P645Low levels of low density lipoprotein cholesterol and cardiovascular, cancer and all-cause mortality outcomes

Aims

The effect of low concentrations of low density lipoprotein-cholesterol (LDL-C) on cardiovascular disease (CVD) cancer and all-cause mortality is still controversial. In a large, young, well characterized, relatively healthy occupational cohort (Kangbuk Samsung health study, KSHS), we tested associations between low levels of LDL-C concentration, and CVD, cancer and all- cause mortality. To validate these associations, we analyzed data from another cohort (Korean genome and epidemiology study, KoGES).

Methods and results

347,971 subjects in KSHS (mean age 39.6 years, 57.4% men) were studied over a mean follow up of 5.64±3.27 years. All subjects treated with any lipid lowering therapy were excluded. After excluding the data from subjects who died during the first 3 years of follow up, five groups were defined according to baseline LDL-C concentration (<70, 70–99, 100–129, 130–159, ≥160 mg/dL). Hazard ratios (HR and 95% CIs) for all-cause mortality, CVD and cancer mortality were estimated using Cox proportional hazards models. In the KoGES validation cohort, 182,943 subjects (mean age 53.1 years, 34.6% men) were studied over a mean follow up of 8.57±2.59 years with same methods. 2,028 deaths (897 from cancer and 282 from CVD) occurred during follow-up in KSHS. The lowest LDL-C group (LDL<70 mg/dL) had a higher risk of all-cause mortality (HR 1.95, 1.55–2.47), CVD mortality (HR 2.02, 1.11–3.64) and cancer mortality (HR 2.06, 1.46–2.90) compared to the reference group (LDL 120–139 mg/dL). This association was more prominent in men than in women. In the validation cohort, 2,338 deaths (1,823 from cancer and 199 from CVD) occurred during follow-up. The lowest LDL-C group (LDL<70 mg/dL) had a higher risk of all-cause mortality (HR 1.81, 1.44–2.28). Men in the lowest LDL-C group had a higher risk of CVD mortality (HR 3.15, 1.21–8.21) and cancer mortality (1.34, 0.99–1.82) in the KoGES cohort.

Conclusions

Low levels of LDL-C concentration are strongly and independently associated with increased risk of cancer, CVD and all-cause mortality especially in men.

2205Caregivers with persistent depressive symptoms are at high risk of having poor health status over 1 year of caregiving

Background

Depressive symptoms are a substantial psychological problem in caregivers of stroke survivors, but there is limited knowledge about the trajectory of depressive symptoms and the consequence in longitudinal study. The purposes of this study were to (1) identify patterns for trajectory of depressive symptoms in caregivers who provided caregiving for stroke survivors for 1 year post-discharge, and (2) examine associations of depressive symptom trajectories with caregivers' burden, family function, social support, and health status over time.

Methods

In this secondary analysis of a longitudinal study, caregivers of stroke survivors completed a survey at post-discharge and 1 year follow up. Depressive symptoms were assessed using the Center for Epidemiologic Studies-Depression scale (CES-D). Caregiving burden, family function, and social support were assessed using the Zarit Burden Interview, the Family Assessment Device, and the Interpersonal Support Evaluation List. Health status was assessed using two items from the SF-36. Pattern of depressive symptom trajectory (i.e., symptom-free, symptom improved, symptom developed, and persistent symptom) were identified by the presence of depressive symptoms (CES-D ≥16) at post-discharge and 1 year follow up. ANOVA, and multinomial logistic regression were used.

Results

Of the 102 caregivers (mean age=58 years, 66% female), 32.4% experienced depressive symptoms at post-discharge; 30.4% experienced depressive symptoms at 1-year follow up. During the first year of the caregiving experience, 57.8% of caregivers were symptom-free but 20.6% experienced persistent depressive symptoms; 11.8% had improved depressive symptoms, and 9.8% developed depressive symptoms. Caregivers with persistent depressive symptoms reported the highest level of burden (p<0.001), and the lowest levels of family function (p=0.02) and interpersonal support (p=0.0001) among the 4 groups at post-discharge and the results were unchanged at 1 year follow up. Furthermore, 33% of caregivers with persistent depressive symptoms reported their health as fair or poor at 1 year follow up and 42% of them reported their health became worse at 1 year follow up. Caregivers who developed depressive symptoms had the 2nd lowest score of interpersonal support (p=0.047) at 1 year follow up. Compared to symptom-free caregivers, caregivers with persistent depressive symptoms were 7 times more likely to have fair or poor health at 1 year follow up (95% CI, 1.55–32.87, p=0.012).

Conclusions

Trajectory of depressive symptoms was associated with caregiving burden, family function, and interpersonal support. The persistence of depressive symptoms is substantial for caregivers of stroke survivors and they are at high risk to have poor health status at 1 year of caregiving. Management of depressive symptoms at the early caregiving stage may be beneficial to prevent the development and persistence of depressive symptoms in caregivers of stroke survivors.

Acknowledgement/Funding

National Institute for Nursing Research R01NR02416

Association between time to treatment and functional outcomes according to the Diffusion-Weighted Imaging Alberta Stroke Program Early Computed Tomography Score in endovascular stroke therapy

BACKGROUND AND PURPOSE

The rate at which the chance of a good outcome of endovascular stroke therapy (EVT) decays with time when eligible patients are selected by baseline diffusion-weighted magnetic resonance imaging (DWI-MRI) and whether ischaemic core size affects this rate remain to be investigated.

METHODS

This study analyses a prospective multicentre registry of stroke patients treated with EVT based on pretreatment DWI-MRI that was categorized into three groups: small [Diffusion-Weighted Imaging Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS)] (8-10), moderate (5-7) and large (<5) cores. The main outcome was a good outcome at 90 days (modified Rankin Scale 0-2). The interaction between onset-to-groin puncture time (OTP) and DWI-ASPECTS categories regarding functional outcomes was investigated.

RESULTS

Ultimately, 985 patients (age 69 ± 11 years; male 55%) were analysed. Potential interaction effects between the DWI-ASPECTS categories and OTP on a good outcome at 90 days were observed (P_interaction  = 0.06). Every 60-min delay in OTP was associated with a 16% reduced likelihood of a good outcome at 90 days amongst patients with large cores, although no associations were observed amongst patients with small to moderate cores. Interestingly, the adjusted rates of a good outcome at 90 days steeply declined between 65 and 213 min of OTP and then remained smooth throughout 24 h of OTP (P_nonlinearity  = 0.15).

CONCLUSIONS

Our study showed that the probability of a good outcome after EVT nonlinearly decreased, with a steeper decline at earlier OTP than at later OTP. Discrepant effects of OTP on functional outcomes by baseline DWI-ASPECTS categories were observed. Thus, different strategies for EVT based on time and ischaemic core size are warranted.

Efficacy and safety of CT-P6 versus reference trastuzumab in HER2-positive early breast cancer: updated results of a randomised phase 3 trial

PURPOSE

Neoadjuvant CT-P6, a trastuzumab biosimilar, demonstrated equivalent efficacy to reference trastuzumab in a phase 3 trial of HER2-positive early-stage breast cancer (EBC) (NCT02162667). We report post hoc analyses evaluating pathological complete response (pCR) and breast pCR alongside additional efficacy and safety measures.

METHODS

Following neoadjuvant treatment and surgery, patients received adjuvant CT-P6 or trastuzumab (6 mg/kg) every 3 weeks for ≤ 1 year.

RESULTS

In total, 271 and 278 patients received CT-P6 and trastuzumab, respectively. pCR and breast pCR rates were comparable between treatment groups regardless of age, region, or clinical stage. Overall, 47.6% (CT-P6) and 52.2% (trastuzumab) of patients experienced study drug-related treatment-emergent adverse events (TEAEs), including 17 patients reporting heart failure (CT-P6: 10; trastuzumab: 7). Two CT-P6 and three trastuzumab patients discontinued adjuvant treatment due to TEAEs.

CONCLUSION

Adjuvant CT-P6 demonstrated comparable efficacy and safety to trastuzumab at 1 year in patients with HER2-positive EBC, supporting CT-P6 and trastuzumab comparability.

Observation of Light-by-Light Scattering in Ultraperipheral Pb+Pb Collisions with the ATLAS Detector

This Letter describes the observation of the light-by-light scattering process, γγ→γγ, in Pb+Pb collisions at sqrt[s_{NN}]=5.02  TeV. The analysis is conducted using a data sample corresponding to an integrated luminosity of 1.73  nb^{-1}, collected in November 2018 by the ATLAS experiment at the LHC. Light-by-light scattering candidates are selected in events with two photons produced exclusively, each with transverse energy E_{T}^{γ}>3  GeV and pseudorapidity |η_{γ}|<2.4, diphoton invariant mass above 6 GeV, and small diphoton transverse momentum and acoplanarity. After applying all selection criteria, 59 candidate events are observed for a background expectation of 12±3 events. The observed excess of events over the expected background has a significance of 8.2 standard deviations. The measured fiducial cross section is 78±13(stat)±7(syst)±3(lumi)  nb.

Association between 18F-FDG uptake in PET/CT, Nrf2, and NQO1 expression and their prognostic significance in non-small cell lung cancer

Two pentose phosphate pathway-related proteins, NF-E2-related factor 2 (Nrf2)/ NAD(P)H dehydrogenase (Quinone) 1 (NQO1) regulate the expression of glucose metabolism and antioxidant genes. We evaluated the prognostic significance of NRF2, NQO1 and 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) parameter and their relationship with non-small cell lung cancer (NSCLC) histology. A total of 241 patients, who underwent surgical resection for NSCLC, were reviewed retrospectively. Preoperative 18F-FDG PET and immunohistochemical results of Nrf2 and NQO1 were evaluated. In SQCC, the maximum standardized uptake value (SUVmax) was significantly higher in NQO1-high than in NQO1-low expression (p=0.023). In adenocarcinoma, SUVmax was not correlated with NQO1 expression. Patients with a high NQO1 expression showed poor recurrence-free survival (RFS) and overall survival (OS) than patients with a low NQO1 expression in squamous cell carcinoma (SQCC) (p=0.002 and p=0.014, respectively). NQO1 expression was not associated with clinical outcome in adenocarcinoma. Nrf2 expression was not correlated with prognosis in two types of NSCLC. High SUVmax was associated with poor RFS (p=0.03) but is not related to poor OS (p=0.569) in SQCC. In multivariate analyses, NQO1 expression and SUVmax were not independent prognostic factors in SQCC. However, in multivariate analysis combining NQO1 and SUVmax values, both low SUVmax and low NQO1 was independent prognostic factor for RFS and OS (HR= 3.790, p = 0.033 and HR= 2.961, p = 0.045, respectively). In conclusion, both low SUVmax and low NQO1 was an independent prognostic factor in SQCC alone. The sample size was small but there was a positive correlation between NQO1 expression and SUVmax in SQCC.

Combination of Searches for Invisible Higgs Boson Decays with the ATLAS Experiment

Dark matter particles, if sufficiently light, may be produced in decays of the Higgs boson. This Letter presents a statistical combination of searches for H→invisible decays where H is produced according to the standard model via vector boson fusion, Z(ℓℓ)H, and W/Z(had)H, all performed with the ATLAS detector using 36.1  fb^{-1} of pp collisions at a center-of-mass energy of sqrt[s]=13  TeV at the LHC. In combination with the results at sqrt[s]=7 and 8 TeV, an exclusion limit on the H→invisible branching ratio of 0.26(0.17_{-0.05}^{+0.07}) at 95% confidence level is observed (expected).

[The correlation between plasma fibrinogen level and different types of sudden sensorineural hearing loss]

Objective: To investigate the correlation between plasma fibrinogen level and the incidence of sudden hearing loss. Method: A total of 225 patients (age ranging from 18 to 70 years) with sudden sensorineural hearing loss(SSNHL) were selected. The disease onset was within 2 weeks. No patient received previous medical intervention. Depending on the types of auditory threshold curve, SSNHL was divided into low frequency descending type, high frequency descending type, flat desending type and total deafness type. Two hundred and twenty-nine cases with normal hearing and no inflammatory diseases in the same period was selected as control group. Fibrinogen level and Blood Routine Indexes were detected for the purpose of retrospective cohort study.Result: The levels of fibrinogen in SSNHL group(2.98±0.59) g/L were significantly higher than that in control group(2.66±0.36) g/L (P<0.01). According to the types of auditory threshold curve, SSNHL groups were divided into group A(55 cases, 24.44%), Group B(36 cases, 16.00%), Group C(43 cases,19.11%) and Group D(91 cases, 40.44%). The average fibrinogen levels before treatment were at(2.75±0.46)g/L, (3.16±0.61) g/L, (3.02±0.63) g/L and(3.03±0.63) g/L respectively. There was no significant difference in fibrinogen level(P=0.286) between group A and the control group. Fibrinogen levels of group B, group C and group D were significantly elevated compared to control group (P<0.01). Conclusion: The level of fibrinogen is not significantly correlated with development of sudden deafness of low frequency descending type. The incidence of high frequency descending type, flat descending type and profound deafness type are all correlated with the level of high fibrinogen at the onset of sudden deafness. The classification of sudden deafness based on audiogram curves could be of great significance for analysis of possible causes and selection of treatment options.

Abstract P2-08-53: Tumor elasticity and clinicopathologic factors affecting neoadjuvant chemotherapy response in breast cancer patients

Background: Neoadjuvant chemotherapy for breast cancer has been increased. Many studies have reported on clinicopathologic factors to predict neoadjuvant chemotherapy response. Elastography, which is usually used to differentiate benign and malignant tumors, can be performed to evaluate tissue elasticity during conventional ultrasonography. The purpose of this study was to determine the clinicopathologic factors, including tumor elasticity, that affect neoadjuvant chemotherapy response in stage II or III breast cancer patients.

Methods: From April 2014 to March 2017, 95 patients received neoadjuvant chemotherapy for clinical stage IIa-IIIc primary breast cancer. To evaluate tumor elasticity, strain elastography was performed in 74 patients before neoadjuvant chemotherapy. Patients were divided into two groups by the Tsukuba elasticity scoring system (soft group ≤3 vs. hard group ≥4). Histologic type, nuclear grade, tumor infiltrating lymphocytes (TILs), tumor cellularity, characteristics of stroma, and hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) status were evaluated using core needle biopsy specimens obtained before neoadjuvant chemotherapy. Pathologic complete response (pCR) was defined as the absence of invasive carcinoma in breast (ypT0 and ypTis) and axillary lymph node (ypN0). Residual cancer burden (RCB) was also calculated in 79 cases and the cases were categorized into 2 groups; favorable RCB group (RCB-0 and I) and unfavorable RCB group (RCB-II and III).

Results: The mean age of patients was 46.43±8.62 years (range, 27-71 years) and the mean initial tumor size was 3.63±1.95cm (range, 2.1-12.8cm). Twenty-four patients (32.4%) were categorized into the soft group and 50 patients (67.6%) into the hard group. The mean tumor cellularity on core needle biopsy specimens and characteristics of stroma were not significantly different between the two groups (p=0.35 and p=0.79, respectively). Twenty-two patients achieved pCR (23.2%). The patients with pCR were more likely to have estrogen receptor (ER) or progesterone receptor (PR) negative breast cancer (p=0.04 and p=0.03). The rate of nuclear grade 3 was higher in patients with pCR than those without (p=0.03). Tumor elasticity was not correlated with pCR (p=0.28). Thirty patients (38.0%) achieved favorable RCB and forty-nine patients (62.0%) had unfavorable RCB. Not only the rates of ER negativity (p=0.05), PR negativity (p=0.03), nuclear grade 3 (p=0.01), and high TILs level (≥ 10%) (p=0.04) but also the mean TILs level (p=0.05) were significantly higher in the favorable RCB group compared withthe unfavorable RCB group. No significant difference in tumor elasticity was observed between the two groups (p=0.30). In univariate analyses, nuclear grade 3 (p=0.03), and high TILs level (≥10%) (p=0.04) were significantly correlated with favorable RCB. HR negativity was an independent predictor of favorable RCB in multivariate analysis (odds ratio, 2.93; 95% confidence interval, 1.04-8.28; p=0.04).

Conclusion: Tumor elasticity was not associated with pCR or RCB. HR negativity was an independent predictor for favorable RCB.Nuclear grade and TILs were also potential predictive factors for neoadjuvant chemotherapy response.

Citation Format: Park JY, Choi JE, Bae YK, Lee SJ. Tumor elasticity and clinicopathologic factors affecting neoadjuvant chemotherapy response in breast cancer patients [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 P2-08-53.

Abstract P6-02-08: SUV max of 18F FDG-PET/CT: A predictive factor associated with pathologic complete response in luminal HER2–negative breast cancer patients (receiving neoadjuvant chemotherapy)

Purpose Neoadjuvant chemotherapy (NAC) is considered to be the standard of care for locally advanced breast cancer. When pathological complete response (pCR) is obtained with NAC it is a predictor of better outcome and often used as a surrogate for survival. However, response to NAC of luminal type breast cancer is variable and mostly limited. This study investigated the predictive relevance of several clinicopathological factors, including parameters of 18F FDG-PET/CT, on the pCR to NAC in patients with luminal HER2–negative breast cancer.

Methods From 2009 to 2015, 117 hormone receptor-positive, HER2-negative breast cancer patients who were treated with NAC followed by curative surgery at the Kyungpook National University Hospital (Daegu, Korea) were retrospectively analyzed. pCR was defined as the absence of cancer cells in breast and axillary node. 18F FDG-PET/CT maximum standardized uptake value (SUV max) was measured at baseline. Patients received from 6 to 8 cycles of anthracycline-based and taxane-based NAC.

Results The median age of the patients was 48 years (range-29-68 years). 104 patients (88.9%) were PR-positive, and forty-nine (41.9%) patients showed high ki-67 expression at initial diagnosis. After NAC, nine patients (7.7%) achieved pCR and patients who had high initial SUV max (≥ 9.09) achieved improved pCR rate compared to low initial SUV max (&lt; 9.09) patients (77.8 % vs. 22.2%).

Conclusion In luminal HER2-negative breast cancer, 18F FDG-PET/CT SUV max was useful for predicting pathologic complete response after NAC

Table 1Characteristics of study populationMedian, range48 (29-68)Initial clinical T stage 1 2 3 48 (6.8) 83 (70.9) 19 (16.2) 7 (6.0)Initial clinical N stage 0 1 2 310 (8.5) 49 (41.9) 47 (40.2) 11 (9.4)Initial ER expression Negative (0-2) Weak (3-5) Strong (6-8)8 (6.8) 14 (12) 95 (81.2)Initial PR expression Negative (0-2) Weak (3-5) Strong (6-8)13 (11.1) 20 (17.1) 84 (71.8)Initial Ki-67 expression &lt;14% ≥14% Not assessed55 (47) 49 (41.9) 13 (11.1)Pathologic T stage 0 I II III16 (13.7) 50 (42.7) 42 (35.9) 9 (7.7)Pathologic Stage (AJCC) pCR 1A 1B 2A 2B 3A 3C9 (7.7) 23 (19.7) 7 (6.0) 27 (23.1) 21 (17.9) 23 (19.7) 7 (6.0)Histologic grade 1 2 322 (18.8) 61 (52.1) 14 (12)Nuclear Grade 1 2 316 (13.7) 9 (7.7) 50 942.7)Pathologic complete response Yes9 (7.7)Recurrence18 (15.4)Death10 (8.5)table 2Association between pathologic complete response and clinicopathologic featuresFactorsPathologic CR NoPathologic CR YesP- valueAll patients108 (92.3)9 (7.7) Age &lt;40 40-55 56-7016 (18.2) 54(61.4) 18 (20.5)2 (22.2) 6 (66.7) 1 (11.1)0.789Initial clinical T stage 1 2 3 48 (7.4) 76 (70.4) 7 (6.5) 17 (15.7)0 (0) 7 (77.8) 2 (22.2) 0 (0)0.676Initial ER expression Negative (0-2) Weak (3-5) Strong (6-8)7 (6.5) 12 (11.1) 89 (8.4)1 (11.1) 2 (22.2) 6 (66.7)0.504Initial PR expression Negative (0-2) Weak (3-5) Strong (6-8)11 (10.2) 20 (18.5) 77 (71.3)2 (22.2) 0 (0) 7 (77.8)0.247Initial Ki-67 expression &lt;14% ≥14%52 (54.7) 43 (45.3)3 (33.3) 6 (66.7)0.301SUV max (tumor) &lt; 9.09 ≥ 9.0972 (66.7) 36 (33.3)2 (22.2) 7 (77.8)0.012SUV max (axilla) &lt; 6.08 ≥ 6.0858 (67.4) 28 (32.6)3 (42.9) 4 (57.1)0.228

Citation Format: Lee IH, Lee SJ, Lee J, Lee RK, Jung J, Park H, Lee S-w, Chae YS. SUV max of 18F FDG-PET/CT: A predictive factor associated with pathologic complete response in luminal HER2–negative breast cancer patients (receiving neoadjuvant chemotherapy) [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 P6-02-08.

Abstract P3-11-07: Exploratory biomarker analysis from a phase II, multicenter, randomized trial of eribulin plus gemcitabine(EG) versus paclitaxel plus gemcitabine(PG) as first-line chemotherapy for human epidermal growth factor receptor 2 (HER2)- negative metastatic breast cancer(MBC): Korean cancer study group trial (KCSG BR13-11)

Introduction : A phase II, multicenter, randomized clinical trial of the comparison between eribulin plus gemcitabine (EG) and paclitaxel plus gemcitabine (PG) as first-line chemotherapy for patients with human epidermal growth factor receptor 2 (HER2)-negative metastatic breast cancer (MBC) found EG was less neurotoxic, but had similar efficacy of PG. In this study, we performed exploratory biomarker analysis of the impact of genetic alterations on the efficacy according to EG and PG chemotherapy.

Methods : This biomarker study was conducted using tumor samples from 40patients. When tissue collection was possible after disease progression, we performed paired sample analysis. Tumor DNA and RNA were extracted from formalin-fixed, paraffin-embedded tissues. To perform targeted deep sequencing, we used CancerScanTM, a 375 cancer gene panel. And we performed an nCounter expression assay for gene expression analysis using 730 PanCancer panel and 730 Immune panel.

Results: In total, we obtained 44 tissue samples from 40 patients. Twenty two patients were assigned in EG arm and 18 patients were in PG arm. Thirty-eight were at baseline and six after disease progression. Gene expression assay were performed in 44 tissue samples but only 31 samples were possible to be targeted deep sequencing.

We performed differently expressed gene(DEG) analysis for detecting the association between level of gene expression and disease progression. In this analysis, high expression of CCNE1, TGFB4 and BAMBI and low expression of DDB2, CD14 and SHC3 were associated with disease progression among 730 PanCancer panel genes (p&lt;0.05, respectively). In terms of immune panel genes, most of immune related genes were highly expressed in a group without disease progression compared with that with disease progression. Only 2 genes, C8G and CD24 were highly expressed in a group with disease progression. Paired sample analysis showed that expression levels of THBS4 and CD27 decreased after disease progression while those of CCNE2 and FGFR4 increased.

In targeted deep sequencing, FAT3 (42.3%) was most frequently mutated gene followed by PKHD1, PIK3CA and TP53. Among mutated genes, EWSR1 mutation and upstream mutation of ETV1 were associated with disease progression, respectively (p&lt;0.05, respectively). In mutation signature analysis, signature 1 (S, age related), S3(homologous recombination deficiency, HRD), S6 (mismatch repair, MMR), S20(MMR) and S21(microsatellite instability, MSI) were enriched in this population. Mutation signature 3 related to short disease free survival (p=0.0026).

Conclusion: In gene expression analysis, high expression of TGF-B signaling pathway related genes was associated with disease progression while high expression of immune related genes were related to prolonged disease free survival. In mutation analysis, EWSR1 and ETV1 mutations indicated short disease free interval and HRD mutation signature was also related to poor prognosis.

Citation Format: Kim J-Y, Lee EJ, Park KH, Im S-A, Kim S-B, Sohn SH, Lee KS, Chae YS, Lee KH, Kim JH, Im Y-H, Kim T-Y, Lee K-H, Ahn J-H, Kim GM, Park IH, Lee SJ, Han HS, Kim SH, Jung KH, Park YH. Exploratory biomarker analysis from a phase II, multicenter, randomized trial of eribulin plus gemcitabine(EG) versus paclitaxel plus gemcitabine(PG) as first-line chemotherapy for human epidermal growth factor receptor 2 (HER2)- negative metastatic breast cancer(MBC): Korean cancer study group trial (KCSG BR13-11) [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 P3-11-07.

Abstract P6-05-10: MicroRNA-137 inhibits cancer progression by targeting DEL-1 in triple negative breast cancer cells, MDA-MB-231

Background: This study aimed to investigate the function of microRNA-137 in Del-1 expression in triple negative breast cancer (TNBC) cells and tissues.

Methods: The Del-1 mRNA and microRNA levels were measured using a qRT-PCR in breast cancer cells (MDA-MB-231, MCF7, SK-BR3, and T-47D) and tissues from 20 patients with TNBC. The effects of miR-137 on cell proliferation, migration, and invasion were determined using MTT, wound healing, and Matrigel Transwell assays.

Results: microRNA-137 (miR-137) levels were remarkably low and Del-1 mRNA expression was higher in MDA-MB-231 cells as compared to other breast cancer cell lines. The luciferase reporter assay revealed that miR-137 binds directly at the 3¢-UTR of Del-1 and that Del-1 expression was downregulated by miR-137 mimics and rescued by its inhibitors. Furthermore, miR-137 inhibited the cell proliferation, migration, and invasion of MDA-MB-231 cells. Moreover, among the 30 TNBC specimens, miR-137 was downregulated (p &lt;0.0001) and the level of Del-1 in plasma was significantly elevated as compared to normal controls (p &lt; 0.0001).

Conclusions: In conclusion, miR-137 regulates Del-1 expression in TNBC via directly binding to the Del-1 gene, and thereby affects cancer progression. This suggests that miR-137 may be a new therapeutic biomarker for patients with TNBC.

Keywords: Del-1, triple negative breast cancer, miR-137, biomarker

Citation Format: Chae YS, Baek DW, Lee IH, Lee SJ, Lee RK, Lee J, Jung J, Park H, Jeong J-H, Kang J, Park J. MicroRNA-137 inhibits cancer progression by targeting DEL-1 in triple negative breast cancer cells, MDA-MB-231 [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 P6-05-10.

Effects of acute lipopolysaccharide-induced toxemia model on some neglected blood parameters

The presence of lipopolysaccharide (LPS) in blood induces an inflammatory response which leads to multiple organ dysfunction and numerous metabolic disorders. Uncontrolled, improper or late intervention may lead to tissue hypoxia, anaerobic glycolysis and a disturbance in the acid -base balance. The effects of LPS-induced toxemia on biological and immunological markers were well studied. However, parameters such as base excess, ions, and acid-base balance were not fully investigated. Therefore, the objective of this study was to examine these blood parameters collectively in LPS-induced inflammatory toxemia in rat's model. After induction of toxemia by injecting LPS at a rate of 5 mg/kg body weight intravenously, blood was collected from the tail vein of twenty rats and immediately analyzed. After 24 hours, the animals were sacrificed and the blood was collected from the caudal vena cava. The results revealed that the levels of pH, bicar- bonate, partial pressure of oxygen, oxygen saturation, Alveolar oxygen, hemoglobin, hematocrit, magnesium (Mg2+), and calcium (Ca2+) were significantly decreased. On the other side, the levels of Base excess blood, Base excess extracellular fluid, partial pressure of carbon dioxide, lactate, Ca2+/Mg2+, potassium, and chloride were significantly increased compared to those found pre toxemia induction. However, sodium level showed no significant change. In conclusion, Acute LPS-toxemia model disturbs acid-base balance, blood gases, and ions. These parameters can be used to monitor human and animal toxemic inflammatory response induced by bacterial LPS conditions to assist in the management of the diagnosed cases.

A 10-min Targeted Geriatric Assessment Predicts Mortality in Fast-Paced Acute Care Settings: A Prospective Cohort Study

OBJECTIVES

To estimate whether a 10-minute Targeted Geriatric Assessment (10-TaGA) adds utility to sociodemographic characteristics and comorbidities in predicting one-year mortality in busy acute care settings. We have also compared the performance of 10-TaGA with the Identification of Seniors at Risk (ISAR) scale.

DESIGN

Prospective cohort study.

SETTING

Geriatric day hospital specializing in acute care in Brazil.

PARTICIPANTS

751 older adults aged 79.4 ± 8.4 years (64% female), presenting non-surgical, medical illness requiring hospital-level care (e.g., intravenous therapy, laboratory test, radiology) for ≤ 12 hours.

MEASUREMENTS

The 10-TaGA, an easy-to-administer screening tool based on the comprehensive geriatric assessment (CGA), provided a measure of cumulative deficits ranging from 0 (no deficits) to 1 (highest deficit) on admission. Standard risk factors, including sociodemographics (age, gender, ethnicity, income) and the Charlson comorbidity index, were evaluated. The ISAR, a well-validated screening tool, was used for comparison.

RESULTS

During one year of follow-up, 130 (17%) participants died. Compared to the ISAR, 10-TaGA offered better accuracy in identifying older patients at risk of death (area under the receiver operating characteristic curve: [AUC] 0.70 vs 0.65; P = 0.03). In a Cox regression model adjusted for sociodemographics and comorbidities, each 0.1 increment in the 10-TaGA score (range 0-1) was associated with increased mortality (hazard ratio = 1.42, 95% confidence interval 1.27-1.59). The addition of 10-TaGA markedly improved the discrimination of the model, which already incorporated standard risk factors (AUC 0.76 vs 0.71; P = 0.005); adding ISAR (AUC 0.73 vs 0.71; P = 0.09) did not have this marked effect.

CONCLUSION

The 10-TaGA is an independent predictor of one-year mortality in acute care patients. This multidimensional screening tool offers better accuracy than ISAR when differentiating between older people at low and high risk of death in healthcare settings where providers have limited time and resources.

The impact of intrinsic motivation on session attendance and reliable cognitive improvement in cognitive remediation in schizophrenia

OBJECTIVE

Cognitive remediation (CR) is considered a potentially effective method of improving cognitive function in people with schizophrenia. Few studies, however, have explored the role of intrinsic motivation on treatment utilization or training outcomes in CR in this population. This study explored the impact of task-specific intrinsic motivation on attendance and reliable cognitive improvement in a controlled trial comparing CR with a computer game (CG) playing control.

METHODS

Forty-nine participants with schizophrenia or schizoaffective disorder, allocated to 10 weeks of group-based CR (n = 25) or CG control (n = 24), provided complete outcome data at baseline. Forty-three participants completed their assigned intervention. Cognition, psychopathology and intrinsic motivation were measured at baseline and end-treatment. Regression analyses explored the relative contribution of baseline motivation and other clinical factors to session attendance as well as the association of baseline and change in intrinsic motivation with the odds of reliable cognitive improvement (calculated using reliable change indices).

RESULTS

Baseline reports of perceived program value were the only significant multivariable predictor of session attendance when including global cognition and psychiatric symptomatology. The odds of reliable cognitive improvement significantly increased with greater improvements in program interest and value from baseline to end-treatment. Motivational changes over time were highly variable between participants.

CONCLUSION

Task-specific intrinsic motivation in schizophrenia may represent an important patient-related factor that contributes to session attendance and cognitive improvements in CR. Regular evaluation and enhancement of intrinsic motivation in cognitively enhancing interventions may optimize treatment engagement and the likelihood of meaningful training outcomes.

Allium hookeri supplementation improves intestinal immune response against necrotic enteritis in young broiler chickens

Three hundred birds (1 day old) were randomly assigned to 6 groups (n = 50 birds/treatment) and fed a basal diet (control) or basal diet supplemented with Allium hookeri (AH) root (1 or 3%). At day 14, half of the birds in each group were orally challenged with E. maxima 41A (1 × 104 cells/chicken), followed by C. perfringens infection (1 × 109 cfu/chicken) on day 18. Necrotic enteritis (NE)-associated infections and intestinal immune response were assessed by average body weight gain, lesion score, and oocyst shedding. The effect of dietary supplementation, AH, on transcript levels of pro-inflammatory cytokines, and tight junction proteins and mucin protein in the jejunum, were quantified by quantitative real-time (qRT)-PCR. At day 20, birds fed with diet supplementation (3% of AH) significantly weighted more than the control group. Although the NE-challenged had significantly reduced average body weight gain, there was no significance in the effect between diet × NE-challenge interactions on the average body weight gain. Among the NE-challenged groups, gut lesion score and oocyst shedding were significantly decreased in birds given AH (1 or 3%) compared to the control group. There was a correlation between diet and NE infection with regards to interleukin (IL)-17A, and inducible nitric oxide synthase (iNOS). The up-regulated transcript levels of cytokines IL-8, IL-17A, iNOS, and LITAF by NE challenged groups were significantly reduced by AH (1 or 3%) supplementation. Down-regulated expression levels of tight junction (TJ) proteins: junctional adhesion molecule 2 (JAM2), occluding, and intestinal mucin 2 (MUC2) by NE challenge, was up-regulated by the addition of AH (1 or 3%) supplementation. All TJ proteins (JAM2, ZO1, Ocluddin and MUC2) in the jejunum had a significant diet × NE-challenge interaction. These findings demonstrate that dietary supplementation of AH in chicken feed could be beneficially used to improve chicken health against NE.

Seven Years of Experiences of Preclinical Experiments of Xeno-Heart Transplantation of Pig to Non-Human Primate (Cynomolgus Monkey)

BACKGROUND

The absolute shortage of donors compared with patients requiring transplantation is currently an unsolved problem, and the only possible solution may be xenotransplantation. To establish a successful clinical trial, a preclinical study using nonhuman primates is essential. Starting in November 2011, our team initiated heterotopic abdominal heart xenotransplantation, the first in the Republic of Korea. We present here the initial 7-year results.

METHODS

A total of 22 xenotransplantation procedures have been performed since 2011. Single transgenic pig (alpha-galactosidase transferase knockout [GalT KO], n = 16), double transgenic pig (GalT KO + CD46, n = 3, and GalT KO + CD39, n = 2), and triple transgenic pig (GalT KO + CD46 + CD70, n = 1) models were used. Our baseline regimen of immunosuppressants comprised CD154 ab, rituximab, anti-thymocyte globulin, tacrolimus, mycophenolate mofetil, and steroids.

RESULTS

The mean graft survival was 16 ± 16.27 days, and the mean graft survival was significantly longer in cases performed since 2014 (7.5 ± 8.03 days vs 24.67 ± 17.50; P = .01). Although the donor heart ischemic time was decreased per annum, no correlations could be found between ischemic time and survival days of the graft. Double or triple genetic manipulated hearts exhibited significantly better survival (11.63 ± 11.29 days vs 30.83 ± 20.34 days; P = .03). When the ratio of heart weight (grams) to nonhuman primate weight (kilograms) was lower, the results tended to be better (P < .05). The rate of immediate postoperative bleeding (9%, n = 2) causing death was relatively high in the earlier period, but there have been no serious surgical complications affecting graft survival since 2013.

CONCLUSIONS

Investigation of effective and optimal target genes for each organ to further progression toward better results is important. In addition, the immunosuppressive regimen needs to be further studied and constantly refined.

Barriers and Facilitators of Responding to Problem Gambling: Perspectives from Australian Mental Health Services

Despite high rates of comorbidity between problem gambling and mental health disorders, few studies have examined barriers or facilitators to the implementation of screening for problem gambling in mental health services. This exploratory qualitative study identified key themes associated with screening in mental health services. Semi-structured interviews were undertaken with 30 clinicians and managers from 11 mental health services in Victoria, Australia. Major themes and subthemes were identified using qualitative content analysis. Six themes emerged including competing priorities, importance of routine screening, access to appropriate screening tools, resources, patient responsiveness and workforce development. Barriers to screening included a focus on immediate risk as well as gambling being often considered as a longer-term concern. Clinicians perceived problem gambling as a relatively rare condition, but did acknowledge the need for brief screening. Facilitators to screening were changes to system processes, such as identification of an appropriate brief screening instrument, mandating its use as part of routine screening, as well as funded workforce development activities in the identification and management of problem gambling.

Biomarkers in chronic graft-versus-host disease: quo vadis?

Biomarkers are increasingly used for diagnosis and treatment of transplant-related complications including the first biomarker-driven interventional trials of acute graft-versus-host disease (GvHD). In contrast, the development of biomarkers of chronic GvHD (cGvHD) has lagged behind due to a broader variety of manifestations, overlap with acute GvHD, a greater variation in time to onset and maximum severity, and lack of sufficient patient numbers within prospective trials. An international workshop organized by a North-American and European consortium was held in Marseille in March 2017 with the goal to discuss strategies for future biomarker development to guide cGvHD therapy. As a result of this meeting, two areas were prioritized: the development of prognostic biomarkers for subsequent onset of moderate/severe cGvHD, and in parallel, the development of qualified clinical-grade assays for biomarker quantification. The most promising prognostic serum biomarkers are CXCL9, ST2, matrix metalloproteinase-3, osteopontin, CXCL10, CXCL11, and CD163. Urine-proteomics and cellular subsets (CD4+ T-cell subsets, NK cell subsets, and CD19+CD21low B cells) represent additional potential prognostic biomarkers of cGvHD. A joint effort is required to verify the results of numerous exploratory trials before any of the potential candidates is ready for validation and subsequent clinical application.

Gemigliptin, a novel dipeptidyl peptidase-IV inhibitor, exerts a synergistic cytotoxicity with the histone deacetylase inhibitor PXD101 in thyroid carcinoma cells

PURPOSE

The influence of the dipeptidyl peptidase-IV inhibitor gemigliptin alone or in combination with the histone deacetylase inhibitor PXD101 on survival of thyroid carcinoma cells was investigated.

METHODS

SW1736, TPC-1, 8505C and BCPAP human thyroid carcinoma cells were used. To assess cell survival, cell viability, the percentage of viable cells and dead cells, cytotoxic activity, ATP levels and FACS analysis were measured. To validate the impact of gemigliptin combined with PXD101, the interactions were estimated by obtaining combination index in cells treated with two agents.

RESULTS

In cells treated with gemigliptin or PXD101, cell viability, the percentage of viable cells and ATP levels were reduced, and the percentage of dead cells and cytotoxic activity were elevated. In cells treated with both gemigliptin and PXD101, compared with PXD101 alone, cell death was augmented, and all of the combination index values were lower than 1.0, suggesting the synergism between gemigliptin and PXD101. The percentage of apoptotic cells, and the protein levels of Bcl2 and cleaved poly (ADP-ribose) polymerase were elevated, and the protein levels of xIAP and survivin were reduced. The protein levels of phospho-Akt and phospho-AMPK were elevated, and cell migration was reduced.

CONCLUSIONS

Our results demonstrate that gemigliptin induces cytotoxicity in thyroid carcinoma cells. Moreover, gemigliptin has a synergistic activity with PXD101 in the induction of cell death through involvement of Bcl2 family proteins, xIAP and survivin as well as mediation of Akt and AMPK in thyroid carcinoma cells.