The complex interplay of modifiable risk factors affecting prostate cancer disparities in African American men

Prostate cancer is the second most commonly diagnosed non-skin malignancy and the second leading cause of cancer death among men in the USA. However, the mortality rate of African American men aged 40-60 years is almost 2.5-fold greater than that of European American men. Despite screening and diagnostic and therapeutic advances, disparities in prostate cancer incidence and outcomes remain prevalent. The reasons that lead to this disparity in outcomes are complex and multifactorial. Established non-modifiable risk factors such as age and genetic predisposition contribute to this disparity; however, evidence suggests that modifiable risk factors (including social determinants of health, diet, steroid hormones, environment and lack of diversity in enrolment in clinical trials) are prominent contributing factors to the racial disparities observed. Disparities involved in the diagnosis, treatment and survival of African American men with prostate cancer have also been correlated with low socioeconomic status, education and lack of access to health care. The effects and complex interactions of prostate cancer modifiable risk factors are important considerations for mitigating the incidence and outcomes of this disease in African American men.

Abstract 3509: 1,25-dihydroxyvitamin D3-mediated suppression of genes associated with cell cycle regulation and actin organization in a non-malignant African American prostate cell line

Vitamin D is a steroid hormone that confers anti-proliferative and anti-inflammatory properties in prostate cells. Vitamin D deficiency is associated with advanced prostate cancer (PCa) stage, grade, and increased mortality. Since AA men are more likely to be vitamin D deficient compared to EA men, elucidating the pleiotropic effects of vitamin D may provide additional drug targets to mitigate disparate outcomes for AA men with PCa. Total RNA sequencing (RNAseq) was performed on an AA prostate cell line, RC-77N/E, derived from non-malignant epithelial tissue obtained from a PCa patient. We compared untreated RC-77N/E cells with RC-77N/E cells treated with 10 nM of vitamin D3 metabolite, 1α,25(OH)2D3 at 24h. Bioinformatic analysis, public cohort data mining, and RT-qPCR was performed to filter and validate selected statistically significant differentially expressed genes from RNAseq analysis. Our comparison of 1α,25(OH)2D3 treated versus untreated control RC-77N/E cell replicates revealed, 1601 significantly differentially expressed genes (DEGs) (FDR p < 0.05). Ingenuity Pathway Analysis software was used to conduct pathway enrichment analysis, which predicted repression of signaling pathways involved in actin cytoskeleton organization, epithelial-mesenchymal transitioning, adherens junction pathway, and RhoA pathway signaling with high enrichment z-score and statistically significant p-value. We additionally report predicted repression of PCa cell viability, invasion, cell proliferation and organismal death, for disease and function. We prioritized differentially expressed genes by identifying genes with 1) vitamin D response elements (VDREs) and 2) predicted poor prognosis, by performing overall survival analyses using The Cancer Genome Atlas (TCGA) Prostate Adenocarcinoma (PRAD) Cohort. We identified ANLN (Anillin) and ECT2 (Epithelial Cell Transforming 2), which were further validated using an AA tumor/benign contralateral matched clinical cohort, and a public cohort study using a non-malignant European prostate cell line, RWPE1. Our data suggest 1α,25(OH)2D3 significantly downregulates ANLN and ECT2 (FDR p < 0.05) in the RC-77N/E cell line, where survival analyses in the TCGA PRAD cohort show low expression of both ANLN and ECT2 are associated with significantly better overall survival outcome (p < 0.05). In our clinical cohort validations, both ANLN and ECT2 also show significantly decreased expression in non-malignant compared to tumor (p < 0.05). In conclusion, our study provides more insight of vitamin D3 regulation of PCa biomarkers and their potential roles in AA prostate cancer prevention, adjuvant treatment, as well as improving cancer survivor outcome

Citation Format: Jabril R. Johnson, Rachel N. Martini, Yate Yuan-Ching, Leanne Woods-Burnham, Mya Walker, Greisha L. Ortiz-Hernandez, Dorothy Galloway, Melissa B. Davis, Sean K. Kimbro, Adam B. Murphy, Rick A. Kittles. 1,25-dihydroxyvitamin D3-mediated suppression of genes associated with cell cycle regulation and actin organization in a non-malignant African American prostate cell line [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 3509.

Abstract P6-05-39: Black Breast Cancer Survivors’ Sociocultural Perspectives of Beauty, and Use of Personal Care Products Containing Endocrine Disrupting Chemicals

The passage of H.R. 2116 (CROWN Act) prohibits hair texture and style discrimination based on race or national origin, thus, theoretically reducing structural barriers to economic mobility. Regardless, hair is synonymous with Black women’s identities. Possibly due to society’s afro-political ideologies of beauty, Black women tend to use more hair products compared to other racial groups. These standards include social structures that affect self-mediated worth, as well as structural and interpersonal racism based on appearance and societal status. The use of personal care products containing endocrine disrupting chemicals (EDCs) has been shown to increase Black women’s breast cancer risk. The Black identity, hair product use, and breast cancer scale (BHBS) was developed to measure the sociocultural constructs associated with Black women’s hair product use and perceived breast cancer risk. The purpose of this study was to validate the BHBS and examine hair product use among Black breast cancer survivors. Methods: Participants (N=162) completed a 27-item survey between 2020 and 2022 via a community-based participatory research project—Bench to Community Initiative. Principal component analyses (PCA) and confirmatory factor analysis (CFA) were used to establish the underlying component structures and determine the model fit. Chi-square tests were used to determine associations between BHBS subscales and product use, with a p-value < 0.05 defined as statistically significant. Products evaluated included washout and leave-in conditioners, salon, and do-it-yourself (DIY) relaxers, and salon and DIY hair dyes. Response options were used daily through several times a year (daily–yearly), used but stopped, and never used. Results: Participants were African American (90%) and African or Caribbean (10%) Black breast cancer survivors. The mean age (standard deviation [SD]) and stage of diagnosis (SD) was 37.4 ± 8.8 and 1.9 ± 0.97, respectively. PCA yielded two components that accounted for 63% of the total variance in the model. Five items measuring sociocultural perspectives about hair and identity (subscale 1 [S1]) accounted for 28% of the total variance (α = 0.73, 95% CI 0.71, 0.82). Six items assessing perceived breast cancer risk related to hair product use (subscale 2 [S2]) accounted for 35% of the total variance (α=0.86, 95% CI= 0.81, 0.94). CFA confirmed the two-component structure (Root Mean Square Error of Approximation = 0.034; Comparative Fit Index = 0.93; Tucker Lewis Index = 0.89). On average, participants used hair products daily–yearly, including conditioners (64%), relaxers (32%), and hair dyes (33%). The use of salon relaxers was significantly associated with BHBS subscales (S1and S2). Similarly, salon hair dye was significantly associated with S2 of the BHBS. Discussion: The BHBS is a valid measure of sociocultural perspectives associated with hair product use and perceived risk for Black breast cancer survivors. Given that hair remains an important cultural expression within the afro-political confines of identity, the health impacts of hair products containing EDCs used to craft these identities should be considered in intervention planning.

Citation Format: Jared Bailey, Marissa Ericson, Tiah Tomlin-Harris, Dorothy Galloway, Lenna Dawkins-Moultin, Adana Llanos, Lindsey Treviño, Susanne B. Montgomery, Dede Teteh. Black Breast Cancer Survivors’ Sociocultural Perspectives of Beauty, and Use of Personal Care Products Containing Endocrine Disrupting Chemicals [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-39.

Abstract PO-023: Connecting under-resourced populations: A community-based prostate cancer screening intervention

Prostate Cancer (PCa) is the number one diagnosed cancer among Black men (BM) in the United States. Diagnosed earlier, with more aggressive disease, BM are dying at higher rates than other race/ethnic groups. Family history of PCa and lack of access to annual screenings are known contributors to the development of lethal disease. In addition, over 70% of BM are vitamin D deficient (VDD), which promotes tumor aggressiveness, and generally have little knowledge of their family history of PCa. When detected at an early stage, BM have higher survival rates for PCa than other racial/ethnic group. As a result, the American Cancer Society recommends that men with a higher risk of developing PCa should receive information about the benefits and limitations of screening between 40 and 50 years of. Community-based screening (CBS) interventions have been shown to increase early detection and increase knowledge of PCa risk for BM). The purpose of this study is to better understand the feasibility of CBS interventions in reducing PCa disparities among BM. Methodology: Participants were recruited between 2018-2020 from CBS events in Southern California. The men completed a 48-item questionnaire prior to receiving a Prostate-Specific Antigen (PSA) test. Vitamin-D levels were also measured. The survey included questions on demographics, general health, cancer history, and family history of cancer. Inclusion criteria involved BM over the age of 40, without a family history of PCa, with PSA scores greater than 4 ng/ml (abnormal screening result), and Vitamin-D values less than 20 ng/ml (Vitamin D deficiency level). Survey data was analyzed using SPSS Version 25. Results: Our participants (n=497) included 68.8% (n=342) BM, 10% (n=50) White, 11.9% (n=59) Latino, 6.8% (n=34) Asian, and 2.4% (n=12) other. 62% of participants (n=269) have never been screened for PCa, and 74% (n=313) are between 40 and 88 years old. Of the Black population, 62% (n=163) never received a PSA screening, and 66% (n=175) did not have a family history of PCa. In addition, 36% (n=113) of the BM were VDD. Of the BM with an Abnormal Screening Result (ASR) (n=32), 44% (n=14) have never been screened, and 53% (n=17) did not have a family history of PCa. In addition, 44% (n=14) of the participants with an ASR were VDD. Lastly, of the BM above the age of 40 with an ASR, and VDD, (n=14), 50% have never been screened and 57% did not have a family history of PCa. Discussion: This study aimed to identify the feasibility of a community based PCa screening intervention for BM in Southern California. As a result of our CBS program, we identified high risk men without a family history of PCa and were VDD. This program offers early detection and screening opportunities to further increase awareness of PCa risk factors for BM. Future research should include the impact of CBS interventions for BM at perceived lower risk of developing PCa.

Citation Format: Dorothy Galloway, Dede Teteh, Leanne Woods-Burnham, Mya Walker, Rick A. Kittles. Connecting under-resourced populations: A community-based prostate cancer screening intervention [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-023.

Genetic ancestry, skin color and social attainment: The four cities study

Introduction

The Black population in the US is heterogeneous but is often treated as monolithic in research, with skin pigmentation being the primary indicator of racial classification. Objective: This paper examines the differences among Blacks by comparing genetic ancestry, skin color and social attainment of 259 residents across four US cities—Norman, Oklahoma; Cincinnati, Ohio; Harlem, New York; and Washington, District of Columbia.

Methods

Participants were recruited between 2004 and 2006 at community-based forums. Cross-sectional data were analyzed using chi-square tests, correlation analyses and logistic regression.

Results

There were variations in ancestry, melanin index and social attainment across some cities. Overall, men with darker skin color, and women with lighter skin color were significantly more likely to be married. Darker skin individuals with significantly more West African ancestry reported attainment of graduate degrees, and professional occupations than lighter skin individuals.

Conclusions

Our findings suggest differences in skin pigmentation by geography and support regional variations in ancestry of US Blacks. Biomedical research should consider genetic ancestry and local historical/social context rather than relying solely on skin pigmentation as a proxy for race.

Abstract B039: I am good but depressed: The mental health impact of breast cancer on the black community

In the US Black women have higher incidence and mortality rates of breast cancer than White women. Patients diagnosed with breast cancer (BC) are known to experience a decline in mental health (MH). Patient’s reactions after diagnosis can involve denial, depression, anxiety, and anger. Close relatives and friends of patients are often also psychologically affected although their involvement and support of the BC patient has been associated with better survival outcomes. There is a gap in our understanding of the mental health impact on Black BC patient’s close friends and family members. The purpose of this study is to explore the MH impact of a BC diagnosis on Black BC patient’s close friends and family. Methodology: Analysis were conducted on a data set of African American (AA) and African/ Caribbean (AC) Women in Southern California. The data were collected from 2014-2016, using a 40-item questionnaire. Analysis included descriptive and inferential statistics. Survey data was analyzed using SPSS Version 25. Results: In our sample (N= 172), 57.8% of respondents were relatives and friends of patients with BC, compared to 35.1% of respondents who were not impacted by the disease. AA (81.3%) were significantly more impacted by BC than our AC participants (57.4%) (p=0.001). While the self-reported MH status of the respondents was excellent (46.4%) or good (35.7%) overall and no one reported their MH status as poor , among participants impacted by the disease (n=105), a higher proportion (18.1%) reported feeling depressed several days (p=0.61) versus those who were unaffected (n=60) by BC (13.3 %). It is important to note, when we analyzed the entire sample of the study (i.e. those with family and friends with breast cancer and those without), there was a significant difference in our respondents’ self-report of their MH status and feelings of depression (p=0.008). Discussion: AA and AC women often have poorer recovery outcomes from BC than White women, including MH issues, though little is known about the MH on the Black BC patients’ close family/friends. In this study, most participants reported their MH as excellent or good and although not statistically significant, we found some differences if respondents reported having a close relative/friend with a history of BC. Our findings point to the need for future studies to better link the diagnosis temporally with BC and should consider if the instrument is appropriate for this community considering the discrepancy in the interpretation of MH versus depression. Future research should consider creating culturally tailored tools to assess the MH impact of BC diagnosis on patients’ relatives and friends.

Citation Format: Dorothy Galloway, Dede Teteh, Phyllis Clark, Eudora Mitchell, Rick Kittles, Susanne Montgomery. I am good but depressed: The mental health impact of breast cancer on the black community [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B039.

Identical and Nonidentical Twins: Risk and Factors Involved in Development of Islet Autoimmunity and Type 1 Diabetes

OBJECTIVE

There are variable reports of risk of concordance for progression to islet autoantibodies and type 1 diabetes in identical twins after one twin is diagnosed. We examined development of positive autoantibodies and type 1 diabetes and the effects of genetic factors and common environment on autoantibody positivity in identical twins, nonidentical twins, and full siblings.

RESEARCH DESIGN AND METHODS

Subjects from the TrialNet Pathway to Prevention Study (N = 48,026) were screened from 2004 to 2015 for islet autoantibodies (GAD antibody [GADA], insulinoma-associated antigen 2 [IA-2A], and autoantibodies against insulin [IAA]). Of these subjects, 17,226 (157 identical twins, 283 nonidentical twins, and 16,786 full siblings) were followed for autoantibody positivity or type 1 diabetes for a median of 2.1 years.

RESULTS

At screening, identical twins were more likely to have positive GADA, IA-2A, and IAA than nonidentical twins or full siblings (all P < 0.0001). Younger age, male sex, and genetic factors were significant factors for expression of IA-2A, IAA, one or more positive autoantibodies, and two or more positive autoantibodies (all P ≤ 0.03). Initially autoantibody-positive identical twins had a 69% risk of diabetes by 3 years compared with 1.5% for initially autoantibody-negative identical twins. In nonidentical twins, type 1 diabetes risk by 3 years was 72% for initially multiple autoantibody-positive, 13% for single autoantibody-positive, and 0% for initially autoantibody-negative nonidentical twins. Full siblings had a 3-year type 1 diabetes risk of 47% for multiple autoantibody-positive, 12% for single autoantibody-positive, and 0.5% for initially autoantibody-negative subjects.

CONCLUSIONS

Risk of type 1 diabetes at 3 years is high for initially multiple and single autoantibody-positive identical twins and multiple autoantibody-positive nonidentical twins. Genetic predisposition, age, and male sex are significant risk factors for development of positive autoantibodies in twins.

In vitro maturation and intracytoplasmic sperm injection of oocytes collected from hormonally stimulated common wombats, Vombatus ursinus

Porcine FSH/LH stimulation successfully induced development of multiple large (>or=4mm) antral follicles in 10 of 11 common wombats. A mean of 5.5 metaphase II (MII) oocytes were aspirated from wombats that were stimulated during the follicular phase of the oestrous cycle (n=3) or after pouch young removal (n=3). Three subadults (n=3) and two anoestrus adults did not produce MII oocytes despite pFSH/pLH administration. In vitro maturation of immature oocytes at the time of aspiration doubled the number of MII oocytes that could be collected from pFSH/pLH stimulated wombats. Immature oocytes with cumulus attached, matured more readily to the MII stage than immature oocytes without cumulus. Following intracytoplasmic sperm injection (ICSI), approximately 5% of the oocytes that were MII at the time of collection cleaved. Approximately 5% of those that were matured by in vitro maturation (IVM) formed two polar bodies following ICSI, although they not cleave. Parthenogenesis cannot be excluded. This demonstrates that assisted reproductive technologies may be applicable to the common wombat.

Radioimmunoassay of milk progesterone as a tool for fertility control in smallholder dairy farms

This study focused on the use of radioimmunoassay of progesterone in milk for the diagnosis of post-partum ovarian cyclicity and accurate detection of oestrus and non-pregnancy in cows in the artificial insemination (AI) programme in Bangladesh. In Investigation 1, milk samples were collected on day 0 (day of AI), day 9-13 and day 21-24 from 444 milking cows of various breeds presented for the first postpartum insemination by 413 farmers living at 182 villages/regions in Mymensingh District from 6 AI centres and sub-centres. Each cow was then examined three times after each AI until it stopped returning to oestrus. Sixty to 90 days after the last AI, the cows were examined per rectum to confirm the pregnancy. Milk progesterone data on day 21-24 contributed to a clear diagnosis with respect to non-pregnancy in 100% cows, indicating a possible use of this progesterone assay for identifying non-pregnant cows in AI programmes. In Investigation 2, milk progesterone was monitored two times in a month with a 10-day interval in 88 cows. The samples were taken between 10 days after calving and the first detected oestrus, followed by two more samples 10 days apart. The proportion of cows accurately detected in oestrus was 30%. Another 30% were stated to be in oestrus when they were not (false positive) and 40% were not detected when they were in oestrus (false negative). The mean intervals between calving and oestrus and between calving luteal activity were 40 to 362 days (median=120, n=82) and 34 to 398 (median=111, n=64) days, respectively. The body condition scores at calving and at the initiation of luteal activity influenced the interval between calving and luteal activity (p < 0.05). Cows suckled twice daily initiated luteal activity earlier than their counterparts suckled several times daily (p < 0.05). Determination of progesterone in milk on day 21-24 is a good means for detecting non-pregnant cows.

Effects of dietary magnesium and short-duration transportation on stress response, postmortem muscle metabolism, and meat quality of finishing swine1

Crossbred pigs, heterozygous for the halothane gene, were used to determine the effects of long-term dietary supplementation of magnesium mica (MM) and short-duration transportation stress on performance, stress response, postmortem metabolism, and pork quality. Pigs were blocked by weight, penned in groups (six pigs per pen), and pens (three pens per diet) were assigned randomly either to a control corn-soybean meal diet or the control diet supplemented with 2.5% MM (as-fed basis; supplemented at the expense of corn). Diets were fed during the early-finisher (0.95% lysine, as-fed basis; 43.7 to 68 kg) and late-finisher (0.85% lysine, as-fed basis; 68 to 103 kg) periods. At the conclusion of the 71-d feeding trial, 12 pigs from each dietary treatment were selected randomly and subjected either to no stress (NS) or 3 h of transportation stress (TS). Dietary MM had no effect (P > or = 0.40) on ADG or ADFI; however, G:F was improved (P < 0.05) during the early-finisher period when pigs were fed MM-supplemented diets. Plasma glucose concentrations were increased in TS pigs fed the control diet, but transportation did not affect plasma glucose in pigs fed 2.5% MM (diet x transportation stress; P = 0.02). Dietary MM did not affect blood lactate, cortisol, insulin, NEFA, Ca, or Mg concentrations in response to TS (diet x transportation stress; P > or = 0.13); however, circulating lactate, cortisol, and glucose concentrations increased in TS pigs (transportation stress x time; P < 0.01). The LM from TS pigs fed MM had higher initial (0-min) and 45-min pH values than the LM from NS pigs fed the control diet (diet x transportation stress x time; P = 0.07). Lactic acid concentration and glycolytic potential were greater in the LM of TS pigs fed MM than TS pigs fed control diets (diet x transportation stress; P < or = 0.01). Although some trends were identified, neither MM (P > or = 0.15) nor TS (P > or = 0.11) altered the color or water-holding capacity of the LM and semimembranosus. The transportation model elicited the expected changes in endocrine and blood metabolites, but dietary MM did not alter the stress response in pigs. Conversely, although pork quality traits were not improved by dietary MM, delaying postmortem glycolysis and elevating 0- and 45-min muscle pH by feeding finishing diets fortified with MM may benefit the pork industry by decreasing the incidence of PSE pork in pigs subjected to short-duration, routine stressors.

A cationic lipid-formulated plasmid DNA vaccine confers sustained antibody-mediated protection against aerosolized anthrax spores

DNA vaccines provide an attractive technology platform against bioterrorism agents due to their safety record in humans and ease of construction, testing, and manufacture. We have designed monovalent and bivalent anthrax plasmid DNA (pDNA) vaccines encoding genetically detoxified protective antigen (PA) and lethal factor (LF) proteins and tested their immunogenicity and ability to protect rabbits from an aerosolized inhalation spore challenge. Immune responses after two or three injections of cationic lipid-formulated PA, PA plus LF, or LF pDNAs were at least equivalent to two doses of anthrax vaccine adsorbed (AVA). High titers of anti-PA, anti-LF, and neutralizing antibody to lethal toxin (Letx) were achieved in all rabbits. Eight or nine animals in each group were challenged with 100x LD(50) of aerosolized anthrax spores 5 or 9 weeks after vaccination. An additional 10 animals vaccinated with PA pDNA were challenged >7 months postvaccination. All animals receiving PA or PA plus LF pDNA vaccines were protected. In addition, 5 of 9 animals receiving LF pDNA survived, and the time to death was significantly delayed in the others. Groups receiving three immunizations with PA or PA plus LF pDNA showed no increase in anti-PA, anti-LF, or Letx neutralizing antibody titers postchallenge, suggesting little or no spore germination. In contrast, titer increases were seen in AVA animals, and in surviving animals vaccinated with LF pDNA alone. Preclinical evaluation of this cationic lipid-formulated bivalent PA and LF vaccine is complete, and the vaccine has received U.S. Food and Drug Administration Investigational New Drug allowance.

Oestrous cycle of the common wombat, Vombatus ursinus, in Victoria, Australia

Wild-caught female common wombats from Victoria, Australia, were studied in captivity to investigate the oestrous cycle by assessing vaginal cytology and peripheral plasma progesterone concentrations. Eight wombats, five adults (21-29 kg) and three subadults (19-23 kg), which were held for between 2 weeks and 11 months did not cycle in captivity. Their progesterone concentrations were consistently low (< or = 6.9 nmol L(-1)) and vaginal smears contained predominantly superficial epithelial cells. Three wombats (21-27 kg), held in captivity for >1 year, regularly cycled (when bodyweights exceeded 23.5 kg). Information gathered from four consecutive cycles in each of these three wombats revealed a follicular phase with low progesterone concentrations (< or = 6.9 nmol L(-1)) and vaginal smears with a high percentage of superficial epithelial cells alternating with periods of high progesterone concentrations (range 41.6-123.8 nmol L(-1)) and smears in which parabasal-intermediate epithelial cells predominated. The average length of the monitored oestrous cycles was 47.2 days (35-60 days). The follicular phase lasted ~19 days and the luteal phase lasted ~28 days. In conclusion, wombats can cycle regularly in captivity even under conditions of intensive monitoring.

Oestrous cycle of the common wombat, Vombatus ursinus, in Victoria, Australia

Wild-caught female common wombats from Victoria, Australia, were studied in captivity to investigate the oestrous cycle by assessing vaginal cytology and peripheral plasma progesterone concentrations. Eight wombats, five adults (21–29 kg) and three subadults (19–23 kg), which were held for between 2 weeks and 11 months did not cycle in captivity. Their progesterone concentrations were consistently low (≤6.9 nmol L–1) and vaginal smears contained predominantly superficial epithelial cells. Three wombats (21–27 kg), held in captivity for >1 year, regularly cycled (when bodyweights exceeded 23.5 kg). Information gathered from four consecutive cycles in each of these three wombats revealed a follicular phase with low progesterone concentrations (≤6.9 nmol L–1) and vaginal smears with a high percentage of superficial epithelial cells alternating with periods of high progesterone concentrations (range 41.6–123.8 nmol L–1) and smears in which parabasal–intermediate epithelial cells predominated. The average length of the monitored oestrous cycles was 47.2 days (35–60 days). The follicular phase lasted ~19 days and the luteal phase lasted ~28 days. In conclusion, wombats can cycle regularly in captivity even under conditions of intensive monitoring.

Improvement in cholestasis associated with total parenteral nutrition after treatment with an antibody against tumour necrosis factor alpha

BACKGROUND

Many patients receiving long-term total parenteral nutrition (TPN) develop liver disease; cholestasis is common and may be severe. Antitumour necrosis factor alpha (TNFalpha) antibodies have recently been used in order to treat Crohn's disease, but their effect on cholestasis in humans has not been previously described.

CASE REPORT

A 45-year-old woman had complicated Crohn's disease with multiple fistulae and only 1 m of residual small bowel. She had been receiving TPN for 2.5 years when she developed cholestasis which worsened despite adjustments to her TPN regimen. Infliximab, an anti-TNFalpha antibody, was given with the aim of treating an enterocutaneous fistula, but it also produced a marked biochemical and histological improvement in the TPN-related cholestasis.

CONCLUSIONS

Anti-TNFalpha antibodies appeared in this case to improve TPN-related cholestasis. This implies that TNFalpha may play an important role in the development of this condition.

Neurotransplantation in neurodegenerative disease: a survey of relevant issues in developmental neurobiology

Neural development and transplantation therapies in neurodegenerative disease share a particular feature. In both cases, undifferentiated neural precursor cells are required to differentiate into a range of neural cell types in a tissue-specific fashion. This similarity opens the possibility that the mechanisms that drive neural development play a similar role in CNS repair. In this chapter, two aspects of neural development are considered in terms of their relevance to CNS repair: the diversity of neural precursor cells and positional specification. We present evidence to suggest that neural stem cells have a degree of diversity that is beyond what might have been expected a priori. We also show that neural stem cells express genes that might encode a positional specification for these cells, and consider a number of hypotheses about the role of positional specification in CNS repair.

Gender differences in motivational style: a comparison of measures and curriculum area

BACKGROUND

Gender has long been implicated in school-based performance with gender differences varying across curriculum domains. Motivational differences have often been cited as a possible cause. However, evidence for the pattern of motivational difference between the genders is unclear.

AIMS

This study compares the motivational responses of girls and boys in the curriculum areas of mathematics and English. Two different measures of motivation are employed.

SAMPLES

The sample consists of all pupils from years 7, 9 and 11 in two secondary schools in Northern England. A total of 435 yr 7, 389 yr 9 and 357 yr 11 students was available.

METHODS

Students completed two assessments of motivation, one based on self-report measures of goal strength and the other on performance over four tasks. Some school performance data were also available.

RESULTS

The two motivation measures produce different patterns of results. The task-based measure shows no gender based differences while the other indicates a pattern of differences broadly suggestive of an advantage for girls.

CONCLUSIONS

Future exploration of gender effects in motivation needs to give careful consideration to the type of motivation under consideration. Univariate models are unlikely to be adequate.

Motivational styles in English and mathematics among children identified as having special educational needs

This study is concerned with the identification, development and prevalence of three different motivational styles: learned helplessness, self-worth motivation and mastery orientation in two National Curriculum core subjects: English and mathematics. These three motivational styles are concerned with the ways in which children respond in the face of difficult and challenging educational tasks. Using Craske's (1988) procedures, a total of 437 children in their first year of secondary school (aged 11-12) were categorised into one of the three motivational styles. Children with special educational needs were identified using a battery of cognitive ability tests (Thorndike, Hagen & France, 1986). This study compares the prevalence of each motivational style in English and mathematics in children of different abilities and presents empirical support for the view that learned helplessness and self-worth motivation are more prevalent among children identified as having special educational needs. Further analyses indicate that: overall, learned helplessness and self-worth motivation are more prevalent in English than mathematics; learned helplessness is more prevalent among girls and self-worth motivation among boys in mathematics. Implications for teachers in developing teaching strategies which foster mastery orientation in their children are discussed.

Laparoscopic and minilaparotomy cholecystectomy: a randomized trial comparing postoperative pain and pulmonary function

BACKGROUND

Upper abdominal surgery is associated with severe postoperative pain and a concomitant reduction in pulmonary function and oxygen saturation. Laparoscopic cholecystectomy is said to result in less postoperative pain compared with open cholecystectomy.

METHODS

In a pragmatic, randomized trial, postoperative pain, opiate analgesic consumption, oxygen saturation, and pulmonary function (forced vital capacity, forced expiratory volume in 1 second, and peak expiratory flow rate) were assessed after laparoscopic (n = 67) and minilaparotomy (n = 65) cholecystectomy.

RESULTS

Compared with minilaparotomy cholecystectomy, laparoscopic cholecystectomy was associated with lower linear analogue pain scores (median 40 vs 59, p < 0.001), lower patient-controlled morphine consumption (median 22 vs 40 mg, p < 0.001), a smaller reduction in postoperative pulmonary function (mean peak expiratory flow rate 64% of preoperative value vs 49%, p < 0.001), and better oxygen saturation (mean 92.9% vs 91.2%, p = 0.008).

CONCLUSIONS

This study confirms that the postoperative pain and pulmonary changes associated with upper abdominal surgery are significantly reduced by the laparoscopic technique. These findings suggest that laparoscopic cholecystectomy may result in a reduced risk of postoperative pulmonary complications.

A randomized pilot trial of low-dose combination lipid-lowering therapy following coronary artery bypass grafting

Vein graft atherosclerosis is a common and serious complication of coronary artery bypass grafting (CABG). There is mounting evidence that lipoprotein abnormalities play an equally important role in the development of lesions in saphenous vein grafts after CABG as in native coronary vessel disease. The potential benefit of low-dose lipid lowering combination therapy in these patients has not been investigated. In a randomized, double-blind, placebo-controlled study, we compared the efficacy and safety of a low-dose combination of colestipol 10 g and simvastatin 10 mg/day (CS) to colestipol 10 mg and bezafibrate 400 mg/day (CB) for 2 months in 33 patients with serum total cholesterol > 6.5 mmol/l and triglyceride < 4.5 mmol/l who had undergone CABG for severe coronary artery disease. In the CS group, total cholesterol decreased by 29% and low-density lipoprotein (LDL) cholesterol by 42%; similarly, CB reduced total cholesterol by 17%, LDL cholesterol by 23%, triglyceride by 19%, and increased high-density lipoprotein (HDL) cholesterol by 14%. Lipoprotein (a) and hemostatic factors were unaffected by either therapy in this study. Both combination therapies were well tolerated with no significant clinical or biochemical side effects. We conclude that low-dose combinations of colestipol and simvastatin or colestipol and bezafibrate are effective and well tolerated in the management of moderate hyperlipidemia in patients who had undergone CABG.

Laparoscopic versus minilaparotomy cholecystectomy: a randomised trial

Although laparoscopic cholecystectomy has rapidly become routine practice in the UK, there has been no rigorous comparison of it with open cholecystectomy. In our trial, 302 patients were randomised to laparoscopic or minilaparotomy cholecystectomy. Recovery after surgery was assessed by length of hospital stay, outpatient review at 10 days and 4 weeks, and patient questionnaires 1, 4, and 12 weeks after surgery. The mean operation time was 14 min shorter for minilaparotomy, while median post-operative hospital stay was 2 days shorter after laparoscopic cholecystectomy. The hospital costs were about 400 pounds greater for the laparoscopic procedure. Laparoscopic patients returned to work in the home sooner; at 1 week, they had better physical and social functioning, were less limited by physical problems, and had less pain and depression. At 4 weeks, only physical functioning and depression scores were better in the laparoscopic group, and by 3 months there were no differences. Laparoscopic patients were more satisfied with the appearance of their scars. The incidence of complications after both procedures was 20%. Compared to minilaparotomy cholecystectomy, laparoscopic cholecystectomy results in shorter hospital stay, less postoperative dysfunction, and quicker return to normal activities, but is more costly.

Localization of alg, opr, phn, pho, 4.5S RNA, 6S RNA, tox, trp, and xcp genes, rrn operons, and the chromosomal origin on the physical genome map of Pseudomonas aeruginosa PAO

The genes encoding the rrn operons, the 4.5S and 6S RNAs, elements of protein secretion, and outer membrane proteins F and I, and regulatory as well as structural genes for exotoxin A, alkaline phosphatase, and alginate and tryptophan biosynthesis, were assigned on the SpeI/DpnI macrorestriction map of the Pseudomonas aeruginosa PAO chromosome. The zero point of the map was relocated to the chromosomal origin of replication.

Anal human papillomavirus infection among human immunodeficiency virus-seropositive and -seronegative men

Homosexual men are at high risk of anorectal human papillomavirus (HPV) infection, HPV-related anal cancer, and precancer, conditions known to increase with immunosuppression. The relationship between anal HPV infection, human immunodeficiency virus (HIV) infection, and immunosuppression was studied in homosexual men seen at a sexually transmitted disease clinic. History or presence of warts on rectal examination, and detection of anorectal HPV DNA were each significantly associated with HIV seropositivity after adjusting for age, previous sexual behavior, and cultural or serologic evidence of other sexually transmitted diseases, including those previously identified as risk factors for acquisition of HIV infection. Decreased mean levels of T4 lymphocytes were significantly associated with the detection of anal HPV DNA. Prospective studies are needed to determine incidences of anal HPV infection and cancer among HIV-seropositive and -seronegative mean and to determine the temporal relationship of these infections to one another.

Scalp colonization by Trichophyton tonsurans in an urban pediatric clinic. ?Asymptomatic carrier state

Random culturing of the scalp in 200 healthy children in a large metropolitan children's hospital revealed that eight (4%) of the patients had cultures that were positive for Trichophyton tonsurans variety sulfureum. Infections were not clinically apparent and were asymptomatic. All of the patients with positive cultures were black and six braided their hair. Trichophyton tonsurans appears to exist in an asymptomatic state in this well-defined population of children.

The case for low dose diuretics in hypertension: comparison of low and conventional doses of cyclopenthiazide

In a double blind placebo controlled randomised parallel study the antihypertensive activity and adverse biochemical effects of three doses of cyclopenthiazide were evaluated in patients with mild essential hypertension that had been recently diagnosed or was being treated with a single drug. After a four week placebo washout period 53 patients with diastolic blood pressures between 90-110 mm Hg were randomly assigned to 50, 125, or 500 micrograms cyclopenthiazide or matching placebo for an eight week period of treatment. Blood pressure was measured in the patients' homes by the same observer every two weeks. Serum urea, electrolytes, urate, and creatinine concentrations and 24 hour urinary sodium excretion were monitored every four weeks and serum magnesium concentration and plasma renin activity at the end of the washout and treatment periods. After eight weeks of treatment systolic and diastolic blood pressures were significantly reduced in patients taking 125 and 500 micrograms cyclopenthiazide when compared with those taking placebo. The decrement in serum potassium concentration (0.6 mmol/l) and increase in serum urate concentration 0.06 mmol/l) were greatest with the 500 micrograms dose, the increase in serum urate concentration alone being significant. No change in serum magnesium concentration or 24 hour urinary sodium excretion was noted with any dose of cyclopenthiazide. Only the 500 micrograms dose of cyclopenthiazide significantly increased the mean plasma renin activity (1.8 (95% confidence interval 0.2 to 3.4)-5.4 (3.9 to 6.8) nmol angiotensin I/l/h); the other doses like the placebo had no effect. Cyclopenthiazide 125 micrograms, a dose lower than is currently marketed, produced a similar hypotensive response to 500 micrograms of the drug without upsetting the biochemical profile.

Neurologic return versus cross-sectional canal area in incomplete thoracolumbar spinal cord injuries

Twenty-four patients with incomplete spinal cord injuries secondary to burst fractures of the thoracolumbar spine were reviewed an average of 26 months after their injury. No patient had had a specific attempt to decompress neural elements but the majority had posterior instrumentation and fusion for spine realignment and stabilization. The amount of neurologic recovery in each patient was compared to the final area of the spinal canal as determined by CT scan. It was concluded that there was no correlation between neurologic improvement and the amount of spinal canal encroachment. In addition, posterior instrumentation to realign the spine will usually restore canal patency to greater than 50% of normal.

Bowel adenocarcinoma in a patient with cystic fibrosis

Cystic fibrosis (CF) is an autosomal recessive condition affecting one in 2,000 live births in the UK. There are few reports of malignant tumours in this condition probably because, until recently, the majority died before the age of 30 years as a result of recurrent and chronic bronchopulmonary infection with impaired growth and development and resistance to infection due to pancreatic malabsorption. We describe an adult male with CF who died from an adenocarcinoma affecting the ileocaecal region of the bowel.

Mental health, absences from work, stress and satisfaction in a sample of New Zealand primary school teachers

A study of 296 primary school teachers in New Zealand revealed a very low correlation between mental health, measured by the General Health Questionnaire, and absence from work. The correlations between mental health and feelings of stress at work and between mental health and job satisfaction were higher. The most highly rated sources of stress were ranked, as were the most highly rated sources of satisfaction. It is suggested that teachers' experiences of stress are associated with lack of satisfaction with intrinsic aspects of their job rather than with dissatisfaction at their conditions of employment.

Herpes simplex virus types 1 and 2 homology in the region between 0.58 and 0.68 map units

The homology between herpes simplex virus type 1 and type 2 (HSV-1 and HSV-2, respectively) DNA between 0.58 and 0.674 map units was compared by Southern and dot blot analysis with DNA of one type of virus as a hybridization probe against the other type. Regions of high homology were interspersed with regions of detectably lower homology. However, only one region (between 0.647 and 0.653 map units) contained few or no homologous sequences. In situ RNA blot hybridization demonstrated that the mRNA species transcribed in the right-hand portion of the region are homologous between HSV-1 and HSV-2, as was previously found for the left-hand portion. A 2.7-kilobase HSV-2 transcript in the right-hand portion of the studied region was clearly that encoding HSV-2 glycoprotein C. Comparative nucleotide sequence analysis of specific regions demonstrated that homologous translational reading frames could be identified in the virus types. This analysis also demonstrated that homology could be abruptly lost outside such reading frames. Comparison of regions of homology with published HSV-1 transcription maps suggests that there can also be large divergence within translational reading frames. Some, but not complete, sequence homology was seen in the putative promoter sequence for the 730-base HSV-1 mRNA mapping to the right of glycoprotein C and the corresponding HSV-2 DNA. This suggests that the rather strict conservation of promoter sequences between homologous HSV-1 and HSV-2 transcripts seen in other regions of the genome may not be a necessary feature between these virus types.

Research note: truants and other absentees

Truants living in a depressed urban area are compared with Other Absentees from school living in the same area. The results show few differences in the social and financial circumstances of the two groups but considerable differences in the children's behaviour and in family relationships. The results are discussed in the light of other research which distinguishes truants from school refusers.

Endotoxaemia and complement activation in acute pancreatitis in man

Twenty-four patients who experienced 26 attacks of acute pancreatitis were studied. Endotoxaemia, as measured by the limulus lysate assay, was present in 13 of the attacks. Six out of seven patients with systemic complications of the disease had endotoxaemia. C3 catabolism was increased in all 26 attacks of pancreatitis, and a falling level of C3 during attacks of severe pancreatitis was associated with a fatal outcome. There was statistical evidence of more complement activation in serum samples taken when patients had positive limulus lysate tests than when endotoxin was not detected in their blood.

Topographic association of fibronectin with elastic fibers in the arterial wall. An immunohistochemical study

Rabbit antibodies to human fibronectin which recognize tissue fibronectin and lack species-specificity have been employed to localize this molecule in the arterial wall of different animal species by indirect immunofluorescence. Fibronectin has been found to be consistently associated with both the inner and external aspects of the internal elastic membrane of large size arteries in mammals. Only scanty staining for fibronectin has been detected in collagen rich areas of the vessel wall, i.e. adventitia. This topographic association of fibronectin and internal elastic membrane is maintained in large size arteries (aorta, truncus arteriosus) of all species studied, including reptiles, amphibia and fish. The present findings suggest that fibronectin may mediate the contraction of vessel wall structures (i.e. elastic membranes) which lack an intrinsic contractile activity.

Clinical metrology--a future career grade?

Clinical metrologists have been employed in Leeds for the past seven years. They have come to assume increasing responsibility, particularly in the conduct and recording of clinical trials in the rheumatic diseases. Their work can be extended to the planning of trials, practical procedures, and other research activities. Analysis of 20 applications for a post that recently fell vacant at Leeds suggests that many married women, highly qualified professionally, who have completed their families, would welcome the opportunity to return to parttime nursing duties in "social hours". Increased responsibility and job satisfaction provided by the post compensate for a reduction in salary. Clinical metrology may be a new career grade in the National Health Service that allows for more careful monitoring of patients with constancy that cannot be achieved with rotating junior medical staff. Physicians can be released from the routine of follow-up, so that they have more time for diagnosis, management of complex problems, and research.