Effect of rechallenge nivolumab in a hemodialysis patient with multiple metastases from a rapidly progressed T1a renal clear cell carcinoma: An autopsy case

Introduction

Distant metastasis of T1a renal cell carcinoma is rare and whether metastasis is more probable in patients undergoing hemodialysis remains unclear. We report the autopsy case of a patient undergoing hemodialysis with multiple metastases that rapidly progressed from T1a renal cell carcinoma treated with multimodal therapy including nivolumab.

Case presentation

A 70-year-old male who underwent hemodialysis was diagnosed with clear cell carcinoma (pT1a, G2) after nephrectomy. Six months post-surgery, bone and lung metastases appeared and treated with radiotherapy and pazopanib, respectively. Nivolumab was administered as second- and fourth-line treatments for lung metastases. The patient died approximately 60 months after initial diagnosis; however, nivolumab controlled disease progression for 24 months. An autopsy revealed the lung's occupation with clear cell carcinoma tumor tissue.

Conclusion

Nivolumab has potential to control lung metastasis progression. Additionally, rechallenge is possible in patients with renal cell carcinoma undergoing hemodialysis.

Robot-assisted radical nephroureterectomy for right renal pelvic tumor post sacrocolpopexy with mesh: A case report

INTRODUCTION

Robot-assisted nephroureterectomy for upper tract urothelial carcinoma has been increasingly performed as a minimally invasive procedure recently. However, there are concerns regarding its adoption in highly complex cases with dense adhesions.

PRESENTATION OF CASE

An 86-year-old woman presented to our hospital with gross hematuria one year after having undergone robot-assisted sacrocolpopexy using a mesh for pelvic organ prolapse. Cystoscopy revealed hematuria from the right ureteral orifice. Computed tomography suggested right hydronephrosis; retrograde pyelography showed a defect in the right renal pelvis with class V urine cytology of the urine from the right kidney. Based on these findings, a right renal pelvic tumor was diagnosed, and robot-assisted nephroureterectomy was performed. The patient was discharged on postoperative day 7 without complications.

DISCUSSION

To the best of our knowledge, this is the first case report in which robot-assisted radical nephroureterectomy was performed after robot-assisted sacrocolpopexy with a mesh. Dense tissue adhesions are encountered not only between the bladder and the anterior vaginal wall but also around the right ureter in the pelvis. In this case, dense adhesions were confirmed around the right ureter in the pelvis.

CONCLUSION

Robot-assisted nephroureterectomy may be considered an option for minimally invasive surgery in cases with a history of pelvic organ prolapse surgery using mesh.

Optogenetic stimulation of neurons in the anterior cingulate cortex induces changes in intravesical bladder pressure and the micturition reflex

Lower urinary tract (LUT) function is controlled by the central nervous system, including higher-order cognitive brain regions. The anterior cingulate cortex (ACC) is one of these regions, but the role of its activity in LUT function remains poorly understood. In the present study, we conducted optogenetic experiments to manipulate neural activity in mouse ACC while monitoring bladder pressure to elucidate how the activity of ACC regulates LUT function. Selective optogenetic stimulation of excitatory neurons in ACC induced a sharp increase in bladder pressure, whereas activation of inhibitory neurons in ACC prolonged the interval between bladder contractions. Pharmacological manipulation of ACC also altered bladder contractions, consistent with those observed in optogenetic experiments. Optogenetic mapping of the cortical area responsible for eliciting the increase in bladder pressure revealed that stimulation to ACC showed more potent effects than the neighboring motor cortical areas. These results suggest that ACC plays a crucial role in initiating the bladder pressure change and the micturition reflex. Thus, the balance between excitation and inhibition in ACC may regulate the reflex bidirectionally.

NAA10 gene expression is associated with mesenchymal transition, dedifferentiation, and progression of clear cell renal cell carcinoma

INTRODUCTION

We aimed to investigate the expression and prognostic role of NAA10 in clear cell renal cell carcinoma (ccRCC).

MATERIAL AND METHODS

We performed a gene expression and survival analysis based on the human cancer genome atlas database of ccRCC patients (TCGA-KIRC).

RESULTS

The patients in the TCGA-KIRC (n = 537) were divided into two subgroups: NAA10-low and NAA10-high expression groups. NAA10-high ccRCC exhibited higher T stages (p = 0.002), a higher frequency of distant metastasis (p = 0.018), more advanced AJCC stages (p < 0.001), a lower overall survival time (p = 0.036), and a lower survival rate (p < 0.001). NAA10-high ccRCC was associated with increased activity of non-specific oncogenic pathways, including oxidative phosphorylation (p < 0.001) and cell cycle progression [G2 to M phase transition (p = 0.045) and E2F targets (p < 0.001)]. Additionally, the NAA10-high tumors showed reduced apoptosis via TRIAL pathways (p < 0.001) and increased levels of activity that promoted epithelial-mesenchymal transition (p = 0.026) or undifferentiation (p = 0.01). In ccRCC, NAA10 expression was found to be a negative prognostic factor in both non-metastatic (p < 0.001) and metastatic tumors (p = 0.032).

CONCLUSIONS

In ccRCC, NAA10 expression was shown to be a negative prognostic factor related to tumor progression rather than tumor initiation, and high NAA10 expression promoted epithelial-mesenchymal transition and undifferentiation.

Hypopituitarism induced by pembrolizumab plus axitinib in the treatment of metastatic renal cell carcinoma: A case report

Immune checkpoint inhibitor (ICI) therapies have broadened the armamentarium for metastatic renal cell carcinoma (mRCC). As the ICI therapy spreads in the clinical settings, immune-related adverse events are more of a concern for clinicians. The present study reports three cases of mRCC treated with pembrolizumab plus axitinib and diagnosed hypopituitarism based on clinical symptoms and hormonal profile. Acute methylprednisolone infusion therapy was necessary in one case because of severe adrenal hypofunction; however, the clinical symptoms of the other two cases were controlled with oral corticosteroid therapy. To the best of our knowledge, there is no report of pembrolizumab plus axitinib related hypopituitarism in the treatment of mRCC. The present cases suggests that hypopituitarism after pembrolizumab plus axitinib treatment for mRCC can be handled with steroid therapy even after the development of hypopituitarism.

Scrotal epidermoid cysts penetrating the penile corpora cavernosa: Two case reports

Introduction

Epidermoid cysts are tumors and that rarely occur in intrascrotal extratesticular tissues. It is extremely rare for the tumors to penetrate the penile corpora cavernosa.

Case presentation

We encountered a 4-year-old and a 6-year-old boy with intrascrotal tumors that penetrated the penile corpora cavernosa. Both the patients underwent tumor resection. In the former case, some of the tumor within the corpora cavernosa was left behind, while in the latter case, the tumor was completely resected. Pathological examination in both cases confirmed the diagnosis of epidermoid cysts.

Conclusion

We should consider the possibility of epidermoid cysts in children presenting with intrascrotal tumors. Moreover, care should be taken when handling the corpora cavernosa during surgery.

A case of proximal migration of a double-J ureteral stent in a patient with metastatic gastric cancer

Ureteral stenting is a common procedure to relieve ureteral obstructions. There are few reports regarding the proper migration of the proximal coil of a double-J ureteral stent into the ureter. Herein, we report a case of proximal stent migration after stent placement for ureteral stenosis caused by a malignant tumor in the gastrointestinal tract.

Bowel movement frequency, stool consistency, and risk of disabling dementia: a population-based cohort study in Japan

OBJECTIVES

This population-based study aimed to evaluate the association between bowel habits from midlife and dementia.

STUDY DESIGN

This was a cohort study using certification records for national long-term care insurance in Japan.

METHODS

Participants aged 50 to 79 years who reported bowel habits from eight districts within the Japan Public Health Center-based Prospective Study (JPHC Study) were followed from 2006 to 2016 for incident dementia. Hazard ratio (HR) and 95% confidence interval (CI) were estimated for men and women separately using Cox proportional hazards models accounting for various lifestyle factors and medical histories.

RESULTS

Among 19,396 men and 22,859 women, 1889 men and 2685 women were diagnosed with dementia. In men, the multivariable-adjusted HRs compared with bowel movement frequency (BMF) of once/day were 1.00 (95% CI: 0.87-1.14) for twice/day or more, 1.38 (1.16-1.65) for 5-6 times/week, 1.46 (1.18-1.80) for 3-4 times/week, and 1.79 (1.34-2.39) for <3 times/week (P for trend <0.001). In women, the corresponding HRs were 1.14 (0.998-1.31), 1.03 (0.91-1.17), 1.16 (1.01-1.33), and 1.29 (1.08-1.55) (P for trend = 0.043). Harder stool was associated with higher risk (P for trend: 0.0030 for men and 0.024 for women), with adjusted HRs compared to normal stool of 1.30 (1.08-1.57) for hard stool and 2.18 (1.23-3.85) for very hard stool in men, and 1.15 (1.002-1.32) and 1.84 (1.29-2.63) in women.

CONCLUSIONS

Lower BMF and harder stool were each associated with higher risk of dementia.

Metastatic rectal neuroendocrine tumor to kidney, pancreas, and bone following renal tumor resected with robot-assisted laparoscopic partial nephrectomy

Neuroendocrine tumor (NET) is a rare tumor commonly found in the gastrointestinal tract and lungs and rarely originates from and metastasizes to the kidney. We report a case of a 66-year-old man with metastatic rectal NET to the kidney, pancreas and bone following the resection of renal tumor with robot-assisted partial nephrectomy (RAPN). A rectal tumor of 10mm in diameter had been endoscopically resected and diagnosed NET with positive surgical margin 9 years before RAPN. Somatostatin receptor (SSR) scintigraphy revealed the other two metastases postoperatively, therefore is an effective tool to detect primary and metastatic sites of NETs.

AB0158 PREDICT OF PROGNOSIS AT ONE YEAR AFTER THE ADMINISTRATION WITH b/tsDMARD FOR PATIENT WITH DIFFICULT-TO-TREAT RHEUMATOID ARTHRITIS

Background

Patients with difficult-to-treat rheumatoid arthritis (D2T RA) are the most serious problem in recent systemic RA treatment protocols [1].

Objectives

Prognosis after biologic or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) is beneficial when predicted in patients with D2T RA. Predictors of post b/tsDMARDs in D2T RA patients were investigated using retrospective cohort data.

Methods

RA patients more than 1 year after the start of newly administered b/tsDMARDs were recruited. The patients were divided into two groups according to the EULAR definition of D2T RA [2]. Patients who met the criteria were classified into the D2T RA group and others into the non-D2T RA group. The incidence of the clinical features described in the criteria of D2T RA and the rheumatoid disease comorbidity index (RDCI) [3] were compared between the two groups at the time of drug initiation (baseline). The primary endpoint was “Success or Failure” 1 year after baseline. Success was defined as b/tsDMARD persisted in remission as the 28 joint disease activity score with erythrocyte sedimentation rate (DAS28) ≤ 2.6, or as b/tsDMARD was discontinued upon achieving clinical remission. The Failure was defined as other decisions such as discontinuation due to failure, adverse events, or characteristic patient problems. In the discontinued cases, the monitoring value at the last observation was carried forward to 1 year.

Cox regression analysis was used to assess each variant as a potential risk factor for Failure. Receiver operating characteristic analysis (ROC) was tested on variants with significantly higher risk ratios, and Kaplan-Meier survival analysis was also tested for cut-off indices.

Results

71 cases of the D2T RA and 259 cases of the non-D2T RA group were analyzed. As shown in Table 1, the clinical characteristics of the D2T RA group were significantly worse than those of the non-D2T RA group.

Higher DAS28 had a significantly higher risk ratio for the Failure from month 3 in the D2T RA group, whereas from baseline in the non-D2T RA group (Figure 1-A). Other factors in the D2T RA group at and after baseline listed in the Table 1 had no significant risk ratios. PS-VAS and EQ5D score had significant higher risk ratios in the non-D2T RA group using univariate models, however, only DAS28 had significant higher risk ratio using multivariate model. The cut-off index (COI) and the area under the curve (AUC) using ROC for each observational period in the two groups were shown in Figure 1-B. Results of Kaplan-Meier survival analyses were shown in Figure 1-C. Hazard ratios of DAS28 > COI exceeded 2.5 even from months 3 with high sensitivity (p < 0.001) in the D2T RA group.

Conclusion

These results indicated that higher DAS 28 suggested a failure prognosis at 12 months after initiation in D2T RA and non-D2T RA patients. Even in patients with D2T RA, strict disease activity control is most important for prognostic management, with 1-year prognosis predictable in the first 3 months. However, this study is a short-term prognostic predictor, and accumulation of short-term predictions is a long-term predictor.

References

[1]Roodenrijs NMT, et al. Rheumatology (Oxford) 2021;60:3778-3788. doi:10.1093/rheumatology/keaa860

[2]Nagy G, et al. Ann Rheum Dis 2021;80:31-35.

[3]England BR, et al. Arthritis Care Res 2015;67:865-872. doi: 10.1002/acr22456.

Disclosure of Interests

None declared

AB1007 CLINICAL SIGNIFICANCE OF SERUM CREATININE-TO-CYSTATIN C RATIO AS A SURROGATE MARKER FOR INCIDENT OSTEOPOROTIC FRACTURE

Background

In a previous article, we introduced a novel index of osteoporosis that represented as T-score ≤ -2.5, which constituted the combined criteria of age, serum creatinine-to-cystatin C ratio (Cr/CysC), and tartrate-resistant acid phosphatase-5b.

Objectives

We hypothesized that serum cystine C to creatine ratio (CysC/Cr), that is the reciprocal of Cr/CysC, might function as a predictive marker of incident osteoporotic fractures in elderly population and tested this hypothesis in a retrospective cohort study.

Methods

Subjects were 50 years of age or older who had their lumbar spine and femoral neck bone mineral density (BMD) measured by dual-energy X-ray absorptiometry, and simultaneously had their CysC/Cr measured. The dates of BMD and CysC/Cr measurements were set as baseline. The primary outcomes were incidental major osteoporotic fractures (MOF), including vertebral fractures, proximal femur fractures, proximal humerus fractures, and distal radius fractures. Follow-up was continued until the first fracture occurred, was terminated at death, was lost to follow-up, or was completed. In these patients, the relationship between baseline developmental MOF and variants was investigated using Cox regression analysis. The variants were candidate risk factors for MOF for positivity and negativity. After identifying risk factors using univariate models, multivariate model was undergone in order to relative higher risk in the factors. Receivers operating characteristic analyses (ROC) were conducted in order to determine cut-off index (COI) of these factors. Kaplan-Meier survival analysis was tested in order to determine hazard ratio for presenting these risk factors.

Results

A total of 175 patients, 38 men and 137 women, were included in the dataset. The mean age at baseline was 70.2 years, ranged from 50 to 98 years, and the mean follow-up was 30.4 months. Mean BMD at baseline was 0.734 and 0.659 g/cm2 (T-score: -2.21 and -2.04) in lumbar spine and femoral neck, respectively, and mean CysC/Cr at baseline was 1.49. fall-ability, LSD, and pr-MOF, were present in, 59, 113, and 77, respectively. Administration of OPD, vitamin-D, GCS, and polypharmacy were present in 92, 170, 12, and 47, respectively (Table 1).

Table 1.

Results of receiver operation characteristics and Kaplan-Meier survival analysis for each factor

Factorcut-off indexarea under the curvep-valueHazard ratio (95%CI)p-valueCysC/Cr> 1.3450.614< 0.016.32 (2.87 – 13.92)< 0.01LSDpresent0.626< 0.013.60 (1.67 – 7.73)< 0.05Fall-abilitypresent0.703< 0.0014.83 (2.16 – 10.21)< 0.001CKDpresent0.612< 0.052.56 (1.06 – 6.20)< 0.05pr-MOFpresent0.685< 0.0014.81 (2.08 – 9.39)< 0.001

In Cox regression analysis, the presence of prevalent MOF (pr-MOF), fall-ability, lifestyle-related diseases (LSD), chronic kidney diseases (CKD) ≥ Grade3a, and higher CysC/Cr had significant higher risk ratios with univariate models. In these, the presence of LSD and fall-ability had significant higher risk ratios with multivariate model. All the binary factors had COI as the presence of each event such with 0.626, 0.703, 0.612, and 0.685 of area under the curve for LSD, Fall-ability, CKD, and pr-MOF, respectively. CysC/Cr also had COI (1.345) with 0.614 of the area under the curve.

In the Kaplan-Meier survival analysis, CysC/Cr > COI, Fall-ability, pr-MOF, LSD, CKD ≥ Grade 3 b was significantly higher in descending order of Hazard ratio (6.32, 4.83, 4.81, 3.60, 2.56, respectively) (Table 1).

Conclusion

These results suggest that CysC/Cr may be a predictor of MOF or a risk factor if it exceeds the COI. This value is the reciprocal of Cr/CysC, and if Cr/CysC reflects muscle mass, CysC/Cr is assumed to reflect low relative muscle mass. It is supposed that this is also affected by sex difference and age. There seems to be a correlation between MOF and CysC/Cr. Early measurement of CysC/Cr facilitates screening for fractures. As a result, it may be easier to implement fracture prevention programs such as drug interventions such as OPD and exercise habit guidance.

Disclosure of Interests

None declared

POS0554 CLINICAL CHARACTERISTICS OF PATIENTS WITH RHEUMATOID ARTHRITIS IN PRE-DIFFICULT-TO-TREAT STATUS

Background

Patients with rheumatoid arthritis (RA) who have a difficult-to-treat condition (D2T RA) are often a burden to both patients and rheumatologists.

Objectives

The aim of this study was to determine the risk factors for failure to treat in patients with refractory conditions and to find them relevant to prevention.

Methods

Patients with RA who were treated under treat-to-target (T2T) strategy more than one year were picked up. Their background characteristics such as sex, age, disease duration, anti-citrullinated polypeptide antibodies titer (ACPA), and disease duration, were collected, and their simplified disease activity index (SDAI) score, Health Assessment Questionnaire Disability Index (HAQ) score, pain score measured with visual analog scale (PS), EuroQol 5th-dimensions score (EQ5D) were monitored every three months. Sharp/van der Heijde score (SHS) was calculated annually.

Difficult-to-treat status was determined in according to the EULAR definition of D2T RA [1], and pre-D2T RA status was determined as follows: (Category-1) a failure history of one kind of action in biologic or targeted synthetic disease modifying anti-rheumatic drug (b/tsDMARD) and switched to another b/tsDMARD with other action mechanism or (Category-2) one or more of following status; mean SDAI score in recent three months exceeded 11 (MDA), three consecutive administration of glucocorticoid steroid no less than 7.5mg in prednisolone equivalent (GCS), rapid radiographic progression with 5 or more in SHS than last time (RRP), or decrease of EQ5D score less than -0.2 in recent 6 months (dEQ5D). Patients were recruited when Category-1 or -2 was matched in treating, and their results were determined in the last observation for each category. When second d/tsDMARD was failed until last observation in patient matched Category-1, the patient was judged as “failure”, and the other patient was judged as “success”. When Category-2 continued until last observation, the patient was judged as “failure”, and escaped from the category, the patient was judged as “success”. Risk factors for failure in background characteristics and monitored items in treating were evaluated for each category using binary logistic regression analysis.

Results

A total of 47 in Category-1 and 491 patients in Category-2 were recruited.

In Category-1 matched patients, female were 83.0% and mean age was 71.3. Mean SDAI score, HAQ score, PS, EQ5D score, and SHS at failure of b/tsDMARD (baseline) were 15.5, 0.457, 40.1, 0.811, and 72.9, respectively. Numbers of the first b/tsDMARD were 32 TNF inhibitors, 8 IL-6 inhibitors, 6 abatacepts, and 1 JAK inhibitor. Numbers of the second after the first were 13 IL-6 inhibitors and 19 JAK inhibitors after THF inhibitor, whereas 3 TNF inhibitors, 2 abatacepts, and 3 JAK inhibitors after IL-6 inhibitor failure, 1 TNF inhibitor, 1 IL-6 inhibitor, and 4 JAK inhibitors after abatacept failure, and 1 TNF inhibitor after 1 JAK inhibitor failure. In these, success counted 18 and failure counted 29. Significant risk factors for Category-1 failure were higher ACPA, higher SDAI score, higher HAQ score, and higher SHS at baseline (p<0.05). There was no significant difference between drugs.

In Category-2 matched patients, numbers of each status at first (baseline) were 455 MDAs, 20 GCSs, 17 RRPs, and 9 dEQ5Ds. Numbers in success and failure for each status at baseline were 315 and 140 for MDA, 16 and 4 for GCS, 9 and 0 for RRP, and 7 and 2 for dEQ5D, respectively. Significant risk factors for each failure status were higher mean SDAI score after baseline for MDA, higher HAQ score at baseline for GCS, and higher mean PS after baseline for dEQ5D (p<0.01).

Conclusion

Clinical background factors besides disease activity such as ACPA, HAQ score, and SHS at baseline were important for preventing fall-in D2T_RA. However, most weighted factor was disease activity control after falling in MDA status. Tight disease activity control is the overriding factor.

References

[1]Nagy G, et al. Ann Rheum Dis 2021;80:31-5.

Disclosure of Interests

None declared.

AB0383 COMPARISON OF EFFICACY AND SAFETY IN JAK INHIBITOR DUE TO A DIFFERENCE OF SELECTIVITY – TOFACITINIB vs. BARICITINIB –

Background

Each Janus Kinase Inhibitor (JAK-i) has different selectivity of JAKs, such as JAK1, JAK2, JAK3, and TIK2. However, little has been known regarding mode of action due to the selectivity difference in clinical practice for treating rheumatoid arthritis (RA).

Objectives

The aim of this study is to compare difference of efficacy and safety in two JAK-i; between tofacitinib (TOF) and baricitinib (BAR) in clinical practice using one-center retrospective cohort.

Methods

Within the case which administered TOF or BAR to the RA patient who the effect was insufficient in the existing treatment and the disease activity was over the middle disease activity using simplified disease activity index (SDAI). At the start of administration (baseline), 5 mg tablets of TOF were taken twice a day or 4 mg tablets of BAR were taken one a day. Patients were divided by drug and included their sex, age at onset, anti-cyclic citrullinated polypeptide antibodies (ACPA) titer, length of RA history at onset, Sharp/van der Heijde score (SHS) at onset, Naïve/Not Naive for biologic DMARDs or JAK-i, 28-joints disease activity score (DAS28), SDAI, Health Assessment Questionnaire Disability Index (HAQ-DI), and pain score with visual analog scale (PS-VAS). It was classified into large joint and small joint, and the point was independently scored by swelling and pressure pain by size and position in each joint. Total score of the involved joints for each part; upper-extremities, lower extremities, big joints, and small joints (UES/LES/BJS/SJS), rheumatoid factor (RF) titer, serum matrix metalloprotease-3 (MMP-3) level, serum creatinine (Cr) level, and estimated glomerular filtration rate (eGFR) of each part were measured. The mean values of each group were obtained at baseline, 1, 2, 3, 6, 9, and 12 months, and the two groups were statistically compared using the Mann-Whitney U-test. As a sub-analysis, each drug group was divided into bio or JAK-i naive, age ≥ 70 years, disease duration ≥ 10 years, SHS ≥ 100. The change of DAS28 under each 2 divided condition was compared using Mann-Whitney U-test. Similar comparison was carried out with RA patient who administered golimumab (GOL) as a control group. The significance level was less than 5%.

Continuation rate (the withdrawal after the remission introduction is put in the continuation) in 12 months after baseline was also compared.

Results

A total of 82 patients were picked up, in whom 22 TOF group, 31 BAR group, and 29 GOL group included. Both DAS28 and SDAI were consistently lower in the BAR than in the other 2 groups from 1 month after baseline. SDAI in the BAR was significantly lower than in the GOL at 3 months after the baseline. The HAQ-DI score at 6 months after baseline was significantly lower in the BAR than in the GOL. PS-VAS in the GOL was significantly higher than the other two groups at 2, 3 and 6 months after baseline. In the joint point, BJS in the BAR was significantly lower than that in the GOL at 2, 3, and 6 month after baseline. SJS in the GOL was significantly lower than that in the TOF at 6 and 12 months after baseline. There was no significant difference in MMP -3, RF, Cr and eGFR between the 3 groups in any observation month, but Cr increased after the start in the BAR group and eGFR tended to decrease.

In the sub-analysis, the decrease of DAS28 at 1 year after baseline with a history of ≥ 10 years was significantly greater than in those with a history of < 10 years in the TOF, as well as DAS28 at 1 year in those with SHS ≥ 100 decreased significantly more than that in those < 100. These phenomena was not observed in the BAR group.

The continuation rate at 12 months after the start of administration was 86.4% in the TOF, 89.3% in the BAR and 69.0% in the GOL.

Conclusion

Even JAK-i characteristics in action differs for each drug. It is needed to choose appropriate drug based on these drug characteristics.

Disclosure of Interests

None declared

AB0236 PRESENCE OF ANTI-CITRULLINATED POLYPEPTIDE ANTIBODIES DECREASES BONE MINERAL DENSITY IN BODY OF PATIENT WITH RHEUMATOID ARTHRITIS: A RETROSPECTIVE COHORT STUDY

Background

Presence of anti-citrullinated polypeptide antibodies (ACPA) is one risk factor of bone erosion of the joint in patients with rheumatoid arthritis (RA). However, bone absorption in the whole body is still not clarified in a longitudinal study.

Objectives

The aim of this study is to clarify effects of ACPA on bone mineral density (BMD) decrease using dual-energy X-ray absorptiometry (DXA) in patient with RA using retrospective longitudinal cohort study.

Methods

Patient with RA who were measured BMD in lumbar spine (LS) and total hip (TH) using dual-energy X-ray absorptiometry (DXA) at first consultation (baseline) and were treated for more than five years, were recruited. Follow-up started at BMD measurement and continued until the development of the first fracture or censoring at death, loss to follow-up or end of the study. Every patients have been followed up with monitoring of SDAI and Health Assessment Questionnaire Disability Index (HAQ) at every another to three months. Sharp/van der Heijde Score (SHS) was measured at baseline and every another year thereafter. BMD were measured every six months. Relationship between BMD and candidate risk factors including ACPA positivity and serum titer level, and other variants for BMD loss were evaluated statistically using linear regression analysis. Evaluations were performed for the absolute value of BMD and Z-score at baseline, mean value of these during follow-up, and change from baseline. Change of Z-score during follow-up was also compared between groups what classified according to ACPA positivity (ACPA positive/negative group).

Results

A total of 222 patients were recruited including 17 male (7.7%) and 205 female (92.3%). The mean age of the patients was 69.2 years old. Mean disease duration at baseline and follow-up length after baseline were 6.4 and 63.3 months, respectively. Mean SDAI score, HAQ score and SHS at baseline were 22.2, 0.516, and 6.6, respectively. The mean ACPA level and positive rate were 202.1 and 77.5%, respectively.

Higher ACPA titer level correlated significantly low BMD and Z-score in TH (p<0.05), whereas ACPA positivity significantly correlated with low Z-score in LS and TH during follow-up using univariate models (p<0.05). The ACPA positivity also correlated with decrease of Z-score in both LS and TH using univariate models (p<0.05), whereas no significant correlation demonstrated using multivariate model.

Change of Z-score in the ACPA positive group was significantly lower than in the ACPA negative group despite no significant difference of disease activity between the two groups demonstrated (p<0.05) (Table 1).

Table 1.

Comparison of the two groups

parametersACPA-positive (n=172)ACPA-negative (n=50)p-valuefemale (%)91.396.50.10at baselineage (year-old)65.471.3<0.001disease duration (months)7.74.6<0.001RF (IU/L)138.3 (197.1)21.5 (49.3)<0.001SDAI26.3 (24.0)21.0 (17.8)<0.05HAQ0.496 (0.618)0.553 (0.639)0.48SHS8.4 (8.2)3.5 (5.0)<0.001BMD in LS (g/cm2)0.825 (0.167)0.849 (0.156)0.23BMD in H (g/cm2)0.700 (0.140)0.710 (0.132)0.75Z-score in LS-0.246 (1.300)0.123 (1.392)<0.05Z-score in TH-0.062 (1.034)0.261 (1.020)<0.05at follow-upfollow-up length (months)64.865.40.65SDAI4.5 (3.1)5.1 (4.4)0.22HAQ0.495 (0.616)0.516 (0.544)0.32SHS8.1 (8.2)3.4 (4.8)<0.001BMD in LS (g/cm2)0.839 (0.171)0.870 (0.165)0.16BMD in TH (g/cm2)0.710 (0.118)0.713 (0.115)0.99Z-score in LS-0.008 (1.361)0.368 (1.426)<0.05Z-score in TH0.129 (0.902)0.396 (0.891)0.11anti-osteoporotic drug administered, ever (%)73.469.80.72GCS administered, ever (%)35.832.90.68

The values are presented as mean (SD) unless indicated otherwise.

Statistically significant within 0.05 are shown as bold styles.

Conclusion

Presence of ACPA potentially have an independent risk of BMD decrease. Its action affects regardless gender and age.

Disclosure of Interests

None declared

AB0243 ASSOCIATIONS BETWEEN JOINT DEFORMITY, DISEASE DURATION, DISEASE ACTIVITY, ACTIVITIES OF DAILY LIVING, QUALITY OF LIFE, PAIN, AND FATIGUE IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background

Patient with rheumatoid arthritis (RA) have disease-related problems such as joint deformity, disease duration, disease activity, activities in daily life (ADL), quality of life, pain, and fatigue. All these problems correlate interactively.

Objectives

Aim of this study is to clarify association among these problems statistically using retrospective cohort data.

Methods

Patients with RA who were followed up more than three years were recruited. Their EuroQol-5th dimension (EQ5D) as an indicator of quality of life (QOL), simplified disease activity index (SDAI) as an indicator of disease activity, Health Assessment Questionnaire Disability Index (HAQ) as an indicator of ADL, pain score using visual analog scale (PS-VAS), and fatigue score using visual analog scale (FS-VAS), were monitored every three months. Sharp/van der Heijde score (SHS) as an indicator of joint deformity was calculated annually. Association among average values of these factors and patient’s sex, age, disease duration (DD), and anti-citrullinated polypeptide antibodies (ACPA) titer were evaluated using multivariate linear regression analysis. Statistical significance was set within 5%.

Results

A total of 447 patients, in whom 120 male and 327 female included, were analyzed. Mean age, disease duration, EQ5D score, SDAI score, HAQ score, SHS, PS-VAS, and FS-VAS during follow-up were 71.6-year-old, 12.9 years, 0.831, 4.26, 0.413, 46.9, 22.5, and 23.2, respectively.

EQ5D score correlated significantly with age, HAQ score, SDAI score, SHS, PS-VAS, FS-VAS, and DD using univariate models. In these, age, HAQ score, and FS-VAS correlated significantly using multivariate model (correlation coefficients (CC): 0.927). HAQ score correlated significantly with age, EQ5D score, SDAI score, SHS, PS-VAS, FS-VAS, and DD using univariate models. In these, EQ5D score, SHS, and FS-VAS correlated significantly using multivariate model (CC: 0.910). SDAI score correlated significantly with female gender, EQ5D score, HAQ score, SHS, PS-VAS, and FS-VAS using univariate models. In these, SHS and PS-VAS correlated significantly using multivariate model (CC: 0.620). SHS correlated significantly with age, female gender, EQ5D score, HAQ score, SDAI score, PS-VAS, and DD using univariate models. In these, HAQ score, SDAI score, and DD correlated significantly using multivariate model (CC: 0.685). PS-VAS correlated significantly with EQ5D, HAQ score, SDAI score, SHS, and FS-VAS using univariate models. In these, SDAI score and FS-VAS correlated significantly using multivariate model (CC: 0.732). FS-VAS correlated significantly with EQ5D score, HAQ score, SDAI score, and PS-VAS using univariate models. In these, EQ5D score, HAQ score, and PS-VAS correlated significantly using multivariate model (CC: 0.715). ACPA did not correlated with any factors significantly.

Conclusion

These results suggested that EQ5D score, namely QOL is influenced by various disease-related factors and aging, especially correlated with ADL and fatigue closely. The HAQ score, namely ADL level is influenced by fatigue level and joint deformity directly. The SDAI score, namely disease activity level correlated with pain level and joint deformity level, and correlates with the other factors indirectly. A schematic figure that represents relationships among factors were shown in Figure 1. These information would beneficial for conducting treatment protocol of RA.

Disclosure of Interests

None declared

Mirabegron for overactive bladder in frail patients 80 years or over (HOKUTO study)

BACKGROUND

We assessed the efficacy and safety of mirabegron, a β₃-adrenoceptor agonist, in older adults (≥ 80 years old) with overactive bladder (OAB).

METHODS

OAB patients aged ≥ 80 years were enrolled in this prospective, single-arm observational study. OAB was diagnosed based on the OAB symptom score (OABSS); i.e., a total score of ≥ 3 points and an urgency score of ≥ 2 points. Patients who received 50 mg mirabegron once daily were evaluated at the baseline and at 4, 8, and 12 weeks. The changes from the baseline in the OABSS, International Prostate Symptom Score (IPSS), OAB questionnaire (OAB-q) score, and Vulnerable Elders Survey (VES-13) score were determined. Adverse events, laboratory tests, 12-lead electrocardiography, the QT interval according to Fridericia's formula (QTcF), uroflowmetry, the post-void residual urine volume (PVR), and the Mini-Mental State Examination (MMSE) score were used to assess safety.

RESULTS

Forty-three patients (median age: 84 years, range: 80-96 years) were examined. They had high rates of comorbidities and polypharmacy. Mirabegron significantly improved in total score of the OABSS, including urgency and urge incontinence. The total IPSS, IPSS quality-of-life (QOL) index, and OAB-q scores also significantly improved. Mirabegron improved in the VES-13 score. There were no significant changes in laboratory test values, uroflowmetry findings, PVR, the QTcF, or MMSE score. Two patients (4.7%) withdrew from the study after experiencing adverse events.

CONCLUSIONS

Mirabegron was well tolerated and significantly improved in OAB symptoms, and QOL in older patients. Trial registration The present clinical study was approved by University of Yamanashi Institutional Review Board prior to study initiation (ID1447) and was retrospectively registered with the UMIN Clinical Trials Registry (UMIN-CTR), Japan (UMIN000045996) on Nov 6, 2021.

Effects of fatty acid metabolites on nocturia

Dysregulation of circadian rhythm can cause nocturia. Levels of fatty acid metabolites, such as palmitoylethanolamide (PEA), 9-hydroxy-10E,12Z-octadecadienoic acid (9-HODE), and 4-hydroxy-5E,7Z,10Z,13Z,16Z,19Z-docosahexaenoic acid (4-HDoHE), are higher in the serum of patients with nocturia; however, the reason remains unknown. Here, we investigated the circadian rhythm of fatty acid metabolites and their effect on voiding in mice. WT and Clock mutant (ClockΔ19/Δ19) mice, a model for nocturia with circadian rhythm disorder, were used. Levels of serum PEA, 9-HODE, and 4-HDoHEl were measured every 8 h using LC/MS. Voiding pattern was recorded using metabolic cages after administration of PEA, 9-HODE, and 4-HDoHE to WT mice. Levels of serum PEA and 9-HODE fluctuated with circadian rhythm in WT mice, which were lower during the light phase. In contrast, circadian PEA and 9-HODE level deteriorated or retreated in ClockΔ19/Δ19 mice. Levels of serum PEA, 9-HODE, and 4-HDoHE were higher in ClockΔ19/Δ19 than in WT mice. Voiding frequency increased in PEA- and 4-HDoHE-administered mice. Bladder capacity decreased in PEA-administered mice. The changes of these bladder functions in mice were similar to those in elderly humans with nocturia. These findings highlighted the novel effect of lipids on the pathology of nocturia. These may be used for development of biomarkers and better therapies for nocturia.

Potential Targets for Overactive Bladder in Older Men Based on Urinary Analysis of Metabolomics

OBJECTIVE

We investigated the association between overactive bladder (OAB) and urinary metabolites in men.

METHODS

This prospective observational study included 42 men aged 65-80 years. The 3-day frequency volume chart (FVC), International Prostate Symptom Score (IPSS), and quality of life score were adapted to assess the micturition behavior. Participants with IPSS urgency score ≥2 were included in the OAB group, and those with IPSS urgency score <2 were included in the control group. We performed a comprehensive metabolomic analysis using urine samples. Metabolites were compared between the groups using an unpaired t test and Fisher's exact test in a nonadjusted analysis. Multivariable logistic regression analysis was performed to investigate the association between OAB and the metabolites.

RESULTS

Overall, 23 men were included in the OAB group and 19 in the control group. There were no differences in the background factors except age between the groups. FVC analysis demonstrated that nocturnal urine volume, 24-h micturition frequency, and nocturnal micturition frequency were significantly higher, and the maximum voided volume was significantly lower in the OAB group than in the controls. Metabolomic analysis revealed 14 metabolites that were differentially expressed between the groups. Multivariate analysis indicated that an increase in the levels of 5-iso prostaglandin F2α-VI (5-iPF2a-VI) and 5-methoxyindoleacetic acid was associated with OAB.

CONCLUSION

Abnormal urinary metabolites, including metabolites in the tryptophan (5-methoxyindoleacetic acid, 3-indoleacetonitrile, and 3-hydroxyanthranilic acid) and arachidonic acid (5-iPF2a-VI) pathways, play a role in the pathogenesis of OAB in older men.

Mayo Adhesive Probability Score Is Associated with the Operative Time in Laparoscopic Adrenalectomy

Background: Laparoscopic adrenalectomy (LA) is the standard treatment for adrenal benign tumors, including primary aldosteronism (PA) or Cushing's syndrome (CS). Several obesity-related factors were associated with prolonged total operative time (OT), but perinephric fat characteristics were not assessed. We investigated whether the Mayo adhesive probability (MAP) score, which evaluates perinephric fat characteristics, was associated with OT for LA. Methods: This single-center, retrospective cohort study examined 141 consecutive patients who underwent LA for PA or CS. We reviewed patients' characteristics and OT. MAP scores were recorded using preoperative imaging. The correlation among characteristics data, MAP score, and OT was evaluated. Results: Overall, we assessed 82 women and 59 men. Adrenal tumors were found in 80 PA and 61 CS patients. There were 74 left-sided and 67 right-sided tumors. For all patients, the median age, body mass index, and tumor size were 56 years (interquartile range [IQR] 46-65), 24.1 kg/m² (IQR 21.7-26.8), and 19 mm (IQR 13-26), respectively. A total of 91 patients had MAP scores of 0, and 50 had MAP >0. The median OT was 183.5 minutes (IQR: 156-224 minutes) in the MAP >0 group and 162 minutes (IQR: 135-194 minutes) in the MAP = 0 group. In single variable analysis (unadjusted), MAP scores >0 and left-sided tumors were correlated with longer OT. Multivariable regression analysis revealed that this correlation was only significant for MAP scores >0. Conclusions: MAP score may be useful in preoperative planning for PA or CS patients undergoing LA.

Visceral fat accumulation and left atrial phasic function in the general population

Background

Obesity carries independent risk for incident atrial fibrillation (AF), although the impact of abdominal fat distribution on LA morphological and functional remodeling is not fully elucidated. Speckle-tracking echocardiography is a novel and sensitive tool that allows quantification and detection of subtle alterations in left atrial (LA) phasic function.

Purpose

This study aimed to investigate whether increased visceral adiposity is independently associated with impaired LA phasic function in a community-based cohort.

Methods

We included 527 participants without overt cardiac disease who underwent laboratory testing, abdominal computed tomographic examination and speckle-tracking echocardiography. Abdominal adiposity was quantitatively assessed as visceral fat area (VFA) and subcutaneous fat area (SFA) at the level of the umbilicus. Speckle-tracking echocardiography was performed to assess LA phasic function including reservoir, conduit and pump strain as well as left ventricular global longitudinal strain (LVGLS).

Results

Mean age was 57±10 years and 362 of the participants (69%) were men. LA reservoir and conduit strain were decreased according to the VFA quartiles (both p&lt;0.05), whereas there was no significant difference in LA volume index and LA pump strain. When stratified by SFA, there was no significant differences in LA volume index and all LA phasic strain across the quartiles. In multivariable analysis, VFA as continuous variable was significantly associated with LA conduit strain, independent of traditional cardiovascular risk factors, pertinent laboratory parameters and LV morphology and function including LVGLS (standardized b=−0.146, p=0.011). Representative cases are shown in the Figure.

Conclusion

In a sample of the general population, VFA accumulation was independently associated with worse LA conduit strain, which may be involved in the pathophysiological mechanism of obesity-related AF.

Funding Acknowledgement

Type of funding source: Foundation. Main funding source(s): Yamauchi Susumu Scholarship for Cardiovascular Research

Carotid intima-media thickness and subclinical left heart dysfunction in the general population

Background

Although carotid intima-media thickness (IMT) is an established marker of atherosclerosis and carries independent risk for cardiovascular disease, its possible association with subclinical cardiac dysfunction has not been extensively evaluated. Left ventricular global longitudinal strain (LVGLS) and peak left atrial longitudinal systolic strain (PALS) can detect subclinical left heart dysfunction.

Purpose

This study aimed to investigate the association between carotid IMT and subclinical left heart dysfunction in a large sample of the general population without overt cardiac disease.

Methods

We examined 1,161 participants who underwent extensive cardiovascular examination. Ultrasonography of common carotid artery was performed for the measurement of maximal carotid IMT. LVGLS and PALS were assessed by 2-dimensional speckle-tracking echocardiography.

Results

Mean age was 62±12 years, and 56% were male. The prevalence of abnormal LVGLS (&gt;−18.6%) and PALS (&lt;31.4%) was greatest in the upper quartile of carotid IMT (both p&lt;0.001; Figure). In multivariable analyses, carotid IMT was associated with abnormal LVGLS (adjusted odds ratio = 1.33 per 1SD increase of IMT, p=0.003) as well as PALS (adjusted odds ratio = 1.33 per 1SD increase of IMT, p=0.005) independent of traditional cardiovascular risk factors, echocardiographic parameters including LV ejection fraction, LV mass index and diastolic dysfunction, and pertinent laboratory parameters. The independent association between carotid IMT and PALS persisted even after adjustment for LVGLS. When carotid IMT was examined as a categorical variable, the upper quartile of carotid IMT carried a significant risk of abnormal LVGLS and PALS in a fully-adjusted model including echocardiographic and laboratory parameters (adjusted odds ratio 2.27 and 3.03 vs. lower quartile, both p&lt;0.01).

Conclusion

Participants with increased IMT had significantly impaired LV and LA function in an unselected community-based cohort. This association may be involved in the higher incidence of cardiovascular disease in individuals with increased carotid IMT.

Funding Acknowledgement

Type of funding source: None

Sex-specific difference in the association between arterial stiffness and subclinical left ventricular dysfunction

Background

Increased arterial stiffness has been proposed as one of the key mechanisms of incident heart failure with preserved ejection fraction (HFpEF). However, the possible association between arterial stiffness and subclinical left ventricular (LV) dysfunction and possible sex-specific differences remain unclarified. LV strain is emerging as a highly sensitive tool to unmask early LV abnormalities.

Purpose

We investigated whether increased arterial stiffness is independently associated with subclinical LV dysfunction in a large community-based cohort without overt cardiovascular disease.

Methods

We examined 1,155 participants who underwent extensive cardiovascular examination. Speckle-tracking echocardiography was employed to assess LV global longitudinal strain (LVGLS) and circumferential strain (GCS), and arterial stiffness was assessed by cardio-ankle vascular index (CAVI).

Results

Mean age was 62±12 years, and 56% were male. CAVI as continuous variable was associated with abnormal LVGLS (&gt;−18.6%), independent of cardiovascular risk factors and pertinent laboratory and echocardiographic parameters (adjusted odds ratio [OR] 1.23, p=0.034), whereas there was no relationship with LVGCS. In sex-stratified analysis, more pronounced association between quartiles of CAVI and abnormal LVGLS was observed in women than in men (unadjusted OR = 6.43 in women and 2.46 in men for upper quartile vs. lower quartile, both p&lt;0.01; Figure). Multivariable analyses demonstrated that CAVI was significantly associated with abnormal LVGLS independent of cardiovascular risk factors in both sexes. However, after further adjustment for LV mass index and diastolic parameters, the independent association persisted in women (adjusted OR 1.49, p=0.041), but not in men (adjusted OR 1.15, p=0.209).

Conclusion

Increased arterial stiffness was independently associated with decreased LVGLS even in the absence of overt cardiovascular disease; a sex-specific pattern exists in the alteration of vascular-ventricular coupling, which might partially explain the greater susceptibility to HFpEF in women.

Funding Acknowledgement

Type of funding source: None

Reinvestigation of the virulence of Rhodococcus equi isolates from patients with and without AIDS

Rhodococcus equi emerged as a zoonotic pathogen of human immunodeficiency virus-infected patients over the last three decades. Two virulence plasmid types of R. equi, pVAPA and pVAPB associated with equine and porcine isolates, have been recognized, and more recently, pVAPN, a novel host-associated virulence plasmid in R. equi, was found in bovine and caprine isolates. We reinvestigated 39 previously reported isolates of R. equi from patients with and without acquired immunodeficiency syndrome (AIDS) by detecting vapA, vapB and vapN using PCR and plasmid profiling. After excluding one isolate that could not be cultured from frozen storage, eight isolates carried a virulence plasmid encoding vapA (pVAPA), 10 carried a virulence plasmid encoding vapB (pVAPB), seven carried a virulence plasmid encoding vapN (pVAPN) and 13 were negative for those genes. Of the 29 isolates from patients with AIDS, 7, 10 and 5 harboured pVAPA, pVAPB and pVAPN respectively. Among nine isolates from patients without AIDS, one and two harboured pVAPA and pVAPN respectively. This study demonstrated that pVAPN-positive R. equi existed in human isolates before 1994 and reaffirmed that equine-associated pVAPA-positive, porcine-associated pVAPB-positive and bovine- or caprine-associated pVAPN-positive R. equi are widely spread globally. Because domestic animals might be major sources of human infection, further research is needed to reveal the prevalence of pVAPN-positive R. equi infection in cattle and goats.

Two-staged anterior urethroplasty using skin flap outside the scrotum: A case report

A thirty-eight-year-old man presented with acute urinary retention due to a long complicated strictures between the meatus and the bulbar urethra. During the first surgery, in addition to the penile skin flap, the flap of the incised skin at 10mm outside the scrotum strip-like tissue was moved medially and sutured onto the incised urethra. After 12 months of the first surgery, we performed the urethroplasty from the bulbar urethra to the meatus. Postoperatively, the patient voided without complications. Thus, this technique using a skin flap outside the scrotum is effective in long complicated urethral strictures.

Feasibility and necessity of the fourth arm of the da Vinci Si surgical system for robot-assisted partial nephrectomy

BACKGROUND

To investigate the feasibility of the fourth arm of the da Vinci Si system for robot-assisted partial nephrectomy (RAPN).

METHODS

Fifty-eight consecutive patients underwent RAPN with the same port placements. After reviewing the surgical videos and records, 38 patients showing usefulness of the fourth arm were categorized into Group A and those not showing usefulness into Group B. The background data, tumor characteristics, and perioperative outcomes were compared between the groups.

RESULTS

Group B had a larger proportion of tumors located on the inner side of the kidney, and the console time was significantly longer. Multivariable logistic regression analysis showed that tumors located on the inner side of the kidney were associated with the non-use of the fourth arm of the da Vinci Si system during RAPN.

CONCLUSIONS

Our findings suggested that use of fourth arm in RAPN by da Vinci Si should be considered for each tumor location.

Measures of body fatness and height in early and mid-to-late adulthood and prostate cancer: risk and mortality in The Pooling Project of Prospective Studies of Diet and Cancer

BACKGROUND

Advanced prostate cancer etiology is poorly understood. Few studies have examined associations of anthropometric factors (e.g. early adulthood obesity) with advanced prostate cancer risk.

PATIENTS AND METHODS

We carried out pooled analyses to examine associations between body fatness, height, and prostate cancer risk. Among 830 772 men, 51 734 incident prostate cancer cases were identified, including 4762 advanced (T4/N1/M1 or prostate cancer deaths) cases, 2915 advanced restricted (same as advanced, but excluding localized cancers that resulted in death) cases, 9489 high-grade cases, and 3027 prostate cancer deaths. Cox proportional hazards models were used to calculate study-specific hazard ratios (HR) and 95% confidence intervals (CI); results were pooled using random effects models.

RESULTS

No statistically significant associations were observed for body mass index (BMI) in early adulthood for advanced, advanced restricted, and high-grade prostate cancer, and prostate cancer mortality. Positive associations were shown for BMI at baseline with advanced prostate cancer (HR = 1.30, 95% CI = 0.95-1.78) and prostate cancer mortality (HR = 1.52, 95% CI = 1.12-2.07) comparing BMI ≥35.0 kg/m2 with 21-22.9 kg/m2. When considering early adulthood and baseline BMI together, a 27% higher prostate cancer mortality risk (95% CI = 9% to 49%) was observed for men with BMI <25.0 kg/m2 in early adulthood and BMI ≥30.0 kg/m2 at baseline compared with BMI <25.0 kg/m2 in early adulthood and BMI <30.0 kg/m2 at baseline. Baseline waist circumference, comparing ≥110 cm with <90 cm, and waist-to-hip ratio, comparing ≥1.00 with <0.90, were associated with significant 14%-16% increases in high-grade prostate cancer risk and suggestive or significant 20%-39% increases in prostate cancer mortality risk. Height was associated with suggestive or significant 33%-56% risks of advanced or advanced restricted prostate cancer and prostate cancer mortality, comparing ≥1.90 m with <1.65 m.

CONCLUSION

Our findings suggest that height and total and central adiposity in mid-to-later adulthood, but not early adulthood adiposity, are associated with risk of advanced forms of prostate cancer. Thus, maintenance of healthy weight may help prevent advanced prostate cancer.

Connexin43 Is Required for the Effective Activation of Spleen Cells and Immunoglobulin Production

Gap junctions (Gjs), formed by specific protein termed connexins (Cxs), regulate many important cellular processes in cellular immunity. However, little is known about their effects on humoral immunity. Here we tested whether and how Gj protein connexin43 (Cx43) affected antibody production in spleen cells. Detection of IgG in mouse tissues and serum revealed that wild-type (Cx43^+/+) mouse had a significantly higher level of IgG than Cx43 heterozygous (Cx43^+/−) mouse. Consistently, spleen cells from Cx43^+/+ mouse produced more IgG under both basal and lipopolysaccharide (LPS)-stimulated conditions. Further analysis showed that LPS induced a more dramatic activation of ERK and cell proliferation in Cx43^+/+ spleen cells, which was associated with a higher pro-oxidative state, as indicated by the increased NADPH oxidase 2 (NOX2), TXNIP, p38 activation and protein carbonylation. In support of a role of the oxidative state in the control of lymphocyte activation, exposure of spleen cells to exogenous superoxide induced Cx43 expression, p38 activation and IgG production. On the contrary, inhibition of NOX attenuated the effects of LPS. Collectively, our study characterized Cx43 as a novel molecule involved in the control of spleen cell activation and IgG production. Targeting Cx43 could be developed to treat certain antibody-related immune diseases.

2140Association of arterial stiffness with left atrial structure and phasic function: a community-based cohort study

Background

Increased arterial stiffness is recognized as an independent risk factor for atrial fibrillation, although the pathophysiological mechanisms remain unclear. Cardio-ankle vascular index (CAVI) is emerging as an important tool to assess arterial stiffness noninvasively which is derived from the concept of stiffness β index and is less dependent on blood pressure at the time of measurement than pulse wave velocity.

Purpose

This study aimed to investigate the association of arterial stiffness with left atrial (LA) volume and phasic function in a community-based cohort.

Methods

We included 1,156 participants without overt cardiovascular disease who underwent extensive cardiovascular examination. Arterial stiffness was evaluated by CAVI. Speckle-tracking echocardiography was employed to evaluate LA phasic function including reservoir, conduit and pump strain as well as left ventricular global longitudinal strain (LVGLS).

Results

CAVI was negatively correlated with reservoir and conduit strain (r=−0.37 and −0.45, both p<0.001; Figure), whereas weakly, but positively correlated with LA volume index and pump strain (r=0.12 and 0.09, both p<0.01). In multivariable analysis, CAVI was significantly associated with reservoir and conduit strain independent of traditional cardiovascular risk factors, pertinent laboratory parameters and LV morphology and function including LVGLS (standardized β=−0.22 and −0.26, respectively, both p<0.001), whereas there was no independent association with LA volume index and pump strain. In the categorical analysis, the abnormal CAVI (≥9.0) carried the significant risk of impaired reservoir (<31.4%) and conduit (<12.4%) strain (adjusted odds ratio = 2.63 and 3.71 vs. normal CAVI, both p<0.01) in a fully-adjusted model including laboratory and echocardiographic parameters.

Figure 1

Conclusion

Arterial stiffness was independently associated with LA reservoir and conduit function, even in the absence of overt cardiovascular disease. This association may explain the higher incidence of atrial fibrillation in individuals with increased arterial stiffness.

Metabolomics analysis of blood identifies potential biomarkers and possible treatment targets for nocturia

Background:

Our aim was to investigate the association between serum metabolites and nocturia.

Methods:

A total of 66 males aged 65–80 years were enrolled in this study and stratified according to micturition behavior, which was characterized in terms of the 24 h frequency volume chart (FVC) for 3 consecutive days, the International Prostate Symptom Score (IPSS), and quality-of-life score. The nocturia group included participants with any total IPSS and ⩾1.5 micturitions/night as the mean of 3 nights, while the control group included participants with total IPSS < 8 and <1.5 micturitions/night. We conducted a comprehensive capillary electrophoresis time-of-flight mass spectrometry (CE-TOFMS) study of plasma metabolites. Between-group comparisons of metabolite levels employed the Welch t test. The relationship between nocturia and metabolite profiles was determined using multivariable logistic regression analysis.

Results:

Of 66 participants, 45 were included in the nocturia group and 21 in the control group. There were no differences in background factors between the two groups. FVC analysis revealed that urine production during night-time, as well as micturition frequency during daytime and night-time were significantly higher in the nocturia group. CE-TOFMS identified eight metabolites whose plasma levels differed between the two groups. Multivariate analysis indicated that increased levels of lauric acid and imidazolelactic acid, as well as decreased levels of thiaproline and glycerol, contribute to the etiology of nocturia in aged men.

Conclusions:

Our findings suggest that abnormal serum levels of metabolites in several pathways play a role in the pathogenesis of nocturia in aged men.

Pharmacological levels of hydrogen sulfide inhibit oxidative cell injury through regulating the redox state of thioredoxin

Hydrogen sulfide (H₂S) is a gaseous mediator with multifaceted biological activities. It has anti-inflammatory and anti-oxidative effects. Currently, the mechanisms are not fully understood. Given that Trx/ASK1/P38 signaling pathway mediates many oxidative cell responses, we tested whether and how H₂S affected this pathway. Exposure of podocytes to Adriamycin (ADR), an antitumor drug, led to a P38-mediated oxidative cell injury, as evidenced by the increased protein carbonylation, oxidative activation of P38, and prevention of the cell death by antioxidants, NADPH oxidase inhibitor and P38 inhibitor. In the presence of H₂S donor NaHS, however, the podocyte injury was largely prevented. NaHS also significantly prevented cell death elicited by H₂O₂, menadione, and thioredoxin (Trx) inhibitors. These effects of H₂S were also associated with a potent inhibition of P38. Further analysis revealed that H₂S did not affect the protein level of TXNIP and Trx, two pivotal regulators of ASK1/P38 activation, but it promoted the dissociation of Trx from TXNIP. Moreover, it disrupted the H₂O₂-initiated polymerization of Trx and converted Trx from the oxidized to the reduced form. In HepG2 cells, inhibition of H₂S-producing enzyme cystathionine γ-lyase (CSE) increased Trx oxidation, promoted Trx binding to TXNIP and exaggerated cell injury caused by Trx inhibition. Collectively, our results indicate that H₂S exerted its antioxidative effects through the regulation of the redox state of Trx and interference with Trx/ASK1/P38 signaling pathway. Given the importance of the pathway in the mediation of multiple oxidative cell responses, our study thus provides novel mechanistic insight into the action of H₂S.

Cigarette smoking and cervical cancer risk: an evaluation based on a systematic review and meta-analysis among Japanese women

Background

There is a body of evidence to suggest that cigarette smoking increases the risk of cervical cancer in women, but no study has examined the magnitude of the association in Japanese women. Here, we evaluated the association between cigarette smoking and the risk of cervical cancer in Japanese women based on a systematic review of epidemiological evidence.

Methods

Original data were obtained from a MEDLINE search using PubMed or from a search of the 'Ichushi' database, as well as by a manual search. Evaluation of associations was based on the strength of evidence and the magnitude of association, together with biological plausibility as evaluated previously by the International Agency for Research on Cancer. Meta-analysis of associations was also conducted to obtain a summarized overview of the data.

Results

We identified two cohort studies and three case-control studies. All five studies had indicated strong positive associations between cigarette smoking and the risk of cervical cancer. Our summary estimate indicated that the relative risk (RR) for individuals who had ever-smoked relative to never-smokers was 2.03 (95% confidence interval: 1.49-2.57). Four studies had also demonstrated dose-response relationships between cigarette smoking and the risk of cervical cancer.

Conclusion

We conclude that there is convincing evidence that cigarette smoking increases the risk of cervical cancer among Japanese women.

A case of subcutaneous leiomyosarcoma of the scrotum presenting as a slowly growing mass in a 36-year-old male: A case report and literature review

Leiomyosarcoma of the scrotum, not involving the testis, epididymis, or spermatic cord, is a very rare type of tumor. A 36-year-old male presented with a slowly growing right scrotal mass (size: 3 × 2 cm). An ultrasound examination revealed a hypoechoic, subcutaneous, solid mass. Laboratory investigations detected normal levels of serum alpha-fetoprotein, beta-human chorionic gonadotropin, and lactate dehydrogenase. The mass was slowly growing and surgically resection was performed diagnosing leiomyosarcoma with histological examination. Wide local excision with a 2-cm margin around the operative scar and right orchiectomy were performed as second surgery. The patient has not suffered recurrence for 28 months.

Menstrual and reproductive factors and risk of vertebral fractures in Japanese women: the Japan Public Health Center-based prospective (JPHC) study

This large-scale population-based cohort study in Japan was conducted to clarify the effects of menstrual and reproductive factors on the risk of later-life vertebral fractures in women. Significant associations were seen for later menarche, irregular menstruation, and shorter reproductive years, corresponding to the effect of reproductive hormonal disturbance on bone metabolism.

INTRODUCTION

This study investigated the association between menstrual and reproductive factors and the risk of later-life vertebral fractures in women.

METHODS

Participants were 43,652 women aged 40-69 years who were followed in the 10-year survey of the Japan Public Health Center-based prospective (JPHC) study. Menstrual/reproductive factors were as follows: age at menarche and menopause, menstrual regularity and cycle length, natural or surgical menopause, years since menopause, reproductive years, parity, age at first birth, number of births, breastfeeding, and female hormone use. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by logistic regression analysis with adjustment for well-known fracture risk factors and menstrual/reproductive factors.

RESULTS

During the 10-year period, 250 women reported first onset of vertebral fractures. Menarche at ≥16 years [OR (95% CI) = 2.08 (1.24-3.48)] compared to ≤ 13 years and irregular menstruation [1.42 (1.01-2.00)] compared to regular menstruation showed significantly higher adjusted ORs. Longer reproductive years had significant inverse association [0.96 (0.92-0.99)] in menopausal women. Women with both menarche ≥ 15 years and irregular menstruation had higher adjusted ORs (95% CI) [2.37 (1.51-3.73) in all women, 2.25 (1.35-3.76) in menopausal women] compared to women without these, and both factors had significant interaction, particularly in menopausal women (additive p = 0.025, multiplicative p = 0.0499).

CONCLUSIONS

Menstrual and reproductive factors, corresponding to the effect of reproductive hormonal disturbance on bone metabolism, might affect the risk of later-life vertebral fractures.

The time-dependent variation of ATP release in mouse primary-cultured urothelial cells is regulated by the clock gene

AIMS

The sensation of bladder fullness (SBF) is triggered by the release of ATP. Therefore, the aim of this study was to investigate whether time-dependent changes in the levels of stretch-released ATP in mouse primary-cultured urothelial cells (MPCUCs) is regulated by circadian rhythm via clock genes.

METHODS

MPCUCs were derived from wild-type and Clock mutant mice (Clock^Δ19/Δ19 ), presenting a nocturia phenotype. They were cultured in elastic silicone chambers. Stretch-released ATP was quantified every 4 h by ATP photon count. An experiment was also performed to determine whether ATP release correlated with the rhythm of the expression of Piezo1, TRPV4, VNUT, and Connexin26 (Cx26) in MPCUCs regulated by clock genes with circadian rhythms. MPCUCs were treated with carbenoxolone, an inhibitor of gap junction protein; were derived from VNUT-KO mice; or treated with Piezo1-siRNA, TRPV4-siRNA, and Cx26-siRNA.

RESULTS

Stretch-released ATP showed time-dependent changes in wild-type mice and correlated with the rhythm of the expression of Piezo1, TRPV4, VNUT, and Cx26. However, these rhythms were disrupted in Clock^Δ19/Δ19 mice. Carbenoxolone eliminated the rhythmicity of ATP release in wild-type mice. However, time-dependent ATP release changes were maintained when a single gene was deficient such as VNUT-KO, Piezo1-, TRPV4-, and Cx26-siRNA.

CONCLUSIONS

ATP release in the bladder urothelium induces SBF and may have a circadian rhythm regulated by the clock genes. In the bladder urothelium, clock gene abnormalities may disrupt circadian ATP release by inducing Piezo1, TRPV4, VNUT, and Cx26. All these genes can trigger nocturia.

Evidence-based cancer prevention recommendations for Japanese

A comprehensive evidence-based cancer prevention recommendation for Japanese was developed. We evaluated the magnitude of the associations of lifestyle factors and infection with cancer through a systematic review of the literature, meta-analysis of published data, and pooled analysis of cohort studies in Japan. Then, we judged the strength of evidence based on the consistency of the associations between exposure and cancer and biological plausibility. Important factors were extracted and summarized as an evidence-based, current cancer prevention recommendation: 'Cancer Prevention Recommendation for Japanese'. The recommendation addresses six important domains related to exposure and cancer, including smoking, alcohol drinking, diet, physical activity, body weight and infection. The next step should focus on the development of effective behavior modification programs and their implementation and dissemination.

Predictive performance of a genetic risk score using 11 susceptibility alleles for the incidence of Type 2 diabetes in a general Japanese population: a nested case-control study

AIMS

To assess the predictive ability of a genetic risk score for the incidence of Type 2 diabetes in a general Japanese population.

METHODS

This prospective case-control study, nested within a Japan Public Health Centre-based prospective study, included 466 participants with incident Type 2 diabetes over a 5-year period (cases) and 1361 control participants, as well as 1463 participants with existing diabetes and 1463 control participants. Eleven susceptibility single nucleotide polymorphisms, identified through genome-wide association studies and replicated in Japanese populations, were analysed.

RESULTS

Most single nucleotide polymorphism loci showed directionally consistent associations with diabetes. From the combined samples, one single nucleotide polymorphism (rs2206734 at CDKAL1) reached a genome-wide significance level (odds ratio 1.28, 95% CI 1.18-1.40; P = 1.8 × 10^-8 ). Three single nucleotide polymorphisms (rs2206734 in CDKAL1, rs2383208 in CDKN2A/B, and rs2237892 in KCNQ1) were nominally significantly associated with incident diabetes. Compared with the lowest quintile of the total number of risk alleles, the highest quintile had a higher odds of incident diabetes (odds ratio 2.34, 95% CI 1.59-3.46) after adjusting for conventional risk factors such as age, sex and BMI. The addition to the conventional risk factor-based model of a genetic risk score using the 11 single nucleotide polymorphisms significantly improved predictive performance; the c-statistic increased by 0.021, net reclassification improved by 6.2%, and integrated discrimination improved by 0.003.

CONCLUSIONS

Our prospective findings suggest that the addition of a genetic risk score may provide modest but significant incremental predictive performance beyond that of the conventional risk factor-based model without biochemical markers.

The oscillation of intracellular Ca2+ influx associated with the circadian expression of Piezo1 and TRPV4 in the bladder urothelium

We previously showed that bladder functions are controlled by clock genes with circadian rhythm. The sensation of bladder fullness (SBF) is sensed by mechano-sensor such as Piezo1 and TRPV4 in the mouse bladder urothelium. However, functional circadian rhythms of such mechano-sensors remain unknown. To investigate functional circadian changes of these mechano-sensors, we measured circadian changes in stretch-evoked intracellular Ca²⁺ influx ([Ca²⁺] _i ) using mouse primary cultured urothelial cells (MPCUCs). Using Ca²⁺ imaging, stretch-evoked [Ca²⁺] _i was quantified every 4 h in MPCUCs derived from wild-type (WT) and Clock ^Δ19/Δ19 mice, which showed a nocturia phenotype. Furthermore, a Piezo1 inhibitor GsMTx4 and a TRPV4 inhibitor Ruthenium Red were applied and stretch-evoked [Ca²⁺] _i in MPCUCs was measured to investigate their contribution to SBF. Stretch-evoked [Ca²⁺] _i showed a circadian rhythm in the WT mice. In contrast, Clock ^Δ19/Δ19 mice showed disrupted circadian rhythm. The administration of both GsMTx4 and Ruthenium Red eliminated the circadian rhythm of stretch-evoked [Ca²⁺] _i in WT mice. We conclude that SBF may have a circadian rhythm, which is created by functional circadian changes of Piezo1 and TRPV4 being controlled by clock genes to be active during wakefulness and inactive during sleep. Abnormalities of clock genes disrupt SBF, and induce nocturia.