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We performed a retrospective analysis of 146 chronic total occlusion CTO patients to evaluate the antecedents of success and failure in CTO – Percutaneous Coronary Intervention (PCI) in Indian patients. The study aimed to identify the technical success rate, analyse immediate patient outcomes, and understand the factors impacting the successful outcomes. Our results showed that J-CTO (Multicenter CTO Registry of Japan) scores correlate well with the success rates of CTO-PCI and two most important factors deciding failure are lesion length more than 20 mm and lesions with calcification. Most important step to success of CTO is wiring, once wire crosses the segment, success rates of the procedure is around 97%. The wire escalation strategy has to be modified once the initial soft (polymer) wire fails, it’s reasonable to use high tip load wire like conquest pro without the use of intermediate wires (except in presence of tortuosity). At 1 year follow up of these patients, there was a statistically significant drop in angina class and major adverse cardiac event rates in the successful CTO group. Keywords: CTO Success predictors

The spread of COVID-19 has caused large-scale loss of life and economic damage. This pandemic has had a swift effect on the macroeconomy, posing a new and different shock to the Canadian economy. Governments have responded in many ways, including through public health measures, fiscal stimulus and monetary policy. Policy-makers seek to understand the current state of the economy for their COVID-19 support to be effective. However, major economic indicators are released with a substantial delay. This problem is usually dealt with by using a linear model of past economic variables. But this is not the best approach presently, given the large and nonlinear effects of COVID-19 on the economy. In this paper, we develop a model to predict the current state of the economy—known as nowcasting—using retail payments system data and machine learning. The Canadian retail payments data aid in understanding the current state of the economy because they include many types of transactions and are available daily. These data features are ideal for macroeconomic nowcasting during a crisis. The flexibility of machine learning can help capture the large and nonlinear effects of the COVID-19 shock. We find that our model—compared with a benchmark model—has a significant increase in prediction accuracy, measured as a 15 to 45 percent reduction in forecast error.

Predicting the economy’s short-term dynamics—a vital input to economic agents’ decision-making process—is often done using lagged indicators in the linear models. This is typically sufficient during normal times, but it could be inadequate during the crisis periods such as COVID-19. In this paper, we demonstrate: (a) the payments systems data which captures a variety of economic transactions can assist in estimating the state of the economy in real time, and (b) the machine learning can provide a set of econometric tools to effectively handle wide variety in the payments data and to capture sudden and large effects of the crisis. Furthermore, we mitigate interpretability and overfitting challenges of machine learning models by using the Shapley value-based approach to quantify marginal contribution of each predictor, and devising a novel cross-validation strategy tailored for the macroeconomic prediction models.

This paper uses reinforcement learning (RL) to approximate the policy rules of banks participating in a high-value payments system. The objective of the agents is to learn a policy function for the choice of amount of liquidity provided to the system at the beginning of the day. Individual choices have complex strategic effects precluding a closed form solution of the optimal policy, except in simple cases. We show that in a simplified two-agent setting, agents using reinforcement learning do learn the optimal policy that minimizes the cost of processing their individual payments. We also show that in more complex settings, both agents learn to reduce their liquidity costs. Our results show the applicability of RL to estimate best-response functions in real-world strategic games.

Stochastic spectral finite element models of practical engineering systems may involve solutions of linear systems or linearized systems for non-linear problems with billions of unknowns. For stochastic modeling, it is therefore essential to design robust, parallel and scalable algorithms that can efficiently utilize high-performance computing to tackle such large-scale systems. Domain decomposition based iterative solvers can handle such systems. Although these algorithms exhibit excellent scalabilities, significant algorithmic and implementational challenges exist to extend them to solve extreme-scale stochastic systems using emerging computing platforms. Intrusive polynomial chaos expansion based domain decomposition algorithms are extended here to concurrently handle high resolution in both spatial and stochastic domains using an in-house implementation. Sparse iterative solvers with efficient preconditioners are employed to solve the resulting global and subdomain level local systems through multi-level iterative solvers. Parallel sparse matrix–vector operations are used to reduce the floating-point operations and memory requirements. Numerical and parallel scalabilities of these algorithms are presented for the diffusion equation having spatially varying diffusion coefficient modeled by a non-Gaussian stochastic process. Scalability of the solvers with respect to the number of random variables is also investigated.

A 51-year-old Indian gentleman, after CABG surgery, developed blood transfusion induced acute hepatitis B infection, which recovered completely with symptomatic treatment. Subsequently, he developed recurrent angina, dyspnoea along with musculoskeletal symptoms with elevated acute phase reactants. A CT angiography showed thickening of bilateral subclavian arteries and left renal artery stenosis. His RIMA graft was totally occluded at the origin and the LIMA graft showed an aneurysm at the anastomotic site with the left anterior descending artery (LAD). FDG-PET scan showed active inflammation of the ascending and descending thoracic aorta. He was diagnosed as Takayasu's arteritis. He responded to steroids and immunosuppressants. One month later he developed acute coronary syndrome and a coronary angiography showed severe left main stenosis with a left main aneurysm and a significant ostial LCx lesion. His LAD had an aneurysm at the anastomotic site with the patent LIMA graft. His RCA also had an aneurysm followed by a total occlusion. His LIMA graft also showed a significant lesion and his RIMA graft was occluded. He underwent angioplasty and stenting with DES to the LAD at the anastomotic site and to the left main-LCx. Discussion The case highlights the diverse modes of presentation of Takayasu's arteritis. Our case presented as acute coronary syndrome with multiple coronary aneurysms and bypass graft disease, which was successfully treated with angioplasty and stenting. The case also highlights the importance of viral infections and vaccinations in the pathogenesis of Takayasu's arteritis.

BACKGROUND: ExteNET showed that 1 year of neratinib, an irreversible pan-HER tyrosine kinase inhibitor, significantly improves 2-year invasive disease-free survival after trastuzumab-based adjuvant therapy in women with HER2-positive breast cancer. We report updated efficacy outcomes from a protocol-defined 5-year follow-up sensitivity analysis and long-term toxicity findings. METHODS: In this ongoing randomised, double-blind, placebo-controlled, phase 3 trial, eligible women aged 18 years or older (≥20 years in Japan) with stage 1-3c (modified to stage 2-3c in February, 2010) operable breast cancer, who had completed neoadjuvant and adjuvant chemotherapy plus trastuzumab with no evidence of disease recurrence or metastatic disease at study entry. Patients who were eligible patients were randomly assigned (1:1) via permuted blocks stratified according to hormone receptor status (hormone receptor-positive vs hormone receptor-negative), nodal status (0 vs 1-3 vs or ≥4 positive nodes), and trastuzumab adjuvant regimen (given sequentially vs concurrently with chemotherapy), then implemented centrally via an interactive voice and web-response system, to receive 1 year of oral neratinib 240 mg/day or matching placebo. Treatment was given continuously for 1 year, unless disease recurrence or new breast cancer, intolerable adverse events, or consent withdrawal occurred. Patients, investigators, and trial funder were masked to treatment allocation. The predefined endpoint of the 5-year analysis was invasive disease-free survival, analysed by intention to treat. ExteNET is registered with ClinicalTrials.gov, number NCT00878709, and is closed to new participants. FINDINGS: Between July 9, 2009, and Oct 24, 2011, 2840 eligible women with early HER2-positive breast cancer were recruited from community-based and academic institutions in 40 countries and randomly assigned to receive neratinib (n=1420) or placebo (n=1420). After a median follow-up of 5·2 years (IQR 2·1-5·3), patients in the neratinib group had significantly fewer invasive disease-free survival events than those in the placebo group (116 vs 163 events; stratified hazard ratio 0·73, 95% CI 0·57-0·92, p=0·0083). The 5-year invasive disease-free survival was 90·2% (95% CI 88·3-91·8) in the neratinib group and 87·7% (85·7-89·4) in the placebo group. Without diarrhoea prophylaxis, the most common grade 3-4 adverse events in the neratinib group, compared with the placebo group, were diarrhoea (561 [40%] grade 3 and one [BACKGROUND: ExteNET showed that 1 year of neratinib, an irreversible pan-HER tyrosine kinase inhibitor, significantly improves 2-year invasive disease-free survival after trastuzumab-based adjuvant therapy in women with HER2-positive breast cancer. We report updated efficacy outcomes from a protocol-defined 5-year follow-up sensitivity analysis and long-term toxicity findings.METHODS: In this ongoing randomised, double-blind, placebo-controlled, phase 3 trial, eligible women aged 18 years or older (≥20 years in Japan) with stage 1-3c (modified to stage 2-3c in February, 2010) operable breast cancer, who had completed neoadjuvant and adjuvant chemotherapy plus trastuzumab with no evidence of disease recurrence or metastatic disease at study entry. Patients who were eligible patients were randomly assigned (1:1) via permuted blocks stratified according to hormone receptor status (hormone receptor-positive vs hormone receptor-negative), nodal status (0 vs 1-3 vs or ≥4 positive nodes), and trastuzumab adjuvant regimen (given sequentially vs concurrently with chemotherapy), then implemented centrally via an interactive voice and web-response system, to receive 1 year of oral neratinib 240 mg/day or matching placebo. Treatment was given continuously for 1 year, unless disease recurrence or new breast cancer, intolerable adverse events, or consent withdrawal occurred. Patients, investigators, and trial funder were masked to treatment allocation. The predefined endpoint of the 5-year analysis was invasive disease-free survival, analysed by intention to treat. ExteNET is registered with ClinicalTrials.gov, number NCT00878709, and is closed to new participants.FINDINGS: Between July 9, 2009, and Oct 24, 2011, 2840 eligible women with early HER2-positive breast cancer were recruited from community-based and academic institutions in 40 countries and randomly assigned to receive neratinib (n=1420) or placebo (n=1420). After a median follow-up of 5·2 years (IQR 2·1-5·3), patients in the neratinib group had significantly fewer invasive disease-free survival events than those in the placebo group (116 vs 163 events; stratified hazard ratio 0·73, 95% CI 0·57-0·92, p=0·0083). The 5-year invasive disease-free survival was 90·2% (95% CI 88·3-91·8) in the neratinib group and 87·7% (85·7-89·4) in the placebo group. Without diarrhoea prophylaxis, the most common grade 3-4 adverse events in the neratinib group, compared with the placebo group, were diarrhoea (561 [40%] grade 3 and one [INTERPRETATION: At the 5-year follow-up, 1 year of extended adjuvant therapy with neratinib, administered after chemotherapy and trastuzumab, significantly reduced the proportion of clinically relevant breast cancer relapses-ie, those that might lead to death, such as distant and locoregional relapses outside the preserved breast-without increasing the risk of long-term toxicity. An analysis of overall survival is planned after 248 events.FUNDING: Wyeth, Pfizer, and Puma Biotechnology.

Coronary perforations are likely in complex lesions like calcified coronaries or chronic total occlusions. The management is challenging in the face of hemodynamic instability. We are reporting an unusual case of coronary artery perforation. After an unsuccessful attempt to pass a guide wire in chronically occluded branch of the diagonal artery, there was type II perforation which sealed off by itself. After the procedure the patient developed cardiac tamponade for which pericardiocentesis was done. After initial improvement in hemodynamics the patient developed signs of tamponade again with continuous drainage of blood from pericardial space. A check shoot, surprisingly showed a type III perforation in the distal LAD! No hardware had been passed into the distal LAD. Retrospectively it was thought that the cause was the pericardiocentesis needle which had nicked the LAD during pericardiocentesis.

Dislodgement or embolization of coronary stents, although rare, is a well-known complication. 1 Successful retrieval with special devices is reported in literature. 2 , 3 , 4 , 5 We managed a case where a previously deployed stent in the Left main coronary artery (LMCA) got dislodged but remained unnoticed for 6 weeks. When a repeat angiography was done 6 weeks later for recurrent unstable angina, the Left main stent was found to be dislodged from the left main and was partially overhanging into the aorta. This stent was successfully extracted using a Goose neck snare. The left main artery was then re-stented.

Sinus of Valsalva aneurysms usually arise from the right or non-coronary coronary sinus in 90–95% of cases. Sinus of Valsalva aneurysms arising from the left coronary sinus are rare. The sinus of Valsalva aneurysms can rupture in any cardiac chamber, but most commonly ruptures into the right ventricle and occasionally into the right atrium. 1 We report an unusual case of a 30 yr old patient with left coronary sinus of Valsalva aneurysm, probably of infective etiology, which ruptured into the left ventricle.

Primary spindle cell sarcoma of the left atrium is an extremely rare tumour. Surgical excision is the mainstay of treatment since it responds poorly to chemotherapy or radiotherapy. In spite of all the treatment, the prognosis remains poor due to inadvertent delay in diagnosis, few therapeutic options and propensity to metastasize. We present a 47-year-old male who underwent a surgical excision of a left atrial mass in February 2010. It was proved to be a high-grade spindle cell sarcoma on histopathology. He presented again in October 2010 with recurrence of the tumour for which he was re-operated. However, the tumour recurred again within one month, to which the patient succumbed.

Introduction: There have been biological findings alluding to the role of selective COX-2 inhibitors in reducing the risk of developing cancers including breast cancer. Epidemiological data suggest that COX-2 inhibitors may prevent the development of cancers, including colorectal, esophageal and lung cancer. To date, there exists no study that reported any relationship between their use and the risk of breast cancer recurrence. Thus, we investigated the associations between the use of COX-2 inhibitors and the risk of tumor recurrence among breast cancer patients. Methods: We reviewed the medical records of female patients diagnosed with stage II/III breast cancer in Albert Einstein Medical Center between 1999 and 2005 and later reached no evident disease (NED) stage. Follow up period was from 1999 to 2008 with mean and maximum being 4.4 years and 9.8 years, respectively. COX-2 inhibitor user was defined as patients taking the medication in NED stage for at least 6 months. Age, race, family history, smoking history, menopausal status, diabetes, HER2/Neu status, hormone receptor status, TNM stage, histology, and treatment received were compared between COX-2 inhibitor users and nonusers. The primary outcome was disease free survival. The secondary outcome was overall survival. Multivariate analyses were performed using Cox proportional hazard model. Results: Of 682 cancer patients, 7.3 % (n=50) were prescribed COX-2 inhibitor; 10.0 % (5/50) of patients developed recurrence among COX-2 inhibitor users, while 22.0% (139/632) did among nonusers (chi-square test: P Conclusions: The use of COX-2 inhibitors seems to be related to a reduced risk of developing recurrence in patients with breast cancer. This result provides the clinical evidence, in accordance with existing biological data, that COX-2 inhibitor use in breast cancer patients may be inversely associated with tumor recurrence. However, prospective randomized trials are required to validate our finding. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P6-10-01.

A 42 year old man presented with classical presentation of Acute ST elevation MI of 2 hours duration. His CAG revealed a spared LMCA with a totally occluded LAD in proximal segment, for which he underwent a successful PAMI with DES to LAD. 2 days later he developed high grade fever, elevated inflammatory markers (ESR/CRP) with a dull aching pain in root of neck. On evaluation of brachiocephalic vessels, CT Aortogram suggested a diagnosis of acute onset Non-Specific Aortoarteritis. Nonspecific Aortoarteritis in young males is an uncommon presentation, though associated coronary artery involvement is known, but its presentation as an Acute MI is a rare phenomenon.

Viscosity measurements on aqueous micellar solutions of cationic surfactants containing phenol with and without sodium bromide were made to study the sphere‐to‐rod transitions. Effect of surfactant structure (nonpolar tail, polar head group sizes and counterion), temperature, and phenol and sodium bromide concentration on the viscosity behavior of the surfactant solution is discussed. The sphere‐to‐rod transition is usually indicated by a marked increase in viscosity. While low temperature, high surfactant concentration, presence of salt, and hydrophobic nature of surfactant all favor the formation of rod‐like micelles, the presence of phenol showed peculiar behavior. Initial additions of phenol (up to about 2.5 wt%) showed a marked increase in viscosity, independent of the nature and concentration of surfactant and temperature; lower viscosities were observed at higher phenol concentration. Conductance and sound velocity results support the viscosity results.

Cloud point, viscosity, and ultrasonic velocity of aqueous solutions of nonionic surfactants (Triton X‐114 and Triton X‐100) in the presence of ionic surfactants (anionic: sodium alkyl sulfate and cationic: alkytrimethylammonium bromides) are reported. The addition of ionic surfactant (at concentrations much less than CMC) to the salt‐free solution of nonionic surfactants increases the cloud point of nonionic surfactants. Such cloud point increase was dependant on the type and hydrophobic tail of surfactants and has been explained in terms of mixed micelles formation. However, in the presence of NaCl (≥0.3 M), the cloud point curve shows a deep minimum as a function of anionic surfactant concentrations. Such minima were not observed in lower concentrations of NaCl in the case of anionic surfactants and in the presence of cationic surfactants. It was seen that the stronger effect was obtained for anionic surfactant. The relative viscosity of this system increased markedly with the variation of the concentr...

PURPOSE To determine the cardioprotective effect of dexrazoxane (DZR) used in a doxorubicin-based combination therapy in advanced breast cancer. PATIENTS AND METHODS Between November 1988 and January 1991, 534 patients with advanced breast cancer were randomized to two multicenter, double-blind studies (088001 and 088006). Patients received fluorouracil, doxorubicin, and cyclophosphamide (FAC) with either DZR (DZR-to-doxorubicin ratio, 10:1) or placebo (PLA) every 3 weeks and were monitored with serial multiplegated acquisition (MUGA) scans. RESULTS The hazards ratio (HR) of PLA to DZR for a cardiac event, which was predefined ejection fraction changes or congestive heart failure (CHF), was 2.63 (95% confidence interval [CI], 1.61 to 4.27; P < .001) for 088001 and 2.00 (95% CI, 1.01 to 3.96; P = .038) for 088006. The objective response rates for 088001 were 46.8% for DZR and 60.5% for PLA, a difference of 14% (95% CI, -25% to -2%; P = .019), and for 088006 were 53.7% for DZR and 49.3% for PLA, a difference of 4% (95% CI, -13% to 22%; P = .63). Time to progression and survival were not significantly different between treatment arms in either study. Toxicities on the DZR arms included lower granulocyte and platelet counts at nadir (P = .009 and P = .004, respectively) and more pain on injection (P = .001), with no difference in the rates of fever, infection, or hemorrhage. CONCLUSION DZR had a significant cardioprotective effect as measured by noninvasive testing and clinical CHF. One of the two studies (088001) showed a lower response rate with DZR, but time to progression and survival were not significantly different. DZR is the first agent shown to reduce cardiotoxicity from doxorubicin.

Rotational atherectomy is contraindicated in dissected coronary arteries since it can lead to progression of the dissection or perforation. In our case, the right coronary artery (RCA) arose anomalously from the left coronary sinus. The lesion in the RCA was an undilatable calcified one. There was a dissection in the RCA due to high pressure balloon dilatation. Since the patient was hemodynamically unstable and there were no options besides rotablation, we proceeded with caution. Rotablation and stenting were successfully done. Our case report highlights the importance of the need for good guide catheter support even in the presence of anomalously arising arteries and the rotablation option for unyielding calcified coronary lesions, even in the setting of a dissection.

The present study focuses on the uncertainty quantification of an aeroelastic instability system. This is a classical dynamical system often used to model the flow induced oscillation of flexible structures such as turbine blades. It is relevant as a preliminary fluid-structure interaction model, successfully demonstrating the oscillation modes in blade rotor structures in attached flow conditions. The potential flow model used here is also significant because the modern turbine rotors are, in general, regulated in stall and pitch in order to avoid dynamic stall induced vibrations. Geometric nonlinearities are added to this model in order to consider the possibilities of large twisting of the blades. The resulting system shows Hopf and period-doubling bifurcations. Parametric uncertainties have been taken into account in order to consider modeling and measurement inaccuracies. A quadrature based spectral uncertainty tool called polynomial chaos expansion is used to quantify the propagation of uncertainty through the dynamical system of concern. The method is able to capture the bifurcations in the stochastic system with multiple uncertainties quite successfully. However, the periodic response realizations are prone to time degeneracy due to an increasing phase shifting between the realizations. In order to tackle the issue of degeneracy, a corrective algorithm using constant phase interpolation, which was developed earlier by one of the authors, is applied to the present aeroelastic problem. An interpolation of the oscillatory response is done at constant phases instead of constant time and that results in time independent accuracy levels. Copyright � 2013 by ASME.

In the design of wind turbine structures, aeroelastic stability is of utmost importance. It becomes even more crucial when there are uncertainties involved in it. A symmetric airfoil with its pitch-plunge flexibility is considered under potential flow. The potential flow model is justified as the classical flutter model involves unseparated flow over the body so that inviscid assumptions are valid. In the present study of aeroelastic system, nonlinear parameters have been considered as it can stabilize the diverging growth of a flutter oscillation. Quantification of aleatoric uncertainties present in the system has been done by modeling them as a Gaussian parameters. The epistemic uncertainty present in the system has also been reduced by considering unsteady vortex lattice method (UVLM) instead of the rigid wake model of Wagner. In this model, the wake is free to evolve and also the shape of airfoil has been considered. The present study involves usage of UVLM code on a NACA 0012 airfoil. The values of the linear flutter speed predicted by using UVLM code is in close agreement with that of the fixed wake model of Lee et al. When the structural nonlinearities are present, the system exhibits a self sustained oscillation of constant amplitude called as Limit Cycle Oscillation (LCO) even beyond the linear flutter speed. In the present study, a horizontal gust is modeled with a given spectra by superposition of a set of sinusoidal components which is a standard practice. This gust has then been applied on the airfoil along with the structural uncertainties. A spectral uncertainty quantification tool called Polynomial Chaos Expansion is used to quantify the effect of uncertainty propagation and calculate the response statistics. A non-intrusive version of the method using stochastic projection approach is used to capture the time histories and plot the PDFs at various time instants of all the realizations with Monte Carlo Simulation as a reference solution. The evolution of PCE coefficients in the time domain along with its ensemble variations has also been looked into in the present study.Copyright © 2012 by ASME

Aeroelastic stability remains an important concern for the design of modern structures such as wind turbine rotors, more so with the use of increasingly flexible blades. A nonlinear aeroelastic system has been considered in the present study with parametric uncertainties. Uncertainties can occur due to any inherent randomness in the system or modeling limitations, and so forth. Uncertainties can play a significant role in the aeroelastic stability predictions in a nonlinear system. The analysis has been put in a stochastic framework, and the propagation of system uncertainties has been quantified in the aeroelastic response. A spectral uncertainty quantification tool called Polynomial Chaos Expansion has been used. A projection-based nonintrusive Polynomial Chaos approach is shown to be much faster than its classical Galerkin method based counterpart. Traditional Monte Carlo Simulation is used as a reference solution. Effect of system randomness on the bifurcation behavior and the flutter boundary has been presented. Stochastic bifurcation results and bifurcation of probability density functions are also discussed. Copyright � 2010 Ajit Desai and Sunetra Sarkar.

Aeroelastic stability remains an important concern for the design of modern structures such as wind turbine rotors, more so with the use of increasingly flexible blades and military aircrafts with increasing maneuvering capabilities etc. A nonlinear aeroelastic system has been considered in the present study with parametric uncertainties. The analysis has been put in a stochastic framework and the propagation of system uncertainties have been quantified in the aeroelastic response. A spectral uncertainty quantification tool called Polynomial Chaos Expansion has been used. A projection based non-intrusive Polynomial Chaos approach is compared to its classical Galerkin based counterpart, and proven to be more efficient as order of chaos expansion increases. Effect of system randomness on the bifurcation behavior and the flutter boundary has been significant. Stochastic bifurcation results and bifurcation of probability density functions are presented here.Copyright © 2010 by ASME

Introduction: Triple-negative breast cancer patients have a worse prognosis as compared to other subtypes of breast cancer. Patients are usually diagnosed at a younger age. Tumor size is usually larger with poorly differentiated histology and possible visceral metastasis. Several studies have been published on the risk factors for developing triple negative breast cancer. On the other hand, factors predicting mortality after diagnosis among triple negative breast cancer patients is still lacking. Objectives: The study aimed to describe the population of triple negative breast cancer patients diagnosed at Albert Einstein Medical Center from 2003–2007. Demographic data, risk factors and treatment interventions in this population were gathered. The measured outcomes were mortality and disease free survival. Methods: This study was a retrospective review of women diagnosed with triple negative breast cancer at the Albert Einstein Healthcare Network Cancer Center in 2003–2007. Patients diagnosed with cancer metastasized to the breast and causes of death other than from complications of cancer were excluded from the study. Statistical Analysis: Descriptive statistics and frequency distribution were used to categorize the characteristics of the subjects. Chi-square test was used for bivariate analysis. Logistic regression was used for multivariate analysis. Results: A total of 214 patients were diagnosed with triple negative breast cancer from 2003–2007. 114 (53%) were African Americans, 84 (39%) were Caucasians and 16 (7%) belonged to other racial groups. The mean age of diagnosis was 56.6 (SD 15.9) years old. At the end of the four year period, 48 (22.4%) of the 214 patients died. Using chi square test and logistic regression, patients who underwent chemotherapy were less likely to die (95% CI 0.14 – 0.83, p 0.02, OR 0.35). The patients with tumor size more than 2 cm or had history of ischemic heart disease had increased mortality (95% CI 1.36 – 8.04, p 0.01, OR 3.3 and 95% CI 1.29 – 49, p 0.03, respectively). Chemotherapy was significantly associated with disease free survival (95% CI 1.49 – 18.65, p 0.01, OR 5.27). There was no significant association between mortality or disease free survival to age and race. Conclusion: Early diagnosis and screening significantly affects treatment and survival outcome. Prompt chemotherapy may contribute to a patient's survival and disease free status. Tumor size more than 2 cms and the presence of ischemic heart disease were significant predictors of mortality outcome whereas age and race were not found to be associated with mortality or disease free survival. Citation Information: Cancer Prev Res 2010;3(1 Suppl):A132.

There have been epidemiologic and biochemical findings alluding to the role of angiotensin converting enzyme inhibitors(ACEIs) and angiotensin receptor blockers(ARBs) in reducing the risk of developing cancer. To date, there exists no study that reported any relationship between their use and the risk of cancer recurrence. Thus, we investigated the associations between the use of ACEI/ARB and the risk of tumor recurrence among breast cancer patients without any evidence of disease.We reviewed the medical records of female patients diagnosed with stage II/III breast cancer in Albert Einstein Medical Center between 1999 and 2005 and later reached no evident disease (NED) stage after curative therapy. Follow up period was from 1999 to 2008 with mean and maximum being 4.4 years and 9.8 years, respectively. ACEI/ARB user was defined as patients taking the medication in NED stage for at least 6 months. Multivariate analyses were performed using logistic regression and Cox proportional hazard model.Of 707 cancer patients and of 335 cancer patients with hypertension, 164, representing 23.3% of total and 49.0% of those with hypertension were prescribed ACEI/ARB. ACEI/ARB use was associated with older age (P Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3121.

As of August 1984, 115 women with advanced breast cancer have been randomized to receive a combination of either cyclophosphamide, Novantrone (mitoxantrone) and 5-fluorouracil (CNF) or cyclophosphamide, Adriamycin (doxorubicin) and 5-fluorouracil (CAF). Seventy-one percent of all patients were post-menopausal and 44% of CNF patients and 57% of CAF patients were estrogen receptor (ER) negative. Slightly over 30% of all patients had received hormonal therapy or chemotherapy in an adjuvant setting. Hematologic toxicity was similar in regard to platelet counts but slightly lower nadirs were experienced with CNF therapy than with CAF. However, there were fewer dosage decreases with CNF. Significantly less nausea and vomiting were observed with the CNF regimen compared to CAF. Moreover, alopecia was reduced appreciably in patients who received CNF. The response rate to CNF for the first 38 eligible and evaluable patients was 42%, and for 53 eligible and evaluable patients who received CAF the response rate was 45%, a non-significant difference. Median response durations were similar also, 140 days for CNF and 168 days for the CAF regimen. Time to treatment failure was similar for both regimens. CNF is an effective regimen for patients with advanced breast cancer, with less toxicity than CAF.