Selenium levels in colorectal cancer: A systematic review and meta-analysis of serum, plasma, and colorectal specimens

BACKGROUND

Colorectal cancer (CRC) is a growing public health problem. Several clinical studies have shown a potentially protective effect of selenium (Se), but the reports are inconsistent. The objective of the study was to examine the evidence for relation between serum/tissue Se status and CRC.

METHOD AND MATERIALS

In this Systematic Review and Meta-Analysis, we searched Cochrane Library, EBSCOhost, EMBASE, ProQuest, PubMed/MEDLINE, Scopus, and Web of Science for studies reporting serum/plasma/whole blood/tissue Se concentrations in CRC patients and controls for articles published till August 2023. Meta-analysis was performed, and study quality, heterogeneity, and small study effects were assessed. Based on a random effects model, summary mean differences in serum levels of Se between CRC patients and healthy controls, and Se levels between malignant and matched non-malignant tissue specimens were assessed.

RESULTS

After initial screening, a total of 24 studies (18 serum and 6 tissue studies) with a pooled total of 2640 participants were included in the meta-analysis. CRC patients had significantly lower serum Se levels than healthy controls, being the difference between the two equal to 3.73 µg/dl (95% CI: 6.85-0.61). However, the heterogeneity was very high, I2= 99% (p < 0.01). Our meta-analysis showed higher Se levels in CRC cancerous specimens than in matched healthy colon tissue: the increase was equal to 0.07 µg/g wet tissue weight (95% CI: 0.06-0.09; p= 0.02).

CONCLUSIONS

CRC patients have lower serum and higher colon cancerous tissue Se levels. Some factors, such as Se levels in different tumor grades of CRC need to be further considered for a more conclusive association between Se levels and risk of CRC.

Comparative Evaluation of Serum Lithium Estimation Using Plain Glass Vial and Serum Clot Activator Vacutainer by Reflectance Photometry

Introduction  The collection of blood samples in different vacutainers can affect the result of serum lithium estimation due to the presence of distinct additives in the blood collection vacutainer for enhancing the clot formation process. Due to the low therapeutic index and threat of toxicity of lithium, it is imperative to correctly report the test result. Thus, it has become a challenge for the laboratory physician to estimate lithium in any clinical laboratory setup. Materials and Methods  Sample of 100 patients were collected and paired into clot activator vacutainers and plain glass vials. After centrifugation, samples from the paired collection tubes were processed immediately for serum lithium estimation by VITROS 4600 analyzer working on the principle of reflectance photometry. Both the paired tubes were stored at 2 to 8°C and were further analyzed, at 24 and 48 hours, respectively, from the time of their collection. The statistical analysis was done in IBM SPSS software version 23. Results  There was a statistically significant differences between the mean of lithium values when processed within 1st hour of collection, obtained from clot activator vacutainers in comparison to glass vials. However, within tube comparison, there was no statistical difference in the lithium values estimated at 1st hour, 24 hours, and 48 hours of collection. Conclusion  In this study, lithium values measured by clot-activated vacutainers are found to be lower as compared with values measured through glass vials.

Maintenance policy selection of n-component repairable system using Genetic Algorithm

A typical manufacturing system consists of a large number of repairable components/ machines which age with time and require maintenance. This paper proposes a novel maintenance policy selection method using genetic algorithm. Where, maintenance problem is formulated for n-component repairable system to minimize the total maintenance cost. The various maintenance policies and repairable components are represented in the form of chromosomes, initially various chromosomes are randomly generated which are then assessed and selected using fitness value and then crossover and mutation function is performed to obtain a better chromosome. Several iterations are performed till the desired results is achieved. The proposed algorithm is further explained and validated through an illustrative example.

Is health consciousness and perceived privacy protection critical to use wearable health devices? Extending the model of goal-directed behavior

Purpose

The present study is an attempt to extend the Model of Goal-directed Behavior (MGB) to consider health consciousness and perceived privacy protection as two critical factors to predict desire and intention by individuals to adopt and use wearable health devices (WHDs).

Design/methodology/approach

Based on the literature review hypotheses were framed and tested using data collected through a questionnaire survey. A total of 418 self-reported complete responses were considered to analyze the hypotheses proposed in the study. Structural equation modeling, effects analysis and model comparison (MGB and extended MGB) were performed to understand the predictability of the suggested model.

Findings

The results of the study corroborate that along with MGB, health consciousness and perceived privacy protection also induces the intention of users toward using WHDs. Health-consciousness is found to have a positive and significant direct and indirect impact on intention to use WHDs. Further, the model comparison exhibits that the proposed extended MGB is a better predictor of intention to use WHDs.

Practical implications

Apart from the conventional framework of MGB, health consciousness and perceived privacy protection promote desire and intention to use WHDs. This research provides a framework for marketers to promote health consciousness among consumers by motivating them to adopt WHDs. Further, privacy protection features should be showcased in order to induce trust in consumers which in turn will trigger their intention to use WHDs to lead a healthy lifestyle.

Originality/value

The current study incorporates health consciousness and perceived privacy protection in MGB to fit into the context of healthcare intention study, which enhances the predictability of intention behavior of consumers and adds to the existing body of MGB and healthcare literature.

Abstract P2-06-24: Cannabinoid receptors agonist induces lysosome-mediated cell death in TNBC

Breast cancer is one of the leading causes of death among women in the United States. Among all the breast cancer subtypes, triple-negative breast cancer (TNBC) is denoted as having the highest rate of mortality due to inefficacious therapy, drug resistance, and high recurrences rate. Despite many therapeutic advances over the past decades, novel therapeutic approaches are required to treat TNBC. Although lysosomes have recently been identified as novel targets in a variety of cancers, not much known about their role in breast cancer especially in TNBC. Due to the altered features of lysosomes in cancerous cells, its functional ability affects cell proliferation, metabolism, adaptation, and autophagy in tumor cells. Thus, the induction of lysosomal membrane permeabilization (LMP) may be used as a novel approach in controlling the aberrant cellular functions in TNBC. Cannabinoid receptor 2 (CB2) is expressed in breast cancer and its agonist JWH-015 has been shown to inhibit TNBC growth and metastasis. However, not much is known about the mechanisms by which JWH015 inhibit growth and metastasis. To investigate JWH015-mediated therapeutic mechanisms, we examined the lysosome-mediated cell death in TNBC cells. We found that JWH015 induces cell death in TNBC cells through lysosomal disruption mechanism. We also showed that JWH-015 treatment increases releases of lysosomal proteins, cathepsin D/B, and autophagy marker LC3B and that leads to activation of apoptotic cell death signaling in TNBC. These alterations result in the formation of autolysosomes to promote LMP. Our findings elucidate the mechanism by which JWH-015 promotes LMP induced autophagy and regulates TNBC cell proliferation. These studies elucidate novel lysosomal-mediated cell death mechanisms through activation of CB2 receptors in TNBC.

Citation Format: Chatterjee N, Das S, Ahiwar D, Mishra S, Kaul K, Ganju R. Cannabinoid receptors agonist induces lysosome-mediated cell death in TNBC [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-06-24.

Autism Spectrum Disorder: the Present Perspective

The last decade has witnessed a surge of awareness about autism among the public and professionals. Much revealing research is being done on this issue and the knowledge base has improved substantially and a set of professionals are specializing on the subject, focusing on its causative factors and management. Autism being a disorder stemming from early childhood and the prevalence rate rising alarmingly over the years, Pediatricians are expected to play a vital role in early detection and early intervention in management of the problem. But, unfortunately, autism is not yet considered to be under the purview of pediatricians. As pediatricians, we are often perplexed when faced with such a different child in our office and either overlook the problem or hurry to hand him over to a psychiatrist, not trying to really identify and understand the problem as a medical entity ourselves. Hence better awareness among pediatricians is the need of the day. As specialists have worked with autism over the decades, it has become clear that: autism is a disorder that involves early development, presently there is no medical answer to autism, and the only management strategy hinges largely on effective training. The earlier the training begins the better it is for the child. It is of paramount importance to start training and bring about changes by the time the child is 18 months old. This throws up interesting new challenges to the profession of pediatrics. To identify the early warning signs of autism, it is important that Pediatricians are able to recognize the signs and symptoms of autistic spectrum disorders (ASD), have a strategy for assessing them systematically, be familiar with available tools for screening as well as developmental and educational resources.DOI: http://dx.doi.org/10.3126/jcmsn.v10i3.12775 Journal of College of Medical Sciences-Nepal, 2014, Vol-10, No-3, 37-47

Anandamide rescues retinal barrier properties in Müller glia through nitric oxide regulation

The blood retinal barrier (BRB) can mitigate deleterious immune response. Dysfunction at the BRB can affect disease progression. Under inflammatory conditions Müller glia produce increased pro-inflammatory factors, like nitric oxide (NO). In this study we describe molecular events at the Müller glia during inflammation which could affect inner BRB properties. Griess assay and 4,5-diaminofluorescein diacetate (DAF-2DA) time-lapse fluorescence were used to measure NO production. Western blot was used to analyze the expression of inducible nitric oxide synthase (iNOS) and mitogen-activated protein kinases (MAPK) components. Lucifer Yellow was used to measure permeability. Griess assay and DAF-2DA time-lapse fluorescence images revealed that lipopolysaccharide (LPS) induced inflammation and increased NO production. In parallel, changes were observed in tight junction proteins, zona occludens 1 (ZO-1), connexin 43 (Cx43), and permeability. This was mediated through activation of iNOS and mitogen-activated protein kinase phosphatase-1 (MKP-1), implicated in immune response. Endocannabinoids can exert a protective and anti-inflammatory effect. Exogenous arachidonoyl ethanolamide (AEA) inhibited NO generation and also abolished LPS-induced increase in permeability. Our work suggests that subtle changes in Müller glia function, which act as part of the BRB, could contribute to retinal health. AEA which can reduce inflammatory cytotoxicity has potential as treatment in several ocular manifestations where the integrity of the BRB is crucial.

Genome-wide association study meta-analysis of European and Asian-ancestry samples identifies three novel loci associated with bipolar disorder

Meta-analyses of bipolar disorder (BD) genome-wide association studies (GWAS) have identified several genome-wide significant signals in European-ancestry samples, but so far account for little of the inherited risk. We performed a meta-analysis of ∼750,000 high-quality genetic markers on a combined sample of ∼14,000 subjects of European and Asian-ancestry (phase I). The most significant findings were further tested in an extended sample of ∼17,700 cases and controls (phase II). The results suggest novel association findings near the genes TRANK1 (LBA1), LMAN2L and PTGFR. In phase I, the most significant single nucleotide polymorphism (SNP), rs9834970 near TRANK1, was significant at the P=2.4 × 10(-11) level, with no heterogeneity. Supportive evidence for prior association findings near ANK3 and a locus on chromosome 3p21.1 was also observed. The phase II results were similar, although the heterogeneity test became significant for several SNPs. On the basis of these results and other established risk loci, we used the method developed by Park et al. to estimate the number, and the effect size distribution, of BD risk loci that could still be found by GWAS methods. We estimate that >63,000 case-control samples would be needed to identify the ∼105 BD risk loci discoverable by GWAS, and that these will together explain <6% of the inherited risk. These results support previous GWAS findings and identify three new candidate genes for BD. Further studies are needed to replicate these findings and may potentially lead to identification of functional variants. Sample size will remain a limiting factor in the discovery of common alleles associated with BD.

Abstract P3-10-02: Modulation of mRNA and miRNAs by the novel histone deacetylase inhibitor, CG-1521 disrupts cytokinesis in SUM149PT inflammatory breast cancer cells

Inflammatory breast cancer (IBC) comprises only 2.0% of all breast cancer cases; however it accounts for 8.0% of breast cancer-specific deaths. IBC is highly aggressive, appears at a younger age, and is more difficult to treat than the common forms of breast cancer. By the time the disease is diagnosed, IBC is usually stage 3 and has already metastasized to neighboring lymphatics. Though many tumors are p53 wild type and/or Her2 positive, the median overall survival among women with IBC is less than 4 years even with aggressive multimodal therapy. To develop IBC-specific therapies, we have compared the effects of two hydroxamic acid histone deacetylase (HDAC) inhibitors, Trichostatin A (TSA) and CG-1521 on the biology of the triple negative SUM149PT IBC cell line. In these cells, CG-1521 and TSA induce dose (0–10 µM) and time dependent (0–96 h) increases in the proportion of cells undergoing cell cycle arrest and cell death, in the presence or absence of 17β-estradiol. To identify the genomic targets of CG-1521, we have performed concurrent microarray analyses of mRNA and miRNA expression followed by qPCR validation. In SUM149PT cells, CG-1521 modulates the expression of approximately 935 transcripts: 341 of these transcripts are up-regulated and 594 are down-regulated after 48h of treatment. Gene ontology analysis demonstrates that many of the down-regulated mRNA transcripts encode proteins that are associated with the spindle assembly checkpoint, chromosome segregation and microtubule based processes including KIF4, PRC1, AURKB and KIF23 (MKLP-1). Strikingly, many genes in these ontologies are potentially targeted by a small number of miRNAs (miR-22, miR-1207-5p & miR-494) which are significantly up-regulated by CG-1521, suggesting that the ability of CG-1521 to down-regulate the transcripts associated with spindle formation and cytokinesis may be significantly modulated by miRNA expression. Immunofluorescence microscopy demonstrates that treatment of SUM149PT cells with CG-1521 results in the appearance of elongated midzone structures visualized by phalloidin staining, similar to the phenotype seen by others after siRNA-mediated knockdown of KIF4 in HeLa cells. These data suggest that CG-1521 affects the central mitotic spindle formation, disrupts furrow formation and abscission, arresting the cells in cytokinesis ultimately leading to cell death. Whether these effects are solely mediated through transcriptional mechanisms or whether CG-1521 also directly affects the activity of these proteins through acetylation remains to be determined. Nevertheless, the data show that histone deacetylase inhibitors induce cell death in IBC cells, and suggest that these small molecules may be useful addition to the armamentarium as adjuvants for the treatment of IBC.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P3-10-02.

Abstract LB-337: Synergistic effects of twelve common genetic polymorphisms and smoking habits on absolute risk of bladder cancer

Smoking is the strongest established risk factor for bladder cancer and recent studies have identified multiple common susceptibility loci for this disease. Evaluation of gene-smoking interactions on absolute risk of bladder cancer could be important for understanding both the public health and biological significance of the combined effect of these factors. However, previous studies of gene-environment interactions focused on relative rather than absolute risk measures and thus did not address this important question. The aim of our analyses was to estimate absolute risk of bladder cancer in relation to smoking habits and 12 known susceptibility variants for this disease, and to evaluate if smoking risk differences (RD) vary by levels of a polygenic risk score derived from these variants, using additive tests for interaction. Analyses were based on data from 4,098 cases and 5,995 controls of European background in eight studies participating in the NCI bladder cancer genome-wide association study (GWAS). Absolute risks were estimated based on US incidence and mortality data. The main outcome measures were 30-year cumulative absolute risk of bladder cancer and RDs for males aged 50 years in relation to smoking habits and the polygenic risk score. RDs for ever compared to never smokers were significantly larger (P-additive interaction &lt; 0.05) for subjects carrying risk alleles for seven out of 12 known susceptibility variants. Polymorphisms in two detoxification enzymes, NAT2 and UGT1A6, provided the strongest evidence of additive interactions (P-additive interaction of 0.0002 and 0.0003, respectively), supporting the presence of biological interactions between smoking and these variants. The 30-year risk of bladder cancer in never, former and current smokers was 0.7%, 1.6% and 3.7%, respectively, for subjects in the bottom quartile of the polygenic risk score, compared to 2.0%, 5.1% and 8.0% for subjects in the top quartile. This translates into a significantly larger number of projected cases, which could be avoided by smoking prevention in subjects at higher compared to lower genetic risk (P-additive (2df)=4.6x10-9 for top to bottom quartile of the polygenic risk score). In conclusion, our analyses provide strong evidence for synergistic effects of smoking and known susceptibility loci for bladder cancer on the absolute risk of the disease. This indicates that targeting intense smoking prevention efforts to individuals at elevated genetic risk for bladder cancer could improve the public health impact of such efforts. However, genetic susceptibility for other smoking-related diseases, as well as practical and ethical considerations, would need to be taken into account before any recommendations could be made. (MGC, NR are Co-first authors; N.C. and DTS are Co-last authors)

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr LB-337. doi:1538-7445.AM2012-LB-337

Kinematic variables and water transport control the formation and location of arc volcanoes

The processes that give rise to arc magmas at convergent plate margins have long been a subject of scientific research and debate. A consensus has developed that the mantle wedge overlying the subducting slab and fluids and/or melts from the subducting slab itself are involved in the melting process. However, the role of kinematic variables such as slab dip and convergence rate in the formation of arc magmas is still unclear. The depth to the top of the subducting slab beneath volcanic arcs, usually approximately 110 +/- 20 km, was previously thought to be constant among arcs. Recent studies revealed that the depth of intermediate-depth earthquakes underneath volcanic arcs, presumably marking the slab-wedge interface, varies systematically between approximately 60 and 173 km and correlates with slab dip and convergence rate. Water-rich magmas (over 4-6 wt% H(2)O) are found in subduction zones with very different subduction parameters, including those with a shallow-dipping slab (north Japan), or steeply dipping slab (Marianas). Here we propose a simple model to address how kinematic parameters of plate subduction relate to the location of mantle melting at subduction zones. We demonstrate that the location of arc volcanoes is controlled by a combination of conditions: melting in the wedge is induced at the overlap of regions in the wedge that are hotter than the melting curve (solidus) of vapour-saturated peridotite and regions where hydrous minerals both in the wedge and in the subducting slab break down. These two limits for melt generation, when combined with the kinematic parameters of slab dip and convergence rate, provide independent constraints on the thermal structure of the wedge and accurately predict the location of mantle wedge melting and the position of arc volcanoes.

Prognostic Value of Baseline High-Sensitivity C–Reactive Protein in Patients Undergoing Replacement Arthroplasty

Introduction:A prospective hospital based blinded study was carried out in an orthopedics department in a medical college hospital of Kolkata, West Bengal, India, with the objective of assessing the role of pre-operative high-sensitivity C-reactive protein (hsCRP) level in predicting postoperative complications in replacement arthroplasty. Methods:One hundred and twenty one study subjects were selected. The blood collected in pre-operative, perioperative and postoperative states were stored and fi nally analyzed after the data collection was over after the stipulated follow-up time of post operative Day-14. The patients were divided into two groups according to baseline hsCRP level <3mg/dl and >3mg/dl. The other preoperative parameters measured were found to be statistically comparable.Results: Among important fi ndings, operative time was signifi cantly higher in the group with hsCRP>3mg/dl, postoperative complication rate was also signifi cantly more in that group. Postoperative complication in Day-7 though quite high among both the groups (45% and 50.9%), the difference was not statistically signifi cant. Comparison of hsCRP levels at baseline, perioperative, postoperative D7 and D14 also showed no significant changes.Conclusions:We concluded that high hsCRP level(>3mg/dl), in patients with apparently no other risk factors may be at higher risk of developing complications after post operative D14 of replacement arthroplasty and operative time also signifi cantly increases with high baseline hsCRP level. Key Words: postoperative morbidity, reactive protein, replacement arthroplasty

Prognostic value of baseline high-sensitivity C-reactive protein in patients undergoing replacement arthroplasty

INTRODUCTION

A prospective hospital based blinded study was carried out in an orthopedics department in a medical college hospital of Kolkata, West Bengal, India, with the objective of assessing the role of pre-operative high-sensitivity C-reactive protein (hsCRP) level in predicting postoperative complications in replacement arthroplasty.

METHODS

One hundred and twenty one study subjects were selected. The blood collected in preoperative, perioperative and postoperative states were stored and finally analyzed after the data collection was over after the stipulated follow-up time of post operative Day-14. The patients were divided into two groups according to baseline hsCRP level < 3 mg/dl and > 3 mg/dl. The other preoperative parameters measured were found to be statistically comparable.

RESULTS

Among important findings, operative time was significantly higher in the group with hsCRP > 3 mg/dl, postoperative complication rate was also significantly more in that group. Postoperative complication in Day-7 though quite high among both the groups (45% and 50.9%), the difference was not statistically significant. Comparison of hsCRP levels at baseline, perioperative, postoperative D7 and D14 also showed no significant changes.

CONCLUSIONS

We concluded that high hsCRP level (> 3 mg/dl), in patients with apparently no other risk factors may be at higher risk of developing complications after post operative D14 of replacement arthroplasty and operative time also significantly increases with high baseline hsCRP level.

Assaying baseline status of particulate laden polyaromatic hydrocarbon for a grass root level industrial project

A study of particulate laden polyaromatic hydrocarbon was conducted at 13 selected locations in a 10 km radial distance of a proposed site for a grass root level industry. Suspended particulate matter samples were continuously monitored for 24 h over a period of 3 months. The Polyaromatic Hydrocarbons (PAHs) were extracted from the particulate samples and analysed using Gas Chromatograph-Mass Spectrometer. Limit of Quantification was also established for individual PAHs. Coal combustion and traffic emission were the major contributors for PAHs in the region. The relative contribution of 2, 3, 4, 5, and 6 ring PAHs in particulates of different sampling sites was also investigated and it is observed that 4 ring (29.76%) and 5 ring (29.06%) compounds are prominent in the particulates measured in the region.

How predictive is the Framingham's risk prediction algorithm in Indian perspective? A retrospective case-control study from Kolkata

OBJECTIVE

In this retrospective case-control study, an attempt was made to assess the predictive efficacy of Framingham's risk prediction algorithm in Indian perspective.

METHODS

A total of 350 patients and 293 age- and sex-matched controls were considered in the study. Those patients, who were presenting for the first time with acute coronary syndrome (ACS) and who did not have any prior manifestation of coronary heart disease (CHD) formed the patient group. The risk prediction algorithm was applied to obtain the risk score and the corresponding 10-year risk in each patient and control. They were divided into two groups: diabetic and nondiabetic. Depending on the 10-year risk, they were further grouped into high risk (10-year risk > 20%), moderately high risk (10-year risk between 10% to 20%), and low risk (10-year risk < 10%). The results were compared and statistically analyzed.

RESULTS

In the diabetic patients with ACS, 14.29% qualified as high risk, 32.79% as moderately high risk, and 52.94% as low risk. The corresponding figures for diabetic subjects without ACS were 3.26%, 54.35%, and 42.39%, respectively. In nondiabetic patients with ACS, 19.91% were in the high-risk group, 38.96% in moderately high risk, and 41.13% in the low-risk group; while among the controls, the corresponding figures were 9.95%, 21.89%, and 68.16%, respectively. In nondiabetic subjects, the mean risk was significantly higher for patients compared to controls (14.13 vs. 8.61, p < 0.01). However, in diabetic subjects, there was no significant difference in the mean projected risk between those with ACS and those without ACS (11.37 vs. 10.41, p = NS).

CONCLUSION

In the Indian perspective, Framingham's risk prediction protocol has a fair amount of predictive efficacy since the difference of mean risk score between the patients and controls was statistically significant. However, it fails to identify a large proportion of high-risk nondiabetic patients. Hence, a better protocol for the Indian perspective is badly needed.

Human epidermal growth factor receptor-2 and estrogen receptor expression, a demonstration project using the residual tissue repository of the Surveillance, Epidemiology, and End Results (SEER) program

BACKGROUND

In 2001, the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program established Residual Tissue Repositories (RTR) in the Hawaii, Iowa, and Los Angeles Tumor Registries to collect discarded tissue blocks from pathologic laboratories within their catchment areas. To validate the utility of the RTR for supplementing SEER's central database, we assessed human epidermal growth factor receptor-2 (HER2) and estrogen receptor expression (ER) in a demonstration project.

MATERIALS

Using a prepared set of tissue microarrays (TMAs) residing in the Hawaii Tumor Registry (HTR), we performed standard immunohistochemistry. Breast cancers in the TMA were diagnosed in 1995, followed through 2006, and linked to SEER's main database.

RESULTS

The TMA included 354 cases, representing 51% of 687 breast cancers in the HTR (1995). The HTR and TMA cases were similar with respect to patient demographics and tumor characteristics. Seventy-six percent (76%, 268 of 354) of TMA cases were HER2+ and/or ER+, i.e., 28 HER2+ER-, 12 HER2+ER+, and 228 HER2-ER+. There were 67 HER2-ER- cases and 19 were unclassified. Age distributions at diagnosis were bimodal with dominant early-onset modes for HER2+ER- tumors and dominant late-onset modes for HER2-ER+ breast cancers. Epidemiologic patterns for concordant HER2+ER+ (double-positive) and HER2-ER- (double-negative) were intermediate to discordant HER2+ER- and HER2-ER+.

CONCLUSION

Results showed contrasting incidence patterns for HER2+ (HER2+ER-) and ER+ (HER2-ER+) breast cancers, diagnosed in 1995. Though sample sizes were small, this demonstration project validates the potential utility of the RTR for supplementing the SEER program.

Vitamin D receptor polymorphisms and renal cancer risk in Central and Eastern Europe

Previous studies investigated the role of vitamin D intake and cancer risk. The kidney is a major organ for vitamin D metabolism, activity, and calcium homeostasis; therefore, it was hypothesized that dietary vitamin D intake and polymorphisms in the vitamin D receptor (VDR) gene may modify renal cell carcinoma (RCC) risk. Three common VDR gene polymorphisms (BsmI, FokI, TaqI) were evaluated among 925 RCC cases and 1192 controls enrolled in a hospital-based case-control study conducted in Central and Eastern Europe. Overall associations with RCC risk were not observed; however, subgroup analyses revealed associations after stratification by median age of diagnosis and family history of cancer. Among subjects over 60 yr, reduced risks were observed among carriers of the f alleles in the FokI single-nucleotide polymorphism (SNP) (odds ratio [OR] = 0.61 for Ff and OR = 0.74 for ff genotypes) compared to subjects with the FF genotype (P trend = 0.04; P interaction = 0.004). Subjects with the BB BsmI genotype and a positive family history of cancer had lower risk compared to subjects with the bb allele (OR = 0.60; 95% CI: 0.33-1.1; P trend = 0.05). Genotype associations with these subgroups were not modified when dietary sources of vitamin D or calcium were considered. Additional studies of genetic variation in the VDR gene are warranted.

Endometrial carcinoma risk among women diagnosed with endometrial hyperplasia: the 34-year experience in a large health plan

Classifying endometrial hyperplasia (EH) according to the severity of glandular crowding (simple hyperplasia (SH) vs complex hyperplasia (CH)) and nuclear atypia (simple atypical hyperplasia (SAH) vs complex atypical hyperplasia (CAH)) should predict subsequent endometrial carcinoma risk, but data on progression are lacking. Our nested case-control study of EH progression included 138 cases, who were diagnosed with EH and then with carcinoma (1970-2003) at least 1 year (median, 6.5 years) later, and 241 controls, who were individually matched on age, date, and follow-up duration and counter-matched on EH classification. After centralised pathology panel and medical record review, we generated rate ratios (RRs) and 95% confidence intervals (CIs), adjusted for treatment and repeat biopsies. With disordered proliferative endometrium (DPEM) as the referent, AH significantly increased carcinoma risk (RR=14, 95% CI, 5-38). Risk was highest 1-5 years after AH (RR=48, 95% CI, 8-294), but remained elevated 5 or more years after AH (RR=3.5, 95% CI, 1.0-9.6). Progression risks for SH (RR=2.0, 95% CI, 0.9-4.5) and CH (RR=2.8, 95% CI, 1.0-7.9) were substantially lower and only slightly higher than the progression risk for DPEM. The higher progression risks for AH could foster management guidelines based on markedly different progression risks for atypical vs non-atypical EH.

Reproductive risk factors for endometrial cancer among Polish women

We conducted a population-based case-control study of reproductive factors in Warsaw and Lódź, Poland, in 551 incident endometrial cancer cases and 1925 controls. The reproductive variable most strongly related to risk was multiparity, with subjects with three or more births having a 70% lower risk than the nulliparous women. The reduced risk was particularly strong below 55 years of age. Subjects with older ages at a first birth were also at reduced risk even after adjustment for number of births. Ages at last birth or intervals since last birth were not strongly related to risk. Spontaneous abortions were unrelated to risk, but induced abortions were associated with slight risk increases (odds ratios=1.28, 95% confidence intervals 0.8-2.1 for 3+ vs no abortions). The absence of effects on risk of later ages at, or short intervals since, a last birth fails to support the view that endometrial cancer is influenced by mechanical clearance of initiated cells. Alternative explanations for reproductive effects should be sought, including alterations in endogenous hormones.

Condom use with steady and casual partners in inner city African-American communities

OBJECTIVES

This study examined rates of and factors associated with consistent condom use with steady partner and with casual partners in inner city African-American communities with high sexually transmitted infection (STI) prevalence.

METHODS

Structured interviews were conducted using street intercept methods and venue based sampling with 997 African-American residents of inner city neighbourhoods in Houston and Dallas, Texas; of which data were analysed for the 736 that reported having sex in past 2 months. Condom use was measured as a proportion of use in last five sex acts with steady and casual partners.

RESULTS

Reported rates of consistent condom use were high-31.4% with steady partner and 29.5% with casual partner. Multivariate logistic models differed by type of partner. Married people and those with history of STI were less likely to use condoms with the main partner, while older people were less likely and males, and those visiting a doctor more likely to use condoms with casual partners.

CONCLUSIONS

The proportion of condom use with both partner types was relatively high reflecting a general trend towards increased condom use in the United States. The finding of lower reported rates with casual partners has been discussed. Factors associated with condom use differ according to type of partner. Precise measurement of actual condom use continues to be an elusive task but is required for the design of appropriate messages and evaluation of STI programmes.

Established breast cancer risk factors by clinically important tumour characteristics

Breast cancer is a morphologically and clinically heterogeneous disease; however, it is less clear how risk factors relate to tumour features. We evaluated risk factors by tumour characteristics (histopathologic type, grade, size, and nodal status) in a population-based case-control of 2386 breast cancers and 2502 controls in Poland. Use of a novel extension of the polytomous logistic regression permitted simultaneous modelling of multiple tumour characteristics. Late age at first full-term birth was associated with increased risk of large (> 2 cm) tumours (odds ratios (95% confidence intervals) 1.19 (1.07-1.33) for a 5-year increase in age), but not smaller tumours (P for heterogeneity adjusting for other tumour features (Phet) = 0.007). On the other hand, multiparity was associated with reduced risk for small tumours (0.76 (0.68-0.86) per additional birth; Phet = 0.004). Consideration of all tumour characteristics simultaneously revealed that current or recent use of combined hormone replacement therapy was associated with risk of small (2.29 (1.66-3.15)) and grade 1 (3.36 (2.22-5.08)) tumours (Phet = 0.05 for size and 0.0008 for grade 1 vs 3), rather than specific histopathologic types (Phet = 0.63 for ductal vs lobular). Finally, elevated body mass index was associated with larger tumour size among both pre- and postmenopausal women (Phet = 0.05 and 0.0001, respectively). None of these relationships were explained by hormone receptor status of the tumours. In conclusion, these data support distinctive risk factor relationships by tumour characteristics of prognostic relevance. These findings might be useful in developing targeted prevention efforts.

Effect of chitosan on lipid levels when administered concurrently with atorvastatin--a placebo controlled study

In a placebo controlled trialthe lipid lowering effects of chitosan, a unique dietary fibre, was assessed when given along with atorvastatin 10 mg in patients with chronic coronary heart disease. Altogether 100 patients were studied. They were randomly allocated in two groups of 50 patients each. Patients of group A received atorvastatin 10 mg before dinner plus 2 g/day chitosan in two divided doses. The groupB patients received atorvastatin 10 mg plus placebo. Patients were followed up for a period of 6 weeks. There was significant reduction in mean body weight in group A patients (3.14% versus 1,29% of body weight, p<0.05). There was also a significant rise in HDL cholesterol value (3.8% versus 1.07%, p=0.02) in group A patients. However, there was no significant reduction in the mean values of total cholesterol, LDL cholesterol and triglyceride in the two groups, although group A patients showed marginally lower values.

Use of unqualified practitioners by disabled people in rural Bangladesh

This community-based study examines health care seeking strategies with respect to types of practitioners consulted by disabled persons in rural Bangladesh. A primary health care specialist collected the data through household surveys. The study found that 81% of the disabled people had sought some forms of care from various health practitioners. Unqualified practitioners were found to be strongly involved (96%) in providing health care in this area. Persons with learning difficulties, speech difficulties, fits and strange behavior were more likely to seek treatment from unqualified practitioners. Mean delay and cost of treatment were significantly higher among the qualified practitioners than the unqualified practitioners. Visits to universally free public or government health care facilities were characterized as frustrating, inconvenient, time-consuming and less rewarding for disabilities by 34% of the disabled people. Further examination of the plurality of providers and practitioners in rural Bangladesh is warranted to see how best they can be used or re-trained to respond to the health care needs of disabled persons.

Beliefs, sexual behaviours and preventive practices with respect to HIV/AIDS among commercial sex workers in Daulatdia, Bangladesh

OBJECTIVES

Despite the rising prevalence of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) since 1994 in Bangladesh, the World Bank found the epidemic to be preventable provided vigorous and prompt action is taken. High-risk heterosexual contact, especially among commercial sex workers (CSWs), is a major mode of transmission. Formulation of relevant and effective prevention programmes for HIV/AIDS requires better understanding of the knowledge, attitudes, behaviours and practices in the high-risk groups.

STUDY DESIGN AND METHODS

A cross-sectional survey comprising face-to-face interviews using a structured questionnaire with items on knowledge, beliefs, condom use and other sexually transmitted diseases (STDs).

SETTINGS

In total, 300 CSWs were interviewed between July and October 2000 in Daulatdia brothel. Daulatdia is one of the largest river ports in Bangladesh.

RESULTS

Although most CSWs had heard of AIDS, correct knowledge of transmission and symptoms was lacking. HIV/AIDS was viewed as a remote threat, over-ridden by immediate economic and survival concerns. Although the majority of CSWs knew that condoms afforded protection against STDs/AIDS, only one-third of sex acts on the last day of work were protected through condom use. CSWs who were married, had been a CSW for less than 5 years, were with a new client, or had two or more clients in last working day reported significantly higher condom use. Client dissatisfaction was the major reason for not using condoms. Many did not obtain treatment for STDs in a timely fashion, if at all.

CONCLUSIONS

Bangladesh needs a comprehensive HIV programme that combines clinical and screening measures with behaviour change and communication interventions, along with change in social norms and attention to the rights of CSWs in order to avert a widespread epidemic.

Carotid intima media thickness: an independent marker for assessment of macrovascular risk in diabetic patients

In view of the global epidemic of diabetes with India being the hottest reservoir of the disease, it was tried to identify carotid intima media thickness as a surrogate marker for atherosclerosis in diabetic subjects. The study becomes more relevant because diabetes is now considered a disease of the endothelium and a risk equivalent of coronary atherosclerosis (paradigm shift). The study incorporated 41 normotensive patients of diabetes and 31 age and sex matched controls. Plasma glucose and lipid profiles were assessed in all and the carotid intima media thickness was measured. Results were statistically analysed for significance and correlation coefficient between values of plasma glucose and carotid intima media thickness. Results clearly showed that carotid intima media thickness abnormality can pick up atherosclerosis even if the lipid parameters are nearly normal. So it crystallises from this small study that, as a non-invasive test carotid intima media thickness is a better and early predictor of atherosclerosis in diabetic subjects. It also revealed the linear relationship between both fasting and postprandial blood sugar with carotid intima media thickness.

Predictive efficacy of Framingham's risk score in Indian scenario--a retrospective case-control study

To assess the predictive ability of Framingham's risk score in primary prevention in our population, 252 cases and 212 age and sex matched controls were taken up for study. Those patients, who were presenting for the first time with acute coronarysyndrome (ACS) and who did not have any prior manifestations of coronary artery disease (CAD) and whose medical records were available formed the patient group. Framingham's risk score was calculated and the corresponding 10 years risk was assessed in each of them. The patients and controls were divided into two groups--diabetic and non-diabetic. Depending on the 10 years risk, they were further grouped into high risk (10 years risk > 20%), moderately high risk (10 years risk 10 to 20%) and low risk (10 years risk less than 10%). Results were compared and statistically analysed. In the diabetic patients with ACS 14% would have qualified as high risk, 33% as moderately high risk and 53% as low risk whereas in diabetic patients without any manifestation of CAD the distribution was 4% in the high risk, 54% in the moderately high risk and 42% in the low risk. In the non-diabetic subjects, amongst the patients of ACS, 20% would have been in high risk, 39% in moderately high risk and 41% in the low risk. The corresponding figures in the non-diabetic control subjects were 10% in high risk, 22% in the moderately high risk and 68% in the low risk. In the non-diabetic subjects, the mean risk was significantly more in patients than in controls (14.15% versus 8.61%, p <0.01). However, in the diabetic patients there was no significant difference in the mean projected risk between patients with ACS and patients without any manifestation of CAD (11.37% versus 10.41%, p>0.05).