U.S. Women with Invasive Cervical Cancer: Characteristics and Potential Barriers to Prevention

Objectives: Although invasive cervical cancer (ICC) rates have declined since the advent of screening, the annual age-adjusted ICC rate in the United States remains 7.5 per 100,000 women. Failure of recommended screening and management often precedes ICC diagnoses. The study aimed to evaluate characteristics of women with incident ICC, including potential barriers to accessing preventive care. Materials and Methods: We abstracted medical records for patients with ICC identified during 2008-2020 in five U.S. population-based surveillance sites covering 1.5 million women. We identified evidence of adverse social and medical conditions, including uninsured/underinsured, language barrier, substance use disorder, incarceration, serious mental illness, severe obesity, or pregnancy at diagnosis. We calculated descriptive frequencies and compared potential barriers by race/ethnicity, and among women with and without symptoms at diagnosis using chi-square tests. Results: Among 1,606 women with ICC (median age: 49 years; non-White: 47.4%; stage I: 54.7%), the majority (68.8%) presented with symptoms. Forty-six percent of women had at least one identified potential barrier; 15% had multiple barriers. The most common potential barriers among all women were being underinsured/uninsured (17.3%), and language (17.1%). Presence of any potential barrier was more frequent among non-White women and women with than without symptoms (p < 0.05). Conclusions: In this population-based descriptive study of women with ICC, we identified adverse circumstances that might have prevented women from seeking screening and treatment to prevent cancer. Interventions to increase appropriate cervical cancer screening and management are critical for reducing cervical cancer rates.

Structural analysis of the lipid A derived from the lipopolysaccharide of Brucella abortus

Lipopolysaccharide (LPS) of Brucella abortus strain 45/20 was purified using a novel method. Monophosphoryl lipid A (MPLA) was prepared from this LPS, methylated, and purified by high performance liquid chromatography. Chemical, mass spectral, and nuclear magnetic resonance analyses showed that MPLA consists of heptaacyl lipid As with molecular weights of 2095, 2123, 2151 and 2179. They contained the β-1,6-linked 2,3-diamino-2,3,-dideoxy-glucose disaccharide backbone and a phosphate group at the 4' position. Bisphosphoryl lipid A was also prepared and completely O-deacylated. It contained an additional phosphate group, and either 2 hydroxyhexadecanoic, 1 hydroxytetradecanoic, 1 hydroxydodecanoic acids or 2 hydroxyhexadecanoic and 2 hydroxydodecanoic acids, all in amide linkage. The predominant ester-linked fatty acyl group in acyloxyacyl linkage was hexadecanoate.

The purified LPS, bisphosphoryl lipid A, and MPLA from B. abortus showed about 14%, 3% and 1%, respectively, of the B cell mitogen activity of ReLPS from Escherichia coli at 1.0 μg/ml.

Pancreatic adenocarcinoma in a young patient population--12-year experience at Memorial Sloan Kettering Cancer Center

BACKGROUND

There is a dearth of data in a younger population of patients with pancreatic ductal adenocarcinoma (PAC) regarding epidemiology, genetics, prognosis, and outcome. This report examines a large cohort of patients with PAC <or=45 years of age evaluated at MSKCC over a 12-year period.

METHODS

A retrospective analysis of patients referred to MSKCC with PAC identified from the institutional tumor registry, who were <or=45 years on the date of the diagnostic biopsy, between January 1995 and February 2008, was performed. Information reviewed included demographics, clinical and pathological staging, surgical management, therapy, date of relapse, death or last follow-up. Survival curves were estimated using the Kaplan-Meier method and compared using the log-rank test.

RESULTS

One hundred thirty-six cases of PAC, age <or=45 years at diagnosis, were identified. Seventy-four (54%) females, 62 (46%) males. Age range: 24-45; 4, 38, and 94 patients in age groups 20-29, 30-39, 40-45 years, respectively. Fifty (37%) had a smoking history. Fourteen (10.3%) had a positive family history of PAC. Thirty-five (25.7%) underwent a curative resection for localized disease. Twenty-eight (20.1%) presented with locally advanced, inoperable disease. Sixty-eight (50%) presented as AJCC Stage IV. Twenty-three (37%) of those resected underwent adjuvant chemoradiation. Thirteen received adjuvant gemcitabine. The median overall survival for the entire cohort was 12.3 months (95% CI 10.2-14.0 months). The median overall survival for the patients with locally resectable disease was 41.8 months (95% CI 20.3-47 months). The median overall survival for the patients who presented with locally advanced, unresectable disease was 15.3 months (95% CI 12-19.3 months). The median overall survival for those who presented with metastatic disease was 7.2 months (95% CI 5.2-9.5 months).

CONCLUSIONS

This is the largest reported cohort of young patients with PAC <or=45 years of age. The data suggest that patients with stages I-II disease may have an improved prognosis, however the prognosis for stages III-IV patients appears to be similar to the typical (older) patient population with PAC.

Direction-selective adaptation in fly visual motion-sensitive neurons is generated by an intrinsic conductance-based mechanism

Motion-sensitive neurons in the blowfly brain present an ideal model system to study the cellular mechanisms and functional significance of adaptation to visual motion. Various adaptation processes have been described, but it is still largely unknown which of these processes are generated in the motion-sensitive neurons themselves and which originate at more peripheral processing stages. By input resistance measurements I demonstrate that direction-selective adaptation is generated by an activity-dependent conductance increase in the motion-sensitive neurons. Based on correlations between dendritic Ca(2+) accumulation and slow hyperpolarizing after-potentials following excitatory stimulation, a regulation of direction-selective adaptation by Ca(2+) has previously been suggested. In the present study, however, adaptation phenomena are not evoked when the cytosolic Ca(2+) concentration is elevated by ultraviolet photolysis of caged Ca(2+) in single neurons rather than by motion stimulation. This result renders it unlikely, that adaptation in fly motion-sensitive neurons is regulated by bulk cytosolic Ca(2+).

Synaptic transfer of dynamic motion information between identified neurons in the visual system of the blowfly

Synaptic transmission is usually studied in vitro with electrical stimulation replacing the natural input of the system. In contrast, we analyzed in vivo transfer of visual motion information from graded-potential presynaptic to spiking postsynaptic neurons in the fly. Motion in the null direction leads to hyperpolarization of the presynaptic neuron but does not much influence the postsynaptic cell, because its firing rate is already low during rest, giving only little scope for further reductions. In contrast, preferred-direction motion leads to presynaptic depolarizations and increases the postsynaptic spike rate. Signal transfer to the postsynaptic cell is linear and reliable for presynaptic graded membrane potential fluctuations of up to approximately 10 Hz. This frequency range covers the dynamic range of velocities that is encoded with a high gain by visual motion-sensitive neurons. Hence, information about preferred-direction motion is transmitted largely undistorted ensuring a consistent dependency of neuronal signals on stimulus parameters, such as motion velocity. Postsynaptic spikes are often elicited by rapid presynaptic spike-like depolarizations which superimpose the graded membrane potential. Although the timing of most of these spike-like depolarizations is set by noise and not by the motion stimulus, it is preserved at the synapse with millisecond precision.

Transfer of visual motion information via graded synapses operates linearly in the natural activity range

Synaptic transmission between a graded potential neuron and a spiking neuron was investigated in vivo using sensory stimulation instead of artificial excitation of the presynaptic neuron. During visual motion stimulation, individual presynaptic and postsynaptic neurons in the brain of the fly were electrophysiologically recorded together with concentration changes of presynaptic calcium (Delta[Ca(2+)](pre)). Preferred-direction motion leads to depolarization of the presynaptic neuron. It also produces pronounced increases in [Ca(2+)](pre) and the postsynaptic spike rate. Motion in the opposite direction was associated with hyperpolarization of the presynaptic cell but only a weak reduction in [Ca(2+)](pre) and the postsynaptic spike rate. Apart from this rectification, the relationships between presynaptic depolarizations, Delta[Ca(2+)](pre), and postsynaptic spike rates are, on average, linear over the entire range of activity levels that can be elicited by sensory stimulation. Thus, the inevitably limited range in which the gain of overall synaptic signal transfer is constant appears to be adjusted to sensory input strengths.

Ultra-short pulse (femtosecond) laser surgery: initial use in LASIK flap creation

The highly localized tissue effects of low energy femtosecond duration (ultrashort) laser pulses may be used to create three-dimensional intrastromal resections with micron precision and minimized collateral tissue damage. A surgical laser system that produces and delivers such pulses has been developed and tested clinically for creation of a corneal flap in LASIK. Expanded evaluation of this technology in this and additional keratorefractive applications is currently underway.

Kinematical two-dimensional multiple-diffraction intensity profiles. Application to ω–ψ scans of silicon and diamond obtained with synchrotron radiation

In a previous paper by Rossmanith [J. Appl. Cryst.(2000),33, 1405–1414], expressions for the calculation of multiple-diffraction patterns observed in ω–ψ scans of Bragg reflections were derived within the framework of the kinematical theory, taking into account the divergence and wavelength spread of the incident beam, as well as the mosaic structure of the crystal sample. Agreement with CuKα experiments was demonstrated. In this paper, it is shown that the theoretical expressions are also suitable for synchrotron radiation experiments.

Two classes of visual motion sensitive interneurons differ in direction and velocity dependency of in vivo calcium dynamics

Neurons exploit both membrane biophysics and biochemical pathways of the cytoplasm for dendritic integration of synaptic input. Here we quantify the tuning discrepancy of electrical and chemical response properties in two kinds of neurons using in vivo visual stimulation. Dendritic calcium concentration changes and membrane potential of visual interneurons of the fly were measured in response to visual motion stimuli. Two classes of tangential cells of the lobula plate were compared, HS-cells and CH-cells. Both neuronal classes are known to receive retinotopic input with similar properties, yet they differ in morphology, physiology, and computational context. Velocity tuning and directional selectivity of the electrical and calcium responses were investigated. In both cell classes, motion-induced calcium accumulation did not follow the early transient of the membrane potential. Rather, the amplitude of the calcium signal seemed to be related to the late component of the depolarization, where it was close to a steady state. Electrical and calcium responses differed with respect to their velocity tuning in CH-cells, but not in HS-cells. Furthermore, velocity tuning of the calcium response, but not of the electrical response differed between neuronal classes. While null-direction motion caused hyperpolarization in both classes, this led to a calcium decrement in CH-cells, but had no effect on the calcium signal in HS-cells, not even when calcium levels had been raised by a preceding excitatory motion stimulus. Finally, the voltage-[Ca2+]i-relationship for motion-induced, transient potential changes was steeper and less rectifying in CH-cells than in HS-cells. These results represent an example of dendritic information processing in vivo, where two neuronal classes respond to identical stimuli with a similar electrical response, but differing calcium response. This highlights the capacity of neurons to segregate two response components.

Dendritic calcium accumulation associated with direction-selective adaptation in visual motion-sensitive neurons in vivo

Motion adaptation in directionally selective tangential cells (TC) of the fly visual system has previously been explained as a presynaptic mechanism. Based on the observation that adaptation is in part direction selective, which is not accounted for by the former models of motion adaptation, we investigated whether physiological changes located in the TC dendrite can contribute to motion adaptation. Visual motion in the neuron's preferred direction (PD) induced stronger adaptation than motion in the opposite direction and was followed by an afterhyperpolarization (AHP). The AHP subsides in the same time as adaptation recovers. By combining in vivo calcium fluorescence imaging with intracellular recording, we show that dendritic calcium accumulation following motion in the PD is correlated with the AHP. These results are consistent with a calcium-dependent physiological change in TCs underlying adaptation during continuous stimulation with PD motion, expressing itself as an AHP after the stimulus stops. However, direction selectivity of adaptation is probably not solely related to a calcium-dependent mechanism because direction-selective effects can also be observed for fast moving stimuli, which do not induce sizeable calcium accumulation. In addition, a comparison of two classes of TCs revealed differences in the relationship of calcium accumulation and AHP when the stimulus velocity was varied. Thus the potential role of calcium in motion adaptation depends on stimulation parameters and cell class.

Maturation and myotonia influence the abundance of cation channels KDR, KIR and CIR differently: a patch-clamp study on mouse interosseus muscle fibres

To detect cation channels, the expression of which is dependent on the physiological state of muscle, single-channel activities of dissociated fibres of the mouse interosseus muscle were recorded using the patch-clamp technique in the cell-attached mode. Fibres were prepared from juvenile and adult wild-type (WT), from chloride channel-deficient myotonic and from denervated adult WT muscles. In all cases delayed-rectifier K+ channels (KDR) with a unitary conductance of 11 pS were recorded in more than 95% of sarcolemmal patches, but with a low, steady-state open probability. Inwards-rectifying K+ channels (KIR) with a conductance of 31 pS in 140 mM [K+]o were active in about 50% of the membrane patches from WT and in more than 90% of those from myotonic fibres. A hitherto undescribed, inwards-rectifying, cation channel, provisionally termed CIR, with fast kinetics and a unitary conductance of 36 pS, was active in nearly every membrane patch from juvenile mice, both WT and myotonic. The abundance of CIR decreased during development, but was not changed 7 days after denervation of adult WT muscle. Ca(2+)-dependent K+ channels were seen sporadically. Channels with the characteristics of adenosine 5'-triphosphate (ATP)-sensitive K+ channels were recorded frequently upon excision of membrane patches, but remained inactive in most cell-attached recordings. In conclusion, of the investigated ion channels, only KIR was responsive to the activity pattern of adult muscle, whereas CIR was down-regulated during muscle maturation.

Effects of betaxolol/timolol on epinephrine stimulated cyclic-AMP levels in human trabecular meshwork cells

The effects of timolol and betaxolol were compared for blocking beta agonist stimulation of cyclic-AMP in cultured human trabecular meshwork cells. Epinephrine (10(-5) M) produced a large and rapid increase in HTM cyclic-AMP; timolol (10(-6) M), at concentrations readily achieved in the aqueous humor after 0.5% eyedrops, completely blocked this effect. Recovery from timolol treatment appeared to be relatively slow, with only a 30-40% recovery observed by 9 hours. In comparison, betaxolol (10(-6) M) produced a smaller blockade of the epinephrine effects; a rapid recovery from the betaxolol effects was observed, with a greater than half-maximal response to epinephrine observed 15 minutes after removal of this beta blocker. These findings may help to explain the clinical observations of an outflow facility effect of epinephrine when used in combination protocols with betaxolol, but not with timolol.

The formalin test and the opioid nature of stress-induced analgesia

Exposure to electric shock produces an analgesic reaction (SIA) that is reversed by opiate antagonists ("opioid" SIA) under some conditions but not under other conditions ("nonopioid" SIA). A number of studies using tail-flick to radiant heat as the measure of pain sensitivity have found that a small number of shocks lead to nonopioid SIA, while a large number of shocks produce opioid SIA. In contrast, a small number of shocks have been reported to produce opioid SIA when the Formalin test was used to measure pain reactivity. However, the Formalin test involves administering a chronic pain stimulus (injection of Formalin into the paw) for an extended period before the shocks. Here it is reported that this "preexperimental" stress is sufficient to convert the SIA after a small number of shocks measured by tail-flick to the opioid form.

Small-cell carcinoma of the esophagus: treatment by chemotherapy alone

Small-cell carcinoma of the esophagus is a rare tumor. In most reported cases, surgery has been the major mode of therapy. Most patients have relapsed rapidly with disseminated disease. We treated a patient with small-cell carcinoma of the esophagus with a multi-drug regimen being used in small cell-carcinoma of the lung. Within two months of beginning therapy, the primary lesion, as evaluated by barium esophogram, had completely resolved. Residual disease was seen on panendoscopy. The patient was considered to be in partial remission. She relapsed nine months after starting therapy and died with widespread metastases. Small-cell carcinoma of the esophagus should not be treated surgically but rather in the same fashion as is small-cell carcinoma of the lung, i.e., with multi-drug chemotherapy and radiation therapy.

Small-cell carcinoma of the esophagus: treatment by chemotherapy alone

Small-cell carcinoma of the esophagus is a rare tumor. In most reported cases, surgery has been the major mode of therapy. Most patients have relapsed rapidly with disseminated disease. We treated a patient with small-cell carcinoma of the esophagus with a multi-drug regimen being used in small cell-carcinoma of the lung. Within two months of beginning therapy, the primary lesion, as evaluated by barium esophogram, had completely resolved. Residual disease was seen on panendoscopy. The patient was considered to be in partial remission. She relapsed nine months after starting therapy and died with widespread metastases. Small-cell carcinoma of the esophagus should not be treated surgically but rather in the same fashion as is small-cell carcinoma of the lung, i.e., with multi-drug chemotherapy and radiation therapy.

Peritonitis in patients with liver disease and ascites. Use of Candida albicans as a microbiological clue in differential diagnosis

Peritonitis in patients with pre-existing liver disease and ascites may be secondary to a local abdominal condition which potentially requires surgery for cure, or alternatively, may be spontaneous in origin. For the latter, antimicrobials are therapeutic while surgery is contraindicated. An easily accessible and important clue for distinguishing these forms of peritonitis may be found in the microbiology of ascitic fluid. Visualization on gram stain smear or recovery on culture of multiple organisms and/or anaerobes favors local abdominal disease over spontaneous peritonitis. The presence of Candida species in the ascitic fluid of such patients, although less common, is highly significant. In the absence of peritoneal dialysis, recent abdominal surgery, or risk factors for disseminated candidiasis, the isolation of Candida suggests specifically gastrointestinal perforation.

Cutaneous manifestation of internal malignancies (I). Acanthosis nigricans

Skin changes may be the first clue to a neoplastic process at a stage when it still is treatable (Such as the development of Acanthosis Nigrican (AN) in an otherwise healthy adult). Ninety percent of the neoplasm responsible for the development of AN originate in the abdomen. The tumor, even in a subclinical state, seems to possess unidentified properties that activate the dermatosis.

Spntaneous perforation of the gastrointestinal tract in patients with cancer

The mortality of spontaneous gastrointestinal perforation in 36 patients with cancer was 84% (30 patients). The main factors responsible for this included failure of recognition, perforation through tumor, advanced uncontrolled disease and multiple organ failure. Six of 19 patients who underwent surgery survived (32%). Five of these patients did not perforate through tumor and their underlying malignancy was in good control. Earlier diagnosis is essential. Prompt surgical intervention and intensive supportive measures are indicated only if additional therapy of the underlying malignancy offers a reasonable chance for continued worthwhile palliation.