Accurate Determination of Colorectal Polyp Counts Is Not Mission Impossible for Pathologists and Is Essential for Surveillance Interval Decision-Making: A Review of 1294 Specimens

Introduction/Objective

The US Multi-Society Task Force on colorectal cancer updated recommendations in 2020 for follow-up after colonoscopy. This emphasized differential surveillance intervals based on the number of polyps removed. We determined how often we accurately counted the number of polyps and what submission practices allowed accurate quantification.

Methods/Case Report

We reviewed consecutive colorectal polyp cases from 10/1 to 12/31, 2019, excluding inflammatory polyps in inflammatory bowel disease. Pathology reports were reviewed to determine if the polyp number could be determined from history, gross description, and histologic findings. When numbers did not match or were unclear, endoscopy reports and glass slides were reviewed.

Results (if a Case Study enter NA)

601 cases with 1294 specimens were identified. We accurately determined polyp number in 1235 (95.4%) specimens. 1072 (82.8%) specimens were submitted as single polyp per container (SP), while 222 (17.2%) were submitted with > 1 polyp per container (MP). Polyp number was not quantifiable in 58 (26.1%) MP due to 11 labeled as “multiple polyps” in requisition/endoscopy reports and 47 submitted with polyp number different from number of tissue portions seen grossly and microscopically. In 1 (0.1%) SP, polyp number was unclear because separate portions of tissue contained two different diagnoses. Rate of accurate polyp count is significantly different between SP and MP (p<0.01) by Fisher exact test.

Conclusion

We accurately determined number of polyps in most specimens (95.4%) because our gastroenterologists usually submit SP. In MP, polyp count in 26.1% of specimens was unquantifiable. This could lead to uncertainty in surveillance follow-up intervals. Therefore, we recommend submitting one polyp per container.

Energetic and myocellular pathways in cardiac and skeletal muscle following anthracycline chemotherapy

Background

Anthracycline-related cardiac dysfunction is a recognised consequence of cancer therapies. Here we assess resting cardiac and skeletal muscle energic status as an early mechanistic pathway of myocyte derangement and explore molecular targets of skeletal myocyte metabolism, protein synthesis/degradation and mitochondrial biogenesis signalling.

Methods

We conducted a prospective, mechanistic, observational, longitudinal study of chemotherapy-naive breast cancer patients undergoing anthracycline-based chemotherapy, compared to a healthy control group. 31P-Magnetic Resonance spectroscopy in cardiac and skeletal muscle (phosphocreatine/gamma adenosine triphosphate (PCr/yATP) and inorganic phosphate/phosphocreatine (Pi/PCr) ratios respectively), cardiac magnetic resonance (CMR) imaging inclusive of T1 and T2 mapping, echocardiography-derived global longitudinal strain function, serum NT-pro-BNP and skeletal muscle biopsies from the right vastus lateralis were assessed before and after 3 cycles of Flurouracil, Epirubicin and Cyclophosphamide followed by 3 cycles of Docetaxel. Statistical significance was set at p<0.05.

Results

Twenty-five female breast cancer patients (median age 53 years, range 32–74 years) receiving a mean epirubicin dose 307 mg/m2) and twenty-eight controls (median age 44 years, range 23–65) were recruited. All study assessments in breast cancer patients at pre-chemotherapy stage were comparable to the matched healthy controls. However, following chemotherapy, breast cancer patients demonstrated a small but significant reduction in cardiac function (global longitudinal strain −22.9±3.9 vs −19.1±3.3%, p=0.01 and CMR-derived ejection fraction 65±5 vs 62±4%, p=0.047), a mild increase in CMR-derived indexed left ventricular volumes (end diastolic 65±10 vs 74±11 ml/m2, p=0.014 and end systolic 23±5 vs 28±5 ml/m2, p=0.01) as well as an increase in left ventricular T1 and T2-mapping (1289±29 vs 1321±31 ms, p=0.004 and 50±4 vs 55±7 ms, p=0.027, respectively) and serum NT-Pro-BNP (49±25 vs 108±84 pg/m, p=0.008). After epirubicin, there was significant reduction in cardiac PCr/yATP ratio (2.0±0.7 vs 1.2±0.6, p=0.007) and a significant increase in skeletal muscle Pi/PCr ratio (0.13±0.04 vs 0.22±0.2, p=0.008) – Figure 1.

Following chemotherapy, there was significant upregulation of skeletal myocyte protein synthesis (mammalian target of rapamycin, 0.44±0.4 vs 0.53±0.2, p<0.001) and degradation (Calcium/calmodulin dependent protein kinase II, 1.4±0.7 vs 2.7±1.1, p<0.001), metabolism (peroxisome proliferator-activated receptor gamma, 0.35±0.2 vs 0.60±0.1, p<0.001) and muscle mass regulator myostatin-2 (0.16±0.1 vs 0.24±0.1, p<0.001).

Conclusion

Contemporary doses of epirubicin for breast cancer result in significant reduction of cardiac and skeletal muscle high energy 31P-metabolism alongside skeletal myocellular alterations of protein synthesis and metabolic regulation pathways.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Tenovus ScotlandNHS Grampian Endowment fund

Renin-angiotensin and endothelin systems in patients post takotsubo syndrome

Background

We investigate if renin-angiotensin and endothelin-1 response pathways follow the same pattern of recovery as left ventricular ejection fraction in patients with takotsubo syndrome.

Purpose

To provide better insight into the pathophysiology underlying this condition.

Methods

Ninety takotsubo syndrome patients [n=30 in each of “acute”, “convalescent” (3–5 months) and “recovered” (>1 year) groups] who were on minimal or no medication and were free of any significant cardiac/metabolic co-morbidities, and 30 healthy controls were studied. Serum concentrations of renin, angiotensin converting enzyme, angiotensin II, big endothelin-1, endothelin-1 were measured using commercially available ELISA, and BNP was measured using an immunoassay.

Results

Left ventricular ejection fraction was 38±1.6% in acute, 63±2.0% in convalescent and 64±2.6% in recovered takotsubo syndrome patients. As shown in Figure 1, serum renin concentrations are persistently elevated after a takotsubo episode (p=0.03 vs controls). Angiotensin converting enzyme levels are significantly depressed during the acute phase compared to convalescent (p=0.004), recovered takotsubo (p=0.02) or controls (p=0.03). Angiotensin II is increased in takotsubo patients (p<0.001 vs controls) remaining persistently elevated long-term in the recovered group (p=0.03 vs controls). B-type natriuretic peptide concentrations remain elevated after a Takotsubo episode compared to controls (p=0.003). Big endothelin-1 levels are unchanged, but endothelin-1 is significantly lower after takotsubo syndrome compared to controls (p=0.03).

Conclusions

Despite “normalisation” of the left ventricular ejection fraction, there is long-term maladaptive activation of renin-angiotensin system in takotsubo syndrome patients. This suggests therapy aimed at modulating this pathway may be beneficial in the long-term.

Funding Acknowledgement

Type of funding sources: Other. Main funding source(s): British Heart Foundation

OUES from submaximal cardiopulmonary exercise

Introduction

Cardiopulmonary exercise testing (CPEX) provides valuable diagnostic and prognostic cardiopulmonary function data. However, in clinical setting a maximal test is not always achievable. The Oxygen Efficiency Uptake Slope (OUES) has been proposed as a possible submaximal measure of cardiopulmonary function as it remains relatively stable during the final quartile of the exercise test. This study explored the validity of OUES as a surrogate marker for cardiopulmonary function in the event of a submaximal test.

Methods

Four groups of subjects [128 healthy controls (73 M), 44 asymptomatic hypertensive (HT) patients (26 M), 67 adult cardiac congenital heart disease (ACHD) patients (44 M) and 35 Heart Failure with preserved Ejection Fraction (HFpEF) (10M) patients] were recruited after informed consent. All subjects underwent clinical assessment, resting ECG, blood pressure and spirometry prior to a treadmill CPEX to volitional exhaustion and a respiratory exchange ratio (RER) of at least 1.1 using the same testing protocol. Peak VO2 (ml/min) was recorded from the last 5s of the maximal test (RER=1.1) and OUES was calculated from complete (RER=1.1) and truncated (RER=0.9) gas exchange data. The linear relationships between absolute peak VO2 and OUES from complete and truncated gas exchange data were assessed using Pearson's correlation coefficient. Subsequently, the two correlations obtained in each patient group were compared. Statistical significance was set at p<0.01.

Results

Mean and 95% confidence intervals of the peak VO2 for males and females in each decile of life examined in the 4 subject groups are shown in the Figure. Peak VO2 values achieved in each of the patient groups were significantly lower when matched for age and sex compared to healthy participants (HT p=0.006, ACHD patients p<0.001 and HFpEF patients p<0.001).

In all 4 groups there was a good correlation between absolute peak VO2 and the OUES at RER 1.1 (healthy volunteers r=0.910, p<0.001, HT r=0.899, p<0.001, ACHD r=0.816, p<0.001 and HFpEF r=0.846, p<0.001). Correlations were inferior for absolute peak VO2 and OUES at RER 0.9 (healthy volunteers r=0.74, p<0.001, HT r=0.780, p<0.001, ACHD r=0.651, p<0.001 and HFpEF r=0.817, p<0.001). Correlations between absolute peak VO2 vs OUES at RER of 1.1 and 0.9 were significantly different only for healthy controls (p=0.001, Z-score = −4.649), but not for HT (p=0.05, Z-score = −1.909), ACHD (p=0.04, Z-score = −2.080) or HFpEF (p=0.7, Z-score = −0.377) patients.

Conclusion

Our data support the use of submaximal OUES at an RER of 0.9 as a surrogate marker for absolute peak VO2 obtained at an RER of 1.1, especially in patients, in whom it can often be difficult to achieve maximal exercise.

Funding Acknowledgement

Type of funding sources: None.

Proposal of a 2-tier histologic grading system for canine cutaneous mast cell tumors to more accurately predict biological behavior

Currently, prognostic and therapeutic determinations for canine cutaneous mast cell tumors (MCTs) are primarily based on histologic grade. However, the use of different grading systems by veterinary pathologists and institutional modifications make the prognostic value of histologic grading highly questionable. To evaluate the consistency of microscopic grading among veterinary pathologists and the prognostic significance of the Patnaik grading system, 95 cutaneous MCTs from 95 dogs were graded in a blinded study by 28 veterinary pathologists from 16 institutions. Concordance among veterinary pathologists was 75% for the diagnosis of grade 3 MCTs and less than 64% for the diagnosis of grade 1 and 2 MCTs. To improve concordance among pathologists and to provide better prognostic significance, a 2-tier histologic grading system was devised. The diagnosis of high-grade MCTs is based on the presence of any one of the following criteria: at least 7 mitotic figures in 10 high-power fields (hpf); at least 3 multinucleated (3 or more nuclei) cells in 10 hpf; at least 3 bizarre nuclei in 10 hpf; karyomegaly (ie, nuclear diameters of at least 10% of neoplastic cells vary by at least two-fold). Fields with the highest mitotic activity or with the highest degree of anisokaryosis were selected to assess the different parameters. According to the novel grading system, high-grade MCTs were significantly associated with shorter time to metastasis or new tumor development, and with shorter survival time. The median survival time was less than 4 months for high-grade MCTs but more than 2 years for low-grade MCTs.

The effects of ingesting a carbohydrate-electrolyte beverage 15 minutes prior to high-intensity exercise performance

The aim of this study was to examine the effect of ingesting a commercially available carbohydrate-electrolyte (CHO-E) solution on strenuous exercise performance. Ten apparently healthy male volunteers (Mean +/- SD; age 20 +/- 2 yrs; height 178 +/- 7 cm; body mass 77 +/- 10 kg; estimated VO(2 max) 56 +/- 3 ml x kg(-1) x min(-1) completed three experimental trials in random order separated by a minimum of 7 days. For each trial, subjects consumed (8 ml x kg(-1) body mass) either a CHO-E solution (6% carbohydrate, 50 mg Na/500 ml), a non-CHO-E placebo, or no fluid, 15 minutes prior to exercise. The exercise involved intermittent shuttle (20 m apart) running for 1 hr followed by an incremental shuttle running test to exhaustion. Subjects displayed longer exercise times when the CHO-E solution was ingested compared with placebo or no fluid groups (exercise time to exhaustion - CHO-E 649 +/- 95 s, vs. placebo 601 +/- 83 s, vs. no fluid 593 +/- 107 s, P < 0.05). There was a main effect for time for specific gravity of urine (P < 0.05 vs. postexercise, pooled data) and body mass (P < 0.05 vs. postexercise, pooled data). The main finding from this investigation indicates that drinking a CHO-E solution 15 minutes prior to exercise improves performance. This study has practical implications for those sports where drinking during activity is restricted.

A review of one year of British Armed Forces mental health hospital admissions

OBJECTIVES

The paper provides a review of one year of military Mental Health (MH) hospital admissions. This includes an exploration into demographic trends, differences in clinical opinion and how information gained is used to improve the service and ensure appropriate, cost effective care in the optimum environment.

METHODS

The sample group is entitled military MH hospital admissions from 1 April 2005 to 31 March 2006. Data was collected on questionnaires with SPSS used for the management and analysis of the quantitative data, with the information exposed to descriptive and inferential statistical analysis.

RESULTS

There were 344 admissions. The paper contains a detailed review of a number of variables. Depression was the most common diagnosis resulting in 112 (33%) hospital admissions and Post Traumatic Stress Disorder accounted for 23 (7%). There were statistically significant differences that may be attributable to gender with more women admitted with depression and more men with alcohol related disorders. The average length of stay was 21 days, with 48% of patients discharged within 3 weeks. 45% of all returns included significant events reporting that highlighted written evidence of good and poor practice.

CONCLUSION

This study is part of an extensive monitoring programme of military MH hospital admissions. Depression is the most common MH problem leading to hospital admission. The results indicate that Service-personnel have access to a highly responsive service that provides brief assessment and treatment within a safe therapeutic environment. 45% of returns included significant event information that resulted in policy changes, leading to improved patient care and a better interface with the NHS. Bench-marking, both internally between military Departments of Community Mental Health and externally have improved visibility and self awareness leading to better GP induction programmes, PHC educational seminars and the establishment of MH web-pages. The Armed Forces need an effective MH service that is accessible, readily available, non-stigmatised and which positively advocates a duty of care. The results highlight the importance of further studies regarding depression to ensure that the Armed Forces are in a better position to maximise the use of MH resources.

Ethics and community-based education: balancing respect for the community with professional preparation

Community-based education and service learning are becoming increasingly common in health and human services education. As students enter the community, several ethical dilemmas arise regarding the university's interaction with the community. This article explores clinical, agency, and community placements in terms of the relationships they engender between the university and the community. The article then outlines some ethical obligations of universities and faculty members and ethical dilemmas that arise in different placements. Finally, a fundamental ethical framework that may guide universities and faculty members in planning community-based educational experiences is proposed.

No evidence for linkage of schizophrenia to DXS7 at chromosome Xp11

There have been claims that a gene on the X chromosome may contribute to susceptibility to schizophrenia. Crow (1988) initially proposed that such a gene might lie in the pseudoautosomal region, but when evidence that weakened this hypothesis accumulated, he proposed that a susceptibility locus might be present elsewhere on the sex chromosomes instead. DeLisi et al. (1994) found a small nonsignificant positive lod score between the marker DXS7 and schizophrenia, but other failed to replicate this finding. Another study reported by Crow and DeLisi's group was also weakly positive for this marker (Dann et al., 1997). This locus was then investigated in a collaborative study by Laval et al. (1997), which produced a nonparametric lod score of 2.44. Using a sample of 17 pedigrees from Britain and Iceland, we have also tested the hypothesis of linkage between DXS7 and schizophrenia. The 17 families were selected from a larger sample on the basis of an absence of male-to-male transmission for schizophrenia. These families were originally selected for having multiple cases of schizophrenia within them and for having no cases of bipolar affective disorder. We genotyped subjects for a marker at DXS7 and performed classical lod score and model-free linkage analysis using broad and narrow definitions of affection with schizophrenia. We found strongly negative lod scores and no evidence for linkage using model-free analysis. Therefore, this study does not support the hypothesis of linkage of schizophrenia to DXS7, and the evidence for a susceptibility locus on this part of the X chromosome is weakened.

Effectiveness of community-directed diabetes prevention and control in a rural Aboriginal population in British Columbia, Canada

This report presents the process and summative evaluation results from a community-based diabetes prevention and control project implemented in response to the increasing prevalence and impact of non-insulin-dependent diabetes mellitus (NIDDM) in the Canadian Aboriginal population. The 24-month project targeted the registered Indian population in British Columbia's rural Okanagan region. A participatory approach was used to plan strategies by which diabetes could be addressed in ways acceptable and meaningful to the intervention community. The strategies emphasised a combination of changing behaviours and changing environments. The project was quasi-experimental. A single intervention community was matched to two comparison communities. Workers in the intervention community conducted interviews of individuals with or at risk for diabetes during a seven-month pre-intervention phase (n = 59). Qualitative analyses were conducted to yield strategies for intervention. Implementation began in the eighth month of the project. Trend measurements of diabetes risk factors were obtained for 'high-risk' cohorts (persons with or at familial risk for NIDDM) (n = 105). Cohorts were tracked over a 16-month intervention phase, with measurements at baseline, the midpoint and completion of the study. Cross-sectional population surveys of diabetes risk factors were conducted at baseline and the end of the intervention phase (n = 295). Surveys of community systems were conducted three times. The project yielded few changes in quantifiable outcomes. Activation of the intervention community was insufficient to enable individual and collective change through dissemination of quality interventions for diabetes prevention and control. Theory and previous research were not sufficiently integrated with information from pre-intervention interviews. Interacting with these limitations were the short planning and intervention phases, just 8 and 16 months, respectively. The level of penetration of the interventions mounted was too limited to be effective. Attention to process is warranted and to the feasibility of achieving effects within 24 months.

Variation by body mass index and age in waist-to-hip ratio associations with glycemic status in an aboriginal population at risk for type 2 diabetes in British Columbia, Canada

BACKGROUND

It is unclear whether obesity and age modify or confound relations between abdominal adiposity and metabolic risk factors for type 2 diabetes.

OBJECTIVE

Our objective was assess the consistency of relations between abdominal adiposity and glycemic variables across discrete categories of obesity and age.

DESIGN

We performed a stratified analysis of prevalence data from a rural screening initiative in British Columbia, Canada. Subjects were Salishan Indians, all healthy relatives of individuals with type 2 diabetes [n = 151; age: 18-80 y; body mass index (BMI, in kg/m2): 17.0-48.2]. We measured waist-to-hip ratio (WHR) (2 categories); insulin, glycated hemoglobin (Hb A1c), and 2-h glucose concentrations (2 categories); and BMI (4 categories). BMI and age-specific odds ratios (ORs) and 95% CIs were calculated.

RESULTS

WHR-glycemic variable relations were not consistent across BMI and age strata. Risks associated with high WHR were: for persons with BMIs from 25 to 29, elevated insulin (OR: 6.71; 95% CI: 1.41, 34.11) and Hb A1c (OR: 16.23; 95% CI: 2.04, 101.73) concentrations; for persons aged 18-34 y, elevated insulin concentrations [OR: indeterminate (+infinity); 95% CI: 1.89, +infinity]; and, for persons aged 35-49 y, elevated Hb A1c (OR: +infinity; 95% CI: 3.17, +infinity) and 2-h glucose (OR: 9.15; 95% CI: 1.74, 59.91) concentrations.

CONCLUSIONS

WHR discriminates risk of type 2 diabetes in overweight but not obese individuals. Abdominal adiposity is associated with elevated insulin concentrations in younger age groups and with impaired glucose control in middle-aged groups, suggesting metabolic staging by age on a continuum from insulin resistance to impaired glucose tolerance.

Evacuation

What happens to your patients when a forest fire burning out of control threatens your community and forces a major evacuation? This summer, nurses in Salmon Arm found they had a lot of support from their colleagues in the region.

Diabetes and Canada's aboriginal peoples: the need for primary prevention

The high prevalence of non-insulin-dependent diabetes mellitus (NIDDM) in Canada's native communities corresponds with high diabetes prevalence rates in other populations of indigenous peoples that have undergone changes associated with acculturation. Behavioural risk factors can be particularly amenable to public health action. There exists a need to develop, implement and test in collaboration with native people, interventions aimed at reducing the incidence and impact of NIDDM, by reducing the risk of its onset, and by early detection and treatment. Intervention programmes should be conceived with sensitivity to the overall health, social, economic, educational and cultural environment within a community. Although this review focuses specifically on diabetes in Canada, many of the points relating to the need for primary prevention of the disease will be appropriate in other situations.

Distribution and function of multiple anion transporter proteins in brain tumor cell lines in relation to glucose transport

The anion transport, "band 3," family of proteins in mammalian brain performs the same functions as that of erythroid band 3. These functions are anion transport, ankyrin binding, and generation of senescent cell antigen, an aging antigen that terminates the life of cells. The presence of 5-7 band 3 related proteins in brain tissue was suggested by the reaction of antibodies to synthetic peptides of erythroid band 3 with a number of bands in immunoblots. Since there are a number of different cell types in brain, tissue cultures of neural cell types were examined to determine whether multiple band 3 related proteins are present in each cell type or whether several band 3 related proteins are present in each cell type. The tumor cell lines exhibit anion transport and are inhibited by the anion transport inhibitors 4,4'-diisothiocyano-2,2' disulfonic acid (DIDS), phenylglyoxal, and furosemide. Glucose transport is inhibited by cytochalasin B and the anion transport inhibitor, phenylglyoxal, in these cell lines, but not by 4,4'-diisothiocyano-2,2' disulfonic acid. Furosemide gave partial inhibition of most, but not all, cell lines. Since phenylglyoxal inhibits anion transport by binding to an arginine near the transport site, inhibition of glucose transport by phenylglyoxal suggests that an arginine lies in the substrate binding site. The number of cytochalasin B and DIDS binding sites was quantitated on cell lines as an approximation of the number of glucose transporter and anion transporter sites, respectively.

Out of entitlement. A nursing organization's journey

The authors describe a major reorganization that took place in an 850-bed academic teaching hospital in the southwestern United States. This reorganization facilitated a paradigm shift and the journey from a deeply entrenched attitude of "entitlement" to one of earning.

Fathers of breastfed infants: postponing and types of involvement

OBJECTIVE

To examine husbands' experiences of having their wives breastfeed.

DESIGN

Qualitative method of grounded theory.

SETTING

In-depth interviews by phone at home.

PARTICIPANTS

Fourteen middle-class, urban, Canadian fathers of successfully breastfed infants.

RESULTS

The fathers reported a disparity in the types of relationships that their children had with each of their parents as a result of breastfeeding. The process that enabled the fathers to accept this perceived difference was labeled postponing. Four fathering styles, which explain the variation in postponing, were found. The phases of postponing include becoming aware of the disparity, simultaneously developing accepting strategies and acknowledging reinforcing factors, and, finally, developing compensating behaviors to increase the fathers' interactions with their infants and promote closer relationships. When weaning occurred, the fathers' relationships with their children changed as the fathers found ways to catch up.

CONCLUSIONS

A need exists for realistic education about the realities of breastfeeding for fathers. More outlets for fathers' negative emotions toward breastfeeding need to be found.

The effect of maternal fluid intake on breast milk supply: a pilot study

To examine the effect of increased and decreased fluids on breast milk supply, a pilot study using a cross-over design with 10 mother-infant pairs was completed. Baseline measures of milk supply were determined over a 3-day period of normal fluid intake based on body weight. Subjects were studied over 3-day periods when fluid intake was alternately 50% more and 50% less than normal level. Milk supply was calculated by averaging breast milk intake, determined by test weighing the infants with electronic scales, and milk yield, measured either by total breast expression with an electric breast pump or a combination of expression and test weighing. Although milk supply decreased with decreased fluids and increased with increased fluids, this change was not statistically significant. Recommendations for further research include replication using subjects' usual fluid intake as a baseline and replication using mothers suspected of insufficient milk syndrome.

Pathophysiology of vascular smooth muscle in renin promoter-T-antigen transgenic mice

The pathophysiological consequence of targeted production of SV-40 T-antigen to renin-expressing cells in the kidney of transgenic mice is reported. A histopathologic analysis of the kidney from adult transgenic mice (12-16 wk old) revealed the presence of severe vascular lesions manifested by marked atypical hyperplasia of vascular smooth muscle. The levels of plasma renin, kidney renin, and kidney renin mRNA were examined in 6- and 9-wk-old transgenic mice and were found to be significantly lower than their age-matched non-transgenic littermates and were nonresponsive to captopril treatment. However, there was no significant difference in conscious mean arterial pressure between transgenic and non-transgenic mice. The levels of renal renin mRNA in transgenics and nontransgenic littermates were compared throughout ontogeny and were found to be equal in newborns, elevated 3- to 5-fold in 1-wk-old transgenics, and yet decreased 10-fold by 6 wk of age in transgenic mice. Expression of the transgene in the kidney exhibited the proper developmental pattern and was properly restricted to juxtaglomerular cells in neonatal mice. Nevertheless, in adult mice, T-antigen-containing cells were found throughout the entire renal arterial tree. The observed ability of renal vascular cells to be recruited to express both renin and T-antigen suggests a mechanism that can explain the development of the renal pathology in these mice.

Initiating breastfeeding: a world survey of the timing of postpartum breastfeeding

A survey of the 'Human Relations Area Files' and ethnographic infant feeding literature from all cultures on the timing of infant feeding revealed that the practice of withholding colostrum from the infant was widespread. Data obtained from 120 cultures showed that in 50 cultures this delay in implementing breastfeeding was more than two days. In many groups, substitute prelacteal feeds were given, while in others, practices such as the use of purgatives exacerbated the risk of dehydration in the infant. The authors warn that nurses and midwives must be aware of the practice of withholding colostrum from the infant, and note that if a mother does not wish to breastfeed in the immediate postpartum, this does not necessarily mean that she wishes to bottle feed the infant.

Defective expression of high affinity IL-2 receptors on activated T cells from aged humans

The proliferative response of T cells from aged humans to a number of mitogens is significantly reduced. We report here that there is a decrease in high affinity IL-2 receptor (IL-2R) expression on activated T cells from aged humans. Scatchard analysis of the binding of [125I]IL-2 demonstrates fewer high affinity IL-2 binding sites. Autoradiographic techniques demonstrate that this results from there being fewer activated T cells from old as compared to young donors that express high affinity IL-2R. However, T cells from old donors that do not express high affinity IL-2 binding sites express both the IL-2 binding 55 and 75 kd chains. Thus, although the two IL-2 binding peptides are expressed on activated T cells from old donors, expression of the high affinity IL-2R is reduced. This may explain the decreased ability of T cells from old donors to respond to IL-2. The impaired ability of activated T cells from old donors to express high affinity IL-2R while expressing the 55 and 75 kd chains may provide insights into the mechanisms of IL-2 interactions with its receptor.

Comparison of patient profiles from a comprehensive cancer center and the general population

Differences in cancer patient profiles between cases seen at comprehensive cancer centers and those seen in the general population are seldom assessed by means of reliable and systematically collected data. This report compares the characteristics of patients treated at Roswell Park Memorial Institute in Buffalo with all reported patients diagnosed in the Western New York population. Data for this study were generated from the Roswell Park Tumor Registry and the Western New York Tumor Registry. The findings indicate that patients presenting for treatment at Roswell Park Memorial Institute, compared to the WNY cancer patient population, are more frequently diagnosed with rare tumors, are younger, and manifest later stage disease. These data may have implications for the planning and evaluation of cancer patient services at the community level.

Results of the national soft-tissue sarcoma registry

Of 191 case reports submitted to the National Soft Tissue Sarcoma Registry, 131 qualified for inclusion. Fifty-two percent were males; 80% were whites. Twenty-one different histologies were assigned, with leiomyosarcoma most frequently represented. Localized disease was reported for 29% of patients. Surgery in combination with radiotherapy and/or chemotherapy was reported as the treatment for 45% of patients, and surgery only was reported for 31%. These data reflect increasing used of adjuvant therapy in the treatment of soft tissue sarcoma.

Increasing incidence of adenocarcinoma of the lung

Review of the histology of 219 lung cancers initially diagnosed at Lutheran General Hospital, Park Ridge, Illinois, in 1963-1967 and 1974-1976, confirms the increasing incidence of adenocarcinoma. This is due to an increase of adenocarcinoma in men. In women, the incidence of adenocarcinoma was higher than squamous carcinoma in the earliest period (44% adeno, 18% squamous). The percentage of women with lung cancer has also significantly increased from 19% to 31%, which increases the overall incidence of adenocarcinoma of the lung. As the number of women with lung carcinoma has increased, there has been no change in the percentage of adenocarcinoma in women.