Depression may be a risk factor for coronary heart disease in midlife women <65 years: A 9-year prospective cohort study

OBJECTIVE

Depression has been suggested as a risk factor for coronary heart disease (CHD). However, whether the risk may be affected by age is unknown. We seek to assess the difference in long-term CHD risk between younger (<65) and older (≥65) women with depressive symptoms.

METHODS

Between June and August 2004, 1995 women presenting for routine mammography were enrolled to the primary study on breast arterial calcification. In 2005 (year 2), each woman completed a validated depression screening questionnaire. A similar questionnaire was mailed to each participant at year 4, 5, and 10 to obtain follow-up data (demographic and CHD risk factors) and record any change in CHD status.

RESULTS

Of 1084 women who returned surveys at year 10, 998 had no history of CHD and answered depression screening questions at year 2 as well as questions about CHD events at year 10. Of 185 out of 998 (18.5%) who had positive depression screening at year 2, 24 (13.0%) developed ≥1 CHD events by year 10, which is significantly higher than the incidence of 6.5% (53/813) in control group (p < 0.001). With CHD risk factors including age adjusted in a logistic regression model, depression was the only significant predictive factor for CHD in women aged <65 (OR = 6.56, 95% CI 1.07-40.09, p = 0.042). However, in women aged ≥65, age was the only significant predictive factor for CHD.

CONCLUSION

A history of depression may increase the risk of CHD over 9 years of follow-up, and more prominently in midlife women aged <65 years.

Decreasing postoperative narcotics in reconstructive pelvic surgery: a randomized controlled trial

BACKGROUND

Postoperative pain control is crucial to any successful recovery plan. Many currently used medication regimens are narcotic-focused.

OBJECTIVE

The objective of our study was to evaluate the efficacy of a multimodal pain regimen after pelvic reconstructive surgery.

STUDY DESIGN

The primary outcome measure was narcotic use. Secondary outcomes included pain, nausea, and constipation. Patients were randomized to either usual care postoperative treatment or multimodal pain regimen. Usual care included no specific preoperative or intraoperative medications, and postoperative narcotics with ibuprofen. Multimodal pain regimen included preoperative and postoperative celecoxib, gabapentin, intraoperative and postoperative intravenous and oral acetaminophen and ibuprofen, and narcotics as needed. All narcotics were converted to milligram equivalents of oral morphine for standardization according to Centers for Disease Control and Prevention guidelines where conversion factors for oral hydrocodone = 1, oral oxycodone = 1.5, and oral hydromorphone = 4. Patients were given the validated Brief Pain Inventory survey preoperatively (baseline), at postoperative day 1, and 1 week postoperatively. At 1 week, bowel function and narcotics usage was assessed.

RESULTS

Seventy patients were randomized to the usual care arm and 68 to the multimodal pain regimen arm. Patients in the multimodal pain regimen arm used significantly fewer intravenous narcotics in the operating room (90.7 ± 39.1 mg vs 104.6 ± 33.5 mg; P = .026) and while in the hospital (10.8 ± 15.1 mg vs 31.2 ± 29.6 mg; P < .001) and were more likely to use 0 oral narcotics after discharge to home (34.8% of patients vs 10.6%; P = .001). Of the patients who did use oral narcotics after discharge to home, there was no difference in amount used between groups (121.3 ± 103.7 mg in the multimodal pain regimen arm vs 153.0 ± 113.8 mg in the usual care arm; P = .139). Total narcotic usage (operating room + hospital + home) was significantly less in the multimodal pain regimen arm of the study (195.5 ± 147.2 mg vs 304.0 ± 162.1 mg; P < .001). There were no significant differences in pain scores between the 2 arms of the study on either postoperative time point. There were no significant differences in antiemetic use while in hospital, consistency of first bowel movement, length of stay, or number of telephone calls to nurses in first 3 weeks postoperatively.

CONCLUSION

A multimodal pain regimen in pelvic reconstructive surgery was found to decrease postoperative opioid requirements, while providing equivalent pain control.

Biomechanical head impact characteristics during sparring practice sessions in high school taekwondo athletes

OBJECTIVE The purpose of this study was to monitor head impact magnitude and characteristics, such as impact location and frequency, at high school taekwondo sparring sessions. METHODS Eight male high school taekwondo athletes participated in this study. The head impact characteristics were recorded by X-Patch, a wireless accelerometer and gyroscope, during 6 taekwondo sparring sessions. The outcome measures were the peak linear acceleration ( g = 9.81 msec²), peak rotational acceleration, rotational velocity, and Head Injury Criterion. RESULTS A total of 689 impacts occurred over 6 sessions involving the 8 athletes. There was an average of 24 impacts per 100 minutes, and there were significant differences in the frequency of impacts among both the sessions and individual athletes. In order of frequency, the most commonly hit locations were the side (38.2%), back (35.7%), and front (23.8%) of the head. CONCLUSIONS The data indicate that there is a relatively high number of head impacts experienced by taekwondo athletes during sparring practice. According to the rotational acceleration predicting impact severity published in previous research, 17.1% of the impacts were deemed to be a moderate and 15.5% were deemed to be severe.

Peripheral Tibial Nerve Stimulation for Overactive Bladder Syndrome: Treatment Success and Patient Satisfaction

OBJECTIVE

To evaluate the success rate and patient satisfaction ofperipheral tibial nerve stimulation (PTNS) therapy.

METHOD

Retrospective cohort study assessing PTNS treatment success and patient satisfaction.

RESULTS

Data from 34 women were included. On average, patients were 70.2 (± 12) years of age, had a BMI of 29.9 (± 8.9) kg/M², and traveled 11.2 (± 12.3) miles to receive weekly PTNS treatments. Overall, 22 patients (64.7%) were satisfied, four (11.8%) unsatisfied, and eight (23.5%) undecided. Those who were satisfied completed an average of 10.9 treatments (± 2.4), those who were unsatisfied completed an average of 9.5 treatments (± 2.6), and those left undecided completed an average of 7.2 treatments (± 4.3). The fourth treatment visit was the most likely to predict whether a patient would be satisfied or unsatisfied by the 12th treatment.

CONCLUSION

Overall the success of the PTNS therapy was 64.7%, consistent with previous studies. Most patients note improvement after the fourth treatment.

Effects of Calcium, Vitamin D, and Hormone Therapy on Cardiovascular Disease Risk Factors in the Women's Health Initiative: A Randomized Controlled Trial

OBJECTIVE

To analyze the treatment effect of calcium+vitamin D supplementation, hormone therapy, both, and neither on cardiovascular disease risk factors.

METHODS

We conducted a prospective, randomized, double-blind, placebo-controlled trial among Women's Health Initiative (WHI) participants. The predefined primary outcome was low-density lipoprotein cholesterol (LDL-C).

RESULTS

Between September 1993 and October 1998, a total of 68,132 women aged 50-79 years were recruited and randomized to the WHI-Dietary Modification (n=48,835) and WHI-Hormone Therapy trials (n=27,347). Subsequently, 36,282 women from WHI-Hormone Therapy (16,089) and WHI-Dietary Modification (n=25,210) trials were randomized in the WHI-Calcium+Vitamin D trial to 1,000 mg elemental calcium carbonate plus 400 international units vitamin D3 daily or placebo. Our study group included 1,521 women who participated in both the hormone therapy and calcium+vitamin D trials and were in the 6% subsample of trial participants with blood sample collections at baseline and years 1, 3, and 6. The average treatment effect with 95% confidence interval, for LDL-C, compared with placebo, was -1.6, (95% confidence interval [CI] -5.5 to 2.2) mg/dL for calcium+vitamin D alone, -9.0 (95% CI -13.0 to -5.1) mg/dL for hormone therapy alone, and -13.8 (95% CI -17.8 to -9.8) mg/dL for the combination. There was no evidence of a synergistic effect of calcium+vitamin D+hormone therapy on LDL-C (P value for interaction=.26) except in those with low total intakes of vitamin D, for whom there was a significant synergistic effect on LDL (P value for interaction=.03).

CONCLUSION

Reductions in LDL-C were greater among women randomized to both calcium+vitamin D and hormone therapy than for those randomized to either intervention alone or to placebo. The treatment effect observed in the calcium+vitamin D+hormone therapy combination group may be additive rather than synergistic. For clinicians and patients deciding to begin calcium+vitamin D supplementation, current use of hormone therapy should not influence that decision.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov, https://clinicaltrials.gov, NCT00000611.

Comparison of Weight-Based Dose vs. Standard Dose Diltiazem in Patients with Atrial Fibrillation Presenting to the Emergency Department

BACKGROUND

Despite evidence-based recommended weight-based (WB) dosing of diltiazem for the initial treatment of atrial fibrillation (AF) with rapid ventricular response (RVR), many providers utilize lower initial doses of diltiazem.

OBJECTIVE

We sought to determine whether a low, standard dose of diltiazem is noninferior to WB diltiazem as an initial bolus dose in the treatment of AF with RVR.

METHODS

This retrospective review included patients who presented to the emergency department (ED) of an urban, academic tertiary medical center experiencing AF with RVR from November 2010 to August 2014. Adult patients were categorized by the dose of diltiazem received; 10 mg standard dose or 0.2-0.3 mg/kg WB dose. The primary outcome of successful treatment was defined as a composite of the following parameters 15 min after the initial bolus dose: heart rate (HR) < 100 beats/min, reduction of HR ≥ 20%, or a conversion to normal sinus rhythm.

RESULTS

Four hundred and fifty-six patients who received diltiazem were included for study evaluation (standard dose: n = 255 patients, WB: n = 201 patients). Baseline characteristics, medical history, and medication use before ED presentation were similar between the groups. Significant differences at baseline between the groups included weight and HR at presentation. The primary outcome of successful treatment was attained in 60.8% of the standard dose patients and 68.7% of the WB patients (p = 0.082).

CONCLUSIONS

In patients presenting to the ED, we found that standard dose diltiazem was noninferior to WB dosing in the initial treatment of AF with RVR.

CREOG In-Training Examination Results: Contemporary Use to Predict ABOG Written Examination Outcomes

BACKGROUND

The in-training examination (ITE) offers formative assessments of residents' developing medical knowledge. Identification of an ITE performance level associated with success on the specialty board examination allows identification of "at risk" residents.

OBJECTIVE

This study sought to identify a threshold score for obstetrics and gynecology residents' performance on the Council on Resident Education in Obstetrics and Gynecology (CREOG) ITE that predicts successful performance on the American Board of Obstetrics and Gynecology (ABOG) written examination.

METHODS

We analyzed ITE and ABOG results of 80 residents who completed 4 years of CREOG ITEs at 2 institutions between 2002 and 2012. We assessed the level of performance associated with successful performance on the ABOG written examination.

RESULTS

Data analyzed included scores for 71 of 80 residents (89%), with an overall pass rate of 82%. A postgraduate year (PGY) 4 score of 200 on the CREOG ITE or twice in any of the PGY training years was associated with a 100% ABOG pass rate. Scoring ≥ 205 in any PGY also was associated with a 100% pass rate. Residents who did not attain a score of 200 had a 35% to 45% chance of failing the ABOG written examination, depending on the PGY of the ITE performance.

CONCLUSIONS

Our findings suggest that a CREOG ITE score of at least 200 twice, or as a PGY-4, offers assurance of successful performance on the ABOG examination. Scores lower than this threshold may be used to identify "at risk" residents for added learning and provide program elements in need of improvement.

A multi-center assessment of the temporal trends in myocardial perfusion imaging

BACKGROUND

Recent literature suggests that the frequency of abnormal SPECT myocardial perfusion imaging (MPI) has decreased over the past two decades despite an increase in the prevalence of many cardiac risk factors. This study examined the trends in the prevalence of obstructive coronary artery disease (CAD) by abnormal and ischemic MPI and invasive angiography.

METHODS

We analyzed all patients who underwent stress MPI or invasive angiography at two academic centers between January 1996 and December 2012, for their demographic data and study results.

RESULTS

A total of 108,654 MPI studies were performed. Over time, the percentage of patients with hypertension, hyperlipidemia, diabetes, and a history of smoking increased. There was a decline in the prevalence of abnormal MPI studies in all patients as well as in those with and without known CAD (from 47.2%, 71.8%, and 31.4% in 1996 to 33.9%, 64.8%, and 18.8% in 2012, respectively, all P < .0001). Similarly, there was a decline in the prevalence of ischemic MPI studies in all patients as well as in those with and without known CAD. A total of 142,924 invasive angiograms were performed. There was a decline in the prevalence of one-vessel and multi-vessel coronary disease (from 29.1% and 53.6% in 1996 to 22.4% and 35.9% in 2012, respectively, all P < .0001).

CONCLUSIONS

There has been a temporal decline in the prevalence of abnormal and ischemic MPI studies as well as the frequency and extent of obstructive CAD on angiography. However, this decline was not to the same extent as previously reported, and the overall 34% abnormal MPI rate, with 19% in patients with no known CAD and 65% in patients with known CAD, remains a clinically relevant percentage of patients tested.

Development and evaluation of a novel taekwondo chest protector to improve mobility when performing axe kicks

The axe kick, in Olympic style taekwondo, has been identified as the most popular scoring technique aimed to the head during full contact competition. The first purpose of this study was to identify and investigate design issues with the current World Taekwondo Federation approved chest protector. A secondary purpose was to develop a novel chest protector addressing the identified design issues and to conduct a biomechanical analysis. Fifteen male elite Taekwondo players were selected to perform three different styles of the axe kick, i.e., front, in-out, and out-in axe kick five times each for a total of 45 kicks. Two-way repeated measures ANOVA showed significant differences between the novel and existing chest protector conditions for vertical height of the toe, downward kicking foot speed, hip flexion angle and ipsilateral shoulder flexion extension range of motion (ROM) (p < 0.05). There were no significant differences between the control condition (no chest protector) and the novel chest protector condition for these variables (p > 0.05). These results indicate that the novel chest protector interferes less with both the lower and upper limbs during the performance of the axe kick and provides a more natural, free-moving alternative to the current equipment used.

Trends in sacral colpopexy for the management of apical prolapse

OBJECTIVE

To evaluate trends in surgical approach for sacral colpopexy since the advent of robotic technology for gynecologic procedures.

STUDY DESIGN

Women who underwent surgery for uterovaginal prolapse, cystocele, and/orvaginalvault prolapse were included in this study. The number of patients undergoing a vaginal approach for prolapse was compared to the number of patients receiving sacral colpopexy. Descriptive statistics comprised means and standard deviations, while categorical data were reported as frequencies. Inferential statistics comprised Student's t-test for assessing two-group differences between means ofcontinuous, normally distributed data and chi-squared tests for comparisons of equality of distribution between categorical variables.

RESULTS

Patients undergoing sacral colpopexy were younger than their vaginal surgery counterparts (P< 0.001). When stage ofprolapsewas dichotomized, among those with stage 1-2 prolapse, a greater percentage of patients received colpopexy in favor of vaginal surgery in 2010 than in 2007 (P=0.001).

CONCLUSION

There is an increasing trend towards robotic-assisted sacralcolpopexyforthe management of apical prolapse.

Socioeconomic status and race as predictors of treatment-seeking behavior for pelvic organ prolapse

OBJECTIVE

We sought to evaluate the prevalence of pelvic organ prolapse (POP) among a diverse group of women and to determine if race/ethnicity and/or socioeconomic status (SES) are factors in treatment-seeking behavior.

STUDY DESIGN

All data were collected from the National Institutes of Health-supported Boston Area Community Health Survey. SES was calculated by a 2-factor index that combined household income with years of education. Inferential statistics comprised 1-way analysis of variance, with a post hoc Scheffé test performed to evaluate whether there were differences between individual groups. A χ(2) test was used to evaluate whether distributions were equal among the various questions by race/ethnicity and SES category.

RESULTS

A total of 3205 women were included in the analysis. Hispanic ethnicity and younger age were associated with POP (P < .002 and P < .001, respectively) as well as with seeking treatment for prolapse (P = .007 and P < .001, respectively). These factors were also associated with subsequent surgical repair (P = .027 and P = .019, respectively). A regression model showed that women were 4.9% more likely to seek treatment for every year younger they were, across the range of age. Although women of a higher SES were more likely to have POP, SES was neither associated with a higher likelihood of seeking treatment nor with the surgical management of prolapse.

CONCLUSION

Hispanic ethnicity and younger age were associated with seeking treatment for POP. Hispanics were more likely than whites or blacks to proceed with surgical management. There was no correlation of SES with any of the above factors.

Advanced pelvic organ prolapse and routine health screening

OBJECTIVE

To evaluate whether patients with advanced pelvic-organ prolapse (POP) were less likely than controls to obtain screening Papanicolaou (Pap) test, mammography, and colonoscopy.

STUDY DESIGN

Records were reviewed from 7/2/2010 through 4/22/2011. We identified patients with advanced POP, defined as prolapse > or = 4 cm beyond the hymenal ring, and made age- and parity-matched controls from patients whose prolapse was <4 cm. Compliance for screening of cervical, breast and colon cancers was compared between the two groups.

RESULTS

Of 933 records, we identified 51 patients with advanced POP and 51 controls. Neither Pap test nor colonoscopy screening differed between the groups (McNemar chi2, P=1.00; McNemar chi2, P=1.00). Mammogram screening did not differ statistically; however, there was a trend towards neglecting screening in the advanced POP group (McNemar chi2, P=0.057).

CONCLUSION

Patients with POP > or = 4 cm beyond the hymenal ring were equally as likely to obtain routine health screening as age- and parity-matched controls whose POP measured <4 cm.

Does the impact of urinary incontinence on quality of life differ based on age?

INTRODUCTION AND HYPOTHESIS

The purpose of this study was to evaluate if the impact of urinary incontinence (UI) on quality of life (QOL) differs between women based on age.

METHODS

A retrospective review of patients presenting for the management of UI was performed. Patients with UI and their corresponding degree of bother were identified by their responses to validated questionnaires. Distributions of comorbidities and types of UI were presented as frequencies and compared between age cohorts with a chi-square test. Mean scale scores were assessed for normality and a one-way analysis of variance with a post hoc Scheffé's test was used to compare the scores.

RESULTS

Of 765 patients meeting inclusion criteria, 22.4 % were <45, 28.9 % were 45-55, and 48.8 % were >55 years of age. Women older than 55 were significantly more likely to have urge UI and mixed UI than their counterparts (p < 0.001). Women <45 and 45-55 were more negatively impacted in their ability to perform physical activities compared to women >55 (p = 0.004), whereas women >55 were significantly less likely to feel frustrated by their incontinence than women <45 (p = 0.022). However, there was no significant difference in overall impact of incontinence among groups (p = 0.585).

CONCLUSIONS

UI equally impacts the functional and psychological QOL in women regardless of age. UI in women <55 results in a greater negative impact on level of physical activity, whereas women <45 are significantly more frustrated.

Sexual dysfunction, depression, and anxiety among patients of an inner-city menopause clinic

OBJECTIVE

The objective of this study was to identify the prevalence of female sexual dysfunction (FSD) in a sample comprising women of mostly Hispanic descent and low socioeconomic status (SES).

METHODS

Demographic data and symptoms related to sexuality were analyzed from 102 women who consecutively came to the Women's Life Center at Hartford Hospital (2004-2008). FSD was defined as decreased sexual desire, dyspareunia, or vaginal dryness; depression as one positive response to a validated three-question screening instrument; and anxiety as a positive response to whether the patient experiences anxiety sometimes or often.

RESULTS

The cohort was 52.9 ± 6.8 years of age (mean ± standard deviation [SD]) and 80.0% Hispanic, and 47.8% were unemployed. The majority (92.8%) earned < $25,000, and most (95.8%) did not have a college degree. The prevalence of FSD was 75.6%. The prevalence of depression was 80.9% vs. 52.8% (p = 0.01) and that of anxiety was 76.6% vs. 45.7% (p = 0.01) among women with vs. without a decrease in sexual desire. The prevalence of depression was 83.3% vs. 55.9% (p = 0.03) and that of anxiety was 76.7% vs. 52.9% (p = 0.07) among women who reported dyspareunia vs. those who did not. Problems sleeping was the only variable associated with a statistically higher likelihood of FSD (odds ratio [OR] 5.57, 95% confidence interval [CI] 1.22-25.33, p = 0.03). No significant differences were seen when comparing FSD between Hispanics and non-Hispanics.

CONCLUSIONS

This sample of predominantly Hispanic women of low SES had a high prevalence of FSD. These data also suggest that poor sleep is significantly associated with FSD and that women of low SES with FSD may have a significantly higher prevalence of depression and anxiety.

The quantification of vitamin D receptors in coronary arteries and their association with atherosclerosis

OBJECTIVE

The activated vitamin D receptor (VDR) may have an important role in vascular health. The objective of this study was to determine whether there is an association between the expression of VDRs in coronary arteries and the extent of diet-induced atherosclerosis.

METHODS

Utilizing a cohort of 39 postmenopausal female cynomolgus monkeys with varying stages of atherosclerosis, histologic sections of the left anterior descending artery (LAD) were analyzed for plaque cross-sectional area, plaque thickness, and VDR quantity using immunohistochemical H-score analysis. The quantities of VDRs were analyzed as a continuous variable and were divided at the median intimal H-score into high vs. low groupings.

RESULTS

In the LAD, a significant negative correlation was observed between the quantity of VDR and plaque size (both cross-sectional area [p<0.001] and plaque thickness [p<0.001]). Monkeys in the low VDR group had a significantly greater cross-sectional plaque area (1.2mm(2)) and greater plaque thickness (0.3mm) than those in the high VDR group (0.4mm(2), p=0.005; 0.1mm, p=0.003, respectively).

CONCLUSIONS

Lower concentrations of VDRs in a main coronary artery were associated with greater atherosclerotic plaque size in postmenopausal female monkeys. Given that coronary artery atherosclerosis is a major cause of coronary heart disease in postmenopausal women, further research to ascertain the relationship between VDRs and atherosclerosis is warranted.

Coronary artery vitamin D receptor expression and plasma concentrations of 25-hydroxyvitamin D: their association with atherosclerosis

OBJECTIVE

The aim of this study was to analyze coronary artery vitamin D receptor (VDR) expression, the plasma concentrations of 25-hydroxyvitamin D3 (25OHD3), and their relationship with coronary artery atherosclerosis.

METHODS

Premenopausal cynomolgus monkeys were fed atherogenic diets containing the equivalent of 1,000 IU/day of vitamin D3. Protein was derived from casein-lactalbumin (C/L, n = 10), soy protein isolate (soy, n = 10), or a combination (n = 19). After 32 months of consuming the diets, each monkey underwent surgical menopause. After 32 postmenopausal months, coronary atherosclerosis was measured in the left circumflex (LCX) artery and left anterior descending (LAD) artery. VDR expression was determined for the LAD, and 25OHD3 concentrations were assessed.

RESULTS

Both the cross-sectional area of atherosclerotic plaques (in square millimeters) and plaque thickness (in millimeters) in the LCX as well as the LAD arteries were analyzed in these monkeys. Those with higher plasma vitamin D3 concentrations and higher VDR were compared with those with higher plasma 25OHD3 concentrations and lower VDR. Significantly smaller plaque sizes were noted with higher plasma 25OHD3 concentrations and higher VDR. For the LCX artery, there was also a significantly lower plaque size (both plaque thickness and cross-sectional area) in those with higher quantities of VDR and lower 25OHD3 concentrations versus those with lower quantities of VDR and higher plasma concentrations of 25OHD3 (P = 0.009 and P = 0.040, respectively).

CONCLUSIONS

Cynomolgus monkeys with higher quantities of VDR have significantly less atherosclerosis than do those with lower quantities of VDR and higher plasma 25OHD3 concentrations. If these findings translate to human beings, it might explain why some individuals with higher plasma concentrations of 25OHD3 have more coronary artery atherosclerosis.

Effects of Olympic-style taekwondo kicks on an instrumented head-form and resultant injury measures

OBJECTIVE

The objective of this study was to assess the effect of taekwondo kicks and peak foot velocity (FVEL) on resultant head linear acceleration (RLA), head injury criterion (HIC15) and head velocity (HVEL).

METHODS

Each subject (n=12) randomly performed five repetitions of the turning kick (TK), clench axe kick (CA), front leg axe kick, jump back kick (JB) and jump spinning hook kick (JH) at the average standing head height for competitors in their weight division. A Hybrid II Crash Test Dummy head was fitted with a protective taekwondo helmet and instrumented with a triaxial accelerometer and fixed to a height-adjustable frame. Resultant head linear acceleration, HVEL, FVEL data were captured and processed using Qualysis Track Manager.

RESULTS

The TK (130.11 ± 51.67 g) produced a higher RLA than the CA (54.95 ± 20.08 g, p<0.001, d=1.84) and a higher HIC15 than the JH (672.74 ± 540.89 vs 300.19 ± 144.35, p<0.001, ES=0.97). There was no difference in HVEL of the TK (4.73 ± 1.67 m/s) and that of the JB (4.43 ± 0.78 m/s; p=0.977, ES<0.01).

CONCLUSIONS

The TK is of concern because it is the most common technique and cause of concussion in taekwondo. Future studies should aim to understand rotational accelerations of the head.

Response to an adequate dietary intake of vitamin D3 modulates the effect of estrogen therapy on bone density

INTRODUCTION

This study analyzed associations between plasma vitamin D(3) (25OHD(3)) and bone mineral density (BMD) and whether the effects of conjugated equine estrogens (CEE) on BMD are modulated by 25OHD(3).

METHODS

Fifty cynomolgus monkeys were fed a diet containing 25OHD(3) (providing a woman's equivalent of 1000 IU/day of 25OHD3). The monkeys underwent bilateral oophorectomy and were randomized to either CEE (equivalent of 0.45 mg/day) (n=25) or placebo (n=25) and continued receiving the same diet. 25OHD(3) and BMD were measured at randomization and after 6 months. BMD also was measured after 20 months (equivalent to 6 human years). Associations between 25OHD(3) and BMD were subsequently analyzed.

RESULTS

Baseline 25OHD(3) plasma concentrations varied from 26 to 95 ng/mL (mean±standard deviation [SD] 54 ± 15 ng/mL). Higher plasma concentrations of 25OHD(3) were associated with a significantly increased BMD. Monkeys on both CEE and placebo had increased BMD over 20 months; however, the increase was not significantly different (0.034 g/cm(2) vs. 0.020 g/cm(2), respectively; p=0.064). The 20-month BMD increased significantly with CEE treatment in those with higher vs. lower 25OHD(3) concentrations (p=0.027). The percent change in BMD over 20 months also increased significantly with CEE treatment in those with higher vs. lower 25OHD(3) concentrations (p=0.018). A higher 25OHD(3) concentration had no significant effect on BMD in those receiving placebo.

CONCLUSIONS

Monkeys fed a diet containing 1000 IU/day equivalent of 25OHD(3) have a wide range of plasma 25OHD(3) concentrations. Those receiving CEE with higher 25OHD(3) concentrations had higher BMDs, suggesting 25OHD(3) and CEE have synergistic effects on BMD.

Effect of surgical approach on physical activity and pain control after sacral colpopexy

OBJECTIVE

We sought to compare recovery of activity and pain control after robotic (ROB) vs abdominal (ABD) sacral colpopexy.

STUDY DESIGN

Women undergoing ROB and ABD sacral colpopexy wore accelerometers for 7 days preoperatively and the first 10 days postoperatively. They completed postoperative pain diaries and Short Form-36 questionnaires before and after surgery.

RESULTS

At 5 days postoperatively, none of the 14 subjects in the ABD group and 4 of 28 (14.3%) in the ROB group achieved 50% total baseline activity counts (P = .283). At 10 days, 5 of 14 (35.7%) in the ABD group and 8 of 26 (30.8%) in the ROB group (P = .972) achieved 50%. Postoperative pain was similar in both groups. Short Form-36 vitality scores were lower (P = .017) after surgery in the ABD group, but not in the ROB group.

CONCLUSION

Women undergoing ROB vs ABD sacral colpopexy do not recover physical activity faster, and pain control is not improved.

Usefulness of stress gated technetium-99m single photon emission computed tomographic myocardial perfusion imaging for the prediction of cardiac death in patients with moderate to severe left ventricular systolic dysfunction and suspected coronary artery disease

Although stress gated technetium-99m single-photon emission computed tomographic (SPECT) myocardial perfusion imaging (MPI) is useful in differentiating ischemic from nonischemic cardiomyopathy, its prognostic usefulness in this patient population is not well understood. Consecutive unique patients with suspected coronary artery disease who, for clinical indications, underwent technetium-99m rest and stress MPI demonstrating ejection fractions ≤40% by gated SPECT imaging were retrospectively identified. In addition to prescan variables, previously defined cutoffs for gated SPECT parameters using visual and standard 17-segment semiquantitative scoring were applied and related to the occurrence of cardiac death up to 5 years after MPI. Of the 475 patients fulfilling criteria for study inclusion, follow-up was complete in 444 (93%) over 3.7 ± 1.6 years. Of 393 patients without subsequent early (≤60 days) coronary revascularization, cardiac death occurred in 64 (16%). The summed stress score, an MPI measure of the extent and severity of coronary artery disease that also accounts for the ischemic burden, was the gated SPECT parameter most related to cardiac death with Kaplan-Meier 5-year cardiac death-free survival of 85.6% and 67.3% in patients with summed stress scores ≤8 and >8, respectively (p <0.001). In multivariate Cox regression analysis, a summed stress score >8 independently contributed to cardiac death (adjusted hazard ratio 2.20, 95% confidence interval 1.34 to 3.61), and its addition to the model significantly increased the global chi-square value over prescan variables (from 32.46 to 41.67, p = 0.002). In conclusion, stress MPI data from gated technetium-99m SPECT scans are useful for the prediction of cardiac death in patients with moderate to severe left ventricular systolic dysfunction in whom there is suspicion of underlying coronary artery disease.

PD03-07: Breast Cancer Heterogeneity and Treatment Resistance: Clues from Metaplastic Tumors

At late stage, nearly all breast cancers are heterogeneous and refractory to treatment, like metaplastic breast cancer is at an early stage. These rare carcinomas are highly aggressive and de-differentiated. They are enriched for mesenchymal and stem cell features and essentially fail current therapies. As metaplastic tumors provide a time-compressed picture of breast cancer progression early on, understanding these tumors will yield insight into mechanisms that drive breast cancer into advanced stages and treatment resistance.

To investigate a genetic basis for heterogeneity in metaplastic breast cancer, we established a progression model comprising three cell lines. The cell lines were derived from a primary tumor, a local recurrence and a pleural effusion of a 40-year old patient. The primary tumor was a stage III invasive metaplastic, triple negative, inflammatory breast cancer, resected after neoadjuvant chemotherapy (capecitabine and taxotere, then adriamycin and one cycle of bevacizumab). The local recurrence, biopsied seven months post mastectomy, developed after the patient received adjuvant carboplatin and gemcitabine for 3 cycles and then radiation to the chest wall. At this time, the patient had lung metastases and was treated with taxol and bevacizumab yielding a mixed response. Local invasive growth continued and a malignant pleural effusion developed four months later. Analyzing the genetic and molecular characteristics of this progression model in vitro, its tumorigenicity and metastasis in vivo, and interrogating lead findings in a growing collection of metaplastic tumors helps us to dissect the genetic heterogeneity in breast cancer, and potentially to identify the cell types that drive disease progression and treatment resistance. Our gene expression analyses and genomic evaluations identified epithelial to mesenchymal transition (EMT) as a key characteristic in the progression and treatment resistance of this cancer. Major changes in cytoskeletal genes, chemokines and their receptors, amplification of drug transporter proteins, metalloproteinases and matrix proteins seen with increasing motility and invasiveness along with recruitment of host inflammatory responses in the in vivo model, loss of chromosomal regions harboring known and putative tumor suppressors, and deletions of genes encoding proteins for metabolic inactivation of sex hormones in the breast tissue, along with specific loss of clusters of desmosomal genes are guiding our understanding of metaplastic breast cancer progression. The results provide insight into the development, the extremely invasive nature, and treatment resistance of these tumors. Our collaborative network of clinicians, pathologists, translational genomic researchers and bioinformatics specialists will enable us to identify and prioritize genetic events as disease drivers, prognostic biomarkers of disease progression, and determinants of treatment resistance. Our goal is to identify molecular and functional targets for effective therapy and evaluate them in the clinic. Lessons learned from metaplastic breast cancer will improve our understanding of breast cancer progression in general, and could translate into effective treatments for advanced breast cancer where current standard of care is failing.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr PD03-07.