Unrecognized volatile and semi-volatile organic compounds from brake wear

Motor vehicles are among the major sources of pollutants and greenhouse gases in urban areas and a transition to "zero emission vehicles" is underway worldwide. However, emissions associated with brake and tire wear will remain. We show here that previously unrecognized volatile and semi-volatile organic compounds, which have a similarity to biomass burning emissions are emitted during braking. These include greenhouse gases or, these classified as Hazardous Air Pollutants, as well as nitrogen-containing organics, nitrogen oxides and ammonia. The distribution and reactivity of these gaseous emissions are such that they can react in air to form ozone and other secondary pollutants with adverse health and climate consequences. Some of the compounds may prove to be unique markers of brake emissions. At higher temperatures, nucleation and growth of nanoparticles is also observed. Regions with high traffic, which are often disadvantaged communities, as well as commuters can be impacted by these emissions even after combustion-powered vehicles are phased out.

Cell-free supernatant of Lactococcus lactis IDCC 2301 exerts anti-inflammatory effects in LPS-induced macrophages via NF-κB and MAPK signaling pathways

This study investigated the anti-inflammatory effects of cell-free supernatant of Lactococcus lactis IDCC 2301 on lipopolysaccharide (LPS)-induced RAW 264.7 macrophages. Expression of inflammatory mediators and cytokines, and the production of nitric oxide (NO) and prostaglandin E2 (PGE2) were qualitatively analysed. The expression of signal transductors in inflammatory cascades was quantified by western blot. Treatment with cell-free supernatant of L. lactis IDCC 2301 significantly decreased the mRNA expression levels of tumour necrosis factor (TNF-α) and interleukins including IL-1β and IL-6. The levels of inducible nitric oxide synthase (iNOS) and cyclooxygenase (COX-2) were also remarkably reduced in LPS-induced macrophages after the treatment. Furthermore, L. lactis IDCC 2301 reduced the levels of both dephosphorylated and phosphorylated forms of nuclear factor-kappa B (NF-κB), IκB-α, extracellular signal-regulated kinases (ERK), c-Jun amino-terminal kinases (JNK), and p38 in LPS-induced RAW 264.7 cells. Therefore, L. lactis IDCC 2301 shows anti-inflammatory activity by suppressing the NF-κB and mitogen-activated protein kinase (MAPK) signaling pathways.

Protective behaviors against COVID-19 and their association with psychological factors in China and South Korea during the Omicron wave: a comparative study

OBJECTIVES

We aimed to explore the level of protective behaviors against COVID-19 and its association with psychological factors in China and South Korea during the Omicron wave.

STUDY DESIGN

Cross-sectional study.

METHODS

We conducted a population-based cross-sectional survey from March 15 to 30, 2023 in China and South Korea. Demographic characteristics, health status, protective behaviors, and psychological factors (including perceived risks, efficacy belief, attribution of disease, fear of COVID-19, trust and evaluation, fatalism, resilience, and pandemic fatigue) were investigated. After adjusting for sociodemographic and health-related factors, multivariable regression models were constructed to explore the psychological influencing factors of protective behavior.

RESULTS

A total of 3000 participants from China and 1000 participants from Korea were included in the final analysis. The mean performance score for protective behaviors among all respondents was 2.885 in China and 3.139 in Korea, with scores ranging from 1 to 4. In China, performance scores were higher in those who were female, aged 30-39, employed, married, living in urban areas, having the highest income level, having the best subjective health status, and having a history of chronic disease (P-value <0.05). In Korea, performance scores were higher for individuals who were female, over 50 years old, educated to high school or below, unemployed, married, had a history of chronic disease, and had never been infected with SARS-CoV-2 (P-value <0.05). In the multivariable regression model, perceived severity (β = 0.067), attribution of disease (β = 0.121), fear of COVID-19 (β = 0.128), trust and evaluation (β = 0.097), psychological resilience (β = 0.068), and efficacy belief (β = 0.216) were positively associated with the performance scores, pandemic fatigue (β = -0.089) was negatively associated with performance scores in China (P-value <0.05). However, in Korea, perceived susceptibility (β = 0.075), fear of COVID-19 (β = 0.107), and efficacy belief (β = 0.357) were positively associated with protective behaviors (P-value <0.05), trust and evaluation (β = -0.078) and pandemic fatigue (β = -0.063) were negatively associated with performance scores (P-value <0.05).

CONCLUSIONS

Populations in both China and Korea demonstrated great compliance with protective behaviors during the Omicron wave. Because of the sociocultural, economic, and political differences, there were differences in the association between psychological factors and protective behaviors in the two countries. This study, from the perspective of psychological factors in different cultural contexts, would provide references for increasing adherence to protective guidelines in future outbreaks of emerging infectious diseases.

3-carene supresses inflammatory cytokine interleukin-4, interleukin-5 and interleukin-13 in a murine model of asthma

Asthma is a common airway disease associated with allergic inflammation. Environmental factors, such as pollens, pollution, insect-borne antigens, or commercial chemicals, cause this disease. The common symptoms of this airway allergic reaction are increasing mucus, narrowing of the airway wall, coughing, and chest tightness. Medications, such as steroids, alleviate the disease but with severe side effects. Several studies have reported the anti-inflammatory effects of tree-based essential oil components, particularly 3-carene. Therefore, this study used 3-carene to determine if it alleviates asthmatic symptoms in the murine model. First, BALB/c mice were sensitized to an ovalbumin and aluminium hydroxide mixture on day 7th and 14th. From days 21st to 23rd, the mice were challenged with 3-carene and budesonide. The lung trachea, plasma, and bronchiolar lavage fluid (BAL fluid) were collected on day 24. The 3-carene treatment suppressed the cytokine gene expression, such as interleukin-4 (IL-4), IL-5, and IL-13, reducing the lung epithelial cell thickness in the asthmatic model. These results suggest that essential oil 3-carene has an anti-asthmatic effect.

Prevalence of resistance-associated viral variants to the HIV-specific broadly neutralising antibody 10-1074 in a UK bNAb-naïve population

Broadly neutralising antibodies (bNAbs) targeting HIV show promise for both prevention of infection and treatment. Among these, 10-1074 has shown potential in neutralising a wide range of HIV strains. However, resistant viruses may limit the clinical efficacy of 10-1074. The prevalence of both de novo and emergent 10-1074 resistance will determine its use at a population level both to protect against HIV transmission and as an option for treatment. To help understand this further, we report the prevalence of pre-existing mutations associated with 10-1074 resistance in a bNAb-naive population of 157 individuals presenting to UK HIV centres with primary HIV infection, predominantly B clade, receiving antiretroviral treatment. Single genome analysis of HIV proviral envelope sequences showed that 29% of participants' viruses tested had at least one sequence with 10-1074 resistance-associated mutations. Mutations interfering with the glycan binding site at HIV Env position 332 accounted for 95% of all observed mutations. Subsequent analysis of a larger historic dataset of 2425 B-clade envelope sequences sampled from 1983 to 2019 revealed an increase of these mutations within the population over time. Clinical studies have shown that the presence of pre-existing bNAb mutations may predict diminished therapeutic effectiveness of 10-1074. Therefore, we emphasise the importance of screening for these mutations before initiating 10-1074 therapy, and to consider the implications of pre-existing resistance when designing prevention strategies.

Factors influencing the willingness to pay a price premium for red meat with potential to improve consumer wellness in Australia and the United States of America

This study determined consumers' attitudes towards physical and mental wellness related to red meat consumption and their willingness to pay (WTP) more for the meat. In 2019, two online surveys of red meat eaters were conducted in the USA (n = 1000) and Australia (n = 523) using commercial platforms. Results showed that over 90% of respondents indicated interest in purchasing red meat to improve their wellness status. Additionally, about 85% indicated their WTP more for red meat for its wellness benefits, with Americans indicating stronger willingness than Australian respondents. The potential of meat consumption to improve overall wellness among red meat eaters was a dominant factor influencing consumers' WTP more. Other factors that increased WTP included frequency of meat consumption, physical exercise, sleep quality, number of children in a household, partnership status, and economic position. Outcomes from this study highlight a unique opportunity for the meat industry to position meat on its qualities that include wellness improvement if backed up with robust scientific evidence.

Achievement of Target Gain Larger than Unity in an Inertial Fusion Experiment

On December 5, 2022, an indirect drive fusion implosion on the National Ignition Facility (NIF) achieved a target gain G_{target} of 1.5. This is the first laboratory demonstration of exceeding "scientific breakeven" (or G_{target}>1) where 2.05 MJ of 351 nm laser light produced 3.1 MJ of total fusion yield, a result which significantly exceeds the Lawson criterion for fusion ignition as reported in a previous NIF implosion [H. Abu-Shawareb et al. (Indirect Drive ICF Collaboration), Phys. Rev. Lett. 129, 075001 (2022)PRLTAO0031-900710.1103/PhysRevLett.129.075001]. This achievement is the culmination of more than five decades of research and gives proof that laboratory fusion, based on fundamental physics principles, is possible. This Letter reports on the target, laser, design, and experimental advancements that led to this result.

Investigating Disparities in Hypopharyngeal/Laryngeal Cancer Survival in Florida With Geospatial Mapping Analysis

OBJECTIVE

Identify predictors of overall survival (OS) after hypopharyngeal/laryngeal cancer in Florida.

MATERIAL AND METHODS

We conducted a retrospective cohort study using data from the Florida Cancer Data System (FCDS) on patients diagnosed with hypopharyngeal or laryngeal cancer from 2010-2017. Primary outcome was OS. Hazard ratios (HRs) were estimated from univariable and multivariable Cox regression models for OS. Data was analyzed from November 1, 2022, to June 30, 2023.

RESULTS

We analyzed 6771 patients, who were primarily male (81.2%), White non-Hispanic (WNH) (78.2%), publicly insured (70.1%), married (51.8%), and residents of urban counties (73.6%). Black patients were more likely to be younger at diagnosis (38.9%), single (43.4%), to have distant SEER stage disease (25.6%). Median OS were lowest among patients who were uninsured (34 months), with hypopharyngeal site disease (18 months), and a smoking history (current: 34 months, former: 46 months, no smoking: 63 months). Multivariable Cox regression analysis showed worse OS for single/unmarried vs married (HR 1.47 [95%CI: 1.36-1.59], P < .001), history of tobacco use (current: HR 1.62 [95%CI: 1.440-1.817], P < .001; former smokers: (HR 1.28 [95%CI: 1.139-1.437], P < .001) vs no history). Improved OS was observed among White Hispanics (WH) vs WNH (HR .73 [95%CI: .655-.817], P < .001) and women vs men (HR .88 [95%CI: .807-.954], P = .002). Geographical mapping showed that mortality rates were highest in census tracts with low income and education.

CONCLUSION

Our findings suggest that sociodemographic and clinical factors impact OS from hypopharyngeal/laryngeal cancer in Florida and vary geographically within the state. These results will help guide future public health interventions.

Expression of NEDD4L and ENaC in Urinary Extracellular Vesicles in Pre-eclampsia

OBJECTIVE

To assess changes in expression of renal epithelial sodium channel (ENaC) and NEDD4L, a ubiquitin ligase, in urinary extracellular vesicles (UEV) of pre-eclamptic women compared to normal pregnant controls.

METHODS

Urine was collected from pre-eclamptic women (PE, n = 20) or during normal pregnancy (NP, n = 20). UEV were separated by differential ultracentrifugation. NEDD4L, α-ENaC and γ-ENaC were identified by immunoblotting.

RESULTS

There was no difference in the expression of NEDD4L (p = 0.17) and α-ENaC (p = 0.10). PE subjects showed increased expression of γ-ENaC by 6.9-fold compared to NP (p < 0.0001).

CONCLUSION

ENaC expression is upregulated in UEV of pre-eclamptic subjects but was not associated with changes in NEDD4L.

National trends in the prevalence of hepatitis B and C in South Korea, before and during the COVID-19 pandemic (2007-2021) - a nationwide representative study

OBJECTIVE

Due to the various changes caused by the COVID-19 pandemic, some infectious diseases showed different epidemiology and prevalence during the pandemic. However, there is a lack of comprehensive studies on trends in the prevalence of hepatitis B and C related to the pandemic. Thus, we compared the prevalence of hepatitis B and C before and during the COVID-19 pandemic in South Korea.

SUBJECTS AND METHODS

We conducted a comprehensive trend analysis with a nationwide serial cross-sectional survey from 2007 to 2021 (n=86,931) using the Korea National Health and Nutrition Examination Survey (KNHANES). The changes in the prevalence of hepatitis B and C were evaluated using a weighted regression model to assess the impact of the COVID-19 pandemic.

RESULTS

From 2007 to 2021, 86,931 Korean adults aged 19 or older were included in the KNHANES data. The prevalence of hepatitis B showed a declining trend until the onset of the pandemic (1.80% in 2007-2009; 1.08% in 2016-2019; and 1.01% in 2020), at which point this trend reversed (1.39% in 2021). The prevalence of hepatitis C remained stable (0.14% in 2007-2009 and 0.18% in 2016-2019), with no particular surge related to the COVID-19 pandemic (βdiff, -0.002; 95% CI, -0.761 to 0.756). For hepatitis B, old age was identified as a pandemic-related vulnerable factor (ratio of odds ratio, 1.68; 95% CI, 1.05-2.70).

CONCLUSIONS

In this study, unlike other infectious diseases, hepatitis B and C did not show a decreasing trend during the pandemic. In particular, hepatitis B showed a rebound trend during the pandemic, which was noticeable in those aged 60 or older. Further studies are needed to support these findings.

Kondo screening in a Majorana metal

Kondo impurities provide a nontrivial probe to unravel the character of the excitations of a quantum spin liquid. In the S = 1/2 Kitaev model on the honeycomb lattice, Kondo impurities embedded in the spin-liquid host can be screened by itinerant Majorana fermions via gauge-flux binding. Here, we report experimental signatures of metallic-like Kondo screening at intermediate temperatures in the Kitaev honeycomb material α-RuCl3 with dilute Cr3+ (S = 3/2) impurities. The static magnetic susceptibility, the muon Knight shift, and the muon spin-relaxation rate all feature logarithmic divergences, a hallmark of a metallic Kondo effect. Concurrently, the linear coefficient of the magnetic specific heat is large in the same temperature regime, indicating the presence of a host Majorana metal. This observation opens new avenues for exploring uncharted Kondo physics in insulating quantum magnets.

First Measurement of the Nuclear-Recoil Ionization Yield in Silicon at 100 eV

We measured the nuclear-recoil ionization yield in silicon with a cryogenic phonon-sensitive gram-scale detector. Neutrons from a monoenergetic beam scatter off of the silicon nuclei at angles corresponding to energy depositions from 4 keV down to 100 eV, the lowest energy probed so far. The results show no sign of an ionization production threshold above 100 eV. These results call for further investigation of the ionization yield theory and a comprehensive determination of the detector response function at energies below the keV scale.

A novel variant in the tropomyosin 3 gene presenting as an adult-onset distal myopathy - a case report

BACKGROUND

We report a patient with a novel c.737 C > T variant (p.Ser246Leu) of the TPM3 gene presenting with adult-onset distal myopathy.

CASE PRESENTATION

A 35-year-old Chinese male patient presented with a history of progressive finger weakness. Physical examination revealed differential finger extension weakness, together with predominant finger abduction, elbow flexion, ankle dorsiflexion and toe extension weakness. Muscle MRI showed disproportionate fatty infiltration of the glutei, sartorius and extensor digitorum longus muscles without significant wasting. Muscle biopsy and ultrastructural examination showed a non-specific myopathic pattern without nemaline or cap inclusions. Genetic sequencing revealed a novel heterozygous p.Ser246Leu variant (c.737C>T) of the TPM3 gene which is predicted to be pathogenic. This variant is located in the area of the TPM3 gene where the protein product interacts with actin at position Asp25 of actin. Mutations of TPM3 in these loci have been shown to alter the sensitivity of thin filaments to the influx of calcium ions.

CONCLUSION

This report further expands the phenotypic spectrum of myopathies associated with TPM3 mutations, as mutations in TPM3 had not previously been reported with adult-onset distal myopathy. We also discuss the interpretation of variants of unknown significance in patients with TPM3 mutations and summarise the typical muscle MRI findings of patients with TPM3 mutations.

Initial phase establishment of an in vitro method for developmental neurotoxicity test using Ki-67 in human neural progenitor cells

Building a precise alternative neurotoxicological test is of great importance to respond to societal and ethical requirements. In this study, a new developmental neurotoxicity test (DNT) was established with the human neural progenitor cell line. ReNcell CX cells were exposed to neurotoxic chemicals (aphidicolin, hydroxyurea, cytosine arabinoside, 5-fluorouracil, and ochratoxin A) or non-neurotoxic chemicals (sodium gluconate, sodium bicarbonate, penicillin G, and saccharin). Propidium iodide (PI) was used to evaluate cell viability. BrdU and Ki-76 were employed to determine cell proliferation. Based on the cell viability and proliferation, mathematical models were built by linear discriminant analysis. Furthermore, the neurotoxic-considered chemicals inhibited cell cycle progression at the protein level, supporting the biomolecular rationale for the predictive model. Overall, these results show that the new test method can be used to determine the potential developmental neurotoxicants or new drug candidates.

Evaluation of the self-administration potential of high-density microarray patches to human skin: A preliminary study

The high-density microneedle array patch (HD-MAP) is a novel vaccine delivery system with potential for self-administered vaccination. In this study, Vaxxas HD-MAPs were applied by both a trained user and self-administered with application sites compared to determine the response of skin and the level of engagement of the HD-MAP with human skin. Twenty healthy participants were enrolled, and the response of skin including erythema was observed at all application sites and no difference was found between trained user or self-administered applications. The majority of participants (70%) preferred the deltoid upper arm application site for applying HD-MAPs. Fluorescent dermatoscope images confirmed HD-MAPs engaged the skin surface and scanning electron microscopy (SEM) image analysis exhibited similar delivery characteristics for the upper arm and forearm sites when applied by either a trained user or self-administered. This study showed that noninvasive methods including dermatoscopy and SEM image analysis were able to estimate the engagement of HD-MAPs with human skin. HD-MAP self-vaccination technology has a unique proposition in pandemic preparedness by alleviating the need for health-care workers to administer vaccines, however greater awareness and understanding of the potential of this technology is required.

Impact of discontinuing isolation in a private room for patients infected or colonized with vancomycin-resistant enterococci (VRE) on the incidence of healthcare-associated VRE bacteraemia in a hospital with a predominantly shared-room setting

BACKGROUND

Isolating patients infected or colonized with vancomycin-resistant enterococci (VRE) in a private room or cohort room to prevent hospital transmission is controversial.

AIM

To evaluate the effect of a relaxed isolation policy for VRE-infected or colonized patients on healthcare-associated (HA) VRE bacteraemia in an acute care hospital with a predominantly shared-room setting.

METHODS

The incidence of HA VRE bacteraemia was compared during a private isolation era (October 2014-September 2017), a cohort isolation era (October 2017-June 2020), and a no isolation era (July 2020-June 2022). Using Poisson regression modelling, an interrupted time-series analysis was conducted to analyse level changes and trends in incidences of HA VRE bacteraemia for each era.

FINDINGS

The proportion of VRE-infected or -colonized patients staying in shared rooms increased from 18.3% in the private isolation era to 82.6% in the no isolation era (P < 0.001). There was no significant difference in the incidences of HA VRE bacteraemia between the private isolation era and the cohort isolation era (relative risk: 1.01; 95% confidence interval: 0.52-1.98; P = 0.977) or between the cohort isolation era and the no isolation era (0.99; 0.77-1.26; P = 0.903). In addition, there was no significant slope increase in the incidence of HA VRE bacteraemia between any of the eras.

CONCLUSION

In a hospital with predominantly shared rooms, the relaxation of isolation policy did not result in increased HA VRE bacteraemia, when other infection control measures were maintained.

Unique Clinical, Radiological and Histopathological Characteristics of a Southeast Asian Cohort of Patients with Limb-Girdle Muscular Dystrophy 2G/LGMD-R7-Telethonin-Related

AIM

We describe a cohort of five patients with limb-girdle muscular dystrophy (LGMD) 2G/LGMD-R7 in a South-east Asian cohort.

BACKGROUND

LGMD2G/LGMD-R7-telethonin-related is caused by mutations in the TCAP gene that encodes for telethonin.

METHODS

We identified consecutive patients with LGMD2G/LGMD-R7-telethonin-related, diagnosed at the National Neuroscience Institute (NNI) and National University Hospital (NUH) between January 2000 and June 2021.

RESULTS

At onset, three patients presented with proximal lower limb weakness, one patient presented with Achilles tendon contractures, and one patient presented with delayed gross motor milestones. At last follow up, three patients had a limb girdle pattern of muscle weakness and two had a facioscapular humeral pattern of weakness. Whole body muscle MRI performed for one patient with a facioscapular-humeral pattern of weakness showed a pattern of muscle atrophy similar to facioscapular-humeral dystrophy. One patient had histological features consistent with myofibrillar myopathy; electron microscopy confirmed the disruption of myofibrillar architecture. One patients also had reduced staining to telethonin antibody on immunohistochemistry.

CONCLUSION

We report the unique clinical and histological features of a Southeast Asian cohort of five patients with LGMD2G/LGMD-R7-telethonin-related muscular dystrophy and further expand its clinical and histopathological spectrum.

Diverse perspectives on social determinants of multicultural adolescents: A focus group study

Background

As Korea transforms into a multicultural society, social vulnerability of the multicultural adolescents (MAs) puts them at risk for poor health and health disparities. However, there is shortage of evidence on social determinants of health (SDH), which refers to the circumstances of people from birth to death, which affects their health outcomes, for MAs. Thus, this study aims to explore the SDH of MAs from diverse stakeholders’ perspectives.

Methods

This qualitative study comprised 17 focus group interviews with 99 participants (MAs, peers, parents, teachers, neighbors, and community leaders), conducted from June to September 2020. The directed content analysis was conducted using the Minority Health and Health Disparities Research Framework with a high rigor level based on the four criteria of Lincoln and Guba’s trustworthiness.

Results

The participants addressed SDH of MAs in five domains: biological (vulnerability and mechanism); behavioral (health behavior, family/school/peer functioning, and policies and laws); physical/built environment (school/community environment); sociocultural environment (MAs'/parental sociodemographic, language proficiency, MAs'/parental acculturation, social network, and response to/interpersonal/local/societal structural discrimination); and health care system (insurance coverage, MAs'/parental health literacy, availability of services, and health care policies). However, limited SDH in biological and physical/built environment domains were identified.

Conclusions

SDH in sociocultural environment domain and interpersonal influence level were the most commonly addressed. Interpersonal discrimination of both MAs and parents were found to be the most important SDH. These findings suggest that future programs to enhance MAs’ health may be targeted toward reducing discrimination and involving their parents.

Key messages

• Sociocultural environment was found to be the most salient SDH domain to affect MAs’ health.

• SDH of MAs are linked to discrimination and their parents’ sociocultural aspects such as acculturation.

Trends in management of cardiovascular risk factors in young adults who go on to develop coronary artery disease

Background

Rates of premature coronary artery disease (CAD) have remained stagnant in many countries in the past two decades. While guidelines on cardiovascular prevention are evolving to improve risk assessment, more data are needed to evaluate changes in risk management in younger patients with high cardiovascular risk.

Purpose

To investigate the trends in pre-presentation prevalence and management of major cardiovascular risk factors (CVRFs) and predictors of initiation of lipid-lowering therapy (LLT) in patients with premature coronary artery disease.

Methods

In this retrospective cohort study, we identified women &lt;55 years old and men &lt;50 years old who presented with obstructive CAD (stenosis &gt;50% or history of coronary revascularization) between 2000 and 2017. Data were collected from administrative databases and provincial cardiac information system and included demographics, all outpatient visits, hospitalizations, pharmacy dispenses in the period of 3 years prior to CAD, presentation characteristics, and results of invasive coronary angiography.

Results

In total, 14,470 patients (29.7% females) met the study criteria. During the study period, prevalence decreased for dyslipidemia and smoking and increased for hypertension, diabetes and obesity (Figure 1). Over 96.5% of patients were eligible for lipid screening 3 years prior to presentation with CAD, 93.5% had visits with primary care physicians, and 57.4% had visits with specialist physicians. Only 20.5% received LLT, with rates rising from 19% in the year 2000 to 24% in 2017 (p=0.023). Additionally, 38.1% of patients received medical treatment for other CVRFs. Figure 2 presents risk management and rates of LLT initiation in patients with five major CVRFs. In multivariable logistic regression analysis, LLT was more likely in patients with diabetes (odds ratio [OR] 3.04, 95% CI 2.74–3.36), hypertension (OR 1.44, 95% CI 1.30–1.58), chronic kidney disease (OR 1.79, 95% CI 1.44–2.23), and depression (OR 1.25, 95% CI 1.11–1.40). Later year of presentation (OR 1.04, 95% CI 1.03–1.05), older age at presentation (OR 1.03, 95% CI 1.02–1.04) and residing in urban areas vs rural (OR 1.36, 95% CI 1.16–1.58) were also positively associated with LLT. Male sex (OR 0.88, 95% CI 0.78–0.98) and smoking (OR 0.68, 95% CI 0.62–0.76) were associated with lower likelihood of treatment. Obesity, hypothyroidism, chronic inflammatory conditions, and malignancies were not significantly associated with LLT.

Conclusion

Despite the rising prevalence of CVRFs, high eligibility for lipid screening, and availability of care, rates of LLT initiation in patients who go on to develop premature CAD remain very low, representing a major missed opportunity for cardiovascular disease prevention. Many of the major CVRFs and risk enhancers endorsed in current guidelines were not associated with treatment initiation, suggesting that new approaches may be required to increase appropriate use LLT in these patients.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): St. Pauls Hospital Foundation, Vancouver, BC, CanadaVancouver General Hospital Foundation, Vancouver, BC, Canada

Association of usual walking with mortality in oldest old adults aged 85 years and older: a nationwide senior cohort study

Background

Current guidelines recommend moderate to vigorous intensity physical activity (MVPA) for health benefit in adults. However, it is difficult to meet the recommended minimum MVPA in “oldest old” aged over 85. Although walking is simple and easy exercise for oldest old, research on the association between walking and mortality in oldest old are lacking.

Purpose

To investigate the association between walking and the risk of all-cause and cardiovascular mortality among older adults aged 85 years and older.

Methods

7047 participants aged 85 or older underwent the Korean National Health Screening Program, including self-administered questionnaire for physical activity. Reported frequency per week of walking for at least 30 minutes increment was used to classify hours of walking per week. We computed multivariable-adjusted hazard ratios for walking and mutually adjusted for MVPA in relation to all-cause and cardiovascular mortality.

Results

The proportions of participants who engaged in walking, moderate- and vigorous-intensity physical activity were 42.5% (2996/7047), 14.7% (1037/7047) and 11.0% (773/7047), respectively. Only 7.6% (538/7047) of participants met the guidelines recommended minimum MVPA. Compared to inactive individuals, those who walked at least 1 hour per week had lower all-cause (HR 0.60 [95% CI, 0.50–0.74]) and cardiovascular mortality risk (HR 0.61 [95% CI, 0.42–0.89]). Walking 1 hour per week was still significant associated with reduction of risk for all-cause (HR 0.50 [95% CI, 0.40–0.61]) and cardiovascular mortality (HR 0.46 [95% CI, 0.30–0.70]) among participants who reported only walking without any MVPA.

Conclusions

1 hour a week of walking might be of benefit for all-cause and cardiovascular mortality in aged over 85 years, even without MVPA. Promoting walking may be a way to help oldest old avoid inactivity and encourage an active lifestyle for all-cause and cardiovascular mortality risk reduction.

Funding Acknowledgement

Type of funding sources: None.

Pathogenic variants damage cell compositions and single cell transcription in cardiomyopathies

 

Pathogenic variants in genes that cause dilated (DCM) and arrhythmogenic cardiomyopathies (ACM) convey high risks for the development of heart failure (HF) through unknown mechanisms. Using single nucleus RNA sequencing (snRNAseq), we characterized the transcriptome of 880,000 nuclei from 18 control and 61 failing, non-ischemic human hearts with pathogenic variants in DCM and ACM genes or idiopathic disease. We performed genotype-stratified analyses of the ventricular cell lineages and transcriptional states. The resultant DCM and ACM ventricular cell atlas demonstrated distinct right and left ventricular responses, highlighting genotype-associated pathways, intercellular interactions, and differential gene expression at single cell resolution. Together these data illuminate both shared and distinct cellular and molecular architectures of human HF and suggest novel candidate therapeutic targets.

Funding Acknowledgement

Type of funding sources: Other. Main funding source(s): Chan Zuckerberg FoundationLeducq Foundation

Alleviation of AF related symptoms following acute conversion of recent-onset, symptomatic atrial fibrillation to sinus rhythm with flecainide acetate oral inhalation solution

Introduction

Pharmacological restoration of sinus rhythm (SR) in patients with symptomatic atrial fibrillation (AF) is expected to be accompanied by prompt alleviation of symptoms to avoid the need for electrical cardioversion (ECV) and/or hospitalization. The feasibility and safety of acute cardioversion of recent-onset (≤48 hours) symptomatic AF to SR with flecainide acetate oral inhalation (FlecIH) solution was shown in the Phase 2, open-label INSTANT trial. We examined symptoms, heart rate, time to discharge and need for ECV reported among patients in the INSTANT trial whose AF was successfully converted to SR (“conversion group”; N=25) versus those whose AF did not convert to SR (“no conversion group”; N=29).

Methods

Conversion success was determined using 12-lead Holter monitoring during a 90-minute observation period. Patients in the no conversion group were offered alternative treatment per the investigator discretion. Symptoms, vital signs, time to discharge, and the need for ECV were evaluated through Day 5.

Results

Data from 54 patients (33.3% female) with a mean age of 62.1 years and a mean BMI of 26.8 kg/m2 were analyzed. All patients reported at least one AF-related symptoms at baseline (palpitations=85%; dizziness=35%; shortness of breath=37%; chest discomfort=39%) and 83.3% presented with AF symptoms ≤24 hours in duration. At 90 minutes, 80.0% of the conversion group were asymptomatic compared to 37.9% of the no conversion group (p&lt;0.001). Mean (SD) ventricular rate at 90 minutes was 70.6 (12.5) bpm in the conversion group compared to 100.4 (29.4) bpm in the no conversion group (p&lt;0.001). Median time to discharge was 2.3 (IQR: 0.75) hours for the conversion group compared to 3.6 (IQR: 1.02) hours for the no conversion group (p=0.001). By Day 5, 23 (79.3%) patients in the no conversion group had undergone ECV; no patients in the conversion group experienced AF recurrence by Day 5 (0% required ECV; p&lt;0.001).

Conclusions

Conversion of recent onset AF to SR with inhaled flecainide was associated with a reduction in symptoms, normalization of heart rate, rapid hospital discharge and avoidance of ECV during a 5-day follow-up period.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): InCarda Therapeutics

The efficacy of immune checkpoint inhibitors in elderly patients: a meta-analysis and meta-regression

Background

Immune checkpoint inhibitor (ICI) therapy has improved patient survival in advanced cancers; however, the efficacy of ICIs in elderly patients is still elusive. This study assessed the efficacy of ICIs in elderly patients with advanced cancer in terms of overall survival (OS) and progression-free survival (PFS).

Materials and methods

We carried out a systematic review and identified 30 head-to-head phase II/III randomized controlled trials that compared immunotherapy with the standard of care in advanced solid tumor patients. The data on patients younger or over 65 years of age were indexed from PubMed-Medline, Embase, and Scopus and obtained for meta-analysis. The subgroup analyses were stratified by primary tumor type, line of treatment, or type of immunotherapy, and a meta-regression analysis was carried out after adjusting for all other variables.

Results

The study included 17 476 patients, comprising 58% (10 119) younger (<65 years old) and 42% (7357) elderly (≥65 years old) patients. The hazard ratio (HR) for OS was 0.77 [95% confidence interval (CI) 0.70-0.85] and 0.77 (95% CI 0.70-0.85) in the younger and elderly groups, respectively, suggesting similar efficacies of ICIs in these two age groups. The subgroup analyses revealed no significant relationship between age and treatment outcomes, except for the PFS benefit in younger patients with melanoma than in elderly patients (HR 0.44 in younger patients versus 0.65 in elderly patients, P = 0.04). These results were further supported by meta-regression analysis, which showed no statistically significant difference in OS (P = 0.954) and PFS (P = 0.555) between the two age groups.

Conclusions

The findings suggest that age-associated impairments of the immune system did not affect the efficacy of ICIs in elderly patients compared to younger patients. Therefore, the choice of ICIs for elderly patients can be considered, regardless of chronological age.

•

We evaluated the efficacy of ICI in 17 476 patients, comprising 58% younger and 42% elderly patients.

•

Meta-analysis resulted in the comparable efficacy of ICI between younger and older age groups.

•

Further, meta-regression analysis showed no significant difference in OS and PFS.

•

Our study suggests that chronological age does not lead to immunosenescence in response to ICI in immune-oncology.

Lawson Criterion for Ignition Exceeded in an Inertial Fusion Experiment

For more than half a century, researchers around the world have been engaged in attempts to achieve fusion ignition as a proof of principle of various fusion concepts. Following the Lawson criterion, an ignited plasma is one where the fusion heating power is high enough to overcome all the physical processes that cool the fusion plasma, creating a positive thermodynamic feedback loop with rapidly increasing temperature. In inertially confined fusion, ignition is a state where the fusion plasma can begin "burn propagation" into surrounding cold fuel, enabling the possibility of high energy gain. While "scientific breakeven" (i.e., unity target gain) has not yet been achieved (here target gain is 0.72, 1.37 MJ of fusion for 1.92 MJ of laser energy), this Letter reports the first controlled fusion experiment, using laser indirect drive, on the National Ignition Facility to produce capsule gain (here 5.8) and reach ignition by nine different formulations of the Lawson criterion.

O049 FRAX score assessment of long term follow up thyroid cancer patients

Introduction

Thyroid stimulating hormone (TSH) suppression with Levothyroxine (LT4) following thyroid cancer surgery is recommended in some patients under long term follow up. However, LT4 may cause reduced bone mineral density. We aimed to assess patients in our long-term thyroid cancer follow up clinic for risk to bone health.

Methods

We conducted a review of all patients in the thyroid cancer follow-up clinic and calculation of FRAX score for those that are &gt;40 years old who are followed up in the Endocrine Surgical Service of NUH. Subsequently patients were categorised into risk groups according to the Osteoporosis Group Guideline (2017) and managed accordingly.

Results

78 patients were identified and had ongoing follow up. 23 patients were excluded as they were &lt;40 years old. 10 patients did not want to participate in the study. 45 patients were assessed with the FRAX score. There were 31 female and 14 male patients, mean age 60.8 (±12.3) years. The mean follow up was 75.0 (±78.9) months. 11% (five patients) were found to require treatment for Osteoporosis without a bone mineral density (BMD) scan, 38% (17 patients) were recommended to assess their BMD, 4% had borderline risk to measure BMD, and 47% required lifestyle and dietary modification.

Conclusion

Thyroid cancer patients aged 40 and above represent a cohort in whom osteoporosis is a substantial risk and warrant assessment with a FRAX score.

Take-home message

Thyroid cancer patients aged 40 and above represent a cohort in whom osteoporosis is a substantial risk and warrant assessment with a FRAX score.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

The natural history of low-risk non-muscle-invasive bladder cancer: a collaborative multi-centre study

BACKGROUND

International guidelines vary in terms of their definition and recommendation for management of low-risk non-muscle-invasive bladder cancer (LRNMIBC). The ideal management for this large subset of bladder cancer patient remains unclear.

OBJECTIVE

To evaluate long-term outcomes of patients with LRNMIBC. As a secondary objective, to assess for intergroup heterogeneity in disease-specific outcomes between G1 and G2LG diseases.

METHODS

A multi-centre, retrospective study of patients who met the 2015 NICE definition of LRNMIBC. Timeline of diagnosis ranged from 01/01/2012 to 30/06/2016.

RESULTS

A total 390 patients had available follow-up data (G1: 142, G2LG: 249). Over a median follow-up time of 36 months (IQR 25-50), 29.2% of the patients developed a recurrence. G2LG patients were statistically more likely to develop a recurrence (G1: 26.8%, G2LG: 33.7%, p < 0.05). 51.8% of recurrences occurred after 1 year of surveillance. Progression to high-grade disease occurred in 1.8% (n = 7, G1: 3, G2LG: 4) and a further 1.0% (n = 4, G1:3, G2LG: 1) of patients developed muscle-invasive bladder cancer (MIBC).

CONCLUSION

The majority of recurrences occurred after 1 year of surveillance. The risk of disease progression was low; however, this was observed in a cohort of patients with regular cystoscopic follow-up. The risk may be higher if patients were pre-maturely discharged. If a 5-year surveillance programme were to be followed, 96.5% of recurrences would be captured. Lastly, there appears to be intergroup heterogeneity within LRNMIBC with G2LG patients having a statistically higher risk of recurrence compared to G1.

POS0641 A RANDOMISED PHASE I PHARMACOKINETIC STUDY COMPARING HIGH-CONCENTRATION, LOW-VOLUME, AND CITRATE-FREE SB5 (40 MG/0.4 ML) WITH PRIOR SB5 FORMULATION, AND ADALIMUMAB BIOSIMILAR, IN HEALTHY MALE SUBJECTS

Background

SB5, an adalimumab (ADL) biosimilar, was developed in a low-concentration (40 mg/0.8 mL, SB5-LC) aligned with the reference ADL product. Pharmacokinetics (PK) equivalence of SB5 and reference ADL was demonstrated in a Phase I study conducted in healthy subjects1. Equivalent efficacy and comparable safety between 40 mg/0.8 mL SB5 and 40 mg/0.8 mL reference ADL were demonstrated in a Phase III study conducted in patients with rheumatoid arthritis2. High-concentration, low-volume, citrate-free SB5 (40 mg/0.4 mL, SB5-HC) has been developed as a part of life cycle management in line with the reference ADL formulation.

Objectives

To compare the PK, safety, and tolerability of the newly developed SB5-HC (40 mg/0.4 mL) to prior SB5-LC (40 mg/0.8 mL) in healthy male subjects.

Methods

This study was a randomised, single-blind, two-arm, parallel group, single-dose study in healthy male subjects. Subjects were randomised in a ratio of 1:1 to receive a single dose of either SB5-HC or SB5-LC by subcutaneous injection on Day 1 and then observed for 57 days during which the PK, safety, and immunogenicity were evaluated. The serum concentration of ADL was measured using an enzyme-linked immunosorbent assay. The primary PK parameters were area under the concentration-time curve from time zero to infinity (AUCinf) and maximum serum concentration (Cmax). Equivalence for the primary PK parameters was to be concluded if the 90% confidence intervals (CIs) for the ratio of geometric least squares means (LSMeans) of the treatment groups compared were completely contained within the pre-defined equivalence margin of 0.80 to 1.25 using an analysis of variance.

Results

Of 188 randomised subjects, 187 subjects were analysed as PK Analysis Set (PKS) (n=93 in SB5-HC and n=94 in SB5-LC). One subject was excluded from the PKS in SB5-HC group (major protocol deviation for not being withdrawn in the event of confirmed COVID-19). The geometric LSMeans ratios for the comparison of SB5-HC and SB5-LC for AUCinf and Cmax were 0.920 and 0.984, respectively, and the corresponding 90% CIs were within the pre-defined equivalence margin of 0.80 to 1.25 (Table 1), indicating the two treatment groups are bioequivalent. There were no deaths, serious adverse events or discontinuation of the study due to treatment-emergent adverse events (TEAEs) during the study. The proportions of subjects who experienced TEAEs were comparable between the two treatment groups (44.7% in SB5-HC vs 51.1% in SB5-LC). The most frequent TEAEs were headache (10.6% in SB5-HC vs 12.8% in SB5-LC).

Table 1.

Comparison of Primary PK Parameters between the Treatments

PK ParameterTreatmentGeometric LSMeanRatio90% CIAUCinf (h·μg/mL)SB5-HC2616.10.9200.8262; 1.0239SB5-LC2844.3Cmax (μg/mL)SB5-HC4.10.9840.9126; 1.0604SB5-LC4.1

Conclusion

This study demonstrated PK equivalence between SB5-HC and SB5-LC in healthy subjects. Both SB5-HC and SB5-LC were generally well tolerated with similar safety profiles.

References

[1]Shin D et al. J Clin Pharm Ther. 2017 Dec;42(6):672-678.

[2]Weinblatt ME et al. Arthritis Rheumatol. 2018 Jun;70(6):832-840.

Disclosure of Interests

None declared

POS0451 DEFICIENCY OF PPM1A IN MACROPHAGE AGGRAVATES PRISTANE-INDUCED LUPUS-LIKE DISEASE

Background

Protein phosphatase Mg2+/Mn2+-dependent 1A (PPM1A) is a phosphatase which regulates various intracellular cell signaling pathways including inflammation. We previously suggested that the inflammatory signal decreased the PPM1A protein level in macrophage and this reduction had correlation with the chronic inflammatory bone disease, implying the possible role of PPM1A in inflammatory responses of macrophage.

Objectives

In this study, we aim to elucidate the potential role of PPM1A in macrophage to regulate inflammatory response during the disease progression of systemic lupus erythematosus.

Methods

We generated macrophage-specific conditional gene-knockout (PPM1Afl/fl;LysM-Cre) mice and developed a lupus-like disease with immune complex glomerulonephritis in these PPM1Afl/fl;LysM-Cre mice by intraperitoneal pristane injection. Mouse serum was collected every 4 weeks after pristane injection. Serum anti-dsDNA IgG, anti-ssDNA IgG, interleukin-17 (IL-17) and tumor necrosis factor-α (TNF-α) was quantified by ELISA. After 41 weeks from pristane injection, histological changes in the kidney, spleen, and lung tissues were observed. To analyze M1/M2 polarization in vitro, LysM-Cre and PPM1Afl/fl;LysM-Cre mouse bone marrow-derived macrophages were cultured with lipopolysaccharide (LPS)/interferon-γ (IFN-γ) or interleukin-4 (IL-4) to check M1 or M2 related genes.

Results

We found that macrophages of PPM1Afl/fl;LysM-Cre mice displayed different gene expression with LPS stimulation especially in M1/M2 related genes through the RNA-seq analysis and showed a decrease in both M1 and M2 polarization induced by LPS/IFN-γ or IL-4 stimulation. Notably, we found that PPM1Afl/fl;LysM-Cre mice with pristane injection showed a significant increase of anti-ssDNA IgG compared to LysM-Cre mice. PPM1Afl/fl;LysM-Cre mice showed severe lupus-like phenotypes such as global glomerular enlargement indicated by endocapillary proliferation and glomerular cellularity in kidney and lung inflammation accompanied by fibrosis, compared to LysM-Cre mouse by pristane injection. Together, serum IL-17 and TNF-α, which are proinflammatory cytokines, were increased in PPM1Afl/fl;LysM-Cre after pristane injection. These results indicate that PPM1A depletion in macrophage deteriorates inflammation and contributes to the tissue damage in a lupus-like disease.

Conclusion

Our findings suggest that the deficiency of PPM1A in macrophages impairs M1/M2 macrophage polarization leading to an immune imbalance in lupus-like disease model, providing a potential link between the loss of function of PPM1A in macrophages and its molecular target for treatment of systemic lupus erythematosus.

References

[1]Kwon, O. C., Choi, B., Lee, E. J., Park, J. E., Lee, E. J., Kim, E. Y., Kim, S. M., Shin, M. K., Kim, T. H., Hong, S., Lee, C. K., Yoo, B., Robinson, W. H., Kim, Y. G., & Chang, E. J. (2020). Negative Regulation of Osteoclast Commitment by Intracellular Protein Phosphatase Magnesium-Dependent 1A. Arthritis & rheumatology (Hoboken, N.J.), 72(5), 750–760. https://doi.org/10.1002/art.41180

[2]Smith, S. R., Schaaf, K., Rajabalee, N., Wagner, F., Duverger, A., Kutsch, O., & Sun, J. (2018). The phosphatase PPM1A controls monocyte-to-macrophage differentiation. Scientific reports, 8(1), 902. https://doi.org/10.1038/s41598-017-18832-7

Disclosure of Interests

None declared.