Outcomes of left bundle branch area pacing compared to His bundle pacing and right ventricular apical pacing in Japanese patients with bradycardia

Background

His bundle pacing (HBP) and left bundle branch area pacing (LBBAP) emerge as better alternatives to right ventricular apical pacing (RVAP) in patients with bradycardia requiring permanent cardiac pacing. We aimed to compare the clinical outcomes of LBBAP, HBP, and RVAP in Japanese patients with bradycardia.

Methods

A total of 424 patients who underwent successful pacemaker implantation (HBP, n = 53; LBBAP, n = 75; and RVAP, n = 296) were retrospectively enrolled in this study. The primary study endpoint was the cumulative incidence of heart failure hospitalization (HFH) during the follow-up.

Results

The success rate for implantation was higher in the LBBAP group than in the HBP group (94.9% and 81.5%, respectively). Capture threshold increase >1V during the follow-up occurred in the HBP and RVAP groups (9.4% and 5.1%, respectively), while it did not in the LBBAP group. The cumulative incidence of HFH was significantly lower in the LBBAP group than the RVAP (adjusted hazard ratio, 0.12 [95% confidence interval: 0.02-0.86]; p = .034); it did not differ between the HBP and RVAP groups (adjusted hazard ratio, 0.48 [95% confidence interval: 0.17-1.34]; p = .16). Advanced age, mean percent right ventricular pacing (per 10% increase), left ventricular ejection fraction <50%, and RVAP were associated with HFH.

Conclusions

Compared to RVAP and HBP, LBBAP appeared more feasible and effective in patients with bradycardia requiring permanent cardiac pacing.

Preparation and characterization of carboxymethylated Aureobasidium pullulans β-(1 → 3, 1 → 6)-glucan and its in vitro antioxidant activity

Aureobasidium pullulans β-(1 → 3, 1 → 6)-glucan (APG) has a high degree of β-(1 → 6)-glucosyl branching and a regular triple helical structure similar to that of schizophyllan. In this study, APG was carboxymethylated to different degrees of substitution (DS = 0.51, 1.0, and 2.0, denoted CMAPG 1-3, respectively) using a heterogeneous reaction. With increasing DS, the triple-helix structure drastically decreased and converted to a random coil structure in CMAPG 3. Further, aqueous solutions of CMAPG changed from pseudoplastic fluids to perfect Newtonian liquids with increasing DS, indicating that the intra- and intermolecular hydrogen bonds had been cleaved by the substituents to form a random coil structure. In addition, APG and CMAPG solutions exhibited scavenging ability against hydroxyl, organic, and sulfate radicals. It was also found that the carboxymethylation of APG drastically enhanced the organic radical scavenging ability. On the basis of the relationship between the DS and radical scavenging ability of the CMAPG samples, we believe hydroxyl and organic radicals were preferably scavenged by the donation of hydrogen atoms from the glucose rings and the methylene moieties of the carboxymethyl groups, respectively. Considering the obtained results, CMAPG and APG are expected to have applications in pharmaceuticals, functional foods, and cosmetics as antioxidant polysaccharides.

Chitosan Hydrogels Crosslinked with Oxidized Sucrose for Antimicrobial Applications

Oxidized sucrose (OS) reacts with amino-group-containing polysaccharides, including chitosan, without catalyst, resulting in hydrogels entirely composed of carbohydrates. The presence of imine bonds with low structural stabilities and unreacted aldehydes in the structures of these hydrogels hinder their application as biomaterials. Therefore, herein, the chitosan hydrogels (CTSGs) obtained after the crosslinking of chitosan with OS were reduced using sodium borohydride to convert imine bonds to secondary amines and aldehydes to alcohols. The structures of CTSGs were comprehensively characterized using Fourier transform infrared and 13C nuclear magnetic resonance spectroscopies, and the results implied that the degree of crosslinking (CR) depended on the OS feed amount used during CTSG preparation. The properties of CTSGs were significantly dependent on CR; with an increase in CR, the thermal stabilities and dynamic moduli of CTSGs increased, whereas their swelling properties decreased. CTSGs exhibited antimicrobial properties against the gram-negative bacterium Escherichia coli, and their performances were also dependent on CR. The results indicated the potentials of CTSGs completely based on carbohydrates as antimicrobial hydrogels for various medical and pharmaceutical applications. We believe that this study will contribute to the development of hydrogels for application in the food, medical, and pharmaceutical fields.

NMR and HPLC profiling of bee pollen products from different countries

•

Analysis using NMR and HPLC can be used to identify countries of origin but not producing years of bee pollens.

•

Flavanoids in bee pollens from different countries were characterized using HPLC.

•

Bee pollens from Spain and Australia were high in sucrose and adenosine.

•

Bee pollens from China were high in trigonelline, uridine, and cytidine.

•

Only the bee pollens from China contained acetic acid.

Bee pollen, a beehive product collected from flowers by honeybees, contains over 250 biological substances, and has attracted increasing attention as a functional food. However, commercial bee pollen products are often multifloral, and samples from different countries vary significantly. There is no universal standard for objective quality assessment of bee pollen based on its chemical composition. Here, we report metabolomic analysis of 11 bee pollen samples from Spain, China, and Australia for quality control. The characteristics of the samples depend on the sucrose, nucleoside, amino acid, and flavanol concentrations. Bee pollen samples from Spain and Australia had higher sucrose and adenosine concentrations, whereas those from China had higher trigonelline, uridine, and cytidine concentrations. Interestingly, acetic acid was only detected in samples from China. These components can be used to identify the country of origin. The obtained profiles of the samples will contribute to universal standard development for bee pollen products.

The Anatomical Position of Graf’s Standard Plane and Its Relationship With Pelvic Morphology: A Computed Tomography-Based Study

Objective

The Graf method is the most widely used ultrasonographic method for evaluating developmental dysplasia of the hip (DDH), and it relies on a set standard plane. However, no previous reports have discussed the detailed anatomical location of the plane. The aim of this study was to evaluate the exact anatomical position of Graf’s standard plane in the pelvis and to ascertain the correlation between this position and pelvic morphology in children without abnormal pelvic morphology.

Methods

We retrospectively assessed the pelvic CT data of 32 children (64 hips) aged three to five years without abnormal pelvic morphology and measured the pelvic winging and acetabular anteversion and coverage. We defined the coronal plane that passed through the center of the bilateral femoral head as plane A. We determined that Graf’s standard plane could be approximated by rotating plane A until the outer wall of the ilium was parallel to the sagittal plane, and we defined this as plane A′. AA′ was defined as the angle from plane A to plane A′ on the sagittal plane. The anterior rotational angle (clockwise, viewing from the right side) was measured as the positive AA′. Moreover, we measured the pelvic rotation, acetabular anteversion, and acetabular coverage and evaluated the correlation between AA′ and these morphological parameters.

Results

The average AA′ was -8.27° and AA′ had a significant correlation with acetabular anteversion (Spearman’s ρ=0.40**, p<0.01).

Conclusions

We found that Graf's standard plane, as determined by the CT scan, tilts slightly posteriorly. This information may be useful in improving the ease of ultrasonographic examination of DDH.

Clinical outcome for heart failure hospitalizations in patients with leadless pacemaker

Introduction

The long‐term performance of leadless pacemaker (LPM) has not been well evaluated.

Methods

Between September 2017 and January 2021, 929 consecutive patients who underwent pacemaker implantation were grouped according to the types of pacemakers: LPM (LPM group, n = 368) and conventional pacemaker (PM group, n = 561).

Results

The median follow‐up duration was 1.7 years (interquartile range 0.8–2.6 years). Hospitalization rate for heart failure in the LPM group was 9.3%, 15.6%, and 21.6% at 1, 2, 3 years, respectively. The LPM group had a significantly higher adjusted heart failure hospitalization risk than the PM group [hazard ratio (HR) 1.70, 95% confidence interval (CI) 1.09–2.64, p = .01]. More patients with symptomatic bradycardia caused by sinus node dysfunction (SND) in the LPM group (n = 150) were admitted to the hospital for heart failure compared to those in the PM group (n = 219) (HR 2.02, 95%CI 1.04–3.90, p = .03), whereas no significant difference was observed between the two groups in the patients with bradycardia caused by atrial fibrillation (LPM group, n = 71; PM group, n = 18) or atrioventricular block (LPM group, n = 147; PM group, n = 324).

Conclusions

Patients who received LPM implantation had greater hospitalization risk for heart failure, compared to those who received conventional pacemaker implantation. The increased risk was mainly attributed to patients with SND.

Optimization of the conditions for the immobilization of glycopolypeptides on hydrophobic silica particulates and simple purification of lectin using glycopolypeptide-immobilized particulates

Glycopolypeptide-immobilized particulates exhibit high binding selectivities and affinities for several analytes. However, to date, the conditions for the synthesis of glycopolypeptide-immobilized particulates have not been optimized and the application of these particulates as carriers for affinity chromatography has not been reported. Accordingly, herein, as a model compound for determining the optimal conditions for the immobilization of an artificial glycopolymer on hexyl-containing hybrid silica particulates (HSPs), the glycopolypeptide poly [GlcNAcβ1,4GlcNAc-β-NHCO-(CH₂)₅NH-/CH₃(CH₂)₉NH-/γ-PGA] (3) containing multivalent chitobiose moieties and multivalent decyl groups with a γ-polyglutamic acid backbone was synthesized. Immobilization of 3 on HSPs under each condition was evaluated by a lectin-binding assay using wheat germ (Triticum vulgaris) agglutinin (WGA), which is an N-acetylglucosamine-binding lectin. As a result, the optimal immobilization conditions for HSPs at 25 mg/mL were obtained at dimethyl sulfoxide (DMSO) concentration of reaction solvent in the range of 1_(DMSO):9_(water) to 4_(DMSO):6_(water) and a compound 3 concentration in the range of 125 nM-1250 nM. Furthermore, the influence of the alkyl group structure introduced into glycopolypeptide for imparting hydrophobicity to it on the immobilization of glycopolypeptide on HSPs was investigated. As a result of comparing three types, poly [GlcNAcβ1,4GlcNAc-β-NHCO-(CH₂)₅NH-/γ-PGA] (1) with no alkyl group, poly [GlcNAcβ1,4GlcNAc-β-NHCO-(CH₂)₅NH-/CH₃(CH₂)₄NH-/γ-PGA] (2) with a pentyl group, and 3 with a decyl group, 3 showed the best immobilization efficiency on HSPs. Finally, 1 mg 3-immobilized HSPs prepared under the optimum conditions adsorbed approximately 7.5 μg WGA in a structure-specific manner. We also achieved a simple WGA purification from raw wheat germ extract as a practical example using 3-immobilized HSPs. We believe that in the future, these glycopolypeptide-immobilized particulates will be used not only for the purification of plant lectins, but also as specific adsorbents for various lectins-like substances such as in vivo lectins, pathogenic viruses, and toxin proteins.

Preparation and Enzyme Degradability of Spherical and Water-Absorbent Gels from Sodium Carboxymethyl Cellulose

To synthesize a biodegradable alternative to spherical polyacrylic acid absorbent resin, spherical hydrogel particles were prepared from carboxymethyl cellulose (CMC) dissolved in an aqueous solution, using ethylene glycol diglycidyl ether (EGDE) as a crosslinking agent. The effect of varying the initial CMC concentration and feed amount of EGDE on the shape, water absorbency, water-holding capacity, and enzyme degradability of the resultant CMC hydrogels was determined. The reaction solution was poured into fluid paraffin, and spherical hydrogel particles were obtained via the shear force from stirring. The shape and diameter of the spherical hydrogel particles in the swollen state depended on the CMC concentration. The spherical hydrogel particles obtained by increasing the amount of EGDE resulted in a decrease in absorbency. Additionally, all the spherical hydrogel particles were degraded by cellulase. Thus, spherical biodegradable hydrogel particles were prepared from CMC, and the particle size and water absorption of the hydrogel could be controlled in the range of 5–18 mm and 30–90 g·g⁻¹ in the swollen state, respectively. As an alternative to conventional superabsorbent polymers, the spherical CMC hydrogels are likely to be useful in industrial and agricultural applications.

Dramatically Increased Binding Constant of Water-Soluble Cyclodextrin Hyperbranched Polymers: Explored with Diffusion Ordered NMR Spectroscopy (DOSY)

We report that the polymerization of cyclodextrin (CD) with epichlorohydrin (ECH) dramatically increases the binding constant of CD to vanillin, from 55 to 8.4 × 10³ M^-1, by approximately 100 times, as determined by diffusion ordered spectroscopy (DOSY)-¹H NMR. The binding constant increased with an increase of the ECH content of the polymer, although ECH polymers without CDs showed no affinity at all, suggesting that the hydrophobicity of the ECH network outside of CDs helps to enhance the binding. This increased binding constant allows CD-ECH polymers to increase the drug loading ratio, which may be one of the most critical issues for drug delivery systems.

Reinforcing Poly(methyl methacrylate) with Bacterial Cellulose Nanofibers Chemically Modified with Methacryolyl Groups

Nanofibrillated bacterial cellulose (NFBC), a type of cellulose nanofiber biosynthesized by Gluconacetobacter sp., has extremely long (i.e., high-aspect-ratio) fibers that are expected to be useful as nanofillers for fiber-reinforced composite resins. In this study, we investigated a composite of NFBC and poly(methyl methacrylate) (PMMA), a highly transparent resin, with the aim of improving the mechanical properties of the latter. The abundant hydroxyl groups on the NFBC surface were silylated using 3-(methacryloyloxy)propyltrimethoxysilane (MPTMS), a silane coupling agent bearing a methacryloyl group as the organic functional group. The surface-modified NFBC was homogeneously dispersed in chloroform, mixed with neat PMMA, and converted into PMMA composites using a simple solvent-casting method. The tensile strength and Young’s modulus of the composite increased by factors of 1.6 and 1.8, respectively, when only 0.10 wt% of the surface-modified NFBC was added, without sacrificing the maximum elongation rate. In addition, the composite maintained the high transparency of PMMA, highlighting that the addition of MPTMS-modified NFBC easily reinforce PMMA. Furthermore, interactions involving the organic functional groups of MPTMS were found to be very important for reinforcing PMMA.

Facile Post-Carboxymethylation of Cellulose Nanofiber Surfaces for Enhanced Water Dispersibility

To improve the water dispersibility of cellulose nanofibers without deteriorating the physical properties, it is necessary to develop methods that can selectively modify fiber surfaces. Herein, the reaction conditions for carboxymethylation of the surface of nanofibrillated bacterial cellulose were optimized using chloroacetic acid as an etherification agent. Carboxymethylation in a high-concentration alkaline solution (>5 wt %) in the presence of isopropanol caused the mercerization and carboxymethylation of not only the nanofiber surface but also the cellulose crystals within the nanofiber, resulting in nanofiber swelling and an increase in fiber width. In contrast, with a dilute alkaline aqueous solution (3 wt %), the nanofiber surface was successfully carboxymethylated without changing the inner structure. Furthermore, the morphology was not affected by the carboxymethylation reaction, and no fiber swelling occurred under these reaction conditions. When the substitution reaction proceeded only on the nanofiber surface, the maximum degree of substitution (i.e., the average number of carboxymethyl groups substituted per anhydroglucose residue in cellulose) was 0.091. After surface modification, the nanofibers became more negatively charged, which improved the dispersibility in water through electrostatic repulsion, resulting in a drastic increase in the transparency of the nanofiber dispersion. This method provides a general approach for the surface modification of cellulose nanofibers to increase water dispersibility.

Incidence and Characteristics of Coronary Artery Spasms Related to Atrial Fibrillation Ablation Procedures - Large-Scale Multicenter Analysis

BACKGROUND

Coronary artery spasms (CASs), which can cause angina attacks and sudden death, have been recently reported during catheter ablation. The aim of the present study was to report the incidence, characteristics, and prognosis of CASs related to atrial fibrillation (AF) ablation procedures.Methods and Results:The AF ablation records of 22,232 patients treated in 15 Japanese hospitals were reviewed. CASs associated with AF ablation occurred in 42 of 22,232 patients (0.19%). CASs occurred during ablation energy applications in 21 patients (50%). CASs also occurred before ablation in 9 patients (21%) and after ablation in 12 patients (29%). The initial change in the electrocardiogram was ST-segment elevation in the inferior leads in 33 patients (79%). Emergency coronary angiography revealed coronary artery stenosis and occlusions, which were relieved by nitrate administration. No air bubbles were observed. A comparison of the incidence of CASs during pulmonary vein isolation between the different ablation energy sources revealed a significantly higher incidence with cryoballoon ablation (11/3,288; 0.34%) than with radiofrequency catheter, hot balloon, or laser balloon ablation (8/18,596 [0.04%], 0/237 [0%], and 0/111 [0%], respectively; P<0.001). CASs most often occurred during ablation of the left superior pulmonary vein. All patients recovered without sequelae.

CONCLUSIONS

CASs related to AF ablation are rare, but should be considered as a dangerous complication that can occur anytime during the periprocedural period.

[Familial Mediterranean Fever-Associated Lenticulostriate Artery Aneurysm Presenting with Intracranial Hemorrhage and Disappearing Spontaneously: A Case Report]

Lenticulostriate artery (LSA) aneurysm is relatively rare, and the need for surgical intervention is controversial. Here, we report a case of ruptured LSA aneurysm which was accompanied by familial Mediterranean fever (FMF). A 45-year-old woman with a history of FMF presented with sudden onset of headache and vertigo. Computed tomography revealed hemorrhage in the right caudate nucleus and lateral ventricles. Digital subtraction angiography revealed a fusiform aneurysm (3mm) at the distal site of medial LSA. Observation was selected, and the aneurysm gradually decreased and eventually disappeared on the 105^th day from the onset. This was the first report describing an LSA aneurysm associated with FMF. It suggests that such aneurysms could be treated conservatively with close radiological follow-up.

Brazilian green propolis promotes the cytoprotective expression of heme oxygenase-1 against oxidative stress injury in murine myoblast cells

Background: Sarcopenia is a progressive skeletal muscle disorder characterized by the progressive loss of muscle mass and function, resulting in physical disability and mortality. Although sarcopenia impacts a large proportion of elderly individuals, no effective treatment for this disease has yet been identified. The excessive production of reactive oxygen species (ROS) can damage tissues and promote aging, and the daily use of dietary antioxidants can be effective for maintaining skeletal muscle health. Propolis, a natural substance that is collected by honey bees, has been used as traditional medicine, and many reports have described its antioxidative properties. However, how propolis exhibits cytoprotective effects and antioxidative effects in skeletal muscles remains unclear. The purpose of this study was to investigate the antioxidative effects of ethanol-extracted Brazilian green propolis (EEBP, from Baccharis dracunculifolia) and its three constituents using an in vitro myoblast cell model.Methods: Murine myoblast C2C12 cells were treated with either EEBP or its constituents, including caffeic acid, trans-ferulic acid, and p-coumaric acid, in the presence of 100 or 300 mM H2O2 to induce oxidative stress injury. The cell death ratio and cell viability were assessed by Hoechst 33342 and propidium iodide staining and the WST-8 assay, respectively. Simultaneously, intracellular ROS production was measured by CM-H2DCFDA [5-(and-6)-chloromethyl-2’,7’-dichlorodihydrofluorescein diacetate, acetyl ester] assay. Finally, immunoblotting was performed in myoblast cell lysates to assess the expression level of an antioxidative enzyme, heme oxygenase-1 (HO-1).Results: We demonstrated that EEBP significantly reduced H2O2-induced cell death at a concentration of 3 µg/ml in myoblasts. Additionally, caffeic acid at 100 µM improved cell viability under oxidative stress conditions, but not trans-ferulic acid or p-coumaric acid. Both EEBP and caffeic acid inhibited the H2O2-induced increase in ROS production. Finally, HO-1 expression was increased by treatment with either EEBP or caffeic acid. The increase in HO-1 expression induced by H2O2 was enhanced in the presence of EEBP and caffeic acid.Conclusions: These findings indicated that EEBP has protective effects against oxidative damage in C2C12 murine myoblast cell line. Caffeic acid is an EEBP constituent that contributes to cytoprotective activity. EEBP may act as an inducer of HO-1 to prevent oxidative stress-induced myoblast death.Keywords: C2C12 murine myoblast cells, heme oxygenase-1, oxidative stress, propolis, reactive oxygen species

Nanofibrillated Bacterial Cellulose Modified with (3-Aminopropyl)trimethoxysilane under Aqueous Conditions: Applications to Poly(methyl methacrylate) Fiber-Reinforced Nanocomposites

The development of eco-friendly fiber-reinforced composite resins is an important objective from an environmental perspective, and nanofibrillated bacterial cellulose (NFBC), with extremely long high-aspect-ratio fibers, is a filler material with high potential for use in such composite resins. In this study, we investigated chemical modification of the surfaces of NFBC fibers by coupling with (3-aminopropyl)trimethoxysilane and fabricated nanocomposite materials using the prepared surface-modified NFBC. The product prepared by the one-pot reaction of (3-aminopropyl)trimethoxysilane with NFBC microfibrils dispersed in aqueous acid retained the same nanofibril structure as the intact NFBC. The degree of molar substitution and the silicon states on the surface of the product depended on the NFBC/(3-aminopropyl)trimethoxysilane ratio. The thermal analysis revealed that the thermal degradation temperature of the products increases with an increase of degree of molar substitution. Highly transparent (78-89% at 600 nm) poly(methyl methacrylate)-based nanocomposites were prepared by solvent casting; the nanocomposite containing 1.0 wt % (3-aminopropyl)trimethoxysilylated NFBC was only 8% less transparent than neat poly(methyl methacrylate) at 600 nm. In addition, the tensile strength of the nanocomposite was more than twice that of neat poly(methyl methacrylate) when 1 wt % of the surface-modified NFBC was added. The surface-modified NFBC is expected to be a reinforcing nanofiber material that imparts excellent physical properties to fiber-reinforced resins.

Substituent distribution of propyl cellulose studied by nuclear magnetic resonance

A series of propyl cellulose (PC) samples with different degrees of substitution (DS) ranging from 0.34 to 2.02 were prepared by a slurry method using propyl bromide as the etherification reagent. Two-dimensional nuclear magnetic resonance (NMR) studies were performed to identify the ¹H and ¹³C chemical shifts of eight anhydroglucose units (AGUs) in PC chains including un-, 2-mono-, 3-mono-, 6-mono-, 2,3-di-, 2,6-di-, 3,6-di-, and 2,3,6-tri-substituted ones. In addition, the mole fractions (χ) of these AGUs in the studied PC samples and their changes with DS were determined from the quantitative ¹³C NMR spectra. The obtained χ-DS profiles were different from those of methyl and ethyl celluloses prepared by a similar slurry method, indicating that the molecular sizes of the substituent reagents utilized for cellulose ethers strongly affected their substituent distributions.

The natural course of the paravertebral muscles after the onset of osteoporotic vertebral fracture

This study revealed the change in the paravertebral muscles in patients with osteoporotic vertebral fracture. Increased pain is likely to be the driver for reduced activity, reduced activities of daily living, and consequent increase in fat infiltration of the paravertebral muscles, assumed to be secondary to reduced activity level or, conversely, partial immobilization.

INTRODUCTION

To reveal the time courses and impact of the paravertebral muscles (PVMs) on the healing process of osteoporotic vertebral fractures and risk factors for PVM decrease.

METHODS

Consecutive patients with symptomatic osteoporotic vertebral fractures were enrolled in 11 hospitals. At enrollment and 3- and 6-month follow-up, PVMs, including the multifidus and erector spinae, were examined using magnetic resonance imaging (MRI). The PVM cross-sectional area (CSA) and fat signal fraction (FSF) were measured at L3. Low back pain (LBP), activities of daily living (ADLs), and risk factors for PVM decrease at the 6-month follow-up were investigated. PVM decrease was defined as > 1 standard deviation decrease of the CSA or > 1 standard deviation increase of the FSF.

RESULTS

Among 153 patients who completed the 6-month follow-up, 117 (92 women, 79%) had MRI of L3 at enrollment and 3- and 6-month follow-up (mean age at enrollment, 78.5 years). The CSA did not change 6 months from onset (p for trend = 0.634), whereas the FSF significantly increased (p for trend = 0.033). PVM decrease was observed in 30 patients (26%). LBP was more severe, and delayed union was more frequent in patients with PVM decrease (p = 0.021 mixed-effect model and p = 0.029 chi-square test, respectively). The risk factors for PVM decrease were ADL decline at the 3-month follow-up (adjusted odds ratio = 5.35, p = 0.026).

CONCLUSION

PVM decrease was significantly related to LBP and delayed union after osteoporotic vertebral fracture onset. ADL decline at the 3-month follow-up was a risk factor for PVM decrease. Therefore, restoring ADLs within 3 months after onset is important.

SAT0116 COMPARISON OF THE EFFICACY OF ABATACEPT ON ELDERLY AND YOUNG PATIENTS WITH RHEUMATOID ARTHRITIS

Background:

The widespread use of biologic agents has greatly improved the prognosis of rheumatoid arthritis (RA). On the other hand, elderly patients with RA are relatively increasing. Although achieving low disease activity is a goal for those elderly patients as well as young patients, the efficacy of tumor necrosis factor inhibitors were reported to be equally or slightly less effective in elderly patients than in young patients. There is a lack of evidence for the efficacy of abatacept (ABT) in elderly patients.

Objectives:

In this study, we aimed to clarify the efficacy of ABT in elderly and young patients with RA compared to csDMARDs.

Methods:

This is a multicenter, open-label, prospective, observational study. All patients with RA enrolled this study are refractory to csDMARDs and have not received any biologics. Either ABT or csDMARDs was administered at the discretion of physicians to elderly (65 years and older) and young (20-64 years) patients (ABT-elderly, ABT-young, control (CTL)-elderly, and CTL-young groups). Comparison was made between 4 groups of patients. The primary study endpoint was a good response by EULAR response criteria at week 24 after administration. The research procedure has been approved by the ethics committee of Toho University School of Medicine (Approval number: A17112).

Results:

A total of 219 patients, 127 in the ABT group and 92 in the CTL group, were enrolled in this study. The majority of patients were women (82.7%) with a mean age (±SD) of 64.9±13.6 years (74.5±5.9 years in the elderly group and 52.4±10.1 years in the young group). The ABT group had higher disease activity, higher HAQ, and higher steroid use rates and dosage than the CTL group. These were also observed in the elderly group. In the young group, although the ABT group had higher disease activity and higher HAQ than the CTL group, no difference was observed in steroid use rates and dosage. The ABT group more frequently achieved a good response by EULAR response criteria compared to the CTL group at week 24 (58.8% and 27.2%, respectively, p<0.0001). The ABT group also showed higher efficacy than the CTL group in the elderly and young groups with a good response. Regarding the improvement in DAS28-ESR and DAS28-CRP, the ABT group was also superior to the CTL group. There was no difference on efficacy between elderly and young patients from the ABT groups.

Based on propensity score matching for disease activity at baseline, 61 matched pairs of patients treated with ABT or csDMARDs were statistically extracted. Although there was no significant difference in the rate of patients with a good response by EULAR response criteria between the ABT and the CTL groups, the ABT group showed significantly better response than the CTL group in the elderly. Furthermore, the ABT group was superior to the CTL group in improvement in both DAS28-ESR and DAS28-CRP, and similar results were obtained in the elderly. However, there was no significant difference between the ABT group and the CTL group in the young. In addition, elderly patients had significant improvement in DAS28-ESR compared with young patients in the ABT group.

Conclusion:

Treatment with ABT showed higher efficacy compared with CTL, particularly in elderly patients with RA.

References:

[1]Harigai M, et al. Mod Rheumatol. 2019;29:747.

[2]Sugihara T, Harigai M. Drugs Aging. 2016;33:97.

Disclosure of Interests:

Sei Muraoka Consultant of: Asahikasei Pharma Corp., Speakers bureau: Ono Pharmaceutical Co., Ltd., Eisai Co., Ltd., Asahikasei Pharma Corp., and Astellas Pharma Inc., Zento Yamada: None declared, Wataru Hirose: None declared, Hajime Kono: None declared, Shinsuke Yasuda Speakers bureau: Bristol Myers Squibb, Chugai Pharmaceutical Co., Tanabe Mitsubishi Parma Co., and GlaxoSmith Kline, Toshihiro Nanki Grant/research support from: Chugai Pharmaceutical Co., Eisai Co., Ltd., Teijin Pharma Ltd., Eli Lilly Japan K.K., Bristol-Myers K.K., Ono Pharmaceutical Co., Ltd., Novartis Pharma K.K., Asahikasei Pharma Corp., Mitsubishi-Tanabe Pharma Co., Astellas Pharma Inc., Ayumi Pharmaceutical Co., Pfizer Japan Inc., Daiichi Sankyo Co., Ltd., Shionogi & Co., Ltd., Sanofi K.K., Nippon Kayaku Co., Ltd., Yutoku Pharmaceutical Ind. Co., Ltd., UCB Japan Co. Ltd., Nihon Pharmaceutical Co., Ltd., and Bayer Yakuhin, Ltd., Consultant of: UCB Japan Co., Ltd., Eisai Co., Ltd., and Chugai Pharmaceutical Co., Speakers bureau: Mitsubishi-Tanabe Pharma Co., Chugai Pharmaceutical Co., Eisai Co., Ltd., Astellas Pharma Inc., Janssen Pharmaceutical K.K., Ayumi Pharmaceutical Co., Pfizer Japan Inc., Asahikasei Pharma Corp., Sanofi K.K., Novartis Pharma K.K., Eli Lilly Japan K.K., Nippon Kayaku Co., Ltd., Teijin Pharma Ltd., Takeda Pharmaceutical Co., Nippon Boehringer Ingelheim Co., Ltd., and AbbVie GK.

SAT0243 SUBPHENOTYPES IN POLYARTERITIS NODOSA (PAN): TARGET ORGAN ASSOCIATIONS OF A WORLDWIDE COLLABORATION STUDY

Background:

There is a paucity of information on the current phenotypes, ethnic and geographic differences of PAN. A global PAN study group has been working for clinical subphenotype and GWAS studies.

Objectives:

This study is aimed to look for target organ associations in PAN.

Methods:

PAN patients fulfilling the EMA vasculitis classification algorithm were recruited. In addition to baseline characteristics, treatment and outcome data, occurrence of any of the clinical manifestations related to PAN during disease course was recorded.

Factor analysis was used to analyse target organ associations of 306 patients. Five factors were identified by factor analysis of variables sex, paediatric-onset, HBV, monogenic disease relationship, cutaneous features, musculoskeletal symptoms, constitutional symptoms and involved areas (abdominal, renal, neurologic, ENT, cardiac, pulmonary).

Results:

PAN cohort from 7 countries were used (Italy: n=59, Japan: n=39, Mexico: n=29, Slovenia: n=14, Sweden:11, TUR: n=106, UK: n=48). 306 (M/F: 171/135 and Caucasian 77.1%, Asian 13.4%, and Hispanic 9.5%) patients were included. 8 were HBV-related, and 22 of TUR patients had a monogenic form of disease (FMF n=15, DADA2 n=7). 21.8% of patients were cutaneous-only PAN patients. 48.4% of patients had radiologic, 64% had biopsy-proven PAN. Median age at disease onset was 40 (IQR 27.0-57.5) years. During a median 57 (16-120) months follow-up, 39 (13%) patients died.

Factor analysis revealed 5 factors that explained 54.1% of the original information on the matrix as follows:Factor 1,represented the association between gastrointestinal and renal involvement, male gender and negatively associated with cutaneous features;Factor 2,the association between monogenic relationship with paediatric onset disease;Factor 3,any of musculoskeletal findings with positive constitutional symptoms;Factor 4any neurologic involvement was associated with ENT and pulmonary findings;Factor 5cardiac involvement in non-HBV patients (Table).

The eigenvalues of the 5 factors were 2.034, 1.470, 1.427, 1.079 and 1.030, in decreasing order, i.e., the highest contribution to the overall variance in the matrix came from the togetherness of the 4 clinical and demographic characteristics that made up Factor 1.

Conclusion:

Target organ associations could support distinctive subphenotypes in PAN. Factor 1 seems the most severe form. Patients with FMF or DADA2 have distinct target organ associations. The jury is out to decide whether these patients should be classified as ‘vasculitis associated with probable etiology’ just as HBV-related-PAN. Factor 4 might define a different subphenotype (ANCA- medium vessel vasculitis?).

Disclosure of Interests:

Omer Karadag: None declared, Ertugrul Cagri Bolek: None declared, Shunsuke Furuta: None declared, Giacomo Emmi: None declared, ALOJZIJA HOCEVAR: None declared, Andrea Hinojosa-Azaola: None declared, Aladdin J Mohammad Speakers bureau: lecture fees from Roche and Elli Lilly Sweden, PI (GiACTA study), Serdal Ugurlu: None declared, Fatma Alibaz-Oner: None declared, Ayten Yazici: None declared, Luca Quartuccio: None declared, Enrica Bozzolo: None declared, Lorenzo Dagna Grant/research support from: Abbvie, BMS, Celgene, Janssen, MSD, Mundipharma Pharmaceuticals, Novartis, Pfizer, Roche, SG, SOBI, Consultant of: Abbvie, Amgen, Biogen, BMS, Celltrion, Novartis, Pfizer, Roche, SG, and SOBI, Giuseppe Alvise Ramirez: None declared, Luca Cantarini: None declared, Gina Gregorini: None declared, Jeannin Guido: None declared, Sara Monti: None declared, Eduardo Martin-Nares: None declared, Franco Schiavon: None declared, Roberto Padoan: None declared, Hajime Kono: None declared, Augusto Vaglio: None declared, Saadettin Kiliçkap: None declared, Ali İhsan Ertenli: None declared, Haner Direskeneli: None declared, Seza Özen Consultant of: Novartis, Pfizer, Speakers bureau: SOBI, Novartis, David Jayne Grant/research support from: ChemoCentryx, GSK, Roche/Genentech, Sanofi-Genzyme, Consultant of: Astra-Zeneca, ChemoCentryx, GSK, InflaRx, Takeda, Insmed, Chugai, Boehringer-Ingelheim

Solid-state relaxation NMR dataset for a water-soluble β-(1→3, 1→6)-glucan from Aureobasidium pullulans and schizophyllan from Schizophyllum commune

We report the solid-state nuclear magnetic resonance (NMR) relaxation dataset for a triple helix and a random structure of water-soluble Aureobasidium pullulans β-(1→3, 1→6)-d-glucan (APG) and those of schizophyllan from Schizophyllum commune (SPG), obtained by the Bruker BioSpin 500 MHz NMR spectrometer. These data include solid-state proton spin-lattice relaxation in the rotating frame (T_1ρH) and ¹³C spin-lattice relaxation (T_1C) of these two β-(1→3, 1→6)-glucans, which are related to the subject of article in International Journal of Biological Macromolecules, entitled “Characterization of the secondary structure and order–disorder transition of a β-(1→3, 1→6)-glucan from Aureobasidium pullulans” [1]. Data can help to investigate the structural characterization of the structural polysaccharides.

Characterization of the secondary structure and order-disorder transition of a β-(1 → 3, 1 → 6)-glucan from Aureobasidium pullulans

This study revealed the secondary structures of the water-soluble Aureobasidium pullulans β-(1 → 3, 1 → 6)-d-glucan (APG) whose primary structural unit is a β-(1 → 3)-d-glucan backbone with four β-(1 → 6)-d-glucosyl branching units every six residues. Solid-state NMR spectroscopy, X-ray diffractometry (XRD), and small-angle X-ray scattering (SAXS) experiments involving samples prepared from lyophilized APG showed that APG forms a triple helix in H₂O and a random structure in DMSO. In addition, it was revealed that the transformation from the triple helix of APG to the random structure occurs reversibly, and that the triple helix is recovered from the random structure in DMSO/H₂O mixtures containing more than 30% H₂O. Solid-state NMR and diffraction studies revealed that the triple helix of APG is more stable than that of schizophyllan (SPG) whose structure comprises a β-(1 → 3)-d-glucan backbone with one β-(1 → 6)-d-branching unit every three residues. The APG helical pitch is 1.82 nm, which is about 10% longer than that of the triple helix of SPG. These findings show that the β-(1 → 6) side-chain frequency strongly affects the stability and helical pitch of a β-(1 → 3, 1 → 6)-d-glucan.

Zeolitic intralayer microchannels of magadiite, a natural layered silicate, to boost green organic synthesis

Despite the considerable attention given to the applications of magadiite in previous research, the properties of this natural layered silicate have remained mysterious due to the lack of crystal structure information. On the other hand, no one has doubted the intercalation capability between the layers. Here we succeed in determining the structure of magadiite using X-ray pair distribution functions and synchrotron powder diffractometry. We discover unexpected zeolitic microchannels within the layers. We describe efficient synthesis of 100% pure benzoic acid from toluene by using magadiite as an additive in a TiO2 photocatalytic system oxidizing toluene. Based on the uncovered structure of magadiite, we clarify the mechanism of this unique photocatalytic system: the microchannels of magadiite not only separate/accommodate the desired partially oxidized product formed on TiO2 but also prevent the accumulation of the overoxidized products on the TiO2 surface that deactivates the photocatalytic activity.

Interleukin-18 is associated with the presence of interstitial lung disease in rheumatoid arthritis: a cross-sectional study

OBJECTIVE

Serum interleukin-18 (IL-18) levels are increased in patients with interstitial lung disease (ILD). In addition, IL-18 levels are increased in patients with rheumatoid arthritis (RA) and are associated with arthritis activity. We determined whether increased IL-18 levels are associated with ILD in RA.

METHOD

RA patients were enrolled using an RA cohort database. Plasma IL-18 levels were measured by enzyme-linked immunosorbent assay. ILD was determined by a pulmonologist and a radiologist based on chest radiography and computed tomography findings. IL-18 levels for RA with ILD and RA without ILD were compared. Associations between ILD and various markers including IL-18 and confounding factors (e.g. smoking history) were investigated by logistic regression analysis. Diagnostic values of IL-18 for the presence of ILD were investigated using receiver operating characteristics curve analysis.

RESULTS

ILD was complicated in 8.2% (n = 26) of the study population (N = 312). Plasma IL-18 levels were higher for RA patients with ILD than for RA patients without ILD (721.0 ± 481.4 vs 436.8 ± 438.9 pg/mL, p < 0.001). IL-18, Krebs von den Lungen-6, and anti-cyclic citrullinated peptide antibody titre and glucocorticoid doses were independently associated with the presence of ILD during multivariate logistic regression analysis. Sensitivity and specificity of IL-18 levels for the detection of ILD in RA patients were 65.3% and 76.3%, respectively (area under the curve = 0.73).

CONCLUSION

Plasma IL-18 levels were higher for RA patients with ILD than for those without ILD. Increased IL-18 levels were associated with the presence of ILD.

Two-dimensional NMR data of a water-soluble β-(1→3, 1→6)-glucan from Aureobasidium pullulans and schizophyllan from Schizophyllum commune

This article contains two-dimensional (2D) NMR experimental data, obtained by the Bruker BioSpin 500 MHz NMR spectrometer (Germany) which can used for the determination of primary structures of schizophyllan from Schizophyllum commune (SPG) and a water-soluble β-(1→3, 1→6)-glucan from Aureobasidium pullulans. Data include analyzed the 2D NMR spectra of these β-glucans, which are related to the subject of an article in Carbohydrate Polymers, entitled “NMR spectroscopic structural characterization of a water-soluble β-(1→3, 1→6)-glucan from A. pullulans” (Kono et al., 2017) [1]. Data can help to assign the ¹H and ¹³C chemical shifts of the structurally complex polysaccharides.

Determination of mole fractions of ethyl-cellulose-containing monomers by NMR

Three samples of ethyl cellulose (EC) with different degrees of substitution (DS)-0.51, 1.41, and 2.28-were prepared by a slurry method using ethyl bromide as the etherification reagent. ¹H-¹³C HSQC and HSQC-TOCSY NMR spectral analysis allowed for complete assignment of the ¹H and ¹³C chemical shifts, respectively, of eight anhydroglucose units (AGUs) comprising EC chains-un-, 2-mono-, 3-mono-, 6-mono-, 2,3-di-, 2,6-di-, 3,6-di-, and 2,3,6-tri-substituted AGUs. In addition, the lineshape of the quantitative ¹³C NMR spectra of the three EC samples provided change in the mole fractions of these AGUs against DS, making it possible to estimate the reaction mechanism for the production of EC, elucidating reactivities of the hydroxyl groups at the 2, 3, and 6 positions of cellulose and interactions between the substituent groups within the same AGU and vicinal AGUs.

The platelet-activating receptor C-type lectin receptor-2 plays an essential role in liver regeneration after partial hepatectomy in mice

Essentials Regeneration role of C-type lectin receptor-2 (CLEC-2) after 70% hepatectomy (HPx) was investigated. Wild-type or CLEC-2 deleted from platelets of chimeric mice (flKO) underwent HPx. The liver/body weight ratio was significantly lower in the flKO than in the wild-type. CLEC-2 plays an essential role in liver regeneration after HPx.

SUMMARY

Background and aim The aim of the present study was to investigate the role of C-type lectin receptor (CLEC)-2 in liver regeneration following partial liver resection in mice. Materials and methods Irradiated chimeric mice transplanted with fetal liver cells from wild-type (WT) mice, CLEC-2-deleted (KO) mice or mice with CLEC-2 deleted specifically from platelets (flKO) were generated. Mice underwent 70% partial hepatectomy (PH). Immunohistochemical staining was performed to investigate the expression of the endogenous ligand for CLEC-2, podoplanin. The accumulation of platelets in the liver was also quantified. The hepatic expression of the IL-6/gp130 and STAT3, Akt and ERK1/2 was also examined. Results The liver/body weight ratio and expression of all cell proliferation markers were significantly lower in the flKO group than in the WT group. The expression of phosphorylated (p) Akt and pERK1/2 was similar in the WT and flKO groups. On the other hand, the expression of pSTAT3 and IL-6 was significantly stronger in the WT group than in the flKO group. The expression of podoplanin was detected in the hepatic sinusoids of both groups. However, the extent to which platelets accumulated in hepatic sinusoids was significantly less in the flKO group than in the WT group. Conclusion CLEC-2 was involved in hepatic regeneration after liver resection and CLEC-2-related liver regeneration was attributed to the interaction between platelets and sinusoidal endothelial cells.

Zero-gap semiconductor to excitonic insulator transition in Ta2NiSe5

The excitonic insulator is a long conjectured correlated electron phase of narrow-gap semiconductors and semimetals, driven by weakly screened electron–hole interactions. Having been proposed more than 50 years ago, conclusive experimental evidence for its existence remains elusive. Ta₂NiSe₅ is a narrow-gap semiconductor with a small one-electron bandgap E_G of <50 meV. Below T_C=326 K, a putative excitonic insulator is stabilized. Here we report an optical excitation gap E_op ∼0.16 eV below T_C comparable to the estimated exciton binding energy E_B. Specific heat measurements show the entropy associated with the transition being consistent with a primarily electronic origin. To further explore this physics, we map the T_C–E_G phase diagram tuning E_G via chemical and physical pressure. The dome-like behaviour around E_G∼0 combined with our transport, thermodynamic and optical results are fully consistent with an excitonic insulator phase in Ta₂NiSe₅.

The nature of an insulating phase in Ta₂NiSe₅ is an open question. Here, Lu et al. report transport, thermodynamic and optical evidences being fully consistent with an excitonic insulator phase in this material.

Time course of osteoporotic vertebral fractures by magnetic resonance imaging using a simple classification: a multicenter prospective cohort study

This study revealed the time course of osteoporotic vertebral fracture by magnetic resonance imaging using a simple classification. Signal changes were associated with the compression degree and mobility of the fractured vertebral body. This classification showed sufficient reliability in categorizing magnetic resonance imaging findings of osteoporotic vertebral fractures.

INTRODUCTION

Magnetic resonance imaging (MRI) is useful in diagnosing osteoporotic vertebral fractures (OVFs). This study investigated the time course of OVFs by MRI using a simple classification.

METHODS

This multicenter cohort study was performed from 2012 to 2015. Consecutive patients with ≤2-week-old OVFs were enrolled in 11 institutions. MRI was performed at enrollment and at 1-, 3-, 6-, and 12-month follow-up. Signal changes on T1-weighted imaging (T1WI), T2WI, and short τ inversion recovery (STIR) were classified according to signal intensity. Height and angular motion of vertebral bodies were also measured.

RESULTS

The 6-month follow-up was completed by 153 patients. At enrollment, fractured vertebrae signal changes were 43 % diffuse and 57 % confined low on T1WI; on T2WI, 56, 24, and 5 % were confined low, high, and diffuse low, respectively; on STIR, 100 % were high. On T1WI, diffuse low remained most common (90 % at 1 month and 60 % at 3 months) until 6 and 12 months, when most were confined low (54 and 52 %, respectively). On T2WI, confined low remained most common (decreasing to 41 % at 12 months). On STIR, high signal change was shown in 98, 87, and 64 % at 3, 6, and 12 months, respectively. At 3, 6, and 12 months, diffuse low signal change was associated with significantly lower vertebral height, and high signal change was associated with significantly greater angular motion.

CONCLUSIONS

MRI signal changes were associated with the compression degree and angular motion of fractured vertebrae. This classification showed sufficient reliability in categorizing MRI findings of OVFs.

Low Molecular Weight Branched PEI Binding to Linear DNA

Polyethylenimine (PEI) is one of the most versatile non-viral vectors used in gene therapy, especially for delivering plasmid DNA to human cells. However, a good understanding of PEI binding to DNA, the fundamental basis for the functioning of PEI as a vector, has been missing in the literature. In this study, PEI (branched, 600 Da) binding to DNA was examined by isothermal titration calorimetry (ITC), quartz crystal microbalance (QCM) and a complementary set of analysis tools. We demonstrated that a separation between the binding heat and the condensation heat is needed and that the excluded site model should be used for PEI binding stage in the ITC analysis. The equilibrium constant for PEI binding to DNA was determined to be 2.5×10⁵ M^-1 from the ITC analysis, and as 2.3×10⁵ M^-1 from the QCM analysis. Additionally, we suggested that the 600 Da branched PEI binds to the major groove of DNA and the rearrangement of PEI on DNA may be difficult to occur because of the small dissociation rate. The binding analysis presented here can be employed to improve our understanding of the functioning of PEI and PEI-like non-viral vectors.

Predicting delayed union in osteoporotic vertebral fractures with consecutive magnetic resonance imaging in the acute phase: a multicenter cohort study

This study demonstrated the predictive values of radiological findings for delayed union after osteoporotic vertebral fractures (OVFs). High-signal changes on T2WI were useful findings.

INTRODUCTION

The purpose of the present study is to determine predictive radiological findings for delayed union by magnetic resonance imaging (MRI) and plain X-rays at two time points in the acute phase of OVFs.

METHODS

This multicenter cohort study was performed from 2012 to 2015. A total of 218 consecutive patients with OVFs ≤2 weeks old were enrolled. MRIs and plain X-rays were performed at the time of enrollment and at 1- and 6-month follow-ups. Signal changes on T1-weighted imaging (T1WI) were classified as diffuse low-, confined low-, or no-signal change; those on T2WI were classified as high (similar to the intensity of cerebrospinal fluid), confined low-, diffuse low-, or no-signal change. The angular motion of the fractured vertebral body was measured with X-rays.

RESULTS

A total of 153 patients completed the 6-month follow-up. A high-signal change on T2WI was most useful in predicting delayed union. Sensitivity, specificity, and positive predictive values were 53.3, 87.8, and 51.6 % at enrollment and 65.5, 84.8, and 51.4 % at the 1-month follow-up, respectively. The positive predictive value increased to 62.5 % with observation of high- or diffuse low-signal changes at both enrollment and the 1-month follow-up. The cutoff value of vertebral motion was 5 degrees. Sensitivity and specificity at enrollment were 52.4 and 74.1 %, respectively.

CONCLUSIONS

This study demonstrated the radiological factors predicting delayed union after an OVF. T2 high-signal changes showed the strongest association with delayed union. Consecutive MRIs were particularly useful as a differential tool to predict delayed union following OVFs.

Survival outcomes of 220 consecutive patients with three-staged thoracoscopic esophagectomy

Patients with thoracic esophageal cancer are often treated by minimally invasive esophagectomy. However, the long-term survival benefits of minimally invasive esophagectomy remain unclear. Two approaches are available for thoracoscopic surgery: one with the patient in the left lateral decubitus position (LLDP), and the other with the patient in the prone position (PP). We investigated the survival benefit of thoracoscopic esophagectomy according to the tumor stage and patient position during the thoracoscopic procedure. We reviewed the records of 220 consecutive patients with esophageal cancer treated from 1998 to 2012. In total, 146 and 74 patients were treated with thoracoscopic esophagectomy in the LLDP and PP, respectively. No patients were initially proposed to be candidates for esophagectomy by thoracotomy during the study period. Data collection was performed with a focus on survival and recurrent disease. Among all the 220 patients, the overall 5-year survival rates were 83.7%, 74.1%, 45.5%, 78.6%, 44.2%, 29.4% and 24.3% in the patients with pStage IA, IB, IIA, IIB, IIIA, IIIB and IIIC disease, respectively. Despite the greater number of dissected mediastinal lymph nodes in the PP procedure, there were no significant differences in the survival curves between the LLDP and PP procedures. The long-term results of thoracoscopic esophagectomy are comparable and acceptable. The PP procedure was not confirmed to offer a superior survival benefit to the LLDP procedure in this retrospective study.