New scoring classification for primary biliary cholangitis-autoimmune hepatitis overlap syndrome

Autoimmune hepatitis (AIH) and primary biliary cholangitis (PBC) are two major immune‐mediated chronic liver diseases. Overlap syndrome (OS) is diagnosed if patients have features of both AIH and PBC; however, there is no consensus on the definition or diagnostic criteria for OS. Here, we report a new scoring classification for OS and evaluate its usefulness. This new scoring classification was developed by modifying the International Autoimmune Hepatitis Group classification by selecting histologic features of AIH and PBC along with modifications of biochemical and immunologic characteristics. We evaluated 272 patients with chronic liver disease, including 105 with AIH, 102 with PBC, and 65 with OS. The best performance for the diagnosis of OS was noted among patients with an overlap score of ≥21 who had a sensitivity of 98.5%, a specificity of 92.8%, a positive predictive value of 81.0%, and a negative predictive value of 99.5%. By using a cut‐off score of 21, 64 (98.5%) patients were diagnosed with OS as opposed to 9 (8.8%) and 6 (5.7%) with PBC and AIH, respectively. All patients with OS had an aggregate score of >19, whereas most patients with PBC or AIH scored <19, making this a safe discriminatory cut‐off point against OS. Conclusion: The new scoring system for the diagnosis of OS has a high sensitivity and specificity for scores ≥21, while a score <19 suggests a diagnosis other than OS. This classification can identify patients and diagnose OS with a reasonable amount of accuracy and may be superior to current OS scoring systems in detecting mild forms of OS. (Hepatology Communications 2018;2:245‐253)

Incidence of Sinusitis Associated With Endotracheal and Nasogastric Tubes: NIS Database

BACKGROUND

Endotracheal and nasogastric tubes are recognized risk factors for nosocomial sinusitis. The extent to which these tubes affect the overall incidence of nosocomial sinusitis in acute care hospitals is unknown.

OBJECTIVE

To use data for 2008 through 2013 from the Nationwide Inpatient Sample database to compare the incidence of sinusitis in patients with nasogastric tubes with that in patients with an endotracheal tube alone or with both an endotracheal tube and a nasogastric tube.

METHODS

Patients' data with any of the following International Classification of Disease, Ninth Revision, Clinical Modification codes were abstracted from the database: (1) 96.6, enteral infusion of concentrated nutritional substances; (2) 96.07, insertion of other (naso-)gastric tube; or (3) 96.04, insertion of an endotracheal tube. Sinusitis was defined by the appropriate codes. Weighted and unweighted frequencies and weighted percentages were calculated, categorical comparisons were made by χ² test, and logistic regression was used to examine odds of sinusitis development by tube type.

RESULTS

Of 1 141 632 included cases, most (68.57%) had an endotracheal tube only, 23.02% had a nasogastric tube only, and 8.41% had both types of tubes. Sinusitis was present in 0.15% of the sample. Compared with patients with only a nasogastric tube, the risk for sinusitis was 41% greater in patients with an endotracheal tube and 200% greater in patients with both tubes.

CONCLUSION

Despite the low incidence of sinusitis, a significant association exists between sinusitis and the presence of an endotracheal tube, especially when a nasogastric tube is also present.

Effects of Fermented Ginger Rhizome (Zingiber officinale) and Fenu Greek (Trigonella foenum-graceum) Supplements on Oxidative stress and Lipid Peroxidation Biomarkers in Poloxamer-407 Induced -Hyperlipidemic Wistar Rats

This research was aimed at investigating the Effects of Fermented Ginger Rhizome (Zingiber officinale) and Fenu Greek (Trigonella foenum-graceum) on Oxidative stress and Lipid Peroxidation Biomarkers in Poloxamer 407Induced-Hyperlipidemic Wistar Rats. Hyperlipidaemia was induced with poloxamer P407 (1.5 g/kg   b.w. i.p.) The Animals were grouped into six of five animals each group. Group 1 normal control, Group 2 served as the hyperlipidemic control, Group 3 administered 0.26 g/kg cholestyramine, Group 4 fed on Fenugreek 25% supplement. Group 5 fed on 25% fermented ginger supplement, while group 6 were fed on 25% ginger and fenu greek combined   respectively. All treatments were given for a period of four week. Serum antioxidant activities such as catalase (CAT), glutathione peroxidase (GPx), Superoxide dismutase (SOD) and Malondialdehyde were evaluated.  As regards to the catalase activity there was a significant decrease in the groups' fed on 25% fenugreek and 25% fermented ginger supplements respectively. However, co-fed with both supplements significantly increase the catalase activity as compared with the hyperlipidaemic control untreated. Comparism with the positive control cholestyramine, there was also a significant increase. Also in relation to the SOD activity there was a significant increase in the activity as compared with the hyperlipidemic control. Furthermore, the Gpx activity there was a significant increase in the as compared with the hyperlipidemic control. oxidative stress biomarker activities SOD) there was significant increase (p<0.05) when compared with hyperlipidemic control. There was a significant (p<0.05) decrease in the Malondialdehyde levels in the groups fed with the supplement when compared with hyperlipidemic control. In conclusion supplements of Fenugreek and Ginger improved antioxidant status and reduced Malondialdehyde in Poloxamer-407 Induced-Hyperlipidemic Wistar Rats.

Approaching a decade since HPV vaccine licensure: Racial and gender disparities in knowledge and awareness of HPV and HPV vaccine

Purpose: Gaps remain in the public's knowledge of the human papillomavirus (HPV). We assessed racial/ethnic and gender disparities in knowledge and awareness of HPV and the HPV vaccine among US adults.

METHODS

Data from the Health Information National Trends Survey 4 Cycle 3 (September - December 2013) and Cycle 4 (August - November 2014) were analyzed for 6,862 respondents aged 18 years and older. Weighted multivariable logistic regression models were used to estimate racial/ethnic and gender disparities in HPV knowledge and HPV vaccination awareness.

RESULTS

Sixty-six percent of respondents had heard of HPV and the HPV vaccine (57% of men vs. 75% of women). In multivariable analyses, compared with men, women were 225% (95% CI: 2.60 - 4.07) more likely to have heard of HPV, and 281% (95% CI: 3.06 - 4.74) more likely to have heard of the HPV vaccine. Non-Hispanic Blacks were 33% (95% CI: 0.47 - 0.96) and 44% (95% CI: 0.39 - 0.81) less likely than non-Hispanic Whites to have heard of HPV and the HPV vaccine, respectively. Hispanics were 27% (95% CI: 0.52 - 1.02) and 53% (95% CI: 0.34 - 0.64) less likely than non-Hispanic Whites to have heard of HPV and the HPV vaccine, respectively.

CONCLUSIONS

There was evidence of disparities in HPV and HPV vaccine awareness among men compared with women and non-Hispanic Blacks and Hispanics compared with non-Hispanic Whites. To foster improvements in HPV vaccine uptake and reduce disparities in HPV associated cancers, future interventions must target men and minority populations, for whom knowledge gaps exist.

Anti-hyperglycaemic Effects of Rutin on Blood Glucose, Oxidative Stress Biomarkers and Lipid Peroxidation in Alloxan-induced Hyperglycaemic Wistar Rats

The present study investigated the anti-hyperglycaemic effect of rutin on blood glucose, oxidative stressbiomarkers and lipid peroxidation in alloxan induced hyperglycaemic wistar rats. Diabetes was induced in rats by anintraperitoneal (i.p) injection of alloxan monohydrate 150 mg/kg body weight. Twenty five wistar rats were divided asfollows; Group1 served as diabetic control received distilled water 2 mg/kg, Group served as positive control received 2mg/kg glibenclamide, 3, 4 and 5 received rutin at 50, 100 and 200 mg/kg body weight for 28 days respectively. At the end of the treatment, rats were sacrificed and the blood and serum were used for the analysis of blood glucose and oxidativestress biomarkers respectively. The determinations of blood glucose levels were carried out at intervals of 7, 14, 21 and 28days respectively Serum oxidative stress biomarkers lipid peroxidation, were done on the 28 days. Administrations of rutinat the three different doses 50,100 and 200 mg/kg to diabetic rats significantly (p<0.05) decreased the blood glucose levelsas compared to diabetic control. The dose of 200 mg/kg exhibited a maximum glucose lowering effect with blood glucoseof 102.8± 0.06 as compared to diabetic control 346.2±0.16. Furthermore, in relation to the oxidative stress biomarkers therewas a significant (p<0.05) increased in the levels of gluthathione peroxidase, superoxide dismutase and catalase as comparedto control. However, there was also a significant decreased in the malondialdehyde levels as compared to control. It may beconcluded that oral administration of Rutin for 28 days decreases blood glucose levels and prevented oxidative stress andantioxidant status in hyperglycaemic rats.

Factors Associated With Parents' Intent to Vaccinate Adolescents for Human Papillomavirus: Findings From the 2014 National Immunization Survey-Teen

Introduction

While factors associated with receipt of human papillomavirus (HPV) vaccination have been well characterized, less is known about the characteristics associated with parents’ intent to have their adolescent children vaccinated. This study aimed to examine factors associated with parental intention toward HPV vaccination.

Methods

We analyzed data on 10,354 adolescents aged 13 to 17 years from the 2014 National Immunization Survey–Teen. Weighted multivariable logistic regression was used to examine associations between sociodemographic characteristics of mothers and adolescents, as well as a health care provider recommendation with parents’ intention to have their children receive HPV vaccine.

Results

Among unvaccinated adolescents, Hispanic ethnicity (boys adjusted odds ratio [AOR], 1.87, 95% confidence interval [CI], 1.34–2.61; and girls AOR, 1.57; 95% CI, 1.05–2.35), mothers with less than a high school diploma (boys AOR, 2.41; 95% CI, 1.58–3.67; and girls AOR, 1.86; 95% CI, 1.02–3.38), and having a health care provider recommend the vaccine (boys AOR, 1.87; 95% CI, 1.52–2.31; and girls AOR, 1.38; 95% CI, 1.05–1.82) were significantly associated with parents’ intention to have their adolescent child vaccinated within the next 12 months. In addition, non-Hispanic black race was a significant predictor of parents’ intent to vaccinate for boys (AOR, 1.89; 95% CI, 1.35–2.65).

Conclusion

Maternal education and Hispanic ethnicity were the strongest predictors of parental intent to vaccinate against HPV, followed by provider recommendation. As HPV vaccination rates in the United States remain below the Healthy People 2020 goal, messages may need to be targeted based on maternal education, race/ethnicity, and provider recommendation.

Not just a woman's business! Understanding men and women's knowledge of HPV, the HPV vaccine, and HPV-associated cancers

Few studies have included men when assessing differences in knowledge about HPV, and HPV-associated cancers. We examined gender differences in knowledge about HPV, HPV vaccine, and HPV-associated cancers. Multivariable logistic regression models were used to analyze data of 3,677 survey respondents aged 18 years and older from the 2014 Health Information National Trends Survey. Covariates included age, race/ethnicity, marital status, education, income level, regular provider, general health, internet use, and family structure aged 9 to 27 years. Analyses were conducted in 2015. Sixty-four percent of respondents had heard of HPV and the HPV vaccine. Seventy-eight percent of respondents knew HPV causes cervical cancer, but only 29% knew it causes penile cancer, 26% knew it causes anal cancer, and 30% knew it causes oral cancer. In multivariable analyses, males were less likely to have heard of HPV (aOR: 0.33; 95% CI: 0.25-0.45), and less likely to have heard of the HPV vaccine (aOR: 0.24; 95% CI: 0.18-0.32) compared to females. No differences existed between males and females regarding knowledge about HPV-associated cancers. In conclusion, knowledge of HPV, the vaccine, and HPV-associated cancers in both males and females in the United States remains very low, especially among men.

A Comparison of Parent- and Provider-Reported Human Papillomavirus Vaccination of Adolescents

INTRODUCTION

There is considerable effort at the state and national levels to monitor human papillomavirus (HPV) vaccine uptake and understand the factors that influence who gets vaccinated. Accurate measurement of vaccination coverage is critical for monitoring HPV vaccination. This study aimed to determine comparability between parent- and provider-reported HPV vaccination status for a sample of adolescents in the U.S.

METHODS

Data from the 2014 National Immunization Survey-Teen were analyzed in 2016 for 20,827 adolescents. Information on HPV vaccine uptake (initiation [one or more dose] and completion [three or more doses]) was obtained using parental (recall) and provider reports (electronic medical records). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and κ-coefficient were computed to determine how comparable parental and provider (ref group) reports were for HPV vaccination.

RESULTS

Prevalence of HPV vaccine initiation was comparable between parental and provider report (51.3% vs 50.0%) and for completion (30.7% vs 27.3%). Compared with provider report, parent-reported HPV vaccine initiation had high sensitivity (86.0%), specificity (87.4%), PPV (87.5%), NPV (85.9%), and acceptable κ-coefficient (0.73). Compared with provider report, parent-reported HPV vaccine completion had a sensitivity of 71.5%, specificity of 91.1%, PPV of 78.5%, NPV of 87.6%, and κ-coefficient of 0.64. Similar characteristics-adolescent age, sex, number of doctor visits, and region-were associated with HPV vaccine uptake using parental and provider reports.

CONCLUSIONS

Parental recall is comparable to provider report in monitoring HPV vaccine uptake for adolescents, although parental recall is less comparable for HPV vaccine completion.

Hematopoietic cell transplant comorbidity index (HCT-CI) to assess AML induction risk

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Background: Induction therapy for acute myeloid leukemia (AML) is intense and methods for risk appraisal of therapy are controversial. Formal comorbidity assessment may allow for improved prognostication in addition to age. The HCT-CI(+/-Age) was developed to inform risk of patients undergoing stem cell transplant, and has found use in predicting early outcomes in AML induction. We applied HCT-CI retrospectively to our experience to analyze the predictive power regarding patient survival during induction. Methods: 140 cases induced with idarubicin and cytarabine (IA) or IA plus cladribine (IAC) between Jan 2008 and Sept 2015. HCT-CI (+/- Age) was derived from information available prior to chemotherapy and NCCN Leukemia Risk were calculated. Death prior to discharge from the initial induction hospitalization was the primary outcome for logistic regression. Results: 107 patients received IAC and 33 IA with mean age of 57 and 66 years respectively (p<0.01). Regimen did not predict death (p=0.27). Median age was 61 (range 20-86) with mean scores of 2.0±0.2 (HCT-CI) and 2.9±0.2 (HCT-CI+Age). In univariate analysis HCT-CI (+/-Age) predicted death during induction. In multivariate analyses, when HCT-CI (+/-Age) was adjusted for (NCCN risk and regimen) or (age and regimen) predictive power was maintained (Table). Conclusions: These data suggest that HCT-CI predicts death during induction of AML and age did not augment prediction, up to age 70. We conclude that HCT-CI(+/-Age) may be a more useful tool than age alone or clinical instinct to help patients and providers make difficult decisions about therapy. [Table: see text]

Correlates of Hookah Pipe Awareness and Perceived Harmfulness Among U.S. Adults

INTRODUCTION

Hookah smoking has recently become a common form of smoking, and its prevalence has increased worldwide. This study determined the prevalence and correlates of hookah awareness and perceived harmfulness among U.S. adults.

METHODS

Weighted multivariable logistic regression analyses were performed on 6,711 adults aged ≥18 years collected from the 2013-2014 Health Information National Trends Survey (Cycles 3 and 4). Analysis was conducted in 2016.

RESULTS

Overall, 74.3% were aware of hookah. Of these, 73.4% believed hookah pipes were equally harmful as cigarettes whereas 15.7% believed otherwise. Older (OR=0.13, 95% CI=0.09, 0.18), black (OR=0.51, 95% CI=0.38, 0.71), Hispanic (OR=0.52, 95% CI=0.37, 0.71), and less-educated (OR=0.42, 95% CI=0.27, 0.65) respondents had lower odds of being aware of hookah. Compared with non-smokers, former smokers had 83% (95% CI=1.44, 2.33) higher odds of hookah awareness. Among those aware of hookah, older (OR=0.44, 95% CI=0.31, 0.62), black (OR=0.64, 95% CI=0.43, 0.96), and less-educated (OR=0.55, 95% CI=0.33, 0.92) respondents had lower odds of perceiving hookah as less harmful than cigarettes.

CONCLUSIONS

Most adults in U.S. are aware of hookah, but only 15.7% believe it is less harmful than cigarettes. This small proportion are mostly young, white, and college graduates. Targeted behavioral interventions will be necessary to increase individuals' perceived risk, knowledge, and perceived harmfulness of hookah smoking.

Disparities in Provider Recommendation of Human Papillomavirus Vaccination for U.S. Adolescents

PURPOSE

To determine the prevalence of and examine factors associated with provider recommendation of human papillomavirus vaccination for U.S. adolescents.

METHODS

Multivariable logistic regression analyses were performed using data from the National Immunization Survey-Teen 2014 on 34,478 adolescents aged 13-17 years.

RESULTS

Overall prevalence of vaccine recommendation was 72.6% for girls and 51.8% for boys. Lower rates were observed among girls aged 13 years, living below poverty line, adolescents of lesser educated mothers, and those residing in the South. Overall, girls had higher odds of vaccine recommendation (odds ratio [OR] = 2.57; 95% confidence interval [CI] = 2.35-2.82). Correlates of higher vaccine recommendation for girls were: older age-17 versus 13 (OR = 1.51; 95% CI = 1.20-1.89), living above versus below poverty line, and residing in Northeast (OR = 1.45; 95% CI = 1.21-1.73) and Midwest (OR = 1.29; 95% CI = 1.11-1.50) versus South. For boys, correlates of higher vaccine recommendation were: non-Hispanic black (OR = 1.30; 95% CI = 1.07-1.58) and Hispanic (OR = 1.24; 95% CI = 1.03-1.48) versus non-Hispanic white race and residing in Northeast (OR = 1.79; 95% CI = 1.54-2.08) and West (OR = 1.41; 95% CI = 1.17-1.70) versus South. Other factors associated with vaccine recommendation were having a college-educated mother and frequent doctor visits in the past 12 months.

CONCLUSIONS

This study highlights significant disparities in provider recommendation of human papillomavirus vaccination for U.S. adolescents. Findings suggest possible areas for tailored interventions to bridge the gap in vaccine recommendation and uptake in high-risk populations.

Abstract 2577: A comparison of parent and provider verified HPV vaccination initiation and completion in US adolescents: findings from the National Immunization Survey - Teen, 2014

Introduction:

Several studies have examined predictors of HPV vaccine initiation and completion. Two common methods to measure HPV vaccine initiation and completion are parental recall and provider verified vaccine history. Some studies use parental recall because it is cost-effective and time-consuming. Others argue that the provider report should be used because it is the gold standard, although it is more costly and time-consuming. Yet, few studies compare the accuracy of parental report versus provider report for HPV vaccine initiation and completion.

Objective:

To compare the accuracy of parental reported and provider reported data on HPV vaccine initiation and completion among a national sample of adolescents in the United States.

Methods:

Data from the 2014 National Immunization Survey-Teen (NIS-Teen) were analyzed for 38,703 adolescents. HPV vaccine initiation and completion were assessed using parental recall (shot cards) and provider verified (medical records) vaccine history. Adjusted, weighted multivariable logistic regression compared the accuracy of parental and provider reported data on HPV vaccine initiation and completion.

Results:

HPV vaccine initiation (a) and completion (b), by subgroup analysis, is similar for parental recall and provider report. However, subgroup analyses for parental report were slightly lower than provider report, although not statistically significant (Table 1).

Conclusion:

This study showed that parental report is comparable to provider report when measuring HPV vaccine initiation and completion among adolescents in the US. For more cost-effective and timely assessment of vaccine uptake, an accurate and practical method of measuring HPV vaccine initiation and completion is paramount. Utilizing parental report may be a more cost-effective and timely alternative to provider report for clinical evaluation of vaccine uptake. Table 1:Subgroup analysis of HPV vaccine initiation and completion, Odds Ratios (95% CI)HPV Vaccine Initiation (a)Parental RecallProvider verifiedGender (Ref: Boys)1.98 (1.81, 2.15)2.02 (1.81, 2.26)Race (Ref: Caucasian)African American1.19 (1.03, 1.37)1.31 (1.10, 1.56)Hispanic1.38 (1.20, 1.58)1.51 (1.27, 1.79)Region (Ref: South)Northeast1.31 (1.18, 1.46)1.46 (1.27, 1.67)Midwest1.11 (1.01, 1.22)1.15 (1.02, 1.30)West1.25 (1.09, 1.43)1.42 (1.20, 1.69)HPV Vaccine Completion (b)Parental RecallProvider verifiedGender (Ref: Boys)2.24 (2.02, 2.48)2.37 (2.09, 2.69)Race (Ref: Caucasian)African American0.91 (0.77, 1.07)1.05 (0.87, 1.28)Hispanic1.06 (0.91, 1.23)1.40 (1.17, 1.68)Region (Ref: South)Northeast1.39 (1.23, 1.57)1.55 (1.34, 1.80)Midwest1.14 (1.02, 1.27)1.24 (1.08, 1.41)West1.20 (1.03, 1.40)1.36 (1.12, 1.66)

Citation Format: Eric Adjei Boakye, Nosayaba Osazuwa-Peters, Kahee A. Mohammed, Christian J. Geneus, Betelihem B. Tobo. A comparison of parent and provider verified HPV vaccination initiation and completion in US adolescents: findings from the National Immunization Survey - Teen, 2014. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 2577.

Abstract 1787: Adolescent boys and the human papillomavirus (HPV) - Geographical patterns of vaccination uptake

INTRODUCTION

Human Papillomavirus (HPV) remains the most common sexually transmitted infection (STI) and is associated with multiple cancers. Previous research has examined HPV vaccine initiation and completion among girls. Among adolescent boys who are also at risk for contracting HPV, however, vaccine initiation and completion have not been widely explored.

OBJECTIVE

To examine predictors of HPV vaccine initiation and completion among boys in the United States.

METHODS

Analysis was conducted on 10,866 adolescent boys aged 13-17 using the 2014 National Immunization Survey-Teen. Our outcomes of interest, HPV vaccine initiation and completion, were measured using provider-verified vaccine history. Weighted multivariable logistic regression models assessed predictors of HPV vaccine initiation and completion.

RESULTS

Data stratified by geographic region showed that the prevalence of HPV vaccine initiation and completion ratio was lowest in the South: South (initiation: 38.82%, completion: 18.20%), Midwest (initiation: 38.15%, completion: 19.69%), West (initiation, 48.88%, completion: 26.12%), Northeast (initiation: 48.30%, completion: 26.96%).

Multivariable analysis of geographic patterns indicated that adolescent boys residing in the West had higher odds of vaccine initiation compared to those in the South (OR = 1.41; 95% CI: 1.08 - 1.83).On the other hand, the odds of vaccine completion were higher in adolescents residing both in the Northeast (OR = 1.46; 95% CI: 1.14 - 1.87) and West (OR = 1.42; 95% CI: 1.03 - 1.95) compared to adolescent boys residing in the South.

Adolescent boys who were recommended the HPV vaccine by a physician had 8.49 (95% CI; 7.03 - 10.26) and 5.97 (95% CI: 4.49 - 7.94) higher odds of initiation and completion, respectively. Compared to White adolescent boys, the odds of vaccine initiation (OR = 1.90; 95% CI: 1.47 - 2.48) and completion (OR = 1.49; 95% CI: 1.09 - 2.04) were higher amongHispanics boys. Moreover, boys aged 17 had higher odds of vaccine initiation compared to those who were 13 (OR = 1.41; 95% CI: 1.05 - 1.90). Finally, while mothers’ education partially influenced the odds of vaccine initiation in adolescent boys (&lt;12 years; OR = 2.053; 95% CI: 1.43 - 2.95), such was not significant in vaccine completion. Instead, higher odds of vaccine initiation among adolescent boys were associated with mothers who had two children aged&lt;18 years compared to one child (OR = 1.29; 95% CI: 1.07 - 1.56).

CONCLUSION

Our findings highlight the suboptimal HPV vaccine across the United States, as well as the sociodemographic disparities and geographic variation of HPV vaccine initiation and completion. Particularly among adolescent boys residing in the South, tailored interventions are needed to improve HPV vaccine uptake.

Citation Format: Christian J. Geneus, Kahee A. Mohammed, Betelihem B. Tobo, Eric Adjei Boakye, Nosayaba Osazuwa-Peters. Adolescent boys and the human papillomavirus (HPV) - Geographical patterns of vaccination uptake. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 1787.

Pineal Gland Calcification in Kurdistan: A Cross-Sectional Study of 480 Roentgenograms

Objective

The goal of this study was to compare the incidence of Pineal Gland Calcification (PGC) by age group and gender among the populations living in the Kurdistan Region-Iraq.

Methods

This prospective study examined skull X-rays of 480 patients between the ages of 3 and 89 years who sought care at a large teaching public hospital in Duhok, Iraq from June 2014 to November 2014. Descriptive statistics and a binary logistic regression were used for analysis.

Results

The overall incidence rate of PGC among the study population was 26.9% with the 51–60 age group and males having the highest incidence. PGC incidence increased after the first decade and remained steady until the age of 60. Thereafter the incidence began to decrease. Logistic regression analysis revealed that both age and gender significantly affected the risk of PGC. After adjusting for age, males were 1.94 (95% CI, 1.26–2.99) times more likely to have PGC compared to females. In addition, a one year increase in age increases the odds of developing PGC by 1.02 (95% CI, 1.01–1.03) units after controlling for the effects of gender.

Conclusion

Our analysis demonstrated a close relationship between PGC and age and gender, supporting a link between the development of PGC and these factors. This study provides a basis for future researchers to further investigate the nature and mechanisms underlying pineal gland calcification.

Abstract A60: A paradox: Engaging in at-risk behavior may not correlate with perceived susceptibility to cancer or heart disease

Background: The Health Belief Model states that behavioral change is highly influenced by perceived susceptibility to disease. The literature shows that physical activity, nutrition, and smoking are top factors associated with heart disease and cancer. Some studies have examined factors that affect perceived susceptibility to heart disease and cancer; however, there are no studies directly comparing predictors of perceived susceptibility to cancer and heart disease.

Objective: The objective of this study was to examine shared and differing predictors of respondents' perceived susceptibility to cancer and heart disease.

Methods: Data from the Health Information National Trends Survey 4 Cycle 3 (November 2013) were analyzed for 2,508 survey participants aged 18 years and older. Binary logistic regression was used to examine behavioral and socio-demographic risk factors for heart disease and cancer to determine predictors' of perceived susceptibility to these diseases.

Results:

Behavioral predictors:

Smoking status (p = 0.4385), nutrition (p = 0.6387), and physical activity (p = 0.5889) were not significant predictors of perceived susceptibility to cancer. Similarly, smoking status (p = 0.3702), nutrition (p = 0.1583), and physical activity (p = 0.0979) were not significant predictors of perceived susceptibility to heart disease. Former and current smokers perceived low susceptibility to heart disease but high susceptibility to cancer compared to non-smokers. In addition, those who consumed less than 5 servings of fruits and vegetables weekly perceived high susceptibility to heart disease but low susceptibility to cancer, compared to respondents who consumed 5 or more servings of fruits and vegetables weekly. Moreover, those who exercised 1-4 times per week perceived high susceptibility to heart disease and cancer, compared to respondents who exercised 5-7 times per week. On the other hand, those who did not engage in any physical activity perceived low susceptibility to heart disease and cancer, compared to respondents who exercised 5-7 times per week. Yet, none of these findings were significant.

Sociodemographic predictors:

Health status (p = 0.0116) was a significant predictor of perceived risk for cancer, illustrating a dose response relationship. Compared to those who reported excellent/very good health, those who reported fair/poor health (OR: 2.0; 95% CI: 1.22, 3.45) and good health (OR: 1.5; 95% CI: 1.04, 2.13) perceived high susceptibility to cancer. Similarly, health status (p = 0.0007) was a significant predictor of perceived susceptibility to heart disease. Compared to those who reported excellent/very good health, those who reported fair/poor health (OR: 1.8; 95% CI: 1.13, 2.99) and good health (OR: 2.0; 95% CI: 1.37, 2.79) perceived high susceptibility to heart disease. Race (p = 0.0002) was a significant predictor of perceived susceptibility to cancer. Compared to White respondents, Non-Hispanic Blacks (95% CI: 0.28, 0.84), Hispanics (95% CI: 0.38, 0.90), and other races (95% CI: 0.19, 0.62) were 49%, 58%, and 34% less likely to perceive susceptibility to cancer, respectively. However, race was not statistically significant predictor of perceived risk for heart disease.

Conclusions: Despite evidence that indicates the significance of engaging in top protective factors against cancer and heart disease—not smoking, proper nutrition, and exercise—our findings show that respondents at higher risk were not significantly more likely to perceive high susceptibility to illness. Perceived susceptibility is a key component of reducing risk behaviors and increasing health promoting behaviors. These paradoxical results pose important implications for disease-specific interventions targeting health behaviors. Healthcare providers and program planners should consider these findings for optimal intervention planning and implementation.

Citation Format: Betelihem B. Tobo, Tonya Short, Nosayaba Osazuwa-Peters, Kahee A. Mohammed, Lorinette Wirth, Christian Geneus, Eric Adjei Boakye. A paradox: Engaging in at-risk behavior may not correlate with perceived susceptibility to cancer or heart disease. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A60.

Talc mediates angiostasis in malignant pleural effusions via endostatin induction

Talc remains the most effective sclerosing agent for pleurodesis. However, its mechanism of action in resolving pleural malignant disease remains unclear. The present study evaluated the angiogenic balance in the pleural space in patients with malignant pleural effusions (MPE) following talc insufflation. Patient pleural fluid samples were collected both before and after talc insufflation. The ability of pleural mesothelial cells (PMC) and malignant mesothelioma cells (MMC) to produce endostatin in vitro was compared. The biological effects of pleural fluids and conditioned media from talc-activated PMC on endothelial cells were evaluated by performing proliferation, invasion, tube formation and apoptosis assays. Pleural fluids from patients with MPE who received thoracoscopic talc insufflation contained significantly higher levels of endostatin (median 16.75 ng.mL(-1)) compared with pre-talc instillation (1.06 ng.mL(-1)). Talc-activated PMC released significantly greater amounts of endostatin (mean+/-SEM 1052.39+/-38.66 pg.mL(-1)) when compared with a MMC line (134.73+/-8.72 pg.mL(-1)). In conclusion, talc alters the angiogenic balance in the pleural space from a biologically active and angiogenic environment to an angiostatic milieu. Functional improvement following talc poudrage in patients with malignant pleural effusions may, in part, reflect these alterations in the pleural space.

Mycobacteria induces pleural mesothelial permeability by down-regulating beta-catenin expression

Patients with pulmonary tuberculosis develop pleural effusions with a high protein content. Pleural mesothelial adherens junctions promote mesothelial cell-cell adhesion and contribute to pleural integrity. In the present study we have investigated the effect of mycobacterium (BCG) on mesothelial cell adherens junction proteins and pleural permeability. BCG enhanced pleural mesothelial cell (PMC) release of vascular endothelial growth factor (VEGF), and decreased electrical resistance across the PMC monolayer. Neutralizing antibodies to VEGF significantly restored the drop in PMC electrical resistance caused by BCG. BCG infection down regulated beta-catenin (adherens junction protein) expression and caused increased permeability across confluent mesothelial monolayer. Our results suggest that in TB pleurisy, mycobacteria cause VEGF release from mesothelial cells and leads to protein exudation by altering mesothelial adherens junction proteins.

Does long-term follow-up have a role for node negative squamous carcinoma of the vulva? The Gateshead experience

A retrospective review was performed of 138 cases of squamous vulval cancer referred to Gateshead between 1986 and 1997, with a median follow-up of 48 months. Eighteen recurrences were detected, 11 within one year of surgery. All nine patients with groin/distant recurrence (including 4 presenting initially with local recurrence only) died of vulval cancer. Vulval pain, bleeding or other symptoms heralded all recurrences. Routine review was ineffective in detecting recurrence. Eight cases were detected by general practitioners, three by specialists, and one was self-diagnosed. Six of these had had clinical review less than two months previously. Follow-up does not appear to offer early detection or survival advantages. Patient education, with symptom-triggered rapid clinic access, may be more effective. Prospective research is indicated to assess both the effectiveness and psychological implications of routine follow-up and alternative strategies.