Utilizing stem cells in reconstructive treatments for sports injuries: An innovative approach

Orthopedic tissue engineering is a rapidly evolving field that holds great promise for the reconstruction and natural repair of bone and joint tissues. Bone loss, fractures, and joint degeneration are common problems that can result from a variety of pathological conditions, and their restoration and replacement are essential not only for functional purposes but also for improving the quality of life for patients. However, current methods rely heavily on artificial materials that can potentially lead to further tissue damage, making tissue engineering a highly attractive alternative. This innovative approach involves the utilization of stem cells (SCs), which are seeded onto a scaffold to form a biological complex. Among these SCs, mesenchymal stem cells (MSCs) extracted from bone marrow and adipose tissue have shown immense potential for bone and joint tissue regeneration. The success of orthopedic tissue engineering is contingent on the careful selection of appropriate scaffolds and inducing molecules, which play a critical role in carrying and supporting cells and inducing their differentiation. This review article comprehensively analyzes the three vital aspects of orthopedic tissue engineering - SCs, scaffolds, and inducing molecules - in order to provide a deeper understanding of this emerging field and its potential for the future of orthopedic medicine.

Absence of atrial fibrillation in the blanking period following cryoballoon pulmonary vein isolation – does it always portend a good prognosis?

Background

Cryoballoon (CB) pulmonary vein isolation (PVI) is an accepted method for ablation in patients with paroxysmal and persistent atrial fibrillation (PAF, PeAF). Freedom from AF in the blanking period (BP), conventionally defined as the first 3-months post-PVI, has been associated with the best long-term outcomes. However, the influence of antiarrhythmic drugs (AADs) during the BP on long-term outcomes is not well understood.

Objective

To compare long-term outcomes between patients who were and were not on an AAD prior to ablation and remained free from AF during the 3-month BP post CB PVI.

Methods

We enrolled consecutive AF patients undergoing CB PVI; all pts had an implantable loop recorder (ILR). No patient had any AF in the first 90 days post CB PVI. We divided the patients into three groups: (1) never had exposure to an AAD; (2) were intolerant to/failed AAD and thus were not taking an AAD at time of ablation; and (3) were on AAD at time of ablation. In the latter group, every effort was made to stop the AAD before the end of the BP.

Results

The cohort included 96 pts (66±10 years; 60 [63%] male; 55 [57%] PAF; CHA2DS2-VASc 2.5±1.4). There were 23 (24%) patients in group 1, 13 (14%) patients in group 2, and 60 (63%) pts in group 3. Patients in group 3 were more likely to have PeAF; AADs were stopped at a median of 36 days IQR (27, 91) in this group. Patients were followed for 1-year during which time 28 (29%) patients had recurrent AF (despite having no AF during the BP). The best outcome was seen in patients who never used an AAD; the worst outcome was seen in patients who were on an AAD at time of ablation (Figure 1).

Conclusion

Our data show that absence of AF during a 3-month post CB PVI BP alone does not guarantee good-long term outcome, unless the patient was never treated with an AAD. In contrast, in patients ablated while taking an AAD, recurrent AF was observed in 37% even though they were completely AF-free during the BP.

Funding Acknowledgement

Type of funding sources: None.

Recurrence of atrial fibrillation following pulmonary vein isolation: impact of body mass index on one- and three-year outcomes

Background

Cryoballoon (CB) pulmonary vein isolation (PVI) is an accepted method for ablation in patients with paroxysmal and persistent atrial fibrillation (PAF, PeAF). However, there are a paucity of data about the impact of body mass index (BMI) on one-year and longer-term outcomes following ablation.

Objective

To objectively understand the impact of BMI on outcomes following CB PVI.

Methods

We enrolled consecutive AF patients undergoing CB PVI; all patients had an implantable loop recorder (ILR), which transmitted data wirelessly daily. We assessed AF recurrences after excluding an initial 3-month post-ablation blanking period.

Results

The cohort included 222 pts (66±9 years; 143 [64%] male; 120 [54%] PAF; CHA2DS2-VASc 2.6±1.6). The mean BMI was 30±5. Patients were followed for 763±347 days, during which time 50% and 68% had recurrent AF 1- and 3-years post ablation. We divided the cohort based on the mean BMI into 2 groups: BMI <30 and BMI >30. Heavier patients were younger and more likely to have PeAF. Over 1-year of follow-up, patients with a BMI <30 had similar likelihood of being free of AF to patients with a BMI >30 (46% vs, 56%, p=0.0.097, Figure 1, left). However, as patients were followed for 3-years, freedom from AF was significantly higher in patients with a BMI <30 (59% vs. 81% in BMI >30, p=0.002, Figure 1, right).

Conclusions

Our data show that although patients had similar outcomes 1-year post-ablation, during longer-term follow-up patients with a BMI >30 had a much worse outcome. Our study uniquely offers objective (using an ILR) assessment of the impact of BMI on long-term outcomes following CB PVI (homogenous ablation strategy). These data highlight the need to identify strategies to improve outcomes in obese patients.

Funding Acknowledgement

Type of funding sources: None.

The impact of atrial fibrillation burden early post cryoballoon pulmonary vein isolation on long-term freedom from recurrent atrial fibrillation

Funding Acknowledgements

Type of funding sources: None.

Background

Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation. A three-month blanking period (BP) is commonly used in clinical trials and practice. Early recurrence of AF portends worse ablation long-term outcome; however, the utility of using AF burden (AFB) early post cryoballoon (CB) PVI to predict long-term outcome is unknown.

Purpose

To determine, using ECG data acquired by an implantable loop recorder (ILR), the relationship between post-ablation AFB and long-term freedom from AF.

Methods

We enrolled consecutive patients with AF who had CB PVI and an ILR. We determined the monthly AFB for the first 3 months post CB PVI and assessed the relationship between AFB and 1-year freedom from AF. We defined 4 distinct AFB groups: (1) 0%, (2) > 0-0.1%, (3) > 0.1-0.5%, and (4) > 0.5%.

Results

There were 210 patients (66 ± 9 years; 138 [66%] male; 116 [55%] paroxysmal AF; CHA2DS2-VASc 2.5 ± 1.6). Following a 3-month BP, 101 (48%) patients had a recurrence of AF at 160 ± 86 days post-ablation. An AFB of > 0% over the first 3 months predicted AF recurrence (p < 0.0001, Figure 1). Patients with > 0.5% AF burden after 1st month and any AF after 2nd month post CB PVI have a very high long-term AF recurrence rate (Figure 2).

Conclusion

The best long term outcome post CB PVI is seen in pts who have no AF in the first 3 months post ablation. An AFB >0.5% after the first month and any AF after the second month portend ablation failure. These data define a clinical utility of using AFB to risk stratify patients post CB PVI.

Yearly incidence and pattern of very late recurrence of atrial fibrillation as detected by continuous electrocardiographic monitoring using an implantable loop recorder

Funding Acknowledgements

Type of funding sources: None.

Background

A very late recurrence (VLR) of atrial fibrillation (AF) is considered present when patients have their first recurrence of AF > 12 months post-ablation. Little is known about the yearly rates and patterns of VLR AF recurrence.

Objective

To assess the yearly incidence and pattern of VLR in pts with AF who underwent cryoballoon (CB) pulmonary vein isolation (PVI).

Methods

We prospectively enrolled consecutive patients with AF who underwent CB PVI and had an implantable loop recorder (ILR) inserted up to 3 months post-ablation. Patients were followed for recurrent AF (excluding a 3-month post-ablation blanking period).

Results

Our cohort included 222 patients (66 ± 9 years; 143 [64%] male; 120 [54%] paroxysmal AF; CHA2DS2-VASc 2.6 ± 1.6). At 1-year, 111 (50%) patients remained free of AF. Two-year follow-up was available in 95 of these patients; 62 (65%) remained in sinus. Three-year follow-up was available in 42 of these patients; 36 (86%) remained in sinus (Figure). Of the 39 patients who developed AF after initially being free of AF for at least 1-year post ablation, 24 (62%) patients had either a frequent or persistent pattern of AF.

Conclusions

Our data show that the greatest likelihood of failure following a CB PVI occurs in the first year of ablation. The rate of failure becomes lower year by year. These data suggest that long term outcome may be driven more by the initial ablation as opposed to progressive evolution of the patient’s substrate

Is there clinical utility to replacement of an implantable loop recorder in patients who have previously undergone cryoballoon pulmonary vein isolation?

Funding Acknowledgements

Type of funding sources: None.

Background

Implantable loop recorders (ILRs) are used for long-term ECG monitoring following catheter ablation in patients (pts) with atrial fibrillation (AF) to guide clinical management. However, little is known about what do when the ILR reaches end of service (EOS).

Purpose

To identify pts who underwent replacement of their ILR and determine the diagnostic yield and clinical utility of the replacement device.

Methods

We enrolled 222 consecutive pts with AF who underwent cryoballoon pulmonary vein isolation (CB PVI) and had an ILR. We identified pts who subsequently underwent ILR replacement. The diagnostic and clinical utility of the newly replaced ILR was determined.

Results

The cohort included 56 pts (64 + 9 years; 35 [63%] male; 27 [48%] PAF; CHA2DS2-VASc 2.3 ± 1.5) in whom the initial ILR reached EOS. They were followed for 3.7 ± 2.1 years. Recurrent AF was observed in 41 (73%) of these pts; this triggered an intervention in 17 (41%) pts (Figure). Of the other 15 (27%) pts without any documented AF, anticoagulation was withheld in 13 [87%] pts. Following ILR replacement, 33 (80%) of the 41 pts had more AF (n=11 [33%] required an intervention) and 5 additional pts had AF for the first time.

Conclusions

Our data show that after CB PVI, ILRs help guide decisions regarding rhythm management and oral anticoagulation. When the initial ILR was replaced by a second ILR, AF was detected (often for the first time) in some patients; the findings were used to guide clinical decision making in the entire cohort. Thus, at this time, it remains undefined when ECG monitoring of these pts can be stopped because it is no longer clinical meaningful.

Defining the optimal blanking period duration after cryoballoon pulmonary vein isolation in patients with atrial fibrillation who have never been treated with an antiarrhythmic drug

Background

Cryoballoon (CB) pulmonary vein isolation (PVI) is an approved method for ablation in patients with paroxysmal (PAF) or persistent (PeAF) atrial fibrillation (AF). Although the first 90 days post-ablation are considered within the blanking period (BP), the optimal duration of the BP remains undefined.

Purpose

To objectively define the BP duration in pts undergoing CB PVI by evaluating a cohort never treated with an antiarrhythmic drug (AAD).

Methods

We enrolled consecutive pts with either PAF or PeAF who underwent initial CB PVI; all pts had an implantable loop recorder (ILR) for long-term ECG monitoring. No pt received an AAD either before or after ablation. We determined the time to last AF episode within the first 90 days of ablation. We then correlated this to the likelihood a patient had recurrent AF between 91 and 365 days of ablation.

Results

There were 45 pts (67±8 years; 26 [58%] male; 40 [89%] PAF; CHA2DS2-VASc 2.6±1.3). We defined 4 distinct groups post ablation based on whether or not they had AF in the BP: (1) no AF days 0–90 (n=19 [42%]), (2) last AF days 0–30 (n=11 [24%]), (3) last AF days 31–60 (n=3 [7%]), and (4) last AF days 61–90 (n=12 [27%]). After the 90-day BP, 15 (33%) pts had AF recurrence. Pts with no AF and those with AF only within 30 days of ablation had similar long-term outcome; however, recurrent AF more than 32 days after ablation predicted long-term ablation failure (Figure).

Conclusion

The post CB PVI blanking period is just a month. AF recurrences beyond a month in patients not on an AAD are associated with AF recurrence in the majority of pts.

Funding Acknowledgement

Type of funding sources: None. Blanking Group by AF Recurrence

Is the optimal blanking period duration after cryoballoon pulmonary vein isolation impacted by use of antiarrhythmic drugs?

Funding Acknowledgements

Type of funding sources: None.

Background

Cryoballoon pulmonary vein isolation (CB) is an accepted method for ablation in patients with atrial fibrillation (AF). A three-month blanking period (BP) is commonly used in clinical trials and practice. However, when the optimal BP duration differs in patients (pts) on or off an antiarrhythmic drug (AAD) at time of ablation remains undefined.

Objective

To compare the BP duration in pts undergoing CB while either taking or not taking an AAD.

Methods

We enrolled consecutive pts with AF who had CB PVI while on an AAD. All pts had an implantable loop recorder (ILR). We prospectively followed all pts and determined the time to last AF episode during the 90-day post-PVI BP. This was then correlated with likelihood of having an AF recurrence between 3-12 months post-PVI.

Results

The cohort included 164 pts (66 ± 9 years; 97 [60%] male; 90 [55%] PAF; CHA2DS2-VASc 2.7 ± 1.7). Ablation was performed with 92 (56%) pts taking an AAD, which was stopped at a median of 80 [36, 105] days post-PVI. We defined 4 distinct groups: (1) no AF in 90-day BP (n = 75 [46%]); (2) last AF within 30 days of PVI (n = 32 [20%]); (3) last AF within 60 days of PVI (n = 17 [10%]); and (4) last AF within 90 days of PVI (n = 40 [24%]). Following the 90-day BP, 81 (49%) pts had a recurrence of AF. Long-term freedom from recurrent AF was similar in pts who did and did not use an AAD, irrespective of BP duration (Figure).

Conclusion

Our data suggest that the optimal BP duration in AF patients undergoing CB PVI while taking an AAD is 30 days. An AF recurrence after 30 days is associated with a very high likelihood of recurrent AF during longer-term follow-up, irrespective of whether an AAD is being used or not. Abstract Figure.

Defining the blanking period duration after cryoballoon pulmonary vein isolation in patients taking an antiarrhythmic drug

Funding Acknowledgements

Type of funding sources: None.

Background

Cryoballoon pulmonary vein isolation (CB) is an accepted method for ablation in patients with atrial fibrillation (AF). A three-month blanking period (BP) is commonly used in clinical trials and practice. However, the actual BP duration in patients (pts) on an antiarrhythmic drug (AAD) at time of ablation remains undefined.

Objective

To objectively define the BP duration in pts undergoing CB while taking an AAD.

Methods

We enrolled consecutive pts with AF who had CB PVI while on an AAD. All pts had an implantable loop recorder (ILR). We prospectively followed all pts and determined the time to last AF episode during the 90-day post-PVI BP. This was then correlated with likelihood of having an AF recurrence between 3-12 months post-PVI.

Results

The cohort included 92 pts (66 ± 10 years; 62 [67%] male; 33 [36%] PAF; CHA2DS2-VASc 2.6 ± 1.7). AADs used included dofetilide (42), dronedarone (14), amiodarone (25), sotalol and propafenone (3 each), and flecainide (5). The AAD was stopped at a median of 80 [36, 105] days post-PVI.  We defined 4 distinct groups: (1) no AF in 90-day BP (n = 45 [49%]); (2) last AF within 30 days of PVI (n = 17 [18%]); (3) last AF within 60 days of PVI (n = 13 [15%]); and (4) last AF within 90 days of PVI (n = 17 [18%]). Following the 90-day BP, 47 (51%) pts had a recurrence of AF. Once recurrent AF was observed > 30 days post-ablation, patients had high likelihood of having a long term AF recurrence (p = 0.037, Figure).

Conclusion

Our data suggest that the optimal BP duration in AF patients undergoing CB PVI while taking an AAD is 30 days. An AF recurrence after 30 days is associated with a very high likelihood of recurrent AF during longer-term follow-up. Abstract Figure.

Estimation of the aerobic capacity by step test in the workers of a tile factory in Yazd in 2017

Introduction: Estimation of the maximum aerobic capacity to find a physiological fitness between worker and the work is of great importance. The purpose of this study was to estimate the highest aerobic capacity and physical work capacity of tile and ceramic workers. Materials and methods: In this cross-sectional study, 90 workers were randomly selected from tile and ceramic workers in Yazd. A questionnaire consisting of two parts was used as data collection tool. The first part of the questionnaire included demographic characteristics completed by the interview. In the second part, parameters including height, weight, BMI and heart rate were inserted in the questionnaire. The Queen step test was used to measure the maximum aerobic capacity. The data were analyzed by SPSS software using Mann-Whitney and Kruskal-Wallis tests and Spearman,s test. Results: The maximum aerobic capacity in tile and ceramic workers was estimated to be 3.60±.0.03 L/m. The results showed that aerobic capacity was significantly correlated with weight and body mass index. Also, there was no significant relationship between aerobic capacity, smoking and exercise, and education, but there was a significant relationship between gob title and aerobic capacity. Conclusion: Weight, BMI and type of occupation affect the aerobic capacity of workers.

ABO blood groups as a new potential predictive factor in radiotherapy hematological changes

AIM

Cancer treatments specially with new high Tec radiotherapy equipment's calling daily progression in method and predictive factors affecting treatment goals. Due to important effect of oxygen on cells radio sensitivity, tumor blood circulation and it's antigens like ABO blood groups maybe an important predictive factor for radiotherapy response and it is adverse events. The aim of this study was the assessment of the hematological manifestations of local radiotherapy and association with ABO blood groups.

METHODS

In this observational study, 2 ml of peripheral blood were taken from 152 patients with routine 3D conformal radiotherapy treatment course and the blood parameters achieve and documented at four stage during treatment courses. The data were analyzed by repeated measurement andone-way ANOVA.

RESULTS

Statistically significant reductions of the platelets, white blood cells (WBC), and lymphocytes counts were demonstrated. Also an increased percentage of polymorphonuclear cells during local radiotherapy exposure was found. The changes in WBC counts were observed to be in association with ABO blood groups. The other evaluated factors were not significantly associated with ABO blood groups.

CONCLUSIONS

Our results showed an association between radiotherapy patients ABO blood groups and some hematological changes in their blood circulation (Fig. 7, Ref. 23).

Sperm characteristics of Chukar partridge (Alectoris chukar) breeders as affected by the addition of calcitriol to the semen extender

This study was carried out to determine the effect of supplementing the semen extender with calcitriol on in vitro sperm characteristics in Chukar partridges. A total of 60 male Chukar partridges were habituated for semen collection by abdominal massage. Pooled ejaculates from several males were extended (1 to 5 v/v ratio) in the Sexton's diluent containing 0, 24, 48, 96, or 192 μg calcitriol/mL. These concentrations represented 0-, 2-, 4-, 8-, and 16-fold levels of the mean seminal calcitriol concentration, respectively. A total of 12 subsamples from each treatment group were kept at 4 to 5°C or 19 to 24°C for 4, 24, or 48 h. The percentages of motile sperm, live sperm, abnormal sperm, incidence of hypoosmotic swelling (HOS), and thiobarbituric acid reactive species (TBARS) concentrations were determined. The data were analyzed by the xtmixed procedure of STATA software. The percentages of motile sperm, live sperm, abnormal sperm, and seminal TBARS were affected by calcitriol (P < 0.05). There was no effect of treatments on HOS (P > 0.05). There was an interaction effect between calcitriol, storage time, and storage temperature on sperm motility, sperm viability, and seminal TBARS. Supplementation of the diluent with 96 μg calcitriol/mL resulted in the highest sperm motility at 4°C. Also, the same treatment group recorded the highest sperm viability and lowest seminal TBARS at 19 to 24°C. Supplementing the diluent with calcitriol had beneficial effects on spermatozoa; however, the fertility rate of spermatozoa extended in calcitriol-supplemented diluent needs to be determined before the procedure can be recommended for use in artificial insemination programs.

Test of the Einstein Equivalence Principle near the Galactic Center Supermassive Black Hole

During its orbit around the four million solar mass black hole Sagittarius A* the star S2 experiences significant changes in gravitational potential. We use this change of potential to test one part of the Einstein equivalence principle: the local position invariance (LPI). We study the dependency of different atomic transitions on the gravitational potential to give an upper limit on violations of the LPI. This is done by separately measuring the redshift from hydrogen and helium absorption lines in the stellar spectrum during its closest approach to the black hole. For this measurement we use radial velocity data from 2015 to 2018 and combine it with the gravitational potential at the position of S2, which is calculated from the precisely known orbit of S2 around the black hole. This results in a limit on a violation of the LPI of |β_{He}-β_{H}|=(2.4±5.1)×10^{-2}. The variation in potential that we probe with this measurement is six magnitudes larger than possible for measurements on Earth, and a factor of 10 larger than in experiments using white dwarfs. We are therefore testing the LPI in a regime where it has not been tested before.

Abstract PD8-04: Neoadjuvant chemotherapy for breast cancer: Nodal downstaging is highly correlated with pathological complete response

Background: Neoadjuvant chemotherapy (NAC) is employed in patients with larger tumors to attempt to downstage locally advanced cancers to allow breast conservation and to assess in vivo tumor response. The Multi-Institutional Neoadjuvant Therapy MammaPrint Project I (MINT) study asked a secondary question of whether complete nodal downstaging could also be achieved with NAC.

Methods: This analysis included 147 eligible invasive breast cancer patients with high tumor burdens, classified as cT2-4N0-3M0 (T2 greater than 3.5cm if N0). Patients who had a positive core biopsy and/or fine needle aspiration (FNA) on an axillary node prior to starting NAC were included in this analysis. Those who had a surgical sentinel lymph node biopsy were not included. Nodal involvement was established following neoadjuvant treatment by axillary lymph node dissection (ALND).

Results: This population was 54% postmenopausal, average age 53 yrs (range 25 to 80 yrs). Tumor characteristics were 91% invasive ductal carcinoma; 65% T2, 29% T3, 6% T4; 87% LN1, 13% LN2-3; 3% low grade, 38% intermediate grade, 59% high grade; 65% ER-positive, 49% PR-positive, and 28% HER2-positive by immunohistochemistry; 84% High Risk (HR) and 16% Low Risk (LR) by MammaPrint (MP). After NAC, 45% (66/147) of these LN-positive patients were down-staged to ypN0 and also achieved a complete pathological response in the primary tumor. The potential for down-staging was inversely-related to tumor burden, where 47% (60/128) of N1, 35% (6/17) of N2, and 0% (0/2) of N3 patients were down-staged to ypN0. There were 3 patients who were down-staged (2 N2 to N1, and 1 N3 to N2), but not to ypN0. At surgery, 34% (44/128) of patients had no change, and 19% (24/129) progressed in LN staging.

Pre vs Post NAC Nodal StagePre NAC Nodal StageypN0ypN1ypN2ypN3TotalcN16044222128cN2626317cN3  112Total6646296147

Conclusions: We confirmed that upon achieving a complete response of the primary tumor that there was also a pathologic complete response in the LN. About 53% of patients had no change or progression of LN involvement following NAC.

Citation Format: Blumencranz P, Habibi M, Treece T, Blumencranz L, Yoder E, Audeh W, Carter E, McNaughton L, Roussos J, Shivers S, Acs G, Cox C, MINT Investigators Group. Neoadjuvant chemotherapy for breast cancer: Nodal downstaging is highly correlated with pathological complete response [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 PD8-04.

Abstract P5-15-08: Economic Impact of MammaPrint (70-gene signature) in a clinical high risk population: A 10yr Markov model, 6,000-patient retrospective analysis of US claim data

Background: MINDACT provided evidence that MammaPrint (MP) can identify patients (pts) with early-stage breast cancer (ESBC) who can safely forego adjuvant chemotherapy (CT). As a result, 46% of clinicopathologically high-risk pts were spared from unnecessary CT toxicities. This study investigates direct and indirect costs for pts and payers during ESBC treatment regimens. The study objective was to quantify average cost of care and savings in a clinical high-risk group where the value of CT is unclear, and MP demonstrates economic and clinical impact. Methods: Risk assessment was based on 6,000 MP tests performed on BCBS members (2016-17). CT claims were retrospectively analyzed utilizing a Blue Cross Blue Shield (BCBS) member database (January-December 2016). Case data was restricted to HR+HER2- ESBC and filtered by authorization for the MP test. All CT claims were including, but not limited to standard of care (SOC) systemic drugs such as cyclophosphamide, docetaxel, paclitaxel and doxorubicin. HCPCS codes were utilized to filter member CT claims. Exclusion criteria: &lt;3 SOC CT claims and previous history of BC. A hybrid decision tree-Markov model was used to estimate cost effectiveness of MP compared to modified Adjuvant Online (mAOL) from a US healthcare payer perspective over a 10yr timeframe. Overall, distant metastasis free survival, and test-utility scores were collected from MINDACT for HR+HER2- pts, and costs derived from the BCBS registry and literature (2016 US dollars). Two scenarios were modelled (1) all women classified as high-risk received CT plus endocrine therapy (ET) while low-risk pts received ET; (2) MP guided treatment was modelled based on the IMPACT study (91% MP Low Risk pts received ET and 83% MP High Risk pts received CT). Outcome measures were quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs). Results: The majority, 3,540 (59.0%) pts were Low Risk or could safely forgo CT; 2,460 (41.0%) were High Risk. The primary driver for cost differences was whether all services were performed in a physician office ($4.6M) or an outpatient setting ($2M). Including provider settings (inpatient, outpatient, emergency), SOC CT regimens and related services the final average amount authorized was $39,675 per patient. In the first scenario, MP guided treatment was associated with a 0.06 QALY gain (0.05 in scenario 2) compared to mAOL. For cost savings and QALY gain MP was dominant over mAOL in both scenarios. Budget impact analysis estimated cost savings of 88.2- 96.6 million dollars based on BCBS registry data. Given the new cases of BC that are expected to be diagnosed in women in the U.S. annually, pts covered in this population by BCBS (˜30%) and MP eligible cohort (˜36K pts), projected cost savings are estimated at 529.2-644.3 million dollars per annum for the health insurer. Conclusions: CT was associated with significant annual costs from both patient and payer perspectives. As demonstrated in MINDACT, less treatment for some pts is optimal without risk to safety or survival. These findings suggest that MP is cost effective and provides substantial value by sparing pts from toxicities, both therapeutic and financial.

Citation Format: Blumencranz LE, Høst-Ragab A, Retèl VP, Garlich H, Hwang C, Neijenhuis S, Habibi M, Audeh W. Economic Impact of MammaPrint (70-gene signature) in a clinical high risk population: A 10yr Markov model, 6,000-patient retrospective analysis of US claim data [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 P5-15-08.

Development of a helicon ion source: Simulations and preliminary experiments

In the present context, the extraction system of a helicon ion source has been simulated and constructed. Results of the ion source commissioning at up to 20 kV are presented as well as simulations of an ion beam extraction system. Argon current of more than 200 μA at up to 20 kV is extracted and is characterized with a Faraday cup and beam profile monitoring grid. By changing different ion source parameters such as RF power, extraction voltage, and working pressure, an ion beam with current distribution exhibiting a central core has been detected. Jump transition of ion beam current emerges at the RF power near to 700 W, which reveals that the helicon mode excitation has reached this power. Furthermore, measuring the emission line intensity of Ar ii at 434.8 nm is the other way we have used for demonstrating the mode transition from inductively coupled plasma to helicon. Due to asymmetrical longitudinal power absorption of a half-helix helicon antenna, it is used for the ion source development. The modeling of the plasma part of the ion source has been carried out using a code, HELIC. Simulations are carried out by taking into account a Gaussian radial plasma density profile and for plasma densities in range of 10¹⁸-10¹⁹ m^-3. Power absorption spectrum and the excited helicon mode number are obtained. Longitudinal RF power absorption for two different antenna positions is compared. Our results indicate that positioning the antenna near to the plasma electrode is desirable for the ion beam extraction. The simulation of the extraction system was performed with the ion optical code IBSimu, making it the first helicon ion source extraction designed with the code. Ion beam emittance and Twiss parameters of the ellipse emittance are calculated at different iterations and mesh sizes, and the best values of the mesh size and iteration number have been obtained for the calculations. The simulated ion beam extraction system has been evaluated using optimized parameters such as the gap distance between electrodes, electrodes aperture, and extraction voltage. The gap distance, ground electrode aperture, and extraction voltage have been changed between 3 and 9 mm, 2-6.5 mm, and 10-35 kV in the simulations, respectively.

Crumpling-based soft metamaterials: the effects of sheet pore size and porosity

Crumpled-based materials are relatively easy to fabricate and show robust mechanical properties for practical applications, including meta-biomaterials design aimed for improved tissue regeneration. For such requests, however, the structure needs to be porous. We introduce a crumpled holey thin sheet as a robust bio-metamaterial and measure the mechanical response of a crumpled holey thin Mylar sheet as a function of the hole size and hole area fraction. We also study the formation of patterns of crease lines and ridges. The area fraction largely dominated the crumpling mechanism. We also show, the crumpling exponents slightly increases with increasing the hole area fraction and the total perimeter of the holes. Finally, hole edges were found to limit and guide the propagation of crease lines and ridges.

Combination of H120 and 1/96 avian infectious bronchitis virus vaccine strains protect chickens against challenge with IS/1494/06 (variant 2)-like infectious bronchitis virus

Avian infectious bronchitis (IB) is a worldwide chicken disease, caused by avian infectious bronchitis virus (IBV) which infects all commercial poultry lines. The present study was done to evaluate protection caused by two different serotype vaccines (Massachusetts and 793/B) in order to evaluate protection against challenge with IS/1494/06-like virus (variant 2-like virus), which is prevalent in the Middle East. SPF chickens were divided into four groups (n = 20). First and second group as negative control group and non-vaccinated-challenged group received no vaccine. Groups 3 and 4 received H120-H120 and H120-1/96 IBV vaccine strains at the 1st and 14th day, respectively. Twenty one days after last vaccination, non-vaccinated-challenged group and vaccinated group were challenged using variant 2-like IBV. Serum samples were collected before challenge to measure humoral immune response of chickens. Five days after challenge, the tissue samples from the trachea, lungs and kidneys were taken to evaluate cilliary activity, viral load (quantitative real-time RT-PCR), and histopathological evaluation. Clinical sign scores were also recorded after challenge. Overall, the results showed a protective efficacy of the used vaccination program. Best cross protection (69.2%) was obtained in the H120-1/96 vaccinated group. Virus replication of the challenged virus in H120-1/96 group compared with H120-H120 group showed a significant reduction of viral load in trachea (1.5×103 compared to 503) and kidneys. Clinical sign scores of the challenged groups showed significant effect of the vaccination program to reduce clinical signs. The trachea pathological scores and histopathological findings in the lungs and kidneys also confirmed better protective efficacy of vaccinated groups. In conclusion, using combination of heterologous IBV vaccine serotypes (Massachusetts and 793/B) would be a better strategy to control variant 2-like viruses, but more evaluation is needed using other circulating isolates to find the best combination of vaccines.

Aqueous extract from Orthosiphon stamineus leaves prevents bladder and kidney infection in mice

BACKGROUND

Extracts from the leaves of Orthosiphon stamineus are used in phytotherapy for treatment of uncomplicated urinary tract infections.

PURPOSES

Evaluation of an aqueous extract against infection with uropathogenic Escherichia coli in vivo; investigation of underlying microbiological mechanisms.

STUDY DESIGN

In vivo studies in mice and in vitro investigations on cytotoxicity, antiadhesive potential, influence on bacterial gene expression and quorum sensing.

METHODS

Extract OWE was prepared by hot water extraction. For in vivo studies BALB/c mice were used in an UPEC infection model. The effect of OWE on bacterial load in bladder/kidney tissue was monitored in pre- and posttreatment. Cytotoxicity of OWE against different UPEC strains, T24 bladder/A498 kidney cells, gene expression analysis, monitoring of phenotypic motility and quorum sensing was investigated by standard methods of microbiology.

RESULTS

OWE was quantified (UHPLC) according to the content of rosmarinic acid, cichoric acid, caffeic acid. Three- and 5-day treatment of animals with OWE (750mg/kg) after transurethral infection with UPEC CFT073 reduced the bacterial load in bladder and kidney, similar to norfloxacin. Four- and 7-day pretreatment of mice prior to the infection with UPEC NU14 reduced bacterial bladder colonization. In vitro investigations indicated that OWE (≤2mg/ml) has no cytotoxic or proliferation-inhibiting activity against different UPEC strains as well as against T24 bladder and A498 kidney cells. OWE exerts a dose dependent antiadhesive activity against UPEC strains NU14 and UTI89. OWE reduced gene expression of fimH, but evoked increase of the expression of motility/fitness gene fliC. Increase of bacterial motility on gene level was confirmed by a changed bacterial phenotype by an increased bacterial motility in soft agar assay. OWE inhibited in a concentration-dependent manner bacterial quorum sensing.

CONCLUSION

OWE is assessed as a strong antiadhesive plant extract for which the traditional use in phytotherapy for UTI might be justified.

Comparison of anterior segment parameter values obtained with Scheimpflug-Placido topographer, optical low coherence reflectometry and noncontact specular microscopy in morbid obesity

OBJECTIVE

To investigate the measurement of anterior segment parameters using Sirius Scheimpflug-Placido topographer, Lenstar optical low coherence reflectometry (OLCR), and noncontact specular microscopy (SM) in morbidly obese and nonobese subjects.

PATIENTS AND METHODS

Twenty-eight morbidly obese subjects (BMI ≥ 40; Group 1) and 28 age- sex-matched healthy nonobese subjects (BMI 18.50-24.99; Group 2) were included in this study. Anterior segment parameters were measured by Scheimpflug-Placido topographer and OLCR. Corneal endothelial cell parameters were measured by non-contact SM. The group data were analyzed using the Mann-Whitney U test and Student's t-test. Bland-Altman plots were used to assess agreement among the instruments, and 95% limits of agreement (LoA) for each comparison were calculated.

RESULTS

In group 1, the mean CCT by Scheimpflug-Placido topographer, OLCR, and noncontact SM were 549.44±30.10 µm, 544.15±31.48 µm, and 541.59±29.87 µm respectively. In group 2, the mean CCT by Scheimpflug-Placido topographer, OLCR, and noncontact SM were 531.0±22.09 µm, 523.15±21.39 µm, and 521.12±21.70 µm respectively. Mean CCT values obtained by the three methods were significantly higher in the morbidly obese than the nonobese subjects. In both groups, mean CCT was significantly higher when measured by Scheimpflug-Placido topographer than by OLCR and noncontact SM, and mean AD and ACD were significantly higher when measured by Scheimpflug-Placido topographer than OLCR. No significant differences were found between mean corneal curvature and corneal astigmatism when measured by Scheimpflug-Placido topographer and OLCR.

CONCLUSIONS

The mean CCT of the morbidly obese subjects were significantly higher than the nonobese subjects when measured by all three methods. The CCT values obtained by Scheimpflug-Placido topographer were significantly higher than those by OLCR and SM.

Effect of dietary fish oil with or without vitamin E supplementation on fresh and cryopreserved ovine sperm

This study was carried out to determine whether dietary fish oil (FO) with or without vitamin E (VE) supplementation would have a beneficial effect on characteristics of fresh and cryopreserved ovine sperm. Sixteen rams were allotted to four groups and fed one of the four diets: control diet (CON; without FO and VE supplementation), VE diet supplying 200 IU VE/day.ram, FO diet containing 2.5% (dry matter basis) FO, and OVE diet containing FO and VE. Semen samples were collected at Weeks 7, 9 and 11 for evaluation of seminal quality. Frozen samples from Weeks 9 and 11 were subjected to computer-assisted semen analysis (CASA). Seminal volume, percentage of sperm with normal morphology and intact acrosome and seminal concentration of malondialdehyde were increased in FO rams (P < 0.05). In VE rams, semen volume and percentage of morphologically normal sperm were higher compared with CON rams; however, in OVE rams these attributes were not different from those in CON rams. Other traits in fresh semen were not affected by the diet. Fish oil alone negatively affected the sperm viability, but not motility, of the frozen–thawed semen; however, simultaneous supplementation with FO and VE resulted in increased percentage of morphologically normal sperm, motility, and viability. The percentages of CASA type A (showing rapid progressive motility) and type B (showing medium progressive motility) sperm were higher in OVE compared with other groups. Vitamin E supplementation decreased the beat-cross frequency values compared with other groups. Other CASA parameters were not affected by the diets. In conclusion, dietary FO and VE in the breeding season of ram, generally, do not cause significant changes in fresh sperm quality but, for cryopreservation of sperm, supplementation of the diet with an antioxidant such as VE may be beneficial when polyunsaturated fatty acids are added to the diet.

Nesfatin-1 hormone levels in morbidly obese patients after laparoscopic sleeve gastrectomy

OBJECTIVE

To investigate changes in body mass index (BMI) and nesfatin-1 levels in patients with morbid obesity who had undergone laparoscopic sleeve gastrectomy (LSG).

PATIENTS AND METHODS

Blood samples were collected from, and the BMI calculated of 30 morbidly obese patients pre-surgery and at 3 and 6 months post-surgery. Nesfatin-1 hormone levels were measured using enzyme-linked immunosorbent assay (ELISA). Descriptive statistical analysis of the data was performed using Kruskal-Wallis variance analysis, one-way ANOVA, and the Bonferroni-Dunn test. The correlations between continuous variables not displaying normal distribution and those displaying normal distributions were analyzed using the Spearman correlation test and the Pearson correlation test, respectively.

RESULTS

The mean age of the 30 patients was 41.23 ± 10.37 years. The mean BMI values (kg/m2) were 49.30 ± 7.92, 39,48 ± 7.32, and 34.39 ± 7.56 presurgery, three months post-surgery, and six months post-surgery, respectively (p < 0.001). Mean nesfatin-1 levels (ng/ml) were 22.80 ± 14.16, 60.23 ± 52.92, and 96.99 ± 40.20 presurgery, three months post-surgery, and six months post-surgery, respectively (p < 0.001). The postoperative months 3 and 6 BMI values were significantly lower than the preoperative BMI value and the postoperative month 6 BMI value was significantly lower than the postoperative month 3 BMI value (p < 0.001). The postoperative months 3 and 6 nesfatin-1 levels were significantly higher than the preoperative nesfatin-1 levels. A negative correlation was found between age and preoperative nesfatin-1 values (p = 0.001, r = -0.0557).

CONCLUSIONS

Observation of significant increases in nesfatin-1 hormone levels in morbidly obese patients who had undergone LSG indicate that nesfatin-1 has important anorexigenic effects post-surgery and may be an important component of future obesity treatments.

Does diazinon-sprayed market melon alter cholinesterase activity in healthy consumers? A randomized control trial

OBJECTIVE

Food contributes in measurable body burden of the widely used organophosphate pesticides. We designed a randomized controlled open label trial in Mashhad University Hospital in Iran, to study the possible alterations in cholinesterase activity resulting from consuming market melon known to be exposed to diazinon.

PATIENTS AND METHODS

Fifty-three young healthy volunteers were recruited. Participants were randomized to consume 250 g per day of organic (N = 22) vs. market melon (N = 31) during fifteen days. The primary outcome was the variation of red blood-cell (RBC) cholinesterase activity between day 15 (after) and day 0 (prior the intervention). The secondary outcome was a variation of the plasma cholinesterase activity between both dates.

RESULTS

Baseline RBC [5.21 ± 0.93 vs. 5.53 ± 0.99 IU/mL, mean ± SD] and plasma cholinesterase activities [54.0 ± 8.1 vs. 57.4 ± 8.6%] did not significantly differ between organic and market melon-exposed participants, respectively. RBC [5.86 ± 1.27 vs. 5.11 ± 1.2 IU/mL] and plasma cholinesterase activities [58.7 ± 10.0 vs. 50.5 ± 13.0%] significantly increased in organic melon-exposed vs. market melon-exposed participants (p = 0.002 and p = 0.001, respectively).

CONCLUSIONS

RBC and plasma cholinesterase activities significantly improved after eating organic instead of market melon during fifteen days. However, the consequences on the health of the observed cholinesterase alterations attributed to diazinon dietary intake remain to be determined.

The retinal nerve fiber layer, choroidal thickness, and central macular thickness in morbid obesity: an evaluation using spectral-domain optical coherence tomography

OBJECTIVE

To assess the effect of morbid obesity on retinal nerve fiber layer (RNFL) thickness, central macular thickness (CMT), retinal ganglion cell (RGC), choroidal thickness (CT), central corneal thickness (CCT), and intraocular pressure (IOP).

PATIENTS AND METHODS

Sixty-seven patients defined as having morbid or class III obesity (BMI ≥ 40; Group 1) scheduled to undergo sleeve gastrectomy surgery and 29 nonobese patients (BMI 18.50-24.99; Group 2) underwent complete ophthalmic examination for measurement of IOP, CT, RNFL thickness, CMT, RGC, and CCT. RNFL thickness, CMT, and RGC were measured using spectral-domain optical coherence tomography (SD-OCT). CT measurement was performed using the enhanced depth imaging technique of the SD-OCT. The group data were analyzed and compared using the Mann-Whitney U test and Student's t-test. The relationship between the clinical ocular variables and obesity was analyzed using the Spearman's rank correlation test.

RESULTS

The mean IOP and CCT of Group 1 were found to be significantly higher (p < 0.001) and the mean RNFL, RGC, and CT significantly lower (p < 0.05) than those of Group 2. While Group 2 was found to have a slightly larger cup-to-disc ratio and Group 1 to have a thinner CMT, the differences between Groups 1 and 2 regarding these variables were not found to be statistically significant (p = 0.322 and p = 0.072, respectively). The results of Spearmen correlation analysis indicated the existence of a moderately positive correlation between IOP and BMI (p < 0.001; r = 0.5-0.6).

CONCLUSIONS

We have demonstrated by SD-OCT that morbid obesity may have a significant influence on RNFL, RGC, and CT. Morbid obesity may induce inflammatory, hormonal, and metabolic changes.

Ileal J-Pouch Perforation: Case Report

A 34-year-old male patient who had undergone total colectomy and J-pouch ileanal anastomosis subsequent to diagnosis of familial adenomatous polyposis five years previously was admitted to the emergency room with complaints of severe abdominal pain of a four-day duration. Physical examination revealed widespread tenderness throughout the abdomen, especially in the lower quadrant. Abdominal ultrasonography revealed fluid between intestinal loops and computed tomography revealed free air and fluid in the abdomen. During laparotomy to expand the ileal J-pouch to approximately 12 cm in diameter, a 2-mm perforation was detected in the blind end of the ileal J-pouch. The perforation was repaired primarily and protective ileostomy was performed. During postoperative endoscopy, neither obstruction nor stasis was observed, but pouchitis was observed in the ileal J-pouch. The patient was postoperatively discharged on the 20th day and followed endoscopically. The endoscopic findings were normal in the sixth month postsurgery.

Effectiveness of group dialectical behavior therapy (based on core distress tolerance and emotion regulation components) one expulsive anger and impulsive behaviors

INTRODUCTION

The purpose of this study is to measure Effectiveness of group dialectical behavior therapy (based on core distress tolerance and emotion regulation components) on Expulsive Anger and Impulsive Behaviors.

MATERIALS & METHODS

Research method is a semi experimental socio-statistic approach consisting of experimental group (dialectical behavior therapy) and control group. Participants were patients referred to Amir Kabir Hospital in Arak who suffered from Expulsive Anger and Impulsive Behaviors. Based on stratified random sampling, 16 patients (women) were placed in each group. Research tools included the structured diagnosis interview according to DSM-IV-TR (2000), Barrat impulsivity scale(1994) Distress Tolerance Scale (2005) Difficulties of Emotion Regulation Scale (2004) and dialectical behavior therapy were done for two months,8 group-sessions).

FINDINGS

Dialectical behavior therapy was effective on Expulsive Anger and Impulsive Behaviors.

DISCUSSION & CONCLUSION

Distress tolerance and emotion regulation components were effective on Expulsive Anger and Impulsive Behaviors.

Evaluation of Zataria MultiFlora Boiss and Carum copticum antibacterial activity on IMP-type metallo-beta-lactamase-producing Pseudomonas aeruginosa

Carbapenem resistance due to acquired metallo-beta-lactamases (MBLs) is considered to be more serious than other resistance mechanisms. The aim of this study was to evaluate the antibacterial activity of Zataria multiflora Boiss and Carum copticum plants on IMP-producing P.aeruginosa strains. This experimental study was carried out on hospitalized burn patients during 2011 and 2012. Antibiotics and extracts susceptibility tests were performed by disc diffusion and broth microdilution methods. MBL detection was performed by Combination Disk Diffusion Test (CDDT). The bla(VIM) and bla(IMP) genes were detected by PCR and sequencing methods. Using Combination Disk Diffusion test method, it was found that among 83 imipenem resistant P.aeruginosa strains, 48 (57.9%) were MBL producers. PCR and sequencing methods proved that these isolates were positive for blaIMP-1 genes, whereas none were positive for bla(VIM) genes. The mortality rate of hospitalized patients with MBL-producing Pseudomonas infection was 4/48 (8.3%). It was shown that Zataria multiflora and Carum copticum extracts had a high antibacterial effect on regular and IMP-producing P. aeruginosa strains in 6.25 mg/ml concentration. The incidence of MBL-producing P. aeruginosa in burn patients is very high. In our study, all MBL-producing isolates carry the blaIMP-1 gene. Therefore, detection of MBL-producing isolates is of great importance in identifying drug resistance patterns in P. aeruginosa, and in prevention and control of infections. In this study, it was shown that extracts of Z. multiflora and C. copticum have high antibacterial effects on ß-lactamase producing P. aeruginosa strains.

Delayed capillary breakup of falling viscous jets

Thin jets of viscous fluid like honey falling from capillary nozzles can attain lengths exceeding 10 m before breaking up into droplets via the Rayleigh-Plateau (surface tension) instability. Using a combination of laboratory experiments and WKB analysis of the growth of shape perturbations on a jet being stretched by gravity, we determine how the jet's intact length l(b) depends on the flow rate Q, the viscosity η, and the surface tension coefficient γ. In the asymptotic limit of a high-viscosity jet, l(b)∼(gQ(2)η(4)/γ(4))(1/3), where g is the gravitational acceleration. The agreement between theory and experiment is good, except for very long jets.