The Associations between Intakes of One-Carbon Metabolism-Related Vitamins and Breast Density among Young Women

BACKGROUND

Folate is the primary methyl donor and B vitamins are cofactors for one-carbon metabolism that maintain DNA integrity and epigenetic signatures implicated in carcinogenesis. Breast tissue is particularly susceptible to stimuli in early life. Only limited data are available on associations of one-carbon metabolism-related vitamin intake during youth and young adulthood with breast density, a strong risk factor for breast cancer.

METHODS

Over 18 years in the DISC and DISC06 Follow-up Study, diets of 182 young women were assessed by three 24-hour recalls on five occasions at ages 8 to 18 years and once at 25 to 29 years. Multivariable-adjusted linear mixed-effects regression was used to examine associations of intakes of one-carbon metabolism-related vitamins with MRI-measured percent dense breast volume (%DBV) and absolute dense breast volume (ADBV) at ages 25 to 29 years.

RESULTS

Folate intake in youth was inversely associated with %DBV (Ptrend = 0.006) and ADBV (Ptrend = 0.02). These inverse associations were observed with intake during post-, though not premenarche. In contrast, premenarche vitamin B2 intake was positively associated with ADBV (Ptrend < 0.001). Young adult folate and vitamin B6 intakes were inversely associated with %DBV (all Ptrend ≤ 0.04), whereas vitamins B6 and B12 were inversely associated with ADBV (all Ptrend ≤ 0.04).

CONCLUSIONS

Among these DISC participants intakes of one-carbon metabolism-related vitamins were associated with breast density. Larger prospective studies among diverse populations are needed to replicate these findings.

IMPACT

Our results suggest the importance of one-carbon metabolism-related vitamin intakes early in life with development of breast density and thereby potentially breast cancer risk later in life.

The need to monitor emerging issues in etomidate usage: the misuse or abuse potential

Since 2011, the misuse or abuse of etomidate has gradually increased when propofol was designated a controlled drug under the Narcotics Control Act in Korea. Accordingly, the Ministry of Food and Drug Safety announced that etomidate would be under the 'Regulation on the designation of drugs that may cause concerns of misuse or abuse' rule in June 2020, which is less stringent than the Narcotics Control Act. Therefore, this review investigates potential misuse or abuse cases of etomidate to consider strengthening its management. A literature search was conducted to compare etomidate with other sedatives in their efficacy and side effects, as well as identify the adverse health outcomes, abuse cases, and analytical methods of etomidate. Etomidate has an equal or higher sedative efficacy and lower risk of adverse cardiopulmonary events than propofol. However, major adverse effects of etomidate include adrenocortical suppression and unproven associated deaths, as well as myoclonus requiring pre-treatment. Although the issue of abuse and misuse of etomidate is emerging in recent years, there are few academic reports on these issues and analytical methods in the forensic field. In order to effectively manage the misuse or abuse of etomidate, it is necessary to continuously monitor related cases with great interest and to be more intensively studied on its abuse potential.

Temporal Changes in Innate and Adaptive Immunity During Sepsis as Determined by ELISpot

Background

The inability to evaluate host immunity in a rapid quantitative manner in patients with sepsis has severely hampered development of novel immune therapies. The ELISpot assay is a functional bioassay that measures the number of cytokine-secreting cells and the relative amount of cytokine produced at the single-cell level. A key advantage of ELISpot is its excellent dynamic range enabling a more precise quantifiable assessment of host immunity. Herein, we tested the hypothesis on whether the ELISpot assay can detect dynamic changes in both innate and adaptive immunity as they often occur during sepsis. We also tested whether ELISpot could detect the effect of immune drug therapies to modulate innate and adaptive immunity.

Methods

Mice were made septic using sublethal cecal ligation and puncture (CLP). Blood and spleens were harvested serially and ex vivo IFN-γ and TNF-α production were compared by ELISpot and ELISA. The capability of ELISpot to detect changes in innate and adaptive immunity due to in vivo immune therapy with dexamethasone, IL-7, and arginine was also evaluated.

Results

ELISpot confirmed a decreased innate and adaptive immunity responsiveness during sepsis progression. More importantly, ELISpot was also able to detect changes in adaptive and innate immunity in response to immune-modulatory reagents, for example dexamethasone, arginine, and IL-7 in a readily quantifiable manner, as predicted by the reagents known mechanisms of action. ELISpot and ELISA results tended to parallel one another although some differences were noted.

Conclusion

ELISpot offers a unique capability to assess the functional status of both adaptive and innate immunity over time. The results presented herein demonstrate that ELISpot can also be used to detect and follow the in vivo effects of drugs to ameliorate sepsis-induced immune dysfunction. This capability would be a major advance in guiding new immune therapies in sepsis.

Awareness survey on drug crime scene investigation and drug detection kits among drug-related police officers

This questionnaire-based study aimed to investigate the drug crime scene experienced by drug-related police officers and the perceptions of drug test kits by them before initiating the development of drug test kits to detect 16 types of drugs. The subjects were 57 drug-related police officers. Most of the respondents (96.5%) had <10 years of experience in drug-related work. Respondents were questioned about the drug scene investigation and perceptions of drug test kits. The questionnaire about drug test kits included the question on 'simple/rapid drug test kit' and 'electronic portable drug analyzer' regarding the disadvantages of existing kits and expecting features when a new kit is developed. First, in the on-site survey, the drug-related crime occurred at the suspect's house (47.8%), and methamphetamine (35.0%) and γ-hydroxybutyric acid (19.5%) were mainly found. In the awareness survey on drug test kits, most respondents (67.2%) had an experience of using 'simple/rapid drug test kits', whereas 17.5% for the 'electronic portable drug analyzer'. In the case of 'simple/rapid drug test kit', the false-positive rate reached 53.8% by a misinterpretation due to ambiguous color change (47.6%). The inaccuracy of the result (33.3%) was the most concern in 'electronic portable drug analyzer'. Respondents most favored pipette type for sample collector when a new kit is developed. In addition, they preferred the smaller kit with short detection times in both kit types. This survey could be applied to the development of efficient and practical kits for police officers working in drug-related fields.

Impacts on the short-term outcome of patients with Tako-Tsubo syndrome

Background

Tako-Tsubo syndrome (TTS) is a form of acute heart failure which mostly affects postmenopausal women, often following an emotional or physical trigger factor. There are many hypotheses for the development of TTS but the complete pathophysiology still remains unclear. Although most patients recover after a few days, some have to be treated at the intensive care unit (ICU) and may even die from the condition.

Purpose

The aim of this study was to find out if pre-existing diseases, cardiovascular risk factors (CVRF), comorbidities and trigger factors have any impact on the short-term outcome of TTS patients.

Methods

Data of all patients who presented to our centre with TTS from 2009–2017 were gathered retrospectively. Baseline characteristics, including somatic and psychiatric pre-existing diseases, CVRF (smoking, hypertension, diabetes, dyslipidaemia) as well as physical and emotional trigger factors were collected. Somatic diseases were additionally categorised into cardiac, autoimmune, malignant and other diseases. Admission to intensive care unit post TTS and/or in-hospital death were defined as poor short-term outcome. Outcome predictors were analysed with binary logistic regression model using the combined variable admission to an ICU and/or death.

Results

Out of 102 patients, 84 (82.4%) were females and 18 (17.6%) males with a median age of 65±15 years. 30 (29.4%) patients had an emotional and 23 (22.5%) a physical trigger factor. 27 (26.5%) had a psychiatric and 88 (86.3%) a somatic pre-existing disease. 33 (32.4%) patients were smokers, 58 (56.3%) had hypertension and 18 (17.5%) were diabetics. 19 patients (18.6%) had to be admitted to ICU and 8 patients (7.8%) died.

No pre-existing diseases, baseline characteristics, CVRF or comorbidities behaved as significant independent predictor for bad outcome in TTS patients. Physical trigger was the only significant predictor for ICU admission and/or death (p=0.012).

Conclusion

Our study showed that patients with physical trigger factors have a higher risk of ICU admission and/or death than patients with emotional or no stressful trigger factors before TTS and should therefore be monitored closely. Interestingly, contrary to many other acute cardiac diseases, pre-existing diseases, cardiovascular risk factors and comorbidities do not seem to have any impact on the short-term outcome of patients with TTS.

Funding Acknowledgement

Type of funding sources: None.

Elevated high-sensitivity C-reactive protein and the risk for cardiovascular events in chronic cardiac disease

Background

High sensitivity C-reactive protein (hs-CRP) is a biomarker used for risk prediction for cardiovascular disease by assessing low concentration of inflammation. This study aims to assess the event-free time for the composite outcome between patients of different hs-CRP risk groups and the possible predictive value of hs-CRP for event occurrence in patients with chronic cardiac disease.

Methods

Data from 607 consecutive patients referred for cardiovascular risk assessment with hs-CRP from November 2017 to October 2018 were reviewed retrospectively. Routine peripheral venous blood samples were taken on the day of study inclusion and sent to the local laboratory, where laboratory parameters were analyzed and processed in accordance with local laboratory standards. 570 patients who had hs-CRP measurement by immunoturbidimetric assay were included in the analysis and classified into three (low-, medium- and high-risk) groups (hs-CRP cut-off: &lt;1, 1–3, &gt;3 mg/L). Association between hs-CRP and occurrence of the composite outcome (acute myocardial infarction, stroke, coronary intervention (percutaneous coronary intervention or bypass surgery) or death) was determined with Cox regression analysis and visualized with Kaplan Meier curves.

Results

In total, 570 patients from our cardiology outpatient clinic were included in this study. Cohorts were formed according to hs-CRP risk groups, 209 (36.7%), 226 (39.6%) and 135 (23.7%) patients were classified as low-, medium- and high-risk, respectively. The composite endpoint occurred in 93 (19.1%) of the 486 patients with available follow-up. Events occurred in 29 (16.3%), 30 (15.7%), 34 (29.1%) patients of the low-, medium- and high-risk group, respectively (p=0.016). There was a significant difference in the event-free survival time patients of the low- and medium-risk groups compared with patients in the high-risk group (p=0.015). The difference between groups is shown by the Kaplan-Meier plot (log rank test, p=0.01) (Figure 1). Univariate Cox proportional-hazard analysis identified age, hs-CRP risk group, hypertension, diabetes, hyperlipidemia, coronary artery disease, peripheral artery disease, cerebrovascular disease log(NT-proBNP) and creatinine as significant predictors for the primary study outcome. In multivariable analysis coronary artery disease and age were found to be highly significant predictors for the occurrence of an composite event during follow-up, while patients categorized in the low- and medium-risk groups appeared to predict a lower likelihood for events (Table 1).

Conclusions

Cardiovascular events were more likely to occur in patients who were older, with hs-CRP &gt;3 mg/L and a history of coronary artery disease. However, assessment of inflammation markers alone may play a secondary role compared to other established cardiovascular risk factors, elevated CRP appears helpful to detect higher risk and in prediction of further cardiovascular events and mortality.

Funding Acknowledgement

Type of funding sources: None.

Temporal evolution of the key neurohumoral regulator renin in chronic stable HFrEF

Background

Renin is the enzyme catalyzing the rate-limiting step of the Renin-Angiotensin-System (RAS) generating Angiotensin II (AngII). RAS inhibitors are a main pillar of current heart failure with reduced ejection fraction (HFrEF). Although used since over 30 years in clinical routine, the studied effects of RAS-inhibitors on renin level changes during the course of HFrEF and its impact on patient outcomes, especially under current guideline directed medical therapy (GDMT), are lacking.

Methods

Consecutive patients with stable chronic HFrEF and GDMT were enrolled prospectively from the our outpatient unit of heart failure between 06/2013 and 08/2021. Active plasma renin concentration (ARC) was documented for all patients consecutively at first measurement, i.e. baseline (BL), and at follow-up (FUP) visits at 12, 24, 36, 48 and 60 months, respectively. BL renin was correlated with N-terminal pro B-type natriuretic peptide (NT-proBNP) and compared between NYHA class, HF medication use and renin levels between baseline and FUP timepoints. To assess the effect of changes in renin levels, patients were categorized into three groups based on the change of renin from baseline within the first year of observation: decrease = change &gt;−50%, undulating=change between −50 to 50%, increase=change&gt;50% and survival curves were displayed as Kaplan-Meier plots and compared for different ARC categories by the log-rank test.

Results

A total of 491 patients were included in the study. BL characteristics are shown in Table1. Renin levels showed no relationship with HF severity reflected by a lack of correlation with NT-proBNP [rs=−0.05, p=0.273] and comparable levels between NYHA groups [p=0.753] (Figure 1A). Renin levels were further comparable for different RAS inhibitors and patients with and without beta blockers, however higher in patients with mineralocorticoid receptor antagonists (MRA) [189 μIE/ml vs. 59 μIE/ml, p=0.0001] and SGLT2-inhibitors [280 μIE/ml vs. 100 μIE/ml, p=0.004] (Figure 1B). Renin levels at different yearly FUP timepoints are displayed in Figure 1C. There was no significant difference in renin levels between BL and 1-year FUP, while renin concentration was increased at 2-year FUP [126 μIE/ml vs. 243 μIE/ml, p=0.002]. Baseline renin levels were not associated with survival [crude HR for an increase of 100μiE/ml 1.014 (95% CI: 0.997–1.032), p=0.102]. Within one year following BL, renin decreased in 77 (27.6%), was undulating in 74 (26.5%) and increased in 128 (45.9%) patients. Kaplan-Meier suggests worse survival for patients with increasing renin though the difference was statistically not significant [p=0.2573] (Figure 1D).

Conclusion

Renin was elevated in patients with MRA and/or SGLT2-inhibitors. Renin tends to increase over time in stable HFrEF. Although RAS is the main target of HFrEF therapy, surprisingly there seems to be no strong association between RAS activation and thereby potential effectivity of achieved RAS-blockade and outcome.

Funding Acknowledgement

Type of funding sources: None.

Development of an Analytical Method for Detection of Anesthetics and Sedatives in Fish

BACKGROUND

Anesthetics and sedatives are frequently used to prevent abrasions caused by stress and facilitate fish management. However, drug residues may persist and cause changes in fish conditions and induce side effects. In addition, drugs that are not permitted for use in edible fish are sometimes potentially used in fish. The drugs can also be found in wastewater and are likely to be detected in fish.

OBJECTIVE

The purpose of this study was to establish a quantitative analytical method for 10 anesthetic and sedative (azaperone, chlorpromazine, diazepam, estazolam, haloperidol, nitrazepam, nordiazepam, oxazepam, perphenazine, and temazepam) residues in fish sold in Korean markets.

METHODS

Shrimp, flounder, and eel samples were selected as matrices. Acetonitrile (ACN) containing 0.1% formic acid was selected as an extraction solvent for shrimp and 100% ACN for flounder and eel. The QuEChERS method with C18 and PSA was used as the extraction procedure, and the analysis was performed by LC-MS/MS.

RESULTS

Limit of quantitation, recovery, accuracy, and precision were validated, and satisfactory results were obtained for the drugs. All results applied to the real samples were negative.

CONCLUSION

An optimal validation method was studied. Since the results for all samples were negative, it is considered that additional studies are needed by increasing the number of drugs.

HIGHLIGHTS

The most effective QuEChERS pretreatment method and conditions of LC-MS/MS for the analysis of anesthetics and sedatives in fish were established.

Agreement between high-sensitivity C-reactive protein and C-reactive protein assays

Background

High sensitivity C-reactive protein (hs-CRP) is a biomarker used for risk prediction for cardiovascular disease (CVD) by assessing low concentrations of inflammatory markers. Measurements of regular CRP assays have become very sensitive too with a detection limit of 0.03mg/dL, while also being more available and cheaper. The aim of this study is to compare the association between CRP and hs-CRP.

Methods

This study compared CRP and hs-CRP serum concentrations and data acquired by medical chart review of 590 patients from 11/2017 to 10/2018 of our cardiology outpatient clinic who were divided into hs-CRP and CRP risk groups for CVD events: low&lt;0.1 mg/dL, average 0.1–0.3mg/dL, high&gt;0.3mg/dL. The agreement of classification in hs-CRP and CRP risk groups was assessed by kappa statistic, with Kappa coefficient of &lt;0.20, 0.21–0.40, 0.41–0.60, 0.61–0.80, 0.81–0.99 interpreted as slight, fair, moderate, substantial and almost perfect agreement, respectively. Bland-Altman (BA) analysis was used to assess agreement between hs-CRP and CRP by plotting the mean of the two measurements on the x-axis against the mean difference of CRP - hs-CRP on the y-axis.

Results

Out of all 590 patients, 37.7% were in low risk, 33.9% in average risk and 28.5% in high risk hs-CRP group. Some group changes occurred after reclassification of the patients according to CRP measurements. Eight percent of patients reclassified into a higher risk group, 0.7% into a lower risk group, while 91.4% remained in the same risk group as determined by hs-CRP (kappa: 0.87; p&lt;0.001) (Tab. 1). Important to note, there was a 100% agreement between the high-risk CRP and hs-CRP group patient classification. BA-plot displayed a fixed bias with an average difference between the two laboratory tests for CRP and hs-CRP of 0.02 mg/dL±0.09SD with only sporadic outliers (Fig. 1). The upper limit of agreement was 0.12 and lower limit of agreement was −0.07. In the lower range of CRP values, measurements were tightly clustered around the average difference. Greater variability could be observed at higher serum level of the inflammatory biomarker in the BA-plot with a bias to higher CRP concentrations than hs-CRP concentrations at values greater than 0.5mg/dL. This proportional bias, which was further demonstrated by linear regression analysis, does not affect the risk predicting qualities of hs-CRP or CRP for CVD because the cut-off values for risk groups (0.1mg/dL for low risk, 0.3mg/dL for high risk) are all below this threshold.

Conclusion

A close agreement between measurements of hs-CRP and CRP assays was identified, therefore regular CRP assays could replace hs-CRP for cardiac risk assessment. Benefits for clinical implementation are: First, CRP assessment is routinely available in most laboratories compared to hs-CRP. Second, CRP is less costly than hs-CRP, since no further laboratory acquisitions are necessary, which is especially relevant in regions where cost efficiency is of importance.

Funding Acknowledgement

Type of funding sources: None. Table 1. Kappa statisticFigure 1. Bland-Altman plot

Impact of overweight or obesity trajectory on health expenditure in Korea

BACKGROUND

This study aimed to identify the effect of the overweight or obesity (OWOB) trajectory on current health care expenditure in South Korea.

METHODS

Ten years of publicly released data (2002-12) were obtained in 2016 from a retrospective cohort of National Health Insurance System claims. This study included 51,844 adults (aged 30-59 years in 2002) and 21,196 elderly adults (aged ≥ 60 years in 2002).

RESULTS

Compared with adults who maintained normal weight (NW), higher yearly total health expenditures were estimated for adults who lost weight over the 10-year period: by 11.5% (95% confidence interval (CI): 0.18-22.96%) when changing from NW to underweight (UW) and 6.2% (95% CI: 0.47-12.01%) from OWOB to UW/NW. Elderly adults had higher health expenditures when they lost weight by 14.0% (95% CI: 0.37-27.70%) from NW to UW and 6.8% (95% CI: 0.13-13.51%) from OWOB to UW/NW compared with when they maintained NW.

CONCLUSIONS

These findings indicate the importance of early intervention to control OWOB, particularly because people in late adulthood have greater health care needs for reasons other than OWOB.

Cognitive Intervention with Musical Stimuli Using Digital Devices on Mild Cognitive Impairment: A Pilot Study

The effect of music therapy on cognitive function has been widely reported; however, its clinical implications remain controversial. Performing therapeutic musical activities in groups using individualized instruments can help overcome the issues of engagement and compliance. We aimed to evaluate the effect of a cognitive intervention with musical stimuli using digital devices on mild cognitive impairment (MCI). In this prospective study, 24 patients with MCI (intervention group, 12; and control group, 12) were enrolled. We developed an electronic device with musical instruments and the Song-based Cognitive Stimulation Therapy protocol (SongCST). Patients in the intervention group underwent a 10-week cognitive intervention involving musical stimuli generated by our device. Effect of the intervention on cognitive function was evaluated by the Mini-Mental State Examination-Dementia Screening (MMSE-DS), Montreal Cognitive Assessment-Korean (MOCA-K), and Clinical Dementia Rating Scale Sum of Boxes (CDR-SOB). In the intervention group, MMSE-DS and MOCA-K scores improved significantly after the 10-week intervention. The changes in MOCA-K and CDR-SB scores were significantly different between the intervention and control groups. Our study showed that music therapy with digital devices has a positive effect on the executive function and overall disease severity in patients with MCI. Our study can facilitate individualization of music therapy using digital devices in groups.

The incidence and seasonal variation of necrotizing fasciitis in Korea: a nationwide cross-sectional study

INTRODUCTION

Necrotizing fasciitis (NF) is a rare but fatal disease, and there is no known annual incidence of NF in Korea. The aim of this study was to investigate the incidence and seasonal variation of NF in Korea.

METHODS

We analysed claims from the nationwide Korean Health Insurance Review and Assessment Service database. Patients who were hospitalized with an NF diagnosis code and received surgical intervention were classified as NF cases. Poisson regression models were used to assess the relationships of incidence rates with year, age and sex. A multivariate Poisson regression model was used to investigate variations in monthly NF incidence trends.

RESULTS

From 2012 to 2017, the overall average annual NF incidence rate was found to be 0.86 per 100 000 population. NF incidence increased with age and was 2.5 times higher among males across all age groups. Two-thirds of cases occurred among patients with diabetes. The peak NF incidence occurred during the summer. Multivariate Poisson regression modelling using national meteorological variables suggested that mean temperatures and number of NF cases in the previous month were associated with the number of NF cases in the current month.

DISCUSSION

Clinicians should consider NF when encountering an elderly man with diabetes during the summer.

P869 Effect of transcatheter MitraClip implantation on exercise performance evaluated by CPET

Methods

Total body bone scintigraphy, 714 MBq 99m-Tc DPD, was performed to confirm the diagnosis of cardiac transthyretin (ATTR) amyloidosis. The extent of mitral regurgitation was assessed using TTE and TEE before and after MC implantation. Coronary angiography and right heart catheterization were performed prior to MC implantation. CPET by a cycle ergometer was used to measure the dynamic response of the heart before and after the procedure. A ramp protocol, adapted to reach maximal capacity after 8-10 min was chosen for the test. The parameter of main interest was maximal oxygen uptake (VO2 max, ml/min), the major factor known to limit exercise capacity.

Results

Bone scan showed tracer accumulation in myocardial tissue, genetic testing was negative which confirmed wild type cardiac transthyretin (ATTR) amyloidosis. Significant coronary artery disease was excluded by coronary angiography. Right heart catheterization disclosed post capillary pulmonary hypertension: mean pulmonary artery pressure of 42 mmHg and mean pulmonary capillary wedge pressure of 25 mmHg and end-diastolic pressure of left ventricle of 118 mmHg. A high grade left ventricular concentric hypertrophy (IVS = 26mm) with slightly reduced left systolic function, a severe MR (EROA = 35 mm2) and enlargement of left and right atria (LA = 68mm, RA = 68mm) were demonstrated by TTE. In TEE left atrium including left atrial appendage were free from thrombi; high grade left ventricular hypertrophy, restriction of posterior leaflet and severe MR with eccentric jet with dilated annulus were demonstrated. CPET before MC implantation: VO2 max 1299 ml/min (83% of predicted peak oxygen uptake value). MC implantation was performed with no post-procedural complications. Follow-up CPET showed higher VO2 max 1373 ml/min compared to the data before MC implantation (88% predicted peak oxygen uptake value).

Conclusions

TTE and TEE are the most common and accurate imaging modalities to evaluate MR regarding MitraClip evaluation. After the MC procedure the dynamic response of the heart can be observed by CPET with VO2 as a surrogate marker for heart function.

Abstract P869 Figure. a.b. TEE prior to MC, c.d. TEE after MC

P974 Sacubitril/valsartan is well tolerated in patients with heart failure and a history of cancer

Introduction

Sacubitril/valsartan has been shown to significantly reduce cardiovascular mortality and hospitalisations due to heart failure in patients with reduced ejection fraction when compared to enalapril. Until now, sacubitril/valsartan has not been evaluated in patients with a history of cancer, as these patients were excluded from the pivotal trial, PARADIGM-HF. The aim of the current study was to assess tolerability of sacubitril/valsartan in patients with a history of cancer.

Methods

We retrospectively enrolled all patients at our heart failure out-patient unit who fulfilled the indication criteria to receive sacubitril/valsartan and had a history of cancer. Fifteen patients receiving sacubitril/valsartan had a diagnosis of histologically confirmed cancer: 26.7% breast cancer (n = 4), 13.3% osteosarcoma (n = 2), 13.3% colorectal cancer (n = 2), 13.3% renal cell carcinoma (n = 2), 6.7% non-Hodgkin lymphoma (n = 1), 6.7% lung cancer (n = 1), 6.7% prostate cancer (n = 1), 6.7% bladder carcinoma and 6.7% myeoloproliferative syndrome (n = 1). Surgery due to cancer was performed in 80% of patients (n = 12), 26.7% previously received chemotherapy (n = 6) and 40% radiation therapy (n = 4).

Results

Sacubitril/valsartan was withdrawn in 2 patients (13.3%) because of dizziness and pruritus respectively. After a mean follow-up of 13 ±8 months, NYHA functional class improved significantly (mean -0.5, p = 0.001), ejection fraction as assassed by echocardiography increased (mean +6.8%, p = 0.018) and NT-proBNP was significantly decreased (mean -1552pg/ml, p = 0.026). There was no significant change in creatinine levels (+0.046 mg/dl, p = 0.564 ).

Conclusions

In this pilot study we were able to show that sacubitril/valsartan is generally well tolerated in patients with a history of cancer. Patients with cardiotoxicity induced heart failure can be treated and uptitrated with sacubitril/valsartan to usual dosages similarly as in other causes of heart failure. Larger studies are needed to confirm these findings in cancer patients with cardiotoxicity.

Complementary approach for accurate determination of carbon isotopic compositions in γ-hydroxybutyric acid using gas chromatography/combustion-isotope ratio mass spectrometry

RATIONALE

γ-Hydroxybutyric acid (GHB) is a naturally endogenous neurotransmitter that is popular as a recreational drug due to its sedative, hypnotic, and euphoric effects. GHB derived from endogenous production or exogenous ingestion has been effectively discriminated by carbon isotopic compositions (δ¹³ C values) through gas chromatography/combustion-isotope ratio mass spectrometry (GC/C-IRMS). However, an unintended uncertainty of isotopic signatures caused by a wide range of GHB quantities remains unsolved when using only single-isotope corrections of the di-TMS derivative.

METHODS

The δ¹³ C values of the original GHB standard were first determined by elemental analyzer/isotope ratio mass spectrometry (EA/IRMS). The δ¹³ C values of silylated GHB in concentrations from 10 to 500 ppm were determined by GC/C-IRMS. With respect to the silylated reaction products, the correction of δ¹³ C values for the introduced carbons was calculated from a stoichiometric mass balance equation.

RESULTS

The results showed a significant quantity-dependent trend in δ¹³ C values of introduced carbon (δ¹³ C_di-TMS values) with increased GHB standard concentrations (r²  = 0.70, p <0.05). We applied a logarithmic equation to determine isotopic data in low-GHB urine specimens from five healthy female volunteers. The δ¹³ C_GHB values in urine samples corrected with quantity-dependent δ¹³ C_di-TMS values were different by an average of 2.7‰ from those corrected with single δ¹³ C_di-TMS values (p <0.05).

CONCLUSIONS

Our results suggest that the overall residual amount-dependent isotope fractionation should be mathematically corrected by the logarithmic function and this may improve the reliability of isotopic analysis to evaluate the origin of GHB before applying the approach to routine toxicological and forensic studies.

A review of drug abuse in recently reported cases of driving under the influence of drugs (DUID) in Asia, USA, and Europe

Driving Under the Influence of Drugs (DUID) is considered a serious issue related to the abuse of illegal drugs. DUID cases, including deaths, are being continuously reported in Asia, USA, and Europe. This literature review focuses on illegal drug abuse in recent DUID cases reported in Asia, USA, and Europe. To determine illegal drug abuse in DUID suspects, previous studies collected and analyzed biological samples, such as blood, urine, oral fluids, and hair. In addition, there were forensic autopsies and surveys for investigation of illegal drugs in DUID cases and drivers. In previous studies, ketamine, morphine, methamphetamine (MA), and khat were mainly reported in Asia, whereas amphetamine, benzodiazepines (BZDs), and cannabinoids were mainly reported in USA, and synthetic cannabinoids (SCs), opiates, and cocaine were mainly reported in Europe. Since DUID suspects related to illegal drugs have been frequently reported in Asia, USA, and Europe, there is a need to plan for national monitoring for drivers or motor vehicles to regulate and prevent drug abuse and relevant DUID cases.

Differentiation of endogenous and exogenous γ-Hydroxybutyrate in rat and human urine by GC/C/IRMS

Gamma (γ)-hydroxybutyric acid (GHB) has been reported to be an endogenous compound in the mammalian brain. It used to treat symptoms of alcohol, opioid, and drug withdrawal and cataplexy of narcolepsy. However, it is often used for criminal purposes because it is colorless, tasteless, and has short half-life. For this reason, there is a need for a method of distinguishing between endogenous and exogenous GHB administration. Therefore, urine from rat before administration of GHB and GHB urine after the single intraperitoneal injection of GHB as 30 mg/100 g were collected from Sprague-Dawley rats (7 weeks old, 10 males and females). Negative control urine, urine from individuals suspected of taking GHB, and urine from victims who were GHB-involved crime were collected. In urine samples, GHB was extracted with two-step SPE and collected fraction was derivatized and analyzed by GC/MS and GC/C/IRMS. In GC/MS and GC/C/IRMS analysis of rat urine, there was a statistically significant difference between urine from rat before administration of GHB and GHB rat urine (p < 0.05). In GC/MS analysis of human urine samples, there was no significant difference among human urine groups (negative control, suspects' urine, and victims' urine), but in GC/C/IRMS analysis of human urine samples, there was a statistically significant difference among human urine groups (p = 0.0001). Through these results, GC/C/IRMS can be more effective tool to identify endogenous and exogenous GHB in urine than GC/MS. This study can build a drug management system in forensic investigation agency and offer interpretation method to forensic science and court.

Abstract P6-02-01: Not presented

This abstract was not presented at the conference.

Citation Format: Luo J, Chen Q, Tang L, Yang L, Han E, Chen Y, Yuan L. Not presented [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-02-01.

Effects of fumonisin B1 and mycotoxin binders on growth performance, tibia characteristics, gut physiology, and stress indicators in broiler chickens raised in different stocking densities

The present study was carried out to investigate the effects of stocking density, fumonisin B1 (FB), and mycotoxin binder (TB) on growth performance, bone quality, physiological stress indicators, and gut health in broiler chickens. Day-old Ross 308 male broiler chicks (n = 1,440/experiment) were randomly allocated to 72 floor pens in a 3 × 2 × 2 factorial arrangement, using 3 stocking densities (12.5 birds/m2 [HSD], 10 birds/m2 [MSD], or 7.5 birds/m2 [LSD]), 2 levels of purified FB (0 or 10 ppm), and 2 levels of TB (0 or 0.2%). Each treatment had 6 replicates (n = 6/treatment) and experiments lasted 34 days. All data were analyzed using 3-way ANOVA with stocking density level, FB, and TB as main factors. Body weight gain and feed intake were lower (P < 0.05) in broilers kept at HSD and MSD compared to LSD-housed counterparts. Birds fed an FB-contaminated diet exhibited a higher feed-to-gain ratio compared with those fed an FB-free diet (P < 0.05). None of the treatments affected intestinal morphology or ileal secretory immunoglobulin A levels. Stocking density affected tibia breaking strength (P < 0.05), which was lower in chickens housed at HSD compared with LSD-housed chickens. The heterophil/lymphocyte ratio (H/L ratio) was elevated (P < 0.05) in HSD and MSD groups compared with the LSD group. Serum nitric oxide (NO) levels were elevated (P < 0.05) in chickens fed the FB-contaminated diet compared with the control diet-fed counterparts. Significant interaction (P < 0.05) between FB and TB on serum NO levels was noted. In summary, increasing stocking density lowered growth performance and bone quality, but increased the H/L ratio. Dietary TB did not affect FB-induced increases in the feed-to-gain ratio. No interaction was observed between stocking density and FB for the measured variables.

Sarcopenia is associated with the risk of significant liver fibrosis in metabolically unhealthy subjects with chronic hepatitis B

BACKGROUND

Sarcopenia is significantly associated with the degree of liver fibrosis. This study investigated the influence of sarcopenia on liver fibrosis in individuals with chronic hepatitis B.

METHODS

Data from the Korean National Health and Nutrition Examination Surveys 2008-2011 were analysed. The sarcopenia index (total appendicular skeletal muscle mass [kg]/body mass index [kg/m² ]) was calculated using dual-energy X-ray absorptiometry. Sarcopenia was defined as the lowest quintile sarcopenia index value (cut-offs: 0.89 for men and 0.58 for women). The fibrotic burden was assessed using the nonalcoholic fatty liver disease fibrosis score and fibrosis-4 index. Significant fibrosis was defined as the highest nonalcoholic fatty liver disease fibrosis score quartile and a fibrosis-4 index ≥2.67.

RESULTS

Among the 506 respondents with chronic hepatitis B (258 men and 248 women), the nonalcoholic fatty liver disease fibrosis score and fibrosis-4 index identified sarcopenia and significant fibrosis in 126 (24.9%) and 217 (42.9%), respectively. Sarcopenia was significantly associated with significant fibrosis, regardless of the fibrosis prediction model used (all P < 0.05). When the study population was stratified according to metabolic factors, sarcopenia was specifically associated with an increased risk of significant fibrosis among subgroups with obesity, insulin resistance, metabolic syndrome and liver steatosis (odds ratio 2.37-3.57; all P < 0.05). An independent association between sarcopenia and significant fibrosis was identified after adjusting for other confounders (odds ratio 2.67-3.62 by the nonalcoholic fatty liver disease fibrosis score and 2.04-2.62 by the fibrosis-4 index; all P < 0.05).

CONCLUSIONS

Sarcopenia is associated with significant fibrosis in subjects with chronic hepatitis B, specifically those with obesity, insulin resistance, metabolic syndrome and liver steatosis.

Development of nutritional risk assessment platform in Korea

Risk assessment has been used to prevent health problems associated with eating habits in response to increased interest in a balanced diet. For nutritional risk assessment (NRA), it is important to 1) consider personal nutrition status based on year-round dietary intake, 2) organize core datasets such as food composition, intake, and health based guidance value (HBGV) datasets with public confidence, and 3) assess and predict the effects by using the computerized NRA tool. Our research staff constructed an integrated database system by compiling and organizing core datasets produced sporadically by different organizations and with different formats and developed a nutritional exposure and risk assessment system called Nutri-Risk (NUTRItional RISK assessment platform), which contained the database. Nutri-Risk is not only capable of NRA, but also contains additional data service functions. Here, the compilations and organization of an integrated database are outlined. In addition, the overall architectures of Nutri-Risk and dietary modeling are described and predictive simulation functions to support the regulatory decisions related to nutritional fortification or reduction policy were demonstrated.

New psychoactive substances of natural origin: A brief review

Plant-based drugs of abuse are as old as recorded human history. Although traditional addictive substances, such as opium, cannabis and coca, have been controlled by the United Nations anti-drug conventions, many, if not most, natural plants with addictive or abuse liability remain elusive. Therefore, the United Nations Office on Drugs and Crime (UNODC) has warned the emerging threat from new psychoactive substances (NPS), which are mostly derived or modified from the constituents of natural origin. For example, synthetic cannabinoids and synthetic cathinones are derived from the cannabis and khat plant, respectively. In this review, we briefly discussed the chemistry, pharmacology and toxicology of five common NPS of natural origin, i.e., khat, kratom, salvia, magic mushroom and mandrake. Through the review, we hope that professionals and general public alike can pay more attention to the potential problems caused by natural NPS, and suitable control measures will be taken.

Low-income African-American adults share weight status, food-related psychosocial factors and behaviours with their children

Objective

This study aims to examine the extent to which low‐income African‐American children's weight status, psychosocial characteristics and food‐related behaviours are associated with that of their adult caregivers.

Methods

Cross‐sectional data from baseline evaluation of B'More Healthy Communities for Kids obesity prevention trial were used. Outcomes of interest were children's overweight and/or obesity status, food‐related self‐efficacy, knowledge, intentions and healthier/less healthy food acquisition scores. The primary exposures were adult caregiver's overweight and/or obesity status, their psychosocial factors and food acquisition scores. Multiple logistic regression analyses were used to assess associations.

Results

Children had higher odds of overweight or obesity if they had an overweight/obese caregiver (odds ratio [OR] 4.04, 95% confidence interval [95%CI] 1.59–10.28) or an obese caregiver (OR 2.50, 95%CI 1.39–4.51). Having a caregiver in the highest quartile of self‐efficacy, food intentions and healthy food acquisition patterns was associated with higher odds of their child also having a higher score on these factors (self‐efficacy: OR 3.77 [95%CI 1.76–8.04]; food intentions: OR 1.13 [95%CI 1.01–1.27]; and healthy food acquisition: OR 2.19 [95%CI 1.05–4.54]).

Conclusions

Child and adult caregiver weight status and psychosocial characteristics were positively associated in this low‐income, urban population. These findings may help inform obesity treatment or prevention programmes and interventions aimed at parents and families.

Comparison of illegal drug use pattern in Taiwan and Korea from 2006 to 2014

BACKGROUND

Illegal drug use has long been a global concern. Taiwan and Korea are geographically adjacent and both countries have experienced the illegal use problems of methamphetamine, a predominant prototype of New Psychoactive Substances (NPS). NPS, a term coined by the United Nations Office on Drugs and Crime (UNODC) in recent years, have not been scrutinized for their safety and may become a new threat to public health and security worldwide. To conduct evidence-based drug policy, it is imperative to estimate the trend and pattern of illegal drug use. Therefore, this study aims to analyze and compare the current status of drug-related seizures, arrests and illegal drug use, with a focus on methamphetamine and NPS, between Taiwan and Korea.

METHODS

Data of illegal drug (including NPS)-related seizures and arrests were collected via anti-drug related agencies of both countries from 2006 through 2014.Since listing of NPS as controlled substances was a result of NPS abuse liability through official evaluation, the items of controlled NPS were used as an indicator of emerging use. These data obtained from Taiwan and Korea was then compared.

RESULTS

The results showed that while methamphetamine remained as a predominant drug in both Taiwan and Korea for decades, different illegal drug use patterns have been observed in these two countries. In Taiwan, the major illegal drugs were methamphetamine, heroin, and ketamine, whereas in Korea those were methamphetamine and cannabis. By comparison of per capita illicit drug seizures, the illegal drug use situation in Taiwan was at a higher stake than that in Korea. In terms of NPS use, ketamine has been a major drug in Taiwan, but it was seldom found in Korea. Besides ketamine, the major type of NPS was synthetic cathinones in Taiwan whereas it was synthetic cannabinoids and phenethylamines in Korea. The difference in the numbers of controlled NPS items between Taiwan (23) and Korea (93) may be due to the implementation of temporary control on NPS in Korea since 2011.

CONCLUSION

While the problem of methamphetamine still lingers, NPS have emerged as a new issue in both countries. However, the NPS pattern was different between Taiwan and Korea. Although the controlled NPS items in Taiwan were far less than those in Korea, the quantity of total NPS seizures, especially with ketamine, was much larger in Taiwan than in Korea. Different NPS pattern may also imply they were from different sources. Factors other than geographical proximity, such as drug policy and availability and accessibility to drugs, should be taken into account for the current status of illegal drug use in Korea and Taiwan.

POST-HARVEST EMBRYO DEVELOPMENT IN GINSENG SEEDS INCREASES DESICCATION SENSITIVITY AND NARROWS THE HYDRATION WINDOW FOR CRYOPRESERVATION

BACKGROUND

Despite its self-pollinating characteristics, Korean ginseng germplasm is mainly maintained in clonal gene banks as there is no defined approach to the long-term conservation of its seed, including the most appropriate stage of embryo development for storage.

OBJECTIVE

The aim of this study was to reveal the effect of embryo development on desiccation tolerance and cryopreservation success in ginseng seeds.

MATERIALS AND METHODS

Seeds of Korean ginseng (Panax ginseng C.A. Meyer) at three post-harvest stages (immediately after harvesting and following treatments to enable internal growth of the embryo) were desiccated and cryopreserved.

RESULTS

The hydration window for the >80% dehiscence and germination of cryopreserved ginseng seeds varied with embryo developmental stage: 3-9% moisture content (MC) for both unpulped and undehisced seeds when the embryo was 0.1 the length of the endosperm, 7-10% MC for dehisced seeds (0.5 embryo:endosperm) and 9-11% MC for seeds with fully developed embryos (0.9 embryo:endosperm). Whilst dried (4-8% moisture content) and undehisced seeds within fruits (unpulped seeds) lost more than half their viability during 1 year's storage at room temperature, cryopreservation enabled germination levels of c. 90%. Overall, 432 accessions of Korean ginseng landraces have been cryopreserved using undehisced seeds with or without fruits.

CONCLUSION

Post-harvest treatment of Korean ginseng seeds to enable embryo development decreases tolerance of very low MCs, and thus narrows the hydration window for cryopreservation. Fresh-harvested and unpulped seeds that have been dried to c. 5% MC are recommended for long-term cryogenic storage.

Relationship between methamphetamine use history and segmental hair analysis findings of MA users

The aim of this study was to investigate the relationship between methamphetamine (MA) use history and segmental hair analysis (1 and 3cm sections) and whole hair analysis results in Korean MA users in rehabilitation programs. Hair samples were collected from 26 Korean MA users. Eleven of the 26 subjects used cannabis with MA and two used cocaine, opiates, and MDMA with MA. Self-reported single dose of MA from the 26 subjects ranged from 0.03 to 0.5g/one time. Concentrations of MA and its metabolite amphetamine (AP) in hair were determined by gas chromatography mass spectrometry (GC/MS) after derivatization. The method used was well validated. Qualitative analysis from all 1cm sections (n=154) revealed a good correlation between positive or negative results for MA in hair and self-reported MA use (69.48%, n=107). In detail, MA results were positive in 66 hair specimens of MA users who reported administering MA, and MA results were negative in 41 hair specimens of MA users who denied MA administration in the corresponding month. Test results were false-negative in 10.39% (n=16) of hair specimens and false-positive in 20.13% (n=31) of hair specimens. In false positive cases, it is considered that after MA cessation it continued to be accumulated in hair still, while in false negative cases, self-reported histories showed a small amount of MA use or MA use 5-7 months previously. In terms of quantitative analysis, the concentrations of MA in 1 and 3cm long hair segments and in whole hair samples ranged from 1.03 to 184.98 (mean 22.01), 2.26 to 89.33 (mean 18.71), and 0.91 to 124.49 (mean 15.24)ng/mg, respectively. Ten subjects showed a good correlation between MA use and MA concentration in hair. Correlation coefficient (r) of 7 among 10 subjects ranged from 0.71 to 0.98 (mean 0.85). Four subjects showed a low correlation between MA use and MA concentration in hair. Correlation coefficient (r) of 4 subjects ranged from 0.36 to 0.55. Eleven subjects showed a poor correlation between MA use and MA concentration in hair. Correlation between MA use and MA concentration in hair of remaining one subject could not be determined or calculated. In this study, the correlation between accurate MA use histories obtained by psychiatrists and well-trained counselors and MA concentrations in hair was shown. This report provides objective scientific findings that should considerably aid the interpretation of forensic results and of the results of trials related to MA use.