Melanoma risk in relation to use of sunscreen or other sun protection methods

BACKGROUND

Epidemiologic evidence supporting sunscreen for melanoma prevention is limited to one small trial; case-control studies report conflicting results. Sunscreen usage patterns or alternative sun protection methods have rarely been studied in relation to melanoma.

METHODS

In a population-based case-control study, participants (1,167 cases; 1,101 controls) reported for each decade year of age outdoor activity-related sunscreen use, sunscreen patterns (SPF15+, amount, skin coverage, reapplication, routine use), and use of other sun protection methods (like hats, long-sleeved shirts, staying in the shade). Scores were averaged across activities and/or decades; scores in the most recent two decades were used to classify individuals as non-, inconsistent- or optimal users. Adjusted mean score differences between cases and controls, and ORs and 95% CIs for melanoma among optimal-, inconsistent- versus nonusers were calculated.

RESULTS

Mean scores for sunscreen, sunscreen patterns or other sun protection methods were low, but higher among controls than cases for SPF15+ sunscreen (P = 0.03) and other sun protection methods (P = 0.006). Adjusted ORs for optimal use of sunscreen and most sunscreen patterns were null or relatively weak, except for routine sunscreen (adjusted OR = 0.44, 95% CI: 0.23-0.86). Optimal use of other sun protection methods was inversely associated with melanoma (adjusted OR = 0.59, 95% CI: 0.44-0.78).

CONCLUSIONS

Optimal use of routine sunscreen or other sun protection methods were most strongly associated with decreased melanoma risk; results are limited by the small number of subjects who used sunscreen routinely and lack of specificity regarding other sun protection methods.

IMPACT

Both improving sunscreen practices and encouraging sun avoidance strategies may be important for melanoma prevention.

The ratio of a urinary tobacco-specific lung carcinogen metabolite to cotinine is significantly higher in passive than in active smokers

4-(Methylnitrosamino)-1-(3-pyridyl)-1-butanol plus its glucuronides (total NNAL), metabolites of the lung carcinogen NNK, and total cotinine, metabolites of nicotine, are biomarkers of active and passive cigarette smoking. We calculated the total NNAL:total cotinine (×10(3)) ratio in 408 passive (infants, children, and adults) and 1088 active smokers. The weighted averages were 0.73 (95% confidence interval 0.71, 0.76) for passive smokers and 0.07 (0.06, 0.08) for active smokers (p < 0.0001). These results demonstrate that cotinine measurements may underestimate exposure of passive smokers to the lung carcinogen NNK in second-hand cigarette smoke. The total NNAL:total cotinine (×10(3)) ratio may provide an improved biomarker for evaluating the health effects of passive smoking.

Effect of age and comorbidity on the treatment and survival of older patients with vulvar cancer

OBJECTIVE

To determine the disease characteristics and comorbidities predictive of vulvar cancer specific mortality and five year overall survival among older women, ages 65 and above.

METHODS

A retrospective analysis was conducted of women diagnosed with vulvar cancer at a single regional cancer center from 1989 to 2003, with a follow up to 2009. Treatment records were extracted for: demographics and treatment information, Eastern Cooperative Oncology Group (ECOG) performance status and Charlson comorbidity index score. Probability of death from vulvar cancer was estimated using cumulative incidence, treating death by other known and unknown causes as competing risks. Predictors of overall survival were determined using multivariate Cox regression analyses.

RESULTS

One hundred forty-six women were identified, with a median age at diagnosis of 79 years (range 65-95). Median follow up was 5.0 years (range 0.1-16.7 years). The cumulative incidence of vulvar cancer-specific mortality was 13% (95% CI: 0.08-0.19) at year one, 24% (95% CI: 0.17-0.31) at year three and 26% (95% CI: 0.19-0.33) at year five. Use of adjuvant therapy or surgical procedure performed did not differ by age at diagnosis (p=0.807 and 0.663) according to age group (65-74, 74-84 and 85+). Increasing age, Charlson comorbidity index score, lymph node involvement and type of surgery performed were associated with increased risk of death from any cause (all p<0.05).

CONCLUSION

Among women aged ≥65, vulvar cancer specific mortality was most significant in the first three years after diagnosis. Conversely other causes of mortality which can be attributed to comorbid conditions steadily increased with time.

MT477 acts in tumor cells as an AURKA inhibitor and strongly induces NRF-2 signaling

BACKGROUND

The novel compound thiopyrano [2,3-c]quinoline (MT477) has been shown to exhibit antitumor activity in both in vitro and in vivo studies. The present study examined the expression levels of 10,000 genes and how they changed after MT477 treatment in three cancer cell lines: H226, MDA231 and MiaPaCa-2. Materials and Methods/

RESULTS

Molecular function analysis revealed changes in genes involved in cell death, cell-cycle progression and cellular growth and proliferation in all three cancer cell lines. Canonical pathway analysis showed the involvement of the NRF2-mediated oxidative stress response, glucocorticoid, p53, RXR-VDR, G(1)/S checkpoint regulation, ERK, SAPK/JNK and JAS/Stat signaling. Analysis of 234 kinases and phosphatases using a kinase inhibition assay demonstrated a strong inhibitory effect for MAPK14 (104 ± 2%), AMPK A2/B1/G1 (89%) and FGR (83 ± 2%). AURKA was inhibited at 77 ± 1%. MiaPaCa-2 tumor xenograft studies showed a 49.5 ±1 4.8% inhibitory effect in mice treated with 100 μg/kg MT477 compared to untreated mice (p=0.0021).

CONCLUSION

MT477 induces molecular mechanisms related to cell death, survival, and inhibition of cellular growth in vitro and in vivo.

A phase II trial of carboplatin and docetaxel followed by radiotherapy given in a "Sandwich" method for stage III, IV, and recurrent endometrial cancer

OBJECTIVE

To determine feasibility and efficacy of administering docetaxel and carboplatin chemotherapy followed by pelvic radiotherapy and then consolidation chemotherapy in patients with advanced or recurrent endometrial cancer.

METHODS

Patients with surgically staged III-IV (excluding IIIA from positive cytology alone) endometrial cancer or biopsy confirmed recurrent disease were eligible. Treatment consisted of 3 cycles of docetaxel (75 mg/m²) and carboplatin (AUC 6) on a q21 day schedule followed by involved field irradiation (45 Gy)± brachytherapy and three additional cycles of docetaxel and carboplatin. Kaplan-Meier (KM) methods estimated overall survival (OS) and progression free survival (PFS).

RESULTS

Forty-two patients enrolled, 7 did not complete therapy. 95% (39/41) had primary disease. Median age=58 years (range: 21-81 years). 78% (32/41)=endometrioid histology. Stages=10 IIIA, 21 IIIC, 1 IVA, 7 IVB, (recurrent=1 IC, 1 IIA). There were 23 non-hematologic and 14 grade 3 and 16 grade 4 hematologic toxicities. Seven patients died following treatment with a median follow-up of 28 months (range: 7-70 months). KM estimates and 95% confidence intervals for OS at 1 year were 95% (82-99%), at 3 years 90% (75-96%), and at 5 years 71% (45-86%). Of the 39 with primary disease, 11 progressed or died within 5 years of study enrollment. KM estimates and 95% confidence intervals for PFS at 1 year were 87% (72-94%), at 3 years 71% (51-83%), and at 5 years 64% (42-80%).

CONCLUSIONS

"Sandwiching" radiation between chemotherapy for advanced or recurrent endometrial cancer merits further development based on the reported PFS and OS.

α,β-Unsaturated carbonyl system of chalcone-based derivatives is responsible for broad inhibition of proteasomal activity and preferential killing of human papilloma virus (HPV) positive cervical cancer cells

Proteasome inhibitors have potential for the treatment of cervical cancer. We describe the synthesis and biological characterization of a new series of 1,3-diphenylpropen-1-one (chalcone) based derivatives lacking the boronic acid moieties of the previously reported chalcone-based proteasome inhibitor 3,5-bis(4-boronic acid benzylidene)-1-methylpiperidin-4-one and bearing a variety of amino acid substitutions on the amino group of the 4-piperidone. Our lead compound 2 (RA-1) inhibits proteasomal activity and has improved dose-dependent antiproliferative and proapoptotic properties in cervical cancer cells containing human papillomavirus. Further, it induces synergistic killing of cervical cancer cell lines when tested in combination with an FDA approved proteasome inhibitor. Exploration of the potential mechanism of proteasomal inhibition by our lead compound using in silico docking studies suggests that the carbonyl group of its oxopiperidine moiety is susceptible to nucleophilic attack by the γ-hydroxythreonine side chain within the catalytic sites of the proteasome.

Leucine-rich alpha-2-glycoprotein-1 is upregulated in sera and tumors of ovarian cancer patients

BACKGROUND

New biomarkers that replace or are used in conjunction with the current ovarian cancer diagnostic antigen, CA125, are needed for detection of ovarian cancer in the presurgical setting, as well as for detection of disease recurrence. We previously demonstrated the upregulation of leucine-rich alpha-2-glycoprotein-1 (LRG1) in the sera of ovarian cancer patients compared to healthy women using quantitative mass spectrometry.

METHODS

LRG1 was quantified by ELISA in serum from two relatively large cohorts of women with ovarian cancer and benign gynecological disease. The expression of LRG1 in ovarian cancer tissues and cell lines was examined by gene microarray, reverse-transcriptase polymerase chain reaction (RT-PCR), Western blot, immunocytochemistry and mass spectrometry.

RESULTS

Mean serum LRG1 was higher in 58 ovarian cancer patients than in 56 healthy women (89.33 ± 77.90 vs. 42.99 ± 9.88 ug/ml; p = 0.0008) and was highest among stage III/IV patients. In a separate set of 193 pre-surgical samples, LRG1 was higher in patients with serous or clear cell ovarian cancer (145.82 ± 65.99 ug/ml) compared to patients with benign gynecological diseases (82.53 ± 76.67 ug/ml, p < 0.0001). CA125 and LRG1 levels were moderately correlated (r = 0.47, p < 0.0001). LRG1 mRNA levels were higher in ovarian cancer tissues and cell lines compared to their normal counterparts when analyzed by gene microarray and RT-PCR. LRG1 protein was detected in ovarian cancer tissue samples and cell lines by immunocytochemistry and Western blotting. Multiple iosforms of LRG1 were observed by Western blot and were shown to represent different glycosylation states by digestion with glycosidase. LRG1 protein was also detected in the conditioned media of ovarian cancer cell culture by ELISA, Western blotting, and mass spectrometry.

CONCLUSIONS

Serum LRG1 was significantly elevated in women with ovarian cancer compared to healthy women and women with benign gynecological disease, and was only moderately correlated with CA125. Ovarian cancer cells secrete LRG1 and may contribute directly to the elevated levels of LRG1 observed in the serum of ovarian cancer patients. Future studies will determine whether LRG1 may serve as a biomarker for presurgical diagnosis, disease recurrence, and/or as a target for therapy.

Indoor tanning and risk of melanoma: a case-control study in a highly exposed population

BACKGROUND

Indoor tanning has been only weakly associated with melanoma risk; most reports were unable to adjust for sun exposure, confirm a dose-response, or examine specific tanning devices. A population-based case-control study was conducted to address these limitations.

METHODS

Cases of invasive cutaneous melanoma, diagnosed in Minnesota between 2004 and 2007 at ages 25 to 59, were ascertained from a statewide cancer registry; age-matched and gender-matched controls were randomly selected from state driver's license lists. Self-administered questionnaires and telephone interviews included information on ever use of indoor tanning, types of device used, initiation age, period of use, dose, duration, and indoor tanning-related burns. Odds ratios (OR) and 95% confidence intervals (CI) were adjusted for known melanoma risk factors.

RESULTS

Among 1,167 cases and 1,101 controls, 62.9% of cases and 51.1% of controls had tanned indoors (adjusted OR 1.74; 95% CI, 1.42-2.14). Melanoma risk was pronounced among users of UVB-enhanced (adjusted OR, 2.86; 95% CI, 2.03-4.03) and primarily UVA-emitting devices (adjusted OR, 4.44; 95% CI, 2.45-8.02). Risk increased with use: years (P < 0.006), hours (P < 0.0001), or sessions (P = 0.0002). ORs were elevated within each initiation age category; among indoor tanners, years used was more relevant for melanoma development.

CONCLUSIONS

In a highly exposed population, frequent indoor tanning increased melanoma risk, regardless of age when indoor tanning began. Elevated risks were observed across devices.

IMPACT

This study overcomes some of the limitations of earlier reports and provides strong support for the recent declaration by the IARC that tanning devices are carcinogenic in humans.

Comparison of presurgical and immediate postsurgical ibuprofen on postoperative periodontal pain

Previous studies have indicated that non-steroidal anti-inflammatory drugs administered prior to oral surgery procedures are effective in reducing postoperative pain. The purpose of the present study was to compare the efficacy of medicating with ibuprofen immediately presurgically to medicating immediately postsurgically on postoperative pain associated with periodontal surgery. Sixty patients who were to undergo periodontal surgery were randomly divided into 3 groups: the I-pretreatment group received 600 mg ibuprofen immediately presurgically and placebo immediately after the surgery; the I-post-treatment group received placebo before surgery and 600 mg ibuprofen postsurgically; the placebo group received placebo at both time periods. Responses from an 8-hour pain diary completed by each subject were quantified and statistically evaluated non-parametrically. Results indicated that dosing with ibuprofen either immediately before or immediately after periodontal surgery significantly delays onset of pain as compared to placebo, with dosing after surgery demonstrating a significantly greater delay of onset of pain as compared to dosing presurgically. In addition, unlike the presurgical dosing, dosing postsurgically significantly decreases mean pain intensity for a combined 8-hour period following periodontal surgery as compared to placebo.

Effect of folate on phenytoin hyperplasia

There have been some reports that folic acid inhibits phenytoin-induced gingival hyperplasia. The purpose of this double-blind study was to quantify clinically the effects of both systemic and topical administration of folic acid on phenytoin-induced gingival overgrowth in man. For a period of 6 months, one group of phenytoin patients received 2 daily topical applications of a folate solution. An additional group received 2 daily doses of systemic folate while a control group received placebo medication. Results indicate that throughout the 180-day period of the study, the topical folate significantly inhibited gingival hyperplasia to a greater extent than either systemic folate or placebo groups.

A comparison of the effectiveness of hand scaling and ultrasonic debridement in furcations as evaluated by differential dark-field microscopy

There have been no previous reports in the literature comparing the effects of hand scaling with ultrasonic debridement in furcations, or which have used dark-field microscopy for this comparison. The purpose of this study was to compare the efficacy of these two modes of debridement in various classes of furcations, using gingival crevicular fluid flow and dark-field microscopy as parameters. A total of 33 furcated molars were evaluated. Results indicated that both hand scaling and ultrasonic debridement were equally effective in Class I furcations in changing the gingival fluid flow and bacterial proportions to those of a healthy state. In contrast, ultrasonic debridement was significantly more effective than hand scaling in Class II and Class III furcations in altering these parameters.

The effects of megadoses of ascorbic acid on PMN chemotaxis and experimental gingivitis

A double-blind study was undertaken to determine the effects of megadose ascorbic acid supplementation on plasma ascorbate levels, polymorphonuclear neutrophil (PMN) chemotaxis and clinical and biochemical determinations of inflammatory progression in individuals with a mean daily ascorbate intake level of approximately twice the recommended daily allowances. Results indicate that although the group receiving ascorbate supplementation demonstrated a significant increase in plasma levels of the vitamin as compared to a placebo group, no significant differences with respect to PMN chemotaxis or responses to experimental gingivitis were found between the groups.

The effects of a topically-active non-steroidal anti-inflammatory drug on ligature-induced periodontal disease in the squirrel monkey

Prostaglandins are believed to be important mediators of periodontal inflammation and bone resorption. The purpose of the present blind study was to quantify clinically and histologically the effects of a topically applied nonsteroidal prostaglandin synthetase inhibitor, namely a substituted oxazolopyridine derivative (SOPD), on ligature-induced periodontal disease in the squirrel monkey. For a period of 14 days, one group of ligated animals received 2 daily topical applications of the SOPD. A group receiving systemically administered indomethacin served as a positive control while a group receiving only topically applied vehicle served as a negative control. Results indicate that throughout the 14-day period of the study, the SOPD significantly inhibited gingival inflammation and loss of attachment as compared to either the placebo or indomethacin groups. Both indomethacin and the SOPD significantly inhibited bone resorption.

Development of a biochemical profile for gingival crevicular fluid. Methodological considerations and evaluation of collagen-degrading and ground substance-degrading enzyme activity during experimental gingivitis

The potential application of gingival crevicular fluid (GCF) analysis to periodontal diagnosis has been examined for more than 25 years. Unfortunately, the information available has not provided the clinician with a more sensitive means of diagnosing periodontal disease or an effective means of monitoring periodontal therapy. A careful review of the literature on GCF, however, suggests that discrepancies occur in the method of GCF collection, the use of GCF for analysis from pooled or isolated crevicular locations, the method of analyzing the samples and the way in which the data is reported. Studies in our laboratory have suggested a technique for GCF analysis that collects GCF from individual crevices with a filter paper strip inserted for a standard time, determines the volume of GCF collected with a calibrated electronic meter and elutes the material into a larger volume of diluent. This approach allows for detection of site-to-site and patient-to-patient differences in GCF volume while providing sufficient samples to analyze GCF for multiple constituents. We have used this approach to evaluate GCF for vertebrate forms of the enzymes collagenase (latent and active forms), beta-glucuronidase and arylsulfatase during the development of experimental gingivitis in man. Interproximal and midradicular areas were studied. Our results indicate that during the 4 weeks of the gingivitis, the absolute amount of active collagenase in GCF increased 550% at the interproximal sites and 190% in the midradicular sites, and the per cent of active collagenase increased from 15 to 71% at the interproximal sites, and from 16 to 36% at the midradicular sites.(ABSTRACT TRUNCATED AT 250 WORDS)

Lactate dehydrogenase, beta-glucuronidase and arylsulfatase activity in gingival crevicular fluid associated with experimental gingivitis in man

Experimental gingivitis provides a useful model for studying the initiation of periodontal disease in man. This study evaluated over a 4-week period the Plaque Index (PLI), Gingival Bleeding Time Index (GBTI), and gingival crevicular fluid (GCF) for resting and flow volume as well as the concentration and total activity of three enzymes in the GCF (lactate dehydrogenase--LDH, beta-glucuronidase--BG and arylsulfatase--AS) from the maxillary right quadrant of eight subjects with healthy gingiva. After rising sharply during the 1st week, the PLI continued to increase during the 2nd week but remained constant during the 3rd and 4th weeks. The GBTI, and the resting and flow GCF volumes, increased steadily throughout the study. LDH concentration in GCF varied minimally during the experiment, while total LDH activity rose slightly over the 4-week period. BG concentration and total activity in GCF rose steadily from baseline to the 3rd week and then either fell or leveled off during the 4th week. AS concentration in GCF rose from baseline to the 2nd or 3rd week and then fell. AS total activity in GCF rose from baseline to the 2nd week and then remained constant. These data suggest that while clinical signs of inflammation increased over the 4 weeks of the experiment, a homeostatic mechanism in the crevicular environment may control ground substance-degrading enzyme activity during experimental gingivitis in man.

The effects of nonsteroidal anti-inflammatory analgesics on pain after periodontal surgery

The results of this study indicate that nonsteroidal anti-inflammatory analgesics are effective for the control of periodontal postsurgical pain. In addition, these drugs are especially useful as they are nonaddictive and produce minimal CNS and gastrointestinal side effects.

The effects of topical steroidal and systemic nonsteroidal anti-inflammatory drugs on experimental gingivitis in man

Retrospective studies in man and prospective studies in animals have indicated that systemically administered anti-inflammatory drugs may decrease plaque-induced inflammation and loss of attachment. The purpose of the present double blind study was to determine the effects of a systemically administered nonsteroidal anti-inflammatory drug and a topically applied steroidal anti-inflammatory drug on experimentally produced gingivitis. Eighteen dental students were brought to a state of optimal gingival health and then divided into three groups. One group received placebo gel to apply topically and placebo capsules. A second group received placebo gel and capsules containing sulindac, a nonsteroidal anti-inflammatory drug. The third group received a topical steroidal gel and placebo capsules. All subjects refrained from home care for 22 days in the maxillary right quadrant. Results of the study indicate that the topical steroidal drug significantly inhibited gingival inflammation while the systemically administered nonsteroidal drug had no apparent effect.

The gingival bleeding time index

Recent studies have supported an emphasis on gingival bleeding indices for detection of inflammation. The purposes of the present study were: (1) to evaluate the relationships between the time necessary for stimulated gingival bleeding to occur and both gingival fluid flow and Löe's gingival index, and (2) to develop a clinical index based on gingival bleeding time. In the first part of the study, the elapsed time for gingival bleeding to first occur after sulcular stimulation was correlated with the gingival index and fluid flow on 150 gingival units. A high correlation was found between bleeding time with both the gingival index and exudate flow. A bleeding time index based on a scattergram of the data obtained in part I of the study was then formulated and evaluated in a similar fashion on an additional 172 gingival units. Results indicate a high correlation between the bleeding time index and the other indices. It is concluded that the bleeding time index may be used by itself as an accurate and objective clinical tool to evaluate gingival inflammation.

The effect of intrasulcular brushing on sulcular epithelial permeability

The purpose of the present study was to determine the effect of intrasulcular toothbrushing on permeability of the sulcular epithelium. Twenty-four dental students were divided into two groups of 12 each. On day 0, subjects in Group I began having the buccal aspects of the maxillary right first and second molars brushed for 30 seconds daily for 49 days by an examiner using an intrasulcular technique while subjects in Group II had the same teeth brushed with an extrasulcular technique. On day 49, clinical evaluation of inflammation was performed and biopsies were taken to evaluate gingival inflammation, sulcular epithelial keratinization and permeability of the sulcular epithelium in vitro using a microperfusion technique. Results indicate that subjects in both groups had attained equally high levels of gingival health. The intrasulcular group demonstrated a significantly higher degree of sulcular epithelial keratinization. However, no relationship was found between the degree of sulcular epithelial keratinization and sulcular epithelial permeability. Thus, the benefits derived from intrasulcular brushing and increasing sulcular epithelial keratinization are questionable.

Periodontal disease associated with amegakaryocytic thrombocytopenia in systemic lupus erythematosus

Inflammatory periodontal disease arises as a response to bacterial plaque. This response, however, may be modified by systemic factors such as nutritional deficiency, hormonal imbalance or severe systemic disease. One such systemic disease that may modify host response to local etiologic factors is systemic lupus erythematosus (SLE). Depression of thrombocyte production is very rarely associated with SLE. A search of the medical literature has revealed only one such reported case. The case history that follows is of a 17-year-old black female with severe gingivitis and spontaneous gingival bleeding associated with systemic lupus erythematosus and amegakaryocytic thrombocytopenia. It is believed to be the first such case reported in the dental literature. The clinical, radiographic and hematologic findings will be presented and the medical and periodontal therapy discussed.

Familial benign chronic neutropenia associated with periodontal disease. A case report

A rare case report of periodontal disease associated with familial benign chronic neutropenia is presented. The medical, dental and family histories as well as clinical and histologic observations are described and discussed.