2nd Quartiles Research Articles

Abstract P5-06-11: Serum thymidine kinase-1 activity (TKa) as a prognostic marker in premenopausal women with hormone receptor positive (HR+) operable breast cancer (BC)

Abstract Introduction: Thymidine kinase is an established marker of cancer cell proliferation and its activity can be measured in blood. We and others have recently shown that baseline and dynamic evaluation of circulating thymidine kinase activity (TKa) during treatment gives prognostic and predictive information in patients with HR+, HER2-negative metastatic BC treated with endocrine therapy alone, as well as in the setting of CDK4/6 inhibition. However, there is limited data regarding the role of TKa as a prognostic biomarker in operable BC. Here we present a retrospective analysis of TKa in serum samples collected in a cohort of premenopausal women with operable BC enrolled in a phase III adjuvant multicenter clinical trial (NCT00201851). Materials and methods: Serum samples were available for 644 (87%) of participants prospectively enrolled in a randomized trial between 2003 and 2009 in South East Asia. All women were premenopausal, had stage II-IIIB HR+ operable BC and uniformly received bilateral surgical oophorectomy concurrent with mastectomy followed by tamoxifen alone for five years. Patients did not receive chemotherapy or targeted therapy pre- or post-operatively. Participants were randomized in the study according to the timing of surgery with respect to the phase of the menstrual cycle. Serum samples were collected preoperatively on the day of surgery. Serum TKa was measured using the ELISA-based DiviTum™ assay (Biovica, Sweden). TKa analysis was performed at a central laboratory, blind to clinical data. Baseline TKa values were correlated with clinico-pathological characteristics and clinical outcome. Clinical outcome was estimated using the Kaplan-Meier method. Results: The majority of patients had both estrogen and progesterone receptor positive tumors (94% and 92% respectively), 65% were HER2 negative (18% positive; 17% unknown). Most had pT2 or pT3 disease (60% and 27% respectively), and more than half were node-positive (pN0 42%, pN1 27%, pN2 19%, pN3 11%, pNx 1%). The overall median TKa value was 65.4 Du/L. At five years, patients with a baseline TKa value below the median had a disease-free survival (DFS) rate of 75% versus 61% in those with a baseline over the median (HR 1.82, 95% CI 1.37-2.4, p<0.001). Similar results were observed when women with HER2+ disease were excluded from analysis (HR 1.71, 95% CI 1.21-2.42, p=0.0025). Further prognostic precision was achieved when TKa values were divided by quartiles, with a 5 year DFS rate of 81%, 69%, 63% and 58% observed in the 1st, 2nd, 3rd and 4th quartiles respectively. After adjusting for major prognostic factors and randomization arm, TKa remained an independent marker. Conclusions: This study shows pre-operative TKa measured in serum is a strong prognostic marker in a large cohort of women with HR+ operable BC uniformly treated within a clinical trial. The notable rate of recurrence seen within this cohort of patients derived from non-high income countries may be mainly attributed to the relative degree of disease burden at diagnosis. TKa may be seen as a potential circulating marker of proliferation akin to tumor Ki67, which may provide useful prognostic information to guide adjuvant therapies. Citation Format: Luca Malorni, Ilenia Migliaccio, Chiara Biagioni, Lorenzo Rossi, Irene De Santo, Richard L Love, Amelia McCartney, Mattias Bergqvist, Martina Bonechi, Francesca De Luca, Francesca Galardi, Matteo Benelli, Dario Romagnoli, Emanuela Risi, Laura Biganzoli, Adriano Laudico, Nguyen Van Dinh, Angelo Di Leo. Serum thymidine kinase-1 activity (TKa) as a prognostic marker in premenopausal women with hormone receptor positive (HR+) operable breast cancer (BC) [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P5-06-11.

Coagulation parameters in adults patients with type 1 Gaucher disease

Increased serum uric acid (SUA) is common in type 2 diabetes mellitus (T2DM) and is associated with left ventricular (LV) myocardial dysfunction. Nonetheless the association of SUA with right ventricular (RV) function in T2DM has not been studied. This study aimed to investigate the association of SUA with biventricular myocardial function in patients with T2DM.A total of 560 patients with T2DM were enrolled and divided into four groups according to sex-specific quartiles of SUA. Transthoracic echocardiography was performed and two-dimensional speckle tracking was used to measure biventricular myocardial strain, including LV global longitudinal strain (GLS), circumferential strain (CS), radial strain (RS), and RV free wall longitudinal strain (RV-FWLS). The absolute value of all biventricular strain parameters showed a stepwise decrease across SUA quartiles (all P < 0.01). In particular, LV assessment by GLS, CS and RS demonstrated that those in the 4th quartile were impaired compared with the other quartiles (all P < 0.05). Similarly, RV-FWLS of the 4th quartile was significantly impaired compared with the 1st and 2nd quartiles (all P < 0.05). The same reduction in biventricular strain across SUA quartiles was observed in patients with estimated glomerular filtration rate < or ≥60 ml/min/1.73 m2, and glycated hemoglobin < or ≥7.0% (all P < 0.05). Multivariable linear regression analysis demonstrated that higher quartile of SUA was independently associated with impaired biventricular myocardial strain (all P < 0.05).SUA was independently associated with biventricular myocardial dysfunction in asymptomatic T2DM patients, regardless of renal function or diabetic control.

Association of urinary metabolites of organophosphate and pyrethroid insecticides, and phenoxy herbicides with endometriosis

Endometriosis is a hormone-responsive gynecologic disease, signifying its connotations across a woman’s life span. Previous studies suggested that endocrine disrupting chemicals were risk factors for endometriosis. Nevertheless, little is known on exposure to organophosphate, pyrethroid and phenoxy acid pesticides on endometriosis diagnosis. In this study, we determined the concentrations of 11 pesticides, metabolites of organophosphate and pyrethroid insecticides, and phenoxy herbicides, in urine collected from 619 reproductive-age women in Utah and California, using liquid chromatography-tandem mass spectrometry. The association of urinary concentrations of pesticides with an increase in the odds of endometriosis diagnosis was examined in 594 women who underwent laparoscopy/laparotomy (operative cohort: n = 471) or pelvic magnetic resonance imaging (population cohort: n = 123), during 2007–2009. 2-Isopropyl-4-methyl-6-hydroxypyrimidine (IMPY), malathion dicarboxylic acid (MDA), para-nitrophenol (PNP), 3,5,6-trichloro-2-pyridinol (TCPY), 3-phenoxybenzoic acid (3-PBA), and 2,4-dichlorophenoxyacetic acid (2,4-D) were detected in ≥95% of the urine samples analyzed. Urinary concentrations of IMPY, MDA, PNP, 3-PBA and 2,4-D tended to be higher in younger, non-Hispanic black, nulliparous and less affluent women. IMPY was the most dominant compound in urine followed by PNP and TCPY. When women in the 4th quartile of IMPY and the 2nd quartile of TCPY concentrations (μg/g creatinine) were compared with women in the 1st quartile, the odds ratios (ORs) for diagnosis of endometriosis increased significantly in unadjusted models (IMPY OR = 1.89, 95% confidence interval (Cl) = 1.12–3.20; TCPY OR = 1.65, 95% Cl = 1.02–2.69) for the operative (n = 471) and entire data set (n = 594), respectively. Our results suggest that exposure to elevated concentrations of diazinon (the parent compound of IMPY) and chlorpyrifos and chlorpyrifos-methyl (parent compounds of TCPY) may be associated with endometriosis.

Relationship between urinary phthalate metabolites and diabetes: Korean National Environmental Health Survey (KoNEHS) cycle 3 (2015-2017).

BackgroundWe aimed to determine relationship diabetes according to urinary phthalate metabolites using adult data from Korean National Environmental Health Survey cycle 3 (2015–2017).MethodThis study was conducted on 3,781 adults aged 19 years and older (1,648 men and 2,133 women) based on KoNEHS cycle 3. Participants' data were analyzed by gender; Relationship between phthalate metabolites in the urine and diabetes was analyzed by dividing the sociodemographic variables, health behavior-related variables, and urinary phthalate metabolite concentrations into quartiles. To determine the relationship between urinary phthalate metabolites and the prevalence of diabetes, the odds ratio (OR) was calculated using logistic regression analysis.ResultsBased on the 1st quartile of each metabolite, the ORs for di-2-ethylhexyl phthalate (DEHP) (4th quartile), mono-(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP) (2nd quartile, 3rd quartile and 4th quartile), mono-(2-ethyl-5-oxohexyl) phthalate (MEOHP) (4th quartile), mono-(2-ethyl-5-carboxypentyl) phthalate (MECCP) (4th quartile), mono-n-butyl phthalate (MnBP) (3rd quartile and 4th quartile), mono-benzyl phthalate (MBzP) (2nd quartile) and 4th quartile), and mono (3-carboxypropyl) phthalate (MCPP) (3rd quartile and 4th quartile) were significantly higher after the adjustment in men. The ORs for DEHP (2nd quartile, 3rd quartile and 4th quartile), MEHHP (2nd quartile, 3rd quartile and 4th quartile), MEOHP (4th quartile), MECCP (4th quartile), MBzP (4th quartile), and MCPP (4th quartile) were significantly higher after the adjustment in women.ConclusionThis study investigated relationship between urinary phthalate metabolites and diabetes. The higher urinary phthalate metabolites, the higher the prevalence of diabetes. Further regulation of phthalate may be needed, and further studies are warranted to confirm the association between phthalate concentration and other chronic diseases (such as hypertension, hyperlipidemia, and cardiovascular disease).

Triglyceride to high-density lipoprotein cholesterol and low-density lipoprotein cholestrol to high-density lipoprotein cholesterol ratios are predictors of cardiovascular risk in Iranian adults: Evidence from a population-based cross-sectional study.

Background:The superiority of TG/HDL-C and LDL-C/HDL-C ratios in predicting CVD risk is a matter of debates. Thus, the objective of this study was to compare TG/HDL-C and LDL-C to HDL-C ratios in predicting the risk of CVD events.Methods:In a population-based cross-sectional study, 567 representative participants aged 40 years or older were entered in the study in Babol, North of Iran. The demographic data, anthropometric measures, and the cardio metabolic risk factors were measured. The individual risk of CVD events was assessed by ACC/AHA risk model. ROC analysis was applied to estimate the diagnostic accuracy and the optimal cut-off points of TG/HDL-C and LDL-C/HDL-C ratios.Results:The AUC of TG/HDL-C and LDL-C/HDL-C ratios were rather similar and both parameters significantly predicted CVD risk in men comparably, and TG/HDL-C at optimal cutoff point of 3.6 produced 75% sensitivity and 39% specificity. However,in women TG/HDL-C with AUC of 0.65( p=0.091) at optimal cutoff value of 3.4 produced a sensitivity of 82% and specificity of 51%. The LDL-C/HDL-C ratio had no discriminative ability in predicting CVD risk in women. The adjusted OR of TG/HDL-C at 2nd quartile was significant (OR=3.22, 95% CI:1.25-8.29) and a greater association was found with 3rd and 4rth quartiles Conclusion:Both TG/HDL–C and LDL-C/HDL-C ratios comparably predict CVD risk in men, whereas in women only TG/ HDL-C is a significant predictor but not LDL-C/HDL-C.

TRI-PONDERAL MASS INDEX IS USEFUL FOR SCREENING CHILDREN AND ADOLESCENTS WITH INSULIN RESISTANCE.

ABSTRACTObjective: To investigate whether tri-ponderal mass index and body mass index Z scores are equivalent for screening children and adolescents with insulin resistance.Methods: Cross-sectional study with 296 children and adolescents enrolled at public schools of Vitória, Espírito Santo, Brazil, aged eight to 14 years. The tri-ponderal mass index was calculated as the ratio between weight and height cubed. The body mass index was calculated as the ratio between weight and height squared. Insulin resistance was defined with the homeostatic model assessment (HOMA-IR).Results: The HOMA-IR was higher in the 4th quartile of body mass index Z scores and tri-ponderal mass index compared to 1st and 2nd quartiles for both girls and boys. The areas under the age-adjusted receiver operating characteristic curves were similar between the indices for girls (body mass index Z scores=0.756; tri-ponderal mass index=0.763) and boys (body mass index Z scores=0.831; tri-ponderal mass index=0.843). In addition, according to the simple linear regression analyses estimations, both body mass index Z scores and tri-ponderal mass index explained a significant fraction of the homeostatic model assessment variability for girls (body mass index Z scores: R2=0.269; tri-ponderal mass index: R2=0.289; p<0.001) and boys (body mass index Z scores: R2=0.175; tri-ponderal mass index: R2=0.210; p<0.001).Conclusions: The tri-ponderal mass index and body mass index Z scores were similar to discriminate children and adolescents with insulin resistance. It is noteworthy that the use of tri-ponderal mass index is clearly advantageous, because it can be calculated with no concerns on adjustments for the age, a fact that makes it very applicable in the clinical practice.

163: Disparities in obstetric readmissions: A multistate analysis, 2007-2014

Hospital readmissions are an area of focus in reducing cost and improving quality of healthcare. Readmission rates are generally higher among racial-ethnic minorities and patients of lower socioeconomic status, however this has not been widely studied in the obstetric population. Our objective was to determine 30-day readmission rates after vaginal and cesarean delivery by race-ethnicity, median income and insurance payer status (social determinants of health; SDH). Using State Inpatient Databases (SID) from the Healthcare Cost and Utilization Project (HCUP) from 2007-2014, we queried all cases with a singleton or multiple birth listed. To produce accurate estimates of the effects of parturients’ SDH on readmission odds, while controlling for confounders at the patient-, hospital- and procedure-level, generalized linear mixed models were used. Interaction models were generated for each combination of the three SDH variables of interest to highlight any associations and their effect on the outcome. Adjusted odds ratios (aORs) with 95% confidence intervals (95% CI) are reported. There were 5,129,867 deliveries with 79,260 (1.5%) 30-day readmissions in the administrative record. Of these, 947 (0.8%) were missing reported race-ethnicity. Of the remaining cases, Black and Hispanic patients were more likely to be readmitted within 30 days of delivery, as compared to White patients (p< 0.0001). Patients in the 2nd quartile of median income were more likely to be readmitted than those living in other quartiles (p< 0.05). Patients with Medicare or Medicaid were also more likely to be readmitted than those with private insurance (p< 0.0001). Table 1 shows aORs for significant interaction terms. Significant racial-ethnic disparities in obstetric readmissions were observed, particularly in patients with government insurance and even in those living in the highest quartile of median income. Next steps include identification of diagnoses by race-ethnicity, with the goal of focusing interventions on those diagnoses, meanwhile taking into account individual SDH.

Association between ovarian reserve and preeclampsia: a cohort study

BackgroundThe risk of cardiovascular disease in women increases after menopause. It has been shown that women with lower pre-menopausal ovarian reserve may experience increased cardiovascular risk. We sought to determine whether there is any association between ovarian reserve, as assessed by Anti-Mullerian hormone (AMH), and preeclampsia (PE).MethodsSubjects of this study were selected from among participants of the Tehran Lipid and Glucose Study (TLGS), a population-based cohort with a 15-year follow-up (1998–2014). Out of 2412 women aged 20–50 years, there were 781 women who met eligibility criteria, including having comprehensive data on their reproductive assessment and ovarian reserve status, identified based on age-specific AMH levels according to the exponential–normal three-parameter model that was measured before pregnancy.There were 80 and 701 participants in the preeclampsia and non-PE groups, respectively. The association between dichotomous outcome variable PE and age-specific AMH quartiles was evaluated using pooled logistic regression.ResultsPE was observed in 23 (11.1%), 12 (6.4%), 26 (13.3%) and 19 (10%) women in the 1st, 2nd, 3rd and 4th quartiles of pre-pregnancy age-specific AMH, respectively (P = 0.16). Median and inter-quartile range of serum AMH levels was 1.05 (0.36–2.2) mg/L in women who experienced PE compared with 0.85 (0.28–2.1) mg/L in women with normotensive pregnancies (P = 0.53). Based on the pooled logistic regression analysis, the effect of age-specific AMH quartiles on PE progression (adjusted for age, BMI, smoking status, and family history of hypertension) were not significant (OR1st vs 4th: 1.5, P-value: 0.1, CI: (0.9, 2.4)).ConclusionsAge-specific AMH may not be a suitable marker for prediction of PE. Further longitudinal studies, considering pre-conception measurement of AMH, are recommended for better interpretation of the association between ovarian reserve status and PE.

ASSESSING THE RELATIONSHIP BETWEEN SERUM IGF-1 AND ADIPOSITY BY AGE IN THE LONG LIFE FAMILY STUDY

Serum levels of insulin-like growth factor 1 (IGF-1) and measures of adiposity, such as body mass index (BMI), are associated with susceptibility to age-related diseases. Previous reports of the relationship between IGF-1 and BMI ranged from positive to negative to no relationship, perhaps because previous reports studied different age cohorts. Using data on 4270 participants (aged 24-110 years) from the Long Life Family Study, we investigated the relationship between IGF-1 and BMI overall and by age groups. IGF-1 and BMI were positively correlated in the total sample (β=0.161, r2= 0.0038, p=1.8-05). However, further analyses revealed that the relationship between IGF-1 and BMI varied by age quartile: in the 1st quartile (24-58yo) the relationship was negative (β=−0.204, r2= 0.011, p=0.0008); in the 2nd quartile (59-66yo) the relationship was negative but non-significant (β=−0.069, r2= 0.0012, p=0.28); in the 3rd quartile (67-86yo) the relationship was positive but non-significant (β=0.106, r2= 0.002, p=0.13); and in the 4th quartile (87-110yo) the relationship was positive (β=0.388, r2= 0.019, p=1.2−05). This pattern did not differ by sex. We also detected a similar age-related pattern between IGF-1 and BMI using an independent dataset (NHANES III), comprising 2550 men and women aged 20-90 years. Our results may clarify some of the inconsistency in previous literature about the relationship between IGF-1 and BMI. Additional studies of IGF-1 and adiposity measures are needed to better understand the underlying mechanisms involved.

Vitamin D Deficiency/Insufficiency Is Associated with Risk of Osteoporotic Thoracolumbar Junction Vertebral Fractures.

BackgroundThe association between serum vitamin D level and vertebral fracture (VFx) remains controversial. The purpose of this study was to determine whether serum 25-hydroxy vitamin D (25(OH)D) level is associated with osteoporotic thoracolumbar junction VFx in elderly patients.Material/MethodsFrom Jan 2013 to Dec 2017, this retrospective case-control study included 534 patients with primary osteoporotic thoracolumbar junction VFx (T10–L2) and 569 elderly orthopedic patients with back pain (without osteoporotic VFx) as controls. Serum 25(OH)D levels were measured and the association with osteoporotic VFx was analyzed. Other clinical data, including BMI, comorbidities, and bone mineral density (BMD), were also collected and compared between these 2 groups.ResultsIt was shown that 25(OH)D levels were significantly lower in patients with T10–L2 VFx than in control patients. Among 534 VFx patients, 417 (78.1%) patients showed grade 2–3 fracture. Serum 25(OH)D levels were significantly related to affected vertebral numbers and VFx severities. The VFx risk was 28% lower (OR=0.72, 95% CI 0.62–0.83) per increased SD in serum 25(OH)D. Compared with the 1st quartile (mean 25(OH)D: 29.67±6.18 nmol/L), the VFx risk was significantly lower in the 3rd (mean 25(OH)D: 60.91±5.12nmol/L) and 4th quartiles (mean 25(OH)D: 103.3±44.21nmol/L), but not in the 2nd quartile (mean 25(OH)D: 45.40±3.95 nmol/L). In contrast, the VFx risk was significantly increased in the 1st quartile (OR=1.87, 95% CI 1.42–2.45) compared with the 2nd–4th quartiles.ConclusionsVitamin D deficiency/insufficiency was associated with risk of osteoporotic thoracolumbar junction vertebral fractures in elderly patients.

Learning curve of laparoscopic living donor right hepatectomy.

The feasibility and learning curve of laparoscopic living donor right hepatectomy was assessed. Donors who underwent right hepatectomy performed by a single surgeon were reviewed. Comparisons between open and laparoscopy regarding operative outcomes, including number of bile duct openings in the graft, were performed using propensity score matching. From 2014 to 2018, 103 and 96 donors underwent laparoscopic and open living donor right hepatectomy respectively, of whom 64 donors from each group were matched. Mean(s.d.) duration of operation (252·2(41·9) versus 304·4(66·5) min; P < 0·001) and median duration of hospital stay (8 versus 10 days; P = 0·002) were shorter in the laparoscopy group. There was no difference in complication rates of donors (P = 0·298) or recipients (P = 0·394) between the two groups. Total time for laparoscopy decreased linearly (R2 = 0·407, β = -0·914, P = 0·001), with the decrease starting after approximately 50 procedures when cases were divided into four quartiles (2nd versus 3rd quartile, P = 0·001; 3rd versus 4th quartile, P = 0·023). Although grafts with bile duct openings were more abundant in the laparoscopy group (P = 0·022), no difference was found in the last two quartiles (P = 0·207). Laparoscopic living donor right hepatectomy is feasible and an experience of approximately 50 cases may surpass the learning curve.

Impact of rotavirus vaccination and piped water access on childhood diarrhea rates in Peru, 2005-2015

OPS 24: Drinking water contamination and children’s health, Room 411, Floor 4, August 27, 2019, 10:30 AM - 12:00 PM Background: Peru has undergone several health and infrastructure developments since 2005, including increased access to piped drinking water and national introduction of oral rotavirus vaccination. We examined whether these factors were associated with lower diarrhea rates in children under five. Methods: We fit a negative binomial model investigating the impact of rotavirus vaccination and piped water access on diarrhea rates in the 195 Peruvian provinces from 2005-2015, considering the interaction between these factors, and controlling for long-term and seasonal (El Niño) trends. We compared the “pre-(rotavirus) vaccine” (2005-2009) and “post-vaccine” (2010-2015) eras. Annual percentages of households in each province with access to piped water were analyzed in quartiles. Results: The 2005 childhood diarrhea rate was ~27 annual clinic visits per 100 children and decreased ~3% per year. Higher access to piped water was associated with significantly lower childhood diarrhea rates in the post-vaccine era only. We found no effect of the rotavirus vaccine in the lowest quartile of piped water access. Controlling for long-term trend, compared to the pre-vaccine era, the diarrhea rate was lower in the post-vaccine era by 7% (95% confidence interval (CI): 2-12%), 13% (95% CI: 7-19%), and 15% (95% CI: 10-20%) in the 2nd, 3rd, and 4th quartiles of piped water access, respectively. Diarrhea rates were significantly higher (6%, 95% CI: 4-8%) during moderate or strong El Niño events. Conclusions: Explanations for higher reductions in diarrhea rates from the pre- to post-vaccine era in provinces with better piped water access include: children without piped water may be predisposed to environmental enteric dysfunction, diminishing oral vaccine impact, and/or the etiologic patterns of diarrhea (and effectiveness of a vaccine targeting a viral pathogen) may differ by water source. Improved access to piped water and rotavirus vaccination may operate synergistically to reduce childhood clinic visits for diarrhea in Peru.

Association of sedentary behavior with overweight and abdominal obesity in older adults

The aim of this study was to examine the association of sedentary behavior with overweight and abdominal obesity in older adults. This was a cross-sectional study with older men and women residing in the municipalities of the Regional Health Superintendency of Uberaba, Minas Gerais. Sedentary behavior was assessed according to the time spent sitting on a weekday and a weekend day. Body mass, height and waist circumference were measured. Excess weight was determined by means of body mass index, while abdominal obesity by waist circumference. Poisson regression analyzes with robust variance were used to examine the association of sedentary behavior with overweight and abdominal obesity. The total sample consisted of 3223 older people (61.3% women), with a mean age of 70 ± 7.26 years. There was no association between quartiles of sedentary behavior and overweight (2nd quartile: PR = 0.99; 95%CI: 0.94–1.05; 3rd quartile: PR = 0.99; 95%CI: 0.93–1.07; 4th quartile: PR = 1.07; 95%CI: 1.00–1.13) and abdominal obesity (2nd quartile: PR = 1.04; 95%CI: 1.00–1.08; 3rd quartile: PR = 1.03; 95%CI: 0.98–1.08; 4th quartile: PR = 0.98; 95%CI: 0.94–1.03) when analyses were adjusted for sociodemographic, health perception and behavioral variables. The sedentary behavior was not associated with overweight and abdominal obesity in the elderly.

Individual and joint association of bioavailable testosterone and aging with neutrophil-to-lymphocyte ratio in Chinese middle-aged and elderly men

Background and objectivesAccumulating evidences suggest that chronic systemic inflammation (CSI) is independently associated with large number of major non-communicable chronic diseases (NCDs) ranging from metabolic disorders to cancers, and neutrophil-to-lymphocyte ratio (NLR) has been accepted as a novel, convenient marker for CSI response. Testosterone deficiency in men is linked to high risk of NCDs. This cross-sectional study aimed to investigate the individual and joint association of bioavailable testosterone (BIOT) and aging with NLR.MethodsA total of 132 male adults were enrolled during Jan. 2011 and Oct. 2017 in the first affiliated hospital of University of Science and Technology of China. Local weighted regression (LOESS) and multivariable generalized linear regression models were utilized to comprehensively examine the individual and joint association between BIOT and age with NLR.ResultsObvious linear relationships between NLR and BIOT or age were observed with the LOESS models. NLR was negatively correlated to BIOT after adjusting for some potential confounding factors (P = 0.034). As compared to the lowest quartile of BIOT, the adjusted decrease of NLR for the 2nd, 3rd and 4th quartiles were 0.40, 0.64 and 0.72, respectively. Meanwhile, NLR was observed to be independently correlated to elevated age (P = 0.043). Furthermore, as compared to the counterparts, men over 70 years combined with plasma BIOT less than 4.7 nmol/L had the highest NLR level, which suggested that low BIOT and aging jointly correlated to the level of NLR (P = 0.005).ConclusionBIOT deficiency and aging were individually and jointly correlated to CSI. Men over 70 years combined with BIOT < 4.7 nmol/L were more like to have higher grade of CSI than others.

Urban Tree Mortality: A Literature Review

Tree survival is a performance metric for urban forestry initiatives, and an understanding of the factors that influence mortality can help managers target resources and enhance survival. Furthermore, urban tree planting investments depend on tree survival to maximize ecosystem services. In this literature review, we categorized factors commonly associated with urban tree mortality and summarized mortality rates published in 56 studies, focusing on studies of trees along streets, in yards, and in landscaped parks. Study designs included quantitative field monitoring of uneven-aged tree populations and tracking planting cohorts of even-aged trees, as well as qualitative analyses. Annual mortality rates ranged from 0.6 to 68.5% for cohort studies and 0 to 30% for repeated inventories of uneven-aged trees. The 1st, 2nd, and 3rd quartiles of annual mortality were 2.8 to 3.8%, 4.4 to 6.5%, and 7.1 to 9.3% for planting cohorts, and 1.6%, 2.3 to 2.6%, and 3.0 to 3.3% for repeated inventories of uneven-aged trees (ranges reflect studies that reported a range for the time period or mortality rate). For cohort studies, annual mortality tended to be highest during the first five years after planting. The most commonly cited biophysical factors associated with mortality were taxa (15 articles), tree size/age (13 articles), and site characteristics (12 articles). The most commonly cited human-related factors were stewardship, maintenance, and vandalism (15 articles). More long-term studies are needed to investigate how site characteristics influence mortality, including rarely examined soil and microclimate characteristics. Future research should also examine institutional structures related to mortality outcomes, as well as parcel-level sociodemographic factors and resident behaviors.

Urban Tree Mortality: A Literature Review

Tree survival is a performance metric for urban forestry initiatives, and an understanding of the factors that influence mortality can help managers target resources and enhance survival. Furthermore, urban tree planting investments depend on tree survival to maximize ecosystem services. In this literature review, we categorized factors commonly associated with urban tree mortality and summarized mortality rates published in 56 studies, focusing on studies of trees along streets, in yards, and in landscaped parks. Study designs included quantitative field monitoring of uneven-aged tree populations and tracking planting cohorts of even-aged trees, as well as qualitative analyses. Annual mortality rates ranged from 0.6 to 68.5% for cohort studies and 0 to 30% for repeated inventories of uneven-aged trees. The 1st, 2nd, and 3rd quartiles of annual mortality were 2.8 to 3.8%, 4.4 to 6.5%, and 7.1 to 9.3% for planting cohorts, and 1.6%, 2.3 to 2.6%, and 3.0 to 3.3% for repeated inventories of uneven-aged trees (ranges reflect studies that reported a range for the time period or mortality rate). For cohort studies, annual mortality tended to be highest during the first five years after planting. The most commonly cited biophysical factors associated with mortality were taxa (15 articles), tree size/age (13 articles), and site characteristics (12 articles). The most commonly cited human-related factors were stewardship, maintenance, and vandalism (15 articles). More long-term studies are needed to investigate how site characteristics influence mortality, including rarely examined soil and microclimate characteristics. Future research should also examine institutional structures related to mortality outcomes, as well as parcel-level sociodemographic factors and resident behaviors.

Correlations between B type natriuretic peptide and blood pressure in patients with type 2 diabetes mellitus

Brain natriuretic peptide (BNP) plays key roles in regulating blood pressure, fluid and electrolyte balance. The aim of our study was to assess correlations between serum BNP levels and blood pressure among patients with type 2 diabetes mellitus (T2DM). We conducted a cross-sectional study among patients with T2DM below the age of 65 years regardless of duration of diabetes and type of antidiabetic drugs. Detailed medical history, measurements of systolic (SBP), diastolic blood pressure (DBP) and serum BNP were recorded. Patients with BNP > 300 pg/mL were excluded. The included patients were divided into four groups according to BNP quartiles: Q1 < 9; Q2 between 9 and 11.9; Q3 between 11.9 and 32.2; Q4 ≥ 32.2 pg/mL. Analysis of group differences was performed using the non-parametric Kruskall-Wallis test for continuous variables. and chi 2 test for trend for categorical variables. The comparison of percentages on independent series was carried out by the Pearson's chi 2 test, and in the case of invalidity, the bilateral Fisher's exact test was used. We included 69 diabetics, mean age: 56.7 ± 6.9 years old, sex ratio (M/F): 1.5, average duration of diabetes of 10.6 ± 7.7 years and average HbA 1c : 9.2 ± 1.9%. The mean level of serum BNP was 27.8 ± 32 pg/mL. More than half (61%) of the patients were hypertensive. Serum BNP was significantly higher among hypertensive patients than non-hypertensive patients (35.6 ± 5.7 vs. 15.7 ± 17.6 μg/mL, P = 0.001). We did not observe statistically significant correlation between the BNP level on the one hand and the SBP and the DBP on the other hand. Fourth quartile patients were 6.9 times more likely to have high blood pressure (95% CI [1.4, 33.5]) than patients in the first three quartiles ( P = 0.008). Patients in the 2nd quartile had significantly higher SBP than patients of the other quartiles ( P = 0.049). The DBP was comparable between the four groups ( P = NS). The relationship between high blood pressure and BNP was not significant among diabetic patients of our study. But it appears that a BNP level ≥ 32.2 pg/mL was a significant predictor of high blood pressure.

Adherence to dietary recommendations and colorectal cancer risk: results from two prospective cohort studies.

Understanding the association between diet and colorectal cancer (CRC) risk is essential to curbing the epidemic of this cancer. This study prospectively evaluated adherence to the Chinese Food Pagoda (CHFP), and two American Dietary Guidelines: the Alternative Healthy Eating Index (AHEI-2010) and the Dietary Approaches to Stop Hypertension (DASH) in association with CRC risk among Chinese adults living in urban Shanghai, China. Participants included 60161 men and 72445 women aged 40-74, from two ongoing population-based prospective cohort studies. Associations between dietary guideline compliance scores and CRC risk were evaluated by Cox proportional hazard regression analyses, with age as time metric, and potential confounders were adjusted. We identified 1670 CRC incidence cases (691 males and 979 females) during an average 8.1 years of follow-up for men and 13.4 years for women. CHFP score was inversely associated with risk of CRC, with hazard ratios (HRs) (95% confidence intervals) of 0.88 (0.77, 1.00), 0.86 (0.75, 0.98) and 0.84 (0.73, 0.96) for the 2nd, 3rd and 4th quartiles versus 1st quartile, respectively (Ptrend= 0.01). The inverse association appeared stronger for rectal cancer, individuals at younger age (< 50 years), with a lower BMI (<25 kg/m2) or without any metabolic conditions at baseline, although no multiplicative interactions were noted. No consistent association pattern was observed for the modified DASH score and the modified AHEI-2010. Compliance with the Dietary Guidelines for Chinese was associated with reduced risk of CRC among Chinese adults. To maximize health impacts, dietary recommendations need to be tailored for specific populations.

High Inter-muscular Fat Is Associated with Poor Mobility Function in Older Adults, Only When Accompanied by Low Muscle Area (P01-026-19)

ObjectivesTo determine whether the associations between thigh inter-muscular-fat area, anthropometric characteristics and physical performance varies in old adults with low vs. high thigh muscle cross-sectional area. MethodsCross-sectional analysis of year 6 data from 1903 participants (52.2% women) of the Health ABC study aged 74–85y. Mid-thigh muscle composition (by CT), body composition (DXA) and physical performance were compared across quartiles of mid-thigh inter-muscular fat area. General linear model univariate analysis was used to study the associations between inter-muscular fat area and physical function according to low or high mid-thigh muscle cross-sectional area (using the 50th percentile). ResultsIn participants with low mid-thigh muscle area, there was a threshold effect in which high inter-muscular fat was related to poor mobility function after the 2nd quartile (>23.7 cm2 in men and >21.3 cm2 in women). While, in participants with high mid-thigh muscle area, high inter-muscular fat was not associated with poor mobility function. Inter-muscular fat had no significant association with isokinetic knee strength in participants with either low or high muscle area. However, across all inter-muscular fat conditions, participants with low muscle area had lower leg strength than those with high muscle area. ConclusionsThe negative effects of inter-muscular fat in aging are greatly influenced by the presence of concurrent low muscle mass. Funding SourcesNIA/NIH.

2461-PUB: Increased Apolipoprotein A1 Can Suggest the Presence of Latent Autoimmune Diabetes and a Lower Cardiovascular Risk Compared with Type 2 Diabetes

Latent autoimmune diabetes (LADA) could be misdiagnosed as type 2 diabetes (DM2). Lipids, apolipoproteins, adiponectin (APN), interleukin-6 (IL-6), homocysteine (HCY), other markers of DM, including antibodies, were tested in 276 patients with DM1, DM2 and LADA. Quartiles of lipid accumulation product (LAP) (Q1:≤21.23, Q2:(21.23, 40.69], Q3:(40.69, 92.02], Q4:&amp;gt;92.02) were calculated as: [waist (cm) - 65 for men/58 for women] x triglycerides (mmol/L)]. In all statistical tests: ANOVA and Tukey post hoc test, and stepwise multivariate regression, α=0.05 was considered statistically significant. ANOVA revealed significant differences in HCY, APN, IL-6 and apolipoprotein A1 (Apo A1) among DM types. Patients with DM1 (1.73±0.33) and LADA (1.66±0.38) had significantly higher values of HDL compared to DM2 (1.33±0.31). IL-6 was statistically increased in DM2 compared to DM1; Apo A1 was statistically increased in LADA (1.7±0.36) compared to DM2 (1.4±0.22), whereas HCY was decreased (LADA: 10.9±2.74 vs. DM2 18.2±9.44). APN was decreased in DM2 compared to the control group. Logistic regression for DM2 pointed to APN (OR=0.826; p=0.02), HCY (OR=1.202; p=0.08) and HDL (OR=0.142; p=0.08) as statistically significant predictors, whereas uric acid (OR=0.991; p=0.08) was a predictor of LADA. After stepwise procedure the best model for APN included HDL (R2=0.46), for HCY glomerular filtration (parR2=0.26) and Apo A1 (parR2=0.08), and for Apo A1 HDL (parR2=0.79) and fasting glucose (parR2=0.03). 60% of DM2 patients, but 10.5% of LADA were in the 4th LAP quartile. Patients in the 4th quartile had significantly lower values of APN and Apo A1 compared to 1th and 2nd quartiles; HCY was increased in 4th compared to the 1th quartile. Significantly increased HDL and Apo A1 and decreased HCY in LADA compared to DM2 uncover LADA prior to determination of antibodies. Only 10.5% of LADA patients in the 4th quartile pointed to a lower cardiovascular risk than in DM2. Disclosure S. Ljubic: None. A. Jazbec: None. I. Antal: None. I. Cudina: None. M. Tomic: None. M. Vucic Lovrencic: None.