Protein Content of Wheat by Near-Infrared Spectroscopy of Whole Grain: Collaborative Study

A collaborative study was performed to assess accuracy, repeatability, and reproducibility of a nearinfrared (near-IR) method for determining crude protein content (PC) of whole-grain wheat. Four types of commercially available near-IR instruments, representing various combinations of wavelength region, mode of energy capture, method of energy dispersion, and treatment of spectral data, were used. Eight, 9,10, and 11 collaborators were involved, the exact number depending on instrument type. All collaborators received 22 samples of whole-grain hard red winter (HRW) wheat. They were furnished reference PCs (i.e., protein concentrations, w/w) corrected to a 12% moisture basis for instrument standardization. AOAC Method 990.03— combustion analysis—was the reference procedure. Standardization consisted of performing one of the following treatments to the instrument manufacturer's (or federal agency's) PC equation: (1) bias correction, (2) slope and intercept correction, or (3) recalibration with inclusion of standardization sample spectra. Standardized equations were then applied to a test set of 12 unknown HRW wheat sample spectra, with 2 samples blindly duplicated. The PCs of test samples ranged from 9 to 16%. Near-IR predictions were compared with reference measurements. Averaged within instrument type, root mean square of differences were 0.22, 0.24, 0.25, and 0.26% PC, depending on instrument. Corrected for bias within the test set, standard errors became 0.22, 0.18, 0.21, and 0.24% PC, respectively. These values were approximately twice the estimated lower limit for error (representing sample inhomogeneity). Overall repeatability relative standard deviation (RSD,) values were 0.92, 0.36, 0.42, and 0.74%, respectively. Overall reproducibility relative standard deviation (RSDR) values were 1.15, 0.61,1.53, and 1.38%. Such values for within-laboratory and between-laboratory variations of the near- IR methods were equivalent to values reported for the combustion method (990.03) for wheat. An inhouse study that examined all 6 U.S. wheat classes with one of the 4 instrument types produced repeatability and reproducibility values similar to those of the collaborative study, suggesting that the near-IR technique may be applied to red, white, hard, soft, and durum wheats. The near-IR method for determination of PC of whole-grain wheat has been adopted First Action (997.06) by AOAC INTERNATIONAL.

Ectopic pregnancy morbidity and mortality in low-income women, 2004-2008

STUDY QUESTION

Does the risk of adverse outcomes at the time of ectopic pregnancy vary by race/ethnicity among women receiving Medicaid, the public health insurance program for low-income people in the USA?

SUMMARY ANSWER

Among Medicaid beneficiaries with ectopic pregnancy, 11% experienced at least one complication, and women from all racial/ethnic minority groups were significantly more likely than whites to experience complications.

WHAT IS KNOWN ALREADY

In this population of Medicaid recipients, African American women are significantly more likely than whites to experience ectopic pregnancy, but the risk of adverse outcomes has not previously been assessed.

STUDY DESIGN, SIZE, AND DURATION

We conducted a cross-sectional observational study of all women (n = 19 135 106) ages 15-44 enrolled in Medicaid for any amount of time during 2004-2008 who lived in one of the following 14 US states: Arizona; California; Colorado; Florida; Illinois; Indiana; Iowa; Louisiana; Massachusetts; Michigan; Minnesota; Mississippi; New York; and Texas.

PARTICIPANTS/MATERIALS, SETTINGS, METHODS

We analyzed Medicaid claims records for inpatient and outpatient encounters and identified ectopic pregnancies with a principal diagnosis code for ectopic pregnancy from 2004-2008. We calculated the ectopic pregnancy complication rate as the number of ectopic pregnancies with at least one complication (blood transfusion, hysterectomy, any sterilization, or length-of-stay (LOS) > 2 days) divided by the total number of ectopic pregnancies. We used Poisson regression to assess the risk of ectopic pregnancy complication by race/ethnicity. Secondary outcomes were each individual complication, and ectopic pregnancy-related death. We calculated the ectopic pregnancy mortality ratio as the number of deaths divided by live births.

MAIN RESULTS AND THE ROLE OF CHANCE

Ectopic pregnancy-associated complications occurred in 11% of cases. Controlling for age and state, the risk of any complication was significantly higher among women who were black (incidence risk ratio [IRR] 1.47, 95% CI 1.43-1.53, P < 0.0001), Hispanic (IRR 1.16, 95% CI 1.12-1.21, P < 0.0001), Asian (IRR 1.34, 95% CI 1.24-1.45, P < 0.0001), American Indian/Alaskan Native (IRR 1.34 95% CI 1.16-1.55, P < 0.0001), and Native Hawaiian/Pacific Islander (IRR 1.61, 95% CI 1.39-1.87, P < 0.0001) compared with white women. The ectopic pregnancy mortality ratio was 0.48 per 100 000 live births, similar to that reported in previous US surveillance.

LIMITATIONS, REASONS FOR CAUTION

This is a secondary analysis of insurance claims.

WIDER IMPLICATIONS OF THE FINDINGS

Among women at higher baseline risk of pregnancy complications due to their economic status, women from racial/ethnic minority groups face an additional risk of ectopic pregnancy adverse outcomes compared with whites. Systematic changes to reduce racial disparities are an essential part of improving maternal health in the USA.

STUDY FUNDING/COMPETING INTERESTS

The Eunice Kennedy Shriver National Institute of Child Health and Human Development (1 K08 HD060663 to D.B.S.). The authors report no conflict of interest.

TRIAL REGISTRATION NUMBER

Not applicable.

Identifying Symptom Clusters in Breast Cancer: Implications on Patient Quality of Life

Background: Patients undergoing treatment for advanced cancer often experience multiple symptoms. These symptoms occur with varying frequency, intensity, and impact. Pain, fatigue, insomnia, anorexia and dyspnea are consistently among the 10 most prevalent symptoms associated with cancer and its treatment. We conducted a multivariate analysis to investigate the impact of cancer symptoms on patient quality of life (QoL) in breast cancer.Material and Methods: A consecutive series of 226 breast cancer patients treated at the Cancer Treatment Centers of America at Southwestern Regional Medical Center between Jan 2001 and Nov 2006. Cancer symptoms were assessed using the symptom subscales of European Organization for Research Treatment of Cancer - Quality of Life Questionnaire (QLQ-C30). Symptom scores range from 0-100 with lower scores indicating better while higher scores indicating worse symptoms. QoL was assessed using Ferrans and Powers Quality of Life Index (QLI). QLI measures overall QoL and QoL in 4 major subscales: health/physical, social/economic, psychological/spiritual, and family. QLI scores range from 0-30 with higher scores indicating better QoL. The relationship between QLQ-C30 symptoms and QLI was evaluated using multivariate linear regression.Results: Of 226 patients, 98 were newly diagnosed while 128 had failed prior treatment before coming to our hospital. The mean age was 52.5 years (range = 27-82 years). We found that every 10 unit increase in fatigue (p=.004) and pain (p=.001) was significantly associated with 0.65 and 0.66 unit decline in QLI health/physical subscale after controlling for age, treatment history, stage at diagnosis and other cancer symptoms. Similarly, every 10 unit increase in insomnia (p=.02) was significantly associated with 0.35 unit decline in QLI family subscale. Finally, every 10 unit increase in pain (p=.01) and insomnia (p=.03) was significantly associated with 0.34 and 0.21 unit decline in overall QoL.Discussion: We found fatigue, pain and insomnia to be independent predictors of QoL after controlling for each other, age, treatment history and stage at diagnosis. Recognition and timely treatment of symptom clusters could result in improved QoL in patients with breast cancer.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 5043.

The effect of naturopathic and nutritional supplement treatment on tumor response, control, and survival in prostate cancer patients treated with radiation therapy

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Background: Potential antagonism of clinical response to cancer treatment by naturopathic/nutritional supplements (NNS) with anti-oxidant activity has been suggested. This study assessed effects of NNS on tumor response to radiation therapy (RT) in prostate cancer patients (PCpts). Methods: Of 134 RT-treated PCpts with localized tumors, 69 received NNS (+NNS; median age=62.0 yrs) and 65 did not (-NNS; median age=61.5 yrs). Based on pre-RT PSA, 52low (4–10 ng); 13 intermediate (10–20 ng); and 4 high risk (> 20 ng) PCpts were +NNS and 50, 10, and 5 low, intermediate & high risk PCpts were -NNS. Tumor stages for +NNS were T1c (39%); T2a (44%); T2b (10%); T2c (5%) with 1 T3b tumor and were T1b (3%); T1c (46%); T2a (32%); T2b (12%); and, T2c (5%) with 1 T3a tumor for -NNS cohorts. RT consisted of external beam therapy (4500–5000 cGy) + HDR brachytherapy (600–650 cGy/fraction x 2–3 fractions) administered over 6–8 weeks. NNS regimens (range 1–7 antioxidants) included Green Tea Extract, Melatonin, high-potency multivitamins, vitamin C, and vitamin E. All pts were monitored ≥ 24 months post RT. Hormonal therapy (HT; oral bicalutamide (50 mg/day) ±leuprolide depot (22.5 mg IM q 3 months) as neoadjuvant or adjuvant HT was given to 39 (57%) and 38 (58%) PCpts in the +NNS and -NNS cohorts respectively. Results: For the +NNS cohort that did not receive HT, PSA levels were 5.05; 0.285; and 0.356 ng at pretreatment, nadir and ≥ 24 months followup respectively with PSA nadir at 27 months and median followup of 36 months. The corresponding values for the -NNS cohort were 5.6, 0.54, and 0.585 ng with PSA nadir at 25 months and median followup of 29.6 months. Differences were not statistically significant. For the +NNS cohort that did receive HT, PSA levels were 6.8, 0.03 and 0.12 ng at pretreatment, nadir and ≥ 24 months followup with median time to nadir = 4.3 months and median followup = 29.2 months. Corresponding values for -NNS cohort were 6.9, 0.03, and 0.11 with median time to nadir = 3.6 months and median followup = 30.5 months. Differences were also not statistically significant. Conclusions: This study shows that NNS with antioxidant activity do not interfere with clinical response to RT ± HT as definitive treatment for limited stage prostate cancer.

No significant financial relationships to disclose.

Differential alterations of NF-kappaB to oxidative stress in primary basal forebrain cultures

Oxidative stress has been linked to neuronal cell death resulting from either acute insults due to ischemia, trauma, excitotoxicity, or chronic neurodegenerative diseases. Cholinergic basal forebrain neurons (CBFNs) compete for nerve growth factor (NGF) synthesized in the hippocampus and cortex via retrograde transport. NGF affects CBFN survival and cholinergic function via activation of the NF-kappaB transcription factor and this signaling pathway appears to be impaired in aged rats. Here, we demonstrate that activation of NF-kappaB in basal forebrain primary culture via treatment with hydrogen peroxide or TNF-alpha is predominantly restricted to CBFNs, and that NF-kappaB activation appears to mostly affect p65 translocation to the nucleus, but not the p50 subunit. These results are consistent with NF-kappaB activation being a part of recovery processes after acute oxidative stress. Since p50 or p49 (also called p52) binding to promoter sites does not stimulate transcription - both p50 and p49 lack an activating domain - and p65 does contain an activating domain and thus can act as a transcription enhancer, differential translocation of different NF-kappaB dimers can act as repressors of constitutive activity or enhancers. These results are in agreement with the hypothesis that p50/p65 is the active trans-activating species of NF-kappaB, as compared to p50/p50 homodimers which bind to NF-kappaB binding sites but do not trans-activate promoters. Our results also suggest that selective activation of different NF-kappaB dimer species may have regulatory significance in neuronal responses to acute or chronic insults to CNS. Thus, increased p65 translocation could have enhancing effects while increased p50 translocation could have a repressor role. Manipulation of the types of NF-kappaB species being translocated could provide a basis for therapeutic strategies.

In vitro folliculogenesis of rat preantral follicles

The impact of various gonadotropic hormones on the growth and development of secondary follicles from primordial and primary follicles obtained by enzymatic dissociation of the ovaries of immature 14-day-old rats was studied in vitro. The substratum-adherent culture technique developed for studying folliculogenesis in the current study permitted direct visualization of follicular growth on a day to day basis by avoiding the cumbersome process of fixing and sectioning follicles in culture. The cultures were maintained in a serum-free modified McCoy's medium in a humidified atmosphere containing 5% CO2 at 37 C. Daily observation of the culture dishes under the phase contrast microscope revealed that the follicles grew and developed from primordial to primary and secondary follicular stages in the presence of FSH. Large antral follicles were able to secrete estradiol and progesterone into the medium, indicating that the follicles are not merely formed by cellular reorganization, but are physiologically functional competent units. The organized release of the oocyte with accompanying corona radiata was made possible in some secondary follicles with large antral structures by introducing LH into the culture medium. However, introduction of hCG (which has the biological properties of LH) into the cultures on day 1 resulted in follicular degeneration within 3-4 days of culture. Follicular organization was also disrupted when LH was introduced together with FSH into the medium on day 1 of culture. Primordial or primary follicles obtained from the ovaries could survive, but could not transform to secondary follicles in the absence of FSH. The results of our in vitro studies indicate, and therefore are in agreement with earlier in vivo studies, that FSH alone is essential for the progression of folliculogenesis to the preovulatory condition, and that LH is essential for the organized expulsion of the oocyte from a mature follicle. Our technique, described in the current study, for producing physiologically functional secondary follicles in culture not only allows progress in folliculogenesis to be monitored very closely, but also serves as a model for studying the various intrinsic factors that may be involved in the successful development of dominant mature Graafian follicles that can finally ovulate. It also facilitates access to the growing follicle along with its oocyte, which can, therefore, be used as a powerful model to study the effects of various test substances on follicular development.(ABSTRACT TRUNCATED AT 400 WORDS)

Endothelial injury following experimental subarachnoid hemorrhage in rats: effects on brain blood flow

BACKGROUND

The leading cause of death and disability in patients suffering from aneurysmal subarachnoid hemorrhage (SAH) is cerebral vasospasm, a persistent, progressive, and often irreversible constriction of cerebral arteries. A wide array of pathological changes occur in cerebral arteries following SAH, with endothelial injury being the earliest and most consistent one. Since intact endothelium modulates many reflexes that influence vascular tone, damage to them may represent a significant contributor to cerebral vasospasm.

METHODS

Changes in local cerebellar blood flow (LCBF) and pathological alterations in major cerebral arteries were studied and compared in rats at various time intervals following SAH. SAH induced by the subarachnoid injection of 0.3 ml of whole blood. Sham rats received a subarachnoid injection of 0.3 ml of isotonic saline.

RESULTS

Except for an immediate but transient decrease, LCBF remained unchanged over a 3 day period following saline injection. Likewise, there were no pathological alterations in cerebral arteries of saline-injected rats. In contrast, the subarachnoid injection of whole blood produced significant changes in both LCBF and cerebral arteries. Within 30 minutes post-blood injection, LCBF became significantly decreased and remained so for 4 hours. However, within 24 hours, LCBF had returned to control levels where it remained for 3 days. Endothelial injury was observed in the basilar and middle cerebral arteries from 30 minutes through 4 hours, the same periods in which LCBF was significantly reduced. Within 24 hours, the time period in which LCBF had rebounded to control ranges, cerebral arteries showed no evidence of endothelial damage and resembled control cells.

CONCLUSION

The results indicate a direct correlation between changes in LCBF and the structural integrity of endothelial cells in the early stages following SAH. The lack of chronically depressed LCBF (after 1 day) may be related to the quick structural repair of endothelium.

Clinical pharmacology of tamoxifen in patients with breast cancer: correlation with clinical data

Blood tamoxifen levels were determined for patients with metastatic breast cancer following initial and chronic dosing at twice daily 10 mg/m2 or a 20 mg/m2 single dose. Median time to response was six weeks. Blood tamoxifen levels at that time were ten-fold greater than those obtained after an initial single dose; however, steady-state values were not achieved until 16 weeks of chronic dosing. On a loading dose schedule of 40 mg/m2 twice daily for seven days and 20 mg/m2 daily thereafter, blood levels greater than or equal to 10 mg/m2 twice daily steady-state values were reached in one week. Levels drawn at peak and trough times suggest that tamoxifen may be given on a once-daily basis. Tamoxifen half-life was 9-12 hours after the initial dose and seven days after chronic dosing.