Neural correlates of theory of mind reasoning in congenitally blind children

Vision is an important source of information about other minds for sighted children, especially prior to the onset of language. Visually observed actions, eye gaze, and facial expressions of others provide information about mental states, such as beliefs, desires, and emotions. Does such experience contribute causally to the development of cortical networks supporting social cognition? To address this question we compared functional development of brain regions supporting theory of mind (ToM), as well as behavioral ToM reasoning, across congenitally blind (n=17) and sighted (n=114) children and adolescents (4-17 years old). We find that blind children in this age range show slightly lower ToM behavioral performance relative to sighted children. Likewise, the functional profile of ToM brain regions is qualitatively similar, but quantitatively weaker in blind relative to sighted children. Alongside prior research, these data suggest that vision facilitates, but is not necessary for, ToM development.

Preferential responses to faces in superior temporal and medial prefrontal cortex in three-year-old children

Perceiving faces and understanding emotions are key components of human social cognition. Prior research with adults and infants suggests that these social cognitive functions are supported by superior temporal cortex (STC) and medial prefrontal cortex (MPFC). We used functional near-infrared spectroscopy (fNIRS) to characterize functional responses in these cortical regions to faces in early childhood. Three-year-old children (n = 88, M(SD) = 3.15(.16) years) passively viewed faces that varied in emotional content and valence (happy, angry, fearful, neutral) and, for fearful and angry faces, intensity (100%, 40%), while undergoing fNIRS. Bilateral STC and MPFC showed greater oxygenated hemoglobin concentration values to all faces relative to objects. MPFC additionally responded preferentially to happy faces relative to neutral faces. We did not detect preferential responses to angry or fearful faces, or overall differences in response magnitude by emotional valence (100% happy vs. fearful and angry) or intensity (100% vs. 40% fearful and angry). In exploratory analyses, preferential responses to faces in MPFC were not robustly correlated with performance on tasks of early social cognition. These results link and extend adult and infant research on functional responses to faces in STC and MPFC and contribute to the characterization of the neural correlates of early social cognition.

Risk of infertility in female adolescents and young adults with cancer: a population-based cohort study

STUDY QUESTION

Do female adolescents and young adults (AYAs) with cancer have a higher risk of subsequent infertility diagnosis than AYAs without cancer?

SUMMARY ANSWER

Female AYAs with breast, hematological, thyroid and melanoma cancer have a higher risk of subsequent infertility diagnosis.

WHAT IS KNOWN ALREADY

Cancer therapies have improved substantially, leading to dramatic increases in survival. As survival improves, there is an increasing emphasis on optimizing the quality of life among cancer survivors. Many cancer therapies increase the risk of infertility, but we lack population-based studies that quantify the risk of subsequent infertility diagnosis in female AYAs with non-gynecological cancers. The literature is limited to population-based studies comparing pregnancy or birth rates after cancer against unexposed women, or smaller studies using markers of the ovarian reserve as a proxy of infertility among female survivors of cancer.

STUDY DESIGN, SIZE, DURATION

We conducted a population-based cohort study using universal health care databases in the province of Ontario, Canada. Using data from the Ontario Cancer Registry, we identified all women 15-39 years of age diagnosed with the most common cancers in AYAs (brain, breast, colorectal, leukemia, Hodgkin lymphoma, non-Hodgkin lymphoma, thyroid and melanoma) from 1992 to 2011 who lived at least 5 years recurrence-free (Exposed, n = 14,316). Women with a tubal ligation, bilateral oophorectomy or hysterectomy previous to their cancer diagnosis were excluded. We matched each exposed woman by age, census subdivision, and parity to five randomly selected unexposed women (n = 60,975) and followed subjects until 31 December 2016.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Infertility diagnosis after 1 year of cancer was identified using information on physician billing codes through the Ontario Health Insurance Plan database (ICD-9 628). Modified Poisson regression models were used to assess the risk of infertility diagnosis (relative risk, RR) adjusted for income quintile and further stratified by parity at the time of cancer diagnosis (nulliparous and parous).

MAIN RESULTS AND THE ROLE OF CHANCE

Mean age at cancer diagnosis was 31.4 years. Overall, the proportion of infertility diagnosis was higher in cancer survivors compared to unexposed women. Mean age of infertility diagnosis was similar among cancer survivors and unexposed women (34.8 years and 34.9 years, respectively). The overall risk of infertility diagnosis was higher in cancer survivors (RR 1.30; 95% CI 1.23-1.37). Differences in infertility risk varied by type of cancer. Survivors of breast cancer (RR 1.46; 95% CI 1.30-1.65), leukemia (RR 1.56; 95% CI 1.09-2.22), Hodgkin lymphoma (RR 1.49; 95% CI 1.28-1.74), non-Hodgkin lymphoma (RR 1.42; 95% CI 1.14, 1.76), thyroid cancer (RR 1.20; 95% CI 1.10-1.30) and melanoma (RR 1.17; 95% CI 1.01, 1.35) had a higher risk of infertility diagnosis compared to women without cancer. After stratification by parity, the association remained in nulliparous women survivors of breast cancer, leukemia, lymphoma and melanoma, whereas it was attenuated in parous women. In survivors of thyroid cancer, the association remained statistically significant in both nulliparous and parous women. In survivors of brain or colorectal cancer, the association was not significant, overall or after stratification by parity.

LIMITATIONS, REASONS FOR CAUTION

Non-biological factors that may influence the likelihood of seeking a fertility assessment may not be captured in administrative databases. The effects of additional risk factors, including cancer treatment, which may modify the associations, need to be assessed in future studies.

WIDER IMPLICATIONS OF THE FINDINGS

Reproductive health surveillance in female AYAs with cancer is a priority, especially those with breast cancer, leukemia and lymphoma. Our finding of a potential effects of thyroid cancer (subject to over-diagnosis) and, to a lesser extent, melanoma need to be further studied, and, if an effect is confirmed, possible mechanisms need to be elucidated.

STUDY FUNDING/COMPETING INTEREST(S)

Funding was provided by the Faculty of Health Sciences and Department of Obstetrics and Gynecology, Queen's University. There are no competing interests to declare.

TRIAL REGISTRATION NUMBER

N/A.

Viscous placebo and carbohydrate breakfasts similarly decrease appetite and increase resistance exercise performance compared with a control breakfast in trained males

Given the common view that pre-exercise nutrition/breakfast is important for performance, the present study investigated whether breakfast influences resistance exercise performance via a physiological or psychological effect. Twenty-two resistance-trained, breakfast-consuming men completed three experimental trials, consuming water-only (WAT), or semi-solid breakfasts containing 0 g/kg (PLA) or 1·5 g/kg (CHO) maltodextrin. PLA and CHO meals contained xanthan gum and low-energy flavouring (approximately 122 kJ), and subjects were told both 'contained energy'. At 2 h post-meal, subjects completed four sets of back squat and bench press to failure at 90 % ten repetition maximum. Blood samples were taken pre-meal, 45 min and 105 min post-meal to measure serum/plasma glucose, insulin, ghrelin, glucagon-like peptide-1 and peptide tyrosine-tyrosine concentrations. Subjective hunger/fullness was also measured. Total back squat repetitions were greater in CHO (44 (sd 10) repetitions) and PLA (43 (sd 10) repetitions) than WAT (38 (sd 10) repetitions; P < 0·001). Total bench press repetitions were similar between trials (WAT 37 (sd 7) repetitions; CHO 39 (sd 7) repetitions; PLA 38 (sd 7) repetitions; P = 0·130). Performance was similar between CHO and PLA trials. Hunger was suppressed and fullness increased similarly in PLA and CHO, relative to WAT (P < 0·001). During CHO, plasma glucose was elevated at 45 min (P < 0·05), whilst serum insulin was elevated (P < 0·05) and plasma ghrelin suppressed at 45 and 105 min (P < 0·05). These results suggest that breakfast/pre-exercise nutrition enhances resistance exercise performance via a psychological effect, although a potential mediating role of hunger cannot be discounted.

Sport science relevance and integration in horseracing: perceptions of UK racehorse trainers

Whilst equestrian sport science research has expanded over recent years, and technologies to positively impact training and performance have been developed, long-standing traditions and experiential learning in the racing industry still appear to impede the integration of sport science knowledge. This study used semi-structured interviews to investigate the perceptions of eleven national hunt and flat-based racehorse trainers to determine the current status of sport science integration within the racing industry, the perceived barriers to its uptake, and areas where trainers sought further knowledge. Three key higher order themes emerged from the interviews: the current training and monitoring principles for health and fitness of racehorses, trainers’ attitudes toward sport science research, and areas for potential future research and integration of sports science in training. Subjective methods grounded in personal experience were found to form the basis of racehorse training principles, with the application of sport science minimal, namely due to poor integration strategies. Negative connotations arising from a general lack of understanding of the application of knowledge and a scepticism toward adapting already successful principles, as well as pressure from industry stakeholders, appear to create barriers to sport science uptake. Trainers felt a stronger evidence base emphasising performance benefits is needed to overcome these. Where trainers identified areas of research potential, many studies had already been undertaken, highlighting the necessity for effective dissemination strategies to demonstrate how research could apply to industry practice. Increased educational initiatives to showcase technology and improve trainer understanding and application of currently available sport science knowledge is also warranted.

Abstract P6-13-05: Association between the UGT2B17 gene deletion, exemestane metabolites and vasomotor QOL in women participating on the MAP3 prevention trial

Background: The aromatase inhibitor Exemestane (EXE) reduces the risk of breast cancer in postmenopausal women. However, participants have varied responses to EXE treatment in terms of efficacy and toxicity, possibly due to differences in EXE metabolism. One of the main elimination pathways for EXE is through glucuronidation by UGT2B17. Aims: This project examined the relationship between the UGT2B17 gene deletion, EXE metabolites and menopause-related quality of life (QOL) in postmenopausal women. Hypothesis: Glucuronidation of the main EXE metabolite, 17-dihydroexemestane (17-DHE), is reduced in women with the UGT2B17 double gene deletion, leading to increased circulating 17-DHE and potential toxicity. Methods: This study included 3576 women nested within the CCTG MAP.3 trial, who were allocated to EXE or placebo treatment groups. Genotyping analysis was conducted with baseline blood cell DNA using real-time PCR and allelic discrimination. Women who were homozygous null were considered “exposed”. In addition to EXE, EXE metabolites including 17-DHE and glucuronidated 17-DHE (17 DHE-Gluc) were analyzed from serum by UPLC/MS. Ratios of the main metabolites (17-DHE/EXE) and glucuronidated metabolites (17-DHE-Gluc/17-DHE) were standardized, using an autoscaling method. Metabolite levels that were below the detection limit were replaced by “half the detection limit for that metabolite”. Women had the outcome if they experienced a clinically meaningful (&gt;10%) worsening in vasomotor QOL from baseline within the first year. Modified Poisson regression models were used to calculate the relative risks for both the (1) UGT2B17 gene deletion and (2) metabolite ratios and vasomotor QOL. Results: Ten percent of participants exhibited the homozygous UGT2B17 deletion genotype. There was no significant relationship between the UGT2B17 deletion polymorphism and worsened vasomotor QOL (RR= 1.04, 95% CI: 0.93, 1.17), adjusted for age, race and treatment. Among women with no vasomotor symptoms at baseline but extremely bothersome symptoms at follow-up (incident vasomotor symptoms), there was a suggestive but non-significant protective effect of the UGT2B17 deletion (RR=0.61, 95% CI: 0.32-1.19). This effect was more extreme in the placebo arm (RR=0.20) than in the EXE arm (RR=0.78; p-interaction=0.17). Among women on EXE, levels of EXE and 17-DHE were not different between UGT2B17 genotypes, but levels of 17-DHE-Gluc were significantly lower for the UGT2B17 deletion genotype (p=&lt;0.0001). An increasing ratio of 17-DHE-Gluc/17-DHE [per standard deviation (SD) increase] had a borderline protective effect against worsened vasomotor QOL (RR=0.94, p=0.049), adjusted for age and race. In contrast, an increasing ratio of 17-DHE /EXE (per SD increase) was associated with a small but significant increased risk of worsened vasomotor QOL (RR=1.02, p=0.01). The effect observed for the 17-DHE/EXE ratio was stronger for very bothersome incident vasomotor symptoms at follow-up, but this did not reach statistical significance [17-DHE/EXE (per SD increase): RR=1.36, p=0.12]. Conclusion: EXE metabolite levels could potentially be used as a biomarker for extreme vasomotor QOL changes in breast cancer chemoprevention settings using EXE.

Citation Format: Richardson H, Knight B, Chen G, Luo S, Massey T, Goss PE, Lazarus P. Association between the UGT2B17 gene deletion, exemestane metabolites and vasomotor QOL in women participating on the MAP3 prevention trial [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-13-05.

Contribution of central and peripheral risk factors to prevalence, incidence and progression of knee pain: a community-based cohort study

AIM

To explore risk factors that may influence knee pain (KP) through central or peripheral mechanisms.

METHODS

A questionnaire-based prospective community cohort study with KP defined as pain in or around a knee on most days for at least a month. Baseline prevalence, and one year incidence and progression (KP worsening) were examined. Central (e.g., Pain Catastrophizing Scale (PCS)) and peripheral (e.g., significant injury) risk factors were examined. Adjusted odds ratio (OR) and 95% confidence interval (CI) were calculated using logistic regression. Proportional risk contribution (PRC) was estimated using receiver-operator-characteristic (ROC) analysis.

RESULTS

Of 9506 baseline participants, 4288 (45%) had KP (men 1826; women, 2462). KP incidence was 12% (men 11%, women 13%), and KP progression 19% (men 16%, women 21%) at one year. While both central and peripheral factors contributed to prevalence, central factors contributed more to progression, and peripheral factors more to incidence of KP. For example, although PCS (OR 2.06, 95% CI 1.88-2.25) and injury (5.62, 4.92-6.42) associated with KP prevalence, PCS associated with progression (2.27, 1.83-2.83) but not incidence (1.14, 0.86-1.52), whereas injury more strongly associated with incidence (69.27, 24.15-198.7) than progression (2.52, 1.48-4.30). The PRC of central and peripheral factors were 19% and 23% for prevalence, 14% and 29% for incidence, and 29% and 5% for progression, respectively.

CONCLUSIONS

Both central and peripheral risk factors influence KP but relative contributions may differ in terms of development (mainly peripheral) and progression (mainly central). Further study of such relative contributions may inform primary and secondary prevention strategies.

Associations between age at first calving and subsequent lactation performance in UK Holstein and Holstein-Friesian dairy cows

Lactation records from 396,534 pedigree Holstein and Holstein-Friesian primiparous cows from 6,985 UK milk recorded herds, calving for the first time during the period between the 1^st of January 2006 and the 31^st of December 2008, were examined in order to determine the associations between age at first calving (AFC) and subsequent production, udder health, fertility and survivability parameters. Heifers were grouped by AFC into single month classes ranging from 21 to 42 months. Mixed effects multivariable regression modelling was used for data analysis. Mean and median AFC were 29.1 and 28 months respectively. Within the study, only 48,567 heifers (12.3% of the studied population) calved for the first time at 24 months of age or younger. 162,157 heifers (40.9%) were 30 months or older at their first calving. An increased AFC was associated with increased first lactation milk, fat and protein yields. The lowest predicted mean 305-day yield (6,617kgs; 95% confidence interval (CI): 6,546–6,687 kgs) was recorded for the 21 month AFC class, significantly lower than any other class. The 36 month AFC class had the highest predicted mean (7,774 kgs; 95% CI: 7,737–7,811 kgs). However, an increased AFC was also associated with increased calving interval and increased first lactation somatic cell count (SCC). Animals calving at 21 months had a predicted mean lactation SCC of 72,765 (95% CI: 68427–77378). Animals calving at 36 months of age had a predicted mean lactation SCC of 86,648 (95% CI: 84,499–88,853). Importantly, an increased AFC was also associated with decreased lifetime daily milk yield and decreased likelihood of calving for a second successive time. Animals calving at 22 months of age had a predicted mean daily lifetime milk yield of 15.24 kgs (95% CI: 15.06–15.35); animals calving at 36 months of age had a predicted mean daily lifetime milk yield of 12.83 kgs (95% CI: 12.76–12.91). Our results highlight the importance of achieving a lower age at first calving which was here associated with improved udder health, increased lifetime daily milk yield, improved reproductive performance and increased likelihood of calving for a second time.

Evaluation of self-swabbing coupled with a telephone health helpline as an adjunct tool for surveillance of influenza viruses in Ontario

Background

Calls to a telephone health helpline (THHL) have been previously evaluated for the ability to monitor specific syndromes, such as fever and influenza-like-illness or gastrointestinal illness. This method of surveillance has been shown to be highly correlated with traditional surveillance methods, and to have potential for early detection of community-based illness. Self-sampling, or having a person take his/her own nasal swab, has also proven successful as a useful method for obtaining a specimen, which may be used for respiratory virus detection.

Methods

This study describes a self-swabbing surveillance system mediated by a nurse-led THHL in Ontario whereby syndromic surveillance concepts are used to recruit and monitor participants with influenza-like illness. Once recruited, participants collect a nasal specimen obtained by self-swabbing and submit for testing and laboratory confirmation. Enumeration of weekly case counts was used to evaluate the timeliness of the self-swabbing surveillance system through comparison to other respiratory virus and influenza surveillance systems in Ontario. The operational efficiency of the system was also evaluated.

Results

The mean and median number of days between the day that a participant called the THHL, to the day a package was received at the laboratory for testing were approximately 10.4 and 8.6 days, respectively. The time between self-swab collection and package reception was 4.9 days on average, with a median of 4 days. The self-swabbing surveillance system adequately captured the 2014 influenza B season in a timely manner when compared to other Ontario-based sources of influenza surveillance data from the same year; however, the emergence of influenza B was not detected any earlier than with these other surveillance systems. Influenza A surveillance was also evaluated. Using the THHL self-swabbing system, a peak in the number of cases for influenza A was observed approximately one week after or during the same week as that reported by the other surveillance systems.

Conclusion

This one-year pilot study suggests that the THHL self-swabbing surveillance system has significant potential as an adjunct tool for the surveillance of influenza viruses in Ontario. Recommendations for improving system efficacy are discussed.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3674-9) contains supplementary material, which is available to authorized users.

Report on a Delphi Process and Workshop to Improve Accrual to Cancer Clinical Trials

Cancer clinical trials (ccts) are essential for furthering knowledge and developing effective interventions to improve the lives of people living with cancer in Canada. Randomized controlled trials are particularly important for developing evidence-based health care interventions. To produce robust and relevant research conclusions, timely and sufficient accrual to ccts is essential. The present report delivers the key recommendations emerging from a workshop meeting, Improve Accrual to Cancer Clinical Trials, that was hosted by the Canadian Cancer Trials Group and funded by the Canadian Institutes of Health Research. The meeting, which took place in Toronto, Ontario, in April 2012 before the Canadian Cancer Trials Group annual spring meeting, brought together key stakeholders from across Canada to explore creative strategies for improving accrual to ccts. The objectives of the workshop were to provide an opportunity for knowledge exchange with respect to the research evidence and the ethics theory related to cct accrual and to promote discussion of best practices and policies related to enhancing cct access and accrual in Canada. The workshop provided the foundation for establishing new interdisciplinary research collaborations to overcome the identified barriers to cct participation in Canada. Meeting participants also supported the development of evidence-based policies and practices to make trials more accessible to Canadians living with cancer.

Increased visual gamma power in schizoaffective bipolar disorder

BACKGROUND

Electroencephalography and magnetoencephalography (MEG) studies have identified alterations in gamma-band (30-80 Hz) cortical activity in schizophrenia and mood disorders, consistent with neural models of disturbed glutamate (and GABA) neuron influence over cortical pyramidal cells. Genetic evidence suggests specific deficits in GABA-A receptor function in schizoaffective bipolar disorder (SABP), a clinical syndrome with features of both bipolar disorder and schizophrenia. This study investigated gamma oscillations in this under-researched disorder.

METHOD

MEG was used to measure induced gamma and evoked responses to a visual grating stimulus, known to be a potent inducer of primary visual gamma oscillations, in 15 individuals with remitted SABP, defined using Research Diagnostic Criteria, and 22 age- and sex-matched healthy controls.

RESULTS

Individuals with SABP demonstrated increased sustained visual cortical power in the gamma band (t 35 = -2.56, p = 0.015) compared to controls. There were no group differences in baseline gamma power, transient or sustained gamma frequency, alpha band responses or pattern onset visual-evoked responses.

CONCLUSIONS

Gamma power is increased in remitted SABP, which reflects an abnormality in the cortical inhibitory-excitatory balance. Although an interaction between gamma power and medication can not be ruled out, there were no group differences in evoked responses or baseline measures. Further work is needed in other clinical populations and at-risk relatives. Pharmaco-magnetoencephalography studies will help to elucidate the specific GABA and glutamate pathways affected.

P4-11-13: Influence of Two Years of Exemestane on Bone Mineral Density in Postmenopausal Women at Increased Risk of Developing Breast Cancer; a Companion Study to the NCIC CTG MAP.3 Trial

Background

Exemestane significantly reduced invasive and preinvasive breast cancers in postmenopausal women at increased risk for breast cancer in the NCIC CTG MAP3 trial with no serious toxicities, including excess fractures or osteoporosis.

Purpose: To provide additional information on the effect of exemestane on bone loss in women at high risk for breast cancer, within a subset of women participating on the NCIC CTG MAP.3B study. The primary hypothesis is that exemestane does not induce clinically significant bone loss in postmenopausal women at increased risk of developing breast cancer at 2 years. The primary objective of this companion study is to examine the effect of exemestane on lumbar spine and total hip BMD by DEXA at 2 years in women participating in the MAP3 trial.

Methods: The MAP.3B bone sub-study registered women from the main MAP. 3 trial from May 2008 to March 2010. Eligible women had to have an acceptable quality BMD scan by DEXA taken within 12 months prior to randomization to MAP.3. A BMD T-score &gt;-2.0 SD (i.e. better than 2 standard deviations below the average peak BMD of a young adult woman) was established as the study population cutoff. A questionnaire including information on height, falls, fractures, lifestyle information including physical activity, tobacco and alcohol use was completed at baseline, 12 months, 24 months and at last visit. Fasting serum for bone biomarkers was collected at 12 months and total hip and L1-L4 (postero-anterior) spine BMD were measured 2 years after randomization on the same Lunar or Hologic scanner. The primary objective was to determine differences in hip and spine BMD at 2 years. Secondary outcomes include number of skeletal fractures and development of osteoporosis 2 years after randomization and changes in bone biomarkers at 1 year after randomization. For the analysis of the primary endpoints, the upper limit of a one sided 95% confidence interval for the difference in mean percentage changes between placebo and exemestane will be calculated for the BMD by DEXA at each site. We will conclude that exemestane does not induce significant bone loss in postmenopausal women at increased risk of developing breast cancer at 2 years when the upper limit is less than 3% for both sites. Similar confidence interval approach will be used to analyze the secondary endpoints.

Results: Between May 2008 and March 2010, 238 postmenopausal women were recruited. Median age was 61.8 years, and the majority of women were Caucasian (91%), with approximately 20% of the participants reporting a recent fall (within past 12 months) and another 13% reporting a recent fracture prior to randomization. We will report results from the primary as well as the secondary endpoints at the SABCS meeting.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-11-13.

S6-1: Menopause-Specific and Health-Related Qualities of Life among Post-Menopausal Women Taking Exemestane for Prevention of Breast Cancer: Results from the NCIC CTG MAP.3 Placebo-Controlled Randomized Controlled Trial

Background: Exemestane, a steroidal aromatase inhibitor, reduced the incidence of invasive breast cancers by 65% among 4560 post-menopausal randomized to exemestane or placebo for 5 years on MAP.3. Differences in quality of life (QOL) were judged to be minimal, but only summary information was reported.

Purpose: To provide more detailed information about effects of exemestane on menopause-specific and health-related qualities of life.

Method: Participation in quality of life assessment was an eligibility criterion. Menopause-specific and health-related qualities of life were assessed using the MENQOL (4 scales; physical, vasomotor, psychosocial, sexual) and SF-36 (8 scales; physical health, role function — physical, bodily pain, general health, vitality, social function, role function — emotional, mental health, and 2 summary scales) instruments, respectively at baseline, 6 months and then yearly after randomization. Compliance with QOL questionnaire completion at each follow-up visit ranged from 93–98%, and did not differ by group. Change scores for each MENQOL and SF-36 scale, calculated for each assessment time relative to baseline, were compared using the Wilcoxon Rank-Sum test. Summary scores were used to summarize the QOL scores observed at each time point for each SF-36 dimension and overall mental (MCS) and physical component summaries (PCS) and MENQOL domains. Clinically important worsening of MENQOL change scores was defined as an increase of ≥0.5/8 points. SF-36 change scores were considered worsened if scores decreased by ≥ 5 points from baseline.

Results: Both groups were balanced on scores for MENQOL and SF-36 at baseline. Median follow-up was 35 months and the proportion of women who stopped study medication early for toxicity reasons was 15% in the exemestane arm and 11% in the placebo arm. There was a statistically significant difference in change scores for vasomotor symptoms among women on exemestane during the first 4 years (p-values &lt;0.01), compared to placebo. However, no between-group differences in vasomotor change met the criterion for clinical importance. Women on exemestane had statistically poorer sexual functioning (mean change = −0.02, SD=1.37) compared to placebo (mean change = −0.12, SD=1.32) during the first 6 months on study (p-value = 0.03) but the differences were not statistically significant thereafter or clinically important at any time. Among the 8 SF-36 scales, only bodily pain was statistically different between exemestane and placebo for the first 24 months on study medication (p-value &lt;0.01), but no between-group difference in change scores exceeded 5 points. Overall SF-36 PCS and MCS assessing changes in overall physical and mental health-related QOL did not differ significantly by group at any assessment.

Conclusion: Our assessment that early differences in vasomotor symptoms and pain were probably not clinically important is supported by the observation of no between-group differences when overall physical and mental health-related QOL changes were compared. Exemestane does not appear to have a major negative impact on the quality of life among these women.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr S6-1.

Exemestane for primary prevention of breast cancer in postmenopausal women: NCIC CTG MAP.3—A randomized, placebo-controlled clinical trial

LBA504

Background: Limited efficacy and serious toxicities have limited uptake of tamoxifen or raloxifene as preventatives of breast cancer. Aromatase inhibitors (AIs) prevent contralateral breast cancers more than tamoxifen in adjuvant trials and have fewer serious side effects. This is the first report of an AI used in primary prevention. Methods: NCIC CTG MAP.3 is a randomized trial designed to detect a 65% reduction in annual incidence of invasive breast cancer (IBC) on exemestane (E) versus placebo (P). Eligible postmenopausal women had ≥ one of the following risk factors: Gail score >1.66%, prior ADH, ALH, LCIS or DCIS with mastectomy, age over 60. Health-related and menopause-specific quality of life (QOL) were assessed by SF-36 and MENQOL questionnaires. Results: From 2004-2010, 4,560 women were randomized: age 62.5 yrs (37-90); Gail Score 2.3 % (0.6-21); BMI 28.0 kg/m2 (15.9-65.4). Risk factors included: age >60 yrs (49%); Gail score >1.66 (40%); and prior ADH, ALH, LCIS or DCIS with mastectomy (11%). At median follow-up of 35 months there were 11 IBCs on E and 32 on P (annual incidence 0.19% vs 0.55%; HR= 0.35, 95% CI 0.18-0.70, p = 0.002); ductal (10E/27P), lobular (1E/5P). Most tumors were ER positive (7E/27P); Her2/neu negative (10E/26P); TNM stage T1 (8E/28P), N0 (7E/22P), M0 (11E/30P). E was superior in all subgroups: by Gail score, age, BMI, prior LCIS and DCIS. The annual incidence rate of IBC or DCIS was 0.35% E and 0.77% P (HR=0.47;95% CI 0.27-0.79; p = 0.004) based on 64 IBCs or DCISs (20E/44P). Clinical bone fractures, osteoporosis, hypercholesterolemia or cardiovascular events were equal in both arms. No clinically meaningful differences in QOL were detected. Conclusions: Exemestane significantly reduced invasive and pre-invasive breast cancers in postmenopausal women at increased risk for breast cancer with no serious toxicities. Exemestane should be considered a new option for primary prevention of breast cancer. Supported by the Canadian Cancer Society; Pfizer Inc. PEG supported in part by Avon Foundation.

A fingernail clam (Sphaerium sp.) shows higher reproductive success in hypoxic waters

Low dissolved O2, or hypoxia, is becoming increasingly prevalent in aquatic habitats and is considered to be stressful for aerobic organisms. However, hypoxia also can be beneficial by decreasing cellular stress, particularly that related to free radicals. Therefore, an animal’s ideal habitat may have the minimum O2 necessary to sustain aerobic metabolism, with excess O2 increasing the need to scavenge free radicals and repair free radical damage. Here we show that a natural population of small (<9 mm shell length) freshwater clams (genus Sphaerium Scopoli, 1777) lives along a dissolved O2 gradient from extreme hypoxia to moderate hypoxia. We tested the hypothesis that clams living in extreme hypoxia would have higher reproductive success than clams that live in moderate hypoxia. Clam abundance was highest in water with very low dissolved O2, conditions previously demonstrated to decrease cellular stress. The internally brooding clams reproduced year-round and had higher reproductive output in extreme hypoxia than in moderate hypoxia. The findings demonstrate that the apparent cellular-level benefits of hypoxia may translate into increased fitness, especially for small organisms.

A randomized, placebo-controlled trial (NCIC CTG MAP.2) examining the effects of exemestane on mammographic breast density, bone density, markers of bone metabolism and serum lipid levels in postmenopausal women

We hypothesized that exemestane (EXE) would reduce mammographic breast density and have unique effects on biomarkers of bone and lipid metabolism. Healthy postmenopausal women were randomized to EXE (25 mg daily) or placebo (PLAC) for 12 months and followed for a total of 24 months. The primary endpoint was change in percent breast density (PD) between the baseline and 12-month mammograms and secondary endpoints were changes in serum lipid levels, bone biomarkers, and bone mineral density (BMD). Ninety-eight women were randomized (49 to EXE; 49 to PLAC) and 65 had PD data at baseline and 12 months. Among women treated with EXE, PD was not significantly changed from baseline at 6, 12, or 24 months and was not different from PLAC. EXE was associated with significant percentage increase from baseline in N-telopeptide at 12 months compared with PLAC. No differences in percent change from baseline in BMD (lumbar spine and femoral neck) were observed between EXE and PLAC at either 12 or 24 months. Patients on EXE had a significantly larger percent decrease in total cholesterol than in the PLAC arm at 6 months and in HDL cholesterol at 3, 6, and 12 months. No significant differences in percent change in LDL or triglycerides were noted at any time point between the two treatment arms. EXE administered for 1 year to healthy postmenopausal women did not result in significant changes in mammographic density. A reversible increase in the bone resorption marker N-telopeptide without significant change in bone specific alkaline phosphatase or BMD during the 12 months treatment period and 1 year later was noted. Changes in lipid parameters on this trial were modest and reversible.

The National Cancer Institute of Canada Clinical Trials Group MAP.3 trial: an international breast cancer prevention trial

Several large phase iii trials have demonstrated that tamoxifen—and more recently, raloxifene—can effectively reduce the incidence of invasive breast cancer by 50%. However, these selective estrogen receptor modulators can also be associated with several rare, but serious, adverse events. Recently, the third-generation aromatase inhibitors (ais) have demonstrated excellent efficacy in adjuvant breast cancer trials, and they show particular promise in the breast cancer prevention setting. The National Cancer Institute of Canada Clinical Trials Group (ncic ctg) has developed a randomized phase iii study to determine the efficacy of an ai (exemestane) to reduce the incidence of invasive breast cancer in postmenopausal women at an increased risk for developing breast cancer. The ncic ctg map.3 (ExCel) trial is a double-blind placebo-controlled multicentre, multinational trial. Based on the known preclinical and clinical profile of the ais, a greater reduction in breast cancer incidence with fewer side effects is hypothesized with this class of agents than with tamoxifen or raloxifene.

Participant characteristics on an international NCIC CTG breast cancer prevention trial

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Background: Antagonizing estrogen with tamoxifen has set the precedent for preventing breast cancer. Aromatase inhibitors reduce contralateral breast cancer in the adjuvant setting more than tamoxifen. The goal of MAP.3 is to determine whether exemestane reduces invasive breast cancers in post-menopausal women at risk for the disease. Methods: NCIC CTG MAP.3 is a randomized placebo controlled double blind trial of exemestane versus placebo. Recruitment began in September 2004 in North America and Spain. Criteria for entry on MAP.3 include: a Gail score of 1.66%; previous benign breast disease including LCIS; age over 60. The target sample size for the trial is 4560. Baseline characteristics of women enrolled thus far on MAP.3 were reviewed to determine whether their projected risk of breast cancer is consistent with the assumptions made in designing the trial. Results: Baseline characteristics are available on the 1784 women enrolled to MAP.3 to date. Over 70% of participants are over 60 years old (mean 64; SD=8.2 years) and the majority of the women are Caucasian (85%). The average 5-year risk of breast cancer is 2.7% (median, 2.2%). However, a greater proportion of women over 60 (30%) have a substantially lower Gail score (<1.66) compared to women less than 60 years of age (8%). Few women in the MAP.3 cohort have been enrolled on a basis of a history of prior breast atypical hyperplasia or LCIS (8%), or DCIS treated with mastectomy (2%). Nearly half the MAP.3 participants (45%) have at least one first degree relative with malignant breast cancer, and 7.5% of these women have 2 or more first degree relatives with the disease. Conclusions: The risk profile of the women on MAP.3 will determine the event rate and therefore the time to trial unblinding and analysis. This initial description of the MAP.3 population enrolled thus far indicates a slightly lower baseline breast cancer risk in comparison to the risk profile of those enrolled in previous breast cancer prevention trials with tamoxifen or raloxifene (NSABP P1, IBIS-1 and STAR). Reasons for this difference are being explored.

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Nitric oxide stimulates insulin gene transcription in pancreatic β-cells

Recent studies have identified a positive role for nitric oxide (NO) in the regulation of pancreatic beta-cell function. The aim of this study was to determine the effects of short-term exposure to NO on beta-cell gene expression and the activity of the transcription factor PDX-1. NO stimulated the activity of the insulin gene promoter in Min6 beta-cells and endogenous insulin mRNA levels in both Min6 and isolated islets of Langerhans. Addition of wortmannin prior to NO stimulation blocked the observed increases in insulin gene promoter activity. Although NO addition stimulated the phosphorylation of p38, inhibition by SB203580 did not block the effect of NO on the insulin gene promoter. NO addition also stimulated both the nuclear accumulation and the DNA binding activity of PDX-1. This study has shown that over 24h, NO stimulates insulin gene expression, PI-3-kinase activity and the activity of the critical beta-cell transcription factor PDX-1.

Effects of rosiglitazone and metformin on pancreatic beta cell gene expression

AIMS/HYPOTHESIS

Rosiglitazone and metformin are two oral antihyperglycaemic drugs used to treat type 2 diabetes. While both drugs have been shown to improve insulin-sensitive glucose uptake, the direct effects of these drugs on pancreatic beta cells is only now beginning to be clarified. The aim of the present study was to determine the direct effects of these agents on beta cell gene expression.

METHODS

We used reporter gene analysis to examine the effects of rosiglitazone and metformin on the activity of the proinsulin and insulin promoter factor 1 (IPF1) gene promoters in the glucose-responsive mouse beta cell line Min6. Western blot and gel retardation analyses were used to examine the effects of both drugs on the regulation of IPF1 protein production, nuclear accumulation and DNA binding activity in both Min6 cells and isolated rat islets of Langerhans.

RESULTS

Over 24 h, rosiglitazone promoted the nuclear accumulation of IPF1 and forkhead homeobox A2 (FOXA2), independently of glucose concentration, and stimulated a two-fold increase in the activity of the Ipf1 gene promoter (p<0.01). Stimulation of the Ipf1 promoter by rosiglitazone was unaffected by the presence of the peroxisome proliferator activated receptor gamma antagonist GW9662. No effect of either rosiglitazone or metformin was observed on proinsulin promoter activity. Metformin stimulated IPF1 nuclear accumulation and DNA binding activity in a time-dependent manner, with maximal effects observed after 2 h.

CONCLUSIONS/INTERPRETATION

Metformin and rosiglitazone have direct effects on beta cell gene expression, suggesting that these agents may play a previously unrecognised role in the direct regulation of pancreatic beta cell function.

Otic barotrauma from air travel

Otic barotrauma occuring during air travel involves traumatic inflammation of the middle ear, caused by a pressure difference between the air in the middle ear and the external atmosphere, developing after ascent or more usually descent. The pressure difference occurs because of failure of the eustachian tube to equilibrate middle ear and atmospheric pressures. It is a common problem, presenting with ear fullness, otalgia and deafness. Severe cases may result in tympanic membrane perforation and even round window membrane rupture. Of three randomized controlled trials, one showed that oral pseudoephedrine decongestants reduced otalgia inadults with recurrent ear pain during air travel, whilst another found that oral pseudoephedrine did not decrease in-flight ear pain in children. The third trial showed that oxymetazoline decongestant nasal spray, taken 30 minutes before descent, did not produce a statistically significant reduction in symptoms of barotrauma in adults with recurrent ear pain during air travel. We review the causes, prevention and treatment of this condition.

Thickness dependence of structural relaxation in spin-cast, glassy polymer thin films

The isothermal structural relaxation of glassy, spin-cast polymer thin films has been investigated. Specifically, the thickness h of freshly cast poly(methyl methacrylate) thin films was measured over time using spectroscopic ellipsometry. The spin-cast films exhibit a gradual decrease in thickness, which is attributed to structural relaxation of the glass combined with simultaneous solvent loss. In all cases, h was found to be greater than the equilibrium thickness h(infinity) , which is obtained by cooling slowly from the melt. It is observed that both the rate of the volume relaxation and the fractional departure from h(infinity) (referred to as delta(0) ) increase with increasing film thickness. In the limit of very thin films, the initial h is close to h(infinity) , and delta(0) is small, whereas in thick films (>500 nm) , a plateau value of delta(0) of 0.16 is observed, which is close to the volume fraction of the solvent at the vitrification point. This dependence of delta(0) on thickness is observed regardless of the substrate, polymer molecular weight, or angular velocity during spin casting. Enhanced mobility near film surfaces could be leading to greater relaxation in thinner films prior to, and immediately after, the vitrification of the polymer during the deposition process.

Influence of the glass transition on solvent loss from spin-cast glassy polymer thin films

The interdependence of solvent loss and vitrification in spin-cast poly(methyl methacrylate) thin films is explored. Fast measurements of decreases in film thickness, achieved with ellipsometry, indicate that the rate of solvent (toluene) loss decreases sharply when the solvent volume fraction phi(solv) falls below about 0.15 and the film vitrifies. Ellipsometry and microgravimetry show that solvent is lost from a glassy thin film (150 nm thick) over of a period of more than ten hours, which is much longer than would be required if it was limited by diffusion in the glass. These results support the recently-proposed idea that the compression of the glass creates an energy barrier that slows down solvent loss.

Structural relaxation of spin-cast glassy polymer thin films as a possible factor in dewetting

Reiter has recently reported a situation in which the dewetting of quasi-solid films is linked to plastic deformation--rather than viscous flow--resulting from capillary forces. Herein we propose that, in thin films of some glassy polymers--especially poly(methyl methacrylate) (PMMA)--prepared by spin-casting from solvent, structural relaxation might impart sufficient stress to cause plastic deformation. We find that PMMA films decrease in thickness by several percent, which is sufficient to create significant stress in those cases in which the film is attached to a rigid substrate. The floating technique, which can take tens of minutes, might allow most of the structural relaxation to occur prior to dewetting experiments.

Assessment of an electronic daily diary in patients with overactive bladder

OBJECTIVE

To assess the effectiveness of a portable electronic diary as a data collection device for overactive bladder symptoms, and to evaluate its level of patient acceptability compared with a conventional paper-based voiding diary.

PATIENTS AND METHODS

Patients were identified through USA and UK hospital incontinence clinics. Patients were trained in the use of paper and electronic diaries before randomization, to complete either diary for 7 days. The diaries were then collected and, after a further training session, patients completed the other diary type for 7 days.

RESULTS

In all, 35 patients were recruited into the trial; overall, patients using the paper diaries (35) and electronic diaries (33) recorded similar data for the median number of incontinent episodes per week (8.2 and 7.0, respectively) and for the median number of significant leaks per day (0.4 and 0.5, respectively). However, the number of daily micturitions was slightly lower for the electronic than for the paper diary (7.3 vs 8.5, respectively). The frequency of urgency recorded in the electronic diary was higher than that recorded in the paper diary (5.8 vs 4.7). As 94% of patients found the electronic diary easy to use, and the electronic diary reflects real-time data entries, the electronic diary data may provide a more accurate reflection of patient symptoms.

CONCLUSION

We confirmed that the electronic diary is a novel method of collecting clinically relevant symptom data from patients with an overactive bladder. In addition, the ease-of-use ratings support the use of the electronic diary as a superior alternative to paper diaries, providing real-time data which can be rapidly analysed, and thus allowing a speedy review of data during ongoing clinical studies.

A comparison of physician and patient perception of the problems of habitual snoring

Assumptions are often made by doctors about the nature of the impact of uncomplicated snoring. The aim of this study was to provide a comprehensive view of the problems experienced by snoring patients, and to compare these with the perceptions of otolaryngologists. Part 1: 121 snorers and 419 otolaryngologists completed open-ended problems lists; Part 2: 56 snorers and 63 matched controls completed a mood questionnaire and the Golombok Rust Inventory of Marital State (GRIMS.) There was a clear agreement between snorers and otolaryngologists that sleep-related difficulties comprise the most frequent category of problems that may result from snoring. Snorers report a significantly greater number of physical problems and significantly fewer relationship problems than perceived by otolaryngologists. GRIMS scores were similar in patients and controls. Snorers, however, were significantly more depressed. Doctors appear to address snoring from the twin perspectives of damaged relationships and possible sleep apnoea. Their patients are more concerned about disturbing the sleep of others, and are subject to low mood. The snorers' 25 different responses are now being used as the basis for a Snoring Symptom Index.

The 1999 Helene Fuld Health Trust Fellowship. Promoting leadership development in undergraduate nursing students

In 1999, based on the recommendation of The Conservation Company. The Helene Fuld Health Trust selected New York University's Robert F. Wagner Graduate School of Public Service, in partnership with the Division of Nursing in the School of Education, to restructure its fellowship program for undergraduate nursing students. Bringing together an interdisciplinary team with experience in leadership development, nursing and health policy, and health care administration, NYU designed and delivered an innovative and state-of-the-art leadership development program for the 1999 Fuld Fellowship program. The new program started in June 1999 with 21 nursing students from all over the country. This article describes the goals and methods of the program; it also discusses early observations of the program's success that could be relevant to nursing education.

The Drosophila Geminin homolog: roles for Geminin in limiting DNA replication, in anaphase and in neurogenesis

We have identified a Drosophila homolog of the DNA replication initiation inhibitor Geminin (Dm geminin) and show that it has all of the properties of Xenopus and human Geminin. During Drosophila development, Dm Geminin is present in cycling cells; protein accumulates during S phase and is degraded at the metaphase to anaphase transition. Overexpression of Dm geminin in embryos inhibits DNA replication, but cells enter mitosis arresting in metaphase, as in dup (cdt1) mutants, and undergo apoptosis. Overexpression of Dm Geminin also induces ectopic neural differentiation. Dm geminin mutant embryos exhibit anaphase defects at cycle 16 and increased numbers of S phase cells later in embryogenesis. In a partially female-sterile Dm geminin mutant, excessive DNA amplification in the ovarian follicle cells is observed. Our data suggest roles for Dm Geminin in limiting DNA replication, in anaphase and in neural differentiation.