Regional Inequalities in Oral Frailty and Social Capital

INTRODUCTION

Oral frailty leads to poor nutritional status, which, in turn, leads to frailty. This cross-sectional study aimed to determine regional differences in the prevalence of oral frailty and to identify factors associated with oral frailty using 3-level multilevel models.

METHODS

This study comprised 165,164 participants aged ≥65 y without long-term care requirements in the Japan Gerontological Evaluation Study. The dependent variable was oral frailty, which was calculated based on age, number of teeth, difficulty in eating tough foods, and choking. The individual-level independent variables included sociodemographics, present illness, social participation, frequency of meeting friends, and social capital. The local district-level independent variable was social capital (n = 1,008) derived from exploratory factor analyses. The municipality-level independent variable was population density (n = 62). Three-level multilevel Poisson regression analysis was performed to calculate the prevalence ratios (PRs).

RESULTS

The prevalence of oral frailty in municipalities ranged from 39.9% to 77.6%. Regarding district-level factors, higher civic participation was significantly associated with a lower probability of oral frailty. At the municipality level, the PR of the rural-agricultural area was 1.17 (95% confidence interval, 1.11-1.23) (reference: metropolitan).

CONCLUSION

These results highlight the usefulness of oral frailty prevention measures in encouraging social participation in rural areas.

KNOWLEDGE TRANSFER STATEMENT

The results of the present study showed regional differences in oral frailty. In particular, rural-agricultural areas show higher prevalence rates of oral frailty than those in metropolitan cities. Promoting measures of social participation among older adults may help prevent oral frailty in rural areas.

Effects of household composition on infant feeding and mother-infant health in northern Kenya

BACKGROUND

Households with alloparents, individuals other than the mother who care for an infant, can shift members' roles and affect mother-infant health.

AIMS

To investigate how household composition relates to infant feeding and infectious disease risk in mother-infant dyads, the team utilized data from breastfeeding dyads (n 208) surveyed during a prolonged drought and food scarcity in northern Kenya.

METHODS

Households were classified by the presence/absence of potential alloparents, distinguishing non-siblings and siblings of the infant. Regression models for breastfeeding frequency, complementary feeding status, and recent infections (n 83) evaluated these outcomes' associations with household type while accounting for food insecurity, adjusted for infant age, infant sex, and maternal age.

RESULTS

Household type was unassociated with breastfeeding frequency, but the presence of non-sibling alloparents interacted with food insecurity, predicting increasing breastfeeding frequency as food insecurity intensified among dyads living with non-sibling alloparents. Households with non-sibling alloparents were also inversely associated with complementary feeding but had no association with infection. Households with siblings were inversely associated with (protective against) infant and maternal infection.

CONCLUSION

Further research is needed to understand the interactive influence of household social and food ecologies on mother-infant diet and health under diverse cultural rules and norms for alloparenting.

P-153 Oocytes with narrow perivitelline space have poor fertilization and developmental potentials after ICSI

Study question

Do oocytes with narrow perivitelline space have poor clinical outcomes after ICSI?

Summary answer

After ICSI, oocytes with narrow perivitelline space have an increased degeneration rate and decreased rates of 2PN and embryo development.

What is known already

Several studies reported that oocytes with dysmorphologies, such as zona pellucida (ZP) abnormalities and cytoplasmic inclusions (vacuoles, smooth endoplasmic reticulum cluster, refractile bodies), have poor developmental potential in IVF/ICSI. In research on perivitelline space (PVS), many studies have focused on the PVS with fragmentation as well as large PVS. On the other hand, oocytes with narrow perivitelline space (narrow PVS oocytes) are considered to have an immature cytoplasm, but there are few reports on the relationship between narrow PVS oocytes and clinical outcomes. In this study, we retrospectively analyzed the effect of narrow PVS oocytes on ICSI outcomes.

Study design, size, duration

This retrospective single-center study analyzed 11149 MII oocytes that underwent ICSI between January 2018 and October 2021. We observed the PVS of MII oocytes during ICSI, and oocytes with sufficient PVS between the ZP and cytoplasm were determined to be non-narrow PVS oocytes. Oocytes without sufficient PVS from any angle (PVS was observed only around the first polar body) were defined as narrow PVS oocytes.

Participants/materials, setting, methods

After ICSI, oocytes were cultured in ONESTEP medium (NakaMedical, Tokyo, Japan). Embryos that developed into blastocysts were used for single vitrified-warmed blastocyst transfer (SVBT). We compared the rates of degeneration, 2PN, cleavage, blastocyst formation, good-grade (Gardner’s criteria ≥BB) blastocyst, top-grade blastocyst (Gardner’s criteria=AA), and clinical pregnancy (presence of a gestational sac) between oocytes with narrow and non-narrow PVS. Logistic regression analysis with consideration of patient age, BMI, and basal AMH was performed for each outcome.

Main results and the role of chance

Of the 11149 MII oocytes, 570 and 10579 were determined to be narrow and non-narrow PVS oocytes, respectively. Narrow PVS oocytes showed significantly higher degeneration rates (aOR: 1.52, 95% CI: 1.12–2.06, p<0.01) and lower 2PN rates (aOR: 0.77, 95% CI: 0.64–0.93, p<0.01) after ICSI compared to non-narrow PVS oocytes. Furthermore, rates of cleavage (aOR: 0.52, 95% CI: 0.31–0.87, p<0.05), blastocyst formation (aOR: 0.56, 95% CI: 0.45–0.70, p<0.01), good-grade blastocyst formation (aOR: 0.59, 95% CI: 0.46–0.76, p<0.01), and top-grade blastocyst formation (aOR:0.625, 95% CI:0.45–0.86, p<0.01), were significantly lower in the narrow PVS oocytes.

Of the blastocysts developed, 32 and 1439 blastocysts from narrow PVS oocytes and non-narrow PVS oocytes, respectively, were used for SVBT. The clinical pregnancy rate was not significantly different between blastocysts developed from narrow (aOR: 0.52, 95% CI, 0.22–1.22, p = 0.131) and non-narrow PVS oocytes. However, in blastocysts developed from narrow PVS oocytes, clinical pregnancy was confirmed only in top-grade blastocysts (58.8% [10/17]), and blastocysts of other grades did not result in pregnancy (0% [0/15]).

Limitations, reasons for caution

The limitation of this study is that it was a retrospective analysis conducted at a single IVF center. It is necessary to confirm the reproducibility at other facilities because the evaluation of PVS differs among embryologists and IVF centers. Therefore, a prospective multicenter study is needed.

Wider implications of the findings

We found that the narrow PVS oocytes showed poor outcomes after ICSI. While a good pregnancy rate could be expected if a top-grade blastocyst from such oocytes was obtained and transferred, the embryonic development rate of narrow PVS oocytes is low.

Trial registration number

Not applicable

P-215 Use of hyaluronan-based solution as an alternative to polyvinylpyrrolidone to improve blastulation in ICSI

Study question

This study aimed to analyze whether hyaluronan as an alternative to polyvinylpyrrolidone (PVP) for sperm immobilization, aspiration, and injection into the ooplasm improves ICSI outcomes.

Summary answer

The use of hyaluronan solution as an alternative to PVP improves the blastocyst formation rate and good quality blastocyst formation rate compared to PVP.

What is known already

The PVP solution facilitates ICSI procedures, such as sperm immobilization, aspiration, and injection into the ooplasm. However, it has been reported that injection of a small amount of PVP along with the sperm into the ooplasm negatively affects subsequent embryo development. Hyaluronan is a natural component of the extracellular matrix of the cumulus-oocyte complex. Balaban et al. (2003) reported that hyaluronan can replace PVP during ICSI procedures in the early embryo transfer cycle without adversely affecting pregnancy outcomes. This study analyzed whether using hyaluronan-based solution for the ICSI procedure would improves blastocyst development compared with ICSI using PVP.

Study design, size, duration

This retrospective study analyzed clinical medical reports at Takahashi Women’s Clinic, Japan. We included 4002 oocytes retrieved from 411 patients under 39 years of age who underwent ICSI using autologous oocytes between December 2019 and August 2021. Of the oocytes used for ICSI, 1909 underwent sperm aspiration and injection into the ooplasm with hyaluronan (Sperm Slow; Origio), and 2093 oocytes with 7% PVP (NakaMedical). We did not perform preimplantation genetic testing-aneuploidy for any cycles.

Participants/materials, setting, methods

We used PVP droplets for sperm selection under 400× magnification in both groups. In hyaluronan-ICSI, the selected sperm were transferred to a hyaluronan droplet and washed three times. The sperm was then aspirated with hyaluronan, and ICSI was performed. In PVP-ICSI, all procedures were performed using PVP. The ICSI and embryo transfer outcomes were compared between hyaluronan-ICSI and PVP-ICSI by logistic regression analysis considering patient age, BMI, and basal level of anti-mullerian hormone.

Main results and the role of chance

Normal fertilization rates were 74.3% (1556/2093) in PVP-ICSI and 75.5% (1442/1909) in hyaluronan-ICSI. There was no significant difference in the normal fertilization rate between PVP-ICSI and hyaluronan-ICSI groups (p = 0.437, aOR:1.06, 95% CI: 0.92–1.22). We cultured 1323 2PN embryos in PVP-ICSI and 1237 2PN embryos in hyaluronan-ICSI until the blastocyst stage. Blastocyst formation rates were 48.1% for PVP-ICSI and 52.3% for hyaluronan-ICSI, and this difference was statistically significant (aOR, 1.20; 95% CI: 1.02–1.40; p = 0.024). Moreover, the good grade (Gardner criteria ≧BB) blastocyst formation rates were significantly higher in the hyaluronan-ICSI group (36.9% and 41.0%, aOR: 1.21, 95% CI: 1.03–1.42, p = 0.022). During the study period, we performed 163 and 169 cryo-thawed blastocyst transfer cycles in PVP-ICSI and hyaluronan-ICSI, respectively. The clinical pregnancy rate (50.9% vs. 54.4%, aOR: 1.19, 95% CI: 0.77–1.83, p = 0.443) and miscarriage rate (19.3% vs. 13.0%, aOR: 0.66, 95% CI: 0.3–1.44, p = 0.295) after embryo transfer were not significantly different between PVP-ICSI and hyaluronan-ICSI.

Limitations, reasons for caution

The study was conducted at a single IVF center, and the oocytes included in this study were collected from patients aged < 39 years. Embryo transfer result is based on ongoing pregnancy, while the live birth data for all pregnancies are not yet available.

Wider implications of the findings

Hyaluronan facilitates ICSI procedures such as sperm immobilization, aspiration, and injection. Moreover, the hyaluronan improves blastocyst development. The present study indicates that using hyaluronan as an alternative to PVP during the ICSI procedure is recommended.

Trial registration number

not applicable

P-395 Use of a granulocyte-macrophage colony-stimulating factor (GM-CSF)-containing medium for poor-grade blastocyst transfer increases the clinical pregnancy and live birth rates

Study question

Does the post-thaw use of a GM-CSF-containing medium improve blastocyst transfer outcomes in all blastocysts in a frozen-thawed embryo transfer cycle?

Summary answer

The use of a GM-CSF-containing medium at post-thawing especially improves the live birth (LB) rate of morphologically poor blastocysts in a frozen-thawed embryo transfer cycle.

What is known already

GM-CSF, a cytokine secreted by the epithelial cells of the female reproductive tract, plays an important role in embryonic development, implantation, and subsequent development in humans and animals. In humans, GM-CSF increases the blastocyst developmental rate and decreases the chances of miscarriage. Previously, we reported that the use of a GM-CSF-containing medium for blastocyst recovery culture after thawing improves the clinical pregnancy (CP) rate in a frozen-thawed blastocyst transfer cycle (ESHRE, 2019). However, it is unclear whether GM-CSF improves embryo transfer outcomes in all blastocysts. In addition, it is necessary to accumulate information regarding its effects on neonatal outcomes.

Study design, size, duration

We performed a retrospective observational study to compare two groups: a GM-CSF group (GM-CSF-containing medium; SAGE-1step GM-CSF, Cooper Surgical) and a control group (GM-CSF-free medium; ONE STEP Medium, NAKA Medical). We analyzed 566 blastocyst transfer cycles in patients aged 30–39 years who underwent frozen-thawed single embryo transfer at Takahashi Women’s Clinic (Japan) from February 2018 to February 2019. Chromosomal analysis was not performed.

Participants/materials, setting, methods

We used a control medium for blastocyst culture and a Cryotop safety kit for blastocyst vitrification. After thawing, we cultured blastocysts in a GM-CSF-containing medium or control medium for 3–5 h until transfer. Embryo transfer outcomes were compared. We performed the multivariate logistic regression analysis(MVRA) to adjust confounding bias. A subgroup analysis was also performed of morphological grade according to Gardner’s criteria (excellent: ≥AA, good: blastocysts containing B, poor: blastocysts containing C).

Main results and the role of chance

There were no difference in patient background between the two groups. The CP and LB rates in the GM-CSF group and control group were 54.3% vs. 42.6% and 42.9% vs. 31.1%. The MVRA adjusted by confounding factors(patient age, BMI, basal AMH, blastocyst grade, day of vitrification, number of previous failed ETs, and assisted hatching) demonstrated that CP (p = 0.0193; adjusted odds ratio [aOR], 1.55) and LB rate (p = 0.0080; aOR, 1.67) were significantly higher in GM-CSF group than that of control group. Moreover, the CP and LB rates of the GM-CSF group and control group were: excellent-blastocysts at 62.0% vs. 58.8% (p = 0.5955; OR, 1.14), 52.7% vs. 45.6% (p = 0.2466, aOR:1.33), good-blastocysts 52.1% vs. 37.6% (p = 0.0561; OR, 1.80), 38.0% vs. 26.6% (p = 0.1072; OR, 1.69), and poor-blastocysts 38.9% vs. 17.9% (p = 0.0115; OR, 2.92), 25.9% vs. 9.0% (p = 0.0164; OR, 3.56). A GM-CSF-containing medium significantly improved the CP and LB rates of poor-grade blastocysts. There were no significant differences between the GM-CSF group and control group in the male ratio (52.7％ vs. 51.0%, p = 0.8057), pregnancy duration (38.8±1.4 weeks vs. 38.5±1.8 weeks, p = 0.2558), cesarean section rate (38.2% vs. 40.8%, p = 0.6979), birth weight (3133±466g vs. 3037±437g, p = 0.1281), and congenital anomaly rate (0.91% vs. 2.04％, p = 0.6026).

Limitations, reasons for caution

This was a single-center, retrospective study. Chromosomal abnormalities in embryos were not considered; however, the LB rate among babies was analyzed. The basic chemical composition of the culture medium (salt concentration, glucose concentration, etc.) used in the control group was different from that of the GM-CSF-containing medium.

Wider implications of the findings

We found that the use of a GM-CSF-containing medium improved the clinical pregnancy and live birth rates of poor-grade blastocysts without affecting the babies. This may be an effective therapeutic strategy for some patients as it may allow for the effective use of poor-grade euploid blastocysts.

Trial registration number

not applicable

Precise Measurement of Differential Cross Sections of the Σ^{-}p→Λn Reaction in Momentum Range 470-650 MeV/c

The differential cross sections of the Σ^{-}p→Λn reaction were measured accurately for the Σ^{-} momentum (p_{Σ}) ranging from 470 to 650  MeV/c at the J-PARC Hadron Experimental Facility. Precise angular information about the Σ^{-}p→Λn reaction was obtained for the first time by detecting approximately 100 reaction events at each angular step of Δcosθ=0.1. The obtained differential cross sections show a slightly forward-peaking structure in the measured momentum regions. The cross sections integrated for -0.7≤cosθ≤1.0 were obtained as 22.5±0.68 [statistical error(stat.)] ±0.65 [systematic error(syst.)] mb and 15.8±0.83(stat)±0.52(syst)  mb for 470<p_{Σ}(MeV/c)<550 and 550<p_{Σ}(MeV/c)<650, respectively. These results show a drastic improvement compared with past measurements of the hyperon-proton scattering experiments. They will play essential roles in updating the theoretical models of the baryon-baryon interactions.

X ray spectroscopy on 𝚵− atoms (J-PARC E03, E07 and future)

X-ray spectroscopy of hadronic atoms is a powerful method to study strong interaction between hadrons and nuclei. At J-PARC, we have conducted two experiments, J-PARC E07 and E03, for hadronic atoms with a doubly strange hyperon, Ξ−, aiming at the world-first detection of their X-rays. The first measurement is performed as a byproduct of J-PARC E07 experiment with the hybrid emulsion technique. The second one, J-PARC E03, is a dedicated experiment for detection of Ξ− Fe atom X rays. The preliminary results and the present status of E07 and E03 are shown in this article. Future prospects of Ξ−-atomic X-ray spectroscopy are also discussed. A new measurement has been proposed for detecting Ξ− C atom X rays, where a novel Ξ− tracking method will be applied to realize an improved signal to noise ratio.

Preparation status of missing-mass spectroscopy for 𝚵 hypernuclei with S-2S magnetic spectrometer

J-PARC E70 experiment measures the missing-mass of Ξ hypernuclei (12ΞBe) in Hadron Experimental Facility at J-PARC. We aim to reach the best missing-mass resolution of 2 MeV/c2 in FWHM with a new magnetic spectrometer S-2S. The high-resolution spectroscopy of Ξ hypernuclei will play an important role to understand the unknown ΞN interaction. The experiment will start at the beginning of 2023. This article presents the preparation status.

Recent progress and future prospects of hyperon nucleon scattering experiment

A new hyperon-proton scattering experiment, dubbed J-PARC E40, was performed to measure differential cross sections of the Σ+p, Σ−p elastic scatterings and the Σ−p → Λn scattering by identifying a lot of Σ particles in the momentum ranging from 0.4 to 0.8 GeV/c produced by the π±p → K+Σ± reactions. We successfully measured the differential cross sections of these three channels with a drastically improved accuracy with a fine angular step. These new data will become important experimental constraints to improve the theories of the two-body baryon-baryon interactions. Following this success, we proposed a new experiment to measure the differential cross sections and spin observables by using a highly polarized Λ beam for providing quantitative information on the ΛN interaction. The results of three Σp channels and future prospects of the Λp scattering experiment are described.

P–145 usefulness of morphokinetic data to predict pregnancy rates of day–6 blastocyst transfers

Study question

Can a scoring model based on morphokinetic data developed to predict pregnancy rates of day–5 blastocyst transfers (KIDSCORE™D5) predict pregnancy rates of day–6 blastocyst transfers?

Summary answer

KIDSCORE™D5 was able to predict the clinical pregnancy rates of embryo transfers done on day 6 with an area under the curve (AUC) of 0.72.

What is known already

KIDSCORE™D5 is a scoring model based on morphokinetic data developed to predict the pregnancy rates of day–5 blastocysts. In 2019, Regnier et al. reported that the AUC of KIDSCORE™D5 for predicting clinical pregnancy rates of day–5 blastocyst transfers was 0.6. However, as KIDSCORE™D5 is constructed based on morphological characteristics and developmental dynamics of day–5 blastocysts, it is unclear whether KIDSCORE™D5 can predict pregnancy rates of day–6 blastocyst transfers. Since there are many cases of day–6 blastocyst transfers, it is important to know if KIDSCORE™D5 can predict pregnancy rates of day–6 blastocyst transfers.

Study design, size, duration

This retrospective single-center study, which included 162 day–5 and 72 day–6 blastocyst transfers, respectively, was conducted at Takahashi Women’s clinic from January to December 2019. Blastocysts derived from 146 patients who underwent intracytoplasmic sperm injection. All blastocysts were cryopreserved and were transferred singly.

Participants/materials, setting, methods

We used EmbryoScope+™ (Vitrolife) for in-vitro culture and calculated KIDSCORE™D5 (ver.3) using Embryoviewer™ (Vitrolife). Blastocyst scoring was done from 1.0 to 9.9. Clinical pregnancy was defined as the presence of a gestational sac confirmed by transvaginal ultrasonography. Statistical analysis was performed with JMP Pro 15.00 (SAS). The relationship between KIDSCORE™D5 and clinical pregnancy was evaluated by the AUC using ROC curve analysis and multivariate analysis adjusted for patient age.

Main results and the role of chance

The mean KIDSCORE™D5 of day–5 and day–6 blastocysts was 7.1±1.7 and 3.7±1.5, respectively. KIDSCORE™D5 of day–6 blastocysts was significantly lower than that of day–5 blastocysts (p &lt; 0.0001, Wilcoxon test). ROC curve analysis showed that the KIDSCORE™D5 could predict clinical pregnancy rates with an AUC of 0.62 for day–5 blastocysts and 0.72 for day–6 blastocysts. The cut-off values for KIDSCORE™D5 were 5.7 and 4.9 for day–5 and day–6 blastocysts, respectively. Blastocysts above the cut off value on both day–5 and day–6 had a significantly higher pregnancy rate than those below the cut off value (day–5: 61.9% vs. 33.3%(p = 0.0023), day–6: 47.4% vs. 7.6%(p = 0.0003)). Multivariate analysis adjusted for patient age showed that KIDSCORE™D5 correlated with clinical pregnancy rates of days 5 and 6 of blastocyst transfer with AUCs of 0.66 and 0.73, respectively.

Limitations, reasons for caution

This study had a small sample size, and it was a retrospective single-center study. In addition, the relationship between KIDSCORE™D5 and clinical pregnancy rates may vary among facilities. Therefore, a prospective multicenter validation is necessary.

Wider implications of the findings: Our study results indicated that KIDSCORE™D5 predicted clinical pregnancy and that morphokinetic parameters related to clinical pregnancy were similar between day–5 and day–6 blastocysts. Hence, morphokinetic evaluation can serve as a criterion for deciding which of multiple day–6 blastocysts can be transferred.

Trial registration number

Not applicable

Coumarin improves tomato plant tolerance to salinity by enhancing antioxidant defence, glyoxalase system and ion homeostasis

Salinity is a severe threat to crop growth, development and even to world food sustainability. Plant possess natural antioxidant defense tactics to mitigate salinity-induced oxidative stress. Phenolic compounds are non-enzymatic antioxidants with specific roles in protecting plant cells against stress-mediated reactive oxygen species (ROS) generation. Coumarin (COU) is one of these compounds, however, to date, little is known about antioxidative roles of exogenous COU in enhancing plant tolerance mechanisms under salt stress. The involvement of COU in increasing tomato salt tolerance was examined in the present study using COU as a pre-treatment at 20 or 30 µM for 2 days against salt stress (100 or 160  NaCl; 5 days). The COU-mediated stimulation of plant antioxidant defence and glyoxalase systems to suppress salt-induced ROS and methylglyoxal (MG) toxicity, respectively, were the main hypotheses examined in the present study. Addition of COU suppressed salt-induced excess accumulation of ROS and MG, and significantly reduced membrane damage, lipid peroxidation and Na⁺ toxicity. These results demonstrate COU-improved plant growth, biomass content, photosynthetic pigment content, water retention and mineral homeostasis upon imposition of salinity. Finally, this present study suggests that COU has potential roles as a phytoprotectant in stimulating plant antioxidative mechanisms and improving glyoxalase enzyme activity under salinity stress.

Two-Dimensional Superconducting Fluctuations Associated with Charge-Density-Wave Stripes in La_{1.87}Sr_{0.13}Cu_{0.99}Fe_{0.01}O_{4}

The presence of a small concentration of in-plane Fe dopants in La_{1.87}Sr_{0.13}Cu_{0.99}Fe_{0.01}O_{4} is known to enhance stripelike spin and charge density wave (SDW and CDW) order and suppress the superconducting T_{c}. Here, we show that it also induces highly two-dimensional superconducting correlations that have been argued to be the signatures of a new form of superconducting order, the so-called pair density wave (PDW) order. In addition, using resonant soft x-ray scattering, we find that the two-dimensional superconducting fluctuation is strongly associated with the CDW stripe. In particular, the PDW signature first appears when the correlation length of the CDW stripe grows over eight times the lattice unit (∼8a). These results provide critical conditions for the formation of the PDW order.

Observation of Coulomb-Assisted Nuclear Bound State of Ξ^{-}-^{14}N System

In an emulsion-counter hybrid experiment performed at J-PARC, a Ξ^{-} absorption event was observed which decayed into twin single-Λ hypernuclei. Kinematic calculations enabled a unique identification of the reaction process as Ξ^{-}+^{14}N→_{Λ}^{10}Be+_{Λ}^{5}He. For the binding energy of the Ξ^{-} hyperon in the Ξ^{-}-^{14}N system a value of 1.27±0.21  MeV was deduced. The energy level of Ξ^{-} is likely a nuclear 1p state which indicates a weak ΞN-ΛΛ coupling.

[A case of distal bile duct carcinoma converted to neuroendocrine cancer and proliferated into the pancreas]

A woman in her 50s was referred due to a solid mass in the head of the pancreas. It was diagnosed as a neuroendocrine carcinoma (NEC) by endoscopic ultrasound-guided fine-needle aspiration. Consequently, pancreatoduodenectomy was performed. A well-differentiated adenocarcinoma component was revealed in the resected bile duct, suggesting a relationship with the NEC component in the pancreas. Genetic examination suggested that cholangiocarcinoma, but not coexisting carcinoma, was converted to NEC after the interstitial invasion. Finally, it was diagnosed as the NEC derived from the extrahepatic bile duct, which is rare at about 0.2-2% in gastrointestinal neuroendocrine neoplasms.

Pathological assessment of osimertinib-associated cardiotoxicity in EGFR-mutated non-small cell lung cancer patients

Background

Osimertinib, a third-generation epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI), inhibits both EGFR-TKI sensitizing mutations and resistant T790M mutations detected in non-small cell lung cancer (NSCLC) patients. Cardiac adverse events (AEs) induced by osimertinib are infrequent; however, cases of severe associated cardiac dysfunction have been reported and remain poorly understood.

Purpose

To assess pathogenesis of osimertinib-associated cardiac AEs, we analyzed myocardial specimens of three NSCLC cases with osimertinib-associated cardiac dysfunction.

Results

Analysis of LVEF prior to and after osimertinb administration in 36 NSCLC patients showed significant decrease of LVEF from 69% to 63%. Within this cohort, right ventricular (RV) biopsy was performed in 2 cases to further understand the pathophysiology of cardiac dysfunction. Case 1 was 78-year-old female with advanced NSCLC harboring an EGFR L858R mutation was treated with osimertinib as second line therapy. After 3 moths of osimetinib treatment, she presented with dyspnea, high NT-proBNP and troponin I, and significantly decreased left ventricular ejection fraction (LVEF) at 28%. RV biopsy showed moderate cardiomyocyte hypertrophy without inflammatory cell infiltration. Case 2 was 52-year-old female with advanced NSCLC harboring L858R mutation. She was treated with osimertinib as first line therapy. After 2 weeks of osimertinib, screening echocardiography revealed a reduction of LVEF from 63% to 41% without cardiac symptom. RV biopsy showed mild cardiomyocyte hypertrophy with infiltration of a few inflammatory cells in interstinum. We further analyzed death case of NSCLC. Case 3 was 63-year-old female with advanced NSCLC harboring EGFR ex. 19 del. and T790M mutations. After 6 months of osimertinib, she suffered from severe respiratory failure and severely reduced LVEF at 27%. She died on the 44th day after admission. Pathological autopsy revealed mild to moderate cardiomyocyte hypertrophy without inflammatory cell infiltration in both ventricles. These pathological findings may indicate neither myocyte injury nor myocarditis was induced by osimertinib in myocardium.

Conclusion

Although additional data collection of advanced NSCLC patients will be important in understanding the pathophysiology of cardiac AEs with osimertinib, osimertinib-associated cardiotoxicity may result from functional inhibition of myocyte contractility by osimertinib without induction of cell death or inflammation.

Funding Acknowledgement

Type of funding source: None

Three Cases of Ampullary Neuroendocrine Tumor Treated by Endoscopic Papillectomy: A Case Report and Literature Review

We herein report three cases of patients with an ampullary neuroendocrine tumor (NET), who underwent endoscopic papillectomy (EP). No tumor recurrence or metastasis was detected in the patients for more than two years after EP. Generally, surgical resection is recommended for ampullary NETs by the European Neuroendocrine Tumor Society. However, as EP is less invasive than surgical resection, there are some reports of low-grade small ampullary NETs curatively treated by EP with long-term follow-up. We consider that EP may be a curative treatment for small and low-grade ampullary NETs without regional or distant metastasis.

Cost-effectiveness analysis for preventing hepatitis B virus reactivation-related death in Japan

Background

There is no worldwide standard recommendation for preventing hepatitis B virus (HBV) reactivation for patients with resolved infection treated with an anti-CD20 antibody for B-cell non-Hodgkin lymphoma. This study aims to compare the cost-effectiveness between two commonly used strategies to prevent HBV reactivation-related death.

Methods

The two strategies compared were prophylactic antiviral therapy (Pro NAT) and HBV DNA monitoring followed by on-demand antiviral therapy (HBV DNA monitoring) using entecavir (Entecavir, a generic drug for Baraclude). Effectiveness was defined as the prevention of death due to HBV reactivation and costs were calculated under the health insurance system of Japan as of April 2018 using Markov model. A cost-minimization analysis, one of the cost-effectiveness analyses, was applied, since the effectiveness was the same between the two strategies according to a meta-analysis. To consider the effect of uncertainty for each parameter, probabilistic sensitivity analysis (PSA) was performed. In the scenario analysis, costs were calculated using lamivudine (Zefix) or tenofovir alafenamide (Vemlidy) instead of entecavir. All analyses were done using TreeAge Pro 2019 (TreeAge Software, Inc., MA, USA).

Results

Estimated costs per patient during the 30 months after initiation of chemotherapy for lymphoma were 1,513 USD with Pro NAT and 1,265 USD with HBV DNA monitoring. A PSA revealed that HBV DNA monitoring was more consistently cost-effective compared with Pro NAT when some parameters were set randomly according to probability distributions. In our scenario analysis, costs of Pro NAT and HBV DNA monitoring were calculated as 2,762 and 1,401 USD using lamivudine, 4,857 and 1,629 USD using tenofovir alafenamide.

Conclusions

Our cost-effectiveness analysis shows that an HBV DNA monitoring strategy using entecavir should be recommended for preventing HBV reactivation-related death in Japan.

Key messages

Cost-effectiveness analysis demonstrated that HBV DNA monitoring was more cost-effective compared to Pro NAT; this result was consistent with PSA. HBV DNA monitoring strategy should be recommended to prevent HBV reactivation-related death for the patients with resolved HBV infection in Japan.

Bone densitometry worldwide: a global survey by the ISCD and IOF

In a global survey of fracture liaison services, most reported that DXA access met needs. However, adherence to basic DXA quality and reporting procedures was confirmed by only around 50% of institutions and many required education for operators/interpreters. Overall, there is significant variability in the access to, and quality of, DXA services worldwide.

INTRODUCTION

While the use of dual-energy X-ray absorptiometry (DXA) has been widely adopted worldwide for the assessment of bone mineral density, the quality of DXA facilities is unknown. To address this, a global survey of fracture liaison services (FLS) was conducted by the International Society for Clinical Densitometry (ISCD) and the International Osteoporosis Foundation (IOF) to assess the quality of their DXA facilities.

METHODS

A questionnaire for the accessibility and quality of DXA services was co-created by representatives of the ISCD and the IOF and made available to institutions who participated in the Capture the Fracture Best Practice Framework. From a list of 331 contacted invitees, 124 FLS centres responded; analyses were based on 121 centres with suitable data.

RESULTS

Over 70% of institutions reported that, for over 90% of the time, DXA access met service needs, and the scanning/reporting quality was perceived as excellent. However, 25% of DXA facilities reported not being accredited by a professional/governmental organization, and adherence to some basic DXA quality assurance and reporting procedures was confirmed by < 50% of services. Importantly, in excess of 50% of institutions stated that they desired ongoing education in osteoporosis and DXA for operators and interpreters.

CONCLUSION

There is significant variability in the access to and quality of DXA services for established FLS worldwide. Despite two decades of training initiatives in osteoporosis densitometry, many centres are falling short of the standards of the IOF-ISCD Osteoporosis Essentials criteria.

Observation of Magnon Polarization

We measure the mode-resolved direction of the precessional motion of the magnetic order, i.e., magnon polarization, via the chiral term of inelastic polarized neutron scattering spectra. The magnon polarization is a unique and unambiguous signature of magnets and is important in spintronics, affecting thermodynamic properties such as the magnitude and sign of the spin Seebeck effect. However, it has never been directly measured in any material until this work. The observation of both signs of magnon polarization in Y_{3}Fe_{5}O_{12} also gives direct proof of its ferrimagnetic nature. The experiments agree very well with atomistic simulations of the scattering cross section.

A patient-level key performance indicator set to measure the effectiveness of fracture liaison services and guide quality improvement: a position paper of the IOF Capture the Fracture Working Group, National Osteoporosis Foundation and Fragility Fracture Network

The International Osteoporosis Foundation (IOF) Capture the Fracture® Campaign with the Fragility Fracture Network (FFN) and National Osteoporosis Foundation (NOF) has developed eleven patient-level key performance indicators (KPIs) for fracture liaison services (FLSs) to guide quality improvement.

INTRODUCTION

Fracture Liaison Services (FLSs) are recommended worldwide to reduce fracture risk after a sentinel fracture. Given not every FLS is automatically effective, the IOF Capture the Fracture working group has developed and implemented the Best Practice Framework to assess the organisational components of an FLS. We have now developed a complimentary KPI set that extends this assessment of performance to the patient level.

METHODS

The Capture the Fracture working group in collaboration with the Fragility Fracture Network Secondary Fragility Fracture Special Interest Group and National Osteoporosis Foundation adapted existing metrics from the UK-based Fracture Liaison Service Database Audit to develop a patient-level KPI set for FLSs.

RESULTS

Eleven KPIs were selected. The proportion of patients: with non-spinal fractures; with spine fractures (detected clinically and radiologically); assessed for fracture risk within 12 weeks of sentinel fracture; having DXA assessment within 12 weeks of sentinel fracture; having falls risk assessment; recommended anti-osteoporosis medication; commenced of strength and balance exercise intervention within 16 weeks of sentinel fracture; monitored within 16 weeks of sentinel fracture; started anti-osteoporosis medication within 16 weeks of sentinel fracture; prescribed anti-osteoporosis medication 52 weeks after sentinel fracture. The final KPI measures data completeness for each of the other KPIs. For these indicators, levels of achievement were set at the < 50%, 50-80% and > 80% levels except for treatment recommendation where a level of 50% was used.

CONCLUSION

This KPI set compliments the existing Best Practice Framework to support FLSs to examine their own performance using patient-level data. By using this KPI set for local quality improvement cycles, FLSs will be able to efficiently realise the full potential of secondary fracture prevention and improved clinical outcomes for their local populations.

AB0089 THE ANALYSIS FOR THE INHIBITION OF ANGIOGENESIS BY JAK INHIBITOR

Background:

Many blood vessels are generated in the hyperplastic synovial tissue of patients with rheumatoid arthritis (RA), and lead to chronic tissue inflammation and joint destruction [1]. Janus kinase (JAK) family consisting of JAK1, JAK2, JAK3 and tyrosine kinase 2 (TYK2) are chain receptors which phosphorylate signal transducers and activators of transcription (STAT) and mediate inflammatory diseases including RA [2]. Nowadays, several JAK inhibitors such as Tofacitinib (TOF), Baricitinib (BAR) and Peficitinib (PEF) have been developed and demonstrated to have the inhibitory effects on inflammatory arthritis [3-5]. However, there were few reports concerning their effects on angiogenesis in vitro.

Objectives:

The purpose of the present study is to investigate the influence of JAK inhibitors on angiogenesis of human umbilical vein endothelial cell (HUVEC) activated by vascular endothelial growth factor (VEGF).

Methods:

The cell line of HUVECs were used for this study. The activity of proliferation and tube formation were analyzed by counting assay and tube formation assay, respectively.

In counting assay, HUVECs (5 × 104cells/ml) were seeded onto 96-well cell culture plate with 20 ng/ml VEGF including various doses (0.1µM, 1µM, 5µM) of TOF, BAR or PEF. After 48 hours incubation at 37°C in a humidified atmosphere containing 5% CO2, cell proliferation of each groups was assessed using cell counting kit. In tube formation assay, HUVECs (5 × 104cells/ml) were treated with 20ng/ml VEGF including various dose (0.1µM, 1µM, 5µM) of TOF, BAR or PEF for 00 hours, then seeded onto 48-well plate applied with Matrigel. After 24 hours incubation on Matrigel, the capillary-like tube formation of each well was photographed using phase contrast microscopy. Tube formation were quantitated by measurement of the length of branch.

Results:

HUVECs were activated in proliferation and tube formation by VEGF treatment. And, the proliferation and tube formation of HUVECs activated by VEGF were suppressed by All of TOF, BAR and PEF. In particular, TOF and PEF could suppress them highly.

Conclusion:

This study showed the inhibitory effect of JAK inhibitors on proliferation and tube formation of HUVECs activated by VEGF. In particular, the angiogenesis of HUVECs activated by VEGF was highly suppressed by TOF and PEF. VEGF is reported to regulate the angiogenesis through multi JAK-STAT signaling pathways [6]. The inhibitory effects on angiogenesis of TOF, BAR and PEF might depend on the differences in their affinity for JAKs. VEGF has been shown to a have a central involvement in the angiogenic process in RA [7]. JAK inhibitors might suppress the angiogenesis in RA synovial tissues by inhibiting VEGF signaling.

References:

[1]Scott DL, et al. Rheumatoid arthritis. Lancet. 2010.

[2]Banerjee S, et al. JAK-STAT signaling as a target for inflammatory and autoimmune diseases: current and future prospects. Drugs. 2017.

[3]William D, et al. JAK inhibitors in dermatology: the promise of a new drug class. Journal of the American Academy of Dermatology. 2017.

[4]Dhillon S. Tofacitinib: A Review in Rheumatoid Arthritis. Drugs. 2017.

[5]Markham A, et al. Peficitinib: First Global Approval. Drugs. 2019.

[6]Zhang HY, et al. Three important components in the regeneration of the cavernous nerve: brain-derived neurotrophic factor, vascular endothelial growth factor and the JAK/STAT signaling pathway. Asian journal of andrology. 2011.

[7]Paleolog EM. Angiogenesis in rheumatoid arthritis. Arthritis research. 2002.

Acknowledgments:

none

Disclosure of Interests:

None declared

SAT0019 HISTOPATHOLOGICAL CHANGES OF SYNOVIAL TISSUE IN RHEUMATOID ARTHRITIS PATIENTS TREATED WITH TNF INHIBITORS

Background:

Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by hyperplasia of synovial tissues [1]. Tumor necrosis factor (TNF)-α is one of the pro-inflammatory cytokines that play a crucial role in the pathogenesis of RA synovitis, and TNF inhibitors (TNFi) were reported to force the RA to go into remission or low disease activity and have brought revolutionary impacts on RA treatment [2]. TNFi have been shown to act on inflammatory cells and form the discoid fibrosis in the sublining layers [3,4]. However, the changes of synovial tissue and the cause of discoid fibrosis in RA patients treated with TNFi has not been determined in detail.

Objectives:

The purpose of this study is to demonstrate the histological changes and the types of cells around discoid fibrosis in RA synovium treated with TNFi.

Methods:

Synovial tissues were obtained from 30 patients with RA during joint surgeries. 6 patients were treated with TNFi (1 patient with golimumab, 3 patients with etanercept, 2 patients with infliximab). As a control, synovial tissues were obtained from 6 patients who were treated only with csDMARDs (6 patients with MTX). The frozen sections were stained by hematoxylin and eosin (HE). To detect the apoptosis, TdT-mediated dUTP nick end labeling (TUNEL) was performed. The immunohistochemical characterization of the synovial cells was performed by using following antibodies: CD20 and CD3 for detecting B and T lymphocytes respectively, CD163 and CD86 for detecting M1 and M2 macrophage respectively.

Results:

In the sections stained with HE, the formation of discoid fibrosis and the other characteristic changes including hydropic degeneration, vacuolation, sclerosis of small vasculature, and the number of multilayered synovial cells was decreased in synovium from RA patients treated with TNFi. In the sections with TUNEL stain, apoptosis of lining cells around the discoid fibrosis was detected in RA synovium treated with TNFi (Figure 1a, 1b). In the sections with immunohistochemistry stain, CD86 expression increased in lining layer of RA synovium treated with TNFi. CD163 positive cells showed diffuse expression in RA synovium treated with TNFi. In contrast, CD20 and CD3 positive cells decreased around discoid fibrosis compared to control sections. These results showed indicated that the types of cells in lining and sublining layers were mainly macrophages and that the apoptosis of macrophages might form the discoid fibrosis in lining layers.

Conclusion:

This study showed the apoptosis of lining cells derived from macrophages resulted in the formation of the discoid fibrosis. These findings indicated TNFi might induce apoptosis of macrophage leading to the suppression of RA synovitis.

References:

[1] Scott Dl, et al. Progression of radiological changes in rheumatoid arthritis. Ann Rheum Dis. 1984.

[2]van der Heijde D,et al. Comparison of etanercept and methotrexate, alone and combined, in the treatment of rheumatoid arthritis: two-year clinical and radiographic results from the TEMPO study, a double-blind, randomized trial. Arthritis Rheum. 2006.

[3] Hirohata S,et al. TNF inhibitors induce discoid fibrosis in the sublining layers of the synovium with degeneration of synoviocytes in rheumatoid arthritis. Rheumatol Int. 2013.

[4] Yamanaka H,et al. Scoring evaluation for histopathological features of synovium in patients with rheumatoid arthritis during anti-tumor necrosis factor therapy. Rheumatol Int. 2010.

Acknowledgments :

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Disclosure of Interests:

None declared

P1570Cardiac strain detects subclinical decline of cardiac function after hematopoietic stem cell transplantation in patients with hematologic malignancies

Background

Hematopoietic stem cell transplantation (HSCT) has been established as a treatment of various hematologic malignancies and improved their prognoses. HSCT includes intensive chemotherapy and systemic radiation, which occasionally induces cardiac dysfunction. However, early predictor of cardiac dysfunction associated with HSCT is still elusive. Recently, left ventricular (LV) global longitudinal strain (GLS) has been recognized as an early detector of cardiotoxicity. In this study, we retrospectively analyzed GLS and cardiac parameters in patients with hematologic malignancies before and after HSCT to explore HSCT-induced cardiac dysfunction.

Methods

Thirty-one consecutive patients undergone HSCT were enrolled and reviewed their cardiac comorbidities, medications, chemotherapy, and radiotherapy before HSCT. Transthoracic echocardiographic variables including GLS, cardiac troponin-I, and B-type natriuretic peptide were analyzed prior to and 1 month after HSCT.

Results

The patients were 49.7±13.5 years of age, 61% were male, and 52% had cardiovascular risk factors. Cardiac troponin-I was significantly increased following HSCT from 0.010±0.002 ng/ml to 0.016±0.014 ng/ml (P=0.02), indicating that HSCT should have certain impact on cardiac myocytes. Echocardiographic analyses revealed that LV GLS was significantly decreased after HSCT from −19.4±0.8% to −18.8±0.8% (P<0.001), whereas there was no significant difference in LV ejection fraction between these time points of HSCT (63.6±5.5% vs. 64.7±4.6%; P=0.13). Although there was no correlation between the decline of GLS and the increase of troponin-I in this cohort, these results clearly indicated that GLS, but not LVEF, predicted HSCT-induced early and subclinical cardiac dysfunction at 1 month after the HSCT.

Conclusion

GLS detected early decline of cardiac function after HSCT in the patients with hematologic malignancies. Further follow-up investigations will reveal relationship between GLS, troponin-I and prognosis of cardiac function after HSCT in patients with hematologic malignancies.

Diffuse Pulmonary Meningotheliomatosis with Sarcomatous Transformation in a Shiba Dog

A 2-year-old neutered female Shiba dog exhibited laboured breathing for 1 month. Computed tomography of the thoracic cavity revealed multiple nodules (2-5 mm diameter) in the lungs. Grossly, the lungs were firm and normal in shape. The nodules were grey-white in colour. Microscopically, the nodules were non-encapsulated and exhibited an irregular shape. They were composed of polygonal or spindle cells with indistinct cell borders arranged in sheets. The cells had large, round, hyperchromatic nuclei and abundant pale eosinophilic cytoplasm with no atypia. Intrapulmonary arterial emboli and infiltration into the bronchioles were observed. Immunohistochemically, the cells were positive for vimentin and negative for cytokeratin, glial fibrillary acidic protein and α-smooth muscle actin. Ultrastructurally, the cells displayed cytoplasmic processes, desmosomes and intermediate filaments. These findings led to a diagnosis of diffuse pulmonary meningotheliomatosis with sarcomatous transformation. To the best of our knowledge, this is the first report of diffuse pulmonary meningotheliomatosis in a dog.

Observation of two types of charge-density-wave orders in superconducting La2-xSrxCuO4

The discovery of charge- and spin-density-wave (CDW/SDW) orders in superconducting cuprates has altered our perspective on the nature of high-temperature superconductivity (SC). However, it has proven difficult to fully elucidate the relationship between the density wave orders and SC. Here, using resonant soft X-ray scattering, we study the archetypal cuprate La_2-xSr_xCuO₄ (LSCO) over a broad doping range. We reveal the existence of two types of CDW orders in LSCO, namely CDW stripe order and CDW short-range order (SRO). While the CDW-SRO is suppressed by SC, it is partially transformed into the CDW stripe order with developing SDW stripe order near the superconducting T_c. These findings indicate that the stripe orders and SC are inhomogeneously distributed in the superconducting CuO₂ planes of LSCO. This further suggests a new perspective on the putative pair-density-wave order that coexists with SC, SDW, and CDW orders.

To fully elucidate the relationship between density wave orders and superconductivity in high-T_c cuprates remains difficult. Here, the authors reveal two types of charge-density-wave orders and their intertwined relationship with spin-density-wave order and superconductivity in La_2-xSr_xCuO_4.

Clinical Impact of Piecemeal Resection Concerning the Lateral Spread of Ampullary Adenomas

Objective Endoscopic papillectomy (EP) has been recognized to be a safe and reliable treatment modality for ampullary adenomas. The purpose of this study was to determine the safety and efficacy of endoscopic piecemeal resection for laterally spreading ampullary adenomas and to compare these findings with a control population of smaller conventional ampullary tumors treated in the same time period. Methods Between May 1999 and September 2015, 136 patients underwent EP at Tokyo Medical University hospital. A total of 125 patients underwent en bloc resection, and 11 patients underwent piecemeal resection. Results The final pathological diagnoses were 103 adenomas, 14 carcinomas in adenomas, 4 carcinomas, and 4 hyperplasia in the en bloc resection group, versus 7 adenomas, 3 carcinomas in adenoma, and 1 carcinomas in the piecemeal resection group. A single treatment session was possible in 104 (83.2%) of the 125 patients in the en bloc resection group and in 8 (72.7%) of the 11 in the piecemeal resection group. The total resection rate including additional treatments was 98.4% in the en bloc resection group and 100% in the piecemeal resection group. Conclusion Piecemeal resection for laterally spreading ampullary adenomas was sufficiently performed compared with en bloc resection.

Novel peroral direct digital cholangioscopy-assisted lithotripsy using a monorail technique through the overtube in patients with surgically altered anatomy (with video)

Efficacy of cholangioscopy-assisted lithotripsy for difficult stones such as huge stones, multiple large stones and an impacted stone in patients with non-altered anatomy has been reported. Herein, we describe peroral direct digital cholangioscopy (PDCS)-assisted electrohydraulic lithotripsy (EHL) with a new technique in patients with surgically altered anatomy. Five patients received PDCS-assisted EHL with the monorail technique due to failed conventional stone extraction. Balloon enteroscope was removed, leaving the stiff guidewire in the bile duct and an overtube with inflated balloons. The cholangioscope was then inserted into the bile duct over the wire through the overtube. After direct visualization of the stone, PDCS-assisted EHL was carried out. This technique was named the 'monorail technique'. Complete removal of biliary stones in one session was accomplished in four patients and only one case required two sessions. There was no adverse event in any of the cases. PDCS-assisted EHL using the monorail technique was effective and safe for difficult biliary stones in patients with surgically altered anatomy.

Expanding the indication of endoscopic papillectomy for T1a ampullary carcinoma

BACKGROUND AND AIM

Endoscopic papillectomy (EP) has been attempted not only for benign lesions but also for early ampullary carcinoma (AC). However, there is still no sufficient evidence or consensus regarding the effectiveness of EP for early AC. Herein, we evaluated the expanding indication of EP for early AC.

METHODS

Between May 1999 and December 2016, 177 patients were diagnosed with ampullary tumor before undergoing EP, and their clinical and histopathological data were analyzed retrospectively.

RESULTS

There were 27 Tis-T1a AC patients and four T1b AC patients who underwent EP. Mean tumor size was 14.1 mm for Tis-T1a AC and 17.0 mm for T1b AC. For the histological grade, 50% (2/4) of T1b AC were moderately differentiated, whereas 96.3% (26/27) of Tis-T1a AC were well differentiated and papillary. For lymphovascular invasion, one (25%) occurred in T1b AC but none occurred in Tis-T1a AC. There was no AC recurrence from the date of EP until a maximum of 5 years (Tis-T1a: mean period 48.5 months [5-60]; T1b: mean period 26.5 months [3-60]).

CONCLUSIONS

Endoscopic papillectomy is useful and reliable for the curative treatment of T1a AC. Large-scale prospective studies with long-term follow up are needed.

Templated Assembly of Pore-forming Peptides in Lipid Membranes

Pore-forming peptides are of interest due to their antimicrobial activity and ability to form gateways through lipid membranes. Chemical modification of these peptides makes it possible to arrange several peptide monomers into well-defined pore-forming structures using various templating strategies. These templated super-structures can exert antimicrobial activity at significantly lower total peptide concentration than their untemplated equivalents. In addition, the chemical moieties used for templating may be functionalized to interact specifically with targeted membranes such as those of pathogens or cancer cells. A range of molecular templates has been explored, including dimerization of pore-forming monomers, their covalent attachment to cyclodextrin, porphyrin or fullerene scaffolds as well as attachment of amino acid linkers or nucleic acid constructs to generate assemblies of 4 to 26 peptides or proteins. Compared to free peptide monomers, templated pore assemblies showed increased membrane affinity, prolonged open-state lifetimes of the pores and more frequent pore formation due to higher local concentration. These constructs are useful model systems for biophysical studies to understand porin and ion channel proteins and their mechanisms of insertion into lipid membranes. Recently designed DNA-templates are expanding the usefulness of templated pore assemblies beyond applications of cell killing and may include targeted drug delivery and accelerate the emerging field of single-molecule detection and characterization of biomolecules by nanopore-based resistive pulse sensing.

Ex vivo assessment of anchoring force of covered biflanged metal stent and covered self-expandable metal stent for interventional endoscopic ultrasound

BACKGROUND AND AIMS

Endoscopic ultrasound (EUS)-guided transmural drainage using a covered biflanged metal stent (CBFMS) and a conventional tubular biliary covered self-expandable metal stent (CSEMS) has recently been performed by EUS experts. However, appropriate traction force of the sheath to prevent the migration during stent deployment is well unknown. Herein, we assessed the anchoring force (AF) of the distal flange in CBFMSs and CSEMSs.

METHODS

The AFs of four CBFMSs (Stents AX, NG, PL, and SX) and six CSEMSs (Stents BF, BP, EG, HN, SP, and WF) were compared in an ex vivo setting. We assessed the AF produced by each stent using an EUS-guided transmural drainage model and an EUS-guided hepaticogastrostomy model consisting of sheet-shaped specimens of the stomach, gelatin gel, and gelatin tubes.

RESULTS

For CBFMSs, the maximum AF of Stent AX was significantly higher than those of Stents PL and SX (P < 0.05) in the porcine model. In the gelatin series, all stents except Stent NG showed a nearly similar AF. For CSEMSs, Stents HN, EG, BF, and WF showed gradual AF elevation in the porcine stomach. Stents SP and BP showed a lower AF than the other four stents. For the gelatin setting, the maximum AF of Stents HN, EG, and WF was higher than those of the other stents regardless of the type of specimens.

CONCLUSIONS

The significance of the AF and traction distance according to the property of various CBFMSs and CSEMSs could be elucidated using ex vivo models.

A retrospective histological comparison of EUS-guided fine-needle biopsy using a novel franseen needle and a conventional end-cut type needle

Background and Objectives:

Recently, a 22G Franseen needle for EUS-guided fine-needle biopsy (EUS-FNB) with three novel symmetric heels has been developed to adequately obtain a core tissue.

Methods:

All 38 consecutive patients with pancreatic masses who underwent EUS-FNB using a Franseen needle were investigated retrospectively to assess the efficacy and safety of EUS-FNB using the Franseen needle. Then, the EUS-FNB outcomes and histological assessments of the tissue obtained by EUS-FNB using the Franseen needle and EUS-FNA using the conventional end-cut type needle for each of the 30 pancreatic ductal adenocarcinoma cases were compared.

Results:

An accurate histological diagnosis of the Franseen needle was achieved with a mean of 2 passes in 97.4% of patients. Although the accurate histological diagnosis rate of pancreatic ductal adenocarcinoma was not significantly different (96.7% vs. 93.3%, P = 0.55), the mean number of passes in the Franseen needle was significantly less than that in the conventional needle (2.1 ± 0.4 vs. 3.2 ± 0.8, P < 0.001). The presence of desmoplastic fibrosis with neoplastic cellular elements and venous invasion were significantly higher (96.7% vs. 40.0%, P < 0.001 and 23.3% vs. 0%, P < 0.01, respectively) and the amount of obtained tissue was significantly larger with the Franseen needle (2.13 mm²vs. 0.45 mm², P < 0.001).

Conclusions:

EUS-FNB using the Franseen needle enables the acquisition of a larger amount of tissue sample and achieves an accurate histological diagnosis with a smaller number of passes than the conventional end-cut type needle.

Hepatitis B virus reactivation in patients with rheumatoid arthritis: Analysis of the National Database of Japan

This study aimed to determine the incidence and risk factors for hepatitis B virus (HBV) reactivation in patients with rheumatoid arthritis (RA) undergoing immunosuppressive therapy. The National Database of Japan, in which insurance claim data have been comprehensively accumulated, was utilized. The subjects were 76 641 RA patients who were plausibly initiated on immunosuppressive therapy from April 2013 to March 2014. Laboratory tests of the hepatitis B surface antigen, anti-hepatitis B virus surface antibody, and anti-hepatitis B virus core antibody were performed in 28.23%, 12.52% and 14.63% of patients, respectively, when the therapy was initiated. We found that HBV reactivation and fulminant hepatitis occurred in both the patients with and without HBV DNA monitoring, indicating insufficient monitoring in Japan during the study. The cumulative incidence of HBV reactivation over 24 months was 1.57% (95% confidence interval [CI] = 1.28%-1.92%) in the monitoring group, which consisted of those with resolved HBV infection. Glucocorticoid administration was a potent risk factor for HBV reactivation (hazard ratio [HR]  = 1.70, 95% CI = 1.26-2.29, P = .001 in all subjects, and HR = 1.82, 95% CI = 1.18-2.81, P = .007 in the nonmonitoring group), although it was not statistically significant in the monitoring group (HR = 1.49, 95% CI = 0.99-2.26 and P = .057). No significant risk difference was observed between single administration of methotrexate and biological drugs.

The Role of Endoscopic Ultrasound-guided Drainage for Autoimmune Pancreatitis-associated Pancreatic Cysts: A Report of Five Cases and a Literature Review

Objective Autoimmune pancreatitis (AIP) has been recognized as a benign disease, which that shows a prompt response to corticosteroid treatment (CST). It was previously believed to not be associated with cyst formation; however, a few cases of AIP-associated pancreatic cyst (PC) have been reported. Some cases were reported to have been effectively treated by CST, while others were refractory to CST. Many of the patients received interventional treatment. Until now, there has been no consensus on the therapeutic strategies for AIP-associated PC. The aim of the present study is to describe a therapeutic strategy for this condition. Methods We conducted a retrospective study of 5 cases of AIP-associated PC that were treated by endoscopic ultrasonography-guided pancreatic fluid collection drainage (ESPD) or CST at Tokyo Medical University Hospital between March 2012 and October 2016, analyzed the therapeutic outcomes, and performed a literature review. Results The initial treatments included CST (n=2) and ESPD (n=3). All of the PCs disappeared after treatment In 1 of the patients who received CST case and 3 of the patients who received ESPD; however, the PC did not disappear in one of the patients who received CST (corticosteroid maintenance therapy), even after the dose of corticosteroids was increased; ESPD was eventually performed and the PC disappeared. There were no procedure-related complaints. Conclusion We propose that CST be administered as the first-line treatment for AIP-associated PC, particularly in cases of PC without a history of CST. However, ESPD can be applied to treat cases of corticosteroid refractory PC.