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Introduction: Although obesity is recognized as an important risk factor for atrial fibrillation (AF), there is limited data on how obesity severity impacts clinical outcomes of patients with existing AF. Hypothesis: Obesity severity predicts worse clinical outcomes in AF patients. Methods: We retrospectively evaluated the records of consecutive patients with AF and BMI ≥30kg/m2 who were seen at a large integrated health-care system (UPMC) between 2010 and 2012. Patients were stratified based on their obesity severity into Class I (BMI 30-34.9 kg/m2), Class II (BMI 35-39.9 kg/m2) and Class III obese (BMI ≥ 40 kg/m2) and followed over a mean of 3.2 ± 2.2 years. Unadjusted and adjusted Cox-proportional hazard models were constructed to assess the impact of obesity severity on AF-related clinical outcomes. Results: A total of 35,999 consecutive AF patients with BMI ≥ 30 kg/m2 were included, 59.4% of whom were Class I, 22.9% Class II, and 17.7% Class III. Compared to Class I, patients with Class II-III were younger and had lower CHA2DS2-VASc score, but with higher prevalence of diabetes, obstructive sleep apnea, and congestive heart failure (CHF) (p<0.001 for all). Results of adjusted models showed that all-cause mortality rates increased incrementally from Class I to Class III (Class II: HR: 1.07; 95% CI: 1.01 to 1.13, p=0.021; Class III: HR: 1.25; 95% CI: 1.16 to 1.34, p<0.001). In addition, Class III had the highest rates for CHF admission (HR: 1.35; 95% CI: 1.21 to 1.51, p<0.001) and cardioversion (HR: 1.36; 95% CI: 1.17 to 1.58, p<0.001). However, AF-related admission and/or AF ablation did not differ between groups. Anticoagulation (AC) rates were 62.5%, 64.4% and 68.4% from Class I to Class III. Among patients on AC, the adjusted rate of embolic stroke or TIA was lower in Class III vs. Class I (HR: 0.71; 95% CI: 0.53 to 0.94, p=0.020). Conclusions: Among obese patients with AF, moderate and severe obesity (classes II and III) are associated with higher all-cause mortality, CHF admissions and cardioversions. Use of AC in these patients was associated with lower risk of embolic stroke or TIA. These data support the need for additional studies to further clarify the impact of obesity severity on cardiovascular outcomes in AF patients. [ABSTRACT FROM AUTHOR]

Purpose: Reprogramming of cancer cells to stem cell-like state provides a promising tool for the study of cancer pathogenesis and drug screening. However, most instances of direct reprogramming have been achieved by forced co-expression of defined transcription factors using viral vectors. Retroviral transduction as well as the ectopic expression of reprogramming factors may alter the differentiation potential of reprogrammed cancer cells or induce malignant transformation. Therefore, generation of reprogrammed cancer cells via virus-free reprogramming strategy needs to be studied., Methods: Melanoma cells were reprogrammed by co-expression of doxycycline-inducible Oct4, Sox2, Klf4, and c-Myc using the piggyBac (PB) transposon system. The expression level of genes was analyzed through RT-PCR, Western blot, and immunofluorescence. Epigenetic modification of genes was detected by bisulfite genomic sequencing. Post reprogrammed melanoma cells were generated through differentiation of reprogrammed melanoma cells. Sensitivity to chemotherapeutic agents and metastasis potential were investigated in post reprogrammed melanoma cells., Results: The virus-free reprogrammed melanoma cells were positive for stem cell markers including Oct4, Nanog, and SSEA-1, and the promoters of Nanog and Oct4 were demethylated. Moreover, reprogrammed melanoma cells gained differentiation potential and higher sensitivity to differentiation-inducing drugs. Post reprogrammed melanoma cells showed lower proliferation rate and metastatic potential compared with the parental cells., Conclusions: Our results indicate that PB transposon-based method is applicable to generate virus-free reprogrammed melanoma cells. These cells can differentiate into other lineages with loss of malignant phenotypes, which may provide a more suitable source for molding of cancer pathogenesis.

Surgical fixation of closed ankle fracture is traditionally viewed as having low risk for post-operative infection. Only a few cases of surgical-site confined infection have been reported. Because of the low infection risk, the necessity for perioperative prophylaxis has been questioned. We report a case of fulminant methicillin-resistant Staphylococcus aureus endocarditis occurring shortly after an elective ankle fixation surgery in an elderly woman with chronic rheumatoid arthritis. Because systemic infection was unexpected, she had been given antipyretics for postoperative fever until just before rapid clinical deterioration. A nearly fatal hematogenous infection occurred after such a procedure, indicating the necessity for being on high alert and considering the possibility of bloodstream infection.

Background: China has the largest population of cigarette smokers worldwide; surveys suggest rising prevalence among young women. Migratory lifestyles may confer increased susceptibility., Objectives: we aimed to understand how migration relates to smoking among young women., Methods: we implemented a cross-sectional behavioral survey of rural-to-urban Chinese women (n = 206) working in restaurants and commercial sex venues, assessing smoking attitudes, behaviors, and health-risk knowledge., Results: rates of ever smoking and current smoking among restaurant workers were high compared with the rates in general population surveys (16.1% and 6.5%, respectively); rates were much higher among sex workers (54.9% and 33.3%, respectively). Multivariate analysis revealed education to be protective, whereas exposure to female-branded cigarettes was a risk for ever smoking., Conclusions: Chinese migrant women appear to be smoking at higher rates than nonmigrant women. Priorities for future research include representative studies in multiple cities examining reasons for uptake and stimuli to quit.