Effectiveness of fosfomycin-based antimicrobial prophylaxis for transrectal ultrasound-guided prostate biopsy: A Korean multicenter study

PURPOSE

Recent studies have highlighted increasing infectious complications due to fluoroquinolone (FQ)-resistant organisms in men undergoing transrectal ultrasound-guided prostate biopsy (TRUSPB). This study investigated whether fosfomycin (FM)-based antibiotic prophylaxis reduces infections after TRUSPB and identified risk factors for infective complications.

MATERIALS AND METHODS

A multicenter study was conducted in the Republic of Korea from January 2018 to December 2021. Patients undergoing prostate biopsy with FQ or FM-based prophylaxis were included. The primary outcome was the post-biopsy infectious complication rate after FQ (group 1) or FM-based antibiotic prophylaxis with FM alone (group 2) or FQ and FM (group 3). Risk factors for infectious complications after TRUSPB were secondary outcomes.

RESULTS

Patients (n=2,595) undergoing prostate biopsy were divided into three groups according to the type of prophylactic antibiotics. Group 1 (n=417) received FQ before TRUSPB. Group 2 (n=795) received FM only and group 3 (n=1,383) received FM and FQ before TRUSPB. The overall post-biopsy infectious complication rate was 1.27%. The infectious complication rates were 2.4%, 1.9%, and 0.5% in groups 1, 2, and 3, respectively (p=0.002). In multivariable analysis, predictors of post-biopsy infectious complications included an association with health care utilization (adjusted odds ratio [OR], 4.66; 95% confidence interval [CI], 1.74-12.4; p=0.002) and combination antibiotic prophylaxis (FQ and FM) (adjusted OR, 0.26; 95% CI, 0.09-0.69; p=0.007).

CONCLUSIONS

In comparison with monotherapy with FM or FQ, combination antibiotic prophylaxis (FQ and FM) showed a lower rate of infectious complications after TRUSPB. Utilization of health care was an independent risk factor for infectious complications after TRUSPB.

LC-MS/MS Method Minimizing Matrix Effect for the Analysis of Bifenthrin and Butachlor in Chinese Chives and Its Application for Residual Study

The matrix effect refers to the change in the analytical signal caused by the matrix in which the sample is contained, as well as the impurities that are co-eluted with the target analyte. In crop sample analysis using LC-MS/MS, the matrix effect can affect the quantification results. Chinese chives are likely to exhibit a strong matrix effect when co-extracted with bifenthrin and butachlor due to the presence of phytochemicals and chlorophyll. A novel analytical method was developed to reduce the matrix effects of bifenthrin and butachlor to a negligible level in Chinese chives. The established method had a limit of quantitation of 0.005 mg/kg and correlation coefficients greater than 0.999 within the range of 0.005-0.5 mg/kg. Matrix effects were found to be negligible, with values ranging from -18.8% to 7.2% in four different sources of chives and two leafy vegetables. Compared to conventional analytical methods for the LOQ and matrix effect, the established method demonstrated improved performances. The analytical method was further applied in a residual study in chive fields. The active ingredient of butachlor 5 granule (GR) was not detected after soil admixture application, while that of bifenthrin 1 emulsifiable concentrate (EC) showed a range from 1.002 to 0.087 mg/kg after foliar spraying. The dissipation rate constant (k) of bifenthrin was determined to be 0.115, thus its half-life was calculated to be 6.0 days. From the results, PHI and safety use standards of both pesticides were suggested. The developed analytical method can be applied to accurately determine bifenthrin and butachlor residues in Chinese chives and provides a foundation for further research on the fate and behavior of these pesticides in the environment.

SAMHD1-induced endosomal FAK signaling promotes human renal clear cell carcinoma metastasis by activating Rac1-mediated lamellipodia protrusion

Human sterile α motif and HD domain-containing protein 1 (SAMHD1) has deoxyribonucleoside triphosphohydrolase (dNTPase) activity that allows it to defend against human immunodeficiency virus type I (HIV-1) infections and regulate the cell cycle. Although SAMHD1 mutations have been identified in various cancer types, their role in cancer is unclear. Here, we aimed to investigate the oncogenic role of SAMHD1 in human clear cell renal cell carcinoma (ccRCC), particularly as a core molecule promoting cancer cell migration. We found that SAMHD1 participated in endocytosis and lamellipodia formation. Mechanistically, SAMHD1 contributed to the formation of the endosomal complex by binding to cortactin. Thereafter, SAMHD1-stimulated endosomal focal adhesion kinase (FAK) signaling activated Rac1, which promoted lamellipodia formation on the plasma membrane and enhanced the motility of ccRCC cells. Finally, we observed a strong correlation between SAMHD1 expression and the activation of FAK and cortactin in tumor tissues obtained from patients with ccRCC. In brief, these findings reveal that SAMHD1 is an oncogene that plays a pivotal role in ccRCC cell migration through the endosomal FAK-Rac1 signaling pathway.

18F-Fluciclovine PET Imaging of Glutaminase Inhibition in Breast Cancer Models

Aggressive cancers such as triple-negative breast cancer (TNBC) avidly metabolize glutamine as a feature of their malignant phenotype. The conversion of glutamine to glutamate by the glutaminase enzyme represents the first and rate-limiting step of this pathway and a target for drug development. Indeed, a novel glutaminase inhibitor (GLSi) has been developed and tested in clinical trials but with limited success, suggesting the potential for a biomarker to select patients who could benefit from this novel therapy. Here, we studied a nonmetabolized amino acid analog, ¹⁸F-fluciclovine, as a PET imaging biomarker for detecting the pharmacodynamic response to GLSi. Methods: Uptake of ¹⁸F-fluciclovine into human breast cancer cells was studied in the presence and absence of inhibitors of glutamine transporters and GLSi. To allow ¹⁸F-fluciclovine PET to be performed on mice, citrate in the tracer formulation is replaced by phosphate-buffered saline. Mice bearing triple-negative breast cancer (TNBC) xenografts (HCC38, HCC1806, and MBA-MD-231) and estrogen receptor-positive breast cancer xenografts (MCF-7) were imaged with dynamic PET at baseline and after a 2-d treatment of GLSi (CB839) or vehicle. Kinetic analysis suggested reversible uptake of the tracer, and the distribution volume (V_D) of ¹⁸F-fluciclovine was estimated by Logan plot analysis. Results: Our data showed that cellular uptake of ¹⁸F-fluciclovine is mediated by glutamine transporters. A significant increase in V_D was observed after CB839 treatment in TNBC models exhibiting high glutaminase activity (HCC38 and HCC1806) but not in TNBC or MCF-7 exhibiting low glutaminase. Changes in V_D were corroborated with changes in GLS activity measured in tumors treated with CB839 versus vehicle, as well as with changes in V_D of ¹⁸F-(2S,R4)-fluoroglutamine, which we previously validated as a measure of cellular glutamine pool size. A moderate, albeit significant, decrease in ¹⁸F-FDG PET signal was observed in HCC1806 tumors after CB839 treatment. Conclusion: ¹⁸F-fluciclovine PET has potential to serve as a clinically translatable pharmacodynamic biomarker of GLSi.

Driving pressure-guided ventilation and postoperative pulmonary complications in thoracic surgery: a multicentre randomised clinical trial

BACKGROUND

Airway driving pressure, easily measured as plateau pressure minus PEEP, is a surrogate for alveolar stress and strain. However, the effect of its targeted reduction remains unclear.

METHODS

In this multicentre trial, patients undergoing lung resection surgery were randomised to either a driving pressure group (n=650) receiving an alveolar recruitment/individualised PEEP to deliver the lowest driving pressure or to a conventional protective ventilation group (n=650) with fixed PEEP of 5 cm H₂O. The primary outcome was a composite of pulmonary complications within 7 days postoperatively.

RESULTS

The modified intention-to-treat analysis included 1170 patients (mean [standard deviation, sd]; age, 63 [10] yr; 47% female). The mean driving pressure was 7.1 cm H₂O in the driving pressure group vs 9.2 cm H₂O in the protective ventilation group (mean difference [95% confidence interval, CI]; -2.1 [-2.4 to -1.9] cm H₂O; P<0.001). The incidence of pulmonary complications was not different between the two groups: driving pressure group (233/576, 40.5%) vs protective ventilation group (254/594, 42.8%) (risk difference -2.3%; 95% CI, -8.0% to 3.3%; P=0.42). Intraoperatively, lung compliance (mean [sd], 42.7 [12.4] vs 33.5 [11.1] ml cm H₂O^-1; P<0.001) and Pa_o2 (median [inter-quartile range], 21.5 [14.5 to 30.4] vs 19.5 [13.5 to 29.1] kPa; P=0.03) were higher and the need for rescue ventilation was less frequent (6.8% vs 10.8%; P=0.02) in the driving pressure group.

CONCLUSIONS

In lung resection surgery, a driving pressure-guided ventilation improved pulmonary mechanics intraoperatively, but did not reduce the incidence of postoperative pulmonary complications compared with a conventional protective ventilation.

CLINICAL TRIAL REGISTRATION

NCT04260451.

Development of novel Escherichia coli cell-based biosensors to monitor Mn(II) in environmental systems

Escherichia coli uses manganese [Mn(II)] as an essential trace element; thus, it has a genetic system that regulates cellular Mn(II) levels. Several genes in the mnt-operon of E. coli respond to intercellular Mn(II) levels, and transcription is regulated by a transcription factor (MntR) that interacts with Mn(II). This study aimed to develop Mn(II)-sensing biosensors based on mnt-operon genetic systems. Additionally, the properties of biosensors developed based on the promoter regions of mntS, mntH, and mntP were investigated. MntR represses the transcription of MntS and MntH after binding with Mn(II), while it induces MntP transcription. Thus, Mn(II) biosensors that decrease and increase signals could be obtained by fusing the promoter regions of mntS/mntH and mntP, with egfp encoding an enhanced green fluorescent protein. However, only the biosensor-based mntS:egfp responded to Mn(II) exposure. Further, E. coli harboring P mntS :egfp showed a concentration-dependent decrease in fluorescence signals. To enhance the sensitivity of the biosensor toward Mn(II), E. coli containing a deleted MntP gene that encodes Mn(II) exporter, was used as a host cell for biosensor development. The sensitivity toward Mn(II) increased by two times on using E. coli-mntP, and the biosensor could quantify 0.01-10 μM of Mn(II). Further, the applicability of Mn(II) in artificially contaminated water samples was quantified and showed >95% accuracy. The newly developed Mn(II) biosensors could detect and quantify the residual Mn(II) from mancozeb in soil samples, with the quantification accuracy being approximately 90%. To the best of our knowledge, this is the first Mn (II)-specific bacterial cell-based biosensor that serves as a valuable tool for monitoring and assessing the risks of Mn(II) in environmental systems.

Morphometry of lumbar muscles in the seated posture with weight-bearing MR scans

Conventional imaging studies of human spine are done in a supine posture in which the axial loading of the spine is not considered. Upright images better reveal the interrelationships between the various internal structures of the spine. The objective of the current study is to determine the cross-sectional areas, radii, and angulations of the psoas, erector spinae, and multifidus muscles of the lumbar spine in the sitting posture. Ten young (mean age 31 ± 4.8 years) asymptomatic female subjects were enrolled. They were seated in an erect posture and weight-bearing T1 and T2 MRIs were obtained. Cross-sectional areas, radii, and angulations of the muscles were measured from L1-L5. Two observers repeated all the measurements for all parameters, and reliability was determined using the inter- and intra-class coefficients. The Pearson product moment correlation was used for association between levels, while level differences were used using a linear regression model. The cross-sectional areas of the psoas and multifidus muscles increased from L1 to L5 (1.9 ± 1.1 to 12.1 ± 2.5 cm2 and 1.8 ± 0.3 to 5.7 ± 1.4 cm2). The cross-sectional area of the erector spinae was greatest at the midlevel (13.9 ± 2.2 cm2) and it decreased in both directions. For the angle, the range for psoas muscles was 75-105°, erector spinae were 39-46° and multifidus was 11-19°. Correlations magnitudes were inconsistent between levels and muscle types. These quantitated data improve our understanding of the geometrical properties in the sitting posture. The weight-bearing MRI-quantified morphometrics of human lumbar spine muscles from this study can be used in biomechanical models for predicting loads on spinal joints under physiological and traumatic situations.

Simultaneous Determination of Pyrethroid Insecticides in Foods of Animal Origins Using the Modified QuEChERS Method and Gas Chromatography-Mass Spectrometry

Pyrethroid insecticides are used in agriculture to treat parasites in livestock. This study developed a simultaneous residue analysis method to measure seventeen pyrethroid insecticides in foods of animal origin, including beef, pork, chicken, milk, and eggs. The method, which comprises instrumental analysis using gas chromatography-tandem mass spectrometry and a modified QuEChERS (quick, easy, cheap, effective, rugged, and safe) method for pretreatment, was optimized to verify the applicability of the method. A mixture of acetonitrile, ethyl acetate, and original salt (MgSO4 4 g, NaCl 1 g) was used as the extraction solvent and salt. MgSO4 (150 mg) primary secondary amine (25 mg) and graphitized carbon black (25 mg) were selected for dispersive solid phase extraction (d-SPE). The method limit of quantitation was 0.01 mg/L, and the linearity of the matrix-matched calibration curves was reasonable (R2 > 0.99). Recovery tests were performed at three concentrations (LOQ, 10 LOQ, and 50 LOQ). Good recoveries (75.2109.8%) and reproducibility (coefficient of variation <10%) were obtained. The matrix effects were in the range of −35.8 to 56.0%. The established method was fully validated and can be used as an official analytical method for quantifying pyrethroid insecticides in animal commodities.

Search for Dark Matter Axions with CAST-CAPP

The CAST-CAPP axion haloscope, operating at CERN inside the CAST dipole magnet, has searched for axions in the 19.74 μeV to 22.47 μeV mass range. The detection concept follows the Sikivie haloscope principle, where Dark Matter axions convert into photons within a resonator immersed in a magnetic field. The CAST-CAPP resonator is an array of four individual rectangular cavities inserted in a strong dipole magnet, phase-matched to maximize the detection sensitivity. Here we report on the data acquired for 4124 h from 2019 to 2021. Each cavity is equipped with a fast frequency tuning mechanism of 10 MHz/ min between 4.774 GHz and 5.434 GHz. In the present work, we exclude axion-photon couplings for virialized galactic axions down to g_aγγ = 8 × 10⁻¹⁴ GeV⁻¹ at the 90% confidence level. The here implemented phase-matching technique also allows for future large-scale upgrades.

Haloscopes aim at detecting axions by converting them into photons using high-quality resonant cavities, where the cavity resonance should be tuned with the unknown axion mass. Here, the authors improve exclusion limits using four phase-matched resonant cavities and a fast frequency scanning technique.

The association between cardiovascular risk factors and coronary CT angiography findings for predicting obstructive coronary artery disease in Korean patients with stable chest pain

Background/Introduction

The 2019 European Society of Cardiology (ESC) guidelines currently recommend the use of coronary computed tomography angiography (CCTA) as the initial test for diagnosing coronary artery disease (CAD) in symptomatic patients in whom obstructive CAD cannot be excluded by clinical assessment alone.

Purpose

The purpose of this study is to identify the prevalence of obstructive CAD in patients with stable chest pain, and the correlation between several clinical cardiovascular disease (CVD) risk factors and CCTA findings presented by Coronary Artery Disease Reporting and Data System (CAD-RADS).

Methods

The present study is a single-center retrospective cross-sectional study. A total of 1,892 patients with stable chest pain who underwent CCTA were enrolled in this study. Diamond-Forrester classification, Framingham risk score (FRS), atherosclerotic CVD (ASCVD) 10-year risk score, coronary artery calcium score (CACS) and CAD-RADS category were obtained from every patient.

Results

Among 1,892 patients (mean age, 60.5±8.6 years; men, 59.3%), 356 (18.8%) had obstructive CAD according to CCTA. Patients with high and intermediate ASCVD 10-year risk score had 2.59 times (aOR 2.59, 95% CI; 1.58 to 4.23) and 1.66 times (aOR 1.66, 95% CI; 1.04 to 2.65) higher odds of having obstructive CAD than patients with low ASCVD 10-year risk score, respectively (adjusted for Diamond-Forrester classification and CACS group). Higher ASCVD risk scores were significantly associated with higher CAD-RADS category (p&lt;0.001), and patients with CAD-RADS category 3 had ASCVD 10-year risk score of 20.1±12.7. CACS showed the highest discrimination in presence of obstructive CAD, followed by ASCVD 10-year risk score, FRS, and Diamond-Forrester classification (AUC: 0.821 [95% CI; 0.797–0.845]; 0.711 [95% CI; 0.683–0.740]; 0.675 [95% CI; 0.646–0.704]; 0.600 [95% CI; 0.569–0.632], respectively).

Conclusion

This is the first study of CCTA findings in stable chest pain patients in Korea. The prevalence of obstructive CAD in patients with stable chest pain was 18.8%. Higher ASCVD score is significantly associated with presence of obstructive CAD and higher CAD-RADS category. As coronary stenosis of 50%-69% had a mean ASCVD score of 20.1, we should consider CCTA for identifying obstructive CAD in patients with ASCVD score over 20 with stable chest pain.

Funding Acknowledgement

Type of funding sources: None.

Inhibition of lysyl oxidase‑like 2 ameliorates folic acid‑induced renal tubulointerstitial fibrosis

Tubulointerstitial fibrosis is characterized by accumulation of the extracellular matrix in the interstitium. Lysyl oxidase-like 2 (LOXL2), a member of the lysyl oxidase family, is known for promoting cancer metastasis, invasion and stromal fibrosis in various organs. Our previous study demonstrated expression of LOXL2 in kidney podocytes and tubular epithelial cells, and the association between elevated LOXL2 and tubulointerstitial fibrosis. The present study evaluated the effect of LOXL2 inhibition using an inhibitory monoclonal antibody (AB0023) on tubulointerstitial fibrosis in a folic acid-induced tubulointerstitial fibrosis mouse model. The association of LOXL2 with epithelial-mesenchymal transformation-related molecules was also evaluated in vitro using HK-2 cells. The present data demonstrated that AB0023 prevented the progression of tubulointerstitial fibrosis significantly, as determined by trichrome and picro-sirius red staining, as well as the total collagen assay. The mean expression of phosphorylated Smad2 and Smad4 was lower in the AB0023-treated group although it was not statistically significant. Following transforming growth factor-β (TGF-β) challenge, LOXL2-deficient HK-2 cells exhibited significantly lower expression of the mesenchymal markers vimentin and fibronectin than control HK-2 cells. In conclusion, LOXL2 inhibition ameliorates renal fibrosis through the TGF-β/Smad signalling pathway.

DWI Metrics Differentiating Benign Intraductal Papillary Mucinous Neoplasms from Invasive Pancreatic Cancer: A Study in GEM Models

KPC (KrasG12D:Trp53R172H:Pdx1-Cre) and CKS (KrasG12D:Smad4L/L:Ptf1a-Cre) mice are genetically engineered mouse (GEM) models that capture features of human pancreatic ductal adenocarcinoma (PDAC) and intraductal papillary mucinous neoplasms (IPMN), respectively. We compared these autochthonous tumors using quantitative imaging metrics from diffusion-weighted MRI (DW-MRI) and dynamic contrast enhanced (DCE)-MRI in reference to quantitative histological metrics including cell density, fibrosis, and microvasculature density. Our results revealed distinct DW-MRI metrics between the KPC vs. CKS model (mimicking human PDAC vs. IPMN lesion): the apparent diffusion coefficient (ADC) of CKS tumors is significantly higher than that of KPC, with little overlap (mean ± SD 2.24±0.2 vs. 1.66±0.2, p<10−10) despite intratumor and intertumor variability. Kurtosis index (KI) is also distinctively separated in the two models. DW imaging metrics are consistent with growth pattern, cell density, and the cystic nature of the CKS tumors. Coregistration of ex vivo ADC maps with H&E-stained sections allowed for regional comparison and showed a correlation between local cell density and ADC value. In conclusion, studies in GEM models demonstrate the potential utility of diffusion-weighted MRI metrics for distinguishing pancreatic cancer from benign pancreatic cysts such as IPMN.

Ingestion and egestion of polystyrene microplastic fragments by the Pacific oyster, Crassostrea gigas

Marine microplastics (MPs) pose a risk to human health through accumulation in maricultural organisms, particularly bivalves. Various studies have reported the presence of MP particles in Pacific oysters (Crasostrea gigas). In this study, we investigated the size-specific ingestion and egestion of polystyrene (PS) MPs by Pacific oysters. The cultivation density of C. gigas was maintained at 1 L of filtered seawater per oyster (n = 5) during the MP ingestion and egestion experiments. On exposure to 300 n/L of PS MP fragments for 7 d, 60.4% of the PS was ingested within 6 h (7.25 × 10² ± 1.36 × 10² n/indv.), and the ingestion was saturated at 12 h (1.2 × 10³ ± 2.2 × 10² n/indv.) in C. gigas. The maximum MP ingestion capacity (Ig_max) of a single Pacific oyster was 73.0 ± 16.3 n/g wet weight. Further, 62.9% of the PS MP particles were egested for 7 d from the saturated single C. gigas. Ingestion and egestion varied according to the PS MP size. In the case of <50 μm PS MP, ingestion rate was low but MP amount and net-ingestion efficiency was significantly higher than other PS MP sizes. In addition, egestion, egestion rate, and net-egestion efficiency for <50 μm PS MPs were significantly higher than other PS MP sizes. Therefore, smaller MPs (<50 μm) normally exhibit the highest ingestion and egestion rates; therefore, the 50-300 μm size fraction exhibited the highest residual possibility (particles >1000 μm were excluded). Additionally, considering the net-egestion efficiency, the most economical and efficient depuration period was 24 h. This study clarifies the size-specific MP accumulation in oysters, and the egestion results suggest that the potential risk of MPs to human health through the intake of maricultural products could be reduced by depuration.

The Effect of Opioid-Free Anesthesia on the Quality of Recovery After Gynecological Laparoscopy: A Prospective Randomized Controlled Trial

Purpose

Opioid-free anesthesia (OFA) is an emerging technique that eliminates intraoperative use of opioids and is associated with lower postoperative opioid consumption and reduced adverse postoperative events. The present study investigated the effect of OFA on the quality of recovery in patients undergoing gynecological laparoscopy.

Patients and Methods

Seventy-five adult patients undergoing elective gynecological laparoscopy were randomly assigned to the OFA group with dexmedetomidine and lidocaine or the remifentanil-based anesthesia (RA) group with remifentanil. Patients, surgeons, and medical staff members providing postoperative care and assessing outcomes were blinded to group allocation. The anesthesiologist performing general anesthesia could not be blinded due to the different drug administration protocols by groups. The primary outcome was the quality of recovery measured using the Quality of Recovery-40 (QoR-40) questionnaire. Secondary outcomes were postoperative pain score, intraoperative and postoperative adverse events, and stress hormones levels.

Results

The patients in both groups had comparable baseline characteristics. The QoR-40 score on postoperative day 1 was significantly higher in the OFA group than in the RA group (155.9 ± 21.2 in the RA group vs 166.9 ± 17.8 in the OFA group; mean difference: −11.0, 95% confidence interval: −20.0, −2.0; p = 0.018). The visual analog scale score at 30 min after surgery was significantly lower in the OFA group than in the RA group (6.3 ± 2.3 in the RA group vs 4.1 ± 2.1 in the OFA group; p < 0.001). The incidences of nausea and shivering in the post-anesthetic care unit were also significantly lower in the OFA group (p = 0.014 and 0.025; respectively). Epinephrine levels were significantly lower in the OFA group (p = 0.002).

Conclusion

OFA significantly improved the quality of recovery in patients undergoing gynecological laparoscopy.

Perioperative Inflammatory Response and Cancer Recurrence in Lung Cancer Surgery: A Narrative Review

While surgical resection is the gold standard treatment for solid tumors, cancer recurrence after surgery is common. Immunosurveillance of remnant tumor cells is an important protective mechanism. Therefore, maintenance of anti-tumor cell activity and proper levels of inflammatory mediators is crucial. An increasing body of evidence suggests that surgery itself and perioperative interventions could affect these pathophysiological responses. Various factors, such as the extent of tissue injury, perioperative medications such as anesthetics and analgesics, and perioperative management including transfusions and methods of mechanical ventilation, modulate the inflammatory response in lung cancer surgery. This narrative review summarizes the pathophysiological mechanisms involved in cancer recurrence after surgery and perioperative management related to cancer recurrence after lung cancer surgery.

Simultaneous determination of nereistoxin insecticides in foods of animal origins by combining pH-dependent reversible partitioning with hydrophilic interaction chromatography-mass spectrometry

Although nereistoxin insecticides (NIs) are banned for animal husbandry operations, they are still used because of their high insecticidal activities. Therefore, a reliable residue analysis method for the simultaneous detection of cartap, bensultap, thiocyclam, and nereistoxin in foods of animal origins, including beef, pork, chicken, milk, and eggs, was developed using hydrophilic interaction liquid chromatography-mass spectrometry (HILIC-LC-MS/MS). The NIs were extracted with an acidic cysteine and formate buffer solution and hydrolyzed to nereistoxin. The molarity and pH of the buffer were optimized at 20 mM and 3, respectively, to keep the pH of the extracts at 4-5. pH-dependent acid-base partitioning coupled with salting-out-assisted liquid-liquid extraction using acetonitrile was performed for purification and for the direct introduction of the extracts to LC. The optimal pH values were 5 and 9 for the acid-base partitioning. Nereistoxin quantitation was achieved with consistent column retention (RSD < 0.6%) and a high degree of separation (N > 10⁶). The matrix-dependent method limit of quantitation was 2 μg nereistoxin/kg, and the calibration curve showed good linearity (R² > 0.998). The recovery efficiencies were in the range of 89.2-109.9% with relative standard deviations less than 10%, and matrix effects did not exceed ± 10%, which satisfied the criteria outlined in the European SANTE/12682/2019 guidelines.

POS1443 IDENTIFYING THE NEW EMERGENCE OF RACIAL DISPARITIES IN GOUT OVER THE PAST 3 DECADES – US NATIONAL SURVEY AND PROSPECTIVE COHORT DATA

Background

Several studies published after 2010 reported a higher frequency of gout and hyperuricemia among US Blacks than Whites.1-4 However, Blacks (in the US and Africa) were previously thought to suffer gout less often than Whites.5 We hypothesized that the racial disparity in Blacks emerged over the past several decades, with flipped prevalence between the two races.

Objectives

To assess trends in racial differences in gout prevalence in the US using both national survey and cohort study data over the past 3 decades.

Methods

Using data from the NHANES (National Health and Nutrition Examination Survey) III (1988-1994) and latest decade (2007-2016), and data from 5 examination periods in the ARIC (Atherosclerosis Risk in Communities) Study between 1988 through 2013, we compared age- and sex-adjusted prevalences and odds ratios (OR) to determine the trend of racial differences in gout prevalence between Blacks and Whites. A time-race interaction term was used to assess differences in the rate of change between the two races.

Results

Among Whites, the sex- and age-standardised prevalence of gout in the NHANES rose from 2.8% (95% CI: 2.4 to 3.2) in 1988-94 to 3.7% (3.2 to 4.1) in 2007/16. Prevalence of gout among Blacks was lower than Whites in 1988-94 (2.6% [2.2 to 3.0]) but rose more sharply over the subsequent decades (p for race-time interaction=0.003), and in 2007/16 came to exceed that of Whites (5.0% [4.4 to 5.6]).

Corresponding age-sex-adjusted ORs for gout in Blacks vs. Whites were 0.93 (0.73 to 1.17) in 1988-94, increasing to 1.46 (1.22 to 1.74) in 2007/16 (Table 1). This disproportionate rise in gout prevalence among Blacks tended to be more prominent among women (OR 1.81 [1.29 to 2.53]) than men (OR 1.26 [1.02 to 1.55]; p for race-time interactions of 0.002 and 0.01, respectively). Similar trends were observed in the ARIC cohort, where the OR for gout among Blacks vs. Whites rose progressively from 0.82 (0.65 to 1.02) in 1987-89 to 1.81 (1.49 to 2.19) in 2011-13.

Table 1.

Temporal Trend of Racial Disparity in Gout Prevalence in NHANES Survey and the ARIC Study Cohort, overall and by sex

Odds Ratio (95% CI) for Gout Among Blacks vs. WhitesOVERALLNHANES1988-19942007-2016Age- and sex-adjusted0.93(0.73 to 1.17)1.46(1.22 to 1.74)ARICVisit 1: 1987-89Visit 2: 1990-92Visit 3: 1993-95Visit 4: 1996-98Visit 5: 2011-13Age- and sex-adjusted0.82(0.65 to 1.02)0.99(0.81 to 1.22)1.24(1.03 to 1.50)1.60(1.35 to 1.90)1.81(1.49 to 2.19)WOMENNHANES1988-19942007-2016Age-adjusted0.98(0.65 to 1.47)1.81(1.29 to 2.53)ARICVisit 1: 1987-89Visit 2: 1990-92Visit 3: 1993-95Visit 4: 1996-98Visit 5: 2011-13Age-adjusted0.92(0.64 to 1.32)1.14(0.82 to 1.59)1.45 (1.07 to 1.96)1.89 (1.45 to 2.46)2.28(1.73 to 3.01)MENNHANES1988-19942007-2016Age-adjusted0.91(0.68 to 1.21)1.26 (1.02 to 1.55)ARICVisit 1: 1987-89Visit 2: 1990-92Visit 3: 1993-95Visit 4: 1996-98Visit 5: 2011-13Age-adjusted0.73 (0.54 to 0.97)0.87 (0.66 to 1.14)1.03(0.79 to 1.33)1.29(1.02 to 1.64)1.34(1.00 to 1.78)

Conclusion

Gout prevalence tended to be lower in Blacks than Whites until late 80’s, then rose and surpassed that of Whites over the past several decades. These trends closely parallel the worsening obesity epidemic during this period,6 particularly in Blacks, partly due to enhanced Western lifestyle. Gout risk genetic profile change would not contribute to this emergence of racial differences, particularly among the same individuals in ARIC, although it remains to be clarified whether Blacks carry genetic profiles that enhance the effect of lifestyle risk factors for gout.

References

[1]PMID 22225548 (2012)

[2]PMID 24330409 (2013)

[3]PMID 24335384 (2014)

[4]PMID: 30618180 (2019)

[5]NEJM PMID: 15014177

[6]JAMA PMID: 12365955

Disclosure of Interests

Natalie McCormick: None declared, Leo Lu: None declared, Chio Yokose: None declared, Amit Joshi: None declared, Yuqing Zhang: None declared, Hyon Choi Consultant of: Ironwood, Selecta, Horizon, Takeda, Kowa, and Vaxart., Grant/research support from: Ironwood and Horizon

POS0280 EXCESS RISK OF ALL-CAUSE AND CARDIOVASCULAR MORTALITY IN FEMALES WITH GOUT – A PROSPECTIVE COHORT STUDY OF 105,502 WOMEN

Background

Despite the disproportionately worsening disease burden of female gout in recent years1 and its frequent associations with key cardiovascular risk factors (more often than male gout2,3), there remains a paucity of specific data about female gout, particularly about its impact on mortality and fatal coronary heart disease (CHD).

Objectives

To prospectively examine the relation of female gout and risk of all-cause and cardiovascular and coronary heart disease-specific deaths.

Methods

Using data from the Nurses’ Health Study (NHS), an ongoing prospective cohort study in which female nurses in the United States completed detailed mailed questionnaires regarding their medical history, lifestyle, and other risk factors at baseline and every two years thereafter, we prospectively analyzed the relation between gout status at baseline and during the follow-up period and the risk of all-cause and cardiovascular mortality using Cox proportional hazards regression to adjust for cardiovascular risk factors such as comorbidities, body mass index, postmenopausal status, medication use, and dietary factors.

Results

The analysis included 105,502 women without gout and 1602 women with gout. Women with gout at baseline in 1982 tended to be older (mean age 54 vs. 50 years), and more likely to report a history of hypertension (44% vs. 22%), hypercholesterolemia (17% vs. 8%), and diabetes (11% vs. 6%). During 24 years of follow-up, we documented 15,255 deaths from all causes, including 3,128 deaths from cardiovascular disease (CVD) and 1,405 deaths from coronary heart disease (CHD). Compared to women without history of gout or CHD at baseline, the multivariable relative risks (RRs) among women with history of gout at baseline were 1.33 (95% CI, 1.21 to 1.46) for total mortality, 1.40 (95% CI, 1.17 to 1.67) for CVD deaths, and 1.49 (95% CI, 1.17 to 1.91) for fatal CHD (Table 1). The corresponding RRs for gout at baseline and during the follow-up were 1.33 (95% CI, 1.23 to 1.44), 1.43 (95% CI, 1.24 to 1.66), and 1.34 (95% CI, 1.08 to 1.66), respectively.

Table 1.

Relative Risks of Death from All-Causes, Cardiovascular Disease, and Coronary Heart Disease According to Gout Status at Baseline in 1982 in the Nurses’ Health Study

No CHDNo GoutGoutDeaths from all causesCases, n14,810445Age-adjusted RR (95% CI)1.01.58 (1.43, 1.73)Multivariable-adjusted* RR (95% CI)1.01.33 (1.21, 1.46)All cardiovascular deathsCases, n3,001127Age-adjusted RR (95% CI)1.02.06 (1.72, 2.46)Multivariable-adjusted* RR (95% CI)1.01.40 (1.17, 1.67)Fatal CHDCases, n1,33570Age-adjusted RR (95% CI)1.02.53 (1.99, 3.22)Multivariable-adjusted* RR (95% CI)1.01.49 (1.17, 1.91)

*Adjusted for age (continuous), history of hypertension, history of hypercholesterolemia, history of diabetes, aspirin use (yes, no), diuretic use (yes, no), smoking (never, past, current <15, current ≥15 cigarettes/day), body mass index (<23, 23-24.9, 25-29.9, 30-34.9, ≥35), physical activity (quintile), alcohol intake (nondrinker, <5, 5-9, 10-29, ≥30g/day), family history of MI (yes, no), menopausal status (premenopause, post menopause), hormone replacement therapy use (premenopause, never user, current user, past user). total energy intake (quintile), trans fat (quintile), dietary cholesterol (quintile), protein (quintile), linoleic fatty acid (quintile), and ratio of polyunsaturated fat/saturated fat.

CHD = coronary heart disease; CI = confidence interval; RR = relative risk.

Conclusion

These prospective data indicate that women with gout have a higher risk of all-cause mortality, which is primarily driven by higher risk of CVD deaths. These findings closely agree with the UK general population data of both sexes that showed unclosing mortality gap over the past two decades.4 Together, these findings provide support for rigorous cardiovascular risk factor modification specifically in female gout to help curtail the rising disease burden of gout worldwide.1

References

[1]Xia et al., PMID 31624843

[2]Puig et al., PMID 2012455

[3]Harrold et al., PMID 16644784

[4]Fisher et al., PMID 28122760

Disclosure of Interests

Chio Yokose: None declared, Natalie McCormick: None declared, Na Lu: None declared, Amit Joshi: None declared, Gary Curhan Consultant of: AstraZeneca, Allena Pharmaceuticals, Shire/Takeda, Dicerna, and Orfan, Grant/research support from: Decibel Therapeutics, Employee of: Chief Medical Officer at OM1, Inc., Hyon Choi Consultant of: Ironwood, Selecta, Horizon, Takeda, Kowa, and Vaxart, Grant/research support from: Ironwood and Horizon