Knowledge and attitudes regarding clinical trials and willingness to participate among prostate cancer patients

BackgroundEnrollment of minorities in clinical trials remains low. Through a California population-based study of men with early stage prostate cancer, we examined the relationships between race/ethnicity and 1) attitudes, 2) knowledge and 3) willingness to participate in clinical trials.MethodsFrom November 2011–November 2012, we identified all incident cases of prostate cancer in African American, Latino, and Asian American men ages 18–75 years, and a random sample of white men diagnosed in 2008, through the California Cancer Registry, living within 60 miles of a site offering ≥ 1 clinical trial. Participants completed a 30-min telephone interview in English, Spanish, or Chinese. In this cross-sectional population-based study, multivariable logistic regression was used to estimate associations between race/ethnicity and 1) attitudes, 2) knowledge and 3) willingness to participate.ResultsOf 855 participants, 52% were ≥ 65 years, 42% were white, 24% Latino, 19% African American and 15% Asian American. The majority (81%) had medium-to-high health literacy. Compared to non-Latino white men, African American men were less likely to have above average knowledge of clinical trials (OR = 0.55; CI = 0.35–0.86), as were Asian American (OR = 0.55; CI = 0.33–0.93) and Latino men (OR = 0.30; CI = 0.18–0.48). There were no racial/ethnic differences in willingness to participate. The attitude that “researchers are the main beneficiaries” was negatively associated with willingness (OR = 0.63; CI = 0.43–0.93); the attitude that “patients are the main beneficiaries” was positively associated with willingness to participate (OR = 1.57; CI = 1.07–2.29).ConclusionsMen with early stage prostate cancer are willing to take part in clinical trials and this willingness does not vary by race/ethnicity.     

MAPPED study design: A 6 month randomised controlled study to evaluate the effect of dutasteride on prostate cancer volume using magnetic resonance imaging

ObjectiveTo evaluate the percentage change in volume of prostate cancer, as assessed by T2-weighted MRI, following exposure to dutasteride (Avodart) 0.5 mg daily for six months.Patients and methodsMRI in Primary Prostate cancer after Exposure to Dutasteride (MAPPED) is a double-blind, placebo-controlled trial, supported by GlaxoSmithKline (GSK). Men with prostate cancer suitable for active surveillance (low-intermediate risk prostate cancer on biopsy), and a visible lesion on T2-weighted MRI of at least 0.2 cc, were eligible for consideration. Forty-two men were randomised to 6 months of daily dutasteride 0.5 mg or placebo. Multi-parametric MRI (mpMRI) scans were performed at baseline, 3 and 6 months. The percentage changes in cancer volume over time will be compared between the dutasteride and placebo groups. Planned analyses will examine the association between tumour volume and characteristics (perfusion and contrast washout) as seen on mpMRI, HistoScan ultrasound and biopsy histopathology in both groups.DiscussionMAPPED is the first randomised controlled trial to use mpMRI to look at the effect of dutasteride on the volume of prostate cancer. If dutasteride is shown to reduce the volume of prostate cancer, it might be considered as an adjunct for men on active surveillance. Analysis of the placebo arm will allow us to comment on the short-term natural variability of the MR appearance in men who are not receiving any treatment.ConclusionMAPPED will evaluate the short-term effect of dutasteride on prostate cancer volume, as assessed by mpMRI, in men undergoing active surveillance for low or intermediate risk prostate cancer. The study completed recruitment in January 2012.     

The association of Phosphatase and tensin homolog (PTEN) deletion and prostate cancer risk: A meta-analysis

ObjectivePhosphatase and tensin homolog (PTEN) deleted on chromosome 10, a tumor suppressor that negatively regulates the phosphoinositide-3-kinase(PI3 K) which has been implicated in a number of human malignancies including prostate cancer. However the prognostic value of PTEN deletion in prostate cancer patient’s diagnosis and the mechanism of PTEN deletion in prostate cancer development still remain unclear.MethodA meta-analysis of 26 published studies including 8097 prostate cancer patients was performed.ResultsCompared to PTEN normal patients, PTEN deletion patients showed a higher aggressive Gleason score(OR: 1.284, 95%CI = 1.145–1.439) and pathological stage(OR: 1.628, 95%CI = 1.270–2.087) which generally had a higher risk in prostate replace(HR: 1.738, 95%CI = 1.264–2.390). Significant association between PTEN deletion and ERG rearrangements in prostate cancer development was also proved that compared to PTEN normal patients, patients with PTEN deletion showed a higher risk in ERG rearrangements(OR: 1.345, 95%CI = 1.102–1.788).ConclusionThis study indicated that patients with PTEN deletion were associated with higher pathological stage or Gleason score and a higher risk in prostate cancer replace potentially represent a novel clinically relevant event to identify individuals at increased risk for the occurrence, progression and prognosis of prostate cancer. Prostate cancer patients with PTEN deletion usually had a higher risk in ERG rearrangements than other patients may be a potential new area for identifying poor prognosis patients and selecting patients for targeted therapies which required confirmation through adequately designed prospective studies.     

Post-treatment circulating plasma BMP6 mRNA and H3K27 methylation levels discriminate metastatic prostate cancer from localized disease

BackgroundWe evaluated the utility of post-treatment plasma levels of the circulating bone-morphogenetic protein-6-specific mRNA (cBMP6 mRNA), cell-free DNA (cf-DNA), apoptotic nucleosomes and Histone H3 lysine 27 trimethylation (H3K27me3), in discriminating metastatic prostate cancer (PCa) from organ confined, locally controlled disease.MethodsPeripheral blood was taken from the patients at the end of therapy, and quantitative PCR was performed to amplify cBMP6 mRNA or cf-DNA from plasma while apoptotic nucleosomes and H3K27me3 were determined by ELISA-based approaches. Following blinded measurements, the markers were compared between the patients with local (n = 22), local advanced (n = 11) or metastatic disease (n = 28).ResultsOf the four markers investigated, the cBMP6 mRNA and H3K27me3 levels revealed significant differences between the three subgroups. We found higher levels of cBMP6 mRNA in the patients with metastases than in those with localized (p = 0.001) or local advanced disease (p = 0.05). When compared to cBMP6, H3K27me3 displayed an inverse distribution and was significantly lower in the patients with metastatic disease than in those with localized (p = 0.05) or local advanced disease (p = 0.024). There was no correlation between the different markers and total PSA levels or Gleason score at diagnosis.ConclusionOur study provides evidence that post-treatment analysis of cBMP6 mRNA and H3K27me3 may be used to distinguish metastatic PCa from organ confined, locally controlled disease.     

Changes in health-related quality of life may predict recurrent breast cancer

BackgroundPatient-reported outcomes incorporated in cancer clinical trials, are increasingly hypothesized to be predictors of disease-free survival. Previous research supports health-related quality of life (HRQoL) as an independent predictor of survival in patients with advanced or metastatic breast cancer. In contrast, recent studies provide evidence that baseline HRQoL scores are not associated with increased risk of relapse or survival in women with early-stage breast cancer. One plausible assumption might be that baseline HRQoL scores are limited as predictors of a recurrence of breast cancer several years after the initial diagnosis. In this explorative study, we examined whether changes in HRQoL over time may predict breast cancer recurrence. As a supplement, we investigated whether baseline HRQoL predicted recurrence.MethodsThe study sample consisted of 141 participants in the International Breast Cancer Study Group adjuvant Trial 12-93 and Trial 14-93, from the Western region of Sweden. HRQoL was assessed, during a 5-year follow up. Poisson regression analysis was used to estimate the hazard function of recurrence depending on time since primary diagnosis and on HRQoL variables.ResultsAccording to the Poisson multivariable regression analysis changes in physical well-being (β = 0.00439, p-value = 0.0470), and nausea/vomiting (β = ?0.00612, p-value = 0.0136) significantly predicted recurrence. Baseline HRQoL outcomes were not predictors of recurrence.ConclusionsChanges of HRQoL during adjuvant therapy may be associated with recurrence. This explorative finding needs prospective investigation.     

Paraoxonase 1 (PON1) as a marker of short term death in breast cancer recurrence

ObjectiveTo relate paraoxonase (PON1) activity to survival time and short term death in breast cancer recurrence.Design and methodsPON1 activity was measured by its rate of hydrolysis of two different substrates, paraoxon (PON) and phenylacetate (ARE) in 50 patients with recurrence of breast cancer. Results were compared between patients surviving more than one year after the analysis (22) and those who died within one year (28).ResultsIn a logistic regression analysis, ARE was negatively associated with early death (OR = 0.10 [0.02–0.58], p = 0.0109). PON did not reach significance (OR = 0.43 [0.17–1.11], p = 0.0826). In a multiple logistic regression analysis model, ARE was independently associated with early death (OR = 0.12 [0.02–0.98], p = 0.0476), besides interval time between diagnosis and recurrence (OR = 0.54 [0.27–1.07], p = 0.0781) and undernutrition (OR = 3.95 [0.81–19.19], p = 0.0883).ConclusionParaoxonase is a potential marker of survival in patients with breast cancer recurrence.     

Prostate cancer biomarker annexin A3 detected in urines obtained following digital rectal examination presents antigenic variability

ObjectivesAnnexin A3 (ANXA3) is a potential marker for prostate cancer (PCa). We aimed to develop robust immunoassays suitable for quantifying ANXA3 in urine samples obtained following digital rectal examination (DRE) in order to facilitate the diagnostic performance evaluation of this marker.Design and methodsAnti-ANXA3 monoclonal antibodies were generated and their epitopes mapped. Two different ANXA3 assay prototypes were established on the VIDAS® automated immunoanalyser and analytical validation was carried out using post-DRE urine samples obtained from patients with PCa (n = 23) or benign prostate hyperplasia (n = 31).ResultsThe assays had the same capture antibody (TGC44) but different detection antibodies (13A12 or 5C5), recognizing novel distinct epitopes. Both had a lower limit of quantification < 1 ng/mL and were highly specific for ANXA3, not cross-reacting with other annexins. Interassay imprecision was ≤ 11% and ≤ 15% for 13A12 and 5C5 assays, respectively. Surprisingly, a total lack of correlation was observed between ANXA3 levels measured by these two assays in post-DRE urines, indicating detection of distinct antigenic variants. Two freeze–thaw cycles did not affect analyte stability in either assay, whereas a lack of stability of antigenic variants was observed when samples were stored at − 80 °C for 1 month.ConclusionsTwo different antigenic variants of ANXA3 are present in post-DRE urines and their clinical significance for diagnosis of prostate cancer should be further investigated. These variants are not stable over time in samples preserved at − 80 °C. Until this issue is resolved, ANXA3 should only be measured in freshly collected samples.     

Association of sociodemographic factors and prostate-specific antigen (PSA) testing

ObjectivesThere are conflicting recommendations regarding the use of prostate specific antigen (PSA) as a screening test. Integral to this debate is an understanding of who is currently being tested. The purpose of this study was to provide a detailed account of PSA testing practices in a major Canadian city (Calgary, Alberta) and to identify variables that may affect access to the PSA test.Design and methodsPSA test counts were retrieved from Calgary Laboratory Services' Laboratory Information System from January 1, 2011 to December 31, 2011. A total of 75,914 individual PSA tests were included in our analysis. The frequency of PSA testing was plotted onto a dissemination area map of Calgary using ArcGIS software. Associations with sociodemographic variables were tested using Poisson regression.ResultsThe median PSA value was 0.93 μg/L and the median age at collection was 58 years. Forty-three percent of men aged 60–69 received a PSA test. Visible minority status ‘Black’ (P = 0.0002) and Métis status (P = 0.0075) were associated with lower PSA testing frequencies, while median household income (P = < 0.0001) and university education (P = < 0.0001) were associated with higher PSA testing frequencies.ConclusionThere are areas in Calgary which are significantly over or under tested relative to the mean. The amount of PSA testing in men < 50 years of age is increasing, which is contrary to PSA testing guidelines.     

ADD-ASPIRIN: A phase III,double-blind,placebo controlled,randomised trial assessing the effects of aspirin on disease recurrence and survival after primary therapy in common non-metastatic solid tumours

BackgroundThere is a considerable body of pre-clinical, epidemiological and randomised data to support the hypothesis that aspirin has the potential to be an effective adjuvant cancer therapy.MethodsAdd-Aspirin is a phase III, multi-centre, double-blind, placebo-controlled randomised trial with four parallel cohorts. Patients who have undergone potentially curative treatment for breast (n = 3100), colorectal (n = 2600), gastro-oesophageal (n = 2100) or prostate cancer (n = 2120) are registered into four tumour specific cohorts. All cohorts recruit in the United Kingdom, with the breast and gastro-oesophageal cohort also recruiting in India. Eligible participants first undertake an active run-in period where 100 mg aspirin is taken daily for approximately eight weeks. Participants who are able to adhere and tolerate aspirin then undergo a double-blind randomisation and are allocated in a 1:1:1 ratio to either 100 mg aspirin, 300 mg aspirin or a matched placebo to be taken daily for at least five years. Those participants ≥ 75 years old are only randomised to 100 mg aspirin or placebo due to increased toxicity risk.ResultsThe primary outcome measures are invasive disease-free survival for the breast cohort, disease-free survival for the colorectal cohort, overall survival for the gastro-oesophageal cohort, and biochemical recurrence-free survival for the prostate cohort, with a co-primary outcome of overall survival across all cohorts. Secondary outcomes include adherence, toxicity including serious haemorrhage, cardiovascular events and some cohort specific measures.ConclusionsThe Add-Aspirin trial investigates whether regular aspirin use after standard therapy prevents recurrence and prolongs survival in participants with four non-metastatic common solid tumours.     

The association between miR-146a gene rs2910164 polymorphism and gastric cancer risk: A meta-analysis

PurposeStudies have demonstrated that single nucleotide polymorphisms (SNPs) in miRNAs may lead to varying functional outcomes by altering miRNAs expression, even leading to the development of cancers. The association between a single nucleotide polymorphism (SNP) in miR-146a rs2910164 and susceptibility to gastric cancer has been studied during the recent years, but the results are still inconclusive and inconsistent. We performed a meta-analysis to evaluate the relationship between miR-146a rs2910164 polymorphism and the risk of gastric cancer.Materials and methodsThe databases of PubMed, MEDLINE and Web of Science were searched for suitable studies. A total of 8 published case–control studies on miR-146a rs2910164 polymorphism and gastric cancer risk including 4308 cases and 6370 controls were included.ResultsOverall, significant association was observed between rs2910164 and gastric cancer risk in allele model (OR = 1.11, 95% CI = 1.02–1.21); homozygote model (OR = 1.26, 95% CI = 1.10–1.43) and dominant model (OR = 1.21, 95% CI = 1.09–1.34). Stratified analysis by ethnicity showed significant association between rs2910164 polymorphism and gastric cancer susceptibility in Asians (OR = 1.10, 95% CI = 1.00–1.23 for G vs. C; OR = 1.25, 95% CI = 1.09–1.43 for GG vs. CC; OR = 1.19, 95% CI = 1.07–1.33 for GG vs. GC+CC, respectively). When stratified by genotyping methods and sample size, increased gastric cancer risk was only observed with the method by TaqMan and the sample size more than 1000.ConclusionIn summary, this meta-analysis indicated that miR-146a rs2910164 polymorphism was associated with the susceptibility to gastric cancer, especially in Asian population.     

Serum neural precursor cell-expressed,developmentally down regulated 9 (NEDD9) level may have a prognostic role in patients with gastric cancer

BackgroundNeural precursor cell-expressed, developmentally down regulated 9 (NEDD9), a member of Crk-associated substrate (CAS) family, is highly expressed in multiple cancer types and involved in cancer cell adhesion, migration and invasion. The prognostic value of NEDD9 has been evaluated before and its expression is a predictor of poor prognosis in cancer patients. The objective of this study was to determine the clinical significance of the serum levels of NEDD9 in gastric cancer (GC) patients.Patients and methodsA total of 68 patients with a pathologically confirmed diagnosis of GC were enrolled into this study. Serum NEDD9 concentrations were determined by the solid-phase sandwich (ELISA) method. Twenty-eight healthy age- and sex-matched controls were included into the analysis.ResultsThe median age at diagnosis was 60 years, range 21 to 84 years. Forty-nine (72%) patients were male and cardia was the most common tumor localization (n = 37, 77%) in GC patients. The most frequent histologic subtype was adenocarcinoma (n = 45, 66%). Liver was the most common metastatic site in 32 patients with metastasis (n = 14, 44%). Sixty-one percent of 23 metastatic patients who received palliative chemotherapy (CTx) were CTx-responsive. The median follow-up time was 8 months (range 1 to 23 months). At the end of the observation period, 17 patients (25%) experienced disease progression and 28 of the remaining patients (41%) died. Median progression-free survival (PFS) and overall survival (OS) of the whole group were 4.0 ± 0.7 months [95% confidence interval (CI) = 3–5 months] and 14.6 ± 1.2 months (95% CI = 12–17 months), respectively. One-year and 2-year OS rates were 54.4% (95% CI = 41.3–67.5) and 51.2% (95% CI = 37.3–65.1), respectively. The median serum NEDD9 levels of GC patients were significantly higher than controls (1339.51 vs. 1187.91 pg/mL, P = 0.02). There was no significant difference according to known disease-related clinicopathological or laboratory parameters (P > 0.05). Serum NEDD9 levels had a significant impact on PFS (P = 0.04). On the other hand, serum NEDD9 levels showed no significantly adverse effect on OS (P = 0.50).ConclusionSerum NEDD9 level may be a diagnostic marker for GC patients. Moreover, our study results showed that it was elevated in GC patients and had an unfavorable prognostic effect. However, it has no predictive role on CTx response.     

Consistent and Breakthrough Pain in Diverse Advanced Cancer Patients: A Longitudinal Examination

Although cancer pain, both consistent and breakthrough pain ([BTP]; pain flares interrupting well-controlled baseline pain), is common among cancer patients, its prevalence, characteristics, etiology, and impact on health-related quality of life (HRQOL) are poorly understood. This longitudinal study examined the experience and treatment of cancer-related pain over six months, including an evaluation of ethnic differences. Patients with Stage III or IV breast, prostate, colorectal, or lung cancer, or Stage II–IV multiple myeloma with BTP completed surveys on initial assessment and at three and six months. Each survey assessed consistent pain, BTP, depressed affect, active coping ability, and HRQOL. Among the respondents (n = 96), 70% were white, 66% were female, and had a mean age of 56 ± 10 years. Nonwhites reported significantly greater severity for consistent pain at its worst (P = 0.009), least (P ≤ 0.001), on average (P = 0.004), and upon initial assessment (P = 0.04), and greater severity for BTP at its worst (P = 0.03), least (P = 0.02), and at initial assessment (P = 0.008). Women also had higher levels of some BTP measures. Ethnic disparities persisted when data estimation techniques were used. Examined longitudinally, consistent pain on average and several BTP measures reduced over time, although not greatly, indicating the persistence of pain in the cancer experience. These data provide evidence for the significant toll of cancer pain, while demonstrating further health care disparities in the cancer pain experience.     

Interleukin-1β genotype and circulating levels in cancer patients: Metastatic status and pain perception

ObjectivesProinflammatory cytokines released during inflammation can cause hyperexcitability in pain transmission neurons, leading to hyperalgesia and allodynia. Polymorphisms in interleukin 1 (IL-1) family of genes (IL1A, IL1B) and in IL-1 receptor antagonist (IL-1Ra, coded by IL1RN) may therefore induce alterations in cytokine levels/effects and pain related response. Our purpose was to investigate the influence of polymorphisms in IL1A/B/RN on cytokine serum levels and its correlation with pain intensity, performance status, adverse effects, metastases and breakthrough pain in Caucasian cancer patients.Design and methodsSerum IL-1α/β levels of 74 cancer patients were measured by competitive enzyme immunosorbent assay. All patients were also genotyped for the polymorphisms in IL1A (rs17561), IL1B (rs1143634) and IL1RN (rs419598) with Real-Time PCR. Results were then correlated to the appearance of bone or CNS metastases and several pain-related parameters.ResultsIL-1β rs1143634 homozygous for T allele were associated with lower levels of IL1-β (p = 0.032, Mann–Whitney test) and presented a trend for lower levels of pain (p = 0.06, Fisher's Exact Test). Also, IL1-β levels were related with cancer onset status, since a four-fold increase probability of metastatic disease was observed in high IL-1β individuals (OR = 4.074, p = 0.010, Pearson χ² test). Among the female patients presenting metastatic disease and carriers of the TT genotype we observed a trend to lower levels of IL1-β (p = 0.053, Pearson χ² test).ConclusionsOur results indicate that genetic variation at IL1-β gene may influence serum levels of IL1-β, with proportional consequences in cancer-related pain.     

Sperm head defects and disturbances in spermatozoal chromatin and DNA integrities in idiopathic infertile subjects: Association with cigarette smoking

ObjectivesTo evaluate sperm chromatin and DNA integrities in idiopathic infertile men and determine the possible association(s) of cigarette smoking on oxidative stress markers, antioxidant capacity and semen quality.Subjects and methodsSemen samples from men referring to the andrology laboratory were categorized into 3 groups: fertile non-smokers (n = 16), infertile non-smokers (n = 36), and infertile smokers (n = 34). Semen analysis was performed according to WHO criteria. The percentage of sperm DNA fragmentation index (%DFI) and the percentage of sperm with abnormally high DNA stainability (HDS%; immature spermatozoa) were determined by SCSA using the metachromatic properties of acridine orange. Lipid peroxidation, superoxide dismutase (SOD), catalase (CAT) and reduced glutathione (GSH) levels in seminal plasma and spermatozoa were measured by spectrophotometric assays.ResultsThe classical semen parameters were negatively correlated with lipid peroxidation in spermatozoa; motility and morphology were negatively correlated with %DFI (p < 0.05). HDS% was also negatively correlated with above markers except for morphology (r = ? 0.352, p = 0.081). DFI% and HDS% were significantly higher in the infertile smokers group than in infertile non-smokers (p = 0.032; p = 0.001 respectively). Cigarette smoking was significantly associated with DFI%, HDS%, TBARS and the fraction of “round-headed” sperm (r = 0.796, p = 0.0001; r = 0.371, p = 0.033; r = 0.606, r = 0.591, p = 0.001 respectively), and decreased SOD levels (r = ? 0.545).ConclusionDFI%, HDS% and round-head sperms are increased in idiopathic infertile men; this increase is associated with cigarette smoking. These defects may be attributed to increased oxidative stress and insufficient scavenging antioxidant enzymes in the seminal fluid of infertile patients.     

Three-year variability in plasma concentrations of the soluble receptor for advanced glycation end products (sRAGE)

ObjectivesThe soluble receptor for advanced glycation end products (sRAGE) has been implicated in the development of diabetes-related vascular complications, but the variability of concentrations of sRAGE in the blood is unknown. The objective of this study was to characterize within-person three-year variability of plasma levels of sRAGE.Design and methodsWe measured sRAGE in plasma samples from 179 men and women in the community-based Atherosclerosis Risk in Communities (ARIC) Study at two time points, three years apart. We calculated correlation coefficients and the within-person coefficient of variation (CV_w) to characterize variability in sRAGE. We compared these estimates to total cholesterol and white blood cell count (WBC) in the same participants.ResultsMean sRAGE concentrations at the two time points (mean time between measurements = 2.9 years) were 1096.2 pg/mL and 990.2 pg/mL, respectively (mean difference = − 106.0 pg/mL, p-value < 0.001). The Pearson's correlation was 0.78 (Spearman's, 0.73). The intra-class correlation coefficient was 0.76 and the CV_w was 26.6%. Compared to sRAGE, Pearson's and Spearman's correlations for total cholesterol (0.76 and 0.77) and white blood cell count (0.61 and 0.72) were similar, although CV_w for both was lower (8.7% for cholesterol, 15.6% for WBC). Less than 4% of participants' values changed substantially (50% or greater) over the three-year interval.ConclusionsWe observed that sRAGE concentrations remained relatively stable over three years. Our findings suggest that a single measure of circulating sRAGE tracks well in a community-based population and could be a useful measure in clinical and epidemiologic studies of long-term risk.     

Elevated ammonia concentrations: Potential for pre-analytical and analytical contributing factors

BackgroundNo study has explored the separate contributions of pre-analytical and analytical factors to hyperammonemia.MethodsLaboratory information systems were queried for tests of ammonia concentrations over a 12 month period. Pre-analytic (collection to laboratory receipt) and analytic (laboratory receipt to result) elapsed times were determined.ResultsUnder routine conditions for 3626 tests, normal and elevated results were similarly distributed if the time from venipuncture to result was < 120 min. Delays, during analysis performance and in transportation to the laboratory, potentially contributed to hyperammonemia in a small number of samples (n = 96, 2.7%). Similar results were obtained from a second hospital with a separate laboratory.ConclusionsDelays, in either transportation to the laboratory after collection or before completion of analysis, have the potential to elevate ammonia concentrations and may cause pseudo-hyperammonemia. Unexpectedly elevated ammonia concentrations need to be evaluated for errors in sampling handling.     

Effect of patient sex on triage for ischaemic heart disease and treatment onset times: A retrospective analysis of Australian emergency department data

Time between emergency department (ED) presentation and treatment onset is an important, but little-researched phase within the revascularization process for ischaemic heart disease (IHD).ObjectiveTo determine if sex influences triage score allocation and treatment onset for patients with IHD in the ED.MethodsRetrospective data for patients 18–85 years presenting to EDs from 2005 to 2010 for acute myocardial infarction (AMI), unstable and stable angina, and chest pain were analysed collectively and separately for AMI.ResultsProportionately more men (61% of males) were triaged correctly for AMI than women (51.4% of females; P < 0.001). Across all triage categories, average treatment time was faster for men than women with AMI (P < 0.001). When incorrectly triaged for AMI, treatment time for men was faster than for women (P = 0.04). When correctly triaged for AMI, there was no difference in mean treatment time between men and women (P = 0.538).ConclusionsSubstantial undertriage of AMI occurred for both sexes, but was worse in women. Incorrect triage led to prolonged treatment times for AMI, with women’s treatment delays longer than men’s. When triaged correctly, both sexes were treated early for AMI, emphasising the need for all patients to be accurately triaged for this time-sensitive disease.     

Risk factors for endometrial cancer in Turkish women: Results from a hospital-based case–control study

Purpose of the researchThe aim of this study was to investigate the association between risk factors and endometrial cancer in Turkish women.Methods and sampleIn a hospital-based case-control study conducted in ?stanbul, 285 patients with histologically confirmed endometrial cancer were compared with 1050 controls, admitted to the different departments of the same hospital. Odds ratios (OR) and 95% confidence intervals (CI) were obtained from multivariate logistic regression analysis, fitted by the method of maximum likelihood.Key resultsRisk factors for endometrial cancer were found to be the state of lower education (OR = 2.53, 5% CI: 1.41–4.54), history of hypertension or diabetes (OR = 3.26, 95% CI: 2.21–4.80), (OR = 3.56, 95% CI: 2.02–6.27), lower parity (OR = 3.89, 95% CI: 2.60–5.82), early menarche age (OR = 9.43, 95% CI: 5.35–16.62) and HRT use (OR = 2.66, 5% CI: 1.40–5.06).ConclusionsIn conclusion, our results are supportive of the hypothesis that having a history of chronic disease, lower parity, early menarche and use of HRT were increased-risk factors but negative family history of cancer was decreased-risk factor for endometrial cancer.