Usual Risk Factors Research Articles

Cardiac troponin I and BNP for predicting zero Agatston score in patients with diabetes mellitus

Abstract Background Coronary artery calcifications (CAC) scoring assessed by the Agatston score has shown an excellent prognostic value in large studies, particularly in diabetic patients, with a very low rate of cardiovascular events in patients with a zero Agatston score. Moreover, recent studies have suggested that high-sensitive cardiac troponin I (hs-cTnI) and brain natriuretic peptide (BNP) may be useful for detecting subclinical atherosclerosis, especially in diabetic patients. However, the link between hs-cTnI/BNP and the Agatston score has not been investigated in this population. Purpose The aim of this study was to investigate if hs-cTnI and BNP can bring additional value to predict zero Agatston score in patients with diabetes mellitus in addition to usual risk factors. Material Between 2015 and 2019, CAC score was prospectively performed in consecutive patients with diabetes mellitus with high cardiovascular risk. Patients with symptoms or known coronary artery disease were excluded. Within 24h from CT exam, peripheral blood samples were taken to measure hs-cTnI and BNP. The relationship between serum hs-cTnI/BNP concentrations and zero Agatston score was evaluated using univariate and multivariate binomial models. 77 variables have been used to build the model. The implication of hs-cTnI and BNP in this multivariate model was evaluated using nested models associated with Chi-squared test of independence. Results A total of 844 patients with diabetes were enrolled (61±7 years, 57% men, mean diabetes duration 18 years). In this population, 294 (35%) had a zero Agatston score, 253 (30%) an Agatston score from 1 to 100, 161 (19%) from 101 to 400, and 136 (16%) higher than 400. In univariate analysis, hs-cTnI and BNP concentrations were associated with a zero Agatston score (respectively OR, 2.63 [95% CI, 1.51–5.01]; p<0.001 and OR, 1.09 [95% CI, 1.01–1.22]; p=0.03). In multivariate analysis, hs-cTnI and BNP concentrations were associated with a zero Agatston score (respectively OR, 2.38 [95% CI, 1.51–4.76]; p=0.009 and OR, 1.18 [95% CI, 1.07–1.32]; p=0.001). Among the 77 variables, the multivariate model including age, gender, smoking, dyslipidaemia, duration of the diabetes, arterial hypertension, presence of diabetic neuropathy, hs-cTnI and BNP concentrations, significantly discriminated the zero Agatston score (AUC = 0.81; p<0.001). The most discriminant threshold was ≤3ng/l for hs-cTnI and <17ng/l for BNP. In nested models, both hs-cTnI and BNP brought information to this multivariate model to predict a zero Agatston score (respectively p=0.003 and p<0.001 to the Chi-squared test). Moreover, removing hs-cTnI and BNP from the model results in a significant reduction in model performance (AUC = 0.79; p=0.004). Conclusions Cardiac biomarkers hs-cTnI and BNP are associated with a zero Agatston score, which is correlated with a very low risk of cardiovascular events in asymptomatic patients with diabetes mellitus. ROC curve to predict zero Agatston score Funding Acknowledgement Type of funding source: None

S2733 A Curious Case of a Bleed Without a Cause

INTRODUCTION: Spontaneous subcapsular hematoma of the liver is usually associated with pregnancy, coagulopathy or liver lesion. We report a rare case of spontaneous subcapsular liver hematoma without any of the above risk factors. CASE DESCRIPTION/METHODS: A 59-year-old lady with a history of hypertension presented with sudden-onset in the right upper abdomen, right chest, shoulder and neck pain. She was otherwise hemodynamically stable other than being mildly hypertensive. Work-up for cardiac ischemia was negative. She was noted to have a low hemoglobin of 10.4 g/dl (prior baseline was 13.7 g/dL) and she had mild hepatocellular injury (ALT 32 IU/L, AST 31 IU/L). She underwent CT scan to rule out pulmonary embolism which incidentally revealed a large subcapsular liver hematoma. MRI abdomen confirmed a large lenticular shaped subscapular collection along the right lobe of the liver measuring approximately 12 × 4 × 16 cm. There was no focal hepatic lesion to explain the cause of bleeding. She did not recall any preceding trauma and there was no obvious trauma on exam. She was not taking any blood thinners. She admitted to inadvertently using oral contraceptives (OCP) for over 30 years for purely birth control purposes. The patient was admitted for observation and remained clinically stable over the next few days. At her 1-month follow-up, an office ultrasound showed that the size of the hematoma had decreased when compared to her prior ultrasound during her hospitalization (thickness from intercostal view decreased from 42 mm to 35 mm). At her 1-year follow-up, an MRI abdomen was repeated that showed a minimal residual hematoma and no discrete underlying lesion. DISCUSSION: Spontaneous subcapsular hematoma of the liver represents an accumulation of blood between the capsule of Glisson and the liver parenchyma, and is frequently located around the right lobe. If it ruptures into the peritoneum, it can be potentially fatal. Our case is unique in that none of the usual risk factors such as pregnancy, trauma, blood thinner use or underlying liver lesion were present. To our knowledge, there are very few similar case reports that describe spontaneous subcapsular hepatic hematoma. OCP use is generally associated with the development of hepatic adenoma, which can in turn cause spontaneous subcapsular hematoma. Theoretically, long-term OCP use in a post-menopausal hypertensive lady (such as in our case) may mimic the pathophysiology of pregnancy and independently lead to spontaneous subcapsular bleeding.Figure 1.: MRI showing large hepatic subcapsular hematoma and no focal lesion.Figure 2.: MRI showing nearly resolved hepatic subcapsular hematoma.

Risk Factors Associated with Breast Cancer

Background: It is reported that genetic and hereditary-familial risk factors for breast cancer contribute 5% and the majority are related to the reproductive life of women. Objective: it has the purpose of determining if the factors considered as risk factors are associated with breast cancer in a group of Mexican women. Material and Methods: A retrospective, observational and descriptive study was carried out in 162 women with breast cancer for 3 years (2002-2004) at the Hospital Juárez de México to determine if the usual risk factors are related to breast cancer. The descriptive analysis included localization and dispersion measures, as well as a graphical analysis using bar diagrams. Results: In the sample of 162 women with breast cancer, the age range at the time of breast cancer diagnosis was from 27 to 78 years (mean of 47.60, standard deviation of 13.09); early menarche only appeared in 12.3% (n=20). The mean age of the first pregnancy was 22 years and of menopause at 51 years of age; 72.2% lactated (n=117) and 45.1% did so for more than 6 months (n=73); the menstrual pattern disorder appeared in 22.8% of cases (n=37); Menopausal hormone therapy was previously used in 19.8% (n=32). The hereditary-family history of breast cancer appeared in 14.2% of the cases (n=23). It seems to be correlated with the fact that in patients with nulliparity, alcoholism and the absence of breastfeeding, breast cancer occurs at an early age (< 45 years) and the risk factor that is related to breast cancer is overweight and obesity with 54.26% and 17.11% respectively (average of 28.00, standard deviation of 3.032). Conclusion: no correlation was found between risk factors considered common for breast cancer; only overweight and obesity were related to its development, further research is required to confirm whether this correlation occurs in other countries.

Assessment of Hearing Impairment in NICU Graduates by Otoacoustic Emission and Brainstem Evoked Response Audiometry Tests

Objectives: To find out the incidence of hearing impairment in Neonatal Intensive Care Unit (NICU)-admitted newborns and to correlate between several risk factors. Design: Prospective observational study. Setting: In a tertiary teaching hospital of Odisha between October 2014 and October 2016. Study population: 100 newborns delivered in the institution and admitted in NICU with usual indications and risk factors that underwent otoacoustic emission 1 and 2 (OAE1, OAE2) and Brainstem Evoked Response Audiometry (BERA). Results: 84 babies in OAE1 and 86 babies in OAE2 got “pass” results. In BERA test, 92 babies got normal waveform. 7 (13.7%) of 51 premature babies, 5 (38.5%) of 13 very low birth weight babies, 7 (17.5%) of 40 babies receiving ototoxic medication for >5 days, 7 (31.8%) of 22 babies with hyperbilirubinemia, 6 (42.9%) of 14 babies with sepsis, 5 (20%) of 20 babies with birth asphyxia, 3 (60%) of 5 babies under mechanical ventilation for >5 days, 1 baby with ear abnormality, and 1 (50%) out of 2 babies with congenital infections had hearing impairment and statistically significant association with abnormal OAE and BERA test. Conclusion: There is high incidence of hearing loss in NICU-admitted newborns. OAE and BERA both should be performed for complete evaluation of hearing. Important risk factors are elaborated. Predischarge hearing assessment in NICU is most important.

Coronavirus 2019 Disease (COVID-19), Systemic Inflammation, and Cardiovascular Disease.

Acute respiratory failure associated with the Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2), has rapidly spread worldwide and presents critical challenges for the public health and medical communities The World Health Organization (WHO) has declared SARS-CoV-2 a public health emergency of international concern, with a global estimate of over 7 million human infections and more than 400000 deaths worldwide as of June 12, 2020 A 2020 report by the China Medical Treatment Expert Group for Coronavirus disease 2010 (COVID-19) (2) showed that the clinical spectrum of the viral infection is dominated by fever (up to 88 7% of patients during hospitalization) and cough (67 8% of patients) followed by symptoms such as headache, fatigue, or shortness of breath

A score to predict one-year risk of recurrence after acute ischemic stroke

An acute ischemic stroke carries a substantial risk of further recurrences. We aimed at developing and validating a prognostic tool to predict one-year stroke recurrence after acute ischemic stroke. An integer score was derived by Cox regression analysis on a hospital-referred cohort of 3246 acute ischemic stroke patients from Switzerland, and tested for external validity in three similar independent cohorts from Athens (n = 2495), Milan (n = 1279), and Helsinki (n = 714) by means of calibration and discrimination. In the derivation cohort, the recurrence rate was 7% (n = 228/3246). We developed a nine-point score comprising: previous stroke or transient ischemic attack (1-point), stroke mechanism (small vessel disease and unknown mechanism: 0-points; rare stroke mechanism: 3-points; other mechanisms: 1-point), pre-stroke antiplatelets (1-point), active malignancy (2-points), chronic cerebrovascular lesions on imaging (1-point) and absence of early ischemic changes on first imaging (1-point). In the derivation cohort, the one-year risk of re-stroke was 3.0% (95%CI 1.9-4.1) in 932 (29%) patients with a score 0-1, 7.2% (6.1-8.3) in 2038 (63%) with a score 2-4, and 19.2% (14.6-23.9) in 276 (8%) with a score ≥ 5. The score calibrated well in the Athens (recurrences = 208/2495), but not in the Helsinki (recurrences = 15/714) or Milan (recurrences = 65/1279) cohorts. The AUC was 0.67 in the derivation cohort, and 0.56, 0.70, and 0.63 in the Athens, Helsinki, and Milan cohorts, respectively. We developed a score to predict one-year stroke recurrence risk in patients with acute ischemic stroke. Since the score was not completely validated when applied to external datasets where it displayed poor to fair calibration and discrimination, additional efforts are required to ameliorate our accuracy for predicting stroke recurrence, by better refining this prognostic tool or developing new ones. Clinical and radiological markers of established cerebrovascular disease and stroke etiology were better predictors than the usual demographic vascular risk factors.

Herbal Medicine for Slowing Aging and Aging-associated Conditions: Efficacy, Mechanisms and Safety.

Aging and aging-associated diseases are issues with unsatisfactory answers in the medical field. Aging causes important physical changes which, even in the absence of the usual risk factors, render the cardiovascular system prone to some diseases. Although aging cannot be prevented, slowing down the rate of aging is entirely possible to achieve. In some traditional medicine, medicinal herbs such as Ginseng, Radix Astragali, Ganoderma lucidum, Ginkgo biloba, and Gynostemma pentaphyllum are recognized by the "nourishing of life" and their role as anti-aging phytotherapeutics is increasingly gaining attention. By mainly employing PubMed here we identify and critically analysed 30 years of published studies focusing on the above herbs' active components against aging and aging-associated conditions. Although many plant-based compounds appear to exert an anti-aging effect, the most effective resulted in being flavonoids, terpenoids, saponins, and polysaccharides, which include astragaloside, ginkgolide, ginsenoside, and gypenoside specifically covered in this review. Their effects as antiaging factors, improvers of cognitive impairments, and reducers of cardiovascular risks are described, as well as the molecular mechanisms underlying the above-mentioned effects along with their potential safety. Telomere and telomerase, PPAR-α, GLUTs, FOXO1, caspase-3, bcl-2, along with SIRT1/AMPK, PI3K/Akt, NF-κB, and insulin/insulin-like growth factor-1 pathways appear to be their preferential targets. Moreover, their ability to work as antioxidants and to improve the resistance to DNA damage is also discussed. Although our literature review indicates that these traditional herbal medicines are safe, tolerable, and free of toxic effects, additional well-designed, large-scale randomized control trials need to be performed to evaluate short- and long-term effects and efficacy of these medicinal herbs.

Validation and reproducibility of the lung function questionnaire (LFQ) for the diagnosis of COPD in Colombia

Abstract Introduction The development of clinical prediction scales and their use can reduce under-diagnosis and increase early detection of chronic obstructive pulmonary disease (COPD). The performance of clinical prediction scales in Colombia is unknown. The objective of this study is to evaluate the validity and reproducibility of the lung function questionnaire (LFQ) in Colombia. Method A cross-sectional study was performed, with analysis of diagnostic validity and reliability in people over 40 years of age who underwent a spirometry test. The LFQ questionnaire was applied. To assess reproducibility, the test was carried out at two time points: first at the initial consultation; and then 1 day to 1 week after the previous application. Spirometry was performed immediately after the initial questionnaire, meeting the American Thoracic Society criteria. Results Among the 1996 subjects included in the analysis, the average age was 65 years (SD: 11.97 years), prevalence of COPD was 21.3%, the intra-class correlation coefficient between the two time points was 0.844 (95% CI: 0.863–0.901) (p < 0.001), and kappa was 0.797 for the dichotomous outcome ≤18 COPD risk points (p < 0.001), validity analysis using the area under the receiver operating characteristic curve for the population evaluated was 0.715 (95% CI: 0.685–0.745); the dichotomous outcome of the questionnaire ≤18 points was as follows: sensitivity – 91.18% (95% CI: 88.0–94.3); specificity – 32.41% (95% CI: 29.8–35.0); positive predictive value – 26.7% (95% CI: 24.1–29.3); negative predictive value – 93.15% (95% CI: 90.7–95.6); likelihood ratio (LR) +: 1.34 (95% CI: 1.28–1.42), LR– 0.27 (95% CI: 0.19–0.39); number needed to diagnose: 4; number needed to misdiagnose: 2 (p < 0.001). Conclusion The LFQ questionnaire has good performance for the diagnosis of COPD, especially in populations without previous respiratory symptoms or usual risk factors, optimising the use of spirometry to increase its detection.

0721 Coronary Atherosclerotic Plaque Burden and Composition in Patients with Obstructive Sleep Apnea by Coronary CT Angiography

Abstract Introduction OSA is closely associated with increased risk of coronary artery disease. Although previous small studies have investigated coronary plaque in OSA patients, limited data are available regarding the association of OSA with plaque morphology and composition. Therefore, we aimed to quantitatively characterize and compare coronary plaque burden and composition between patients with no or mild obstructive sleep apnea (OSA) and moderate-severe OSA using coronary computed tomography angiography (CTA) in a large-scale study. Methods We retrospectively analyzed consecutive patients who underwent sleep monitoring and coronary CTA. Metrics reflecting coronary plaque characteristics were compared between patients with no or mild OSA with apnea hypoxic index (AHI) ≤15 and moderate-severe OSA (AHI>15). The associations of OSA with coronary plaque components were determined by logistic and linear regression analysis. Results A total of 854 patients were enrolled in the study. Of these, 162 did not meet the inclusion criteria and of the remaining 692 patients 400 (57.8%) had moderate-severe OSA and 292 had no or mild OSA. Patients with moderate-severe OSA had a significantly higher total plaque volume, total non-calcified plaque (NCP) volume and total low density non-calcified plaque (LD-NCP) volume, and corresponding burden than those with no or mild OSA (all with p<0.05). Multivariate logistic regression analysis revealed that moderate-severe OSA patients are more likely to have any plaque, NCP and LD-NCP than those without no or mild OSA (p<0.05). In addition, stepwise multivariate linear regression analysis further revealed an independent relationship between moderate OSA (15<AHI≤30) and more so between severe OSA (AHI>30) and, NCP volume, LD-NCP volume, NCP composition, and LD-NCP composition, following adjustment for traditional cardiovascular risk factors, compared to no or mild OSA (AHI<15) (all with a p<0.05). Moderate-severe OSA conferred a similar odds ratio for LD-NCPs (a high-risk plaque) as the usual cardiovascular risk factors. Conclusion In this large cross-sectional study, OSA severity was associated with high-risk plaque features independent of traditional cardiovascular risk factors, suggesting an increased risk for cardiovascular events. Support This study was supported by NSFC (Project 81870335), International Science & Technology Cooperation Program of China (No.2015DFA30160), Beijing Municipal Science & Technology Commission (No. Z141100006014057)

C difficile 2020

The study by Miranda-Katz et al from Kaiser Permanente Northern California approximates the true incidence of community-associated Clostridioides difficile diarrheal disease—13.7 cases per 100 000 per year for the population aged 1 to 17 years. Compared with previous studies, this study has several strengths of broad geographic range, large number of subjects, and optimal testing methods for C difficile and toxin. Equally important, the investigators used rigorous methods to minimize inclusion of colonized but unaffected patients: 1) limiting cases to ages 1 year and older and to those with diarrhea and 2) excluding patients with hospital-acquired infection and those in whom another pathogen also is detected in stool specimen. Using a case-control study format, they also identified the usual risk factors for C difficile as healthcare visits in the preceding year and receipt of certain antimicrobial agents in the preceding three months. This said, the highest case incidence (70 cases/100 000/year) occurred in children in the community between 1 and 2 years of age without remarkable healthcare-related risk factors. This epidemiology has not been widely recognized previously or definitively shown. Here is an alert to the up-to-date consumer of the medical literature. The gurus of medical microbiology have decided that the genus Clostridioides should replace the genus Clostridium for the species difficile. Thankfully, the designation as C difficile or “C diff” still works. Article page 99 ▸ Epidemiology and Risk Factors for Community Associated Clostridioides difficile in ChildrenThe Journal of PediatricsVol. 221PreviewTo assess which risk factors are associated with community-associated Clostridioides difficile infection (CDI) in children. Full-Text PDF

Potential Impact of Umbilical-Cord-Blood Procalcitonin-Based Algorithm on Antibiotics Exposure in Neonates With Suspected Early-Onset Sepsis

Context: The incidence of early-onset neonatal infection has greatly decreased, but a new diagnostic approach is needed to avoid overdiagnosis and overtreatment. The aim of this study was to assess the potential impact of an algorithm incorporating umbilical-cord-blood procalcitonin (PCT) level on neonatal antibiotics prescription rate as compared with current practice.Material and methods: We conducted a prospective study in three maternity wards in France. All term and preterm neonates with the usual risk factors for neonatal group B Streptococcus infection were eligible for umbilical-cord-blood PCT testing. We compared the proportion of neonates who were exposed early to antibiotics (before 6 days of life) to that of neonates for whom antibiotics prescription would be indicated according to the PCT-based algorithm.Results: Among the 3,080 neonates included, 1 neonate presented with certain infection and 38 neonates with probable infection. The global antibiotics prescription rate was 4.6% [95% confidence interval (CI), 4.1–5]. With the PCT-based algorithm, the potential decrease in prescription rate would be 1.8% (95% CI, 1.3–2.3), corresponding to a 39% (95% CI, 37.3–40.7) relative reduction in antibiotics exposure (p < 0.05).Conclusion: These results suggest that the umbilical-cord-blood PCT-based algorithm could significantly help the clinicians in their antibiotic prescription decision to decrease neonatal antibiotics exposure as compared with current practice. If validated in a larger interventional randomized study, this approach could help clinicians stratify the risk of early-onset neonatal infection and initiate early antibiotics treatment in newborns at high risk of infection while limiting the deleterious effects of useless prescriptions in non-infected newborns.

The association of polymorphism in PHACTR1 rs9349379 and rs12526453 with coronary artery atherosclerosis or coronary artery calcification. A systematic review.

There is a need to identify genetic factors that may produce coronary artery atherosclerotic disease (CAD) that are not involved in the usual risk factors leading to CAD. Previous studies have often equated coronary artery calcification (CAC) with CAD with coronary stenosis or its sequelae. The objective of this study was to examine the relationship between phosphatase and actin regulator 1 (PHACTR1) single nucleotide polymorphisms (SNPs) and the type of coronary artery disease CAD versus CAC. A systematic review of the literature was conducted to answer the question of whether PHACTR1 gene polymorphisms are associated with coronary artery disease expressed as coronary artery atherosclerosis or CAC. Eighteen studies spanning seven PHACTR1 SNPs were identified and evaluated for the relationship between PHACTR1 and coronary artery disease. There were significant relationships between rs9349379, rs12526453, and CAD with odds ratios (ORs) (confidence interval) of, respectively, 1.15 (1.13-1.17), 1.13 (1.09-1.17) but not for rs2026458, 1.03 (0.88-1.19). The OR for CAC was 1.22 (1.18-1.26) for rs9349379 and 1.28 (1.21-1.38) for rs12526453. Several PHACTR1 specifically rs9349379 and rs12526453 polymorphisms but not rs2026458, are associated with CAD. There are differences in the association of PHACTR1 SNPs with CAC. PHACTR1 warrants more attention and study for the prevention and treatment of CAD.

Abstract P5-08-02: Association of daily alcohol intake, volumetric density and breast cancer risk

Abstract Background: Alcohol intake and breast density are established risk factors for breast cancer (BC). A few studies suggest breast density is on the causal pathway between alcohol and BC but the literature is not consistent. We examine the interrelationship between alcohol, volumetric breast density and BC risk, specifically whether there is a stronger alcohol and BC association among women with dense breasts and/or whether breast density mediates the alcohol and BC association. Methods: We conducted a nested case-control study within the San Francisco Mammography Registry consisting of four breast screening centers. From 2006-2013, through linkages with the California cancer registry, we identified 2572 women diagnosed with BC who had screening mammograms performed at least six months prior to diagnosis. Controls (5119) were matched to cases on age, date of earliest mammogram, race/ethnicity, facility, and mammography machine. We obtained the raw format of digital mammograms on average 3.1 (standard deviation (SD) =1.7) years prior to diagnosis or corresponding date for controls. We ascertained usual daily alcohol intake and other risk factors from a clinical questionnaire at time of mammography. We obtained BI-RADS density from clinical records and used VolparaTM to assess volumetric percent density, dense volume and non-dense volume from the mammogram. We examined the associations of daily alcohol intake (none, one or less, two or more drinks per day) and volumetric density phenotypes (per 1 SD) with BC risk using logistic regression (odds ratios, OR; 95% confidence intervals, CI; and trend tests). We examined deviation from multiplicative interaction using chi-squared tests. We evaluated mediation of the alcohol and BC association by volumetric density measures using logistic regression to estimate the association between alcohol use and BC with and without adjustment for density measures. Percent mediation was estimated using the differences in the log OR estimates from the two models. All models were adjusted for age, 1/BMI and menopause and matching factors. Analyses were also stratified by menopausal status. Results: Alcohol intake was available on 2233 cases and 4562 controls, 88% of those eligible. BC cases and controls had similar age (57.2 years (SD=11.5) vs. 57.1 years (SD=11.5)), BMI (25.3 kg/m2 (SD=5.3) vs. 24.9 kg/ m2 (SD=5.1)) and race (69.0% vs. 68.2% Caucasian). Cases were more likely to drink alcohol daily than controls (52.1% vs. 49.0%), in particular two or more drinks per day (14.8% vs. 13.2%). Alcohol was associated with increased BC risk (OR=1.14, 95% CI:1.02-1.27, for one or less drinks per day and OR=1.22, 95% CI:1.05-1.42 for 2 or more drinks per day) compared to non-drinkers (p-trend=0.004). Percent volumetric density (OR=1.45 per SD, 95%CI: 1.36-1.56,) and dense volume (OR=1.30, 95% CI: 1.24-1.37) were also positively associated with BC risk; non-dense volume was inversely associated (OR=0.93, 95%CI: 0.86-1.01). Associations were similar by menopausal subgroup. There was no evidence for a differential association of alcohol and breast cancer risk by dense breasts assessed using any of the density phenotypes examined (all P’s&amp;gt;0.1). However, the association between alcohol and overall risk of BC was partially mediated by dense volume among all women (percent mediated=25%, P=0.01) and postmenopausal women (percent mediated=19%, P=0.03). Conclusions: The association of daily alcohol intake and breast cancer risk was similar among women with dense and non-dense breasts. However, dense volume partially mediated the association between alcohol and risk of breast cancer, particularly among postmenopausal women, suggesting that alcohol partially influences breast cancer risk through changes in breast tissue composition. Citation Format: Celine Marie Vachon, Christopher G. Scott, Stacey J Winham, John A Shepherd, Kathleen R Brandt, Matthew R Jensen, Carrie B Hruska, John J Heine, V. Shane Pankratz, Karla Kerlikowske. Association of daily alcohol intake, volumetric density and breast cancer risk [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 P5-08-02.

E-Coaching: the DianaWeb study to prevent breast cancer recurrences.

Breast cancer is the most common cancer in women worldwide, for which the survival rate is increasing over time. Growing evidence are showing that the effect of lifestyle could have the same weight of the effect of the usual clinical-pathological risk factors on survival rate. The DianaWeb study responds to the pressing request of patients diagnosed with breast cancer to know the most advanced point of scientific research on the prevention of recurrences, to have a virtual space to meet, where to receive advice and practical information for the daily management the lifestyle change. DianaWeb is a community-based participatory research, dedicated to breast cancer patients, aimed to monitor lifestyle, provide them tips to encourage sustainable lifestyle changes, and to analyze clinical outcomes. In order to achieve these aims, DianaWeb uses a specific interactive website (http://www.dianaweb.org/). The web architecture has been designed essential and light, with a rigorous implantation that brings the figure of the woman to the center. In order to humanized the project the acronym used to identify the study was Diana (Diet and Androgens), a classical female name, who was illustrated as a female avatar, aimed to symbolize all women. The graphical interface was developed using seven pastel tones colors, which become a fundamental elements of the layout, such as frame, navigation menu, and separation interspaces. The project started in 2015, and in 4 days the web site was visited by more than 1000 people. A total of 2823 persons enrolled in the study, but 2182 did not send the full documentations, 61 persons abandoned the study, 641 timely answered to the questionnaires. The high number of participants' interaction within the web page, confirmed the high usability of the web page and the great interest of patients. Prevention of breast cancer recurrences with low cost technologies, easily available to everybody, is a priority for both public health and public finances.

Association of Serum Vitamin D with Acute Myocardial Infarction in Young Patients (≤40 Years)

Background: Coronary heart disease (CHD) is the leading cause of death worldwide, with acute myocardial infarction (AMI) being the most severe manifestation. Recent evidence suggests that vitamin D deficiency (moderate/severe) is an important risk factor for coronary artery disease.&#x0D; Objectives: Considering paucity of the literature focusing young MI, the study was planned to assess the relation of different grades of low serum vitamin D with AMI in young patients admitted in a tertiary care hospital.&#x0D; Methods: This Hospital based case-control study was conducted in the department of cardiology in Dhaka Medical College Hospital (DMCH) over 1-year period. Patients with acute MI in young age (≤40 years) admitted in the CCU of DMCH were approached for inclusion in the study. Total 120 subjects (60 cases and 60 controls) were studied. Patients with acute MI were considered as cases and similar number of age and sex matched apparently healthy individual were included as controls. All study population were subjected to relevant investigations and detailed history along with socio-demographic data were collected. Serum vitamin D levels were categorized as severe vitamin D deficiency as a level &lt;10ng/ml, moderate vitamin D deficiency at a level 10-20 ng/ml, vitamin D insufficiency as 21-29 ng/ml and a level of ≥30ng/ml was considered as normal. Serum 25(OH) vitamin D assay was performed for cases and controls using chemiluminescence immunoassay. Vitamin D status (normal/insufficiency vs moderate/severe deficiency) was studied among cases and controls. All necessary information were recorded in a pretested case record form. Statistical analyses were done by SPSS 22.&#x0D; Results: Mean age of cases and controls were 35.31±4.84 and 33.83±5.11 years respectively. Vitamin D deficiency (moderate/severe) was present in 86.7% cases and 46.7% controls and the difference was statistically significant (P&lt;0.001). Among 60 cases of acute MI, 83% patients had acute ST segment elevated myocardial infarction and 17% patients had acute non-ST segment elevated myocardial infarction. Vitamin D deficient (moderate/severe) subjects were more likely to develop AMI than subjects who had normal/insufficient vitamin D levels in blood (OR 7.42, 95%CI 3.18-18.28, P&lt;0.001). And among all the usual coronary risk factors, vitamin D deficiency (moderate/ severe), Hypertension, Family history of premature CAD and smoking were significantly associated with increased incidence of acute MI (STEMI and NSTEMI) (P value&lt;0.05 in all cases).&#x0D; Conclusion: Vitamin D deficiency (moderate/severe) is associated with increased incidence of acute MI in young age (≤40 years).&#x0D; Bangladesh Heart Journal 2019; 34(2) : 80-85

The trans-DATA study: aims and design of a translational breast cancer prognostic marker identification study

BackgroundThe effect of extended adjuvant aromatase inhibition in hormone-positive breast cancer after sequential tamoxifen, aromatase inhibitor treatment of 5 years was recently investigated by the DATA study. This study found no statistically significant effect of prolonged aromatase therapy. However, subgroup analysis showed post hoc statistically significant benefits in certain sub-populations. The trans-DATA study is a translational sub-study aiming to identify DNA methylation markers prognostic of patient outcome.MethodsPatients from the DATA study are included in the trans-DATA study. Primary breast tumour tissue will be collected, subtyped and used for DNA isolation. A genome-wide DNA methylation discovery assay will be performed on 60 patients that had a distant recurrence and 60 patients that did not have a distant recurrence using the Infinium Methylation EPIC Bead Chip platform. Differentially methylated regions of interest will be selected based on Akaike’s Information Criterion, Gene Ontology Analysis and correlation between methylation and expression levels. Selected candidate genes will subsequently be validated in the remaining patients using qMSP.DiscussionThe trans-DATA study uses a cohort derived from a clinical randomised trial. This study was designed to avoid common pitfalls in marker discovery studies such as selection bias, confounding and lack of reproducibility. In addition to the usual clinical risk factors, the results of this study may identify predictors of high recurrence risk in hormone receptor-positive breast cancer patients treated with sequential tamoxifen and aromatase inhibitor therapy.

Long term exposure to air pollution and atherosclerotic plaques in the Malmö Diet and Cancer Cohort

TPS 671: Cardiometabolic effects of long-term air pollution exposure, Exhibition Hall, Ground floor, August 26, 2019, 3:00 PM - 4:30 PM Background: Long-term exposure to air pollution increases the risk of cardiovascular morbidity and mortality, but the mechanism is not fully known. It has been suggested that air pollution exposure contributes to the development of atherosclerosis, such as carotid artery plaques, a well known precursor of cardiovascular disease. Methods: A Swedish population-based cohort (age 46–67 years) was recruited within the Malmo Diet and Cancer study between 1991 and 1994, of which 6103 underwent ultrasound examination of the right carotid artery. The definition of carotid artery plaque was “a focal thickening of the intima-media complex of >1.2 mm and with an area of ≥10 mm2”. Also intima-media thickness (IMT) was measured (1 cm proximal to the bifurcation). Participants were assigned individual residential air pollution exposure (source-specific PM2.5, PM10, NOx, BC) at recruitment from Gaussian dispersion models. Logistic and linear regression was used to examine associations between air pollution and the prevalence of carotid artery plaques, and IMT, adjusted for potential confounders and usual cardiovascular risk factors. Results: The prevalence of carotid plaques was 34%. The mean levels of PM2.5 and PM10 at recruitment were about 10 and 14 µg/m3, most of which was due to long range transport. The mean NOx level was 39 µg/m3, most of which was due to local emissions. There was only a limited and non-significant association between PM2.5 and plaque prevalence (OR: 1.07, 95% CI 0.91 – 1.26, per µg/m3), and no association with PM10, NOx or BC. There was also no significant linear trend between plaque and air pollution levels in quartiles. There was a slight positive association between IMT and PM2.5, but not statistically significant. Conclusions: Overall we found only limited support for the hypothesis that air pollution exposure for PM10, PM2.5, BC or NOx increases the risk of atherosclerosis in the carotid arteries.

A Rare Gingivobuccal Complex Cancer in a Pediatric patient: A Case Report

Squamous cell carcinoma (SCC) of the oral cavity ranks as the 12th most common cancer in the world and the 8th most frequent cancer in males. Oral cavity SCC (OCSCC) is extremely unusual in the pediatric population. Researchers believe that the pathology of SCC in pediatric patients is a separate entity different from SCC in the adult population. SCC is a malignant and clinically variable epithelial neoplasm. When located in the gingiva, this neoplasm may mimic common inflammatory lesions. This neoplasm is generally more frequent in males than in females, but this is not observed in cases of SCC located in the gingiva. Usual risk factors such as tobacco and alcohol exposure are typically absent.

Différences de prise en charge de l’HTA entre la métropole et les DOM-ROM

BackgroundHigh blood pressure (HBP) is the most common chronic disease worldwide. In France, its prevalence varies by region. It is high in most Overseas Departments and Regions (DOM-ROM), at 38.2% in Réunion (1), 44% in Mayotte (2), 28% in the French Antilles, 18% in French Guiana, 25% in French Polynesia (3) and 28% in Saint-Martin (4). PurposeTo determinate the differences within the same healthcare system between hypertension in Metropolitan France compared to Overseas France Departments and Regions (DOM-ROM). ResultsSex-based differences. In contrast to Metropolitan France, in Overseas France the prevalence of HBP is higher in women, although women show better rates of care (screening and rates of patients “normalised” under medical treatment). The main explanation for this is the higher prevalence of obesity in women. Obesity multiplies the risk of developing hypertension by 2.5 Obesity in Guadeloupe affects 14% of men compared to 31% of women. Socio-economic particularities of hypertension in Overseas France. The numerous epidemiological surveys carried out in the French Antilles have demonstrated the major role of socio-economic conditions in the occurrence of hypertension, alongside the usual risk factors such as sedentary lifestyle, salt consumption and obesity (7). In the absence of socio-economic disparity, there is no significant disparity in the prevalence of hypertension specially in men. ConclusionsThere are differences between France Overseas Regions and Territories (DOM-ROMs) and Metropolitan France in terms of the prevalence, knowledge, treatment and control of hypertension, and these vary according to sex. For men, the prevalence and treatment of hypertension differ very little when considering a population of workers or employees in both regions. On the other hand, for women, the prevalence of hypertension is higher in the French Antilles-Guiana. This difference is not fully explained by the higher prevalence of obesity observed among female employees in the French Antilles-Guiana. For these patients, we also observe better knowledge and better control of hypertension. Care for men in socio-economically disadvantaged situations of precarity must be improved in terms of screening and adherence to treatment.

Systemic sclerosis and urinary symptoms: a complex pathophysiology.

Lower urinary tract symptoms (LUTS) have long been overlooked in systemic sclerosis (SSc). However, they are out of proportion of what would be expected based on age, sex, and presence of usual risk factors. Thus, there must be specific scleroderma-related mechanisms to result in LUTS. Fibrosis, nervous involvement (notably, dysautonomia), early signs of menopauses, and functional restriction play certainly a role, but available evidence shows inconsistent results. Thus, these factors are not sufficient to explain all aspect of LUTS in SSc. In vitro experiments point out a promising alternative mechanism, already observed in other rheumatologic diseases: an antibody-mediated etiology. However, more research is needed to better understand the pathophysiology of LUTS in SSc and develop specific treatment.