Frequency of hereditary nonpolyposis colorectal cancer in southern Alberta

The frequency of hereditary nonpolyposis colorectal cancer was evaluated in a group of colorectal cancer patients under age 50 diagnosed in southern Alberta between 1973 and 1987. Families were identified as positive for this syndrome if three-first-degree relatives in the kindred had colorectal cancer. Of the 390 patients with adenocarcinoma, 318 patients participated. The frequency of hereditary nonpolyposis colorectal cancer was 3.1% (12 families) in this group (Ci₉₅ 1.6–5.3%). Clinical characteristics reported on from the index patients include tumor location, Dukes stage at presentation, frequency of synchronous and metachronous tumors, frequency of second primaries, and survival. The 5- and 10-year actuarial survival was 86% and 69%, respectively.This work was supported by grants from Alberta Cancer Board and Foothills Hospital Foundation.Presented in part at the annual American Gastroenterological Association meeting (1990).     

What cause of mortality can we predict by cholesterol screening in the Japanese general population?

OBJECTIVE: In a population with a markedly lower coronary mortality such as in Japan, the benefit of cholesterol screening may be different from Western populations. We attempted to assess the importance of cholesterol screening in Japan. DESIGN: A 13.2-year cohort study for cause-specific mortality. SETTING: Three hundred randomly selected districts throughout Japan in which the National Survey on Circulatory Disorders 1980 was performed. SUBJECTS: A total of 9216 community dwelling persons aged 30 years and over, with standardized serum cholesterol measurement and without a past history of cardiovascular disease. RESULTS: There were 1206 deaths, which included 462 deaths due to cardiovascular disease with 79 coronary heart diseases. Hypercholesterolemia (>6.21 mmol L-1) showed a significant positive relation to coronary mortality (relative risk; 2.93, 95% confidence interval; 1.52-5.63) but not to stroke. Although hypocholesterolemia (<4.14 mmol L-1) was significantly associated with an increased risk of liver cancer, noncardiovascular, noncancer disease and all-cause mortality, these associations, except for liver cancer, disappeared after excluding deaths in the first 5 years of the follow-up. The multivariate adjusted attributable risk of hypercholesterolaemia for coronary disease was 0.98 per 1000 person-years, which was threefold higher than that of hypocholesterolemia for liver cancer: 0.32 per 1000 person-years. The attributable risk percentage of hypercholesterolaemia was 66% for coronary heart disease. CONCLUSION: Similar to Western populations, it is recommended to provide screening for hypercholesterolaemia in Japan, especially for males, although its attributable risk for coronary disease might be small.     

The creation of a large UK-based multicentre cohort of HIV-infected individuals: The UK Collaborative HIV Cohort (UK CHIC) Study

Objectives

This paper describes the development of the UK Collaborative HIV Cohort (CHIC) Study. The aim of the study is to collate routinely collected data on HIV‐infected individuals attending one of seven clinical centres in the UK since 1 January 1996, with the objectives of describing changes over time in the frequency of AIDS‐defining illnesses, describing the uptake of and response to highly active antiretroviral therapy (HAART), and identifying factors associated with virological and immunological responses to HAART.

Methods

By December 2002, demographic, clinical and laboratory data had been collected on HIV‐positive patients seen at six of the seven HIV centres. Missing and inconsistent data had been investigated and the datasets audited. Records identified as relating to the same patient had been merged, and cross‐checks made with UK death registers to improve the accuracy of death reporting.

Results

The cohort currently contains information on 13 833 individuals. Eighty‐two per cent of the cohort are male, and the median age was 34 years at first follow‐up. The main risk factors for HIV infection have been determined as sex between men (63%) and sex between men and women (24%). Twenty‐five per cent of the cohort are known to have developed AIDS, and 8% have died.

Conclusions

The UK CHIC Study provides important information on the status of individuals infected with HIV in the UK, and provides a means to study the response to HAART and to monitor changes in the clinical event and death rates that have occurred since the introduction of HAART in the UK.

     

Investigation of Genetically Mediated Child Effects on Maltreatment

Theory and empirical evidence suggest that children’s genetically influenced characteristics help to shape the environments they experience, including the parenting they ‘receive’. The extent of these genetically-mediated child effects on childhood maltreatment is not well known. The present study estimates the magnitude of genetically mediated child effects on maltreatment in 3,297 twins and siblings who were part of a large nationally representative sample of adolescents (ADD health). Participants in early adulthood retrospectively reported their experiences of physical and sexual maltreatment and neglect. Results are consistent with small genetically-mediated child effects on physical maltreatment and neglect, and none on sexual maltreatment, and all three forms of maltreatment are influenced mainly by idiosyncratic individual circumstances. Edited by Deborah Finkel.     

Longitudinal trends of total and allergen-specific IgE throughout childhood

Background:  The development and the quantitative relationship between allergen-specific IgE (S-IgE) responses and total IgE (T-IgE), during childhood and adolescence have not been described and understood in detail. The objective of this study was to describe and compare the longitudinal trends of serum levels of S-IgE and T-IgE during childhood.
Methods:  We analysed data from participants in the MAS birth cohort study at 2, 5, 7 and 10 years of age ( n  = 273) and at 1, 3, 5, 6, 7, 10 and 13 years ( n  = 84). Total-IgE and the overall level of specific-IgE against nine locally relevant airborne and food allergens were determined by FEIA (ImmunoCAP). Allergic rhino-conjunctivitis and asthma were ascertained by questionnaires.
Results:  Longitudinal patterns of T-IgE levels from age 1 to 13 years were highly heterogeneous (declining, flat or increasing with different profiles). From 5 years of age, logarithmic (log₁₀) transformed values of T-IgE and of S-IgE levels tend to follow a parallel trend, so that their relation remained constant throughout school age. A flat trend of T-IgE vs a constantly increasing trend of T-IgE was associated with a low or, respectively, high rate of wheezing at 13 years of age.
Conclusions:  Beginning at the age of 5 years, total serum IgE levels in children from an industrialized country evolved in parallel with overall S-IgE levels. Therefore, variations in T-IgE levels at school age closely reflect variations in overall S-IgE levels. Further studies are required to strengthen the biological and clinical implication of this novel finding.     

Insomnia and long sleep duration are risk factors for later work disability. The Hordaland Health Study

Both insomnia and sleep duration have previously been linked with a range of adverse outcomes, but no studies have explored their relative effect on subsequent work disability. The aim of the present study was to investigate the contribution of insomnia versus sleep duration to later long-term work disability. Using a historical cohort design with 4-year follow-up, data on insomnia, sleep duration and potential confounders were gathered from 6599 working persons (40–45 years). The outcome was award of disability pension, as registered in the National Insurance Administration. After controlling for baseline exposure to disability and sick leave, insomnia was a strong predictor of permanent work disability [odds ratio (OR) = 4.56], and this effect remained significant after controlling for sleep duration, as well as for other possible confounders (OR = 1.88). Short sleep duration was not significantly associated with subsequent work disability, while long sleep duration (>8.5 h) did predict work disability (OR = 2.96), also in the fully adjusted model (OR = 2.14).The present study demonstrates that both insomnia and long sleep duration are strong and independent risk factors for subsequent work disability.     

生物反馈结合线索暴露治疗降低海洛因依赖者药物线索反应

目的:了解生物反馈结合线索暴露治疗是否降低海洛因依赖者环境线索诱发渴求及心理生理反应.方法:采用前瞻性的队列研究将60例环境线索诱发心理渴求增高的康复期海洛因依赖者分成实验组(n=36)与对照组(n=24),对照组只进行劳教场所的常规帮教,实验组除帮教外进行12次生物反馈结合线索暴露治疗,评估治疗前后环境线索诱发心理渴求与心理生理反应情况.结果:两组治疗结束后,实验组环境诱发前、后的心理渴求,肌电和皮导得分均低于对照组[诱发前:心理渴求(3.06±7.26)mm vs.(22.32±20.26)mm、肌电(8.52±4.23)μV vs.(12.06±5.17)μV、皮导(2.14±1.43)μS vs.(4.61±2.24)μS;诱发后:心理渴求(6.97±10.30)vs.(33.14±25.40)mm、肌电(8.72±4.31)vs.(14.79±5.86)μV、皮导(2.15±1.33)vs.(4.49±2.59)μS,P≤0.01].结论:生物反馈结合线索暴露治疗可降低康复期海洛因依赖者渴求及环境诱发心理生理反应.     

中职学生自我概念、社会支持与心身症状的关系

目的探讨中职学生自我概念、社会支持与心身症状间的关系。方法采用自我概念描述问卷和自编的中职学生社会支持评定问卷测查2012名中职学生（男972人,女1040人）。结果自我概念的各因子与社会支持的各因子、症状总均分间存在一定的相关;自我概念的非学业自我与一般自我、社会支持的主观支持、支持利用度只能解释中职学生的心理健康状况的22%的变异。结论自我概念和社会支持对中职学生的心理健康均产生影响。     

Management of extreme carpal tunnel syndrome: Evidence from a long‐term follow‐up study

Extreme carpal tunnel syndrome (CTS) is characterized by severe thenar atrophy, plegia of the abductor pollicis brevis (APB), fixed sensory deficit in the median nerve distribution, and absence of median motor and sensory responses on electrophysiological examination. In this study we report long‐term follow‐up of 37 patients with extreme CTS. Of the 24 patients with idiopathic extreme CTS, 9 were untreated, and 3 received conservative treatment. At follow‐up, none of these patients showed objective or electrophysiological improvement, and all but 1 still reported positive symptoms. Conversely, 12 patients (14 hands) who underwent carpal tunnel release showed: resolution of positive symptoms in all but 1 hand; reappearance of median compound muscle action potentials (4.2 ± 0.6 mV); reappearance of sensory nerve action potentials in all but 1 (7.9 ± 0.8 μV); improvement of APB strength to grade 4 or 5 on the Medical Research Council scale in 11 hands; and resolution of hypesthesia in 1 hand. Six of 13 patients with non‐idiopathic extreme CTS were operated. Of the 6, we found no or poor reinnervation in 3 patients, restoration of nerve responses and normal APB strength but no relief from pain and/or paresthesia in 2, and full recovery in 1. If untreated, extreme CTS is an irreversible condition. Although the outcome is considered to be disappointing in such cases, carpal tunnel release provides long‐term relief, significant sensorimotor reinnervation, and improvement of motor deficit in most patients. It should be considered to be the first‐choice treatment for idiopathic extreme CTS. Associated diseases do not necessarily imply a poor surgical outcome. Muscle Nerve, 2009     

Electrophysiology in chronic inflammatory demyelinating polyneuropathy with IGIV

Patients with chronic inflammatory demyelinating polyneuropathy (CIDP) received immune globulin intravenous, 10% caprylate/chromatography purified (IGIV‐C, Gamunex; n = 59) or placebo (n = 58) every 3 weeks for up to 24 weeks (first period) in a randomized, double‐blind, parallel‐group, response‐conditional, crossover study. Motor and sensory nerves were assessed at baseline and endpoint/week 24. A nonsignificant trend toward improvement in the proximal amplitude of the most severely affected motor nerve was observed with IGIV‐C (0.69 ± 1.86 mV) versus placebo (0.47 ± 2.29 mV), and a greater improvement of 1.08 ± 2.15 mV with IGIV‐C versus 0.46 ± 2.03 mV with placebo (P = 0.089) was observed with exclusion of data from Erb's point stimulation. Greater improvements from baseline favoring IGIV‐C were observed for 127/142 electrophysiologic parameters. The averaged motor amplitudes from all motor nerves significantly improved with IGIV‐C versus placebo [treatment difference, 0.62 mV; 95% confidence interval (CI), 0.05, 1.20; P = 0.035], and conduction block decreased significantly (treatment difference, ?5.54%; 95% CI, ?10.43, ?0.64; P = 0.027), particularly in the lower limbs. Overall, the data suggest that IGIV‐C improves electrophysiologic parameters in CIDP. Muscle Nerve, 2009