Abstract P1-12-07: Prospective 36-month follow-up to determine changes in body mass index and weight among Chinese breast cancer survivors

Background:Anticancer treatment for breast cancer has been associated with weight gain but such observation has mainly been reported in western patients. More recent data in Asian patients have inconsistent findings. Factors including socio-demographic, clinical and lifestyle may be associated with post-diagnosis weight gain. In this prospective cohort study of women with breast cancer, the objectives were to determine the body mass index (BMI) and weight changes over 36 months after initial diagnosis and the factors associated with such changes.

Methods: Chinese women with newly diagnosed early-stage breast cancer were recruited. Individual woman had her weight measured at breast cancer diagnosis (W0), at study entry (W1) and at 36-month follow-up (W2). Body height was measured at W0. We evaluated change in weight and body mass index (BMI) before and after breast cancer diagnosis.Socio-demographic, clinical and lifestyle factors were assessed to identify potential associated factors with weight changes.

Results: A total of 1133 women with breast cancer had detailed weight measurements at the 3 time-points of assessment. The mean age at diagnosis was 52 years. Fifty-four percent were premenopausal at W1. The proportion of patients with stage 0-I, II and III diseases were 35%, 46% and 19%, respectively.

The proportions of patients who were overweight and obese at the three assessment time-points were 21.2% and 28.5% at W0, 19.7% and 26.6% at W1, and 21.7% and 30.9% at W2 assessment, respectively. When compared to W0, the proportions of women who gained weight within 2-5kg at W1 and W2 were 2.4% and 20.6% respectively, that with weight gain of >5kg at W1 and W2 were 0.5% and 10.0% respectively; 6.1% and 19.6% of women had weight loss >2kg at W1 and W2 respectively.

Compared to W0, the median value of weight change was -0.5 kg (range: -11.4, 18.3) at W1 and 0.6 kg (range: -19.6, 20.5) at W2. On multivariate analysis, only BMI at diagnosis were significantly associated with weight change betweenassessments at diagnosis and W2; the median (range) for weight changes for women who were underweight, normal, overweight and obese were respectively 0.9 (-4.8, 7.6), 0.6 (-13.2, 20.5), 0.5 (-11.5, 13.0) and 0.5 (-19.6, 12.6) kg, p <0.001.

Conclusions: In this prospective study of Chinese women with a history of breast cancer who were followed-up over a 36-months' period, the proportions of women with overweight and obese statuses were relatively stable; weight gain was uncommon among Hong Kong women with breast cancer during the same period. These findings are in contrast with studies conducted in the West, where weight gains were more commonly reported.

Funding: World Cancer Research Fund International (Grant Number WCRF 2010/249 and WCRF 2014/1197)

Citation Format: Yeo W, Lei YY, Cheng AC, Kwok CC, Cheung KL, Lee R, Lee IC, He YQ, Ho S. Prospective 36-month follow-up to determine changes in body mass index and weight among Chinese breast cancer survivors [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 P1-12-07.

Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study

BACKGROUND

Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery.

METHODS

This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy.

RESULTS

Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51-19.97) than planned admissions (OR: 2.32, 95% CI: 1.43-3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8-51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI.

CONCLUSIONS

After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.

Critical Role of Central Facilitation in the Glottic Closure Reflex

The sphincteric function of the larynx, essential to lower airway protection, is most efficiently achieved through strong reflex adduction by both vocal cords. We hypothesize that central facilitation is an essential component of a bilateral adductor reflex and that its disturbance could result in weakened sphincteric closure. Six adult 50-kg pigs underwent evoked response laryngeal electromyography under 0.5 to 1.0 minimal alveolar concentration (MAC) isoflurane anesthesia. The internal branch of the superior laryngeal nerve was stimulated through bipolar platinum-iridium electrodes, and recording electrodes were positioned in the ipsilateral and contralateral thyroarytenoid muscles. Consistent threshold responses were obtained ipsilaterally from 0.5 to 1.0 MAC anesthesia. However, the contralateral reflex responses approached 0% in successive trials as anesthetic levels approached 1.0 MAC. Alteration of central facilitation by deepening anesthesia abolishes the crossed adductor reflex, predisposing to a weakened glottic closure response. A precise understanding of this effect may improve the prevention of aspiration in patients emerging from prolonged sedation or under heavy psychotropic control.

Bioengineering bacteriophages to enhance the sensitivity of phage amplification-based paper fluidic detection of bacteria

Bacteriophage (phage) amplification is an attractive method for the detection of bacteria due to a narrow phage-host specificity, short amplification times, and the phages' ability to differentiate between viable and non-viable bacterial cells. The next step in phage-based bacteria detection is leveraging bioengineered phages to create low-cost, rapid, and easy-to-use detection platforms such as lateral flow assays. Our work establishes the proof-of-concept for the use of bioengineered T7 phage strains to increase the sensitivity of phage amplification-based lateral flow assays. We have demonstrated a greater than 10-fold increase in sensitivity using a phage-based protein reporter, maltose-binding protein, over the detection of replicated T7 phage viron itself, and a greater then 100-fold increase in sensitivity using a phage-based enzymatic reporter, alkaline phosphatase. This increase in sensitivity enabled us to detect 10(3)CFU/mL of Escherichia coli in broth after 7h, and by adding a filter concentration step, the ability to detect a regulatory relevant E. coli concentration of 100CFU/100mL in inoculated river water after 9h, where the current standard requires days for results. The combination of the paper fluidic format with phage-based detection provides a platform for the development of novel diagnostics that are sensitive, rapid, and easy to use.

Language and understanding of cardiopulmonary resuscitation amongst an aged inpatient population

Greater patient involvement in health decision-making requires exchange of information between the patient and the healthcare professionals. Decisions regarding healthcare at the end of life include consideration of cardiopulmonary resuscitation (CPR). The stated objectives of this study were to determine how often language around concepts of resuscitation is used in the community by examination of the English language corpora (ELC); to explore the understanding of the same language by a group of older hospital patients; and to determine the patients' knowledge of the process and success of CPR, as well as the sources of their information. Medical inpatients aged 75 years and older were surveyed to this end in the setting of a tertiary university teaching hospital. Interrogation of the Australian, British and American English Corpora was accomplished by a linguist, and a questionnaire and semi-structured interview were administered to ascertain patient knowledge. We demonstrated that although medical inpatients have some familiarity with terms relating to resuscitation, there is a lack of understanding of the context, process and outcomes of CPR. The predominant sources of information were television and print media. Examination of the ELC revealed a paucity of the use of terms related to resuscitation. This finding indicates that physicians have a duty of care to determine patients' understanding around resuscitation language, and terms used, in discussions of their preferences before assuming their engagement in shared decision-making. More open public discussion around death and resuscitation would increase the general knowledge of the population and would provide a better foundation for the discussions in times of need.

Attack risk for butterflies changes with eyespot number and size

Butterfly eyespots are known to function in predator deflection and predator intimidation, but it is still unclear what factors cause eyespots to serve one function over the other. Both functions have been demonstrated in different species that varied in eyespot size, eyespot number and wing size, leaving the contribution of each of these factors to butterfly survival unclear. Here, we study how each of these factors contributes to eyespot function by using paper butterfly models, where each factor is varied in turn, and exposing these models to predation in the field. We find that the presence of multiple, small eyespots results in high predation, whereas single large eyespots (larger than 6 mm in diameter) results in low predation. These data indicate that single large eyespots intimidate predators, whereas multiple small eyespots produce a conspicuous, but non-intimidating signal to predators. We propose that eyespots may gain an intimidation function by increasing in size. Our measurements of eyespot size in 255 nymphalid butterfly species show that large eyespots are relatively rare and occur predominantly on ventral wing surfaces. By mapping eyespot size on the phylogeny of the family Nymphalidae, we show that these large eyespots, with a potential intimidation function, are dispersed throughout multiple nymphalid lineages, indicating that phylogeny is not a strong predictor of eyespot size.