[Bladder cancer screening with urine-based tumour markers - occupational medical experience]

OBJECTIVE

Bladder cancer responds favourably to treatment and has a good survival rate, provided it is diagnosed at an early stage. Established methods exist for the early detection, however, their specificity and positive predictive value are not yet satisfactory. Innovative markers have been proposed, but still require validation in prospective studies. We provide a literature-based short overview on the currently available and some proposed markers for the early detection of bladder cancer and evaluate the need for validation in further studies. We further provide some first results of such a recently finished study in an occupational setting.

MATERIAL AND METHODS

We conducted a prospective screening study over seven years in 1610 males with former occupational exposure to carcinogenic aromatic amines. Annual bladder cancer screening according to statutory requirements was offered. In addition to the regularly performed check for hematuria and urine cytology, the markers NMP22, UroVysion™ and survivin were performed in voided urine samples of the participants. Positive findings (not for survivin) were further followed through urethrocystoscopy.

RESULTS AND CONCLUSIONS

A total of 7219 urine samples were screened. During the study period 16 incidental and 4 recurrent bladder tumours, thereof three papillomas, occurred in a total of 19 participants. 14 out of twenty tumours were marker-positive, and all but two were early stage findings. Cell-based markers (cytology, UroVysion™) und molecular markers (NMP22, survivin) were largely complementary, thus acting as a "multi-marker panel". Eight of the tumours were identified by a positive cytology. Six tumours were not detected by any of the tumour markers. The results will be further evaluated through the inclusion of confounding factors, which have so far rarely been examined in other studies. This may lead to the development of tiered diagnostic strategies with the aim to reduce the number of invasive diagnostic procedures in the future.

Centrality dependence of the charged-particle multiplicity density at midrapidity in Pb-Pb collisions at sqrt[s(NN)] = 2.76 TeV

The centrality dependence of the charged-particle multiplicity density at midrapidity in Pb-Pb collisions at sqrt[s_{NN}]=2.76  TeV is presented. The charged-particle density normalized per participating nucleon pair increases by about a factor of 2 from peripheral (70%-80%) to central (0%-5%) collisions. The centrality dependence is found to be similar to that observed at lower collision energies. The data are compared with models based on different mechanisms for particle production in nuclear collisions.

Socioeconomic status, education, and reproduction in modern women: an evolutionary perspective

Although associations between status or resources and reproduction are positive in premodern societies and also in men in modern societies, in modern women the associations are typically negative. We investigated how the association between socioeconomic status and reproductive output varies with the source of status and resources, the woman's education, and her age at reproductive onset (proxied by age at marriage). By using a large sample of US women, we examined the association between a woman's reproductive output and her own and her husband's income and education. Education, income, and age at marriage are negatively associated with a woman's number of children and increase her chances of childlessness. Among the most highly educated two-thirds of the sample of women, husband's income predicts the number of children. The association between a woman's number of children and her husband's income turns from positive to negative when her education and age at marriage is low (even though her mean offspring number rises at the same time). The association between a woman's own income and her number of children is negative, regardless of education. Rather than maximizing the offspring number, these modern women seem to adjust investment in children based on their family size and resource availability. Striving for resources seems to be part of a modern female reproductive strategy--but, owing to costs of resource acquisition, especially higher education, it may lead to lower birthrates: a possible evolutionary explanation of the demographic transition, and a complement to the human capital theory of net reproductive output.

Elliptic flow of charged particles in Pb-Pb collisions at sqrt[S(NN)] = 2.76 TeV

We report the first measurement of charged particle elliptic flow in Pb-Pb collisions at sqrt[S(NN)] =2.76 TeV with the ALICE detector at the CERN Large Hadron Collider. The measurement is performed in the central pseudorapidity region (|η|<0.8) and transverse momentum range 0.2<p t<5.0 GeV/c. The elliptic flow signal v₂, measured using the 4-particle correlation method, averaged over transverse momentum and pseudorapidity is 0.087 ± 0.002(stat) ± 0.003(syst) in the 40%-50% centrality class. The differential elliptic flow v₂ p t reaches a maximum of 0.2 near p t =3 GeV/c. Compared to RHIC Au-Au collisions at sqrt[S(NN)] 200 GeV, the elliptic flow increases by about 30%. Some hydrodynamic model predictions which include viscous corrections are in agreement with the observed increase.

Charged-particle multiplicity density at midrapidity in central Pb-Pb collisions at sqrt[S(NN)] = 2.76 TeV

The first measurement of the charged-particle multiplicity density at midrapidity in Pb-Pb collisions at a center-of-mass energy per nucleon pair √ S NN = 2.76 TeV is presented. For an event sample corresponding to the most central 5% of the hadronic cross section, the pseudorapidity density of primary charged particles at midrapidity is 1584 ± 4(stat) ± 76(syst), which corresponds to 8.3 ± 0.4(syst) per participating nucleon pair. This represents an increase of about a factor 1.9 relative to pp collisions at similar collision energies, and about a factor 2.2 to central Au-Au collisions at √ S NN = 2.76 TeV. This measurement provides the first experimental constraint for models of nucleus-nucleus collisions at LHC energies.

Midrapidity antiproton-to-proton ratio in pp collisons at sqrt[s]=0.9 and 7 TeV measured by the ALICE experiment

The ratio of the yields of antiprotons to protons in pp collisions has been measured by the ALICE experiment at sqrt[s]=0.9 and 7 TeV during the initial running periods of the Large Hadron Collider. The measurement covers the transverse momentum interval 0.45<p_{t}<1.05  GeV/c and rapidity |y|<0.5. The ratio is measured to be R_{|y|<0.5}=0.957±0.006(stat)±0.014(syst) at 0.9 TeV and R_{|y|<0.5}=0.991±0.005(stat)±0.014(syst) at 7 TeV and it is independent of both rapidity and transverse momentum. The results are consistent with the conventional model of baryon-number transport and set stringent limits on any additional contributions to baryon-number transfer over very large rapidity intervals in pp collisions.

Direct comparison of sensitivity encoding (SENSE) accelerated and conventional 3D contrast enhanced magnetic resonance angiography (CE-MRA) of renal arteries: effect of increasing spatial resolution

PURPOSE

To assess the effect of attaining higher spatial resolution in contrast-enhanced magnetic resonance angiography (MRA) of renal arteries using parallel imaging, sensitivity encoding (SENSE), by comparing the SENSE contrast-enhanced (CE) MRA against a conventional CE-MRA protocol with identical scan times, injection protocol, and other acquisition parameters.

MATERIALS AND METHODS

Numerical simulations and a direct comparison of SENSE-accelerated versus conventional acquisitions were performed. A total of 41 patients (18 male) were imaged using both protocols for a direct comparison. Both protocols used fluoroscopic triggering, centric encoding, breath-holding, equivalent injection protocol, and lasted approximately 30 seconds.

RESULTS

Simulated point-spread functions were narrower for the SENSE protocol compared to the conventional protocol. In the patient study, although the SENSE protocol produced images with lower signal-to-noise ratio (SNR), image quality was better for all segments of the renal arteries. In addition, ringing of kidney parenchyma and renal artery blurring were significantly reduced in the SENSE protocol. Finally, reader confidence improved with the SENSE protocol.

CONCLUSION

Despite a reduction in SNR, the higher-resolution SENSE CE-MRA provided improved image quality, reduced artifacts, and increased reader confidence compared to the conventional protocol.

Perfluorinated and other persistent halogenated organic compounds in European shag (Phalacrocorax aristotelis) and common eider (Somateria mollissima) from Norway: a suburban to remote pollutant gradient

Samples of two marine bird species, European shag (Phalacrocorax aristotelis) and common eider (Somateria mollissima) sampled at a remote coastal site in Norway were analysed for POPs and PFCs. Additionally samples of common eider were analysed from two other locations in Norway, representing a gradient from "densely populated" to "remote". The variety, concentration and distribution of lipophilic POPs in comparison to PFCs were investigated. PCBs were the dominating group of contaminants in the analysed egg samples. Shag eggs had median sum PCBs levels of 4,580 ng/g l.w. in 2004. Six different PBDE congeners could be detected in the shag eggs. BDE 47 and 100 were the main contributors with 24 and 27 ng/g l.w. respectively, sum PBDEs was 90 ng/g l.w. Relatively high concentrations of chlordanes were found with a total sum of 903 ng/g l.w. Of other OCs, toxaphene 26 and 52 together (sum 657 ng/g l.w.) and HCB (165 ng/g l.w.) were contributing majorly to the egg burden. Sum HCHs were low; only 54 ng/g l.w. PFOS was the main PFC in egg, plasma and liver samples. Similar median levels of 29, 32 and 27 ng/g w.w. were observed. PFOSA, PFH x S, and PFDcA were observed additionally in all shag samples at minor concentrations with the exception of elevated levels observed in liver for PFOSA and PFDcA with median levels of 7.6 and 7.9 ng/g w.w., respectively. In common eider eggs, the POP concentrations decreased up to 1/8th along the sampled spatial gradient from suburban to remote. Of the 9 detected PFCs, PFOS dominated all samples by one order of magnitude, followed by PFOA. Sum PFC concentrations were twice as high at the two fjord sites compared to the remote site. Shorter chained PFCAs like PFOA and PFNA could be detected in the eider eggs whilst being absent in shag eggs.

The utility of delayed-enhancement magnetic resonance imaging for identifying nonischemic myocardial fibrosis in asymptomatic patients with biopsy-proven systemic sarcoidosis

BACKGROUND

The pathophysiology of sarcoidosis includes infiltrative inflammatory injury, as well as interstitial fibrosis formation. Delayed-enhancement (DE) magnetic resonance imaging (MRI) techniques have been shown to identify fibrotic tissue as areas of hyperenhancement. To test the hypothesis that DE-MRI can be used to identify myocardial fibrosis resulting from cardiac sarcoidosis, we assessed this method in asymptomatic patients with biopsy-proven systemic sarcoidosis.

METHODS

Thirty-one patients with biopsy-confirmed systemic sarcoidosis and no known history of heart disease or sarcoid cardiac involvement underwent DE-MRI after gadolinium-chelate administration. The location and extent of DE were quantified by 2 radiologists experienced at evaluating cardiovascular MRI images.

RESULTS

According to DE-MRI, 8 (26%) of the 31 patients had nonischemic fibrosis, as evidenced by abnormal DE patterns. Unlike characteristic ischemic injuries, most of the fibrosis was mid-myocardial, extending to the adjacent endocardium, epicardium, or both. The most frequent site of fibrosis was the basal inferoseptum, followed by the basal inferolateral wall.

CONCLUSIONS

In asymptomatic patients with systemic sarcoidosis, DE-MRI may provide a novel, noninvasive method for the early identification of myocardial fibrosis.

Effects of nutritional quality during early development on body weight and reproductive maturation of guinea pigs (Cavia aperea f. porcellus)

In many species, somatic and reproductive maturation are sensitive to seasonally-fluctuating environmental conditions such as food quality. The protein content of the diet during early development has been considered to be particularly important, a low-protein diet during gestation and lactation typically delaying growth and reproductive onset. To investigate the effects of maternal and early postnatal diet quality on body weight and puberty of male and female domestic guinea pigs, we fed F0-mothers either a low-protein (14%, LQ-group) or a high-protein diet (23%, HQ-group) during gestation and lactation. Their male and female offspring received the same respective diets until six weeks of age; afterward they were switched to an intermediate control diet. Body weight of F1-subjects was significantly affected by the dietary treatment. Reproductive parameters were only affected in F1-females but not in F1-males. We conclude that in guinea pigs, growth is sensitive to the quality of the maternal and early postnatal diet, and that reproductive maturation is more sensitive in females.

Strong association between birth month and reproductive performance of Vietnamese women

Epidemiological studies on premodern and modern Western societies indicate that birth season may influence female reproduction. Nothing is known, however, about this effect in developing economies. Many of the latter are characterised by tropical climates with a rainy season associated with lower food availability and a greater prevalence of infectious diseases. We therefore predict that an association between birth month and reproductive output, if it exists, should be related to the rainy season. To test this prediction, we analysed census data of Vietnam obtained from IPUMS-International (Vietnam 1999 Population and Housing Census). Based on 493,853 women born between 1950 and 1977 and thus aged 22 to 49 years, we found that the time series of mean offspring count per month of birth has a highly significant period of 12 months (power = 46.871, P < 0.00001). Our results further indicate that the 12-month periodic signal has a maximum in July and a minimum in January. Accordingly, the peak corresponds to birth during the rainy season, the low if the third pregnancy month concurs with the rainy season. The month of birth is therefore clearly associated with the later reproductive performance of Vietnamese women, strongly supporting the assumption that environmental and maternal conditions during early development exert long-term effects on reproductive functioning. Provided the rainy season adversely affects developmental processes due to inadequate food and/or high infection risk, the association reported here points to a critical period of reproductive development during early pregnancy.

Safety of gadoversetamide in patients with acute and chronic myocardial infarction

PURPOSE

To assess the safety data from two large, multicenter, phase 2 trials on the use of gadoversetamide (OptiMARK, Tyco Healthcare/Mallinckrodt, St. Louis, MO) as a contrast agent in delayed hyperenhancement magnetic resonance imaging (DE-MRI) in patients with acute and chronic myocardial infarction (MI).

MATERIALS AND METHODS

The study population from both trials comprised 577 patients who were randomly assigned to one of four dose groups (0.05, 0.1, 0.2, or 0.3 mmol/kg) before undergoing DE-MRI. Safety evaluations included physical and electrocardiographic (ECG) examinations. Vital signs, laboratory values, adverse events (AE), and serious adverse events (SAE) were monitored before and after contrast administration.

RESULTS

Of the 577 patients who received gadoversetamide, 124 (21.5%) reported a total of 164 AEs; most were mild (139 AEs; 84.8%) or moderate (25 AEs; 15.2%). ECG-related changes were the most frequent AE. Site investigators judged only eight AEs as likely related to gadoversetamide and only two of the eight as clinically relevant. Further evaluation suggested neither AE was related to gadoversetamide. Two SAEs were reported, but none was judged related to gadoversetamide by the site investigators.

CONCLUSION

Gadoversetamide is safe for use in patients with acute or chronic MI up to a dose of 0.3 mmol/kg.

Month of birth related to fecundity and childlessness among contemporary women

To determine the associations of fecundity and childlessness with month of conception and to find a causal mechanism for these associations, we reanalyzed some of our previous data according to the predictions of the seasonal optimal ripening oocyte (SOptRO) and seasonal preovulatory over-ripeness ovopathy (SPrOO) hypotheses. Prime and minor SOptRO months as well as high-risk, no-risk, and very high risk SPrOO months were defined on the basis of a priori knowledge of the existence of ovulatory and anovulatory seasons in mammals and of the general birth distribution in Europe. The month of birth was assessed among 899 mothers with three or more children and 388 childless women extracted from a 1% sample of the Austrian population. The women with three or more children were born in excess during the prime and less often during the minor SOptRO months (chi2 = 2.81; p = 0.045; relative risk = 1.16; 95% CI = 1.01-1.33). This is in line with the SOptRO predictions. The childless women were more frequently born during the high-risk SPrOO months compared to the no-risk months but less often during the very high risk months. The linear trend (chi2 = 8.43; p = 0.009) is in line with the SPrOO predictions. We suggest that fecundity and childlessness are dependent on the gradient of oocyte maturation reflected by mother's month of birth, which may modulate future constitution.