Death causes in breast cancer patients

BACKGROUND

Due to improved outcomes in breast cancer (BCa), the proportion of affected women dying of other causes has increased. Thus, a better survival of BCa requires knowledge of other causes of death.

MATERIALS AND METHODS

Data on the population, cancers, and causes of death were gathered from the nationwide Swedish Family-Cancer Database, enrolling ∼3.68 million Swedish women. A Cox regression model, comparing BCa patients against all other women, was applied. Cause-of-death-specific hazard ratios (HRs) were calculated for both underlying and multiple causes of death.

RESULTS

Among 641 000 deaths from 1987 to 2006, 48,000 were BCa patients. For underlying causes except BCa, the highest cause-specific HRs were found for diseases of pulmonary circulation {1.51 [95% confidence interval (CI) 1.36-1.68]}, suicide [1.39 (1.19-1.63)], and heart failure [1.29 (1.22-1.37)]. For specific multiple causes, the highest ratios were found for external causes [1.86 (1.80-1.91)] and gastrointestinal disease [1.68 (1.62-1.74)].

CONCLUSIONS

Diagnosis of BCa is associated with increased risks of dying of various causes, including external causes, heart failure, diseases of pulmonary circulation, and gastrointestinal disease. The study fulfills the gap in knowledge of death causes in BCa patients and suggests to draw more attention to comorbidities.

Sucrose-sweetened beverages increase fat storage in the liver, muscle, and visceral fat depot: a 6-mo randomized intervention study

BACKGROUND

The consumption of sucrose-sweetened soft drinks (SSSDs) has been associated with obesity, the metabolic syndrome, and cardiovascular disorders in observational and short-term intervention studies. Too few long-term intervention studies in humans have examined the effects of soft drinks.

OBJECTIVE

We compared the effects of SSSDs with those of isocaloric milk and a noncaloric soft drink on changes in total fat mass and ectopic fat deposition (in liver and muscle tissue).

DESIGN

Overweight subjects (n = 47) were randomly assigned to 4 different test drinks (1 L/d for 6 mo): SSSD (regular cola), isocaloric semiskim milk, aspartame-sweetened diet cola, and water. The amount of intrahepatic fat and intramyocellular fat was measured with (1)H-magnetic resonance spectroscopy. Other endpoints were fat mass, fat distribution (dual-energy X-ray absorptiometry and magnetic resonance imaging), and metabolic risk factors.

RESULTS

The relative changes between baseline and the end of 6-mo intervention were significantly higher in the regular cola group than in the 3 other groups for liver fat (132-143%, sex-adjusted mean; P < 0.01), skeletal muscle fat (117-221%; P < 0.05), visceral fat (24-31%; P < 0.05), blood triglycerides (32%; P < 0.01), and total cholesterol (11%; P < 0.01). Total fat mass was not significantly different between the 4 beverage groups. Milk and diet cola reduced systolic blood pressure by 10-15% compared with regular cola (P < 0.05). Otherwise, diet cola had effects similar to those of water.

CONCLUSION

Daily intake of SSSDs for 6 mo increases ectopic fat accumulation and lipids compared with milk, diet cola, and water. Thus, daily intake of SSSDs is likely to enhance the risk of cardiovascular and metabolic diseases. This trial is registered at clinicaltrials.gov as NCT00777647.

Perfusion MRI (dynamic susceptibility contrast imaging) with different measurement approaches for the evaluation of blood flow and blood volume in human gliomas

BACKGROUND

Perfusion magnetic resonance imaging (MRI) is increasingly used in the evaluation of brain tumors. Relative cerebral blood volume (rCBV) is usually obtained by dynamic susceptibility contrast (DSC) MRI using normal appearing white matter as reference region. The emerging perfusion technique arterial spin labelling (ASL) presently provides measurement only of cerebral blood flow (CBF), which has not been widely used in human brain tumor studies.

PURPOSE

To assess if measurement of blood flow is comparable with measurement of blood volume in human biopsy-proven gliomas obtained by DSC-MRI using two different regions for normalization and two different measurement approaches.

MATERIAL AND METHODS

Retrospective study of 61 patients with different types of gliomas examined with DSC perfusion MRI. Regions of interest (ROIs) were placed in tumor portions with maximum perfusion on rCBF and rCBV maps, with contralateral normal appearing white matter and cerebellum as reference regions. Larger ROIs were drawn for histogram analyses. The type and grade of the gliomas were obtained by histopathology. Statistical comparison was made between diffuse astrocytomas, anaplastic astrocytomas, and glioblastomas.

RESULTS

rCBF and rCBV measurements obtained with the maximum perfusion method were correlated when normalized to white matter (r = 0.60) and to the cerebellum (r = 0.49). Histogram analyses of rCBF and rCBV showed that mean and median values as well as skewness and peak position were correlated (0.61 < r < 0.93), whereas for kurtosis and peak height, the correlation coefficient was about 0.3 when comparing rCBF and rCBV values for the same reference region. Neither rCBF nor rCBV quantification provided a statistically significant difference between the three types of gliomas. However, both rCBF and rCBV tended to increase with tumor grade and to be lower in patients who had undergone resection/treatment.

CONCLUSION

rCBF measurements normalized to white matter or cerebellum are comparable with the established rCBV measurements used for the clinical evaluation of cerebral gliomas.

[Gallstone ileus of the colon]

Gallstone is a rare cause of large bowel obstruction. The condition is mainly reported in elderly women with considerable comorbidity and hence with high morbidity and mortality. We describe a case of a 75 year-old woman, with known gallbladder stone, presenting with symptoms of large bowel obstruction. Computed tomography of the abdomen confirmed a large gallstone obstructing the colon. The gallstone was subsequent removed by cololithotomi and the patient made a full recovery.

Prednisolone treatment affects the performance of the QuantiFERON gold in-tube test and the tuberculin skin test in patients with autoimmune disorders screened for latent tuberculosis infection

BACKGROUND

During screening for latent tuberculosis infection (LTBI), before anti-tumor-necrosis-factor-α treatment, most patients are already receiving immunosuppressive therapy. The objective was to evaluate the performance of the QuantiFERON Gold In-Tube (QFT-IT) and the Tuberculin Skin Test (TST).

METHODS

A prospective multicenter study included 248 patients with ulcerative colitis (39), Crohn's disease (54), rheumatoid arthritis (111), and spondylo-arthropathy (44).

RESULTS

QFT-IT was positive in 7/248 (3%), negative in 229 (92%), and indeterminate in 12 (5%). TST was positive in 54/238 (23%) patients. Chest x-ray was suspect for tuberculosis in 5/236 (2%), and 35/167 (21%) had ≥1 risk-factors for infection with Mycobacterium tuberculosis. The main finding was a pronounced negative effect on QFT-IT and TST performance associated with prednisolone treatment. During prednisolone treatment interferon gamma (IFN-γ) response to mitogen stimulation was impaired (median IFN-γ response 4.9 IU/mL; interquartile range [IQR] 0.8 to ≥10.0) compared to patients 1) not receiving corticosteroids (median ≥10.0; IQR 5.0 to ≥10.0; P = 0.0015) or 2) receiving long-acting corticosteroids (median >10.0; IQR 9.7 to >10.0; P = 0.0058). Prednisolone treatment was strongly associated with negative TST, adjusted odds ratio (AOR) 0.22 (0.1-0.8; P = 0.018), and with an increased risk of indeterminate QFT-IT results AOR 16.1 (4.1-63.2; P < 0.001), whereas no negative effect was found for long-acting corticosteroids. Doses of ≥10 mg prednisolone were associated with a 27% risk of indeterminate results. Single use of azathioprine, methotrexate, or 5-aminosalicylate (5-ASA) did not affect the test results.

CONCLUSIONS

Oral prednisolone severely suppressed QFT-IT and TST performance, whereas the long-acting corticosteroids methotrexate, azathioprine, and 5-ASA did not have a similar detrimental effect. Patients should be screened for LTBI with QFT-IT or TST prior to initiation of prednisolone therapy and negative QFT-IT or TST results interpreted with caution in patients treated with any corticosteroid until further data are available.

QTL explaining variation in production traits and udder health in the Danish Holstein population

Abstract. The main objective was to locate QTL and estimate the proportion of total genetic variance attributable to quantitative trait loci (QTL) for production index traits and the udder health index identified on six Bos taurus autosomes in the Danish Holstein dairy cattle population. Data were obtained from a granddaughter design of 20 sire families with a total of 1 869 progeny tested sons. The number of sons per grandsire ranged from 20 to 284, with an average family size of 93.5. Indexes of the estimated breeding values were obtained for the milk production traits and for the udder health index from the Danish Agricultural Advisory Service database. A random-QTL model was applied to incorporate marker information into parameter estimation for each single QTL. The procedure allowed us to detect new QTL on BTA3, BTA16 and BTA28 and to estimate the proportion of total genetic variance attributed to different QTL on a total of six Bos taurus autosomes for the udder health index and yield index traits in the Danish Holstein population. Variance estimates vary between 2 to 58 % of the total variance for different QTL and seem to explain a substantial part of the variance at certain positions of the cattle genome. The results are discussed against the background of the failure of marker-assisted selection (MAS) and the recent availability of large panels of single nucleotide polymorphisms (SNPs) that have improved the search for mutations underlying variation in complex traits resulting in modern genomic selection.

Diagnostics design for steady-state operation of the Wendelstein 7-X stellarator

The status of the diagnostic developments for the quasistationary operable stellarator Wendelstein 7-X (maximum pulse length of 30 min at 10 MW ECRH heating at 140 GHz) will be reported on. Significant emphasis is being given to the issue of ECRH stray radiation shielding of in-vessel diagnostic components, which will be critical at high density operation requiring O2 and OXB heating.

Observation of confined current ribbon in JET plasmas

We report the identification of a localized current structure inside the JET plasma. It is a field-aligned closed helical ribbon, carrying current in the same direction as the background current profile (cocurrent), rotating toroidally with the ion velocity (corotating). It appears to be located at a flat spot in the plasma pressure profile, at the top of the pedestal. The structure appears spontaneously in low density, high rotation plasmas, and can last up to 1.4 s, a time comparable to a local resistive time. It considerably delays the appearance of the first edge localized mode.

Diagnostic developments for quasicontinuous operation of the Wendelstein 7-X stellarator

The stellarator Wendelstein 7-X will allow for quasicontinuous operation with the duration only being limited to two 30 min discharges per day, at a continuous heating power of 10 MW electron cyclotron resonance heating (ECRH) at 140 GHz, by the capacity of the cooling water reservoir. This will result in high thermal loads on all plasma facing components of 50-100 kW/m(2) from radiation alone and of up to about 500 kW/m(2) on components additionally exposed to convective loads. In high density scenarios toroidally varying ECRH stray radiation levels of 50-200 kW/m(2) need to be coped with, requiring careful material selection and different shielding and hardening techniques. Furthermore, a gradual buildup of coatings on plasma facing optical components, which without any measures being taken, would lead to high transmission losses already within a few days of long pulse operation (equivalent to about 1 year of operation in pulsed devices like JET or ASDEX-upgrade) and therefore needs to be prevented as much as possible. In addition in situ cleaning as well as absolute calibration techniques need to be developed for all plasma facing optical systems. Here we report about some of our efforts to find, for various types of diagnostics, ways to cope with these adverse effects. Moreover, we give a few examples for individual diagnostic specific issues with respect to quasicontinuous operation, such as the development of a special integrator for the magnetic diagnostics as well as special interferometer types which can cope with unavoidable vibrations and slow path length changes due to, e.g., thermal expansion of the plasma vessel.

Across-family marker-assisted selection using selective genotyping strategies in dairy cattle breeding schemes

This study investigated the potential loss expected from marker-assisted selection (MAS) when only a proportion of animals are genotyped using several selective genotyping strategies. A population resembling a commercial dairy cattle population over 25 yr was simulated, and the most informative individuals for genotyping were identified among the potential breeding candidates (young bulls and bull-dams). Two strategies were used to identify the most informative animals. The first genotyping strategy was based on selecting individuals for genotyping with predicted total genetic effect [sum of the predicted quantitative trait locus (QTL) and polygenic effects] close to the truncation point for selection. The second strategy used an index that extended the previous strategy to include the variance due to segregation of the QTL in the parents. The 2 strategies for selective genotyping were applied at the 2 different genotyping levels and compared with random selection of candidates for genotyping and complete genotyping of the potential candidates. All selective genotyping strategies at the same proportion of genotyping showed similar cumulative genetic level. The frequency of the favorable QTL allele increased faster with more animals genotyped. Extra response in total genetic effect (polygenic and QTL) was not significantly different between genotyping all candidates (100%), 20%, and 50% genotyping (except for yr 13), but all MAS strategies resulted in significantly higher response than BLUP until yr 18. With 50% (20%) genotyping of candidates for selection within a population, 95% (89%) of maximum cumulative QTL response was achieved in yr 13. All MAS schemes resulted in a 19% decrease in the rate of inbreeding compared with the BLUP scheme. Therefore, it is possible to use selective genotyping in practical dairy cattle breeding and decrease the genotyping costs with a minimal loss of response compared with complete genotyping of the potential candidates.

Whither Papillon? — Future Directions for Contact Radiotherapy in Rectal Cancer

Although contact radiotherapy was developed 70 years ago, and is highly effective with cure rates of over 90% for early rectal cancer, there are few centres that offer this treatment today. One reason is the lack of replacement of ageing contact X-ray machines, many of which are now over 30 years old. To address this problem, the International Contact Radiotherapy Evaluation (ICONE) group was formed at a meeting in Liverpool in 2005 with the aim of developing a new contact X-ray unit and to establish clinical protocols that would enable the new machine to safely engage in the treatment of rectal cancer. As a result of these efforts, a European company is starting production of the new Papillon RT-50 machine, which will be available shortly. In addition, the ICONE group is planning an observational study on contact X-ray and transanal endoscopic microsurgery (CONTEM) for curative treatment of rectal cancer. This protocol will ensure standardised diagnostic procedures, patient selection and treatment in centres across the world and the data will be collected prospectively for analysis and audit. It is hoped that the CONTEM trial will provide the scientific evidence that is needed to obtain a broader acceptance of local contact radiotherapy as a treatment option for selected cases with early stage rectal cancer.

Photosynthetic responses to elevated CO(2) and O(3) in Quercus ilex leaves at a natural CO(2) spring

Photosynthetic stimulation and stomatal conductance (Gs) depression in Quercus ilex leaves at a CO(2) spring suggested no down-regulation. The insensitivity of Gs to a CO(2) increase (from ambient 1500 to 2000 micromol mol(-1)) suggested stomatal acclimation. Both responses are likely adaptations to the special environment of CO(2) springs. At the CO(2)-enriched site, not at the control site, photosynthesis decreased 9% in leaves exposed to 2x ambient O(3) concentrations in branch enclosures, compared to controls in charcoal-filtered air. The stomatal density reduction at high CO(2) was one-third lower than the concomitant Gs reduction, so that the O(3) uptake per single stoma was lower than at ambient CO(2). No significant variation in monoterpene emission was measured. Higher trichome and mesophyll density were recorded at the CO(2)-enriched site, accounting for lower O(3) sensitivity. A long-term exposure to H(2)S, reflected by higher foliar S-content, and CO(2) might depress the antioxidant capacity of leaves close to the vent and increase their O(3) sensitivity.

Spatiotemporal temperature fluctuation measurements by means of a fast swept Langmuir probe array

Stationary Langmuir probe measurements of ion saturation current and floating potential in a plasma cannot give direct information on density and plasma potential fluctuations in the presence of temperature fluctuations. This problem can be avoided if the probe bias voltage is continuously swept faster than the fluctuation time scale, recording the current-voltage characteristic. This article reports the development of a spatiotemporal highly resolving Langmuir probe array with 15 fast swept tips, operating in the strongly magnetized, collisionless edge plasma of the Wendelstein 7-AS stellarator [Plasma Phys. Controlled Fusion 31, 1579 (1989)]. The probe tips are aligned in the poloidal direction, the tip spacing is 2 mm, and the sweeping frequency is 1.4 MHz. Current and voltage data are sampled with 50 MHz. The high bandwidth of the measurement is achieved by placing miniaturized differential amplifiers close to the probe tips in order to do an impedance transform. The surface-mounting technology and an additional inverse feedback module are utilized, allowing for an input voltage range of +/-100 V, and a common mode rejection rate of 55 dB at 4 MHz, which is sufficient to resolve the nonlinear probe characteristic. For the evaluation of the data, a fit model for stationary probes is employed and found adequate. Changes of the plasma parameters during one voltage sweep are taken into account by a linear interpolation of the fit parameters. Spatio-temporal fluctuation data gained by a fast swept Langmuir probe array, which can be relevant for the turbulent radial transport of particles and energy, are presented.

Confirmation of quantitative trait loci for somatic cell score on bovine chromosome 18 in the German Holstein

Abstract. Fifty-one half-sib families with 2768 sires were selected for this study to confirm a quantitative trait locus (QTL) detected within a previous project initiated by the German Cattle Breeders Federation (ADR). The data based on a granddaughter design were divided into two parts and were analysed using linear models and paternal half sib regression methods. The results strongly support the hypothesis that the chromosomal region around marker TGLA227 at the telomeric end of chromosome 18 harbours a QTL for somatic cell score (SCS) in the German Holstein population. Using a two-QTL model the analysis showed evidence for another QTL for SCS in that region on chromosome 18. Further fine mapping studies should be carried out to decide on the two QTL hypothesis.

Mapping of quantitative trait loci for lactation persistency traits in German Holstein dairy cattle

A whole genome scan to map quantitative trait loci (QTL) for persistency of milk yield (PMY), persistency of fat yield (PFY), persistency of protein yield (PPY) and persistency of milk energy yield (PEY) was performed in a granddaughter design in the German Holstein dairy cattle population. The analysis included 16 paternal half-sib families with a total of 872 bulls. The analysis was carried out for the first lactation and for the first three lactations combined using univariate weighted multimarker regression. Controlling the false discovery rate across traits and data sets at a level of 0.15 and treating the four persistency traits as different traits revealed 27 significant QTL. A total of 12 chromosomes showed significant QTL effects on a chromosomewise basis. The DGAT1 effect was highly significant for PPY and protein yield. A haplotype analysis using results of previous studies of the same design revealed a co-segregation of various persistency QTL and QTL affecting health traits like dystocia and stillbirth and functional traits like non-return rate 90 and somatic cell score.

Conventional radiography requires a MRI-estimated bone volume loss of 20% to 30% to allow certain detection of bone erosions in rheumatoid arthritis metacarpophalangeal joints

The aim of this study was to demonstrate the ability of conventional radiography to detect bone erosions of different sizes in metacarpophalangeal (MCP) joints of rheumatoid arthritis (RA) patients using magnetic resonance imaging (MRI) as the standard reference. A 0.2 T Esaote dedicated extremity MRI unit was used to obtain axial and coronal T1-weighted gradient echo images of the dominant 2nd to 5th MCP joints of 69 RA patients. MR images were obtained and evaluated for bone erosions according to the OMERACT recommendations. Conventional radiographs of the 2nd to 5th MCP joints were obtained in posterior-anterior projection and evaluated for bone erosions. The MRI and radiography readers were blinded to each other's assessments. Grade 1 MRI erosions (1% to 10% of bone volume eroded) were detected by radiography in 20%, 4%, 7% and 13% in the 2nd, 3rd, 4th and 5th MCP joint, respectively. Corresponding results for grade 2 erosions (11% to 20% of bone volume eroded) were 42%, 10%, 60% and 24%, and for grade 3 erosions (21% to 30% of bone volume eroded) 75%, 67%, 75% and 100%. All grade 4 (and above) erosions were detected on radiographs. Conventional radiography required a MRI-estimated bone erosion volume of 20% to 30% to allow a certain detection, indicating that MRI is a better method for detection and grading of minor erosive changes in RA MCP joints.

New alleles in calpastatin gene are associated with meat quality traits in pigs

Suggestive QTL affecting raw firmness scores and average Instron force, tenderness, juiciness, and chewiness on cooked meat were mapped to pig chromosome 2 using a three-generation intercross between Berkshire and Yorkshire pigs. Based on its function and location, the calpastatin (CAST) gene was considered to be a good candidate for the observed effects. Several missense and silent mutations were identified in CAST and haplotypes covering most of the coding region were constructed and used for association analyses with meat quality traits. Results demonstrated that one CAST haplotype was significantly associated with lower Instron force and cooking loss and higher juiciness and, therefore, this haplotype is associated with higher eating quality. Some of the sequence variation identified may be associated with differences in phosphorylation of CAST by adenosine cyclic 3', 5'-monophosphate-dependent protein kinase and may in turn explain the meat quality phenotypic differences. The beneficial haplotype was present in all the commercial breeds tested and may provide significant improvements for the pig industry and consumers because it can be used in marker-assisted selection to produce naturally tender and juicy pork without additional processing steps.

Characterization of quantitative trait loci for growth and meat quality in a cross between commercial breeds of swine

A three-generation resource family was created by crossing two Berkshire grandsires with nine Yorkshire granddams to identify QTL affecting growth, body composition, and meat quality. A total of 512 F2 offspring were evaluated for 11 traits related to growth and body composition and 28 traits related to meat quality. All animals were initially genotyped for 125 markers across the genome. The objectives of this advanced phase of the project were to further identify and characterize QTL after genotyping for another 33 markers in special regions of interest, and to develop and apply methods for detecting QTL with parent-of-origin effects. New marker linkage maps were derived and used in QTL analysis based on line-cross least squares regression-interval mapping. A decision tree for identifying QTL with parent-of-origin effects was developed based on tests against the Mendelian mode of expression. Empirical significance thresholds were derived at chromosomewise and genomewise levels using specialized permutation strategies to create data under the null hypothesis appropriate for each test. Significance thresholds derived by the permutation tests were validated based on simulation of a pedigree and data structure similar to the Berkshire-Yorkshire population. The addition of 33 markers resulted in the discovery of 29 new QTL at the 5% chromosomewise level using the Mendelian model of analysis. Thirteen of the original QTL were no longer significant at the 5% chromosomewise level. A total of 33 QTL with parent-of-origin effects were identified, including QTL with paternal expression for backfat and loin muscle area on chromosome 2, near IGF2, and QTL with maternal expression for drip loss and reflectance on chromosome 9. Tests for imprinting against Mendelian expression identified much fewer QTL with parent-of-origin effects than tests based on significance of paternal and maternal alleles, which have been used in other studies. The detected QTL and their identified mode of expression will allow further research in these QTL regions and their utilization in marker-assisted improvement of meat quality.