Surgical management of breast cancer in the elderly patient

BACKGROUND

Breast cancer in the older woman is a major health issue and therapeutic challenge. This study asked if presentation, surgical treatment, and outcome of breast cancer are different in elderly women compared with their younger counterparts.

METHODS

There were 816 women < 70 years (younger) and 190 > or = 70 years (older) treated surgically for breast carcinoma between January 1992 and April 2000. Data for younger and older patients was analyzed from our prospective database.

RESULTS

More older women had mammographic lesions (P < 0.006). Breast conservation was the treatment of choice for both groups. Stage, tumor size, histology and disease-specific survival were similar for both. There was no evidence of disease in 93% of cases in the < 70 years group at median follow-up of 38.4 months and 91% for the > or = 70 years group at 44.5 months.

CONCLUSIONS

In our population the presentation, surgical treatment, and survival from breast cancer is similar in older and younger women.

Role for sentinel lymph node dissection in the management of large (> or = 5 cm) invasive breast cancer

BACKGROUND

Sentinel lymph node dissection (SLND) for small, early-stage breast cancer is well accepted. However, the role of SLND for large primary breast cancer is controversial. We investigated the feasibility and clinical applicability of SLND in patients with large (> or = 5 cm) breast cancers and clinically negative axillae.

METHODS

A prospectively entered database was used to identify all patients who underwent surgical management of histopathologically confirmed primary breast carcinomas > or = 5 cm in diameter between September 1991 and August 2000. Patients who had clinically negative axillae and underwent SLND followed by completion axillary lymph node dissection (ALND) were selected for the study. The positivity rate, accuracy rate, and false-negative rate of SLND were determined.

RESULTS

Of the 41 patients selected for the study, 24 had infiltrating ductal carcinoma and 17 had infiltrating lobular carcinoma. Mean tumor size was 7.12 cm (range, 5-23 cm). At least one sentinel lymph node (SLN) was identified in all cases. Thirty patients had tumor-positive SLNs. Axillary metastasis was also identified in one patient who did not have a positive SLN. Thus, SLN status accurately predicted regional nodal status in 98% (40 of 41) of cases. The false-negative rate of SLND was 3% (1 of 31). None of the three patients with SLN micrometastasis, defined as a tumor focus < or = 2 mm, had tumor deposits in nonsentinel axillary lymph nodes. Only SLN macrometastasis (> 2-mm tumor deposit) and primary tumor size > or = 7 cm predicted nonsentinel axillary metastasis with significance on multivariate analysis (P = .008 and P = .046, respectively).

CONCLUSIONS

SLND is feasible and accurate in patients with large breast cancers and clinically negative axillae. Axillary lymph node dissection can be avoided in nearly one third of patients by focused examination of the SLN.

Use of a computer model to identify potential hotspots for dengue fever in New Zealand

AIMS

To describe the areas of potential dengue fever risk in New Zealand for present climatic conditions and projected scenarios of climate change.

METHODS

A computer model, the HOTSPOTS System, was developed. This allowed the integration of climatic, topographical, entomological, demographic, trade and travel data to generate spatial information describing vector introduction risk, potential vector distribution and dengue fever risk.

RESULTS

Under present climatic conditions, Auckland and Northland, and some coastal areas of other northern parts of the North Island, have a potential risk for dengue outbreaks supported by the vector Aedes albopictus. Greenhouse gas induced climate change could make these areas also receptive to Aedes aegypti--the more efficient tropical dengue vector--and increase the potential distribution of A. albopictus to much of the South Island.

CONCLUSIONS

Given the introduction of a competent vector, there is an appreciable risk of dengue fever occurring in New Zealand under present climatic conditions. Greenhouse gas induced climate change would substantially increase the magnitude and spatial extent of this risk.

Nationwide study of cancer risk among hip replacement patients in Sweden

BACKGROUND

Orthopedic implants and their fixatives contain materials with carcinogenic potential. Whether these implants are linked to subsequent cancer development remains unknown, mainly because large-scale, long-term follow-up data are scarce.

METHODS

We conducted a nationwide cohort study in Sweden to examine cancer incidence among 116,727 patients who underwent hip replacement surgery during the period from 1965 through 1994. Through record linkage to the Swedish Cancer Register, we identified all incident cancers through 1995 in this population (693,954 person-years of observation). For each cancer type, the observed number of cases was divided by that expected in the general Swedish population to produce standardized incidence ratios (SIRs).

RESULTS

Relative to the general population, the cohort had no overall cancer excess (SIR = 1.01; 95% confidence interval [CI] = 0.99 to 1.03). However, we observed elevated SIRs for prostate cancer (SIR = 1.16; 95% CI = 1.11 to 1.22) and melanoma (SIR = 1.15; 95% CI = 1.01 to 1.30) and a reduction in stomach cancer risk (SIR = 0.83; 95% CI = 0.75 to 0.92). Long-term follow-up (>or=15 years) revealed an excess of multiple myeloma (SIR = 1.86; 95% CI = 1.01 to 3.11) and a statistically nonsignificant increase in bladder cancer (SIR = 1.42; 95% CI = 0.98 to 1.99). There was no material increase in risk for bone or connective tissue cancer for either men or women in any follow-up period.

CONCLUSIONS

In this, the largest study to date, hip implant patients had similar rates of most types of cancer to those in the general population. Although the excesses of melanoma, multiple myeloma, and prostate and bladder cancers may be due to chance, confounding, or detection bias and should be interpreted cautiously, they warrant further investigation because of the ever-increasing use of hip implants at younger ages.

Breast cancer risk in male alcoholics in Sweden

OBJECTIVE

To investigate the association between alcoholism and risk of male breast cancer.

METHODS

We conducted a retrospective population-based cohort study in Sweden of men diagnosed with alcoholism between 1965 and 1995. The cohort was followed up through interlinkages with nationwide registries (the national cancer registry, immigration registry, causes of death registry, and population registry), using the national registration numbers. Standardized incidence ratios (SIRs), calculated using the Swedish national cancer incidence rate as reference, were used as estimates of relative risks.

RESULTS

A total of 145,811 men were enrolled into the cohort, contributing 1,499,504 person-years of follow-up. Sixteen incident breast cancer cases were identified, and the mean age at diagnosis was 68 years. We excluded the first year of follow-up (cases and person-years) from the analysis to avoid detection bias. The overall SIR (excluding the first year of follow-up) was 1.1 (95% CI 0.6-2.0). Although based on small numbers we found no indication of a differential SIR according to duration of follow-up, age at cohort enrolment, or age at follow-up (attained age or age at cancer diagnosis).

CONCLUSION

The observed associations are not compatible with an increase in breast cancer risk among male alcoholics.

Climate variations and New Zealand agriculture: the CLIMPACTS system and issues of spatial and temporal scale

Internationally and nationally, New Zealand has a growing requirement to assess and report on the possible effects of climate change. In association with this requirement, the science of climate change is rapidly evolving requiring a capacity for rapid reassessment of effects to take account of scientific advances. Consequently, past assessment methods, which have not been computationally efficient, nor easily repeated, are becoming outdated. To address this gap, an integrated assessment model (IAM), the CLIMPACTS system, has been developed for New Zealand. The CLIMPACTS system has been developed to provide flexibility in application, to be easily updated to take account of scientific advances, and capable of providing information in a manner that is relevant to policymakers. In order to be relevant in New Zealand, it has been necessary to account for different scales of assessment, nationally, at specific sites, and regionally. Nationally, the focus is on spatial applications (e.g., changes in areas of suitability), whereas at sites, the focus is on temporal applications (e.g., changes in risk). The regional capacity in the CLIMPACTS system has required an integration of spatial and temporal applications. This paper describes briefly the capability that has been developed at these different scales of assessment, with brief examples for each. The CLIMPACTS system has enhanced New Zealand's capability to examine environmental sensitivities to climate change, as a basis for better informed policy decisions. Importantly, it is an evolving platform that can be readily extended to other sectors and updated, for example, to account for the effects of internationally agreed greenhouse gas (GHG) emission targets.

[Preliminary study on relationship between TCM syndrome-type and insulin resistance in coronary heart disease]

OBJECTIVE

To observe the relationship between TCM Syndrome-type and insulin resistance (ISR) in coronary heart disease (CHD).

METHODS

Fifty patients were divided into 3 groups according to the Syndrome Differentiation-typing in TCM, the Heart blood stasis (HBS) Syndrome group, the Phlegm-Turbid stagnation (PTS) Syndrome group and both Qi-Yin Deficiency (QYD) Syndrome group. The fasting blood glucose (FBG), fasting blood insulin (Ins), insulin antibody (IAA), islet cell antibody (ICA), glutamic acid decarboxylase antibody (GAD-Ab) and related blood lipid parameters in patients were determined and insulin sensitive index (ISI) was calculated simultaneously. Then the above-mentioned data were compared with those determined in 20 healthy control subjects.

RESULTS

The levels of FBG and Ins in CHD group were higher than those in healthy control group significantly (P < 0.05), but ISI level was obviously lower (P < 0.01). Moreover, the positive ratio of IAA (40%) was higher in CHD group than that in the control group (5%) significantly (P < 0.01). Comparison between the 3 TCM Syndrome-type groups and the control group showed that ISI level in HBS and PTS group was obviously lower than that in the control and the QYD (P < 0.05) respectively, and the IAA positive ratio in the former 2 groups (50%, 47.3%) was higher than that in the later two (5%, P < 0.01 and 15.38%, P < 0.05) markedly. While Ins level increased only in the HBS group (P < 0.05). Besides, patients of HBS and PTS were accompanied by lipid metabolic disturbance.

CONCLUSION

ISR presents in part of CHD patients particularly in those with HBS and PTS, which was partly due to the existence of IAA in patients serum.

Association between cholecystectomy and adenocarcinoma of the esophagus

BACKGROUND & AIMS

Barrett's esophagus, which is linked to adenocarcinoma of the esophagus, is associated with reflux of bile. Duodenogastric reflux is increased after cholecystectomy. This study aims to evaluate if cholecystectomy is associated with an increased risk of adenocarcinoma of the esophagus.

METHODS

A population-based cohort study of cholecystectomized patients in Sweden between 1965 and 1997 cross-linked with the Swedish Cancer Register.

RESULTS

Cholecystectomized patients had an increased risk of adenocarcinoma of the esophagus (standardized incidence ratio [SIR], 1.3; 95% confidence interval [CI], 1.0-1.8). Esophageal squamous-cell carcinoma was not found to be associated with cholecystectomy (SIR, 0.9; 95% CI, 0.7-1.1). Patients with gallstone disease on whom surgery was not performed did not have an increased risk of adenocarcinoma or squamous-cell carcinoma of the esophagus.

CONCLUSIONS

Cholecystectomy is associated with a moderately increased risk of adenocarcinoma of the esophagus, possibly by the toxic effect of refluxed duodenal juice on the esophageal mucosa. Further studies are needed regarding the link between bile reflux and esophageal carcinogenesis.

Intestinal cancer after cholecystectomy: is bile involved in carcinogenesis?

BACKGROUND & AIMS

Results concerning an association between cholecystectomy and right-sided colon cancer are inconsistent. Little is known about the relation between cholecystectomy and small bowel cancer. Therefore, we evaluated cholecystectomy and risk of bowel cancer.

METHODS

Cholecystectomized patients, identified through the Swedish Inpatient Register, from 1965 through 1997, were followed up for subsequent cancer. The standardized incidence ratio (SIR) estimated relative risk.

RESULTS

In total, 278,460 cholecystectomized patients, contributing 3,519,682 person-years, were followed up for a maximum of 33 years after surgery. Cholecystectomized patients had an increased risk of proximal intestinal adenocarcinoma, which gradually declined with increasing distance from the common bile duct. The risk was significantly increased for adenocarcinoma (SIR, 1.77; 95% confidence interval [CI], 1.37-2.24) and carcinoids of the small bowel (SIR, 1.71; 95% CI, 1.39-2.08), and right-sided colon cancer (SIR, 1.16; 95% CI, 1.08-1.24). No association was found with more distal bowel cancer. The gradient was further pronounced when surgery of the common bile duct was included. The associations remained increased up to 33 years after cholecystectomy. No differences between sexes were found.

CONCLUSIONS

Cholecystectomy increases the risk of intestinal cancer, a risk that declines with increasing distance from the common bile duct. Changes in the intestinal exposure to bile might be the underlying biological mechanism.

Risk of cancers of the lung, head and neck in patients hospitalized for alcoholism in Sweden

Alcoholic patients are at increased risk of cancers of the head and neck but little information is available on the magnitude of the risk for specific sites and for different histological types. We followed 182 667 patients with a hospital discharge diagnosis of alcoholism during 1965-1994, for an average of 10.2 years. We compared their incidence of site- and histological type-specific cancers of the oral cavity, pharynx, larynx and lung with that of the national population. The standardized incidence ratio (SIR) of cancer of the oral cavity and pharynx was 5.33 (95% confidence interval [CI] 5.04-5.64, based on 1207 cases). The SIRs of laryngeal and lung cancer were 4.21 (95% Cl 3.78-4.68, 347 cases) and 2.40 (2.29-2.51, 1880 cases), respectively. The SIR was highest for cancers of the hypopharynx, floor of the mouth, mesopharynx and base of the tongue. The relative excess of lung cancer was similar for squamous cell carcinoma and adenocarcinoma. Low age at first hospitalization was associated with higher SIRs for all sites under study. 25 years after first hospitalization for alcoholism, the cumulative probability of developing a lung cancer was in the order of 5%, for oral and pharyngeal cancer it was 2.5%, and for oesophageal or laryngeal cancer 1% each. Our study shows that the risk of head and neck cancer among heavy drinkers is highest for sites in direct contact with alcohol. The high risk of head and neck neoplasms may justify specific medical attention.

Alcoholism and risk for cancer of the cervix uteri, vagina, and vulva

We conducted a population-based cohort study to analyze the risk of developing cancers of the female genitals among 36,856 patients with a hospital discharge diagnosis of alcoholism (ICD-7: 307, 322; ICD-8: 291, 303; ICD-9: 291, 303, 305A) in Sweden between 1965 and 1995. The follow-up was done by linkages of national registries. Standardized incidence ratios (SIRs) and 95% confidence intervals (CIs) were computed based on nationwide specific cancer rates. The first year of follow-up was excluded from all analyses to minimize the impact of selection bias. We found that alcoholic women had excess risks for in situ cervical cancer (SIR, 1.7; 95% CI, 1.6-1.9), for invasive cervical cancer (SIR, 2.9; 95% CI, 2.4-3.5), and for cancer of the vagina (SIR, 4.6; 95% CI, 2.2-8.5) but not for cancer of the vulva (SIR, 1.0; 95% CI, 0.4-2.0). The fact that alcoholics had an excess risk also for the in situ cancer suggests that the observed excess in invasive cervical cancer may not only be attributable to less use of Pap smear screening among them. The alcoholic women may be at higher risk for the progression from human papillomavirus infection to a malignant lesion for lifestyle-related reasons (promiscuity, smoking, use of contraceptive hormones, and dietary deficiencies). We conclude that alcoholic women are at high risk for in situ and invasive cervical cancer and for cancer of the vagina.

Two unusual oleanane saponins from Anemone anhuiensis

From the rhizomes of Anemone anhuiensis (Ranunculaceae), two new triterpene saponins, anhuienosides A (1) and B (2), were isolated. These compounds are glycosylated at C-23 and their structures were elucidated as hederagenin 23-O-beta-D-glucopyranosyl-(1-->2)-beta-D-glucopyranoside (1) and 23-O-beta-D-glucopyranosyl-(1-->2)-beta-D-glucopyranosyl hederagenin 28-O-alpha-L-rhamnopyranosyl(1-->4)-beta-D-glucopyranosyl(1-->6)-beta-D-glucopyranosyl ester (2) on the basis of chemical and spectral evidence.

Alcoholism and risk for endometrial cancer

Endogenous estrogens increase the risk of endometrial cancer and are also elevated among women with high alcoholic intake. It is incompletely known, however, whether alcohol intake in general and alcohol abuse in particular increases risk for endometrial cancer. We thus analyzed prospectively the risk for endometrial cancer among 36,856 women hospitalized with alcoholism between 1965 and 1994 through linkages between several national Swedish registers. Compared with the general population, women who were alcoholics had an overall 24% lower risk of developing endometrial cancer, a finding challenging our a priori hypothesis. However, among women below the age of 50 years at follow-up, the mean age of menopause among Swedish women, the risk was 70% higher, whereas the risk among women aged 50 years or more at follow-up was 40% lower compared with the general population. Hence, the effect of alcoholism on endometrial cancer appears to be age dependent.

[An epidemiological study of risk factors of rampant caries in Shanghai children]

OBJECTIVE

To explore the risk factors of rampant caries in order to provide suggestion to prevention and clinical treatment.

METHODS

A case control study and logistic regression were performed to observe some variables that possibly related to rampant caries in children on the base of a field survey.

RESULTS

The risk factors of rampant caries were incepting cariogenic foods too much and bottle feeding with sugar containing bovine milk. The risk of suffering from rampant caries also increased with duration of breast feeding.

CONCLUSION

Incepting cariogenic foods too much and unappropriate patterns of infant feeding were the important risk factors of rampant caries.

Attenuation of ischemia-induced mouse brain injury by SAG, a redox-inducible antioxidant protein

Cerebral ischemia resulting from a disruption of blood flow to the brain initiates a cascade of events that causes neuron death and leads to neurologic dysfunction. Reactive oxygen species are thought, at least in part, to mediate this disease process. The authors recently cloned and characterized an antioxidant protein, SAG (sensitive to apoptosis gene), that is redox inducible and protects cells from apoptosis induced by redox agents in a number of in vitro cell model systems. This study reports a neuroprotective role of SAG in ischemia/reperfusion-induced brain injury in an in vivo mouse model. SAG was expressed at a low level in brain tissue and was inducible after middle cerebral artery occlusion with peak expression at 6 to 12 hours. At the cellular level, SAG was mainly expressed in the cytoplasm of neurons and astrocytes, revealed by double immunofluorescence. An injection of recombinant adenoviral vector carrying human SAG into mouse brain produced an overexpression of SAG protein in the injected areas. Transduction of AdCMVSAG (wild-type), but not AdCMVmSAG (mutant), nor the AdCMVlacZ control, protected brain cells from ischemic brain injury, as evidenced by significant reduction of the infarct areas where SAG was highly expressed. The result suggests a rather specific protective role of SAG in the current in vivo model. Mechanistically, SAG overexpression decreased reactive oxygen species production and reduced the number of apoptotic cells in the ischemic areas. Thus, antioxidant SAG appears to protect against reactive oxygen species-induced brain damage in mice. Identification of SAG as a neuroprotective molecule could lead to potential stroke therapies.

Monocyte chemoattractant protein-1 expressed in neurons and astrocytes during focal ischemia in mice

Focal cerebral ischemia elicits an inflammatory response characterized by the infiltration and accumulation of leukocytes, as well as the secretion of inflammatory mediators (Clark et al., Brain Res. Bull., 35 (1994) 387-392; Garcia et al., Am. J. Pathol., 144 (1994) 188-199; Wang et al., J. Neurochem. 71 (1998) 1194-1204). Leukocytes eliminate microbial invaders and necrotizing tissue debris, and can also turn against surrounding healthy tissue and exacerbate tissue injury (Furie and Randolph, Am. J. Pathol., 146 (1995) 1287-1301; Kochanek and Hallenbeck, Stroke 23 (1992) 1367-1379). Inflammatory mediators are considered to play an important role in attracting and stimulating leukocytes (Weiss, N. Engl. J. Med., 320 (1989) 365-376). Monocyte chemoattractant protein-1 (MCP-1) functions as an inflammatory mediator, whose source and role in focal cerebral ischemia is worth studying. MCP-1, a potent chemoattractant factor, may play an important role in ischemia-induced inflammatory response. The aim of the present study is to determine the time course and cell type of MCP-1 protein expression after permanent focal ischemia in mice. ELISA and immunohistochemical staining were used to detect the expression of MCP-1 protein after 0 h, 2 h, 4 h, 12 h, 1 day, 2 days, 3 days, 5 days and 7 days of middle cerebral artery occlusion (n=3-5 in each group). Double-labeled fluorescent staining was used to examine the cellular localization of MCP-1. The results demonstrated that MCP-1 expression was mainly observed in the ischemic core after 12 h of middle cerebral artery occlusion, then gradually increased and extended to the ischemic perifocal area. MCP-1 expression peaked at 2 days and 3 days, and gradually decreased after 5 days of MCAO. Double-labeled immunostaining for MCP-1 and neuron specific enolase (NSE) or glial fibrillary acidic protein (GFAP) showed that MCP-1 positive neurons were observed as early as 12 h of ischemia, while MCP-1 positive astrocytes were observed after 2 days of ischemia. These results support the functional role of MCP-1 in ischemic brain injury and reveal a distinct temporal and spatial expression of MCP-1 in cells believed to be neurons and astrocytes.

Repeat hepatic cryotherapy for metastatic colorectal cancer

This study evaluated the risks and benefits of repeat hepatic cryotherapy for recurrent, unresectable hepatic metastases from colorectal carcinoma. Review of a prospective database identified 195 patients who underwent hepatic cryotherapy for metastatic colorectal carcinoma during a 7-year period. Of the 14 patients who underwent successful repeat cryotherapy for recurrences confined to the liver, 86% had Duke's stage D colorectal carcinoma at initial diagnosis. The median age of the 14 patients was 58 years (range 41 to 77 years). The median number of hepatic metastases was three at the first cryotherapy and two at the second cryotherapy. At a median follow-up of 71 months, the mean survival times from original diagnosis, first cryotherapy, and second cryotherapy were 53, 42, and 19 months, respectively. At the most recent follow-up, eight patients (57%) have died of their disease, four (29%) are alive with disease, and two (14%) have no evidence of disease. The mean interval between the first and second cryotherapies was 23 months. The complication rates after the first and second cryotherapies were 7% and 14%, respectively. One patient developed a wound dehiscence after the first cryotherapy. Following the second cryotherapy, one patient had a small bowel obstruction and another had a pleural effusion. There was no perioperative mortality. Repeat cryotherapy for recurrent, unresectable hepatic metastases from colorectal cancer is safe and improves survival. However, a prospective trial is needed to validate the efficacy of systemic therapy and to better define the indications for repeat hepatic cryotherapy.

Incidence of cancer among patients with hidradenitis suppurativa

BACKGROUND

On the basis of some case reports, a relationship has been suggested between hidradenitis suppurativa (HS) and the development of nonmelanoma skin cancer.

OBJECTIVES

To confirm this relationship and to explore the risk of other cancers among patients with HS.

PATIENTS

Patients with a discharge diagnosis of HS were obtained from the computerized database of hospital discharge diagnoses from January 1, 1965, through December 31, 1997. A total of 2119 patients with HS were identified.

SETTING

All hospitals in Sweden.

DESIGN

With record linkage to the Swedish National Cancer Registry, standardized incidence ratios (SIR [the ratio of the observed to expected incidence]) were calculated to estimate relative risk.

RESULTS

The risk of developing any cancer in the cohort with HS increased 50% (95% confidence interval of SIR, 1.1-1.8, based on 73 observed cases). Statistically significant risk elevations were observed for nonmelanoma skin cancer (5 cases; SIR, 4.6; 95% confidence interval, 1.5-10.7), buccal cancer (5 cases; SIR, 5.5; 95% confidence interval, 1.8-12.9), and primary liver cancer (3 cases; SIR, 10.0; 95% confidence interval, 2.1-29.2).

CONCLUSIONS

This study confirms an increased risk of nonmelanoma skin cancer among patients with HS. The risk for buccal cancer and primary liver cancer was also elevated among this cohort, but these associations should be interpreted cautiously because the combination of multiple significance testing and the few observed cases may have generated chance findings.

CancerVax, an allogeneic tumor cell vaccine, induces specific humoral and cellular immune responses in advanced colon cancer

BACKGROUND

The immunogenicity of the polyvalent tumor cell vaccine CancerVax has been correlated with the survival of patients receiving active immunotherapy for melanoma. Because the various antigens expressed on the vaccine are common to colon adenocarcinoma cells, we examined the survival impact of immune responses elicited by CancerVax in patients with advanced colon cancer refractory to standard therapy.

METHODS

Twenty-seven patients with American Joint Committee on Cancer (AJCC) stage IV colorectal adenocarcinoma were entered prospectively into the study. CancerVax was coadministered with bacille Calmette-Guerin (BCG) for the first 2 weeks of vaccine treatment. Blood was drawn at the start of therapy and every 2 weeks thereafter to measure serum titers of immunoglobulin (Ig)G and IgM against TA90 (a 90-kD immunogen common to colon cancer and CancerVax cells) and against purified protein derivative (PPD), a nontumor control antigen. Cellular immune responses were evaluated by delayed-type hypersensitivity (DTH) reaction to vaccine cells and to PPD. Mean follow-up time was 17.5 months.

RESULTS

There was a significant (P = .0001) increase in anti-TA90 IgG and IgM titers and in DTH response to vaccine cells. Humoral and skin responses to TA90 did not correlate with responses to PPD (P = .199 for IgM, P = .958 for IgG, and P = .149 for DTH). This suggests that these responses are not a manifestation of general immune competence. The median overall survival (OS) was 21.9 months for the entire group. Overall survival was higher among patients whose IgMTA90 titer was >800 (P = .003) or whose disease-free interval exceeded 12 months (P = .031). Multivariate Cox regression analysis-using age, sex, disease-free interval, disease status, extent of metastasis, humoral responses, and DTH responses-found only peak IgMTA90 titer to be a significant predictor of overall survival (P = .0365).

CONCLUSIONS

CancerVax can induce measurable humoral and cellular immune responses to tumor-associated antigens in patients with advanced-stage colon cancer. These responses correlate with overall survival. This novel therapeutic regimen for patients with advanced colon cancer merits further investigation.

[A survey on blood lipid levels among newborns and healthy inhabitants in urban Shanghai from 1997 to 1999]

OBJECTIVE

To analyze the blood lipid levels among inhabitants of different ages in urban Shanghai by the end of 1990 and compare the results with those in 1970 s and 1980 s.

METHODS

Venous blood samples were collected from 3647 persons undergoing annual health examination, including workers and staff members, employees, functionaries, and students of factories, governmental organizations, institutions, enterprises, and schools. Umbilical blood samples were collected from 88 newborns. Serum TC, TG, LDL-C, and HDL-C were determined.

RESULTS

3647 blood samples were collected in total. It is found that: (1) The levels of blood lipids increased along with the age. The levels of TC and LDL-C among females over their fifty were higher that those among the males in the same age groups. The level of TG among females over fifty was similar to that among the males in the same age groups. The levels of LDL-C were higher in families in all of the age groups than those in the males of the same ages. (2) In comparison to those in 1970 s the levels of TC and TG in 1990 s were significantly higher by 6.79% - 17.69% and 21.95% - 45.53% respectively, and the level of HDL-C decreased by 8.02% - 29.19%. (3) The percentage of persons over forty with their TC levels over the upper normal limit was much larger in 1990 s than in 1970 s (for TC 11.57% vs. 4.40% among males and 16.02% vs. 5.40% among females, for TG 21.83% vs. 5.20% among males and 13.32% vs. 5.70% among females). and (4) The percentage of persons with their TC/HDL-C >or= 4 and TG >or= 1.70 mmol/L was much larger among persons over forty than among persons under forty (20.74% vs. 10.99% among males and 13.32% vs. 2.05% among females).

CONCLUSION

The mean serum TC, TG, and LDL-C levels increased and the HDL-C level decreased significantly among healthy inhabitants in urban Shanghai in 1990 s. Along with the rise of living standards of people, their mean lipid level increases too. Nutrition education is necessary.

U7C beamline and XAFS station of national synchrotron radiation laboratory

The XAFS station on beamline U7C of National Synchrotron Radiation Laboratory (NSRL) was completely constructed in December 1998. The source for XAFS station is from a 3-pole superconducting wiggler with magnetic field of 6 T inserted in the straight section of the storage ring. Using a Si(111) double crystal monochromator with a fixed slit, the X-ray intensity at the sample position is about 3x10(9) photons/second at the energy of 8980 eV of Cu K-edge. The Keithley 65 17 electrometers are used to record the electron charges that are produced in the ionization chambers. A high ratio of signal to noise has been obtained for the XAFS spectra of Cu, Ni and Fe foils. Furthermore, the XAFS spectrum of Cu foil in NSRL is in good agreement with that obtained in BSRF and KEK.

Antisweet saponins from Gymnema sylvestre

Three new oleanane-type triterpene glycosides (1-3), along with the sodium salt of alternoside II (4), were isolated from an ethanol extract of the leaves of Gymnema sylvestre. The structures of these new saponins were identified as 21 beta-O-benzoylsitakisogenin 3-O-beta-D-glucopyranosyl(1-->3)-beta-D-glucuronopyranoside (1), the potassium salt of longispinogenin 3-O-beta-D-glucopyranosyl(1-->3)-beta-D-glucuronopyranoside (2), and the potassium salt of 29-hydroxylongispinogenin 3-O-beta-D-glucopyranosyl(1-->3)-beta-D-glucuronopyranoside (3). The aglycon of 3, gymnemagenol (3a), was characterized as 3 beta,16 beta,28, 29-tetrahydroxyolean-12-ene. Structure elucidation was accomplished by interpretation of NMR (DQF-COSY, HMQC, and HMBC) results, FABMS, and hydrolysis. Saponin 1 and the sodium salt of alternoside II (4) exhibited antisweet activity.

Inverse association between intake of cereal fiber and risk of gastric cardia cancer

BACKGROUND & AIMS

Recent data show that salivary nitrites form carcinogenic nitrosamines, especially at the gastric cardia. Wheat fiber has been shown to neutralize such mutagen formation. Our aim was to evaluate the association between dietary fiber and cancers of the esophageal and gastric cardia.

METHODS

We examined data from a large-scale population-based case-control study of risk factors for adenocarcinoma of the gastric cardia and esophagus and squamous cell carcinoma of the esophagus.

RESULTS

We found a strong dose-dependent inverse association between total dietary fiber intake and risk of gastric cardia adenocarcinoma, which was driven mainly by intake of cereal fiber. The odds ratio among individuals in the highest quartile of cereal fiber intake compared with the lowest was 0.3 (95% confidence interval, 0.2-0.5; P trend < 0.0001). High intake of cereal fiber was also associated with a moderately decreased risk of esophageal adenocarcinoma, but no linear dose-risk trend was observed. There was no association between dietary fiber and esophageal squamous cell carcinoma.

CONCLUSIONS

High intake of cereal fiber may significantly lower the risk of gastric cardia cancer.

Inverse association between intake of cereal fiber and risk of gastric cardia cancer

BACKGROUND & AIMS

Recent data show that salivary nitrites form carcinogenic nitrosamines, especially at the gastric cardia. Wheat fiber has been shown to neutralize such mutagen formation. Our aim was to evaluate the association between dietary fiber and cancers of the esophageal and gastric cardia.

METHODS

We examined data from a large-scale population-based case-control study of risk factors for adenocarcinoma of the gastric cardia and esophagus and squamous cell carcinoma of the esophagus.

RESULTS

We found a strong dose-dependent inverse association between total dietary fiber intake and risk of gastric cardia adenocarcinoma, which was driven mainly by intake of cereal fiber. The odds ratio among individuals in the highest quartile of cereal fiber intake compared with the lowest was 0.3 (95% confidence interval, 0.2-0.5; P trend < 0.0001). High intake of cereal fiber was also associated with a moderately decreased risk of esophageal adenocarcinoma, but no linear dose-risk trend was observed. There was no association between dietary fiber and esophageal squamous cell carcinoma.

CONCLUSIONS

High intake of cereal fiber may significantly lower the risk of gastric cardia cancer.

Reduction of inflammatory response in the mouse brain with adenoviral-mediated transforming growth factor-ss1 expression

Background and Purpose-Chemokines have been shown to play an important role in leukocyte and monocyte/macrophage infiltration into ischemic regions. The purpose of this study is to identify whether overexpression of the active human transforming growth factor-ss1 (ahTGF-ss1) can downregulate expression of monocyte chemoattractant protein-1 (MCP-1), macrophage inflammatory protein-1alpha (MIP-1alpha), and intercellular adhesion molecule-1 (ICAM-1) and reduce ischemic brain injury.

METHODS

-Overexpression of transforming growth factor-ss1 (TGF-ss1) was achieved through adenoviral gene transfer. Five days after adenoviral transduction, the mouse underwent 30 minutes of middle cerebral artery occlusion followed by 1 to 7 days of reperfusion. TGF-ss1, MCP-1, MIP-1alpha, and ICAM-1 were detected by enzyme-linked immunosorbent assay and immunohistochemistry. Infarct areas and volumes were measured by cresyl violet staining.

RESULTS

-MCP-1 and MIP-1alpha expression is increased after middle cerebral artery occlusion, and double-labeled immunostaining revealed that MCP-1 is colocalized with neurons and astrocytes. Viral-mediated TGF-ss1 overexpression was significantly greater at measured time points, with a peak at 7 to 9 days. The expression of MCP-1 and MIP-1alpha, but not ICAM-1, was reduced in the mice overexpressing ahTGF-ss1 (P:<0.05). Furthermore, infarct volume was significantly reduced in the mice overexpressing ahTGF-ss1 (P:<0.05).

CONCLUSIONS

-This study demonstrates that MCP-1 and MIP-1alpha expressed in the ischemic region may play an important role in attracting inflammatory cells. The reduction of MCP-1 and MIP-1alpha, but not ICAM-1, in the mice overexpressing ahTGF-ss1 suggests that the neuroprotective effect of TGF-ss1 may result from the inhibition of chemokines during cerebral ischemia and reperfusion.