High somatic mutations in circulating tumor DNA predict response of metastatic pancreatic ductal adenocarcinoma to first-line nab-paclitaxel plus S-1: prospective study

AIMS

We previously showed that the nab-paclitaxel plus S-1 (NPS) regimen had promising effects against metastatic pancreatic ducal adenocarcinoma (mPDAC), whose efficacy however could not be precisely predicted by routine biomarkers. This prospective study aimed to investigate the values of mutations in circulating tumor DNA (ctDNA) and their dynamic changes in predicting response of mPDAC to NPS chemotherapy.

METHODS

Paired tumor tissue and blood samples were prospectively collected from patients with mPDAC receiving first-line NPS chemotherapy, and underwent next-generation sequencing with genomic profiling of 425 genes for ctDNA. High mutation allelic frequency (MAF) was defined as ≥ 30% and ≥ 5% in tumor tissue and blood, respectively. Kappa statistics were used to assess agreement between mutant genes in tumor and ctDNA. Associations of mutations in ctDNA and their dynamic changes with tumor response, overall survival (OS), and progression-free survival (PFS) were assessed using the Kaplan-Meier method, multivariable-adjusted Cox proportional hazards regression, and longitudinal data analysis.

RESULTS

147 blood samples and 43 paired tumor specimens from 43 patients with mPDAC were sequenced. The most common driver genes with high MAF were KRAS (tumor, 35%; ctDNA, 37%) and TP53 (tumor, 37%; ctDNA, 33%). Mutation rates of KRAS and TP53 in ctDNA were significantly higher in patients with liver metastasis, with baseline CA19-9 ≥ 2000 U/mL, and/or without an early CA19-9 response. κ values for the 5 most commonly mutated genes between tumor and ctDNA ranged from 0.48 to 0.76. MAFs of the genes mostly decreased sequentially during subsequent measurements, which significantly correlated with objective response, with an increase indicating cancer progression. High mutations of KRAS and ARID1A in both tumor and ctDNA, and of TP53, CDKN2A, and SMAD4 in ctDNA but not in tumor were significantly associated with shorter survival. When predicting 6-month OS, AUCs for the 5 most commonly mutated genes in ctDNA ranged from 0.59 to 0.84, larger than for genes in tumor (0.56 to 0.71) and for clinicopathologic characteristics (0.51 to 0.68). Repeated measurements of mutations in ctDNA significantly differentiated survival and tumor response. Among the 31 patients with ≥ 2 ctDNA tests, longitudinal analysis of changes in gene MAF showed that ctDNA progression was 60 and 58 days ahead of radiologic and CA19-9 progression for 48% and 42% of the patients, respectively.

CONCLUSIONS

High mutations of multiple driving genes in ctDNA and their dynamic changes could effectively predict response of mPDAC to NPS chemotherapy, with promising reliable predictive performance superior to routine clinicopathologic parameters. Inspiringly, longitudinal ctDNA tracking could predict disease progression about 2 months ahead of radiologic or CA19-9 evaluations, with the potential to precisely devise individualized therapeutic strategies for mPDAC.

The associations of erythrocyte membrane polyunsaturated fatty acids with skeletal muscle loss: A prospective cohort study

BACKGROUND & AIMS

Polyunsaturated fatty acids (PUFAs) may play a vital role in maintaining skeletal muscle mass in the aged population. This study investigated the longitudinal relationship between the concentrations of erythrocyte membrane PUFAs and age-related changes in skeletal muscle mass over an average 6.5 years of follow-up in a Chinese middle-aged and older adult population.

METHODS

A total of 1494 participants aged 57.4 ± 4.7 years were included in this study. Skeletal muscle mass was determined using dual-energy X-ray absorptiometry. Per year percent changes in the skeletal muscle index (Δ% SMI), appendicular skeletal muscle index (Δ% ASMI), and total body lean mass index (Δ% TBLMI) from baseline were calculated. Concentrations of total and individual cis-n-3 and cis-n-6 PUFAs of the erythrocyte membrane were determined using gas-liquid chromatography.

RESULTS

Fully adjusted linear regression models showed that per unit increases in the concentrations of C18:2 n-6, C20:4 n-6, C22:4 n-6, and total n-6 PUFAs resulted in increases of 0.022%-0.155 % in the Δ% SMI (P for linearity: <0.001-0.006). Restricted cubic spline analysis revealed an inverted U-shaped relationship between the concentrations of C20:2 n-6, C22:5 n-3, C22:6 n-3, and total n-3 PUFAs and the Δ% SMI (P for non-linearity: <0.001-0.036). In addition, an inverted U-shaped curve was also detected for the relationships of the linoleic acid/α-linolenic acid ratio (P for non-linearity = 0.010) and n-6/n-3 PUFA ratio (P for non-linearity = 0.013) with the Δ% SMI, with the Δ% SMI peaking at respective ratios of 124.96 and 3.69. Similar associations were revealed by the Bayesian kernel machine regression model. No interaction effect was detected between the individual PUFAs for the Δ% SMI in the bivariate exposure-response analysis. Overall, similar results were observed for the Δ% ASMI and Δ% TBLMI.

CONCLUSIONS

The associations between different individual PUFAs and age-related muscle loss in middle-aged and older adults may be different. Our results suggest that high concentrations of erythrocyte membrane n-6 PUFAs may be correlated with less skeletal muscle mass loss, whereas extremely high concentrations of n-3 PUFAs may be correlated with more muscle loss.

Self-regulation as a resource for coping with developmental challenges during middle childhood and adolescence: the prospective longitudinal PIERYOUTH-study

BACKGROUND

Self-regulation (SR) as the ability to regulate one's own physical state, emotions, cognitions, and behavior, is considered to play a pivotal role in the concurrent and subsequent mental and physical health of an individual. Although SR skills encompass numerous sub-facets, previous research has often focused on only one or a few of these sub-facets, and only rarely on adolescence. Therefore, little is known about the development of the sub-facets, their interplay, and their specific contributions to future developmental outcomes, particularly in adolescence. To fill these research gaps, this study aims to prospectively examine (1) the development of SR and (2) their influence on adolescent-specific developmental outcomes in a large community sample.

METHODS/DESIGN

Based on previously collected data from the Potsdam Intrapersonal Developmental Risk (PIER) study with three measurement points, the present prospective, longitudinal study aims to add a fourth measurement point (PIER_YOUTH). We aim to retain at least 1074 participants now between 16 and 23 years of the initially 1657 participants (6-11 years of age at the first measurement point in 2012/2013; 52.2% female). The study will continue to follow a multi-method (questionnaires, physiological assessments, performance-based computer tasks), multi-facet (assessing various domains of SR), and multi-rater (self-, parent-, and teacher-report) approach. In addition, a broad range of adolescent-specific developmental outcomes is considered. In doing so, we will cover the development of SR and relevant outcomes over the period of 10 years. In addition, we intend to conduct a fifth measurement point (given prolonged funding) to investigate development up to young adulthood.

DISCUSSION

With its broad and multimethodological approach, PIER_YOUTH aims to contribute to a deeper understanding of the development and role of various SR sub-facets from middle childhood to adolescence. The large sample size and low drop-out rates in the first three measurements points form a sound database for our present prospective research. Trial registration German Clinical Trials Register, registration number DRKS00030847.

Adverse childhood experiences and incident coronary heart disease: a counterfactual analysis in the Whitehall II prospective cohort study

Objectives

Adverse childhood experience is thought to be associated with risk of coronary heart disease, but it is not clear which experiences are cardiotoxic, and whether risk increases with the accumulation of adverse childhood experiences.

Methods

Participants were 5149 adults (72.6% men) in the Whitehall II cohort study. Parental death was recorded at phase 1 (median age in years 44.3), and 13 other adverse childhood experiences at phase 5 (55.3). We applied Cox proportional hazards regression with person-time from phase 5 to examine associations of adverse childhood experiences with incident coronary heart disease. We predicted hazard ratios according to count of the experiences, and examined dose-response effect. We finally estimated reduction of coronary heart disease in a hypothetical scenario, the absence of adverse childhood experiences.

Results

Among study participants, 62.9% had at least one adversity, with "financial problems" having the highest prevalence (26.1%). There were 509 first episodes of coronary heart disease during an average 12.9 years follow-up. Among 14 adverse childhood experiences in a multiply adjusted model, "parental unemployment" showed the highest hazard of coronary heart disease incidence (hazard ratio; 95% confidence interval: 1.53; 1.16 to 2.02). No dose-response effect was observed (constant for proportionality in hazard ratio: 1.05, 0.99 to 1.11). Based on the estimates of final model, in the absence of childhood adversities, we estimated a 6.0% reduction in coronary heart disease (0.94; 0.87 to 1.01), but the confidence interval includes one.

Conclusion

Although individual adverse childhood experiences show some association with coronary heart disease, there is no clear relationship with the number of adverse experiences. Further research is required to quantify effects of multiple and combinations of adverse childhood experiences considering timing, duration, and severity.

The Regeneración Urbana, Calidad de Vida y Salud - RUCAS project: a Chilean multi-methods study to evaluate the impact of urban regeneration on resident health and wellbeing

BACKGROUND

The available evidence of the health effects of urban regeneration is scarce In Latin America, and there are no studies focused on formal housing that longitudinally evaluate the impact of housing and neighborhood interventions on health. The "Regeneración Urbana, Calidad de Vida y Salud" (Urban Regeneration, Quality of Life, and Health) or RUCAS project is a longitudinal, multi-method study that will evaluate the impact of an intervention focused on dwellings, built environment and community on the health and wellbeing of the population in two social housing neighborhoods in Chile.

METHODS

RUCAS consists of a longitudinal study where inhabitants exposed and unexposed to the intervention will be compared over time within the study neighborhoods (cohorts), capitalizing on interventions as a natural experiment. Researchers have developed a specific conceptual framework and identified potential causal mechanisms. Proximal and more distal intervention effects will be measured with five instruments, implemented pre- and post-interventions between 2018 and 2021: a household survey, an observation tool to evaluate dwelling conditions, hygrochrons for measuring temperature and humidity inside dwellings, systematic observation of recreational areas, and qualitative interviews. Survey baseline data (956 households, 3130 individuals) is presented to describe sociodemographics, housing and health characteristics of both cohorts, noting that neighborhoods studied show worse conditions than the Chilean population.

DISCUSSION

RUCAS' design allows for a comprehensive evaluation of the effects that the intervention could have on various dimensions of health and health determinants. RUCAS will face some challenges, like changes in the intervention process due to adjustments of the master plan, exogenous factors -including COVID-19 pandemic and associated lockdowns- and lost to follow-up. Given the stepped wedge design, that the study capitalizes on within household changes over time, the possibility of adjusting data collection process and complementarity of methods, RUCAS has the flexibility to adapt to these circumstances. Also, RUCAS' outreach and retention strategy has led to high retention rates. RUCAS will provide evidence to inform regeneration processes, highlighting the need to consider potential health effects of regeneration in designing such interventions and, more broadly, health as a key priority in urban and housing policies.

Protocol for iGrow (Infant Growth and Development Study): biopsychosocial predictors of childhood obesity risk at 2 years

Background

Childhood obesity remains a significant public health problem. To date, most research on the causes and correlates of obesity has focused on a small number of direct predictors of obesity rather than testing complex models that address the multifactorial nature of the origins of obesity in early development. We describe the rationale and methods of iGrow (Infant Growth and Development Study) which will test multiple pathways by which (a) prenatal maternal psychobiological risk predicts infant weight gain over the first 6 months of life, and (b) this early weight gain confers risk for obesity at age 2. Infant hormonal and psychobiological risk are proposed mediators from prenatal risk to early weight gain, though these are moderated by early maternal sensitivity and obesogenic feeding practices. In addition, higher maternal sensitivity and lower obesogenic feeding practices are proposed predictors of adaptive child self-regulation in the second year of life, and all three are proposed to buffer/reduce the association between high early infant weight gain and obesity risk at age 2.

Methods

iGrow is a prospective, longitudinal community-based study of 300 diverse mothers and infants to be followed across 5 data waves from pregnancy until children are age 2. Key measures include (a) maternal reports of demographics, stress, well-being, feeding practices and child characteristics and health; (b) direct observation of maternal and infant behavior during feeding, play, and distress-eliciting tasks during which infant heart rate is recorded to derive measures of vagal withdrawal; (c) anthropometric measures of mothers and infants; and (d) assays of maternal prenatal blood and infant saliva and urine. A host of demographic and other potential confounds will be considered as potential covariates in structural equation models that include tests of mediation and moderation. Efforts to mitigate the deleterious effects of COVID-19 on study success are detailed.

Discussion

This study has the potential to inform (1) basic science about early life processes casually related to childhood obesity and (2) development of targeted intervention and prevention approaches that consider mother, infant, and family risks and resources.

Bidirectional relationship between physical health symptoms and depressive symptoms in the pre- and postpartum period

OBJECTIVE

To test the bidirectional relationships between physical health symptoms (PHS) and depressive symptoms (DS) as well as between the intensity of 'any pain' and DS in the pre- and postpartum period METHOD: Women (N = 615) completed the Edinburgh Postnatal Depression Scale, the Patients Health Questionnaire-15, and numerical pain rating scales when they were between 32 and 37 weeks of gestation, and subsequently one, three, and six months postpartum. We conducted two random intercept cross-lagged panel models (RI-CLPM) RESULTS: Both models presented excellent fits. The relationship between PHS and DS was bidirectional across all the data waves (χ²(9) = 6.610, p = .678, CFI = 1, TLI = 1, RMSEA = 0). The magnitude of the standardized cross-lagged regression coefficient was relatively similar from DS to PHS (raging between 0.081 and 0.171); and from PHS to DS (raging between 0.121 and 0.138). The relationship between 'any pain' intensity and DS was also bidirectional, but only during the postnatal period (χ²(9) =11.765, p = .227, CFI = 0.99, TLI = 0.98, RMSEA = 0.022). The magnitude of the standardized cross-lagged regression coefficient was higher from DS to 'any pain' intensity (raging between 0.214 and 0.216); than from 'any pain' intensity to DS (raging between 0.092 and 0.097).

CONCLUSIONS

Concurrently intervening over physical and mental health symptoms could promote women's perinatal health.

Current practice in the introduction of solid foods for preterm infants

OBJECTIVE

The present study compared the age of first solid foods in a cohort of preterm infants with term infants and identified factors influencing timing of solid food introduction.

DESIGN

Structured interviews on infant feeding practices, growth and medical status at term equivalence and at 3, 6, 9 and 12 months corrected postnatal age. The age of solid food introduction was compared between term and preterm infants, and the influence of maternal, infant and milk feeding factors was assessed.

SETTING

This prospective longitudinal study recruited primary carers of preterm and term infants from a regional metropolitan referral hospital in eastern Australia.

PARTICIPANTS

One hundred and fifty infants (preterm, n 85; term, n 65).

RESULTS

When corrected for prematurity, preterm infants received solid foods before the recommended age for the introduction of solid foods for term infants. Median introduction of solid foods for preterm infants was 14 weeks corrected age (range 12-17 weeks). This was significantly less than 19 weeks (range 17-21 weeks) for term infants (P < 0·001). Lower maternal education and male gender were associated with earlier introduction of solid foods among preterm infants.

CONCLUSIONS

Preterm infants are introduced to solid foods earlier than recommended for term infants, taking account of their corrected age. Further research is needed to assess any risk or benefit associated with this pattern and thus to develop clear evidence-based feeding guidelines for preterm infants.

Head Growth and Intelligence from Birth to Adulthood in Very Preterm and Term Born Individuals

OBJECTIVES

The aim of this study was to investigate the effects of infant and toddler head growth on intelligence scores from early childhood to adulthood in very preterm (&lt;32 weeks gestational age; VP) and/or very low birth weight (&lt;1500 g; VLBW) and term born individuals.

METHODS

203 VP/VLBW and 198 term comparisons were studied from birth to adulthood as part of the prospective geographically defined Bavarian Longitudinal Study (BLS). Head circumference was assessed at birth; 5, 20 months; and 4 years of age. Intelligence was assessed with standardized tests in childhood (6 and 8 years: K-ABC) and at 26 years (Wechsler Adult Intelligence Scale, WAIS). Structural equation modeling (SEM) was used to model the effect of head growth on IQ.

RESULTS

On average, VP/VLBW had lower head circumference at birth (27.61 cm vs. 35.11 cm, mean difference 7.49, 95% confidence interval [7.09-7.90]) and lower adult intelligence scores (88.98 vs. 102.54, mean difference 13.56 [10.59-16.53]) than term born comparison individuals. Head circumference at birth (e.g., total effect β=.48; p&lt;.001 for adult IQ) and head growth in childhood predicted intelligence development from age 6 to 26 years in both VP/VLBW and term born individuals (70% of variance in adult IQ explained by full model). Effects of gestation and birth weight on intelligence were fully mediated by head circumference and growth.

CONCLUSIONS

This longitudinal investigation from birth to adulthood indicates head growth as a proxy of brain development and intelligence. Repeated early head circumference assessment adds valuable information when screening for long-term neurocognitive risk. (JINS, 2019, 25, 48#x2013;56).

Studying entrepreneurial occupations in the Terman women

To achieve a better understanding of entrepreneurship development in women, longitudinal data on 672 individuals collected from 1922 to 1959 were analysed in a secondary investigation of the Terman Longitudinal Study. Women's reports on their occupations during 10 different years were assigned to one of two categories: work for pay (0/1), and work allowing for self-employment (0/1) in the respective year. Structural equation modelling supported earlier results concerning male entrepreneurial activity. Personality and aspects of the parenting context the women had experienced by the average age of 12 predicted early entrepreneurial competencies (inventions, leadership) and occupational interests by age 13, which related to an entrepreneurship-related career goal in 1936, when the participants were about 27 years of age on average. Such a career goal in turn predicted a higher number of occasions of entrepreneurship-prone work. Surprisingly, we also found a relationship to divorce. Women who had experienced the failure of a marriage were in occupations with a potential for entrepreneurship more often. Reasons are discussed against a backdrop of historical timing and current findings to identify general aspects of entrepreneurship development.