Intra-articular injection of magnesium chloride attenuates osteoarthritis progression in rats

OBJECTIVE

To explore the effects of Mg²⁺ on the expression of osteoarthritic markers in human cartilage and synovium tissue explants. To investigate the therapeutic effect of intra-articular injection of Mg²⁺ in an established rat OA (Osteoarthritis) model of anterior cruciate ligament transection with partial medial meniscectomy (ACLT + PMM).

DESIGN

Human cartilage and synovium explants were collected from total knee replacement surgeries and incubated with MgCl₂ (20 mmol/L) in vitro. A rat OA model was established by ACLT + PMM surgery in 450-500 g male Sprague Dawley (SD) rats. To select the optimal dose, intra-articular injections of MgCl₂ (0.05, 0.5, 5 mol/L) were performed at 4 weeks after the surgery every 3 days for 2 weeks. The effect of optimized MgCl₂ was further determined by histology, immunohistochemistry, and quantitative real-time polymerase chain reaction.

RESULTS

The expressions of osteoarthritic markers in human cartilage and synovium explants were inhibited by Mg²⁺in vitro. Immunohistochemical analysis further suggested the inhibitory effects of Mg²⁺ on the expression of MMP-13 and IL-6 in the human tissue explants. Cartilage degeneration and synovitis in ACLT + PMM rats were significantly improved by intra-articular injections of Mg²⁺ (0.5 mol/L). Immunohistochemical analysis also showed the regulatory effects of Mg²⁺ on osteoarthritic markers in both cartilage and synovium in rats, consistent with in vitro results.

CONCLUSION

Intra-articular injections of Mg²⁺ at 0.5 mol/L attenuate the progression of OA in the ACLT + PMM rat model. Such effect was at least in part explained by the promotion of cartilage matrix synthesis and the suppression of synovial inflammation.

The role of miR-146b-5p in TLR4 pathway of glomerular mesangial cells with lupus nephritis

OBJECTIVE

MicroRNAs (miRNAs) are now recognized as important regulators of gene expression. The aim of the study was to investigate the role of miR-146b-5p in the TLR4 pathway and provide the basis for the treatment of lupus nephritis.

MATERIALS AND METHODS

The glomerular mesangial cells were cultured in vitro and divided into 3 groups: control group, a group of miR-146b-5p mimic added, and a group of miR-146b-5p inhibitor added. The levels of IL-6 and IL-8 in the cell culture supernatant of the three groups were detected by ELISA. The cell proliferation was detected by MTT. The expressions of MiR-146b-5p and TLR4 pathway-associated factor TRAF6 were detected by RT- PCR. The expression of TRAF6 and IRAK1 protein was detected by Western blot.

RESULTS

The overexpression of miR-146b-5p could reduce the level of IL6 and IL8 in cell culture and inhibit glomerular mesangial cell proliferation in some degree. Also, the overexpression of miR-146b-5p could inhibit the expressions of TLR4 pathway-associated factor TRAF6 and IRAK1mRNA, and the expressions of TRAF6 and IRAK1 protein.

CONCLUSIONS

MiR-146b-5p attenuated the inflammatory response of glomerular mesangial cells by inhibiting the expressions levels of TRAF6 and IRAK1 in lupus nephritis.

Overexpression of the long non-coding RNA Oprm1 alleviates apoptosis from cerebral ischemia-reperfusion injury through the Oprm1/miR-155/GATA3 axis

Numerous differentially expressed long non-coding RNAs (lncRNAs) have been identified in cerebral ischemia-reperfusion (I/R) injury using RNA-Seq analysis. However, little is known about whether and how lncRNAs are involved in cerebral I/R injury. In this study, we investigated the function of the lncRNA Oprm1 in cerebral I/R injury and explored the underlying mechanism. An oxygen-glucose deprivation model in N2a cells was utilized to mimic cerebral I/R injury in vitro. Trypan blue staining, terminal deoxytransferase-mediated dUTP-biotin nick end labelling and caspase-3 were measured to evaluate apoptosis. Middle cerebral artery occlusion was performed in mice to evaluate the function of lncRNA Oprm1 in vivo. Real-time PCR and western blotting were used to measure the expression levels of lncRNA Opmr1, caspase-3, miR-155, GATA binding protein 3 (GATA3) and nuclear factor (NF)-κB. lncRNA Oprm1 was mainly located in the cytoplasm. Overexpression of lncRNA Oprm1 alleviated the apoptosis induced by oxygen-glucose deprivation and significantly reduced cleaved caspase-3 levels. Infarct size was distinctly decreased in the lncRNA Oprm1-overexpression group. The neurological score was also improved. Our findings showed that the lncRNA Oprm1/miR-155/GATA3 axis plays an important role in cerebral I/R injury. lncRNA Oprm1 may attenuate cerebral injury through the NF-κB pathway. lncRNA Oprm1 may serve as a potential target for new therapeutic interventions in patients with ischemic stroke.

Baicalein, an enteric microbial metabolite, suppresses gut inflammation and cancer progression in ApcMin/+ mice

OBJECTIVE

Chronic inflammation is recognized as a risk factor for colorectal cancer (CRC) development. Baicalin (BI), a major constituent in an anti-inflammatory herb Scutellaria baicalensis, can be biotransformed into baicalein (BE) by the intestinal microbiota. We evaluated the anti-inflammation and anti-CRC effects of the metabolite BE.

METHODS

The in vitro biotransformation by human intestinal microbiota from BI into BE has been determined with HPLC. Using a gut-specific Apc^Min/+ mouse model, the effects of oral BE on the life span, organ index, and tumor multiplicity were evaluated. The expressions of inflammatory cytokines were determined using ELISA. To verify the in vivo data, the anti-inflammatory and antiproliferative effects of BE were determined with an in vitro cell model.

RESULTS

HPLC analysis showed that BI was quickly transformed into BE by the intestinal microbiota. Oral BE (30 mg/kg/day) significantly increased the life span, from 125.2 to 218.4 days (P < 0.01%). BE treatment also decreased intestine index and increased spleen index. Compared with the model group, following BE treatment, tumor numbers were significantly reduced in the small intestine and colon (P < 0.01, P < 0.05, respectively). In the gut tissues, BE treatment significantly reduced inflammatory cytokine levels such as IL-1β, IL-2, IL-6, IL-10, G-CSF, and GM-CSF. In vitro data supported our in vivo results that the anti-CRC effects of BE were via the inhibition of gut inflammation and induction of cancer cell death.

CONCLUSION

Our results suggest that the parent compound BI can be quickly converted into its microbial metabolite BE, which has stronger bioactive effects than BI. Baicalein is an active chemopreventive metabolite for inflammatory associated CRC.

2214Prevalence and severity of coronary disease in patients with familial hypercholesterolemia hospitalized for an acute myocardial infarction: data from the RICO survey

Aim

Individuals with heterozygous familial hypercholesterolemia (FH) are at high risk of early myocardial infarction (MI). However, coronary artery disease (CAD) burden of FH remains not well described. From a large database of a regional registry of acute MI, we aimed to address prevalence of FH and severity of CAD.

Methods

Consecutive patients hospitalized with MI in a multicentre database from 2001–2017 were considered. An algorithm, adapted from Dutch Lipid Clinic Network criteria, was built upon 4 variables (LDL-cholesterol (LDL-C) and lipid lowering agents, premature and family history of CAD) to identify FH probabilities.

Results

Among the 11624 patients included in the survey, 249 (2.1%) had probable/definite FH (score ≥6), and 2405 (20.7%) had possible FH (score 3–5). When compared with patients without FH (score 0–2), FH patients (score ≥6) were 20y younger (51 (46–57) vs 71 (61–80) y, p<0.001), with a lower rate of hypertension (47 vs 59%, p<0.001), diabetes (17 vs 25%, p<0.001) and prior stroke (4 vs 8%, p=0.016), but a higher prevalence of smokers (56 vs 23%, p<0.001), personal (20 vs 15%, p=0.02) or familial history of CAD (78 vs 18%, p<0.001). Chronic statin treatment was only used in 48% of FH patients and ezetimibe in 8%. After adjustment for age, sex and diabetes, FH patients were characterized by increased extent of CAD (syntax score 11 (4–19) vs 7 (1–13), p<0.001) and multivessel disease (55 vs 40%, p<0.001).

Conclusion

In this large real world population of acute MI, a high prevalence of FH was found. FH patients were characterized by their young age associated with the severity of CAD burden and limited use of preventive lipid lowering therapy.

Acknowledgement/Funding

University Hospital Center Dijon Bourgogne, Agence Régionale de Santé Bourgogne Franche Comté, France

Effect of Sustained Joint Loading on TMJ Disc Nutrient Environment

The temporomandibular joint (TMJ) disc nutrient environment profoundly affects cell energy metabolism, proliferation, and biosynthesis. Due to technical challenges of in vivo measurements, the human TMJ disc extracellular nutrient environment under load, which depends on metabolic rates, solute diffusion, and disc morphometry, remains unknown. Therefore, the study objective was to predict the TMJ disc nutrient environment under loading conditions using combined experimental and computational modeling approaches. Specifically, glucose consumption and lactate production rates of porcine TMJ discs were measured under varying tissue culture conditions (n = 40 discs), and mechanical strain-dependent glucose and lactate diffusivities were measured using a custom diffusion chamber (n = 6 discs). TMJ anatomy and loading area were obtained from magnetic resonance imaging of healthy human volunteers (n = 11, male, 30 ± 9 y). Using experimentally determined nutrient metabolic rates, solute diffusivities, TMJ anatomy, and loading areas, subject-specific finite element (FE) models were developed to predict the 3-dimensional nutrient profiles in unloaded and loaded TMJ discs (unloaded, 0% strain, 20% strain). From the FE models, glucose, lactate, and oxygen concentration ranges for unloaded healthy human TMJ discs were 0.6 to 4.0 mM, 0.9 to 5.0 mM, and 0% to 6%, respectively, with steep gradients in the anterior and posterior bands. Sustained mechanical loading significantly reduced nutrient levels (P < 0.001), with a critical zone in which cells may die representing approximately 13.5% of the total disc volume. In conclusion, this study experimentally determined TMJ disc metabolic rates, solute diffusivities, and disc morphometry, and through subject-specific FE modeling, revealed critical interactions between mechanical loading and nutrient supply and metabolism for the in vivo human TMJ disc. The results suggest that TMJ disc homeostasis may be vulnerable to pathological loading (e.g., clenching, bruxism), which impedes nutrient supply. Given difficulties associated with direct in vivo measurements, this study provides a new approach to systematically investigate homeostatic and degenerative mechanisms associated with the TMJ disc.

The applied anatomy and clinical significance of the proximal, V1 segment of vertebral artery

BACKGROUND

The aim of the study was to probe the morphological features of the proximal segment (V1) of vertebral artery (VA) in a sample of Chinese cadavers.

MATERIALS AND METHODS

The origin, course and outer diameter at origin of the pre-vertebral part of the VAs were evaluated in 119 adult cadavers.

RESULTS

It was found that 94.12% of the VAs originated from the subclavian arteries, bilaterally. The variant origins were present in 5.88% of the cadavers and all originated directly from the arch of the aorta. All the variations were observed on the left side of male cadavers. The average outer diameters at origin of the normal and variation groups were 4.35 ± 1.00 mm and 4.82 ± ± 1.42 mm, respectively, p = 0.035. In the normal group, but not in the variation group, the average diameter in the males was significantly larger than that in the females (4.50 ± 0.99 mm, 3.92 ± 0.92 mm, respectively, p = 0.000). In addition, only 5 cadavers in the normal group had hypoplastic VAs (4.20%, 4 males, 3 right-sided). Vertebral artery dominance (VAD) was present in 91 (69 males) out of 112 cadavers and more common on the left (n = 48). In addition, 3 cadavers satisfied conditions for coexistence of VAD and vertebral artery hypoplasia. All 7 cadavers in the variation group exhibited VAD, which was more common on the right side (n = 5).

CONCLUSIONS

The morphologic variations and frequencies described above have implications for the early prevention, abnormal anatomy detection, accurate diagnosis, safe surgery and endovascular treatment of cardiovascular and neurological disease.

[Study on the correlation between work-related musculoskeletal disorders and work ability among nurses at three level general hospital in Xinjiang]

Objective: To investigate the correlation between work-related musculoskeletal disorders (WMSDs) and work ability (WA) among nurses in Xinjiang. Methods: A total of 1 873 nursing staff in the Departments of Internal Medicine, Surgery, Emergency and ICU Department, Operating Room and Supply Room of 6 Grade 3 General Hospitals in Xinjiang Beijiang Region were randomly selected by means of random sampling, and revised Nordic National Musculoskeletal Disorders Standard Questionnaire and Work Ability Index Scale were used to evaluate the status of nursing WMSDs and WA. Results: (1) The symptom incidence of work-related musculoskeletal disorders among nursing staff in the past year was 77.42%; The highest symptom incidence in all parts of the body was waist, neck, shoulder and back, and the symptom incidence was 63.59%, 59.80%, 47.78% and 37.32%, respectively; (2) The total score of nursing staff's work ability was (35.91±5.143) ; The proportion of "poor" , "middle" , "good" and "excellent" were 5.23%, 47.41%, 41.43% and 5.93% respectively; (3) The total working capacity of the sick group was (35.11±5.044) , The working ability of the non-diseased group was (38.64±4.507) , The difference between the two groups was statistically significant (t=13.773, P<0.01) ; There was a significant difference in the level of work ability between the two groups (z=-12.335, P<0.01) ; The working ability of "poor" and medium in the injury group was significantly higher than that of the non injury group, while the working ability was "better" and "excellent" than that of the non injury group; (4) The working ability of nursing staff of different age in WMSDs injury group was lower than that in non injury group, the difference was statistically significant (P<0.01) ; There was a negative correlation between the working ability of the injury group and the length of service, that is, with the increase of the length of service, the working ability index decreased (P<0.01) ; There was a positive correlation between the working ability of the non injury group and the length of service, that is, with the increase of the length of service, the work ability index increased gradually, but the correlation was not statistically significant (r=0.063, P=0.195) ; (5) The working ability of nursing staff of different departments in WMSDs injury group was lower than that in non injury group, the difference was statistically significant (P<0.01) . (6) Multiple linear regression analysis showed that the factors influencing the working ability of nursing staff were: past medical history, WMSDs disease, length of service and night shift frequency; Conclusion: The symptom incidence of WMSDs was high among nurses; Work Ability at a moderate level; work-related musculoskeletal disorders is associated with reduced ability of nursing staff; work-related musculoskeletal disorders are associated with reduced working capacity of nursing staff.

Abstract P4-04-11: A small amount of primary breast cancer shows high tumor mutation burden that may benefit from immune checkpoint inhibitor therapy

Background: Targeted therapy using immune checkpoint inhibitors (ICIs) is a major breakthrough in cancer treatment in the last decade. ICIs like PD1 or PD-L1 antibodies have been shown to be quite effective in cancer like melanoma. However, in most other tumor types including breast cancer, the situation is not as optimistic. Only a small percentage of those patients respond to ICIs therapy. This highlights the importance of identifying biomarkers to predict which patients may benefit from such treatment. Tumor Mutation Burden (TMB) has been shown to be a sensitive marker for ICI treatment. This study is to investigate whether TBM could be used as a biomarker for breast cancer treatment.

Methods: We reviewed next generation sequencing studies of breast cancer. Two such studies with raw data provided were included in our analysis. One study entitled METABRIC performed targeted sequencing of 173 cancer-related genes in around 2500 primary breast cancer tissues. The other study was from TCGA breast cancer project, which performed Whole Exome Sequencing (WES) of around 1000 primary breast cancer samples. Mutation data were downloaded from public data deposit. The number of mutations per sample was calculated. TBM was calculated by divide the coverage in million base pair from that of the total mutation counts.

Results: In METABRIC study, 17272 mutations were identified in 2369 samples, with a median of 7 mutations per sample (95% CI: 6 ˜ 7). The median TMB of METABRIC dataset was 5.8 SNVs/Mb (95% CI: 5 ˜ 5.8). Totally 30 out 2369 (1.3%) samples had a TMB equal or large than 20 SNVs/Mb. In another cohort from TCGA breast cancer study using WES technology, 90172 mutations were identified in 977 samples, with a median of 44 mutations per sample (95% CI: 39 ˜ 50). The median TMB was 1 SNVs/Mb (95% CI: 0.9 ˜ 1.1). Totally 13 out 977 (1.3%) samples had a TMB equal or large than 20 SNVs/Mb.

Conclusions: Breast cancer shows middle to low mutation burden compared to other cancer types. Around 1.3% of breast cancer has quite high TMB of at least 20 SNVs/Mb, which may be qualified for immune checkpoint inhibitors therapy. Our study indicates that TMB may be incorporated as a standard test for late stage breast cancer patients in the clinical practice.

Keywords: Breast cancer, Tumor Mutation Burden, Whole exome sequencing, Targeted sequencing, Immune checkpoint

Citation Format: Wang J, Chen W, Jiang Z, Lin X, Qin T, Yang X, Liu T, Hu H, Li Z, Xie D, Yao H, Song E. A small amount of primary breast cancer shows high tumor mutation burden that may benefit from immune checkpoint inhibitor therapy [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 P4-04-11.

Abstract P4-08-32: Derivation and validation of a novel prediction model in breast phyllodes tumors after surgery

Aim

This study aimed to develop a nomogram based on clinicopathological features to evaluate the recurrence probability of breast phyllodes tumors following surgery. The criteria for atypia, mitoses, overgrowth, and surgical margin (AMOS) were also validated.

Method

Data from 334 patients with breast phyllodes tumors, who underwent surgical treatment at Sun Yat-sen Memorial Hospital from January 2005 to December 2014, were used to develop a prediction model. Additionally, data of 36 patients from Peking University Shenzhen Hospital and data of 140 patients from Sun Yat-sen University Cancer Center during the same period were used to validate the model. The medical records and tumor slides were retrospectively reviewed. The log-rank and Cox regression tests were used to develop a clinical prediction model of breast phyllodes tumors as well as validating the AMOS criteriaAll statistical analyses were performed using R and STATA.

Results

Of all 334 patients included in the study, 224 had benign, 91 had borderline, and 19 had malignant tumors. The local and distant recurrence rate was 17.7%. The 1-,3-, and 5-year cumulative recurrence-free survival was 98.5%, 97.9%, and 96.8%, respectively. Surgical margin, mitoses, and tumor border were identified as independent risk factors for breast phyllodes tumors. A nomogram was developed based on these three variables. The C-index of internal and external validation was 0.71and 0.67, respectively. The area under the curve of AMOS criteria was 0.59.

Conclusions

The present study model presented a more concise and objective variables to evaluate the recurrence-free survival of patients after surgery compared with that using the AMOS criteria, which is more appropriate for clinical practice and also allows for a more accurate prediction.

Citation Format: Song E, Chao X, Nie Y, Jin X, Tan C, Cui J, Hu H, Yao H. Derivation and validation of a novel prediction model in breast phyllodes tumors after surgery [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 P4-08-32.

Abstract P1-16-07: Progression-free survival is a surrogate of survival in maintenance therapy for metastatic breast cancer: Randomized trial level analysis

Background:The validity of progression-free survival (PFS) as a surrogate end point for overall survival (OS) in maintenance therapy trials of metastatic breast cancer (MBC) is uncertain. We aimed to compare treatment effect sizes and the strength of associations between OS and PFS in trials of maintenance therapy for MBC.

Methods: We searched for randomized trials investigating maintenance chemotherapy, endocrine therapy or immunotherapy after first-line chemotherapy in MBC and selected those reporting results for both OS and PFS. Treatment effect size differences between OS and PFS by a ratio of hazard ratios (rHRs) with 95% confidence intervals [CIs] were evaluated using random effects analysis. Surrogacy were analyzed using a weighted linear regression model, correlations were evaluated by squared correlation R2.

Results: We analyzed data from 16 trials and 3,898 patients that received maintenance chemotherapy, endocrine therapy or immunotherapy for MBC. In the all trial-level analysis, treatment effect sizes were 28% greater for PFS than for OS (combined rHR, 0.72; 95% CI, 0.62 to 0.85, P &lt; 0.001), and the correlation coefficient R2 between PFS and OS was 18% (95% CI, 12% to 26%). Differences were greater with PFS than OS for trials of maintenance chemotherapy compared with observation (rHR, 0.72; 95% CI, 0.59 to 0.80, P &lt; 0.001), and the correlation coefficient R2between treatment effects on PFS and on OS ranged from 12% (95% CI, 8% to 16%) when all trials were considered to 40% (95%CI, 30% to 54%) after exclusion of one highly influential trial by sensitivity analysis. Differences were also great for trials of maintenance endocrine therapy vs. observation (rHR, 0.54; 95% CI, 0.44 to 0.66), and immunotherapy vs. observation (rHR, 0.85; 95% CI, 0.80 to 0.91).

Conclusion: PFS was greater than OS in the treatment effect sizes, which is a valid surrogate end point for OS to assess treatment effect in MBC maintenance therapy trials.

PROSPERO registry: No. CRD42017071858; Support: ChiCTR-IIR-17014036, SYS-C-201801.

Citation Format: Song E, Yao H, Yu Y, Ou Q, Wang Y. Progression-free survival is a surrogate of survival in maintenance therapy for metastatic breast cancer: Randomized trial level analysis [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 P1-16-07.

Abstract OT2-05-01: FAMILY: A randomized, multicenter, open-label, phase III trial of fulvestrant versus capecitabine as maintenance therapy after first-line combination chemotherapy in patients with hormone receptor-positive, human epidermal growth factor receptor-2 negative metastatic breast cancer

Background: Metastatic breast cancer (MBC) is incurable. Although first-line endocrine therapy is preferred to hormone receptor positive (HR+), human epidermal growth factor receptor-2 negative (HER2-) MBC, combination chemotherapy should be reserved as the initial treatment for patients with rapid clinical progression, life-threatening visceral metastases, and need for rapidly symptom control. Either prolonged chemotherapy or endocrine therapy may be used as maintenance after disease control. However, which maintenance strategy is superior in terms of delaying disease progression as well as maintaining quality of life (QOL) remains uncertain. This phase III trial aims to compare the efficacy and safety of fulvestrant or capecitabine as maintenance therapy after first-line combined chemotherapy in HR+/HER2- MBC.

Trial Design: FAMILY is a multicenter, randomized, open-label phase III trial for HR+ and HER2- MBC. Eligible participants are randomized (1:1) to receive capecitabine (2000mg/m2 twice daily x 14 days followed by 7 days off) or fulvestrant (500mg Days 0, 14, 28, then every 28 days) until disease progression, unacceptable toxicity, or patient refusal. Stratification factor for randomization is sensitivity to adjuvant hormonal therapy (disease-free interval ≤24 months vs. &gt;24 months).

Eligibility Criteria: Eligible patients must have HR+ (ER and/or PR&gt;1%, by IHC) and HER2- MBC; achieved a complete or partial response or stable disease (investigator assessed) after 4-8 cycles of first-line combination chemotherapy. Patients with central nervous system metastasis and/or prior use of endocrine therapy for advanced breast cancer are excluded.

Specific Aims: The primary endpoint is progression free survival (PFS). Secondary endpoints include overall survival, overall response rate, disease control rate, safety and QOL. A prospective translational research is also planned to assess the correlations between biomarkers and response.

Statistical Design: The planned sample size of 256 patients provides approximately 80% of power to detect a 6 months difference of PFS using a log-rank test with two-sided alpha of 0.05.

Target Accrual: Recruitment is ongoing. Up to 256 evaluable subjects will be enrolled within 24 months. (ChiCTR-IIR-17014036).

Citation Format: Yao H, Wu W, Ding L, Yu Y, Wang Y, Zeng Y, Zhao J, Li Q. FAMILY: A randomized, multicenter, open-label, phase III trial of fulvestrant versus capecitabine as maintenance therapy after first-line combination chemotherapy in patients with hormone receptor-positive, human epidermal growth factor receptor-2 negative metastatic breast cancer [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 OT2-05-01.

Glycaemic variability is associated with severity of coronary artery disease in patients with poorly controlled type 2 diabetes and acute myocardial infarction

BACKGROUND

In patients with type 2 diabetes (T2D), glycaemic variability (GV), another component of glycaemic abnormalities, is a novel potentially aggravating factor for coronary artery disease (CAD).

OBJECTIVES

The aim of our study was to identify interactions between GV and severity of CAD in diabetes patients admitted for acute myocardial infarction (AMI).

METHODS

All patients with T2D admitted to our university hospital for AMI from March 2015 to February 2017 who received intravenous (IV) insulin therapy and underwent coronary angiography were included. GV was assessed by mean amplitude of blood glucose excursion (MAGE) values taken within 2 days of admission. Patients with higher GV (highest MAGE tertile) were compared with those with lower GV (first and second MAGE tertiles).

RESULTS

A total of 204 patients were included: median age was 72 (61-81) years; 32% were female; HbA_1c was 7.3% (6.4-8.2%); diabetes duration was 10 (2-17.5) years; and MAGE value was 0.65 (0.43-0.92) g/L. Compared with those with lower GV, patients with the highest GV were more often women, treated with previous insulin, and had higher blood glucose and HbA_1c levels. In addition, patients with elevated GV had significantly higher SYNTAX scores: 17 (10-28) vs. 12 (6-22) (P = 0.009). Indeed, SYNTAX scores (OR: 1.05, 95% CI: 1.02-1.08; P = 0.001) remained independently associated with high GV beyond HbA_1c levels (OR: 1.51, 95% CI: 1.2-1.89; P <  0.001).

CONCLUSION

In AMI patients with poorly controlled diabetes, GV is associated with CAD severity beyond chronic hyperglycaemia. Although no causality can be determined from our observational study, the results suggest that, in AMI, early evaluation of GV might contribute to the identification of those diabetes patients at high risk, and serve as a therapeutic target for both primary and secondary prevention.

Revealing Color Forces with Transverse Polarized Electron Scattering

The Spin Asymmetries of the Nucleon Experiment measured two double spin asymmetries using a polarized proton target and polarized electron beam at two beam energies, 4.7 and 5.9 GeV. A large-acceptance open-configuration detector package identified scattered electrons at 40° and covered a wide range in Bjorken x (0.3<x<0.8). Proportional to an average color Lorentz force, the twist-3 matrix element, d[over ˜]_{2}^{p}, was extracted from the measured asymmetries at Q^{2} values ranging from 2.0 to 6.0  GeV^{2}. The data display the opposite sign compared to most quark models, including the lattice QCD result, and an unexpected scale dependence. Furthermore, when combined with the neutron data in the same Q^{2} range the results suggest a flavor independent average color Lorentz force.