefficients for the O2Hb signal and SBF at 50 and 70 % VO2peak were 0.877 (P < 0.01) and -0.707 (P < 0.01), respectively. The correlation coefficients for O2Hb and MAP during warm-up, 30 % VO2peak, and 50 % VO2peak were 0.725 (P < 0.01), 0.472 (P < 0.01), and 0.939 (P < 0.01), respectively. Changes in the state of the cardiovascular system influenced O2Hb signals positively during low and moderate-intensity exercise, whereas a negative relationship was observed during high-intensity exercise. These results suggest that the relationship between the O2Hb signal and systemic changes is affected by exercise intensity.

Efficacy of probiotic treatment with Bifidobacterium longum 536 for induction of remission in active ulcerative colitis: A randomized, double-blinded, placebo-controlled multicenter trial

BACKGROUND AND AIM

We conducted a randomized, double-blinded, placebo-controlled trial to investigate the efficacy of Bifidobacterium longum 536 (BB536) supplementation for induction of remission in Japanese patients with active ulcerative colitis (UC).

METHODS

Fifty-six patients with mild to moderate UC were enrolled. Three patients had pancolitis, 36 had left-sided colitis, and 17 had proctitis. Patients were randomly treated with 2-3 × 10(11) freeze-dried viable BB536 (28 patients) or placebo (28 patients) for 8 weeks.

RESULTS

In total, 63% of patients receiving BB536 showed clinical remission (UC disease activity index [UCDAI] ≤2) at week 8 compared to 52% of those receiving placebo (P = 0.395). We observed a significant decrease of UCDAI scores (3.8 ± 0.4 at baseline to 2.6 ± 0.4 at week 8) in the BB536 group (P < 0.01), whereas there was no significant decrease in the placebo group (P = 0.88). There was also a significant decrease in the Rachmilewitz endoscopic index (EI) and the Mayo subscore at week 8 in the BB536 group, whereas there was no significant decrease in the placebo group. A single patient in the BB536 group complained of a mild side-effect, but no other adverse effects were observed.

CONCLUSION

Supplementation with BB536 was well tolerated and reduced UCDAI scores, EI and Mayo subscores after 8 weeks in Japanese patients with mild to moderately active UC.

Regional Changes in Cerebral Oxygenation During Repeated Passive Movement Measured by Functional Near-infrared Spectroscopy

The aim of this study is to investigate the influence of passive movement repetition frequency at 1.5-Hz and 1-Hz on changes in cerebral oxygenation and assess the temporal properties of these changes using functional near-infrared spectroscopy (fNIRS). No significant differences in systemic hemodynamics were observed between resting and passive movement phases for either 1.5-Hz or 1-Hz trial. Changes in cortical oxygenation as measured by fNIRS in bilateral supplementary motor cortex (SMC), left primary motor cortex (M1), left primary somatosensory cortex (S1), and left posterior association area (PAA) during passive movement of the right index finger revealed greater cortical activity at only 1.5-Hz movement frequency. However, there were no significant differences in the time for peak oxyhemoglobin (oxyHb) among regions (bilateral SMC, 206.4 ± 14.4 s; left M1, 199.1 ± 14.8 s; left S1, 207.3 ± 9.4 s; left PAA, 219.1 ± 10.2 s). Therefore, our results that passive movement above a specific frequency may be required to elicit a changed in cerebral oxygenation, and the times of peak ΔoxyHb did not differ significantly among measured regions.

Initial Experience Performing Percutaneous Ultrasound Examination with Real-Time Virtual Sonography with Color Display

PURPOSE

We report the efficacy of percutaneous ultrasound (US) examination using a novel real-time virtual sonography (RVS) method that collates multiple Digital Imaging and Communications in Medicine (DICOM) data sources and displays reference images in color.

MATERIALS AND METHODS

A total of 7 patients with 9 hepatocellular carcinomas were evaluated. Using the SYNAPSE VINCENT volume analyzer, DICOM data of the portal vein, hepatic vein, tumor, and hepatic segment were isolated from contrast-enhanced computed tomography DICOM data. Each portion of DICOM data was uploaded into an US scanner (HI VISION Ascendus, Hitachi Aloka Medical Ltd., Tokyo, Japan) and unified on a US platform to create a single reference image. Each uploaded portion of DICOM data was assigned a different color. Further, conventional RVS was performed using this information.

RESULTS

The maximal tumoral diameter ranged from 6.4 to 15 mm (mean ± SD, 11.0 ± 2.8). DICOM data could be isolated, enabling the display of color RVS in all patients. Color RVS facilitated superior visibility compared with conventional grayscale RVS and facilitated the comprehension of spatial positioning.

CONCLUSION

RVS with color display demonstrates utility in increasing operator comprehension of spatial and positional relationships during percutaneous US examination.

Effect of electrical stimulation-induced muscle force and streptomycin treatment on muscle and trabecular bone mass in early-stage disuse musculoskeletal atrophy

OBJECTIVES

The aim was to determine whether daily muscle electrical stimulation (ES) and streptomycin treatment would have positive or negative effects on trabecular bone mass in disuse rats.

METHODS

Seven-week-old male F344 rats were randomly divided into five groups of eight animals each: an age-matched control group (CON); a sciatic denervation group (DN); a DN + direct electrical stimulation group (DN+ES); a DN + streptomycin treatment group (DN+SM); and a DN+ES+SM group. The tibialis anterior (TA) muscles in all ES groups were stimulated with 16mA at 10Hz for 30 min/day, six days/week, for one week. Bone volume and structure were evaluated using micro-CT, and histological examinations of the tibiae were performed.

RESULTS

Direct ES significantly reduced the disuse-induced trabecular bone loss. Osteoid thickness were also significantly greater in the ES groups than in the DN group. Micro CT and histomorphological parameters were significantly lower in the DN+ES+SM group than in the DN+ES group, while there were no significant differences between the DN and DN+SM groups.

CONCLUSIONS

These results suggest that ES-induced muscle force reduced trabecular bone loss, and streptomycin treatment did not induce bone loss, but attenuated the effects of ES-induced muscle force on reducing the loss of disused bone.

No relation between afferent facilitation induced by digital nerve stimulation and the latency of cutaneomuscular reflexes and somatosensory evoked magnetic fields

Primary motor cortex (M1) excitability can be assessed using transcranial magnetic stimulation (TMS) and can be modulated by a conditioning electrical stimulus delivered to a peripheral nerve prior to TMS. This is known as afferent facilitation (AF). The aim of this study was to determine whether AF can be induced by digital nerve stimulation and to evaluate the relation between the interstimulus interval (ISI) required for AF and the latency of the E2 component of the cutaneomuscular reflex (CMR) and the prominent somatosensory evoked field (SEF) deflection that occurs approximately 70 ms after digital nerve stimulation (P60m). Stimulation of the digital nerve of the right index finger was followed, at various time intervals, by single-pulse TMS applied to the contralateral hemisphere. The ISI between digital nerve stimulation and TMS was 20, 30, 40, 50, 60, 70, 80, 100, 140, 180, 200, or 220 ms. Single-pulse TMS was performed alone as a control. SEFs were recorded following digital nerve stimulation of the index finger, and the equivalent current dipole of prominent deflections that occurred around 70 ms after the stimulation was calculated. CMRs were recorded following digital nerve stimulation during muscle contraction. Motor evoked potentials (MEPs) were facilitated at an ISI between 50 and 100 ms in 11 of 13 subjects, and the facilitated MEP amplitude was larger than the unconditioned MEP amplitude (p < 0.01). There was no significant correlation between the ISI at which AF was maximal and the latency of the P60m component of the SEF (r = −0.50, p = 0.12) or the E2 component of the CMR (r = −0.54, p = 0.88). These results indicate that the precise ISI required for AF cannot be predicted using SEF or CMR.

The modulatory effect of electrical stimulation on the excitability of the corticospinal tract varies according to the type of muscle contraction being performed

Afferent input caused by electrical stimulation of a peripheral nerve increases corticospinal excitability during voluntary contractions, indicating that proprioceptive sensory input arriving at the cortex plays a fundamental role in modulating corticospinal excitability. The purpose of this study was to investigate whether the effect of electrical stimulation on the corticospinal excitability varies according to the type of muscle contraction being performed. Motor-evoked potentials (MEPs) were elicited by transcranial magnetic stimulation (TMS) during a shortening contraction, an isometric contraction, or no contraction of the first dorsal interosseous (FDI) muscle. In some trials, electrical stimulation of the ulnar nerve was performed at 110% of the sensory threshold or 110% of the motor threshold prior to TMS. Electrical stimulation involved either a train of 50 pulses at 10 Hz or a single pulse. Shortening contraction with the train of electrical stimuli significantly increased MEP amplitudes, and the increase was dependent on the type of stimulation. Isometric contraction with the train of electrical stimuli and electrical stimulation without voluntary contraction did not affect MEP amplitudes. A single pulse of electrical stimulation did not affect MEP amplitudes in any condition. Thus, electrical-stimulation-induced modulation of corticospinal excitability varied according to the type of muscle contraction performed and the type of stimulation. These results show that the type of contraction should be considered when using electrical stimulation for rehabilitation in patients with central nervous system lesions.