Is there a preferred platinum and fluoropyrimidine regimen for advanced HER2-negative esophagogastric adenocarcinoma? Insights from 1293 patients in AGAMENON-SEOM registry

BACKGROUND

The optimal chemotherapy backbone for HER2-negative advanced esophagogastric cancer, either in combination with targeted therapies or as a comparator in clinical trials, is uncertain. The subtle yet crucial differences in platinum-based regimens' safety and synergy with combination treatments need consideration.

METHODS

We analyzed cases from the AGAMENON-SEOM Spanish registry of HER2-negative advanced esophagogastric adenocarcinoma treated with platinum and fluoropyrimidine from 2008 to 2021. This study focused exclusively on patients receiving one of the four regimens: FOLFOX (5-FU and oxaliplatin), CAPOX (capecitabine and oxaliplatin), CP (capecitabine and cisplatin) and FP (5-FU and cisplatin). The aim was to determine the most effective and tolerable platinum and fluoropyrimidine-based chemotherapy regimen and to identify any prognostic factors.

RESULTS

Among 1293 patients, 36% received either FOLFOX (n = 468) or CAPOX (n = 466), 20% CP (n = 252), and 8% FP (n = 107). FOLFOX significantly increased PFS (progression free survival) compared to CP, with a hazard ratio of 0.73 (95% CI 0.58-0.92, p = 0.009). The duration of treatment was similar across all groups. Survival outcomes among regimens were similar, but analysis revealed worse ECOG-PS (Eastern Cooperative Oncology Group-Performance Status), > 2 metastatic sites, bone metastases, hypoalbuminemia, higher NLR (neutrophil-to-lymphocyte ratio), and CP regimen as predictors of poor PFS. Fatigue was common in all treatments, with the highest incidence in FOLFOX (77%), followed by FP (72%), CAPOX (68%), and CP (60%). Other notable toxicities included neuropathy (FOLFOX 69%, CAPOX 62%), neutropenia (FOLFOX 52%, FP 55%), hand-foot syndrome in CP (46%), and thromboembolic events (FP 12%, CP 11%).

CONCLUSIONS

FOLFOX shown better PFS than CP. Adverse effects varied: neuropathy was more common with oxaliplatin, while thromboembolism was more frequent with cisplatin.

Importance of cardiac imaging assessment of epicardial adipose tissue after a first episode of myocardial infarction

BACKGROUND

Over the past years, information about the crosstalk between the epicardial adipose tissue (EAT) and the cardiovascular system has emerged. Notably, in the context of acute myocardial infarction (AMI), EAT might have a potential role in the pathophysiology of ventricular structural changes and function, and the clinical evolution of patients. This study aims to assess the impact of EAT on morpho-functional changes in the left ventricle (LV) and the outcome of patients after an AMI.

METHODS

We studied prospectively admitted patients to our hospital with a first episode of AMI. All patients underwent percutaneous coronary intervention (PCI) during admission. Transthoracic echocardiography (TTE) was performed within 24-48 h after PCI, as well as blood samples to assess levels of galectin-3 (Gal-3). Cardiac magnetic resonance (CMR) was performed 5-7 days after PCI. Clinical follow-up was performed at 1 and 5 years after MI.

RESULTS

Mean age of our cohort (n = 41) was 57.5 ± 10 years, and 38 (93%) were male. Nine patients had normal BMI, 15 had overweight (BMI 25-30), and 17 were obese (BMI > 30). Twenty three patients (56%) had ≥ 4 mm thickness of EAT measured with echo. In these patients, baseline left ventricular ejection fraction (LVEF) after AMI was significantly lower, as well as global longitudinal strain. EAT thickness ≥ 4 m patients presented larger infarct size, higher extracellular volume, and higher T1 times than patients with EAT < 4 mm. As for Gal-3, the median was 16.5 ng/mL [12.7-25.2]. At five-year follow-up 5 patients had major cardiac events, and all of them had EAT ≥ 4 mm.

CONCLUSIONS

Patients with EAT >4 mm have worse LVEF and GLS, larger infarct size and longer T1 values after a MI, and higher levels of Gal-3. EAT >4 mm was an independent predictor of MACE at 5-year follow-up. EAT thickness is a feasible, noninvasive, low-cost parameter that might provide important information regarding the chronic inflammatory process in the myocardium after an infarction.

Prognostic value of computed tomography pulmonary angiography indices in patients with cancer-related pulmonary embolism: Data from a multicenter cohort study

OBJECTIVE

To analyze the prognostic value of pulmonary artery obstruction versus right-ventricle (RV) dysfunction radiologic indices in cancer-related pulmonary embolism (PE).

METHODS

We enrolled 303 consecutive patients with paraneoplastic PE, evaluated by computed tomography pulmonary angiography (CTPA) between 2013 and 2014. The primary outcome measure was serious complications at 15days. Multivariate analyses were conducted by using binary logistic and robust regressions. Radiological features such as the Qanadli index (QI) and RV dysfunction signs were analyzed with Spearman's partial rank correlations.

RESULTS

RV diameter was the only radiological variable associated with an adverse outcome. Subjects with enlarged RV (diameter>45mm) had more 15-day complications (58% versus 40%, p=0.001). The QI correlated with the RV diameter (r=0.28, p<0.001), left ventricle diameter (r=-0.19, p<0.001), right ventricular-to-left ventricular diameter ratio (r=0.39, p<0.001), pulmonary artery diameter (r=0.22, p<0.001), and pulmonary artery/ascending aorta ratio (r=0.27, p<0.001). A QI≥50% was only associated with 15-day complications in subjects with enlarged RV, inverted intraventricular septum, or chronic cardiopulmonary diseases. The central or peripheral PE location did not affect the correlations among radiological variables and was not associated with clinical outcomes.

CONCLUSIONS

Right ventricular dysfunction signs in CTPA are more useful than QI in predicting cancer-related PE outcome.

Circulating endothelial progenitor cells and erectile dysfunction: possibility of nutritional intervention?

To provide an overview of molecular and cellular processes involved in erectile dysfunction (ED) with emphasis on circulating endothelial progenitor cells (EPC) and discuss possible nutraceutical means of intervention. A review of literature on Pubmed related to EPC and ED was conducted. Patients with ED appear to possess a reduced number of circulating EPC, which is associated with poor endothelial function possibly as a result of underlying low-grade inflammation. Several studies support the possibility of improving erectile function by inhibition of inflammation as well as administration of various stem cell types. One particularly interesting approach is nutraceutical supplementation to increase circulating EPC, as demonstrated in the product Stem-Kine. Interventions aimed at increasing circulating EPC may have potential in treatment of vascular ED.

Retinal Morphology and Electrophysiology of Two Caprimulgiformes Birds: The Cave-Living and Nocturnal Oilbird (Steatornis caripensis), and the Crepuscularly and Nocturnally Foraging Common Pauraque (Nyctidromus albicollis)

Oilbirds (Steatornis caripensis) breed in the total darkness of caves and forage at night on fruits. Common pauraques (Nyctidromus albicollis) are crepuscular and nocturnal foragers on flying insects. We examined if their retinal structure and function can be correlated with their types and periods of activity. Electroretinograms (ERGs) were obtained from anesthetized birds in photopic and scotopic conditions to a wide range of light intensities, following which the retinas were processed for histological analysis. Retinal sensitivity is higher in oilbirds than in common pauraques. Under scotopic conditions with maximum flash luminance, the average (+/- 95% CI) b-wave amplitude of oilbirds is double that of common pauraques (500.4 +/- 49.8 and 245.4 +/- 40.9 microV, respectively) but, under photopic conditions, the results are the reverse (common pauraque: 69.4 +/- 18.1; oilbird: 23.0 +/- 4.4 microV). On the other hand, the retina of both species is highly rod-dominated, but rods are highly more numerous in oilbirds than in common pauraques (rods:cones ratio: 123:1 and 5:1, respectively). In oilbirds, rods are largely thinner and their outer segments are 1.0 microm in diameter and 18.6 microm in length. They are distributed over various levels in the photoreceptor layers, an arrangement known for deep-sea fishes, but so far unknown for birds. In common pauraques, rods are patchily distributed and their outer segments are 4.0 microm in diameter and 53 microm in length. The oilbirds rod thinness allows more rods per area unit, and thus to catch more photons per area unit under darkness, while the low cone number suggests that the species has poor daytime vision, which concurs with the species cavernicolous daytime habits. The lower rod number of common pauraques, compared to oilbirds, appears counterbalanced by their patchiness and longer and thicker outer segments to provide high retinal sensitivity. In addition, common pauraques also have a tapetum. These features, combined with a higher proportion of cones, show that common pauraques are well equipped for crepuscular and nocturnal foraging on flying insects in an open environment.

Factor variability of the Center for Epidemiological Studies Depression Scale (CES-D) among urban Latinos

Establishing comparable measurement properties across different populations or in different population subgroups is a crucial yet often neglected step in instrument development. Failure to have comparable factor structures across groups makes any comparison between groups suspect. Previous analyses of the measurement structure of the Center for Epidemiologic Studies Depression Scale (CES-D) in diverse racial/ethnic populations have resulted in conflicting results. In the present analysis, data from three studies of urban Latinos (N = 1,403) were analyzed using structural equation modeling techniques to (1) fit the original four-factor solution separately in men and women; (2) evaluate configural and metric invariance between men and women; and (3) evaluate the mediating effects of age and acculturation on the fit of this model to the data. Results indicated that the four-factor model proposed by Radloff provided adequate fit to the data for Latina women when age and acculturation were included in the model. The four-factor model did not fit the data for Latino men; thus tests of configural and metric invariance across these two groups failed. We conclude that the CES-D may not measure the same constructs in Latino men and women and that further evaluation of the use of this measure in diverse populations is needed. Additionally, prior to comparison with other groups in which the four-factor solution is observed, the effects of age and acculturation should be controlled in Latinas.

A simple method to microinject solid neural tracers into deep structures of the brain

We have developed an instrument to perform microinjections of solid neural tracers into deep structures of the brain. The instrument consists of a thin hypodermic needle equipped with a movable internal rod, which is connected to a pressure chamber. When a pressure pulse is applied to the chamber, the rod moves forward and back inside the needle, pushing out a solid load previously packed inside the needle tip. By attaching a microelectrode to the instrument, it is also possible to have electrophysiological control of the injection placement. To test the instrument, we microinjected DiI and rhodamine crystals into selected structures of the visual system of pigeons. The results show small, well-defined injection sites, accurately located in the desired targets, together with well-developed anterogade and retrograde transport, selectively originated from the injection sites. This method extends the usage of solid tracers to most structures in the brain and may, in certain cases, be more advantageous than the conventional method of injecting tracer solutions.

Ethnic comparison of attitudes and beliefs about cigarette smoking

OBJECTIVE

To determine if hypothesized differences in attitudes and beliefs about cigarette smoking between Latino and non-Latino white smokers are independent of years of formal education and number of cigarettes smoked per day.

DESIGN

Cross-sectional survey using a random digit dial telephone method.

SETTING

San Francisco census tracts with at least 10% Latinos in the 1990 Census.

PARTICIPANTS

Three hundred twelve Latinos (198 men and 114 women) and 354 non-Latino whites (186 men and 168 women), 18 to 65 years of age, who were current cigarette smokers participated.

MEASUREMENTS AND MAIN RESULTS

Self-reports of cigarette smoking behavior, antecedents to smoking, reasons to quit smoking, and reasons to continue smoking were the measures. Latino smokers were younger (36.6 vs 39.6 years, p < .01), had fewer years of education (11.0 vs 14.3 years, p < .001), and smoked on average fewer cigarettes per day (9.7 vs 20.1, p < .001). Compared with whites, Latino smokers were less likely to report smoking "almost always or often" after 13 of 17 antecedents (each p < .001), and more likely to consider it important to quit for 12 of 15 reasons (each p < .001). In multivariate analyses after adjusting for gender, age, education, income, and number of cigarettes smoked per day, Latino ethnicity was a significant predictor of being less likely to smoke while talking on the telephone (odds ratio [OR] 0.41; 95% confidence interval [CI] 0.26, 0.64), drinking alcoholic beverages (OR 0.66; 95% CI 0.44, 0.99), after eating (OR 0.55; 95% CI 0.37, 0.81), or at a bar (OR 0.62; 95% CI 0.41, 0.94), and a significant predictor of being more likely to smoke at a party (OR 1.72; 95% CI 1.14, 2.60). Latino ethnicity was a significant predictor of considering quitting important because of being criticized by family (OR 1.93; 95% CI 1.26, 2.98), burning clothes (OR 1.57; 95% CI 1.02, 2.42), damaging children's health (OR 1.67; 95% CI 1.08, 2.57), bad breath (OR 2.07; 95% CI 1.40, 3.06), family pressure (OR 1.67; 95% CI 1.10, 2.60), and being a good example to children (OR 1.83; 95% CI 1.21, 2.76).

CONCLUSIONS

Differences in attitudes and beliefs about cigarette smoking between Latinos and whites are independent of education and number of cigarettes smoked. We recommend that these ethnic differences be incorporated into smoking cessation interventions for Latino smokers.

[Low energy transcatheter atrial defibrillation in one patient with refractory atrial fibrillation]

Most cases of atrial fibrillation are converted with antiarrhythmic medications or external electric defibrillation. However, in some refractory patients, an internal transcatheter defibrillation must be attempted. We report a 50 years old male with an atrial fibrillation of one year duration that was refractory to pharmacological treatment and in whom external cardioversion was unsuccessful. After the application of a bifasic shock of 10 joules between a catheter in the right atrium and another one located at the coronary sinus, the patient was converted to sinus rhythm. At two months of follow up, the patient continues in sinus rhythm.

Differential perceptions of drinkers of alcoholic beverages by Mexican-Americans and non-Hispanic whites

Random samples of 534 Mexican-Americans and 616 non-Hispanic Whites were interviewed over the telephone in San José, California and in San Antonio, Texas. Mexican-Americans tended to favor most frequently negative traits for their perceptions of drinkers than non-Hispanic Whites. Excessive drinkers were perceived most frequently in generally negative fashion by members of both ethnic groups although they were also perceived as happy persons. Highly acculturated Mexican-Americans reported perceptions of drinkers and of excessive drinkers that differed from those held by the less acculturated Mexican-Americans and that resembled those held by the non-Hispanic White respondents.

[Occlusion of interventricular septal rupture in 2 patients with an infarction]

We describe two women with interventricular septal rupture secondary to a myocardial infarction due to a total obstruction of the anterior descendent coronary artery. With the aim to stabilize the hemodynamic state of the patients before the surgical closure of the defect, we inserted a balloon-catheter introducing it to the left ventricle from the aorta and inflating it in the right ventricle after passing it through the septal orifice. After occlusion, we observed decreases in the pulmonary to systemic blood flow ratio (6% in one patient and 26% in the other) and in the arteriovenous blood flow shunt (8 and 31%); a 10% systemic blood flow increase was observed in one patient. Since the pulmonary arterial pressure did not change and the pulmonary blood flow increased, an increase of the pulmonary arterial resistance was observed but no modification of the pulmonary and systemic arterial pressure occurred. In the following days, the oxymetric differences between the pulmonary artery and the right atrium showed a tendency to remain below the figures before occlusion and the pulmonary blood flow and pressure showed a tendency to decrease. One patient died 14 days after the surgical closure of the rupture, and the other, seven days after the balloon occlusion of the rupture before any surgery. We present the physiological evolution of the patients.

Changes in reported awareness of product warning labels and messages in cohorts of California Hispanics and non-Hispanic whites

A cohort of 777 Hispanics and 234 non-Hispanic Whites were interviewed in San Francisco, California, over the telephone in 1991 and again 1 year later. Overall, both Hispanics and non-Hispanic Whites showed an increase in awareness of a general product warning label for beer and wine containers but a decrease in awareness of a product warning label for cigarettes. High- and low-acculturated Hispanics' awareness of a general product warning label increased for alcoholic beverage containers, although highly acculturated Hispanics were more aware. Both Hispanics and non-Hispanic Whites showed an increase in awareness of specific warning messages. The highly acculturated Hispanics showed more increased awareness of specific message than the less acculturated Hispanics.

Changes across 3 years in self-reported awareness of product warning messages in a Hispanic community

This study investigated the self-reported awareness of product warning messages among independent random samples of Hispanics in San Francisco surveyed from 1989 through 1992. Messages tested were primarily related to cigarette smoking and the consumption of alcoholic beverages. In general, respondents reported low levels of awareness of product warning messages with the exception of those messages dealing with the consumption of alcohol or cigarettes during pregnancy. Nevertheless, there were increases in awareness across years for the alcohol-related warning messages and for one of the cigarette messages, indicating that continued exposure increases awareness of the message. A notable proportion of the respondents reported being aware of a bogus message implying the presence of socially desirable responses in self-reports of message awareness. Gender, education, age and acculturation level of the respondents also showed effects on reported awareness of specific messages. Continued exposure to product warning messages seems useful in producing health-enhancing behaviors among Hispanics.

Expectancies for drinking and excessive drinking among Mexican Americans and non-Hispanic whites

This study was designed to identify the expectancies held by Mexican Americans toward the drinking of alcoholic beverages as well as toward excessive drinking. Random samples of 534 Mexican American and 616 non-Hispanic White residents of San José, California and of San Antonio, Texas were interviewed over the telephone. Mexican Americans were found to have unique expectancies toward drinking of alcoholic beverages and toward excessive drinking that differed from those held by non-Hispanic Whites. In addition, Mexican Americans expected the various outcomes in greater proportion than non-Hispanic Whites and the Mexican American respondents classified as high in acculturation tended to respond in a manner similar to that of non-Hispanic White respondents. Multivariate analyses of variance with common (across ethnic groups) factor scales with ethnicity, gender, and drinking status as independent variables showed main effects for drinking status and for ethnicity. The group differences in expectancies identified here support the need for culturally appropriate interventions that target group-specific beliefs.

Perceptions by Hispanics of channels and sources of health messages regarding cigarette smoking

OBJECTIVE

To identify the perceptions that two communities of urban Hispanics have of various sources and channels of information regarding cigarette smoking and to compare them with those of non-Hispanic whites.

DESIGN

Random samples of subjects of both ethnic groups and of both genders were surveyed by telephone to determine the perceived credibility and motivating power of 13 different channels of information and of 14 different sources of cigarette smoking information.

SUBJECTS

544 Hispanics and 542 non-Hispanic whites from San Francisco, California and Houston, Texas, 18-65 years in age, of both genders.

RESULTS

Differences in the proportion of respondents assigning various perceived qualities to sources and channels of information regarding cigarette smoking were found to exist across ethnic groups (Hispanics and non-Hispanic whites); the respondents' gender (particularly among Hispanics); and the acculturation level of the Hispanic respondents. Nevertheless, there was a cluster of channels (printed media and television news) and of sources (physicians, people with cancer, friends, and peers) that were positively evaluated by large proportions of the respondents in both ethnic groups.

CONCLUSIONS

Hispanics differ from non-Hispanic whites in their evaluation of various possible sources and channels of information about tobacco control. Culturally appropriate interventions for Hispanics need to be designed so as to use those channels and sources of information that are more positively perceived by Hispanics.

Expectancies for driving under the influence of alcohol among Hispanics and non-Hispanic Whites

A random sample of 1418 (40.8% male) Hispanics and 501 (46.1% male) non-Hispanic Whites were surveyed about their behavioral expectations for driving under the influence of alcoholic beverages (DUI). Hispanics reported more often than Whites that the effects of DUI would be driving carelessly, being angry at other drivers, feeling nervous, losing the respect of friends, feeling guilty, feeling too tired to drive, and losing their self-respect. There were gender differences among Hispanics but not among Whites. Hispanic abstainers reported the likelihood of the various outcomes more frequently than drinkers although drinking status produced no statistically significant differences among non-Hispanic Whites.

Case report of association of congenital coronary fistulae with coronary atherosclerosis

The authors report the clinical case of a 70 year old male with a congenital plexiform fistula between a branch of the left coronary artery and the pulmonary artery, associated with the atherosclerotic lesions of the coronary arteries, both surgically treated by ligature of the fistula and aorto-coronary grafts. The patient remained asymptomatic up to the age of 65 when both cardiac ischemia and infarction ocurred, probably coincidental with the development of the coronary arterial obstruction. From data gathered from medical literature, the authors discuss the association between coronary congenital anomalies (fistulae and ectopies) with atherosclerotic obstruction of the coronary arteries. Coronary arterial atherosclerosis affects patients with congenital fistulae of the coronary arteries in the same way as in normal humans.

A research agenda for health education among underserved populations

This article summarizes the outcome of health education efforts among populations that, due to their cultural heritage, have received limited services. The literature reviewed shows that programs found to be effective in one population cannot be assumed to be equally effective with a different population. An argument is made for the design of culturally appropriate and group-specific interventions which would properly serve the various underserved populations. Research needs to be conducted to identify appropriate approaches and intervention strategies, as well as the group-specific sociopsychological characteristics (attitudes, norms, values, expectancies) that are related to health-damaging and protective behaviors.

The role of gender and acculturation on determining the consumption of alcoholic beverages among Mexican-Americans and Central Americans in the United States

This study analyzed the responses of 391 Mexican-Americans (44.9% males) and 531 Central Americans (40.2% males) who were between 21 and 65 years of age and resided in San Francisco, California. In general, Mexican-Americans were found to have a lower proportion of abstainers (56.8%) than Central Americans (64.4%). Mexican-Americans reported drinking more often and in greater quantities than Central Americans, and the proportion of "high" drinkers was higher among Mexican-American men and women than among the Central American respondents. Despite this diversity in the topography of alcoholic beverage consumption between Mexican-Americans and Central Americans, the role of gender and acculturation on shaping those variables was fairly consistent across groups. The acculturation level of the respondents was found to significantly affect the proportion of abstainers in both groups. Furthermore, gender was an important determinant of frequency, total number of drinks, and volume of drinking for Mexican-Americans and for Central Americans.

Is serum cotinine a better measure of cigarette smoking than self-report?

OBJECTIVES

To address the question of whether serum cotinine is a better measure of cigarette smoking than self-reported behavior by examining the relation of biochemical, physical examination, and depression assessments to self-reported cigarette consumption and serum cotinine in a population-based sample.

METHODS

Serum from 743 Mexican American participants in the Hispanic Health and Nutrition Examination Survey (HHANES) categorized by sex and number of cigarettes smoked per day (0, 1 to 9, 10 to 19, > or = 20) was analyzed for cotinine. HHANES results from hematocrit, hemoglobin, red blood cells (RBCs), white blood cells (WBCs), mean corpuscular volume (MCV), iron, transferrin, lead, erythrocyte protoporphyrin (EPP), vitamin E, vitamin A, cholesterol, body mass index (BMI), pulse rate, systolic and diastolic blood pressure (DBP), Center for Epidemiological Depression Scale (CES-D), and Diagnostic Interview Schedule (DIS) depression diagnosis were compared by category of cigarettes smoked per day and serum cotinine.

RESULTS

Among women significant correlations were found between cigarettes per day and cotinine, respectively, and hematocrit (r = 0.148, r = 0.338), hemoglobin (r = 0.152, r = 0.342), WBCs (r = 0.160, r = 0.272), and BMI (r = -0.124, r = -0.164). Among men significant correlations were found between cigarettes per day and cotinine, respectively, and WBCs (r = 0.176, r = 0.296), MCV (r = 0.310, r = 0.264), lead (r = 0.105, r = 0.177), and BMI (r = -0.110, r = -0.192). Cotinine, but not cigarettes per day, was significantly correlated with hemoglobin (r = 0.179) and DBP (r = -0.146) in men and EPP (r = -0.135) and cholesterol (r = 0.105) in women. Mean CES-D score was correlated with cigarettes per day for both men (r = 0.106) and women (r = 0.158) but not with cotinine. CES-D caseness (score > or = 16) and a positive diagnosis of depression by DIS was not related to smoking behavior measures among men. Women smokers compared to nonsmokers had higher levels of depression. Multivariate regression models controlling for sex, age, and education indicated that serum cotinine was a significant predictor of hematocrit, hemoglobin, RBCs, WBCs, lead, and DBP; self-reported cigarettes was significant only for MCV.

CONCLUSIONS

Serum cotinine may be a better method of quantifying risks from cigarette use in epidemiological studies.

Effects of a community intervention to change smoking behavior among Hispanics

Our purpose was to evaluate the effects of the Program Latino para Dejar de Fumar (PLDF), a community-wide smoking cessation intervention developed for Spanish-speaking Hispanics. PLDF community intervention was based on research to identify culture-specific aspects of smoking cessation for Hispanics and included targeted distribution of a self-help cessation guide, an electronic and printed media campaign, raffles for smokers who quit, and participation in community activities. The main outcome measures were smoking cessation and associated behaviors. Exposure to the intervention, the primary predictor variable, was defined as affirmative responses to questions about recognizing the PLDF name, having the PLDF smoking cessation guide, having heard or seen messages about PLDF on various media, and knowing about a PLDF-sponsored $500 raffle. Four cross-sectional telephone surveys of Hispanic adults 18 to 65 years of age, living in neighborhoods in San Francisco, California, defined as having at least 10% Hispanics in the 1980 U.S. Census, were conducted preceding (1986-1987) and following (1988-1989) start of PLDF (total n = 7,667). Although smoking prevalence decreased over the four years, smoking cessation in the 12 months prior to the survey was unrelated to exposure to PLDF. For the two surveys conducted after PLDF was started (n = 3,551), nonsmokers, women, older adults, and less acculturated persons were more likely to report exposure to PLDF.(ABSTRACT TRUNCATED AT 250 WORDS)

[Morphofunctional correlation in congenital anomalies of the coronary arteries. II. The ectopic origin of the coronary arteries]

The authors describe the morphogenesis and functional alterations of the coronary arterial net in the ectopic coronary arteries: a) with origin in the aorta or its branches and b) with origin in the pulmonary artery. The coronary arteries are developed from: 1) endothelial sprouts localized in the great arteries walls at the level of the sigmoidal values, 2) right and left subepicardial vascular network and 3) the intramyocardial sinusoids. Most of the ectopic coronary arteries result from alterations in the connection between these three embryonic elements. The deviation of one of the subepicardial vascular network in a wrong way (in direction of pulmonary artery or the opposite Valsalva sinus) will stimulate the development of endothelial sprouts which will connect such network originating abnormal connections and anomalous origin of the coronary arteries. The origin of both coronary arteries from the pulmonary artery is in compatible with life. Myocardial ischemia is absent in patients with type I (infant) or type II (adult) anomalous origin of one coronary artery from the pulmonary artery, only in the transitional phase between both types (I and II) there is myocardial ischemia previous to the formation of the collateral coronary circulation. The ectopic origin of the coronary artery from the aortic Valsalva sinus have very little hemodynamic repercussion in the patient. Although there are cases with postexercise sudden dead. These anomalies associated to atherosclerotic coronary stenosis have an impact on the evolution and prognosis of ischemic heart disease.

Estradiol inhibits growth hormone receptor gene expression in rabbit liver

We studied the ontogeny of GH receptor mRNA levels and the effect of exogenous estradiol administration on GH receptor mRNA levels in rabbit liver. A solution hybridization-RNase protection assay revealed a predominant 370-base long protected band corresponding to the mRNA encoding the transmembrane GH receptor, and a 241-base long protected band, representing about 9.0%, with the predicted size for the truncated form of the GH receptor. To study the developmental profile of GH receptor expression, we studied 12 female rabbits, at ages 1, 3, 5 and 7 months. Maximal GH receptor mRNA levels were observed in 3-month-old animals and decreased in 7-month-old animals. To investigate the effect of estradiol, 8-week-old immature female rabbits were randomly divided into five groups, and received subcutaneous pellets containing either placebo or estradiol at doses of 0.1, 0.5, 1.5 and 5.0 mg for 3 weeks. Exogenous administration of estradiol, at doses that resulted in physiological circulating levels, induced a reduction in GH receptor expression, measured both by GH binding (36 and 46%), and GH receptor mRNA levels (38 and 87%), in animals receiving pellets containing 1.5 and 5.0 mg of estradiol, respectively. We conclude that estradiol decreases GH receptor expression in rabbit liver. The results of our study suggest that there is an inverse relationship between circulating estrogen concentrations and liver GH receptor expression.

Behavioral risk factors: a comparison of Latinos and non-Latino whites in San Francisco

OBJECTIVES

The purpose of the study was to evaluate differences between Latino and non-Latino White adults in health-related behavioral risk factors.

METHODS

Telephone interviews were conducted with 652 Latinos and 584 non-Latino Whites in San Francisco selected by random-digit dialing.

RESULTS

Latino men and women, compared with their non-Latino White counterparts, were less likely to have consumed any alcoholic beverage in the previous month (59% and 29% vs 77% and 75%, respectively), consumed fewer drinks per week (6.6 and 3.0 vs 8.9 and 5.1, respectively), and were more likely to be sedentary (40% and 46% vs 17% and 23%). Latina women were less likely than non-Latina Whites to smoke cigarettes (8% vs 29%), to have ever had a Pap smear (76% vs 93%), and to have ever had a clinical breast examination (81% vs 96%). Multivariate analyses adjusting for sex, age, education, and employment confirmed univariate findings.

CONCLUSIONS

Behavioral risk factor profiles by ethnicity help emphasize priorities of health promotion programs for a community. Latino needs include maintenance of limited consumption of alcohol and cigarettes, promotion of regular physical activity, and increasing use of low-cost cervical and breast cancer screening tests.

[Morphofunctional correlation in congenital anomalies of the coronary arteries. I. Coronary artery fistulas]

In order to explain the congenital coronary arteries malformations, the authors review the recent concepts on the coronary artery morphogenesis, based in the findings that in the human embryo, these arteries evolve from three sources: 1) endothelial aortic buds, 2) cavitary cellular groups from pericardial origin and with angiogenic character, which migrate to the cardiac zones where the coronary arteries will be distributed, and 3) the intramyocardial sinusoids. The anatomic and histologic cardiac alterations will be reflected in modifications of the coronary artery pattern. The coronary artery fistulae are formed by the persistence of the sponge structure of the myocardial wall, present in the early ontogenic steps of the cardiac development; such fistulae alter the normal functions of the coronary vascular tree and are capable to cause angina pectoris to the patient through diverse mechanisms: absence of capillarization, steal phenomenon aggravated by the altered coronary arteries properties when aneurysm or vascular channels are developed. The authors suggest a classification of the congenital coronary arteries anomalies: I. Anomalous origin in the sinus of Valsalva (anomalous and ectopic origin), II. Malformations of the coronary branches (in number, distribution and wall anomalies) and III. Anomalous connection of the coronary arteries: fistulae and persistence of the intramyocardial sinusoids isolated or communicated to left and right ventricles. The latter are frequently associated with aortic or pulmonary valve atresia. They do not cause myocardial ischemia and are formed secondary to the intracavitary elevated pressure which maintained the persistence, dilatation and communication of the ventricular chambers with such sinusoids and coronary arteries in the case of pulmonary valve atresia and with coronary veins in the case of aortic valve atresia.

Self-reported awareness of the presence of product warning messages and signs by Hispanics in San Francisco

This study investigated the self-reported awareness of the presence of product warning messages and signs among random samples of Hispanics in San Francisco surveyed in 1990 and in 1991. The messages that were tested related to cigarettes, alcoholic beverages, and other consumer products. A random sample of 1,204 Hispanics (43.5 percent males) were interviewed by telephone in 1990. The corresponding figure for the second survey in 1991 was 1,569 Hispanics (41.1 percent males). In general, respondents reported low levels of awareness of the presence of product warning messages and signs. The exception was warning messages on cigarette packets which approximately 70 percent of the respondents reported having seen within the 12 months before the survey. There was an increase from 1990 to 1991 in the reported awareness of warning messages for wine, beer, and cigarettes. Smokers and drinkers of alcoholic beverages reported the highest levels of awareness of the relevant warning messages and signs. Length of exposure to warning messages and multiplicity of sources (for example, advertisements and products) seem to produce greater levels of awareness of the presence of product warning messages. Less acculturated, Spanish-speaking Hispanics are less likely to report being aware of the warnings, particularly those that appear only in English (for example, alcoholic beverages).

[Isolated agenesis of the pulmonary valve in the adult. When is the proper time for surgery?]

The congenital absence of the pulmonary valves is a rare malformation that mainly affects children, frequently is associated with other cardiac malformations and very rarely is present in adults. Elective or urgent surgery is indicated in the symptomatic child; on the other hand, surgical treatment in the asymptomatic adult with this anomaly is controversial. Based on the reported experience in the literature, in the present article, the authors discuss the therapeutic approach of an asymptomatic 22-year-old male with pulmonary valvular absence with practically no hemodynamic repercussion. Although there had been few reported cases of isolated pulmonary valvular absence, the authors concluded that surgery is not a satisfactory solution and that it might be postponed to the time that patients develop congestive heart failure and or respiratory insufficiency. In order to detect that on time, we recommend a follow up based on periodic echocardiographic studies.

A comprehensive smoking cessation program for the San Francisco Bay Area Latino community: Programa Latino Para Dejar de Fumar

Background. Prevalence of cigarette smoking among Latinos compared to whites is higher among men (30.9% versus 27.9%), but lower among women (16.3% versus 23.5%). More acculturated Latina women, however, smoke more. Compared to other smokers, Latinos report consuming about half the average number of cigarettes per day. Up to a quarter of Latino smokers of less than 10 cigarettes per day may be underreporting consumption. The association between smoking and depression has also been found in Latinos. Program Goals. The Programa Latino Para Dejar de Fumar (Programa) goals are: 1) to evaluate attitudinal, behavioral, and cultural differences between Latino and white smokers; 2) to integrate these findings into a comprehensive, culturally-appropriate smoking cessation intervention; and 3) to implement the intervention in a defined community in order to decrease cigarette smoking prevalence, increase behaviors that may lead smokers to quit, and promote a nonsmoking environment. Program Components. Heightened concern about health effects of smoking, the importance of social smoking, and the influence of the family on behavior are integrated in the Programa components: 1) the promotion of a full-color, Spanish-language, self-help, smoking cessation guide (Guia), distributed at no charge; 2) an anti-smoking, Spanish-language, electronic media campaign; 3) community involvement; 4) quit smoking contests; 5) smoking cessation, individual, telephone consultations (consultas); and 6) collaboration with health care personnel. Results. Effectiveness of the Programa is being evaluated by annual, cross-sectional, random digit dialing telephone surveys compared to two baseline surveys. After 19 months of intervention, the proportion who had heard of the Programa increased from 18.5% to 44.0%, and over one third of less acculturated smokers had the Guia. Future directions will emphasize smoking prevention among youth, prevention of relapse among quitters, and depression prevention.

Misclassification of smoking status by self-reported cigarette consumption

To evaluate possible misclassification of smokers and nonsmokers, we compared self-reported cigarette consumption and serum cotinine levels in a sample of 743 Mexican American participants in the Hispanic Health and Nutrition Examination Survey (HHANES). The study sample was stratified by sex and self-reported cigarettes consumed per day (0, 1 to 9, 10 to 19, and greater than or equal to 20) and selected from those with available serum. We defined biochemical smokers as persons with serum cotinine levels greater than or equal to 0.084 microM/L (14 ng/ml). Misclassification was defined as a discrepancy between self-reported smoking and the serum cotinine level used to define a biochemical smoker. Of 189 self-reported nonsmokers, 12 (6.3%) were defined as biochemical smokers and possibly misclassified by self-report. Among 124 never smokers only 5 (4%) were biochemical smokers compared with 7 of 65 (10.8%) self-reported former smokers. Only 1 of the 12 misclassified nonsmokers reported living with a current smoker. In 9 of the 12 misclassified nonsmokers, serum cotinine levels were consistent with light smoking. Among the 547 self-reported smokers, 66 (12.1%) were found to have serum cotinine levels less than or equal to 0.084 microM/L (14 ng/ml) and possibly misclassified by self-report. Of these, one person reported 20 or more cigarettes per day. We conclude that self-reported cigarette consumption may be an insufficient measure of the risks associated with tobacco use and measurement of serum cotinine may be important to assess the magnitude of misclassification of smoking status in epidemiologic studies.

Evaluation of "Guia para Dejar de Fumar," a self-help guide in Spanish to quit smoking

Because of the absence of culturally appropriate self-help smoking cessation materials for Latinos, a new Spanish language cessation guide, "Guia para Dejar de Fumar," was developed and evaluated. It was distributed as part of a community-wide intervention to decrease the prevalence of smoking. The "Guia" is an attractive full-color booklet written in universal Spanish that uses simple text and numerous photographs. Motivation to quit smoking is emphasized, and graphic demonstrations of the adverse health effects of smoking are included. A menu of quitting and maintenance techniques is presented. A total of 431 smokers were identified for evaluation at approximately 3, 6, and 12 months after receiving the "Guia." Self-reported quit rates declined from 21.1 percent at 2.5 months to 13.7 percent at 14 months; 8.4 percent of the sample had a validated quit status by saliva cotinine test at 1 year. Persons older than 44 years were more likely to remain nonsmokers, but sex, education, acculturation score, and cigarettes smoked per day did not predict smoking cessation. The components of the "Guia" most mentioned by those who were surveyed were the graphic photographs, the health emphasis, and the overall format. The authors concluded that the "Guia" is an appropriate self-help smoking cessation booklet for Spanish-speaking Latinos in the United States.

Depressive symptoms and cigarette smoking among Latinos in San Francisco

We administered the Center for Epidemiological Studies Depression (CES-D) Scale to 547 San Francisco Latinos as part of a random digit dialing telephone survey to evaluate smoking behavior. Both men and women current smokers had the highest mean CES-D levels (9.7 and 14.3, respectively). Logistic regression analysis adjusting for gender, acculturation, education, age, and employment showed that current smokers had an odds ratio of 1.7 (95% CI = 1.3, 2.2) for significant depressive symptoms compared to former smokers (OR = 1.1;95% CI = .8, 1.6) and never smokers (OR = 1).

Apparent underreporting of cigarette consumption among Mexican American smokers

To determine the accuracy of self-report of cigarette consumption among Mexican American smokers, we compared self-reported cigarette use and serum cotinine concentrations in a sample of 547 participants in the Hispanic Health and Nutrition Examination Survey (HHANES). We defined underreporting of cigarette use as a cotinine to cigarette-per-day ratio of greater than 0.142 microM/l which represented a substantial discrepancy between self-reported consumption and serum cotinine. Of the 98 men and 97 women who reported smoking one to nine cigarettes/day, 20.4 percent and 24.7 percent, respectively, underreported their cigarette consumption. Underreporting was less common among men and women smoking 10 to 19 cigarettes/day (8.3 percent and 10.8 percent, respectively) and 20 or more cigarettes/day (2.2 percent and 2.9 percent, respectively). Comparison of underreporters to other smokers by demographic characteristics within sex and cigarettes/day categories showed no differences. Differences in cotinine metabolism and extremely efficient smoking are alternative explanations that can not be ruled out with these data. We believe, however, that a proportion of Mexican American light smokers may underreport the quantity of cigarettes smoked per day, and may truly be moderate or heavy smokers.

Stereotypes of smokers held by Hispanic and white non-Hispanic smokers

A group of Hispanic and White non-Hispanic smokers were asked to report the stereotypes they hold of smokers in general. All respondents tended to think that smokers were Nervous, Friendly, and Sociable; although White non-Hispanics felt more certain than Hispanics that smokers were Friendly, Aggressive, Sociable, Attractive, and Feminine. Factor analyses of the responses showed three common (across ethnicity) factors: Sociability, Self-Presentation, and Nervousness. Only the Self-Presentation factor showed statistically significant differences between the two ethnic groups. The amount of cigarettes smoked had no effect on the stereotypes but the more highly acculturated Hispanics showed stereotypes that resembled those of the White non-Hispanics.