Oxytocin revisited: its role in cardiovascular regulation

Traditionally associated with female reproduction, oxytocin (OT) was revisited recently and was revealed to have several new roles in the cardiovascular system. Functional OT receptors have been discovered in the rat and human heart, as well as in vascular beds. The cardiovascular activities of OT include: (i) lowering blood pressure; (ii) negative cardiac inotropy and chronotropy; (iii) parasympathetic neuromodulation; (iv) vasodilatation; (v) anti-inflammatory; (vi) antioxidative; and (vii) metabolic effects. These outcomes are mediated, at least in part, by stimulating cardioprotective mediators, such as nitric oxide and atrial natriuretic peptide. OT and its extended form OT-Gly-Lys-Arg have been shown to be abundant in the foetal mouse heart. OT has the capacity to generate cardiomyocytes from various types of stem cells, including the cardiac side population. Mesenchymal cells transfected with OT-Gly-Lys-Arg, or preconditioned with OT, are resistant to apoptosis and express endothelial cell markers. OT increases glucose uptake in cultured cardiomyocytes from newborn and adult rats, in normal, hypoxic and even insulin resistance conditions. In rats with experimentally-induced myocardial infarction, continuous in vivo OT delivery improves the cardiac healing process, as well as cardiac work, reduces inflammation and stimulates angiogenesis. Therefore, in pathological conditions, OT exerts anti-inflammatory and cardioprotective properties, and improves vascular and metabolic functions. Thus, OT has potential for therapeutic use.

Deletion of the SPARC acidic domain or EGF-like module reduces SPARC-induced migration and signaling through p38 MAPK/HSP27 in glioma

We previously demonstrated that secreted protein acidic and rich in cysteine (SPARC) increases heat shock protein 27 (HSP27) expression and phosphorylation and promotes glioma cell migration through the p38 mitogen-activated protein kinase (MAPK)/HSP27 signaling pathway. As different regions of the SPARC protein mediate different SPARC functions, elucidating which SPARC domains regulate HSP27 expression, signaling and migration might provide potential therapeutic strategies to target these functions. To investigate the roles of specific domains, we used an SPARC-green fluorescent protein (GFP) fusion protein and constructs of SPARC-GFP with deletions of either the acidic domain (ΔAcidic) or the epidermal growth factor (EGF)-like module (ΔEGF). GFP, SPARC-GFP and the two deletion mutants were expressed in U87MG glioma cells. Characterization of the derived stable clones by confocal imaging and western blotting suggests proper folding, processing and secretion of the deletion constructs. Uptake of the constructs by naive cells suggests enhanced internalization of ΔAcidic and reduced internalization of ΔEGF. Wound and transwell migration assays and western blot analysis confirm our previous results and indicate that ΔAcidic reduces SPARC-induced migration and p38 MAPK/HSP27 signaling and ΔEGF decreases SPARC-induced migration and dramatically decreases the expression and phosphorylation of HSP27 but is poorly internalized. Loss of the EGF-like module suppresses the enhanced HSP27 protein stability conferred by SPARC. In conclusion, deletions of the acidic domain and EGF-like module have differential effects on cell surface binding and HSP27 protein stability; however, both regions regulate SPARC-induced migration and signaling through HSP27. Our data link the domains of SPARC with different functions and suggest one or both of the constructs as potential therapeutic agents to inhibit SPARC-induced migration.

Red wine consumption is inversely associated with 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine-DNA adduct levels in prostate

In humans, genetic variation and dietary factors may alter the biological effects of exposure to 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP), one of the major heterocyclic amines generated from cooking meats at high temperatures that has carcinogenic potential through the formation of DNA adducts. Previously, we reported grilled red meat consumption associated with PhIP-DNA adduct levels in human prostate. In this study, we expanded our investigation to estimate the associations between beverage consumption and PhIP-DNA adduct levels in prostate for 391 prostate cancer cases. Of the 15 beverages analyzed, red wine consumption had the strongest association with PhIP-DNA adduct levels showing an inverse correlation in both tumor (P = 0.006) and nontumor (P = 0.002) prostate cells. Red wine consumption was significantly lower in African American compared with white cases, but PhIP-DNA adduct levels in prostate did not vary by race. In African Americans compared with whites, however, associations between red wine consumption and PhIP-DNA adduct levels were not as strong as associations with specific (e.g., SULT1A1 and UGT1A10 genotypes) and nonspecific (e.g., African ancestry) genetic variation. In a multivariable model, the covariate for red wine consumption explained a comparable percentage (13%-16%) of the variation in PhIP-DNA adduct levels in prostate across the two racial groups, but the aforementioned genetic factors explained 33% of the PhIP-DNA adduct variation in African American cases, whereas only 19% of the PhIP-DNA adduct variation in whites. We conclude that red wine consumption may counteract biological effects of PhIP exposure in human prostate, but genetic factors may play an even larger role, particularly in African Americans.

Polymorphisms in glutathione S-transferase genes increase risk of prostate cancer biochemical recurrence differentially by ethnicity and disease severity

Objective

Genetic polymorphisms that modify the detoxifying activity of glutathione S-transferases (GSTs) can affect the level of carcinogenic metabolites created by endogenous steroid hormones and exogenous chemical substances. Although the GSTM1 null genotype has been shown to increase prostate cancer mortality in Caucasians, potential associations between GST polymorphisms and prostate cancer biochemical recurrence (BCR) have not been well studied, particularly in African-Americans.

Methods

We examined potential associations between the GSTM1 null, GSTT1 null and GSTP1 Ile105Val polymorphisms and BCR, after prostatectomy, in 168 African-American and 226 Caucasian patients treated at Henry Ford Hospital in Detroit, Michigan using Cox proportional hazards modeling.

Results

We found that African-Americans with the GSTT1 null genotype had increased BCR risk compared to those having GSTT1 present (hazard ratio (HR) = 2.30; 95% CI = 1.01–5.18; p = 0.04); and African-Americans with the GSTT1 null genotype and high grade tumors had an even greater risk (HR = 7.82; 95% CI = 2.49–24.50; p < 0.001). In Caucasians, an increased risk was observed in those patients with high grade tumors and the GSTM1 null genotype (HR = 2.88; 95% CI = 1.16–7.14; p = 0.02). Similar associations were observed for advanced stage and more aggressive (high grade or advanced stage) disease.

Conclusion

Our results suggest GSTs may hold promise as therapeutic targets in more advanced prostate cancers, particularly, in African-Americans.

The effects of P2X receptor agonists on renal sodium and water excretion in anaesthetized rats

AIM

To investigate in vivo effects of P2X receptor activation on sodium and water excretion in urine.

METHODS

The clearance experiments were carried out in anaesthetized rats during intravenous infusion (2 μmol kg(-1) + 20 nmol (kg min)(-1) , v = 40 μL min(-1)) of P2X receptors agonists: α,β-methylene ATP (α,β-meATP) and β,γ-methylene ATP (β,γ-meATP). Cortical blood flow (CBF) was estimated by laser Doppler flux during intrarenal artery infusion of β,γ-meATP (20 nmol (kg min)(-1) , v = 2 μL min(-1)). Influence of α,β-meATP and β,γ-meATP on the activity of Na-K-ATPase was investigated in isolated proximal tubules.

RESULTS

Intravenous infusion of β,γ-meATP resulted in a marked, progressively increasing diuresis and this effect was accompanied by a progressive increase in the sodium excretion rate. The glomerular filtration rate was unaffected. The effects of β,γ-meATP were abolished by P2 receptor antagonist PPADS (70 nmol (kg min)(-1)). CBF increased by 16 ± 2% during renal artery infusion of β,γ-meATP. Furthermore, α,β-meATP and β,γ-meATP increased 1.5-fold lithium clearance (C(Li)). Sodium excretion, expressed as a fraction of the distal delivery (C(Na) C(Li) (-1)), increased 1.5-fold during infusion of α,β-meATP or β,γ-meATP. Both agonists at 10(-6) (M) produced a statistical significant decrement in the ouabain-sensitive ATPase activity about 16-20% and these effects were blocked in the presence of PPADS.

CONCLUSION

Activation of P2X receptors increased renal sodium and water excretion. Mechanistically, P2X agonists increased renal perfusion and inhibited sodium reabsorption via an Na-K-ATPase-dependent mechanism.

Methylation of Retinoic Acid Receptor, Beta (RARB) Gene Increases Risk for Prostate Cancer in African-American Men

DNA methylation is an indicator of the initiation of prostate carcinogenesis and as such has utility as a marker of risk in pathologically negative prostate tissue samples. We conducted a matched case-control study nested in a historical cohort of over 6,000 men with pathologically benign prostate specimens identified between January 1991 and November 2002 with no previous history of prostate cancer. Eligible cases were diagnosed with prostate cancer at least one year after cohort entry. Controls were selected through incidence density sampling and matched to cases on date and age at cohort entry, race, and type of specimen. In 310 matched prostate cancer case-control pairs (65% white; 35% African American), we assayed the DNA of the benign prostate specimen for presence of methylation in a five-gene panel (APC, RARB, CCND2, RASSF1, MGMT) and then estimated the risk of developing prostate cancer associated with methylation at each gene for the whole sample and stratified by race. Overall, methylation of RARB had the strongest association with prostate cancer risk (HR = 1.94; 95% CI = 1.30 – 2.91). In race-stratified analyses, the majority of the increased risk associated with RARB was found in the African-American sample (HR = 3.40; 95% CI = 1.68–6.88). In addition, APC was also associated with increased risk for prostate cancer in the African-American sample (HR = 2.17; 95% CI = 1.09–4.29). In a model that included both genes, only RARB remained statistically significantly associated with prostate cancer (HR = 3.14; 95% CI = 1.54–6.44). In whites, methylation was not associated with prostate cancer for any of the five genes assayed. In summary, positive methylation status at RARB and APC in pathologically benign prostate is associated with significant increased risk for subsequent prostate cancer, but primarily in African-American men. Whether this race-specific risk is due to racial differences in environmental stimuli and/or biology is unclear, but further study of DNA methylation in the earliest stages of prostate carcinogenesis may help explain the disproportionate burden of this disease among African-American men.

Downregulation of oxytocin receptors in right ventricle of rats with monocrotaline-induced pulmonary hypertension

AIM

pulmonary hypertension (PH) in the rat leads to right ventricular (RV) hypertrophy, inflammation and increased natriuretic peptide (NP) levels in plasma and RV. Because the release of nitric oxide (NO) and atrial natriuretic peptide (ANP) is a function of the oxytocin receptor (OTR), we examined the effect of PH on gene and protein expression of OTR, NP (A, atrial; B, brain) and receptors (NPRs), nitric oxide synthases (NOS), interleukin (IL)-1β, IL-6 and tumour necrosis factor-α in the hypertrophied RV in a model of PH.

METHODS

RV hypertrophy was induced in male Sprague-Dawley rats with monocrotaline (MCT; 60 mg kg(-1) ) and was confirmed by the presence of an increased RV weight and RV-to-[left ventricle (LV) and septum] ratio.

RESULTS

in the RV of MCT-treated rats, a approximately 40% reduction in OTR mRNA and protein was observed compared with the RV of control rats. This reduction was associated with increased transcripts of ANP and BNP in both ventricles and a corresponding increase in NP receptor mRNA expression for receptors A, B and C. Protein expression of inducible NOS was increased in the RV, whereas endothelial NOS transcripts were increased only in the LV of MCT-treated rats. In the RV of MCT-treated rats, downregulation of OTR was also associated with increased mRNA expression of IL-1β and IL-6.

CONCLUSION

our results show that downregulation of the OTR in the RV of MCT-treated rats is associated with increased expression of NP and their receptors as well as IL-1β and IL-6. This reduction in OTR in RV myocardium may have an impact on cardiac function in the MCT-induced model of PH.

Abstract B93: Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers may decrease cancer-related mortality in patients with small-cell lung cancer

Introduction: Small-cell lung cancer (SCLC) is the most aggressive type of lung cancer. The overall survival at five years for patients with SCLC is estimated to be five to ten percent. Angiotensin-Converting Enzyme (ACE) inhibitors and Angiotensin Receptor Blockers (ARBs) have been reported to decrease the risk of lung cancer. The aim of this retrospective study was to investigate the association between ACE inhibitors and ARBs and cancerrelated mortality in patients with SCLC.

Methods: In this study, we retrospectively reviewed the charts of 360 patients diagnosed with SCLC in our institution between 1995 and 2004. 199 patients with advanced SCLC, deceased at the time of this report, and for whom the cause of death was known, were identified. Within this group, cancer-related mortality in patients who were on ACE inhibitors and/or ARBs was compared to that of patients not on these medications.

Results: Out of 199 patients, 58 (29%) were on ACE inhibitors and/or ARBs, 141 (71%) were not. In ACE inhibitor and/or ARB users, cancer was the cause of death in 34 patients. In patients not on ACE inhibitors and/or ARBs, 103 died from cancer. Patients on ACE inhibitors and/or ARBs had a 14% decrease in cancer-related mortality compared to patients who were not on these medications (59% versus 73% respectively, P= 0.046).

Conclusion: Our data support the fact that ACE inhibitors and ARBs may be associated with a decrease in cancer-related mortality in patients with SCLC. This could be related to their inhibitory effects on angiogenesis and tumor growth, by blocking angiotensin II and increasing the levels of angiotensin (1–7). However, prospective studies are needed to establish the effect of ACE inhibitors and ARBs on cancer-related mortality in patients with SCLC.

Citation Information: Cancer Prev Res 2010;3(1 Suppl):B93.

An improved manufacturing process for Xyntha/ReFacto AF

SUMMARY

ReFacto Antihemophilic Factor is a second-generation antihaemophilia A product manufactured using a process that includes therapeutic grade human serum albumin (HSA) in the cell culture medium, but is formulated without HSA as a stabilizer. Even though this second-generation antihaemophilia product has a good safety profile, a programme was implemented to eliminate all animal- and human-derived raw materials from the production process, thus producing a third-generation product. To that end, HSA has been removed from the master and working cell banks and from the culture medium. The hybridoma-derived monoclonal antibody formerly used in the purification process has been replaced by a chemically synthesized affinity peptide, and a virus-retaining filtration step has been added to enhance the clearance of large viruses, such as retroviruses. The purification process has been validated for the removal of a panel of model viruses and provides significant clearance of all viruses tested. Host cell- and process-derived impurity removal validations also were conducted, including host cell DNA and protein, in addition to the affinity peptide. Compared with the product manufactured according to the original process, these changes had no detectable effect on the structural integrity, stability or clinical efficacy of this antihaemophilia A product. The product produced by the improved manufacturing process is named Xyntha/ReFacto AF.

Cannabidiol-induced lymphopenia does not involve NKT and NK cells

The major non-psychoactive compound of cannabis plant, cannabidiol, has been reported to be a promising therapeutic agent for many inflammatory, autoimmune and neurodegenerative diseases. In spite of growing interest in therapeutic use of cannabidiol very little is known about its influence on the immune system. Present study aimed to evaluate lymphocyte subsets distribution in peripheral blood after repeated, systemic administration of cannabidiol. Adult male Wistar rats received intraperitoneal injections of vehicle or cannabidiol at dose of 2.5 or 5 mg/kg/day, for 14 consecutive days. Blood samples were collected one hour after the last injection. Three-color immunofluorescent antibody staining procedure (CD3-FITC/CD45RA-PC7/CD161A-APC and CD3-FITC/CD4-PC7/CD8-APC) was used for determination of T, B, NK, NKT, T helper, and T cytotoxic lymphocyte subsets. Total leukocyte number and percentage numbers of leukocyte subpopulations were also assessed. Administration of cannabidiol at dose of 5 mg/kg caused a significant decrease in total leukocyte number and a significant fall in total numbers of T, B, and both T helper and T cytotoxic lymphocyte subsets. This immunosuppressive effect did not affect the total numbers of NK and NKT cells that are responsible for the primary, nonspecific antiviral and antitumor immune response. In contrast, administration of cannabidiol at dose of 2.5 mg/kg increased the total and percentage NKT cells numbers, and the percentage number of NK cells. The results suggest that repeated treatment with cannabidiol inhibits specific immunity by reduction of T, B, T cytotoxic, and T helper cell numbers, and may enhance nonspecific antiviral and antitumor immune response related to NK and NKT cells.

How to develop guidelines for clinical practice

Recent decades have seen an explosion of clinical practice guidelines documents developed to inform clinicians about the best options for managing treatment, with the explicit intent to influence behaviour. As our exposure to guidelines has increased it has become clear that the process of guideline development should follow specific rules in order to avoid disagreement, misunderstanding, misleading recommendations, and confusion. In this article, we review the approach to developing clinical practice guidelines suggested by an international Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) workgroup. This approach suggests several steps for guideline development: 1. determine the purpose, scope, and intended audience; 2. select the panel of guideline authors; 3. specify the main focused clinical questions that the recommendations will address; 4. decide on the relative importance of outcomes; 5. find and summarize the evidence supporting each recommendation; 6. determine the quality of the available evidence; 7. evaluate the balance of desirable and undesirable consequences for a particular course of action; 8. formulate recommendations, including their strenght; and 9. consider a system for subsequent guideline implementation and evaluation. We aim to help the readers of practice guidelines asses those guidelines' quality and validity, as well as to assist the authors of future guidelines in systematically generating clinical recommendations.

The use of insulin and the effect on survival of non-small cell lung cancer patients

e22073

Background: Diabetes mellitus (DM) is one of the common morbidities in United States. Insulin therapy has been frequently used in its treatment. Some studies have postulated that activation of Insulin and Insulin-like growth factor (IGF) pathway may contribute to cancer proliferation, growth and resistance to anticancer therapies. The impact of insulin on diabetic patients with non-small cell lung cancer (NSCLC) has not been reported. Methods: 1,233 patients with NSCLC diagnosed between January 1999 and December 2004 were identified from the Tumor Registry at Henry Ford Health System. Based on inclusion criteria, data from 1,206 patients were extracted from the electronic medical records. Statistical analyses were performed between insulin and non insulin users. Results: Out of 1,206 patients, 193 patients had NSCLC and DM. Data was available from 192 patients. Sixty (31.3%) were on insulin at the time of NSCLC diagnosis and defined as insulin users, while 132 were not on insulin and defined as non- users (68.7%). Demographics, co-morbidities, disease stage at diagnosis, therapeutic interventions, and laboratory values were analyzed for overall and cancer-specific survival. More insulin users (81%) than non-users (64%) presented with advanced disease (stage ≥ 3) at diagnosis (P=0.02). Although no significant difference of Hemoglobin A1c was observed, the median survival from all causes of death was 6.5 months for insulin-users versus 9.9 months for non-users (P=0.08). When survival time was calculated from cancer-specific death, the median survival between insulin and non-insulin users was 7.2 months versus 38.7 months, respectively (P=0.002), with a hazard ratio (HR) for insulin use equals 1.91. Results from our univariable and multivariable analyses will be presented at the ASCO annual meeting in detail. Conclusions: This data indicates that the use of insulin may adversely affect the biology and clinical course of NSCLC with a tendency of advanced disease stage at diagnosis and a shorter cancer-specific survival time. Prospective study of DM with NSCLC or other cancer diagnosis will improve our understanding of this potential adverse effect on cancer biology and provide scientific rational to target IGF-pathway especially in diabetic patients.

No significant financial relationships to disclose.

Purinergic regulation of glomerular microvasculature and tubular function

Purinergic molecules: ATP, ADP and adenosine regulate physiological processes through activation of purinoceptors in the plasma membrane. Experimental evidence supports the view that purinergic molecules affect glomerular and tubular functions. Purinergic molecule-induced changes of tension of mesangial cells and/or podocytes may influence GFR by affecting the glomerular ultrafiltration coefficient. On the other hand, purinoceptors are crucial for electrolyte and fluid homeostasis by modulating activity of sodium-potassium-ATPase, voltage-independent or -dependent ion channels and cAMP-dependent water channels.

Dissociation between the effects of P1, P4-diadenosine tetraphosphate (Ap4A) on renal haemodynamics and tubular function in anaesthetized rats

Previous studies from our laboratory have reported a marked reduction in glomerular filtration rate (GFR) and sodium reabsorption in renal proximal tubule during intravenous infusion of P(1),P(4)-diadenosine tetraphosphate (Ap(4)A) at dose of 1.0 micromol/kg + 10 nmol/kg/min (i.v., injection followed by infusion) in anaesthetized Wistar rats. In the present study, the changes of GFR and urine sodium excretion were investigated in response to systemic infusion of Ap(4)A at different doses. Ap(4)A at dose of 0.1 micromol/kg + 1.0 nmol/kg/min did not change GFR and sodium urinary excretion whereas 2-fold higher dose produced significant (3.4-fold) increase in sodium excretion without changes in GFR. Significant but transient reduction in GFR by approximately 21% was observed during infusion of Ap(4)A at dose of 0.5 micromol/kg + 5.0 nmol/kg/min. Higher doses of Ap(4)A (1.0 micromol/kg + 10 nmol/kg/min and 2.0 micromol/kg + 20 nmol/kg/min) reduction in GFR and marked natriuresis. Our results suggest that tubular sodium transport systems are more sensitive to Ap(4)A than systems involved in GFR regulation.

Damage to the nucleus accumbens shell but not core impairs ventral tegmental area stimulation-induced feeding

Food intake is regulated not only by homeostatic requirements but also by emotional factors (e.g. palatability of food, alleviation of emotional tension etc.). The nucleus accumbens (Acb) is a part of the mesolimbic dopaminergic system which is responsible for a positive emotional aspect of various homeostasis-relevant stimuli. In the present work, we tested the Acb involvement in feeding behaviour using an experimental paradigm specifically designed to assess motivational vs motor aspect of food ingestion. In rats, feeding was evoked by electrical stimulation of the midbrain ventral tegmental area (a somatodendritic region of mesolimbic system) and assessed quantitatively with the use of the latency to feed/stimulation frequency curve-shift paradigm before and after electrolytic lesion of Acb. An impairment of stimulation-induced feeding manifesting as an elevation of the reaction threshold and a rightward, parallel shift of the stimulation frequency/reaction latency curve in the range of frequency which is sensitive to motivational aspects of food occurred after lesions localized mainly in the Acb shell. The lesions situated mainly in the Acb core were ineffective. The results obtained indicate that the Acb shell connected with the limbic system but not the motor-related Acb core affects motivational aspects of feeding behaviour.

The use of statins may prolong survival of non-small cell lung cancer patients: Final update from 1,205 cases

7638

Background: Hypercholesterolemia is one of the most common morbidities in United States. Statins have been proven as effective cholesterol-lowering agents and have been widely used in this country. They have been reported reducing the incidence and risk of various cancer types. However, the impact of using statins on the survival of 407 patients with diagnosed non-small cell lung cancer (NSCLC) was initially reported (Wang, et al. Abstract #7149, ASCO Meeting 2006). Methods: 1,233 patients with diagnosed non-small cell lung cancer were identified from the Tumor Registry at Henry Ford Health System between January 1999 and December 2004. The data from 1,206 patients were extracted from their available electronic medical records. Statistical analyses were performed and stratified for statin users versus non statin users. Results: Data from 1,205 eligible patients were included in this updated report. There were 391 patients with hypercholesterolemia, 250 of them were statin users at the time of their non-small cell lung cancer diagnosis. Average age was 68 (range 46–90) years for statin users and 65.9 (range 29–94) years for non statin users. Overall median survival of 1,205 subjects was 9.85 months. After stratifying for statin use, the median survival of statin users was 13.9 (95% C.I. 9.9 - 17.4) months while the median survival of non statin users was 9.6 (95% C.I. 8.1 - 10.4) months, with a P value of 0.0001. After having several prognostic variables (age, stage, co-morbids, other cancers, performance status, anti-cancer therapies, and serum albumin, etc.) adjusted, statin use still demonstrated protection from death with a hazard ratio of 0.74 (95% C.I. 0.59 - 0.95, P=0.017). Conclusion: The trend of survival benefit from NSCLC among statin users was shown in our previous report and it has maintained with further enhanced statistical significance in this update. Though statin use will unlikely become an independent anti-cancer regimen by itself, the choice of continuation of statin among NSCLC patients may still provide survival benefit to this population. The favorable impact of statin use on NSCLC patients is intriguing; a prospective study of co-morbidity management with statins in patients with non-small cell lung cancer is warranted.

No significant financial relationships to disclose.

Predictors and outcomes associated with gastrointestinal bleeding in patients with acute coronary syndromes

BACKGROUND

Potent antiplatelet and anticoagulant agents along with early revascularization are increasingly used in patients hospitalized with acute coronary syndromes (ACS). An important complication associated with these therapies is gastrointestinal bleeding (GIB); yet, the predictors, optimal management, and outcomes associated with GIB in ACS patients are poorly studied.

METHODS

We investigated the incidence, predictors, pathological findings, and clinical outcomes associated with GIB in patients with ACS hospitalized at a United States tertiary center between 1996 and 2001.

RESULTS

Three percent (80/3,045) of ACS patients developed clinically significant GIB. Predictors of GIB were older age, female gender, non-smoking status, peak troponin I, and prior heart failure, diabetes, or hypertension. Patients with GIB were more critically ill with lower blood pressure and higher heart rates. GIB was associated with an increased need for transfusion, mechanical ventilation, and inotropes/pressors. In-hospital mortality was significantly higher in ACS patients with versus without GIB (36% vs. 5%, P < 0.001). Thirty patients (38%) with GIB underwent endoscopy with no procedural complications of death, arrhythmia, urgent ischemia, or hemodynamic deterioration.

CONCLUSION

In patients with ACS, GIB is associated with older age, female sex, peak troponin I, non-smoking status, diabetes, hypertension, and heart failure. Hospital mortality is increased eightfold when ACS patients experience GIB. More studies are needed to establish the safety of and optimal timing of endoscopy in these patients.

The use of statins may prolong survival of non-small cell lung cancer patients

7149

Background: Hypercholesterolemia is one of the most common morbidities in United States. Statins have been proven as effective cholesterol-lowering agents and have been widely used in this country. They have been reported reducing the incidence and risk of various cancer types. However, the impact of using statins on the survival of patients with diagnosed non-small cell lung cancer is unknown. Methods: Ongoing retrospective study involves a cohort of 1,233 patients with diagnosed non-small cell lung cancer. Patients were identified from the Tumor Registry at Henry Ford Health System between January 1999 and December 2004. To date, the electronic medical records from 407 of the 1,233 cases were reviewed. Statistical analyses were performed and stratified for statin users versus non statin users. Results: Data from 407 patients were included in this analysis. There were 109 patients with hypercholesterolemia, 54 of them were statin users at the time of their non-small cell lung cancer diagnosis. Average age was 70 (range 46–85) years for statin users and 65 (range 29–93) years for non statin users. Median survival of 407 subjects was 9.82 months. After stratifying for statin use, the median survival of statin users was 12.38 months while the median survival of non statin users was 9.75 months, with a p value of 0.012. Conclusion: Though small sample size, this study is the first time ever suggesting a possible survival benefit of statin use in patients with non-small cell lung cancer who have received their standard anti-tumor regimens. Other variables that may contribute to this result will be further clarified and discussed after completing the data collection and analysis of this entire cohort. Based on our preliminary result, a prospective study of co-morbidity management with statins in patients with non-small cell lung cancer is warranted.

No significant financial relationships to disclose.

The use of statins and the effect on survival in patients with small cell lung cancer

17121

Background: Hypercholesterolemia is one of the most common morbidities in United States. Statins have been proven as effective cholesterol-lowering agents and have been widely used in this country. They have been reported reducing the incidence and risk of various cancer types. However, the impact of using statins on the survival of patients with diagnosed small cell lung cancer is unknown. Methods: A retrospective study involved a cohort of 282 patients with diagnosed small cell lung cancer. Patients were identified from the Tumor Registry at Henry Ford Health System between January 1995 and December 2002. Electronic medical records of these patients were reviewed. Statistical analyses were performed and stratified for statin users versus non statin users. Results: Out of 282 patients, there were 73 patients with hypercholesterolemia, 37 of them were statin users at the time of their small cell lung cancer diagnosis. Average age was 65 (range 34–87) years for non statin users and 69 (range 52–85) years for statin users. Median survival of 282 subjects was 7.37 months. After stratifying for statin use, the median survival of statin users was 8.66 months while the median survival of non statin users was 7.17 months (p = 0.29). Conclusion: Though slightly prolonged median survival in statin-users was observed, no survival benefit is demonstrated from this patient population. Factors that may have contributed to this result will be further discussed. With the trend of an increase in median survival among statin users, whenever possible, continuation of statins as co-morbidity management may still benefit patients with small cell lung cancer, during their receiving standard anti-tumor therapies.

No significant financial relationships to disclose.