Tocilizumab modifies clinical and laboratory features of macrophage activation syndrome complicating systemic juvenile idiopathic arthritis
Identifieur interne : 000058 ( Main/Exploration ); précédent : 000057; suivant : 000059Tocilizumab modifies clinical and laboratory features of macrophage activation syndrome complicating systemic juvenile idiopathic arthritis
Auteurs : Masaki Shimizu [Japon] ; Mao Mizuta [Japon] ; Nami Okamoto [Japon] ; Takahiro Yasumi [Japon] ; Naomi Iwata [Japon] ; Hiroaki Umebayashi [Japon] ; Yuka Okura [Japon] ; Noriko Kinjo [Japon] ; Tomohiro Kubota [Japon] ; Yasuo Nakagishi [Japon] ; Kenichi Nishimura [Japon] ; Mariko Mohri [Japon] ; Masato Yashiro [Japon] ; Junko Yasumura [Japon] ; Hiroyuki Wakiguchi [Japon] ; Masaaki Mori [Japon]Source :
- Pediatric Rheumatology Online Journal [ 1546-0096 ] ; 2020.
Abstract
This study aimed to determine the influence of tocilizumab (TCZ) in modifying the clinical and laboratory features of macrophage activation syndrome (MAS) complicating systemic juvenile idiopathic arthritis (s-JIA). Furthermore, we assessed the performance of the 2016 MAS classification criteria for patients with s-JIA-associated MAS while treated with TCZ.
A panel of 15 pediatric rheumatologists conducted a combination of expert consensus and analysis of real patient data. Clinical and laboratory features of s-JIA-associated MAS in 12 TCZ-treated patients and 18 untreated patients were evaluated. Possible MAS was defined as having characteristic laboratory features but lack of clinical features of MAS, or atypical MAS, or early treatment that prevented full-blown MAS.
Clinically, the TCZ-treated patients with s-JIA-associated MAS were less likely febrile and had significantly lower ferritin, triglyceride, and CRP levels than the untreated patients with s-JIA-associated MAS. Other laboratory features of MAS including lower platelet counts and lower fibrinogen were more pronounced in TCZ-treated patients. The TCZ-treated patients with s-JIA-associated MAS were less likely to be classified as MAS based on the MAS classification criteria (25% vs 83.3%,
TCZ could modify the clinical and laboratory features of s-JIA-associated MAS. When evaluating the s-JIA patients while treated with TCZ, it is not applicable to use MAS classification criteria. Care must be taken to not underdiagnose MAS based on the MAS classification criteria.
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DOI: 10.1186/s12969-020-0399-1
PubMed: 31924225
PubMed Central: 6954608
Affiliations:
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xml:lang="fr">Japon</country><wicri:regionArea>Ube</wicri:regionArea></affiliation></author><author><name sortKey="Mori, Masaaki" sort="Mori, Masaaki" uniqKey="Mori M" first="Masaaki" last="Mori">Masaaki Mori</name><affiliation wicri:level="1"><nlm:aff id="Aff11"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 1014 9130</institution-id><institution-id institution-id-type="GRID">grid.265073.5</institution-id><institution>Department of Lifetime Clinical Immunology, Graduate School of Medical and Dental Sciences,</institution><institution>Tokyo Medical and Dental University,</institution></institution-wrap>Tokyo, Japan</nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Tokyo</wicri:regionArea></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">31924225</idno><idno type="pmc">6954608</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6954608</idno><idno 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Graduate School of Medical Sciences,</institution><institution>Kanazawa University,</institution></institution-wrap>13-1 Takaramachi, Kanazawa, 920-8641 Japan</nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>13-1 Takaramachi, Kanazawa</wicri:regionArea><wicri:noRegion>Kanazawa</wicri:noRegion></affiliation></author><author><name sortKey="Mizuta, Mao" sort="Mizuta, Mao" uniqKey="Mizuta M" first="Mao" last="Mizuta">Mao Mizuta</name><affiliation wicri:level="1"><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 2308 3329</institution-id><institution-id institution-id-type="GRID">grid.9707.9</institution-id><institution>Department of Pediatrics, Graduate School of Medical Sciences,</institution><institution>Kanazawa University,</institution></institution-wrap>13-1 Takaramachi, Kanazawa, 920-8641 Japan</nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>13-1 Takaramachi, Kanazawa</wicri:regionArea><wicri:noRegion>Kanazawa</wicri:noRegion></affiliation></author><author><name sortKey="Okamoto, Nami" sort="Okamoto, Nami" uniqKey="Okamoto N" first="Nami" last="Okamoto">Nami Okamoto</name><affiliation wicri:level="1"><nlm:aff id="Aff2"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 2109 9431</institution-id><institution-id institution-id-type="GRID">grid.444883.7</institution-id><institution>Department of Pediatrics, Osaka Medical College,</institution></institution-wrap>Takatsuki, Japan</nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Takatsuki</wicri:regionArea></affiliation></author><author><name sortKey="Yasumi, Takahiro" sort="Yasumi, Takahiro" uniqKey="Yasumi T" first="Takahiro" last="Yasumi">Takahiro Yasumi</name><affiliation wicri:level="1"><nlm:aff id="Aff3"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0372 2033</institution-id><institution-id institution-id-type="GRID">grid.258799.8</institution-id><institution>Department of Pediatrics,</institution><institution>Kyoto University Graduate School of Medicine,</institution></institution-wrap>Kyoto, Japan</nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Kyoto</wicri:regionArea></affiliation></author><author><name sortKey="Iwata, Naomi" sort="Iwata, Naomi" uniqKey="Iwata N" first="Naomi" last="Iwata">Naomi Iwata</name><affiliation wicri:level="1"><nlm:aff id="Aff4">Department of Immunology and Infectious Diseases, Aichi Children’s Health and Medical Center, Obu, Japan</nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Department of Immunology and Infectious Diseases, Aichi Children’s Health and Medical Center, Obu</wicri:regionArea><wicri:noRegion>Obu</wicri:noRegion></affiliation></author><author><name sortKey="Umebayashi, Hiroaki" sort="Umebayashi, Hiroaki" uniqKey="Umebayashi H" first="Hiroaki" last="Umebayashi">Hiroaki Umebayashi</name><affiliation wicri:level="1"><nlm:aff id="Aff5"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0471 4457</institution-id><institution-id institution-id-type="GRID">grid.415988.9</institution-id><institution>Department of Rheumatics,</institution><institution>Miyagi Children’s Hospital,</institution></institution-wrap>Sendai, Japan</nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Sendai</wicri:regionArea></affiliation></author><author><name sortKey="Okura, Yuka" sort="Okura, Yuka" uniqKey="Okura Y" first="Yuka" last="Okura">Yuka Okura</name><affiliation wicri:level="1"><nlm:aff id="Aff6"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 1771 5774</institution-id><institution-id institution-id-type="GRID">grid.417164.1</institution-id><institution>Department of Pediatrics,</institution><institution>KKR Sapporo Medical Center,</institution></institution-wrap>Sapporo, Japan</nlm:aff><country 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1801</institution-id><institution-id institution-id-type="GRID">grid.258333.c</institution-id><institution>Department of Pediatrics, Graduate School of Medical and Dental Sciences,</institution><institution>Kagoshima University,</institution></institution-wrap>Kagoshima, Japan</nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Kagoshima</wicri:regionArea></affiliation></author><author><name sortKey="Nakagishi, Yasuo" sort="Nakagishi, Yasuo" uniqKey="Nakagishi Y" first="Yasuo" last="Nakagishi">Yasuo Nakagishi</name><affiliation wicri:level="1"><nlm:aff id="Aff9"><institution-wrap><institution-id institution-id-type="GRID">grid.415413.6</institution-id><institution>Department of Pediatric Rheumatology,</institution><institution>Hyogo Prefectural Kobe Children’s Hospital,</institution></institution-wrap>Kobe, Japan</nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Kobe</wicri:regionArea></affiliation></author><author><name sortKey="Nishimura, Kenichi" 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last="Yasumura">Junko Yasumura</name><affiliation wicri:level="1"><nlm:aff id="Aff13"><institution-wrap><institution-id institution-id-type="ISNI">0000 0000 8711 3200</institution-id><institution-id institution-id-type="GRID">grid.257022.0</institution-id><institution>Department of Pediatrics,</institution><institution>Hiroshima University Graduate School of Biomedical & Health Sciences,</institution></institution-wrap>Hiroshima, Japan</nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Hiroshima</wicri:regionArea></affiliation></author><author><name sortKey="Wakiguchi, Hiroyuki" sort="Wakiguchi, Hiroyuki" uniqKey="Wakiguchi H" first="Hiroyuki" last="Wakiguchi">Hiroyuki Wakiguchi</name><affiliation wicri:level="1"><nlm:aff id="Aff14"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 0660 7960</institution-id><institution-id institution-id-type="GRID">grid.268397.1</institution-id><institution>Department of Pediatrics,</institution><institution>Yamaguchi University Graduate School of Medicine,</institution></institution-wrap>Ube, Japan</nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Ube</wicri:regionArea></affiliation></author><author><name sortKey="Mori, Masaaki" sort="Mori, Masaaki" uniqKey="Mori M" first="Masaaki" last="Mori">Masaaki Mori</name><affiliation wicri:level="1"><nlm:aff id="Aff11"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 1014 9130</institution-id><institution-id institution-id-type="GRID">grid.265073.5</institution-id><institution>Department of Lifetime Clinical Immunology, Graduate School of Medical and Dental Sciences,</institution><institution>Tokyo Medical and Dental University,</institution></institution-wrap>Tokyo, Japan</nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Tokyo</wicri:regionArea></affiliation></author></analytic><series><title level="j">Pediatric Rheumatology Online Journal</title><idno type="eISSN">1546-0096</idno><imprint><date when="2020">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p id="Par1">This study aimed to determine the influence of tocilizumab (TCZ) in modifying the clinical and laboratory features of macrophage activation syndrome (MAS) complicating systemic juvenile idiopathic arthritis (s-JIA). Furthermore, we assessed the performance of the 2016 MAS classification criteria for patients with s-JIA-associated MAS while treated with TCZ.</p></sec><sec><title>Methods</title><p id="Par2">A panel of 15 pediatric rheumatologists conducted a combination of expert consensus and analysis of real patient data. Clinical and laboratory features of s-JIA-associated MAS in 12 TCZ-treated patients and 18 untreated patients were evaluated. Possible MAS was defined as having characteristic laboratory features but lack of clinical features of MAS, or atypical MAS, or early treatment that prevented full-blown MAS.</p></sec><sec><title>Results</title><p id="Par3">Clinically, the TCZ-treated patients with s-JIA-associated MAS were less likely febrile and had significantly lower ferritin, triglyceride, and CRP levels than the untreated patients with s-JIA-associated MAS. Other laboratory features of MAS including lower platelet counts and lower fibrinogen were more pronounced in TCZ-treated patients. The TCZ-treated patients with s-JIA-associated MAS were less likely to be classified as MAS based on the MAS classification criteria (25% vs 83.3%, <italic>p</italic> < 0.01). This is ascribed to the absence of fever or insufficient ferritin elevation, compared with the untreated patients.</p></sec><sec><title>Conclusion</title><p id="Par4">TCZ could modify the clinical and laboratory features of s-JIA-associated MAS. When evaluating the s-JIA patients while treated with TCZ, it is not applicable to use MAS classification criteria. Care must be taken to not underdiagnose MAS based on the MAS classification criteria.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Mellins, Ed" uniqKey="Mellins E">ED Mellins</name></author><author><name sortKey="Macaubas, C" uniqKey="Macaubas C">C Macaubas</name></author><author><name sortKey="Grom, Aa" uniqKey="Grom A">AA Grom</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Behrens, Em" uniqKey="Behrens E">EM Behrens</name></author><author><name sortKey="Beukelman, T" uniqKey="Beukelman T">T Beukelman</name></author><author><name sortKey="Paessler, M" uniqKey="Paessler M">M Paessler</name></author><author><name sortKey="Cron, Rq" uniqKey="Cron R">RQ Cron</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Shimizu, M" uniqKey="Shimizu M">M Shimizu</name></author><author><name sortKey="Nakagishi, Y" uniqKey="Nakagishi Y">Y Nakagishi</name></author><author><name sortKey="Kasai, K" uniqKey="Kasai K">K Kasai</name></author><author><name sortKey="Yamasaki, Y" uniqKey="Yamasaki Y">Y Yamasaki</name></author><author><name sortKey="Miyoshi, M" uniqKey="Miyoshi M">M Miyoshi</name></author><author><name sortKey="Takei, S" uniqKey="Takei S">S Takei</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Schulert, Gs" uniqKey="Schulert G">GS Schulert</name></author><author><name sortKey="Minoia, F" uniqKey="Minoia F">F Minoia</name></author><author><name sortKey="Bohnsack, J" uniqKey="Bohnsack J">J Bohnsack</name></author><author><name sortKey="Cron, Rq" uniqKey="Cron R">RQ Cron</name></author><author><name sortKey="Hashad, S" uniqKey="Hashad S">S Hashad</name></author><author><name sortKey="Kone Paut, I" uniqKey="Kone Paut I">I KonÉ-Paut</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ravelli, A" uniqKey="Ravelli A">A Ravelli</name></author><author><name sortKey="Minoia, F" uniqKey="Minoia F">F Minoia</name></author><author><name sortKey="Dav, S" uniqKey="Dav S">S Dav</name></author><author><name sortKey="Horne, A" uniqKey="Horne A">A Horne</name></author><author><name sortKey="Bovis, F" uniqKey="Bovis F">F Bovis</name></author><author><name sortKey="Pistorio, A" uniqKey="Pistorio A">A Pistorio</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Shimizu, M" uniqKey="Shimizu M">M Shimizu</name></author><author><name sortKey="Mizuta, M" uniqKey="Mizuta M">M Mizuta</name></author><author><name sortKey="Yasumi, T" uniqKey="Yasumi T">T Yasumi</name></author><author><name sortKey="Iwata, N" uniqKey="Iwata N">N Iwata</name></author><author><name sortKey="Okura, Y" uniqKey="Okura Y">Y Okura</name></author><author><name sortKey="Kinjo, N" uniqKey="Kinjo N">N Kinjo</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="De Benedetti, F" uniqKey="De Benedetti F">F De Benedetti</name></author><author><name sortKey="Brunner, Hi" uniqKey="Brunner H">HI Brunner</name></author><author><name sortKey="Ruperto, N" uniqKey="Ruperto N">N Ruperto</name></author><author><name sortKey="Kenwright, A" uniqKey="Kenwright A">A Kenwright</name></author><author><name sortKey="Wright, S" uniqKey="Wright S">S Wright</name></author><author><name sortKey="Calvo, I" uniqKey="Calvo I">I Calvo</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Yokota, S" uniqKey="Yokota S">S Yokota</name></author><author><name sortKey="Itoh, Y" uniqKey="Itoh Y">Y Itoh</name></author><author><name sortKey="Morio, T" uniqKey="Morio T">T Morio</name></author><author><name sortKey="Sumitomo, N" uniqKey="Sumitomo N">N Sumitomo</name></author><author><name sortKey="Daimaru, K" uniqKey="Daimaru K">K Daimaru</name></author><author><name sortKey="Minota, S" uniqKey="Minota S">S Minota</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ravelli, A" uniqKey="Ravelli A">A Ravelli</name></author><author><name sortKey="Magni Manzoni, S" uniqKey="Magni Manzoni S">S Magni-Manzoni</name></author><author><name sortKey="Pistorio, A" uniqKey="Pistorio A">A Pistorio</name></author><author><name sortKey="Besana, C" uniqKey="Besana C">C Besana</name></author><author><name sortKey="Foti, T" uniqKey="Foti T">T Foti</name></author><author><name sortKey="Ruperto, N" uniqKey="Ruperto N">N Ruperto</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="De Benedetti, F" uniqKey="De Benedetti F">F de Benedetti</name></author><author><name sortKey="Massa, M" uniqKey="Massa M">M Massa</name></author><author><name sortKey="Robbioni, P" uniqKey="Robbioni P">P Robbioni</name></author><author><name sortKey="Ravelli, A" uniqKey="Ravelli A">A Ravelli</name></author><author><name sortKey="Burgio, Gr" uniqKey="Burgio G">GR Burgio</name></author><author><name sortKey="Martini, A" uniqKey="Martini A">A Martini</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Yokota, S" uniqKey="Yokota S">S Yokota</name></author><author><name sortKey="Imagawa, T" uniqKey="Imagawa T">T Imagawa</name></author><author><name sortKey="Mori, M" uniqKey="Mori M">M Mori</name></author><author><name sortKey="Miyamae, T" uniqKey="Miyamae T">T Miyamae</name></author><author><name sortKey="Aihara, Y" uniqKey="Aihara Y">Y Aihara</name></author><author><name sortKey="Takei, S" uniqKey="Takei S">S Takei</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Yokota, S" uniqKey="Yokota S">S Yokota</name></author><author><name sortKey="Itoh, Y" uniqKey="Itoh Y">Y Itoh</name></author><author><name sortKey="Morio, T" uniqKey="Morio T">T Morio</name></author><author><name sortKey="Origasa, H" uniqKey="Origasa H">H Origasa</name></author><author><name sortKey="Sumitomo, N" uniqKey="Sumitomo N">N Sumitomo</name></author><author><name sortKey="Tomobe, M" uniqKey="Tomobe M">M Tomobe</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kessler, Ea" uniqKey="Kessler E">EA Kessler</name></author><author><name sortKey="Vora, Ss" uniqKey="Vora S">SS Vora</name></author><author><name sortKey="Verbsky, Jw" uniqKey="Verbsky J">JW Verbsky</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Shimizu, M" uniqKey="Shimizu M">M Shimizu</name></author><author><name sortKey="Yokoyama, T" uniqKey="Yokoyama T">T Yokoyama</name></author><author><name sortKey="Yamada, K" uniqKey="Yamada K">K Yamada</name></author><author><name sortKey="Kaneda, H" uniqKey="Kaneda H">H Kaneda</name></author><author><name sortKey="Wada, H" uniqKey="Wada H">H Wada</name></author><author><name sortKey="Wada, T" uniqKey="Wada T">T Wada</name></author><author><name sortKey="Toma, T" uniqKey="Toma T">T Toma</name></author><author><name sortKey="Ohta, K" uniqKey="Ohta K">K Ohta</name></author><author><name sortKey="Kasahara, Y" uniqKey="Kasahara Y">Y Kasahara</name></author><author><name sortKey="Yachie, A" uniqKey="Yachie A">A Yachie</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Shimizu, M" uniqKey="Shimizu M">M Shimizu</name></author><author><name sortKey="Nakagishi, Y" uniqKey="Nakagishi Y">Y Nakagishi</name></author><author><name sortKey="Inoue, N" uniqKey="Inoue N">N Inoue</name></author><author><name sortKey="Mizuta, M" uniqKey="Mizuta M">M Mizuta</name></author><author><name sortKey="Ko, G" uniqKey="Ko G">G Ko</name></author><author><name sortKey="Saikawa, Y" uniqKey="Saikawa Y">Y Saikawa</name></author><author><name sortKey="Kubota, T" uniqKey="Kubota T">T Kubota</name></author><author><name sortKey="Yamasaki, Y" uniqKey="Yamasaki Y">Y Yamasaki</name></author><author><name sortKey="Takei, S" uniqKey="Takei S">S Takei</name></author><author><name sortKey="Yachie, A" uniqKey="Yachie A">A Yachie</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Weiss, Es" uniqKey="Weiss E">ES Weiss</name></author><author><name sortKey="Girard Guyonvarc H, C" uniqKey="Girard Guyonvarc H C">C Girard-Guyonvarc'h</name></author><author><name sortKey="Holzinger, D" uniqKey="Holzinger D">D Holzinger</name></author><author><name sortKey="De Jesus, Aa" uniqKey="De Jesus A">AA de Jesus</name></author><author><name sortKey="Tariq, Z" uniqKey="Tariq Z">Z Tariq</name></author><author><name sortKey="Picarsic, J" uniqKey="Picarsic J">J Picarsic</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Bracaglia, C" uniqKey="Bracaglia C">C Bracaglia</name></author><author><name sortKey="De Graaf, K" uniqKey="De Graaf K">K de Graaf</name></author><author><name sortKey="Pires Marafon, D" uniqKey="Pires Marafon D">D Pires Marafon</name></author><author><name sortKey="Guilhot, F" uniqKey="Guilhot F">F 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Inoue</name></author><author><name sortKey="Nakagishi, Y" uniqKey="Nakagishi Y">Y Nakagishi</name></author><author><name sortKey="Yachie, A" uniqKey="Yachie A">A Yachie</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Shimizu, M" uniqKey="Shimizu M">M Shimizu</name></author><author><name sortKey="Inoue, N" uniqKey="Inoue N">N Inoue</name></author><author><name sortKey="Mizuta, M" uniqKey="Mizuta M">M Mizuta</name></author><author><name sortKey="Nakagishi, Y" uniqKey="Nakagishi Y">Y Nakagishi</name></author><author><name sortKey="Yachie, A" uniqKey="Yachie A">A Yachie</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Girard Guyonvarc H, C" uniqKey="Girard Guyonvarc H C">C Girard-Guyonvarc'h</name></author><author><name sortKey="Palomo, J" uniqKey="Palomo J">J Palomo</name></author><author><name sortKey="Martin, P" uniqKey="Martin P">P Martin</name></author><author><name sortKey="Rodriguez, E" uniqKey="Rodriguez E">E Rodriguez</name></author><author><name sortKey="Troccaz, S" uniqKey="Troccaz S">S Troccaz</name></author><author><name sortKey="Palmer, G" uniqKey="Palmer G">G Palmer</name></author><author><name sortKey="Gabay, C" uniqKey="Gabay C">C Gabay</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Japon</li></country></list><tree><country name="Japon"><noRegion><name sortKey="Shimizu, Masaki" sort="Shimizu, Masaki" uniqKey="Shimizu M" first="Masaki" last="Shimizu">Masaki Shimizu</name></noRegion><name sortKey="Iwata, Naomi" sort="Iwata, Naomi" uniqKey="Iwata N" first="Naomi" last="Iwata">Naomi Iwata</name><name sortKey="Kinjo, Noriko" sort="Kinjo, Noriko" uniqKey="Kinjo N" first="Noriko" last="Kinjo">Noriko Kinjo</name><name sortKey="Kubota, Tomohiro" sort="Kubota, Tomohiro" uniqKey="Kubota T" first="Tomohiro" last="Kubota">Tomohiro Kubota</name><name sortKey="Mizuta, Mao" sort="Mizuta, Mao" uniqKey="Mizuta M" first="Mao" last="Mizuta">Mao Mizuta</name><name sortKey="Mohri, Mariko" sort="Mohri, Mariko" uniqKey="Mohri M" first="Mariko" last="Mohri">Mariko Mohri</name><name sortKey="Mori, Masaaki" sort="Mori, Masaaki" uniqKey="Mori M" first="Masaaki" last="Mori">Masaaki Mori</name><name sortKey="Nakagishi, Yasuo" sort="Nakagishi, Yasuo" uniqKey="Nakagishi Y" first="Yasuo" last="Nakagishi">Yasuo Nakagishi</name><name sortKey="Nishimura, Kenichi" sort="Nishimura, Kenichi" uniqKey="Nishimura K" first="Kenichi" last="Nishimura">Kenichi Nishimura</name><name sortKey="Okamoto, Nami" sort="Okamoto, Nami" uniqKey="Okamoto N" first="Nami" last="Okamoto">Nami Okamoto</name><name sortKey="Okura, Yuka" sort="Okura, Yuka" uniqKey="Okura Y" first="Yuka" last="Okura">Yuka Okura</name><name sortKey="Umebayashi, Hiroaki" sort="Umebayashi, Hiroaki" uniqKey="Umebayashi H" first="Hiroaki" last="Umebayashi">Hiroaki Umebayashi</name><name sortKey="Wakiguchi, Hiroyuki" sort="Wakiguchi, Hiroyuki" uniqKey="Wakiguchi H" first="Hiroyuki" last="Wakiguchi">Hiroyuki Wakiguchi</name><name sortKey="Yashiro, Masato" sort="Yashiro, Masato" uniqKey="Yashiro M" first="Masato" last="Yashiro">Masato Yashiro</name><name sortKey="Yasumi, Takahiro" sort="Yasumi, Takahiro" uniqKey="Yasumi T" first="Takahiro" last="Yasumi">Takahiro Yasumi</name><name sortKey="Yasumura, Junko" sort="Yasumura, Junko" uniqKey="Yasumura J" first="Junko" last="Yasumura">Junko Yasumura</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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