Low HR Research Articles

Survival and its relationship with the type of peritoneal solute transfer rate, in patients with chronic kidney disease incident on peritoneal dialysis therapy in RTS Colombia between the years 2007–2017

IntroductionIn some studies, the peritoneal solute transfer rate (PSTR) through the peritoneal membrane has been related to an increased risk of mortality. It has been observed in the literature that those patients with rapid diffusion of solutes through the peritoneal membrane (high/fast transfer) and probably those with high average transfer characterized by the Peritoneal Equilibrium Test (PET) are associated with higher mortality compared to those patients who have a slow transfer rate. However, some authors have not documented this fact. In the present study, we want to evaluate the (etiological) relationship between the characteristics of peritoneal membrane transfer and mortality and survival of the technique in an incident population on peritoneal dialysis in RTS Colombia during the years 2007–2017 using a competing risk model. Materials and methodsA retrospective cohort study was carried out at RTS Colombia in the period between 2007 and 2017. In total, there were 8170 incident patients older than 18 years, who had a Peritoneal Equilibration Test (PET) between 28 and 180 days from the start of therapy. Demographic, clinical, and laboratory variables were evaluated. The (etiological) relationship between the type of peritoneal solute transfer rate at the start of therapy and overall mortality and technique survival were analyzed using a competing risk model (cause-specific proportional hazard model described by Royston-Lambert). ResultsPatients were classified into four categories based on the PET result: Slow/Low transfer (16.0%), low average (35.4%), high average (32.9%), and High/Fast transfer (15.7%). During follow-up, with a median of 730 days, 3025 (37.02%) patients died, 1079 (13.2%) were transferred to hemodialysis and 661 (8.1%) were transplanted. In the analysis of competing risks, adjusted for age, sex, presence of DM, HTA, body mass index, residual function, albumin, hemoglobin, phosphorus, and modality of PD at the start of therapy, we found cause-specific HR (HRce) for high/fast transfer was 1.13 (95% CI 0.98–1.30) p = 0.078, high average 1.08 (95% CI 0.96–1.22) p = 0.195, low average 1.09 (95% CI 0.96–1.22) p = 0.156 compared to the low/slow transfer rate. For technique survival, cause-specific HR for high/rapid transfer of 1.22 (95% CI 0.98–1.52) p = 0.66, high average HR was 1.10 (95% CI 0.91–1.33) p = 0.296, low average HR of 1.03 (95% CI 0.85–1.24) p = 0.733 compared with the low/slow transfer rate, adjusted for age, sex, DM, HTA, BMI, residual renal function, albumin, phosphorus, hemoglobin, and PD modality at start of therapy. Non-significant differences. ConclusionsWhen evaluating the etiological relationship between the type of peritoneal solute transfer rate and overall mortality and survival of the technique using a competing risk model, we found no etiological relationship between the characteristics of peritoneal membrane transfer according to the classification given by Twardowski assessed at the start of peritoneal dialysis therapy and overall mortality or technique survival in adjusted models. The analysis will then be made from the prognostic model with the purpose of predicting the risk of mortality and survival of the technique using the risk subdistribution model (Fine & Gray).

Cardiovascular Autonomic Control During Hibernation in American Black Bears

The dramatic early decrease in HR upon entry into torpor in small hibernators has recently been shown to be associated with a marked increase in cardiac parasympathetic activity as indicated by increased short term beat to beat heart rate variability (RMSSD) normalized to average R-R interval (RMDSSD/RR, Zanetti et al 2023). At steady state torpor, as their body temperature drop to ~2°C, small hibernators benefit from the Q10 effect on cardiac pacemaker cells in maintaining a low HR with a reduced parasympathetic activity. Black bears in hibernation maintain body temperatures between 30-35°C while suppressing metabolism by 75% and with a marked decrease in HR from non-hibernating 55 bpm to hibernating 6-12 bpm including extreme respiratory sinus arrhythmia (Tøien et al 2011). As hibernating bears would not significantly benefit from the Q10 effect on cardiac pacemaker cells to sustain a low HR, we hypothesized that an elevated cardiac parasympathetic tone is needed to suppress HR. Continuous electrocardiogram (ECG) and blood pressure (BP) were recorded with implantable telemetry transmitters (DSI D70-CCP/EET and Konigsberg T28F-14B) in American black bears. A Pan-Tomkins algorithm modified for R-wave detection with long R-R intervals followed by visual inspection was used for the analysis. RMDSSD/RR for a 2 hour period in mid hibernation with no activity was 3 times higher than that during the resting phase in non-hibernation (0.68 vs. 0.23, n=10 and 7 respectively, p<0.001), confirming the presence of a high parasympathetic tone during hibernation. HR decreased from 68.3 ± 5.8 bpm to 12.9 ± 0.9 bpm (±SE, p<0.0001). RMSSD/RR during a 10 min period recovering from anesthesia (Telazol with supplemental Ketamin) during hibernation in mid March was only 0.019 ± 0.008 vs 0.58 ± 0.14 during a 10 min period before disturbance to induce anesthesia and HR 87.0 ± 8.7 b/min vs. 16.3 ± 1.4 b/min, demonstrating a parasympatholytic effect (n=6, p< 0.0006). The longest R-R intervals during extreme sinus arrhythmia detected in mid hibernation ranged from 11.8 to 33.0 s (Mean 19.0 ± 2.7, n=21). BP typically increased to above 200 mmHg during periods of rapid heart beats, and decayed slowly to 50-60 mmHg at the end of the longest R-R intervals. Analysis of data from a single bear from 2 hour periods at 2 week intervals throughout hibernation and recovery indicates that a high parasympathetic activity is maintained throughout hibernation and strongly correlated to the maximum observed R-R interval. We conclude that opposed to small hibernators, hibernating bears sustain low HR in hibernation with high parasympathetic activity controlling the extreme sinus arrhythmia. We suggest that BP is maintained during long R-R intervals by peripheral vasoconstriction. Supported by NIH COBRE grant number [P20GM130443]. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Socioeconomic inequality in prostate cancer diagnostics, primary treatment, rehabilitation, and mortality in Sweden.

We designed a nationwide study to investigate the association between socioeconomic factors (household income and education) and different aspects of prostate cancer care, considering both individual- and neighbourhood-level variables. Data were obtained from Prostate Cancer data Base Sweden (PCBaSe), a research database with data from several national health care registers including clinical characteristics and treatments for nearly all men diagnosed with prostate cancer in Sweden. Four outcomes were analysed: use of pre-biopsy magnetic resonance imaging (MRI) in 2018-2020 (n = 11,843), primary treatment of high-risk non-metastatic disease in 2016-2020 (n = 6633), rehabilitation (≥2 dispensed prescriptions for erectile dysfunction within 1 year from surgery in 2016-2020, n = 6505), and prostate cancer death in 7770 men with high-risk non-metastatic disease diagnosed in 2010-2016. Unadjusted and adjusted odds and hazard ratios (OR/HRs) with 95% confidence intervals (CIs) were calculated. Adjusted odds ratio (ORs) comparing low versus high individual education were 0.74 (95% CI 0.66-0.83) for pre-biopsy MRI, 0.66 (0.54-0.81) for primary treatment, and 0.82 (0.69-0.97) for rehabilitation. HR gradients for prostate cancer death were significant on unadjusted analysis only (low vs. high individual education HR 1.41, 95% CI 1.17-1.70); co-variate adjustments markedly attenuated the gradients (low vs. high individual education HR 1.10, 95% CI 0.90-1.35). Generally, neighbourhood-level analyses showed weaker gradients over the socioeconomic strata, except for pre-biopsy MRI. Socioeconomic factors influenced how men were diagnosed with prostate cancer in Sweden but had less influence on subsequent specialist care. Neighbourhood-level socioeconomic data are more useful for evaluating inequality in diagnostics than in later specialist care.

Inhaled corticosteroids and Stenotrophomonas maltophilia in outpatients with chronic obstructive pulmonary disease: a retrospective cohort study

ObjectivesInhaled corticosteroids (ICS) are widely used in patients with chronic obstructive pulmonary disease (COPD). However, ICS are associated with an increased risk of adverse effects.We aimed to determine whether an...

Association of immune inflammatory biomarkers with pathological complete response and clinical prognosis in young breast cancer patients undergoing neoadjuvant chemotherapy.

The persistence of inflammatory stimulus has a tight relationship with the development of age-related diseases, ultimately resulting in a gradual escalation in the prevalence of tumors, but this phenomenon is rare in young cancer patients. Breast cancer arising in young women is characterized by larger tumor diameters and more aggressive subtypes, so neoadjuvant chemotherapy (NACT) can be especially appropriate for this population. Immune inflammatory biomarkers have been reportedly linked to the prognosis of some malignant tumor types, with varying results. In this study, we investigated the possible predictive value of blood-based markers in young breast cancer patients undergoing NACT, in addition to the association between the clinicopathological features and prognosis. From December 2011 to October 2018, a total of 215 young breast cancer patients referred to Harbin Medical University Cancer Hospital received NACT and surgery were registered in this retrospective study. The pretreatment complete blood counts were used to calculate the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), and pan-immune-inflammation value (PIV). NLR, PLR, MLR, and PIV optimal cut-off values were 1.55, 130.66, 0.24, and 243.19, as determined by receiver operating characteristic analysis. Multivariate analysis revealed that PIV, HR status, HER-2 status, and Ki-67 index were all independent predictive factors for pathological complete response. Subgroup analysis revealed that young breast cancer patients in the population characterized by low PIV and HR negative group were more likely to get pCR (P=0.001). The five-year overall survival (OS) rate was 87.9%, and Cox regression models identified PIV as independently related to OS. In the present study, the pretreatment PIV was found to be a useful prognostic indicator for pCR and long-term survival in young breast cancer patients undergoing NACT. High immune and inflammation levels, MLR and PIV were connected to poor clinical prognosis in young breast cancer patients. PIV is a promising biomarker to guide strategic decisions in treating young breast cancer.

Upskilling and Reskilling in Improving Competence of Competitive Human Resources in the Era of Digital Economy

This research aims to analyse upskilling and reskilling in improving the competence of competitive human resources in the digital economy era, especially in MSMEs. This research uses descriptive qualitative methods, with data collection through online document searches and literature reviews. The results showed that increasing the competence of MSME HR in the digital economy era is prioritised on how to gather resources and create the right synergy to direct each workforce, especially those with low to high competence. Creating a comprehensive approach to low competency HR can be addressed in a coordinated and coherent manner, comprehensive and ensuring that MSMEs have ongoing support. The implementation of upskiling and reskilling to improve the competence of MSME HR needs to involve the public sector, private sector and other stakeholders so that a good and comprehensive ecosystem is built

Digital Branding and Marketing Strategy ABA Kindergarten Mancasan Ambarketawang, Batu Gamping, Yogyakarta

Abstract. The target partner for community service is the ABA Mancasan Ambarketawang Kindergarten School, Gamping, Yogyakarta. Target partners need to carry out school branding and improve skills for HR in strengthening the ability to use information technology, especially skills in using social media as a means of school communication with the target audience of student parents. The problems of target partners are still low HR capabilities in using IT and a lack of school facilities that support digital promotion. The purpose of this service activity is: 1) to help partners strengthen school branding; 2) to improve HR skills so that they are able to utilize social media Instagram, Facebook, and YouTube as a means of marketing communication; and 3) to increase understanding of the importance of school financial management. The method used was Focus Group Discussion; The training was attended by teachers and principals. Results of the training: 1) participants understand the importance of marketing for schools through branding strategies using the 3C approach (visual identity, value identity, and communication identity), as well as understanding consumer behavior through the 5A concept (aware, appeal, ask, action, advocate); 2) the results of the participants' digital marketing practices have been able to create their school accounts on social media, currently have Instagram, Facebook, and YouTube channel accounts; and 3) participants, especially school principals, increase their knowledge about the importance of financial management in schools. The output of the service program is in the form of published articles in journals, publications in the mass media, and video documentation of community service activities.

Heart rate and ejection fraction as prognostic markers in recurrent pericarditis

Abstract Background Heart rate (HR) and left ventricular ejection fraction (LVEF) are both important markers in assessing symptom improvement in patients with recurrent pericarditis (RP). However, their prognostic significance in predicting RP outcomes remains largely unexplored, as no prior studies have investigated this relationship. Methods Patients with RP were identified from a pericardial database covering the period between 2012 and 2019. The outcome of interest was clinical remission, which was defined as the resolution of symptoms without any further recurrences after discontinuing all anti-inflammatory therapies. Results A total of 365 patients were included in this study, of which the majority were females (56%) and less than 55 years old (68%). The mean number of recurrences at baseline was ≥4 in 158 (43%) of patients. The time to clinical remission was 24 months in the low HR group (HR ≤ 70 bpm), 60 months in the moderate HR group (HR: 71-90 bpm), and could not be determined for the high HR group (HR ≥ 90 bpm) due to few events. Patients with LVEF < 60% took 56 months to achieve clinical remission, compared with patients with LVEF ≥ 60%, who took over 60 months. Multivariable analysis revealed that patients in the high (HR: 0.22, 95% CI: 0.09-0.51, p=<0.001) and moderate (HR: 0.39, 95% CI: 0.21-0.75, p=0.005) HR groups were less likely to achieve clinical remission than those in the low HR group. Similarly, patients with LVEF ≥ 60% were less likely to achieve clinical remission than those with LVEF < 60% (HR: 0.54, 95% CI: 0.36-0.80, p=0.002). Conclusion Both HR and LVEF play important roles in prognosticating outcomes in patients with RP. The significance of both markers can be attributed to the heightened shear stress on the pericardium, which can exacerbate inflammation.Multivariable analysis

Clonidine premedication in spinal anaesthesia: Effect on hemodynamic status and vasopressor response to ephedrine

Introduction: Premedication has an important role to play in modern day anaesthesia care. In recent years, clonidine is making a comeback as a premedicant. Our study deals with haemodynamic changes to ephedrine after oral clonidine premedication for spinal anaesthesia with or without concurrent administration of drugs.The purpose of the study is to know the effect of oral clonidine premedication on haemodynamic status including vasopressor response of ephedrine during spinal anaesthesia. Materials: This is a prospective randomized double blinded controlled study. Sixty adult patients belonging to ASA I scheduled for elective surgery under spinal anaesthesia were selected. The patients were randomly assigned to 2 groups.Oral clonidine 4 microgram/kg was administered to group A(Clonidine group, n equal to 30) and 90 and one tablet of vitamin (placebo) orally 90 minutes was administered to group B (Control group, n equal to 30)90 minutes prior to anaesthesia. On the morning of surgery, blood pressure was measured before premedication and 90 minutes later. Sedation and anxiolysis were scored during clonidine premedication and 90th minute afterwards. When SBP decreased to 80% of the pre-spinal value, bolus IV injection of ephedrine 0.1 mg/kg was administered. After ephedrine injections, blood pressure and heart rate were recorded at 1 minute interval for 10 minutes. Results: Group A patients were found to have low SBP, DBP, MBP and HR when compared to group B. Intravenous ephedrine augmented blood pressure more than the control group. Statistically significant difference was found for SBP after 5 minutes, for MBP after 4 minutes of ephedrine administration and no significant difference was found for DBP. Conclusion: We conclude from our study that clonidine administered orally in a dose of 4 microgram/kg as a premedicant increases the pressor responses to IV injection ephedrine 0.2 mg/kg in patients with subarachnoid block.

Abstract 18473: Role of Linguistic Acculturation and Physical Activity With Risk of 1 Year Hospital Readmission After Suspected Acute Coronary Syndrome

Background: Disparities in acute coronary syndrome (ACS) outcomes after hospital care exist beyond racial and ethnic factors. In particular, low linguistic acculturation (LA) may impact care and lead to poorer prognosis. Few studies have examined LA’s impact on outcome disparities post-hospitalization and identified modifiable behaviors, such as physical activity (PA) engagement, that can mitigate risk. Aim: To evaluate the association of LA with 1-year hospital readmission risk among patients evaluated for ACS and examine PA as an effect modifier. Methods: Patients evaluated for ACS in the emergency unit (n=609, 47.8% female, 58.0% Hispanic, 63±12yrs) were studied. LA was classified into three levels (low, intermediate, high) based on patient’s self-reported native and preferred languages and English fluency. Continuous total PA was objectively assessed 30 days post-discharge via a GENEActiv accelerometer worn on the non-dominant wrist. One-year all-cause hospital readmissions were ascertained via hospital medical record searches. Cox regression models used high LA as referent group. Results: Over 1-year follow-up, 264 (44.0%) patients had a subsequent hospital admission. Low LA was associated with increased 1-year readmission risk after adjusting for demographic factors, comorbidities, disease severity, and PA indicators (intermediate HR=1.44; 95% CI: 0.91-2.28; low HR=1.63; 95% CI: 1.05-2.55; p-trend=0.035). PA moderated this association (p-interaction=0.003). Low LA was only associated with greater risk of 1-year readmission among those with low PA levels (below median of 158 min/day; HR=1.88; 95% CI: 1.00, 2.79). Among those with high PA, the association between low LA and risk of readmission was attenuated and not statistically significant (HR=1.46; 95% CI: 0.75, 2.83). Conclusion: Among a diverse cohort of patients with suspected ACS, LA was associated with reduced risk of 1-year hospital readmission. PA significantly moderated this relationship, with higher volumes of PA attenuating the positive association between low LA and increased risk of 1-year hospital readmission. These findings implicate low LA as a potential risk factor for readmission post-ACS and suggest increased engagement in PA can help mitigate this risk.

Abstract 12538: Myocardial Bridge Induced Cardiomyopathy

Introduction: A myocardial bridge(MB) is a condition in which the epicardial coronary artery traverses through the myocardium, has an intra-myocardial course of varying length, and then exits the myocardium and appears on the surface of the heart. Clinical Presentation: A 54-year-old male with no significant past medical history except tobacco abuse and anxiety presented to the hospital with retrosternal chest pain radiating to the back and shoulder and associated with nausea and diaphoresis. His SBP was 100/60, and his heart rate 46. His EKG showed ST elevation in inferior leads, and he was given a nitro tablet, which improved the chest pain to 5/10. He was emergently taken to the Cath lab and found to have proximal left circumflex artery occlusion and underwent PCI with a 2.25x23 Xience Drug-eluting stent. Troponin was elevated to 2.35. His cath also showed a significant mid-LAD myocardial bridge. His echocardiogram showed mid and apical anterior, anterior septal, apical wall, and inferior wall hypokinesis. His EF has been reduced to 30%. Coronary CTA showed mid-LAD has myocardial bridging, which is more than 2 cm long and 5 mm deep in the muscle. The patient has persistently low HR in 40-45, beta-blocker was not started. Due to significant cardiomyopathy induced by a myocardial bridge, unroofing of LAD was done off-pump. His EF improved to 55% after three months of surgery. Discussion: CABG or myotomy is the treatment of choice for patients with symptomatic myocardial bridging refractory to medical therapy, evidence of myocardial ischemia or infarction, or >75% systolic coronary compression on angiography. Incidental myocardial bridging finding without ischemia or symptoms does not require any treatment. Symptomatic patients with ischemia on stress tests can be offered beta or calcium channel blockers. Medical therapy is superior to revascularization with percutaneous intervention.

Early heart rate fluctuation and outcomes in critically ill patients with sepsis: A retrospective cohort study of the MIMIC-IV database

BackgroundHeart rate (HR) abnormalities are common in critically ill patients, but the significance of HR fluctuation in sepsis remains unclear. We aimed to assess the association of HR fluctuation with intensive care unit (ICU) mortality, hospital mortality, and 28-day mortality in patients with sepsis and identify the cutoff value of HR fluctuation associated with the lowest risk of death. MethodsWe conducted a retrospective cohort study using the medical information mart for the intensive care IV database. HR fluctuation, defined as the difference between maximum and minimum HR within the first 24 h of ICU admission, was analyzed for its association with outcomes using restricted cubic spline and multivariable Cox regression models. ResultsAmong 24,419 eligible patients with sepsis, HR fluctuation showed a J-shaped association with ICU mortality, hospital mortality, and 28-day mortality. The high HR fluctuation group (≥ 35 bpm) had a significantly increased risk of ICU mortality ([hazard ratio, 95% confidence interval] 1.12,1.02–1.22, P = 0.013), hospital mortality (1.10,1.02–1.19, P = 0.013), and 28-day mortality (1.11,1.03–1.20, P = 0.007) compared to the control group (HR fluctuation 25–34 bpm). The low HR fluctuation group (< 25 bpm) showed no significant difference in the risk of mortality compared to the control group. ConclusionsOur large-sample study suggests that early high HR fluctuation is indicative of poor prognosis in critically ill patients with sepsis. Early HR fluctuation may serve as a readily available “high-risk alert system” influencing therapeutic decision-making.

Prediction of atrioventricular conduction disturbance after ablation of persistent atrial fibrillation.

The prevalence of atrioventricular conduction disturbance (AVCD) in patients with persistent atrial fibrillation (AF) has not yet been fully investigated. We sought to identify the predictors of AVCD in patients with AF by analyzing the relationship between pre-ablation heart rate during AF and the PR interval in sinus rhythm after ablation. We analyzed pre-ablation 24-h Holter electrocardiogram (ECG) and 12 lead ECG 12months after ablation of 121 consecutive patients with persistent AF who underwent their first ablation procedure and maintained sinus rhythm at 12months. AVCD was defined as a first-degree atrioventricular block (AVB), second-degree AVB, high-degree AVB, or third-degree AVB observed on ECG at 12months after ablation. Seventeen out of 121 patients (14.0%) had AVCD at 12months. In the group with AVCD, total heartbeat (THB) and maximum heart rate (Max HR) were significantly lower, and the prevalence of concomitant Cavo-tricuspid isthmus-dependent atrial flutter before ablation and the appearance of macro reentrant atrial tachycardia (AT) during the procedure were significantly higher than those in the group without AVCD. Multiple regression analysis revealed that maximum HR and macro reentrant AT were significant predictors of AVCD. Receiver operating characteristic curve analysis revealed that Max HR of <165.0bpm predicts AVCD with a sensitivity of 76.47% and a specificity of 74.00%. In patients with persistent AF, low Max HR and the presence of macro reentrant AT during the ablation procedure were predictors of AVCD.

Supervivencia y su relación con el tipo de transferencia de solutos de membrana peritoneal, en pacientes con enfermedad renal crónica incidentes en terapia de diálisis peritoneal en RTS Colombia entre los años 2007-2017

IntroductionIn some studies, the peritoneal solute transfer rate (PSTR) through the peritoneal membrane has been related to an increased risk of mortality. It has been observed in the literature that those patients with rapid diffusion of solutes through the peritoneal membrane (high/fast transfer) and probably those with high average transfer characterized by the peritoneal equilibrium test (PET) are associated with higher mortality compared to those patients who have a slow transfer rate. However, some authors have not documented this fact. In the present study, we want to evaluate the (etiological) relationship between the characteristics of peritoneal membrane transfer and mortality and survival of the technique in an incident population on peritoneal dialysis in RTS Colombia during the years 2007 to 2017 using a competing risk model. Materials and methodsA retrospective cohort study was carried out at RTS Colombia in the period between 2007 and 2017. In total, there were 8170 incident patients older than 18 years, who had a PET between 28 and 180 days from the start of therapy. Demographic, clinical, and laboratory variables were evaluated. The (etiological) relationship between the type of peritoneal solute transfer rate at the start of therapy and overall mortality and technique survival were analyzed using a competing risk model (cause-specific proportional hazard model described by Royston-Lambert). ResultsPatients were classified into four categories based on the PET result: slow/low transfer (16.0%), low average (35.4%), high average (32.9%), and high/fast transfer (15.7%). During follow-up, with a median of 730 days, 3025 (37.02%) patients died, 1079 (13.2%) were transferred to hemodialysis and 661 (8.1%) were transplanted. In the analysis of competing risks, adjusted for age, sex, presence of DM, HTA, body mass index, residual function, albumin, hemoglobin, phosphorus, and modality of PD at the start of therapy, we found cause-specific HR (HRce) for high/fast transfer was 1.13 (95% CI 0.98–1.30) P = .078, high average 1.08 (95% CI 0.96–1.22) P = .195, low average 1.09 (95% CI 0.96–1.22) P = .156 compared to the low/slow transfer rate. For technique survival, cause-specific HR for high/rapid transfer of 1.22 (95% CI 0.98–1.52) P = .66, high average HR was 1.10 (95% CI 0.91–1.33) P = .296, low average HR of 1.03 (95% CI 0.85–1.24) P = .733 compared with the low/slow transfer rate, adjusted for age, sex, DM, HTA, BMI, residual renal function, albumin, phosphorus, hemoglobin, and PD modality at start of therapy. Non-significant differences. ConclusionsWhen evaluating the etiological relationship between the type of peritoneal solute transfer rate and overall mortality and survival of the technique using a competing risk model, we found no etiological relationship between the characteristics of peritoneal membrane transfer according to the classification given by Twardowski assessed at the start of peritoneal dialysis therapy and overall mortality or technique survival in adjusted models. The analysis will then be made from the prognostic model with the purpose of predicting the risk of mortality and survival of the technique using the risk subdistribution model (Fine & Gray).

Partisipasi Masyarakat Dalam Menciptakan Kampung Tangguh Nasional (Studi Kasus Desa Lueng Ie Aceh Besar)

National Tangguh Village is a program held in leng ie Village, Kec. Krueng Barona Jaya, Kab. Aceh Besar which aims to create a village on a national scale. The programs are carried out by the government of Lueng Ie Village, Krueng Barona Jaya District, Kab. Aceh Besar is the existence of the Poskesdes Program where the activities carried out at the Poskesdes are Posyandu. Then there is also the construction of rental houses built by the village government to increase the income of Lueng Ie Village. In this case the village government of Lueng Ie has an important role to socialize this program to the community. And the community also has a role that is no less important to participate in the success of the program. But in reality the people of Lueng Ie Village are not participating due to the lack of information about the National Tangguh Village Program and the relatively low HR factor.

Abstract 3383: Liquid biopsy for PDL-1 status by analysis of cfRNA: Clinical data from a large community practice

Abstract PD-L1 testing via immunochemistry has become a widely used tool to predict response to immune checkpoint inhibitor (ICI) therapy in many tumor types. However this marker can be expressed heterogeneously, and can vary with time, treatment effects, and local factors including cytokine expression. Gene expression profiles of immunologically active genes are currently being studied to more accurately predict response to ICI treatment. To evaluate a potentially more straightforward way to accomplish this, we utilized an assay of cfRNA in plasma for PD-L1, utilizing a real-time PCR based assay (Circulogene, Inc, Birmingham, AL). The demonstrated limit of detection for PD-L1 RNA was 1 copy/ul. Results were reported as either not detected, or low at over 1%, or high at over 50%. We used the PCR 30th percentile Ct value corresponding to a tissue IHC PD-L1 of&amp;gt;50%, and the 66th percentile Ct value corresponding to a tissue PD-L1 expression of &amp;gt;1%. We then collected data on over 400 patients over a two year period at a large community oncology practice and at a university clinic (Florida Cancer Specialists and Atrium Health/Wake Forest-Baptist Comprehensive Cancer Center) who had a clinical necessity for molecular testing in a commercially available setting with a CLIA certified lab. In some cases the corresponding tissue PD-L1 testing was also available, and may have been either positive or negative.To date 41 patients have been found to have high levels of cfRNA for PD-L1. Their clinical course has been analyzed using the electronic medical record. Some patients have received standard of care therapy, and some have been given CPI therapy with or without chemotherapy, if the attending oncologist felt this to be the best palliative option. These include tumors such as CRPC, metastatic low grade neuroendocrine carcinoma and HR+ metastatic breast carcinoma, that have rarely been treated successfully with CPI therapy. Tumor types - all are stage IV solid tumor patients: 19 NSCLC, 7 breast carcinoma, 3 colorectal cancer, 3 castrate resistant prostate carcinoma, 9 other tumor types.Data collection for tumor response or clinical benefit on the 41 patients is ongoing and will be presented at the meeting, and compared to published CPI response data using standard tissue IHC testing. Citation Format: Lowell L. Hart, Magali Van den Bergh. Liquid biopsy for PDL-1 status by analysis of cfRNA: Clinical data from a large community practice [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 3383.

Ivabradine monotherapy in pediatric patients with focal atrial tachycardia: a single-center study.

Ivabradine is well-tolerated and may provide early heart rate control in pediatric FAT and can be considered early, especially in the presence of left ventricular dysfunction. Further investigations are deserved to confirm the optimal dose and long-term efficacy in this population. •Focal atrial tachycardia (FAT) is the most common arrhythmia associated with tachycardia-induced cardiomyopathy (TIC) in children, and the efficacy of conventional antiarrhythmic medications in the treatment of FAT is poor. •Ivabradine is currently the only selective hyperpolarization-activated cyclic nucleotide-gated (HCN) inhibitor, which can effectively low HR without negative effect on blood pressure or inotropy. • Ivabradine (0.1-0.2 mg/kg every 12 h) can effectively suppress focal atrial tachycardia in 50% of pediatric patients. •Ivabradine provides early control of heart rate and hemodynamic stabilization in children with severe left ventricular dysfunction due to atrial tachycardia within 48 h.

Abstract P5-03-14: Prevalence of germline BRCA mutations in unselected Korean patients with HER2-negative breast cancer: A Prospective cohort study

Abstract Backgrounds Since OlympiAD study, National Comprehensive Cancer Network guideline recommends assessment of germline BRCA1/2 mutation in all patients with recurrent or metastatic breast cancer to identify candidates for PARP inhibitor therapy, which is not always possible in clinical practice due to limited resources for testing. Data on the prevalence of gBRCA mutation is still lacking, especially in patients with non-high risk for hereditary breast and ovarian cancer syndrome. In this study, we investigated prevalence of gBRCA mutation in unselected Korean patients with HER2-negative advanced BC in a prospective cohort and analyzed oncologic outcome. Methods Eligible patients were diagnosed with HER2-negative advanced BC and had initiated palliative systemic treatment. Peripheral blood was prospectively drawn from each patient and gBRCA mutation status was assessed by next generation sequencing using NGeneBio BRCAaccuTest®. In 100 patients, somatic mutations including BRCA1/2 from tumor tissue were investigated using targeted panel sequencing. To estimate the prevalence of gBRCA mutation with margin of error to be no more than ±4% at the 95% confidence interval in a population size of 20,000, 583 patients were to be enrolled. Results A total of 583 patients were enrolled between Oct 2019 and Mar 2022, and the prevalence of gBRCA mutation was analyzed in 570 patients, excluding ineligible patients. Median age was 54 years old (range 26-87) and 567 patients were female. 475 patients had HR+/HER2- BC and 94 patients had triple negative breast cancer (TNBC). The overall prevalence of gBRCA1/2 pathogenic mutation was 7.3% (42/570) in unselected patients. The prevalence of gBRCA1 mutation was 1.6%(9/570) overall, 0.8%(4/475) in HR+/HER2- BC, and 5.3%(5/94) in TNBC. The prevalence of gBRCA2 mutation was 5.8%(33/570) overall, 6.3%(30/475) in HR+/HER2- BC, 3.2%(3/94) in TNBC. Prevalence in low risk TNBC (&amp;gt;60 years at first BC diagnosis, no known family history of relevant cancer and unilateral breast cancer) was 10.5% (2/19, all 2 patients had gBRCA2 mutation). Prevalence in low risk HR+/HER2- (&amp;gt;40 years at first BC diagnosis, no known family history of relevant cancer and unilateral breast cancer) was 5.9% (18/307, 17 patients had gBRCA2 mutation). The overall prevalence of gBRCA1/2 pathogenic mutation in Korean patients with low risk HER2-negative advanced BC was 6.1%. The result of somatic mutation, treatment patterns and clinical outcome according to gBRCA1/2 mutation will be further analyzed. Conclusions The prevalence of gBRCA mutation among Korean patients with HER2-negative advanced BC classified as low risk (6.1%) in this study supports routine testing of gBRCA mutation in this population. Citation Format: Hee Kyung Ahn, Jee Hung Kim, Mirae Kim, Seri Park, Su-Jin Koh, Joo Hyuk Sohn, Myoung Joo Kang, Kyung Hae Jung, Kyoung Eun Lee, Jieun Lee, Sung Ae Koh, Yee Soo Chae, Jae Ho Byun, In Hae Park, Hee-Jun Kim, Jee Hyun Kim, Han Jo Kim, Joo Young Jung, Jung Lim Lee, Yoon Young Cho, Kyong Hwa Park, Ji-Yeon Kim, Seock-Ah Im, Yeon Hee Park. Prevalence of germline BRCA mutations in unselected Korean patients with HER2-negative breast cancer: A Prospective cohort study [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P5-03-14.

Public health determinants of child malaria mortality: a surveillance study within Siaya County, Western Kenya

BackgroundMalaria deaths among children have been declining worldwide during the last two decades. Despite preventive, epidemiologic and therapy-development work, mortality rate decline has stagnated in western Kenya resulting in persistently high child malaria morbidity and mortality. The aim of this study was to identify public health determinants influencing the high burden of malaria deaths among children in this region.MethodsA total of 221,929 children, 111,488 females and 110,441 males, under the age of 5 years were enrolled in the Kenya Medical Research Institute/Center for Disease Control Health and Demographic Surveillance System (KEMRI/CDC HDSS) study area in Siaya County during the period 2003–2013. Cause of death was determined by use of verbal autopsy.Age-specific mortality rates were computed, and cox proportional hazard regression was used to model time to malaria death controlling for the socio-demographic factors. A variety of demographic, social and epidemiologic factors were examined.ResultsIn total 8,696 (3.9%) children died during the study period. Malaria was the most prevalent cause of death and constituted 33.2% of all causes of death, followed by acute respiratory infections (26.7%) and HIV/AIDS related deaths (18.6%). There was a marked decrease in overall mortality rate from 2003 to 2013, except for a spike in the rates in 2008. The hazard of death differed between age groups with the youngest having the highest hazard of death HR 6.07 (95% CI 5.10–7.22). Overall, the risk attenuated with age and mortality risks were limited beyond 4 years of age. Longer distance to healthcare HR of 1.44 (95% CI 1.29–1.60), l ow maternal education HR 3.91 (95% CI 1.86–8.22), and low socioeconomic status HR 1.44 (95% CI 1.26–1.64) were all significantly associated with increased hazard of malaria death among children.ConclusionsWhile child mortality due to malaria in the study area in Western Kenya, has been decreasing, a final step toward significant risk reduction is yet to be accomplished. This study highlights residual proximal determinants of risk which can further inform preventive actions.

Heart Rate Lowering Significantly Increases Feasibility in Doppler Recording Blood Flow Velocity in Coronaries during Transthoracic Doppler Echocardiography.

Background: Coronary blood flow Doppler recording by Transthoracic Doppler in convergent mode (E-Doppler TTE) might be further improved by lowering heart rate (HRL) down to <60 bpm, since low HR < 60 b/m causes a disproportional lengthening of the diastole, so the coronaries are still for a longer time, very much improving the Doppler signal/noise ratio. Methods: A group of 26 patients underwent E-Doppler TTE before and after HR lowering in four branches of the coronary tree, namely, the left main (LMCA); left anterior descending (LAD), subdivided into three segments: proximal, mid and distal; proximal left circumflex (LCx); and obtuse marginal (OM). Color and PW coronary Doppler signal was judged by two expert observers as undetectable (SCORE 1), weak or with clutter artifacts (SCORE 2), or well delineated (SCORE 3). In addition, local accelerated stenotic flow (AsF) was measured in the LAD before and after HRL. Results: Beta-blockers significantly decreased the mean HR from 76 ± 5 to 57 ± 6 bpm (p < 0.001). Before HRL, the Doppler quality was very poor in the proximal and mid-LAD segments (median score value = 1 in both), while in the distal LAD, it was significantly better but still suboptimal (median score value = 1.5, p = 0.009 vs. proximal and mid-LAD score). After HRL, blood flow Doppler recording in the three LAD segments was strikingly improved (median score value = 3, 3 and 3, p = ns), so the effect of HRL was more efficacious in the two more proximal LAD segments. In 10 patients undergoing coronary angiography (CA), no AsF as expression of transtenotic velocity was detected at baseline. After HRL, thanks to the better quality and length of color flow, ASF was detected in five patients while in five others, it was not in perfect agreement with CA (Spearman correlation coefficient = 1, p < 0.01). The color flow in the proximal LCx and OM was extremely poor at baseline (color flow length 0 and 0, median (interquartile range) mm, respectively) and improved considerably after HRL (color flow length 23 [13.5] and 25 [12.0] mm, respectively, p < 0.001). Conclusions: HRL greatly improved the success rate of blood flow Doppler recording in coronaries, not only in the LAD, but also in the LCx. Therefore, AsF for stenosis detection and coronary flow reserve assessment can have wider clinical applications. However, further studies with larger samples are needed to confirm these results.