Dietary (poly)phenol intake is associated with cardiometabolic health parameters in adolescents

The protective role of(poly)phenols against metabolic disorders has been extensively studied in adults but not in adolescents.To assess associations of dietary(poly)phenols and their subclasses with cardiometabolic health parameters in adolescents.A cross-sectional study was conducted in 944 individuals aged 11–14 years enrolled in the SI!Program for Secondary Schools trial(NCT03504059).(Poly)phenol intake was assessed using semiquantitative food frequency questionnaires and the Phenol-Explorer database.The measured cardiometabolic parameters were waist circumference(WC)age-sex Z-score,blood pressure(BP)age-sex Z-score,blood glucose(BG),triglycerides(TG),and high-density lipoprotein cholesterol(HDL-c).Multilevel mixedeffect linear regression models were applied to examine the association between(poly)phenol quintiles and cardiometabolic health parameters.Compared to the lowest quintile,adolescents in the highest quintile of total(poly)phenol intake had lower WC Z-scores,mean arterial pressure Z-scores,and HDL-c after multivariable adjustment.The WC Z-scores and HDL-c were lower in the highest quintile of flavonoid intake compared to the lowest quintile.The highest quintile of phenolic acid intake was associated with a lower WC Z-score and TG levels,and the highest quintile of stilbene intake with lower BG and TG,and with higher HDL-c compared to the lowest quintile.A higher intake of(poly)phenols,especially flavonoids,phenolic acids,and stilbenes,was associated with better cardiometabolic parameters in adolescents.

Coronary angiography findings in cardiac arrest patients with non-diagnostic post-resuscitation electrocardiogram:A comparison of shockable and non-shockable initial rhythms

AIM To investigate the impact of coronary artery disease in a cohort of patients resuscitated from cardiac arrest with non-diagnostic electrocardiogram.METHODS From March 2004 to February 2016, 203 consecutive patients resuscitated from in or out-of-hospital sudden cardiac arrest and non-diagnostic post-resuscitation electrocardiogram(defined as ST segment elevation or pre-sumably new left bundle branch block) whounderwent invasive coronary angiogram during hospitalization were included. For purpose of analysis and comparison, patients were classified in two groups: Initial shockable rhythm(ventricular tachycardia or ventricular fibrillation; n = 148, 72.9%) and initial non-shockable rhythm(n = 55, 27.1%). Baseline characteristics, coronary angiogram findings including Syntax Score and long-term survival rates were compared. RESULTS Sudden cardiac arrest was witnessed in 95.2% of cases, 66.7% were out-of-hospital patients and 72.4% were male. There were no significant differences in baseline characteristics between groups except for higher mean age(68.1 years vs 61 years, P = 0.001) in the nonshockable rhythm group. Overall 5-year mortality of the resuscitated patients was 37.4%. Patients with non-shockable rhythms had higher mortality(60% vs 29.1%, P < 0.001) and a worst neurological status at hospital discharge based on cerebral performance category score(CPC 1-2: 32.7% vs 53.4%, P = 0.02). Although there were no significant differences in global burden of coronary artery disease defined by Syntax Score(mean Syntax Score: 10.2 vs 10.3, P = 0.96) there was a trend towards a higher incidence of acute coronary lesions in patients with shockable rhythm(29.7% vs 16.4%, P = 0.054). There was also a higher need for ad-hoc percutaneous coronary intervention in this group(21.9% vs 9.1%, P = 0.03). CONCLUSION Initial shockable group of patients had a trend towards higher incidence of acute coronary lesions and higher need of ad-hoc percutaneous intervention vs nonshockable group.

Deep diving in the PACIFIC:Practical issues in stage III non-small cell lung cancer to avoid shipwreck

After publication of the PACIFIC trial results,immune checkpoint inhibitor-based immunotherapy was included in the treatment algorithm of locally advanced non-small cell lung cancer(NSCLC).The PACIFIC trial demonstrated that 12 mo of durvalumab consolidation therapy after radical-intent platinum doublet chemotherapy with concomitant radiotherapy improved both progression-free survival and overall survival in patients with unresectable stage III NSCLC.This is the first treatment in decades to successfully improve survival in this clinical setting,with manageable toxicity and without deterioration in quality of life.The integration of durvalumab in the management of locally advanced NSCLC accentuates the need for multidisciplinary,coordinated decision-making among lung cancer specialists,bringing new challenges and controversies as well as important changes in clinical work routines.The aim of the present article is to review—from a practical,multidisciplinary perspective—the findings and implications of the PACIFIC trial.We evaluate the immunobiological basis of durvalumab as well as practical aspects related to programmed cell death ligand 1 determination.In addition,we comprehensively assess the efficacy and toxicity data from the PACIFIC trial and discuss the controversies and practical aspects of incorporating durvalumab into routine clinical practice.Finally,we discuss unresolved questions and future challenges.In short,the present document aims to provide clinicians with a practical guide for the application of the PACIFIC regimen in routine clinical practice.

Neoadjuvant immunotherapy in non-small-cell lung cancer:Times are changing—and fast

Recent data from a phase 3 trial have shown that the addition of immunotherapy to neoadjuvant chemotherapy improves event-free survival in patients with nonsmall-cell lung cancer(NSCLC).This is the first positive phase 3 trial in this setting,although several phase 3 trials are currently investigating the efficacy of neoadjuvant and adjuvant immunotherapy in resectable NSCLC.