Employment exit and entry among U.S. adults with and without arthritis during the Great Recession. A longitudinal study: 2007-2009, NHIS/MEPS

BACKGROUND

Negative employment consequences of arthritis are known but not fully understood. Examining transitions in and out of work can provide valuable information.

OBJECTIVE

To examine associations of arthritis with employment during the Great Recession and predictors of employment transitions.

METHODS

Data were for 3,277 adults ages 30-62 years with and without arthritis from the 2007 National Health Interview Survey followed in the Medical Expenditure Panel Survey 2008-2009. Employment (working vs. not working) was ascertained at baseline and five follow-ups. We estimated Kaplan Meier survival curves with 95% confidence intervals (CI) separately for time to stopping work (working at baseline) and starting work (not working at baseline) using Cox proportional hazards regression models with hazard ratios (HR).

RESULTS

Arthritis was significantly associated with greater risk of stopping work (HR = 1.7, 95% CI = 1.3-2.2; adjusted HR= 1.5, 95% CI = 1.1-2.0) and significantly associated with 40% lower chance of starting work (HR = 0.6, 95% CI = 0.4-0.8), which reversed on adjustment (HR = 1.5, 95% CI = 1.0-2.2). Employment predictors were mixed by outcome.

CONCLUSIONS

During the Great Recession, adults with arthritis stopped work at higher rates and started work at lower rates than those without arthritis.

Ten-year review of Clostridium difficile infection in acute care hospitals in the USA, 2005-2014

Clostridium difficile infection (CDI) is a major health concern for acute care hospitals because of the increase in the number and severity of cases. Using the Nationwide Inpatient Sample database, a 10-year review was performed on the trends in incidence, mortality, and hospital charges for CDI patients in acute care hospitals during 2005-2014. The review found increased CDI incidence and hospital charges, but decreased mortality during the 10-year study period.

Abstract P5-04-02: Serum thymidine kinase 1 activity as a pharmacodynamics marker of cyclin-dependent kinase 4/6 inhibition in patients with early stage breast cancer receiving neoadjuvant palbociclib

Background: Thymidine kinase 1 (TK1) is a fundamental enzyme in DNA synthesis. TK1 expression is E2F-dependent and peaks in the S-phase of the cell cycle. In preclinical studies, inhibition of cyclin-dependent kinase (CDK) 4/6 led to dose dependent reduction of TK1 activity in cultured media. We hypothesized that serum TK1 could serve as a non-invasive surrogate marker of cell proliferation in patients (pts) receiving CDK4/6 inhibitors. In this study, we examined serum TK1 activity from breast cancer (BC) pts enrolled on a neoadjuvant study of palbociclib (Palbo) plus anastrozole (A), for changes induced by Palbo, and correlated with changes in tumor Ki67.

Methods: In this phase II neoadjuvant study, 50 pts with clinical stage II or III estrogen receptor positive (ER+) HER2- BC, received A (in combination with goserelin if premenopausal) alone for 28 days in cycle 0 (C0), followed by the addition of Palbo (125 mg daily on days 1-21) on cycle 1 day 1 (C1D1) for 4 28-day cycles (C1 to C4) unless C1D15 tumor Ki67>10%, in which case pts went off study. Following completion of cycle 4, A was continued for another 3-5 weeks to allow Palbo washout prior to surgery, except in 8 pts who received an additional 10-12 days of Palbo immediately prior. Blood and tumor biopsies were collected at 4 time points: baseline, C1D1, C1D15, and surgery. Serum TK1 activity was measured using the highly sensitive Divitum™ assay according to the Divitum™ Instructions for use (Biovica, Sweden). Tumor Ki67 IHC was performed at the Washington University AMP laboratory using the CONFIRM anti-Ki67 rabbit monoclonal antibody (clone 30-9), and pathologist guided image analysis.

Results: There was no statistically significant difference in TK activity between baseline and C1D1 serum samples (Table 1). However, serum TK activity decreased significantly from C1D1 to C1D15 following the addition of Palbo and increased significantly from C1D15 to surgery following Palbo washout (Table 1), indicating a significant effect of Palbo on TK activity. At C1D15, TK activity was below the detection limit of 20 Du/L in 44 of 48 pts, and was at low levels (24, 26, 26, and 58 Du/L) in the remaining 4 pts, indicating a profound effect by Palbo. Interestingly, the TK activities of the 4 pts with tumor Ki67 >10% at C1D15 were all below 20 Du/L, suggesting the possibility of tumor cell proliferation independent of CDK4/6 inhibition.

The sensitivity and specificity of change (increase/decrease) in serum TK activity to predict tumor Ki67 (increase/decrease) induced by Palbo were 83% (19/23, 95%CI: 66-99%) and 93% (26/28, 95%CI: 83%-100%), respectively. The Kappa statistic was 0.761 (P<0.001), indicating substantial agreement between the two tests.

Conclusions: Serum TK1 activity may serve as a pharmacodynamics marker of CDK4/6 inhibition and further investigation is warranted.

Table 1. Serum TK1 and tumor Ki67 Serum TKKi67 Median (IQR) (Du/L)NMedian (IQR) (%)NBaseline46 (25-73)4824.34% (11.92%-35.43%)45Cycle 1 day 143 (27.5-98)495.37% (2.49%-13.59%)*45Cycle 1 day 1520 (20-20)*480.78% (0.23%-1.05%)*45Day of surgery136.0 (37.5-259)*378.33% (2.25%-23.03%)*34*P<0.001 compared to the preceding time point.

Citation Format: Liu N, Thomas S, Luo R, Hoog J, Suh EM, Bergqvist M, Neumüller M, Guo Z, Vij K, Sanati S, Ellis M, Ma C. Serum thymidine kinase 1 activity as a pharmacodynamics marker of cyclin-dependent kinase 4/6 inhibition in patients with early stage breast cancer receiving neoadjuvant palbociclib [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-04-02.

[Association between β-arrestin2 genetic polymorphism and response to methadone maintenance treatment in heroin-dependent patients in Han population in Hunan province]

OBJECTIVE

To study the distributions of three single nucleotide polymorphisms (SNPs) in β-arrestin2 (ARRB2) which including rs3786047, rs1045280 and rs2036657 and to elucidate the relationship between these SNPs and response to methadone maintenance treatment (MMT) among heroin-dependent patients of Han ethnicity population in Hunan.

METHODS

Han MMT patients were recruited in four random-chosen MMT clinics from Hunan province. Demographics, history of drug-use and MMT were recorded. ARRB2 SNPs were genotyped to determine the association between SNPs and response to MMT.

RESULTS

Distributions of the three SNPs were in Hardy-Weinberg equilibrium in both groups (responders vs. non-responders). There was no statistical significance in the distribution frequency of genotype on rs3786047 (χ(2)=0.486 2, P=0.784), rs1045280 (χ(2)=1.591 9, P=0.451) and rs2036657 (χ(2)=1.061 5, P=0.588) in ARRB2 among the responders or the non-responders.

CONCLUSION

Associations between the ARRB2 genotypes, rs3786047, rs1045280 and rs2036657, and MMT response in Han MMT patients in Hunan province did not appear.

miR-374a-CCND1-pPI3K/AKT-c-JUN feedback loop modulated by PDCD4 suppresses cell growth, metastasis, and sensitizes nasopharyngeal carcinoma to cisplatin

miR-374a has been reported to function as an oncogene during tumor pathogenesis. In this study, miR-374a is observed to reduce nasopharyngeal carcinoma (NPC) cell proliferation, migration, invasion, metastasis and cisplatin (DDP) resistance in vitro and in vivo. Mechanistic analyses indicate that miR-374a directly targets CCND1 to inactivate pPI3K/pAKT/c-JUN forming a negative feedback loop, as well as suppressing downstream signals related to cell cycle progression and epithelial-mesenchymal transition (EMT). Interestingly, we also observed that miR-374a direct targeting of CCND1 is modulated by tumor suppressor PDCD4 via suppressing pPI3K/pAKT/c-JUN signaling. In clinical specimens, miR-374a was positively and negatively correlated with expression of PDCD4 and CCND1, respectively. Our studies are the first to demonstrate that the miR-374a-CCND1-pPI3K/AKT-c-JUN feedback loop induced by PDCD4 supresses NPC cell growth, metastasis and chemotherapy resistance.

Management of a patient with small-area burns, severe sepsis and superficial vein thrombosis

Sepsis is frequently seen in severely burned patients, however it is not common in those with small-area burns. We present a case of a 22-year-old man suffering from a hot crush injury to his left hand dorsum covering 1% of his total body surface area. The patient developed severe sepsis and superficial vein thrombosis, probably due to wound infection. Culture of the wound secretion indicated Corynebacterium striatum. Following intensive topical and systemic treatment the severe sepsis was controlled. The local wound was repaired by the abdominal skin pedicle flap which had taken well by day 27 post admission. A topical superficial vein thrombosis, unintentionally found 42 days after admission, was partially excised. This case demonstrates that when treating severe sepsis in patients with small-area burns, the timely recognition and diagnosis along with active systemic support, play a vital role in successful management.

DECLARATION OF INTEREST

None of the authors have any financial interest to declare.

Transcriptional repression of CDKN2D by PML/RARα contributes to the altered proliferation and differentiation block of acute promyelocytic leukemia cells

Cell proliferation and differentiation are highly coordinated processes. These two processes are disrupted during leukemogenesis, resulting in differentiation block and uncontrolled proliferation in leukemia. To understand the mechanisms disrupting the coordination between the two processes in acute promyelocytic leukemia (APL), we investigated the regulatory mechanism of the negative cell cycle regulator CDKN2D by the promyelocytic leukemia/retinoic acid receptor α (PML/RARα) fusion protein and the role of CDKN2D in cell differentiation and proliferation. We found that CDKN2D expression in APL cells was significantly lower than that in normal promyelocytes. By chromatin immunoprecipitation and luciferase reporter assays, we showed that PML/RARα directly bound to and inhibited the transactivation of the CDKN2D promoter. Further evidence by the truncated and mutated CDKN2D promoters revealed that the everted repeat 8 (ER8) motif on the promoter was the binding site of PML/RARα. Forced expression of CDKN2D induced G0/G1 phase arrest and partial granulocytic differentiation in APL-derived NB4 cells, suggesting the function of CDKN2D in regulating both cell proliferation and granulocytic differentiation. Furthermore, all-trans retinoic acid (ATRA) significantly induced CDKN2D expression in APL cells and knockdown of CDKN2D expression during ATRA treatment partially blocked the ATRA-induced differentiation and cell cycle arrest. Collectively, our data indicate that CDKN2D repression by PML/RARα disrupts both cell proliferation and differentiation in the pathogenesis of APL, and induced expression of CDKN2D by ATRA alleviates the disruption of both processes to ensure treatment efficiency. This study provides a mechanism for coupling proliferation and differentiation in leukemic cells through the action of CDKN2D.

Tip30 controls differentiation of murine mammary luminal progenitor to estrogen receptor-positive luminal cell through regulating FoxA1 expression

Estrogen receptor-alpha positive (ER⁺) breast cancers comprise the majority of human breast cancers, but molecular mechanisms underlying this subtype of breast cancers remain poorly understood. Here, we show that ER⁺ mammary luminal tumors arising in Tip30^−/−MMTV-Neu mice exhibited increased enrichment of luminal progenitor gene signature. Deletion of the Tip30 gene increased proportion of mammary stem and progenitor cell populations, and raised susceptibility to ER⁺ mammary luminal tumors in female Balb/c mice. Moreover, Tip30^−/− luminal progenitors displayed increases in propensity to differentiate to mature ER⁺ luminal cells and FoxA1 expression. Knockdown of FoxA1 expression in Tip30^−/− progenitors by shRNA specific for FoxA1 reduced their differentiation toward ER⁺ mature luminal cells. Taken together, our results suggest that TIP30 is a key regulator for maintaining ER⁺ and ER⁻luminal pools in the mammary luminal lineage, and loss of it promotes expansion of ER⁺ luminal progenitors and mature cells and ER⁺ mammary tumorigenesis.

Screening differential expression of serum proteins in AFP-negative HBV-related hepatocellular carcinoma using iTRAQ -MALDI-MS/MS

Hepatocellular carcinoma(HCC) is serious condition associated with a high morbidity and mortality. Therefore is an urgent need to develop novel noninvasive techniques for early diagnosis, particularly for patients with AFP-negative [AFP(-)] HCC. In this study, iTRAQ-MALDI-MS/MS was used to identify differentially expressed proteins in AFP(-) HBV-related HCC compared with non-cancerous hepatitis B virus (HBV) and healthy controls subjects.Serum was obtained from 18 patients with AFP(-) HBV-related HCC, 18 matched patients with HBV without HCC and 18 healthy control subjects. High abundance proteins were removed from serum and the differentially expressed proteins from the three groups were screened out using iTRAQ-MALDI-MS/MS. The Gene Ontology (GO) function and the interaction networks of differentially expressed proteins were then analyzed. A total of 24 expressed differential proteins associated with AFP(-) HBV-related HCC were screened out, 15 proteins were up-regulated and 9 down-regulated. The most common molecular function of the 24 differentially expressed proteins was enzyme inhibition. Interaction network of the 24 differentially expressed proteins showed that 14 proteins (C5, KNG1, FN1, LRG1, HRG, SERPINC1, CRP, APOB, SAA1, APCS, C4BPA, CFI, CFB and GSN) were central to the functional network. The expression levels of the GSN protein were down-regulated in AFP(-) HBV-related HCC subjects compared with healthy controls and the HBV group (p<0.01), consistent with the iTRAQ results.The 14 proteins from the serum of AFP(-) HBV-related HCC appeared at the fulcrum of the functional network and were differentially expressed compare to HBV and healthy controls suggesting a possible association with HCC progression.