Racial/ethnic differences in health-related quality of life among female breast cancer survivors: cross-sectional findings from the Medical Expenditure Panel Survey

OBJECTIVES

Breast cancer survivors have reported worse health-related quality of life (HRQoL) outcomes on some subscales when compared with members of the general population. However, the increased attention to breast cancer survivorship should have improved the HRQoL of these survivors. Our aim was to examine whether physical and mental component scores (PCS-12 and MCS-12) using the Short Form (SF-12) questionnaire were different for racial/ethnic minorities, specifically for Black and Hispanic women relative to White women. Furthermore, we stratified the data by age group to evaluate these racial/ethnic differences in HRQoL of breast cancer survivors.

STUDY DESIGN

Cross-sectional study.

METHODS

Pooled cross-sectional analyses using data from the Medical Expenditure Panel Survey between 2008 and 2016 were conducted. Pooled ordinary least squares (OLS) regression was used to examine the racial/ethnic differences in PCS-12 and MCS-12 scores of breast cancer survivors. Furthermore, stratified analyses by age group were conducted to evaluate racial/ethnic differences in HRQoL by the age of breast cancer survivors.

RESULTS

After adjusting for confounders, there was no association between race/ethnicity and PCS-12 scores. However, Hispanic breast cancer survivors had statistically significantly lower MCS-12 scores (by 1.9 points [95% confidence interval {CI}: -3.53 to -0.37]) when compared with White breast cancer survivors. For PCS-12, after stratifying by age, the adjusted analyses showed no significant differences in PCS-12 scores when White female breast cancer survivors were compared with the other racial/ethnic categories. On the other hand, Black female survivors aged <50 years had 4.3 points (95% CI: 0.46-8.13) higher MCS-12 scores when compared with their White counterparts, while Hispanic breast cancer survivors aged <50 years had 3.1 points (95% CI: -0.40-6.69) higher MCS-12 scores relative to White women. Furthermore, among female breast cancer survivors aged ≥50 years, Hispanic women had 3.2 points (95% CI: -4.98 to -1.40) lower MCS-12 scores than White women.

CONCLUSION

Our study generated findings showing the racial/ethnic differences in HRQoL of breast cancer survivors and presented results stratified by age group. These findings provide the much-needed rationale for targeted and racial/ethnic-specific HRQoL improvement strategies among breast cancer survivors.

Yield of chest radiograph in tuberculosis screening for HIV-infected persons at a district-level HIV clinic

SETTING

An Hoa Clinic, a district-level human immunodeficiency virus (HIV) clinic in Ho Chi Minh City, Viet Nam.

OBJECTIVE

To assess the performance of chest radiograph (CXR) in screening for pulmonary tuberculosis (PTB) among HIV-infected individuals and identify misdiagnosed opportunities.

DESIGN

This cross-sectional study was conducted in 397 HIV-infected patients consecutively enrolled at the An Hoa Clinic in Ho Chi Minh City, Viet Nam, from August 2009 to June 2010. The performance of CXR in TB screening was assessed based on its sensitivity, specificity, positive likelihood ratio and negative likelihood ratio.

RESULTS

Symptom screening alone missed 50% of PTB cases. The combination of CXR and symptom screening yielded an additional 28.6% (8/28) in PTB screening as compared with symptom screening alone, and should be applied routinely, especially in high TB prevalent settings.

CONCLUSION

CXR is a good predictor for PTB even in HIV-infected individuals. The combination of CXR and screening for common TB symptoms considerably improved the sensitivity of detecting active PTB in people living with HIV. If available, routine sputum culture and the World Health Organization-endorsed Xpert(®) MTB/RIF assay should be implemented to achieve a more accurate diagnosis.

Tuberculosis infection in drug users: interferon-gamma release assay performance

SETTING

An inner city neighborhood in Houston, Texas, known for a high rate of drug use.

OBJECTIVE

To determine the prevalence of latent tuberculosis infection (LTBI) using the QuantiFERON-TB Gold (QFT-G) test, the TSPOT.TB test and the tuberculin skin test (TST) in drug users and to evaluate the performance of the QFT-G and TSPOT.TB tests vs. the TST.

DESIGN

Cross-sectional study. Bivariate and multivariate logistic regression analyses were used to determine risks associated with each test outcome.

RESULTS

The prevalence of LTBI in 119 drug users studied was 28% by TST and 34% by QFT-G and T-SPOT.TB. Kappa statistics indicated fair to moderate concordance between QFT-G and TSPOT.TB vs. TST. About one-fifth of the population that tested negative with TST was positive with either QFT-G or T-SPOT.TB. On multivariate analysis, the likelihood of testing QFT-positive or T-SPOT.TB-positive increased by 8% and 6%, respectively, for every year of age; TST positivity was associated with smoking crack at home; being Caucasian or having a history of alcohol use was positively associated with a positive T-SPOT.TB test.

CONCLUSION

Interferon-gamma release assays (IGRAs) are superior to the TST in drug users with a higher prevalence of LTBI. Future studies need to assess the predictive value of IGRAs on the progression from LTBI to active TB in high-risk populations.

Significance of anti-hbc in the absence of other hepatitis B markers in a college-aged population

A study of 291 college students in the Houston (Tex., USA) area was performed to determine the relationship between alanine aminotransferase (ALT) level and antibodies to the hepatitis B virus (HBV) core antigen (anti-HBc) in the absence of other HBV markers (referred to as isolated anti-HBc). Participants were drawn from three groups: those positive only for anti-HBc (cases), those positive for hepatitis B surface antigen, a marker of acute/chronic HBV infection (control group 1), and those with no previous exposure to the HBV (control group 2). There were no significant differences between the groups in percentages of subjects with an elevated ALT level. The mean ALT level from active HBV infections was highest with HBV-negative controls having the lowest mean ALT concentration (p = 0.06), but no significant differences were found between ALT levels of those with isolated anti-HBc and either control group. This study may further aid in determining the presence of any liver damage when testing positive only for the antibodies to HBc.

Epidemiology and molecular characterization of co-circulating influenza A/H3N2 virus variants in children: Houston, Texas, 1997-8

Co-circulating variants of influenza A/H3N2 viruses in children were studied in Houston, Texas between October 1997 and March 1998 to assess the effects of a new variant strain on the severity of clinical illness. Influenza A virus was isolated from the nasal wash or nasal aspirate specimens collected from children at two tertiary care hospitals, and 271 isolates were available for variant-specific subtyping using RT-PCR and restriction fragment length polymorphism (RFLP) analysis. We classified 124 (46%) influenza viruses as A/H3N2/Wuhan/359/95-like and 137 (50%) as A/H3N2/Sydney/05/97-like. Ten (4%) virus isolates could not be classified. Ill contacts in the household were reported more frequently in patients infected with A/Sydney-like viruses than in those infected with A/Wuhan-like viruses (85% vs. 71%, respectively, P=0.02). There were no differences in other demographic variables among children infected with these strains. This study found no increase in illness severity in children infected with a newly emerging strain.

Functional regulation of immunoproteasomes and transporter associated with antigen processing

The central event in the cellular immune response to invading pathogens is the presentation of non-self antigenic peptides by major histocompatibility complex (MHC) class I molecules to cytotoxic T lymphocytes (CTLs). As peptide binding and transport proteins, MHC class I molecules have evolved distinct biochemical and cellular strategies for acquiring antigenic peptides, providing CTLs an extracellular representation of the intracellular antigen content. Whereas efficient generation of MHC class I binding peptides depends on the intracellular, immunoproteasome-mediated proteolysis machinery, translocation of peptides into the lumen of the endoplasmic reticulum requires the endoplasmic reticulum-resident, adenosine 5'-triphosphate (ATP) binding cassette transporter associated with antigen processing (TAP). Here we show, for the first time, that immunoproteasomes, TAP complexes, and MHC class I molecules are physically associated, providing an effective means of transporting MHC class I binding peptides from their sites of generation into the lumen of the endoplasmic reticulum for loading onto MHC class I molecules. In this review, we assess the current understanding of the functional regulation of immunoproteasomes and transporter associated with antigen processing.

Acceptance of syphilis screening among residents of high-STD-risk Houston communities

The purpose of this study was to assess the rate of acceptance of street-intercept syphilis screening and to identify barriers to screening among residents of 2 Houston communities with high rates of syphilis. Each of 691 people who participated in a street-intercept survey about syphilis was offered a free syphilis test immediately after completion of the survey. Acceptors of screening had blood drawn at the site of the interview, and blood samples were tested by rapid plasma reagin (RPR) and a confirmatory microhaemagglutination-Treponema pallidum (MHA-TP) for those with a positive antibody reaction on the RPR. On-street syphilis screening was accepted by 26% of the sample. The most common reason for refusal was not wanting to have blood drawn (19.5%). Among those screened for syphilis (n=148), seroprevalence was 19%, with 33% of women testing positive and 10% of men. The results of this study point to a need for increased case-finding, standard screening recommendations, and interventions targeting specific barriers to syphilis screening.

The role of hepatitis C in hepatocellular carcinoma: a case control study among Egyptian patients

BACKGROUND

Egypt has one of the highest prevalence rates of hepatitis C virus (HCV) infection in the world; however, the risk and attribution related to HCV in Egyptian patients with hepatocellular carcinoma (HCC) remains unknown.

GOALS

The current study was undertaken to estimate the risk of HCC in relation to HCV in Egypt.

STUDY

Thirty-three patients with HCC and 35 healthy controls who had a similar socioeconomic status were prospectively enrolled at the University of Cairo National Cancer Institute.

RESULTS

Anti-HCV antibodies were present in 75.8% of the patients and in 42.9% of the controls (p = 0.01); hepatitis B surface antigen (HBsAg) was present in 15.2% of the patients and in 2.9% of the controls (p = 0.03). In addition, the sex-and age-adjusted odds ratio (OR) for anti-HCV antibodies was 5.1 (95% CI = 1.5-17.4) and for HBsAg was 13.2 (95% CI = 1.2-148.2). Concurrent Schistosoma mansoni and anti-HCV was associated with an OR of 10.3 (95% CI = 1.3-79.8), which was higher than that for anti-HCV (6.5; 95% CI = 1.6-26.6) and S. mansoni infection (0.2; 95% CI = 0.1-6.2) alone. Finally, we estimated the attributable fraction of HCC to HCV to be 64% in this study population and 48% in the general Egyptian population.

CONCLUSIONS

Both HCV and hepatitis B virus infection increase the risk of HCC in Egyptian patients, whereas isolated Schistosoma infection does not. Because of the very high prevalence rate of HCV in the general Egyptian population, it accounts for most HCC cases in Egypt.

Erythema elevatum diutinum mimicking extensive keloids; quiz 386

GOAL

To describe a case of erythema elevatum diutinum (EED) that clinically mimicked extensive keloids.

OBJECTIVES

Upon completion of this activity, dermatologists and general practitioners should be able to: 1. Describe the clinical presentation and lesion appearance in EED. 2. Discuss the electron microscopic and laboratory findings of EED. 3. Outline treatment options for EED. CME: This article has been peer reviewed and approved by Michael Fisher, MD, Professor of Medicine, Albert Einstein College of Medicine.

REVIEW DATE

April 2001. This activity has been planned and implemented in accordance with the Essentials and Standards of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Albert Einstein College of Medicine and Quadrant HealthCom, Inc. The Albert Einstein College of Medicine is accredited by the ACCME to provide continuing medical education for physicians. Albert Einstein College of Medicine designates this educational activity for a maximum of 1.0 hour in category 1 credit toward the AMA Physician's Recognition Award. Each physician should claim only those hours of credit that he/she actually spent in the educational activity. This activity has been planned and produced in accordance with ACCME Essentials.

Prevalence of sexually transmitted infections and associated risk factors among populations of drug abusers

A cross-sectional survey was conducted of sexually transmitted diseases (STDs) and risky behaviors among 407 drug abusers in treatment facilities in 1998. Infections with human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), herpes simplex virus type 2 (HSV-2), and syphilis were detected by testing serum antibody levels; chlamydia and gonorrhea were detected by testing nucleic acid levels in urine. Logistic regression analysis was performed to measure associations. Prevalences of antibodies were as follows: to HSV-2, 44.4%; to HCV, 35.1%; to HBV, 29.5%; to HIV, 2.7%. The prevalence of syphilis was 3.4%; of chlamydia, 3.7%; and of gonorrhea, 1.7%. Of the 407 subjects, approximately 62% had markers for 1 of the STDs. HIV infection was associated with African American race, use of smokable freebase (crack) cocaine, and STD history. HBV infection was associated with age >30 years, injecting drugs, needle sharing, a history of treatment for drug abuse, and African American race. HCV infection was associated with an age >30 years, injecting drugs, and needle sharing, and HSV-2 infection with an age >30 years, female sex, and African American race. Syphilis was associated with a history of STDs. High prevalences of STDs among drug abusers indicate the need for integration of STD screening and treatment into drug treatment programs.

HIV-related malignancies: community-based study using linkage of cancer registry and HIV registry data

For people immunosuppressed by human immunodeficiency virus (HIV), we expect an increase in cancer incidence similar to that documented in transplant patients. We examined the cancer spectrum in an HIV-infected cohort, specifically malignancies not currently associated with acquired immunodeficiency syndrome (AIDS), in relation to the general population. Cancer incidence data for residents of Harris County, Texas, diagnosed between 1975 and 1994, were linked to HIV/AIDS registry data by Soundex code and date of birth to identify malignancies in an HIV-infected cohort of 14,986 persons. Incidence of cancer in this cohort was compared to the general population by standardized incidence ratio (SIR) analysis. From the HIV-infected cohort, 2289 persons (15%) were identified as having one or more malignancies, with 97% occurring in males. The linkage alone identified 29.5% of the malignancies, of which only 28.7% were diagnosed in males. Adjusting for age, HIV-infected men and women had incidences of cancer that were 16.7 [95% confidence interval (CI) 16.1-17.3] and 2.9 (95% CI 2.3-3.7) times that expected for the general population of Harris County, Texas. Besides Kaposi's sarcoma, non-Hodgkin's lymphoma, cervix cancer and brain lymphoma, non-AIDS related malignancies of Hodgkin's lymphoma, non-melanotic skin cancer in males and colon cancer in females, exhibited significant SIRs of 5.6 (95% CI 3.6-8.4), 6.9 (95% CI 4.8-9.5) and 4.0 (95% CI 1.1-10.2). Increased incidences of lung, prostate and breast malignancies were not seen in this HIV cohort. Persons infected with HIV appear to be at increased risk for the non-AIDS related malignancies, Hodgkin's lymphoma, non-melanotic skin cancer in males and colon cancer in females.

A direct interaction between EXT proteins and glycosyltransferases is defective in hereditary multiple exostoses

Hereditary multiple exostoses (HME) is an autosomal dominant condition in which bony outgrowths occur from the juxtaepiphyseal regions of the long bones. In a few percent of cases these exostoses undergo malignant transformation to chondrosarcomas. HME results from mutations in one of two homologous genes, EXT1 and EXT2. These are members of a new gene family that is conserved from Caenorhabditis elegans to higher vertebrates. In humans this family comprises five genes which are most conserved at their C-termini, but they do not contain any discernible functional motifs and their function(s) is unclear. Indirect evidence suggests that EXT proteins are involved in glycosaminoglycan synthesis, act as tumor suppressors and affect hedgehog signaling. One recent study has also reported that these proteins co-purify with glycosyltransferase (GlcA and GlcNAc transferase) activity and on that basis it has been postulated that they are themselves glycosyl-transferases. We performed two-hybrid screens with a fragment of EXT2 from the region that is most highly conserved in the gene family and identified two interacting proteins: the tumor necrosis factor type 1 associated protein and a novel UDP-GalNAc:poly-peptide N -acetylgalactosaminyltransferase. Significantly, both these interactions were abrogated by a disease-causing EXT mutation, indicating that they are important in the etiology of HME. The EXT2-GalNAc-T5 interaction provides the first direct physical link between EXT proteins and known components of glycosamino-glycan synthesis.

Prevalence of antibody to Trypanosoma cruzi in pregnant Hispanic women in Houston

We assessed the seroprevalence of antibodies to Trypanosoma cruzi among pregnant Hispanic women in Houston. Sera from 2,107 Hispanic and 1,658 non-Hispanic subjects were tested by ELISA for the presence of antibodies to T. cruzi. Twenty-two (0.6%) of 3,765 subjects had sera that were reactive. Seroreactivity was confirmed by hemagglutination assay. Eleven subjects had reactive sera, giving a confirmed seroprevalence of 0.3% (95% CI, 0-1%). Nine sera from Hispanic and two from non-Hispanic women were positive by hemagglutination assay, for a prevalence of 0.4% and 0.1%, respectively, during pregnancy. On the basis of these seroreactivity data, transplacental transmission of T. cruzi could occur in the continental United States. Screening for antibodies to T. cruzi during pregnancy would provide the potential for early intervention in congenital Chagas' disease.

Hepatitis B vaccination in high-risk infants: 10-year follow-up

The long-term efficacy of hepatitis B vaccination among high-risk infants was determined in 805 vaccine responders, immunized at birth in Taiwan during 1981-1984 and followed to age 10 years, via life table survival and Cox multivariate analyses. At 10 years, cumulative persistence of antibody to hepatitis B surface antigen (anti-HBs) was 85%, and cumulative incidence of hepatitis B virus (HBV) infection was 15%. Three children became carriers. Twelve-month anti-HBs titer was the strongest predictor of efficacy. The higher the initial titer, the lower the risk of anti-HBs loss (relative risk [RR], 0.26 for titer of 100-999 mIU/mL; RR, 0.08 for titer >1000 mIU/mL; P<.001) and HBV infection (RR, 0.55 and 0.27; P<.05). Maternal hepatitis B e antigen positivity but not hepatitis B immunoglobulin dose or gender predicted greater antibody persistence to age 10 years. Because the level of antibody persistence remained high and few became carriers, booster revaccination within 10 years seems unnecessary.

Sexual behaviour, STDs and drug use in a crack house population

We aimed to investigate the prevalence of ulcerative sexually transmissible diseases (STDs) and hepatitis in crack users. We interviewed 435 crack users on site in crack houses in Houston, Texas and took blood for laboratory analysis. There was evidence of syphilis infection in 13%, herpes simplex virus-2 (HSV-2) in 61%, HIV in 12%, hepatitis B in 52%, and hepatitis C in 41% of cases. On DSM-III-R criteria, 12% were crack abusers and 84% crack dependent: over half reported previous treatment. Forty per cent reported also injecting. Sexual behaviour indicated a mean of 2.4 partners in the past month for men, 3.7 for women. Sexual behaviour was largely vaginal, although women also reported more than twice the level of oral sex of men. Significant multivariate predictors for HIV and hepatitis B and C were previous reported STD and injecting drug use (including sharing needles), while female gender for syphilis and HSV-2, and additionally condom use for HSV-2, were significant risks. These data confirm high rates of STDs in a crack house population as inferred from previous clinic-based and community studies, and the link between STDs, injecting and HIV. The high rates of STDs found should lead to considering STDs and substance abuse to be dual diagnoses in crack users and the integration of STD diagnosis and treatment into crack outreach and treatment programmes.

The epidemiology of syphilis in the waning years of an epidemic: Houston, Texas, 1991-1997

BACKGROUND

National and local syphilis rates have fallen since 1990. Accurate epidemiologic information about the distribution of syphilis during the waning years of an epidemic are important to health care organizations so that they can specifically target screening and intervention programs.

GOALS

To describe the epidemiology of syphilis in Houston, Texas, from 1991 through 1997.

STUDY DESIGN

Descriptive evaluation of morbidity surveillance data from the Houston Department of Health and Human Services.

RESULTS

Between 1991 and 1997, rates for syphilis fell 61%. Rates for primary and secondary syphilis fell 90% among men and women in all race/ethnicity groups; early latent rates fell 81% among blacks, 57% among Hispanics, and 50% among whites. Late latent rates were stable among blacks and whites and increased among Hispanics. The proportion of total cases identified as late latent disease increased from 16% in 1991 to 63% in 1997. Congenital syphilis rates have remained at approximately 2 per 1,000 live births since 1993.

CONCLUSION

Syphilis continues to be a problem in Houston. The medical community and HIV/STD prevention programs need to be vigilant in actively screening high-risk individuals to identify syphilis at earlier stages of the disease and to prevent congenital syphilis.

Problems in physician's classification and reporting of congenital syphilis

The diagnosis of congenital syphilis (CS) in newborns can only be made through a review of the mothers' testing and treatment history and through the infants' clinical and laboratory findings. We describe difficulties in the classification of CS by physicians and the health department during a recent syphilis epidemic. The records of infants identified as potential cases of CS by laboratory testing, discharge diagnosis, or health department records were reviewed by epidemiologists. The reasons for concordance and discordance in classification between the physician and the epidemiologist were determined. Congenital syphilis was identified in 126 infants. Seventeen cases were discordant and 12 cases concordant but the physician's classification was for incorrect reasons. Misclassification occurred because physicians lacked data known to the health department (n=7), health departments lacked data known to the physician (n=1), and physicians misinterpreted the case definition for CS (n=21). Suggestions for improving the diagnosis and reporting of CS are included.

Conservation of function and primary structure in the BRCA1-associated RING domain (BARD1) protein

The BRCA1 gene encodes a tumor suppressor that has been implicated in hereditary forms of breast and ovarian cancer. During S phase of the cell cycle, BRCA1 polypeptides are found in discrete nuclear bodies ('BRCA1 nuclear dots') together with HsRad51, a human homolog of the E. coli recA protein, and BARD1, a protein that interacts with BRCA1 to form a stable heterodimer. BARD1 is structurally similar to BRCA1 in that both molecules harbor an amino-terminal RING domain and two carboxy-terminal BRCT domains. Here we describe the amino acid sequence and expression pattern of murine Bard1. A comparison of the mouse and human sequences reveals that the recognizable protein motifs of BARD1 are well conserved, including the RING domain, the three tandem ankyrin repeats, and, to a lesser extent, the two BRCT domains. However, the remaining sequences of BARD1 display a markedly lower degree of phylogenetic conservation, comparable to those reported for BRCA1 and BRCA2. Moreover, murine Bard1 retains the ability to associate in vivo with BRCA1, and its expression pattern in adult mice mirrors that of Brca1, with elevated levels of RNA transcripts found in the testes and spleen. These data suggest that BRCA1 and BARD1 have co-evolved to participate in a common pathway of tumor suppression.

Mutagen sensitivity as a susceptibility marker for human hepatocellular carcinoma

Although the pathogenesis of hepatocellular carcinoma (HCC) remains poorly understood, hepatitis B virus and dietary aflatoxin exposures are established etiological factors for this disease. We conducted a pilot study of 28 patients with HCC and 110 healthy controls matched for age, sex, and ethnicity to determine whether constitutional genetic instability, based on the quantification of mutagen-induced chromatid breaks in cultured lymphocytes, modifies an individual's risk of HCC development. The mean numbers of bleomycin-induced breaks per cell for cases and controls were 0.92 and 0.55, respectively (P < 0.0001). For benzo(a)pyrene diol epoxide (BPDE) sensitivity, the values were 0.90 for cases and 0.46 for controls (P < 0.0001). Nearly 68% of the cases but only 27% of the controls exhibited bleomycin sensitivity (i.e., had > or = 0.68 breaks per cell). Eighty % of the case group but only 22% of the control group exhibited BPDE sensitivity (i.e., had > or = 0.58 breaks per cell). On multivariate analyses, both bleomycin sensitivity and BPDE sensitivity were associated with significantly elevated risks for HCC, with odds ratios (95% confidence intervals) of 5.63 (2.30, 13.81) and 14.13 (3.52, 56.68), respectively. For individuals who were sensitive to both assays, the risk was 35.88. A synergistic interaction between the bleomycin sensitivity and BPDE sensitivity in HCC risk was suggested. These preliminary findings suggest that differences in host factors related to the predisposition to chromosome breakage, the capacity for DNA repair, or both may be involved in HCC development by influencing the predisposition of hepatitis B virus integration into human DNA or that the carcinogens induced DNA damage susceptibility. A larger study is needed to confirm these intriguing results.

Impact of the 1993 CDC surveillance definition of AIDS in Texas, 1991-1994

In 1993, the Centers for Disease Control and Prevention (CDC) expanded the surveillance case definition of AIDS to include all individuals showing immune suppression, measured by absolute CD4 lymphocyte count or CD4/CD8 ratio, as well as those presenting with the 23 clinical conditions from previous case definitions or with three new indicator conditions (pulmonary tuberculosis, recurrent pneumonia, and invasive cervical cancer). The greatest impact of the expanded definition is the dramatic increase in cases reported in 1993, largely due to a backlog of 1992-diagnosed cases that meet the new criteria. Texas reported a 136% increase in cases in 1993 compared with 1992. Despite a drop between 1993 and 1994, the number of reported cases increased 75% overall between 1992 and 1994. Most cases reported in 1993 and 1994 fall under the 1993 expanded surveillance case definition (59% and 60%, respectively). More than 90% of all cases reported under the new definition are classified under immunologic criteria. The Department of Health and Human Services (DHHS) Public Health Region 4 was the most affected, with a 213% increase in reported cases between 1992 and 1993, and a 163% increase between years 1992 and 1994. In Texas, the new definition shows the greatest impact among women, blacks, and "other" ethnic groups, persons 20 through 29 years of age, and cases attributable to heterosexual contact. From 1992 to 1993, cases reported in Texas increased 161% among females, 171% among blacks, 219% among persons 15 through 19 years old, and 189% among cases citing heterosexual contact. The new definition has successfully identified population subgroups affected most recently by the epidemic. The inflated growth in cases caused by the expanded case definition carries implications for program administrators and health care providers in both allocating resources and targeting prevention efforts.

The epidemiology of early syphilis in Houston, Texas, 1994-1995

BACKGROUND AND OBJECTIVES

Since 1990, rates of syphilis in the United States have steadily declined. However, the South still records disproportionately high rates of syphilis infection.

GOAL

The objective of this study is to describe the epidemiology of early syphilis in Houston, TX, the largest urban center in the South, in 1994 and 1995.

STUDY DESIGN

The study is cross-sectional and descriptive, and uses data collected by Disease Intervention Specialists on the Interview Form 73.54 from interviews with men and women diagnosed with early syphilis.

RESULTS

Early syphilis in Houston is highly concentrated in a "belt" that extends north to south in a line just east of the city center. Although sex-specific rates of early syphilis are roughly equal, men are 3.5 times more likely than women to be diagnosed with primary syphilis, whereas women are nearly 2 times more likely than men to be diagnosed with secondary syphilis and 1.5 times more likely to be diagnosed with early latent syphilis.

CONCLUSION

Routine surveillance data indicate that young, African-American men and women in Houston's inner-city neighborhoods are disproportionately affected by syphilis. Particular efforts must be made to reach women, who are detected and treated at later stages of the disease than men.

Congenital syphilis in Harris County, Texas, USA, 1990-92: incidence, causes and risk factors

From local health department data, we determined the 1990-92 incidence of congenital syphilis (CS) in Harris County, Texas, USA, applying for the first time the Centers for Disease Control and Prevention (CDC) 1990 surveillance case definition to a population-based sample. We also evaluated factors that discriminated between women whose infants were or were not cases. The incidence of CS per 1000 live births was 3.2 in 1990, 4.6 in 1991 and 4.2 in 1992. Because of failure to apply part of the case definition, the local health department reported only 60% (418/694) of the cases that we identified. In the multivariate analysis, the significant factors for CS were lack of prenatal care and late latent syphilis. No factor identified high-risk women to target for special public health interventions. Improved laboratory services and better education of local providers and surveillance workers will solve some problems in the diagnosis and therapy of syphilis during pregnancy. Ambiguity in the CDC's case definition of CS needs correction.

Identification of a RING protein that can interact in vivo with the BRCA1 gene product

The hereditary breast and ovarian cancer gene, BRCA1, encodes a large polypeptide that contains the cysteine-rich RING motif, a zinc-binding domain found in a variety of regulatory proteins. Here we describe a novel protein that interacts in vivo with the N-terminal region of BRCA1. This BRCA1-associated RING domain (BARD1) protein contains an N-terminal RING motif, three tandem ankyrin repeats, and a C-terminal sequence with significant homology to the phylogenetically conserved BRCT domains that lie near the C terminus of BRCA1. The BARD1/BRCA1 interaction is disrupted by BRCA1 missense mutations that segregate with breast cancer susceptibility, indicating that BARD1 may be involved in mediating tumour suppression by BRCA1.

Problems in the current case definitions of congenital syphilis

During the course of a population-based epidemiologic study of congenital syphilis, we found discrepancies and problems of validity in the case definitions of congenital syphilis of the Centers for Disease Control and Prevention and other experts. We analyzed these problems and determined their impact on case classification in our study. The most important problem that we found was the case definitions' lack of a valid scientific basis for the classification of symptom-free infants born to mothers who have been treated for syphilis but have uncertain infection status (286 infants in our study). The classification of these infants is based on diagnostic tests whose sensitivity and specificity are unknown. In our study, we found that results of some tests were rarely positive and that values for others were similar to those in uninfected infants. We believe that symptom-free infants of treated mothers of uncertain infection status should be classified as cases, pending the development of better diagnostic tests for congenital syphilis. The economic impact of treating these infants can be lessened by obtaining fewer diagnostic tests and by use of one injection of penicillin rather than a 10- to 14-day course, an approach suggested by a literature review. Use of infants' diagnostic tests to classify any other group of symptom-free infants does not seem appropriate, even though this is often recommended.

Risk factors for HIV in pregnant women

Worldwide, the number of childbearing women infected with the human immunodeficiency virus (HIV) is rising. Early intervention can improve care for these women and reduce HIV transmission to their children. However, for intervention strategies to be effective, childbearing women at risk must be identified. HIV prevalence and risk factors vary widely from one region to another, and strategies for HIV testing must be tailored to local conditions. In this review, published data on HIV risk factors in pregnant women are presented by region, and implications for regional strategies for HIV testing in pregnant women are discussed.

Synthesis and conformational analysis by 1H NMR and restrained molecular dynamics simulations of the cyclic decapeptide [Ser-Tyr-Ser-Met-Glu-His-Phe-Arg-Trp-Gly]

The design of enzyme mimics with therapeutic and industrial applications has interested both experimental and computational chemists for several decades. Recent advances in the computational methodology of restrained molecular dynamics, used in conjunction with data obtained from two-dimensional 1H NMR spectroscopy, make it a promising method to study peptide and protein structure and function. Several issues, however, need to be addressed in order to assess the validity of this method for its explanatory and predictive value. Among the issues addressed in this study are: the accuracy and generizability of the GROMOS peptide molecular mechanics force field; the effect of inclusion of solvent on the simulations; and the effect of different types of restraining algorithms on the computational results. The decapeptide Ser-Tyr-Ser-Met-Glu-His-Phe-Arg-Trp-Gly, which corresponds to the sequence of ACTH1-10, has been synthesized, cyclized, and studied by two-dimensional 1H NMR spectroscopy. Restrained molecular dynamics (RMD) and time-averaged restrained molecular dynamics (TARMD) simulations were carried out on four different distance-geometry starting structures in order to determine and contrast the behavior of cyclic ACTH1-10 in vacuum and in solution. For the RMD simulations, the structures did not fit the NOE data well, even at high values of the restraining potential. The TARMD simulation method, however, was able to give structures that fit the NOE data at high values of the restraining potential. In both cases, inclusion of explicit solvent molecules in the simulation had little effect on the quality of the fit, although it was found to dampen the motion of the cyclic peptide. For both simulation techniques, the number and size of the NOE violations increased as the restraining potential approached zero. This is due, presumably, to inadequacies in the force field. Additional TARMD vacuum-phase simulations, run with a larger memory length or with a larger sampling size (16 additional distance-geometry structures), yielded no significantly different results. The computed data were then analyzed to help explain the sparse NOE data and poor chymotryptic activity of the cyclic peptide. Cyclic ACTH1-10, which contains the functional moieties of the catalytic triad of chymotrypsin, was evaluated as a potential mimic of chymotrypsin by measurement of the rate of hydrolysis of esters of L- and D-phenylalanine. The poor rate of hydrolysis is attributed to the flexibility of the decapeptide, the motion of the side chains, which result in the absence of long-range NOEs, the small size of the macrocycle relative to that of the substrate, and the inappropriate orientation of the Gly, His, and Ser residues. The results demonstrate the utility of this method in computer-aided molecular design of cyclic peptides and suggest structural modifications for future work based on a larger and more rigid peptide framework.

The role of chromosome translocations in T cell acute leukemia

A variety of unique chromosome translocations are found in the malignant cells of patients with T cell acute lymphoblastic leukemia (T-ALL). Molecular analysis of these translocations has implicated nine different proto-oncogenes in the pathogenesis of T-ALL. Despite the apparent genetic complexity of this disease, recent studies have uncovered a common pathway of T-ALL development that involves two distinct families of transcription factors.

Outcome of perinatal hepatitis B virus exposure is dependent on maternal virus load

To evaluate the role of maternal hepatitis B virus (HBV) DNA levels in perinatal infection, two nested case-control studies were done within a cohort of 773 hepatitis B surface antigen (HBsAg)-positive Taiwanese women and their infants. As serum HBV DNA levels increased from < 0.005 to > or = 1.4 ng/mL among the hepatitis B e antigen (HBeAg)-positive mothers, the odds ratio (OR) for having a persistently infected infant increased from 1.0 to 147.0 (P for trend < .001). Among HBeAg-negative mothers, the OR for having a persistently infected infant was 19.2 (95% confidence interval, 2.3-176.6) in mothers with high versus low levels of serum HBV DNA. A logistic regression analysis identified maternal HBV DNA to be a stronger independent predictor of persistent infection than HBeAg status. Thus, perinatal exposure to high levels of maternal HBV DNA is the most important determinant of infection outcome in the infant.

Products of the TAL2 oncogene in leukemic T cells: bHLH phosphoproteins with DNA-binding activity

The TAL2 gene is activated as a result of the (7;9) (q34;q32) translocation, a chromosome defect found in the malignant cells of some patients with T-cell acute lymphoblastic leukemia (T-ALL). TAL2 potentially encodes a basic helix-loop-helix motif that is highly related to those specified by TAL1 and LYL1, distinct genes that have also been implicated in T-ALL. In this report we show that leukemic cells bearing the (7;9) (q34;q32) translocation express a TAL2 gene product of 108 amino acids. In leukemic cells this product exists in both a phosphorylated (pp13TAL2) and an unphosphorylated (p12TAL2) form. Serine residue 100 is the major site of TAL2 phosphorylation in vivo, and it serves as an effective in vitro substrate for mitogen-activated protein (MAP) kinases such as ERK1. TAL2 polypeptides interact in vivo with the E2A gene products (E47 and E12) to form bHLH heterodimers that bind DNA in a sequence-specific manner. The TAL2 polypeptides do not bind DNA by themselves, however, suggesting that their functional properties may be contingent upon association with other bHLH proteins. Taken together, the properties of TAL2 evaluated here broadly resemble those described previously for TAL1, and therefore support the idea that both proteins promote T-ALL by a common mechanism.

Expression of the TAL1 proto-oncogene in cultured endothelial cells and blood vessels of the spleen

The TAL1 proto-oncogene encodes a basic helix-loop-helix (bHLH) protein that has been implicated in the pathogenesis of T-cell acute lymphoblastic leukemia. Normal expression of TAL1 is observed in erythrocytic, megakaryocytic and mastocytic cells of the hematopoietic lineage. We now report that both RNA transcripts and polypeptide products of TAL1 are present in human umbilical vein endothelial cells cultured in vitro. Moreover, in situ hybridization revealed a restricted pattern of TAL1 expression in endothelial cells in vivo, including vessels within the white pulp and follicles of the spleen. In view of its presumptive role as a transcriptional factor, the TAL1 gene product may serve during normal development as a regulator of endothelial cell growth or differentiation.

Products of the TAL1 oncogene: basic helix-loop-helix proteins phosphorylated at serine residues

TAL1 gene rearrangement is observed in nearly 30% of patients with T-cell acute lymphoblastic leukemia (T-ALL), and thus it represents the most common genetic lesion associated with this disease. Nevertheless, the presence of TAL1 gene products in normal or leukemic cells has not been reported. Therefore, immunoprecipitation with anti-TAL1 antisera was used to demonstrate the presence of TAL1 phosphoproteins, pp42TAL1 and pp22TAL1, in both T-ALL and erythroleukemia cell lines. The pp42TAL1 and pp22TAL1 proteins appear to be phosphorylated forms of full-length and truncated TAL1 gene products respectively. Phosphoamino acid analysis revealed that pp42TAL1 contains phosphoserine residues. The TAL1 phosphoproteins were detected in all of the T-ALL cell lines that harbor obvious TAL1 gene rearrangements. Interestingly, pp42TAL1 and pp22TAL1 were also present in some, but not all, of the T-ALL lines without detectable TAL1 gene alterations. Therefore, TAL1 activation may promote leukemogenesis in a far greater proportion of T-ALL patients than the 30% that bear gross TAL1 gene rearrangements.

Study of high density Escherichia coli fermentation for production of porcine somatotropin protein

Recombinant E. coli strains and culture conditions were studied for the fermentation expression of porcine somatotropin (PST) inclusion bodies under the control of a pL promoter. Our objective was to achieve high cell density together with a high level of recombinant protein expression. Improved fermentation conditions included oxygen enrichment, yeast extract (YE) effect, optimal specific growth to switch on gene expression, and feeding strategies. To maintain a low residual glucose concentration, a medium feed rate was controlled on a real-time basis by using cell density information estimated from on-line carbon dioxide monitoring of a fermentor's exhaust gas. The optimal specific growth rate required to initiate a temperature shift in our system was found to be around 0.2 hr-1. The cell density and PST expression level could reach 55 OD600 and 35%, respectively, after 16 hours of cultivation under optimal conditions by applying computer-controlled nutrient feed. In our recombinant host/vector system, the location of cl gene appears to affect gene expression under YE-supplemented and/or a high cell density culture condition. With cl gene placed on plasmid, our E. coli host no longer showed sensitivity toward YE in PST gene expression.

Antibody to Epstein-Barr virus-specific DNase as a marker for field survey of patients with nasopharyngeal carcinoma in Taiwan

A serological survey using antibody to Epstein-Barr virus (EBV)-specific DNase activity as a marker for the identification of patients with nasopharyngeal carcinoma (NPC) has been carried out on healthy subjects who visited Government Employees' Clinic Center (GECC) for routine health examination and on individuals residing in NPC high-risk areas (HRA) in Taiwan. During a 3-year prospective study, 22,596 and 9,869 sera were collected from the GECC and HRA groups, respectively. Taking neutralization of 2 or more units of EBV DNase activity as a positive response, the positivity rates in the GECC and HRA groups were 5.4% and 11.92%, respectively. Among the antibody-positive individuals, three cases of NPC were found in the GECC group (detection rate 0.63%) and 11 in the HRA group (detection rate 1.32%). A further patient at stage III of the disease was found in the first year of following up of 1,005 antibody-positive individuals. Among the 12 NPC patients in the HRA, five were newly diagnosed as having stage II (three patients) and stage III (two patients) NPC. These results support the hypothesis that antibody against EBV-specific DNase activity may be a useful marker for detection of patients with NPC, and they imply that individuals having high levels of antibody to EBV DNase activity may have an increased risk of development of NPC.

Human immunodeficiency virus seroprevalence among blood product recipients in San Francisco before transfusion

To determine the incidence of transfusion-associated human immunodeficiency virus (HIV) infection after routine screening of donated blood, a pilot study estimated the pretransfusion prevalence of HIV infection among blood product recipients in San Francisco. Among the 911 nonduplicate pretransfusion specimens from recipients without a clinical history of acquired immune deficiency syndrome (AIDS) or AIDS-related complex (ARC), the overall prevalence of antibody to HIV was 2.9 percent (5.2% among males and 0.6% among females; p = 0.00002). If recipients in specifically defined or possible high-risk groups (n = 348) were excluded, a seropositivity rate of 1.8 percent (10/563) was detected, with all the positives occurring in men (10/242, 4.1%) and none in women (0/321, 0%). This demonstrated prevalence of HIV infection among blood product recipients in San Francisco before transfusion was substantially higher than the known 0.02 to 0.04 percent prevalence in the donor population. Therefore, the population of women without known risk for AIDS is the best in which to assess the risk of HIV infection in patients who are currently receiving seronegative blood transfusions.

Epidemiology of hepatitis B virus infection in South African Chinese

The authors determined the age-specific prevalence of hepatitis B virus markers in 1,408 Chinese who resided in South Africa in 1983-1985. The small South African Chinese community consists of original Chinese settlers, almost all of whom migrated from the hepatitis B virus endemic mainland China province of Guangdong, and their South African-born descendants. The Chinese live among the white South African community, which has a very low hepatitis B virus carrier rate. The overall hepatitis B virus carrier rate was 5.3%, and the carrier rate was highest in age group 30-39 years (11.9%) and significantly lower in children aged 1-9 and 10-19 years (2.4% and 2.0%, respectively). Overall infection rates increased progressively with increasing age, starting at about 10% in the children aged 1-19 years and reaching 50% in adults aged 60-69 years. Among carrier children, 89% had carrier mothers, and all of the latter were also hepatitis e antigen (HBeAg)-positive. The prevalence of hepatitis B virus carriers in South African Chinese women of child-bearing age was 6.1%, and 41.9% of these carriers were HBeAg-positive. The age-specific prevalence of hepatitis B virus markers among South African Chinese is appreciably lower than that of Chinese in southeastern China, who have carrier rates of 15-20% with a peak in childhood. The prevalence of hepatitis B virus infection appears to be decreasing in South African Chinese, probably because improved hygienic and socioeconomic circumstances, in comparison with those in Guangdong, have resulted in less horizontal transmission of the virus. A diminishing pool of carriers is maintained by perinatal maternal-infant infection.

Prospective study of asymptomatic HBsAg carrier children infected in the perinatal period: clinical and liver histologic studies

Liver histologic findings were studied in 18 children who were 4 to 9 years old, and who had been HBsAg carriers since having been infected by their mothers in the perinatal period. All were born to HBeAg-HBsAg carrier mothers; the children were followed periodically from birth. Throughout their entire course, none developed symptoms or signs suggestive of liver disease. All of the 18 children showed mild but definite liver histologic changes: 15 had nonspecific histologic changes, and three had chronic persistent hepatitis. In 13 of 18 children, follow-up aminotransferase activities were abnormal, but none exceeded 100 KU. At the time of biopsy, ALTs on four children were above the upper limit of normal. All children were HBeAg-positive in early infancy, but five lost this antigen and developed antibody during follow-up. The histologic findings in HBeAg-positive children did not differ from those in children with antibody. Perinatal hepatitis B virus infection has been thought to play an important role in chronic liver disease, including hepatocellular carcinoma. This study indicates that some pathologic changes following perinatal infection begin very early.

Prognostic significance of histologic findings in resected small hepatocellular carcinoma

Fifty-one patients with histologically proven small (less than 5 cm) hepatocellular carcinoma underwent hepatic resection. In ten cases (group A) the cancer cells were confined within the tumor capsule, in ten (group B) there was extracapsular extension of growth, in 23 (group C) there was also invasion of the portal vein from the main tumor or from satellite nodules, or both, and in eight cases (group D) the findings were the same as in group C but there was no tumor capsule. The mean follow-up period was 54 +/- 12 months, minimum 37 months. The estimated 7-year survival rates in groups A-D were, respectively 100, 47.5, 47.5 and 37.5%. The classification of gross tumor appearance as typical or atypical was fairly well correlated to the histologic pattern in groups A, C and D, but not in group B. Although safety margin at resection did not emerge as a prognostic factor, the group A patients with a good margin were free from tumour recurrence.

Anti-HBc IgM in cases of hepatocellular carcinoma and cirrhosis in Taiwan

The sera of apparently healthy carriers of hepatitis B virus surface antigen enrolled in the Taiwan Prospective Study were tested retrospectively for anti-HBc IgM, to determine whether this test would be useful in predicting the development of hepatocellular carcinoma (HCC) and/or cirrhosis. In comparison with men who did not develop HCC or cirrhosis, the relative risk of those with anti-HBc IgM elevations was 3.4 and 5.6, respectively. Each of these factors was highly statistically significant, although the difference between them was not. Demonstration of anti-HBc IgM titers of greater than 1:1000 in serum probably reflects ongoing low level viral replication but not recent infection. Anti-HBc IgM appears to be a useful prognostic indicator for the future development of HCC and/or cirrhosis.

Surgical treatment of 109 patients with symptomatic and asymptomatic hepatocellular carcinoma

A total of 109 patients with histologically proved hepatocellular carcinoma (HCC) have undergone hepatic resection during the 56-month period from October 1978 to May 1983. There were two sources of patients: those with symptomatic HCC (n = 47) and those with asymptomatic HCC (n = 62). A family tendency of HCC was noted in 11% of the patients studied. The percent of positive hepatitis B surface antigen (HBsAg) was 87%, and the serum alpha-fetoprotein was less than 20 ng/ml in 30% in the group with symptoms. The operative mortality rate was 3% and the hospital mortality rate was also 3%. The postoperative course was complicated with pleural effusion in 10%, bile leakage in 4%, subphrenic abscess in 4%, and upper gastrointestinal bleeding caused by gastritis in 1% of the patients. The actual survival rate for the 103 cases was 84% for 350 days and 28% for 1400 days. However, in the group with asymptomatic HCC with an average tumor size of 3.35 +/- 1.49 cm in diameter, the rate was 92% for 350 days and 44% for 1400 days. In the group with symptomatic HCC with an average tumor size of 10.6 +/- 5.1 cm in diameter, the rate was 76% for 350 days and 8% for 1400 days. The survival rate of the group with asymptomatic HCC was far better than that of the group with symptoms (p less than 0.05). In analysis of factors that might affect the patient's survival, only second or third operations (p less than 0.05), typical gross findings of tumor appearance (p less than 0.05), and an adequate margin were closely related (p less than 0.001). Neither the tumor size, the status of accompanying liver cirrhosis, the tumor location, nor the patient's sex and age affected the patient's survival (all p greater than 0.05).

HBsAG and HBeAG markers among pregnant women in Manila, Philippines

The sera of 5,684 pregnant women were tested for HBsAG and 432 (7.6%) were found positive. Positive HBsAG sera were then tested for the e antigen and of 413 tested, 115 or 27.8% were positive. The over-all prevalence rate of e antigen was 2.03%. All women were asymptomatic. Six of 13 HBsAG-HBeAg-positive mothers delivered infants who became HBsAg-positive within two years of age for a rate of 46%. The findings support earlier studies on the importance of the e antigen as an index of perinatal transmission. Also, they support evidence of unusually high rates of transmission among Asian ethnic groups.

Prognostic histologic features of resected small hepatocellular carcinoma (HCC) in Taiwan. A comparison with resected large HCC

The morphologic features and their prognostic significance were analyzed in 83 surgically resected hepatocellular carcinomas (HCC): 44 of them were of less than or equal to 5 cm in diameter and 39 were larger. This study demonstrated a high prevalence of tumor capsule in both small and large HCCs, 86.4% and 84.6%, respectively. In small HCC, the capsule formation was significantly higher in the liver with cirrhosis (96.9%, or 31/32) than without (58.3%, or 7/12) (P less than 0.003). In both small and large HCCs, the most important histologic parameter influencing the tumor recurrence was the liver invasion. In the small but not in the large HCC, the invasion through the capsule also correlated well with recurrence (P less than 0.05). None of the 19 patients whose HCC were confined by a tumor capsule and did not invade the liver, had a recurrence during the 10 months or longer follow-up period. The significantly more favorable outcome of smaller HCC was related to the lower frequencies of liver invasion (P less than 0.001), portal vein involvement (P less than 0.01), and satellite formation (P less than 0.01). Tumor recurrence did not correlate with the tumor grading, presence of clear cells, liver cell dysplasia, or host inflammatory response. The HBsAg positivity in tumor cells was significantly higher in small (40.9%, or 18/44) than in large HCC (10.3%, or 4/39), suggestive of a gradual loss of the cytoplasmic expression of HBsAg in the tumor cells during the growth of HCC.

Prognostic histologic features of resected small hepatocellular carcinoma (HCC) in Taiwan. A comparison with resected large HCC

The morphologic features and their prognostic significance were analyzed in 83 surgically resected hepatocellular carcinomas (HCC): 44 of them were of less than or equal to 5 cm in diameter and 39 were larger. This study demonstrated a high prevalence of tumor capsule in both small and large HCCs, 86.4% and 84.6%, respectively. In small HCC, the capsule formation was significantly higher in the liver with cirrhosis (96.9%, or 31/32) than without (58.3%, or 7/12) (P less than 0.003). In both small and large HCCs, the most important histologic parameter influencing the tumor recurrence was the liver invasion. In the small but not in the large HCC, the invasion through the capsule also correlated well with recurrence (P less than 0.05). None of the 19 patients whose HCC were confined by a tumor capsule and did not invade the liver, had a recurrence during the 10 months or longer follow-up period. The significantly more favorable outcome of smaller HCC was related to the lower frequencies of liver invasion (P less than 0.001), portal vein involvement (P less than 0.01), and satellite formation (P less than 0.01). Tumor recurrence did not correlate with the tumor grading, presence of clear cells, liver cell dysplasia, or host inflammatory response. The HBsAg positivity in tumor cells was significantly higher in small (40.9%, or 18/44) than in large HCC (10.3%, or 4/39), suggestive of a gradual loss of the cytoplasmic expression of HBsAg in the tumor cells during the growth of HCC.

Antibody response to Epstein-Barr-virus-specific DNase in 13 patients with nasopharyngeal carcinoma in Taiwan: a retrospective study

Serum samples obtained from 13 individuals who were found to have a previous history of or to be suffering from nasopharyngeal carcinoma (NPC) were examined for the presence of antibody to Epstein-Barr virus (EBV) DNase activity. Significant to high levels of antibody to EBV DNase activity were detected in most serum samples obtained from four patients prior to the diagnosis of NPC. The samples from the other nine patients showed variable levels of antibody. The majority of the samples collected at the remission stage of the disease, especially those from long-term survivors, contained little or no antibody to the DNase activity. Data presented here suggest that antibody to EBV DNase activity may be a useful marker for the early diagnosis as well as the prognosis of NPC.

Perinatal transmission of hepatitis B virus: role of maternal HBeAg and anti-HBc IgM

The development of hepatitis B surface antigen (HBsAg) carrier states in newborns of HBsAg-positive mothers was correlated to the presence of anti-HBc IgM and HBeAg in the mothers. There was a positive correlation between infection of the newborn and the presence of HBeAg, as shown previously, but no correlation with anti-HBc IgM.