Clinical and ultrasound features of difficult-to-treat rheumatoid arthritis: A multicenter RA ultrasound cohort study

OBJECTIVE

The optimal strategy for difficult-to-treat (D2T) rheumatoid arthritis (RA) has not been identified, and the ultrasound characteristics of D2T RA have not been reported. We investigated the clinical characteristics and factors contributing to the outcome in D2T RA in a multicentre RA ultrasound observational cohort.

METHOD

We reviewed 307 Japanese patients diagnosed with RA who underwent treatment with biological and targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs). We compared the differences in patient characteristics between the D2T RA and non-D2T RA groups. We examined the factors contributing to a good response [defined as b/tsDMARD continuation and Clinical Disease Activity Index (CDAI) ≤ 10 at 12 months] in the D2T RA patient group.

RESULTS

Forty-three patients (14%) were categorized as D2T RA and the remaining 264 (86%) as non-D2T RA at baseline. The grey-scale (GS) score, disease duration, and CDAI at the initiation of treatment were significantly higher in the D2T RA group than in the non-D2T RA group. In contrast, the power Doppler (PD) score was not significantly different between the two groups. Of the 43 D2T RA patients, 20 achieved a good response. The introduction of CTLA4-Ig (n = 5) was significantly associated with a good response in analysis based on inverse probability weighting with propensity score. GS and PD scores at baseline were not significantly associated with therapeutic response at 12 months in D2T RA patients.

CONCLUSIONS

Patients with D2T RA had high clinical and ultrasound activity and poor responses to treatment with b/tsDMARDs. CTLA4-Ig was associated with a good response at 12 months in D2T RA patients.

O-183 Frequent spontaneous abortion in pregnancies followed by ICSI using frozen sperm from patients with testicular germ cell tumor (TGCT)

Study question

Despite the high rate of sperm chromosome abnormalities in testicular germ cell tumor (TGCT), why is newborn aneuploidy rate in pregnancies with TGCT patient normal?

Summary answer

Miscarriage rate is higher in the pregnancy of TGCT patients than of non-TGCT cancer patients, although the pregnancy rate in ICSI was not significantly different.

What is known already

Previous reports showed higher sperm aneuploidy in TGCT patients than control males. The sperm aneuploidy rate is high before treatment, and after radical treatments peaked at 6 months after treatment and remained high until 24 months after treatment. However, in the Swedish government base study, the rate of newborn malformations including aneuploidy in all pregnancy with TGCT patients was higher than without TGCT, but not statistically significant. In only natural pregnancies, the rate was not significantly different between the two groups. The cause for discrepancy within sperm aneuploidy and newborn aneuploidy was not well clarified.

Study design, size, duration

To clarify the mechanism for the purifying selection of aneuploid sperm in conception, we examined ICSI cases with TGCT patients that did not include natural sperm competition and compared to controls with non-TGCT cancer patient, who have normal rate of aneuploid sperm. By investigating ICSI outcomes, we aimed to determine which stage of embryonic development are affected by the sperm of TGCT patients.

Participants/materials, setting, methods

Under ethical review of Yokohama city university, the 10 TGCT patients (123 oocytes) and 16 non-TGCT cancer patients (251 oocytes) who underwent ICSI with their frozen sperm from 2012 to 2021 were enrolled. Fertilization, embryo viability and embryo transfer outcomes (pregnancy and miscarriage rate) were examined between two groups underwent ICSI with cryopreserved sperm for fertility preservation. Clinical information was retrospectively collected from medical records.

Main results and the role of chance

The patients' age of sperm cryopreservation was 21-56 years old. 10 cases of TGCT were diagnosed as seminoma (3), non seminoma (6), and unknown (2). 15 cases of non-TGCT were diagnosed as malignant blood diseases (9), prostate cancer (2), bladder cancer (1), and others (3). In both groups, all patients were treated by ICSI with cryopreserved sperm obtained prior to chemotherapy. The mean age of female partners in TGCT was 33.2±3.5 years and not different with 35.8±3.4 years in non-TGCT meaning no different age factor. The fertilization rate, viable embryo rate, pregnancy rate and chemical abortion rate of TGCT vs non-TGCT group were 76.4% vs 67.7%, 64.3% vs 61.7%, 37.1% vs 21.7%, 7.1% vs 23.1%, respectively. Those developmental evaluations were not significantly different between two groups. However, spontaneous abortion rate was significantly higher 46.2% in TGCT group than 10% in non-TGCT group (p < 0.05). Further, in our follow-up, no congenital malformations in the babies born in either group (5 babies in TGCT vs 7 babies in non-TGCT group). The outcome of ICSI using sperm in TGCT patients show normal pregnancy rate but include higher spontaneous abortions rate, suggesting aneuploid embryo were negatively purifying selected under post-implantation stage.

Limitations, reasons for caution

Because ICSI with fertility-preserving frozen sperm in TGCT patient is rare even in reproduction center in general university hospital, single center analysis is still small and limited. More case reports and studies for TGCT fertility preservation are needed for more accurate evaluation.

Wider implications of the findings

In TGCT patients, chromosome aberrations and DNA fragmentation of sperm may not be apparent in natural pregnancies with normal sperm competition, but may become apparent as spontaneous abortions when ICSI were performed, suggesting PGT-A can predict and avoid the hidden risk of repeated pregnancy loss in ICSI to TGCT patients.

Trial registration number

not applicable

Psychological impact of the covid-19 pandemic on the operating room paramedical staff

Introduction

the recent covid19 pandemic is not devoid of psychological risks on paramedical staff. Among them, those who work in the operating theaters are exposed to such risks.

Objectives

to determine the perceived stress level and the psychological impact of COVID-19 on paramedics in the operating room.

Methods

This is an observational, descriptive and analytical study carried out in the operating rooms of Sahloul University Hospital during a 3 month period. The data collection tool was a self-administered questionnaire composed of 5 main parts (socio-demographic characteristics, occupational characteristics, exposure to COVID-19, the Perceived Stress Scale (PSS) and the Hospital Anxiety and depression scale (HADS)).

Results

96 paramedical staff participated in our study. The average perceived stress score was significantly higher among anesthetists. 48% of participants had anxiety. Anesthetists had significantly higher anxiety scores (p = 0.001). 26.1% of participants had definite depression. Of those with definite depression, 35.3% were anesthetists (p = 0.028). Factors significantly associated with the occurrence of anxiety were: psychiatric history, increased workload, contact with a positive coronavirus patient in the operating room, and severe perceived stress. However, the factors significantly associated with the occurrence of depression were: initial training in the management of covid-19 patients, personal infection with SARS-COV2 and severe perceived stress.

Conclusions

Covid-19 pandemic is causing significant symptoms of anxiety and depression among operation room staff. Primary and secondary prevention strategies must then be undertaken.

Disclosure

No significant relationships.

Datopotamab Deruxtecan, a Novel TROP2-directed Antibody-drug Conjugate, Demonstrates Potent Antitumor Activity by Efficient Drug Delivery to Tumor Cells

Trophoblast cell surface antigen 2 (TROP2) is highly expressed on various epithelial tumors and correlates with poor prognosis. We developed the novel TROP2-directed antibody-drug conjugate (ADC), datopotamab deruxtecan (Dato-DXd, DS-1062a), with a potent DNA topoisomerase I inhibitor (DXd), and evaluated its antitumor activity and safety profiles in preclinical models.The pharmacologic activity and mechanism of action of Dato-DXd were investigated in several human cancer cell lines and xenograft mouse models including patient-derived xenograft (PDX) models. Safety profiles were also assessed in rats and cynomolgus monkeys.Dato-DXd bound specifically to TROP2 and was internalized into tumor cells followed by intracellular trafficking to lysosome and DXd release, which induced DNA damage and apoptosis in TROP2-expressing tumor cells in vitro. Dato-DXd exhibited in vivo antitumor activity with DNA damage induced by the accumulated DXd in TROP2-expressing xenograft tumors, but neither isotype control IgG-ADC nor anti-TROP2 antibody had this effect. Dato-DXd also showed potent antitumor activity with tumor regression in several TROP2-expressing xenograft tumors including NSCLC PDX models. Safety profiles of Dato-DXd in rats and cynomolgus monkeys were acceptable.Dato-DXd demonstrated potent antitumor activity against TROP2-expressing tumors by efficient payload delivery into tumors and acceptable safety profiles in preclinical models. These results suggest Dato-DXd could be a valuable treatment option for patients with TROP2-expressing tumors in the clinical setting.

Ultrasound efficacy of targeted-synthetic disease-modifying anti-rheumatic drug treatment in rheumatoid arthritis: a multicenter prospective cohort study in Japan

OBJECTIVE

This study investigated the effectiveness of treatment with Janus kinase (JAK) inhibitors in rheumatoid arthritis (RA) assessed by ultrasonography (US) activity, and the influence of patient characteristics and previous treatments.

METHOD

This prospective study assessed 60 treatment initiations among 53 Japanese patients diagnosed with RA who underwent treatment with JAK inhibitors during June 2013 to February 2020. Of the 53 patients, seven patients were enrolled in duplicate because they were treated with two different JAK inhibitors at different periods. For each case, the improvement rate on the power Doppler (PD) score was assessed at 6 month follow-up. Median improvement rate of PD score was used to classify cases as either US responders or non-responders, and patient characteristics were compared between the two groups.

RESULTS

All indicators of clinical disease activity and US activity showed a significant improvement at 3 months compared with baseline. Although the JAK inhibitor-cycler group and the interleukin-6 (IL-6) inhibitor inadequate response (IR) group tended to show a later improvement for US activity, all indicators of clinical disease activity and US activity showed a significant improvement at 6 months compared with baseline for both groups. Multivariate analysis showed that concomitant methotrexate use and an IR to the previous biologic or targeted-synthetic disease-modifying anti-rheumatic drug (b/tsDMARD) treatment were independently and significantly associated with US responders.

CONCLUSION

Use of a JAK inhibitor in combination with methotrexate and an absence of IR to any previous b/tsDMARDs demonstrated superior effectiveness for patients with RA.

P–572 Purifying selection for aneuploidy cells in mosaicism embryo at post-implantation stage

Study question

Why low ratio mosaicism embryos develop to normal karyotype babies?

Summary answer

Our in vitro implantation assay clarified purifying selection for aneuploid cells in post implantation embryos.

What is known already

There are some reports about healthy live birth after transfer of mosaic embryos, which was reported for the first time from Italy in 2015. It is also reported that the abnormal cell is screened with the mouse in the embryo development, and only a normal cell contributes to the development. But it has not been examined in human.

Study design, size, duration

To clarify the change of aneuploid cells and mitochondrial activity in human embryo, we biopsied several parts from one blastocyst and examined karyotype. After in vitro implantation assay for biopsied embryos, we compared the karyotype of biopsy sample with that of cultured cell mass.

Participants/materials, setting, methods

Under the ethical review of Yokohama City University and informed consent with patients, we collected human surplus blastocysts those are donated after successful clinical treatment or discarded because of poor development grade. We biopsied multiple parts from one blastocyst and cultured the biopsied embryos, and extracted whole DNA from the biopsy samples and cultured embryos. Karyotyping by next generation sequencing were performed.

Main results and the role of chance

We analyzed 34 samples from 11 embryos, including 25 biopsy sample from 11 embryos and 9 cell mass from 7 cultured embryos. In the karyotype tracking results, even though biopsy sample analysis before the culture were uniformed aneuploid or chromosome mosaic, the developing embryo cell mass had normal karyotype. In one embryo as an example, among the three biopsied extra trophectoderm samples from that, two of them were mosaic, and one of them had uniformed chromosome 21 trisomy and chromosome 16 mosaic monosomy. But the embryo formed multiple cell mass in implantation assay. We examined karyotype of three cell mass, and the result from all were normal karyotype. We suggested that the chromosome aberration cells were screened in the human embryo development, and when the function was not carried out the embryo stopped the development.

Limitations, reasons for caution

Because of small number of samples available, we need more samples for a more accurate evaluation. Furthermore, we cannot evaluate the absolute mechanism that cells with chromosome aberration decreases.

Wider implications of the findings: Conventional PGT-A techniques are based on uniformed embryos developing hypothesized past time. As showed in some clinical reports, PGT-A can reduce of spontaneous abortion and chance of embryo transfer. Thinking about aneuploid cell purifying system in embryo development, effectiveness of PGT-A should be more questionable for infertility treatment.

Trial registration number

A200326004

Discrepancy between clinical and ultrasound remissions in rheumatoid arthritis: a multicentre ultrasound cohort study in Japan

Objectives: Using multicentre ultrasound (US) cohort data among patients with rheumatoid arthritis (RA), we aimed to identify baseline factors that permit differentiation between two patient cohorts achieving US remission and clinical remission, and to determine the factors contributing to the discrepancy.Method: We reviewed 248 Japanese patients diagnosed with RA who underwent treatment with biological disease-modifying anti-rheumatic drugs at 13 centres. We performed US assessments of the synovia of 22 joints. We assessed the percentages of patients with clinical remission and US remission, defined as total power Doppler scores of 0 at 12 months.Results: The 87 patients who achieved US remission were divided into a group that achieved both clinical and US remission (n = 53) and a group that achieved US remission only (n = 34). Baseline factors that were significantly and independently associated with clinical remission at 12 months among patients who also achieved US remission included short disease duration, the presence of concomitant methotrexate use, and low patient global assessment score (p < 0.05, p < 0.05, and p < 0.005, respectively).Conclusions: RA patients with baseline high patient global assessment scores and long disease duration at baseline were unlikely to achieve clinical remission even after achieving US remission. Objective joint assessments using US provide additional information of potential importance for the management of RA.

Significance of anti-Ro/SSA antibodies in the response and retention of abatacept in patients with rheumatoid arthritis: a multicentre cohort study

Objective: To determine whether the positivity of baseline anti-Ro/Sjögren's syndrome antigen A (SSA) antibodies influences the response to abatacept, we compared therapeutic responses between anti-Ro/SSA antibody-negative and -positive patients with rheumatoid arthritis (RA) using a multicentre RA ultrasonography prospective cohort. Method: We reviewed Japanese patients with RA who started abatacept as the first biological disease-modifying anti-rheumatic drug between June 2013 and April 2018. We assessed 28-joint Disease Activity Score-erythrocyte sedimentation rate (DAS28-ESR) change between baseline and 6 or 12 months after treatment in RA patients treated with abatacept, and European League Against Rheumatism (EULAR) response at 6 and 12 months. The Global OMERACT-EULAR Synovitis Score (GLOESS) was calculated at baseline and at 6 and 12 months. Results: Overall, 51 patients were enrolled and divided into anti-Ro/SSA antibody-negative and -positive groups of 35 and 16, respectively. Median age at baseline was significantly higher in the anti-Ro/SSA antibody-negative group (p = 0.04). The retention rate and percentage of EULAR good responders at 12 months were significantly higher in the anti-Ro/SSA antibody-negative group (both p = 0.02). Anti-Ro/SSA antibody-negative patients exhibited larger decreases in both DAS28-ESR and DAS28-C-reactive protein at 12 months than anti-Ro/SSA antibody-positive patients (p = 0.02 and 0.04, respectively). GLOESS decreased significantly at 6 months in anti-Ro/SSA antibody-negative patients (p = 0.03). Multivariate analyses showed that anti-Ro/SSA antibody positivity was an independent factor associated with change in the DAS28-ESR at 6 months (p < 0.05). Conclusion: Anti-Ro/SSA antibody positivity predicts a poor response to abatacept and low retention rate.

Oncolytic Herpes Simplex Virus Vectors Fully Retargeted to Tumor- Associated Antigens

Oncolytic virotherapy is a novel therapeutic modality for malignant diseases that exploits selective viral replication in cancer cells. Herpes simplex virus (HSV) is a promising agent for oncolytic virotherapy due to its broad cell tropism and the identification of mutations that favor its replication in tumor over normal cells. However, these attenuating mutations also tend to limit the potency of current oncolytic HSV vectors that have entered clinical studies. As an alternative, vector retargeting to novel entry receptors has the potential to achieve tumor specificity at the stage of virus entry, eliminating the need for replication-attenuating mutations. Here, we summarize the molecular mechanism of HSV entry and recent advances in the development of fully retargeted HSV vectors for oncolytic virotherapy. Retargeted HSV vectors offer an attractive platform for the creation of a new generation of oncolytic HSV with improved efficacy and specificity.

Femoral morphology asymmetry in hip dysplasia makes radiological leg length measurement inaccurate

AIMS

The aim of this study was to examine whether hips with unilateral osteoarthritis (OA) secondary to developmental dysplasia of the hip (DDH) have significant asymmetry in femoral length, and to determine potential related factors.

PATIENTS AND METHODS

We enrolled 90 patients (82 female, eight male) with DDH showing unilateral OA changes, and 43 healthy volunteers (26 female, 17 male) as controls. The mean age was 61.8 years (39 to 93) for the DDH groups, and 71.2 years (57 to 84) for the control group. Using a CT-based coordinate measurement system, we evaluated the following vertical distances: top of the greater trochanter to the knee centre (femoral length GT), most medial prominence of the lesser trochanter to the knee centre (femoral length LT), and top of the greater trochanter to the medial prominence of the lesser trochanter (intertrochanteric distance), along with assessments of femoral neck anteversion and neck shaft angle.

RESULTS

The percentages of hips with an absolute difference of > 5 mm in femoral GT and LT lengths were significantly larger in the DDH group (24% for both) compared with those of the control group (2% and 7%, respectively). The femoral length GT of the affected femur was significantly shorter in Crowe I and longer in Crowe IV than that of the unaffected side. The affected-to-unaffected difference of the intertrochanteric distance showed positive correlation with that of the femoral length GT in Crowe I and Crowe II/III, and negative correlation with that of the femoral length LT in the Crowe I and Crowe IV groups.

CONCLUSION

Hips with unilateral end-stage OA secondary to DDH show significant asymmetry in femoral length between both the greater and lesser trochanter and the knee compared with controls. The intertrochanteric distance was a morphological factor related to femoral-length asymmetry. When undertaking total hip arthroplasty (THA) in the presence of DDH, long leg radiographs or CT measurements should be used to assess true leg-length discrepancy. Cite this article: Bone Joint J 2019;101-B:297-302.

Material Behavior in the Plasticizing Cylinder of an Injection Molding of the Vent Type

Thermoplastic injection molding is applied in a wide variety of products. It is known that volatile components generated when resin melts cause structural defects during the thermoplastic injection process. Not only that, the pre-injection preparation work including drying the material and maintaining the metal mold, have become standard procedures to prevent these defects, but these procedures deteriorate productivity. Vent-type injection molding involves the use of cylinders featuring a vent hole at the center of the plasticizing cylinder. Although it is a conventional molding method, there are many issues including resin leakage from a vent hole and difficulty of material replacements. These issues prevented it from widespread application. Moreover, the vent-type plasticization process has not been examined theoretically or systematically. In order to maximize and generalize functions of vent-type molding, it is necessary to clarify the flow behavior of resin in the vent cylinder. In this study, we verified the flow behavior of resin in the vent-type plasticization cylinder through experimentation and simulation. In the simulation, using the flow analysis method, the filling rate inside the screw was determined by the pressure distribution inside the screw. In the experiments, the molding condition that causes venting up was verified by changing the screw rotation rates and the supply amount of the resin, for determining the filling rate of resin inside the screw. The filling rates obtained through the simulation and the experiment are almost the same. The result suggests that this simulation is very effective for predicting the filling rate.

Copy number loss in the region of the ASPN gene in patients with acetabular dysplasia: ASPN CNV in acetabular dysplasia

Objectives

We have previously investigated an association between the genome copy number variation (CNV) and acetabular dysplasia (AD). Hip osteoarthritis is associated with a genetic polymorphism in the aspartic acid repeat in the N-terminal region of the asporin (ASPN) gene; therefore, the present study aimed to investigate whether the CNV of ASPN is involved in the pathogenesis of AD.

Methods

Acetabular coverage of all subjects was evaluated using radiological findings (Sharp angle, centre-edge (CE) angle, acetabular roof obliquity (ARO) angle, and minimum joint space width). Genomic DNA was extracted from peripheral blood leukocytes. Agilent’s region-targeted high-density oligonucleotide tiling microarray was used to analyse 64 female AD patients and 32 female control subjects. All statistical analyses were performed using EZR software (Fisher’s exact probability test, Pearson’s correlation test, and Student’s t-test).

Results

CNV analysis of the ASPN gene revealed a copy number loss in significantly more AD patients (9/64) than control subjects (0/32; p = 0.0212). This loss occurred within a 60 kb region on 9q22.31, which harbours the gene for ASPN. The mean radiological parameters of these AD patients were significantly worse than those of the other subjects (Sharp angle, p = 0.0056; CE angle, p = 0.0076; ARO angle, p = 0.0065), and all nine patients required operative therapy such as total hip arthroplasty or pelvic osteotomy. Moreover, six of these nine patients had a history of operative or conservative therapy for developmental dysplasia of the hip.

Conclusions

Copy number loss within the region harbouring the ASPN gene on 9q22.31 is associated with severe AD. A copy number loss in the ASPN gene region may play a role in the aetiology of severe AD.

Cite this article: T. Sekimoto, M. Ishii, M. Emi, S. Kurogi, T. Funamoto, Y. Yonezawa, T. Tajima, T. Sakamoto, H. Hamada, E. Chosa. Copy number loss in the region of the ASPN gene in patients with acetabular dysplasia: ASPN CNV in acetabular dysplasia. Bone Joint Res 2017;6:439–445. DOI: 10.1302/2046-3758.67.BJR-2016-0094.R1.

Electronic structure of K-doped picene film on HOPG

We have performed potassium (K)-doping dependent photoemission (PES) measurements of picene film on highly oriented pyrolytic graphite (HOPG). K-doping dependent valence band PES data exhibits a shift of the valence band to a higher binding energy, indicative of the charge transfer from the K atoms to the picene film. K-doping dependent PES spectra near the Fermi level (E _F) show the appearance and disappearance of a Fermi edge, indicating the metallic properties of the film at certain K concentrations. High-resolution PES spectrum at the lowest measured temperature does not show an opening of the superconducting gap, requesting further studies to explore the superconducting properties of the K-doped picene film. The results will be discussed by comparison with previous and recent spectroscopic studies.

Distribution of Glycoconjugates in the Kidney Studied by Use of Labeled Lectins

Distribution of glycoconjugates in different areas of the rat kidney was studied by light and electron microscopy using six different horseradish peroxidase-labeled lectins. Glomeruli and brush borders of the proximal tubules reacted differently to these lectins, which indicated differences in the carbohydrate compositions of those regions. The ascending limb of Henle's loop (ALH) had strong binding sites for peanut agglutinin (PNA) and soybean agglutinin (SBA). Dolichos biflorus agglutinin (DBA) did not stain the cells of ALH but did stain those of distal convoluted tubules (DCT). DBA is a good marker for distinguishing ALH from DCT. DBA, PNA, and SBA were also good markers of the collecting duct. Ricinus communis agglutinin (RCA-1) and wheat germ agglutinin (WGA) diffusely stained the various components of different parts of the kidney.

Cell Surface Antibody Retention Influences In Vivo Antitumor Activity Mediated by Antibody-dependent Cellular Cytotoxicity

BACKGROUND

Multiple factors affect the in vivo antitumor activity of antibody-based therapeutics; however, the influence of cell surface retention on antibody-dependent cellular cytotoxicity (ADCC) is not fully understood. Here we evaluated the importance of cell surface antibody retention in antitumor activity mediated by ADCC in vivo.

MATERIALS AND METHODS

Two mAbs against tumor-associated calcium signal transducer 2 (TACSTD2/TROP2), AR47A6.4.2 and Pr1E11, were used. Antitumor activities against BxPC3 and Colo205 cells were investigated through in vitro and in vivo assays.

RESULTS

Pr1E11 showed better cell surface retention than AR47A6.4.2 in vitro although Pr1E11 and AR47A6.4.2 showed equivalent ADCC activity. Complement-dependent cytotoxicity and antiproliferative activity were not observed for either antibody. Pr1E11 exhibited higher antitumor activity than AR47A6.4.2 in vivo.

CONCLUSION

Our results suggest that high cell surface retention can result in potent ADCC activity in vivo. This observation could provide novel insight into how effectively screen for antibodies with strong in vivo antitumor activity.

Intraductal papillary mucinous tumors of the pancreas

Purpose: To compare the effectiveness of thin-section helical CT and MR imaging with gadolinium-enhanced dynamic technique and MR cholangiopancreatography (MRCP) in the examination of patients with intraductal papillary mucinous tumors.

Material and Methods: Helical CT, dynamic MR imaging, and MRCP of 25 intraductal papillary mucinous tumors were compared with ERCP and surgical findings.

Results: The duodenal papilla was identified by helical CT and dynamic MR imaging in 11 (44%) and 20 (80%) of the 25 patients, respectively ( p<0.05). The main pancreatic duct was visualized on helical CT, dynamic MR imaging, and MRCP in all patients (100%): 25 (96.2%), 24 (92.3%), and 26 (100%) cystic lesions were depicted, respectively. A communicating duct between the main pancreatic duct and the cystic lesion was visualized on helical CT, dynamic MR imaging, and MRCP in 14 (53.8%), 11 (42.3%), and 15 (55.7%) lesions, respectively. The papillary projections corresponding to 3 mm or larger papillary neoplasms were depicted on helical CT and MR imaging in 7 patients (25%).

Conclusion: MR imaging was equal or slightly superior to thin-section helical CT in the evaluation of intraductal papillary mucinous tumors.

Possible association of single nucleotide polymorphisms in the 3' untranslated region of HOXB9 with acetabular overcoverage

OBJECTIVES

Excessive acetabular coverage is the most common cause of pincer-type femoroacetabular impingement. To date, an association between acetabular over-coverage and genetic variations has not been studied. In this study we investigated the association between single nucleotide polymorphisms (SNPs) of paralogous Homeobox (HOX)9 genes and acetabular coverage in Japanese individuals to identify a possible genetic variation associated with acetabular over-coverage.

METHODS

We investigated 19 total SNPs in the four HOX9 paralogs, then focused in detail on seven of those located in the 3' untranslated region of HOXB9 (rs8844, rs3826541, rs3826540, rs7405887, rs2303485, rs2303486, rs79931349) using a case-control association study. The seven HOXB9 SNPs were genotyped in 316 subjects who had all undergone radiological examination. The association study was performed by both single-locus and haplotype-based analyses.

RESULTS

The genotype and allele frequencies of the five HOXB9 SNPs showed significant association with acetabular over-coverage compared with controls (rs7405887 OR = 3.16, p = 5.29E-6, 95% CI 1.91 to 5.25). A significant difference was also detected when haplotypes were evaluated (OR = 2.59, p = 2.61E-5, 95% CI 1.65 to 4.08). The two HOXB9 SNPs (rs2303485, rs2303486) were associated with decreased acetabular coverage (rs2303485 OR = 0.524, p = 0.0091, 95% CI 0.322 to 0.855; rs2303486 OR = 0.519, p = 0.011, 95% CI 0.312 to 0.865).

CONCLUSIONS

The five HOXB9 SNPs (rs8844, rs3826541, rs3826540, rs7405887, rs79931349) were associated with acetabular over-coverage. On the other hand, the two SNPs (rs2303485 and rs2303486) were associated with the lower acetabular coverage. The association of rs2303486 would be consistent with the previous study. Therefore, the HOXB9 SNPs might be involved in the morphogenesis of acetabular coverage, and could be an independent risk factor for developing pincer-type femoroacetabular impingement. Cite this article: Bone Joint Res 2015;4:50-5.

Pr1E11, a novel anti-TROP-2 antibody isolated by adenovirus-based antibody screening, recognizes a unique epitope

TROP-2 is a type Ⅰ transmembrane glycoprotein that is highly expressed in various epithelial cancer cells, and its increased expression correlates with poor prognosis. Although several anti-TROP-2 antibodies have been described, they were found unsuitable for antitumor therapy use in vivo as naked antibodies. In this study, we established a novel anti-TROP-2 antibody, designated Pr1E11, from mice immunized with primary prostate cancer cells. Antibody screening was based on the infection activity of Adv-LacZ-FZ33, which displays an immunoglobulin G binding domain in the adenoviral fiber protein. We found that Pr1E11 specifically binds to TROP-2 with high affinity and recognizes diverse epithelial cancer cell lines and primary pancreatic cancer tissues. Epitope analysis using TROP-2 deletion mutants revealed that binding site of Pr1E11 is a cysteine-rich domain, a unique epitope compared with other available anti-TROP-2 antibodies. In addition, Pr1E11 exhibited low internalization activity, which may make it suitable for naked antibody therapeutics. Our results suggest that Pr1E11 may stimulate different biological activities from other anti-TROP-2 antibodies based on its unique binding epitope, and is a potential candidate for naked antibody therapeutics for various epithelial cancer treatments.

Development of a sensitive screening method for selecting monoclonal antibodies to be internalized by cells

Antibody-drug conjugates (ADCs), drugs developed by conjugation of an anticancer agent to a monoclonal antibody (mAb), have lately attracted attention in cancer therapy because ADCs can directly bind cancer cells and kill them. Although mAbs for ADCs must be internalized by the target cells, few methods are available for screening mAbs for their ability to be internalized by cells. We have developed a recombinant protein, termed DT3C, which consists of diphtheria toxin (DT) lacking the receptor-binding domain but containing the C1, C2, and C3 domains of Streptococcus protein G (3C). When a mAb-DT3C conjugate, which functions in vitro like an ADC, reduces the viability of cancer cells, the mAb being tested must have been internalized by the target cells. DT3C can thus be a tool to identify efficiently and easily mAbs that can be internalized by cells, thereby enhancing the development of promising ADCs.

Vaccination during the 2013-2014 influenza season in pregnant Japanese women

This questionnaire survey was conducted at 11 hospitals in Japan to determine vaccination coverage against seasonal influenza and the prevalence rate of influenza among pregnant Japanese women. Of 2,808 postpartum women who gave birth at the 11 hospitals during the study period from March 1, 2014, to July 31, 2014, 1,713 (61 %) participated in this study and 876 (51 %) reported having received vaccination against influenza in or after October 2013. Women aged <25 years had a significantly lower vaccination rate than those aged ≥25 years (31 % vs. 53 %, respectively; p = 0.0000). Eighty-seven (5.1 %) and 1,626 (94.9 %) women did and did not contract influenza, respectively. Although prior birth did not affect overall vaccination coverage (50 % for primiparous vs. 53 % for multiparous), multiparous women had a significantly higher rate of contracting influenza than primiparous women, irrespective of vaccination status (5.6 % vs. 2.2 % [p = 0.0216] and 9.7 % vs. 3.5 % [p = 0.0003] for women with and without vaccination, respectively). The 2013-2014 vaccination program significantly reduced the influenza infection rate by 35 % (3.9 % vs. 6.3 % for women with and without vaccination, respectively; p = 0.0272). Seventy-two (83 %) of the 87 women took antiviral agents for the treatment of influenza and two (2.3 %) required hospitalization. These results suggested that pregnant Japanese women had a high level of concern regarding seasonal influenza. However, campaigns targeting young pregnant Japanese women, as well as multiparous women, for vaccination are needed in order to further reduce the incidence of influenza among pregnant Japanese women.

Effect of Pre-Molding Process and Additive of Injection Molded Wood/PP Composites

Injection molded composites are becoming more widespread in recent years because of their high quality and low cost. However, compared to synthetic fiber composites, it is difficult to maintain a constant fiber volume fraction and uniform distribution for natural fiber composites during the direct injection process. This is mainly because natural fibers are more easily twisted during feeding into the injection machine, owing to their rough surfaces. These feeding difficulties are particularly due to the low bulk densities of natural fibers, especially natural fillers. Additional challenges to the injection process include the concentration and, especially for natural filler reinforced composite. To address these problems, the current study investigates the mechanical properties and morphologies of polypropylene (PP) reinforced by wood powder. Two pre-molding processes, dry-blending and compounding, were compared, and the effects of an additive (crystalline polyalpha olefin (CPAO)) on the mechanical properties of the wood/PP composites were investigated. This investigation is based on tensile, three point bending, and Izod impact tests, and scanning electron microscope (SEM) observation of the fracture surfaces. Results indicated that the composites molded through compounding exhibited better mechanical properties than the samples molded through the direct dry-blending process. In addition, the tensile and bending properties of the composites produced through compounding were found to increase with the addition of CPAO content, because of improved wood powder distribution in the PP matrix.

Short-fiber protein of ad40 confers enteric tropism and protection against acidic gastrointestinal conditions

The lack of vectors for selective gene delivery to the intestine has hampered the development of gene therapy strategies for intestinal diseases. We hypothesized that chimeric adenoviruses of Ad5 (species C) displaying proteins of the naturally enteric Ad40 (species F) might hold the intestinal tropism of the species F and thus be useful for gene delivery to the intestine. As oral-fecal dissemination of enteric adenovirus must withstand the conditions encountered in the gastrointestinal tract, we studied the resistance of chimeric Ad5 carrying the short-fiber protein of Ad40 to acid milieu and proteases and found that the Ad40 short fiber confers resistance to inactivation in acidic conditions and that AdF/40S was further activated upon exposure to low pH. In contrast, the chimeric AdF/40S exhibited only a slightly higher protease resistance compared with Ad5 to proteases present in simulated gastric juice. Then, the biodistribution of different chimeric adenoviruses by oral, rectal, and intravenous routes was tested. Expression of reporter β-galactosidase was measured in extracts of 15 different organs 3 days after administration. Our results indicate that among the chimeric viruses, only intrarectally given AdF/40S infected the colon (preferentially enteroendocrine cells and macrophages) and to a lesser extent, the small intestine, whereas Ad5 infectivity was very poor in all tissues. Additional in vitro experiments showed improved infectivity of AdF/40S also in different human epithelial cell lines. Therefore, our results point at the chimeric adenovirus AdF/40S as an interesting vector for selective gene delivery to treat intestinal diseases.

Weld Line Strength in PC/ABS Injection Moldings

Polycarbonate(PC)/ABS is a very common immiscible polymer blend. The internal structure such as distribution of each component in the injection moldings of PC/ABS would be strongly affected by the processing parameters. Especially, the weld line formed by meeting two melt flows and the internal structure at the weld area would be a very complex form. By observing the etched samples of PC/ABS injection moldings using scanning electron microscopy, a weld part with fine dispersion of ABS was found in the area below V-notch. When tensile load was applied perpendicular to the weld line, the fracture initiated from the V-notch, but the crack propagated along the interface between the weld part with fine dispersion and the part behind the weld part. This leads to unique characteristics of the weld strength.

Flow Behavior of Sandwich Injection Molding in Sequential and Simultaneous Injection

The flow behavior of skin and core materials in co-injection molding was investigated to understand the flow patterns that could lead to core breakthrough in sequential and simultaneous injection molding. A spiral-flow mold was used and the core material was loaded with a black master batch to facilitate the monitoring of the core material. PC/ABS blend was used as the skin material and ABS was the core material. It was revealed irrespective of simultaneous injection time, sandwich injection molding display the four flow regions identified earlier i. e. primary injection region, core advance region, core expansion region and core breakthrough region. The flow length of core expansion region lengthened with increasing simultaneous injection time of skin and core material while the overall injection time decreased. It was also observed that the core became thinner and wider with increasing simultaneous injection time.

Morphology of Injection Molded Polyacetal during Filling

The morphology of injection molded polyacetal was investigated using spiral-flow test mold and shear effect on crystallization phenomena is discussed. Morphology differed for skin, shear and core layers. The thickness of the shear layer was proportional to flow time.

The Flow Behavior of Core Material and Breakthrough Phenomenon in Sandwich Injection Molding

The processing conditions that exert influence on the occurrence of breakthrough during sandwich injection molding were investigated. A spiral flow mold mounted on a twin-barrel injection machine fitted with a single nozzle was used. The effect of mold cavity thickness and the effects of skin material cylinder temperature on skin material viscosity, melt strength, and drawing ratio were considered. Scanning electron microscopy was used to study the morphology of the skin material at the flow front. It was found that the flow length at core expansion region increased and breakthrough phenomenon was delayed as the thickness of the mold cavity increased. When cylinder temperature is increased, the viscosity is lowered and the flow front of the skin material extends with greater ease when pushed by the core material, thus, a greater core volume can be accommodated. As the flow front progresses, the tendency is that the skin material becomes thinner. Polishing and etching followed by SEM examination of the skin material at the flow front revealed that the skin material is oriented perpendicular to the flow direction and the extent of orientation increases with increasing cylinder temperature. This further supported the observation that the deformation ratio and drawing ratio increased with increasing cylinder temperature.

The Flow Behavior of Core Material and Breakthrough Phenomenon in Sandwich Injection Molding

The processing variables that control the occurrence of breakthrough phenomenon in sandwich injection molding were investigated. Particular attention was paid to the conditions that would yield an optimum sandwich molded part. The effects of variation of core volume ratio that would yield optimum core shot size, injection speed and the skin/core viscosity ratio were examined. The flow morphology at the various stages of flow was also explored. The study was conducted with a bar-flow mold mounted on a twin-barrel injection machine fitted with a common nozzle. It was noted that the core material flow distance depends on the core cylinder screw metering position (core shot size). At the stage at which the core material completely penetrated through the skin material (breakthrough), four distinct regions of flow could be identified. The flow distance of the core material is controlled by the injection speed of the core material while the injection speed of the skin material is of little significance. In order to increase the flow distance of the core material, it is effective to increase the core material injection speed albeit limited by an optimum value of screw metering position. It was found that the flow distance of the core material was longer when the core material viscosity was lower than that of the skin material but breakthrough occurred much earlier so core volume is limited. Breakthrough failed to occur when the viscosity of the core material was higher than that of the skin material. It was found that optimum core volume and core distribution occurred when skin/core viscosities were intermediate. The morphology of the skin material leading to breakthrough was also analyzed.

Flexural Stiffness of Injection Molded Glass Fiber Reinforced Thermoplastics

Using a simulated laminated-plate model, an analytical method is presented for predicting stiffness of fiber reinforced injection moldings including the effects of fiber orientation and fiber length distributions. The mechanical properties of fiber reinforced composites depend not only on the elastic properties and the volume fraction of the constituent materials, but also on the fiber orientation and fiber length distributions in the molding. In this study, two probability density functions are proposed for modeling the distributions of fiber orientation and fiber length in the injection moldings, respectively. Inserting the fiber orientation and fiber length distributions into the components of the stiffness constant, the elastic moduli of the fiber reinforced injection moldings are predicted on the basis of a generalized laminated-plate theory.

A Study on Flexural Properties of Sandwich Injection Moldings

In recent years composite materials have been widely used, largely because of their superior mechanical properties. Sandwich constructions can be suitably tailored to make use of each material's properties in the moldings, effectively (for example in honeycomb core constructions) in order to improve the mechanical properties of the moldings. In the injection molding process, however, it is quite difficult to fabricate sandwich constructions. A sandwich injection molding process in which the sandwich injection moldings are performed using two melt sources and one nozzle has been developed. At the present, there have been few investigations with respect to the mechanical properties of the sandwich structures produced by the injection moldings.

In this study, we tried to examine the sandwich construction made by the injection molding process. Three kinds of materials including polyamide resin, the short and the longer fiber reinforced polyamides were used as layer structural materials for the sandwich injection moldings. The flexural properties for the sandwich injection moldings were measured and their fracture surfaces observed to clarify the mechanical behaviors. Furthermore, the flexural moduli for the sandwich injection moldings composed of the polyamides reinforced with the different fiber lengths were predicted based on two-layer orientation model.

Flexural Modulus of Compression Molded Glass Fiber Reinforced Thermoplastics

The flexural properties of compression molded stampable glass fiber reinforced polypropylene are examined. Fibers flowing with the polymeric matrix are found to be oriented close to the edge of the die. The fiber orientation distribution is characterized by a fiber orientation index using an image processing system. The flexural elastic modulus of the plaque estimated from laminated-plate theory is found to be in good agreement with the experimental results.

Image Simulation and Evaluation of Fiber Orientation Distribution

A new method is presented for analyzing fiber orientation distribution in fiber reinforced composites. A fiber orientation state in fiber reinforced composites is first obtained from soft X-ray image by making contract micro-radiograph (CMR). The distribution of the fiber orientation is measured by a fiber orientation index G(θ) as proposed in this paper. Furthermore, a computer simulation for the fiber orientation distribution is carried out in order to evaluate the fiber orientation index G(θ). It has been found that the value of the fiber orientation G(θ) decreases with an increase in the scatter of the fiber orientation distribution. Not only the direction but also the degree of the fiber orientation can be shown from the curve of the fiber orientation index G(θ). The result shows that this method is easy and useful to evaluate the fiber orientation distribution in fiber reinforced composites.

Interfacial Characteristics of Film Insert Moldings Consisting of Semicrystalline and Amorphous Polymers

Film insert moldings were produced from amorphous and crystalline polymers, i. e. PC + ABS and PET respectively. The vastly different characteristics of these polymers provide an interesting platform to study the mechanisms that are responsible for interfacial bond formation, particularly when these materials were molded at different molding conditions. It was observed that intermolecular diffusion between amorphous polymers takes place at virtually any temperature as long as it is kept above the glass transition temperature of the material, though higher temperatures are favorable to accelerate diffusion. As for crystalline polymers, there is an initial need to create free and mobile molecular chains by heating the materials to its melting temperature before any significant diffusion takes place. Certain criteria have to be met, irrespective of the materials used, before good interfacial bonding is achieved. Firstly, the injection molding parameters should be optimized to ensure intimacy between the surfaces of the film and injected resin. Once this is achieved, interdiffusion of molecules should be promoted to ensure extensive film-substrate molecular entanglements. The state of molecular entanglement should then be retained for a sufficient amount of time as the material solidifies in order to obtain good film-substrate adhesion.

Cyclophosphamide enhances antitumor efficacy of oncolytic adenovirus expressing uracil phosphoribosyltransferase (UPRT) in immunocompetent Syrian hamsters

Oncolytic viruses (OVs) are novel cancer therapeutics with great promise, but host antiviral immunity represents the hurdle for their efficacy. Immunosuppression by cyclophosphamide (CP) has thus been shown to enhance the oncolytic efficacy of many OVs, but its effects on OVs armed with therapeutic genes remain unknown. We have previously reported on the efficacy of AxE1CAUP, an oncolytic adenovirus (OAd) expressing uracil phosphoribosyltransferase (UPRT), an enzyme that markedly enhanced the toxicity of 5-fluorouracil (5-FU), in immunodeficient, Ad-nonpermissive nude mice. Here we explored the efficacy and safety of intratumoral (i.t.) AxE1CAUP/5-FU therapy and of its combination with CP for syngenic HaP-T1 pancreatic cancers in immunocompetent, Ad-permissive Syrian hamsters. AxE1CAUP infected, replicated, expressed UPRT, and increased the sensitivity to 5-FU in HaP-T1 cells in vitro. I.t. AxE1CAUP/5-FU treatment inhibited the growth of subcutaneous HaP-T1 allografts. The combination with high-dose CP inhibited serum Ad-neutralizing antibody formation, increased intratumoral AxE1CAUP replication and UPRT expression, and resulted in further enhanced therapeutic effects with 5-FU. Neither body weight nor histology of the liver and lung changed during these treatments. A clinically-approved, intermediate-dose CP also enhanced the efficacy of i.t. AxE1CAUP/5-FU treatment in these hamsters, which was not affected by preexisting immunity to the vector. These data demonstrate the excellent antitumor efficacy and safety of an OAd armed with a suicide gene in combination with CP for treating syngenic tumors in immunocompetent, Ad-permissive animals, indicating the efficacy of CP in overcoming the hurdle of antiviral immunity for effective OV-mediated gene therapy.

Manipulation of human early T lymphopoiesis by coculture on human bone marrow stromal cells: potential utility for adoptive immunotherapy

T cell precursors are an attractive target for adoptive immunotherapy. We examined the regulation of human early T lymphopoiesis by human bone marrow stromal cells to explore in vitro manipulation of human T cell precursors in a human-only coculture system. The generation of CD7(+)CD56(-)cyCD3(-) proT cells from human hematopoietic progenitors on telomerized human bone marrow stromal cells was enhanced by stem cell factor, flt3 ligand, and thrombopoietin, but these stimulatory effects were suppressed by interleukin 3. Expression of Notch ligands Delta-1 and -4 on stromal cells additively promoted T cell differentiation into the CD7(+)cyCD3(+) pre-T cell stage, while cell growth was strongly inhibited. By combining these coculture systems, we found that initial coculture with telomerized stromal cells in the presence of stem cell factor, flt3 ligand, and thrombopoietin, followed by coculture on Delta-1- and -4-coexpressing stromal cells led to a higher percentage and number of pre-T cells. Adoptive immunotherapy using peripheral blood T cells transduced with a tumor antigen-specific T cell receptor (TCR) is a promising strategy but has several limitations, such as the risk of forming a chimeric TCR with the endogenous TCR. We demonstrated that incubation of TCR-transduced hematopoietic progenitors with the combination of coculture systems gave rise to CD7(+)TCR(+)CD3(+)CD1a(-) T cell precursors that rapidly proliferated and differentiated under the culture condition to induce mature T cell differentiation. These data show the regulatory mechanism of early T lymphopoiesis on human stromal cells and the potential utility of engineered human stromal cells to manipulate early T cell development for clinical application.

Origin of heterogeneity of interleukin-6 (IL-6) levels in malignant pleural effusions

We measured interleukin-6 (IL-6) concentrations from 48 malignant pleural effusions by an enzyme immunoassay and found a marked heterogeneity of the concentrations. The histological type of the malignant cells and total counts or differentials of the cells in effusions could not account for the heterogeneity. We newly established five malignant cell lines and found that the amounts of IL-6 produced by them were well correlated with IL-6 concentrations of the effusions from which these lines were derived (r=0.96; p<0.01). These results suggest that a marked heterogeneity of IL-6 concentrations in malignant effusions reflects the differential production of IL-6 by malignant cells in pleural space.

[Laparoscopic surgery in the treatment of urogenital prolapse. Current status]

Urogenital prolapse is an emerging problem because of the increasing life expectancy of populations. Nearly 42% of women between 15 and 97 years have a pelvic floor disorder (PFD). On the basis of Medline search, we present the main laparoscopical techniques to treat PFD: Burch, sacrocolpopexy, lateral suspension, uterosacral suspension, paravaginal repair, the benefits of laparoscopic surgery, its success rates and complications, and response to various questions that frequently arise about some techniques: should we perform a hysterectomy? Should we make a paravaginal repair? Should we treat prophylactically a stress urinary incontinence? What type of mesh should we use? What to prefer: staples or sutures? Is the posterior mesh necessary?

Pancreatic stellate cells enhance stem cell-like phenotypes in pancreatic cancer cells

The interaction between pancreatic cancer cells and pancreatic stellate cells (PSCs), a major profibrogenic cell type in the pancreas, is receiving increasing attention. There is accumulating evidence that PSCs promote the progression of pancreatic cancer by increasing cancer cell proliferation and invasion as well as by protecting them from radiation- and gemcitabine-induced apoptosis. Recent studies have identified that a portion of cancer cells, called "cancer stem cells", within the entire cancer tissue harbor highly tumorigenic and chemo-resistant phenotypes, which lead to the recurrence after surgery or re-growth of the tumor. The mechanisms that maintain the "stemness" of these cells remain largely unknown. We hypothesized that PSCs might enhance the cancer stem cell-like phenotypes in pancreatic cancer cells. Indirect co-culture of pancreatic cancer cells with PSCs enhanced the spheroid-forming ability of cancer cells and induced the expression of cancer stem cell-related genes ABCG2, Nestin and LIN28. In addition, co-injection of PSCs enhanced tumorigenicity of pancreatic cancer cells in vivo. These results suggested a novel role of PSCs as a part of the cancer stem cell niche.