Relationship of circulating immune cells with lifestyle factors and cancer recurrence in early-stage breast cancer.

PURPOSE: To evaluate the relationship of circulating immune cells with recurrence and metabolic/lifestyle factors in patients with early-stage breast cancer. METHODS: Patients with early-stage breast cancer were identified from the electronic record and institutional registry. Lymphocyte and monocyte counts were obtained from blood samples at time of diagnosis prior to any chemotherapy. Correlations between lymphocyte and monocyte and recurrence were assessed in the entire cohort and among obese patients, those reporting alcohol consumption and smoking. Competing risk regression was used to analyze time to recurrence. RESULTS: A total of 950 patients with ≥ 5 years of follow-up were identified; 433 had complete data and were eligible for analysis. 293 (68%) had hormone receptor-positive breast cancer, 82 (19%) HER2 positive, and 53 (13%) triple negative. Patients in the highest quintile of lymphocytes compared to the lowest quintile had lower risk of recurrence (subhazard ratio (SHR) = 0.17, 95% CI [0.03-0.93], p = 0.041) while patients in the highest quintile of monocytes had lower risk for recurrence (SHR = 0.19, 95% CI [0.04, 0.92], p = 0.039). Higher monocytes were more strongly associated with lower recurrence among those reporting alcohol consumption (HR = 0.10, 95% CI [0.01, 0.91], p = 0.04). In obese patients, higher lymphocytes were associated with lower risk of recurrence (p = 0.046); in non-obese patients, higher monocytes were associated with lower risk of recurrence (p = 0.02). There were no correlations among patients who reported tobacco use. CONCLUSIONS: High lymphocyte and monocyte counts are associated with lower recurrence rate in early-stage breast cancer, particularly in obese patients and those reporting alcohol consumption.

DEVELOPMENT OF A PORTABLE BLOOD POTASSIUM MONITORING DEVICE FOR DIALYSIS PATIENTS.

Approximately 500,000 dialysis patients in America are at a high risk of hyperkalemia, a condition where blood potassium becomes elevated above normal levels. Hyperkalemia is extremely dangerous, as it can result in severe cardiac complications if untreated. Hyperkalemia may be silent or present vague symptoms until those complications develop, at which point patients require emergency medical care. However, if patients have the ability to measure their potassium levels at home, they could detect hyperkalemia before it reaches a dangerous stage, and seek preventative medical care to avoid severe complications. Therefore, we have designed a novel device allowing patients to measure their blood potassium levels at home. The workflow of our solution is as follows: (1) patients obtain a blood sample from a finger prick, (2) potassium concentration is measured with an ion specific electrode (ISE), and (3) the device displays their potassium levels and a recommended course of action based on their hyperkalemic risk. We validate our solution with three major tests. First, our portable ISE technology must accurately measure potassium concentration in blood samples. Second, appropriate lancet parameters (gauge and depth) to minimize hemolysis in capillary blood samples must be found to minimize falsely elevated readings. Third, device portability and ease of use must be evaluated using patient input, as these factors will affect patient compliance. We have validated the use of portable ISE technology to feasibly measure potassium, and we continue to collect data for our second and third tests.