Effect of different doses of ketamine with low-dose rocuronium on intubation conditions in children: prospective randomized double blind trial

OBJECTIVE

The effect of ketamine on intubation condition, when used as an induction agent with low-dose rocuronium, is unknown. This study aimed to compare the effects of three doses of ketamine used with 0.3 mg/kg rocuronium and 1 µg/kg fentanyl on intubation conditions in children undergoing short elective surgery.

PATIENTS AND METHODS

The study was performed as a prospective, randomized double-blind clinical trial. A total of 60 children aged 2 to 12 years, who were scheduled for inguinal herniorrhaphy under general anesthesia, were randomly allocated into three groups on the basis of ketamine dose: 1 mg/kg (Group K1, n = 20), 1.5 mg/kg (Group K1.5, n = 20), and 2 mg/kg (Group K2, n = 20). The primary outcome was the intubation condition. Other assessments included hemodynamic data, recovery profile, adverse events in the postanesthetic care unit (PACU) and use of fentanyl as a rescue analgesic in the PACU were also assessed.

RESULTS

The occurrence of a clinically acceptable intubation condition increased with the use of an increased dose (≥ 1.5 mg/kg) (K1/K1.5/K2: 30%/65%/65%; p=0.038, for trends p=0.028). Hemodynamic data, recovery profile and adverse events in PACU showed no difference among groups. Fentanyl dose used in the PACU was higher in K1 than K2 and the number of patients requiring rescue analgesics in the PACU decreased in accordance with the dose of ketamine (K1/K1.5/K2: 30%/15%/0%; p=.031, for trends p=0.013).

CONCLUSIONS

Different intubation conditions were observed on the basis of ketamine dose used in conjunction with 0.3 mg/kg rocuronium and fentanyl 1 µg/kg. Ketamine dose ≥ 1.5 mg/kg with low-dose rocuronium should be used to improve intubation conditions in pediatrics.

Abstract OT3-04-04: A randomized phase II study of pembrolizumab in combination with carboplatin versus carboplatin alone in breast cancer patients with chest wall disease, with immunologic and genomic correlative studies

Background: Thirty percent of patients with breast cancer may experience chest wall recurrence, which is associated with a higher risk of developing distant metastases and a poor prognosis. Cancer cells may evade immune rejection through the programmed cell death 1 (PD-1) pathway. Pembrolizumab, an anti-PD-1 antibody, binds PD-1 and inhibits its interaction with the programmed death ligand 1 (PD-L1) to facilitate tumor immune rejection. We hypothesize that pembrolizumab may be an effective therapy in chest wall recurrence, given the inflammatory nature, and the high expression of PD-1 in tumors with lymphovascular invasion. Platinum agents may enhance anti-tumor immunity in a synergistic manner, and the combination of pembrolizumab and carboplatin has demonstrated efficacy in advanced lung cancer. In this study, the combination of pembrolizumab and carboplatin is being evaluated in breast cancer patients with chest wall disease.

Methods: This is a randomized phase II study of breast cancer patients with advanced, unresectable breast cancer involving the chest wall, being conducted through the Translational Breast Cancer Research Consortium (TBCRC). Patients may have hormone resistant disease (at least 2 prior lines of hormone therapy), triple negative breast cancer, or refractory HER2+ disease for enrollment. They may have other sites of distant metastases, have received any number of prior lines of therapy, have had prior surgery, but prior chest wall radiation is not necessary. Eighty-four patients at 7 TBCRC sites will be randomized 2:1 to treatment with pembrolizumab 200 mg IV and carboplatin AUC 5 IV every 3 weeks followed by pembrolizumab 200 mg IV alone every 3 weeks (Arm A, n=56) or carboplatin AUC 5 IV every 3 weeks (Arm B, n=28), with an option for patients in Arm B to cross-over to single agent pembrolizumab 200 mg IV every 3 weeks (arm Bx) on progression. Patients will undergo imaging with CT chest, abdomen, and pelvis at baseline and every 2 cycles of treatment for response evaluation. The primary endpoint is the disease control rate in the chest wall and distant sites at 18 weeks of treatment, and this study is powered to determine a 20% difference in disease control rates between arms A and B (hazard ratio of 0.52, α= 0.10, β= 0.20). After 18 patients are enrolled into Arm B, an interim analysis for futility will be conducted to enable early closure of that arm for lack of efficacy. Secondary endpoints in the study are toxicity, progression free survival, and response based on PD-L1 expression and irRECIST. Exploratory endpoints, which will be studied using peripheral blood testing and chest wall tumor biopsies at baseline and after 2 cycles of treatment, include determining associations of response with changes in tumor and peripheral blood immune composition, soluble PD-L1 expression, circulating tumor cells, cell free DNA, and tumor PD-L1 and MYC genomic expression. Ultimately this study promises to improve our understanding of checkpoint inhibition and chemotherapy for chest wall disease, and the underlying mechanism of action. This study is open for enrollment and 2 patients are currently enrolled. (NCT03095352).

Citation Format: Vidula N, Goga A, Hwang J, Liu MC, Park BH, Nanda R, Pohlmann PR, Storniolo AM, Brufsky A, Abramson V, Rugo HS. A randomized phase II study of pembrolizumab in combination with carboplatin versus carboplatin alone in breast cancer patients with chest wall disease, with immunologic and genomic correlative studies [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT3-04-04.

Abstract WP546: Changes in Promoter Methylation in AIRE1 and ALOX12: Novel Epigenetic Markers in Atherosclerotic Tissues

Objective: The present study aimed to identify and validate specific genes developing changes in promoter methylation in atherosclerotic plaques.

Approach and Results: We initially comprehensively profiled DNA methylation signatures via Solexa sequencing, using amplicons prepared via methylated-CpG island amplification (MCA) in genomic DNA obtained from 5 plaques acquired through carotid endarterectomy (CEA) to identify genes with altered promoter methylation. The changes in promoter methylation of these genes were validated via bisulfite pyrosequencing from plaques and non-plaque intima of the common carotid artery (CCA) harvested from 20 cadavers as well as from 27 CEA plaques and 5 human umbilical vein endothelial cell (HUVEC) lines. Expression changes based on changes in promoter methylation in these genes were evaluated in 20 CEA plaques and in 2 HUVEC cell lines after demethylation with 5-aza-2'-deoxycytidine. Upon MCA-Solexa sequencing, five genes ( AIRE1 , ALOX12 , FANK1 , NETO1 , and SERHL2 ) displayed changes in promoter methylation. Of these, AIRE1 and ALOX12 displayed significantly greater promoter methylation in plaques rather than in the non-plaque intima of the CCA. Furthermore, promoter methylation was greater in AIRE1 in CEA plaques than in HUVECs, while that in ALOX12 was greater in HUVEC cells than in CEA plaques. Concurrently, gene expression levels decreased with an increase in promoter methylation in these genes in CEA plaques. After DNA demethylation in HUVEC cells, AIRE1 and ALOX12 expression levels increased by 23 and 52 folds.

Conclusions: Changes in promoter methylation in AIRE1 and ALOX12 were identified and validated in atherosclerotic plaques, thereby establishing novel epigenetic markers for atherosclerosis.

Abstract WP551: Senescence-Induced Methylation Changes in Global DNA and Atherosclerosis-Related Genes in Human Vascular Endothelial Cells

Background: Endothelial senescence has been known as a pathophysiological alteration related to atherosclerosis development. We investigated whether methylation changes in global DNA and atherosclerosis-related genes are developed in in-vitro senescence of human vascular endothelial cells.

Methods: We induced in-vitro replicative senescence by subculturing 5 human umbilical vein endothelial cell (HUVEC) lines from three to fifteen passages. Using DNA extracted from the 5th, 10th, and 15th passages of the 5 HUVECs, we evaluated LINE1 methylation for global methylation status as well as promoter methylation status for 5 genes ( AIRE1, ALOX12, FANK1, NETO1 , and SERHL2 ) profiled from carotid endarterectomy plaques for gene-specific methylation evaluations. Differences in LINE1 methylations and promoter methylations of the 5 genes were evaluated using pyrosequencing and compared among the 5th, 10th, and 15th passages of the 5 HUVECs using analysis of variance (ANOVA) tests.

Results: LINE1 global methylation subsequently decreased as passages were advanced from 5 to 15 (p<0.001). On gene-specific promoter methylation analysis, ALOX12 (p<0.001) and SERHL2 (p<0.001) showed significant passage-dependent increase of promoter methylation. AIRE1 and NETO1 also showed an increase of promoter methylation as passages increased, but without statistical significance. FANK1 exhibited an increase-decrease pattern of methylation changes showing an increase of methylation at passage 10 compared to passage 5, but showing a decrease in passage 15 (p=0.005).

Conclusion: After replicative senescence for vascular endothelial cells, global methylation subsequently decreased. However, atherosclerosis-related genes showed either a increase or an increase-decrease of promoter methylations. In particular, the increase of ALOX12 methylation showed as a possible epigenetic marker related to vascular endothelial cell senescence.

Abstract WP541: Profiling of Microrna From Atherosclerotic Tissues and Validation of Their Significance From Peripheral Blood of Ischemic Stroke Patients Having Atherosclerosis

Background and Objectives: To search circulating microRNAs related to atherosclerosis, we first performed a microRNA expression profiling using atherosclerotic plaques. Then, their expression significance was validated using the serum of stroke patients having severe atherosclerosis on cranial vessels.

Methods: We performed miRNA expressions from 10 carotid endarterectomy (CEA) plaques and 2 human umbilical vein endothelial cell (HUVEC) lines using a microRNA microarray kit (TaqMan® Array MicroRNA Cards, Applied Biosystems®, Life Technologies). The expression differences were compared using relative quantitation (RQ=2 -(miRNA expression -reference RNA expression) ) between the CEA plaques and the HUVECs following a criteria including over 4-fold-up or less than 0.25-fold-down regulations after log2 transformation of the expression difference. Among the microRNAs showing significant expression differences, target microRNAs were selected using an internal clustering validation measurement (Xie-Beni index). The expression of the target microRNAs was validated with the serum of 32 patients with severe atherosclerosis and that of 33 patients with no atherosclerosis in intra- and extra-cranial vessels.

Results: A total of 151 microRNAs were identified after the comparison of the microRNA expressions between CEA and HUVECs. Among them, eight miRNAs (miR199b, miR142-3p, miR145, miR145, miR204, miR9, miR370, miR23b, and miR363) were selected as the final target microRNAs after the clustering validation analysis. As for the validation experiments with the serum of the atherosclerosis and non-atherosclerosis patients, the RQ of miR142-3p (atherosclerosis, 3.79±7.57; no-atherosclerosis patients, 1.10±1.45, p=0.043), among the 8 target miRNAs, showed significant differences in the serum of patients with atherosclerosis.

Conclusion: The present study profiled miRNAs from CEA plaques and validated their significance within the serum of atherosclerosis patients. These findings suggest that miR142-3P could be a potential marker for atherosclerosis that is detectable from the circulating blood.

Influence of Glass Microsphere Filler on the Rheological Behavior of an Epoxy Resin

The rheological behavior of epoxy resin filled with glass hollow microspheres was studied using three types of microspheres with different particle size distributions. The shear-rate dependence on viscosity, as well as relative apparent viscosity, of the suspensions was investigated at different microsphere filler loadings. The change in relative viscosity with different types of microsphere loads was also investigated using the established semi empirical model to estimate the critical filler load. It was found that the critical filler load for all suspensions tested depends mostly on the filler size distribution, neither on the average filler size nor on the specific surface area of the filler.

Abstract OT1-02-03: TBCRC 044: A randomized phase II study of pembrolizumab in combination with carboplatin versus carboplatin alone in breast cancer patients with chest wall disease

Background: Patients with breast cancer (BC) and chest wall disease have limited treatment options. We hypothesize that checkpoint inhibition may be an effective treatment approach due to the inflammatory nature of chest wall infiltration, and the association of PD-1 expression with lymphocytic infiltration. Platinum chemotherapy may facilitate anti-tumor immunity in a synergistic manner, and clinical studies of the PD-1 inhibitor pembrolizumab with platinum combinations have been effective in the treatment of advanced lung cancer. In this study, we will evaluate the combination of carboplatin and pembrolizumab in BC patients with chest wall disease.

Methods: This is a randomized phase II multicenter study in the TBCRC including patients with advanced, unresectable BC with hormone resistant or triple negative chest wall disease. Patients may have had prior surgery, prior chest wall radiation is not required, and other sites of distant metastases are allowed. Eighty-four patients at TBCRC sites will be randomized 2:1 to receive pembrolizumab and carboplatin (n=56, Arm A) or carboplatin alone (n=28, Arm B) until disease progression. Patients randomized to Arm B may cross-over following progression to pembrolizumab alone (Arm Bx). Patients in Arm A will be treated with pembrolizumab 200 mg IV and carboplatin AUC 5 IV every 3 weeks for at least 6 cycles followed by maintenance pembrolizumab 200 mg IV every 3 weeks if stable or responding disease. Patients in Arm B will be treated with carboplatin AUC 5 IV every 3 weeks until progression, then may cross-over to pembrolizumab 200 mg IV every 3 weeks alone (Arm Bx). An interim analysis for futility will be performed after 18 patients are enrolled into Arm B to allow early closure of that arm for lack of efficacy. The primary endpoint is disease control rate at 18 weeks of treatment; the study is powered to detect a 20% difference in disease control rates between arms (hazard ratio 0.52, α= 0.10, β= 0.20). Secondary endpoints include progression free survival, toxicity, and response based on PD-L1 expression and irRECIST. Exploratory endpoints include association of response with a number of biomarkers including tumor PD-L1 gene expression, tumor and peripheral blood immune composition and cytokine expression, peripheral T-cell PD-1 expression, circulating tumor DNA, circulating tumor cells, and tumor MYC genomic expression using tumor biopsy and peripheral blood testing before and after treatment. This study should be open to accrual by August of 2017. (NCT03095352)

Citation Format: Vidula N, Goga A, Krummel M, Hwang J, Liu M, Park BH, Nanda R, Pohlmann P, Storniolo AM, Van Poznak C, Brufsky A, Abramson V, Wolff A, Rugo HS. TBCRC 044: A randomized phase II study of pembrolizumab in combination with carboplatin versus carboplatin alone in breast cancer patients with chest wall disease [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT1-02-03.

Abstract WMP73: Adck5, Mtnr1b And Kndc1 : Atherosclerosis-related Epigenetic Biomarkers Identified From Peripheral Leukocytes of Atherosclerotic Patients

Background and objectives: The present study initially profiled and identified gene-specific promoter methylation changes in peripheral leukocytes (WBC) of patients having severe atherosclerosis. Then, the gene-specific promoter methylation changes of WBC were validated in atherosclerotic plaques by comparison with normal intima.

Methods: We first profiled and identified specific genes showing promoter methylation differences between WBC of 8 patients having severe atherosclerosis and of other 8 patients having no-atherosclerosis in extra- and intra-cranial vessels using Digital Restriction Enzyme Analysis of Methylation (DREAM) sequencing. To select candidate CpG sites from DREAM sequencing data, we used criteria; located in -1,000 bp from transcription start sites, < or >5% of methylation differences between two groups, and <0.05 false positive rate. Significance of the gene-specific promoter methylation changes identified from WBC were validated from normal intima and atherosclerotic plaques obtained from common carotid artery of 20 human cadaveric donors (male, 13, age, 62.2±14.2 years).

Results: On DREAM sequencing, CpG sites located in promoter regions of ADCK5 (no-atherosclerosis, 67.57% vs. atherosclerosis patients, 55.18%), KNDC1 (67.08% vs. 56.81%), MTNR1B (11.5% vs. 3.8%) had over 5% of the methylation differences with <0.05 false positive rate. On validation experiments using human vascular tissues, all ADCK5 (normal intima, 4.02±1.02; plaque, 4.79±1.14, p< 0.05), KNDC1 (9.76±2.25 vs. 12.11±2.91, p< 0.05), MTNR1B (14.08±2.93 vs. 17.53±5.07, p< 0.05) showed significant higher promoter methylation in atherosclerotic plaques than normal intima.

Conclusion: The present study identified promoter methylation changes in ADCK5 , KNDC1 , and MTNR1B from WBC of atherosclerotic patients, and validated their significance in human atherosclerotic tissues. The three genes showed possibilities as epigenetic biomarkers for atherosclerosis, even though future validations are needed for their significance in atherosclerosis development.

Ionic cellulose-stabilized gold nanoparticles and their application in the catalytic reduction of 4-nitrophenol

A novel strategy for the synthesis of highly stable gold nanoparticles (GNPs) was designed by reducing HAuCl₄ with NaBH₄ in an aqueous solution of water-soluble ionic cellulose composed of dimethylimidazolium cations and phosphite-bound cellulose anions. NMR and UV-Vis analysis along with the measurement of the zeta potential suggest that the exceptionally high stability of GNPs originates from the strong interaction of GNPs with the phosphite groups of the ionic cellulose. The thus prepared GNPs exhibit excellent catalytic activity for the reduction of 4-nitrophenol to 4-aminophenol, a model hydrogenation reaction.

Gold nanoparticles (GNP) were highly stabilized by water soluble ionic cellulose by the strong interaction of GNP with the phosphite groups and showed extremely high catalytic activity for the reduction of 4-nitrophenol to 4-aminophenol.

The association between serum uric acid and asymptomatic intracranial arterial stenosis in middle-aged Koreans

BACKGROUND AND AIMS

Intracranial arterial stenosis (ICAS) is one of the most common causes of stroke, especially in Asians. Hyperuricemia has been associated with an increased risk of comorbidities such as metabolic syndrome or cardiovascular diseases. However, there are few studies focusing on the association between serum uric acid (SUA) levels and asymptomatic ICAS. The aim of this study was to explore the association between SUA and the prevalence of ICAS in middle-aged Korean health screening examinees.

METHODS AND RESULTS

A cross-sectional study was performed on 9417 males and 7755 females who underwent a comprehensive health examination including transcranial Doppler (TCD) ultrasonography. The association of SUA and ICAS was analyzed using multivariate logistic regression. The prevalence of ICAS among the total examinee population was 3.55%. In females, the multivariate-adjusted odds ratio for ICAS was 1.52 (confidence interval 1.13-2.04) in the 3rd quartile of SUA and 1.45 (1.05-2.00) in the highest quartile, compared to the reference (P for trend 0.008). This trend was evident in all clinically relevant subgroups evaluated, including women with low inflammation status. SUA was not significantly associated with the prevalence of ICAS among males. In a sensitivity analysis, the multivariate-adjusted odds ratio of middle cerebral artery stenosis in females was 1.60 (1.09-2.37) in the highest quartile compared to the reference (P for trend 0.023).

CONCLUSIONS

Higher SUA level was associated with increased risk of ICAS among middle-aged females but not males. A further cohort study is warranted to elucidate the effect of SUA on asymptomatic ICAS.

Antiviral activity of exopolysaccharides from Arthrospira platensis against koi herpesvirus

Although koi herpesvirus (KHV) has a history of causing severe economic losses in common carp and koi farms, there are still no treatments available on the market. Thus, the aim of this study was to test exopolysaccharides (EPS) for its antiviral activity against KHV, by monitoring inhibition and cytotoxic effects in common carp brain cells. These substances can be easily extracted from extracellular algae supernatant and were identified as groups of sulphated polysaccharides. In order to reach this aim, Arthrospira platensis, which is well known for its antiviral activity of intra- and extracellular compounds towards mammalian herpesviruses, was investigated as standard organism and compared to commercial antiviral drug, ganciclovir, which inhibits the viral DNA polymerization. The antiviral activity of polysaccharides of A. platensis against KHV was confirmed in vitro using qualitative assessment of KHV life cycle genes, and it was found by RT-PCR that EPS, applied at a concentration of >18 μg mL^-1 and a multiplicity of infection (MOI) of 0.45 of KHV, suppressed the viral replication in common carp brain (CCB) cells even after 22 days post-infection, entirely. Further, this study presents first data indicating an enormous potential using polysaccharides as an additive for aquacultures to lower or hinder the spread of the KHV and koi herpesvirus disease (KHVD) in future.

Semi-quantitative assessment of disease risks at the human, livestock, wildlife interface for the Republic of Korea using a nationwide survey of experts: A model for other countries

Wildlife-associated diseases and pathogens have increased in importance; however, management of a large number of diseases and diversity of hosts is prohibitively expensive. Thus, the determination of priority wildlife pathogens and risk factors for disease emergence is warranted. We used an online questionnaire survey to assess release and exposure risks, and consequences of wildlife-associated diseases and pathogens in the Republic of Korea (ROK). We also surveyed opinions on pathways for disease exposure, and risk factors for disease emergence and spread. For the assessment of risk, we employed a two-tiered, statistical K-means clustering algorithm to group diseases into three levels (high, medium and low) of perceived risk based on release and exposure risks, societal consequences and the level of uncertainty of the experts' opinions. To examine the experts' perceived risk of routes of introduction of pathogens and disease amplification and spread, we used a Bayesian, multivariate normal order-statistics model. Six diseases or pathogens, including four livestock and two wildlife diseases, were identified as having high risk with low uncertainty. Similarly, 13 diseases were characterized as having high risk with medium uncertainty with three of these attributed to livestock, six associated with human disease, and the remainder having the potential to affect human, livestock and wildlife (i.e., One Health). Lastly, four diseases were described as high risk with high certainty, and were associated solely with fish diseases. Experts identified migration of wildlife, international human movement and illegal importation of wildlife as the three routes posing the greatest risk of pathogen introduction into ROK. Proximity of humans, livestock and wildlife was the most significant risk factor for promoting the spread of wildlife-associated diseases and pathogens, followed by high density of livestock populations, habitat loss and environmental degradation, and climate change. This study provides useful information to decision makers responsible for allocating resources to address disease risks. This approach provided a rapid, cost-effective method of risk assessment of wildlife-associated diseases and pathogens for which the published literature is sparse.

Synergy of circulating miR-212 with markers for cardiovascular risks to enhance estimation of atherosclerosis presence

Synergy of specific microRNAs (miRNAs) with cardiovascular risk factors to estimate atherosclerosis presence in ischemic stroke patients has not been investigated. The present study aimed to identify atherosclerosis-related circulating miRNAs and to evaluate interaction with other cardiovascular markers to improve the estimation of atherosclerosis presence. We performed a miRNA profiling study using serum of 15 patients with acute ischemic stroke who were classified by the presence of no (n = 8) or severe (n = 7) stenosis on intracranial and extracranial vessels, which identified miR-212, -372, -454, and -744 as miRNAs related with atherosclerosis presence. Of the 4 miRNAs, only miR-212 showed a significant increase in expression in atherosclerosis patients in a validation study (atherosclerotic patients, n = 32, non-atherosclerotic patients, n = 33). Hemoglobin A1c, a high-density lipoprotein cholesterol, and lipoprotein(a), both established risk markers, were independently related with atherosclerosis presence in the validation population. miR-212 enhanced the accuracy of atherosclerosis presence by the three existing markers (three markers, 78.5%; three markers+miR-212, 84.6%, P<0.05) and significantly added to the area under the receiver operating characteristic curve (three markers, 0.8258; three markers+miR-212, 0.8646, P<0.05). The inclusion of miR-212 increased the reclassification index calculated using net reclassification improvement (0.4527, P<0.05) and integrated discrimination improvement (0.0737, P<0.05). We identified circulating miR-212 as a novel marker of atherosclerosis. miR-212 enhanced the estimation of atherosclerosis presence in combination with hemoglobin A1c, high-density lipoprotein cholesterol, and lipoprotein(a). Thus, miR-212 is expected to improve the estimation of atherosclerosis using peripheral blood of patients.

Genetic alterations in mesiodens as revealed by targeted next-generation sequencing and gene co-occurrence network analysis

OBJECTIVE

Mesiodens is the most common type of supernumerary tooth which includes a population prevalence of 0.15%-1.9%. Alongside evidence that the condition is heritable, mutations in single genes have been reported in few human supernumerary tooth cases. Gene sequencing methods in tradition way are time-consuming and labor-intensive, whereas next-generation sequencing and bioinformatics are cost-effective for large samples and target sizes.

MATERIALS AND METHODS

We describe the application of a targeted next-generation sequencing (NGS) and bioinformatics approach to samples from 17 mesiodens patients. Subjects were diagnosed on the basis of panoramic radiograph. A total of 101 candidate genes which were captured custom genes were sequenced on the Illumina HiSeq 2500. Multistep bioinformatics processing was performed including variant identification, base calling, and in silico analysis of putative disease-causing variants.

RESULTS

Targeted capture identified 88 non-synonymous, rare, exonic variants involving 42 of the 101 candidate genes. Moreover, we investigated gene co-occurrence relationships between the genomic alterations and identified 88 significant relationships among 18 most recurrent driver alterations.

CONCLUSION

Our search for co-occurring genetic alterations revealed that such alterations interact cooperatively to drive mesiodens. We discovered a gene co-occurrence network in mesiodens patients with functionally enriched gene groups in the sonic hedgehog (SHH), bone morphogenetic proteins (BMP), and wingless integrated (WNT) signaling pathways.

Abstract WMP70: Enhancement of Atherosclerosis Prediction by Interaction of Circulating mir-212 with Hemoglobin A1c, Lipoprotein(a), and High-density Lipoprotein Cholesterol

Background and Objectives: The present study aimed to identify atherosclerosis-related circulating miRNAs and to evaluate their interaction with other cardiovascular risk markers to improve the prediction of atherosclerosis presence.

Methods: We used miRNA profiling to identify atherosclerosis-related miRNAs using serum of 8 non-atherosclerotic and 7 severe atherosclerotic ischemic stroke patients. Expression of the target miRNAs identified was validated in 38 non-atherosclerotic and 37 atherosclerotic patients. Associations of the target miRNAs with other cardiovascular risk markers to predict atherosclerosis presence were analyzed using forward logistic regression analysis. Interactions of miRNAs with risk markers in the prediction of atherosclerosis presence were analyzed using accuracy and discrimination analysis.

Results: miR-212, -30c, -372, -454, and, -744 were identified as atherosclerosis-related miRNAs. Only miR-212 showed a significant increase in expression in atherosclerotic patients of the validation population. Of various established markers tested, hemoglobin A1c, high-density lipoprotein cholesterol, and lipoprotein(a) were independently related with atherosclerosis presence in the validation population. miR-212 significantly increased the accuracy (three markers, 78.55%; three markers+miR-212, 84.6%) and area under the receiver operating characteristic curve (three markers, 0.8258; three markers+miR-212, 0.8646) of atherosclerosis prediction by the three existing markers.

Conclusion: We identified circulating miR-212 as a novel marker of atherosclerosis. miR-212 synergistically enhanced the prediction of atherosclerosis-presence in combination with hemoglobin A1c, high-density lipoprotein cholesterol, and lipoprotein(a). Thus, miR-212 is expected to improve the prediction of atherosclerosis using peripheral blood of patients.

Bone-density testing interval and transition to osteoporosis in patients with rheumatoid arthritis

The study aims to evaluate the rate of transition to osteoporosis in 360 RA patients and estimate the rescreening intervals of bone mineral density (BMD) testing. Osteoporosis was newly developed in 24.8 % during mean follow-up of 7.4 years. The estimated time of a BMD testing interval was dependent on the baseline T-score in RA patients.

INTRODUCTION

Although BMD testing is routinely performed in RA patients, the interval between BMD tests has not been determined.

METHODS

We retrospectively recruited 360 consecutive female patients with RA, who underwent repeated BMD testing, with a mean age of 53.7 ± 10.2 years and a mean follow-up duration of 7.4 ± 5.0 years. We stratified the study participants into five groups based on their baseline T-score range. The testing interval was defined as the estimated time for 10 % of patients in each subgroup to transition to osteoporosis. Competing-risk analyses were performed with sensitivity analysis by menopausal status and risk factors for transition to osteoporosis.

RESULTS

At baseline, 15 % of screened patients had osteoporosis, and during follow-up, that proportion increased to 24.8 %. The estimated BMD testing interval for 10 % of patients to develop osteoporosis was 9.6 years for those with normal BMD, 7.6 years for those with mild osteopenia, 4.7 years for those with moderate osteopenia, and 2.1 years for those with severe osteopenia. No significant risk factor for transition to osteoporosis was identified in this cohort.

CONCLUSIONS

Our data indicate that osteoporosis will develop in less than 10 % of female RA patients during rescreening intervals of approximately 9 years for those with normal bone density at baseline, 7 years for those with mild osteopenia, 4 years for those with moderate osteopenia, and 2 years for those with severe osteopenia at baseline. BMD interval in RA patients could be adjusted according to their baseline BMD T-scores.