Novel prognostic impact and cell specific role of endocan in patients with coronary artery disease

BACKGROUND

Both the clinical and mechanistic impacts of endocan were not well elucidated especially in coronary artery disease (CAD).

OBJECTIVE

This study aimed to investigate the prognostic and potential pathological role of endocan for cardiovascular (CV) events in stable CAD patients.

METHODS

A total of 1,071 stable CAD patients with previous percutaneous coronary intervention (PCI) were enrolled prospectively in a nationwide Biosignature study. Another cohort of 76 CAD patients with or without PCI were enrolled for validation. Baseline biomarkers including endocan level was measured and total CV events especially hard CV events (including CV mortality, non-fatal myocardial infection and stroke) during follow-up were identified. Circulating endothelial progenitor cells (EPCs) as an in vivo biological contributor to vascular repairment from CAD patients were used for the in vitro functional study.

RESULTS

After 24 months, there were 42 patients (3.92%) with hard CV events and 207 (19.3%) with total CV events in the study group. The incidence of both events was increased with the tertiles of baseline endocan level (hard events: 1.7%,3.4%, and 6.7% in 1st,2nd, and 3rd tertile respectively, p = 0.002; total events: 13.8%vs.16.2%vs.28.0%, p < 0.0001). Multivariate regression analysis revealed the independent association of endocan level with total and hard CV events. These findings were validated in another cohort with a 5-year follow-up. Furthermore, in vitro inhibition of endocan improved cell migration and tube formation capacities, and reduced cell adhesiveness of EPCs from CAD patients.

CONCLUSIONS

Endocan might be a novel prognostic indicator, mechanistic mediator, and potential therapeutic target for clinical CAD.

Arginine-linked HPV-associated E7 displaying bacteria-derived outer membrane vesicles as a potent antigen-specific cancer vaccine

BACKGROUND

Bacteria-based cancer therapy have demonstrated innovative strategies to combat tumors. Recent studies have focused on gram-negative bacterial outer membrane vesicles (OMVs) as a novel cancer immunotherapy strategy due to its intrinsic properties as a versatile carrier.

METHOD

Here, we developed an Human Papillomavirus (HPV)-associated E7 antigen displaying Salmonella-derived OMV vaccine, utilizing a Poly(L-arginine) cell penetrating peptide (CPP) to enhance HPV16 E7 (aa49-67) H-2 Db and OMV affinity, termed SOMV-9RE7.

RESULTS

Due to OMV's intrinsic immunogenic properties, SOMV-9RE7 effectively activates adaptive immunity through antigen-presenting cell uptake and antigen cross-presentation. Vaccination of engineered OMVs shows immediate tumor suppression and recruitment of infiltrating tumor-reactive immune cells.

CONCLUSION

The simplicity of the arginine coating strategy boasts the versatility of immuno-stimulating OMVs that can be broadly implemented to personalized bacterial immunotherapeutic applications.

FLT3L-induced virtual memory CD8 T cells engage the immune system against tumors

BACKGROUND

Previous research in FMS-like tyrosine kinase 3 ligands (FLT3L) has primarily focused on their potential to generate dendritic cells (DCs) from bone marrow progenitors, with a limited understanding of how these cells affect CD8 T cell function. In this study, we further investigated the in vivo role of FLT3L for the immunomodulatory capabilities of CD8 T cells.

METHODS

Albumin-conjugated FLT3L (Alb-FLT3L) was generated and applied for translational medicine purposes; here it was used to treat naïve C57BL/6 and OT1 mice for CD8 T cell response analysis. Syngeneic B16ova and E.G7ova mouse models were employed for adoptive cell transfer to evaluate the effects of Alb-FLT3L preconditioning of CD8 T cells on tumor progression. To uncover the underlying mechanisms of Alb-FLT3L modulation, we conducted bulk RNA-seq analysis of the CD44high CD8 T cells. STAT1-deficient mice were used to elucidate the functional roles of Alb-FLT3L in the modulation of T cells. Finally, antibody blockade of type one interferon signaling and in vitro coculture of plasmacytoid DCs (pDCs) with naive CD8 T cells was performed to determine the role of pDCs in mediating regulation of CD44high CD8 T cells.

RESULTS

CD44high CD8 T cells were enhanced in C57BL/6 mice administrated with Alb-FLT3L. These CD8 T cells exhibited virtual memory features and had greater proliferative and effective functions. Notably, the adoptive transfer of CD44high naïve CD8 T cells into C57BL/6 mice with B16ova tumors led to significant tumor regression. RNA-seq analysis of the CD44high naïve CD8 T cells revealed FLT3L to induce CD44high CD8 T cells in a JAK-STAT1 signaling pathway-dependent manner, as supported by results indicating a decreased ability of FLT3L to enhance CD8 T cell proliferation in STAT1-deficient mice as compared to wild-type control mice. Moreover, antibody blockade of type one interferon signaling restricted the generation of FLT3L-induced CD44high CD8 T cells, while CD44 expression was able to be induced in naïve CD8 T cells cocultured with pDCs derived from FLT3L-treated mice. This suggests the crucial role of pDCs in mediating FLT3L regulation of CD44high CD8 T cells.

CONCLUSIONS

These findings provide critical insight and support the therapeutic potential of Alb-FLT3L as an immune modulator in preconditioning of naïve CD8 T cells for cancer immunotherapy.

Salmonella immunotherapy engineered with highly efficient tumor antigen coating establishes antigen-specific CD8+ T cell immunity and increases in antitumor efficacy with type I interferon combination therapy

Bacteria-based cancer therapy employs various strategies to combat tumors, one of which is delivering tumor-associated antigen (TAA) to generate specific immunity. Here, we utilized a poly-arginine extended HPV E7 antigen (9RE7) for attachment on Salmonella SL7207 outer membrane to synthesize the bacterial vaccine Salmonella-9RE7 (Sal-9RE7), which yielded a significant improvement in the amount of antigen presentation compared to the previous lysine-extended antigen coating strategy. In TC-1 tumor mouse models, Sal-9RE7 monotherapy decreased tumor growth by inducing E7 antigen-specific immunity. In addition, pairing Sal-9RE7 with adjuvant Albumin-IFNβ (Alb-IFNβ), a protein cytokine fusion, the combination significantly increased the antitumor efficacy and enhanced immunogenicity in the tumor microenvironment (TME). Our study made a significant contribution to personalized bacterial immunotherapy via TAA delivery and demonstrated the advantage of combination therapy.

Sex and age differences of major cardiovascular events in patients after percutaneous coronary intervention

BACKGROUND

Women usually have higher risk after receiving percutaneous coronary interventions (PCIs) than men with coronary artery disease (CAD). The aim of this study was to investigate the association of sex differences with future outcomes in CAD patients undergoing PCI, to assess the role of age, and to extend observed endpoints to stroke and congestive heart failure.

METHODS

Six thousand six hundred forty-seven patients with CAD who received successful PCIs. The associations between clinic outcomes and sex were analyzed. The primary outcome was major cardiovascular events (MACE), including cardiac death, nonfatal myocardial infraction, and nonfatal stroke. The secondary outcome was MACE and hospitalization for heart failure (total CV events).

RESULTS

During a mean of 52.7 months of follow-up, 4833 men and 1614 women received PCI. Univariate and multivariate analyses showed that women were independently associated with an increased risk of cardiac death (HR, 1.78; 95% CI, 1.32-2.41), hospitalization for heart failure (HR, 1.53; 95% CI, 1.23-1.89), MACE (HR, 1.34; 95% CI, 1.10-1.63), and total CV events (HR, 1.39; 95% CI, 1.20-1.62). In the subgroup analysis, women aged under 60 years had higher cardiovascular risks than men of the same age category.

CONCLUSION

Women with CAD after successful PCI had poorer cardiovascular outcomes than men. Additionally, younger women (aged <60 years) were especially associated with a higher risk of developing future adverse cardiovascular outcomes.

[Association between maternal plasma one-carbon biomarkers during pregnancy and fetal growth in twin pregnancies]

Objective: To characterize the relationship between the levels of plasma methyl donor and related metabolites (including choline, betaine, methionine, dimethylglycine and homocysteine) and fetal growth in twin pregnancies. Methods: A hospital-based cohort study was used to collect clinical data of 92 pregnant women with twin pregnancies and their fetuses who were admitted to Peking University Third Hospital from March 2017 to January 2018. Fasting blood was collected from the pregnant women with twin pregnancies (median gestational age: 18.9 weeks). The levels of methyl donors and related metabolites in plasma were quantitatively analyzed by high-performance liquid chromatography combined with mass spectrometry. The generalized estimation equation was used to analyze the relationship between maternal plasma methyl donors and related metabolites levels and neonatal outcomes of twins, and the generalized additive mixed model was used to analyze the relationship between maternal plasma methyl donors and related metabolites levels and fetal growth ultrasound indicators. Results: (1) General clinical data: of the 92 women with twin pregnancies, 66 cases (72%) were dichorionic diamniotic (DCDA) twin pregnancies, and 26 cases (28%) were monochorionic diamniotic (MCDA) twin pregnancies. The comparison of the levels of five plasma methyl donors and related metabolites in twin pregnancies with different basic characteristics showed that the median levels of plasma choline and betaine in pregnant women ≥35 years old were higher than those in pregnant women <35 years old, and the differences were statistically significant (all P<0.05). (2) Correlation between plasma methyl donor and related metabolites levels and neonatal growth indicators: after adjusting for confounding factors, plasma homocysteine level in pregnant women with twins was significantly negatively correlated with neonatal birth weight (β=-47.9, 95%CI:-94.3- -1.6; P=0.043). Elevated methionine level was significantly associated with decreased risks of small for gestational age infants (SGA; OR=0.5, 95%CI: 0.3-0.9; P=0.021) and low birth weight infants (OR=0.6, 95%CI: 0.4-0.9; P=0.020). Increased homocysteine level was associated with increased risks of SGA (OR=1.5, 95%CI: 1.0-2.2; P=0.029) and inconsistent growth in twin fetuses (OR=1.9, 95%CI: 1.0-3.7; P=0.049). (3) Correlation between the levels of plasma methyl donors and related metabolites and intrauterine growth indicators of twins pregnancies: for every 1 standard deviation increase in plasma choline level in pregnant women with twin pregnancies, fetal head circumference, abdominal circumference, femoral length and estimated fetal weight in the second trimester increased by 1.9 mm, 2.6 mm, 0.5 mm and 20.1 g, respectively, and biparietal diameter, abdominal circumference and estimated fetal weight increased by 0.7 mm, 3.0 mm and 38.4 g in the third trimester, respectively, and the differences were statistically significant (all P<0.05). (4) Relationship between plasma methyl donor and related metabolites levels in pregnant women with different chorionicity and neonatal birth weight and length: the negative correlation between plasma homocysteine level and neonatal birth weight was mainly found in DCDA twin pregnancy (β=-65.9, 95%CI:-110.6- -21.1; P=0.004). The levels of choline, betaine and dimethylglycine in plasma of MCDA twin pregnancy were significantly correlated with the birth weight and length of newborns (all P<0.05). Conclusion: Homocysteine level is associated with low birth weight in twins, methionine is associated with decreased risk of SGA, and choline is associated with fetal growth in the second and third trimesters of pregnancy.

Performance Metric Analysis of a Radiation Oncology Educational Podcast

PURPOSE/OBJECTIVE(S)

Asynchronous podcast education is a popular supplementary tool with up to 88% of medical residents reporting its use, and is perceived by faculty to have high educational value with convenience and connection to broader medical communities.1,2 Radiation oncology (RO) podcasts remain scarce compared to other specialties, and ones focused exclusively on education are largely absent. We analyze the early performance, listenership, and engagement of the first RO medical education podcast.

MATERIALS/METHODS

Episode data and listener demographics were gathered from Spotify and iTunes. Episode engagement was defined as a percentage of plays on unique devices playing >40% of an episode within a single session. Listenership was defined by the number of plays per day (ppd) on unique devices, averaged over 60 days from publication date. Episodes were case based, categorized by disease subsite, and reviewed by a board-certified radiation oncologist. Quantitative endpoints included episode engagement and listenership. Qualitative comments were not solicited but received through email and Twitter. Pearson's correlation coefficient calculations were used for analysis.

RESULTS

Eighteen total episodes had 8,517 total plays since July 2022 over 176 days. Median episode length was 13.8 minutes (range 9.2-20.1). Popular listening platforms included iTunes (53.5%) and Spotify (34.0%). Listener demographics included 59.4% male, 39.6% female, and 1.0% other, ranging from age 23-27 (14%), 28-34 (65%), 35-44 (14%), 45-59 (4%), and 60+ (1%). ATB was played in 48 countries, with the most listeners in North America (74.6%) followed by Asia (7.8%), Europe (7.6%), Australia (7.0%), Africa (2.0%), and South America (0.4%). There was a 464% increase in listenership since publication with median growth of 63.3% per month. Median listenership and engagement were 9.2 ppd (IQR, 7.7-9.9) and 77.8% (IQR, 68.1-81.2) for all episodes, respectively. Among 8 topics, head and neck (HN) episodes had the highest mean listenership with 17.8 ppd, followed by genitourinary (GU, 10.8) and lung (10.5). GU episodes had the highest mean engagement at 84.6%, followed by lung (82.3) and sarcoma (81.2). Dosimetry had the lowest listenership and engagement at 5.9 ppd and 63.1%, respectively. A significant negative relationship between episode length and engagement was observed, (r(18) = -0.469, p = 0.05). There was no statistically significant relationship between ppd and episode length, (r(18) = -0.303, p = 0.22).

CONCLUSION

Evidenced by its significant rise in listenership, high listener engagement, and large international audience, there were previously unmet needs for RO medical education that may be supplemented by podcasts. HN episodes were most popular with GU exhibiting highest engagement. Longer episode length correlated with a significant decrease in engagement but no effect on popularity.

Racial and Ethnic Disparities in Health-Related Quality of Life for Patients with Colorectal Cancer: Analysis of the SEER-MHOS Linked Data Set

PURPOSE/OBJECTIVE(S)

We hypothesized that racial and ethnic disparities exist in health-related quality of life (HRQOL) among older adults with colorectal cancer, both before and after diagnosis.

MATERIALS/METHODS

The Surveillance, Epidemiology, and End Results and Medicare Health Outcomes Survey (SEER-MHOS) linked data set was used to identify patients 65 years old and above who were diagnosed with colorectal cancer between 1996 and 2015. Self-reported race/ethnicity, the predictor of interest, was categorized as White (W), Asian/Pacific Islander (API), Black/African American (B), or Hispanic (H). HRQOL data from the 36-Item Short Form Survey and Veterans RAND 12-Item Health Survey were extracted within 24 months pre- and post-diagnosis. HRQOL was measured using the Physical Component Summary (PCS), Mental Component Summary (MCS), and Total Component Summary (TCS, a summation of PCS and MCS), which were the response variables. Associations were assessed via univariable (UVA) and multivariable (MVA) linear regression analysis, adjusting for age, sex, region, marital status, education, income, number of comorbidities, limitations in activities of daily living, stage, and histology. Pairwise comparisons were performed between all racial and ethnic groups.

RESULTS

We identified a total of 1,204 evaluable patients, with 815 in the pre-diagnosis cohort and 562 in the post-diagnosis cohort, including 173 patients in both. With unadjusted p-values, pre-diagnosis UVA revealed a higher mean PCS in API patients compared to W, B, and H patients (p<0.001, p<0.001, p = 0.02) as well as in W compared to H patients (p = 0.002); a higher mean MCS in W and API patients compared to B (p<0.001, p = 0.002) and H patients (p<0.001, p = 0.002); and a higher mean TCS in API compared to W, B, and H patients (p = 0.027, p<0.001, p<0.001) as well as in W compared to B and H patients (p<0.001, p = 0.012). Pre-diagnosis MVA revealed a higher mean PCS in API compared to B patients (p = 0.028) and a higher mean MCS in W and B compared to H patients (p = 0.022, p = 0.021). Post-diagnosis UVA showed a higher mean MCS in W compared to B and H patients (p<0.001 for both) as well as in API compared to H patients (p = 0.002), and a higher mean TCS in W and API patients compared to B (p<0.001, p = 0.045) and H patients (p<0.001, p = 0.007). Post-diagnosis MVA showed a higher mean MCS in API compared to H patients (p = 0.035). Compared to pre-diagnosis, post-diagnosis mean TCS was numerically lower for all groups.

CONCLUSION

Among older adults with colorectal cancer, there appear to be racial and ethnic disparities in HRQOL. Before the cancer diagnosis, API patients had better physical HRQOL than B patients, while W and B patients had better mental HRQOL than H patients. After diagnosis, API patients had better mental HRQOL than H patients. For all groups, the cancer diagnosis seemed to have a negative impact on overall HRQOL.

Trends in Racial and Ethnicity Disparities in the Health-Related Quality of Life in Older Adults with Breast Cancer: A SEER-MHOS National Database Study

PURPOSE/OBJECTIVE(S)

To examine racial and ethnic disparities in Health-Related Quality of Life (HRQOL) in older adults with breast cancer, both pre- and post-diagnosis.

MATERIALS/METHODS

Using the Surveillance, Epidemiology and End Results-Medicare Health Outcomes Survey (SEER-MHOS) database, we included patients > 65 years old with breast cancer diagnosed from 1998-2019, who had completed the Health Outcomes Survey within 24 months pre- and post-diagnosis, and who had a reported ethnicity of non-Hispanic White (W), non-Hispanic Asian or Pacific Islander (API), non-Hispanic Black or African American (B), or Hispanic (H). HRQOL data was measured by the Physical Component Summary (PCS) and Mental Component Summary (MCS) scores from the Medical Outcomes Study Short Form-36 and the Veterans RAND 12-Item Health Survey instruments. Univariable (UVA) and multivariable (MVA) linear regression models were fitted for MCS, PCS, and TCS (composite MCS and PCS) as response variables to assess for potential disparities between races and ethnicities. MVA models were adjusted for sex, age, marital status, education, income, number of comorbidities, limitations in activities of daily living, national region, histology, and treatment type (in post-diagnosis cohort only).

RESULTS

We identified 1,008 in the pre-diagnosis cohort (56.6% stage I, 29.8% stage II, 9.3% stage III, and 4.3% stage IV) and 991 patients in the post-diagnosis cohort (58.3% stage I, 28.6% stage II, 9.3% stage III, 3.8% stage IV). On UVA, differences in mean scores of TCS, PCS, and MCS, respectively, were found among W, API, B, and H patients in both pre-diagnosis and post-diagnosis cohorts (pre-diagnosis - TCS: 93.4, 93.0, 87.0, 86.3; PCS: 40.3, 40.0, 37.0, 37.5; MCS: 53.1, 52.9, 50.0, 48.7; post-diagnosis - TCS: 90.8, 90.3, 84.3, 83.5; PCS: 38.5, 39.2, 36.8, 34.5; MCS: 52.3, 51.1, 49.8, 46.8; all p < .001). A drop in PCS, MCS, and TCS scores numerically was observed for all groups. Among patients in the pre-diagnosis cohort who would be diagnosed with stage IV breast cancer, race was found to be a predictor of PCS with overall significance (p = 0.04) within MVA linear regression. Specifically, on the local test, compared to B, W had higher pre-diagnosis PCS scores (+13.32, p = 0.03). Race was not found to be a predictor in PCS, MCS, or TCS scores otherwise.

CONCLUSION

Among older patients who would be diagnosed with stage IV breast cancer, W had better physical HRQOL as compared to B patients' pre-diagnosis. The decrease in numerical HRQOL scores of the physical domain in all groups post-diagnosis highlights the potential negative physical impact breast cancer has on patients, demonstrating the need for determining the proper resources and support to improve physical HRQOL following diagnosis.

Racial and Ethnic Disparities in Health-Related Quality of Life in Older Adults with Non-Hodgkin Lymphoma

PURPOSE/OBJECTIVE(S)

To investigate whether health-related quality of life (HRQOL) disparities exist among different racial and ethnic groups in older patients with Non-Hodgkin Lymphoma (NHL), pre- and post-diagnosis.

MATERIALS/METHODS

Using the Surveillance, Epidemiology, and Ends Results-Medicare Health Outcomes Survey (SEER-MHOS) linked database, we included individuals 65 years and older with NHL and reported ethnicities of Whites, Asian, Black, and Hispanic, diagnosed from 1998-2019. HRQOL data within 24 months before and after diagnosis were measured by the Physical Component Summary (PCS) and Mental Component Summary (MCS) scores from the SF-36® and VR-12 instruments. The total combined score (TCS) is reflected by both the PCS and MCS. Multivariate analyses (MVA) adjusted for sex, age, marital status, education, income, year of diagnosis, number of comorbidities, limitations in activities of daily living (ADLs), national region, treatment type (post-diagnosis cohort only), stage, and histology.

RESULTS

We identified 2506 patients in the pre-diagnosis and 1903 patients in the post-diagnosis cohorts. In the pre-diagnosis cohort, univariate analysis (UVA) revealed that Whites had higher MCS scores than Asians (53.4 vs 50.2, p = 0.001), Blacks (53.4 vs 48.3, p<0.001), and Hispanics (53.4 vs 49.9, p<0.001). It was also revealed that Whites had higher PCS scores than Blacks (40.5 vs 37.4, p = 0.005), Whites had higher TCS scores than Blacks (93.4 vs 85.1, p<0.0001) and Hispanics (93.4 vs 87.3, p<0.0001), and Asians had higher TCS scores than Blacks (90.5 vs 85.1, p = 0.012). MVA revealed the following: Whites had higher MCS scores than Asians (52.3 vs 50.0, p = 0.038), Blacks (52.3 vs 49.1, p = 0.002), and Hispanics (52.3 vs 49.8, p = 0.005); Whites had higher TCS scores than Blacks (92.5 vs 87.9, p<0.006) and Hispanics (92.5 vs 88.6, p = 0.006); and Asians had higher TCS scores than Blacks (92.6 vs 87.9, p = 0.045). In the post-diagnosis cohort, UVA revealed that Whites had higher PCS scores than Hispanics (36.2 vs 34.1, p = 0.046); Whites had higher MCS scores than Asians (51.3 vs 48.8, p = 0.035), Blacks (51.3 vs 48.7, p = 0.033), and Hispanics (51.3 vs 46.7, p<0.0001); Whites had higher TCS scores than Blacks (87.0 vs 82.3, p = 0.021) and Hispanics (87.0 vs 78.5, p<0.0001); and Asians had higher TCS scores than Hispanics (86.5 vs 78.5, p = 0.001). MVA revealed that Whites had higher MCS scores than Hispanics (47.6 vs 44.0, p = 0.002); Whites had higher TCS scores than Hispanics (83.5 vs 76.5, p<0.0001), and Asians had higher TCS scores than Hispanics (83.7 vs 76.5, p = 0.006).

CONCLUSION

HRQOL disparities exist among different racial and ethnic groups in older patients with NHL. Pre-diagnosis, Whites had better mental HRQOL compared to Asians, Blacks, and Hispanics. Whites also had better overall HRQOL as compared to Blacks and Hispanics, and Asians had better overall HRQOL than Blacks. Post-diagnosis, Whites had better mental and overall HRQOL than Hispanics, and Asians had overall better HRQOL than Hispanics.

[Progress in research of deaths and disease burden of major chronic diseases caused by indoor and outdoor air pollution in China]

Health damage including chronic disease caused by air pollution have attracted increasing attention. With the acceleration of industrialization and urbanization, the emission of air pollutants has increased, and its association with chronic diseases has become a research trending topic. Cardiovascular disease, cancer, diabetes, and chronic respiratory disease are the major chronic diseases, causing about 86.6% of the total deaths in China. The prevention and control of chronic diseases, especially the etiologic prevention, is a major public health issue related to national health. This article summarizes the recent progress in research of association of indoor and outdoor air pollution with all-cause mortality, the deaths and disease burden of four major chronic diseases, i.e. cardiovascular disease, cancer, diabetes, and chronic respiratory disease, and puts forward suggestions for the reduction of the burden caused by chronic diseases due to air pollution to provide a theoretical foundation to revise air quality standards in China.

[Progress in research of relationship between metal or metalloid and persistent organic pollutants exposures and cardiovascular disease]

Cardiovascular disease (CVD) is the leading cause of mortality and healthy life expectancy loss, ranking first in causing the global burden of disease. In addition to the traditional CVD risk factors, such as hypertension and diabetes, environmental chemical pollutants may also play a role in the development of CVD. This paper summarizes the evidence regarding the relation of exposures to metal or metalloid and persistent organic pollutants with risk for CVD and introduces the research progress in the relation between the exposures to two environmental chemical pollutants and CVD risk. The study aims to provide scientific evidence for the effective prevention of CVD through the management of chemical pollutants in environment.

Renal function during hospitalization and outcome in Chinese patients with acute decompensated heart failure: A retrospective study and literature review

BACKGROUND

The heart and kidneys had demonstrated a bidirectional interaction that dysfunction of the heart or kidneys can induce dysfunction in the other organ.

HYPOTHESIS

Renal function and its decline during hospitalization may have impact on cardiovascular outcomes in patients with acute decompensated heart failure (ADHF).

METHODS

A total of 119 consecutive Chinese patients admitted for ADHF were prospectively enrolled. The course of renal function was presented with estimated glomerular filtration rate (eGFR), calculated by the four-variable equation proposed by the Modification of Diet in Renal Disease (MDRD) Study. Worsening renal function (WRF) was defined as eGFR decline between admission (eGFR_admission ) and predischarge (eGFR_predischarge ). Clinical outcomes were defined as 4P-major adverse cardiovascular events (4P-MACE), including the composition of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, and nonfatal HF hospitalization.

RESULTS

During an average 2.6 ± 3.2 years follow-up, 66 patients (55%) experienced 4P-MACE. Patients with impaired eGFR_predischarge (<60 ml/min/1.73 m² ) had more 4P-MACE than those with preserved eGFR_predischarge (64.7% vs. 43.1%, p = .019). The Kaplan-Meier survival curves showed significantly higher incidence of 4P-MACE in patients with impaired eGFR_predischarge than those with preserved eGFR_predischarge (p = .002). Cox regression analysis revealed that impaired eGFR_predischarge was significantly correlated with the development of 4P-MACE (hazard ratio, 2.003; 95% confidence interval, 1.072-3.744; p = .029). In contrast, outcomes would be similar with regard to eGFR on admission and eGFR decline during hospitalization.

CONCLUSIONS

Impaired renal function before discharge, but not impaired renal function on admission or WRF, is a significant risk factor for poor outcomes in patients with ADHF.

Association between visit-to-visit blood pressure variability and adverse events in coronary artery disease patients after coronary intervention

Blood pressure variability (BPV) is independently associated with higher cardiovascular risks. However, whether BPV is associated with poor outcomes for coronary artery disease (CAD) patients after percutaneous coronary intervention (PCI) remained undetermined. We aimed to investigate the relationship between BPV and the outcomes of CAD patients undergoing PCI. Two thousand seven hundred and sixty-two CAD patients (1938 males, mean age 69.6 ± 12.9) who received PCI at Taipei Veterans General Hospital from 2006 to 2015 with multiple blood pressure measurements before and after the index PCI were enrolled. We calculated the standard deviation of systolic blood pressure, diastolic blood pressure, and pulse pressure as parameters of BPV. The primary endpoint was the composite of major adverse cardiovascular events [MACE comprising of cardiovascular death, nonfatal myocardial infarction (MI), and non-fatal stroke] and heart failure hospitalization (HHF). The key secondary endpoint was MACE. Both pre-PCI and post-PCI BPV were associated with CV events even after adjusting for co-morbidities and mean blood pressure. In Cox analysis, for every 1 mmHg increase in systolic BPV, the hazard ratio for the MACE + HHF, MACE, HHF, and cardiovascular death was 1.04 (95%CI: 1.03-1.05), 1.04 (95%CI: 1.02-1.05), 1.05 (95%CI: 1.04-1.06), and 1.06 (95%CI: 1.03-1.09), respectively. The association between BPV and cardiovascular risk is independent of blood pressure control status. The prognostic value of BPV was superior to mean blood pressure in both pre-PCI and post-PCI period. BPV is independently associated with cardiovascular events after PCI and has a better prognostic value than mean blood pressure suggesting the importance of maintaining stable blood pressure for CAD patients.

Localization of Salmonella and albumin-IL-2 to the tumor microenvironment augments anticancer T cell immunity

Background

For centuries, microbial-based agents have been investigated as a therapeutic modality for the treatment of cancer. In theory, these methods would be cheap to produce, broadly applicable in a wide array of cancer types, and could synergize with other cancer treatment strategies. We aimed to assess the efficacy of combining microbial-based therapy using Salmonella SL7207 with interleukin-2 (IL-2), a potent immunostimulatory agent, in the treatment of murine colon carcinoma.

Methods

Female BALB/c mice were implanted subcutaneously with CT26 tumors, a model of colon carcinoma. Mice bearing tumors were selected and administered Albumin-IL-2 (Alb-IL2), a fusion protein, for further analysis of anticancer effect.

Results

We demonstrated that Salmonella SL7207, a genetically modified strain of Salmonella enterica serovar Typhimurium, preferentially accumulates in the tumor microenvironment, potentiating it to stimulate localized innate immunity. We delivered IL-2 as a fusion protein, Alb-IL2, which we demonstrate to have preferential accumulation properties, bringing it to the tumor and secondary lymphoid organs. Treatment of tumor-bearing mice with Salmonella + Alb-IL2 leads to superior tumor control and enhanced overall survival compared to controls. When assessing immunological factors contributing to our observed tumor control, significantly enhanced T cell population with superior effector function was observed in mice treated with Salmonella + Alb-IL2. We confirmed that these T cells were indispensable to the observed tumor control through antibody-mediated T cell depletion experiments.

Conclusions

These findings highlight the ability of Salmonella + Alb-IL2 to serve as a novel therapeutic approach to induce T cell-mediated antitumor immunity and exert long-term tumor control in a murine model of cancer.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12929-022-00841-y.

SLC12A3 Variation and Renal Function in Chinese Patients With Hypertension

Objective

SLC12A3 (solute carrier family 12 member 3) gene variants are associated with diabetic nephropathy; however, their association with hypertensive nephropathy remains unknown. We aimed to investigate the association between SLC12A3 gene polymorphisms and renal function in patients with hypertension.

Methods

Participants from three non-diabetic hypertensive cohorts, including young-onset hypertension (cohort 1, n = 882), treatment-naïve hypertension (cohort 2, n = 90), and follow-up cohort (cohort 3, n = 166), underwent genotyping for single nucleotide polymorphisms in SLC12A3. Renal events were defined as a >25 and >50% decline in estimated glomerular filtration rate (eGFR).

Results

In cohort 1, SLC12A3 rs16963397 C/C or C/G (P = 0.005), rs13334864 C/C or C/T (P = 0.020), and rs7187932 A/A or A/G polymorphisms (P = 0.014) had higher eGFRs compared to their counterparts, with similar findings observed in cohort 2. In cohort 3, over a mean follow-up of 5.8 ± 1.7 years, participants with either SLC12A3 rs16963397 C/C or rs13334864 C/C polymorphisms had more >25 and >50% eGFR decline than their counterparts (log-rank test, P = 0.058 and P = 0.038, respectively). Cox regression analysis revealed that SLC12A3 rs16963397 C/C and rs13334864 C/C polymorphisms were significantly associated with an increased risk of >25% [hazard ratio (HR), 3.294; 95% confidence interval (CI), 1.158–9.368; P = 0.025] and >50% decline in eGFR (HR, 18.630; 95% CI, 1.529–227.005, P = 0.022) than their counterparts.

Conclusion

SLC12A3 polymorphisms are associated with renal function in Chinese patients with hypertension.

miR-548j-5p regulates angiogenesis in peripheral artery disease

Peripheral artery disease (PAD) is a vascular disease involving diffuse atherosclerosis, and is associated with increased cardiovascular mortality and morbidity. Critical limb ischemia (CLI) is the most severe complication of PAD. In addition to medical and interventional treatment, therapeutic angiogenesis is a novel therapy for PAD. Circulating microRNAs (miRNAs) are considered key regulators of gene expression, but their role in ischemic-induced angiogenesis is poorly-characterized. There is currently a limited understanding of the specific miRNAs associated with PAD. To determine the regulation of miRNAs, we obtained miRNA profiles using RNA isolated from patients with PAD and a control group. The effects of specific miRNAs on angiogenesis were evaluated by assessing the in vitro angiogenic function of endothelial progenitor cells (EPCs), performing an in vivo angiogenesis assay, and employing a mouse hindlimb ischemic model. Our results demonstrated that circulating miR-548j-5p was significantly reduced in patients with PAD as compared with the controls. miR-548j-5p promoted EPC angiogenesis by enhancing migration and tube formation. The endothelial nitric oxide synthase (NOS) and stromal cell-derived factor (SDF)-1 signaling pathways appeared to be potential targets of miR-548j-5p. Furthermore, the results of a directed in vivo angiogenesis assay of EPCs and a hindlimb ischemia mouse model demonstrated that miR-548j-5p enhanced the capillary density and blood flow recovery in hindlimb ischemia. In conclusion, our data indicated that up-regulation of miR-548j-5p promotes angiogenesis in ischemic tissue and may represent a novel therapeutic approach for PAD.

[Comparison of alignment and position of prosthesis between portable accelerometer-based navigation device and conventional instrumentation in total knee arthroplasty with valgus deformity]

Objective: To explore the differences of alignment and position of prosthesis between portable accelerometer-based navigation device (PAD) and conventional instrumentation (CI) in total knee arthroplasty (TKA) with valgus deformity. Methods: Patients with knee osteoarthritis and valgus deformity who underwent primary TKA in Peking University Third Hospital from January 2017 to December 2020 were enrolled in this retrospective study and were divided into PAD group and CI group according to the surgical instruments. Five male patients and 44 female patients were included with a mean age of (67.2±7.0) years. The differences in preoperative general data, preoperative and postoperative alignment between the two groups were studied. Results: A total of 49 patients (25 patients in the PAD group and 24 in the CI group) were enrolled in this study. There were no statistically significant differences in gender, age, height, weight, body mass index, surgical side, preoperative hip-knee-ankle (HKA) angle, preoperative HKA angle deviation, Keblish classification and Ranawat classification between the two groups (all P>0.05). There was no significant difference in the accuracy of postoperative HKA angle (2.0°±1.4° vs 3.0°±2.2°, P=0.082), coronal femoral component angle (CFCA) (1.5°±1.2° vs 2.1°±1.6°, P=0.144) and coronal tibial component angle (CTCA) (1.2°±0.8° vs 1.3°±1.0°, P=0.695) between the two groups; but the standard deviation of the above-mentioned three indices in PAD group were all smaller than those in CI group. The rate of outliers of postoperative HKA angle of the PAD group was smaller than that in the CI group (P<0.05), but there was no significant difference in the rate of outliers of CFCA and CTCA between the two groups (both P>0.05). Conclusion: TKA assisted by PAD can provide good alignment and prosthesis position in patients with valgus deformity, and it is superior to TKA with CI in terms of precision and rate of outliers of postoperative overall alignment of lower extremity.

[Comparison of alignment between computer assisted surgery and personal specific instrumentation in total knee arthroplasty]

Objective: To explore the differences of alignment and operative time between computer assisted surgery (CAS) and personal specific instrumentation (PSI) in total knee arthroplasty (TKA). Methods: Patients with knee osteoarthritis who underwent unilateral primary TKA in Peking University Third Hospital from June 2019 to April 2021 were enrolled in this prospective study and were randomly divided into CAS group and PSI group with random number table. The differences in preoperative general data, operative time, preoperative and postoperative alignment between the two groups were studied. Results: A total of 80 patients were enrolled in this study, including 40 patients in the CAS group with an average age of (68±6) years (male/female, 6/34 cases) and 40 patients in the PSI group with an average age of (69±6) years (male/female, 5/35 cases). There was no significant differences in gender, age, height, weight, body mass index, surgical side, preoperative hip-knee-ankle (HKA) angle, and preoperative HKA angle deviation between the two groups (all P>0.05). The accuracy of sagittal femoral component angle (sFCA) (1.7°±1.2° vs 2.5°±1.4°, P<0.05) and sagittal tibial component angle (sTCA) (1.2°±0.9° vs 2.3°±1.8°, P<0.01) of the CAS group were both smaller than those in the PSI group, but there was no significant difference in the accuracy of postoperative HKA angle, mechanical lateral distal femoral angle (mLDFA) and mechanical medial proximal tibia angle (mMPTA) between the two groups (all P>0.05). The precision of postoperative HKA angle and sTCA of the CAS group were both smaller than those in the PSI group (2.0°±1.0° vs 2.6°±1.7°, 1.2°±0.9° vs 2.3°±1.8°, both P<0.01), but there was no significant differences in the precision of mLDFA, mMPTA and sFCA between the two groups (all P>0.05). The rate of outliers of postoperative HKA angle (10.0% vs 27.5%, P<0.05), sFCA(5.0% vs 20.0%, P<0.05) and sTCA (2.5% vs 22.5%, P<0.01) of the CAS group were all smaller than those in the PSI group, but there was no significant difference in the rate of outliers of mLDFA and mMPTA between the two groups (both P>0.05). CAS group had significantly longer surgical time than the PSI group ((81±12) min vs (52±8) min, P<0.01). Conclusions: CAS is better than PSI in overall coronal alignment and sagittal position of the prosthesis after TKA. However, CAS requires a longer operation time.

Prediction of Masked Hypertension and Masked Uncontrolled Hypertension Using Machine Learning

Objective: This study aimed to develop machine learning-based prediction models to predict masked hypertension and masked uncontrolled hypertension using the clinical characteristics of patients at a single outpatient visit.

Methods: Data were derived from two cohorts in Taiwan. The first cohort included 970 hypertensive patients recruited from six medical centers between 2004 and 2005, which were split into a training set (n = 679), a validation set (n = 146), and a test set (n = 145) for model development and internal validation. The second cohort included 416 hypertensive patients recruited from a single medical center between 2012 and 2020, which was used for external validation. We used 33 clinical characteristics as candidate variables to develop models based on logistic regression (LR), random forest (RF), eXtreme Gradient Boosting (XGboost), and artificial neural network (ANN).

Results: The four models featured high sensitivity and high negative predictive value (NPV) in internal validation (sensitivity = 0.914–1.000; NPV = 0.853–1.000) and external validation (sensitivity = 0.950–1.000; NPV = 0.875–1.000). The RF, XGboost, and ANN models showed much higher area under the receiver operating characteristic curve (AUC) (0.799–0.851 in internal validation, 0.672–0.837 in external validation) than the LR model. Among the models, the RF model, composed of 6 predictor variables, had the best overall performance in both internal and external validation (AUC = 0.851 and 0.837; sensitivity = 1.000 and 1.000; specificity = 0.609 and 0.580; NPV = 1.000 and 1.000; accuracy = 0.766 and 0.721, respectively).

Conclusion: An effective machine learning-based predictive model that requires data from a single clinic visit may help to identify masked hypertension and masked uncontrolled hypertension.

Prognostic indicators for the onset of ischaemic versus haemorrhagic stroke in stable coronary artery disease

The incidence of stroke may be increased in patients with coronary artery disease (CAD). We aimed to investigate the specific risk factors for the development of ischaemic and haemorrhagic stroke in stable CAD patients.Patients with stable CAD were prospectively enrolled for future cardiovascular events in Taiwan. All the patients had received coronary interventions and were stable for least 1 month before enrolment. The incidence of ischaemic stroke was identified and confirmed by telephone and hospital records. Baseline characteristics, including demographic data, lipid profiles, medications, and biomarkers for potential inflammatory and atherosclerosis, were analysed.In total, 1428 patients (age, 63.07 ± 11.4 years; 1207 males) were under standard medical treatment and regularly followed-up for at least 4 years. Multivariate logistic regression analysis showed that baseline serum myeloperoxidase (MPO) level (hazard ratio [HR]: 1.89, 95% CI: 1.16-3.10, P = .01) and statin use (HR: 0.37; 95% CI: 0.17-0.79, P = .01) were independently associated with the onset of ischaemic stroke. Age (HR: 1.07, 95% CI: 1.00-1.14, P = .04) and angiotensin receptor blocker (ARB) use (HR: 0.37, 95% CI: 0.17-0.79, P = .01) were independently associated with future onset of intracranial haemorrhage (ICH), implying the different mechanisms of ischaemic stroke and ICH.Age and ARB use were related to ICH onset. Baseline MPO level and statin use were independently associated with longer and shorter future ischaemic stroke onset in stable CAD patients, respectively. Further studies are indicated to confirm the potential mechanisms and advance individual risk stratification for the onset of different types of stroke in clinical CAD.

[Association between platelet parameters and risk for stroke in people with different blood pressure levels: Dongfeng-Tongji cohort]

Objective: To explore the associations of platelet parameters platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW) and plateletcrit (PCT) with the risk for stroke in people with different blood pressure levels. Methods: All the participants were from Dongfeng-Tongji cohort, including 38 295 retired employees from Dongfeng Motor Corporation at the first follow-up survey. After excluding participants with coronary heart disease, stroke, cancer, history of platelet influential drug use and those with missed data of platelet parameters or blood pressure or lost to follow-up, finally a total of 21 294 participants were included in this study. All the participants completed baseline questionnaires, physical examinations, clinical biochemical tests, and blood sample collection. Cox proportional hazard models were used to estimate the hazard ratios (HRs) and the corresponding 95% confident intervals (CIs) for the associations between platelet parameters and risk for stroke in people with different blood pressure levels. Results: After a mean follow-up of 8.0 years, 1 578 participants developed incident stroke [1 266 ischemic stroke (IS) cases and 312 hemorrhagic stroke (HS) cases]. Compared with the participants with PLT<188×10⁹/L, those with PLT≥188×10⁹/L among hypertension cases were significantly associated with higher risks for stroke and IS (stroke: HR=1.27, 95%CI: 1.12-1.44; IS: HR=1.39, 95%CI: 1.21-1.60). Among hypertension group, compared with participants with PCT<0.165%, PCT≥0.165% were significantly associated with higher risk for stroke (HR=1.15, 95%CI: 1.01-1.30) and lower risk for HS (HR=0.70, 95%CI: 0.53-0.93); Among non-hypertension and hypertension group, PCT ≥0.165% were significantly associated with higher risks of IS (HR=1.27, 95%CI: 1.05-1.54; HR=1.31, 95%CI: 1.14-1.50). MPV and PDW were not significantly associated with risk for stroke. Risk for stroke increased significantly in hypertension cases with different platelet parameters levels compared with non-hypertension cases with lower levels of each platelet parameters. Conclusion: Higher levels of PLT and PCT could increase the risks for stroke and IS in middle-aged and elderly hypertension patients, and lower levels of PCT could decrease the risk for HS in hypertension patients.

Significance of serum FGF-23 for risk assessment of contrast-associated acute kidney injury and clinical outcomes in patients undergoing coronary angiography

Background

Fibroblast growth factor (FGF)-23 levels rise as kidney function declines. Whether elevated FGF-23 levels are associated with an increased risk for contrast-associated acute kidney injury (CA-AKI) and major adverse cardiovascular events (MACE) in patients undergoing coronary angiography remain uncertain.

Methods

In total, 492 patients receiving coronary angiography were enrolled. Their serum FGF-23 levels were measured before administration of contrast media. The occurrence of CA-AKI was defined as a rise in serum creatinine of 0.5 mg/dL or a 25% increase from the baseline value within 48 h after the procedure. All patients were followed up for at least 1 year or until the occurrence of MACE including death, nonfatal myocardial infarction (MI), and ischemic stroke.

Results

Overall, CA-AKI occurred in 41 (8.3%) patients. During a median follow-up of 2.6 years, there were 24 deaths, 3 nonfatal MIs, and 7 ischemic strokes. Compared with those in the lowest FGF-23 tertile, individuals in the highest FGF-23 tertile had a significantly higher incidence of CA-AKI (P < 0.001) and lower incidence of MACE-free survival (P = 0.001). In multivariate regression analysis, higher FGF-23 level was found to be independently associated with a graded risk for CA-AKI (OR per doubling, 1.90; 95% CI 1.48–2.44) and MACE (HR per doubling, 1.25; 95% CI 1.02–1.52).

Conclusions

Elevated FGF-23 levels were associated with an increased risk for CA-AKI and future MACE among patients undergoing coronary angiography. FGF-23 may play a role in early diagnosis of CA-AKI and predicting clinical outcomes after coronary angiography.

Optimal blood pressure for patients with end-stage renal disease following coronary interventions

Hypertension is a frequent manifestation of chronic kidney disease but the ideal blood pressure (BP) target in patients with coronary artery disease (CAD) with end-stage renal disease (ESRD) (eGFR < 15 ml/min/1.73m² ) still unclear. The authors aimed to investigate the ideal achieved BP in ESRD patients with CAD after coronary intervention. Five hundred and seventy-five ESRD patients who had undergone percutaneous coronary interventions (PCIs) were enrolled and their clinical outcomes were analyzed according to the category of systolic BP (SBP) and diastolic BP (DBP) achieved. The clinical outcomes included major cardiovascular events (MACE) and MACE plus hospitalization for congestive heart failure (total cardiovascular (CV) event).The mean systolic BP was 135.0 ± 24.7 mm Hg and the mean diastolic BP was 70.7 ± 13.1 mm Hg. Systolic BP 140-149 mm Hg and diastolic BP 80-89 mm Hg had the lowest MACE (11.0%; 13.2%) and total CV event (23.3%; 21.1%). Patients with systolic BP < 120 mm Hg had a higher risk of MACE (HR: 2.01; 95% CI: 1.17-3.46, p = .008) than those with systolic BP 140-149 mm Hg. Patients with systolic BP ≥ 160 mm Hg (HR: 1.84; 95% CI, 3.27-1.04, p = .04) and diastolic blood BP ≥ 90 mm Hg (HR: 2.19; 95% CI: 1.15-4.16, p = .02) had a higher risk of total CV event rate when compared to those with systolic BP 140-149 mm Hg and diastolic BP 80-89 mm Hg. A J-shaped association between systolic (140-149 mm Hg) and diastolic (80-89 mm Hg) BP and decreased cardiovascular events for CAD was found in patients with ESRD after undergoing PCI in non-Western population.

A novel pseudovirus-based mouse model of SARS-CoV-2 infection to test COVID-19 interventions

BACKGROUND

The spread of SARS-CoV-2, the virus that causes Coronavirus Disease 2019 (COVID-19), has been characterized as a worldwide pandemic. Currently, there are few preclinical animal models that suitably represent infection, as the main point of entry to human cells is via human angiotensin-converting enzyme 2 (ACE2) which is not present in typical preclinical mouse strains. Additionally, SARS-CoV-2 is highly virulent and unsafe for use in many research facilities. Here we describe the development of a preclinical animal model using intranasal administration of ACE2 followed by non-infectious SARS-CoV-2 pseudovirus (PsV) challenge.

METHODS

To specifically generate our SARS-CoV-2 PsV, we used a lentivirus system. Following co-transfection with a packaging plasmid containing HIV Gag and Pol, luciferase-expressing lentiviruses, and a plasmid carrying the SARS-CoV-2 spike protein, SARS-CoV-2 PsVs can be isolated and purified. To better understand and maximize the infectivity of SARS-CoV-2 PsV, we generated PsV carrying spike protein variants known to have varying human ACE2 binding properties, including 19 deletion (19del) and 19del + D614G.

RESULTS

Our system demonstrated the ability of PsVs to infect the respiratory passage of mice following intranasal hACE2 transduction. Additionally, we demonstrate in vitro and in vivo manipulability of our system using recombinant receptor-binding domain protein to prevent PsV infection.

CONCLUSIONS

Our PsV system is able to model SARS-CoV-2 infections in a preclinical mouse model and can be used to test interventions or preventative treatments. We believe that this method can be extended to work in various mouse strains or to model infection with different coronaviruses. A simple in vivo system such as our model is crucial for rapidly and effectively responding to the current COVID-19 pandemic in addition to preparing for future potential coronavirus outbreaks.

Effects of Postoperative Percutaneous Coronary Intervention, Pharmacologic Treatment, and Predisposing Factors on Clinical Outcomes in Patients With and Without Type 2 Diabetes Along With Critical Limb Ischemia

PURPOSE

Critical limb ischemia (CLI) has been identified as being connected to rates of cardiovascular mortality and lower extremity amputation (LEA). This prospective study investigated the effects of percutaneous coronary intervention (PCI), pharmacologic treatment, and predisposing factors on clinical outcomes in patients with and without type 2 diabetes mellitus (DM) along with CLI after endovascular intervention.

METHODS

249 consecutive patients with CLI (Fontaine stages III-IV) received pharmacologic treatment after successful endovascular intervention. Their primary patency rates of infrapopliteal lesions and cardiovascular and amputation events during a 36-month follow-up period were assessed.

FINDINGS

Patients with DM were more likely to be younger (P = 0.026); 50% (n = 63), 42.9% (n = 54), 52.4% (n = 66), and 77% (n = 97) of DM patients had arterial calcification, end-stage renal disease, diabetic neuropathy, and Fontaine stage IV (P < 0.001, P < 0.001, P < 0.001, and P = 0.019, respectively). The primary patency rates were 61%, 48.8%, and 42.3% at 12, 24, and 36 months, in the patients without DM (P = 0.034, P = 0.013, and P = 0.005). Patients with DM had higher risks of 36-month coronary artery disease, cerebrovascular accident, mortality, and LEA (P = 0.005, P = 0.042, P = 0.042, and P < 0.001). Patients with CLI receiving long-term cilostazol treatment had a better primary patency and amputation-free survival, and a lower risk of mortality at 36 months (P < 0.001, P < 0.001, and P = 0.001). Statin use was associated with 36-month amputation-free survival but not with primary patency (P = 0.032 and P = 0.088). Subgroup multivariate Cox analyses showed that primary patency was independently associated with long-term cilostazol treatment, PCI in the first postoperative year, and direct revascularization in the DM group, whereas in the control group, long-term cilostazol treatment was the main independent factor. The risk of amputation was independently associated with a high high-sensitivity chronic reactive protein level, diabetic neuropathy, sole use of an oral hypoglycemic agent, and lack of supervised exercise.

IMPLICATIONS

Long-term cilostazol treatment, aggressive management of dyslipidemia, and meticulous assessment and prevention of postoperative unstable coronary artery disease should be considered in CLI patients with and without DM to maximize clinical outcomes. PCI in the first postoperative year may be a predisposing factor for patency failure in patients with CLI, especially those with DM. A large-scale prospective randomized trial should be conducted to confirm these findings (TVGH IRB No. 2013-08-020B).

Sex difference in sympathetic nervous system activity and blood pressure in hypertensive patients

Increased sympathetic nervous system (SNS) activity leads to increased risk of cardiovascular morbidity and mortality. This study investigated whether there were sex differences in SNS activity among Chinese patients with hypertension. Ethnic Chinese non‐diabetic hypertensive patients aged 20–50 years were enrolled in Taiwan. A total of 970 hypertensive patients (41.0 ± 7.2 years) completed the study, 664 men and 306 women. They received comprehensive evaluations including office blood pressure (BP) measurement, 24‐h ambulatory BP monitoring, and 24‐h urine sampling assayed for catecholamine excretion. Compared to women, men were younger, had higher body mass index (BMI), office systolic BP (SBP), office diastolic BP (DBP), 24‐h ambulatory BP, and 24‐h urine catecholamine excretion. In men, 24‐h urine total catecholamine levels were correlated with 24‐h SBP (r = 0.103, p = .008) and 24‐h DBP (r = 0.083, p = .033). In women, however, there was no correlation between 24‐h urine total catecholamine levels and 24‐h ambulatory BP. Multivariate linear regression indicated that being male (β = 1.65, 95% confidence interval [CI] 0.01–3.29, p = .048) and 24‐h urine total catecholamine (β = 5.03, 95% CI 0.62–9.44, p = .025) were both independently associated with 24‐h SBP; being male was independently associated with 24‐h DBP (β = 3.55, 95% CI 2.26–4.85, p < .001). In conclusion, Chinese men with hypertension had higher SNS activity than women, and SNS activity was independently associated with 24‐h ambulatory BP in men rather than in women. These findings suggest that different hypertensive treatment strategies should be considered according to patient sex.

Long-Term Cilostazol Treatment and Predictive Factors on Outcomes of Endovascular Intervention in Patients with Diabetes Mellitus and Critical Limb Ischemia

INTRODUCTION

Despite improvements in endovascular interventions and multidisciplinary approaches, improving clinical outcomes and increasing limb salvage have become increasingly challenging. This prospective study investigated the associations of cilostazol treatment with clinical outcomes and predictive factors in patients with diabetes mellitus (DM) and critical limb ischemia (CLI) after endovascular revascularization of the affected angiosome.

METHODS

In this study, 172 consecutive patients with CLI (Fontaine levels III-IV) received cilostazol treatment after successful endovascular intervention according to the angiosome concept, and their primary patency rates and cardiovascular and amputation events during a 24-month follow-up period were assessed.

RESULT

The 24-month primary patency rate, mortality rate, and amputation rate were better in the patients under long-term cilostazol treatment (P < 0.001, P = 0.029, and P = 0.014). Weighted multivariate Cox analyses with a propensity scoring-based method showed that long-term cilostazol treatment [hazard ratio (HR) 0.2, 95% confidence interval (CI) 0.11-0.36, P < 0.001], direct revascularization (DR) (HR 0.46, 95% CI 0.28-0.74, P = 0.002), and supervised exercise (HR 0.4, 95% CI 0.24-0.66, P < 0.001) were independently associated with primary patency. Patients with lower-extremity amputation (LEA) had a higher risk of coronary artery disease (CAD) and mortality. Cellulitis and neuropathy were independently associated with LEA events (cellulitis: HR 2.89, 95% CI 1.66-5.05, P < 0.001; neuropathy: HR 2.2, 95% CI 1.31-3.7, P = 0.003).

CONCLUSION

Our results showed that patients with DM who received cilostazol treatment for more than 3 months had significantly better outcomes and decreased amputation and mortality rates after DR, and cellulitis and neuropathy were highly associated with the risk of limb loss. A large-scale randomized trial should be conducted in the future to confirm these results.

TRIAL REGISTRATION

Taipei Veterans General Hospital (TVGH) IRB no. 2013-08-020B. Registered 30 August 2013.

Simplified quantification of 13N-ammonia PET myocardial blood flow: A comparative study with the standard compartment model to facilitate clinical use

BACKGROUND

Short imaging protocol to quantify myocardial blood flow (MBF) and myocardial flow reserve (MFR) may enhance the clinical application of 13N-ammonia cardiac PET. We assessed the flow quantitation of 13N-ammonia PET implementing simple retention model and two-compartment model.

METHODS

Fourteen healthy volunteers (HVT) and twenty-three clinical patients received 13N-ammonia PET/CT. The simple retention model used the first 7-minute image to quantify MBF. Global and regional MBF and MFR of the two models were compared.

RESULTS

Global and regional MBF and MFR of these two models were highly correlated with mildly inferior correlation in RCA territory (global R2: rest MBF = 0.79, stress MBF = 0.65, MFR = 0.77; regional R2: rest MBF ≥ 0.72, stress MBF ≥ 0.52, MFR ≥ 0.68). There were significant differences for MFR (4.04 ± 0.72, 3.66 ± 0.48, p = .02) and rest MBF (0.69 ± 0.12, 0.78 ± 0.12, p = .02) between the two models in the HVT group.

CONCLUSIONS

13N-ammonia global and regional MBF and MFR from the simple retention model demonstrate strong correlations with that from the two-compartment model. Significant differences of MFR and rest MBF are noted in the HVT group, with a proposed normal reference value for the 13N-ammonia short simple retention protocol.

Risk of nosocomial transmission of coronavirus disease 2019: an experience in a general ward setting in Hong Kong

BACKGROUND

Coronavirus disease 2019 (COVID-19) was first reported in Wuhan in December 2019 and has rapidly spread across different cities within and outside China. Hong Kong started to prepare for COVID-19 on 31st December 2019 and infection control measures in public hospitals were tightened to limit nosocomial transmission within healthcare facilities. However, the recommendations on the transmission-based precautions required for COVID-19 in hospital settings vary from droplet and contact precautions, to contact and airborne precautions with placement of patients in airborne infection isolation rooms.

AIM

To describe an outbreak investigation of a patient with COVID-19 who was nursed in an open cubicle of a general ward before the diagnosis was made.

METHOD

Contacts were identified and risk categorized as 'close' or 'casual' for decisions on quarantine and/or medical surveillance. Respiratory specimens were collected from contacts who developed fever, and/or respiratory symptoms during the surveillance period and were tested for SARS-CoV-2.

FINDINGS

A total of 71 staff and 49 patients were identified from contact tracing, seven staff and 10 patients fulfilled the criteria of 'close contact'. At the end of 28-day surveillance, 76 tests were performed on 52 contacts and all were negative, including all patient close contacts and six of the seven staff close contacts. The remaining contacts were asymptomatic throughout the surveillance period.

CONCLUSION

Our findings suggest that SARS-CoV-2 is not spread by an airborne route, and nosocomial transmissions can be prevented through vigilant basic infection control measures, including wearing of surgical masks, hand and environmental hygiene.

Systemic immune-inflammation index (SII) predicted clinical outcome in patients with coronary artery disease

BACKGROUND

This study examines the predictive value of a novel systemic immune-inflammation index (SII, platelet × neutrophil/lymphocyte ratio) in coronary artery disease (CAD) patients.

METHODS

A total of 5602 CAD patients who had undergone a percutaneous coronary intervention (PCI) were enrolled. They were divided into two groups by baseline SII score (high SII vs low SII) to analyse the relationship between SII groups and the long-term outcome. The primary outcomes were major cardiovascular events (MACE) which includes nonfatal myocardial infarction (MI), nonfatal stroke and cardiac death. Secondary outcomes included a composite of MACE and hospitalization for congestive heart failure.

RESULTS

An optimal SII cut-off point of 694.3 × 10⁹ was identified for MACE in the CAD training cohort (n = 373) and then verified in the second larger CAD cohort (n = 5602). Univariate and multivariate analyses showed that a higher SII score (≥694.3) was independently associated with increased risk of developing cardiac death (HR: 2.02; 95% CI: 1.43-2.86), nonfatal MI (HR: 1.42; 95% CI: 1.09-1.85), nonfatal stroke (HR: 1.96; 95% CI: 1.28-2.99), MACE (HR: 1.65; 95% CI: 1.36-2.01) and total major events (HR: 1.53; 95% CI: 1.32-1.77). In addition, the SII significantly improved risk stratification of MI, cardiac death, heart failure, MACE and total major events than conventional risk factors in CAD patients by the significant increase in the C-index (P < .001) and reclassification risk categories by significant NRI (P < .05) and IDI (P < .05).

CONCLUSIONS

SII had a better prediction of major cardiovascular events than traditional risk factors in CAD patients after coronary intervention.

Associated factors and impacts of sedentary behaviour in patients with heart failure: A longitudinal study

BACKGROUND

Sedentary behaviours may be related to factors such as self-efficacy, mood and social support. However, there is a paucity of longitudinal follow-up studies examining factors related to sedentary behaviour from physical-psychosocial perspectives in patients with heart failure.

AIMS

The purpose of this study was to explore the multidimensional associated factors and impacts of sedentary behaviour in heart failure patients.

METHODS

A longitudinal design was used. A convenience sample of 128 heart failure patients recruited from two large medical centres in northern Taiwan was obtained. Patients were interviewed with structured questionnaires to assess physical activity, symptom distress, exercise self-efficacy, anxiety and depression, social support, sleep quality and quality of life before discharge and at 3 and 6 months after discharge.

RESULTS

Heart failure patients reported low physical activity and tended to be sedentary. Sedentary behaviour was gradually reduced from hospitalization to 6 months after discharge. Sleep quality, quality of life, analgesic use, symptom distress and exercise self-efficacy were significant associated factors that explained 42.1-51% of the variance in sedentary behaviour. Patients with high sedentary behaviour had significantly greater depression and poorer sleep and quality of life than those with low sedentary behaviour at hospitalization and showed a significant improvement in depression at 3 and 6 months after discharge.

CONCLUSION

Sedentary behaviour is common in heart failure patients and has impacts on depression and quality of life. An appropriate physical activity programme focusing on disease self-management and enhancing self-efficacy is needed for heart failure patients to improve their sedentary behaviour and quality of life.

Association of variability in uric acid and future clinical outcomes of patient with coronary artery disease undergoing percutaneous coronary intervention

BACKGROUND AND AIMS

Hyperuricemia is independently associated with cardiovascular disease (CVD) and is considered to be one of the major risk factors for CVD. However, the impact of inter-visit uric acid (UA) variability on cardiovascular risk remains undetermined.

METHODS

We enrolled 3202 patients with coronary artery disease (CAD), who received successful coronary intervention, in a cohort from Taipei Veterans General Hospital from 2006 to 2015. All post-baseline visits UA measurements using standard deviation (SD) were analyzed to correlate with long-term outcome. The primary outcome was the composite of cardiac death, nonfatal MI, nonfatal stroke (MACE). The secondary event was MACE and hospitalization for heart failure.

RESULTS

During an average 65.06 ± 32.1-month follow-up, there were 66 cardiovascular deaths, 175 nonfatal myocardial infarctions, 64 nonfatal strokes, 287 hospitalizations for heart failure, and 683 revascularization procedures. There was a linear association between high UA SD and future adverse events. Compared to the lowest quartile SD, subjects in the highest quartile SD had a higher risk of MACE (HR: 2.53, 95% CI: 1.78-3.59), myocardial infarction (HR: 2.43, 95% CI: 1.53-3.86), cardiovascular death (HR: 6.45, 95% CI: 2.52-16.55), heart failure-related hospitalization (HR: 3.43, 95% CI: 2.32-5.05), and total major CV events (HR: 2.72, 95% CI: 2.09-3.56). Furthermore, compared to the average achieved on-treatment UA value, increasing UA SD had a stronger association of higher risk of developing MACE (HR: 1.51, 95% CI: 1.36-1.68), myocardial infarction (HR: 1.37, 95% CI: 1.38-1.68), ischemic stroke (HR: 1.43, 95% CI: 1.13-1.82), CV death (HR: 1.77, 95% CI: 1.50-2.11), HF (HR: 1.43, 95% CI: 1.29-1.58), and total major CV events (HR: 1.46, 95% CI: 1.34-1.58).

CONCLUSIONS

High UA variability is associated with a higher risk of developing future cardiovascular events, suggesting the importance of maintaining stable serum UA levels and avoiding large fluctuations in CAD patients after percutaneous coronary intervention (PCI).

Activation of heme oxygenase-1 by Ginkgo biloba extract differentially modulates endothelial and smooth muscle-like progenitor cells for vascular repair

Vascular progenitors such as endothelial progenitor cells (EPCs) and smooth muscle-like progenitor cells (SMPCs) may play different roles in vascular repair. Ginkgo biloba extract (GBE) is an exogenous activator of heme oxygenase (HO)-1, which has been suggested to improve vascular repair; however, the detailed mechanisms have yet to be elucidated. This study aimed to investigate whether GBE can modulate different vascular progenitor cells by activating HO-1 for vascular repair. A bone marrow transplantation mouse model was used to evaluate the in vivo effects of GBE treatment on wire-injury induced neointimal hyperplasia, which is representative of impaired vascular repair. On day 14 of GBE treatment, the mice were subjected to wire injury of the femoral artery to identify vascular reendothelialization. Compared to the mice without treatment, neointimal hyperplasia was reduced in the mice that received GBE treatment for 28 days in a dose-dependent manner. Furthermore, GBE treatment increased bone marrow-derived EPCs, accelerated endothelial recovery, and reduced the number of SMPCs attached to vascular injury sites. The effects of GBE treatment on neointimal hyperplasia could be abolished by co-treatment with zinc protoporphyrin IX, an HO-1 inhibitor, suggesting the in vivo role of HO-1. In this in vitro study, treatment with GBE activated human early and late EPCs and suppressed SMPC migration. These effects were abolished by HO-1 siRNA and an HO-1 inhibitor. Furthermore, GBE induced the expression of HO-1 by activating PI3K/Akt/eNOS signaling in human late EPCs and via p38 pathways in SMPCs, suggesting that GBE can induce HO-1 in vitro through different molecular mechanisms in different vascular progenitor cells. Accordingly, GBE could activate early and late EPCs, suppress the migration of SMPCs, and improve in vivo vascular repair after mechanical injury by activating HO-1, suggesting the potential role of pharmacological HO-1 activators, such as GBE, for vascular protection in atherosclerotic diseases.

Analysis of Late Positive Component of Event-related Potentials by Face Expression Images in Traumatic Brain Injury Patients with Mood Disorders

OBJECTIVES

To explore the application of event-related potentials （ERP） by positive, negative, and neutral face expression images in the evaluation of mood disorders in brain traumatic patients.

METHODS

ERP was tested by face expression images in 24 patients mainly with anxiety and depression symptoms （depression group） and 19 patients mainly with hostile and suspicion symptoms （hostile group）, respectively. The findings were compared with those of the control group.

RESULTS

There were no significant differences, between the depression group and the hostile group, on latencies and amplitudes of late positive potential （LPP） induced by the three types of face expression images, except the amplitude induced by negative face expression image. Compared with the control group, the latencies were extended and the amplitudes were lower in both depression and hostile groups. Within each group, the difference of latencies induced by the three images was not significant. The amplitudes induced by negative face expression image was higher than those induced by positive and neutral face expression images, with significant differences in the hostile group and the control group （P<0.05） but not in the depression group.

CONCLUSIONS

Changes in latencies and amplitudes of LPP could be an objective indicator in the evaluation of mood disorders of brain traumatic patients. The LPP induced by negative face expression images could be more meaningful for patients mainly with anxiety and depression symptoms.

Phorbol ester-induced angiogenesis of endothelial progenitor cells: The role of NADPH oxidase-mediated, redox-related matrix metalloproteinase pathways

Endothelial progenitor cells (EPCs) may contribute to ischemia-induced angiogenesis in atherosclerotic diseases. The protein kinase C (PKC) family is involved in the regulation of angiogenesis, however the role of PKCα in EPCs during angiogenesis is unclear. The aim of this study was to evaluate the role of PKCα in EPCs during angiogenesis. Phorbol-12-myristate-13-acetate (PMA), a PKCα activator, significantly increased the activity and expression of matrix metalloproteinases (MMP) -2 and -9 in human (late outgrowth) EPCs in vitro. The MMPs promoted the migratory function and vascular formation of EPCs, which then contributed to neovascularization in a mouse hindlimb-ischemia model. Reactive oxygen species derived from nicotinamide adenine dinucleotide phosphate (NADPH) oxidase enhanced the expression of MMPs to increase the bioactivity of EPCs during angiogenesis. The mitogen-activated protein kinase (MAPK) signal pathway was associated with the activation of NADPH oxidase. PMA extensively activated the extracellular signal–regulated kinase (Erk) signal pathway to increase the expression of MMP-9. PMA also activated the p38, Erk, and c-Jun N-terminal kinase signal pathways to increase the expression of MMP-2. PMA-stimulated EPCs enhanced neovascularization in a mouse model of hindlimb ischemia via nuclear factor-κB translocation to up-regulation of the expression of MMP-2 and MMP-9. PMA could activate PKCα and promote the angiogenesis capacity of human EPCs via NADPH oxidase-mediated, redox-related, MMP-2 and MMP-9 pathways. The PKCα-activated, NADPH oxidase-mediated, redox-related MMP pathways could contribute to the function of human EPCs for ischemia-induced neovascularization, which may provide novel insights into the potential modification of EPCs for therapeutic angiogenesis.

Ascites Volumes and the Ovarian Cancer Microenvironment

Epithelial ovarian cancer is the leading cause of death from gynecologic malignancy among women in developed countries. Epithelial ovarian cancer has a poor prognosis, due to the aggressive characteristics of the disease combined with the lack of effective therapies. Options for late-stage ovarian cancer are limited and invasive, especially once malignant ascites develops. Malignant ascites, a complication observed in terminal ovarian cancer, significantly contributes to poor quality of life and to mortality. Excess accumulation of fluid in the peritoneal cavity occurs due to a combination of impaired fluid drainage and increased net filtration, mostly due to increasing intraperitoneal vascular permeability. Here we applied non-invasive magnetic resonance imaging (MRI) and spectroscopic imaging (MRSI) of syngeneic mouse tumors in vivo, and high-resolution ¹H MRS of mouse tumor extracts, to characterize the relationship between ascites volumes and the vasculature and metabolism of an experimental model of ovarian cancer. Differences were observed in the tumor vasculature and metabolism in tumors based on ascites volumes that provide new insights into the development of this condition.

Tocilizumab, a Humanized Monoclonal Antibody Against the Interleukin-6 Receptor, Inhibits High Glucose-Induced Vascular Smooth Muscle Cell Migration Through Mitogen-Activated Protein Kinase Signaling Pathways

Rheumatoid arthritis (RA) with diabetes increases the risk of cardiovascular diseases. Interleukin-6 (IL-6) promotes the disease activity of RA and insulin resistance. This study aimed to evaluate the potential effects and molecular mechanisms of IL-6 blocker, tocilizumab, in atherosclerosis with diabetes. Human aortic smooth muscle cells (HASMCs) cultured under hyperglycemic conditions were evaluated for migration, expression of adhesion molecules, and matrix metalloproteinases before and after treatment with tocilizumab. High glucose (HG) significantly increased expression of IL-6, intercellular adhesion molecule (ICAM-1), matrix metalloproteinase-2 & 9, and migration of vascular smooth muscle cells. Tocilizumab suppressed HG-induced expression of ICAM-1, MMP-2, and MMP-9. Pretreatment with tocilizumab also inhibited migration, MAPK signaling, and nuclear translocation of p65-NF-κB in HG-stimulated HASMCs. Our data suggested that tocilizumab may exert an antiatherosclerotic activity in diabetes.

[Analysis of prevalence and related factors of osteoporosis in retired population based on Dongfeng-Tongji Cohort]

Objective: To investigate the prevalence and related factors of osteoporosis among retired population in Dongfeng-Tongji cohort. Methods: 27 009 retired participants were recruited from Dongfeng Motor Corporation in Hubei Province in 2008 and followed up from April to October in 2013. newly retired participants also were recruited. Data were collected by using questionnaire, physical examination, serum hepatase detection and bone densitometry. Totally, 30 916 participants were included for data analysis after excluding participants with severe bone metabolic diseases, taking hormone drugs, incomplete follow-up data and who were under 45 years old. Age-standardized prevalence of osteoporosis was calculated according to data of the 2010 Sixth National Population Census. Multivariate logistic regression analysis was applied to explore the associated factors of osteoporosis. Results: Prevalence of osteoporosis was 42.3% (13 083/30 916) and age standardized prevalence was 40.7%: 35.0% (4 854/13 878) and 34.8% for males; 48.3% (8 229/17 038) and 47.1% for females. Significantly associated factors with osteoporosis for both males and females included: older age (male: OR=1.67, 95%CI: 1.40-1.99; female:OR=3.34, 95%CI: 2.70-4.13), lower BMI (male: OR=1.70, 95%CI: 1.40-2.06; female: OR=1.27, 95%CI: 1.04-1.53), exercise (male: OR=0.69, 95%CI: 0.61-0.78; female: OR=0.87, 95%CI: 0.80-0.96), abnormal elevated serum alkaline phosphatase (ALP) (male: OR=1.12, 95%CI: 1.01-1.24; female: OR=1.15, 95%CI: 1.06-1.25), γ-glutamyltransferase (γ-GT) (male: OR=1.16, 95%CI: 1.02-1.30; female: OR=1.13, 95%CI: 1.03-1.24) and aspartate transaminase/alanine aminotransferase (AST/ALT) (male: OR=1.15, 95%CI: 1.05-1.25; female: OR=1.28, 95%CI: 1.19-1.38). Smoking (OR=1.27, 95%CI: 1.07-1.39) and drinking (OR=1.11, 95%CI: 1.08-1.16) were associated factors for males while menopausal (OR=1.67, 95%CI: 1.47-1.89) for females. There were positive dose-response correlation relationships of serum levels of ALP, γ-GT and AST/ALT with osteoporosis (all P values<0.05). Conclusion: Osteoporosis was relatively common among retired population in Dongfeng-Tongji cohort. In addition to known factors such as older age, lower BMI and exercise, abnormal elevated serum ALP, γ-GT and AST/ALT were also associated with osteoporosis.

[Association of alcohol use and incidence of type 2 diabetes mellitus in the middle-aged and elderly male population: a prospective cohort study]

Objective: To investigate the association between alcohol use and incidence of type 2 diabetes mellitus (T2DM) in the middle-aged and elderly male population. Methods: All participants were from Dongfeng-Tongji cohort, 27 009 retired employees from Dongfeng Motor Corporation in Hubei Province were enrolled in the Dongfeng-Tongji cohort baseline survey in 2008. In baseline study, information of alcohol use and other covariates were collected by semi-structured questionnaire and all participants completed physical examination including the test of fasting glucose and blood lipid levels. A total of 6 784 male participants from Dongfeng-Tongji cohort who were without diagnosis of diabetes, coronary heart disease, stroke, or cancer in baseline study were enrolled in this study. We completed the first follow-up in 2013 and the outcome of disease or death was retrieved based on health-care medical records according to the unique medical insurance ID. Cox proportional hazard regression model was used to estimate the association between alcohol use and incidence of type 2 diabetes mellitus (T2DM), by drinking features and patterns. Results: Out of the 6 784 participants, 3 541 participant were defined as non-alcohol drinkers and there were 15 852.2 person-years of follow-up; among which 270 new cases of T2DM were diagnosed withthe crude incidence density of non-alcohol drinkers at 1 703.2/100 000 person-years. The other 3 243 subjects were classified as alcohol drinkers and there were 14 509.8 person-years of follow-up; and among which 258 new cases of T2DM were diagnosed, with the crude incidence density of T2DM at 1 778.1/100 000 person-years. Multivariate COX proportional hazard regression model indicated that there was no significantly increased risk of T2DM incidence between alcohol drinkers and non-alcohol drinkers(HR(95% CI): 1.09 (0.91- 1.30)). However, participants who averagely consumed >20 g/d or>7 times/week had a significantly increased risk of T2DM compared with non-alcohol drinkers, and the value of HR(95%CI) was 1.27 (1.02- 1.58) and 1.35 (1.00- 1.83), respectively. Among men who consumed alcoholic beverages more than 7 times/week, HR (95%CI) for T2DM incidence in the subjects who consumed 0.01 to 40 g and > 40 g once a time were 1.48 (1.05- 2.09) and 1.27 (0.80- 2.10), respectively. Conclusion: Although we found no relationship between alcohol use and T2DM incidence overall, alcohol use more than 20 g/d or more than 7 times/week would increase the risk of T2DM.

Metabolomic characterization of experimental ovarian cancer ascitic fluid

INTRODUCTION

Malignant ascites (MA) is a major cause of morbidity that occurs in 37% of ovarian cancer patients. The accumulation of MA in the peritoneal cavity due to cancer results in debilitating symptoms and extremely poor quality of life. There is an urgent unmet need to expand the understanding of MA to design effective treatment strategies, and to improve MA diagnosis.

OBJECTIVE

Our purpose here is to contribute to a better characterization of MA metabolic composition in ovarian cancer.

METHOD

We determined the metabolic composition of ascitic fluids resulting from orthotopic growth of two ovarian cancer cell lines, the mouse ID8-vascular endothelial growth factor (VEGF)-Defb29 cell line and the human OVCAR3 cell line using high-resolution ¹H MRS. ID8-VEGF-Defb29 tumors induce large volumes of ascites, while OVCAR3 tumors induce ascites less frequently and at smaller volumes. To better understand the factors driving the metabolic composition of the fluid, we characterized the metabolism of these ovarian cancer cells in culture by analyzing cell lysates and conditioned culture media with ¹H NMR.

RESULTS

Distinct metabolite patterns were detected in ascitic fluid collected from OVCAR3 and ID8-VEGF-Defb29 tumor bearing mice that were not reflected in the corresponding cell culture or conditioned medium.

CONCLUSION

High-resolution ¹H NMR metabolic markers of MA can be used to improve characterization and diagnosis of MA. Metabolic characterization of MA can provide new insights into how MA fluid supports cancer cell growth and resistance to treatment, and has the potential to identify metabolic targeting strategies to reduce or eliminate the formation of MA.

Risks for Staphylococcus aureus colonization in patients with psoriasis: a systematic review and meta-analysis

Evidence on whether patients with psoriasis have a higher risk for staphylococcal colonization than healthy controls remains controversial. To synthesize the current literature, we performed a systematic review on the prevalence and relative risk (RR) of Staphylococcus aureus colonization in patients with psoriasis. We modified the QUADAS-2 instrument to assess the reporting quality of individual studies and applied random-effects models in meta-analysis. Overall we identified 21 eligible studies, of which 15 enrolled one or more comparison groups. The pooled prevalence of staphylococcal colonization in patients with psoriasis was 35·3% [95% confidence interval (CI) 25·0-45·6] on lesional skin and 39·2% (95% CI 33·7-44·8) in the nares. Patients with psoriasis were 4·5 times more likely to be colonized by S. aureus than healthy controls were on the skin (RR 5·54, 95% CI 3·21-9·57) and 60% more in the nares (RR 1·60, 95% CI 1·11-2·32). Cutaneous and nasal colonization by meticillin-resistant S. aureus also appeared higher in patients with psoriasis (pooled prevalence 8·6%) than in healthy controls (2·6%), yet the difference was not statistically significant (P = 0·74). In contrast, despite of a similar risk for nasal staphylococcal colonization (RR 0·67, 95% CI 0·38-1·18), patients with psoriasis were less likely to carry S. aureus on lesional skin than atopic patients (RR 0·64, 95% CI 0·40-1·02). In summarizing the current literature, we found that patients with psoriasis were at an increased risk for staphylococcal colonization compared with healthy individuals. Prospective studies on how bacterial loads correlate with disease activity can guide the clinical management of bacterial colonization while preventing the emergence of drug-resistant strains.

HDAC1 Upregulation by NANOG Promotes Multidrug Resistance and a Stem-like Phenotype in Immune Edited Tumor Cells

Cancer immunoediting drives the adaptation of tumor cells to host immune surveillance. Immunoediting driven by antigen (Ag)-specific T cells enriches NANOG expression in tumor cells, resulting in a stem-like phenotype and immune resistance. Here, we identify HDAC1 as a key mediator of the NANOG-associated phenotype. NANOG upregulated HDAC1 through promoter occupancy, thereby decreasing histone H3 acetylation on K14 and K27. NANOG-dependent, HDAC1-driven epigenetic silencing of cell-cycle inhibitors CDKN2D and CDKN1B induced stem-like features. Silencing of TRIM17 and NOXA induced immune and drug resistance in tumor cells by increasing antiapoptotic MCL1. Importantly, HDAC inhibition synergized with Ag-specific adoptive T-cell therapy to control immune refractory cancers. Our results reveal that NANOG influences the epigenetic state of tumor cells via HDAC1, and they encourage a rational application of epigenetic modulators and immunotherapy in treatment of NANOG⁺ refractory cancer types. Cancer Res; 77(18); 5039-53. ©2017 AACR.

Abstract 2505: High-resolution MRS characterization of malignant ascites in two models of ovarian cancer

Build-up of malignant ascites occurs in more than one third of ovarian cancer patients and significantly contributes to poor quality of life and mortality. Advances in understanding malignant ascites formation and finding new therapeutic options are urgently needed. High-resolution 1H MRS has been described as extremely useful in detecting endogenous metabolites to diagnose cancer, by providing a detailed overview of metabolic pathways in a single measurement. In the present study, we are using two ovarian cancer cell lines, the murine ID8-VEGF-Defb29 cell line and the human OVCAR3 cell line. Implanted orthotopically, these two ovarian cancer models are characterized by different profile of ascites formation. The mouse cell line ID8-VEGF-Defb29 induces large volumes of ascites, often more than 10 mL, while the human OVCAR3 cell line induces ascites less frequently and at smaller volumes, usually less than 0.2 mL. We applied high-resolution 1H MRS to compare the metabolic composition of both ascitic fluids. To better understand the differences observed, we characterized the metabolism of these ovarian cancer cells in culture by analyzing cell lysates and conditioned culture media with 1H MRS to advance our understanding of cancer cell metabolic reprogramming in malignant ascites formation and the role of the tumor microenvironment in ascites formation and composition. The two tumor models used in this study induced different ascitic profiles. While OVCAR3 tumor bearing mice developed small viscous volume of ascites, ID8-VEGF-Defb29 induced higher volumes. ID8-VEGF-Defb29 ascitic fluids were characterized by higher levels of glutamine, glucose, poly-unsaturated fatty acids and pyruvate compared to the OVCAR3 fluids, while all the other metabolites, including glutamate, lactate, myo-inositol, choline and acetate, were lower. To determine if the differences observed in the ascitic fluids were only due to a different metabolism of the cancer cells, we investigated their metabolism in vitro. We analyzed the metabolites present in the conditioned cell culture media, and in the cells, and observed differences in OVCAR3 and ID8-VEGF-Defb29 cells metabolism in vitro, without replicating the differences observed in vitro. A Venn diagram of the different metabolites present in the cells, media and ascites showed differences in the metabolites present in those 3 compartments, and highlighted the ones in common. Beta-hydroxybutyrate, lipids, maleic and citrate were found in both ascites, and not in the cells or media. Ascites MRS derived biomarkers could help in ovarian cancer diagnosis, and enhance our understanding of the biochemical and metabolic changes associated with ovarian cancer, and with ascites formation.

Supported by Tina’s Wish Foundation, NIH P50CA013175 and P30CA06973.

Citation Format: Santosh Bharti, Flonne Wildes, Chien-Fu Hung, TC Wu, Zaver Bhujwalla, Marie-France Penet. High-resolution MRS characterization of malignant ascites in two models of ovarian cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 2505. doi:10.1158/1538-7445.AM2017-2505

[DNA damage associated genetic variants contribute to lung cancer susceptibility in a Han Chinese population]

OBJECTIVE

To explore the association between DNA damage-related genetic variants and lung cancer susceptibility in a Han Chinese population.

METHODS

This case-control study enrolled patients from the Cancer Hospital of Jiangsu Province and Jiangsu Province Hospital from 2003 to 2009. Controls were randomly selected from individuals who visited the same hospital or a community-based health examination program during the same time period. A 5 ml venous blood sample was obtained from each participant and epidemiological information was collected on a standard questionnaire. Illumina Infinium(®) BeadChip was used for genotyping of 35 DNA damage-related single nucleotide variations (SNVs), which were identified in our previous study. Multivariate and binary logistic regressions were used to calculate the OR and 95%CI for lung cancer risk. HaploReg V4.1 and Regulome DB were used to understand functional annotation on important SNV.

RESULTS

The distributions of age (61.06±10.15) vs. (61.32±11.07) years; t=-0.72, P=0.473) and sex (χ(2)=1.81, P=0.179) were similar between cases and controls. However, the case group had a higher frequency of smokers (61.08% vs. 48.54%; χ(2)=50.04, P<0.001) and heavy smokers (42.28% vs. 24.07%; χ(2)=122.32, P<0.001). Among the 34 SNVs that passed quality control, two SNVs were significantly associated with lung cancer risk after adjustments for age, sex and cumulative smoking dose: rs9267576 C>A (CA genotype/CC genotype, OR=1.56, 95% CI: 1.01-2.40) and rs3130683 A>G (AG genotype/AA genotype, OR=1.87, 95%CI: 1.13-3.09). After step-wise logistic regression analysis, only the rs3130683 SNV was retained in the model, indicating that the association between rs9267576 and lung cancer may be due to the effect of rs3130683. Functional annotation indicated that rs3130683 was located in the promoter and enhancer regions, and was an expression quantitative trait loci of HLA. The Cancer Genome Atlas indicated that expression of HLA-C, DQB1, DRB1 and DRB5 in lung cancer tissue was significantly lower than in paired normal tumor-adjacent tissue, with down-regulation of the four respective genes in 81.3%, 88.8%, 90.7% and 90.7% of lung cancer tissues (P-values were 6.68×10(-15), 2.21×10(-13), 2.20×10(-16), 2.58×10(-13), respectively).

CONCLUSIONS

The SNV rs3130683 (A>G) was associated with the risk of lung cancer in a Han Chinese population. This SNV may affect the risk of lung cancer by regulating HLA expression.

Increased risk of ventricular tachycardia and cardiovascular death in patients with myocarditis during the long-term follow-up: A national representative cohort from the National Health Insurance Research Database

The incidence of acute myocarditis complicated with ventricular tachycardia (VT) is unknown. This study aimed to investigate the association between myocarditis and the incidence of VT and mortality. We also aimed to determine the independent predictors that increased the VT risk in those patients. From 2000 to 2004, 13,250 patients with a history of myocarditis were identified from the Taiwan National Health Insurance Research Database. The same number of individuals without heart disease with a matched sex and underlying diseases were selected as the control group. The long-term risks of life-threatening ventricular arrhythmias and mortality in patients with a history of myocarditis were investigated by an adjusted Cox proportional hazards regression. After a mean follow-up of 10.4 ± 2.94 years (interquartile range: 12, 10.19-12), the myocarditis patients showed a higher incidence of new onset VT events compared with healthy controls (5.4% [519 per 100,000 person-year] in the myocarditis group vs, 0.47% [43 per 100,000 person-year] in the healthy controls; adjusted hazard ratio [HR]: 16.1, 95% confidence interval [CI]: 12.4-20.9; P < .001). A higher incidence of cardiovascular death was noted in the myocarditis group than healthy controls (6.52% vs 3.18%; HR: 2.42, 95% CI: 2.14-2.73; P < .001) after adjusting for the multivariate confounders including sex, age, underlying comorbidities, and medications. The results of this study suggested that there was higher incidence of life-threatening VT and mortality during the very long-term follow-up in patients with a history of myocarditis. Future work should focus on an in-depth risk stratification of VT in myocarditis patients.