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.

Morphological redescription of Simulium takahasii (Rubtsov), the first species of the subgenus Wilhelmia Enderlein (Diptera: Simuliidae) recognized in East Asia.

Simulium takahasii (Rubtsov), which was originally described from Japan, and recorded from Korea and China, is the first among the 19 species of the subgenus Wilhelmia Enderlein recorded from East Asia. It is striking in mating, blood-feeding and ovipositing in captivity and in experimentally transmitting Dirofilaria immitis (Leidy) and Brugia pahangi (Buckley & Edeson), and it is a severe biter of cattle and horses, rarely of humans. Nevertheless, updated information about its morphological characteristics was lacking, making comparisons with related species described from China difficult, since species of the subgenus Wilhelmia are almost indistinguishable from one another, in particular, in their female terminalia, male genitalia and most of larval features. In this study, as many morphological characteristics as possible of S. takahasii based on specimens from Japan are redescribed. New information about many features of this species including the length of the female sensory vesicle against the third palpal segment, number of male upper-eye (large) facets, arrangement of the eight pupal gill filaments, presence or absence of tiny dark setae on the dorsum of the larval abdomen and the number of rows and hooklets of the larval posterior circlet will be useful in evaluating the species status of several Wilhelmia species in China including the species regarded as S. takahasii.

Morphological and genetic analyses of Simulium (Gomphostilbia) okinawense Takaoka and S. (G.) tokarense Takaoka (Diptera: Simuliidae) from the Nansei Islands, Japan: redescription and transfer from the S. ceylonicum species-group to the S. asakoae species-group.

Simulium (Gomphostilbia) okinawense Takaoka and S. (G.) tokarense Takaoka, both from the Nansei Islands, Japan, were morphologically reexamined and genetically analysed by using the COI gene sequences. The female, male, pupa and mature larva of the two species are redescribed. Morphological reexamination shows that both species are more similar to species in the S. asakoae species-group than to those in the S. ceylonicum species-group, by having a medium-long female sensory vesicle, yellow tuft hairs (S. (G.) okinawense) or yellow tuft hairs mixed with a few to several dark hairs (S. (G.) tokarense) at the base of the radial vein in the female and male, and medium-long larval postgenal cleft. However, the body of the male ventral plate (viewed ventrally) is parallel-sided (S. (G.) okinawense) or parallelsided or slightly narrowed (S. (G.) tokarense) and not emarginated basally, differing from those of most species in the S. asakoae species-group. Our genetic analysis shows that S. (G.) tokarense is in the S. asakoae species-group, and S. (G.) okinawense formed a separate sister clade with other members of the S. asakoae species-group with high bootstrap support. From the results of morphological and genetic analysis combined, S. (G.) okinawense and S. (G.) tokarense are transferred from the S. ceylonicum species-group to the S. asakoae species-group.

Description of the males of Simulium (Gomphostilbia) miblosi Takaoka and S. (G.) apoense Takaoka (Diptera: Simuliidae) from Mindanao, the Philippines.

The males of Simulium (Gomphostilbia) miblosi Takaoka in the S. epistum species-group, and S. (G.) apoense Takaoka in the S. ceylonicum species-group, both from Mindanao, the Philippines, are described for the first time. The male of S. (G.) miblosi is characterized by the hind tibia yellowish white on the basal three-fifths, elongate calcipala 1.5 times as long as its basal width, and ventral plate triangular ventrally (0.74 times as high as its greatest width) when viewed caudally. Tubercles on the frons and trichomes on the head and thorax of the pupa of this species are illustrated for the first time. The male of S. (G.) apoense is characterized by the small sensory vesicle 0.16-0.19 times as long as the third palpal segment, and enlarged hind basitarsus 1.0 and 1.2-1.3 times as wide as the hind tibia and femur, respectively. Taxonomic notes of these two species relevant to related species in each species-group are given.

Description of the female of Simulium (Wallacellum) tuyense Takaoka (Diptera: Simuliidae) from the Philippines.

Simulium (Wallacellum) tuyense Takaoka, one of the 14 Philippine species in the subgenus Wallacellum Takaoka, is a rare species in having the pupal antennal sheath with a row of stout spines on the apex of each protuberance corresponding to flagellomeres 2-9. The female of this species is described for the first time based on specimens from Mindoro, the Philippines. It is characterized by an elongate sensory vesicle, triangular ovipositor valve, genital fork with two projections, and paraproct not produced anteriorly. This species is morphologically indistinguishable in the female, as in the male and pupa, from S. (W.) yonakuniense Takaoka from Yonakuni Island, Japan and Lanyu Island, Taiwan. Taxonomic notes on the female of this species relevant to those of related species are provided. Collection data to validate earlier distribution records of S. (W.) tuyense and S. (W.) suyoense Takaoka from Mindanao are presented.

Morphological revision of Simulium (Gomphostilbia) ogatai (Rubtsov) in the S. ceylonicum species-group (Diptera: Simuliidae) from Japan.

Simulium (Gomphostilbia) ogatai (Rubtsov) from Japan, the only Palaearctic species in the S. ceylonicum species-group, is morphologically revised. Its female is described for the first time and its male and pupa are redescribed based on specimens from Gifu, Honshu. It is characterized in the female and male by the base of the radius with a tuft of yellow hairs, in the female by the head slightly wider than the thorax, 5.89 times as wide as the greatest width of the frons, and short sensory vesicle 0.21-0.24 times as long as the third palpal segment; in the male by the number of upper-eye (large) facets in 15 vertical columns and 16 horizontal rows, and hind basitarsus spindle-shaped, enlarged, 3.79 times as long as wide, and 0.83 and 1.00 times as wide as the greatest width of the hind tibia and femur, respectively; and in the pupa by the terminal hooks simple and cone-like, and the cocoon with an anterodorsal projection. Taxonomic notes for this species are given relevant to several related species in the Oriental Region, and its assignment to the S. ceylonicum species-group is confirmed.

A new species of black fly, formerly cytoform C of the Simulium angulistylum complex (Diptera: Simuliidae), from a high mountain in northeastern Thailand.

Cytoform C, one of three cytoforms in the Simulium angulistylum Takaoka & Davies complex from a high mountain in northeastern Thailand was morphologically and molecularly investigated. All known life stages (larva, pupa, adult male and female except egg) were morphologically similar to, but distinguishable from S. angulistylum s. str. and S. isanense Takaoka, Srisuka & Saeung in the adults by the relative length of the fore and hind basitarsi and relative length of the tooth to the claw. It is also morphologically distinct from other species of the S. epistum species-group. Here, it is formally described as a new species, S. prayooki. Molecular genetic data based on mitochondrial cytochrome c oxidase subunit I (COI) also supported the morphological similarity between the new species and the two related known species (S. angulistylum s. str. and S. isanense) as phylogenetic analysis retrieved them all from a single clade and with a low level of interspecific genetic divergence (1.74%). This might possibly have resulted from incomplete lineage sorting as they are likely to share a recent common ancestor. Despite limitation of molecular genetic differentiation, the new species was distinctly different from two other cytoforms of S. angulistylum complex based on polytene chromosome banding patterns and ecology of the immature stages. Thus, this study highlights the necessity of using an integrated approach for fully understanding black fly biodiversity.

Description of the male of Simulium triglobus Takaoka & Kuvangkadilok (Diptera: Simuliidae) from Thailand.

Simulium triglobus Takaoka & Kuvangkadilok from Thailand, in the Simulium (Simulium) multistriatum species-group, is unique among species in the family Simuliidae in having the female terminalia with three spermathecae (rather than one spermatheca). This species was described from Nan province, northern Thailand based on larvae, pupae and females but its male has remained unknown. In this study, the male of S. triglobus is described for the first time based on adult males reared from pupae collected from the type locality. The most distinctive characteristic of the male of S. triglobus is the shape of the ventral plate, which is hexagonal when viewed ventrally. No other members of S. multistriatum species group known thus far have such a unique ventral plate. In addition, the number of upper-eye (large) facets and color patterns of the legs can be used to differentiate this species in the male from other members of the S. multistriatum species-group. Mitochondrial cytochrome c oxidase I sequences enabled association of adult male specimens of S. triglobus with previously known life stages. Phylogenetic analysis based on these sequences revealed that specimens of S. triglobus formed a strongly supported monophyletic clade, being genetically distinct from other members of S. multistriatum species-group in Thailand.

Descriptions of adults of Simulium (Gomphostilbia) sachini Takaoka & Henry and S. ( G.) williei Takaoka & Thapa in the S. (G.) gombakense species-group (Diptera: Simuliidae) from India.

The Simulium gombakense species-group, one of the 15 species-groups of the subgenus Gomphostilbia Enderlein, is small, being represented by only 12 species, all of which are distributed in the Oriental Region. It is characterized by the pupal gill composed of an inflated structure and eight or ten slender filaments. Among the 12 species, S. sachini Takaoka & Henry, and S. williei Takaoka & Thapa were originally described from two pupae, and one pupa and two larvae, respectively, from Darjeeling, India. In the present paper, the adult females and males of these species are described for the first time from specimens reared from pupae collected at the type locality. Simulium sachini is distinctive in the female by the claw with a medium-sized basal tooth, and in the male by the somewhat enlarged, spindle- shaped hind basitarsus and ventral plate with its ventral margin much depressed medially, while S. williei is characterized by the small number of male upper-eye (large) facets in 12 vertical columns and 13 or 14 horizontal rows and ventral plate much produced posteroventrally. Taxonomic notes are given to separate these two species in the adult stage from their related species.

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.

Two new black fly species of the Simulium ( Simulium) rufibasis subgroup (Diptera: Simuliidae) from Taiwan.

Simulium ( Simulium) rufibasis Brunetti originally described from India was once considered a geographic generalist widely distributed in the Oriental Region. In this study, the species previously regarded as S. (S.) rufibasis in Taiwan was morphologically re-evaluated and found to be distinguished in the male and pupa from true S. (S.) rufibasis from India. This new species is described as S. ( S.) hehuanense sp. nov. based on a female, a male and their pupal exuviae in Taiwan. This new species is placed in the S. rufibasis subgroup of the S. tuberosum species-group, and is similar to S. (S.) yamatoense Takaoka, Adler & Fukuda from Japan and Korea, but it is barely distinguished by the slenderer forebasitarsi of the female and male. Another new, related species, S. (S.) xiulinense sp. nov., is described based on a male and its pupal exuviae. This new species is distinguished from S. (S.) hehuanense sp. nov. by the number of male upper-eye (large) facets in 20 or 21 vertical columns and 22 horizontal rows (19 vertical columns and 19 horizontal rows in the latter species), and presence of a pair of dorsolateral shiny spots on male abdominal segment 5 (absence in the latter species). Both new species inhabit streams at high elevations (ca, 2,600 m). They differ from S. (S.) sp. (probably S. (S.) arisanum Shiraki) from Taiwan, of the same subgroup, which breeds in streams at low elevations (433-685 m), by the pupal head and thorax covered with tubercles (bare in the latter species).

A male black fly of Simulium (Simulium) iwatense (Shiraki) (Diptera: Simuliidae) with genitalia-like appendages on abdominal segment 8.

A rare non-sex mosaic abnormality represented by genitalia-like appendages on the ventral surface of abdominal segment 8 of a male black fly collected in Hokkaido, Japan, is reported. The appendages consist of a pair of style-like projections each arising from a coxite-like base, inverted-Y shaped ventral plate-like structure, and isolated round structure. This male was morphologically and molecularly identified as an abnormal form of S. (S.) iwatense (Shiraki), the only species in the Simulium (Simulium) ornatum species-group in Japan, although certain morphological characteristics of this male including the reduced number of uppereye (large) facets and elongate cerci are different from those of S. (S.) iwatense.

A new species and four newly recorded species of black flies (Diptera: Simuliidae) from Bhutan.

Simulium (Simulium) thimphuense sp. nov. is described from a pupa and a mature larva in Bhutan. This new species is placed in the S. multistriatum species-group, and is characterized by the pupal gill with eight thread-like filaments divergent basally at an acute angle when viewed laterally and the cocoon slipper-shaped with several small openings anterolaterally. Four species of Simulium (Simulium) are newly recorded from Bhutan: S. barraudi Puri in the S. multistriatum species-group, S. nodosum Puri in the S. nobile species-group, S. chiangmaiense Takaoka & Suzuki in the S. striatum species-group and S. himalayense Puri in the S. variegatum species-group. Our study increases the number of black fly species known from Bhutan from 18 to 23.

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.

Descriptions of the female, male and mature larva of Simulium contractum Takaoka (Diptera: Simuliidae) from Sulawesi, Indonesia.

Simulium (Simulium) contractum Takaoka from Sulawesi, Indonesia was known only as the pupa. Its female, male and mature larva are described for the first time. The tentative assignment of this species in the Simulium dumogaense species-group is confirmed by the adult characters including the female and male genitalia. The female and male of this species are similar to those of Simulium (Simulium) tumpaense Takaoka and Roberts but are distinguished by the yellowish femora.

Surgical approaches for condylar fractures related to facial nerve injury: deep versus superficial dissection.

The aim of this study was to investigate the probability of facial nerve injury (FNI) in the treatment of condylar neck and subcondylar fractures (CN/SCFs) with percutaneous approaches and to identify factors predicting FNI. The data of 80 patients with 87 CN/SCFs were evaluated retrospectively. The primary outcome was FNI occurrence. The predictor variables were age, sex, aetiology, alcohol consumption, fracture site and pattern (dislocation or not), concomitant fractures, time interval to surgery, surgeon experience, plate type, and the dual classification of percutaneous approaches. The approaches were classified based on whether subcutaneous dissection traversed the marginal mandibular branch (MMB) deeply (deep group: submandibular and retroparotid approaches) or superficially (superficial group: transparotid, transmasseteric anteroparotid (TMAP), and high cervical-TMAP approaches). Twenty-two patients (27.5%) suffered FNI, of whom two in the deep group had permanent paralysis of the MMB. In the multivariate logistic regression model, deeply traversing surgery approaches (odds ratio 12.4, P=0.025) and the presence of a dislocated fracture (odds ratio 6.66, P=0.012) were associated with an increased risk of FNI. These results suggest that percutaneous approaches in the superficial group should be recommended for the treatment of CN/SCFs to reduce the risk of FNI.

A new species of the Simulium (Simulium) crocinum species-group (Diptera: Simuliidae) from Vietnam.

A new black fly species, Simulium yukawai, is described on the basis of one female and its pupal exuviae from Vietnam. This new species is placed in the S. crocinum species-group of Simulium (Simulium) (Diptera: Simuliidae). It is characterized in the female by the paraproct covered with 48-50 distinct hairs on its ventral and lateral surfaces, and in the pupa by the frons and most of the thorax bare, gill with six dark filaments in three pairs closely arising from the base, of which the two outer filaments of the dorsal and middle pairs are much longer than other filaments, abdomen with distinct spine-combs on the dorsal surface of segments 7-9, and cocoon wall-pocket shaped, with a large anterolateral window on each side. Taxonomic notes are given to separate this new species from related species. This species is the fourth member of the S. crocinum species-group known from Vietnam.

New records of five species of black flies (Diptera: Simuliidae) from Myanmar, with descriptions of the male and pupa of Simulium chanyae.

Five species of black flies are newly recorded from Myanmar: Simulium (Gomphostilbia) gombakense Takaoka and Davies, S. (G.) siamense Takaoka and Suzuki, S. (Simulium) chanyae Takaoka and Choochote, S. (S.) nigrifacies Datta and S. (S.) tani Takaoka and Davies (complex). This increases the number of species of black flies from Myanmar from 23 to 28. The male and pupa of S. (S.) chanyae are described for the first time. The pupa of this species is characterized by having the wall-pocket-shaped cocoon without anterolateral windows, separating it from most other species of the Simulium multistriatum species-group.