Protective efficacy and hepatitis B virus clearance in mice enhanced by cell-mediated immunity with novel prime-boost regimens

In this study, anti-hepatitis B virus (HBV) immunity was evaluated in mice using several regimens of the HBV recombinant protein vaccine HBSS1 that expressed in CHO cells containing S (1-223 aa) and preS1 (21-47 aa) and recombinant adenovirus rAdSS1 vaccine. Further, the protective efficacy of these vaccine regimens was studied in a mouse model. High titres of antigen-specific antibodies and neutralizing activity were elicited in mice after vaccination. However, robust multi-antigen (preS1 and S)-specific cell-mediated immunity (CMI) was only detected in mice primed with HBSS1 and boosted with rAdSS1. Moreover, functional T-cell responses with high levels of cytokines and antigen-specific cytotoxic T-cell responses (CD107a⁺ CD8⁺ ) were also detected in the mice. Rapid clearance of hepatitis B surface antigen and HBV DNA in blood and significantly decreased hepatitis B envelope antigen levels were observed in mice immunized with the heterogeneous prime-boost vaccine after hepatitis B virus challenge by hydrodynamic injection (HI) of pCS-HBV1.3. The clearance of HBV correlated well with antigen-specific CMI (Th1 and CTL responses) and cytokine profiles (IFN-γ, TNF-α, IL-2) elicited by vaccination. Taken together, our results might contribute to the development of new human HBV vaccines and a better understanding of the mechanisms underlying immune protection and clearance of hepatitis B virus infection.

[Correlations between genetic variations of glutathione synthetase gene and the response to platinum-based chemotherapy and prognosis of small cell lung cancer patients]

Objective: To explore the associations between genetic variations of glutathione synthetase gene (GSS) and response to platinum-based chemotherapy of small cell lung cancer(SCLC), and to analyze the influencing factors on survival. Methods: Four haplotype-tagging single nucleotide polymorphisms (htSNPs) of GSS were genotyped by Sequenom MassARRAY methods in 903 SCLC patients who received platinum-based chemotherapy, and had different response and survival time. The associations between genotypes and platinum-based chemotherapy response were measured by odds ratios (OR) and 95% confidence intervals (CI), adjusted for sex, age, smoking, KPS, staging and chemotherapy regiments, by unconditional logistic regression model. The hazard ratios (HR) were estimated by Cox proportional hazards regression model. Results: Among the 903 patients, 462(51.2%) cases received cis-platinum and etoposide treatment while others were treated with carboplatin and etoposide. 656 patients were chemotherapy responders in the study with a response rate of 72.6%. Patients were followed up to get their survival information. The median survival time (MST) of these patients was 25.0 months.We found that rs725521 located in the 3' near gene region of GSS was significantly associated with chemotherapy response. Compared with the T allele, patients with C allele had a worse chemotherapy response and an increased risk of no-responders (P=0.027). Rs7265992 and rs725521 of GSS were associated with the overall survival (OS) of SCLC patients who received platinum-based chemotherapy (HR=1.16, 95% CI=1.02-1.33, P=0.027; HR=1.17, 95% CI=1.05-1.31, P=0.006, respectively). The patients carrying 1 or 2 risk alleles and the patients carrying 3 or 4 risk alleles had worse MST than the patients without the rs7265992A and rs725521C risk alleles (24.0 and 22.0 versus 30.0 months), with the HR for death being 1.26 (95% CI=1.04-1.54) and with the HR of 1.52 (95%CI=1.18-1.97, P=0.001). Rs2025096 and rs2273684 were not associated with the OS of SCLC patients who received platinum-based chemotherapy. Age ≤ 56, KPS> 80, limited-stage, chemotherapy response and radiation therapy had a remarkably prolonged OS (all P<0.05). Conclusions: These results suggest that GSS genetic polymorphism rs725521 plays an important role in the response to platinum-based chemotherapy, while rs7265992 and rs725521 have important effect on the prognosis of SCLC patients, which may be potential genetic biomarkers for personalized treatment of SCLC.

Single-cell genomic profiling of acute myeloid leukemia for clinical use: A pilot study

Although bulk high-throughput genomic profiling studies have led to a significant increase in the understanding of cancer biology, there is increasing awareness that bulk profiling approaches do not completely elucidate tumor heterogeneity. Single-cell genomic profiling enables the distinction of tumor heterogeneity, and may improve clinical diagnosis through the identification and characterization of putative subclonal populations. In the present study, the challenges associated with a single-cell genomics profiling workflow for clinical diagnostics were investigated. Single-cell RNA-sequencing (RNA-seq) was performed on 20 cells from an acute myeloid leukemia bone marrow sample. Putative blasts were identified based on their gene expression profiles and principal component analysis was performed to identify outlier cells. Variant calling was performed on the single-cell RNA-seq data. The present pilot study demonstrates a proof of concept for clinical single-cell genomic profiling. The recognized limitations include significant stochastic RNA loss and the relatively low throughput of the current proposed platform. Although the results of the present study are promising, further technological advances and protocol optimization are necessary for single-cell genomic profiling to be clinically viable.

Mussel-inspired polydopamine for bio-surface functionalization

Surface functionalization via molecular design has been a key approach to incorporate new functionalities into existing biomaterials for biomedical application. Mussel-inspired polydopamine (PDA) has aroused great interest as a new route to the functionalization of biomaterials, due to its simplicity and material independency in deposition, favorable interactions with cells, and strong reactivity for secondary functionalization. Herein, this review attempts to highlight the recent findings and progress of PDA in bio-surface functionalization for biomedical applications. The efforts made to elucidate the polymerization mechanism, PDA structure, and the preparation parameters have been discussed. Interactions between PDA coatings and the various cell types involved in different biomedical applications including general cell adhesion, bone regeneration, blood compatibility, and antimicrobial activity have also been highlighted. A brief discussion of post-functionalization of PDA and nanostructured PDA is also provided.

Comparison of hospital length of stay and hospitalization costs among patients with non-valvular atrial fibrillation treated with apixaban or warfarin: An early view

OBJECTIVE

To quantify and compare hospital length of stay (LOS) and costs between hospitalized non-valvular atrial fibrillation (NVAF) patients treated with either apixaban or warfarin via a large claims database.

METHODS

Adult patients hospitalized with AF were selected from the Premier Perspective Claims Database (01JAN2013-31MARCH2014). Patients with evidence of valvular heart disease, valve replacement procedures, or pregnancy during the index hospitalization were excluded. Patients treated with apixaban or warfarin during hospitalization were identified. Propensity score matching (PSM) was performed to control for baseline imbalances between patients treated with apixaban or warfarin. Primary outcomes were hospital LOS (days), post-medication administration LOS, and index hospitalization costs, and were compared using paired t-tests in the matched sample.

RESULTS

Before PSM, 2894 apixaban and 124,174 warfarin patients were identified. Patients treated with warfarin were older and sicker compared to those treated with apixaban. After applying PSM, a total of 2886 patients were included in each cohort, and baseline characteristics were balanced. The mean (standard deviation [SD] and median) hospital LOS was significantly (p = 0.002) shorter for patients treated with apixaban for 5.1 days (5.7 and 3) compared to warfarin for 5.5 days (4.8 and 4). The trend appeared consistent in the hospital LOS from point of apixaban or warfarin administration to discharge (4.5 vs 4.7 days, p = 0.051). Patients administered apixaban incurred significantly lower hospitalization costs compared to those administered warfarin ($11,262 vs $12,883; p < 0.001).

CONCLUSIONS

Among NVAF patients, apixaban treatment was associated with significantly shorter hospital LOS and lower costs when compared to warfarin treatment.

Randomized trial comparing efficacies of zoledronate and alendronate for improving bone mineral density and inhibiting bone remodelling in women with post-menopausal osteoporosis

WHAT IS KNOWN AND OBJECTIVE

Bisphosphonates are the first-line medications for treating osteoporosis. The aim of our prospective study was to compare the efficacy of zoledronate with that of alendronate in women with post-menopausal osteoporosis based on the evaluations of bone mineral density (BMD) and serum levels of biochemical markers of bone remodelling.

METHODS

Chinese women with post-menopausal osteoporosis were randomly assigned to the zoledronate (n = 52) or alendronate (n = 53) group, and were treated with 5 mg zoledronate intravenously once per year and 70 mg alendronate orally once per week, respectively. During a 3-year follow-up period, the lumbar spine, femoral neck and total hip were examined using dual-energy x-ray absorptiometry every 12 months to assess BMD, and the serum levels of amino-terminal propeptide of type I procollagen (P1NP) and carboxy-terminal cross-linked telopeptides of type 1 collagen (CTX) were measured to evaluate bone formation and resorption, respectively.

RESULTS AND DISCUSSION

Greater increases in BMD occurred in the zoledronate group over the 3-year follow-up period, with increases in BMD of 41·3%, 13·5% and 20·0% at the lumbar spine, femoral neck and total hip, respectively, compared with 16·9%, 5·88% and 8·93% in the alendronate group, respectively (P < 0·05 for all). At the 3-year follow-up, P1NP and β-CTX levels were reduced by 42·1% and 50·5% in the zoledronate group, respectively, whereas the levels of each were reduced by 19·5% and 19·4% in the alendronate group, respectively (P < 0·05 for all).

WHAT IS NEW AND CONCLUSIONS

Once yearly zoledronate administered intravenously was more efficacious for improving BMD and reducing the serum levels of P1NP and β-CTX in Chinese women with post-menopausal osteoporosis than alendronate administered orally once per week. The incidence of adverse events after the second and third zoledronate treatments was substantially lower than that in the alendronate group, suggesting a substantially lower risk of adverse events with long-term use of zoledronate in Chinese women, compared with that of alendronate use.

Low Concentrations of a Silver-Based Nanocomposite to Manage Bacterial Spot of Tomato in the Greenhouse

Bacterial spot, caused by four Xanthomonas spp., is one of the most damaging diseases of tomato worldwide. Due to limited disease management options, growers rely heavily on copper-based bactericides, which are often ineffective due to the presence of copper-resistant Xanthomonas strains. This study was undertaken to characterize the antibacterial activity of a silver-based nanocomposite, Ag-dsDNA-GO, and its potential as an alternative to copper. Ag-dsDNA-GO at rates as low as 10 μg/ml killed all bacterial cells of copper-tolerant and -sensitive Xanthomonas perforans strains in suspensions containing approximately 10³ CFU/ml within 15 min of exposure in vitro, whereas equivalent rates of copper (10, 25, and 50 μg/ml) were unable to significantly reduce populations compared with the untreated control after 24 h of exposure (P = 0.05). All copper concentrations killed the copper-sensitive X. perforans strain but required exposure for ≥1 h. Ag-dsDNA-GO also exhibited antibacterial activity against copper-tolerant X. vesicatoria, X. euvesicatoria, and X. gardneri strains. In greenhouse studies, tomato plants treated with Ag-dsDNA-GO at either 75 or 100 μg/ml prior to artificial inoculation significantly reduced disease severity when compared with copper-mancozeb and negative controls (P = 0.05). This study highlights the potential of Ag-dsDNA-GO as an alternative to copper in tomato transplant production.

Physician and Patient Preferences for Nonvalvular Atrial Fibrillation Therapies

OBJECTIVES

The objective of this study was to compare patient and physician preferences for different antithrombotic therapies used to treat nonvalvular atrial fibrillation (NVAF).

METHODS

Patients diagnosed with NVAF and physicians treating such patients completed 12 discrete choice questions comparing NVAF therapies that varied across five attributes: stroke risk, major bleeding risk, convenience (no regular blood testing/dietary restrictions), dosing frequency, and patients' out-of-pocket cost. We used a logistic regression to estimate the willingness-to-pay (WTP) value for each attribute.

RESULTS

The 200 physicians surveyed were willing to trade off $38 (95% confidence interval [CI] $22 to $54] in monthly out-of-pocket cost for a 1% (absolute) decrease in stroke risk, $14 (95% CI $8 to $21) for a 1% decrease in major bleeding risk, and $34 (95% CI $9 to $60) for more convenience. The WTP value among 201 patients surveyed was $30 (95% CI $18 to $42) for reduced stroke risk, $16 (95% CI $9 to $24) for reduced bleeding risk, and -$52 (95% CI -$96 to -6) for convenience. The WTP value for convenience among patients using warfarin was $9 (95% CI $1 to $18) for more convenience, whereas patients not currently on warfarin had a WTP value of -$90 (95% CI -$290 to -$79). Both physicians' and patients' WTP value for once-daily dosing was not significantly different from zero. On the basis of survey results, 85.0% of the physicians preferred novel oral anticoagulants (NOACs) to warfarin. NOACs (73.0%) were preferred among patients using warfarin, but warfarin (78.2%) was preferred among patients not currently using warfarin. Among NOACs, both patients and physicians preferred apixaban.

CONCLUSIONS

Both physicians and patients currently using warfarin preferred NOACs to warfarin. Patients not currently using warfarin preferred warfarin over NOACs because of an apparent preference for regular blood testing/dietary restrictions.

Metagenomic analysis of viral genetic diversity in respiratory samples from children with severe acute respiratory infection in China

Severe acute respiratory infection (SARI) in children is thought to be mainly caused by infection with various viruses, some of which have been well characterized; however, analyses of respiratory tract viromes among children with SARI versus those without are limited. In this study, nasopharyngeal swabs from children with and without SARI (135 versus 15) were collected in China between 2008 and 2010 and subjected to multiplex metagenomic analyses using a next-generation sequencing platform. The results show that members of the Paramyxoviridae, Coronaviridae, Parvoviridae, Orthomyxoviridae, Picornaviridae, Anelloviridae and Adenoviridae families represented the most abundant species identified (>50% genome coverage) in the respiratory tracts of children with SARI. The viral population found in the respiratory tracts of children without SARI was less diverse and mainly dominated by the Anelloviridae family with only a small proportion of common epidemic respiratory viruses. Several almost complete viral genomes were assembled, and the genetic diversity was determined among several samples based on next-generation sequencing. This research provides comprehensive mapping of the viromes of children with SARI and indicates high heterogeneity of known viruses present in the childhood respiratory tract, which may benefit the detection and prevention of respiratory disease.

Warfarin time in therapeutic range and its impact on healthcare resource utilization and costs among patients with nonvalvular atrial fibrillation

BACKGROUND

Warfarin is efficacious for reducing stroke risk among patients with nonvalvular atrial fibrillation (NVAF). However, the efficacy and safety of warfarin are influenced by its time in therapeutic range (TTR).

OBJECTIVE

To assess differences in healthcare resource utilization and costs among NVAF patients with low (<60%) and high (≥60%) warfarin TTRs in an integrated delivery network (IDN) setting.

METHODS

Patients with NVAF were identified from an electronic medical record database. Patients were required to have ≥6 international normalized prothrombin time ratio (INR) tests. NVAF patients were grouped into two cohorts: those with warfarin TTR <60% (low TTR) and those with warfarin TTR ≥60% (high TTR). Healthcare resource utilization and costs were evaluated during a 12 month follow-up period. Multivariable regressions were used to assess the impact of different warfarin TTRs on healthcare costs.

RESULTS

Among the study population, greater than half (54%, n = 1595) had a low TTR, and 46% (n = 1356) had a high TTR. Total all-cause healthcare resource utilization was higher among patients in the low TTR cohort vs. the high TTR cohort (number of encounters: 70.2 vs. 56.1, p < 0.001). After adjusting for patient characteristics, total all-cause healthcare costs and stroke-related healthcare costs were $2398 (p < 0.001) and $687 (p = 0.02) higher, respectively, for patients in the low TTR cohort vs. the high TTR cohort.

LIMITATIONS

In this retrospective study, we were only able to evaluate the association and not the causality between healthcare resource utilization and costs with the different warfarin TTRs.

CONCLUSION

Many warfarin-treated NVAF patients have a low warfarin TTR. NVAF patients with low vs. patients with high warfarin TTR used healthcare resources to a greater extent, which was reflected in higher healthcare costs.

Validation of the Vitiligo Noticeability Scale: a patient-reported outcome measure of vitiligo treatment success

BACKGROUND

Patient-reported outcome measures are rarely used in vitiligo trials. The Vitiligo Noticeability Scale (VNS) is a new patient-reported outcome measure assessing how 'noticeable' vitiligo patches are after treatment. The noticeability of vitiligo after treatment is an important indicator of treatment success from the patient's perspective.

OBJECTIVES

To evaluate the construct validity, acceptability and interpretability of the VNS.

METHODS

Clinicians (n = 33) and patients with vitiligo (n = 101) examined 39 image pairs, each depicting a vitiligo lesion pre- and post-treatment. Using an online questionnaire, respondents gave a global assessment of treatment success and a VNS score for treatment response. Clinicians also estimated percentage repigmentation of lesions (< 25%; 25-50%; 51-75%; > 75%). Treatment success was defined as 'yes' on global assessment, a VNS score of 4 or 5, and > 75% repigmentation. Agreement between respondents and the different scales was assessed using kappa (κ) statistics.

RESULTS

Vitiligo Noticeability Scale scores were associated with both patient- and clinician-reported global treatment success (κ = 0·54 and κ = 0·47, respectively). Percentage repigmentation showed a weaker association with patient- and clinician-reported global treatment success (κ = 0·39 and κ = 0·29, respectively). VNS scores of 4 or 5 can be interpreted as representing treatment success. Images depicting post-treatment hyperpigmentation were less likely to be rated as successful.

CONCLUSIONS

The VNS is a valid patient-reported measure of vitiligo treatment success. Further validation of the VNS is required, using larger sets of clinical pre- and post-treatment images, affecting a wider range of anatomical sites.

Study on the hydrocyclonic separation of waste plastics with different density

The recycling of waste plastics is an important aspect in the recycling of solid waste. Based on the difference in density, PET and PVC particles was separated with help of the centrifugal sedimentation and shearing dispersion in a hydrocyclone. Through tests and CFD simulation, the relationship between the separating efficiency and pressure drop and split ratio has been investigated. Test results show that the Newton efficiency can reach above 80%, i.e. the purity of PVC could reach 93.2% while the purity of PET could reach 94.5%.

Toxicological effects of benzo[a]pyrene on DNA methylation of whole genome in ICR mice

It has been well known that alterations in DNA methylation - an important regulator of gene transcription - lead to cancer. Therefore a change in the level of DNA methylation of whole genome has been considered as a biomarker of carcinogenesis. Previously, a large number of experimental results in genetic toxicology have showed that benzo[a]pyrene could cause DNA mutation and fragmentation. However, there was little to no studies on alterations in DNA methylation of genome directly result from exposure to benzo[a]pyrene. In this paper, possible mechanisms of alterations in whole genomic DNA methylation by benzo[a]pyrene were investigated using ICR mice after benzo[a]pyrene exposure. The blood, liver, pancreas, skin, lung and bladder of ICR mice were removed and checked after a fixed time interval (6 hours) of benzo[a]pyrene exposure, and whole genomic DNA methylation level was determined by high performance liquid chromatography (HPLC). The results exhibited tissue specificity, that is, the level of whole genomic DNA methylation decreases significantly in blood and liver, rather than pancreas, lung, skin and bladder of ICR mice. This study investigated the direct relationship between aberrant DNA methylation level and benzo[a]pyrene exposure, which might be helpful to clarify the toxicological mechanism of benzo[a]pyrene in epigenetic perspectives.

Mass Measurement of 56Sc Reveals a Small A = 56 Odd-Even Mass Staggering, Implying a Cooler Accreted Neutron Star Crust

We present the mass excesses of (52-57)Sc, obtained from recent time-of-flight nuclear mass measurements at the National Superconducting Cyclotron Laboratory at Michigan State University. The masses of 56Sc and 57Sc were determined for the first time with atomic mass excesses of -24.85(59)((-54)(+0))  MeV and -21.0(1.3)  MeV, respectively, where the asymmetric uncertainty for 56Sc was included due to possible contamination from a long-lived isomer. The 56Sc mass indicates a small odd-even mass staggering in the A = 56 mass chain towards the neutron drip line, significantly deviating from trends predicted by the global FRDM mass model and favoring trends predicted by the UNEDF0 and UNEDF1 density functional calculations. Together with new shell-model calculations of the electron-capture strength function of 56Sc, our results strongly reduce uncertainties in model calculations of the heating and cooling at the 56Ti electron-capture layer in the outer crust of accreting neutron stars. We find that, in contrast to previous studies, neither strong neutrino cooling nor strong heating occurs in this layer. We conclude that Urca cooling in the outer crusts of accreting neutron stars that exhibit superbursts or high temperature steady-state burning, which are predicted to be rich in A≈56 nuclei, is considerably weaker than predicted. Urca cooling must instead be dominated by electron capture on the small amounts of adjacent odd-A nuclei contained in the superburst and high temperature steady-state burning ashes. This may explain the absence of strong crust Urca cooling inferred from the observed cooling light curve of the transiently accreting x-ray source MAXI J0556-332.

Abstract 234: Comparison of Hospital Length of Stay and Costs between Non-valvular Atrial Fibrillation Patients Treated with Either Apixaban or Warfarin

Background: Patients with non-valvular atrial fibrillation (NVAF) have an increased risk of stroke and are often treated with oral anticoagulants (i.e. warfarin). However, apixaban, a novel oral anticoagulant (NOAC), has been shown to significantly reduce stroke risk and result in a significantly shorter hospital length of stay (LOS) compared to those treated with warfarin.

Objectives: To compare LOS and hospitalization costs among real-world hospitalized NVAF patients treated with apixaban or warfarin. Evaluate the difference in costs among different patient characteristics, including LOS and CHADS 2 score.

Methods: Patients ≥18 years of age diagnosed with AF (ICD-9-CM code: 427.31) were identified from the Premier Perspective Claims Database (01JAN2009-31MAR2014). Patients were required to have 30 days of follow-up post-index hospitalization discharge. Patients with claims for mitral valvular heart disease, valve replacement procedures, pregnancy or other NOACs during the index hospitalization were excluded. Patients were classified into two cohorts (apixaban and warfarin) depending on treatment received during hospitalization. Demographic and clinical characteristics were collected 12 months prior to and during the NVAF index hospitalization. The two cohorts were 1:1 propensity score matched (PSM) on patient and hospital characteristics to compare hospital LOS (days) and index hospitalization costs. Additionally, costs were stratified by LOS and CHADS 2 score.

Results: Before matching, patients treated with warfarin were older and sicker compared to those treated with apixaban. After 1:1 PSM, 2,571 patients were matched in each cohort, and baseline characteristics were well-balanced. The mean CHADS 2 score was 2.4 for both cohorts. The mean (standard deviation [SD], median) hospital LOS (p<0.001) was significantly shorter for patients prescribed apixaban (5.1 [5.7], 3 days) compared to warfarin (5.7 [5.3], 4 days). Patients treated with apixaban had significantly lower hospitalization costs compared to those prescribed warfarin ($11,115 vs. $13,483; p<0.001), specifically among patients with LOS ≤7 days (0-2 days: $4,909 vs. $5,780, p=0.006; 3-7 days: $9,430 vs. $10,289, p=0.007). The results were consistent when stratified by CHADS 2 score; patients with CHADS 2 0-1 ($9,761 vs. $13,418) and CHADS 2 ≥2 ($11,607 vs. $13,506) treated with apixaban incurred significantly lower costs compared to those treated with warfarin (p<0.001).

Conclusions: NVAF patients treated with apixaban had significantly shorter hospital LOS and lower index hospitalization costs compared to those treated with warfarin. Costs remained significantly lower for apixaban patients across all CHADS 2 scores.

Abstract 221: Outcomes Associated with Warfarin Time in Therapeutic Range Among Nonvalvular Atrial Fibrillation Patients Treated in an Integrated Healthcare Delivery System in the U.S

Background: The efficacy of warfarin therapy for stroke risk reduction among nonvalvular atrial fibrillation (NVAF) patients is reduced when its time in therapeutic range (TTR) is not optimal. This study assessed differences in healthcare resource utilization and costs among NVAF patients with different warfarin TTRs in an integrated healthcare delivery system (IHDS) setting in the U.S.

Methods: Patients with NVAF were identified from an electronic medical record database (1/1/2004-8/31/2013). Patients were required to have ≥6 international normalized prothrombin time ratio (INR) tests to ensure chronic warfarin therapy. The first INR test was defined as the index event with the corresponding date as the index date. The warfarin TTR of NVAF patients was determined by the modified Rosendaal method. NVAF patients were grouped into two cohorts, those with warfarin TTR <60% (Low TTR) and those with warfarin TTR ≥60% (High TTR). Demographics, clinical characteristics, healthcare resource utilization and costs were evaluated during a 12-month follow-up period. Multivariable regressions were used to assess the impact of different levels of warfarin TTRs on healthcare costs.

Results: NVAF patients in the high TTR cohort (n=1,595) had an average warfarin TTR of 73%, while patients in the low TTR cohort (n=1,356) had an average warfarin TTR of 45%. Total all-cause healthcare resource utilization was greater among patients in the low TTR cohort vs. the high TTR cohort (number of all-cause healthcare encounters: 70.2 vs. 56.1, p<0.001). The mean number of all-cause inpatient admissions (0.64 vs. 0.33, p<0.001), hospital length-of-stay (3.3 vs. 1.6 days, p<0.001), and ICU length-of-stay (0.21 vs. 0.09, p=0.02) were significantly greater for the low TTR cohort in comparison to the high TTR cohort during the follow-up period. After adjusting for patient characteristics, total healthcare costs for all-cause and stroke-related healthcare costs were $2,398 (p<0.001) and $687 (p=0.02) higher, respectively for patients in the low TTR cohort vs. the high TTR cohort (Table).

Conclusions: NVAF patients with low warfarin TTR, in comparison to those with high warfarin TTR, used more healthcare resources resulting in higher healthcare costs.

Abstract 150: Antithrombotic Use in Nonvalvular Atrial Fibrillation (NVAF): Alignment between Guidelines and Emerging Evidence with Clinician Prescribing Preferences

Background: 2014 AHA/ACC/HRS guidelines recommend anticoagulation for NVAF patients with a CHA2DS2-VASc≥2, but do not endorse a specific therapy. Several published indirect treatment comparisons demonstrate similar stroke risk reduction but distinct differences for bleeding risk among novel oral anticoagulants (NOACs) in NVAF patients.

Objectives: Survey physicians to determine how their preferences over antithrombotic therapies compare with current treatment guidelines and indirect treatment comparisons.

Methods: An online survey was completed by 200 physicians who regularly treat patients with NVAF. Respondents answered 12 questions comparing two hypothetical antithrombotic treatments that varied across five attributes: stroke risk, major bleeding risk, inconvenience (i.e., regular INR blood-testing/dietary restrictions), dosing frequency and patient out-of-pocket (OOP) cost. Physician willingness to trade higher OOP cost for improvements in other attributes was estimated using a logistic regression. Based on these results, we calculated the share of prescriptions that would be written for apixaban, aspirin, dabigatran, rivaroxaban and warfarin using real-world US patient OOP costs.

Results: Physicians were willing to trade an increase in monthly OOP cost of $38.21 (95% CI: $22.07-$54.34) for a 1 percentage point (absolute) decrease in annual stroke risk. Physicians also placed a positive value on less inconvenience ($34.46, 95% CI: $8.50-$60.41), and a 1 percentage point reduction in the risk of a major bleed ($14.44, 95% CI: $8.01-$20.88). Physicians did not have a significant willingness to pay to reduce dosing frequency from twice to once per day ($17.16; 95% CI: -0.08-$34.40). Cardiologists and cardiac electrophysiologists had higher willingness to pay for stroke risk reduction than general practitioners ($54.32 vs. $24.74, p<0.001). Based on these preferences, physicians would recommend NOACs to 77% of patients, with apixaban (32%) being the preferred NOAC.

Conclusions: Similar to findings from indirect treatment comparison studies, physicians largely prefer NOACs_particularly apixaban_compared to warfarin or aspirin for stroke risk reduction in NVAF patients. Additional research is needed to determine why NOACs are underused in practice.

Mass measurements demonstrate a strong N=28 shell gap in argon

We present results from recent time-of-flight nuclear mass measurements at the National Superconducting Cyclotron Laboratory at Michigan State University. We report the first mass measurements of ^{48}Ar and ^{49}Ar and find atomic mass excesses of -22.28(31)  MeV and -17.8(1.1)  MeV, respectively. These masses provide strong evidence for the closed shell nature of neutron number N=28 in argon, which is therefore the lowest even-Z element exhibiting the N=28 closed shell. The resulting trend in binding-energy differences, which probes the strength of the N=28 shell, compares favorably with shell-model calculations in the sd-pf shell using SDPF-U and SDPF-MU Hamiltonians.

Topical axitinib suppresses angiogenesis pathways induced by pulsed dye laser

BACKGROUND

The recurrence of port-wine stain (PWS) blood vessels by pulsed dye laser (PDL)-induced angiogenesis is a critical barrier that must be overcome to achieve a better therapeutic outcome.

OBJECTIVES

To determine whether PDL-induced angiogenesis can be suppressed by topical axitinib.

METHODS

The mRNA expression profiles of 86 angiogenic genes and phosphorylation levels of extracellular signal regulated kinases (ERKs), phosphorylated protein kinase B (AKT) and ribosomal protein S6 kinase (p70S6K) in rodent skin were examined with or without topical axitinib administration after PDL exposure.

RESULTS

The PDL-induced increased transcriptional levels of angiogenic genes peaked at days 3-7 post-PDL exposure. Topical application of 0·5% axitinib effectively suppressed the PDL-induced increase in mRNA levels of the examined angiogenic genes and activation of AKT, P70S6K and ERK from days 1 to 7 post-PDL exposure. After topical administration, axitinib penetrated into rodent skin to an approximate depth of 929·5 μm.

CONCLUSIONS

Topical application of 0·5% axitinib can systematically suppress the PDL-induced early stages of angiogenesis via inhibition of the AKT/mammalian target of rapamycin/p70S6K and Src homology 2 domain containing transforming protein-1/mitogen-activated protein kinase kinase/ERK pathway cascades.

Abstract W P309: Hemorrhagic Risk Associated with Warfarin Initiation among Patients with Atrial Fibrillation: Assessment via a Large Insurance Database

Objective: Studies suggest that warfarin may increase the risk of stroke in the first month after initiation among atrial fibrillation (AF) patients. This study assess whether there is a similar occurrence with major bleeds. We compared rates of major bleeds (hospitalizations for bleeding) in the first 30 days and >30 days after warfarin initiation between AF patients treated with warfarin and AF patients not on oral anticoagulants (OACs) in a large database.

Methods: We identified adult AF patients via one inpatient or two outpatient AF diagnosis claims from the MarketScan insurance database with 95 million enrollees from 1/1/2008 to 3/31/2012. AF patients who started warfarin based on prescription claims, 1/1/2009-12/31/2010 and who didn’t use OACs 6-month prior were defined as warfarin initiators. Comparators were AF patients not on OACs from 7/1/2008-12/31/2010 and were 1:1 matched to warfarin initiators on age, sex and date of AF diagnosis. Patients were followed until major bleeding, discontinuation/switch of therapy, disenrollment, or end of study. We report crude rates of major bleeding and adjusted hazard ratios (HRs).

Result: We studied 45,052 AF patients with an average follow-up of 1.9 years. Warfarin initiators and comparators were the same age (73.0) and sex (50% female) but had slightly lower CHADS2 scores (1.7 vs. 1.8) and ATRIA bleed scores (2.2 vs. 2.4). Compared to patients not on OACs, the rates of bleeding were higher among warfarin initiators during the first 30 days (adjusted HR=1.70) and after 30 days (adjusted HR=1.77) (Table) (p for interaction=0.86). The bleeding rate was higher in the first 30 days than after 30 days for the warfarin initiators, but this was also observed for the comparators (p=.02).

Conclusion: Compared with AF patients not on OACs, warfarin appears to increase the risk of major bleeding similarly during the first 30 days and thereafter even though the rate was higher in the first 30 days for both warfarin initiators and comparators.