Epidemiology and impact of frailty in patients with atrial fibrillation in Europe

BACKGROUND

Frailty is a medical syndrome characterised by reduced physiological reserve and increased vulnerability to stressors. Data regarding the relationship between frailty and atrial fibrillation (AF) are still inconsistent.

OBJECTIVES

We aim to perform a comprehensive evaluation of frailty in a large European cohort of AF patients.

METHODS

A 40-item frailty index (FI) was built according to the accumulation of deficits model in the AF patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Association of baseline characteristics, clinical management, quality of life, healthcare resources use and risk of outcomes with frailty was examined.

RESULTS

Among 10,177 patients [mean age (standard deviation) 69.0 (11.4) years, 4,103 (40.3%) females], 6,066 (59.6%) were pre-frail and 2,172 (21.3%) were frail, whereas only 1,939 (19.1%) were considered robust. Baseline thromboembolic and bleeding risks were independently associated with increasing FI. Frail patients with AF were less likely to be treated with oral anticoagulants (OACs) (odds ratio 0.70, 95% confidence interval 0.55-0.89), especially with non-vitamin K antagonist OACs and managed with a rhythm control strategy, compared with robust patients. Increasing frailty was associated with a higher risk for all outcomes examined, with a non-linear exponential relationship. The use of OAC was associated with a lower risk of outcomes, except in patients with very/extremely high frailty.

CONCLUSIONS

In this large cohort of AF patients, there was a high burden of frailty, influencing clinical management and risk of adverse outcomes. The clinical benefit of OAC is maintained in patients with high frailty, but not in very high/extremely frail ones.

POS1107 CHANGE IN ULTRASOUND-BASED KNEE JOINT INFLAMMATORY MARKERS AFTER WEIGHT LOSS IN PATIENTS WITH OSTEOARTHRITIS: A PROSPECTIVE COHORT STUDY

Background

Pain and impaired function due to knee OA (KOA) can be reduced with weight loss in obese patients. The role of synovitis in symptom improvement after weight loss is not fully understood. MRI and ultrasound (US) can be used in assessment of inflammation in the KOA. Knee joint synovitis assessed by MRI does not seem to change with weight loss, however, the typical MRI score is semiquantitative, which might be less sensitive to change than a quantitative score. US has a higher resolution than MRI and borders between synovium and surrounding tissues might be clearer allowing for a quantitative score. Changes in US-based synovitis following a weight has not been assessed.

Objectives

To assess changes in US synovitis in the knee joint after 8 weeks low-calorie weight loss intervention in overweight persons with KOA.

Methods

prospective cohort study (NCT02931370) including overweight persons (BMI ≥ 27 kg/m2) with KOA. Weight loss was induced by an intensive 8-week diet (1200 kcal/day), participants had symptomatic and radiographically confirmed KOA (KL grade 1-3). At week 0 and 8 all participants filled in the KOOS questionnaire assessing pain, physical function, symptoms, quality of life, and sport/recreation in relation to KOA (0= worst; 100=best). Furthermore, an US examination of the most affected knee was performed assessing the amount of synovial hypertrophy (SH) and effusion in medial and lateral recesses. The US examination was performed in a strictly standardized manner on a high-end US machine. The subsequent image evaluation was done both according to a semiquantitative score from 0 to 3 (0=no SH/effusion and 3=pronounced SH/effusion) and a quantitative scoring system using specific anatomic landmarks to measure the synovial hypertrophy/effusion in millimeter.

Statistical analyses were performed on the per protocol population (participants completing diet intervention).

Results

135 patients with KOA with a mean age of 60y (SD 9.8), a body weight of 106.0 kg (SD18.5) and mean BMI of 36.4 (SD5.4) completed the weight loss intervention. After the diet intervention mean weight change was -12.8 kg (95%CI -13.3 to -12.4) and the reductions in SH were -0.3mm (95%CI -0.5 to -0.1) (medial recess) and -0.4mm (95%CI -0.6 to -0.1) (lateral recess), and -0.03 (-0.13 to 0.07) (medial recess) and -0.07 (-0.20 to 0.05) using the semi-quantitative system. The mean change in the KOOS subscales range from 15.8 (sport/recreation) to 7.4 (QoL). See Table 1.

Table 1.n=135BaselineChangeMean (SD)Mean (95%CI)PAge60.0 (9.8)--Females, n (%)87 (64.4%)--BMI36.4 (5.4)-4.4 (-4.5 to -4.3)<.0001KL-scores; 122 (16.3%)--KL-scores; 256 (41.5%)--KL-scores; 357 (42.2%)--KL-scores; 40 (0%)--Synovial HypertrophyMedial, mm3.8 (1.8)-0.3 (-0.5 to -0.1)0.0198Lateral, mm5.3 (2.3)-0.4 (-0.6 to -0.1)0.0210Medial, 0-31.2 (0.6)-0.03 (-0.13 to 0.07)0.5584Lateral, 0-31.8 (0.8)-0.07 (-0.20 to 0.05)0.2311KOOS, 0-100Pain64.1 (16.0)12 (10.2 to 13.8)<.0001Function68.4 (17.3)14 (12.4 to 15.6)<.0001Symptoms68.9 (16.4)9 (7.2 to 10.8)<.0001Sports/Recreation35.9 (24.0)15.8 (13.2 to 18.3)<.0001QoL43.8 (17.5)7.4 (5.7 to 9.2)<.0001

SD = Standard Deviation; CI = Confidence Interval; BMI = Body Mass Index;

KOOS = Knee injury and Osteoarthritis Outcome Score; QoL = Knee-related Quality of Life

Conclusion

Quantitative measures of SH assessed by US decreased after a significant weight loss over 8-weeks; however, no linear association with weight loss magnitude was seen. A weak correlation between changes in SH in the lateral recess and change in pain was seen. This indicates changes in SH assessed by US examination is associated with a low-calorie diet but seems uncoupled with weight loss magnitude. The weight loss induced changes in synovitis and KOA symptoms seem vaguely related.

Disclosure of Interests

None declared

Daunorubicin associated to lipid core nanoparticles reduces atherosclerotic lesions, inflammation and cardiotoxicity in atherosclerosis rabbit model

Introduction

Antiproliferative agents used in cancer chemotherapy have low toxicity and increased pharmacological action when carried into lipid core nanoparticles (LDE). LDE has similar structure to LDL and binds to LDL receptors through apo E it acquires in contact with plasma. Previously, we showed that treatment of rabbits with atherosclerosis with drugs such as taxanes and etoposide associate to LDE had pronounced reduction of the atherosclerotic lesions. In this study, we hypothesized whether daunorubicin (DNR) that belongs to another class of anti-cancer drugs, with a distinct mechanism of action and that has strong cardiotoxicity could also have effects against atherosclerosis.

Methods

Sixteen New Zealand male rabbits were fed with a 1% cholesterol diet for 8 weeks to induce atherosclerosis. After 4 weeks, the animals were treated weekly with LDE-DNR (6mg/kg, iv, n=9) or with LDE only (n=7). In addition, 3 animals without any intervention were used as a control group. Chow consumption, lipid and hematological profiles, body weight, and echocardiography were evaluated at baseline, pre-treatment and post-treatment. Morphometry and protein expression were performed to analyze the aortas.

Results

There was no difference in food intake and body weight for control, LDE and LDE-DNR groups. Total cholesterol, HDL-C, non-HDL-C and triglycerides increased in LDE and LDE-DNR groups when comparing baseline and post-treatment. Red blood cells decreased in LDE group at post-treatment in comparison to baseline, while LDE-DNR presented no such difference. Regarding aortic lesions of LDE-DNR group was 50% lower than LDE group. The protein expression of the inflammatory markers CD68, TNF-α and IL-6 in LDE-DNR was lower than LDE. Pro-apoptotic factors caspase 3, caspase 9 and BAX were also lower in LDE-DNR compared to LDE. Protein expression of vascular endothelial growth factor (VEGF) and vascular cell adhesion molecule (VCAM) was lower in the LDE-DNR group when compared to the LDE group. To test the cardiotoxicity of LDE-DNR, echocardiography was performed and observed that under LDE-DNR both systolic and diastolic function were preserved with no difference in cardiac mass in LDE-DNR when compared to control and LDE groups. However, LDE showed a significant increase in relative heart weight compared to control while LDE-DNR had no such difference. Treatment with LDE-DNR did not induce observable hematological toxicity.

Conclusion

The treatment with LDE-DNR reduced aortic lesions, diminished inflammatory and pro-apoptotic factors, diminished VCAM expression in the aorta and promoted cardiac preservation in a rabbit atherosclerosis model. In conclusion, LDE-DNR can be eligible for future developments in the quest for novel effective and safe treatments for atherosclerosis.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): FAPESP (Fundaçao de Amparo a Pesquisa do Estado de Sao Paulo)

Methotrexate associated with a lipid core nanoparticle prevented the dilation and dissection of the aortic arch in mice with Marfan syndrome

Introduction

Mutations in the fibrillin-1 gene result in dilation, dissection and rupture of the aorta, the main cause of mortality in patients with Marfan syndrome (MFS). Inflammation is associated with greater susceptibility to dissection and rupture of the aorta. Previously, we showed that methotrexate (MTX) carried in lipid core nanoparticles (LDE) had powerful anti-inflammatory and anti-proliferative effects on rheumatoid arthritis and atherosclerotic lesions induced in rabbits and improved myocardial infarction morphological and functional aspects in rats with ligation of left coronary artery. When MTX is associated to LDE, the uptake of the drug by the cells is increased several-fold, which conceivably endows MTX with enhanced action mechanisms and the drug toxicity is diminished.

Purpose

To investigate whether treatment with LDE-MTX can prevent the development of aortic arch lesions in a murine model of MFS.

Methods

mgΔloxPneo MFS murine model and wild-type mice were allocated in 3 groups of treatment: LDE only; MTX in commercial formulation; LDE-MTX. The treatment occurred weekly at a dose of 1mg/kg ip, between the 3rd and 6th month of life, period in which both dilation and dissection of the aortic arch are observed. After 12 weeks, the animals were submitted to echocardiography, morphometry and protein expression of the aortic arch.

Results

Compared to LDE and MTX groups, LDE-MTX treatment showed smaller lumen area of ascending and descending aorta and aortic arch segments in MFS mice. LDE-MTX also decreased the collagen volume fraction and the amount of aortic dissections, but did not affect the thickness of the vessel wall and the number of elastic fiber ruptures. The protein expression of the inflammatory markers CD68 (macrophages), CD3 (lymphocytes) and tumor necrosis factor alpha, of the apoptotic marker caspase 3 and of type 1 collagen were lower in MFS LDE-MTX group when compared to MFS mice treated with LDE and MTX. Moreover, treatment with LDE-MTX reduced TGF-β, ERK and the SMAD3 protein expression. Of note, CD68 and CD3 protein expression was positively correlated with the lumen area of the aortic arch (r2=0.36; p&lt;0.001), indicating the importance of inflammation for the aortic dilation. The increase in bioavailability of intracellular adenosine in MFS animals treated with LDE-MTX was suggested by the higher expression of A2a adenosine receptor and the lower expression of adenosine deaminase in the aortic arch.

Conclusion

Possibly by increasing the bioavailability of intracellular adenosine, LDE-MTX treatment had the ability to reduce the processes of inflammation, apoptosis and fibrosis that are consequent to fibrillin-1 mutation. By these means, LDE-MTX may conceivably prevent the development of the dilation and dissection in the aortic arch, the hallmarks of MFS, in this animal model.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): FAPESP (Fundação de Amparo à Pesquisa do Estado de São Paulo)

Treatment with methotrexate carried in lipid core nanoparticles prevents the development of diastolic dysfunction in septic rats

Introduction

In the development of sepsis, besides the dysregulation of the immune system and disturbances of several vital organs, life-threatening cardiac dysfunction often occurs. Previously, we showed that non-protein nanoparticles that resemble the lipid structure of low-density lipoprotein, termed LDE, concentrate in inflammatory sites. When incorporated in LDE, the cellular uptake of MTX increases several-fold compared to the uptake of commercial MTX. The novel LDE-MTX formulation was shown to have the ability to modulate the immune response in in rabbits with atherosclerosis and in rats with myocardial infarction. LDE-MTX reduced the inflammation and improved the post-infarction cardiac function by increasing the release of angiogenesis, thereby improving hypoxia. The aim of the current study was to test the hypothesis whether LDE-MTX could also improve the cardiac status in septic rats.

Methods

Septicemia was induced in Wistar rats by two I.P. injections of lipopolysaccharide (LPS, 10mg/kg) administered with a 24h interval. Rats were allocated to control group (CT, without sepsis; n=5) and 3 groups with sepsis: LDE (n=7), treated with LDE only; MTX (n=6), with commercial MTX (1mg/kg); and LDE-MTX (n=7), with LDE-MTX (1mg/kg). Echocardiography was performed 72h after sepsis induction. Animals were euthanised and LV tissues were collected for protein expression analysis of inflammatory, apoptotic, angiogenesis, hypoxia and adenosine bioavailability markers.

Results

Septic rats treated with LDE developed diastolic dysfunction and presented decreased diastolic volume and diameter of the LV. Treatment with LDE-MTX totally prevented the appearance of diastolic dysfunction and the alterations in LV diastolic dilation. Also, LDE-MTX treatment elicited cardiac hypertrophy through the increase of the thickness of septum and of the LV posterior wall. LDE-MTX increased LV mass and the relative heart weight, as compared to the other 3 groups. There were no differences in the protein expression of inflammatory (lymphocytes, tumor necrosis factor, interleukins) and apoptotic (caspases and B-cell lymphoma family) markers among the four groups. However, LDE-MTX showed higher expression of CD68 (macrophage marker). Angiogenesis was higher, while cellular hypoxia was lower in LDE-MTX, respectively represented by vascular endothelial growth factor (VEGF) and hypoxia-inducible factor 1 alpha, in comparison to the other 3 groups. The intracellular adenosine bioavailability was increased in LDE-MTX-treated animals, as promoted by the higher expression of the A1 receptor, as compared to CT.

Conclusion

The treatment with LDE-MTX was successful in precluding the appearance of the cardiac dysfunction associated to sepsis. This outcome was conceivably attained by different effects of the treatment observed here, such as those on angiogenesis, macrophage recruitment and adenosine bioavailability in the LV.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): FAPESP (Fundacao de Amparo a Pesquisa do Estado de Sao Paulo)

Improving transitions from acute care to home among complex older adults using the LACE Index and care coordination

BACKGROUND

Improving transitions in care is a major focus of healthcare planning. The objective of this study was to determine the improvement in transitions from an intervention identifying complex older adult patients in acute care and supporting their discharge into the community.

METHODS

This was a quality assurance study evaluating an intervention on high-risk patients admitted in an acute care hospital. In phase 1, the Length of Stay, Acuity of the Admission, Charlson Comorbidity Index Score, and Emergency Department Use (LACE Index) was selected to assess a patient's risk for readmission and a standard discharge protocol was developed. In phase 2, the intervention was implemented: (1) all patients were screened for the risk of readmission using the LACE Index; and (2) the high-risk patients were provided care coordination including follow-up phone calls focused on medications, equipment and homecare services. Emergency department (ED) revisits and hospital readmissions were measured.

RESULTS

The LACE Index identified 433/1621 (27%) patients at high risk for readmission. Care coordination was achieved within 72 hours in 79% of patients. The 433 high-risk patients receiving the intervention, compared with a group without intervention (n=231), had lower lengths of stay (12.7 days vs 16.6 days); similar 7-day ED revisits (10.6% vs 10.8%) and 30-day ED revisits (30.5% vs 33.3%); lower 90-day readmissions (39.3% vs 44.6%); and lower 6-month readmissions (50.9% vs 58.4%). The 7-day and 30-day readmissions were similar in both groups.

CONCLUSIONS

Identifying complex patients at high risk for readmission and supporting them during transitions from acute care to home potentially decreases lengths of hospital stay and prevents short-term ED revisits and long-term readmissions.

NWChem: Past, present, and future

Specialized computational chemistry packages have permanently reshaped the landscape of chemical and materials science by providing tools to support and guide experimental efforts and for the prediction of atomistic and electronic properties. In this regard, electronic structure packages have played a special role by using first-principle-driven methodologies to model complex chemical and materials processes. Over the past few decades, the rapid development of computing technologies and the tremendous increase in computational power have offered a unique chance to study complex transformations using sophisticated and predictive many-body techniques that describe correlated behavior of electrons in molecular and condensed phase systems at different levels of theory. In enabling these simulations, novel parallel algorithms have been able to take advantage of computational resources to address the polynomial scaling of electronic structure methods. In this paper, we briefly review the NWChem computational chemistry suite, including its history, design principles, parallel tools, current capabilities, outreach, and outlook.

The effect of breast cancer on work participation in different sectors. A Danish registry based study

Background

A breast cancer diagnosis affects an individual’s affiliation to the labor market, but whether the effect of breast cancer variates in different sectors in a Danish setting has not been examined. The present study investigated the effect of stage IA breast cancer (tumor&lt;20 mm and no lymph nodes involved in six sectors among Danish women being part of the work force. Stage IA breast cancer has a good prognosis, and it would be assumed that the majority have returned to work after 1 year.

Methods

This registry-based cohort study was based on data from linked Danish nationwide registries. We identified 5,543 women (aged 25-63 years) diagnosed with breast cancer (BC) stage IA (exposed) and 65.889 women without breast cancer (unexposed) and included women from the different sectors. We calculated a yearly Work Participation Score (WPS), defined as the proportion of weeks being self-supported during a year. We compared the means of WPS for exposed and unexposed women in six different sectors: 1) teaching, 2) childcare, 3) eldercare, 4) cleaning, 5) administration and 6) hospitality industry.

Results

BC had a negative effect on being self-supporting for women in all six sectors in all three years, although the effect declined. In the first year, the difference in WPS varied between 0.38 and 0.54. During the second year all BC patients had still significantly lower WPS with the largest difference in hospitality industry (0.65 (95% CI 0.50-0.80) for exposed women and 0.86 (95% CI 0.83-0.88) for unexposed women). In the third year, the effect further declined although WPS was still significantly lower for most sectors with the biggest difference in the cleaning sector.

Conclusions

A stage IA BC diagnosis had a negative effect on being self-supportive after 2 and 3 years among women in all six sectors, although the difference was largest among cleaning workers. This may indicate, that individual follow-up in relation to work participation is necessary.

Key messages

Although breast cancer stage IA has a good prognosis, it still affects being self-supporting after three years. A diagnosis of breast cancer affects the affiliation to the labour market, but the effect differs according to different sectors.

Experimental Observation of Proton Bunch Modulation in a Plasma at Varying Plasma Densities

We give direct experimental evidence for the observation of the full transverse self-modulation of a long, relativistic proton bunch propagating through a dense plasma. The bunch exits the plasma with a periodic density modulation resulting from radial wakefield effects. We show that the modulation is seeded by a relativistic ionization front created using an intense laser pulse copropagating with the proton bunch. The modulation extends over the length of the proton bunch following the seed point. By varying the plasma density over one order of magnitude, we show that the modulation frequency scales with the expected dependence on the plasma density, i.e., it is equal to the plasma frequency, as expected from theory.

Experimental Observation of Plasma Wakefield Growth Driven by the Seeded Self-Modulation of a Proton Bunch

We measure the effects of transverse wakefields driven by a relativistic proton bunch in plasma with densities of 2.1×10^{14} and 7.7×10^{14}  electrons/cm^{3}. We show that these wakefields periodically defocus the proton bunch itself, consistently with the development of the seeded self-modulation process. We show that the defocusing increases both along the bunch and along the plasma by using time resolved and time-integrated measurements of the proton bunch transverse distribution. We evaluate the transverse wakefield amplitudes and show that they exceed their seed value (<15  MV/m) and reach over 300  MV/m. All these results confirm the development of the seeded self-modulation process, a necessary condition for external injection of low energy and acceleration of electrons to multi-GeV energy levels.

Acceleration of electrons in the plasma wakefield of a proton bunch

High-energy particle accelerators have been crucial in providing a deeper understanding of fundamental particles and the forces that govern their interactions. To increase the energy of the particles or to reduce the size of the accelerator, new acceleration schemes need to be developed. Plasma wakefield acceleration^1–5, in which the electrons in a plasma are excited, leading to strong electric fields (so called ‘wakefields’), is one such promising acceleration technique. Experiments have shown that an intense laser pulse^6–9 or electron bunch^10,11 traversing a plasma can drive electric fields of tens of gigavolts per metre and above—well beyond those achieved in conventional radio-frequency accelerators (about 0.1 gigavolt per metre). However, the low stored energy of laser pulses and electron bunches means that multiple acceleration stages are needed to reach very high particle energies^5,12. The use of proton bunches is compelling because they have the potential to drive wakefields and to accelerate electrons to high energy in a single acceleration stage¹³. Long, thin proton bunches can be used because they undergo a process called self-modulation^14–16, a particle–plasma interaction that splits the bunch longitudinally into a series of high-density microbunches, which then act resonantly to create large wakefields. The Advanced Wakefield (AWAKE) experiment at CERN^17–19 uses high-intensity proton bunches—in which each proton has an energy of 400 gigaelectronvolts, resulting in a total bunch energy of 19 kilojoules—to drive a wakefield in a ten-metre-long plasma. Electron bunches are then injected into this wakefield. Here we present measurements of electrons accelerated up to two gigaelectronvolts at the AWAKE experiment, in a demonstration of proton-driven plasma wakefield acceleration. Measurements were conducted under various plasma conditions and the acceleration was found to be consistent and reliable. The potential for this scheme to produce very high-energy electron bunches in a single accelerating stage²⁰ means that our results are an important step towards the development of future high-energy particle accelerators^21,22.

Electron acceleration to very high energies is achieved in a single step by injecting electrons into a ‘wake’ of charge created in a 10-metre-long plasma by speeding long proton bunches.

Abstract P6-14-05: Phase 2 study evaluating the efficacy and safety of eribulin mesylate administered biweekly for patients with human epidermal growth factor receptor 2-negative metastatic breast cancer

Background: Eribulin mesylate, a microtubule inhibitor, is approved in the US for the treatment of patients (pts) with metastatic breast cancer (MBC) who have previously received at least 2 chemotherapeutic regimens for the treatment of metastatic disease, including an anthracycline and a taxane. The recommended dose is 1.4 mg/m2 (equivalent to 1.23 mg/m2 eribulin [expressed as free base]) on day (D) 1 and D8 of a 21-D cycle. However, this schedule can result in dose delays and reductions due to myelosuppression. A dosing regimen of eribulin (1.4 mg/m2) administered intravenously (IV) biweekly (Q2W; on D1 and D15) in 28-D cycles was evaluated with the intent of improving eribulin's safety profile without compromising efficacy.

Methods: Female pts with human epidermal growth factor receptor (HER)2-negative MBC, who had received 2-5 prior chemotherapy regimens and had ECOG PS ≤2 were enrolled in 12 sites in the US. Prophylactic granulocyte colony-stimulating factor (G-CSF) was not allowed. If neutropenia occurred, growth factors were used during eribulin treatment at the physician's discretion. Primary endpoints were objective response rate (ORR) and disease control rate (DCR). Secondary endpoints were progression-free survival (PFS), overall survival (OS), dose intensity (measured by feasibility rate), safety and tolerability.

Results: Median age of the 58 enrolled pts was 64 yrs (range: 38-85). The majority of pts (93%) had ECOG PS ≤1, and 12% of pts had triple-negative MBC. Number of prior chemotherapeutic regimens: 2 (17% of patients), 3 (24%), 4 (27%), and 5 (31%). 76% Of pts had visceral disease and 86% had previous taxane therapy. ORR (95% confidence interval [CI]) was 12% (5-24), DCR (CR+PR+SD) was 65% (95% CI: 51-77), and CBR (CR+PR+SD ≥23 weeks) was 30% (95% CI: 18-43) [n=57]. Median PFS (95% CI) was 3.6 mo (2.9-4.1). Median OS (95% CI) was 13.2 mo (10.6-not estimable). 6-Month and 12-month OS rates were 84% and 54%, respectively. Dose intensity measured by the feasibility rate (defined as the percentage of pts completing the first 2 and 4 cycles without a dose delay &gt;5 days or dose reduction due to an adverse event [AE]) was 70% and 46%, respectively.

The most frequent AEs (all grades) were neutropenia (69%), fatigue (48%), alopecia (45%), and constipation (36%). 22% Of pts had grade (G) 1 alopecia and 22% of pts had G2 alopecia. 72% Of pts had G3/4 AEs: neutropenia, 57%, and peripheral neuropathy, 12%. G3 peripheral sensory neuropathy occurred in 9% of pts, with no G4 incidence. There were 2 deaths (1 sepsis, 1 acute respiratory failure), which were considered not related to treatment. 50% (29/58) Of all patients received at least 1 dose of growth factor and 70% (28/40) of patients with neutropenia received growth-factor support.

Conclusions: Tumor response rates and OS of this treatment schedule in a heavily pretreated patient population were similar compared to previously reported phase 3 studies of eribulin. The toxicities associated with biweekly eribulin were manageable.

Citation Format: Smith II J, Irwin A, Jensen L, Tedesco K, Misir S, Zhu W, Almonte A, He Y, Olivo M, O'Shaughnessy J. Phase 2 study evaluating the efficacy and safety of eribulin mesylate administered biweekly for patients with human epidermal growth factor receptor 2-negative metastatic breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-14-05.

Muscular response to the first three months of deflazacort treatment in boys with Duchenne muscular dystrophy

OBJECTIVE

Duchenne muscular dystrophy (DMD) patients are often treated with glucocorticoids; yet their precise molecular action remains unknown.

METHODS

We investigated muscle biopsies from nine boys with DMD (aged: 7,6±2,8 yrs.) collected before and after three months of deflazacort treatment and compared them to eight healthy boys (aged: 5,3±2,4 yrs.). mRNA transcripts involved in activation of satellite cells, myogenesis, regeneration, adipogenesis, muscle growth and tissue inflammation were assessed. Serum creatine kinase (CK) levels and muscle protein expression by immunohistochemistry of selected targets were also analysed.

RESULTS

Transcript levels for ADIPOQ, CD68, CDH15, FGF2, IGF1R, MYF5, MYF6, MYH8, MYOD, PAX7, and TNFα were significantly different in untreated patients vs. normal muscle (p⟨0.05). Linear tests for trend indicated that the expression levels of treated patients were approaching normal values (p⟨0.05) following treatment (towards an increase; CDH15, C-MET, DLK1, FGF2, IGF1R, MYF5, MYF6, MYOD, PAX7; towards a decrease: CD68, MYH8, TNFα). Treatment reduced CK levels (p⟨0.05), but we observed no effect on muscle protein expression.

CONCLUSIONS

This study provides insight into the molecular actions of glucocorticoids in DMD at the mRNA level, and we show that multiple regulatory pathways are influenced. This information can be important in the development of new treatments.

Oligomerization of Mannan-binding Lectin Dictates Binding Properties and Complement Activation

The complement system is a part of the innate immune system and is involved in recognition and clearance of pathogens and altered-self structures. The lectin pathway of the complement system is initiated when soluble pattern recognition molecules (PRMs) with collagen-like regions bind to foreign or altered self-surfaces. Associated with the collagen-like stems of these PRMs are three mannan-binding lectin (MBL)-associated serine proteases (MASPs) and two MBL-associated proteins (MAps). The most studied of the PRMs, MBL, is present in serum mainly as trimeric and tetrameric oligomers of the structural subunit. We hypothesized that oligomerization of MBL may influence both the potential to bind to micro organisms and the interaction with the MASPs and MAps, thus influencing the ability to initiate complement activation. When testing binding at 37 °C, we found higher binding of tetrameric MBL to Staphylococcus aureus (S. aureus) than trimeric and dimeric MBL. In serum, we found that tetrameric MBL was the main oligomeric form present in complexes with the MASPs and MAp44. Such preference was confirmed using purified forms of recombinant MBL (rMBL) oligomers, where tetrameric rMBL interacted stronger with all of the MASPs and MAp44, compared to trimeric MBL. As a direct consequence of the weaker interaction with the MASPs, we found that trimeric rMBL was inferior to tetrameric rMBL in activating the complement system. Our data suggest that the oligomeric state of MBL is crucial both for the binding properties and the effector function of MBL.

The Biosynthesis of Infrared-Emitting Quantum Dots in Allium Fistulosum

The development of simple routes to emissive solid-state materials is of paramount interest, and in this report we describe the biosynthesis of infrared emitting quantum dots in a living plant via a mutual antagonistic reaction. Exposure of common Allium fistulosum to mercury and tellurium salts under ambient conditions resulted in the expulsion of crystalline, non-passivated HgTe quantum dots that exhibited emissive characteristics in the near-infrared spectral region, a wavelength range that is important in telecommunications and solar energy conversion.

Danish experience with free flaps in war wounds

INTRODUCTION

To describe the lessons learned from treatment of war casualties at a public hospital in Denmark.

METHODS

A retrospective review of soldiers who underwent free flap reconstruction at Rigshospitalet, Denmark, between January 2006 and December 2010.

RESULTS

Nine patients were treated using free flaps. The age distribution was 21-34 years. Extremity fractures associated with considerable soft tissue loss were seen in all cases. The mean time from injury to reconstruction was 13.2 days. A total of 11 free flaps were used, the majority of which were latissimus dorsi flaps (seven out of 11). Flap-loss occurred in one patient, presumably due to leakage at the anastomotic site, which necessitated another free flap procedure. All patients received rehabilitation services following discharge from the inpatient unit, including prosthetic fitting. The mean follow-up time was 26 months.

CONCLUSIONS

This report is the first to detail the reconstructive procedures in soldiers treated at a public hospital in Denmark. The treatment of war casualties has not only been a challenge to the surgeons tasked with managing these devastating injuries, but also to Danish healthcare in general. The outcome of multidisciplinary treatment, combining the expertise of various specialties, is highly encouraging. The rate of complications was low, and the aesthetic appearance of the reconstructed limbs and the functional recovery were satisfactory. We therefore recommend the use of free flaps to reconstruct defects resulting from battlefield trauma.

FUNDING

none.

TRIAL REGISTRATION

not relevant.

Collectin liver 1 and collectin kidney 1 and other complement-associated pattern recognition molecules in systemic lupus erythematosus

The objective of this study was to explore the involvement of collectin liver 1 (CL-L1) and collectin kidney 1 (CL-K1) and other pattern recognition molecules (PRMs) of the lectin pathway of the complement system in a cross-sectional cohort of systemic lupus erythematosus (SLE) patients. Concentrations in plasma of CL-L1, CL-K1, mannan-binding lectin (MBL), M-ficolin, H-ficolin and L-ficolin were determined in 58 patients with SLE and 65 healthy controls using time-resolved immunoflourometric assays. The SLE patients' demographic, diagnostic, clinical and biochemical data and collection of plasma samples were performed prospectively during 4 months. CL-L1, CL-K1 and M-ficolin plasma concentrations were lower in SLE patients than healthy controls (P-values < 0.001, 0.033 and < 0.001, respectively). H-ficolin concentration was higher in SLE patients (P < 0.0001). CL-L1 and CL-K1 plasma concentrations in the individuals correlated in both patients and controls. Patients with low complement component 3 (C3) demonstrated a negative correlation between C3 and CL-L1 and CL-K1 (P = 0.022 and 0.031, respectively). Patients positive for anti-dsDNA antibodies had lower levels of MBL in plasma than patients negative for anti-dsDNA antibodies (P = 0.02). In a cross-sectional cohort of SLE patients, we found differences in the plasma concentrations of CL-L1, CL-K1, M-ficolin and H-ficolin compared to a group of healthy controls. Alterations in plasma concentrations of the PRMs of the lectin pathway in SLE patients and associations to key elements of the disease support the hypothesis that the lectin pathway plays a role in the pathogenesis of SLE.

Counter-regulatory hormone responses to hypoglycaemia in people with type 1 diabetes after 4 weeks of treatment with liraglutide adjunct to insulin: a randomized, placebo-controlled, double-blind, crossover trial

AIMS

To investigate the effect of glucagon-like peptide 1 receptor agonist liraglutide on the counter-regulatory hormone response to hypoglycaemia in type 1 diabetes.

METHODS

We conducted a randomized, double-blind, placebo-controlled, single-centre trial, in which a total of 45 adults with type 1 diabetes [mean ± standard deviation age 34.5 ± 11.2 years, BMI 23.9 ± 2.4 kg/m(2) , glycated haemoglobin (HbA1c) 7.6 ± 0.8%, diabetes duration 16.6 ± 9.4 years] underwent a hypoglycaemic clamp after 4 weeks' crossover treatment with once-daily liraglutide/placebo added to insulin in one of three liraglutide dose groups: 0.6 mg (n = 15); 1.2 mg (n = 14); and 1.8 mg (n = 16). The main outcome measure was glucagon concentration at nadir plasma glucose (2.5 mmol/l). Clinical outcomes were also evaluated. Five participants were withdrawn from the trial; three because of adverse events. All participants were included in the analysis.

RESULTS

Glucagon concentration at nadir plasma glucose was modest, trending towards lower concentrations at increasing liraglutide dose versus placebo: 34.7 versus 38.1 pg/ml, p = 0.555 (0.6 mg); 28.8 versus 37.2 pg/ml, p = 0.126 (1.2 mg); and 28.4 versus 37.5 pg/ml, p = 0.092 (1.8 mg). There was no difference, however, between liraglutide and placebo in incremental change in glucagon during hypoglycaemia. Other counter-regulatory hormone levels increased during hypoglycaemia with no systematic differences between groups. Glucose infusion rates were significantly lower with liraglutide versus placebo during the clamp. After 4 weeks' treatment, HbA1c remained unchanged in the liraglutide and placebo groups. Greater reductions in insulin dose and body weight were seen with liraglutide versus placebo.

CONCLUSIONS

Liraglutide did not compromise hypoglycaemic responses in type 1 diabetes after 4 weeks' treatment.

A crossover randomised and controlled trial of the impact of active video games on motor coordination and perceptions of physical ability in children at risk of Developmental Coordination Disorder

BACKGROUND

Impaired motor development can significantly affect a child's life and may result in an increased risk of a range of physical and psychological disorders. Active video game (AVG) interventions have been demonstrated to enhance motor skills in children with Developmental Coordination Disorder (DCD); however a home-based intervention has not been assessed.

OBJECTIVES

The primary aim of this study was to compare the changes in motor coordination between a 16 week period of AVG use, with 16 weeks of normal activities (NAG). The secondary aim was to compare the child and parent perceptions of their physical performance between the AVG and NAG conditions.

METHODS

Twenty-one 9-12 year olds (10 males) were confirmed to be at risk of DCD (⩽ 16th percentile Movement Assessment Battery for Children-2nd edition (MABC-2) and ⩽ 15th percentile Developmental Coordination Disorder Questionnaire (DCDQ)) and participated in this crossover randomised and controlled trial. Data was collected at study entry, after the first 16 week condition and following the final 16 week condition, including; (1) the MABC-2, (2) three-dimensional motion analysis of single leg balance and finger-nose tasks, and (3) parent perception of physical skills. Participant perception of physical skills was collected only after the first and second conditions.

RESULTS

There was no significant difference between AVG and NAG for any of the primary variables including the MABC-2, balance centre-of-mass path distance and finger-nose path distance. There was no significant intervention effect for secondary measures of motor coordination; however the children perceived their motor skills to be significantly enhanced as a result of the AVG intervention in comparison to the period of no intervention.

CONCLUSION

A 16 week home based AVG intervention did not enhance motor skills in children with DCD, although they perceived their physical skills to be significantly improved.

TRIAL REGISTRATION

Australia and New Zealand Clinical trials Registry (ACTRN 12611000400965).

EFNA3 long noncoding RNAs induced by hypoxia promote metastatic dissemination

The presence of hypoxic regions in solid tumors is an adverse prognostic factor for patient outcome. Here, we show that hypoxia induces the expression of Ephrin-A3 through a novel hypoxia-inducible factor (HIF)-mediated mechanism. In response to hypoxia, the coding EFNA3 mRNA levels remained relatively stable, but HIFs drove the expression of previously unknown long noncoding (lnc) RNAs from EFNA3 locus and these lncRNA caused Ephrin-A3 protein accumulation. Ephrins are cell surface proteins that regulate diverse biological processes by modulating cellular adhesion and repulsion. Mounting evidence implicates deregulated ephrin function in multiple aspects of tumor biology. We demonstrate that sustained expression of both Ephrin-A3 and novel EFNA3 lncRNAs increased the metastatic potential of human breast cancer cells, possibly by increasing the ability of tumor cells to extravasate from the blood vessels into surrounding tissue. In agreement, we found a strong correlation between high EFNA3 expression and shorter metastasis-free survival in breast cancer patients. Taken together, our results suggest that hypoxia could contribute to metastatic spread of breast cancer via HIF-mediated induction of EFNA3 lncRNAs and subsequent Ephrin-A3 protein accumulation.

Abstract P3-08-08: Pattern of use of an online primary health care information resource for breast cancer survivorship education: The pink ribbon survivors network

Introduction: The Pink Ribbon Survivors Network, a 501(c)(3) nonprofit organization founded by cancer professionals, developed an online educational resource for breast cancer survivors, cancer care professionals, and primary health care providers. The organization created a separate online educational library for each of these three separate audiences. The organization's website launched in July, 2012.

Methods: The Primary Health Care Library for breast cancer survivorship education houses 15 unique categories. Utilizing the organization's administrative website, numerical pattern of access of each separate listing in the 15 categories can be obtained. In addition, Google Analytics data was utilized to determine total website activity for all three educational libraries.

Results: As of abstract submission, the Primary Healthcare Breast Cancer Survivorship Education Library contains 141 clinical articles in 15 categories. The website has been utilized in all 50 of the United States, and in 66 countries and 890 cities. The five most viewed categories of the 15 total categories are (in descending order): 1.) Lifestyle Modifications, 2.) Creating a Link between Cancer Care and Primary Care: Clinical Literature on Survivorship, 3.) Depression/Mood Disturbance, 4.) Consensus Panel Guidelines for Breast Cancer Follow up, and 5.) Gynecologic Issues: Sexuality/Fertility.

Conclusion: Since it's creation in mid- 2012, an online breast cancer survivorship resource is being utilized for educational review. Users of the website are preferentially interested in QOL, healthcare system, and Consensus guidance in their educational viewing. This system can be utilized to disseminate nationally recognized clinical advice for Primary Healthcare Providers as they care for breast cancer survivors in their routine healthcare practices.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-08-08.

Ageing is associated with diminished muscle re-growth and myogenic precursor cell expansion early after immobility-induced atrophy in human skeletal muscle

Recovery of skeletal muscle mass from immobilisation-induced atrophy is faster in young than older individuals, yet the cellular mechanisms remain unknown. We examined the cellular and molecular regulation of muscle recovery in young and older human subjects subsequent to 2 weeks of immobility-induced muscle atrophy. Retraining consisted of 4 weeks of supervised resistive exercise in 9 older (OM: mean age) 67.3, range 61-74 yrs) and 11 young (YM: mean age 24.4, range 21-30 yrs) males. Measures of myofibre area (MFA), Pax7-positive satellite cells (SCs) associated with type I and type II muscle fibres, as well as gene expression analysis of key growth and transcription factors associated with local skeletal muscle milieu, were performed after 2 weeks immobility (Imm) and following 3 days (+3d) and 4 weeks (+4wks) of retraining. OM demonstrated no detectable gains in MFA (vastus lateralis muscle) and no increases in number of Pax7-positive SCs following 4wks retraining, whereas YM increased their MFA (P < 0.05), number of Pax7-positive cells, and had more Pax7-positive cells per type II fibre than OM at +3d and +4wks (P < 0.05). No age-related differences were observed in mRNA expression of IGF-1Ea, MGF, MyoD1 and HGF with retraining, whereas myostatin expression levels were more down-regulated in YM compared to OM at +3d (P < 0.05). In conclusion, the diminished muscle re-growth after immobilisation in elderly humans was associated with a lesser response in satellite cell proliferation in combination with an age-specific regulation of myostatin. In contrast, expression of local growth factors did not seem to explain the age-related difference in muscle mass recovery.