Sperm-specific histone H1 in highly condensed sperm nucleus of Sargassum horneri

Spermatogenesis is one of the most dramatic changes in cell differentiation. Remarkable chromatin condensation of the nucleus is observed in animal, plant, and algal sperm. Sperm nuclear basic proteins (SNBPs), such as protamine and sperm-specific histone, are involved in chromatin condensation of the sperm nucleus. Among brown algae, sperm of the oogamous Fucales algae have a condensed nucleus. However, the existence of sperm-specific SNBPs in Fucales algae was unclear. Here, we identified linker histone (histone H1) proteins in the sperm and analyzed changes in their gene expression pattern during spermatogenesis in Sargassum horneri. A search of transcriptomic data for histone H1 genes in showed six histone H1 genes, which we named ShH1.1a, ShH1b, ShH1.2, ShH1.3, ShH1.4, and ShH1.5. Analysis of SNBPs using SDS-PAGE and LC-MS/MS showed that sperm nuclei contain histone ShH1.2, ShH1.3, and ShH1.4 in addition to core histones. Both ShH1.2 and ShH1.3 genes were expressed in the vegetative thallus and the male and female receptacles (the organs producing antheridium or oogonium). Meanwhile, the ShH1.4 gene was expressed in the male receptacle but not in the vegetative thallus and female receptacles. From these results, ShH1.4 may be a sperm-specific histone H1 of S. horneri.

Erratum: Search for Cosmic-Ray Boosted Sub-GeV Dark Matter Using Recoil Protons at Super-Kamiokande [Phys. Rev. Lett. 130, 031802 (2023)]

This corrects the article DOI: 10.1103/PhysRevLett.130.031802.

Colloid Carcinoma Arising in an Intestinal-Type Intraductal Papillary Mucinous Neoplasm with High-Grade Dysplasia Appearing as Signet-Ring Cells of the Pancreas by Serial Pancreatic Juice Aspiration Cytology: A Case Report

We report a case of colloid carcinoma (CC) arising from an intestinal-type intraductal papillary mucinous neoplasm with high-grade dysplasia (IPMNHGD) of the pancreas, diagnosed with serial pancreatic juice aspiration cytological examination (SPACE). A rapidly growing intraductal papillary mucinous neoplasm (IPMN) in a 71-year-old Japanese man accelerated his hospitalization in our institute. Clinically, a large, ruptured pancreatic cyst was suspected. Cytologically, several mucin-positive signet-ring cells were scattered in the inflammatory, necrotic, or mucinous background. Signet-ring cells in cell block specimens were immunoreactive for MUC2, MUC5AC, maspin, S100P, and claudin-18. The final cytologic diagnosis was CC arising in an intestinal-type IPMNHGD with intraperitoneal penetration. The patient died two months after an explorative laparotomy. The cytologic diagnosis was achieved through SPACE, and the presence of signet-ring cells was characteristic. Anti-claudin-18.2-specific monoclonal antibody therapy will likely be used to treat patients with IPMNHGD in the future. This case highlights the diagnostic utility of SPACE, with particular emphasis on the characteristic presence of signet-ring cells. Furthermore, it anticipates the potential use of anti-claudin-18.2- specific monoclonal antibody therapy in the management of IPMNHGD patients.

Measurements of neutrino oscillation parameters from the T2K experiment using 3.6×1021 protons on target

The T2K experiment presents new measurements of neutrino oscillation parameters using 19.7 ( 16.3 ) × 10 20 protons on target (POT) in (anti-)neutrino mode at the far detector (FD). Compared to the previous analysis, an additional 4.7 × 10 20 POT neutrino data was collected at the FD. Significant improvements were made to the analysis methodology, with the near-detector analysis introducing new selections and using more than double the data. Additionally, this is the first T2K oscillation analysis to use NA61/SHINE data on a replica of the T2K target to tune the neutrino flux model, and the neutrino interaction model was improved to include new nuclear effects and calculations. Frequentist and Bayesian analyses are presented, including results on sin 2 θ 13 and the impact of priors on the δ CP measurement. Both analyses prefer the normal mass ordering and upper octant of sin 2 θ 23 with a nearly maximally CP-violating phase. Assuming the normal ordering and using the constraint on sin 2 θ 13 from reactors, sin 2 θ 23 = 0 . 561 - 0.032 + 0.021 using Feldman-Cousins corrected intervals, and Δ m 32 2 = 2 . 494 - 0.058 + 0.041 × 10 - 3 eV 2 using constant Δ χ 2 intervals. The CP-violating phase is constrained to δ CP = - 1 . 97 - 0.70 + 0.97 using Feldman-Cousins corrected intervals, and δ CP = 0 , π is excluded at more than 90% confidence level. A Jarlskog invariant of zero is excluded at more than 2 σ credible level using a flat prior in δ CP , and just below 2 σ using a flat prior in sin δ CP . When the external constraint on sin 2 θ 13 is removed, sin 2 θ 13 = 28 . 0 - 6.5 + 2.8 × 10 - 3 , in agreement with measurements from reactor experiments. These results are consistent with previous T2K analyses.

SAFARIS: a spatial analytic framework for pest forecast systems

Non-native pests and diseases pose a risk of economic and environmental damage to managed and natural U.S. forests and agriculture. The U.S. Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS) Plant Protection and Quarantine (PPQ) protects the health of U.S. agriculture and natural resources against invasive pests and diseases through efforts to prevent the entry, establishment, and spread of non-native pests and diseases. Because each pest or disease has its own idiosyncratic characteristics, analyzing risk is highly complex. To help PPQ better respond to pest and disease threats, we developed the Spatial Analytic Framework for Advanced Risk Information Systems (SAFARIS), an integrated system designed to provide a seamless environment for producing predictive models. SAFARIS integrates pest biology information, climate and non-climate data drivers, and predictive models to provide users with readily accessible and easily customizable tools to analyze pest and disease risks. The phenology prediction models, spread forecasting models, and other climate-based analytical tools in SAFARIS help users understand which areas are suitable for establishment, when surveys would be most fruitful, and aid in other analyses that inform decision-making, operational efforts, and rapid response. Here we introduce the components of SAFARIS and provide two use cases demonstrating how pest-specific models developed with SAFARIS tools support PPQ in its mission. Although SAFARIS is designed to address the needs of PPQ, the flexible, web-based framework is publicly available, allowing any user to leverage the available data and tools to model pest and disease risks.

Prognostic value of increased intraepithelial lymphocytes and lymphocytic clonality in dogs with chronic enteropathy or small-cell lymphoma

The clinical significance of severe infiltration of small intraepithelial lymphocytes (IEL) and the results of polymerase chain reaction for antigen receptor rearrangement (PARR) in dogs with chronic enteropathy (CE) and small-cell lymphoma (SCL) are controversial. This cohort study aimed to evaluate the prognostic significance of the IEL and PARR results in dogs with CE or SCL. Although definitive diagnostic histopathological criteria for SCL in dogs have yet to be established, dogs with the histopathological findings of severe IEL infiltration were diagnosed with SCL in this study. One hundred and nineteen dogs were recruited, with 23 dogs classified as having SCL and 96 dogs as having CE. The positive rate of PARR was 59.6% (71/119) in the duodenum and 57.7% (64/111) in the ileum. Subsequently, three dogs with SCL and four dogs with CE developed large-cell lymphoma (LCL). The median overall survival (OS) of dogs with SCL was 700 days (range, 6-1410 days), and that of dogs with CE was not reached. In the log-rank test, shorter OS was observed in cases with histopathological SCL (P = 0.035), clonal TCRγ rearrangement in the duodenum (P < 0.012), and clonal IgH rearrangement in the ileum (P < 0.0001). The Cox proportional hazards model adjusted for sex and age showed that histopathological SCL (hazard ratio [HR] 1.74; 95% confidence interval [CI], 0.83-3.65), duodenal clonal TCRγ rearrangement (HR, 1.80; 95% CI, 0.86-3.75), and ileal clonal IgH rearrangement (HR, 2.28; 95% CI, 0.92-5.70) could shorten overall survival, although their 95% CIs included 1.0. These results indicate that severe IEL infiltration could be a useful histopathological feature for diagnosing SCL, and clonality-positive results could be a negative prognostic factor in dogs with CE. Furthermore, the development of LCL should be carefully monitored in dogs with CE and SCL.

Contaminated consignment simulation to support risk-based inspection design

Invasive nonnative plant pests can cause extensive environmental and economic damage and are very difficult to eradicate once established. Phytosanitary inspections that aim to prevent biological invasions by limiting movement of nonnative plant pests across borders are a critical component of the biosecurity continuum. Inspections can also provide valuable information about when and where plant pests are crossing national boundaries. However, only a limited portion of the massive volume of goods imported daily can be inspected, necessitating a highly targeted, risk-based strategy. Furthermore, since inspections must prioritize detection and efficiency, their outcomes generally cannot be used to make inferences about risk for cargo pathways as a whole. Phytosanitary agencies need better tools for quantifying pests going undetected and designing risk-based inspection strategies appropriate for changing operational conditions. In this research, we present PoPS (Pest or Pathogen Spread) Border, an open-source consignment inspection simulator for measuring inspection outcomes under various cargo contamination scenarios to support recommendations for inspection protocols and estimate pest slippage rates. We used the tool to estimate contamination rates of historical interception data, quantify tradeoffs in effectiveness and workload for inspection strategies, and identify vulnerabilities in sampling protocols as changes in cargo configurations and contamination occur. These use cases demonstrate how this simulation approach permits testing inspection strategies and measuring quantities that would otherwise be impossible in a field-based setting. This work represents the first steps toward a decision support tool for creating dynamic inspection protocols that respond to changes in available resources, workload, and commerce trends.

Search for Cosmic-Ray Boosted Sub-GeV Dark Matter Using Recoil Protons at Super-Kamiokande

We report a search for cosmic-ray boosted dark matter with protons using the 0.37  megaton×years data collected at Super-Kamiokande experiment during the 1996-2018 period (SKI-IV phase). We searched for an excess of proton recoils above the atmospheric neutrino background from the vicinity of the Galactic Center. No such excess is observed, and limits are calculated for two reference models of dark matter with either a constant interaction cross section or through a scalar mediator. This is the first experimental search for boosted dark matter with hadrons using directional information. The results present the most stringent limits on cosmic-ray boosted dark matter and exclude the dark matter-nucleon elastic scattering cross section between 10^{-33}cm^{2} and 10^{-27}cm^{2} for dark matter mass from 1  MeV/c^{2} to 300  MeV/c^{2}.

Neuromedin U-deficient rats do not lose body weight or food intake

Studies in genetically modified mice establish that essential roles of endogenous neuromedin U (NMU) are anorexigenic function and metabolic regulation, indicating that NMU is expected to be a potential target for anti-obesity agents. However, in central administration experiments in rats, inconsistent results have been obtained, and the essential role of NMU energy metabolism in rats remain unclear. This study aims to elucidate the role of endogenous NMU in rats. We generated NMU knockout (KO) rats that unexpectedly showed no difference in body weight, adiposity, circulating metabolic markers, body temperature, locomotor activity, and food consumption in both normal and high fat chow feeding. Furthermore, unlike reported in mice, expressions of Nmu and NMU receptor type 2 (Nmur2) mRNA were hardly detectable in the rat hypothalamic nuclei regulating feeding and energy metabolism, including the arcuate nucleus and paraventricular nucleus, while Nmu was expressed in pars tuberalis and Nmur2 was expressed in the ependymal cell layer of the third ventricle. These results indicate that the species-specific expression pattern of Nmu and Nmur2 may allow NMU to have distinct functions across species, and that endogenous NMU does not function as an anorexigenic hormone in rats.

High-precision measurement of the W boson mass with the CDF II detector

The mass of the W boson, a mediator of the weak force between elementary particles, is tightly constrained by the symmetries of the standard model of particle physics. The Higgs boson was the last missing component of the model. After observation of the Higgs boson, a measurement of the W boson mass provides a stringent test of the model. We measure the W boson mass, M_W, using data corresponding to 8.8 inverse femtobarns of integrated luminosity collected in proton-antiproton collisions at a 1.96 tera-electron volt center-of-mass energy with the CDF II detector at the Fermilab Tevatron collider. A sample of approximately 4 million W boson candidates is used to obtain [Formula: see text], the precision of which exceeds that of all previous measurements combined (stat, statistical uncertainty; syst, systematic uncertainty; MeV, mega-electron volts; c, speed of light in a vacuum). This measurement is in significant tension with the standard model expectation.

Surgical treatment for non-tuberculous mycobacterial pulmonary disease: analysis of prognostic factors

BACKGROUND: The surgical treatment for non-tuberculous mycobacterial pulmonary disease (NTM-PD) has an important adjunctive role and reported outcomes have been generally good; however, the prognostic factors remain unclear.METHODS: Sixty-one patients with NTM-PD who underwent surgical resection for a therapeutic purpose from January 2000 to March 2017 at five affiliated institutions were enrolled. We explored the factors that influence complications and prognosis by retrospectively referring to the medical records.RESULTS: The mean age of the present cohort was 61.8 ± 11.4 years. The pathogen was Mycobacterium avium complex in 49 patients, M. abscessus in 5. The most common indications were refractory to medication in 39. The surgical techniques employed were lobectomy or further resection in 49, sublobar resection in 8, with video-assisted thoracoscopic surgery in 21. Sputum culture conversion rate was 95.1%. Univariate analysis of factors associated with deterioration revealed significant differences related to age (P = 0.025), pre-operative albumin level (P = 0.001) and development of postoperative complications (P = 0.037), while pre-operative albumin level alone was a significant factor in multivariate analysis (P = 0.009).CONCLUSION: Outcomes after resection were generally good in the present cases. Nutritional status, as indicated by albumin level, may affect prognosis after surgical treatment.

Iteratively forecasting biological invasions with PoPS and a little help from our friends

Ecological forecasting has vast potential to support environmental decision making with repeated, testable predictions across management-relevant timescales and locations. Yet resource managers rarely use co-designed forecasting systems or embed them in decision making. Although prediction of planned management outcomes is particularly important for biological invasions to optimize when and where resources should be allocated, spatial-temporal models of spread typically have not been openly shared, iteratively updated, or interactive to facilitate exploration of management actions. We describe a species-agnostic, open-source framework - called the Pest or Pathogen Spread (PoPS) Forecasting Platform - for co-designing near-term iterative forecasts of biological invasions. Two case studies are presented to demonstrate that iterative calibration yields higher forecast skill than using only the earliest-available data to predict future spread. The PoPS framework is a primary example of an ecological forecasting system that has been both scientifically improved and optimized for real-world decision making through sustained participation and use by management stakeholders.

Azathioprine-induced severe myelosuppression accompanied by massive hair loss and painful oral ulcer in an autoimmune hepatitis patient with NUDT15 minor variant: A case report

This report highlights azathioprine-induced severe myelosuppression in the patient with NUDT15 minor variant. This case report is particularly instructive because several typical symptoms are the clues to this critical adverse drug reaction.

Surgical outcomes of totally extraperitoneal repair for inguinal hernia: A retrospective multicenter propensity score-matched study

BACKGROUND

Laparoscopic surgical approaches, including total extraperitoneal repair (TEP), have been widely accepted for inguinal hernia repair in Japan. However, there are limited data regarding recurrence after TEP in Japan, given the limited versatility of this procedure. This study retrospectively evaluated the rates of hernia recurrence after TEP and open mesh repair at multiple Japanese centers.

METHODS

This retrospective study evaluated 1917 patients who underwent inguinal hernia repair at 32 institutions in the Oita prefecture between January 2014 and December 2015. Eligible patients were grouped according to whether they underwent TEP (1011 patients) or open mesh repair (636 patients). Propensity score matching was performed 1:1 (total: 1076 patients, 538 patients from each group). The outcomes of interest were recurrence, morbidity, and postoperative recovery.

RESULTS

The TEP and open mesh repair groups had similar baseline characteristics. After propensity score matching, there was no significant difference between the two groups in terms of recurrence rate (TEP: 0.5% vs open mesh repair: 1.0%, P = .375). However, the TEP group had significantly longer operating times (median: 70.2 min vs 65.0 min, P < .001), significantly less blood loss (0-5.1 mL vs 0-20.4 mL, P < .001), and significantly shorter postoperative hospital stays (median: 5.0 days vs 6.4 days, P < .001). The overall incidences of morbidity were 6.2% in the TEP group and 7.2% in the open mesh repair group (P = .535).

CONCLUSION

This multicenter retrospective study with propensity score matching revealed that the recurrence rates were similarly low for TEP and open mesh repair of inguinal hernia. Thus, a well-trained surgical team could use TEP as a standard procedure.

Modeling the Effectiveness of TV and Social Media Advertisements on the Dynamics of Water-Borne Diseases

Cholera is a serious threat to the health of human-kind all over the world and its control is a problem of great concern. In this context, a nonlinear mathematical model to control the prevalence of cholera disease is proposed and analyzed by incorporating TV and social media advertisements as a dynamic variable. It is considered that TV and social media ads propagate the knowledge among the people regarding the severe effects of cholera disease on human health along with its precautionary measures. It is also assumed that the mode of transmission of cholera disease among susceptible individuals is due to consumption of contaminated drinking water containing Vibrio cholerae. Moreover, the propagation of knowledge through TV and social media ads makes the people aware to adopt precautionary measures and also the aware people make some effectual efforts to washout the bacteria from the aquatic environment. Model analysis reveals that increase in the washout rate of bacteria due to aware individuals causes the stability switch. It is found that TV and social media ads have the potential to reduce the number of infectives in the region and thus control the cholera epidemic. Numerical simulation is performed for a particular set of parameter values to support the analytical findings.

A cross-sectional study on metabolic similarities and differences between inpatients with schizophrenia and those with mood disorders

BACKGROUND

One of the main causes of death in psychiatric patients is cardiovascular diseases which are closely related with lifestyle-related diseases. Psychiatric disorders include schizophrenia and mood disorders, whose symptoms and treatment medicines are different, suggesting that they might have different metabolic disorders. Thus, we studied the differences of lifestyle-related diseases between schizophrenia and mood disorders in Japan.

METHODS

This cross-sectional study was performed from 2015 to 2017. Study participants were 189 Japanese hospitalized patients (144 schizophrenia group, 45 mood disorders group) in the department of psychiatry at Kohnodai hospital. We examined physical disorders, metabolic status of glucose and lipid, estimated glomerular filtration rate (eGFR) and brain magnetic resonance imaging. We compared these data between schizophrenia and mood disorders groups using analysis of covariance or logistic regression analysis. In comparisons between inpatients with schizophrenia or mood disorders group and the standard, we quoted 'The National Health and Nutrition Survey in Japan 2015' by Ministry of Health, Labor and Welfare as the standard.

RESULTS

eGFR and prevalence of smoking were significantly lower in patients with mood disorder group than those with schizophrenia group by adjustment for age. In comparisons between patients with schizophrenia group or mood disorders group and each standard, the ratio of silent brain infarction (SBI) and cerebral infarction were significantly high in both groups. Schizophrenia group showed significantly higher prevalence of diabetes, low high-density lipoprotein (HDL) cholesterolemia, metabolic syndrome and smoking than the standard. Mood disorders group had significantly high prevalence of low HDL-cholesterolemia compared with the standard. Fasting blood glucose and HbA1c were significantly higher in schizophrenia group and female mood disorders group than the standard. Female mood disorders group had significantly decreased eGFR with increased ratio of eGFR < 60 ml/min than the standard.

CONCLUSIONS

Participants of both groups had increased ratio of SBI and cerebral infarction, accompanied with glucose and lipid disorders. Compared with schizophrenia group, mood disorders group showed significantly low eGFR and prevalence of smoking.

Metabolic changes of Japanese schizophrenic patients transferred from hospitalization to outpatients

It is well known that schizophrenic patients have high incidence of metabolic syndrome and life-style related diseases. There are reports that the rates of these diseases are increased more in outpatients than inpatients, but are also reports that the rates are not different between both patient groups. These differences might be related to the length of hospitalization. Hospitalization of Japanese psychiatric patients is about 300 days, much longer than western countries (below 50 days). Therefore, we investigated lipid and glucose metabolism of schizophrenic patients transferred from hospitalization to outpatients at Kohnodai hospital with a mean of 80 days hospitalization period to clarify metabolic characteristics in Japanese patients. Study participants were 144 schizophrenia inpatients and 109 outpatients at Kohnodai Hospital. These 109 outpatients were followed for approximately 2 years, without changes of administrated drugs, and from 144 inpatients. Data from outpatients were obtained at 6 months, 1 year and 2 years after their discharge. Outpatients 2 years after discharge had significantly higher levels of total cholesterol, triglyceride and non-high density lipoprotein (non-HDL) cholesterol than inpatients, accompanied with an increase of body weight. Serum HDL-cholesterol (HDL-C), low density lipoprotein-cholesterol (LDL-C), fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) levels had no significant difference between both groups. These lipids and glucose levels also showed the same tendency in outpatients 0.5 year and 1 year after discharge as those after 2 years. We found that schizophrenic patients in our study appeared to have changes of lipid metabolism 2 years after their discharge, but no significant changes of glucose metabolism, such as FPG and HbA1c.

Rare Neurologic Disease-Associated Mutations of AIMP1 are Related with Inhibitory Neuronal Differentiation Which is Reversed by Ibuprofen

Background: Hypomyelinating leukodystrophy 3 (HLD3), previously characterized as a congenital diseases associated with oligodendrocyte myelination, is increasingly regarded as primarily affecting neuronal cells. Methods: We used N1E-115 cells as the neuronal cell model to investigate whether HLD3-associated mutant proteins of cytoplasmic aminoacyl-tRNA synthase complex-interacting multifunctional protein 1 (AIMP1) aggregate in organelles and affect neuronal differentiation. Results: 292CA frame-shift type mutant proteins harboring a two-base (CA) deletion at the 292th nucleotide are mainly localized in the lysosome where they form aggregates. Similar results are observed in mutant proteins harboring the Gln39-to-Ter (Q39X) mutation. Interestingly, the frame-shift mutant-specific peptide specifically interacts with actin to block actin fiber formation. The presence of actin with 292CA mutant proteins, but not with wild type or Q39X ones, in the lysosome is detectable by immunoprecipitation of the lysosome. Furthermore, expression of 292CA or Q39X mutants in cells inhibits neuronal differentiation. Treatment with ibuprofen reverses mutant-mediated inhibitory differentiation as well as the localization in the lysosome. Conclusions: These results not only explain the cell pathological mechanisms inhibiting phenotype differentiation in cells expressing HLD3-associated mutants but also identify the first chemical that restores such cells in vitro.

Search for Electron Antineutrino Appearance in a Long-Baseline Muon Antineutrino Beam

Electron antineutrino appearance is measured by the T2K experiment in an accelerator-produced antineutrino beam, using additional neutrino beam operation to constrain parameters of the Pontecorvo-Maki-Nakagawa-Sakata (PMNS) mixing matrix. T2K observes 15 candidate electron antineutrino events with a background expectation of 9.3 events. Including information from the kinematic distribution of observed events, the hypothesis of no electron antineutrino appearance is disfavored with a significance of 2.40σ and no discrepancy between data and PMNS predictions is found. A complementary analysis that introduces an additional free parameter which allows non-PMNS values of electron neutrino and antineutrino appearance also finds no discrepancy between data and PMNS predictions.

Fucosyltransferase 8 plays a crucial role in the invasion and metastasis of pancreatic ductal adenocarcinoma

PURPOSE

Pancreatic ductal adenocarcinoma (PDAC) is the most common type of pancreatic cancer. It is an aggressive malignancy associated with poor prognosis because of recurrence, metastasis, and treatment resistance. Aberrant glycosylation of cancer cells triggers their migration and invasion and is considered one of the most important prognostic cancer biomarkers. The current study aimed to identify glycan alterations and their relationship with the malignant potential of PDAC.

METHODS

Using a lectin microarray, we evaluated glycan expression in 62 PDAC samples. Expression of fucosyltransferase 8 (FUT8), the only enzyme catalyzing core fucosylation, was investigated by immunohistochemistry. The role of FUT8 in PDAC invasion and metastasis was confirmed using an in vitro assay and a xenograft peritoneal metastasis mouse model.

RESULTS

The microarray data demonstrated that core fucose-binding lectins were significantly higher in carcinoma than in normal pancreatic duct tissues. Similarly, FUT8 protein expression was significantly higher in carcinoma than in normal pancreatic duct tissues. High FUT8 protein expression was significantly associated with lymph-node metastases and relapse-free survival. FUT8 knockdown significantly reduced the invasion in PDAC cell lines and impaired peritoneal metastasis in the xenograft model.

CONCLUSIONS

The findings of this study provide evidence that FUT8 plays a pivotal role in PDAC invasion and metastasis and might be a therapeutic target for this disease.

P1307 An echocardiographic observation over the disappearing process of the prosthetic valve thrombus caused by the inflammatory hypercoagulability; a case report

Background

Whenever fever and inflammatory reaction continue for a while in the patients with a prosthetic valve, than usual, we must keep infective endocarditis in mind. On the other hand, inflammation and thrombosis are well known to coexist often. There are several reports of thrombotic valves associated with inflammation-activated hypercoagulability. Furthermore, C-reactive protein (CRP) has been reported to imply an increased risk of thrombus especially in the presence of an injury on the prosthetic valve.

Case report

We report a case of a 70-year-old male with a leaflet thrombus on the bioprosthetic aortic valve. He suffered from fever, and symptoms of heart failure and was hospitalized for treatment. Blood tests presented that white blood cell count was 4900/μL (neutrophil 81.1%) and CRP 10.82 mg/dL. Infectious endocarditis (IE) was suspected. Transthoracic echocardiography (TTE) was per-formed, however, vegetation and abscess were not found. Noteworthily, the bioprosthetic valve leaflet on the right coronary cusp showed thickening and opening dysfunction (Figure A, parasternal short axis). Mean pressure gradient (mPG) through the aortic valve was 15mmHg and peak velocity (Vmax) 2.7m/s. Blood culture was negative, and his body temperature and CRP were improved by empirical antibiotic administration. The anticoagulation therapy with warfarin was started, he was discharged from the hospital and followed up in the outpatient clinic. TTE after the initiation of anticoagulation therapy, did not reveal any more dysfunction on the bioprosthetic valve (mPG: 9mmHg, Vmax: 2.2m/s) (Figure B, parasternal short axis). The diagnostic and therapeutic process of this case implied success. The opening-dysfunction of prosthetic valve leaflets was reversible and therefore, we concluded that the thickening of the prosthetic valve could be attributed to thrombus adhesion. Computed Tomography (CT) was not performed because he suffered from chronic kidney disease.

Conclusion

Surely, CT is very useful for the evaluation of thrombotic valves in the patients in whom it is permissible to use contrast agent. However, we could successfully evaluate the recovery process of leaflet thrombosis by echocardiography because of a difficult reason of CT use in this case. The prolongation of inflammatory reaction in the patients with a prosthetic valve should keep IE in mind in everyday life. Even if the findings of bacterial infection are obscure, it is more and more important to observe carefully the change of leaflets, whenever an open-dysfunction and a thrombus adhesion of the prosthetic valves exist.

Abstract P1307 Figure.

P702 An unusual echocardiographic finding of protrusive vegetation caused by perivalvular abscess perforation into the left atrium

Background

It is well-known that Infective endocarditis (IE) caused by S. aureus progresses rapidly and is highly destructive. The most often abscess formation after aortic valve replacement (AVR) is the mitral-aortic intervalvular fibrosa (MAIVF). It is difficult to cure MAIVF radically once infection occurs, and then the abscess tends to spread. After abscess formation is once established, IE tends to be widespread, the prognosis is definitely poor unless surgical repairment is executed, and then an emergency surgery is essential and unavoidable for complete cure. We report an unusual case of aortic valve abscess with perforation of vegetation into the left atrium after aortic valve replacement.

Case report

A 77-year-old man underwent the bioprosthetic AVR for aortic valve stenosis one month ago. On the 9th day after discharge, he visited the hospital for the follow-up. At the time, the body temperature was 36.6 ° C, the blood pressure 133/50 mmHg, white blood cell count 10500/μL, and C-reactive protein 3.31 mg/dL. Transthoracic echocardiography (TTE) demonstrated the perivalvular abscesses on the prosthetic aortic valve and mass structures attached to the MAIVF in the left atrium (Figure A, C). He was hospitalized again and had an emergency re-operation. Intraoperative transesophageal echocardiography (TEE) showed a perivalvular abscess on the prosthetic valve, and a high-intensity structure (vegetation like) protruding from the Valsalva Sinus into the left atrium of the MAIVF (Figure B, D). Surgical findings did not reveal any wart on the native valve itself. One-third of the annulus was disrupted. The subvalvular tissue all around was abscessed. Notably, the abscess cavity between NCC and LCC reached MAIVF of the anterior mitral leaflet, and the structure projecting to the left atrium was vegetation. In this case, TTE pointed out a perivalvular abscess of the aortic valve, IE was suspected at the time of outpatient visit at an early stage after discharge, and the spread of inflammation was observed with a high speed beyond the expectation at the time of operation.

Conclusion

Early after the operation, TTE revealed a mass was protruded into the left atrium. Generally, vegetation is soft and flexible in itself. However, in this case, the vegetation was less mobile, and for that reason, abscesses or tumors were suspected. TEE enabled us to obtain anatomically more detailed information and to foresee the left atrial wall repairment at the time of reoperation. We reported an unusual case of IE with solid vegetation attached to the wall and difficult to diagnose.

Abstract P702 Figure.

P248 Changes of atrial septum defect caused by posture during three-dimensional transesophageal echocardiography ( a case of Platypnea-orthodeoxia syndrome)

Background

Platypnea-Orthodeoxia syndrome (POS) is a rare phenomenon which is characterized postural hypoxia due to the intracardiac shunt from right to left through a patent foramen ovale, an atrial septal defect or a pulmonary arteriovenous malformation. POS is often underestimated because the hypoxia by postural change is difficult to be detected. We evaluated three-dimensional transesophageal echocardiography (TEE) to diagnose POS in an elderly patient.

Case report

A 84-year-old woman suffered from repetitive syncope for several years. She undertook twelve leads electrocardiogram (ECG), screening transthoracic echocardiography (TTE), twenty-four hours ECG and treadmill stress ECG, however, the cause of syncope was not identified. After another syncope event happened, she was transferred to the emergency room. Then, the hypoxia caused by sitting position was pointed out for the first time.

Her hypoxia was improved by supine position and oxygen administration. TTE demonstrated no right heart enlargement. Shunt flow was suspected on her atrial septum; however, it was difficult to reveal it by TTE because of her obesity. Therefore, she underwent intravenous saline injection test. In the decubitus position, an intravenous injection of saline under Valsalva maneuver revealed the shunt flow from the right atrium to the left atrium. Her arterial oxygen saturation (SpO2) was 95%. In the sitting position, a visible shunt flow was observed, then her SpO2 dropped to 85%. By TEE, the shunt hole was found in the oval fossa of the atrial septum. TEE was evaluated by different positions. The atrial defect hole became larger in the sitting position (area 1.05cm2) than in the supine position (area 0.43cm2). As a result, the postural change to sitting revealed Platypnea-Orthodeoxia syndrome associated with ASD. The pulmonary blood flow/systemic blood flow ratio (Qp/Qs) was estimated at 1.6. After surgical ASD closure, she was discharged without any symptoms.

Conclusion

Unclearness of TTE and the absence of a right heart overload may lead to misdiagnosis of POS. If a syncope patient caused hypoxia in the only sitting position, detailed echocardiography should be needed to rule out a diagnosis of POS. This is considerably valuable case of three-dimensional TEE confirmed the changes of ASD size by postural change.

Abstract P248 Figure.

P1472 Concealed thrombus in a 12-year-old boy diagnosed by disappearance of intricate comb-like pectinate muscle form in the left atrial appendage

Background

As previously known, patients with prolonged atrial fibrillation often have atrial thrombus. However, in children, cardiogenic embolism due to atrial fibrillation is rare. Also, the diagnosis of residual thrombus in the left atrial appendage is sometimes difficult even by transesophageal echocardiography (TEE). We have obtained a meaningful comparison between TEE findings and surgical specimen of bilateral atrial appendage.

Case report

A 12-year-old boy admitted to the nearby hospital, because of sudden onset of right-side hemiplegia. Till then, he was born at normal weight and grew up without any problem. The electrocardiogram indicated atrial fibrillation. He was transferred to the pediatric cardiology department of a hospital with higher function for the treatment of cardiogenic thromboembolism.

After 72 hours from the onset of first thromboembolism, a new embolic event happened in his left brachial artery. The contrast-enhanced computed tomography (CT) showed thrombus of bilateral atrium and coronary sinus. Consequently, residual thrombus led to the potential risk of additional embolization. Therefore, catheter cerebral thrombectomy was performed, and then surgical thrombectomy for the bilateral atrium was planned. Preoperative CT showed thrombus in the left atrial appendage (LAA). However, intraoperative TEE showed no obvious thrombus in the LAA. Intricate pectinate muscle formation in the left atrial appendage almost disappeared (figure1A), which suspected remaining thrombus. In addition, massive thrombus was seen in the right atrium and coronary sinus. Coronary sinus thrombus was removed as far as possible, and bilateral atrial appendage resection and myocardial biopsy were performed. Simultaneously, modified-Maze was also done. Heart rhythm returned into sinus rhythm after surgery. Pathological findings did not show specific findings of myocarditis or pericarditis.

Until now, the cause of thrombotic factors has not been fully clarified. Although the time of onset is unknown, probably, heart failure was triggered by atrial fibrillation, and consequently thromboembolism occurred. In the resected left atrial appendage, small thrombus remained among pectinate muscle (figure1B); therefore, postoperative anticoagulation should be needed.

Conclusion

We experienced a boy with thrombus in bilateral atrial appendages. In the resected left atrial appendage, multiple small thrombi remained in the pectinate muscle. From our experience, the disappearance of comb-like form in pectinate muscle by TEE suspects the residual thrombus, especially in the case of cardiogenic embolism.

Abstract P1472 Figure.

Hypomyelinating leukodystrophy-associated mutation of RARS leads it to the lysosome, inhibiting oligodendroglial morphological differentiation

Pelizaeus-Merzbacher disease (PMD) is a central nervous system (CNS) demyelinating disease in human, currently known as prototypic hypomyelinating leukodystrophy 1 (HLD1). The gene responsible for HLD1 encodes proteolipid protein 1 (PLP1), which is the major myelin protein produced by oligodendrocytes. HLD9 is an autosomal recessive disorder responsible for the gene differing from the plp1 gene. The hld9 gene encodes arginyl-tRNA synthetase (RARS), which belongs to a family of cytoplasmic aminoacyl-tRNA synthetases. Herein we show that HLD9-associated missense mutation of Ser456-to-Leu (S456L) localizes RARS proteins as aggregates into the lysosome but not into the endoplasmic reticulum (ER) and the Golgi body. In contrast, wild-type proteins indeed distribute throughout the cytoplasm. Expression of S456L mutant constructs in cells decreases lysosome-related signaling through ribosomal S6 protein phosphorylation, which is known to be required for myelin formation. Cells harboring the S456L mutant constructs fail to exhibit phenotypes with myelin web-like structures following differentiation in FBD-102b cells, as part of the mammalian oligodendroglial cell model, whereas parental cells exhibit them. Collectively, HLD9-associated RARS mutant proteins are specifically localized in the lysosome with downregulation of S6 phosphorylation involved in myelin formation, inhibiting differentiation in FBD-102b cells. These results present some of the molecular and cellular pathological mechanisms for defect in myelin formation underlying HLD9.

Generation of a neutralizing antibody against RD114-pseudotyped viral vectors

The feline endogenous RD114 glycoprotein has proved to be an attractive envelope to pseudotype both retroviral and lentiviral vectors. As a surface protein, its detection on packaging cells as well as viral particles would be useful in different fields of its use. To address this, we generated a monoclonal antibody against RD114 by immunization of rats, termed 22F10. Once seroconversion was confirmed, purified 22F10 was cloned into murine Fc and characterized with a binding affinity of 10nM. The antibody was used to detect RD114 and its variant envelopes on different stable viral packaging cell lines (FLYRD18 and WinPac-RD). 22F10 was also shown to prevent the infections of different strains of RD-pseudotyped vectors but not related envelope glycoproteins by blocking cell surface receptor binding. We are the first to report the neutralization of viral particles by a monoclonal αRD114 antibody.

Pharmacokinetic and toxicodynamic evaluation of 5-fluorouracil administration after major hepatectomy in a rat model

BACKGROUND

Chemotherapy after hepatectomy for colorectal liver metastasis has not been established, due to the toxic side effects, which are likely related to impaired drug clearance during liver regeneration. We investigated the pharmacokinetic and toxicodynamic evaluation of 5-fluorouracil (5-FU) during liver regeneration after major hepatectomy in a rat model.

METHODS

Thirty-six male Wistar rats were divided into control (C), control with chemotherapy (CC), hepatectomy (H), and hepatectomy with chemotherapy (HC) groups. The CC and HC groups were administered 5-FU for 4 days. Plasma 5-FU, liver weight, and liver dihydropyrimidine dehydrogenase (DPD) were measured. The ileal villous height was measured to determine adverse effects.

RESULTS

The area under the curve and maximum plasma concentration of 5-FU increased by up to 51% and 32%, respectively, in the HC group compared to the CC group. The liver regeneration rate was significantly lower in the HC group than in the H group (67.3 ± 7.4 vs 33.0 ± 5.7%, p < 0.001). The HC group had a significantly lower liver DPD than the CC group (4.4 ± 1.1 mg vs 6.9 ± 1.1 mg, p < 0.01). The HC group had a significantly lower ileal villous height than the CC group (253 ± 40 μm vs. 318 ± 36 μm, p < 0.05).

CONCLUSIONS

Reduction of the total liver DPD following major hepatectomy caused increased plasma 5-FU levels and 5-FU-associated toxicity.

Efficacy, Immunogenicity, and Safety of a 9-Valent Human Papillomavirus Vaccine: Subgroup Analysis of Participants From Asian Countries

Background

A 9-valent human papillomavirus-6/11/16/18/31/33/45/52/58 (9vHPV) vaccine extends coverage to 5 next most common oncogenic types (31/33/45/52/58) in cervical cancer versus quadrivalent HPV (qHPV) vaccine. We describe efficacy, immunogenicity, and safety in Asian participants (India, Hong Kong, South Korea, Japan, Taiwan, and Thailand) from 2 international studies: a randomized, double-blinded, qHPV vaccine-controlled efficacy study (young women aged 16–26 years; NCT00543543; Study 001); and an immunogenicity study (girls and boys aged 9–15 years; NCT00943722; Study 002).

Methods

Participants (N = 2519) were vaccinated at day 1 and months 2 and 6. Gynecological samples (Study 001 only) and serum were collected for HPV DNA and antibody assessments, respectively. Injection-site and systemic adverse events (AEs) were monitored. Data were analyzed by country and vaccination group.

Results

9vHPV vaccine prevented HPV-31/33/45/52/58–related persistent infection with 90.4%–100% efficacy across included countries. At month 7, ≥97.9% of participants seroconverted for each HPV type. Injection-site AEs occurred in 77.7%–83.1% and 81.9%–87.5% of qHPV and 9vHPV vaccine recipients in Study 001, respectively, and 62.4%–85.7% of girls/boys in Study 002; most were mild to moderate.

Conclusions

The 9vHPV vaccine is efficacious, immunogenic, and well tolerated in Asian participants. Data support 9vHPV vaccination programs in Asia.

Clinical Trials Registration

NCT00543543; NCT00943722.

Data on the effects of Charcot-Marie-Tooth disease type 2N-associated AARS missense mutation (Arg329-to-His) on the cell biological properties

Charcot-Marie-Tooth (CMT) diseases are genetic neuropathies in the peripheral nervous system (PNS). Type 1 CMT diseases are neuropathies in Schwann cells, PNS myelinating glial cells, whereas type 2 CMT diseases are axonal neuropathies. In addition, there are other types of categories in CMT diseases. CMT diseases are associated with approximately 100 responsible genes. Taiwanese mutation (Asn71-to-Tyr) of alanyl-tRNA synthetase (AARS) in type 2N CMT disease has been reported to have several pathological effects on properties of AARS proteins themselves [1]. Also, some mutations in other responsible genes affect cell biological properties of their gene products [2,3]. Herein we provide the data regarding the effects of another type 2N CMT disease-associated AARS mutation (Arg329-to-His) in French family on the cellular properties.

[Automated Classification of Calcification and Stent on Computed Tomography Coronary Angiography Using Deep Learning]

In computed tomography coronary angiography (CTCA), calcification and stent make it difficult to evaluate intravascular lumen. This is a cause of low positive-predictive value of coronary stenosis. Therefore, it is expected to develop a computer-aided diagnosis (CAD) system that can automatically detect stenosis in coronary arteries. The purpose of this study is to automatically recognize calcifications or stents in coronary arteries and classify them from the normal coronary artery in CTCA. We used 4960 coronary-cross-sectional images, which consisted of 1113 images with calcification, 1353 images with a stent, and 2494 normal artery images. These images were automatically classified using the deep convolutional neural network (LeNet, AlexNet, and GoogLeNet). The classification accuracy of LeNet, AlexNet, and GoogLeNet were 58.4%, 75.9%, and 81.3%, respectively. The proposed method would be a fundamental technique of CAD in CTCA.

Abstract P3-06-04: Clonal evolution of non-malignant proliferative lesions into breast cancers

[Introduction] Non-malignant proliferative lesions in the breast have been implicated in the development of invasive breast cancer. Previous studies showed that adjacent atypical proliferative lesions and breast cancers shared common genetic alterations, suggesting that these evolved from the same ancestral cell. However, the clonal structure of atypical proliferative lesions and their clonal dynamics during progression to cancer are poorly understood. In this study, we compared genetic profiles (with and without pathogenic germline mutations) of normal mammary ducts, non-malignant proliferative lesions, and cancer tissues from the same patients to illustrate the clonal evolution of cancer from a non-malignant epithelial cell.

[Methods] Multiple samples were collected from different proliferative lesions within the cancer-borne breast, including invasive cancers, using micro-dissection from formalin-fixed, paraffin-embedded surgical specimens. Somatic mutations and copy number alterations (CNAs) were then evaluated by whole exome sequencing.

[Results] We analyzed a total of 34 samples from 5 premenopausal females carrying estrogen receptor-positive cancers, where the samples were obtained from normal ducts (N = 6), non-atypical (N = 1) and atypical (N = 8) proliferative lesions, and non-invasive (N = 16) and invasive (N = 3) cancers. The number of somatic mutations per sample ranged from 1 to 276 and increased with disease progression, regardless of the germline mutation status. Two cases with bilateral cancers had a pathogenic germline mutation of either BRCA2 or TP53, where no somatic mutations or CNAs were shared by individual proliferative lesions, suggesting multifocal independent cancerous evolutions. By contrast, in the remaining three unilateral cases, no pathogenic germline mutations were detected, but all proliferative lesions, which were separated by a distance of 7-25 mm, shared one or more driver alterations, such as an AKT1 mutation (UID: KU01), concurrent 1q gain and 16q loss (der(1;16)) (UID: KU02), and a GATA3 mutation and der(1;16) (UID: KU03), while harboring private mutations and/or CNAs of their own. The phylogenetic analysis based on the number of shared mutations predicted an early origin of these founder mutations, which frequently predated decades before the onset of cancer.

[Conclusions] Our results suggest that early breast cancer development is shaped by the evolution of multiple precancerous clones. These clones are originated from a common ancestor that acquired a founder mutation long before the onset of cancer, followed by branching evolution of multiple clones that acquired additional driver mutations of their own, from which an invasive cancer ultimately develops. In hereditary cases, this process is thought to be substantially promoted multi-focally from within the entire breasts by a germline mutation shared by all mammary cells, frequently resulting in bilateral and/or multifocal breast cancers. Our findings provide unique insight into the early development of breast cancer.

Citation Format: Nishimura T, Yoshida K, Kawata Y, Takeuchi Y, Kakiuchi N, Shiozawa Y, Aoki K, Hirata M, Kataoka TR, Sakurai T, Baba S, Shiraishi Y, Chiba K, Takeuchi K, Haga H, Miyano S, Toi M, Ogawa S. Clonal evolution of non-malignant proliferative lesions into breast cancers [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-06-04.

Search for CP Violation in Neutrino and Antineutrino Oscillations by the T2K Experiment with 2.2×10^{21} Protons on Target

The T2K experiment measures muon neutrino disappearance and electron neutrino appearance in accelerator-produced neutrino and antineutrino beams. With an exposure of 14.7(7.6)×10^{20} protons on target in the neutrino (antineutrino) mode, 89 ν_{e} candidates and seven anti-ν_{e} candidates are observed, while 67.5 and 9.0 are expected for δ_{CP}=0 and normal mass ordering. The obtained 2σ confidence interval for the CP-violating phase, δ_{CP}, does not include the CP-conserving cases (δ_{CP}=0, π). The best-fit values of other parameters are sin^{2}θ_{23}=0.526_{-0.036}^{+0.032} and Δm_{32}^{2}=2.463_{-0.070}^{+0.071}×10^{-3}  eV^{2}/c^{4}.