Reference-frame-independent, measurement-device-independent quantum key distribution using fewer quantum states

Reference-frame-independent quantum key distribution (RFI-QKD) provides a practical way to generate secret keys between two remote parties without sharing common reference frames. On the other hand, measurement-device-independent QKD (MDI-QKD) offers a high level of security, as it is immune to all quantum hacking attempts to measurement devices. The combination of these two QKD protocols, i.e., RFI-MDI-QKD, is one of the most fascinating QKD protocols, since it holds advantages of both practicality and security. For further practicality of RFI-MDI-QKD, it is beneficial to reduce the implementation complexity. Here, we show that RFI-MDI-QKD can be implemented using fewer quantum states than those of its original proposal. We find that, in principle, the number of quantum states for one of the parties can be reduced from six to three without compromising security. Compared to conventional RFI-MDI-QKD where both parties transmit six quantum states, it significantly simplifies the implementation of the QKD protocol. We also verify the feasibility of the scheme with a proof-of-principle experiment.

Natural purification capacity of tidal flats for organic matters and nutrients: A mesocosm study

The regulating services by natural tidal flats to purify organic pollutants are increasingly recognized, but a quantitative assessment is very limited. We developed a mesocosm system to determine removal efficiency of organic matters and nutrients by simulating a natural tidal condition. The tidal flat sediments significantly removed waterborne organic pollutants to background levels in ~2 and 6-7 days for COD and TP, respectively. This rapid removal of organic matters by natural sediments could be attributed to the microbe community degrading the corresponding pollutants. Temporal trend and degree of removal rates for COD and TP were similar between the bare tidal flat and the salt marsh. Meantime, the salt marsh environment removed waterborne DIP much quickly and also efficiently, implying a high affinity of halophytes on dissolved organic matters. Of note, sedimentary organic sink prevailed in defaunated condition under the smaller bioturbation effect. A mini-review on the purification capacity of natural and/or constructed coastal wetlands generally supported a high efficiency of vegetation to remove various sources of organic matters.

Multiple Bioassays and Targeted and Nontargeted Analyses to Characterize Potential Toxicological Effects Associated with Sediments of Masan Bay: Focusing on AhR-Mediated Potency

An enhanced, multiple lines of evidence approach was applied to assess potential toxicological effects associated with polluted sediments. Two in vitro bioassays (H4IIE-luc and Vibrio fischeri) and three in vivo bioassays (microalgae: Isochrysis galbana and Phaeodactylum tricornutum; zebrafish embryo: Danio rerio) were applied. To identify causative chemicals in samples, targeted analyses (polycyclic aromatic hydrocarbons (PAHs), styrene oligomers (SOs), and alkylphenols) and nontargeted full-scan screening analyses (FSA; GC- and LC-QTOFMS) were performed. First, great AhR-mediated potencies were observed in midpolar and polar fractions of sediment extracts, but known and previously characterized AhR agonists, including PAHs and SOs could not fully explain the total potencies of samples. Enoxolone was identified as a novel AhR agonist in a highly potent sediment fraction by use of FSA. Enoxolone has a relative potency of 0.13 compared to benzo[a]pyrene (1.0) in the H4IIE-luc bioassay. Nonylphenols associated with membrane damage that influenced the viability of the microalgae were also observed. Finally, inhibitions of bioluminescence of V. fischeri and lethality of D. rerio embryos were strongly related to nonpolar compounds. Overall, the present work addressed assay- and end point-specific variations and sensitivities for potential toxicities of mixture samples, warranting a significant utility of the "multiple lines of evidence" approach in ecological risk assessment.

Large-scale monitoring and ecological risk assessment of persistent toxic substances in riverine, estuarine, and coastal sediments of the Yellow and Bohai seas

The Yellow and Bohai seas comprise one of the most rapidly developing regions in the world, but efforts to assess coastal pollution by persistent toxic substances (PTSs) on wide spatial scale are lacking. The present study aimed to (1) measure the concentrations of PTSs, such as polycyclic aromatic hydrocarbons (PAHs), alkylphenols (APs), and styrene oligomers (SOs) via large-scale sediment monitoring (total of 125 locations), (2) assess potential ecological risk of PTSs in sediments to coastal ecosystems, (3) estimate various sources and fresh inputs of PTSs, (4) determine distribution patterns of PTSs by human activities and land-use type, and (5) address decadal (2008-2018) changes in distributions of PTSs. The high concentrations of PAHs [> 7000 ng g^-1 dry weight (dw)] in sediments were detected in Nantong in the Yellow Sea of China (YSC) and Huludao and Qinhuangdao in the Bohai Sea (BS), whereas lesser concentrations (< 200 ng g^-1 dw) were detected in the Yellow Sea of Korea (YSK). We found relatively high concentrations of sedimentary APs and SOs in Nantong, Huludao, and Qinhuangdao from the YSC and BS regions, but corresponding concentrations were generally below < 100 ng g^-1 dw in other locations. Concentrations of PAHs at 38 locations (30% of YSC and BS) posed a potential risk to aquatic ecosystems, whereas relatively low risk concentrations occurred in all locations of YSK. The main source of PAHs (concentrated in YSC and BS) were by-products of diesel and gasoline combustion (42% of total concentration), whereas biomass combustion (24%) dominated in YSK. Fresh inputs of PTSs indicated that the generation and use of PTSs continue across all regions and locations. Among PTSs, concentrations of PAHs were significantly associated with location (p < 0.05) relative to land-use within a given region, whereas concentrations of APs and SOs showed no significant relationships (p > 0.05) among or within regions. Over time, concentrations of PAHs have generally declined, but sediment contamination has increased at some locations in China, with sources shifting from a mixture of PAHs types to those linked to diesel and gasoline combustion. Additional studies are needed on the fate and potential ecological risk posed by certain PTSs in hotspots. This is one of the first efforts providing backgrounds on PTS pollution in the large marine ecosystem of the Yellow and Bohai seas.

Integrated assessment of west coast of South Korea by use of benthic bacterial community structure as determined by eDNA, concentrations of contaminants, and in vitro bioassays

During the past few decades, contamination of sediments by persistent toxic substances (PTSs) has been observed in estuarine and coastal areas on the west coast of South Korea. The contaminants are suspected to cause toxicities in aquatic biota, but little is known about their ecological effects, particularly on benthic microbial communities. In this study, an eDNA-based assessment was applied along with classic assessments of exposure, such as chemistry and in vitro bioassays, to evaluate condition of benthic bacterial communities subjected to PTSs. Two strategies were adopted for the study. One was to conduct a comprehensive assessment in space (by comparing seawater and freshwater sites at five coastal regions) and in time (by following change over a 5-y period). Although we found that bacterial composition varied among and within years, some phyla, such as Proteobacteria (28.7%), Actinobacteria (13.1%), Firmicutes (12.7%), and Chloroflexi (12.5%) were consistently dominated across the study regions. Certain bacterial groups, such as Firmicutes and Verrucomicrobia have been linked to contamination at some sites in the study area and at specific points in time. Bacterial communities were not significantly correlated with salinity or AhR- and ER-mediated potencies, whereas concentrations of PAHs, APs, and certain metals (Cd and Hg) exhibited significant associations to the structure of bacterial communities at the phylum level. In fact, the relative abundance of microbes in the phylum Planctomycetes was significantly and negatively correlated with concentrations of PAHs and metals. Thus, the relative abundance of Planctomycetes could be used as an indicator of sedimentary contamination by PAHs and/or metals. Based on our correlation analyses, Cd and ER-mediated potencies were associated more with bacterial abundances at the class taxonomic level than were other PTSs and metals. Overall, the eDNA-based assessment was useful by augmenting more traditional measures of exposure and responses in a sediment triad approach and has potential as a more rapid screening tool.

Rapid recovery of coastal environment and ecosystem to the Hebei Spirit oil spill's impact

The 2007 Hebei Spirit oil spill (HSOS), the largest in the national history, has negatively impacted the entire environment and ecosystem along the west coast of South Korea. Although many studies have reported the damages and impacts from the HSOS, quantitative assessment evaluating the recovery time and status have not been documented. Here, we first address the recovery timeline of the HSOS, by comprehensive analyses of 10-years accumulated data in quantitative manner. Concentrations of residual oils in seawater, sediments, and oysters rapidly dropped to backgrounds in 16, 75, and 33 months, respectively. Also, damaged benthic communities of intertidal and subtidal areas were fully recovered only after ~6 years. The present results collectively indicated unexpectedly fast recovery of the damaged environment and ecosystem from such a huge oil spill. The high tidal mixing (~9 m tidal height) and intensive human cleanup (~1.2 million volunteers) at the initial cleanup period might have contributed to rapid recovery; cf. 4-5 times faster than the Exxon Valdez oil spill. However, potential risk to human health remains unclear. Thus, it is warranted to conduct more in depth epidemiological studies to address chronic health effects associated with the cleanup volunteers as well as the local residents who have been living nearby the oil spill impacted sites.

Abstract ES4-2: Single cell transcriptomics reveals multi-step adaptations to endocrine therapy

Resistant tumours are thought to arise from the action of Darwinian selection on genetically heterogenous cancer cell populations. However, simple clonal selection is inadequate to describe the late relapses often characterising luminal breast cancers treated with endocrine therapy (ET), suggesting a more complex interplay between genetic and non-genetic factors. During this talk, I will briefly introduce a series of molecular tools that can be used to study transcriptional changes at the single cell level in relevant models. I will then show how used these tools to dissect the contributions of clonal genetic diversity and transcriptional plasticity during the early and late phases of ET at single-cell resolution. Using single-cell RNA-sequencing and imaging we could disentangle the transcriptional variability of plastic cells and define a rare subpopulation of pre-adapted (PA) cells which undergoes further transcriptomic reprogramming and copy number changes to acquire full resistance. We find evidence for sub-clonal expression of a PA signature in primary tumours and for dominant expression in clustered circulating tumour cells. I will then update the audience on how it is possible to integrate these technologies directly into clinical studies and what developments are happening in the field of single cell technologies. I will finally propose a multi-step model for ET resistance development and advocate the use of stage-specific biomarkers.

Citation Format: L Magnani, I Barozzi, S Hong. Single cell transcriptomics reveals multi-step adaptations to endocrine therapy [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr ES4-2.

Diabetes mellitus and tuberculosis in Korean adults: impact on tuberculosis incidence, recurrence and mortality

<sec id="st1"> <title>SETTING</title> The prevalence of diabetes mellitus (DM) worldwide is increasing markedly, and many countries with rising rates also have a high incidence rate of tuberculosis (TB). </sec> <sec id="st2"> <title>OBJECTIVE</title> To investigate the relationships of fasting serum glucose (FSG) and DM with TB incidence, recurrence and mortality risk in a prospective cohort study in South Korea. </sec> <sec id="st3"> <title>DESIGN</title> Our study comprised 1 267 564 Koreans who received health insurance from the National Health Insurance System, had an initial medical evaluation between 1997 and 2000 and were prospectively followed biennially. </sec> <sec id="st4"> <title>RESULTS</title> Participants with DM had a higher risk for incident TB (hazard ratio [HR] 1.81, 95%CI 1.71-1.91 in males, HR 1.33; 95%CI 1.20-1.47 in females) than those without DM. There was a strong positive trend for TB risk with rising FSG among males. The risk for recurrent TB among those with previous TB was significantly higher in males (HR 1.58, 95%CI 1.43-1.75) and in females with DM (HR 1.38, 95%CI 1.08-1.76). The increased risk of death from TB during follow-up was also significant in men (HR 1.91, 95%CI 1.87-1.95) and in women (HR 1.71, 95%CI 1.65-1.77). </sec> <sec id="st5"> <title>CONCLUSIONS</title> A diagnosis of DM is a risk factor for TB, TB recurrence and death from TB. Screening for TB should be considered among people living with DM in Korea, particularly those with severe DM. </sec>.

Long-term trends of persistent toxic substances and potential toxicities in sediments along the west coast of South Korea

For decades, in response to industrialization and urbanization, environmental qualities of estuarine and coastal areas of the west coast of Korea have been deteriorating. Long-term changes in concentrations of persistent toxic substances (PTSs) in sediments, including PAHs, styrene oligomers, nonylphenols, and metals and their potential toxicities via AhR- and ER-mediated potencies, and bioluminescent bacterial inhibition, were investigated. Long-term monitoring in five estuarine and coastal areas (2010-2018; 10 sites) showed that concentrations of PAHs and nonylphenols in sediments have declined while concentrations of some metals, Cd, Cr, and Hg have increased. Similarly, AhR-mediated potencies in sediments have declined, but inhibitions of bioluminescent bacteria have increased. Concentrations of sedimentary PAHs and AhR-mediated potencies were significantly (p < 0.01) and positively correlated. Sources of PAHs from combustion have been gradually declining while inputs from vehicle exhaust by-products have been increasing. Overall, this study brought our attention a balanced regulation in chemical-specific manner.

Variability of trophic magnification factors as an effect of estimated trophic position: Application of compound-specific nitrogen isotope analysis of amino acids

The trophic magnification of persistent organic pollutants (POPs), which is the relationship between POP concentration and the trophic position (TPs) of an organism, is considered an important factor for prioritizing chemicals of concern in the environment. Organismal TPs are typically based on nitrogen isotope ratios of bulk tissue (δ¹⁵N_bulk). In this study, nitrogen isotope ratios of amino acids (δ¹⁵N_AAs), a more precise approach for TP estimation (TP_AAs), was applied and compared with estimations of TP based on δ¹⁵N_bulk (TP_bulk) in marine organisms living in Masan Bay, South Korea. Compound-specific isotope analysis of the amino acids (CSIA-AAs) in fish samples allows us to calculate robust TPs by correcting the variation in baseline isotope values with use of the δ¹⁵N_bulk technique. In a benthic food chain, this approach reveals more significant magnification trends for POPs [polychlorinated biphenyls (PCBs), polybrominated diphenyl ethers (PBDEs), and organochlorine pesticides (OCPs)] than those revealed by analysis of the relationship between TP_bulk and POPs. The trophic magnification factors (TMF) associated with TP_AAs were significant for some POPs, especially pp'-DDD and chlordane. The results presented in this study suggest that TP calculations based on δ¹⁵N_AAs are an effective tool for characterizing trophic magnification trends related to the fates of various pollutants.

Recovery of renal function in patients with lupus nephritis and reduced renal function: the beneficial effect of hydroxychloroquine

Background

Reduced renal function is associated with worse renal outcome in patients with lupus nephritis (LN). However, there is insufficient knowledge regarding renal function recovery in patients with LN with reduced baseline renal function. Therefore, the present study aimed to investigate renal function recovery and related factors in patients with reduced baseline renal function.

Methods

The present retrospective longitudinal cohort study included patients with LN and reduced renal function. Reduced renal function was defined as an estimated glomerular filtration rate (eGFR) of <60 mL/min/1.73 m2. Recovery of renal function was determined by an eGFR of >60 mL/min/1.73 m2 at six months after baseline, and factors associated with it were evaluated using logistic regression analysis.

Results

We included 90 patients with LN, with a mean eGFR value of 37.2 ± 13.9 mL/min/1.73 m2. Forty-six (51.1%) patients recovered their renal function after six months. On multivariate analysis, hydroxychloroquine use (odds ratio (OR) = 3.891, 95% confidence interval (CI) 1.196–12.653, p = 0.024), prolonged LN (OR = 0.926, 95% CI 0.874–0.981, p = 0.009) and high-grade tubular atrophy (OR = 0.451, 95% CI 0.208–0.829, p = 0.013) were associated with renal function recovery. During follow up, 25 patients were on end-stage renal disease (ESRD). Kaplan–Meier analysis revealed that renal function recovery after six months and lower probability of ESRD are associated.

Conclusions

In patients with LN and reduced renal function, renal function recovery at six months was associated with use of hydroxychloroquine and inversely related to longer duration of LN and higher grade of tubular atrophy.

Major AhR-active chemicals in sediments of Lake Sihwa, South Korea: Application of effect-directed analysis combined with full-scan screening analysis

This study utilized effect-directed analysis (EDA) combined with full-scan screening analysis (FSA) to identify aryl hydrocarbon receptor (AhR)-active compounds in sediments of inland creeks flowing into Lake Sihwa, South Korea. The specific objectives were to (i) investigate the major AhR-active fractions of organic extracts of sediments by using H4IIE-luc in vitro bioassay (4 h and 72 h exposures), (ii) quantify known AhR agonists, such as polycyclic aromatic hydrocarbons (PAHs) and styrene oligomers (SOs), (iii) identify unknown AhR agonists by use of gas chromatography-quadrupole time-of-flight mass spectrometry (GC-QTOFMS), and (iv) determine contributions of AhR agonists to total potencies measured by use of the bioassay. FSA was conducted on fractions F2.6 and F2.7 (aromatics with log K_ow 5-7) in extracts of sediment from Siheung Creek (industrial area). Those fractions exhibited significant AhR-mediated potency as well as relatively great concentrations of PAHs and SOs. FSA detected 461 and 449 compounds in F2.6 and F2.7, respectively. Of these, five tentative candidates of AhR agonist were selected based on NIST library matching, aromatic structures and numbers of rings, and available standards. Benz[b]anthracene, 11H-benzo[a]fluorene, and 4,5-methanochrysene exhibited significant AhR-mediated potency in the H4IIE-luc bioassay, and relative potencies of these compounds were determined. Potency balance analysis demonstrated that these three newly identified AhR agonists explained 1.1% to 67% of total induced AhR-mediated potencies of samples, which were particularly great for industrial sediments. Follow-up studies on sources and ecotoxicological effects of these compounds in coastal environments would be required.

Multimedia distributions, bioaccumulation, and trophic transfer of microcystins in the Geum River Estuary, Korea: Application of compound-specific isotope analysis of amino acids

To determine distributions, bioaccumulation, and trophic transfer of freshwater cyanobacterial toxins such as microcystins (MCs), surface water, suspended solids, sediments, and coastal organisms were collected from seven stations in inner and outer regions of the estuary dam in the Geum River Estuary in June and July 2017. Concentrations of MC variants (MC-LR, -RR, and -YR) in the multimedia samples were analyzed using a HPLC-MS/MS. Trophic position (TP) of organisms (fish, bivalve, gastropod, decapod, and polychaete) was determined by nitrogen stable isotope analyses of both bulk tissues and amino acids. From July to August 2017, great concentrations of MCs were detected in discharged freshwater ranging from 0.4 to 75 μg L^-1. Considerable amounts of MCs are delivered to the Geum River Estuary in summer season. MCs spread far away as dissolved phases (18.7-49.5 ng L^-1) in July when large amount of freshwater was discharged during the rainy season. Concentrations of MCs in marine organisms varied among species, ranging from 40 to 870 ng g^-1 dw. Bioaccumulated MCs tend to decrease with increasing TP of organisms, suggesting that MCs are biodiluted through the marine food web. Compound-specific isotope analysis (nitrogen of amino acids) provides more reliable TPs compared with those by bulk isotope analysis in a closed estuary (such as the Geum River Estuary) with large fluctuations in the isotope ratio of primary producers.

Natural and anthropogenic signatures on sedimentary organic matters across varying intertidal habitats in the Korean waters

Sedimentary organic matters in the typical intertidal areas were investigated to address year-round monthly distributions and site-specific sources. Target areas included four natural tidal flats (Ganghwa, Garolim, Sinan, and Suncheon) and one artificially closed estuary (Nakdong River), South Korea (in 2018). Among the parameters monitored, mud content was a key factor controlling organic matter contents, across varying habitats, with significant positive correlations to total organic carbon (TOC, r = 0.66, p < 0.001) and total nitrogen (TN, r = 0.44, p < 0.001). The elevated TOC and TN contents and heavier carbon stable isotope ratios (δ¹³C) in sediments of Garolim and Suncheon from February to April reflected the winter microphytobenthos blooms, receiving prevailed marine sources. Whilst, the depleted δ¹³C and δ¹⁵N values in sediments of Nakdong River estuary were observed during flood season (September-October), indicating direct influence of terrestrial organic input through freshwater discharge. Overall, distributions and sources of sedimentary organic matters in the Korean coastal waters suggested variabilities in season and space, with anthropogenic alteration. The data accumulated in this study would provide baseline information for sediment organic carbon stocks in the Korean coastal waters and elsewhere.

Multiple evaluation of the potential toxic effects of sediments and biota collected from an oil-polluted area around Abu Ali Island, Saudi Arabia, Arabian Gulf

After the Gulf War Oil Spill, there have been many investigations about distributions of oil-derived pollutants nearby areas, but lacking in ecotoxicological assessment. We evaluated the potential toxicity of asphalt mats, sediments, and biota (polychaetes, chitons, snapping shrimps, and crabs) by combining two bioassays (H4IIE-luc and Vibrio fischeri) and in situ microbial community (eDNA). Samples were collected from Abu Ali Island, and organic extracts were bioassayed and further fractionated according to the chemical polarity using silica gel column. Great aryl hydrocarbon receptor (AhR)-mediated potencies and inhibition of bioluminescence were mainly found in aromatics (F2) and saturates (F1) fractions of asphalt mat and sediments, respectively, while great toxicological responses in biota samples were found in resins and polar (F3) fraction. We also confirmed that potential toxicities of biota were species-specific; great AhR-mediated potencies were found in polychaetes and great bioluminescence inhibitions were found in crabs. In microbial communities, most genera (up to 90%) were associated with polycyclic aromatic hydrocarbons (PAHs)-degrading bacteria, supporting that PAHs are the primary stressors of the benthic community around Abu Ali Island. The present study provides useful information on the contamination status, risk assessment of environmental matrices and benthic organisms in Abu Ali Island.

Impact of stringent response in proteinuria on long-term renal outcomes in proliferative lupus nephritis

Objectives

Favourable long-term prognosis in proliferative lupus nephritis (LN) is associated with the achievement of complete renal response (CR), which is defined as a urine protein/creatinine ratio (UPCR) of < 0.5. However, it is unclear whether a more stringent cut-off for proteinuria (normal value of proteinuria; UPCR < 0.15) is better than CR. We aimed to evaluate the effect of stringent CR, defined as a UPCR of <0.15, on long-term renal outcomes in proliferative LN.

Methods

We included 87 patients with class III or IV LN who achieved CR at one year after induction therapy. Clinical and laboratory data were compared between the stringent and non-stringent CR groups. Logistic regression analysis was performed to identify factors associated with achievement of stringent CR. Cox analysis was performed to analyse the risk factors for renal flare and development of chronic kidney disease (CKD).

Results

The stringent and non-stringent CR groups included 58 and 29 patients, respectively. The two groups showed no significant baseline differences in terms of the clinical, laboratory and pathological classification. The sustained CR rates during five years were 91.3% and 50.0% ( p = 0.014) in the stringent and non-stringent CR groups, respectively. In Cox analyses, the achievement of stringent CR was associated with a lower risk of five-year renal flare rate (hazard ratio (HR) = 0.161, 95% confidence interval (CI) 0.063–0.411, p < 0.01) and development of CKD (HR = 0.189, 95% CI 0.047–0.752, p = 0.018). Mycophenolate mofetil induction therapy was associated with achievement of stringent CR at a borderline level of significance (HR = 7.268, 95% CI 0.894–59.089, p = 0.064).

Conclusion

Achievement of stringent CR predicted lower risk of renal flare and development of CKD in proliferative LN. These findings suggest that stringent CR is a valuable treatment target in proliferative LN.

Anthropogenic influences on benthic food web dynamics by interrupted freshwater discharge in a closed Geum River estuary, Korea

Stable isotope analysis was used to investigate the benthic food web dynamics in the Geum River estuary where continuous river flow has been blocked by a sea dike over the past 25 years. In order to address the dike effect(s) on distribution of food sources (i.e., organic matters and microphytobenthos) and their utilization by marine predators, a three years monitoring survey (total of 30 surveys) was seasonally conducted at four fixed locations at both inside of dike and outer tidal flats. All the collected biota (total of 19 species; >1100 individuals and microphytobenthos) and abiotic (n = 118) samples were analyzed for carbon (δ¹³C) and nitrogen (δ¹⁵N) stable isotopes. In particular, two dominant marine bivalves inhabiting outer reach of tidal flats, Mactra veneriformis and Cyclina sinensis, were targeted to identify their feeding strategies that being related to a year-round population growth. In general, the stable isotopic signatures of samples indicated dissimilarity in distribution of organic matters between inside and outside of dike, supporting geographical and/or trophic isolation. The taxa-dependent trophic levels are also evidenced in consistent manner, with two to three levels being positioned over the years. Meantime, their dietary contributions varied in time, i.e., seasonal chances in compositions of major food sources (microphytobenthos and particulate organic matters) were observed for two target bivalves. Such temporal variations could be further linked to selective feedings that evidenced by age(size)-dependent and/or tissue specific distributions. Altogether, the present study suggested seasonality, diet preference, and growth dependent food web dynamics in the Geum River estuary. Overall, the present study suggested that the stable isotopic technique could be a powerful tool for characterizing the long-term anthropogenic influences of a sea dike on marine food-web dynamics.

Newly Identified AhR-Active Compounds in the Sediments of an Industrial Area Using Effect-Directed Analysis

Effect-directed analysis was used to identify previously unidentified aryl hydrocarbon receptor (AhR) agonists in sediments collected from a highly industrialized area of Ulsan Bay, Korea. The specific objectives were to (i) investigate potent fractions of sediment extracts using the H4IIE-luc bioassay, (ii) determine the concentrations of known AhR agonists (polycyclic aromatic hydrocarbons (PAHs) and styrene oligomers (SOs)), (iii) identify previously unreported AhR agonists in fractions by use of GC-QTOFMS, and (iv) evaluate contributions of individual compounds to overall AhR-mediated potencies, found primarily in fractions containing aromatics with log K_ow 5-8. Greater concentrations of PAHs and SOs were also found in those fractions. On the basis of GC-QTOFMS and GC-MSD analyses, 16 candidates for AhR agonists were identified in extracts of sediments. Of these, seven compounds, including 1-methylchrysene, benzo[j]fluoranthene, 3-methylchrysene, 5-methylbenz[a]anthracene, 11H-benzo[b]fluorene, benzo[b]naphtho[2,3-d]furan, and benzo[b]naphtho[2,1-d]thiophene, exhibited significant AhR activity. Relative potency values of newly identified AhR agonists were found to be greater than or comparable to that of benzo[a]pyrene (BaP). The potency balance analysis showed that newly identified AhR agonists explained 0.07-16% of bioassay-derived BaP-EQs. These chemicals were widely distributed in industrial sediments; thus, it is of immediate importance to conduct studies on sources and potential effects of those chemicals.

Comparative evaluation of bioremediation techniques on oil contaminated sediments in long-term recovery of benthic community health

While various bioremediation techniques have been widely used at oil spill sites, the in situ efficiency of such techniques on recovering the benthic communities in intertidal areas has not been quantified. Here, the performance of several bioremediation tools such as emulsifiers, multi-enzyme liquid (MEL), microbes, and rice-straw was evaluated by a 90-days semi-field experiment, particularly targeting recovery of benthic community. Temporal efficiency in the removal of sedimentary total petroleum hydrocarbons (TPH), reduction of residual toxicity, and recovery of bacterial diversity, microalgal growth, and benthic production was comprehensively determined. Concentrations of TPH and amphipod mortality for all treatments rapidly decreased within the first 10 days. In addition, the density of bacteria and microphytobenthos generally increased over time for all treatments, indicating recovery in the benthic community health. However, the recovery of some nitrifying bacteria, such as the class Nitrospinia (which are sensitive to oil components) remained incomplete (13-56%) during 90 days. Combination of microbe treatments showed rapid and effective for recovering the benthic community, but after 90 days, all treatments showed high recovery efficiency. Of consideration, the "no action" treatment showed a similar level of recovery to those of microbe and MEL treatments, indicating that the natural recovery process could prevail in certain situations.

A66 Tracing the evolutionary history of an emerging Salmonella 4,[5],12:i:- clone in the United States

Salmonellosis is one of the leading causes of foodborne disease worldwide, with an estimated one million cases a year in the United States. Salmonella 4,[5],12: i:-, a monophasic variant of Salmonella typhimurium, is an emerging serovar that has been associated with multiple foodborne outbreaks throughout the world, mostly attributed to pig and pig products. Recently, we have demonstrated that two distinct groups of Salmonella 4,[5],12:i:- circulate in the USA and Europe, with the majority of isolates recovered during recent years belonging to an emerging multidrug-resistant clade (Elnekave et al. 2018). We applied Bayesian phylodynamic reconstruction to uncover the evolutionary history of this clade. We used a dataset of whole-genome sequences of 1446 4,[5],12:i:- isolates from different sources (livestock, human, food products, and others) from the USA (n = 752) and Europe (n = 694), collected between 2008 and 2017 and belonging to the Multilocus Subtype 34, which was predominant in the emerging clade (Elnekave et al. 2018). A subset (n = 110) of Salmonella 4,[5],12:i: isolates was then randomly selected after stratifying by location and year of isolation in order to achieve balanced sampling. Evidence of temporal signal was confirmed by looking at root-to-tip divergences using TempEst. Evolutionary hypotheses using strict and relaxed-clock models were tested using BEAST for a variety of demographic models and assuming a general time reversible substitution model. Model selection was performed by estimating Bayes Factors using path sampling and stepping-stone sampling. The selected model was then used for applying discrete trait models comparing different scenarios of transmission between locations (i.e. bidirectional symmetric/asymmetric or unidirectional). Our preliminary phylodynamic inference results indicate that the origin of this subtype was in Europe and dates back to 1990 (HPD 95%: 1984–2001). We report an exponential growth rate of 0.362 per year, which corresponds to a doubling time of 1.43 years. Our results suggest that this subtype was introduced to the US in the year 2000 (HPD 95%: 1994–2006). Phylodynamic analysis suggests that the recent increase in isolation of Salmonella 4,[5],12:i:- from different sources in the USA may be due to the exponential expansion of an emerging clone which originated in Europe and then expanded to the USA. The emergence and expansion of this serovar is of great public health importance due to the high prevalence of multidrug resistance traits found in USA isolates from this group and especially due to the presence of plasmid-mediated resistance genes for quinolones and extended spectrum cephalosporins, key antimicrobials used for the treatment of invasive Salmonella infections.

Occurrence and bioaccumulation of persistent toxic substances in sediments and biota from intertidal zone of Abu Ali Island, Arabian Gulf

North Abu Ali Island is contaminated by crude oil from exogenous sources with a variety of persistent toxic substances (PTSs) being input into intertidal sediments. We detected an array of PTSs in sediments and benthic biota off north Abu Ali Island (Arabian Gulf), including 35 polycyclic aromatic hydrocarbons (PAHs), 6 alkylphenols (APEOs), 10 styrene oligomers (SOs), and tributyltin. The PTS concentrations were generally greater than those reported in other areas of Arabian Gulf. PAHs mainly originated from petrogenic sources, and APEOs and SOs seem to be of recent origin. Field-based biota-sediment accumulation factors (BSAF) varied by taxa and compounds, but clearly depended on the log K_ow values of individual compounds. Some PTSs exceeded the established guidelines for sediments and biota; we found particularly great BSAFs for alkyl-naphthalenes (C1- and C2-), nonylphenol monoethoxylates, and 2,4,6-triphenyl-1-hexene. Remediation will require on-site clean-up of toxic chemicals together with immediate efforts on preventing input of current pollution sources in the given area.

Carbon and nitrogen stable isotope signatures linked to anthropogenic toxic substances pollution in a highly industrialized area of South Korea

Sources of organic matter in a polluted coastal embayment (Lake Sihwa) indicated that δ¹³C and δ¹⁵N of suspended particulate matter (SPM) and sediments could be distinguished by land-use type and surrounding activities. Specifically, low δ¹⁵N occurred in inland creeks near industrial complex, where severe contamination by persistent toxic substances (PTSs) is evidenced. To identify the sources of ¹⁵N-depleted organic matter and PTSs, the SPM and/or sediments were collected along ~8 km of the Singil Creek and in stormwater drainage pipes that carried pollutants to the creeks from upland areas. Results indicated that stormwater originating in industrial areas was the main source of low δ¹⁵N and elevated PTSs, which appeared to flow into stormwater drains with rainwater and eventually into the creeks at stormwater outfalls. To improve the water quality of inland creeks, it will be necessary to reduce the amount of untreated stormwater entering stormwater drainage system from industrial complex.

The effects of cortisol and adrenal androgen on bone mass in Asians with and without subclinical hypercortisolism

Analyses using the largest Korean cohort of adrenal incidentaloma (AI) revealed that subtle cortisol excess in premenopausal women and reduced dehydroepiandrosterone-sulfate (DHEA-S) in postmenopausal women and men are associated with bone mineral density (BMD) reduction in Asian patients with subclinical hypercortisolism (SH).

INTRODUCTION

Few studies evaluated bone metabolism in Asians with SH. We investigated associations of cortisol and DHEA-S, an adrenal androgen, with BMD in Asians with AI, with or without SH.

METHODS

We used cross-sectional data of a prospective multicenter study from Korea. We measured BMD, bone turnover markers, cortisol levels after 1-mg dexamethasone suppression test (1-mg DST), DHEA-S, and baseline cortisol to DHEA-S ratio (cort/DHEA-S) in 109 AI patients with SH (18 premenopausal, 38 postmenopausal women, and 53 men) and 686 with non-functional AI (NFAI; 59 premenopausal, 199 postmenopausal women, and 428 men).

RESULTS

Pre- and postmenopausal women, but not men, with SH had lower BMDs at lumbar spine (LS) than those with NFAI (P = 0.008~0.016). Premenopausal women with SH also had lower BMDs at the hip than those with NFAI (P = 0.009~0.012). After adjusting for confounders, cortisol levels after 1-mg DST demonstrated inverse associations with BMDs at all skeletal sites only in premenopausal women (β = - 0.042~- 0.033, P = 0.019~0.040). DHEA-S had positive associations with LS BMD in postmenopausal women (β = 0.096, P = 0.001) and men (β = 0.029, P = 0.038). The cort/DHEA-S had inverse associations with LS BMD in postmenopausal women (β = - 0.081, P = 0.004) and men (β = - 0.029, P = 0.011). These inverse associations of cort/DHEA-S remained significant after adjusting for cortisol levels after 1-mg DST (β = - 0.079~- 0.026, P = 0.006~0.029). In postmenopausal women, the odds ratios of lower BMD by DHEA-S and cort/DHEA-S was 0.26 (95% CI, 0.08-0.82) and 3.40 (95% CI, 1.12-10.33), respectively.

CONCLUSION

Subtle cortisol excess in premenopausal women and reduced DHEA-S in postmenopausal women and men may contribute to BMD reduction in Asians with SH.

MMP-8-Responsive Polyethylene Glycol Hydrogel for Intraoral Drug Delivery

Currently available drug delivery systems for oral diseases suffer from short retention time and poor local concentrations at the target site. A biodegradable stimulus-responsive hydrogel was synthesized in the present study to evaluate its application as an environmentally sensitive carrier for on-demand intraoral drug delivery. The hydrogel was synthesized from diacrylate-containing polyethylene glycol-based scaffolds and a cysteine-terminated peptide crosslinker (CGPQG↓IWGQC) via a Michael-type addition reaction. Because CGPQG↓IWGQC can be cleaved by matrix metalloproteinase 8 (MMP-8), minocycline hydrochloride, bovine serum albumin, or an antibacterial peptide (KSL) was incorporated into the scaffolds to evaluate the MMP-8-responsive release behavior of the on-demand drug delivery system. Hydrogel characterization and gelation kinetics were examined with gel time, Fourier-transform infrared spectroscopy, scanning electron microscopy, and measurements of rheologic parameters. Degradation behavior and MMP-8-responsive drug release were performed by high-performance liquid chromatography and protein-specific assay. Biocompatibility evaluation indicated that the hydrogels were noncytotoxic. Antibacterial testing demonstrated that the released drugs were able to maintain bioactivity. Taken together, these results suggest that the MMP-8-sensitive hydrogel is a promising candidate for on-demand intraoral localized drug delivery. Because MMP-8 is one of the most important biomarkers for periodontitis, the MMP-8-responsive hydrogel has potential to be used for in situ adaptive degradation in response to chronic periodontitis and peri-implantitis. This notion has to be tested in animal models of periodontal disease.

6-year change in resting heart rate is associated with incident type 2 diabetes mellitus

BACKGROUND AND AIMS

Elevated resting heart rate (RHR) is associated with risk of type 2 diabetes mellitus (T2DM). However, the association of change in RHR (ΔRHR) and incident T2DM is not fully elucidated. We aimed to assess the dose-response association between 6-year ΔRHR and T2DM.

METHODS AND RESULTS

A total of 12155 non-T2DM participants ≥18 years old were enrolled during 2007-2008 and followed up during 2013-2014. ΔRHR was calculated by subtracting the baseline RHR from the RHR value at 6-year follow-up. Age-, sex-, and RHR-specific relative risks (RRs) and 95% confidence intervals (CIs) for the effect of ΔRHR on incident T2DM were calculated by using modified Poisson regression models. As compared with ΔRHR of 0 beats/min, the adjusted risk of T2DM was significantly increased with RHR increment and reduced with RHR reduction. ΔRHR was positively associated with future risk of T2DM [RR per unit increase: 1.03 (1.03-1.04)]. As compared with stable change in RHR group (-5<ΔRHR<5 beats/min), for ΔRHR ≤ -10 beats/min, -10<ΔRHR ≤ -5 beats/min, 5≤ΔRHR<10 beats/min, and ΔRHR ≥10 beats/min groups, the pooled adjusted RR (95% CI) of T2DM was 0.69 (0.55-0.86), 0.90 (0.73-1.11), 1.31 (1.07-1.61), and 1.90 (1.59-2.26), respectively. This significant association still existed on subgroup analyses based on age, sex, and baseline RHR and sensitivity analyses.

CONCLUSIONS

Dynamic RHR change was significantly associated with incident T2DM. Our study suggests that RHR may be a non-invasive clinical indicator for interventions aiming to reduce incident T2DM in the general population.

Abstract P6-18-11: Long-term responders to single-agent margetuximab, an Fc-modified anti-HER2 monoclonal antibody, in metastatic HER2+ breast cancer patients with prior anti-HER2 therapy

Background

Margetuximab is an Fc-optimized anti-HER2 antibody that recognizes the same epitope as trastuzumab. Margetuximab has increased affinity for the activating CD16A Fc-receptor on NK cells and macrophages as well as decreased affinity for the inhibitory CD32B receptor compared to trastuzumab. In a Phase 1 study (NCT01148849) of 66 patients with relapsed or metastatic HER2+ cancer across multiple indications, margetuximab was well tolerated at all doses. Among 60 response-evaluable patients, confirmed partial response (PR) and stable disease (SD) were seen in 7 (12%) and 30 (50%) patients, respectively. Tumor reductions occurred in 18/23 (78%) evaluable breast cancer patients. Ex-vivo analyses of patient peripheral blood mononuclear cell samples confirmed margetuximab's ability to enhance antibody dependent cell-mediated cytotoxicity over that from trastuzumab. We report on 3 breast cancer patients with prior anti-HER2 therapy failure with durable (≥ 3.5 years) SD (1) or PR (2).

Methods

Enrolled patients had histologically/cytologically-confirmed carcinoma with documented HER2 overexpression by immunohistochemistry (2+ or 3+) and disease progression during/following last therapy. Eligibility included life expectancy ≥3 months; performance status ≤1; measurable disease by Response Criteria for Solid Tumors 1.1; adequate bone marrow, renal, hepatic function; and left ventricular ejection fraction ≥50%. Margetuximab was given by intravenous infusion at 0.1 – 6.0 mg/kg for 3 of every 4 weeks or once every 3 weeks (10 – 18 mg/kg).

Results

Three of 17 HER2 3+ metastatic breast cancer patients received long-term margetuximab. Patient 35 had 3 prior regimens (adjuvant doxorubicin+cyclophosphamide followed by docetaxol+trastuzumab; gemcitabine+vinorelbine; lapatinib+capecitabine) and received margetuximab at 10 mg/kg q3wk, 88 cycles to date, with PR achieved Cycle 1 Day 43, maintained 4.4 years. Patient 44 had 3 prior regimens for metastatic disease (docetaxel+trastuzumab+pertuzumab; doxorubicin+cyclophosphamide; lapatinib+capecitabine) and received margetuximab at 15 mg/kg q3wk, 79 cycles to date with SD for 4.3 years. Patient 50 had 4 prior regimens for recurrent/metastatic disease (tamoxifen; anastrozole; capecitabine+trastuzumab; lapatinib+capecitabine) and received margetuximab dose of 18 mg/kg q3wk with PR achieved Cycle 1 Day 43, maintained 3.5 years. Progression was noted at Cycle 57, and margetuximab continues at 63 cycles to date. No cardiac toxicities were found during long-term follow-up for these 3 patients and there were no treatment-related adverse events ≥Grade 3.

Conclusions

Margetuximab is well-tolerated without cardiac toxicities in long-term responders, with single-agent activity including durable responses in heavily pre-treated metastatic breast cancer. A Phase 3, randomized, multi-center clinical trial (SOPHIA; NCT02492711) is enrolling patients with metastatic breast cancer, comparing margetuximab plus chemotherapy to trastuzumab plus chemotherapy in patients who have received 1 to 3 lines of therapy for advanced disease.

Citation Format: Im S-A, Bang Y-J, Oh D-Y, Giaccone G, Bauer T, Nordstrom J, Li H, Moore P, Hong S, Baughman J, Rock E, Burris H. Long-term responders to single-agent margetuximab, an Fc-modified anti-HER2 monoclonal antibody, in metastatic HER2+ breast cancer patients with prior anti-HER2 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 P6-18-11.

Evaluation of residual toxicity of hypochlorite-treated water using bioluminescent microbes and microalgae: Implications for ballast water management

Total residual oxidants (TRO) in treated ballast water can produce various disinfection by-products (DBPs) depending on local conditions, such as salinity and organic matter content in water. Because TRO and DBPs are known to be harmful to aquatic organisms and humans, ecotoxicity tests have been proposed for screening the residual toxicity before discharging treated ballast water. In the present study, we aimed to address the decay rates and toxicity changes of TRO under various conditions in salinity, initial TRO concentrations, and residence time of TRO. In addition, the toxicological sensitivities of bioluminescent bacteria Vibrio fischeri and a commonly-used microalgae Skeletonema costatum relative to the residual toxicity of TRO and six selected DBPs were determined. Decay rate of TRO concentration increased as a function of salinity and was affected by the initial concentrations of TRO. Unexpectedly, significant bioluminescence inhibition was observed for hypochlorite-treated water at < 0.1 mg L^-1 TRO (expressed as Cl₂), which is a lower concentration than the maximum allowable discharge concentration (MADC) to marine waters established by the International Maritime Organization (IMO). The ecotoxicological thresholds of no observed effective concentration and median effect concentration for all tested DBPs were about 3-10 times lower for V. fischeri than for S. costatum. The results indicate that bioluminescent microbes possess an ecologically-relevant sensitivity to both TRO and DBPs in ballast water. In general, bioassay using V. fischeri was potentially more effective than microalgae for screening the total toxicity of TRO and DBPs in treated ballast water, especially given that ballast water usually contains a highly variable and complex mixture of toxicants.

Clinical characteristics of diabetic ketoacidosis in users and non-users of SGLT2 inhibitors

AIM

This study investigated the clinical characteristics of diabetic ketoacidosis (DKA) and compared the DKA characteristics between patients treated with and without SGLT2 inhibitors.

METHODS

Data were collected from patients aged ≥ 18 years admitted for DKA at nine centres in Korea between September 2014 and April 2017. The electronic medical records of these subjects were retrospectively reviewed. Based on their history of medications taken before admission, subjects were classified as either users or non-users of SGLT2 inhibitors and their clinical characteristics of DKA were compared.

RESULTS

During the study, the main subtype of DKA episodes (n = 523) was identified as type 2 diabetes (51%). Average hospitalization duration was 11 days, and average intensive care unit (ICU) time was 2.5 days. The in-hospital mortality rate was 3%, but no users of SGLT2 inhibitors died during DKA treatment. In patients taking SGLT2 inhibitors (n = 15), DKA manifested at 124 days, on average, after starting the inhibitors (range: 7-380 days). Also, SGLT2 inhibitors users had significantly lower plasma glucose levels (413 mg/dL) compared with non-users (554 mg/dL), and longer ICU stays (4 vs. 2 days; P = 0.019).

CONCLUSION

In this report of recent data on the clinical features of DKA in Korea, patients using SGLT2 inhibitors needed longer treatment in ICUs compared with non-users and had lower levels of blood glucose, whereas DKA associated with SGLT2 inhibitors was rare.

Silencing of ATPase family AAA domain-containing protein 2 inhibits migration and invasion of colorectal cancer cells

Colorectal cancer is one of the most common malignant tumors with a high rate of distant metastasis, postoperative recurrence and mortality. ATPase family AAA domain-containing protein 2 (ATAD2), a member of ATPase family, is highly expressed in various cancers, including colorectal cancer. However, whether ATAD2 plays a role in the migration and invasion of colorectal cancer cells remains unknown. In this study, we established ATAD2 knockdown in colorectal cancer cell lines by RNA interference and found that silencing of ATAD2 inhibited the migration and invasion ability of Caco-2 and SW-480 cells. Moreover, ATAD2 silencing suppressed epithelial-mesenchymal transition (EMT), and reduced the expression and enzymatic activity of matrix metalloproteinases (MMPs) in Caco-2 and SW-480 cells. In summary, our results suggest that silencing of ATAD2 inhibits migration and invasion of colorectal cancer cells by suppressing EMT and decreasing the activity of MMPs. Hence, ATAD2 could be considered as a novel molecular marker of metastatic colorectal cancer, and it may provide new insights for clinical diagnosis and treatment of colorectal cancer.

Chemical-, site-, and taxa-dependent benthic community health in coastal areas of the Bohai Sea and northern Yellow Sea: A sediment quality triad approach

To investigate benthic ecological quality associated with coastal pollution in the Bohai Sea and northern Yellow Sea, a sediment quality triad (SQT) approach was applied. Chemical (six groups of persistent toxic substances (PTSs) and 8 metals and metalloids), toxicological (AhR-mediated potency), and ecological (bacterial and meiofaunal communities) elements were selected and used in an integrated sediment assessment. The benthic meiofaunal community was newly analyzed and used as an additional component of the infaunal community during the SQT. Concentrations of chemicals and potential toxicity in sediments both indicated moderate to severe pollution in the study area, characterized by site-specific and land-uses. In particular, As, DDTs, and bioassay-derived dioxin equivalents exceeded corresponding sediment quality guidelines at nearly all locations. Limited occurrences of meiofaunal taxa (mean = 5.2) and relatively low species diversity, mainly comprised of nematodes (75.3%) and copepods (14.6%), among locations was generally consistent with pollution. The benthic community was consistent with compound-specific responses to gradients of contamination, particularly for As. Densities of two taxa, Nematoda and Nemertea exhibited strong negative correlations with concentrations of As. Compound-, site-, and taxa-specific variability of pollution of sediments was further supported by results of cluster analysis (CA) and nonmetric multidimensional scaling (NMDS). Finally, assessment integrating five benthic quality elements, including: 1) PTSs; 2) metals and metalloids; 3) sediment toxicity; 4) sediment microbiome; and 5) benthic meiofaunal community, explained contamination of sediments associated with land-uses, locality, or habitat. Status of the benthic community could not be explained by single component and their associations were not quantitative. Results of the integrated assessment, considering multiple benthic quality elements were useful to address overall quality of sediment, and were consistent with chemical-, species-, or site-dependent pollution of sediments in the Bohai and Yellow Seas.

Long-term immunogenicity and immune persistence of live attenuated and inactivated hepatitis a vaccines: a report on additional observations from a phase IV study

Both live attenuated (HA-L) and inactivated (HA-I) hepatitis A vaccine were licensed for routine use in China. Although phase 1, 2 and 3 clinical studies of both vaccines have been completed, further systematic evaluation of their immunogenicity and immunological persistence under phase 4 clinical studies in a wide range of conditions and involving large populations is necessary. A phase IV clinical trial (NCT02601040) was performed in 9000 participants over 18 months of age. Geometric mean concentrations (GMCs) and seroconversion rates (SRs) were compared at five time points during 3 years for 1800 individuals among them. The SRs of HA-L and HA-I were 98.08% (95% CI 95.59%-99.38%) and 99.64% (95% CI 98.93%-100.00%) respectively 28 days after administration of the first dose, and remained at 97.07% (95% CI 94.31%-98.73%) or above and 96.73% (95% CI 94.07%-98.42%) or above respectively during the following 3 years. The GMCs for both the HA-L and HA-I groups showed that both vaccines elicited high anti-HAV titres, considerably more than the threshold of protection needed against HAV infection in humans, and these titres were sustained. Hence, both HA-I and HA-L vaccines could provide an excellent long-term protective effect, and supported the routine use of both vaccines.

A J-shaped relation of BMI and stroke: Systematic review and dose-response meta-analysis of 4.43 million participants

BACKGROUND AND AIM

Many studies have shown increased risk of stroke with greater adiposity as measured by body mass index (BMI), but questions remain about the shape of the dose-response relation. We conducted a systematic review and meta-analysis of prospective studies to clarify the strength and shape of the dose-response relation between BMI and risk of stroke.

METHODS AND RESULTS

PubMed and Embase databases were searched for articles published up to May 11, 2018. Random-effects generalized least-squares regression models were used to estimate study-specific dose-response association, and restricted cubic splines were used to model the association. We included reports of 44 prospective cohort studies describing 102 466 incident cases among 4 432 475 participants. With a 5-unit increment in BMI, the summary relative risk for stroke incidence was 1.10 (95% confidence interval, 1.06 to 1.13; I² = 88.0%). The dose-response relation was J-shaped (P_{non-linearity} <0.001). The risk was not increased at the low BMI range (<24 kg/m²), but was increased within the high BMI range (>25 kg/m²).

CONCLUSION

Both overweight and obesity increase the risk of stroke with a J-shaped dose-response relation, and the nadir of the curve was observed at BMI 23-24 kg/m².