Citations

AbstractBackgroundLarge cohort studies provide conflicting evidence regarding the prognostic value of early repolarization pattern (ERP) in the general population, complicated by the complex or heterogeneous definitions of ERP applied in different studies.HypothesisWe hypothesized that ERP was associated with increased cardiovascular risk with the definition of ERP recommended by the expert consensus statements.MethodsA total of 13673 middle‐aged subjects from the prospective, population‐based Atherosclerosis Risk in Communities (ARIC) study were included in this analysis. Cox models were used to estimate the hazard ratios (HRs) adjusted for possible confounding factors. ERP was defined as ST‐segment elevation ≥0.1mV at the end of the QRS or J wave on the QRS downstroke in two or more contiguous leads.ResultsCompared with those without ERP, subjects with ERP had a significantly increased risk of developing sudden cardiac death (SCD) (HR, 1.48; 95% CI, 1.08–2.04) and death from coronary heart disease (CHD) (HR, 1.45; 95% CI, 1.10–1.92) after a median follow‐up of 20.1 years. ERP was significantly predictive of SCD in females, whites, younger people, and subjects with relatively low cardiovascular risk. ERP with ST‐segment elevation appeared to indicate poor cardiovascular outcomes. ERP was associated with an absolute risk increase of 93.3 additional SCDs per 100 000 person‐years.ConclusionsOur findings suggest that ERP was an independent predictor of SCD and CHD death in the middle‐aged biracial population.

AbstractMolecular prognostic factors for individualized treatment of squamous cell carcinoma (SCC) are poorly defined. Our study developed and validated a novel molecular tools aid in preinguinal and postinguinal lymphadenectomy risk stratification in node‐positive penile SCC. Patients with node‐positive penile SCC who underwent inguinal or ilioinguinal lymphadenectomy were divided into three cohorts: a discovery set, a development set and a validation set. The local ethics committee approved the study. The primary endpoint was cancer‐specific survival (CSS). At the discovery stage, 17 CpG sites were significantly associated with CSS. In the development set, we constructed a 3‐CpG‐based prognostic score for survival prediction. The hazard ratio (HR) of the panel (dichotomized using the optimal cutoff) was 5.8 in the multivariate analyses (P < .001). The addition of the methylation score significantly improved the pN‐stage C‐index from 0.70 to 0.79 (incremental C = 0.09, P < .001). In the validation set, the methylation panel showed a HR of 9.9 in the multivariate analyses. The addition of the molecular marker improved the pN‐stage C‐index from 0.69 to 0.78 (incremental C = 0.09, P < .001). The methylation score remarkably separated survival curves in different pN stages, which indicate that the tool can be applied to tailor the treatment in both preinguinal and postinguinal lymphadenectomy settings. We developed and validated a prognostic methylation panel for node‐positive penile SCC. The tool may aid in the risk stratification of the population with heterogeneous outcomes and needs prospective validation. Patients in high‐risk group may benefit from more aggressive therapy or clinical trials.

Proton therapy is an expanding radiotherapy modality in the United States and worldwide. With the number of proton therapy centers treating patients increasing, so does the need for consistent, high‐quality clinical commissioning practices. Clinical commissioning encompasses the entire proton therapy system's multiple components, including the treatment delivery system, the patient positioning system, and the image‐guided radiotherapy components. Also included in the commissioning process are the x‐ray computed tomography scanner calibration for proton stopping power, the radiotherapy treatment planning system, and corresponding portions of the treatment management system. This commissioning report focuses exclusively on intensity‐modulated scanning systems, presenting details of how to perform the commissioning of the proton therapy and ancillary systems, including the required proton beam measurements, treatment planning system dose modeling, and the equipment needed.

Abstract Aims Baduanjin (eight silken movements), a traditional Chinese exercise, is an alternative to the most common cardiac rehabilitation programmes due to their scarcity and unaffordability in China. The aim of this study was to measure the intensity and energy expenditure during Baduanjin and to determine the relative oxygen consumption (VO2) and heart rate (HR) responses of Baduanjin compared with maximal capacity in patients with chronic heart failure. Methods and results Twenty participants (age: 65 ± 10 years, male: n = 17) with New York Heart Association II–III volunteered for this study. Participants were examined during two separate sessions, with 1–2 weeks between sessions. During session one, a symptom-limited cardiopulmonary exercise testing was performed on a cycle ergometer for measurement of maximal exercise capacity. Additionally, participants were taught Baduanjin exercise from a professional coach and were required to do it at home until the second session when their technique was confirmed by the coach. During session two, participants performed one 9 min round of Baduanjin with continuous measurement of VO2 and HR. Measurements obtained during the Baduanjin were compared with data obtained during cardiopulmonary exercise testing. While performing Baduanjin, the mean VO2 and HR were 7.1 ± 1.2 mL/kg/min and 86.1 ± 15.2 b.p.m., respectively. Compared with the cardiopulmonary exercise test, the VO2 was 44% of their VO2max and 67% of their HRmax, categorizing Baduanjin as a moderate-intensity exercise. The average energy expenditure during Baduanjin was 23.3 ± 4.4 kcal. Additionally, the VO2 and HR responses during Baduanjin both exhibited a bimodal pattern. Conclusions The results suggest that Baduanjin is a moderate-intensity aerobic exercise that could be an effective and safe exercise modality for home-based cardiac rehabilitation.

Abstract Background: Whether circulating polyunsaturated fatty acid (PUFA) levels are associated with pancreatic cancer risk is uncertain. Mendelian randomization (MR) represents a study design using genetic instruments to better characterize the relationship between exposure and outcome. Methods: We utilized data from genome-wide association studies within the Pancreatic Cancer Cohort Consortium and Pancreatic Cancer Case–Control Consortium, involving approximately 9,269 cases and 12,530 controls of European descent, to evaluate associations between pancreatic cancer risk and genetically predicted plasma n-6 PUFA levels. Conventional MR analyses were performed using individual-level and summary-level data. Results: Using genetic instruments, we did not find evidence of associations between genetically predicted plasma n-6 PUFA levels and pancreatic cancer risk [estimates per one SD increase in each PUFA-specific weighted genetic score using summary statistics: linoleic acid odds ratio (OR) = 1.00, 95% confidence interval (CI) = 0.98–1.02; arachidonic acid OR = 1.00, 95% CI = 0.99–1.01; and dihomo-gamma-linolenic acid OR = 0.95, 95% CI = 0.87–1.02]. The OR estimates remained virtually unchanged after adjustment for covariates, using individual-level data or summary statistics, or stratification by age and sex. Conclusions: Our results suggest that variations of genetically determined plasma n-6 PUFA levels are not associated with pancreatic cancer risk. Impact: These results suggest that modifying n-6 PUFA levels through food sources or supplementation may not influence risk of pancreatic cancer.

Background: Myocardial bridging (MB) is commonly treated in patients with hypertrophic cardiomyopathy (HCM). However, whether and how MB should be treated in patients with hypertrophic obstructive cardiomyopathy (HOCM) who underwent septal myectomy remain unclear. Methods: A total of 823 adults with HOCM who underwent septal myectomy at the Fuwai Hospital from 2011 to 2017 were retrospectively studied. Results: Overall, 31 events occurred: 24 patients died and 7 had nonfatal myocardial infarction (MI). The 3-year cumulative event-free survival of all-cause death (97.9% vs 100% vs 100% vs 98.4%, p=0.89) and cardiovascular death (98.3% vs 100% vs 100% vs 98.4%, p=0.63) were similar among the four groups (non-MB, CABG, unroofing, untreated, respectively). The 3-year cumulative event-free survival of nonfatal MI (100% vs 97.5% vs 98.0% vs 89.9%, p<0.001) and combined endpoints (97.9% vs 97.5% vs 98.0% vs 88.4%, p=0.02) were significantly lowest in untreated MB. Cox regression analysis indicated that untreated MB was a significant independent predictor of combined endpoints (hazard ratio [HR]: 4.06, 95% confidence interval [CI]: 1.60–10.32, p<0.001). Moreover, 49 patients underwent coronary artery computed tomography after surgery. The patency rate of the saphenous vein graft (SVG) was significantly higher than that of the left internal mammary artery (LIMA) (13.3% vs 84.2%, p<0.001). No MB was detected in the unroofing group. Conclusions: Surgical MB treatment could be beneficial and performed safely during septal myectomy. Myocardial unroofing is the recommended treatment for MB, and unroofing when technically possible may be preferable for long-term outcomes.

AbstractBackgroundObstructive sleep apnea (OSA) is a common disease associated with worse structural and functional impairment of the heart in patients with hypertrophic obstructive cardiomyopathy (HOCM).HypothesisThe presence and severity of OSA can decrease the right ventricular ejection fraction (RVEF) in patients with HOCM.MethodsIn total, 151 consecutive patients with a confirmed diagnosis of HOCM at Fuwai Hospital between September 2017 and September 2018 were included. Polysomnography and cardiac magnetic resonance imaging were performed in all patients.ResultsOverall, 84 (55.6%) patients were diagnosed with OSA. The RVEF significantly decreased with the severity of OSA (none, mild, moderate‐severe: 46.1 ± 8.2 vs 42.9 ± 7.5 vs 41.4 ± 7.4, P = .009). The apnea‐hypopnea index (AHI) was significantly high in patients with RVEF<40% among the different OSA groups (mild, moderate:7.7 ± 2.4 vs 9.6 ± 2.9, P = .03; 24.4 ± 9.0 vs 36.3 ± 18.0, P = .01). In the multiple linear regression model, the right ventricular end‐systolic volume (β = −0.28, P < .001), AHI (β = −0.09, P = .02), and oxygen desaturation index (β = −0.11, P = .04) were independently associated with a decrease in RVEF (adjusted R2 = 0.347, P < .001). Furthermore, the prevalence of RVEF<40% was high in patients with OSA. Compared with RVEF>40%, RVEF<40% was associated with more symptoms, mainly chest pain, chest distress, NYHA class III or IV, pulmonary hypertension, and moderate or severe mitral regurgitation.ConclusionIn patients with HOCM, the presence and severity of OSA is independently associated with a lower RVEF. In addition, compared with patients with RVEF>40%, those with RVEF<40% had more symptoms, including chest pain, chest distress, and NYHA class III or IV.