P834Secondary prevention medications of cardiovascular diseases in China: findings from China PEACE million persons project

Background

Cardiovascular diseases (CVD) is the leading cause of death in China. Secondary prevention medications can improve the prognosis of CVD, yet little is known about the current use, variation and associated factors of these therapies in China.

Purpose

The aim of this study was to describe the current use of secondary prevention medications among patients with established CVD in the community setting in China, assess variations across population subgroups, and identify the individual characteristics associated with these therapies.

Methods

We studied 2.6 million participants aged 35–75 years from all 31 provinces in the China Patient-Centered Evaluative Assessment of Cardiac Events (PEACE) Million Persons Project, a government-funded public health program conducted from 2014 to 2018. Participants self-reported their history of ischemic heart disease (IHD) or ischemic stroke (IS) and medication use in an interview. Among participants with IHD and/or IS, we assessed the reported use of secondary prevention medications (anti-platelet drugs and statins) in the overall population and in 1,530,408 population subgroups, defined by all possible combinations of 16 factors (age, sex, urbanity, geographic region, ethnicity, occupation, annual household income, education, marital status, medical insurance, current smoker, current drinker, history of hypertension, history of diabetes, body mass index and years since diagnosis). Multivariable mixed models with a logit link function and community-specific random intercepts were fitted to assess the associations of demographic, socioeconomic and health behavior factors with the reported use of secondary prevention mediations.

Results

Among 2,613,035 screened participants, 2.9% (74,830) had history of IHD and/or IS (1.2% for IHD, 2.4% for IS). Overall, the reported use rate either anti-platelet drugs or statins was 21.9% (18.3% anti-platelet drugs, 11.0% statins, and 7.4% both). Among the 1,530,408 population subgroups, the use of secondary prevention medications varied substantially (3.4% to 52.0%). Multivariable analyses found that that younger people, women, those living in rural areas, current smokers, current drinkers, people without hypertension or diabetes, and those with established CVD for more than 2 years were less likely to take anti-platelet drugs or statins (Figure).

Forest plot of multivariable mixed model

Conclusions

The current use of secondary prevention drugs is suboptimal and varies substantially across population subgroups in China. Our study identifies target populations for interventions to improve secondary prevention of CVD.

Acknowledgement/Funding

This study was supported by the Ministry of Finance of China and National Health Commission of China

Time distributions and prognosis factors of breast cancer recurrence in different sites after operation

Abstract #2080

Objective Our study aims to analyze the breast caner patients with different sites of recurrence, and to have knowledge of the regular patterns and influence factors of metastastic breast cancer.
 Methods We performed a retrospective study of 210 female breast cancer patients who were continuously followed up in our hospital from January 2005 to May 2007 and had complete data of metastasis. The clinical and biological characteristics were compared between the patients with organ metastases (lung, liver, brain) and non-viscera metastases (lymph node, bone).
 Results Cox regression analysis-hazard function showed that patients with elder age (RR=0.927 95%CI 0.877∼0.981, P=0.008) and HER-2 negative(RR=0.253 95%CI 0.076∼0.836, P=0.024)tended to develop non-viscera metastases, while patients with larger tumors (RR=3.832 95%CI 1.073∼13.687, P=0.039) tended to develop organ metastasesp.
 
 When stratified by the prognostic factors, the annual risk hazard curve of the patients with high risk of recurrence had double peaks at the second year and the ninth years after mastectomy respectively, and it was significantly higher than those of the patients with middle and low risk.[figure1]Annual risk hazard curves of both local relapse and metastasis also showed a double-peaked pattern. The curves for lymph node, bone, lung and liver metastasis showed a similar pattern, but all the peaks of curve emerged later than that of the local relapse.
 
 Conclusion Patients with different clinical and biological characteristics may develop recurrence in different sites. There are certain regular patterns of time distribution for different metastasis sites after mastectomy. The local recurrence may be the foreboding for the metastasis and we should pay attention to the local relapse signs especially in the patients with high risk.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 2080.

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Abstract P1-02-07: Adherence to breast cancer screening recommendations among underserved participants in an urban safety net mammography clinic

Background: The Georgetown Lombardi Comprehensive Cancer Center's Capital Breast Care Center (CBCC) is a safety net mammography screening center that uses a community-based patient navigation program to provide underserved minority women guidelines-concordant mammography screening. Given that screening navigation is designed to eliminate some established barriers such as, access, transportation, and cost, we retrospectively examined patient adherence rates to regular (annual/biennial) mammography screening. We also investigated whether patient demographics are associated with adherence to breast cancer screening.

Methods: Data were derived from medical records of patients that received a baseline mammogram at CBCC in 2011 (n = 1,637) and were followed up for 4 years. Within the study time period of 2011-2015, patients were of age 40-74 and had not received a prior breast cancer diagnosis. 10 definitive cases of breast cancer were newly diagnosed in this population during the follow-up period and were excluded from the analysis. Adherence was then calculated based on the American College of Radiology (annual screening starting at 40) and the United States Preventive Services Task Force guidelines (biennial screening starting at 50).

Results: In 2011, the mean age of women screened at CBCC was 51.25 years with 45% being 40-50 years of age. CBCC has a predominantly minority population with 48% of the women identifying as Black/African American (AA) and 41% identifying as Hispanic in 2011. Over the 4 year follow up period, 41.11% of the patients screened in 2011 did not return for another screen. The adherence rate for annual screening in the 40-74 age group was 3.3% (3.0% in Black/AA; 4.2% in Hispanic) over the 4-year follow-up. The adherence rate for biennial screening among the 50-74-year-old age group was 21% overall (20% among Black/AA; 26% among Hispanics). Approximately 40% of the participants with baseline screenings in 2011 received at least one additional screening over the 4 year follow up but their mammography schedules were not guidelines concordant and they were labeled as “partially adherent” for this analysis.

Conclusion: While the number of partially adherent patients was consistent with previous population-based adherence studies, the proportion of non-adherent patients was higher compared with other population-based studies in primarily Non-Hispanic White populations. Our analysis highlights the importance of focusing on adherence to guidelines and not just mammography initiation in underserved minority populations through educational interventions targeted to patients and providers.

Citation Format: McClenathan MM, Lu J, Oppong BA, Adams-Campbell LL, Dash C. Adherence to breast cancer screening recommendations among underserved participants in an urban safety net mammography clinic [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-02-07.

[Survival analysis after kidney transplantation in 1,180 cadaveric graftings]

OBJECTIVE

To analyze the outcome of twenty-two years of cadaveric kidney transplantation and the predict factors impacting on graft survival.

METHODS

The data of 1,180 cadaveric kidney graftings in 1,039 patients between October of 1977 and June of 1999 were summarized by calculation of patient and graft survival rates using Kaplan-Meier product limit estimates. 13 factors that may influence on graft survival were analyzed by the log-rank and Cox model.

RESULTS

The total of 1-, 5-, 10-, 15-, and 20-year patient survival rates were 93.02%, 80.25%, 67.86%, 65.34% and 65.34%, and the corresponding graft survival rates 88.6%, 68.3%, 43.8%, 43.8%, and 32.8%, respectively. Graft half-life was (13.98 +/- 0.96) years. The longest survivor was 22 years after cadaveric kidney transplantation. The quality of life after grafting in 835 alive patients was improved apparently; 95% of them had a normal graft function and 85% returned to work. The result of multivariable analysis using Cox model showed that 8 factors of patient's age, grafting time, pretransplant blood transfusion, cold ischemia time, delayed graft function, time of normal graft function, immunosuppressive regimen, and acute rejection were very important to affect the graft survival.

CONCLUSION

Cadaveric kidney transplantation is a successful and effective method to rescue the patients with end-stage renal disease.

[Pathological features of liver biopsy from 66 cases of long term blood donors with chronic hepatitis C]

OBJECTIVE

To study the pathological features of liver biopsy from long-term blood donors with chronic hepatitis C.

METHODS

From 250 long-term blood donors with positive serum anti-HCV antibody for more than five years, 66 donors with abnormal ALT level were selected and enrolled in this study. Liver biopsy was performed on these cases and the specimens stained with HE, and reticulin. Modified Schemer's classification for grading and staging was used during pathological observation. Twenty biopsies with serum HCV-RNA levels higher than 5.0 Meq/ml (bDNA) were studied immunohistochemically (SABC) for NS5.

RESULTS

All cases displayed mild pathological changes. Grade 1 (G(1)) inflammation was 4.8% (3/63), G(2) 63.5% (40/63), G(3) 28.6%(18/63), G(4) two case. Stage 1 (S(1)) fibrosis was 60.3% (38/63), S(2) 34.9% (22/63), S(3) 3.2% (2/63), S(4) only one case. The main lesion was periportal inflammation, such as bile duct damage (100.0%), dense lymphoid aggregates (82.5%) and piecemeal necrosis (89.5%). Intralobular injury of hepatocytes was rather mild. Bridging necrosis and steatosis were not common and observed in only 12.3% (8/66) and 9.2% (6/66) respectively. As for fibrosis, proliferation and deposition of collagen were mainly distributed in the portal and perisinusoidal areas. Among 20 specimens with serum HCV-RNA levels higher than 5.0 Meq/ml (bDNA), all bile duct epithelial cells were positive for HCV-NS5 antigen, while hepatocytes in 4 cases were negative.

CONCLUSION

(1) The pathological changes in this series show overall similarity with that of patients with posttransfusion hepatitis C. The main damages are portal and periportal inflammation, such as lymphoid aggregates, bile duct damage, piecemeal necrosis, and extensive periportal and perisinusoidal fibrosis. Intralobular damage was mild with occasional steatosis, which may be related to malnutrition, low level of serum iron due to long term donation. (2) Epithelial cells of the bile duct may be of another site for virus replication, thus it is related with bile duct damage and periportal inflammation.

Regulative effect of P38MAPK on release of TNFalpha and NO from alveolar macrophages under endotoxin stimulation

OBJECTIVE

To evaluate activation of P38 mitogen-activated protein kinase (P38MAPK) in alveolar macrophage (AM), release of TNFalpha and NO from cells, and their relationship following lipopolysaccharide (LPS) stimulation.

METHODS

AM was isolated from branch alveolar lavage fluid (BALF). The activation of P38MAPK was assayed by Western blot. SB203580, a specific inhibitor of P38MAPK, was used with gradient concentration to evaluate the regulative effect of P38MAPK on the release of TNFalpha and NO from AM.

RESULTS

P38MAPK was activated by LPS (100 ng/ml) with peak activation at 30 minutes. The activation of P38MAPK was inhibited by SB203580. The secretion of TNFalpha and NO stimulated with LPS increased (P<0.01) and was inhibited by SB203580 significantly.

CONCLUSIONS

The results indicate that P38MAPK is involved in the secreting process of TNFalpha and NO following LPS stimulation. P38MAPK may be an important site for controlling the secretion of both inflammatory mediators during lung inflammatory disorders.

Intratumoral injection of boiling carboplatin (BCBP) solution for treatment of liver cancer in the animal model

BACKGROUND/AIMS

To develop a new modality of local hyperthermal chemotherapy for liver cancer.

METHODOLOGY

Carboplatin solutions of various concentrations were heated at 60 degrees C, 80 degrees C and 100 degrees C, and carboplatin content, pH value and ultraviolet absorption spectrum were assayed before and after heating. By establishing BALB/c murine model of subcutaneous transplant liver cancer, intratumoral injection of boiling carboplatin solution (group A), 45 degrees C carboplatin solution (group B), room-temperature carboplatin solution (group C), boiling distilled-water (group D) and room-temperature distilled-water (control group) was carried out, and tumor growth curve, tumor regression rate and pathohistological features following treatment were evaluated.

RESULTS

Carboplatin content remained stable, ultraviolet absorption spectrum presented no remarkable changes and pH value showed a slight decline after being heated for up to 20 min. Following treatment, all 16 tumors in group A were completely regressed up to day 21. In groups B, C and control group, no tumors became fully regressed and a size of 1.98 +/- 1.11 cm2, 1.50 +/- 0.58 cm2 and 4.83 +/- 0.37 cm2 was presented on day 21, respectively. In group D, though all tumors grossly disappeared during the early post-treatment days, 12 out of 16 recurred on day 21. The tumor regression rate in group A was significantly lower as compared with that of groups B, C, D and control group (all P < 0.01). Histological examination revealed massive necrosis with some degenerated tumor cells at the tumor margin in groups A and D, and only focal necrosis with more viable tumor cells at the center and margin in groups B and C on post-treatment day 1 and 3. Twenty-one days after injection, all tumors in group A presented complete necrosis and were partly replaced by fibrotic tissue. Except for 4 regressed tumors in group D which had the same histological features as those in group A, all other tumors in groups B, C, D and control group presented the same histological features as those untreated.

CONCLUSIONS

Carboplatin solution remained stable at boiling status. Intratumoral injection of boiling carboplatin solution could completely devitalize liver cancer tissue via synergistic effects of direct tumoricidal role of heat and the heat-enhanced tumoricidal role of carboplatin.

Oxygen free radical injury and its relation to bacterial and endotoxin translocation after delayed fluid resuscitation: clinical and experimental study

OBJECTIVE

To examine whether there is generation of oxygen free radicals (OFR) and lipid peroxidation of cell membrane after volume replacement for burn shock, and to study the relationship between OFR injury and enterogenous endotoxemia.

METHODS

Forty-seven burn patients were involved in this study. Among them, 18 had delayed fluid resuscitation (DR) and the others had early fluid resuscitation (ER) within 6 hours postburn. Sixty-six gnotobiotic rats were used in a collaborating experiment as burn models. They were divided into 4 groups: sham injury (n = 6), early resuscitation (n = 24), late resuscitation (n = 24) and vitamins E and C treatment group (n = 12). All the rats, except those in the sham injury group, were inflicted with 40% total body surface area (TBSA) third-degree burns. OFR was determined in the blood of patients with electron spin resonance (ESR). S/W ratio and tau c values of patients' erythrocytes were measured with ESR spectrometer. Blood superoxide dismutase (SOD) and glutathione peroxidase (GSHPx) activities, malondialdehyde contents and plasma endotoxin levels were assayed. Rats were sacrificed at the 12th, 24th, 48th and 72nd hour after injury. Plasma endotoxin levels, mucosal SOD, GSHPx and malondialdehyde (MDA), as well as diamine oxidase activity of ileum were determined. Cultures of mesenteric lymph nodes (MLN), liver, spleen, heart, lung, kidney and blood were done.

RESULTS

A significant increase in blood OFR contents and plasma MDA, and a significant decline in blood SOD and GSHPx were found after resuscitation in DR group as compared with those in ER group. Both strong to weak spectra component (S/W) ratio and tau c value were higher in DR group in contrast with those in ER group. Higher elevation in plasma endotoxin level in DR group was seen. In DR group, plasma MDA content was correlated with S/W ratio, tau c value and plasma endotoxin level. In rats, the level of mucosal MDA, plasma endotoxin and incidence of bacterial translocation (BT) were significantly higher. Mucosal SOD, GSHPx and diamine oxidase (DAO) activity were significantly lower in DR group as compared with those in ER group. In DR group, mucosal MDA content was negatively correlated with mucosal DAO activity, while the latter was negatively correlated with BT. After treatment with vitamins E and C, mucosal MDA content decreased, plasma endotoxin and BT significantly declined and mucosal DAO heightened.

CONCLUSIONS

Tissue reperfusion might induce the production of OFR, resulting in lipid peroxidation injury, especially to intestinal mucosa, and resulting in disruption of mucosal barrier function followed by endotoxemia and BT.

[A pathological study of goat multiple organ failure model]

We succeeded in replication a standardized goat model of multiple organ failure (MOF). In the experimentation, the animals were monitored and supported with facilities pertaining to a human intensive care unit, with constant infusion of LPS into portal vein following trauma and hemorrhagic shock. The main organs of MOF goats were observated by the light microscopy and electronmicroscopy, including the lungs, hearts, livers, kidneys, intestines and spleens. The results showed that there were some areas of spotty and mass necrosis in the organ parenchyma with inflammatory cell infiltration. Our studies suggested that once the clinical multiple organ failure, severe pathological changs occur in organs.

Cervical venous structure in the inter-transverse and intra-transverse foraminal region: an anatomic study

Vertebral venous bleeding is frequently encountered during anterolateral cervical decompression. The present study was undertaken to identify the pattern and location of the vertebral vein in relationship to the vertebral artery in the inter-transverse and intra-transverse foraminal regions. Twenty-one cadavers were dissected to determine the anatomic features of the vertebral vein in the inter-transverse and intra-transverse foramina. The vertebral veins in the inter-foraminal and intraforaminal regions from C-3 to C-6 can be classified into three types: single or double veins, venous plexus, and absence of the vein. Of the 21 specimens, vertebral veins were found bilaterally in five specimens (24%) and unilaterally in eight specimens (38%). The veins were situated either anterolateral or anteromedial to the vertebral artery. The venous structures showed in venous plexus in two specimens (9.5%). In six specimens (29%), there were no obvious venous structures related to the vertebral artery in its intra-transverse and inter-transverse foraminal course. The veins are contained in a fibrous and osseous tunnel as they descend through the transverse foramina. Subperiosteal dissection of fibrous tissue from the lateral aspect of the uncinate process after removal of the anterior wall of the transverse foramen may minimize hemorrhages from the vertebral vein in the inter-transverse and intra-transverse foraminal region during resection of the uncovertebraljoint or neural foraminotomy with retraction of the vertebral artery laterally.

Location of the first and second sacral nerve roots in relation to pedicle screw placement

Dissection and measurements of the first 2 sacral nerve roots with regard to the commonly used entrance points for S1 and S2 pedicle screw placement were performed to determine the location of the first 2 sacral nerve roots in relation to the pedicle screw entrance points in the upper 2 sacral vertebrae. The sacral nerve roots, dural sac, and pedicles were exposed after laminectomy. The mean distance from the reference point to the adjacent nerve roots superiorly and inferiorly at the S2 pedicle level was smaller than those at the S1 pedicle level. The medial angle of the sacral nerve roots progressively decreased from L5 to S3. The nerve root passing through the next foramen formed an immediate medial relation to the sacral pedicle rather than the dural sac. Pedicle screw placement in the first 2 sacral vertebral pedicles has been recommended for lumbosacral fusion and internal fixation of sacral fractures. No anatomic study is available regarding the location of the sacral nerve roots relative to the entrance points of sacral pedicle screw placement. Violation of the sacral canal and foramina by a sacral pedicle screw may injure the sacral nerve roots, especially at the level of the S2 pedicle.

[The classes, structures, functions and signaling transduction of cytokine receptors]

There are many kinds of cytokine receptors that belong to different receptor families. Most cytokine receptors function as: (1) receptor tyrosine kinase and tyrosine-kinase-associated receptor; (2) receptor serine/threonine kinase; (3) G-protein linked receptor. Following binding with cytokines and activation, the receptors trigger different cascade of intracellular protein phosphorylation to transduction signals, thereby altering the cell's pattern of gene expression and leading to biological effects.

[Studies on tannin and hydrolysate in three species of Chinese Caesalpinia plants]

OBJECTIVE

To get Chinese Caesalpinia plants that can replace the imported Tara to produce tannin and gallic acid.

METHOD

Extract tannin with water, condense and hydrolyze the extracts with alkali, the hydrolysates were identified. Furthermore, an enlarged scale experiment was conducted.

RESULT

Tannin contents of the plants were 32.2%, 46.6% and 58.5% respectively, the converted ratios of raw material to hydrolysate were 154:1, 11.8:1, 3.09-2.79:1 respectively.

CONCLUSION

We got the Tara-replacing plants in Chinese Caesalpinia plants for the first time.

[The protective effects of total flavonoids from Lycium Barbarum L. on lipid peroxidation of liver mitochondria and red blood cell in rats]

The protective effects of total flavonoids from Lycium Barbarum L. (TFL) on lipid peroxidation in mitochondria and red blood cells (RBC) induced by oxygen radicals produced by Fe2+ cysteine system were investigated. The mitochondria lipid peroxidation (measured as malondialdehyde, MDA) was significantly inhibited by TFL with a dose-response relation between the concentrations of 0.025 and 2.0 mg/ml, and the fluidity of mitochondria membrane was also protected effectively. It was observed by scan electron microscope, that the shape of RBC in the Fe2+ system was damaged significantly. The shape of RBC was remained with the addition of TFL.