[Speckle-type POZ protein up-regulates c-Jun protein expression and promotes proliferation and invasion of renal carcinoma cells]

OBJECTIVE

To investigate the effect of speckle-type POZ protein (SPOP) on proliferation, apoptosis, migration and invasion of renal cell carcinoma (RCC) and explore the potential mechanisms.

OBJECTIVE

Renal carcinoma cell lines (786-O, A704, and Caki-2) cultured in vitro were transfected with a SPOP-overexpressing plasmid, and the changes in proliferation of the cells were detected using colony formation and MTT assay; TUNEL assay was used to assess apoptosis of the cells. The changes in migration and invasion abilities of the cells were examined using wound healing assay and Transwell assay. The mRNA and protein levels of SPOP and c-Jun in the transfected cells were measured using real-time PCR and Western blotting.

OBJECTIVE

SPOP over-expression obviously promoted the proliferation, migration and invasion of 786-O, A704 and Caki-2 cells (P < 0.05). Compared with the control cells, 786-o and Caki-2 cells over-expressing SPOP exhibited significantly lowered apoptosis rates (P < 0.05). The results of real-time PCR demonstrated that the transfected cells did not show obvious changes in the mRNA level of c-Jun, but the protein expressions of SPOP and c-jun increased significantly as shown by Western blotting (P < 0.05).

OBJECTIVE

SPOP can promote proliferation, migration, and invasion and suppress apoptosis of renal carcinoma cells possibly by promoting the expression of c-Jun.

Retraction notice to "30MO ORIENT-3: A randomized, open-label, phase III study of sintilimab versus docetaxel in previously treated advanced/metastatic squamous non-small cell lung cancer (sqNSCLC)": [Annals of Oncology Volume 31, Supplement 7, December 2020, Page S1428]

This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This article was retracted at the request of the authors. The authors of this abstract have advised that full agreement between authors and sponsors on publication of the abstract has not been reached and they are therefore unable to publish this data at present.

Impact of the combined timing of PD-1/PD-L1 inhibitors and chemotherapy on the outcomes in patients with refractory lung cancer

Background

PD-1/PD-L1 inhibitors in combination with chemotherapy are widely used in clinical practice. However, the ideal combined timing of them has not been fully explored.

Methods

In this study, simulation experiments to explore the impacts of the combination of anti-PD-1 antibody (anti-PD-1 Ab) on the cytotoxic effects of chemotherapeutic drugs in peripheral blood mononuclear cells were performed. In addition, the effects of the combined timing of PD-1/PD-L1 inhibitors and chemotherapy on efficacy and safety were retrospectively analysed in patients with refractory lung cancer.

Results

Experiments in vitro showed that administering the anti-PD-1 Ab 3 days after chemotherapy (represented by dicycloplatin) resulted in significantly weaker cytotoxic effects on lymphocytes, compared with administering the anti-PD-1 Ab before or concurrent with chemotherapy. Moreover, data from 64 lung cancer patients treated with PD-1/PD-L1 inhibitors plus chemotherapy as a second- or higher-line therapy were retrospectively analysed. The results showed that administering PD-1/PD-L1 inhibitors 1-10 days (especially 3-5 days) after chemotherapy was associated with longer overall survival [17.3 months versus 12.7 months; hazard ratio (HR) = 0.58, 95% confidence interval (CI) 0.28-1.19, P = 0.137 in univariate analysis; HR = 0.36, 95% CI 0.16-0.80, P = 0.012 in multivariate analysis] and a trend of improved progression-free survival (5.1 months versus 4.2 months; HR = 0.81, 95% CI 0.42-1.54, P = 0.512) compared with administering PD-1/PD-L1 inhibitors before or concurrent with chemotherapy.

Conclusion

Our findings suggest that administering PD-1/PD-L1 inhibitors 1-10 days (especially 3-5 days) after chemotherapy is superior to administering PD-1/PD-L1 inhibitors before or concurrent with chemotherapy in patients with refractory lung cancer, but this result needs to be further explored by prospective studies.

•

The cytotoxic effects of chemotherapeutic drugs were positively correlated with the activation states of PBMCs.

•

Administering the anti-PD-1 Ab 3 days after chemotherapy resulted in weaker cytotoxic effects on lymphocytes in vitro.

•

Administering PD-1/PD-L1 inhibitors a few days after chemotherapy resulted in better survival in lung cancer patients.

Molecular mechanisms of MCM3AP-AS1 targeted the regulation of miR-708-5p on cell proliferation and apoptosis in gastric cancer cells

OBJECTIVE

Gastric cancer (GC) is a common malignancy of the digestive tract. Accumulated studies proved that long non-coding RNA MCM3AP-AS1 (MCM3AP-AS1) modified the mechanism of the progression of GC. However, the molecular mechanism is still greater elusive. Hence, we aimed to explore the molecular mechanism of MCM3AP-AS1 targeting the regulation of microRNA-708-5p on cell proliferation and apoptosis in GC cells.

MATERIALS AND METHODS

The expression levels of MCM3AP-AS1 (MCM3AP antisense RNA 1) in gastric mucosal cells GES-1 and gastric cancer cell lines of MGc-803 and SGC-7901 cells were detected by qRT-PCR. Moreover, the protein levels of Cyclin D1, P21, Bax and Bcl-2 in MGc-803 and SGC-7901 cells after transfection were detected by Western blot. MTT assay was performed to detect cell proliferation and flow cytometry was carried out to determine GC cell apoptosis in vitro. In the endpoint, the targeting relationship between MCM3AP-AS1 and microRNA-708-5p was detected by Dual-Luciferase reporter assay.

RESULTS

The level of MCM3AP-AS1 was significantly promoted in GC cell lines. Knockdown of MCM3AP-AS1 curbed cell proliferation and enhanced apoptosis in MGc-803 and SGC-7901 cells. Furthermore, the effect of the downregulation of MCM3AP-AS1 on cell proliferation and apoptosis was reversed by knockdown of miR-708-5p, which was targeted by MCM3AP-AS1 in vitro.

CONCLUSIONS

MCM3AP-AS1 regulates the proliferation and apoptosis of gastric cancer cells by targeting the expression of microRNA-708-5p. The study may be useful to the therapy target of human GC.

Development of the Physiological-Psychological-Social Three-dimensional Human Ageing Scale for older people

OBJECTIVES

Ageing is related to physical, psychological and social conditions. The aim of this study was to develop a scale that comprehensively assesses these three dimensions to reflect the ageing state of the human body.

STUDY DESIGN

The study design of this study is a cross-sectional study.

METHODS

The items for the preliminary scale were selected from relevant high-quality literature. The preliminary scale was developed by experts through two rounds of the Delphi method. The analytic hierarchy process was used to determine the weights of the items. Cronbach's α, the test-retest reliability, the content validity index and exploratory factor analysis (EFA) were used to evaluate the validity and reliability of the scale.

RESULTS

This study developed the Physiological-Psychological-Social Three-dimensional Human Ageing Scale (PPSHAS), which includes 3 dimensions, 10 components and 51 items. The Cronbach's α of the PPSHAS was 0.930, and the test-retest reliability coefficient was 0.856 (P < 0.001). The scale-level content validity index/universal agreement was 0.82, and the scale-level content validity index/average was 0.98. The EFA yielded 10 components; the total variance explained by these components was 57.491%.

CONCLUSIONS

This PPSHAS is an easy-to-use instrument for assessing the ageing process among elderly people and has adequate validity and reliability.

Subclinical ketosis risk prediction in dairy cows based on prepartum metabolic indices

ABSTRACT Ketosis can seriously impair cow performance. This study detected changes in prepartum blood metabolic parameters for predicting postpartum ketosis occurrence in dairy cows. Body condition score (BCS) was assessed before and after delivery. Blood samples of 63 cows were collected from 10 days before calving to 10 days after calving to measure metabolic parameters including β-hydroxybutyric acid (BHBA), non-esterified fatty acid (NEFA), glucose (GLU), total bilirubin (TBIL), direct bilirubin (DBIL), indirect bilirubin (IBIL), total protein (TP), albumin (ALB), globulin (GLO), alanine aminotransferase (ALT), and aspartate aminotransferase (AST). There was a postpartum subclinical ketosis incidence of 42.25%. Compared with prepartum, plasma, levels of BHBA, AST, and NEFA significantly increased postpartum, and prepartum AST (R=0.57) and NEFA (R=0.45) showed a significant positive correlation with ketosis postpartum. Plasma GLU level significantly decreased postpartum and was significantly negatively correlated with ketosis (R=-0.21). Receiver operating characteristic curve analysis revealed prepartum BSC < 2.88, and prepartum plasma AST > 68.0 U/L, GLU < 3.97mmol/L, NEFA > 0.27mmol/L, and BHBA > 0.43mmol/L, indicating a high risk of subclinical ketosis postpartum. These levels can be used as risk indicators to predict the occurrence of subclinical ketosis in postpartum cows.

[Analysis of the effect of transgluteal percutaneous drainage in the treatment of deep pelvic abscess]

Objective: To investigate the safety and feasibility of transgluteal percutaneous drainage using double catheterization cannula in the treatment of deep pelvic abscess. Methods: A retrospective analysis of the clinical data of patients who underwent transgluteal percutaneous drainage using double catheterization cannula with deep pelvic abscesses admitted to the Jinling Hospital from May 2017 to September 2020 was conducted. Seven patients were enrolled, including 5 males and 2 females, who aged 26-74 (median 53.0) years old, and all of them had digestive fistula. One male patient was punctured again due to the tube falling off, and a total of 7 patients underwent 8 times of transgluteal percutaneous drainage, all under the guidance of CT. The puncture and drainage steps of the double catheterization cannula group are as follows: (1) Locate the puncture point under CT in the lateral position; (2) Place the trocar into the abscess cavity; (3) Confirm that the trocar is located in the abscess cavity under CT; (4) Pull out the inner core and insert into the double catheterization cannula through the operating hole; (5) Confirmthat the double catheterization cannula is located in the abscess cavity under CT; (6) The double catheterization cannula is properly fixed to prevent it from falling off. The white blood cells, C-reactive protein (CRP), procalcitonin, and interleukin-6 (IL-6) of all patients before the drainage and 1 days, 3 days, and 5 days after the drainage were collected, as well as the bacterial culture results of the drainage fluid. The changes of various infection biomarkers before and after the drainage were compared. Results: All 7 patients were cured. No complications such as hemorrhage and severe pain were observed. The average time with drainage tube was 60.8 (18-126) days. Five patients finally underwent gastrointestinal reconstruction surgery due to gastrointestinal fistula. The median serum interleukin-6 of patients before drainage, 1 day, 3 days and 5 days after drainage were 181.6 (113.0, 405.4) μg/L, 122.2 (55.8, 226.0) μg/L, 59.2 (29.0,203.5) μg/L and 64.1 (30.0,88.4) μg/L, respectively.The level of serum interleukin-6 at 3 days and 5 days after drainage was significantly lower than before drainage (F=3.586, P=0.026). Although the white blood cell count, C-reactive protein, and procalcitonin decreased gradually after drainage compared with before drainage, the difference was not statistically significant (all P>0.05). Conclusion: Transgluteal percutaneous drainage with double catheterization cannula is simple and effective, and can be used for the treatment of deep pelvic abscess.

Dual-energy CT for differentiating early glottic squamous cell carcinoma from chronic inflammation and leucoplakia of vocal cord: comparison with simulated conventional 120 kVp CT

AIM

To evaluate the value of dual-energy (DE) computed tomography (CT) in discriminating early glottic squamous cell carcinoma (eGSCC) from chronic inflammation and leucoplakia of the vocal cord, and to compare the diagnostic efficiency of DECT with that of simulated conventional 120 kVp CT.

MATERIALS AND METHODS

Seventy patients with glottic lesions confirmed by histopathology (38 cases with eGSCC, 11 cases with chronic inflammation, 21 cases with leucoplakia) were enrolled in this prospective study. The DECT-derived parameters were measured and compared using independent sample t-test. Receiver operating characteristic (ROC) curve was performed to evaluate the diagnostic performance, and comparison of the area under the ROC curve (AUC) was made using the Z test to further select the best diagnostic parameters.

RESULTS

Significantly higher iodine concentration (IC), normalised IC (NIC), effective atomic number (Z_eff), 40-100 keV (20 keV-interval), slope(k), and Mix-0.3 values were found in eGSCC than those in chronic inflammation, leucoplakia, and inflammation + leucoplakia (all p<0.05). Compared with attenuation measurement of simulated conventional 120 kVp CT, the NIC, 60 keV values derived from DECT showed significantly higher AUC in discriminating these glottic lesions (p<0.05).

CONCLUSIONS

DECT is more accurate for differentiating eGSCC from chronic inflammation and leucoplakia when compared with simulated conventional 120 kVp CT.

LncRNA SND1-IT1 accelerates the proliferation and migration of osteosarcoma via sponging miRNA-665 to upregulate POU2F1

OBJECTIVE

To clarify the role of long non-coding RNA (lncRNA) SND1-IT1 in accelerating the proliferative and migratory abilities of osteosarcoma (OS) via sponging miRNA-665 to upregulate POU2F1.

PATIENTS AND METHODS

The relative level of SND1-IT1 in OS tissues was determined by quantitative Real Time-Polymerase Chain Reaction (qRT-PCR). The target gene of SND1-IT1 was predicted by bioinformatics and verified by Dual-Luciferase reporter gene assay. Similarly, the target gene of miRNA-665 was identified. Correlation among SND1-IT1, miRNA-665 and POU2F1 was evaluated through linear regression test. Regulatory effects of SND1-IT1/miRNA-665/POU2F1 on cellular behaviors of MG63 and U2OS cells were evaluated.

RESULTS

SND1-IT1 was upregulated in OS, knockdown of which attenuated proliferative and migratory abilities of OS cells. MiRNA-665 was the target gene of SND1-IT1, which was negatively correlated to SND1-IT1 in OS. POU2F1 was the target gene of miRNA-665. Its level was negatively regulated by miRNA-665 and positively regulated by SND1-IT1. Inhibited proliferative and migratory abilities of OS cells with SND1-IT1 knockdown were partially elevated by transfection of miRNA-665 inhibitor, and further downregulated by POU2F1 knockdown.

CONCLUSIONS

LncRNA SND1-IT1 accelerates proliferative and migratory abilities of OS via sponging miRNA-665 to upregulate POU2F1, thus stimulating the progression of OS.

Circ_0000064 adsorption of microRNA-143 promotes malignant progression of hepatocellular carcinoma

OBJECTIVE

The aim of this study was to investigate the expression characteristics of circ_0000064 in hepatocellular carcinoma, and to further explore the underlying mechanism.

PATIENTS AND METHODS

Real time quantitative-Polymerase Chain Reaction (qPCR) was used to detect the expression of circ_0000064 in 42 hepatocellular carcinoma tissues and adjacent normal tissues. Meanwhile, the relationship between circ_0000064 expression and clinical indicators, as well as the prognosis of patients with hepatocellular carcinoma, were detected. QPCR was applied to measure circ_0000064 level in hepatocellular carcinoma cell lines as well. Subsequently, the circ_0000064 knockdown model was successfully constructed using lentivirus in hepatocellular carcinoma cell lines. Cell counting kit-8 (CCK-8), colony formation assay, and flow apoptosis were performed to analyze the influence of circ_0000064 on the biological functions of hepatocellular carcinoma cells. The potential mechanism was explored using cell recovery experiments. In addition, the relationship between circ_0000064 and microRNA-143 was finally explored.

RESULTS

QPCR results showed that the expression level of circ_0000064 in hepatocellular carcinoma tissues was remarkably higher than that of adjacent normal tissues, and the difference was statistically significant. Compared with patients with lower expression of circ_0000064, patients with higher expression of circ_0000064 exhibited remarkably higher pathological stage and lower overall survival rate. In vitro experiments demonstrated that the proliferation ability of the cells was remarkably reduced after the transfection of si-circ_0000064, while cell apoptosis ability significantly increased when compared with the NC group. Meanwhile, qPCR results indicated that microRNA-143 expression was negatively correlated with circ_0000064 expression in hepatocellular carcinoma. Luciferase reporter gene assay indicated that circ_0000064 could be targeted by microRNA-143 through their binding site. In addition, the cell recovery experiment confirmed that circ_0000064 and microRNA-143 could be mutually regulated, which affected the malignant progression of hepatocellular carcinoma together.

CONCLUSIONS

Circ_0000064 level was remarkably upregulated in hepatocellular carcinoma and was associated with high pathological stage and poor prognosis of patients. In addition, circ_0000064 significantly promoted proliferation and inhibited apoptosis of hepatocellular carcinoma cells via modulating microRNA-143.

Circular RNA circ-PRKCI promotes cell proliferation and invasion by binding to microRNA-545 in gastric cancer

OBJECTIVE

The carcinogenic effects of circular RNA circ-PRKCI have been recognized in a variety of malignancies. However, the exact biological function of circ-PRKCI in gastric cancer has not been fully elucidated. Therefore, the aim of this study was to explore the expression of circ-PRKCI in gastric cancer (GC) and to investigate its potential regulation mechanism in the pathogenesis and progression of GC.

PATIENTS AND METHODS

The expression of circ-PRKCI in 50 GC tissues and cell lines was detected by quantitative Real Time-Polymerase Chain Reaction (qRT-PCR). Statistical methods were used to analyze the relation between circ-PRKCI expression and overall survival rate of patients. The effect of circ-PRKCI on GC cell proliferation was examined by cell counting kit-8 (CCK-8) and cell colony formation assays. Meanwhile, the effect of circ-PRKCI on the invasion ability of GC cells was determined by transwell invasion assay. Flow cytometry was used to detect the apoptosis of GC cells. Bioinformatics was used to search for miRNAs that might have direct effects with circ-PRKCI. In addition, the binding of circ-PRKCI to microRNA-545 was validated using Dual-Luciferase reporter gene assay.

RESULTS

Circ-PRKCI was significantly highly expressed in GC tissues, as well as cell lines. High expression of circ-PRKCI was positively associated with a poor prognosis of GC patients. Overexpression of circ-PRKCI significantly promoted the proliferation and invasion of GC cells, whereas reduced the proportion of apoptotic GC cells. Subsequent Dual-Luciferase reporter gene assay revealed that circ-PRKCI could bind to microRNA-545 and inhibit its expression in GC cells. These results indicated that circ-PRKCI might promote the development of GC by adsorbing microRNA-545 in a sponge manner.

CONCLUSIONS

Circ-PRKCI can be used as a potential prognostic indicator of GC, providing a new perspective for the potential bio-molecular mechanism in GC.

MicroRNA-135 inhibits gastric cancer metastasis by targeting SMAD2

OBJECTIVE

The purpose of this study was to investigate whether microRNA-135 plays a role in the malignant progression of gastric cancer (GC) by regulating SMAD2 and its underlying mechanism.

PATIENTS AND METHODS

Quantitative Real Time-Polymerase Chain Reaction (qRT-PCR) was performed to examine microRNA-135 expression in tumor tissue specimens and paracancerous ones of 28 patients with GC, and the interplay between microRNA-135 level and clinical indexes and prognosis of GC patients was also analyzed. Subsequently, when negative control (NC) sequence or microRNA-135 mimics were transfected into GC cell lines, Cell Counting Kit-8 (CCK-8), transwell and wound healing assays were used to analyze the impact of microRNA-135 on proliferation and apoptosis of GC cells. Finally, the mechanism of microRNA-135 on the downstream gene SMAD2 was explored by a cell recovery experiment.

RESULTS

QRT-PCR results revealed that in tumor tissues of GC patients, the microRNA-135 level was conspicuously lower than that in the adjacent tissues, and the difference was statistically significant. The overall survival rate was lower in patients with low expression of microRNA-135 compared with patients with a high one. In addition, in the GC cell lines including BGC-823 and SGC-7901, the cell proliferation, as well as invasion and migration ability of microRNA-135 mimics group, was significantly decreased compared with the NC group. Moreover, the research verified that SMAD2 expression in GC cell lines and tissues was markedly increased and negatively correlated with microRNA-135 level. The cell recovery study found that overexpression of SMAD2 can offset the influence of microRNA-135 mimics on proliferation and metastasis of GC cells, thus affecting the malignant progression of GC.

CONCLUSIONS

In this work, microRNA-135 was found conspicuously associated with lymph node or distant metastasis and poor prognosis of GC patients. Additionally, microRNA-135 may inhibit the malignant progression of GC by targeted regulating SMAD2 expression.

RETRACTED: ORIENT-3: A randomized, open-label, phase III study of sintilimab versus docetaxel in previously treated advanced/metastatic squamous non-small cell lung cancer (sqNSCLC)

This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This article was retracted at the request of the authors. The authors of this abstract have advised that full agreement between authors and sponsors on publication of the abstract has not been reached and they are therefore unable to publish this data at present.

[Current status and research progress in load assessment methods for occupational low back pain]

With the development of industry, musculoskeletal disorders have become increasingly prominent, and low back pain is one of the major problems. The United States and Germany have already included it in the category of occupational diseases. Therefore, it is extremely important to determine the occupational factors affecting low back pain and evaluate the load level of workers. In this paper, combined with the existing literature, the evaluation methods of the load of low back pain were reviewed, in order to provide reference for the development of prevention strategies of low back pain from the perspective of occupational factors.

Increasing use of ablation in the management of atrial fibrillation in heart failure: insights from a national database on 10 year trends in the United States

Background

Atrial fibrillation (AF) is the most commonly encountered arrhythmia in clinical practice, even more so among patients with heart failure (HF). Results of the recent CABANA and CASTLE-AF trials indicate significant improvements in ejection fraction, HF readmissions as well as overall mortality with the incorporation of rhythm control strategies in HF patients. These findings challenge existing notions of equivalency of rate vs rhythm control strategies. In this study, we analyzed the impact of this evidence on treatment practices and the short term outcomes of ablation in this patient cohort.

Methods

We conducted a retrospective study using the AHRQ-HCUP National Readmission Database for the years 2005–2014. ICD 9 diagnosis codes were used to identify all adult patients (≥18 years) undergoing AF ablation procedures as well as a sub-cohort of patients with existing HF. Trends in the use of ablation procedures, patient characteristics as well as details of short term procedural outcomes were studied. Multivariate regression analysis was utilized to adjust for confounders. Complications were defined as per the Agency for healthcare research and quality guidelines. Independent risk factors for in-hospital mortality were identified using proportional hazards model.

Results

Our results indicate a trend of rising rates of AF ablation procedures overall with a peak in 2011 at 20,046 and gradual downtrend thereafter (10,195 in 2005 to 11735 in 2014). Our data revealed a consistent rise in ablation procedures among heart failure patients during the same period (832 to 2245). A definite reduction in peri-procedural mortality is noted (0.24% in 2005 to 0.17% in 2014, p=0.2) – an improvement that is maximally apparent in the heart failure group (2.49% to 0.4%, p=0.07). Overall complication rates however are significantly increased overall with a proportional rise noted among HF patients.

Conclusions

Our data from a nationally representative registry indicates an increasing utilization of ablation as a therapeutic modality in the management of atrial fibrillation in HF. Future prospective studies are required to assess the positive impact of these changes in clinical practice as offset by their associated complications.

10 year AF ablation trends in HF

Funding Acknowledgement

Type of funding source: None

Impact of outflow tract obstruction in the management of atrial fibrillation in hypertrophic cardiomyopathy: insights from the national readmission database

Background

Atrial fibrillation (AF) is commonly encountered in patients with Hypertrophic Cardiomyopathy (HCM). Presence of AF in this high risk population is detrimental due to its effect on hemodynamics, diastolic function and potential induction of ventricular tachyarrhythmias. For these reasons a rhythm control strategy is highly desirable, and yet catheter ablation of AF is consistently inefficacious with poorer overall outcomes. We hypothesize that in HCM presence of outflow tract obstruction by virtue of its effect on left atrial hemodynamics, altered circulatory flow patterns in the pulmonary veins, and stretch related triggered activities would create an arrhythmogenic substrate, and have significant impact on the outcomes of catheter ablation of AF. In this study, we aimed to evaluate AF ablation outcomes based on the presence or absence of outflow tract obstructions in patients with HCM.

Methods

We conducted a retrospective study using the AHRQ-HCUP National Readmission Database for the years 2016–17. All adults (≥18 years) with HCM undergoing AF ablation procedures were identified using ICD-9 codes. The cohort was divided into two groups; Obstructive HCM (Group A) and Non-Obstructive HCM (Group B)

Multivariate regression analysis was utilized to adjust for confounders. Independent risk factors for in-hospital mortality were identified using a proportional hazards model. Complications were defined as per the Agency for Health Care Research and Quality guideline.

Results

From a total of 71,451,419 patients in the NRD registry, 97 patients with HCM were identified and formed the study cohort. When divided based on the presence or absence of outflow tract obstruction, there were 25 patients with Obstructive HCM and 72 patients with Non-obstructive HCM.

Both groups were similar in clinical characteristics including CHADVASc scores and Charlson Comobidity indices as outlined in Table 1. Procedural outcome analysis revealed higher 30-day cardiac readmissions in the Obstructive HCM group compared to Non-obstructive HCM (25.2% vs 7.97%, p=0.049). The Obstructive HCM group had higher rates of atrial arrhythmias, 57.97%, compared to 32.44% in the non-obstructive HCM group, and heart failure exacerbations, 41.27% vs 25.82%. However, both indices did not reach statistical significance. The procedural complications rates tended to be higher in the non-obstructive HCM group, 10.8% vs. 5.6% in the Obstructive HCM group (p=0.54).

Conclusions

Presence of an obstructive component to HCM is associated with significantly increased short term cardiac readmissions predominantly driven by recurrent atrial arrhythmias and heart failure. These findings suggest negative influence of altered cardiac hemodynamics related to outflow tract obstruction on atrial arrhythmias. The arrhythmogenic substrate of HCM may therefore be different and less amenable to catheter ablation.

HCM ablation outcomes

Funding Acknowledgement

Type of funding source: None

Impact of age on the obesity paradox in acute coronary syndrome: a nationwide analysis

Background

The obesity paradox – indicating improved short term mortality in obese individuals has been widely explored in a number of cardiovascular conditions. However, its validity in an elderly population and the possible physiological impact of aging on this phenomenon in Acute Coronary syndrome (ACS) remain unclear. In this study, we aim to determine the relationship between obesity and in-hospital mortality, morbidity, and health care resource utilization in this cohort of patients.

Methods

A retrospective study was conducted using the AHRQ-HCUP National Inpatient Sample for the year 2014. Elderly adults (≥65 years) with a principal diagnosis of ACS and a secondary diagnosis of obesity were identified using ICD-9 diagnosis codes as described in the literature. The primary outcome of in-hospital mortality and secondary outcomes like length of hospital stay (LOS), and total hospitalization costs were analyzed. Propensity score (PS) using the next neighbor method without replacement with 1:1 matching was utilized to adjust for confounders. Independent risk factors for mortality were identified using a multivariate logistic regression model.

Results

In total, 1,137,108 hospital admissions with a primary diagnosis of ACS were identified, of which 7.46% were obese. In-hospital morality during the index admission was lower among obese patients with ACS compared to non-obese patients (4.62 vs 6.87%, p&lt;0.001) with significantly lower 30-day readmission rates as well (p&lt;0.001). However, in-hospital mortality rates during readmission were statistically equivalent between the obese and non-obese groups (5.6 vs 8.3%, p=0.72). LOS during the index admission was longer for obese patients (6.39 vs 5.36 days, p=0.65) but equivalent to non-obese patients during subsequent readmissions (p=0.12). The total cost of these admissions was significantly more in the obese cohort as well (p&lt;0.001).

Conclusion

In this study, obese elderly patients admitted with ACS were found to have significantly reduced in-hospital mortality and 30-day readmission rates when compared to non-obese patients - reinforcing the obesity paradox independent of patient age.

Funding Acknowledgement

Type of funding source: None

Impact of chronic sequential LV-RV pacing with cardiac resynchronization therapy for patients with narrower (&lt;130 ms) QRS complexes following evaluation of acute myocardial strain characteristics

Background

Prior studies have shown acute improvement in myocardial strain patterns (SP) and strain rates (SR), left ventricular ejection fraction (LVEF), and long-term clinical improvement by Cardiac Resynchronization Therapy (CRT) preferential LV pacing. This relationship has not been studied in patients (pts) with narrower QRS.

Objectives

We aimed to evaluate myocardial speckle tracking SP and SR at different VV intervals in pts with narrow (&lt;130 ms) and wide (&gt;130 ms) QRS.

Methods

We assessed LVEF and speckle tracking myocardial SP and SR as per the American Society of Echocardiography (ASE) Dyssynchrony Writing Group methods in pts with CRT in acute settings at VV0, VV60 and LV-only pacing. For SP assessment, we used Bull's eye format display of the LV segments, and scores for SR, 2 = early stretch, late peak, 1= early stretch, early peak, and 0 = single peak at aortic closure.

Results

Total cohort of 271 pts; age 69.2±10.3 yrs (mean ± SD), male - 60%, divided into 2 groups; Gp A (QRS &lt;130 ms, n=69) and Gp B (QRS &gt;130 ms, n=202). QRS width and LVEF in Gp A and B were 120.1±12.3 ms and 152.1±12.9 ms, and 22.3±9.4% and 23.3±10.2% respectively. With VV0 increase in LVEF, 67±6.0% from baseline 22.3±9.4% was seen in Gp A compared to 43±6.5% from 23.3±10.2% in Gp B (p&lt;0.01). With VV60 and LV-only pacing further rise in LVEF to 100.0±7.1% and 112.0±7.2% in Gp A and 80.2±8.0% and 93±8.1% in Gp B was seen. (Figure 1). Strain scores at different VV timings in both groups are shown in Table 1.

Conclusions

In pts with CRT, different VV timings show differences in acute myocardial speckle tracking SP and SR, and LVEF. These changes are markedly favorable with LV-only and sequential LV-RV pacing even in pts with narrower QRS. Our findings support chronic sequential LV-RV pacing programming in CRT pts with narrow QRS.

Figure 1

Funding Acknowledgement

Type of funding source: None

Efficacy of cardiac rehabilitation with motion assistance from wearable cyborg hybrid assistive limb in patients with chronic heart failure: a randomized controlled trial

Background

Recent Cochrane Systematic Review suggested that the participation in cardiac rehabilitation is associated with approximately 20% lower cardiovascular mortality and morbidity. Exercise therapy is the key component of cardiac rehabilitation programs. In recent years, innovative technologies have been introduced into the field of rehabilitation, and a typical example is the wearable cyborg Hybrid Assistive Limb (HAL). The wearable cyborg HAL provides motion assistance based on detection of bioelectrical signals on the skin surface when muscle forces are generated. The lumbar-type HAL is expected to expand the therapeutic options for severe cardiac patients who have difficulty in performing usual cardiac rehabilitation programs, such as bicycle pedaling or walking.

Purpose

We aim to compare the efficacy of exercise therapy performed with motion assistance from a lumbar-type HAL versus conventional training (sit-to-stand exercise without HAL) in patients with chronic heart failure.

Methods

This clinical trial is a randomized, non-blinded, and controlled study. Twenty-eight heart failure patients (73.1±13.8 years) who have difficulty in walking at the usual walking speed of healthy subjects were randomly assigned to 2 groups (HAL group or control group) with a 1:1 allocation ratio and performed sit-to stand exercise either with HAL or without HAL for 5 to 30 minutes once a day, and 6 to 10 days during the study period. The brain natriuretic peptide (BNP), isometric knee extensor strength, standing ability (30-seconds chair-stand test: CS-30), short physical performance battery (SPPB) and 6-minute walking distance (6MWD) were measured before and after the completion of cardiac rehabilitation. Cardiac events such as death, re-hospitalization, myocardial infarction and worsening of angina pectoris and heart failure during 1 year after discharge were evaluated.

Results

There was no significant difference in the number of days of exercise therapy between the two groups. BNP, SPPB and 6MWD were improved in both groups. In the HAL group, the isometric knee extensor strength (0.29±0.11 vs 0.35±0.11 kgf/kg, p=0.003) significantly improved and CS-30 (5.5±5.1 vs 8.2±5.3, p=0.054) tended to improve. However, in the control group, either the isometric knee extensor strength (0.35±0.11 vs 0.36±0.14 kgf/kg, p=0.424) or CS-30 (6.0±4.3 vs 9.2±6.2, p=0.075) did not significantly change. HAL group showed significantly more improvement in the isometric knee extensor strength than control group (p=0.045). Cardiac events occurred in 20% in the HAL group and 43% in the control group.

Conclusion

The improvement in isometric knee extensor strength with the assistance from lumbar-type HAL suggests that exercise therapy using this device may be useful in chronic heart failure patients with flail or sarcopenia, a strong poor prognostic factor in these patients.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): This work was supported in part by a grant-in-aid for Scientific Research from the Ministry of Education, Science, and Culture of Japan (JSPS KAKENHI grant number JP17K09485) and funded by the ImPACT Program of the Council for Science, Technology and Innovation (Cabinet Office, Government of Japan) (grant number 2017-PM05-03-01).

Predictors of sudden cardiac arrest in adolescents with mitral valve prolapse: an analysis of the nationwide inpatient sample

Background

Mitral valve prolapse (MVP) is the most commonly encountered valvular pathology seen in 2–3% of the general population. Though traditionally regarded as a benign pathology, recent literature suggests that sudden cardiac death is significantly more common in these patients with estimates of 0.2–0.4%/year. The exact underlying mechanism of these higher rates of SCD remain poorly understood. In this study, we aim to identify predictors of sudden cardiac arrest (SCA) in an adolescent population.

Methods

We conducted a retrospective study using the AHRQ-HCUP National Inpatient Sample 2016-2017 for the years 2016-17. All patients (≤18 years) admitted with Mitral valve prolapse were identified using ICD-10 codes and further sub stratified based on presence or absence of sudden cardiac arrest (SCA). Baseline characteristics were obtained and multivariate regression analysis was utilized to identify potential predictors of SCA. Independent risk factors for in-hospital mortality were identified using a proportional hazards model. Complications were defined as per the Agency for Health Care Research and Quality guideline.

Results

We screened a total of 71,473,874 admissions in the NIS database to identify a total of 1,372 adolescent patients admitted with MVP in the years 2016–17. These patients were then sub-categorized based on presence or absence of SCA during the hospitalization. Our findings revealed that patients with SCA were generally slightly older (15y vs 13y, p=0.036, OR-1.1, p=0.007) and more likely female (83.3% vs 13%, p=0.227, OR – 3.55, p=0.57)). Interestingly, patients in the SCA cohort were noted to have almost 4 fold higher rates of Mitral regurgitation (66.6% vs 18.35%, p=0.008, OR-8.89, p=0.005) as well as family history of SCD (16.7% vs 4.1%, p=0.145, OR-4.65, p=0.14).

Conclusions

Presence of Mitral regurgitation and a family history of sudden cardiac death are associated with significantly higher rates of SCA in adolescent patients with mitral valve prolapse.

Predictors of SCA in Adolescent MVP

Funding Acknowledgement

Type of funding source: None

10-year trend analysis of in-hospital cardiac arrest: 2008–2017 United State hospitalizations

Introduction

In-hospital cardiac arrest (IHCA) survival trends have not been well reported in recent years. Whether the implementation of the new 2015 AHA guideline affects the survival of IHCA is largely unknown. Our study aims to provide an updated analysis of the trends of IHCA among the hospitals in the United States

Method

Using United States National Inpatient Sample Database 2008–2017, the cohort was generated with patients age above 18 who received Cardiopulmonary resuscitation during Hospitalization. Hospitalization with a principle diagnosis of cardiac arrest or ventricular fibrillation/ventricular tachycardia were excluded as outside hospital cardiac arrest. Demographic features, baseline characteristic as well as hospital outcomes were described. Trend analysis was performed using a multivariate model adjusted for age, sex, and comorbidities score.

Results

From 2008 to 2017, the cases of In-hospital cardiac arrest (IHCA) has steadily increased from 96,771 to 106,320. This trend was accompanied by a decline in age from (67.48±0.30 to 65.78±0.13, Ptrend &lt;0.001) but increase in comorbidity score (from 2.44±0.27 to 3.47±0.21, Ptrend &lt;0.001). It is noted that the mortality rate has been steadily declining since 2008 (from 74.01% to 68.68%, Ptrend &lt;0.001)), although no significant changes before or after 2015 were noted (from 68.90 to 68.68, P&gt;0.05). Length of stay has decreased from an average of 9.06± days to 8.76±0.13 days at the cost of increased health care costs (from 30.78 to 37.40 thousand dollar P&lt;0.001 adjusted for inflation rate).

Conclusion

The survival rate of In-hospital cardiac arrest has increased from 2008 to 2017 despite increased comorbidity burden. The length of stays has decreased at the cost of an increase in health costs.

Funding Acknowledgement

Type of funding source: None

Breast cancer patients have lower in-hospital mortality after acute coronary syndrome, a 5 year nationwide analysis

Background

Breast cancer and cardiovascular disease (CVD) share common risk factors, and breast cancer therapies are well known to cause cardiotoxicity. Prior studies highlighted the higher burden coronary artery disease and the importance to further assess its consequences on breast cancer patients.

Purpose

We sought to evaluate the revascularization rate and in-hospital short-term outcomes of breast cancer patients following acute coronary syndrome (ACS) compared to the general female population.

Methods

We reviewed the Nationwide Inpatient Sample from 2010 to 2014 to identify female patients with principal diagnosis of ACS (ST-elevation and non ST-elevation myocardial infarction, and unstable angina). Two subgroups were identified, women with a history of breast cancer and women without, and were propensity matched.

Multivariate regression analyses were performed to evaluate the impact of breast cancer on primary outcome (in-hospital mortality) and secondary outcomes: occurrence of shock, acute kidney injury (AKI), mechanical ventilation (MV), and length of stay (LOS). We also compared the rate of cardiac procedures. Statistical significance of odd ratios (OR) is defined with p-value&lt;0.05 and reported 95% confidence intervals (CI).

Results

We identified a total of 245,563 female patients with primary diagnosis of ACS, among them 10,625 (4.3%) had a history of breast cancer. The comorbidity of breast cancer was associated with statistically significant lower rates of mortality (OR 0.83, CI 0.74–0.94), shock (OR 0.87, CI 0.77–0.99), AKI (OR 0.90, CI 0.82–0.98), MV (OR 0.81, CI 0.71–0.92) and relative 5.4% decrease in LOS (CI: −7.8%, −3.0%). The cardiac procedural rates were similar for left heart catheterization (OR 0.96, CI 0.90–1.02), for percutaneous coronary intervention (OR 0.95, CI 0.89–1.02) and for CABG (OR 0.88, CI 0.78–1.00) compared to control group.

Conclusion

Breast cancer patients received a comparable catheterization and revascularization procedure rate and exhibited a statistically significant lower morbidity and mortality rates during hospitalization after an ACS event compared to the general female population.

Funding Acknowledgement

Type of funding source: None

10-year trend analysis of atrioventricular node ablation in patient with atrial fibrillation: 2005–2014 United State hospitalization

Introduction

Atrial fibrillation (AF) ablation and Atrioventricular Node (AVN) ablation are both important non-pharmacological therapy of AF. In spite of increased availability of AF ablation data, that of AVN ablation per se is limited.

Method

AF ablation was identified using ICD-9 procedure code with principle diagnosis of AF from United States National Inpatient Sample database 2005–2014. From procedure and diagnosis codes of pacemaker insertion followed by ablation, the cohort who underwent AVN ablation was identified. Patients hospitalization with any diagnosis of other type of arrythmia or epicardial ablation were excluded. Complications were defined as per the Agency for Health Care Research and Quality guideline.

Results

Total AF ablation was noted to increase from 2005- 2011, and declined steadily from 2011–2014. In contrast, the number of AVN ablations increased from 4505 cases to 5175 (Figure 1). AVN ablation were mainly performed in elderly patient (mean age 72), and increasingly in patient with higher Charlson Commobidity index (0.9 to 1.7)and higher CHA2DS2-VASc score (2.8 to 3.7) (Table 1). An increasing trend in procedure complications but no significant change in mortalitywere observed with AVN ablation. Progressive increase in the length of stay and the hospitalization cost were also observed over the years with AVN ablation.

Conclusion

AVN ablation is being performed at a steady volume, and increasingly in patients with multiple comorbidities. This trend although was not associated with increased mortality, it was associated with increased hospital complications.

Funding Acknowledgement

Type of funding source: None

RNA-seq reveals transcriptome changes of the embryonic lens cells in Prox1 tissue specific knockout mice

OBJECTIVE

Prox1 is expressed in both lens epithelial cells and fiber cells and is essential for lens fiber cell elongation. This study aimed to explore the molecular mechanisms of how Prox1 mutations influence lens fiber cells development.

MATERIALS AND METHODS

Comparative transcriptomes analysis of Prox1 conditional knockout (cKO) lens and wild-type (WT) lens were performed using the data GSE69940 downloaded from the Gene Expression Omnibus database. Differentially expressed genes (DEGs) were determined by the R package "edgeR" of Trinity software. GO (Gene Ontology) enrichment analysis and KEGG (Kyoto Encyclopedia of Genes and Genomes databases) enrichment analysis were performed using the cluster Profiler R package. Then, the protein-protein interaction (PPI) network was predicted using Cytoscape, and the Module analysis of the PPI network was analyzed through the Cytoscape MCODE plugin. Moreover, MotifDb package in R was used to predict the transcription factors binding to Prox1 promoter regions.

RESULTS

In total, 2263 differentially expressed genes were identified between the two groups. GO and KEGG analysis showed that the down-regulated genes were enriched in camera-type eye term, nucleosome assembly, lens fiber cell differentiation, and cell modified and amino acid metabolism. The KEGG pathway of up-regulated genes was associated with lens development, including Hedgehog signaling pathway and MAPK signaling pathway. GO terms of up-regulated DEGs were mainly relevant to bone morphological development, muscle development, and sensory organ morphological development. Next, the PPI network of DEGs was constructed, and 4 modules were analyzed. Moreover, 30 transcription factors were predicted, which are likely to be downstream targets of Prox1 with potential roles in lens development in mice.

CONCLUSIONS

This study provides insights into the unique transcriptome profile of lens cells in Prox1 conditional knockout mice, which is a valuable resource for further study of mouse lens genomics.

[Predictive factors of poor prognosis in children with acute kidney injury treated with renal replacement therapy]

Objective: To investigate the predictive factors of poor prognosis in children with acute kidney injury (AKI) treated with renal replacement therapy (RRT). Methods: In this retrospective case-control study, the clinical data were collected from 134 pediatric patients (82 male, 52 female) with AKI treated with RRT in six tertiary hospitals from May 2015 to June 2018. According to the serum creatinine level at discharge, the patients were divided into the favorable outcome group and unfavorable outcome group. The data of sex, age, primary diseases, AKI stage, time from diagnosis of AKI to start of RRT (h) and whether to start RRT within 24 hours, urine volume and complications between the two groups were compared. Continuous variables were compared by t test and Mann-Whitney U test, and percentage or proportions were compared by Chi square test. The predictive factors of adverse prognosis were analyzed by using univariate and unconditional binary logistic regression analysis. Results: The average age of the 134 AKI patients was (6±4) years. There were 114 patients (85.0%) in the favorable outcome group and 20 patients (15.0%) in the unfavorable outcome group. No statistically significant differences were found between the two groups in terms of sex (χ(2)=2.596, P=0.107), age (t=0.718, P=0.474), primary disease (χ(2)=2.076, P=0.722), AKI stage (χ(2)=0.004, P=0.998), time from diagnosis of AKI to start RRT (h) (P=0.745), whether to start RRT within 24 hours (χ(2)=0.016, P=0.899), urine volume (χ(2)=3.118, P=0.374), fluid overload (χ(2)=0.014, P=0.905), multiple organ dysfunction syndrome (MODS) (χ(2)=2.972, P=0.085), acidosis (χ(2)=3.204, P=0.073), hyperkalemia (χ(2)=2.829, P=0.093), the level of blood urea nitrogen (t=1.351, P=0.179) and serum creatinine (P=0.901) at the beginning of RRT. In the unfavorable outcome group, the proportion of patients with mechanical ventilation (45.0% (9/20) vs. 12.3% (14/114), χ(2)=12.811, P<0.01) and the incidence of extra organ injury (≥3) (30.0% (6/20) vs. 10.5% (12/114), χ(2)=6.365, P=0.041) were higher than those in the favorable outcome group. Logistic regression analysis showed that mechanical ventilation (OR=12.540, 95%CI: 3.376-46.577, P<0.01) and hyperkalemia (OR=4.611, 95%CI: 1.265-16.805, P=0.021) were the predictive factors of poor prognosis in patients with AKI treated with RRT. Conclusion: Mechanical ventilation and hyperkalemia may predict a poor prognosis in AKI patients treated with RRT.