FullText URL fulltext20240213-01.pdf
Author Urata, Tomohiro| Naoi, Yusuke| Jiang, Aixiang| Boyle, Merrill| Sunami, Kazutaka| Imai, Toshi| Nawa, Yuichiro| Hiramatsu, Yasushi| Yamamoto, Kazuhiko| Fujii, Soichiro| Yoshida, Isao| Yano, Tomofumi| Chijimatsu, Ryota| Murakami, Hiroyuki| Ikeuchi, Kazuhiro| Kobayashi, Hiroki| Tani, Katsuma| Ujiie, Hideki| Inoue, Hirofumi| Tomida, Shuta| Yamamoto, Akira| Kondo, Takumi| Fujiwara, Hideaki| Asada, Noboru| Nishimori, Hisakazu| Fujii, Keiko| Fujii, Nobuharu| Matsuoka, Ken-ichi| Sawada, Keisuke| Momose, Shuji| Tamaru, Jun-ichi| Nishikori, Asami| Sato, Yasuharu| Yoshino, Tadashi| Maeda, Yoshinobu| Scott, David W.| Ennishi, Daisuke|
Published Date 2023-12-14
Publication Title Blood Advances
Volume volume7
Issue issue24
Publisher American Society of Hematology
Start Page 7459
End Page 7470
ISSN 2473-9529
Content Type Journal Article
language English
OAI-PMH Set 岡山大学
Copyright Holders © 2023 by The American Society of Hematology.
File Version publisher
PubMed ID 37552496
DOI 10.1182/bloodadvances.2023010402
Web of Science KeyUT 001141306600001
Related Url isVersionOf https://doi.org/10.1182/bloodadvances.2023010402
Author Hayashi, Eiko| Takata, Katsuyoshi| Sato, Yasuharu| Tashiro, Yukie| Tachiyama, Yoshiro| Sawada-Kitamura, Seiko| Hiramatsu, Yasushi| Sugiguchi, Shun| Nose, Soichiro| Hirokawa, Mitsuyoshi| Ando, Midori| Abd Mader, Lamia| Maeda, Yoshinobu| Tanimoto, Mitsune| Yoshino, Tadashi|
Published Date 2013-09
Publication Title Human Pathology
Volume volume44
Issue issue9
Content Type Journal Article
FullText URL fulltext.pdf
Author Yoshino, Tadashi| Tanaka, Takehiro| Sato, Yasuharu|
Keywords chronic lymphocytic leukemia/small lymphocytic lymphoma differential diagnosis indolent lymphoma
Published Date 2020
Publication Title Journal of Clinical and Experimental Hematopathology
Volume volume60
Issue issue4
Publisher Japanese Society for Lymphoreticular Tissue Research
Start Page 124
End Page 129
ISSN 1346-4280
NCID AA11556796
Content Type Journal Article
language English
OAI-PMH Set 岡山大学
Copyright Holders © 2020 by The Japanese Society for Lymphoreticular Tissue Research
File Version publisher
PubMed ID 32249238
DOI 10.3960/jslrt.19041
Web of Science KeyUT 000599137300002
Related Url isVersionOf https://doi.org/10.3960/jslrt.19041
JaLCDOI 10.18926/AMO/54978
FullText URL 71_2_105.pdf
Author Shinya, Takayoshi| Tanaka, Takashi| Soh, Junichi| Matsushita, Toshi| Sato, Shuhei| Toyooka, Shinichi| Yoshino, Tadashi| Miyoshi, Shinichiro| Kanazawa, Susumu|
Abstract We retrospectively assessed the dual-time-point (DTP) F-18 FDG PET/CT findings of thymic epithelial neoplasms (TENs) and investigated the diagnostic capacity of PET/CT compared to that of CT for predicting carcinoma. We calculated the ratio of the standardized uptake value of the tumor and that of the aortic arch (T/M ratio) for both the 90-min early scan and the 2-h delayed scan in 56 TEN patients. We used a multivariate logistic regression (MLR) analysis to estimate the CT features of carcinoma. We compared the diagnostic capacities of PET/CT and chest CT using receiver operating characteristic (ROC) analyses. The ROC curve revealed that the appropriate cut-off T/M ratio value for the highest accuracy was 2.39 with 75.0% accuracy. The area under the curve (AUC) was 0.855. The statistical analyses for DTP scans of 35 TEN patients demonstrated 74.3% accuracy and 0.838 AUC for the early scan versus 82.9% and 0.825 for the delayed scan. The MLR analysis indicated that mediastinal fat infiltration was a predictor of carcinoma. The ROC curve obtained for the model yielded an AUC of 0.853. Delayed scanning could improve the diagnostic capacity for carcinoma. The T/M ratio and mediastinal fat infiltration are predictive of carcinoma with moderate diagnostic accuracy.
Keywords thymic epithelial neoplasm thymic carcinoma thymoma dual-time-point PET/CT chest CT
Amo Type Original Article
Publication Title Acta Medica Okayama
Published Date 2017-04
Volume volume71
Issue issue2
Publisher Okayama University Medical School
Start Page 105
End Page 112
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language English
Copyright Holders CopyrightⒸ 2017 by Okayama University Medical School
File Version publisher
Refereed True
PubMed ID 28420891
FullText URL fulltext.pdf
Author Nasu, Atsuko| Gion, Yuka| Nishimura, Yoshito| Nishikori, Asami| Sakamoto, Misa| Egusa, Yuria| Fujita, Azusa| Yoshino, Tadashi| Sato, Yasuharu|
Keywords SOX4 p16 adult T-cell leukemia/lymphoma peripheral T-cell lymphoma not otherwise specified
Published Date 2021-04-24
Publication Title Diagnostics
Volume volume11
Issue issue5
Publisher MDPI
Start Page 766
ISSN 2075-4418
Content Type Journal Article
language English
OAI-PMH Set 岡山大学
Copyright Holders © 2021 by the authors.
File Version publisher
PubMed ID 33923245
NAID 120007042395
DOI 10.3390/diagnostics11050766
Web of Science KeyUT 000653793000001
Related Url isVersionOf https://doi.org/10.3390/diagnostics11050766
JaLCDOI 10.18926/AMO/32636
FullText URL fulltext.pdf
Author Kondo, Eisaku| Yoshino, Tadashi| Akagi, Tadaatsu| Hayashi, Kazuhiko| Takahashi, Kiyoshi|
Abstract

Southern blot hybridization was used to detect the rearrangement and amplification of five proto-oncogenes (bcl-2, bcl-1, c-myc, c-myb and c-Ha-ras) and one tumor suppressor gene (RB-1) in 55 Japanese patients with non-Hodgkin's lymphoma; 16 with T-cell lymphomas and 39 with B-cell lymphomas (7 follicular and 32 diffuse lymphomas). Genetic abnormalities of the proto-oncogenes were detected in 7 of the 55 (13%). Genetic abnormalities of bcl-2 plus other genes were detected in 5 of 7 cases of follicular lymphoma (71%), rearrangements of bcl-2 and c-myc, rearrangement of bcl-2 and amplification of c-myb. Genetic abnormalities were observed in only three cases of diffuse lymphoma. In each of 3 cases of B-cell lymphoma, one of the genes, blc-2 mbr, bcl-2 mcr and c-myc, was rearranged respectively. The incidence of genetic abnormalities in diffuse lymphomas (6.3%) was lower than that in follicular lymphomas. None of diffuse lymphomas had double oncogene abnormality. No abnormalities were found in RB-1, bcl-1, and Ha-ras. These findings suggest that follicular lymphomas are associated with some abnormalities of oncogenes not restricted to bcl-2 that facilitate growth which may be associated with their clinical features.

Keywords malignant lymphoma cellular oncogenes
Amo Type Article
Publication Title Acta Medica Okayama
Published Date 1992-12
Volume volume46
Issue issue6
Publisher Okayama University Medical School
Start Page 407
End Page 415
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language English
File Version publisher
Refereed True
PubMed ID 1485535
Web of Science KeyUT A1992KE49600002
JaLCDOI 10.18926/AMO/30484
FullText URL fulltext.pdf
Author Tonoyama, Yuji| Teramoto, Norihiro| Sarker, Ashit Baran| Yoshino, Tadashi| Hayashi, Kazuhiko| Takahashi, Kiyoshi| Akagi, Tadaatsu|
Abstract

To elucidate the latent state and reactivation of Epstein-Barr virus (EBV) in non-neoplastic lymphoid lesions, we investigated 144 non-neoplastic lymphoid lesions by in situ hybridization (ISH) to detect the expression of EBV-encoded small RNAs (EBER)-1 and BCRF-1 and by immunostaining for latent membrane protein (LMP)-1 and ZEBRA. ISH for EBER-1 detected EBER-1-positive cells (EPC) in 31 of the 144 examined lesions (22%). EPC were detected in 4 of 49 cases of nonspecific lymphoid hyperplasia, in 16 of 20 abscess-forming granulomatous lymphadenitis (AFGL), 5 of 25 Kikuchi's disease, and in 3 of 3 infectious mononucleosis. LMP-1 was expressed in 6 of 124 non-neoplastic lymphoid lesions (4.8%). LMP-1-positive cells were observed in 6 of the 31 EBER-1-positive cases (19%). EPC were detected significantly more frequently in LMP-1- and ZEBRA-positive specimens than in the LMP-1- and ZEBRA-negative specimens. BCRF-1 was expressed in 4 of 11 cases examined: 2 of 3 AFGL, 1 of 2 Kikuchi's disease, and in the 1 case of atypical lymphoid hyperplasia. This study suggests that Epstein-Barr virus is prevalent and can be reactivated in the lymph nodes effaced by destructive inflammation, such as AFGL. Such inflammation may provide a local milieu that is conducive for EBV to enter the lytic cycle.

Keywords EBER-I BCRF-l LMP-l ZEBRA lymphoid lesion
Amo Type Article
Publication Title Acta Medica Okayama
Published Date 1996-04
Volume volume50
Issue issue2
Publisher Okayama University Medical School
Start Page 89
End Page 96
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language English
File Version publisher
Refereed True
PubMed ID 8744934
Web of Science KeyUT A1996UJ08100005
Related Url http://ousar.lib.okayama-u.ac.jp/metadata/5331
FullText URL K0005304 other1.pdf
Author Igawa, Takuro| Sato, Yasuharu| Takata, Katsuyoshi| Iwaki, Noriko| Tanaka, Takehiro| Asano, Naoko| Maeda, Yoshinobu| Orita, Yorihisa| Nakamura, Naoya| Nakamura, Shigeo| Yoshino, Tadashi|
Keywords Cyclin D2 CD5 Diffuse large B-cell lymphoma
Note 学位審査副論文|
Published Date 2013-05-15
Publication Title Diagnostic Pathology
Volume volume8
Publisher BioMed Central
Start Page 81
ISSN 1746-1596
Content Type Journal Article
language English
OAI-PMH Set 岡山大学
Copyright Holders https://creativecommons.org/licenses/by-nc-nd/4.0/deed.ja
File Version publisher
PubMed ID 23675804
DOI 10.1186/1746-1596-8-81
Web of Science KeyUT 000319266300002
Related Url https://doi.org/10.1186/1746-1596-8-81 http://ousar.lib.okayama-u.ac.jp/54287
FullText URL fulltext.pdf
Author Hirami, Yuki| Nishimura, Midori Filiz| Urata, Tomohiro| Morimoto, Michiko| Maekawa, Yukina| Yoshino, Tadashi| Nishimura, Yoshito| Sato, Yasuharu|
Keywords intravascular large B-cell lymphoma diffuse large B-cell lymphoma soluble interleukin-2 receptor lactate dehy-drogenase B symptoms
Published Date 2023
Publication Title Journal of Clinical and Experimental Hematopathology
Volume volume63
Issue issue1
Publisher Japanese Society for Lymphoreticular Tissue Research
Start Page 25
End Page 31
ISSN 1346-4280
Content Type Journal Article
language English
OAI-PMH Set 岡山大学
Copyright Holders © 2023 The Japanese Society for Lymphoreticular Tissue Research
File Version publisher
PubMed ID 36843068
DOI 10.3960/jslrt.22043
Web of Science KeyUT 000937326000001
Related Url isVersionOf https://doi.org/10.3960/jslrt.22043
JaLCDOI 10.18926/AMO/30447
FullText URL fulltext.pdf
Author Yoshino, Tadashi| Hoshida, Yoshihiko| Murakami, Ichiro| Takahashi, Kiyoshi| Akagi, Tadaatsu|
Abstract

We have attempted to clarify the characteristics of monoclonal antibodies (MAbs) detecting lymphocyte subsets in fixed materials. We examined by means of flow cytometric technique influences of fixatives and reactivity with malignant lymphomas (MLs). Specific markers for T-cells were UCHL1 and OPD4, which reacted especially with helper/inducer T-cells. MT1 recognized almost all of T-cells from peripheral blood and tonsils, but reacted with a part of B-MLs. As for B-cell markers, L26 was the most reliable marker for B-MLs. L26 and MB1 antigens could not be detected on living cells flow cytometrically. LN1 reacted with a part of T-cells as well as B-cells, but fluorescent intensity of the former was apparently stronger than that of the latter. Although LN2 antigen was located mainly in the cytoplasm close to the nuclear membrane immunohistochemically, it could be detected on living cells flow cytometrically. LN2 positive cells belonged to B-cells in peripheral blood and tonsils. When fixed for relatively short time, B5 and buffered formalin were better for examining MAbs than non-buffered formalin and ethanol.

Keywords monoclonal antibodies lymphocyte subset flow cytometry
Amo Type Article
Publication Title Acta Medica Okayama
Published Date 1990-10
Volume volume44
Issue issue5
Publisher Okayama University Medical School
Start Page 243
End Page 250
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language English
File Version publisher
Refereed True
PubMed ID 1701954
Web of Science KeyUT A1990EG00700002
FullText URL fulltext.pdf
Author Sakatani, Akio| Igawa, akuro| Okatani, Takeshi| Fujihara, Megumu| Asaoku, Hideki| Sato, Yasuharu| Yoshino, Tadashi|
Keywords classic Hodgkin lymphoma CD79a prognosis immunohistochemistry
Published Date 2020
Publication Title Journal of Clinical and Experimental Hematopathology
Volume volume60
Issue issue3
Publisher The Japanese Society for Lymphoreticular Tissue Research
Start Page 78
End Page 86
ISSN 1346-4280
NCID AA11556796
Content Type Journal Article
language English
OAI-PMH Set 岡山大学
Copyright Holders © 2020 by The Japanese Society for Lymphoreticular Tissue Research
File Version publisher
PubMed ID 32641598
NAID 130007907547
DOI 10.3960/jslrt.20010
Web of Science KeyUT 000575120100003
Related Url isVersionOf https://doi.org/10.3960/jslrt.20010
FullText URL fulltext.pdf
Author Ikeda, Tomoka| Gion, Yuka| Sakamoto, Misa| Tachibana, Tomoyasu| Nishikori, Asami| Nishimura, Midori Filiz| Yoshino, Tadashi| Sato, Yasuharu|
Keywords Lymphoid tissues Lymphoma
Published Date 2020-06-19
Publication Title Modern Pathology
Volume volume33
Issue issue12
Publisher Springer Nature
Start Page 2437
End Page 2448
ISSN 0893-3952
NCID AA1067307X
Content Type Journal Article
language English
OAI-PMH Set 岡山大学
Copyright Holders © Authors
File Version author
PubMed ID 32561847
DOI 10.1038/s41379-020-0599-8
Web of Science KeyUT 000541317200003
Related Url isVersionOf https://doi.org/10.1038/s41379-020-0599-8
Author Toda, Hiroko| Sato, Yasuharu| Takata, Katsuyoshi| Orita, Yorihisa| Asano, Naoko| Yoshino, Tadashi|
Published Date 2013-02-28
Publication Title PLoS ONE
Volume volume8
Issue issue2
Content Type Journal Article
FullText URL fulltext.pdf
Author Nishimura, Midori Filiz| Nishimura, Yoshito| Nishikori, Asami| Maekawa, Yukina| Maehama, Kanna| Yoshino, Tadashi| Sato, Yasuharu|
Keywords Castleman disease hyaline vascular type unicentric Castleman disease abdominal cavity mediastinum
Published Date 2021-10-28
Publication Title Diagnostics
Volume volume11
Issue issue11
Publisher MDPI
Start Page 2008
ISSN 2075-4418
Content Type Journal Article
language English
OAI-PMH Set 岡山大学
Copyright Holders © 2021 by the authors.
File Version publisher
PubMed ID 34829355
DOI 10.3390/diagnostics11112008
Web of Science KeyUT 000723760100001
Related Url isVersionOf https://doi.org/10.3390/diagnostics11112008
JaLCDOI 10.18926/AMO/32293
FullText URL fulltext.pdf
Author Jin, Zaishun| Teramoto, Norihiro| Yoshino, Tadashi| Takada, Kenzo| Oka, Takashi| Hayashi, Kazuhiko| Akagi, Tadaatsu|
Abstract

It has been reported that Epstein-Barr virus (EBV) resides in resting B cells in vivo. However, an ideal in vitro system for studying EBV latent infection in vivo has not yet been established. In this study, a mantle cell lymphoma line, SP53, was successfully infected with a recombinant EBV containing a neomycin-resistant gene. The EBV-carrying SP53 cells were obtained by selection using G418. They expressed EBER-1, EBNAs, and LMP1; this expression pattern of the EBV genes was similar to that in a lymphoblastoid cell line (LCL). However, proliferation assay showed that the EBV-carrying SP53 cells have a doubling time of 73 h, compared with 57 h of SP53 cells. Transplantation of 10(8) SP53 cells to nude mice formed tumors in 4 of 10 mice inoculated, but the EBV-carrying SP53 cells did not. Unexpectedly, EBV infection reduced the proliferation and tumorigenicity of SP53 cells. However, the EBV-carrying SP53 cells showed higher resistance to apoptosis induced by serum starvation than did the SP53 cells. The inhibition of proliferation and the resistance to apoptosis induced in SP53 cells by EBV infection indicate that this cell line might to some extent provide a model of in vivo EBV reservoir cells.

Keywords Epstein-Barr virus mantle cell lymphoma latent infection in vivo reservoir SP53 line
Amo Type Article
Publication Title Acta Medica Okayama
Published Date 2000-10
Volume volume54
Issue issue5
Publisher Okayama University Medical School
Start Page 193
End Page 200
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language English
File Version publisher
Refereed True
PubMed ID 11061568
Web of Science KeyUT 000090098600002
FullText URL fulltext.pdf
Author Kitamura, Wataru| Kobayashi, Hiroki| Urata, Tomohiro| Sato, Yumiko| Naoi, Yusuke| Yoshino, Tadashi| Maeda, Yoshinobu| Kuyama, Shoichi|
Keywords nodal peripheral T-cell lymphoma with T follicular helper phenotype immune thrombocytopenia prednisolone
Published Date 2023
Publication Title Journal of Clinical and Experimental Hematopathology
Volume volume63
Issue issue1
Publisher The Japanese Society for Lymphoreticular Tissue Research
Start Page 37
End Page 42
ISSN 1346-4280
NCID AA11556796
Content Type Journal Article
language English
OAI-PMH Set 岡山大学
Copyright Holders © 2023 The Japanese Society for Lymphoreticular Tissue Research
File Version publisher
PubMed ID 36990775
DOI 10.3960/jslrt.22038
Web of Science KeyUT 000960504100006
Related Url isVersionOf https://doi.org/10.3960/jslrt.22038
JaLCDOI 10.18926/AMO/31091
FullText URL fulltext.pdf
Author Teramoto, Norihiro| Tonoyama, Yuji| Akagi, Tadaatsu| Sarker, Ashit Baran| Yoshino, Tadashi| Yamadori, Ichiro| Takahashi, Kiyoshi|
Abstract

The sensitivity and specificity of single cell polymerase chain reaction (PCR) were studied. Its high sensitivity enabled detection of a single-copy gene, such as human T-lymphotropic virus type I genome in paraffin sections. The rate of obtaining positive signals with this method was affected by the number of copies of the gene in the target cell. Specificity was satisfactory if the procedure was properly and carefully followed. Since the single cell PCR is a time-consuming method which requires skill and experience to pick up the target cells accurately, the applicability of this method is limited. It works best when it is used to analyze a single or a few copy genes in histologically identified cells.

Keywords polymerase chain reaction human T-lymphotropic virus type I paraffin section single cell single copy gene
Amo Type Article
Publication Title Acta Medica Okayama
Published Date 1994-08
Volume volume48
Issue issue4
Publisher Okayama University Medical School
Start Page 189
End Page 193
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language English
File Version publisher
Refereed True
PubMed ID 7817773
Web of Science KeyUT A1994PE51400003
JaLCDOI 10.18926/AMO/30764
FullText URL fulltext.pdf
Author Ino, Hideo| Hayashi, Kazuhiko| Yanai, Hiroyuki| Teramoto, Norihiro| Koirala, Tirtha Raj| Chen, Hong-Li| Oka, Takashi| Yoshino, Tadashi| Takahashi, Kiyoshi| Akagi, Tadaastu|
Abstract

A simian cell line, Si-IIA, harboring Epstein-Barr-virus (EBV) -related herpesvirus (Si-IIA-EBV), produces malignant lymphoma in rabbits when administered by intravenous inoculation. In this study, we analyzed the Si-IIA-EBV genome and compared it with human EBV and herpesvirus macaca fascicularis 1 (HVMF 1 ), which is associated with B-cell lymphoma developing in SIV-infected immunosuppressed monkeys. DNA from Si-IIA-EBV was amplified by the polymerase chain reaction using three different primer pairs complementary to human EBV (B95-8) DNA; two of the primer pairs covered part of the long internal repeat 1 region (IR 1) and the third covered part of the BRRF 1 region. Direct sequencing of the three PCR products revealed that Si-IIA-EBV DNA had about 82% nucleotide homology to the human EBV DNA in all three regions and 92.4% homology to HVMF1 in the IR1 region. The blotting pattern by Southern blot analysis was different between Si-IIA-EBV and human EBV.

Keywords Epstein-Barr virus HVMF 1 lymphoma ?monkey cell line PCR
Amo Type Article
Publication Title Acta Medica Okayama
Published Date 1997-08
Volume volume51
Issue issue4
Publisher Okayama University Medical School
Start Page 207
End Page 212
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language English
File Version publisher
Refereed True
PubMed ID 9284968
Web of Science KeyUT A1997XU03200004
FullText URL fulltext.pdf
Author Okatani, Takeshi| Nishimura, Midori Filiz| Egusa, Yuria| Yoshida, Sayako| Nishimura, Yoshito| Nishikori, Asami| Yoshino, Tadashi| Yamamoto, Hidetaka| Sato, Yasuharu|
Keywords methotrexate-associated lymphoproliferative disorders other iatrogenic immunodeficiency-associated lymphoproliferative disorders lymphoproliferative disorders arising in immune deficiency/dysregulation NOTCH1
Published Date 2024
Publication Title Journal of Clinical and Experimental Hematopathology
Volume volume64
Issue issue1
Publisher Japanese Society for Lymphoreticular Tissue Research
Start Page 1
End Page 9
ISSN 1346-4280
NCID AA11556796
Content Type Journal Article
language English
OAI-PMH Set 岡山大学
Copyright Holders © 2024 The Japanese Society for Lymphoreticular Tissue Research
File Version publisher
PubMed ID 38281745
DOI 10.3960/jslrt.23038
Web of Science KeyUT 001155420800001
Related Url isVersionOf https://doi.org/10.3960/jslrt.23038
Author Kobayashi, Hiroki| Asada, Noboru| Igawa, Takuro| Abe, Masaya| Meguri, Yusuke| Ennishi, Daisuke| Nishimori, Hisakazu| Fujii, Nobuharu| Matsuoka, Ken-ichi| Yoshino, Tadashi| Maeda, Yoshinobu|
Keywords adult T-cell leukemia-lymphoma breast involvement positron emission tomography/computed tomography
Published Date 2020-11-01
Publication Title Internal Medicine
Volume volume59
Issue issue21
Publisher 日本内科学会
Start Page 2757
End Page 2761
ISSN 0918-2918
NCID AA10827774
Content Type Journal Article
language English
OAI-PMH Set 岡山大学
Copyright Holders © 2020 by The Japanese Society of Internal Medicine
File Version publisher
DOI 10.2169/internalmedicine.5077-20
Related Url isVersionOf https://doi.org/10.2169/internalmedicine.5077-20