Monocyte recruitment in venous pulmonary embolism at time of cancer diagnosis in upper gastrointestinal cancer patients

Upper gastrointestinal cancer is frequently complicated by venous thromboembolisms (VTE), especially pulmonary embolisms (PE) increase the mortality rate. Monocytes are a part of the innate immune system and up-regulation may indicate an ongoing inflammatory response or infectious disease and has lately been associated with a moderate risk of suffering from VTE. This prospectively study aims to compare the incidence of pulmonary embolism with markers of coagulation and compare it to the absolute monocyte count. A consecutive cohort of 250 patients with biopsy proven upper gastrointestinal cancer (i.e. pancreas, biliary tract, esophagus and gastric cancer) where included at the time of cancer diagnosis and before treatment. All patients underwent bilateral compression ultrasonography for detection of deep vein thrombosis (DVT). Of these 143 had an additionally pulmonary angiografi (CTPA) with the staging computer tomography. 13 of 250 patients (5.2%) had a DVT and 11 of 143 (7.7%) had CTPA proven PE. PE was significantly more common among patients with elevated D-dimer (OR 11.62, 95%CI: 1.13-119, P = 0.039) and elevated absolute monocyte count (OR 7.59, 95%CI: 1.37-41.98, P = 0.020). Only patients with pancreatic cancer had a significantly higher risk of DVT (OR 11.03, 95%CI: 1.25-97.43, P = 0.031). The sensitivity of absolute monocyte count was 63.6 (95%CI: 30.8-89.1) and specificity 80.3 (95%CI: 72.5-86.7), with a negative predictive value of 96.4 (95%CI: 91-99) in PE. An increased absolute monocyte count was detected in patients suffering from PE but not DVT, suggesting a possible interaction with the innate immune system.

Childhood and adolescence physical activity and multimorbidity later in life: A systematic review

Background

No systematic summary exists on childhood physical activity and later-life multimorbidity risks. We primarily investigated the association of physical activity in childhood and adolescence and the development of multimorbidity in adulthood. Secondarily, we examined whether physical activity level differ in children and adolescents with and without multimorbidity and whether there is a cross-sectional association between physical activity and multimorbidity.

Methods

Following Cochrane Handbook guidelines and adhering to PRISMA recommendations, we included cross-sectional, case-control and longitudinal studies that investigated the association between physical activity in children and adolescents and development of multimorbidity. Results were summarized narratively and we assessed the certainty of the evidence using the GRADE approach. The protocol was registered in PROSPERO, CRD42023407063.

Results

Of 9064 studies identified, 11 were included in 13 papers. Longitudinals studies suggested that being physically active in childhood and adolescence was associated with a lower risk of multimorbidity in adulthood. Three out of five studies reported lower physical activity level in children and adolescents with multimorbidity compared to those without, and two did not find a between-group difference. Cross-sectional evidence on the association between multimorbidity and lower physical activity was uncertain. Overall, the evidence certainty for all outcomes was considered low due to the indirectness and inconsistency in findings.

Conclusions

Childhood and adolescence physical activity appeared to be linked with a reduced risk of later-life multimorbidity but the certainty of the evidence is low. These results support the promotion of physical activity during childhood and adolescence.

Promoter hypermethylation of SFRP1 as a prognostic and potentially predictive blood-based biomarker in patients with stage III or IV pancreatic ductal adenocarcinoma

BACKGROUND

Pancreatic ductal adenocarcinoma remains one of the major causes of cancer-related mortality globally. Unfortunately, current prognostic biomarkers are limited, and no predictive biomarkers exist. This study examined promoter hypermethylation of secreted frizzled-related protein 1 (phSFRP1) in cfDNA as a prognostic biomarker and predictor of treatment effect in patients with metastatic FOLFIRINOX-treated PDAC and locally advanced PDAC.

METHODS

We performed methylation-specific PCR of the SFRP1 genes' promoter region, based on bisulfite treatment. Survival was assessed as time-to-event data using the pseudo-observation method and analyzed with Kaplan-Meier curves and generalized linear regressions.

RESULTS

The study included 52 patients with FOLFIRINOX-treated metastatic PDAC. Patients with unmethylated (um) SFRP1 (n = 29) had a longer median overall survival (15.7 months) than those with phSFRP1 (6.8 months). In crude regression, phSFRP1 was associated with an increased risk of death of 36.9% (95% CI 12.0%-61.7%) and 19.8% (95% CI 1.9-37.6) at 12 and 24-months, respectively. In supplementary regression analysis, interaction terms between SFRP1 methylation status and treatment were significant, indicating reduced benefit of chemotherapy. Forty-four patients with locally advanced PDAC were included. phSFRP1 was associated with an increased risk of death at 24-months CONCLUSIONS: This indicates that phSFRP1 is a clinically useful prognostic biomarker in metastatic PDAC and possibly in locally advanced PDAC. Together with existing literature, results could indicate the value of cfDNA-measured phSFRP1 as a predictive biomarker of standard palliative chemotherapy in patients with metastatic PDAC. This could facilitate personalized treatment of patients with metastatic PDAC.

Abstract B047: Promoter hypermethylation of SFRP1 as a prognostic and predictive blood-based biomarker in patients with stage IV pancreatic ductal adenocarcinoma

Background: Pancreatic ductal adenocarcinoma (PDAC) is a disease with an abysmal prognosis. Unfortunately, no reliable prognostic or predictive blood-based biomarkers are currently available. An increasingly promising prognostic and predictive tool in cancer is the analysis of genetic and epigenetic alterations in cell-free DNA. One such alteration, promoter hypermethylation (ph) of SFRP1, has recently been linked to poor prognosis in gemcitabine-treated patients with stage IV PDAC. This study aimed to further examine phSFRP1 as a clinically relevant prognostic and predictive biomarker in FOLFIRINOX-treated patients with stage IV PDAC. Methods: Serum samples from patients with stage IV PDAC, treated with first-line FOLFIRINOX, were obtained from two danish biobanks. All blood samples were drawn before the initiation of palliative treatment. Based on a bisulfite treatment, we conducted a methylation-specific polymerase chain reaction analysis of the promoter region of the gene SFRP1. Methylation status was dichotomized based on the measured Cycle threshold. Survival according to SFRP1 promoter methylation status was assessed with Kaplan-Meier curves, log-rank tests, and Cox proportional hazard regression models. The adjusted Cox regression model included SFRP1 promoter methylation status, WHO performance status, age > 65 years, and sex. Results: Fifty-two FOLFIRINOX-treated patients with stage IV PDAC were included in the study. Patients with phSFRP1 (n = 23) had a median overall survival (mOS) of 6.8 months, significantly shorter than patients with unmethylated (um) SFRP1 (n = 29) who had a mOS of 15.7 months (log-rank test, p < 0.01). Likewise, in both crude and adjusted Cox-regression analysis, patients with phSFRP1 had an hazard ratio for death of 2.78 (95% CI 1.55-4.99) and 2.82 (95% CI 1.55-5.14) respectively, compared to patients with umSFRP1. Conclusions: Results indicate that FOLFIRINOX-treated stage IV PDAC patients with phSFRP1 have significantly shorter survival than patients with umSFRP1. Combined with previous literature, this indicates the value of phSFRP1 as a blood-based prognostic biomarker in patients with stage IV PDAC, regardless of the given first-line palliative chemotherapy. In addition, it indicates that phSFRP1 may also have predictive value for chemotherapy sensitivity in patients with stage IV PDAC. This knowledge may facilitate individualized treatment of patients with stage IV PDAC. Additionally, SFRP1 could be a valuable target for treatment with hypomethylating drugs to improve treatment response.

Citation Format: Benjamin E. Stubbe, Stine D. Henriksen, Poul H. Madsen, Anders C. Larsen, Henrik B. Krarup, Inge S. Pedersen, Julia S. Johansen, Carsten P. Hansen, Ole Thorlacius-Ussing. Promoter hypermethylation of SFRP1 as a prognostic and predictive blood-based biomarker in patients with stage IV pancreatic ductal adenocarcinoma [abstract]. In: Proceedings of the AACR Special Conference on Pancreatic Cancer; 2022 Sep 13-16; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2022;82(22 Suppl):Abstract nr B047.

Comprehensive Test of the Brink-Axel Hypothesis in the Energy Region of the Pygmy Dipole Resonance

The validity of the Brink-Axel hypothesis, which is especially important for numerous astrophysical calculations, is addressed for ^{116,120,124}Sn below the neutron separation energy by means of three independent experimental methods. The γ-ray strength functions (GSFs) extracted from primary γ-decay spectra following charged-particle reactions with the Oslo method and with the shape method demonstrate excellent agreement with those deduced from forward-angle inelastic proton scattering at relativistic beam energies. In addition, the GSFs are shown to be independent of excitation energies and spins of the initial and final states. The results provide a critical test of the generalized Brink-Axel hypothesis in heavy nuclei, demonstrating its applicability in the energy region of the pygmy dipole resonance.

Arteria lusoria: a trick of nature

Dysphagia has several typical causes. In this case report a young adult with difficulties in swallowing since childhood is diagnosed with a rare anatomical variation of the aortal branches.

Radiative Width of the Hoyle State from γ-Ray Spectroscopy

The cascading 3.21 and 4.44 MeV electric quadrupole transitions have been observed from the Hoyle state at 7.65 MeV excitation energy in ^{12}C, excited by the ^{12}C(p,p^{'}) reaction at 10.7 MeV proton energy. From the proton-γ-γ triple coincidence data, a value of Γ_{rad}/Γ=6.2(6)×10^{-4} was obtained for the radiative branching ratio. Using our results, together with Γ_{π}^{E0}/Γ from Eriksen et al. [Phys. Rev. C 102, 024320 (2020)PRVCAN2469-998510.1103/PhysRevC.102.024320] and the currently adopted Γ_{π}(E0) values, the radiative width of the Hoyle state is determined as Γ_{rad}=5.1(6)×10^{-3}  eV. This value is about 34% higher than the currently adopted value and will impact models of stellar evolution and nucleosynthesis.

Publisher's Note: Experimental Neutron Capture Rate Constraint Far from Stability [Phys. Rev. Lett. 116, 242502 (2016)]

This corrects the article DOI: 10.1103/PhysRevLett.116.242502.

Strong Neutron-γ Competition above the Neutron Threshold in the Decay of ^{70}Co

The β-decay intensity of ^{70}Co was measured for the first time using the technique of total absorption spectroscopy. The large β-decay Q value [12.3(3) MeV] offers a rare opportunity to study β-decay properties in a broad energy range. Two surprising features were observed in the experimental results, namely, the large fragmentation of the β intensity at high energies, as well as the strong competition between γ rays and neutrons, up to more than 2 MeV above the neutron-separation energy. The data are compared to two theoretical calculations: the shell model and the quasiparticle random phase approximation (QRPA). Both models seem to be missing a significant strength at high excitation energies. Possible interpretations of this discrepancy are discussed. The shell model is used for a detailed nuclear structure interpretation and helps to explain the observed γ-neutron competition. The comparison to the QRPA calculations is done as a means to test a model that provides global β-decay properties for astrophysical calculations. Our work demonstrates the importance of performing detailed comparisons to experimental results, beyond the simple half-life comparisons. A realistic and robust description of the β-decay intensity is crucial for our understanding of nuclear structure as well as of r-process nucleosynthesis.

Erratum: Spectroscopic Quadrupole Moments in ^{96,98}Sr: Evidence for Shape Coexistence in Neutron-Rich Strontium Isotopes at N=60 [Phys. Rev. Lett. 116, 022701 (2016)]

This corrects the article DOI: 10.1103/PhysRevLett.116.022701.

Experimental Neutron Capture Rate Constraint Far from Stability

Nuclear reactions where an exotic nucleus captures a neutron are critical for a wide variety of applications, from energy production and national security, to astrophysical processes, and nucleosynthesis. Neutron capture rates are well constrained near stable isotopes where experimental data are available; however, moving far from the valley of stability, uncertainties grow by orders of magnitude. This is due to the complete lack of experimental constraints, as the direct measurement of a neutron-capture reaction on a short-lived nucleus is extremely challenging. Here, we report on the first experimental extraction of a neutron capture reaction rate on ^{69}Ni, a nucleus that is five neutrons away from the last stable isotope of Ni. The implications of this measurement on nucleosynthesis around mass 70 are discussed, and the impact of similar future measurements on the understanding of the origin of the heavy elements in the cosmos is presented.

Spectroscopic Quadrupole Moments in {96,98}Sr: Evidence for Shape Coexistence in Neutron-Rich Strontium Isotopes at N=60

Neutron-rich {96,98}Sr isotopes have been investigated by safe Coulomb excitation of radioactive beams at the REX-ISOLDE facility. Reduced transition probabilities and spectroscopic quadrupole moments have been extracted from the differential Coulomb excitation cross sections. These results allow, for the first time, the drawing of definite conclusions about the shape coexistence of highly deformed prolate and spherical configurations. In particular, a very small mixing between the coexisting states is observed, contrary to other mass regions where strong mixing is present. Experimental results have been compared to beyond-mean-field calculations using the Gogny D1S interaction in a five-dimensional collective Hamiltonian formalism, which reproduce the shape change at N=60.

Validity of the Generalized Brink-Axel Hypothesis in (238)Np

We analyze primary γ-ray spectra of the odd-odd (238)Np nucleus extracted from (237)Np(d,pγ)(238)Np coincidence data measured at the Oslo Cyclotron Laboratory. The primary γ spectra cover an excitation-energy region of 0≤E(I)≤5.4  MeV, and allow us to perform a detailed study of the γ-ray strength as a function of excitation energy. Hence, we can test the validity of the generalized Brink-Axel hypothesis, which, in its strictest form, claims no excitation-energy dependence on the γ strength. In this work, using the available high-quality (238)Np data, we show that the γ-ray strength function is to a very large extent independent of the initial and final states. Thus, for the first time, the generalized Brink-Axel hypothesis is experimentally verified for γ transitions between states in the quasicontinuum region, not only for specific collective resonances, but also for the full strength below the neutron separation energy. Based on our findings, the necessary criteria for the generalized Brink-Axel hypothesis to be fulfilled are outlined.

Venous thrombosis in pancreaticobiliary tract cancer: outcome and prognostic factors

BACKGROUND

The differences in outcome among cancer patients with incidental vs. symptomatic venous thromboembolism (VTE) are unknown. In this study, patients with extrahepatic pancreaticobiliary tract cancer (PBC) were selected for a prospective cohort study between February 2008 and February 2011.

METHODS

At the time of cancer diagnosis, all patients were examined for deep vein thrombosis with bilateral compression ultrasonography (biCUS). Computed tomography pulmonary angiography was also performed to diagnose pulmonary embolisms. After inclusion, the patients were followed up with clinical examinations, blood collections, and biCUS.

RESULTS

A total of 121 PBC patients were enrolled. At the time of cancer diagnosis, 15 patients had experienced a VTE (12.4%, 95% confidence interval [CI] 7.1-19.6), including six symptomatic and nine incidental cases. A total of 25 first-time VTE events were identified (20.7%; 95% CI 13.8-29.0). Patients with a VTE had reduced survival, with a median overall survival (OS) of 4.4 months (95% CI 2.2-11.5). The median OS of the patients with incidental VTE was 3.0 months (95% CI 0.1-15.0), which was not different from the median OS of the patients with symptomatic VTE (5.0 months; 95% CI 2.1-14.5). The median OS was 11.9 months (95% CI 8.1-14.7) in the PBC patients with no VTEs.

CONCLUSION

The occurrence of a VTE event in a PBC patient within the first months of the disease is associated with significantly increased mortality.

Large low-energy M1 strength for ^{56,57}Fe within the nuclear shell model

A strong enhancement at low γ-ray energies has recently been discovered in the γ-ray strength function of ^{56,57}Fe. In this work, we have for the first time obtained theoretical γ decay spectra for states up to ≈8  MeV in excitation for ^{56,57}Fe. We find large B(M1) values for low γ-ray energies that provide an explanation for the experimental observations. The role of mixed E2 transitions for the low-energy enhancement is addressed theoretically for the first time, and it is found that they contribute a rather small fraction. Our calculations clearly show that the high-ℓ(=f) diagonal terms are most important for the strong low-energy M1 transitions. As such types of 0ℏω transitions are expected for all nuclei, our results indicate that a low-energy M1 enhancement should be present throughout the nuclear chart. This could have far-reaching consequences for our understanding of the M1 strength function at high excitation energies, with profound implications for astrophysical reaction rates.

Novel technique for constraining r-process (n, γ) reaction rates

A novel technique has been developed, which will open exciting new opportunities for studying the very neutron-rich nuclei involved in the r process. As a proof of principle, the γ spectra from the β decay of ^{76}Ga have been measured with the SuN detector at the National Superconducting Cyclotron Laboratory. The nuclear level density and γ-ray strength function are extracted and used as input to Hauser-Feshbach calculations. The present technique is shown to strongly constrain the ^{75}Ge(n,γ)^{76}Ge cross section and reaction rate.

Shape coexistence in the neutron-deficient even-even (182-188)Hg isotopes studied via coulomb excitation

Coulomb-excitation experiments to study electromagnetic properties of radioactive even-even Hg isotopes were performed with 2.85  MeV/nucleon mercury beams from REX-ISOLDE. Magnitudes and relative signs of the reduced E2 matrix elements that couple the ground state and low-lying excited states in Hg182-188 were extracted. Information on the deformation of the ground and the first excited 0+ states was deduced using the quadrupole sum rules approach. Results show that the ground state is slightly deformed and of oblate nature, while a larger deformation for the excited 0+ state was noted in Hg182,184. The results are compared to beyond mean field and interacting-boson based models and interpreted within a two-state mixing model. Partial agreement with the model calculations was obtained. The presence of two different structures in the light even-mass mercury isotopes that coexist at low excitation energy is firmly established.

Prevalence of venous thromboembolism at diagnosis of upper gastrointestinal cancer

BACKGROUND

Venous thromboembolism (VTE) in patients with upper gastrointestinal (GI) cancer increases morbidity and mortality. This study aimed to determine the prevalence of VTE at diagnosis of upper GI cancer.

METHODS

Patients admitted between February 2008 and February 2011 with upper GI cancer (pancreatic, extrahepatic biliary, lower oesophageal, gastro-oesophageal junction or gastric cancer) were investigated in a cross-sectional cohort study. At cancer diagnosis, all patients were examined for deep vein thrombosis (DVT) by means of bilateral compression ultrasonography. From February 2009 and onwards, computed tomographic pulmonary angiography (CTPA) was also performed for the diagnosis of pulmonary embolism (PE).

RESULTS

Some 250 patients had ultrasonography; CTPA was performed in 143 patients on admission. DVT was detected in 13 (5·2 per cent) of the 250 patients, eight (3·2 per cent) of whom were asymptomatic. DVT was correlated with tumour location in the pancreaticobiliary tract (odds ratio (OR) 6·27, 95 per cent confidence interval 1·18 to 33·38; P = 0·031) and tumour stage IV (OR 19·34, 2·33 to 160·70; P = 0·006). PE was detected in 11 (7·7 per cent) of 143 patients, eight (5·6 per cent) of whom were asymptomatic. PE embolism was also significantly more common in patients with pancreaticobiliary tract cancer (OR 7·81, 1·28 to 47·62; P = 0·026) and in those with stage IV disease (OR 17·19, 1·83 to 161·50; P = 0·013).

CONCLUSION

The prevalence of VTE at cancer diagnosis was significantly higher in patients with pancreaticobiliary tract cancer than in those with other forms of upper GI cancer, and in patients with advanced cancer stage.

Evidence for the dipole nature of the low-energy γ enhancement in 56Fe

The γ-ray strength function of 56Fe has been measured from proton-γ coincidences for excitation energies up to ≈11  MeV. The low-energy enhancement in the γ-ray strength function, which was first discovered in the (3He,αγ)56Fe reaction, is confirmed with the (p,p'γ)56Fe experiment reported here. Angular distributions of the γ rays give for the first time evidence that the enhancement is dominated by dipole transitions.

Low-energy enhancement of magnetic dipole radiation

Magnetic dipole strength functions are deduced from averages of a large number of M1 transition strengths calculated within the shell model for the nuclides 90Zr, 94Mo, 95Mo, and 96Mo. An enhancement of M1 strength toward low transition energy is found for all nuclides considered. Large M1 strengths appear for transitions between close-lying states with configurations including proton as well as neutron high-j orbits that recouple their spins and add up their magnetic moments coherently. The M1 strength function deduced from the calculated M1 transition strengths is compatible with the low-energy enhancement found in (3He, 3He') and (d, p) experiments. The Letter presents an explanation of the experimental findings.

Observation of large scissors resonance strength in actinides

The orbital M1 scissors resonance has been measured for the first time in the quasicontinuum of actinides. Particle-γ coincidences are recorded with deuteron and (3)He-induced reactions on (232)Th. The residual nuclei (231,232,233)Th and (232,233) Pa show an unexpectedly strong integrated strength of B(M1)=11-15μ(n)(2) in the E(γ)=1.0-3.5 MeV region. The increased γ-decay probability in actinides due to scissors resonance is important for cross-section calculations for future fuel cycles of fast nuclear reactors and may also have an impact on stellar nucleosynthesis.

Enhanced radiative strength in the quasicontinuum of 117Sn

The radiative strength function of 117Sn has been measured up to the neutron separation energy using the (3He, 3He' gamma) reaction. An increase in the slope of the strength function around E gamma=4.5 MeV indicates the onset of a resonancelike structure, giving a significant enhancement of the radiative strength function compared to standard models in the energy region 4.5<or=E gamma<or=8.0 MeV. For the first time, the functional form of this resonancelike structure has been measured in an odd tin nucleus below neutron threshold in the quasicontinuum region.

Measurement of the sign of the spectroscopic quadrupole moment for the 2(1)+ state in 70Se: no evidence for oblate shape

Using a method whereby molecular and atomic ions are independently selected, an isobarically pure beam of 70Se ions was postaccelerated to an energy of 206 MeV using REX-ISOLDE. Coulomb-excitation yields for states in the beam and target nuclei were deduced by recording deexcitation gamma rays in the highly segmented MINIBALL gamma-ray spectrometer in coincidence with scattered particles in a silicon detector. At these energies, the Coulomb-excitation yield for the first 2+ state is expected to be strongly sensitive to the sign of the spectroscopic quadrupole moment through the nuclear reorientation effect. Experimental evidence is presented here for a prolate shape for the first 2+ state in 70Se, reopening the question over whether there are, as reported earlier, deformed oblate shapes near to the ground state in the light selenium isotopes.