Visual outcome after proton beam irradiation of uveal melanoma

Prognostic factors for visual loss following proton irradiation of uveal melanoma were evaluated for 440 eyes treated from 1975 to 1984, with visual acuity 20/200 or better before treatment. Analysis involved Kaplan-Meier survival curves and Cox proportional hazards analysis with visual outcome defined as worse than 20/200. Prognostic factors were tumor height: rate ratio (ratio of rate of visual loss for one category of the variable relative to the rate of visual loss for a reference category of that variable) of 5.26 (95% confidence interval, 2.66-10.39) for tumors greater than 5 mm compared to tumors 3.0 mm or less in height; distance of tumor from the optic disc and fovea: rate ratio 2.59 (1.63-4.11) for tumors 2DD or less from both the optic disc and fovea compared to those greater than 2 DD from these structures. Also predictive of visual loss were tumor location close to disc only, or close to fovea only, macular detachment, worse pretreatment vision, and higher radiation doses delivered to both the disc and fovea, and lens. Regression analysis using a visual acuity scale gave similar results.

Prognostic factors for metastasis following proton beam irradiation of uveal melanomas

Prognostic indicators for the development of metastasis following proton beam irradiation of uveal melanomas were evaluated for 510 patients treated from 1975 to 1984. Thirty-three patients developed metastasis (6.5%) from 3 to 51 months following treatment. The primary site of metastasis was the liver in 28 cases (85%). Both demographic and clinical factors were considered. The three leading predictors of survival without metastasis after proton beam irradiation in order of importance were: (1) largest diameter of the tumor; (2) location of the anterior margin of the tumor; and (3) age at treatment. Worse prognosis was associated with largest tumor diameter greater than 15.0 mm, tumor involvement of the ciliary body and age at treatment older than 59 years.

Physical activity, all-cause mortality, and longevity of college alumni

We examined the physical activity and other life-style characteristics of 16,936 Harvard alumni, aged 35 to 74, for relations to rates of mortality from all causes and for influences on length of life. A total of 1413 alumni died during 12 to 16 years of follow-up (1962 to 1978). Exercise reported as walking, stair climbing, and sports play related inversely to total mortality, primarily to death due to cardiovascular or respiratory causes. Death rates declined steadily as energy expended on such activity increased from less than 500 to 3500 kcal per week, beyond which rates increased slightly. Rates were one quarter to one third lower among alumni expending 2000 or more kcal during exercise per week than among less active men. With or without consideration of hypertension, cigarette smoking, extremes or gains in body weight, or early parental death, alumni mortality rates were significantly lower among the physically active. Relative risks of death for individuals were highest among cigarette smokers and men with hypertension, and attributable risks in the community were highest among smokers and sedentary men. By the age of 80, the amount of additional life attributable to adequate exercise, as compared with sedentariness, was one to more than two years.

Adolescent suicidal and self-destructive behavior. Results of an intervention study

This study evaluates an intervention program designed to reduce suicidal, self-destructive behavior among high-risk adolescents aged 13- to 17 years. The intervention combined a program of community education and direct service to youth who had required emergency care for self-inflicted injuries. The intervention program was effective in increasing subjects' compliance with medical regimen. To a lesser degree, the intervention also facilitated early help seeking among adolescents with suicidal thoughts and appeared to diminish slightly the overall occurrence of emergency room admissions for suicidal behaviors. However, the intervention program had no demonstrable effect on the occurrence of repeat suicidal episodes.

Immunological uniqueness of human monoamine oxidases A and B: new evidence from studies with monoclonal antibodies to human monoamine oxidase A

Monoamine oxidase (EC 1.4.3.4; MAO) is the primary enzyme responsible for the intraneuronal degradation of biogenic amines in the central nervous system. An understanding of the physiological significance of the functional and regulatory differences between the two forms of the enzyme, MAOs A and B, would be facilitated by the availability of antibodies specific for the two forms of the enzyme. We previously isolated and characterized a monoclonal antibody (MAO B-1C2, previously designated MAO-1C2) which binds human MAO B but not A. We describe here four new monoclonal antibodies (designated MAO A-3C9, A-4F10, A-7B10, and A-7E10) which were elicited to highly purified MAO A from human placenta and which, in the presence of antimouse IgG and Staphylococcus aureus, immunoprecipitate greater than 90% of the catalytically active purified MAO A. MAO A-3C9 appears to have a lower affinity for purified MAO A than the other three antibodies and does not immunoprecipitate either MAO A or MAO B from human platelets or from Triton X-100 extracts of human placental and liver mitochondria. MAO A-4F10, A-7B10, and A-7E10 immunoprecipitate catalytically active MAO A from Triton X-100 extracts of human placental and liver mitochondria, but not catalytically active MAO B from either pletelets or from Triton X-100 extracts of human liver mitochondria. Collectively, these anti-MAO monoclonal antibodies reveal unique epitopes on human MAO A not shared by MAO B, and at least one epitope on MAO B not shared by MAO A. These immunochemical differences support the hypothesis that MAO A and MAO B are different proteins, presumably isozymes.

Comparison of survival rates for patients with uveal melanoma after treatment with proton beam irradiation or enucleation

We compared survival experiences for three groups with uveal melanoma: (1) 120 patients treated by proton beam irradiation from 1975 to 1981; (2) 235 patients treated by enucleation from 1953 to 1973 (enucleation group 1); and (3) 161 patients treated by enucleation from 1975 to 1981 (enucleation group 2). The following variables were predictive of melanoma-related deaths.

TREATMENT

rate ratio (ratio of the rate of death for one category of the variable relative to the rate of death for another category) of 6.32 (95% confidence interval 1.70 to 23.51) for enucleation group 1 vs proton beam, 3.06 (0.81 to 11.54) for enucleation group 2 vs proton beam, and 2.07 (1.05 to 4.07) for enucleation group 1 vs enucleation group 2. Size: rate ratio of 3.61 (1.51 to 8.64) for large (16+ mm) vs small (less than 11 mm) tumors.

LOCATION

rate ratio of 3.19 (1.56 to 6.53) for tumors anterior vs posterior to the equator. When death from all causes was evaluated as the outcome, the estimated rate ratios were similar. When melanoma metastasis was evaluated as the outcome, the estimated rate ratios were reduced in magnitude.

Note on interval estimation of the difference between proportions from correlated series

This paper presents a procedure for estimating the confidence interval of the difference between proportions in paired observations. As an extension of McNemar's test, this large sample interval estimation procedure uses a variance estimator obtained at the limit and is not conditional on the number of discordant pairs.

Vitamin A supplementation and plasma retinol levels: a randomized trial among women

Although dietary intake of vitamin A has little, if any, overall effect on blood retinol in generally well-nourished populations, subgroups may exist that would be responsive to supplementation. The hypothesis that vitamin A supplementation increases blood retinol in apparently well-fed individuals with lower than usual blood levels was tested in female health workers, with relatively low blood retinol values, who were randomly assigned to receive vitamin A (10,000 IU daily) or placebo. After 4 weeks the mean change in plasma retinol was -0.4 micrograms/dl for the group receiving placebo and +4.1 micrograms/dl (an increase of 9% over base-line values) for the group receiving vitamin A (P = .02). The results were similar when the base-line retinol level and several other covariates were considered. Thirteen women who had initially received placebo were then switched to vitamin A for 4 weeks. These women experienced a mean increase of 5.3 micrograms/dl in plasma retinol (P = .04). Responses to vitamin A supplementation tend to be greater among women with lower previous total vitamin A intake, as assessed by questionnaire [Spearman rank correlation coefficient (r) = 0.50; P = .01].

Apnea of infancy and subsequent neurologic, cognitive, and behavioral status

A pilot study investigated the neurologic, cognitive, and behavioral consequences of nonfatal infancy apnea. Fifteen formerly apneic, monitored children were compared with age-similar siblings and with age-sex matched playmates. Significant impairment in gross motor development and mild cognitive deficiencies were observed when those who had had apnea were compared with their siblings but not when contrasted with their playmates. Lack of difference between those who had had apnea and playmates might have been due to a selection bias involving assortive friendships. The frequency and the severity of apneic episodes were associated but neither one showed a clear gradient of risk for poor outcome in the areas under study, indicating the possibility that apnea may have a threshold effect on subsequent development.

Age at first birth and breast atypia

The relation between age at first birth and the occurrence of fibrocystic breast disease of different atypia subtypes was evaluated using data from a cohort study of the health effects of oral-contraceptive use. Multivariate case-control analysis was performed on 218 parous women with biopsied fibrocystic disease and 928 parous controls. Fibrocystic breast disease, as a whole and as atypia subtypes, was found to be unrelated to age at first birth. Furthermore, the estimated effect of age at first birth did not vary from one atypia subtype to another. Women with high parity were found to be at decreased risk of fibrocystic breast disease compared to those with low parity. Age at completion of education, used as an indicator of socioeconomic status, was found to be moderately associated with fibrocystic breast disease. The estimated effect of parity and age at completion of education also did not vary among subtypes. More epidemiologic studies specific to histopathologic classifications of benign breast disease are called for.

Oral contraceptive use and fibrocystic breast disease of different histologic classifications

The relationship between oral contraceptive (OC) use and occurrence of fibrocystic breast disease (FBD) of different histologic classifications was evaluated with data from a cohort study. Biopsy specimens from 232 women with FBD were classified into different atypia categories. In 96 matched pairs of OC users and nonusers, atypia scores were lower in users than in nonusers. Women without breast diseases (500 OC users and 500 nonusers) were sampled from the original cohort to form a two-stage "anamorphic" study with the 232 cases of FBD. The previously shown inverse association between OC use and FBD occurrence was present and increased with increased length of OC use. However, the "protective effect" of OC use did not vary for different histologic classifications of FBD. The findings from both paired and anamorphic analyses of the data are not consistent with the hypothesis that the use of OC is associated with decreased frequency only of FBD with minimal epithelial atypia.

Age at any birth and breast cancer risk

In an effort to assess the relative importance of age at first birth, age at subsequent births, and total parity to the occurrence of breast cancer, reproductive data from 4,225 women with breast cancer and 12,307 hospitalized women without breast cancer were analyzed by a multiple logistic regression model. Age at first birth was confirmed to be the most important reproductive risk indicator; it was associated with a 3.5% increase of relative risk for every year of increase in age at first birth (the 95% confidence interval of this estimate was 2.3 to 4.7% increase per year). However, age at any birth after the first was also an independent and statistically significant risk indicator; it was associated with a 0.9% increase of relative risk for every year of increase in age at any (and every) birth (the 95% confidence interval of this estimate was 0.4 to 1.5% increase per year). There is evidence that the age of approximately 35 years represents for every birth a critical point; before this age any full-term pregnancy confers some degree of protection; after this age any full-term pregnancy appears to be associated with increase in breast cancer risk. The effect of parity is determined by the age of occurrence of the component pregnancies. While most pregnancies occur under the age of 35, the distribution varies from population to population, and this may account for the differences between populations in whether or not a protective effect is seen for births after the first, and if it is seen, its extent.

Grouping occupations according to carcinogenic potential: occupation clusters from an exposure linkage system

An occupational clustering scheme has been developed from an occupation and exposure linkage system. In this scheme, occupational titles are grouped together hierarchically according to the numbers and degrees of their shared exposures. The use of the clusters obtained from this hierarchy is demonstrated in the analysis of the data from a case-control study of bladder cancer.

Consumption of alcohol and tobacco and other risk factors for pancreatitis

Histories of alcohol and tobacco consumption and other potential risk factors were obtained from 98 patients with pancreatitis and 451 comparison patients at 11 large hospitals in Eastern Massachusetts and Rhode Island between 1975 and 1979. The great majority of the patients with pancreatitis had chronic or recurrent disease. From the comparison patients were excluded patients with other diseases of the pancreas and biliary tract and those admitted for disorders known to be associated with smoking or alcohol use. A statistically significant association of pancreatitis with alcohol use was present in males, but not in females. Cigarette use was very strongly associated with pancreatitis in males and less so in females. The associations with alcohol and cigarette use were independent, each retaining significance after adjustment for the other. There was no significant association of risk with coffee consumption in either sex. A history of biliary tract disease was given by 45 per cent of the male and 60 per cent of the female cases. The associations with alcohol use and cigarette smoking did not appear to be restricted either to the patients with or those without a history of biliary tract disease. Chronic or recurrent pancreatitis appears to have different dominant etiologies in males and females.

Reactions of powdered human enamel and fluoride solutions with and without intermediate CaHPO4 x 2H2O formation

Powdered human enamel treated for three minutes each with a CaHPO4 x 2H2O forming solution and a fluoride solution, and then suspended in "synthetic saliva" for 72 hours acquired a large amount of apatitic fluoride. This apatitic fluoride appears to form after the fluoride treatment.

Studies on Thermoactinomyces sp. TM9208. I. Description of the strain

A strain of Thermoactinomyces sp., TM9208, isolated from a soil sample in the Taipei area showed antagonistic activity to Gram positive bacteria but not to the Gram negative on the potato extract agar plate by the cross streaking method. The strain showed strong starch hydrolysis, beta type of hemolysis, brownish yellow growth on the potato extract agar and green on the nutrient agar. Its aerial mycelium, white to grayish white, was long and straight with short branches. The spores are single and have smooth surface. It is a good utilizer of starch, maltose and cellobiose as carbon source, but utilizes dulcitol, salicin, sucrose, rhamnose and sorbitol poorly.