Developmental programming: deficits in reproductive hormone dynamics and ovulatory outcomes in prenatal, testosterone-treated sheep

Prenatal testosterone excess leads to neuroendocrine, ovarian, and metabolic disruptions, culminating in reproductive phenotypes mimicking that of women with polycystic ovary syndrome (PCOS). The objective of this study was to determine the consequences of prenatal testosterone treatment on periovulatory hormonal dynamics and ovulatory outcomes. To generate prenatal testosterone-treated females, pregnant sheep were injected intramuscularly (days 30-90 of gestation, term=147 days) with 100 mg of testosterone-propionate in cottonseed oil semi-weekly. Female offspring born to untreated control females and prenatal testosterone-treated females were then studied during their first two breeding seasons. Sheep were given two injections of prostaglandin F2alpha 11 days apart, and blood samples were collected at 2-h intervals for 120 h, 10-min intervals for 8 h during the luteal phase (first breeding season only), and daily for an additional 15 days to characterize changes in reproductive hormonal dynamics. During the first breeding season, prenatal testosterone-treated females manifested disruptions in the timing and magnitude of primary gonadotropin surges, luteal defects, and reduced responsiveness to progesterone negative feedback. Disruptions in the periovulatory sequence of events during the second breeding season included: 1) delayed but increased preovulatory estradiol rise, 2) delayed and severely reduced primary gonadotropin surge in prenatal testosterone-treated females having an LH surge, 3) tendency for an amplified secondary FSH surge and a shift in the relative balance of FSH regulatory proteins, and 4) luteal responses that ranged from normal to anovulatory. These outcomes are likely to be of relevance to developmental origin of infertility disorders and suggest that differences in fetal exposure or fetal susceptibility to testosterone may account for the variability in reproductive phenotypes.

Long-term use of Swedish moist snuff and the risk of myocardial infarction amongst men

BACKGROUND

The scientific evidence on cardiovascular risks associated with long-term use of snuff is limited and inconclusive. The use of this smokeless tobacco has increased in recent decades, and adverse health effects associated with snuff use could be of great public health concern.

OBJECTIVE

We aimed to study whether long-term use of snuff affects the risk of myocardial infarction.

DESIGN

Between 1978 and 1993 all construction workers in Sweden were offered repeated health check-ups by the Swedish Construction Industry's Organization for Working Environment Safety and Health. A cohort was created with information on tobacco use and other risk factors, collected through questionnaires.

SETTING

In total, 118,395 nonsmoking men without a history of myocardial infarction were followed through 2004. Information on myocardial infarction morbidity and mortality was obtained from national registers. Relative risk estimates were derived from Cox proportional hazards regression model, with adjustment for age, body mass index and region of residence.

RESULTS

Almost 30% of the men had used snuff. In total, 118 395 nonsmoking men without a history of myocardial infarction were followed through 2004. The multivariable-adjusted relative risks for ever snuff users were 0.91 (95% confidence interval, 0.81-1.02) for nonfatal cases and 1.28 (95% confidence interval, 1.06-1.55) for fatal cases. Heavy users (>or=50 g day(-1)) had a relative risk of fatal myocardial infarction of 1.96 (95% confidence interval, 1.08-3.58). Snuff use increased the probability of mortality from cardiovascular disease amongst nonfatal myocardial infarction patients.

CONCLUSION

Our results indicate that snuff use is associated with an increased risk of fatal myocardial infarction.

Subclinical hemostatic activation and surgical volume predict peri-operative bleeding with radical prostatectomy

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Background: Subclinical activation of hemostasis and fibrinolysis is common in cancer and has been linked with outcome. We have previously presented (2007 Prostate Cancer Symposium) preliminary data on the relationship of laboratory markers to age and prognostic variables. We now expand our report on peri-operative (op) complication implications in early prostate cancer. Methods: With IRB approval and informed consent, blood was collected prior to open radical retropubic prostatectomy with lymph node dissection. Pre-op therapy, thrombosis, and anticoagulation were exclusion criteria. Plasma was assayed in duplicate for D-dimer, thrombin-antithrombin complex (TAT), IL-6, and IL-8. Relationships to peri-op bleeding/thrombotic events (pre-op to POD#2 hemoglobin (Hgb) drop, estimated blood loss (EBL), transfusion, post-op thrombosis) were analyzed in univariate then multivariable linear regression. Results: 153 subjects have been analyzed. Median age was 63.1 (range 35–81), pre-op PSA was 5.92 ng/mL (0.23–26.2), and 118 (77%) were clinical stage T1c. 117 (76.5%) had disease confined to the prostate; 36 had pT3 and/or lymph node involvement. Pathologic Gleason scores were 6 or less in 68 (44.4%), 7 in 71 (46.4%), and 8 or higher in 14 (9%). Median EBL was 400 mL (range 50-3000), median Hgb drop was 3.5 g/dL (-0.1–6.6), and 8 (5.2 %) required RBC transfusion. One subject experienced a DVT. On univariate analysis, pre-op TAT (p<0.001) and D-Dimer (p=0.023) levels correlated with hemoglobin drop. Platelet count, INR, and aPTT did not predict EBL nor Hgb drop. The 8 who required transfusions had lower pre-op platelet counts than those not requiring transfusion (p=0.004). Higher surgeon volume correlated with lower EBL (p<0.001) and Hgb drop (p=0.002). Multivariable linear regression showed that TAT remained significantly associated with Hgb drop (p=0.008) and surgeon volume with EBL (p<0.001) and Hgb drop (p=0.002). Conclusions: Pre-op activation of the hemostatic system is associated with less surgically related bleeding when assessed by objective measures, predicting drop in Hgb better than PT, aPTT, or platelet counts. Surgeon volume may also predict bleeding by subjective and objective measures.

No significant financial relationships to disclose.

Deep vein thrombosis in trauma: a prospective study of lower limb orthopedic trauma patients in Tianjin Hospital, China

AIM

Pulmonary embolism is a third leading cause of death in trauma patients. The prevalence of deep vein thrombosis (DVT) in Asian countries is considered to be less than in Western countries. Our aim was to establish the rate of DVT in orthopedic trauma patients in Tianjin Hospital, to identify DVT risk factors and to support the use of prophylaxis.

METHODS

Patients admitted between November 2003 and October 2004 with recent fracture had data collected prospectively to record type of fracture, mechanism of injury, history of DVT, blood transfusion requirements, operation details, extent of postoperative swelling, use of traction, immobilization, bandaging and patient positioning. Each patient had 3 duplex ultrasound examinations, the first within 24 h of admission. Patients requiring surgery had a second ultrasound within 2 days preoperatively, then 7 days postoperatively. Patients not requiring surgery had second and third ultrasound examinations 5 and 14 days after admission.

RESULTS

There were 547 patients, median age 39.6 years (interquartile range: 28-50 years). DVT developed in 12.4% (95% confidence interval: 9.7-15.2%), most occurring with femoral shaft fractures (30.6%), 15.8% occurred with hip fractures, 14.5% with fractures around the knee and 10.8% with fractured tibia and fibula. Over half of DVTs (56.7%) developed within 3 days following injury.

CONCLUSION

The incidence of DVT in Chinese orthopedic trauma patients approaches that in Western countries. Guidelines for DVT prophylaxis should be applied in China as in Western countries.

Ecological genomics of marine Roseobacters

Bacterioplankton of the marine Roseobacter clade have genomes that reflect a dynamic environment and diverse interactions with marine plankton. Comparative genome sequence analysis of three cultured representatives suggests that cellular requirements for nitrogen are largely provided by regenerated ammonium and organic compounds (polyamines, allophanate, and urea), while typical sources of carbon include amino acids, glyoxylate, and aromatic metabolites. An unexpectedly large number of genes are predicted to encode proteins involved in the production, degradation, and efflux of toxins and metabolites. A mechanism likely involved in cell-to-cell DNA or protein transfer was also discovered: vir-related genes encoding a type IV secretion system typical of bacterial pathogens. These suggest a potential for interacting with neighboring cells and impacting the routing of organic matter into the microbial loop. Genes shared among the three roseobacters and also common in nine draft Roseobacter genomes include those for carbon monoxide oxidation, dimethylsulfoniopropionate demethylation, and aromatic compound degradation. Genes shared with other cultured marine bacteria include those for utilizing sodium gradients, transport and metabolism of sulfate, and osmoregulation.

Prospective study of body size and risk for stroke amongst women below age 60

The relation between obesity, particularly abdominal obesity, and risk of stroke amongst women remains unclear. In 1991-1992, a prospective study was initiated in Sweden amongst women who returned a self-administered questionnaire. Through linkage with nation-wide registries, 45,449 women, free of stroke at entry, were followed up until diagnosis of first incident stroke, death, or the end of follow-up in 2002. We estimated multivariate relative risks (RRs) with 95% confidence intervals (CIs) from Cox proportional hazards regression models. A total of 170 incident stroke cases occurred during an average of 11 years of follow-up. The RR of stroke amongst women in the highest compared with the lowest quintile was 2.4 (95% CI 1.3-4.2; P for trend 0.04) for waist-to-hip ratio, 2.5 (95% CI 1.5-4.3; P for trend 0.01) for waist-to-height ratio and 2.3 (95% CI 1.2-4.3; P for trend 0.02) for waist circumference. Adjustment for hypertension and diabetes attenuated these risk estimates. In contrast, birth weight, body mass index (BMI) at age 18, BMI at entry, weight change in adulthood and adult height were not significantly associated with risk of stroke. This study provides evidence that, in contrast to BMI, several different measures of abdominal obesity are strong predictors of stroke in women.

Twenty-four hour growth hormone and leptin secretion in active postpubertal adolescent girls: impact of fitness, fatness, and age at menarche

CONTEXT

GH is strongly related to body composition, physical activity, and pubertal progression. Adolescent girls decrease physical activity during puberty, whereas their weight increases. Because leptin is a good index of energy balance in active young women, we hypothesized that leptin is related to GH secretion in this population while taking into account fitness, fatness, and age at menarche.

METHODS

We measured body composition and maximal oxygen consumption (VO(2)max) in 37 postpubertal adolescent girls aged 16-21 yr. GH was sampled every 10 min and leptin hourly for 24 h. We first analyzed 6-h time blocks by repeated measures for GH and leptin, with body mass index (BMI), percent body fat, and VO(2)max as covariates for the entire group and a lean subgroup. The deconvolution method was used to characterize GH pulsatility from individual time points.

RESULTS

GH varied through the day (P < 0.0001), with the highest concentrations overnight. BMI, percent body fat, and VO(2)max were related to GH concentrations in the entire group, whereas leptin predicted GH in the entire group as well as the lean subgroup of girls. Higher leptin was related to lower GH concentrations (P = 0.011), regardless of time. A log leptin level increase by 1 unit decreased GH by 27%. Pulsatility characteristics showed a 1-yr increase of age at menarche increasing total GH input by 20% (P = 0.0035) independently from BMI.

CONCLUSION

In postpubertal adolescent girls, leptin is related to GH concentration across the lean to overweight BMI spectrum. GH pulsatile secretion was greater in girls with later age at menarche.

Functional heterogeneity of prostatic intra-epithelial neoplasia: Length of hormonal therapy influences response

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Background: Prostatic intraepithelial neoplasia (PIN) is a premalignant lesion of the prostate etiologically linked to prostate cancer. While androgen deprivation therapy (ADT) has been used to reduce prostate cancer, there are controversial data regarding the effect of ADT on PIN. We hypothesized that PIN is a heterogeneous entity with respect to hormone responsiveness, that this may explain aspects of the heterogeneity in the natural history of this disease, and have used the clinical model of ADT followed by radical prostatectomy as a test of this hypothesis. Methods: We performed a retrospective study on a cohort of patients who underwent prostatectomy with biopsy proven prostate cancer. Study patients were those who must have received at least 3 months of ADT at the discretion of their surgeons. Patients from the same cohort who did not undergo ADT were used as controls. Patients were randomly selected from the database and their pathology slides were reviewed by a blinded pathologist looking for presence of PIN with an independent observer. Fisher’s exact test was used to compare the proportions of subjects who had residual PIN in the study group and the control group. Exact logistic regression was used to evaluate the duration of ADT in PIN regression. Results: Eighteen patients initially diagnosed with PIN who did not receive hormonal therapy were identified; 28 patients with PIN who underwent hormonal therapy were also studied. All patients who did not receive hormonal therapy had residual PIN whereas 7 of 28 patients undergoing ADT had no residual PIN (p = 0.043). Evaluation of hormonal therapy between responders and non-responders showed statistically significant association between PIN regression and hormone therapy duration (p < 0.001). However PIN response to ADT was not uniform as 16% of patients with ADT longer than 6 months had residual PIN, suggesting variable sensitivity of PIN to ADT. Conclusions: Our results demonstrate that ADT does cause PIN regression, and that there is heterogeneity in this effect with respect to hormonal duration. We propose for future prospective, multi-centered, randomized trials in which ADT impact on PIN is characterized further.

No significant financial relationships to disclose.

Tamoxifen exposure and risk of oesophageal and gastric adenocarcinoma: a population-based cohort study of breast cancer patients in Sweden

In a population-based cohort study of all women aged over 50 years with breast cancer in the Swedish Cancer Register in 1961–2003, those diagnosed before 31 December 1987 were regarded as unexposed to tamoxifen, whereas those diagnosed after that date were considered potentially exposed. Crosslinkages within the Cancer Register and the Registers of Death and Emigration enabled follow-up. Standardised incidence ratios (SIRs) of oesophageal and gastric cancer represented relative risks. Among 138 885 cohort members contributing with 1 075 724 person-years of follow-up, we found a nonsignificantly increased risk of oesophageal adenocarcinoma during the potential tamoxifen exposure period (SIR 1.60, 95% confidence interval (CI) 0.83–3.08), but the risk estimates decreased with increasing latency interval. No association was observed during the unexposed period. No increased risk of cardia adenocarcinoma was identified in either period. The risk of non-cardia gastric adenocarcinoma was increased in the potential tamoxifen period (SIR 1.27, 1.03–1.57), and almost doubled (SIR 1.86, 95% CI 1.10–3.14) in the period of longest latency (10–14 years). The corresponding overall SIR was increased in the unexposed group also, but here SIR did not increase with longer latency intervals. An increased risk of tobacco-related tumours, that is, oesophageal squamous-cell carcinoma and lung cancer, was limited to the unexposed cohort, indicating that confounding by smoking might explain the increased SIR during the unexposed period. We concluded that there might be a link between tamoxifen and risk of non-cardia gastric adenocarcinoma.

Antibiotic treatment and risk of gastric cancer

BACKGROUND/AIMS

Helicobacter pylori infection is undoubtedly an important risk factor for gastric cancer. It remains unclear however whether antibiotic treatment may prevent gastric cancer development. Our aim was to assess long term gastric cancer risks in historic cohorts of patients presumed to have been heavily exposed to antibiotics.

SUBJECTS

Using the Swedish Inpatient Register, we identified 501 757 individuals discharged with any one of 10 selected infectious disease diagnoses between 1970 and 2003.

METHODS

We counted person time and non-cardia gastric cancer occurrences through linkage to virtually complete population and health care registers. Standardised incidence ratios (SIRs) were calculated for comparisons with cancer incidence rates of the general population in Sweden.

RESULTS

No reduction in gastric cancer risk was observed in the infectious disease cohort in total (SIR 1.08 (95% confidence intervals 1.00-1.17) or for any of the presumed antibiotic regimens. There were no clear trends towards decreasing risk with time of follow up, but the risk tended to fall with increasing age at first hospitalisation for the infection (p<0.04).

CONCLUSIONS

Our results do not confirm earlier observational findings of a reduced risk of gastric cancer following exposure to heavy antibiotic treatment among hip replacement patients. Suboptimal drug regimens, inadequate timing of H pylori eradication, or insufficient follow up time may possibly explain the lack of association in this setting. Although our findings do not rule out the cancer preventive potential of H pylori eradication, they emphasise that detection of such an effect, if any, may require considerable efforts.

Elevated anal squamous cell carcinoma risk associated with benign inflammatory anal lesions

BACKGROUND

The association between benign anal lesions and anal cancer is still unclear. Few data from large cohort studies are available.

METHODS

We conducted a register based retrospective cohort study including 45,186 patients hospitalised for inflammatory anal lesions (anal fissures, fistulas, and perianal abscesses) as well as 79,808 haemorrhoid patients, from 1965 to 2002. Multiple record linkages identified all incident anal (squamous cell carcinoma only) and colorectal cancers through to 2002. Relative risk was estimated by standardised incidence ratio (SIR), the ratio of observed number of cases divided by that expected in the age, sex, and calendar year-matched general Swedish population.

RESULTS

There was a distinct incidence peak in the first three years of follow up among patients with inflammatory lesions. SIR then levelled off at around 3 and remained at this level throughout follow up (SIR during years 3-37 of follow up was 3.3 (95% confidence interval 1.8-5.7)). A similar initial incidence peak was observed among haemorrhoid patients but was confined to the first year; SIR was 2.8 in the second year, and then it decreased further and was close to unity in the following years (SIR during years 3-37 was 1.3 (95% confidence interval 0.7-2.1)). Among inflammatory lesion and haemorrhoid patients, a significantly increased risk of colorectal cancer was observed only in the first year after hospitalisation.

CONCLUSIONS

Inflammatory benign anal lesions are associated with a significantly increased long term risk of anal cancer. In contrast, haemorrhoids appear not to be a risk factor for this malignancy.

Progress in parasitic plant biology: host selection and nutrient transfer

Host range varies widely among species of parasitic plants. Parasitic plants realize host selection through induction by chemical molecular signals, including germination stimulants and haustoria-inducing factors (HIFs). Research on parasitic plant biology has provided information on germination, haustorium induction, invasion, and haustorial structures and functions. To date, some molecular mechanisms have been suggested to explain how germination stimulants work, involving a chemical change caused by addition of a nucleophilic protein receptor, and direct or indirect stimulation of ethylene generation. Haustorium initiation is induced by HIFs that are generated by HIF-releasing enzymes from the parasite or triggered by redox cycling between electrochemical states of the inducers. Haustorium attachment is non-specific, however, the attachment to a host is facilitated by mucilaginous substances produced by haustorial hairs. Following the attachment, the intrusive cells of parasites penetrate host cells or push their way through the host epidermis and cortex between host cells, and some types of cell wall-degrading enzymes may assist in the penetration process. After the establishment of host-parasite associations, parasitic plants develop special morphological structures (haustoria) and physiological characteristics, such as high transpiration rates, high leaf conductance, and low water potentials in hemiparasites, for nutrient transfer and resource acquisition from their hosts. Therefore, they negatively affect the growth and development and even cause death of their hosts.

Multiple intracranial aneurysms as delayed complication of atrial myxoma. Case report and literature review

SUMMARY

We report a case of multiple intracranial aneurysms as delayed complication of atrial myxoma.We reviewed the literature of intracranial myxomal aneurysms, and trying to find reasonable therapy methods, but got the conclusion that neurosurgery and interventional treatment were not helpful, chemotherapy and radiotherapy maybe useful in the treatment of such cases.

Morphological and Molecular Characterization of Longidorus americanum n. sp. (Nematoda: Longidoridae), a Needle Nematode Parasitizing Pine in Georgia

We describe and illustrate a new needle nematode, Longidorus americanum n. sp., associated with patches of severely stunted and chlorotic loblolly pine, (Pinus taeda L.) seedlings in seedbeds at the Flint River Nursery (Byromville, GA). It is characterized by having females with a body length of 5.4-9.0 mm; lip region slightly swollen, anteriorly flattened, giving the anterior end a truncate appearance; long odontostyle (124-165 microm); vulva at 44%-52% of body length; and tail conoid, bluntly rounded to almost hemispherical. Males are rare but present, and in general shorter than females. The new species is morphologically similar to L. biformis, L. paravineacola, L. saginus, and L. tarjani but differs from these species either by the body, odontostyle and total stylet length, or by head and tail shape. Sequence data from the D2-D3 region of the 28S rDNA distinguishes this new species from other Longidorus species. Phylogenetic relationships of Longidorus americanum n. sp. with other longidorids based on analysis of this DNA fragment are presented. Additional information regarding the distribution of this species within the region is required.

Lifestyle related risk factors in the aetiology of gastro-oesophageal reflux

BACKGROUND/AIM

The aetiology of gastro-oesophageal reflux is largely unknown. The authors' aim was to examine the relation between lifestyle habits and gastro-oesophageal reflux symptoms.

SUBJECTS

Participants of two consecutive public health surveys in Nord-Trondelag, Norway.

METHODS

In a case control study within the two public health surveys, 3153 individuals who in the second survey reported severe heartburn or regurgitation during the last 12 months were defined as cases, while 40 210 people without reflux symptoms constituted the control group. The risk of reflux symptoms was estimated and multivariately calculated as odds ratios in relation to exposure to tobacco smoking, alcohol, coffee, tea, table salt, cereal fibres, and physical exercise.

RESULTS

There was a significant dose response association between tobacco smoking and reflux symptoms. Among people who had smoked daily for more than 20 years the odds ratio was 1.7 (95% confidence interval 1.5 to 1.9) compared with non-smokers. A similar positive association was found for table salt intake. The odds ratio for reflux was 1.7 (95% CI 1.4 to 2.0) among those who always used extra table salt compared with those who never did so. We found moderately strong negative associations between the risk of reflux and exposure to coffee, bread high in dietary fibre content, and frequent physical exercise. Intake of alcohol or tea did not affect the risk of reflux.

CONCLUSIONS

Tobacco smoking and table salt intake seem to be risk factors for gastro-oesophageal reflux symptoms. Dietary fibres and physical exercise may protect against reflux. Alcohol, coffee, and tea do not seem to be risk factors for reflux.

Prevalence of gastro-oesophageal reflux symptoms and the influence of age and sex

BACKGROUND

Most previous studies of reflux symptom prevalence are of small sample size. No reliable data concerning age- and sex-stratified prevalence are available.

METHODS

Among 65,363 adult participants in a public health survey in Nord-Trondelag, Norway, 58,596 (90%) responded concerning occurrence and severity of heartburn or regurgitation during the past 12 months. The prevalence of minor, severe and any reflux symptoms was calculated, including stratification for age and sex. In order to examine whether the relative risk of reflux symptoms between sexes, in different age groups, was affected by other potential risk factors for reflux, confounding effects were tested using multivariate logistic regression. Odds ratios and their 95% confidence intervals were used to estimate relative risks.

RESULTS

Total prevalence of reflux symptoms was 31.4%, whereof 26.0% were minor symptoms and 5.4% severe symptoms. The prevalence of symptoms occurring at least weekly was 11.6%. Among women, the prevalence increased gradually from 22.1% in the youngest age category to 37.5% in the oldest, while among men it gradually increased from 25.8% in the youngest age group to peak at 36.0% between the ages of 50 and 60 years, after which it declined to 33.8% after age 70. A higher prevalence among women compared to men in the oldest age groups was not explained by confounding by body mass, tobacco smoking, alcohol consumption, dietary factors, or physical exercise.

CONCLUSIONS

About every third adult person suffered from reflux symptoms. The prevalence increases linearly with age among women, while among men it peaked between the age of 50 and 70 years and thereafter declined.

Risk of cancers of the oesophagus and stomach by histology or subsite in patients hospitalised for pernicious anaemia

BACKGROUND

Although pernicious anaemia is an established risk factor for stomach cancer, data by anatomical subsite are not available. Moreover, a previous suggestion of a link to increased risk of oesophageal cancer needs further exploration.

METHODS

We followed 21 265 patients hospitalised for pernicious anaemia in Sweden from 1965 to 1999 for an average of 7.1 years. Standardised incidence ratio (SIR) adjusted for sex, age, and calendar year was used to estimate relative risk, using the Swedish nationwide cancer incidence rates as reference.

RESULTS

Significant excess risks for squamous cell carcinoma of the oesophagus, and stomach cancer distal to the cardia, were observed in pernicious anaemia patients (SIR 3.3 (95% confidence interval (CI) 2.4-4.4); SIR 2.4 (95% CI 2.1-2.7), respectively). The excess risks increased with increasing follow up duration. Among distal stomach cancers, the most conspicuous excess risk was for carcinoid tumours (SIR 26.4 (95% CI 14.8-43.5)). Compared with the general population, no significant increased risk was observed for adenocarcinoma of the oesophagus (SIR 1.7 (95% CI 0.7-3.4)) or gastric cardia (SIR 1.2 (95%CI 0.6-2.0)).

CONCLUSIONS

Achlorhydria following type A atrophic gastritis is associated with an elevated risk of adenocarcinoma of the non-cardia stomach, and surprisingly, with a risk of oesophageal squamous cell carcinoma. In contrast, no significant association, either positive or negative, was found with oesophageal or cardia adenocarcinoma. The mechanism for the observed increased risk of oesophageal squamous cell carcinoma warrants further study.

No excess risk of colorectal cancer among alcoholics followed for up to 25 years

We conducted a population-based retrospective cohort study among 179,398 Swedish patients hospitalised for alcoholism from 1970 to 1994, and found no excess risk for colorectal cancers, overall or at any anatomical subsite. Our findings challenge the hypothesis that alcohol intake is a risk factor for cancer of the large bowel.

Alcohol abuse and the risk of pancreatic cancer

BACKGROUND

Although most epidemiological studies do not support a role for alcohol in the aetiology of pancreatic cancer, an increased risk among heavy drinkers cannot be excluded.

METHODS

In a retrospective cohort based on the Swedish Inpatient Register, we analysed the risk of pancreatic cancer among patients admitted to hospital for alcoholism (n=178 688), alcoholic chronic pancreatitis (n=3500), non-alcoholic chronic pancreatitis (n=4952), alcoholic liver cirrhosis (n=13 553), or non-alcoholic liver cirrhosis (n=7057) from 1965 to 1994. Follow up through to 1995 was accomplished by linkage to nationwide registers. Standardised incidence ratios (SIRs) express the relative risks by taking the general Swedish population as reference. To minimise the possible influence of selection bias, we excluded the first year observations.

RESULTS

Alcoholics had only a modest 40% excess risk of pancreatic cancer (SIR 1.4, 95% confidence interval (CI) 1.2-1.5). Overrepresented smokers among alcoholics might confound a true SIR of unity among alcoholics to approximately 1.4. SIR among alcoholic chronic pancreatitis patients (2.2, 95% CI 0.9-4.5) was considerably lower than that among non-alcoholic chronic pancreatitis patients (8.7, 95% CI 6.8-10.9), and decreased with increasing duration of follow up in both groups, indicating that most of the excess might be explained by reversed causation from undiagnosed cancers. Among patients with alcoholic liver cirrhosis, the increased risk of pancreatic cancer was also moderate (SIR 1.9, 95% CI 1.3-2.8) while no significant excess risk was found among non-alcoholic liver cirrhosis patients (SIR 1.2, 95% CI 0.6-2.2).

CONCLUSIONS

The excess risk for pancreatic cancer among alcoholics is small and could conceivably be attributed to confounding by smoking.

Body mass and reflux oesophagitis: an oestrogen-dependent association?

BACKGROUND

There is widespread belief that obesity is associated with gastro-oesophageal reflux disease, but the scientific evidence is weak and contradictory. Our aim is to evaluate the relation between body mass and reflux oesophagitis.

METHODS

A population-based case-control study of endoscopically verified case subjects with reflux oesophagitis, and of randomly selected, control subjects matched for age, sex and area of residence. Subjects were classified within three body mass index (BMI) categories: BMI <25 (normal in the WHO classification), BMI 25-30 (overweight) and BMI >30 (obese). Odds ratios (OR) with 95% confidence intervals (CI) were the measures of association.

RESULTS

Of 179 matched case-control pairs included in the study, 71 pairs were female. In males, no association between overweight and/or obesity and the risk of reflux oesophagitis was found. In females, there was a strong association between increasing BMI and the risk of reflux oesophagitis, with an OR of 2.9 (95% CI: 1.1-7.6) in the BMI 25-30 group and 14.6 (95% CI: 2.6-80.9) in the BMI >30 group (P value for trend = 0.0007). The association between obesity and oesophagitis was further strengthened by the use of oestrogen replacement medication.

CONCLUSIONS

The study discloses a strong and dose-dependent association between body mass and reflux oesophagitis in women as opposed to no association among men. This association might be caused by increased oestrogen activity in overweight and obese females.

Lung cancer risk in a population-based cohort of patients hospitalized for asthma in Sweden

It has been suggested that asthma increases the risk of lung cancer in males but not in females. However, previous studies may suffer from report bias and are based on a small numbers of cases. The objective of the present study was to assess the incidence of lung cancer in males and females using a nationwide Swedish cohort of asthma patients. Patients (n=92,986) aged > or = 20 yrs with a hospital-discharge diagnosis of asthma and who were alive and free from malignancy I yr after first hospitalization were followed-up, for incidence of lung cancer during the period 1965-1994 (average duration of follow-up, 8.5 yrs). Their incidence of lung cancer was compared with that of the national population. The authors observed 713 lung cancers (standardized incidence ratio (SIR) 1.58, 95% confidence interval (CI) 1.47-1.70). The SIR was 1.51 in males (95% CI 1.38-1.65, 492 cases) and 1.78 in females (95% CI 1.55-2.03, 221 cases). The SIR decreased with duration of follow-up and increased with calendar period and age at first hospitalization. The risk of lung cancer was higher for squamous cell and small cell carcinoma than for adenocarcinoma, and it was higher in patients with other diseases as the main diagnosis and in patients hospitalized in departments other than internal and respiratory medicine. It was confirmed that asthma patients are at increased risk of lung cancer, but there is no heterogeneity in risk between the sexes. Several indirect arguments point towards a noncausal explanation of these findings; in particular, confounding by tobacco smoking is a plausible explanation.

[The effect of frozen storage for amniotic membrane ultrastructure]

OBJECTIVE

To observe the effect of frozen storage for amniotic membrane ultrastructure, and provide the experimental evidence for clinical use.

METHODS

The amniotic membranes of fresh-obtained and -80 degrees C frozen storage 30 d, 60 d, 90 d and 180 d were examined with transmission electron microscope, and the ultrastructural changes were observed.

RESULTS

The epithelium in the fresh-obtained amniotic membrane was observed as intact structure, abundant organelles in cytoplasm and intercellular contact with desmosome. A great quantity of collagen micro-fibrils were found in the stroma, and the light and shade striation were observed in the collagen micro-fibrils of fresh-obtained amniotic membrane. The epithelium degenerated and died gradually as the increase of frozen storage time. At the frozen storage of 90 days, the epithelial chromatin dissolved, organelles degenerated and mitochondrion vacuolated. At the frozen storage of 30 days and 60 days, the pattern of collagen micro-fibrils in stoma was similar to that in fresh-obtained amniotic membrane; At the frozen storage of 90 days, some of collagen micro-fibrils in stoma showed intumescence. At the frozen storage of 180 days, the number of collagen micro-fibrils in stoma decreased, and some of them showed intumescence and dissolvent.

CONCLUSION

Frozen storage can result in amniotic membrane epithelium death and collagen micro-fibrils intumescence and dissolvent.

Risk of adenocarcinomas of the esophagus and gastric cardia in patients with gastroesophageal reflux diseases and after antireflux surgery

BACKGROUND & AIMS

Gastroesophageal reflux has been proposed as an important risk factor for esophageal and gastric cardia adenocarcinoma, but prospective data are lacking. Furthermore, the effect of antireflux surgery has not yet been studied. We conducted a population-based retrospective cohort study to fill these gaps.

METHODS

A cohort of 35,274 male and 31,691 female patients with a discharge diagnosis of gastroesophageal reflux diseases, and another cohort of 6406 male and 4671 female patients who underwent antireflux surgery, were identified in the Swedish Inpatient Register. Follow-up was attained through record linkage with several nationwide registers. Standardized incidence ratio (SIR) was used to estimate relative risk of upper gastrointestinal cancers, using the general Swedish population as reference.

RESULTS

After exclusion of the first year follow-up, 37 esophageal and 36 gastric cardia adenocarcinomas were observed among male patients who did not have surgery (SIR, 6.3, 95% confidence interval [CI], 4.5-8.7; SIR, 2.4, 95% CI, 1.7-3.3, respectively). SIR for esophageal adenocarcinoma increased with follow-up time (P = 0.03 for trend). Among male patients who had undergone antireflux surgeries, risks were also elevated (16 esophageal adenocarcinoma, SIR, 14.1, 95% CI, 8.0-22.8; 15 gastric cardia adenocarcinomas, SIR, 5.3, 95% CI, 3.0-8.7) and remained elevated with time after surgery. The cancer risk pattern in women was similar to that for men, but the number of cases were much smaller.

CONCLUSIONS

Gastroesophageal reflux is strongly associated with the risk of esophageal adenocarcinoma, and to a lesser extent, with gastric cardia adenocarcinoma. The risk of developing adenocarcinomas of the esophagus and gastric cardia remains increased after antireflux surgery.

Distinct regulators control the expression of the mid-hindbrain organizer signal FGF8

Local expression of FGF8 at the mid/hindbrain boundary (MHB) governs the development of multiple neurons and support cells. Here we show that the paired-domain protein Pax2 is necessary and sufficient for the induction of FGF8 in part by regulating the expression of Pax5&8. A network of transcription and secreted factors, including En1, Otx2, Gbx2, Grg4 and Wnt1&4, that is established independently of Pax2, further refines the expression domain and level of FGF8 at the MHB through opposing effects on Pax2 activity. Our results indicate that the expression of local organizing factors is controlled by combinatorial interaction between inductive and modulatory factors.

Hepatic cytoreduction followed by a novel long-acting somatostatin analog: a paradigm for intractable neuroendocrine tumors metastatic to the liver

BACKGROUND

Optimal management of symptomatic neuroendocrine tumors that metastasize to the liver is controversial. We investigated aggressive hepatic cytoreduction and postoperative administration of octreotide long-acting release (LAR), a long-acting somatostatin analog.

METHODS

Between December 1992 and August 2000, 31 patients underwent hepatic surgical cytoreduction (20 carcinoid, 10 islet cell, and 1 medullary). All patients had progressive symptoms refractory to conventional therapy.

RESULTS

Hepatic cytoreduction (resection, cryosurgery, and/or radiofrequency ablation) eliminated symptoms in 27 patients (87%) and decreased secretion of hormones by an overall mean of 59%. When minor symptoms returned and/or hormonal levels increased during follow-up, adjuvant therapy was started. Ten patients received adjuvant octreotide LAR once a month, and 21 received other adjuvants. At a median postoperative follow-up of 26 months, 16 patients had progressive/recurrent disease, 13 had died of their disease, and 2 remained free of disease. Median symptom-free interval was 60 months (95% confidence interval, 48-72) with octreotide LAR and 16 months (95% confidence interval, 10-29) with other adjuvants (P = .0007). Two-year symptom-free survival rate was 100% with octreotide LAR and 33% with other adjuvants.

CONCLUSIONS

Hepatic surgical cytoreduction can palliate progressive symptoms associated with liver metastases from intractable neuroendocrine tumors. Postoperative adjuvant therapy with octreotide LAR can prolong symptom-free survival.

Risk of adenocarcinomas of the oesophagus and gastric cardia in patients hospitalized for asthma

In the first cohort study of the question we followed 92 986 (42 663 men and 50 323 women) adult patients hospitalized for asthma in Sweden from 1965 to 1994 for an average of 8.5 years to evaluate their risk of oesophageal and gastric cardia adenocarcinoma. Standardized incidence ratio (SIR) adjusted for gender, age and calendar year was used to estimate relative risk, using the Swedish nationwide cancer incidence rates as reference. Asthmatic patients overall had a moderately elevated risk for oesophageal adenocarcinoma (SIR = 1.5, 95% confidence interval CI, 0.9-2.5) and gastric cardia cancer (SIR = 1.4, 95% CI, 1.0-1.9). However, the excess risks were largely confined to asthmatic patients who also had a discharge record of gastro-oesophageal reflux (SIR = 7.5, 95% CI, 1.6-22.0 and SIR = 7.1, 95% CI, 3.1-14.0, respectively). No significant excess risk for oesophageal squamous-cell carcinoma or distal stomach cancer was observed. In conclusion, asthma is associated with a moderately elevated risk of developing oesophageal or gastric cardia adenocarcinoma. Special clinical vigilance vis-à-vis gastro-esophageal cancers seems unwarranted in asthmatic patients, but may be appropriate in those with clinically manifest gastro-oesophageal reflux.

[The relation between expression of basic fibroblast growth factor and mast cells in pterygium]

OBJECTIVE

To examine the expression and distribution of basic fibroblast growth factor (bFGF) and mast cells in pterygium, and evaluate its effects in the pterygium formation and progression.

METHOD

The expression of bFGF and mast cell tryptase in 17 primary pterygia, 6 recurrent pterygia and 6 normal conjunctival specimens were studied. The mast cell count and bFGF expression situation were observed.

RESULTS

The bFGF was specifically localized in the epithelium, blood vessels and a subset of connective tissue cells. The bFGF expression was increased in the recurrent pterygium. The numbers of infiltrating mast cells (five 400 x sights) were (45.47 +/- 5.50) cells and (48.83 +/- 3.19) cells in the primary and recurrent pterygium respectively. In the comparisons between the cells in the pterygium (primary and recurrent) and (4.24 +/- 2.36) cells in the normal connective tissue, there were significant differences (F = 200.3128; q = 26.6762, 23.7341; P < 0.05). The shape and distribution of all the tryptase-positive cells (mast cells) in the pterygium tissues were similar to that of the cells with bFGF expression in the connective tissue. And the majority of bFGF-positive cells (87.54 +/- 3.60)% were similar to that of mast cells in the connective tissue.

CONCLUSIONS

All infiltrating mast cells in pterygium have bFGF-positive expression. The bFGF expression is increased in the epithelium, blood vessels and infiltrating mast cells of the pterygium, and may contribute to the formation and progression of a pterygium.

Risk of pancreatic cancer after cholecystectomy: a cohort study in Sweden

BACKGROUND

Although some experimental studies have indicated that cholecystectomy may increase the risk of pancreatic cancer, data from epidemiological studies are conflicting.

AIMS

We conducted a register based retrospective cohort study to explore the relationship between cholecystectomy and pancreatic cancer.

SUBJECTS

The cohort included 87 263 men and 181 049 women with a documented cholecystectomy for cholelithiasis between 1965 and 1997.

METHODS

By record linkage to the nationwide and virtually complete registers of Cancer, Emigration, and Causes of Death, the cohort was followed up until the occurrence of any cancer, emigration, death, or the end of follow up, 31 December 1997, whichever came first. Relative risk was estimated by standardised incidence ratio (SIR) using the Swedish nationwide sex, age, and calendar year specific cancer incidence rates as reference.

RESULTS

During the period of observation, 1053 cases of pancreatic cancer were found, among which 231 (22%) occurred within 12 months after operation. After excluding cases and person years accrued during the first two years of follow up, we observed a non-significant 6% excess risk for pancreatic cancer (95% confidence interval (CI) -2 to 14%). The relative risk did not increase with increasing follow up duration, with a SIR equal to 0.98 (95% CI 0.79-1.20) 20 years or more after operation. Patients with a comorbidity of diabetes or chronic pancreatitis had higher relative risks (SIR=1.79, 95% CI 1.39-2.28; SIR=3.17, 95% CI 1.37-6.24, respectively). After excluding patients with recorded diabetes or chronic pancreatitis, the relative risk was close to unity (SIR=1.01, 95% CI 0.94-1.09).

CONCLUSIONS

Our findings do not support the hypothesis that cholecystectomy increases the subsequent risk of pancreatic cancer.

[Genomic structure and proteins sequence analysis of full-length of segment A of three infections bursal disease viruses]

The full-length of segment A of three infectious bursal disease viruses (IBDV), including an attenuated strain HZ2, an attenuated vaccine strain JD1 and a virulent field isolate ZJ2000, were cloned by long RT-PCR and sequenced respectively. All the three results revealed the identity of IB-DV with two overlapping open reading frames (ORF) flanked by 5'- and 3'-noncoding regions(NCR) in 3259 bp long. The strains shared high identity with each other at nucleotide or deduced amino acid level, and also had four unique sites H253, N279, T284, R330 which are common in other attenuated and some classic or highly virulent strains. The virulent strain ZJ2000 had several key amino acid mutations located in hypervariant region of VP2 and near the VP2-VP4 cleavage site of polypeptide, which is probably related to the virulence. Sequence comparison supported that VP2 is not the sole determinant of the virulence. The highly conservation in 5'- and 3'-NCR of different strains indicated the NCR may be not responsible for the virulence. But the same conservation appeared in VP5 revealed another complex relationship between VP5 and the virulence.

Primary brain tumors following traumatic brain injury--a population-based cohort study in Sweden

OBJECTIVES

The aim of this study was to explore the association between traumatic brain injury and brain tumor development.

METHODS

A cohort of patients hospitalized for traumatic brain injury during 1965-1994 was compiled using the Swedish Inpatient Register. Complete follow-up through 1995 was attained through record linkage with the Swedish Cancer Register, the Cause of Death Register, and the Emigration Register. Standardized incidence ratios (SIRs), defined as the ratios of the observed to the expected numbers of brain tumors, were used as the measure of relative risk. The expected number of brain tumors was calculated by multiplying the observed person-time by age-, gender- and calendar year-specific incidence-rates derived from the general Swedish population.

RESULTS

The cohort included 311,006 patients contributing 3,225,317 person-years. A total of 281 cases of brain tumors were diagnosed during follow-up. No associations were found between traumatic brain injury and the risk of primary brain tumors, neither overall (SIR: 1.0; 95% confidence interval (CI): 0.9-1.2), nor in analyses broken down by main groups of brain tumors. Stratified analyses according to age at entry into the cohort, year of follow-up, and severity of the brain injury all showed essentially the same null results.

CONCLUSION

No association between traumatic head injury and primary brain tumors has been found.

The risk of liver and bile duct cancer in patients with chronic viral hepatitis, alcoholism, or cirrhosis

No prospective study has analyzed simultaneously chronic viral hepatitis and alcoholism as risk factors for liver carcinogenesis, while taking into consideration the role of cirrhosis. Nor has the risk for hepatocellular carcinoma among patients with chronic viral hepatitis been prospectively evaluated in a low-risk Western population. Last, the relationship between hepatocellular carcinoma risk factors and bile duct cancer remains to be clarified. We analyzed prospectively the risk for primary liver and extrahepatic biliary tract cancer among 186,395 patients hospitalized with either chronic viral hepatitis, alcoholism, cirrhosis, or any combination of these conditions through linkages between national Swedish registers. Compared with the general population, the relative risk of hepatocellular carcinoma was 34.4 for chronic viral hepatitis alone, 2.4 for alcoholism alone, and 40.7 for cirrhosis alone. Among patients with combinations of these risk conditions, the relative risk of hepatocellular carcinoma was 27.3 for chronic viral hepatitis and alcoholism, 118.5 for chronic viral hepatitis and cirrhosis, 22.4 for alcoholism and cirrhosis, and 171.4 for all 3 conditions. We found limited evidence for an excess risk of intrahepatic, but not for extrahepatic, biliary duct cancer. Cirrhosis amplifies the risk of hepatocellular carcinoma among patients with chronic viral hepatitis, but it is not a prerequisite for liver carcinogenesis. In contrast, cirrhosis may be a necessary intermediate for the development of hepatocellular carcinoma among alcoholics.

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.