Expert Recommendations on the Diagnosis of Eosinophilic Esophagitis in the United Arab Emirates

Eosinophilic esophagitis (EoE) is a chronic, progressive, type 2 inflammatory esophageal disease presenting as dysphagia to solid food and non-obstructive food impaction. Knowledge gaps exist in its diagnosis and management. These expert recommendations focused on the diagnosis of EoE in the United Arab Emirates. An electronic search of PubMed and Embase databases was used to gather evidence from systematic reviews, randomized controlled trials, consensus papers, and expert opinions from the last five years on the diagnosis of EoE. The evidence was graded using the Oxford system. Literature search findings were shared with the expert panel. A 5-point scale (strongly agree, agree, neither agree nor disagree, disagree, and strongly disagree) was used, and a concordance rate of >75% among experts indicated agreement. Using a modified Delphi technique, 18 qualified experts provided 17 recommendations. Eleven statements achieved high agreement, four got moderate agreement, and two got low agreement. Challenges exist in diagnosing EoE, particularly in children. Esophageal biopsies were crucial in diagnosis, irrespective of visible mucosal changes. Further research on diagnostic tools like endoscopic mucosal impedance and biomarkers is needed. Diagnosis relies on esophageal biopsies and symptom-histology correlation; however, tools like EoE assessment questionnaires and endoscopic mucosal impedance could enhance the accuracy and efficiency of EoE diagnosis. The diagnosis of EoE is challenging since the symptoms seldom correlate with the histological findings. Currently, diagnosis is based on patient symptoms and endoscopic and histological findings. Further research into mucosal impedance tests and the role of biomarkers is needed to facilitate diagnosis.

Dominant A1 Direction as an Additional Factor for Deciding Surgical Approach for A1 Bifurcation Aneurysms

BACKGROUND AND OBJECTIVE

Clipping of aneurysms located in the anterior communicating artery (AcomA) is considered a critical surgical procedure for neurosurgeons worldwide because of the complexity of the surgical area. The present study was conducted to discuss the importance of the geometric curvatures and the direction of the dominant A1 artery and their impact on aneurysmal growth direction and choice of side selection of the pterional surgical approach side.

METHODS

The present study enrolled 183 patients with ruptured AcomA-located aneurysms. The aneurysms were all treated surgically through a pterional approach. Because of multiple dominant A1 directions, we divided the artery into 2 segments, and based on the second segment direction, we categorized the patients into ascending A1, descending A1, and horizontal A1 groups. The ascending group includes the superiorly projecting aneurysms, whereas the horizontal and descending groups include the anteriorly and inferiorly projecting aneurysms, respectively. A contralateral pterional approach to the dominant A1 was chosen for aneurysms with an ascending artery. However, the ipsilateral pterional approach was conducted in the horizontal and descending A1 dominant groups.

RESULTS

The aneurysmal growth projection axis always follows the direction of the second dominant A1 segment. Full neck control with satisfactory inspection of perforators was achieved through the contralateral approach in most cases of an ascending A1, especially if ipsilateral A2 was posterior to the neck. The A1 segment can be satisfactorily seen from the contralateral exposure before the aneurysmal neck is exposed in ascending A1 geometries.

CONCLUSIONS

A1 direction is an important additional factor that is to be considered for side selection when deciding pterional exposure of A1 bifurcation aneurysms. Accessing the contralateral dominant ascending A1 has better visualization of the neck than entering from an ipsilateral approach, especially if the ipsilateral A2 was posterior to the neck.

Geometrical Characteristics of Grade III Arteriovenous Malformations That Contribute to Better Outcomes in Endovascular Treatment

BACKGROUND

Grade III brain arteriovenous malformation (AVM) is a distinct subgroup of AVMs that encompasses multiple subtypes according to the Spetzler-Martin classification.

METHODS

This retrospective study included 61 patients with grade III AVM who underwent embolization between 2010 and 2022. The study analyzed the angioarchitecture of the AVM nidus and evaluated the outcomes of the embolization procedures.

RESULTS

There were 29 patients (47.5%) with subtype S1E1V1, 20 patients (32.8%) with subtype S2E1V0, and 12 patients (19.7%) with subtype S2E0V1. The rate of complete occlusion in all patients was 47.5% (29 patients). The rate of complete occlusion was higher in cases with a compact nidus (P < 0.001). Several parameters were associated with occlusion of the AVM nidus, including ≤3 arterial feeders (P = 0.017) and presentation with hemorrhage (P = 0.007), with the majority of patients with a compact nidus presenting with hemorrhage. Other factors associated with compact geometry were the presence of a single deep vein, ≤3 arterial feeders, ≤2 superficial draining veins, and an AVM nidus size ≤3 cm.

CONCLUSIONS

The compact nature of grade III AVM is a crucial predictor for the success of embolization. Several characteristics associated with a compact nidus, such as presentation with hemorrhage and a lower number of arterial feeders, have a significantly higher closure rate. Other factors, such as a single deep draining vein, reduced superficial venous drainage, and small size, show a strong association with complete obliteration.

Angiographic predictors of spontaneous obliteration of transarterial partially embolized brain arteriovenous malformations

BACKGROUND

Spontaneous obliteration of cerebral arteriovenous malformations is uncommon but could occur after partial embolization.

METHODS

A retrospective study of 140 patients that underwent embolization for cerebral AVMs from 2005 to August 2019 using liquid embolic agents. The angiographic outcome of patients was classified as regard complete embolization, partial embolization, and complete obliteration after partial embolization. The parameters studied included size, location, number of arterial feeders, number of draining veins, rupture status, embolic agent, and patient factors as well.

RESULTS

The study patients included 74 (53%) females and 66 (47%) males. Their age ranged from 7 to 43 years old. One hundred and eight patients (77%) presented with hemorrhage. The AVM grades were grade II in 57 (40.7%) patients and grade III in 56 (39.3%) patients. Sixty-one (43.57%) patients were treated by n-Butyl Cyanoacrylate and 71 (50.71%) patients were treated with Onyx, and both materials were used together in 8 cases. Follow-up angiography was done from 6 to 36 months after embolization. The rate of complete occlusion in all patients was 61.43% (86 patients). There were three groups of patients, the first group had complete occlusion of the nidus at the time of embolization and included 68 (48.57%) patients. The second group had partial embolization with partial occlusion of the nidus 54 patients (38.57%). The 3rd group included 18 patients (12.85%) with complete nidal occlusion on follow up after partial embolization. The delay in the venous drainage of the AVM to the late arterial phase or early venous phase with flow stasis was a significant predictor of future obliteration on follow up after partial embolization. Other significant parameters that were associated with the progressive disappearance of the AVM nidus on follow up after partial embolization are presentation with hemorrhage, AVMs size less than 3 cm, the presence of single draining or double draining veins, superficial venous drainage, and one or 2 arterial feeders.

CONCLUSION

Spontaneous closure of intracranial arteriovenous malformations after partial embolization may be encountered in cases of stasis of flow during embolization procedure with a delay of the venous drainage. A long-term follow-up of more cases over many years is required to confirm the validity of this conclusion.

Oridonin supplementation attenuates atherosclerosis via NLRP-3 inflammasome pathway suppression

Atherosclerosis, a long-term inflammatory and immune condition affecting medium- and large-sized arteries, results in the thickening of artery walls and the accumulation of inflammatory cells and fatty streaks that establish fibrous capsules with macrophages at the site of injury. Atherosclerosis has a major impact on the pathogenesis of cardiovascular diseases. Oridonin has been shown to exclusively inhibit the NLRP3 inflammasome without affecting the activation of AIM-2 or NLRC-4 inflammasomes. The current study aimed to evaluate how adding Oridonin to a diet impacts the onset of atherosclerosis. Twenty-one male rabbits weighing 1.5 to 2.0 kg were included in the study. The rabbits were kept in controlled environmental conditions and divided into three groups: a normal control group fed a conventional chow diet, an atherogenic control group fed a high-cholesterol diet (2% cholesterol-rich), and an Oridonin-treated group (Ori) fed an atherogenic diet supplemented with Oridonin (20 mg/kg) administered orally once daily. Compared to animals on a normal diet, an atherogenic diet was associated with a statistically significant (p=0.001) increase in the mean expression of the NLRP3 inflammasome mRNA. The Oridonin-treated group showed a statistically significant (p=0.001) decline in the mean expression of NLRP3 inflammasome mRNA compared to the atherogenic group. Furthermore, the initial atherosclerotic lesion in the group treated with Oridonin was statistically (p=0.001) less severe compared to the atherogenic group. Finally, Ori treated group had significantly (p≤0.001) lower IL-1B immunostaining intensity than the atherogenic group (mean rank 14.5,25 respectively). The study concluded that Oridonin supplementation resulted in less severe initial atherosclerotic lesions, likely due to the suppression of NLRP3 inflammasome and the anti-inflammatory effect through the downregulation of IL1B expression.

Angiopoietin-like 4 induces head and neck squamous cell carcinoma cell migration through the NRP1/ABL1/PXN pathway

OBJECTIVES

The molecular mechanisms whereby angiopoietin-like 4 (ANGPTL4), a pluripotent protein implicated in cancer development, contributes to head and neck squamous cell carcinoma (HNSCC) growth and dissemination are unclear.

MATERIALS AND METHODS

We investigated ANGPTL4 expression in human normal oral keratinocytes (NOKs), dysplastic oral keratinocytes (DOKs), oral leukoplakia cells (LEUK1), and HNSCC cell lines, as well as in tissue biopsies from patients with oral dysplasia, and primary and metastatic HNSCC. We further examined the contribution of ANGPTL4 cancer progression in an HNSCC orthotopic floor-of mouth tumor model and the signaling pathways linking ANGPTL4 to cancer cell migration.

RESULTS

ANGPTL4 expression was upregulated in premalignant DOKs and HNSCC cell lines compared to NOKs and was increased in tissue biopsies from patients with oral dysplasia, as well as in primary and metastatic HNSCC. We also observed that downregulation of ANGPTL4 expression inhibited primary and metastatic cancer growth in an HNSCC orthotopic tumor model. Interestingly, ANGPTL4 binding to the neuropilin1 (NRP1) receptor led to phosphorylation of the focal adhesion protein, paxillin (PXN), and tumor cell migration; this was dependent on the tyrosine kinase ABL1. Treatment with the ABL1 inhibitor, dasatinib and small interfering RNA silencing of NRP1 or ABL1 expression blocked PXN phosphorylation and tumor cell migration.

CONCLUSION

Our findings suggest an early, sustained, and angiogenesis-independent autocrine role for ANGPTL4 in HNSCC progression and expose ANGPTL4/NRP1/ABL1/PXN as an early molecular marker and vulnerable target for the prevention of HNSCC growth and metastasis.

Oridonin supplementation in rabbits may help to improve the outcome of induced atherosclerosis via autophagy induction

BACKGROUND AND AIM

Inflammation plays a crucial role in the development of atherosclerotic plague. Oridonin is the major active ingredient of the traditional Chinese medicinal herb Rabdosia rubescens. It is a natural terpenoids that is known as a strong anti-inflammatory supplement by acting as a potent inhibitor of the TXNIP/NLRP3 pathway. Hence, it can reduce the severity of inflammation and improve the outcome of atherosclerotic changes. This study aims to evaluate the anti-inflammatory effects of oridonin in the progression of atherosclerotic plague in rabbits.

METHODS

Sixty-three male rabbits were included. The rabbits were randomly assigned to one of the three study groups (21 rabbits in each group), normal control diet (NC) fed normal diet for 8 weeks, atherogenic control (AC) fed atherogenic diet (2% cholesterol-enriched diet) for 8 weeks, and oridonin treated group (OT) fed atherogenic diet (2% cholesterol-enriched diet) with oridonin (purity 94%, Sigma-Aldrich, USA) at 20 mg/kg orally daily for 8 weeks. After the end of the study, blood and tissue samples were collected for analysis of various markers of inflammation and atherosclerotic plaque progression.

RESULTS

Serum lipids showed a statistically significant improvement in terms of reduction in total cholesterol and low-density lipoprotein (LDL) in the OT group compared to the AC group. This was associated with a significant reduction in serum F2-isoprostane (marker of inflammation) and LC3B (marker of tissue autophagy) between the OT group compared to the AC group. There was also a significant reduction in NLRP3 inflammasome RNA expression in OT group, P<0.001.

CONCLUSIONS

In animal model, with atherogenic diet, oridonin supplementation can significantly improve the outcome of atherosclerosis by its strong anti-inflammatory action.

Role of endovascular super selective intra-arterial injection of CA channel blocker agent (nimodipine) in management of cerebral vasospasm following aneurysmal SAH: a single institution experience

Background

Vasospasm is a grave complication of aneurysmal subarachnoid hemorrhage (SAH) with a significant rate of morbidity and mortality. Endovascular intra-arterial injection of Ca channel blocker agent (Nimodipine) may offer a promising solution in refractory vasospasm.

Results

During the period between April 2017 and May 2019, 120 patients who presented with SAH due to a ruptured intracranial aneurysm were admitted to the neurosurgery department at Alexandria University Hospitals. Among them, 30 patients developed refractory vasospasm and were subjected to endovascular super selective intraarterial injection of nimodipine. The angiographic improvement was excellent in three (10%), good in 14 (46%) and poor in the remaining 13 procedures (43%). Clinical improvement was achieved in 15 cases while 15 cases showed no improvement on Modified Rankin Scale. No cases deteriorated following the injection.

Conclusions

Endovascular chemical angioplasty using a ca channel blocker agent (Nimodipine) is a safe and efficient method for the treatment of refractory post aneurysmal SAH vasospasm. The quest is still needed for developing a better efficient agent to overcome the vasospasm dilemma.

Abstract P3-07-26: Anti-cancer activity of naturally formulated Trigonella foenum graecum (Fenugreek) PLGA hyaluronic acid-coated nanoparticles for treatment of breast cancer cell lines

There are several growing evidences of anticancer complementary and alternative medicines worldwide. Trigonella foenum graecum (Fenugreek) is traditionally applied to treat several disorders such as diabetes, inflammation, and gastrointestinal ailments. Previously, we reported that Fenugreek has anticancer properties against liver cancer due to its active beneficial chemical constituents. Herein, Fenugreek-loaded poly (l-lactic-co-glycolic acid) (PLGA) hyaluronic acid (HA)-coated nanoparticles have been formulated to improve and enhance the anticancer potential of Fenugreek against human breast cancer cell lines. The cytotoxic effects, physicochemical characterization in vitro and pharmacodynamic study of optimized formulation of the FCE-loaded (PLGA)-(HA)-coated nanoparticles in vivo were investigated in (ER-positive) and (triple-negative), breast cancer cell lines, ZR-75-1 and MDA-MB-231, respectively. The particle size, PDI, zeta potential, entrapment efficiency, and loading capacity of FCE-loaded nanoparticles were 188.5 ± 3.1 d.nm, 0.198 ± 0.114, −.118 mV, 38.41 ± 1.4%, and 6.37 ± 1.08%, respectively. The in vitro cytotoxicity study of FCE-loaded NPs by Wst-1 proliferation assay on both tested breast cancer cell lines showed an anti-cancer activity after 48 h of treatment in a dose-dependent manner. Furthermore, the anticancer effect of FCE-loaded nanoparticles was examined by the morphological cell changes, histone release, caspase-3 activity, and modulation of the oncogenic signal pathways of m-tor, β-catenin, cyclin D-1 and STAT3 that are constitutively active in wide variety of breast cancer cell lines which in turn could be important as therapeutic targets in breast cancer. 66 μg/mL FCE-loaded PLGA nanoparticles induced 67.3% apoptosis in both tested cell lines after 48 h that was associated with increased expression of caspase 3, Bax, Bak, p53, and cell cycle arrest at G0/G1 in a time-and dose-dependent manner compared to unloaded-nanoparticles or untreated cells. Moreover, there were significant inhibition in m-tor, β-catenin, cycline-D1, and STAT3 expression levels in both tested cell lines compared to un-loaded-nanoparticles or untreated cells. All in all, our results showed that the formulated FCE-loaded (PLGA)-(HA)-coated nanoparticles induced apoptosis in both ER-positive and triple-negative breast cancer cell lines respectively by increase the expression of pro-apoptotic genes and inhibited several oncogenic genes that might hold a promise for the complementary therapy for human breast cancer.

Citation Format: Islam Yahiya, Rana Saeed, Ahmed Sultan. Anti-cancer activity of naturally formulated Trigonella foenum graecum (Fenugreek) PLGA hyaluronic acid-coated nanoparticles for treatment of breast cancer cell lines [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P3-07-26.

COVID-19 Pandemic and Its Effect on Resident Physicians' Mental Well-Being: A Cross-Sectional Study in Kuwait

OBJECTIVE

Concerns about COVID-19's long-term consequences on the mental health of frontline health professionals are mounting as the entire world strives anew to contain it. The primary objective of this research is to describe the impact of working during the COVID-19 pandemic on resident physicians' mental health.

SUBJECT AND METHODS

A cross-sectional online survey using the Google Forms platform was conducted from May 1 to May 30, 2021, on 311 residents currently enrolled in a residency program at the Kuwait Institutional of Medical Specialization (KIMS). Socio-demographic details of each resident physician were collected and the scores related to depression, anxiety, and stress were measured using the previously validated depression anxiety stress scale-21 (DASS-21).

RESULTS

Higher stress and depression scores were seen in those who were devoid of the option to work with COVID-19 patients, who reported that working during the pandemic affected their study schedule, and who lost off-service training time. Further, the anxiety scores were significantly higher in females.

CONCLUSION

The impact of the ongoing pandemic on residents' mental health is grave, necessitating psychological treatment and support. The study discovered various factors linked to depression, anxiety, and stress. As a result, these aspects must be regarded to protect the doctors' mental health.

EGS P05 Surgical Same Day Emergency Care at a District General Hospital - Our Experience

Background

Surgical Same day emergency care (SDEC) is a new service started at a medium sized district general hospital (DGH) since November 2021. The surgical SDEC service is divided into Theatre (ambulatory theatres) and non-theatre (Hot Clinic) pathways aiming at improving patient experience, and reducing length of stay (LOS), by introducing a pathway through which patients are assessed, diagnosed, and initiated treatment and discharge on the same day for common emergency surgical conditions of gallstone disease, appendectomy, painful hernia, and abscesses. The service delivery planned with the existing facilities leading to structured fewer admissions, increased diagnostics, coordinating the patient flow with preop assessments, day case theatre utilisation and post-operative criteria led discharge. The Surgical SDEC is now established, and we continue to audit to benchmark success, recommend improvement and for quality assurance.

Methods

It's a prospective data collection of patients admitted under general surgery with the above common surgical emergency presentations over 6 months period since the start of the service in November 2021. The inclusion criteria were stable patients of ASA grade 1 and 2, BMI less than 40 kg/m2, and with social support. The unstable patients, ASA 3 or more and without social support were excluded. The postoperative follow up was arranged with virtual ward, clinics and in the event a post-surgery hot clinic review.

Results

From 15th November 2021 to 27th May 2022, 192 surgical operations were carried out. 130 Laparoscopic cholecystectomies, 22 hernia repairs, 13 diagnostic laparoscopies, and 27 abscesses incision and drainage. There were 77 male patients and 115 female patients with age ranging from 20 to 88 years old. About 70% of the patients were successfully discharged on the same day with a readmission rate of 3.6%. The cholecystectomy patients had a mean waiting time of 3.2 days and almost all cases were done within a week of admission. All the other cases including appendectomy were performed either the same day or the following day.

Conclusions

Surgical Same Day Emergency Care service proved to be a step forward for improving patient care. It allows the same day diagnostics and treatment, and reduces the length of stay, prevents readmissions, improves the quality of care, and helps recovery following the impacts of the pandemic. Finally, it has a significant financial benefit by decreasing readmissions, and it also utilisation of hospital beds more desired cases.

Pulsed field ablation for atrial fibrillation: acute procedural efficacy and safety of an initial German multicenter experience

Background

Pulsed field ablation (PFA) is a novel non-thermal energy source to conduct catheter ablation of atrial fibrillation (AF). However, real-world multi-center data regarding acute procedural efficacy and safety is sparse.

Purpose

To study acute procedural success and safety in patients undergoing PFA for catheter ablation of AF in a multicenter registry.

Methods

Consecutive paroxysmal and persistent AF patients undergoing PFA-based catheter ablation using a multispline catheter were enrolled. The cohort included first and repeat ablation procedures. Procedural parameters, acute success and in-hospital safety were evaluated. A follow-up of all patients was conducted.

Results

Five German centers enrolled a total of 154 patients undergoing PFA in this study. Mean age was 68±12 years, median CHA2DS2-VASc Score was 3 (Q1-Q3: 2–4).

Patients suffered from paroxysmal AF (n=55; 36%), persistent AF (n=93; 60%) and consecutive atrial tachycardias (AT) due to previous CA (n=6; 4%).

The median left atrial (LA) PFA and total procedure times were 33 (Q1-Q3: 24–53) and 90 (Q1-Q3: 73–116) minutes, respectively. Mean LA PFA fluoroscopy and total fluoroscopy times were 12.1±5.5 and 20.2±8.7 minutes. Of all 154 procedures, 130 (84%) were index ablation procedures with isolation of pulmonary veins (PVI) only and 24 (16%) were repeat procedures (including re-PVI and ablation of consecutive AT).

Acute PV reconnection following primary PVI and the initial set of PFA-applications was found in 20/130 (15%) patients, necessitating additional PFA ablation. Finally, successful PFA-guided PVI was achieved in all patients.

Additional PFA lesion sets (including LA posterior wall isolation, anterior ablation, mitral isthmus ablation) were applied in 17/154 (11%) patients.

Complications occurred in a total of 6/154 (3.8%) patients (including three groin site complications, two pericardial tamponades, one transient coronary spasm without sequela). The follow up data is still being assessed and will be provided by the time of the ESC 2022 meeting.

Conclusion

PFA performed in patients with atrial fibrillation demonstrates high acute procedural success rates and a favorable safety profile in this first real-world multicenter registry.

Funding Acknowledgement

Type of funding sources: None.

Effects of Isoprenaline on ventricular myocyte shortening and Ca2+ transport in the Zucker rat

Obesity is an important risk factor for diabetes mellitus (DM) which is a major global health problem. Electro-mechanical dysfunction has been extensively described in diabetic heart and cardiovascular complications are an important cause of mortality and morbidity in diabetic patients.

OBJECTIVES

To examine the effects of Isoprenaline (ISO) in obesity and diabesity on ventricular myocyte shortening and Ca²⁺ transport in Zucker fatty (ZF), Zucker diabetic fatty (ZDF) in comparison to Zucker lean (ZL) rats.

METHODS

Myocyte shortening and intracellular Ca²⁺ were investigated with video imaging and fluorescence photometry, respectively.

RESULTS

The amplitude of Isoprenaline stimulated shortening was significantly (p < 0.05) decreased in ZDF and ZF compared to ZL myocytes. The amplitude of Isoprenaline stimulated Ca²⁺ transient was also significantly (p < 0.05) reduced in ZF compared to ZL and modestly reduced in ZDF compared to ZL myocytes. Mean Isoprenaline stimulated time to peak along with time to half relaxation of shortening were unchanged in ZDF and ZF compared to ZL myocytes. Mean Isoprenaline stimulated time to peak Ca²⁺ transient was significantly shortened in ZF compared to ZL myocytes. Time to half decay of the Ca²⁺ transient was considerably prolonged in ZDF compared to ZL myocytes. Amplitude of Isoprenaline stimulated caffeine-evoked Ca²⁺ transients were significantly reduced in ZDF and ZF in comparison to ZL myocytes.

CONCLUSION

Isoprenaline was less effective at generating an increase in the amplitude of shortening in ZDF and ZF in comparison to ZL myocytes and defects in Ca²⁺ signaling, and in particular SR Ca²⁺ transport, might partly underlie these abnormalities.

Effects of Obesity and Diabesity on Ventricular Muscle Structure and Function in the Zucker Rat

(1) Background: Cardiovascular complications are a leading cause of morbidity and mortality in diabetic patients. The effects of obesity and diabesity on the function and structure of ventricular myocytes in the Zucker fatty (ZF) rat and the Zucker diabetic fatty (ZDF) rat compared to Zucker lean (ZL) control rats have been investigated. (2) Methods: Shortening and intracellular Ca²⁺ were simultaneously measured with cell imaging and fluorescence photometry, respectively. Ventricular muscle protein expression and structure were investigated with Western blot and electron microscopy, respectively. (3) Results: The amplitude of shortening was increased in ZF compared to ZL but not compared to ZDF myocytes. Resting Ca²⁺ was increased in ZDF compared to ZL myocytes. Time to half decay of the Ca²⁺ transient was prolonged in ZDF compared to ZL and was reduced in ZF compared to ZL myocytes. Changes in expression of proteins associated with cardiac muscle contraction are presented. Structurally, there were reductions in sarcomere length in ZDF and ZF compared to ZL and reductions in mitochondria count in ZF compared to ZDF and ZL myocytes. (4) Conclusions: Alterations in ventricular muscle proteins and structure may partly underlie the defects observed in Ca²⁺ signaling in ZDF and ZF compared to ZL rat hearts.

Neutrophil-to-lymphocyte ratio (NLR) variations in relationship with childhood maltreatment in patients with anorexia nervosa: a retrospective cohort study

PURPOSE

Anorexia nervosa (AN) is a serious mental illness. It is frequently accompanied by a history of childhood maltreatment (CM) that may constitute a specific ecophenotype in patients with eating disorders necessitating special assessment and management. This retrospective study tested whether in patients with AN, CM-related chronic stress may manifest through low-grade inflammation reflected by an increase in white blood cell ratios (neutrophil-to-lymphocyte ratio, NLR, platelet-to-lymphocyte ratio, and monocyte-to-lymphocyte ratio).

METHODS

Participants (N = 206) were enrolled at an eating disorder daycare unit in Montpellier, France, from March 2013 and January 2020. CM was assessed using the childhood trauma questionnaire (CTQ). The Eating Disorder Examination Questionnaire (EDE-Q) and the MINI were used to assess AN severity and the other clinical characteristics, respectively.

RESULTS

NLR was higher in patients with AN and history of CM (p = 0.029) and in patients with AN and history of emotional abuse (p = 0.021), compared with patients with AN without history of CM. In multivariate analysis, emotional abuse (β = 0.17; p = 0.027) contributed significantly to NLR variability.

CONCLUSION

In patients with AN, NLR is a low-grade inflammation marker that is influenced by various sociodemographic, clinical and biological factors. It is more directly affected by some CM types, especially emotional abuse, than by the presence/absence of CM history. Future studies should focus on mediators between CM and increased inflammation, such as interoceptive awareness, emotional dysregulation, food addiction, and stress sensitization.

LEVEL OF EVIDENCE

III. Evidence obtained from well-designed cohort or case-control analytic studies.

Abstract 6295: Grape seed procyanidins inhibit cell proliferation & induce apoptosis in both human breast & liver cancer cell lines

As a potential anticancer agent, grape seed procyanidins (GSPs) have been shown to be effective in treating and preventing various cancer types, but the mechanistic inhibitory effect at cellular and molecular levels in most of the cancer types remains unclear. The objective of the present study was to investigate the potential influence of GSPs on both liver and breast cancers. The anticancer efficacy of GSPs was investigated in vitro, using two human cancer cell lines; human hepatocellular carcinoma (HepG2) and human breast carcinoma, Zr-75-1.The potential influence of extracted GSPs was examined on cell proliferation, clonogenic assays, morphological alteration, and western blot was used to analyze the expression of oncogenic signaling pathways of STAT3, β-catenin, T-ERK, and pERK, Bax, Bcl-2, mutant-p53, and caspase enzyme activity assay was measured by caspase colorimetric assay.Our data showed that GSPs treatment inhibits both cellular viability and proliferation in a concentration-and time-dependent fashion in both breast and liver cancer cell lines after 48h. Furthermore, mechanistic studies showed that GSPs induced late apoptosis by 72% that was associated with cell morphological changes, histone release from fragmented DNA, caspase-3 activation in a dose-dependent manner after 48h. Furthermore, GSPs down-regulated pERK, STAT3, β-catenin, and mutant p53 levels as well as increased p21and Bax, pro-apoptotic signal, in both breast and liver cancer cells as determined by western blot analysis. All in all, our findings suggest that GSPs inhibit breast and liver cancer cells proliferation and induce cell apoptosis by suppressing the oncogenic signaling pathways that play a role in cancer progression which in turn introduce GSPs as a promising phytochemical for cancer treatment.

Citation Format: Rana Hamed Alneanaey, Nabil Taha, Mohammed Lebda, Aml Hashem, Ahmed Sultan. Grape seed procyanidins inhibit cell proliferation & induce apoptosis in both human breast & liver cancer cell lines [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 6295.

Abstract 115: Combined treatment of letrozole or olaparib with aspirin inhibits cell proliferation and induces apoptosis through upregulation of wild p53 and modulation of aurora kinases in human breast cancer cell lines

Although, there are several breakthroughs in the treatment of breast cancer on the past few decades, high incidence of relapse and progression after conventional therapies is deeply concerning, indicating a great need for developing new therapeutics for breast cancer. In the present study, the anti-cancer effects of combinational therapy of Letrozole (Aromatase inhibitor) or Olaparib (PARP inhibitor) with Aspirin, non-steroidal anti-inflammatory drugs (NSAIDs), were examined on well differentiated ER-positive and poorly differentiated triple negative breast cancer cell lines, T-47D and MDA-MB-231, respectively. In addition, the effect of combined treatment was also examined by detecting cell survival, cell cycle analysis, and alterations in signaling pathway that play a role in breast cancer progression such as β -catenin, STAT3, cyclin D1, Bax, c-PARP, wild and Mutant p53. In addition the effect of combined treatments were examined on gene expression levels of Cytochromes; CYP1A1, CYP1B1, Aurora kinases; Aurora-A and Aurora-B were determined by RT-PCR.Our data showed that combined treatments of 50 nmol Letrozole or 250 nmol Olaparib with 5 mmol, 2.5mmol Aspirin for 24 and 48 h, respectively, promoted apoptosis induction through enhanced histone release and caspase-3 activation compared to control and cells treated with each drug alone. Furthermore, apoptotic induction was associated with upregulation of Bax and downregulation of Bcl-2, cyclin D1, β-catenin, and STAT3 signaling pathways in both tested cell lines compared to control, suggesting that Aspirin may enhance the sensitivity of tested cells to Letrozole or Olaparib in both (ER) positive and triple negative breast cancer cell lines. In addition, cell cycle analysis showed a cell arrest at G0/G1 phase in both cell lines. Interestingly, in T-47D cells, combined treatment of Letrozole with Aspirin significantly upregulated wild p53 at protein level and downregulated CYP1A1, CYP1B1, Aurora-A, and Aurora-B expression at gene level compared to control, suggesting that combined treatment may inhibit breast cancer cell proliferation via down-regulation of Aurora-A and Aurora-B. In MDA-MB-231 cells, combined treatment of Olaparib with Aspirin showed a significant downregulation of Mutant p53 at protein level and CYP1A1, CYP1B1, Aurora-B and upregulation of Aurora-A at gene level compared to control, suggesting that there is a crosstalk between Olaparib/Aspirin and P53

In conclusion, combined treatment of Letrozole or Olaparib with Aspirin might be a promising approach to inhibit both ER (+) and triple negative breast cancer cell lines survival and proliferation.

Citation Format: Marwa Elsayed ElKamel, Salah Sheweita, Ahmed Sultan. Combined treatment of letrozole or olaparib with aspirin inhibits cell proliferation and induces apoptosis through upregulation of wild p53 and modulation of aurora kinases in human breast cancer cell lines [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 115.

Abstract 6332: Pegylated arginase isolated from beef liver tissue inhibited cell proliferation, induced apoptosis & inhibits induced mammary tumors in human breast cancer in vitro & in vivo

Arginase, an enzyme of the urea cycle, converts L-arginine to L-ornithine, which is the precursor of polyamines that are essential components of cell proliferation. However, Arginine deprivation and Arginase clinical implications in human breast and liver cancers have not been fully elucidated. The objective of the current study was to investigate the potential role of the Arginine degrading enzyme, Arginase, on three cell lines; Luminal A breast cancer (T-47D), TNBC (MDA-MB-231), and HCC cell line, HepG2, respectively. Herein, Arginase was extracted and purified from the beef liver and its specific activity was 0.2 IU/mg protein yielded 49% compared to the crude beef liver Arginase. The purified Arginase is covalently bound via a succinamide propionic acid (SPA) linker to polyethylene glycol (PEG) of molecular weight 5,000 to enhance the half-life time compared to the native enzyme with a maximum specific activity between 37~55℃ and pH 7~9. The potential influence of extracted Peg-Arginase was examined on cell proliferation, clonogenic assays, morphological alteration, and oncogenic signaling pathways of STAT3, β-catenin, and miR-23a. Our data showed that Peg-Arginase treatment displayed a significant inhibition in cell proliferation and viability in a dose-dependent manner in both breast cancer cell lines, but not in HepG2 cells after 48h. Furthermore, mechanistic studies showed that Peg-Arginase induced apoptosis that was associated with cell morphological changes, histone release from fragmented DNA, caspase-3 activation in a dose-dependent manner after 48h, and cell cycle arrest at S and/or G2/M phases. Moreover, Peg-Arginase down-regulated miR-23a, STAT3, β-catenin, cyclin D1, and mutant p53 levels as well as increased p21and Bax, pro-apoptotic signal, in both breast cancer cells as determined by flow cytometry and western blot analysis. In vivo, the effects of native- and Peg-Arginase enzymes were examined on MNU-induced mammary tumors in Albino-Wister rats. Our data showed that 400 IU of native- or peg- Arginase twice per week for two weeks significantly inhibited the growth of MNU-induced mammary tumors by 58.8±4.1 % for peg-Arginase compared to 19.7±3.5 % for native-Arginase. Furthermore, the results also revealed a significant reduction in activities of ALT, AST, and ALP in the Peg-Arginase group compared to MNU untreated or native-Arginase groups, suggesting that Peg-Arginase may eliminate the hepatotoxic effect of the MNU. All in all, our results suggested that the arginine-depleting enzyme, Peg-Arginase, exerted an anticancer effect against both T-47D and MDA-MB-231 breast cancer cell lines through cell proliferation inhibition and apoptosis induction.

Citation Format: Asmaa Ali, Omnia Ali, Doaa Othman, Ahmed Sultan. Pegylated arginase isolated from beef liver tissue inhibited cell proliferation, induced apoptosis & inhibits induced mammary tumors in human breast cancer in vitro & in vivo [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 6332.

Sign language identification and recognition: A comparative study

Sign Language (SL) is the main language for handicapped and disabled people. Each country has its own SL that is different from other countries. Each sign in a language is represented with variant hand gestures, body movements, and facial expressions. Researchers in this field aim to remove any obstacles that prevent the communication with deaf people by replacing all device-based techniques with vision-based techniques using Artificial Intelligence (AI) and Deep Learning. This article highlights two main SL processing tasks: Sign Language Recognition (SLR) and Sign Language Identification (SLID). The latter task is targeted to identify the signer language, while the former is aimed to translate the signer conversation into tokens (signs). The article addresses the most common datasets used in the literature for the two tasks (static and dynamic datasets that are collected from different corpora) with different contents including numerical, alphabets, words, and sentences from different SLs. It also discusses the devices required to build these datasets, as well as the different preprocessing steps applied before training and testing. The article compares the different approaches and techniques applied on these datasets. It discusses both the vision-based and the data-gloves-based approaches, aiming to analyze and focus on main methods used in vision-based approaches such as hybrid methods and deep learning algorithms. Furthermore, the article presents a graphical depiction and a tabular representation of various SLR approaches.

Modern technologies for radiofrequency pulmonary vein isolation. Comparison of radiofrequency balloon catheter with high power-short duration ablation in patients with paroxysmal atrial fibrillation

Funding Acknowledgements

Type of funding sources: None.

Background

Pulmonary vein isolation (PVI) is an established therapy for symptomatic atrial fibrillation (AF). Traditional point by point ablation can be time consuming requiring advanced training. Novel radiofrequency (RF) ablation techniques sought to facilitate PVI. Point by point ablation using high power short duration (HPSD) settings has already shown to be safe and effective whereas there is paucity of data using a novel multi-electrode balloon catheter (Heliostar™, Biosense Webster, CA, USA).

Purpose

We aimed to assess procedure characteristics, efficacy, and safety of the Heliostar™ RF-balloon catheter in direct comparison with the latest RF ablation technique.

Methods

All patients undergoing PVI using the Heliostar™ between September and November 2021 were included in this ongoing single center registry. Procedural data and outcome were assessed and compared with data from patients undergoing initial PVI for paroxysmal AF with the HPSD approach from our specifically designed database. A power setting of 70W/7s (70W/5s at posterior wall) was considered as HPSD.

Results

A total of 51 consecutive patients (61±16 years, 49% male) were included. Of those 13 patients undergoing RF-balloon and 38 patients HPSD ablation. Baseline parameters did not differ between groups. Acute PVI was achieved in all patients. For every RF-application with the RF-balloon all necessary criteria were met: Inflation index was between 0.9 and 1.0 and a minimum of 9/10 electrodes were within impedance range. A mean of 2.8±1.4 applications per vein (LSPV 3.2±2.9, LIPV 2.6±2.5, RSPV 2.8±2.0 and RIPV 1.8±0.8) were necessary to achieve durable isolation. The mean maximum esophageal temperature was 40.2±0.8°C. When comparing procedural parameters with HPSD no statistically significant difference was seen regarding procedure duration (Heliostar™ 111±28min and HPSD 100±25min; p=0.3) and left atrial dwell time (Heliostar™ 90±23min and HPSD 80±26min; p=0.08). Fluoroscopy time (Heliostar™ 17±4min and HPSD 13±5min; p=0.005) and dose (Heliostar™ 3961±1325mGy*cm2 vs. HPSD 3153±1833mGy*cm2; p=0.04) were higher in the Heliostar™ group. No major complication occurred in both groups. A three month follow up was available for 10 patients in the Heliostar™ and for 38 patients in the HPSD group. All 10 Heliostar™ patients and 79% of the HPSD patients were free from atrial arrhythmias at follow up.

Conclusion

The novel multi-electrode RF-balloon has shown to be safe and effective in the first clinical routine AF ablation procedures. The tendency towards longer LA dwell times, procedure durations and the significantly higher fluoroscopy exposition in comparison with the HPSD PVI can be attributed to the learning curve applying a new ablation system. More experience is needed in the future to determine the benefits of the novel RF-balloon.

Procedural and outcome impact of obesity in cryoballoon versus radiofrequency pulmonary vein isolation in atrial fibrillation patients

Funding Acknowledgements

Type of funding sources: None.

Background

Cryoballoon-(CB)- and radiofrequency-(RF)-ablation are the most common techniques for pulmonary vein isolation (PVI) in patients (pts) with symptomatic atrial fibrillation (AF). An increasing number of pts undergoing PVI are obese.

Objective

To address the paucity of procedural differences and outcome data of CB- vs. RF-based PVI in relation to body mass index (BMI) of AF patients.

Methods

All pts undergoing de novo PVI between 01/2018-08/2019 at our university hospital were included in this retrospective analysis. Pts of each group (CB-PVI vs. RF-PVI) were subdivided based on their BMI: normal weight BMI &lt;25kg/m², pre-obesity 25-30kg/m², obesity stage I 30-35kg/m² and severe obesity stage II ≥35kg/m². Hereafter, procedural characteristics and AF recurrence rate during follow-up were compared with regard the different BMI groups.

Results

A total of 526 pts (62% male, 65.3±11.2 years) underwent successful de novo PVI (320 CB and 206 RF). Especially in obese patients, differences in procedural characteristics were noted: A significantly increased contrast medium volume in CB group (all: CB 50 [40-80] vs. RF 20 [20-30], p&lt;0.001; BMI≥35: CB 70 [54.5-102.5] ml vs. RF 20 [15-30] ml, p&lt;0.001). In line with previous studies, the overall procedure time was significantly shorter with CB-PVI (CB 75 [60-100] vs. RF 120 [110-180], p&lt;0.001). Also, as expected, lower fluoroscopy dose was detected in RF group (all: CB 392.4 [197.9-995.9] vs. RF 282.5 [139.8-507.2], p&lt;0.001). The complication rate was equal throughout all BMI groups.

A 12-month follow up was available in 480 of 526 (91%) pts. Freedom from any arrhythmia was comparable between CB-PVI and RF-PVI (CB 77% vs. RF 75%, p=0.63). However, for obese pts a trend towards higher AF recurrence rate after RF- compared to CB-PVI was observed (BMI≥35: CB 24% vs. RF 50%, p=0.099).

Conclusion

For obese pts CB-PVI is similarly safe and effective as RF-PVI. The significantly shorter procedure time for CB-PVI may minimize potential obesity-related complications. However, the lower contrast medium quantity and fluoroscopy dose in RF-PVI must be considered. AF recurrence rates were comparable between CB-PVI und RF-PVI. Randomised trials are needed to evaluate the long-term freedom of AF recurrence in pts with higher BMI comparing CB- vs. RF-based PVI and possible obesity related complication.

Patient motivation and adherence to an on-demand app-based heart rate and rhythm monitoring infrastructure for atrial fibrillation management through teleconsultation. TeleCheck-AF project results

Funding Acknowledgements

Type of funding sources: None.

Background

TeleCheck-AF is a mobile health (mHealth) infrastructure developed to provide remote management and comprehensive care to patients with atrial fibrillation (AF) during the Covid disease-19 pandemic lockdown within cardiology centers in Europe. TeleCheck-AF integrates an on-demand photoplethysmography-based heart rate/rhythm monitoring application supported a scheduled teleconsultation.

Purpose

The current sub-study of the TeleCheck-AF project aimed to provide the first real-world dataset on patient adherence and motivation to a standardized mHealth application integrated in remote AF management.

Methods

Patients were instructed to perform 60-second app-based heart rate/rhythm recordings three times daily and in case of symptoms for seven consecutive days prior to teleconsultation. Motivation was defined as number of days in which the expected number of measurements (≥three/day) were performed per number of days over the entire prescription period. Adherence was defined as number of performed measurements per number of expected measurements over the entire prescription period.

Results

Data from 990 consecutive patients with diagnosed AF (median age 64 [57-71] years, 39% female) from 10 centers that included the highest number of patients (≥25) were analyzed. Patients with both optimal motivation (100%) and adherence (≥100%) constituted 28% of the study population and had a lower percentage of recordings in sinus rhythm (90 [53-100%] vs 100 [64-100%], P&lt;0.001) compared to others. Age and diabetes were predictors of both optimal motivation and adherence (odds ratio [OR] 1.02, 95% coincidence interval [95% CI] 1.01-1.04, P&lt;0.001 and OR, 0.49, 95% CI 0.28-0.86, P=0.013, respectively). Patients with 100% motivation also had ≥100% adherence. Independent predictors for optimal adherence alone were age (OR 1.02, 95% CI 1.00-1.04, P=0.014), female sex (OR 1.70, 95% CI 1.29-2.23, P&lt;0.001), previous AF ablation (OR 1.35, 95%CI 1.03-1.07, P=0.028).

Conclusion

In the TeleCheck-AF project, older age and diabetes were predictors of optimal patient motivation and adherence to app-based heart rate/rhythm monitoring. Therefore, physicians, nurses and allied health specialists involved in the management and care for patients with AF should not be discouraged to provide a mHealth infrastructure to elderly patients. Patient engagement improves mHealth adherence/motivation, hence, it is crucial to tailor the mHelath intervention to the needs and preferences of the patient.

Validation of seven risk scores in a prospective and independent cohort: the challenge of predicting recurrence after atrial fibrillation ablation

Funding Acknowledgements

Type of funding sources: None.

Background

Several predictive scores for atrial fibrillation (AF) recurrence after ablation have been developed, only some of these are validated in prospective cohorts. The predictive value of such scores has thus far been limited, and many have not been compared with one another.

Aims

We sought to compare the predictive value of seven previously described risk scores ((CHA2DS2 and CHA2DS2-VASC, HATCH, APPLE, CAAP-AF, BASE-AF2, MB-LATER) for prediction of AF recurrence risk at 12 months after AF ablation. Further, we aimed to identify additional variables to predict recurrences after AF ablation.

Methods

We analyzed data from of our prospective digital AF ablation registry to compare the previously published scores in an independent and prospective cohort (n=883, 50.8% with paroxysmal AF). Patients were undergoing de-novo ablation of AF received a pulmonary vein isolation (PVI) using radiofrequency (RF) ablation or cryoablation. Ablation procedures for recurrences of AF after initial PVI included re-isolation of the pulmonary veins by RF ablation, with additional substrate modification at the operators’ discretion.

Early recurrence and recurrence after ablation were defined as any AF or atrial tachycardia episode lasting ≥ 30 s in the first 3 months after ablation and from the end of the 3-month period to 12 months after ablation. Follow-up of patients was scheduled at regular intervals 3 and 12 months after ablation, and included Holter-ECG, 12-lead ECG and history. Outcome-relevant data from implanted cardiac devices (CIED), such as 2-chamber ICD and pacemakers, or implantable loop recorders were analyzed when available.

A predefined subgroup analysis was performed in the following subgroups: first procedure vs. redo procedure, paroxysmal vs. persistent AF, and RF ablation vs. cryoablation.

Results

The BASE-AF2 (AUC 0.630, p&lt;0.001), MB-LATER (AUC 0.612, p&lt;0.001) CAAP-AF (AUC 0.591, p&lt;0.001), APPLE (AUC 0.591, p&lt;0.001) and CHA2DS2-VASC (AUC 0.547, p=0.018) scores had a significant but modest predictive value for 12-month AF-recurrence. None of these scores was significantly superior. Other previously published scores had no predictive value. There was no difference in the predictive value for 12-month recurrence of AF between first procedure vs. redo procedure and RF ablation vs. cryoablation. Unlike other scores, MB-LATER showed better predictive value for paroxysmal vs. persistent AF (AUC 0.632 vs. 0.551, p=0.038). In the multivariate logistic regression, only age (p=0.006), number of prior electrical cardioversions (p&lt;0.001) and early AF recurrence (p&lt;0.001) were independent predictors of 12-month AF recurrence.

Conclusion

Despite numerous available scores, predicting recurrences after AF ablation remains challenging. New simple and robust predictors are needed, potentially based on diagnostic interventions, as well as novel genetic, functional and anatomic parameters.

Impact of pacing output and cycle length on qrs morphology in ablation of premature ventricular contractions (PACE-MAP-Trial)

Funding Acknowledgements

Type of funding sources: None.

Background

Pace mapping is an established technique to localize the origin of premature ventricular contractions (PVC). The QRS morphology induced by endocardial pacing is compared with a previously recorded template of the target arrhythmia. Based upon historic in-vitro models pacing at the arrhythmia’s coupling interval (CI) and stimulation threshold has become the gold standard in pace mapping.

Purpose

There is a paucity of data supporting pacing at the CI and stimulation threshold as the gold standard for pace mapping. In this prospective study, we sought to assess systematically the impact of variations of pacing output and cycle length on the resulting QRS morphology during pace mapping in the context of PVC ablation (NCT05061498).

Methods

All patients undergoing ablation of idiopathic PVC were prospectively enrolled in this study. Pace mapping was performed using four different parameter settings: (1) A predefined fixed burst at maximum output (10V/2ms), (2) fixed burst at stimulation threshold, (3) coupling interval at maximum output and (4) coupling interval at stimulation threshold. Pacing cycle length (PCL) of the fixed burst was defined as follows: for a CI ≤450ms = PCL of CI+100ms and for a CI ≥450 = PCL of CI-100ms. Using an automated waveform comparison algorithm, the resulting QRS complexes were matched with the clinical PVC, and with the gold standard. For every parameter setting the mean of the matching percentage of three QRS complexes entered the analysis.

Results

We report data of the first 22 consecutive patients (53±15 years, 64% female) enrolled in this ongoing study between May and November 2021. The pacing protocols were performed at 39 different sites: 5/39 epicardially via great cardiac vein, 15/39 in the RVOT 12/39 and 7/22 in the left ventricular cavity. When comparing the QRS morphologies resulting from the four different pace mapping settings with the clinical PVC, the univariate analysis revealed no difference between groups (p=0.9). Furthermore, there was no difference comparing the paced QRS morphologies at different output and cycle length to the gold standard of threshold pacing at coupling interval (p=0.9).

Conclusion

Variations of pacing output and stimulation cycle length during pace mapping does not affect QRS morphology during PVC ablation. Applying a modern automated waveform comparison tool, no advantage was observed when comparing with the gold standard. It is therefore reasonable to assume, that pace mapping can be performed using an easily applicable setting of a fixed burst at maximum pacing output.

Abstract P5-10-06: Arginine- depleting enzyme, pegylated arginase, isolated from beef-liver tissue induces growth inhibition, apoptosis, cell cycle arrest and inhibits induced mammary tumors: A promising strategy for human breast cancer treatment in vitro and in vivo

Arginine auxotrophy occurs in certain tumor types, renders tumors vulnerable to treatment with arginine-degrading enzymes, and leads to their rapid demise. Arginine is a semi-essential amino acid but is essential for rapidly proliferating cells. Thus, Arginine deprivation can be exploited as a potential targeted therapy for the treatment of various cancers. Arginase, an enzyme of the urea cycle, converts L-arginine to L-ornithine, which is the precursor of polyamines that are essential components of cell proliferation. However, Arginine deprivation and Arginase clinical implications in human breast cancer have not been fully elucidated. The objective of the current study was to investigate the potential role of the Arginine degrading enzyme, Arginase on two breast cell lines that have different differentiation patterns, Luminal A breast cancer (T-47D), and TNBC (MDA-MB-231), respectively. Herein, Arginase was extracted and purified from the beef liver and its specific activity was 0.2 IU/mg protein yielded 49% compared to the crude beef liver Arginase. The purified Arginase is covalently bound via a succinamide propionic acid (SPA) linker to polyethylene glycol (PEG) of molecular weight 5,000 to enhance the half-life time compared to the native enzyme with a maximum specific activity between 37~55°C and pH 7~9. The potential influence of extracted Peg-Arginase was examined on cell proliferation, clonogenic assays, morphological alteration, and oncogenic signaling pathways of STAT3, β-catenin, and miR-23a. Our data showed that Peg-Arginase treatment displayed a significant inhibition in cell proliferation and viability in a dose-dependent manner in both breast cancer cell lines compared to control after 48h. Furthermore, mechanistic studies showed that Peg-Arginase induced apoptosis that was associated with cell morphological changes, histone release from fragmented DNA, caspase-3 activation, and cell cycle arrest at S and/or G2/M phases in a dose-. dependent manner after 48h. Moreover, Peg-Arginase down-regulated miR-23a, STAT3, β-catenin, cyclin D1, and mutant p53 levels as well as increased p21and Bax, pro-apoptotic signal, in both breast cancer cells as determined by qRT-PCR and western blot analysis. In vivo, the effects of native- and Peg-Arginase enzymes were examined on MNU-induced mammary tumors in Albino-Wister rats. Our data showed that injecting 400 IU of native- or peg- Arginase twice per week for two weeks significantly inhibited the growth of MNU-induced mammary tumors by 58.8±4.1 % for peg-Arginase compared to 19.7±3.5 % for native-Arginase. Furthermore, the results also revealed a significant reduction in activities of ALT, AST, and ALP in the Peg-Arginase group compared to MNU untreated or native-Arginase groups, suggesting that Peg-Arginase may eliminate the hepatotoxic effect of the MNU. Furthermore, Peg-Arginase treatment reduced the localization and expression of oncogenic β-catenin in the nucleus compared to MNU-untreated and native-Arginase groups. All in all, our results suggested that the arginine-depleting enzyme, Peg-Arginase, exerted an anticancer effect against both luminal A and triple-negative breast cancer cell lines, through cell proliferation inhibition and apoptosis induction, which might provide a promising alternative strategy targeting oncometabolite in human breast cancer.

Citation Format: Islam Yahiya, Asmaa Ali, Omnia Ali, Ahmed Sultan. Arginine- depleting enzyme, pegylated arginase, isolated from beef-liver tissue induces growth inhibition, apoptosis, cell cycle arrest and inhibits induced mammary tumors: A promising strategy for human breast cancer treatment in vitro and in vivo [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P5-10-06.

Multidisciplinary management of juvenile nasopharyngeal angiofibroma

Background

Juvenile nasopharyngeal angiofibroma (JNA) is a rare benign, but the locally aggressive, vascular tumor that occurs almost exclusively in young men. Although this tumor accounts for only about 0.5% of head and neck tumors, it is by far the most common benign nasopharyngeal neoplasm. It is presented typically with epistaxis, obstructive symptoms, and chronic otomastoiditis. The examination of this tumor reveals pale reddish-blue mass. The tumor is seen on imaging as vividly augmenting soft-tissue mass centered on the sphenopalatine foramen. The treatment of choice is usually surgical resection; either open or endoscopic. Pre-operative embolization is usually done to help with hemostasis. We aim to address the efficiency and the safety of endovascular modality in JNA.

Methods

In the period between January 2012 to December 2017, 20 male patients with age ranging from 6 to 20 years were referred to the Endovascular Unit, at Departments of Neurosurgery in Sohag, Alexandria, and Tanta University Hospitals with JNF. Preoperative trans-arterial embolization was done, followed by endoscopic surgical resection by our ENT surgeons. All patients were subjected to clinical and radiological Imaging evaluation pre embolization, post embolization, and post endoscopic resection. All patients had clinical and radiological follow-ups for at least 1 year.

Results

20 male patients with JNA underwent preoperative super-selective trans-arterial embolization. The average age at presentation was 13 years. All patients underwent successful embolization with total obliteration of vascular blush of the tumor in 15 patients, and near-total obliteration of blush in 5 patients. The dramatic effect of preoperative embolization was observed on limiting intraoperative blood loss (average 200 ml) and decreasing the time of surgery (average 2.5 h). There was no permanent morbidity or mortality related to either embolization or endoscopic resection in all patients.

Conclusions

Trans-arterial embolization is strongly recommended in patients with JNA, it offers a good assist to the surgeon, reduces blood loss, decreases the amount of transfusion, improves the degree of resection, reduces operative time, and decreases the incidence of recurrence.

The photoplethysmography dictionary: practical guidance on signal interpretation and clinical scenarios from TeleCheck-AF

Introduction

During the coronavirus disease 2019 (COVID-19) pandemic, numerous centres in Europe used on-demand photoplethysmography (PPG) technology to remotely assess heart rate and rhythm in conjunction with teleconsultations within the TeleCheck-AF project.

Purpose

To develop an educational structured stepwise practical guide on how to interpret PPG signals and to study typical clinical scenarios how on-demand PPG was used in the TeleCheck-AF project.

Methods

During an online conference, the structured stepwise practical guide on how to interpret PPG signals was discussed and further refined during an internal review process. We provide the number of respective PPG recordings and number of patients managed within a clinical scenario during the TeleCheck-AF project.

Results

To interpret PPG recordings, we introduce a structured stepwise practical guide and provide representative PPG recordings. In the TeleCheck-AF project, 2522 subjects collected 90.616 recordings. The majority of these recordings was classified by the PPG algorithm as sinus rhythm (57.6%), followed by atrial fibrillation (AF) (23.6%). In 9.7% of recordings the quality was too low to interpret. Other observed rhythms were tachycardia (1.4%), extra systoles (4.7%), bigeminy episodes (1.8%), trigeminy episodes (0.6%) and atrial flutter (0.2%). The most frequent clinical scenario where PPG technology was used in the TeleCheck-AF project was follow-up after AF ablation (1110 patients) followed by heart rate and rhythm assessment around (tele)consultation (966 patients), sometimes including remote PPG-guided adaption of rate or rhythm control. 275 patients were followed around cardioversion, either (semi-)acute or elective. Other possible scenarios are assessment of palpitations, assessment of symptom-rhythm correlation and monitoring during up-titration of heart failure medication.

Conclusion

We introduce a newly developed structured stepwise practical guide on PPG signal interpretation developed based on presented experiences from TeleCheck-AF. The present clinical scenarios for the use of on-demand PPG technology derived from the TeleCheck-AF project will help to implement PPG technology in the management of arrhythmia patients.

Funding Acknowledgement

Type of funding sources: None. TeleCheck-AF clinical scenariosClassification of PPG recordings

Characterization of a Coliphage AS1 isolated from sewage effluent in Pakistan

The emergence of multi-drug resistant (MDR) bacterial strains, which are posing a global health threat has developed the interest of scientists to use bacteriophages instead of conventional antibiotics therapy. In light of an increased interest in the use of phage as a bacterial control agent, the study aimed to isolate and characterize lytic phages from sewage effluent. During the current study, bacteriophage AS1 was isolated from sewage effluent against E.coli S2. The lytic activity of phageAS1 was limited to E.coli S2 strain showing monovalent behavior. The calculated phage titer was 3.5×109 pfu/ml. PhageAS1 was stable at a wide range of pH and temperature. The maximum stability was recorded at 37ºC and pH 7.0, while showing its normal lytic activity at temperature 60ºC and from pH 5.0 to11.0 respectively. At temperature 70ºC, phage activity was somewhat reduced whereas, further increase in temperature and decrease or increase in pH completely inactivated the phage. From the current study, it was concluded that waste water is a best source for finding bacteriophages against multi-drug resistant bacterial strains and can be used as bacterial control agent.

Mechanisms underlying electro-mechanical dysfunction in the Zucker diabetic fatty rat heart: a model of obesity and type 2 diabetes

Diabetes mellitus (DM) is a major and worsening global health problem, currently affecting over 450 million people and reducing their quality of life. Type 2 diabetes mellitus (T2DM) accounts for more than 90% of DM and the global epidemic of obesity, which largely explains the dramatic increase in the incidence and prevalence of T2DM in the past 20 years. Obesity is a major risk factor for DM which is a major cause of morbidity and mortality in diabetic patients. The electro-mechanical function of the heart is frequently compromised in diabetic patients. The aim of this review is to discuss the pathophysiology of electro-mechanical dysfunction in the diabetic heart and in particular, the Zucker diabetic fatty (ZDF) rat heart, a well-studied model of T2DM and obesity.

Comparison of geographic workflow preferences with real-time dynamic regional mapping data during catheter ablation

Funding Acknowledgements

Type of funding sources: None.

Introduction

The clinical benefit of multielectrode high-density (HD) mapping during catheter ablation has been an area of active research. One advantage of HD mapping is improved sensitivity which can lead to better visualization and substrate delineation during the procedure. In addition to the advantages offered by the multielectrode grid mapping catheter (HD Grid), a novel software enable the display of beat-to-beat, dynamic regional mapping data from the current location of HD Grid in real-time (LiveView). The optimal settings and workflows to incorporate the dynamic data into routine ablation procedures have not been explored.

Purpose

To examine the common settings and workflow patterns among operators from different geographies when using dynamic mapping.

Methods

Observational procedural data including procedure time, total RF time, workflow preference, and fluoroscopy time, were prospectively collected from operators across Europe, the U.S., and Asia Pacific countries from May to September 2020. Cases from both catheter ablation of atrial and ventricular arrhythmias were included in the analysis.

Results

A total of 754 cases were collected (428, 133, and 193 cases from Europe, the U.S., and the Asia Pacific region, respectively). The most commonly reported indication across all three geographies was de novo paroxysmal atrial fibrillation (223/754, 30.0%). A steerable sheath was more frequently used with the mapping catheter in Europe and U.S. compared to Asia Pacific countries. Contrary to cases from the U.S. and Asia Pacific countries where the double transseptal approach was the preferred technique for left atrial procedures (78.8% and 55.3%, respectively), the single transseptal approach was more commonly observed in European cases (233/428, 54.4%). Visualization of real-time mapping data after creation of traditional full-chamber maps were commonly observed in all three geographies. Regardless of geography, the CS catheter was commonly used a reference electrode; and the most common map appearance settings for interior projection, exterior projection, and interpolation was 7, 7, and 7 respectively. Voltage cutoff of 0.1 mV, range from 0.01 to 1.5 mV, was most frequently observed for delineating scar in atrial arrhythmia cases analyzed in this dataset.

Conclusions

While there is a geographical difference in ablation workflow, common settings and patterns can be observed in all three regions. This data suggests that minimal workflow changes are required to incorporate the use of dynamic data into routine procedures. Adaptation of LiveView can help improve procedure efficiency and efficacy by reducing the need for full chamber maps, identifying areas that were under ablated, and confirming ablation endpoints. Further control study examining procedure efficiency and efficacy associated with dynamic mapping may be warranted.

The TeleCheck-AF project on remote app-based management of atrial fibrillation during the COVID-19 pandemic: Patient experiences

Funding Acknowledgements

OnBehalf

Aims

Methods

Results

Conclusions

Workflows and clinical utilization of dynamic mapping data in radiofrequency catheter ablation of cardiac arrhythmias

Funding Acknowledgements

Type of funding sources: None.

Introduction

Previous publications suggest that the use of high-density (HD) mapping leads to better substrate visualization and may lead to improved procedural outcomes. A novel dynamic mapping software, utilizes the HD grid mapping catheter (HD Grid) to display beat-to-beat, dynamic regional mapping data (LiveView). Incorporation of real-time dynamic mapping data into routine mapping/ablation workflows may further enhance the clinical benefits of HD mapping during radiofrequency (RF) catheter ablation procedures.

Purpose

 To examine the clinical utility and common workflows when dynamic mapping data was used during RF ablation procedures among operators with various experience levels.

Methods

Observational procedural data including procedure time, total RF time, and workflow preference were prospectively collected in catheter ablation cases utilizing LiveView from May to September 2020. Mapping and ablation strategies were determined at the operator’s discretion. Total percentage exceed 100% when multiple usage were reported.

Results

A total of 428 cases were collected from over 25 operators in 11 European countries. LiveView was used in a variety of cases including atrial fibrillation (paroxysmal and persistent), atrial flutter (typical and atypical), and VT (ischemic, non-ischemic, and idiopathic). Visualization of real-time mapping data from the current location of the HD Grid was commonly used after creation of traditional full-chamber maps (319/428, 74.5%). While operators in over 55% of the cases indicated that the use of dynamic display during mapping helped identify areas that were under ablated (238/428, 55.6%), using LiveView did not affect the lesion delivery strategies in those regions. LiveView was also used as a primary method for confirmation of pulmonary vein isolation (PVI) in 213 cases (49.8%). The most common reported usage of LiveView among the 428 cases analyzed was PVI confirmation/gap identification (75.2%), ablation line gap identification (41.1)%, and identification of breakthrough activation (23.6%)

Conclusions

This initial analysis demonstrated the diverse clinical utilization of LiveView dynamic display during RF catheter ablation procedures, including atrial and ventricular arrhythmias. Without causing significant changes to normal workflow, dynamic display of regional signals allows for rapid identification of ablation targets. When used during RF delivery, real-time assessment of regional activation patterns helped improve outcomes by rapidly identifying critical ablation location and ensuring successful lesion delivery. A further study that examines the impact of dynamic display on procedure efficacy may be warranted.

Effects of obesity and diabesity on heart rhythm in the Zucker rat

Obesity and type 2 diabetes mellitus are risk factors for hypertension, coronary heart disease, cardiac arrhythmias including atrial fibrillation, heart failure and sudden cardiac death. The effects of obesity and diabesity on heart rhythm were investigated in the Zucker diabetic fatty (ZDF) and Zucker fatty (ZF) compared to the Zucker lean (ZL) control rat. In vivo biotelemetry techniques were used to assess the electrocardiogram and other cardiac and metabolic parameters. ZDF rats were characterized by age-dependent elevations in fasting and non-fasting blood glucose, glucose intolerance and weight gain and ZF rats were characterized by smaller elevations in fasting and non-fasting blood glucose and greater weight gain compared to ZL rats. Heart rate (HR) was progressively reduced in ZDF, ZF and ZL rats. At 195 days (6.5 months) of age there were significant differences in HR between ZDF (265 ± 8 bpm, n = 10), ZF (336 ± 9 bpm, n = 10) and ZL (336 ± 10 bpm, n = 10) rats and significant differences in HRV between ZDF (22 ± 1 bpm, n = 10), ZF (27 ± 1 bpm, n = 10) and ZL (31 ± 1 bpm, n = 10) rats. Power spectral analysis revealed no significant (P > 0.05) differences in HRV at low frequencies, reduced HRV at high frequencies and increased sympathovagal balance in ZDF compared to ZF and ZL rats. HR was reduced by ageing and additionally reduced by diabesity in the absence of changes in physical activity and body temperature. Reductions in HRV associated with altered sympathovagal drive might partly underlie disturbed HR in the ZDF rat. Possible explanations for reduced HR and future mechanistic studies are discussed.

Abstract PS19-28: Thymoquinone and tamoxifen co-treatment synergistically inhibit proliferation, invasion and induce apoptosis in human breast cancer cell lines in vitro and in vivo

Epidemiological studies and experimental analysis indicate that dietary factors influence thedevelopment of breast cancer, suggesting the role of natural products as modifying factors againstbreast cancer. Thymoquinone (TQ) (a dietary phytochemical compound) the main active ingredientof the volatile oil of black seed (Nigella sativa) has been used to be safe when administered to awide variety of normal cells. In addition, Tamoxifen (TAM), a nonsteroidal triphenylethylene derivateand selective ER modulator, has been used as a single agent in the treatment of ER positive breastcancer.In the present study, we report the possible chemo-sensitizing effect of TQ as a promisingconventional chemotherapeutic agent, using a panel of human breast cancer cell lines, MCF-7, ZR-75-1, T-47D and BT-20 respectively in vitro and in vivo.Our data revealed that TQ, TAM or combined treatments significantly inhibited cell viability of MCF-7, T-47D, ZR-75-1 but slightly of BT-20 cell lines consistently with down-regulation of signaltransducer and activator of transcription 3 (STAT 3), mTOR, cyclin D1, oncogenic β-catenin,signaling a specific transcription factor and PPAR-gamma in a dose dependent manner. Mostimportantly, combined treatment enhanced inhibition of cell viability, DNA fragmentation andapoptosis induction through Caspase-3 activation and Bcl-2 down regulation in all tested cell linesbut this effect was limited in BT-20 cells compared to controls. Moreover, our data was supported bymicroscopic examination using electron scanning microscopy that revealed many apoptoticalterations after combined treatment compared to each TQ or TAM. Furthermore, confocalfluorescence microscopy examination revealed that only combined treatment showed a significantinhibition of filopodia formation as a sign of invasion inhibition in both BT-20 and MCF-7 humanbreast cancer cell lines. In vivo, tumor xenotransplants of human ZR-75-1 cells revealed that onlycombined treatment showed a significant regression in tumor size by 53% after 72h and enhancedE-cadherin expression as analyzed by immunohistochemistry and confocal fluorescencemicroscopy.Taken together, our findings provide strong in vitro and in vivo molecular evidences in support ofour hypothesis that Thymoquinone synchronized as chemo-preventive agent with Tamoxifen to inhibithuman breast cancer cell lines proliferation, invasion and induce apoptosis that might have a potentialimplication in breast cancer prevention and treatment.

Citation Format: Islam Yahiya, Heba Helmy, Ahmed Sultan. Thymoquinone and tamoxifen co-treatment synergistically inhibit proliferation, invasion and induce apoptosis in human breast cancer cell lines in vitro and in vivo [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS19-28.

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

BACKGROUND

80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality.

METHODS

This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494.

FINDINGS

Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70-8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39-8·80) and upper-middle-income countries (2·06, 1·11-3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26-11·59) and upper-middle-income countries (3·89, 2·08-7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications.

INTERPRETATION

Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications.

FUNDING

National Institute for Health Research Global Health Research Unit.

Association of TNF-α G-308 a Promoter Polymorphism with the Course and Outcome of COVID-19 Patients

Background: Tumor necrosis factor-ɑ (TNF-ɑ) is one of the most important cytokines that manage the host defense mechanism, which may play a role in the pathogenesis of COVID-19 patients. The work aims to study the association of TNF-ɑ G-308 A gene polymorphism with the course and outcome of COVID-19 patients in Mansoura University Hospital.Methods: 900 patients with COVID-19 infection and 184 controls were tested for TNF-ɑ G-308 A promoter polymorphism. Different genotypes of TNF-ɑ G-308 A were compared as regards the severity and prognosis of the disease.Results: No statistically significant difference was found between patients and controls as regards the demographic data. The AA genotype of TNF-ɑ showed a higher incidence of the disease in comparison to the other genotypes. As regards the demographic and laboratory characters, no statistically significant difference was found between the different genotypes except for age, lymphopenia, CRP, and serum ferritin levels. In 336(80.0%) cases of the AA genotype, the disease was severe in comparison to 90(41.7%) cases in the GA genotype and no cases in the GG genotype with P = .001.Conclusion: People who carry the A allele of TNF-ɑ polymorphism are more prone to COVID-19 infection. The AA genotype of TNF-ɑ is associated with a more aggressive pattern of the disease. In those patients, the use of anti - TNF therapy may be promising.

Value of Adding Dexmedetomidine in Endoscopic Ultrasound-Guided Celiac Plexus Neurolysis for Treatment of Pancreatic Cancer-Associated Pain

BACKGROUND

Abdominal and back pain is present in up to 80% of patients with pancreatic cancer and represents a significant cause of morbidity. Celiac plexus neurolysis (CPN) demonstrated good results in relief of pain of upper abdominal malignancy. Dexmedetomidine is alpha-2 adrenoceptor highly selective agonist approved for procedural sedation use.

PATIENTS AND METHODS

Fifty patients divided in two groups with locally advanced pancreatic cancer-associated abdominal pain underwent endoscopic ultrasound (EUS)-guided CPN using bupivacaine 0.5% alone with alcohol for the first group and bupivacaine 0.5% plus dexmedetomidine in the second. Patients scored their pain according to the Numeric Rating Scale (NRS-11) before, 2, 4, 6, 8, 12, 16, and 24 week after the procedure.

RESULTS

The study has included 50 patient in two groups. There was no significant difference between the two groups as regards medical, laboratory, or tumor characters. The median pain score decreases from 8.32 ± 0.75 before the procedure to 3.75 ± 3.72 24 week after the procedure in group 1 and from 8.08 ± 0.86 before to 1.67 ± 2.3 24 week after the procedure in group 2. However, there was no significant difference between the two groups in the median pain score during the first 4 weeks. There was no statistically significant difference between the two groups as regards the median survival time.

CONCLUSION

The addition of dexmedetomidine to bupivacaine 0.5% in EUS-CPN demonstrated beneficial effects as regards the degree and duration of pain relieve with negligible effect on the patient survival.

AB0176 RISK OF ANTI-CITRULLINATED PEPTIDE ANTIBODIES AND RHEUMATOID FACTOR IN MALE SMOKERS: DATA FROM KUWAIT REGISTRY FOR RHEUMATIC DISEASES (KRRD)

Background:

Smoking has been proposed to be associated with the development of anti-citrullinated peptide antibodies (ACPA) in rheumatoid arthritis (RA) patients.

Objectives:

To study the relationship between smoking and ACPA as well as smoking and RF in patients with RA in Kuwait Registry for Rheumatic Diseases (KRRD).

Methods:

Data on RA patients were extracted from KRRD from four major hospitals from February 2013 through December 2019. As females rarely smoke in Kuwait with a smoking prevalence of 3% in female RA patients in KRRD, females were excluded from the study population to reach the minimum statistical percentage needed to perform chi square test and assess the association between smoking and other variables. Statistical tests were applied where appropriate. Logistic regression was conducted to adjust for possible confounders including age, disease duration, comorbidities, family history of a rheumatic disease, ANA, treatment agents and disease activity and quality of life assessment tools.

Results:

A total of 863 RA male patients were studied with a mean age of 53.9±12.5 years and a mean disease duration 7.3±5.5 years. 652 (75.6%) had positive RF and 624 (72.3%) had positive ACPA. 431 (50%) had at least one comorbidity. 640 (74.2%) were on conventional disease modifying agents (cDMARD’s) and 223 (25.8%) were on biologic therapy. 183 (21.2%) were smokers. After adjustment of other factors, logistic regression showed that smokers were significantly different than non-smokers in terms of a positive ACPA (β=-1.051,p<0.001, odds=4.019) and a positive RF (β=-0.804,p=0.019, odds=2.517).

Conclusion:

Smokers have a higher risk of expressing a positive RF and a positive ACPA in a male population. Smoking should be considered as a possible risk factor for RA and efforts should be done to educate the population to cease smoking to possibly lower that risk.

References:

[1]Benowitz, N.L., 2009. Pharmacology of nicotine: addiction, smoking-induced disease, and therapeutics. Annual review of pharmacology and toxicology, 49, pp.57-71.

[2]Firestein, G.S., 2003. Evolving concepts of rheumatoid arthritis. Nature, 423(6937), p.356.

[3]Heliövaara, M., Aho, K., Aromaa, A., Knekt, P. and Reunanen, A., 1993. Smoking and risk of rheumatoid arthritis. The Journal of rheumatology, 20(11), pp.1830-1835.

[4]Hoy, K. W., 2009. Quantitative Research in Education: A Primer. SAGE. pp. 69-86.

[5]Kerlan-Candon, S., Combe, B., Vincent, R., Clot, J., Pinet, V. and Eliaou, J.F., 2001. HLA-DRB1 gene transcripts in rheumatoid arthritis. Clinical & Experimental Immunology, 124(1), pp.142-149.

[6]Kuada, J., 2012. Research Methodology: A Project Guide for University Students. Samfundslitteratur. pp. 45-56.

[7]Kumar, R., 2010. Research Methodology: A Step-by-Step Guide for Beginners. SAGE. pp. 148-159.

[8]Masdottir, B., Jonsson, T., Manfreðsdóttir, V., Víkingsson, A., Brekkan, Á. and Valdimarsson, H., 2000. Smoking, rheumatoid factor isotypes and severity of rheumatoid arthritis. Rheumatology, 39(11), pp.1202-1205.

[9]Neuman, W., 2009. Understanding research. Boston: Pearson. pp. 230- 255.

Disclosure of Interests:

None declared

Exploring the presence of dental anomalies as a consequence of treatment of malignancy: A case report

Simultaneous presentation of tuberculosis (TB) and lymphoma in a young child is indeed a very rare entity. Malignancy such as Hodgkin's disease (HD) most commonly causes suppression of the cell-mediated immunity, which makes the individual, especially children, more prone to tuberculous infection. One of the non-life threatening complications in these young cancer survivors is the associated dental anomalies. These can seriously impair the quality of life of teenagers and young adults. Higher incidence of caries, discoloration of teeth or even early loss of teeth requiring dental prosthesis, can be associated with the use of cytostatic drugs. These drugs can also disturb odontogenesis, resulting in the absence of tooth buds, microdontia, dilacerations or shortening of tooth roots. Some of the anticancer drugs, including busulfan, cyclophosphamide, doxorubicin etc. May particularly play a significant role in the development of dental anomalies. This paper is a short review and case report of an 11 year old child having oligodontia and secondary dental complications caused as a side effect of treatment of Hodgkin's lymphoma with Tuberculous Lymphadenitis.

Metabolic regulation of calcium pumps in pancreatic cancer: role of phosphofructokinase-fructose-bisphosphatase-3 (PFKFB3)

BACKGROUND

High glycolytic rate is a hallmark of cancer (Warburg effect). Glycolytic ATP is required for fuelling plasma membrane calcium ATPases (PMCAs), responsible for extrusion of cytosolic calcium, in pancreatic ductal adenocarcinoma (PDAC). Phosphofructokinase-fructose-bisphosphatase-3 (PFKFB3) is a glycolytic driver that activates key rate-limiting enzyme Phosphofructokinase-1; we investigated whether PFKFB3 is required for PMCA function in PDAC cells.

METHODS

PDAC cell-lines, MIA PaCa-2, BxPC-3, PANC1 and non-cancerous human pancreatic stellate cells (HPSCs) were used. Cell growth, death and metabolism were assessed using sulforhodamine-B/tetrazolium-based assays, poly-ADP-ribose-polymerase (PARP1) cleavage and seahorse XF analysis, respectively. ATP was measured using a luciferase-based assay, membrane proteins were isolated using a kit and intracellular calcium concentration and PMCA activity were measured using Fura-2 fluorescence imaging.

RESULTS

PFKFB3 was highly expressed in PDAC cells but not HPSCs. In MIA PaCa-2, a pool of PFKFB3 was identified at the plasma membrane. PFKFB3 inhibitor, PFK15, caused reduced cell growth and PMCA activity, leading to calcium overload and apoptosis in PDAC cells. PFK15 reduced glycolysis but had no effect on steady-state ATP concentration in MIA PaCa-2.

CONCLUSIONS

PFKFB3 is important for maintaining PMCA function in PDAC, independently of cytosolic ATP levels and may be involved in providing a localised ATP supply at the plasma membrane.

Co-morbidity of down syndrome with autism spectrum disorder: Dental implications

Over the past several years, numerous studies have emerged documenting the high incidence (1-11%) of comorbidity of autism spectrum disorders (ASD) in Down syndrome (DS). While children with these health issues are reported to be more cognitively impaired presenting significantly lower IQ scores, they also demonstrate differences in social and expressive language skills when compared to their coequals with DS only. More than that subjects with DS and ASD comorbidity exhibit atypical behaviour manifested by stereotypic anxiety and social withdrawal when compared to DS alone. This article provides a brief understanding of this challenging concurrence along with a case report of a 12-year-old male patient with ASD-DS condition reporting with multiple missing teeth (Oligodontia).

The Impact of Angiographic Geometry on the Clinical Presentation of True Vein of Galen Aneurysmal Malformations

BACKGROUND PURPOSE

Vein of Galen aneurysmal malformations (VGAM) may carry life-threatening and catastrophic sequelae in children. Their clinical presentations are differently variable between cardiac and cerebral syndromes. There may be a possible relationship between the Galenic angioarchitecture and the clinical presentation. We aimed to study the effect of the venous outflow impairment on the incidence of high-flow heart failure and the incidence of hydrocephalus.

MATERIALS AND METHODS

The angiographies of 21 patients with true VGAM have been studied. MR angiography, 3-dimensional CT angiogram (3D CTA), and conventional digital subtraction angiography were performed for all patients with true VGAM. Transarterial embolization was done in 1 or more sessions for all cases.

RESULTS

Among the 21 cases, 14 cases were mural type, 5 cases were choroidal type, and 2 cases were mixed. Hydrocephalus was observed more in infants (92.3%), mural types (92.9%), giant and supergiant (87.5%) aneurysms, and in cases with persistent limbic circle (90.91%). All cases of hydrocephalus were associated with significant stenosis (>70%) of the Falcine sinus draining system (100%).

CONCLUSION

Significant stenosis (>70%) of the draining sinus is a significant factor for VGAM aneurysmal enlargement and occurrence of hydrocephalus. Probably, venous outflow impairment decreases the incidence of high-flow heart failure and increases the incidence of hydrocephalus.