Perioperative risk and benefit of antiplatelet therapy in patients undergoing non-cardiac surgery within 1 year after percutaneous coronary intervention with second-generation drug-eluting stents

Background

Antiplatelet therapy (APT) in patients undergoing non-cardiac surgery (NCS) after percutaneous coronary intervention (PCI) is still on debate due to its opposite effects which are to prevent from cardiovascular events and to cause bleeding. There is no apparent consensus on how to determine perioperative APT strategy within 1 year after PCI. Therefore, we investigated the risk and benefit of APT in NCS within 1 year after PCI.

Methods

Patients undergoing NCS after PCI with second-generation drug-eluting stents are retrospectively included from multicenter cohort of 8 medical centers in Korea. Perioperative clinical event within 30 days after NCS was recorded. Net adverse clinical event (NACE) including all cause death, major adverse cardiac event (MACE, a composite of cardiac death, myocardial infarction, and stent thrombosis) and major bleeding were evaluated. To overcome bias, propensity score covariate adjustment was performed using logistic regression analysis to generate propensity scores for patients of both APT strategies.

Results

Total 1130 patients (median age 69 years, female 30.5%) undergoing NCS within 1 year after PCI were eligible in the cohort. Study population included 55.1% patients suffered from ACS and 22.5% underwent complex PCI. NCS included 45.8% intermediate-to-high risk surgery and 10.7% urgent or emergent surgery. APT was continued during NCS in 62.7% of the patients. More patients continued DAPT (48% vs. 32%, p<0.001) among the patients who underwent NCS within 6 months after PCI than those who underwent NCS after 6 months. There were 49 NACE (4.3%), 16 MACE (1.4%) and 23 major bleeding events (2.0%), respectively. Continuing APT was associated with a lower risk of NACE (Adjusted hazard ratio [HR], 0.49; 95% confidence interval [CI], 0.27–0.89; p=0.020)) and MACE (Adjusted HR, 0.35; 95 CI, 0.12–0.96; p=0.042). Subgroup analysis showed a tendency that continuing APT might be favorable than discontinuing APT in terms of MACE in patients who were diagnosed with ACS, underwent complex PCI, or underwent NCS within 6 months after PCI.

Conclusions

About two thirds of the patients were continuing APT during NCS. Our findings may support a careful consideration of APT continuation for some of the patients who are undergoing NCS within 1 year after PCI.

Funding Acknowledgement

Type of funding sources: None.

18F-FDG-PET in guided dose-painting with intensity modulated radiotherapy in oropharyngeal tumours: A phase I study (FiGaRO)

BACKGROUND AND PURPOSE

The FiGaRO trial assessed the feasibility and safety of using an FDG-PET-based dose-painting technique to deliver a radiotherapy (RT) boostto the FDG-avid primary tumour in patients with locally advanced high and intermediate risk oropharyngeal cancer.

MATERIALS AND METHOD

Patients underwent a planning 18FDG-PET-CT scan, immobilised in the treatment position, after one cycle of induction chemotherapy. The volume of persistent FDG-avidity in the primary tumour was escalated to 71.5 Gy in30 fractions delivered using a simultaneous integrated boost Intensity Modulated RT (SIB-IMRT) technique. RT was delivered with concomitant Cisplatin following 2 cycles of induction chemotherapy. The primary outcome was the incidence of grade ≥ 3 late mucosal toxicity 12 months post-treatment, with an excess rate of >10% regarded as unacceptable.

RESULTS

Twenty-nine patients were included and twenty-four were treated between 2014 and 2018, in two UK centres. Median follow-up was 36 months (range 4-56 months). Pre-defined planning target volume objectives and organ at risk dose constraints were met in all cases. There were no incidents of acute grade 4 toxicity. There were 4 cases of grade ≥ 3 mucosal toxicity at 12 months post-treatment (19.1%). There were no cases of persistent mucosal ulceration at 12 months. Overall survival at 3-years was 87.5%, 92.9% for intermediate and 70.0% for high risk patients.

CONCLUSION

Late toxicity rates, although higher than anticipated, are comparable to contemporary published data for standard dose chemo-IMRT. Results suggest improved 3y survival rates for high risk patients. This approach merits further investigation. ClinicalTrials.gov Identifier: NCT02953197.

Comparative identification, nutritional, and physiological regulation of chicken liver-enriched genes

The liver performs a number of vital functions in the chicken. In order to identify unique gene expression patterns and link them to potential functions in the chicken liver, genes enriched in the liver of chickens needed to be investigated in a comparative manner. In this study, 41 liver-enriched genes were identified through chicken microarray, and many of them were validated through comparative analysis of mice and humans. Thirteen of them were unique in chickens, and their liver enhancement was confirmed by reverse transcription PCR. Furthermore, the expression of those 13 chicken liver-enriched genes was investigated, in response to nutritional and physiological challenges. Real-time PCR revealed that expression of PIT54 (P < 0.01), phosphoribosyl pyrophosphate synthetase 2 (PRPS2) (P < 0.05), sulfotransferase (SULT) (P < 0.05), and cytochrome P450 family 2 subfamily C, polypeptide 18 (CYP2C18) (P < 0.05) were significantly decreased in the liver during fasting compared to ad libitum control. During the post-laying stage, expression of GAL8 was significantly increased (P < 0.01), but CYP2C18 expression was significantly reduced (P < 0.05). Liver-enriched genes that were identified in this study and their expression patterns under fasting and the post-laying stage will serve as future targets to gain a better understanding of liver physiology, function and development in poultry.

Improving anti-bullying laws and policies to protect youth from weight-based victimization: parental support for action

BACKGROUND

Weight-based bullying is a prevalent problem among youth with overweight and obesity, but remains neglected in existing policy-level strategies to address youth bullying. Parental support is an influential catalyst motivating political will for policy decisions affecting youth, but has received limited research attention.

OBJECTIVES

To assess levels of, and predictors of, parental support for school-based policies and state/federal legal measures to address weight-based bullying in 2014 and 2015.

METHODS

Identical online questionnaires were completed by two independent national samples of parents in 2014 and 2015 (N = 1804).

RESULTS

Parental support for all policy actions was high (at least 81%) and significantly increased from 2014 to 2015 for legal measures that would a) require state anti-bullying laws to add protections against weight-based bullying, and b) enact a federal anti-bullying law that includes weight-based bullying.

CONCLUSIONS

These findings can inform policy discourse about remedies for youth bullying, and suggest that parental support for improved legal protections against weight-based bullying is present, consistent, and strong.

Legislating for weight-based equality: national trends in public support for laws to prohibit weight discrimination

The prevalence of weight discrimination in the United States has led to increasing calls for legal measures to address weight-based inequities on a broader scale. This study examined public support in 2014 and 2015 for three proposed laws prohibiting weight discrimination, and compared findings with public attitudes towards the same laws from 2011 to 2013. An online survey was completed by a diverse national sample of US adults (N=2411) in June-July of 2014 and 2015 to assess their support for anti-discrimination legislation. Public support increased for the anti-discrimination laws from 2014 to 2015, and at least 71% of participants expressed support for each of the laws in both years. Compared with public support documented in 2011-2013, there was a significant increase in support in 2014-2015 for legislation to extend disability protections to individuals with obesity and for laws that would include body weight in existing state civil rights statutes. Consistently, high levels of support (78%) were documented across this 5-year period for laws to address weight-based discrimination in employment. As public approval is a powerful catalyst motivating political will needed to make policy changes, these findings provide important insights and implications for advancing policy-level discourse about remedies for weight discrimination.

Radiation promotes invasiveness of non-small-cell lung cancer cells through granulocyte-colony-stimulating factor

Despite ionizing radiation (IR) is being widely used as a standard treatment for lung cancer, many evidences suggest that IR paradoxically promotes cancer malignancy. However, its molecular mechanisms underlying radiation-induced cancer progression remain obscure. Here, we report that exposure to fractionated radiation (2 Gy per day for 3 days) induces the secretion of granulocyte-colony-stimulating factor (G-CSF) that has been commonly used in cancer therapies to ameliorate neutropenia. Intriguingly, radiation-induced G-CSF promoted the migratory and invasive properties by triggering the epithelial-mesenchymal cell transition (EMT) in non-small-cell lung cancer cells (NSCLCs). By irradiation, G-CSF was upregulated transcriptionally by β-catenin/TCF4 complex that binds to the promoter region of G-CSF as a transcription factor. Importantly, irradiation increased the stability of β-catenin through the activation of PI3K/AKT (phosphatidylinositol 3-kinase/AKT), thereby upregulating the expression of G-CSF. Radiation-induced G-CSF is recognized by G-CSFR and transduced its intracellular signaling JAK/STAT3 (Janus kinase/signal transducers and activators of transcription), thereby triggering EMT program in NSCLCs. Taken together, our findings suggest that the application of G-CSF in cancer therapies to ameliorate neutropenia should be reconsidered owing to its effect on cancer progression, and G-CSF could be a novel therapeutic target to mitigate the harmful effect of radiotherapy for the treatment of NSCLC.

Novel signaling axis for ROS generation during K-Ras-induced cellular transformation

Reactive oxygen species (ROS) are well known to be involved in oncogene-mediated cellular transformation. However, the regulatory mechanisms underlying ROS generation in oncogene-transformed cells are unclear. In the present study, we found that oncogenic K-Ras induces ROS generation through activation of NADPH oxidase 1 (NOX1), which is a critical regulator for the K-Ras-induced cellular transformation. NOX1 was activated by K-Ras-dependent translocation of p47(phox), a subunit of NOX1 to plasma membrane. Of note, PKCδ, when it was activated by PDPK1, directly bound to the SH3-N domain of p47(phox) and catalyzed the phosphorylation on Ser348 and Ser473 residues of p47(phox) C-terminal in a K-Ras-dependent manner, finally leading to its membrane translocation. Notably, oncogenic K-Ras activated all MAPKs (JNK, ERK and p38); however, only p38 was involved in p47(phox)-NOX1-dependent ROS generation and consequent transformation. Importantly, K-Ras-induced activation of p38 led to an activation of PDPK1, which then signals through PKCδ, p47(phox) and NOX1. In agreement with the mechanism, inhibition of p38, PDPK1, PKCδ, p47(phox) or NOX1 effectively blocked K-Ras-induced ROS generation, anchorage-independent colony formation and tumor formation. Taken together, our findings demonstrated that oncogenic K-Ras activates the signaling cascade p38/PDPK1/PKCδ/p47(phox)/NOX1 for ROS generation and consequent malignant cellular transformation.

Symptomatic correlates of six-minute walk performance in persons with multiple sclerosis

BACKGROUND

The six-minute walk (6MW) test has been identified as a valid, reliable, and reproducible measure of endurance walking performance that differentiates persons with multiple sclerosis (MS) and controls and correlates with disability and walking impairment.

AIM

This study examined symptoms of fatigue, pain, and depression as correlates of 6MW performance and the possibility that such symptoms would account for the difference in 6MW distance between persons with MS and controls.

DESIGN

Observational.

SETTING

Research laboratory.

POPULATION

Sixty-six persons, 33 with MS and 33 controls matched on age, sex, height, and weight. METHODS. Participants completed the fatigue severity scale (FSS), short-form of the McGill pain questionnaire (SF-MPQ), and depression items of the hospital anxiety and depression scale (HADS-D) and then performed the six-minute walk (6MW) in a rectangular corridor.

RESULTS

There were statistically significant differences between groups in 6MW distance (p = 0.0001) and FSS (P=0.0001) and SF-MPQ (P=0.025), but not HADS-D (P>0.05), scores. 6MW distance was significantly correlated with FSS (P=-0.66), SF-MPQ (P=-0.38), and HADS-D (P=-0.33) scores in the overall sample, but 6MW distance was significantly correlated with only FSS scores in the separate samples of those with MS (P=-0.46) and controls (P=-0.46). Only group (β=0.32) and FSS scores (β=-0.53) explained variance in overall 6MW distance in a hierarchical, linear regression analysis.

CONCLUSION

This study provides new insight into the symptomatic correlates of 6MW performance and identifies fatigue as a possible target of interventions designed to improve walking endurance in MS.

CLINICAL REHABILITATION IMPACT

Clinicians and practitioners might consider targeting fatigue as a method of managing compromised endurance walking in persons with MS.

Temporal myosin heavy chain isoform expression transitions faster in broiler chickens compared with Single Comb White Leghorns

Myosin heavy chain (MyHC), one of the major components in the contractile machinery of skeletal muscle fibers, is found in several isoforms during myogenesis. During chicken development, embryonic, neonatal, and adult MyHC isoforms are expressed. Broiler chickens have been selected for fast and large muscle growth, whereas Single Comb White Leghorn (SCWL) chickens have been selected for egg laying capabilities. This has led to an obvious difference in muscle growth and development with broilers being much larger than SCWL. The objective of this study was to determine if differences in muscle growth and development of SCWL and broilers are associated with differences in temporal expression of MyHC isoforms in skeletal muscle between the 2 breeds. Pectoralis major muscle (PM) was collected from SCWL and broilers at embryonic d 15, 17, and 19 and 1, 5, 11, 20, 27, and 33 d posthatch with n = 3 samples per time point and breed. Western blotting using 3 monoclonal antibodies (EB165, 2E9, and AB8) was performed to compare the expression patterns of embryonic/adult, neonatal, and adult isoforms of MyHC, respectively, for all time points in both SCWL and broiler chickens. Both broiler and SCWL chickens began expressing the neonatal MyHC isoform on d 5; however, SCWL chickens expressed the neonatal isoform much longer than broilers. The SCWL chickens had sustained expression of the neonatal MyHC isoform through d 27, whereas in broiler chickens the neonatal isoform was not expressed at d 20. Pectoralis major tissue from broiler chickens expressed the adult MyHC isoform as early as d 20, whereas the SCWL chickens began expressing the adult isoform later. The rate of transition to neonatal and adult MyHC isoforms in broilers and Leghorns is consistent with the faster maturation and growth of broilers relative to Leghorns. This relationship between faster growth of the PM and the rate of transition of MyHC isoforms within the fast skeletal muscle of the PM may indicate a selection marker for improvement of broiler PM growth.

Physical activity and multiple sclerosis: new insights regarding inactivity

OBJECTIVES

There is increasing recognition that physical activity has beneficial consequences among persons with multiple sclerosis (MS), but there is concern regarding the current degree of physical inactivity in this population because of limitations with previous research and increased recognition of health behaviors in MS. This study compared physical activity levels between large samples of persons with mild MS and matched controls using validated measures of physical activity.

MATERIALS AND METHODS

The sample included 77 cases of MS and 77 controls matched on age, height, weight, and gender. Physical activity was assessed using five measures, namely the Godin Leisure-Time Exercise Questionnaire (GLTEQ), International Physical Activity Questionnaire (IPAQ), and activity counts per day, step counts per day, and time spent in moderate-to-vigorous physical activity (MVPA) per day by accelerometry.

RESULTS

There were statistically significant differences between groups in accelerometer activity counts (t = -3.87, P = 0.0001), accelerometer step counts (t = -4.29, P = 0.0001), time spent in MVPA (t = -2.39, P = 0.01), GLTEQ scores (t = -3.83, P = 0.0001), and IPAQ scores (t = -3.42, P = 0.0001). The average effect size across all five measures was d = -0.59 and indicated that persons with MS overall were moderately less physically active than the matched controls.

CONCLUSIONS

The primary finding was a moderate reduction in physical activity among those with MS, but the magnitude was substantially smaller than reported in a published meta-analysis. Importantly, the degree of physical inactivity can likely be overcome through the delivery of behavioral interventions for increasing physical activity and this should translate into meaningful consequences for persons with MS.

Circumferential resection margin (CRM) in esophageal (OC) and gastroesophageal (GOJ) cancers

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Background: We hypothesized that CRM size affect survival and local recurrence for OC and GOJ cancer. We also assessed the utility of CT in predicting margin status.

Methods: A retrospective analysis of a prospective database was carried out on all patients who had esophagectomy between January 2000 and July 2008. Patients diagnosed with OC and GOJ tumors on final pathologic examination were included. Distance from the CRM was assessed by a specialist upper GI pathologist. Two radiologists, blinded to postoperative margin status, reviewed preoperative CT scans using 16 separate parameters, comparing them to measured CRM status.

Results: 419 patients were assessed. 223 pts had OC or GOJ type 1 tumors, average age 62 years (range 36–80), mean follow-up 5.8 years (2-9.5). There were 125 deaths and median overall survival (OS) 3.33 years (95% CI 2.76-6.24). 76 patients had recurrence at a median of 1.3 years (0.1-4.7). For 144 patients had OC or GOJ type 1 T3 tumors. Selected results are presented in the Table. There was no CRM size above which there was no further reduction in recurrence. Postoperative chemoradiation did not improve OS (p=0.79) or recurrence (p=0.96) in patients with CRM of 0-1 mm. In 50 patients the CT parameters significantly correlated with margin status were largest axial diameter (p=0.003) and contact with adjacent structures (p=0.005). A complete statistical review with multivariate and subgroup analyses will be presented.

Conclusions: CRM size is strongly correlated with survival and recurrence in OC and type 1 GOJ tumors. Prediction of a close CRM could be used to select for more intensive therapy prior to undergoing radical surgery, such as chemoradiation. Preoperative CT can help in this prediction.

[Table: see text]

No significant financial relationships to disclose.

Cloning of avian G(0)/G(1) switch gene 2 genes and developmental and nutritional regulation of G(0)/G(1) switch gene 2 in chicken adipose tissue

Adipose triglyceride lipase (ATGL), a newly identified lipase, is a rate-limiting enzyme for triglyceride hydrolysis in adipocytes. The regulatory proteins involved in ATGL-mediated lipolysis in fat tissue are not fully identified and understood. The G(0)/G(1) switch gene 2 (G0S2) is an inhibitor of ATGL activity by interacting with ATGL through the hydrophobic domain of G0S2. Here, for the first time, we have cloned the coding sequence of G0S2 cDNA for the chicken, turkey, and quail. Sequence comparisons with mammals revealed that the avian G0S2 also have a conserved hydrophobic domain. Avian G0S2 is predominantly expressed in adipose tissues relative to other tested tissues. Within the adipose tissue, G0S2 is expressed 20-fold greater in the adipocyte than in the stromal-vascular (SV) fraction (P < 0.001). Expression of G0S2 mRNA gradually increased during differentiation of chicken adipocytes in culture (P < 0.05). However, there is G0S2 expression in embryonic adipose tissue, SV fraction, and primary preadipocytes before confluence that generally have an increased capacity of cell proliferation, which indicates it has an important role in adipocyte differentiation rather than proliferation. For a better understanding of how G0S2 responds to environmental stimuli, chickens were fasted for 24 h and then refed. Expression of G0S2 in adipose tissue was dramatically decreased (P < 0.05) in the chickens and quail after a 24-h fasting period, and increased to the control level after refeeding. In contrast to G0S2 expression, ATGL expression was induced (P < 0.05) after the 24-h fasting period and rapidly returned to the control level during the refeeding period. These data indicate that changes in lipolytic activities of adipose tissue in vivo can be regulated by G0S2 expression, as an inhibitor of ATGL.

TAC (docetaxel, doxorubicin, and cyclophosphamide) adjuvant chemotherapy supported by G-CSF without dose-reduction in node-positive breast cancer

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Background: For node-positive breast cancer, TAC (Docetaxel-Doxorubicin-Cyclophosphamide) chemotherapy is preferred as an adjuvant treatment. However, due to its high toxicity profiles such as severe neutropenia, TAC is a lot beyond enthusiasm. G-CSF support or even prophylaxis has been recommended to help patients recover from nadir, along with some dose-reduction schedule. We tried to evaluate whether TAC with G-CSF support from day 5 can be sustained without dose reduction in women under 69-years old. Methods: After getting IRB approval, between Mar. 2005 and Oct. 2008, 61 node-positive breast cancer patients (33 - 69 years old) had underwent TAC chemotherapy as an adjuvant treatment after curative resection after getting informed consent. Total of 366 cycles (6 cycles per patient, 75–50–500 mg/m2)were completed, G-CSF support was initiated from day 5 to full neutrophil recovery. In case of neutropenia, prophylactic antibiotics (cefoperazone 2 g and tobramycin 200 mg iv) were given. Results: Among 366 cycles, not a single cycle should be delayed to recover from any hematologic shortcomings such as neutropenia, anemia or thrombocytopenia. Interval of three weeks between each cycle could be maintained. No other problem happened for any patient to stop or postpone scheduled chemotherapy. None of antibiotics except prophylaxis with cefoperazone and tobramycin was needed. Conclusions: Maximum tolerable dose of chemotherapeutic agents should be given to patients to get the best oncologic outcome to fight against cancer. It is evident that huge scale prospective clinical trials can answer this question, but we presume that node-positive breast cancer patients between in her fourth and seventh decade can stand TAC chemotherapy with G-CSF support without dose reduction as routine.

No significant financial relationships to disclose.

Weight gain after adjuvant TAC (docetaxel, doxorubicin, and cyclophosphamide) chemotherapy for node-positive breast cancer

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Background: Despite of its proven therapeutic efficacy, TAC (docetaxel, Doxorubicin and cyclophosphamide) regimen as an adjuvant chemotherapy has some serious adverse effects such as fluid retention and neutropenia. Even though dexamethasone is known to be given for three days to the patients having TAC chemotherapy to prevent severe fluid retention, most patients have ironically been complaining of much weight gain more than 15% increase after the use of dexamethasone. We tried to determine abbreviated use of dexamethasone is better to decrease the extent of weight gain after TAC chemotherapy. Methods: Eighty node-positive patients between Jan. 2006 and Oct. 2007 were randomly assigned either into 24-hr (group A: 10 mg dexamethasone the night before TAC, and 10 mg dexamethasone (bid) were given for the day 1) or 72-hr dexamethasone premedication (group B) only after getting informed consent since all the protocols were reviewed by IRB. We compared the incidence of severe weight gain (more than 15%) on completion of six cycles in two groups. No patient was found to have heart or kidney problem before the commencement of chemotherapy. Results: Each group was comprised of 40 patients. All patients underwent 6 cycles. Mean age of each group was 48.5 (A) and 50.3 (B) years. The incidence of severe weight gain was 47.3 % in Group A, and 78.4 % in Group B. There was no difference in the duration of recovering from weight gain in both groups (A: 6.52 months vs. B: 7.02 months). No other hematologic complications seemed different between two groups. Conclusions: Though larger scale prosepctive randomized trials should be required to get the definitive conclusion on this matter, we think that current dexamethasone premedication may aggravate weight gain than to prevent it. If shorter schedule is as much effective as longer one, abbreviated and reduced dexamethasone premedication is more helpful for patients having TAC chemotherapy.

No significant financial relationships to disclose.