The association between osteoporotic hip fractures and actinic lesions as a biomarker for cumulative sun exposure in older people-a retrospective case-control study in Argentina

The aim of this study was to analyze the association between the presence of actinic lesions (solar keratosis and non-melanoma skin cancer) and osteoporotic hip fractures in older patients. Both pathologies are common conditions in this age group. Since cumulative sun exposure is difficult to quantify, the presence of actinic lesions can be used to indirectly analyze the association between ultraviolet radiation and osteoporotic hip fractures. This was an observational case-control study. We reviewed the centralized medical records of patients with hip fracture (cases, n = 51) and patients with other diseases hospitalized in the same institution and period (controls, n = 59). The mean age of the patients was 80 ± 8.3 years (range 50-103 years). Differences in maternal hip fracture history were found between cases and controls (14.8 and 8 %, respectively; p = 0.047). Falls history in the past year was higher in cases than in controls (p < 0.0001). Actinic lesions were observed in 32.7 % of patients (prevalence rate 23.5 % in cases, 40.7 % in controls; p = 0.04). When considering patients with actinic lesions, controls have a higher FRAX score compared with cases. Although sun exposure is recommended for bone health, it represents a risk factor for actinic lesions. The presence of actinic lesions may indicate a lower osteoporotic hip fracture risk. A balance between adequate lifetime sun exposure and protection against its adverse effects is required for each patient, in the context of geographic location.

Abstract P3-07-61: Predictors of response and follow up biomarkers for metronomic chemotherapy with cyclophosphamide and celecoxib in advanced breast cancer patients

Low-dose metronomic chemotherapy (MC) with Cyclophosphamide (Cy) and Celecoxib (Cel) has demonstrated to be effective and well-tolerated in advanced breast cancer patients (ABCP) but predictive markers of response or follow-up are lacking. Given the antiangiogenic properties of MC we analyzed several angiogenesis-related biomarkers and evaluated their potential role as predictors of response or treatment follow-up of ABCP treated with MC. Treatment plan: Patients received Cy 50 mg p.o./day + Cel 200 mg p.o./ bid. Cellular parameters: Circulating endothelial cells (CEC) and Circulating progenitor endothelial Cells (CEP) were determined by Flow Cytometry. Serologic parameters: Serum levels of vascular endothelial growth factor (VEGF), VEGF-C, soluble VEGF Receptors 2 and 3 (sVEGFR-2, sVEGFR-3) and Thrombospondin-1 (TSP-1) were determined by ELISA. Blood samples were collected before and during treatment. Twenty patients were enrolled. Response Rate was 5% and Clinical Benefit (CB) 55%. Most of the patients showed prolonged stable disease (SD≥24 weeks). Biomarkers were determined in all patients. Levels of CEC and CEP showed no clear trend variations during treatment. However, levels of CEC significantly increased at the time of disease progression in those patients who showed CB (P=0.014). Also baseline values of CEC and CEP showed marginally significant associations withTime To Progression. Serum VEGF concentration decreased during treatment (P=0.050) while sVEGFR-2 increased (P=0.005). VEGF-C, sVEGFR-3 and TSP-1 showed non-significant variations. VEGF/sVEGFR-2 ratio decreased during treatment (P=0.041), whereas VEGF/TSP-1, and VEGF-C/sVEGFR-2 ratios showed non-significant variations. Baseline values of VEGF, and VEGF/sVEGFR-2 showed negative and significant associations with TTP (P=0.0354 and P=0.0300, respectively) while sVEGFR-2 did not. When considering the two variables together, the goodness of prediction was not improved. To confirm the value of baseline VEGF and VEGF/sVEGFR-2 as predictors of response, we used the 50th percentile as a cutoff value to analyze the % of progression free survival. Patients with values lower than the 50th percentile for both biomarkers showed longer TTP (P=0.0001 and P=0.0008, respectively). The treatment had anti-angiogenic effect (VEGF decrease and sVEGFR-2 increase). The absence of variation in VEGF-C and sVEGFR-3 would indicate the lack of effect on lymphangiogenesis. Increased levels of CEC could be useful for detecting progression. If confirmed with a higher number of patients, baseline VEGF and VEGF/sVEGFR-2 values could be useful as early predictors of response.

Citation Format: Perroud HA, Alasino CM, Rico MJ, Menacho-Marquez MA, Mainetti LE, Queralt F, Pezzotto SM, Rozados VR, Scharovsky G. Predictors of response and follow up biomarkers for metronomic chemotherapy with cyclophosphamide and celecoxib in advanced breast cancer patients. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-07-61.

Emerging therapy in arthritis: Modulation of markers of the inflammatory process

The induction of tolerance has been proposed as a therapeutic strategy for arthritis aiming to decrease progression of the pathology, probably by promoting suppressor mechanisms of the autoimmune response. This work aimed to confirm whether the treatment with vitamin D3 could synergize oral tolerance induced by hydrolyzed collagen peptides, in our experimental model of antigen induced arthritis in New Zealand rabbits. Clinical observation of the phenomenon indicates that simultaneous treatment with hydrolyzed collagen peptides and vitamin D3 was beneficial when compared with no treatment, for arthritic animals, and for arthritic animals that received treatment with only hydrolyzed collagen peptides or vitamin D3. Treatment with hydrolyzed collagen peptides caused diminished proinflammatory cytokine levels, an effect synergized significantly by the simultaneous treatment with vitamin D3. The anatomical-pathological studies of the animals that received both treatments simultaneously showed synovial tissues without lymphocytic and plasma cell infiltrates, and without vascular proliferation. Some of the synovial tissue of the animals of these groups showed a slight decrease in Galectin-3 expression. We propose that simultaneous oral treatment with vitamin D3 and hydrolyzed collagen peptides could increase the immunoregulatory effect on the process of previously triggered arthritis. We used articular cartilage hydrolysate and not collagen II because peptides best expose antigenic determinants that could induce oral tolerance. Oral tolerance may be considered in the design of novel alternative therapies for autoimmune disease and we have herein presented novel evidence that the simultaneous treatment with vitamin D3 may synergize this beneficial effect.

A nested case-control study on dietary fat consumption and the risk for gallstone disease

BACKGROUND

Gallstone disease (GD) incidence and prevalence rates differ between populations. Diet and lifestyle may be involved in GD development. To our knowledge, no study to date has evaluated quantitative data on diet when studying the relationship between fat consumption levels and GD in an Argentinean population. The present study aimed to assess the association between dietary fat intake and GD.

METHODS

A nested case-control study design was applied. Data were taken from subjects who participated in a previous cross-sectional study carried out in a random sample of asymptomatic people in Rosario, Argentina. Participants underwent a personal interview, and current weight and height, ancestor's ethnicity, and socio-economic status were recorded. Applying a food-frequency questionnaire and a food photography atlas, quantitative dietary data were estimated by combining the intake frequency, portion size and food composition. Logistic regression analysis was used to compute odds ratios and 95% confidence intervals adjusted by age, sex, ancestor's ethnicity, body mass index and daily total energy intake as potential confounders.

RESULTS

In total, 114 patients were studied (49 cases and 65 controls), without any statistically significant differences for age, sex, socio-economic status, body mass index and ancestry. The mean energy intake was higher in cases than in controls, and significant differences were found for dietary fat consumption. Obese or overweight people have a higher GD risk than subjects with normal weight. Increased GD risks were associated with high intakes of energy, total fat, and saturated and monounsaturated fatty acids.

CONCLUSIONS

According to our results, total fat, saturated and monounsaturated fatty acids high intakes are associated with increased GD risk.

Association between baseline VEGF/sVEGFR-2 and VEGF/TSP-1 ratios and response to metronomic chemotherapy using cyclophosphamide and celecoxib in patients with advanced breast cancer

BACKGROUND

Metronomic chemotherapy (MCT) with cyclophosphamide (Cy) and celecoxib (Cel) has therapeutic efficacy and low toxicity profile in advanced breast cancer patients (ABCP), but no reliable biomarkers of response have been found yet that allow patient selection for treatment.

AIM

To investigate the potential role as biomarkers of pro- and antiangiogenic parameters and evaluate their response in ABCP receiving metronomic Cy 50 mg p.o./day + Cel 400 mg p.o./day.

MATERIALS AND METHODS

Serum levels of vascular endothelial growth factor-C (VEGF-C), soluble VEGF receptors 2 and 3 (sVEGFR-2, sVEGFR-3), were measured at different time points in 13/15 patients included in a phase II trial of MCT with Cy+Cel.

RESULTS

Serum levels of sVEGFR-2 and sVEGFR-3 increased significantly during treatment (P = 0.0392; P = 0.0066, respectively). VEGF-C showed no significant modifications. Previous determinations of VEGF and TSP-1 in the same patients were utilized. VEGF/sVEGFR-2, VEGF/TSP-1, and VEGF-C/sVEGFR-3 ratios decreased significantly along the treatment (P = 0.0092; P = 0.0072; P = 0.0141, respectively). Nonsignificant variations were observed for VEGF-C/sVEGFR-2 ratio. Baseline values of VEGF/sVEGFR-2 and VEGF/TSP-1 ratios were associated with time to progression (TTP) (P = 0.0407; P = 0.0394, respectively) meanwhile baseline VEGF was marginally significant (P = 0.0716). Patients with values lower than the 50th percentile for both ratios showed longer TTP.

CONCLUSIONS

We have identified the baseline VEGF/sVEGFR-2 and VEGF/TSP-1 ratios as potential biomarkers of response in ABCP treated metronomically with Cy+Cel. This finding warrants its confirmation in a higher number of patients.

[C-reactive protein as a marker of mortality in intensive care unit]

OBJECTIVE

To determine C-reactive protein (CRP) prognostic value and in patients admitted to the intensive care unit (ICU).

DESIGN

Retrospective cohort study.

PATIENTS

A total of 879 patients admitted to the ICU for any cause over a 2-year period and who were hospitalized at least for 24 hours were studied.

METHOD

CRP levels were determined on admission and the value of the APACHE II score at 24 hours. The CRP values were correlated with APACHE II score along with other variables (gender, age, disease at onset, length of stay).

RESULTS

The highest CRP levels were those from subjects admitted for an infectious disease or shock-sepsis-multiple organ failure. Patients with CRP values greater than 10 mg/dl were older, had higher APACHE II score, remained hospitalized for more time and the mortality rate was higher in this group (p < 0.0001). CRP predictive value for mortality was higher as it increased in level with a specificity of 72.3% when these were over 10 mg/dl.

CONCLUSIONS

CRP is an early and specific indicator of outcome, qualities that make it useful as a routine test of patients at admission to the ICU.

[Food habits and caries experience in young adults from Rosario, Argentina]

Odontological assistance in Rosary City is offered in private and public services. The public ones lack programs to avoid dental loss in adults. Our aim was to describe the caries experience and dietetic habits in three sub-populations of young adults. Applying a standardized anamnesis, 517 patients, both sexes, 15-45 years old, attending to a private service (19%) and two public ones (81%), were investigated. Studied variables: oral health, lacteal and sweet food consumed, and instruction level. Student t-test, ANOVA and chi-square tests were applied. Average decayed teeth were 1.7+/-2.0 in the private service, and 4.1+/-2.8 in the public ones (p<0.0001); missing teeth were 5.4+/-5.2 and 6.8+/-5.4 (p=0.04); and filled teeth were 4.4+/-4.2 and 1.3+/-2.2, respectively (p<0.0001). Dairy foods daily consumption was higher in the private service (p<0.001). Patients in the public services expressed to replace milk by mate, and to relate its consumption with pregnancy and lactation, or to leave it for children. Sweets delicacies consumed in the private sector -considered of risk- were sweet breads, cakes, cookies and sweets, and in the public ones were soft candies, "alfajores" and sweet made with milk. Minor risk sweets consumption in private patients were ice creams, sodas and chocolates, and in the public ones, hard candies and chewing gums, with and without sugar. Although a high number of patients consume delicacies and sweet foods at any hour, private patients were a minority; and they were a majority when considering its ingestion only after a food.

Morphological and demographic associations of biliary symptoms in subjects with gallstones: findings from a population-based survey in Rosario, Argentina

BACKGROUND

Gallstone disease is a frequently encountered disorder in subjects living in Rosario. The reasons for the presence or absence of symptoms are unknown.

AIMS

To determine associations between biliary symptoms and ultrasonographic features of gallbladder and gallstones.

SUBJECTS

A random study was conducted on 1,173 subjects, inhabitants of 20 years and older, in the city of Rosario, Argentina.

METHODS

High-resolution abdominal ultrasound examinations were performed. Biliary pain was defined based on previously published definitions.

RESULTS

Gallstones were found in 149 subjects (101 female, 48 male) of whom 51% of females and 35% of males with cholelithiasis were symptomatic. Mean age was 53 years in symptomatic and 55 in asymptomatic subjects. Gallbladder size was normal in 97% of symptomatic and in 96% of the asymptomatic participants. There were no significant differences between the groups as far as concerns size and gallstone number. Impacted stones were observed in 10% of symptomatic and in none of the asymptomatic subjects (p<0.01).

CONCLUSIONS

Subjects' age and gender, gallstones size and number, as well as ultrasonographic features of gallbladder and biliary tract did not differ significantly between symptomatic and asymptomatic subjects. Only impacted stones were significantly more frequent in symptomatic subjects.

Epidemiology of gallstone disease in Argentina: prevalences in the general population and European descendants

To assess gallstone disease prevalence in Argentina, a random sample of the Rosario City population was studied, considering already known associated factors, and analyzing ethnic groups living in the city. A total of 1,173 participants (69% response), both sexes, 20 years and older were studied. Each subject underwent an abdominal ultrasound examination, a blood test, and a standardized questionnaire. It was seen that gallstone disease prevalence (gallstones or cholecystectomy), overall was 20.5% (23.8% in women and 15.5% in men; (P = 0.0005), and was associated with age and body mass index in both sexes, and with pregnancy number and hypertriglyceridemia in women. As regards ancestors' nationalities, Italian and Spanish descendants presented higher prevalence rates for all age groups than those described in Italy and Spain. Thus far, in a subsample of 78% of nonparticipants submitted to a new home visit, presence of cholecystectomy or symptoms did not differ from participants, supporting the validity of our results.

Occupation and histopathology of lung cancer: A case-control study in Rosario, Argentina

BACKGROUND

Male age-adjusted lung cancer mortality rate is high in Rosario City, Argentina (62.7 per 100,000).

METHODS

Case-control study involving interviews with 367 male lung cancer patients and 576 controls.

RESULTS

The histological distribution detected was: squamous cell 39%, adenocarcinoma 34%, small cell carcinoma 13%, and other or no specified cell type 14%. When comparing with the group unlikely to be exposed to occupational carcinogens, a 60% increase in risk was observed for the remaining occupations (P < 0.008). Risks were high for drivers (OR=1.9, CI: 1.1-4.0), construction (OR=2.5, CI: 1.0-5.9), and agricultural workers also (OR=1.8, CI: 1. 1-3.1). In regard to squamous cell carcinoma, increased risks were observed in the metal industry, particularly in welders (OR=2.9, CI: 1.0-10.1) and mechanics (OR=1.8, CI: 0.9-4.2). Smoking was not a substantial confounding effect.

CONCLUSIONS

Occupational exposures partly account for the high lung cancer mortality rate among male residents of Rosario City.

Irritable bowel syndrome: clinical and psychopathological correlations

Irritable bowel syndrome is a common disorder in gastroenterology consultations. Our objectives were to assess patients' psychic functioning, the relationships between psychopathology and pain, the degree of psychopathology in constipated and diarrheic subgroups, and if previous abdominal surgery was related to pain intensity. Forty-five gastroenterological outpatients, both sexes, were studied. Patients were grouped as predominantly constipated, predominantly diarrheic, or alternating constipation and diarrhea. After diagnosis, patients had: Psychologist half-guided interviews, Bender Visuomotor Gestalt Test, Hammer Graphic Tests, and Rorschach Psychodiagnostic Tests. The last one showed that 78% suffered from distortion in reality perception; 100% thought away from reality and had a deficit in organizing capability, synthesis, and integration. Within psychological gnosiology, these patients would be diagnosed as borderline personalities and this would imply an overlapping of neurotic and psychotic functioning. Affective vulnerability and overadjustment to environment were found, and this finding is an original one to the best of our knowledge.

Outcome of hip fractures among elderly subjects

This paper reports a retrospective study (1979-1995) on 200 patients (154 women and 46 men), 50-101 years old, who received medical attention because of unilateral hip fracture. Nine women and four men fractured twice. In 75% of women and 90% of men, surgery was carried out between one and five days after fracture. A non significant greater proportion of women (14/154) than men (6/46) died in the first year after injury (chi 2 = 3.459, P = 0.062). Survival was assessed using Cox proportional hazards model. Survival was a function of age (P = 0.000) and sex (P = 0.008). After adjustment to a common mean age (79 years), the median survivals for men and women were 3.9 and 8.4 years, respectively. Controlled concurrent life-threatening diseases, the kind of fracture [medial (subcapital and transcervical) or lateral (inter- and subtrochanteric)] and the type of prosthesis (total/partial articulation replacement) had no significant impact on survival. No differences in evolution were observed: 80% returned to their ambulatory status before injury, 8.5% required walking aids and 5.5% could not walk. The overall information afforded by this study suggests that with worldwide improvement of hip fracture outcome, the cost/effectiveness of surgical treatment of hip fracture may become, from the standpoint of public health investment, a favorable alternative with respect to cost/effectiveness of prevention-treatment measures.

Variation in smoking-related lung cancer risk factors by cell type among men in Argentina: a case-control study

A high mortality rate for lung cancer (62.7 per 100,000) is found in Rosario, Argentina. To investigate the reasons for this high rate, a case-control study was carried out among 215 male cases with histologically confirmed lung cancer and 433 hospitalized controls for conditions unrelated to tobacco consumption. Odds ratios (OR) of squamous cell (SQ), adenocarcinoma (AD), and small cell (SM) carcinoma of the lung associated with different characteristics of the smoking habit were quantified. Ninety-eight percent of the cases had smoked regularly. Smokers were significantly younger at diagnosis than ex-smokers (P < 0.0001), a pattern consistent for all cell types. The ORs for the heaviest cf the lowest consumption categories were 15.3 for SQ, 11.6 for AD, and 11.6 for all lung cancer (P < 0.0001). Risks associated with the use of unfiltered cigarettes were three to five times higher than those for filtered cigarettes, depending on cell types. For ex-smokers, risks after 10 years of nonsmoking were about 12 times lower than those of current smokers (P < 0.001). To halt further increases in lung cancer, preventive measures in Argentina should be directed primarily towards smoking control.

[Prevalence of smoking in young people and their parents. Important associations with education and occupation]

Rosario, with a million inhabitants, is the second major urban concentration in Argentina and serves as the commercial and industrial center for a large area. In view of the lack of information on the present prevalence of smoking in this area as for the country as a whole, a study was performed on random samples of young people and university students of medicine and economics, as well as on their parents. Information was obtained on their life smoking habits, education and occupation. The prevalence of the habit was higher: a) in men, both in the youngsters and their parents; b) in medical students than in those of the economic sciences; c) in parents with university education. The smoking habit of these subjects and parents was highly associated (p less than 0.001) in the sample of young people, although no association was found between the prevalence of smoking among university students and their parents. Peer smoking was the main factor influencing the onset of cigarette smoking given by 69% of the subjects. Knowledge of specific adverse health effects of smoking was poor. Attitudes toward restrictive measures were highly associated (p less than 0.001) with the non-smoker category. Based on these findings, we conclude that while there is a need for educational programs for the population in general, the university as a whole and specifically the school of medicine should implement a program to increase knowledge and awareness on this public health problem.