Microalbuminuria prevalence study in hypertensive type 2 diabetic patients in Malaysia

Microalbuminuria is the earliest indicator of diabetic kidney disease and generalised vascular endothelial dysfunction. The Microalbuminuria Prevalence (MAP) Study was carried out to assess the prevalence of macroalbuminuria, microalbuminuria and normoalbuminuria in Asian hypertensive patients with type 2 diabetes on usual care. This paper presents a subanalysis of data from patients in Malaysia. In 733 analysed patients, the prevalence of macroalbuminuria and microalbuminuria was 15.7% and 39.7%, respectively. The high prevalence of diabetic nephropathy in these high-risk patients is a cause for concern, and the Malaysian Health Care system should be prepared for a pandemic of end-stage renal disease due to diabetic nephropathy.     

Therapeutic radiation physics primer

Therapeutic radiological physics is the branch of physics as applied to radiation therapy. Therapeutic radiological physics involves the understanding of the radiation sources, types, and characteristics of radiation, interaction of radiation with matter, and thereafter the deposition of energy in matter. In clinical practice, therapeutic radiological physics deals with the technical tasks of preparing a patient to undergo radiation therapy. These tasks include simulation, patient data acquisition, individualized planning, verification, and dose delivery. The role of a therapeutic radiological physicist is to manage the technical aspects of patient care: providing technical expertise to the development of the institution, recommending and introducing new treatment techniques, and ensuring that all patients undergoing radiation therapy receive the best standard of care.     

A cohort study of incident myopia in Singaporean children

PURPOSE: To determine the risk factors of incident myopia in a school-based cohort study in Singaporean children. METHODS: A 3-year prospective cohort study was conducted in Singaporean school children aged 7 to 9 years in three schools at entry. Chinese children without myopia at baseline (n = 994) were included in the analysis. The main outcome was incident myopia, defined as spherical equivalent (SE) at least -0.75 D based on cycloplegic autorefraction. Other definitions of incident myopia, at least -0.5 D and at least -1.0 D, were also assessed. RESULTS: After controlling for school, age, gender, income, reading in books per week and intelligence quotient (IQ) test scores, we found the relative risk (RR) of incident myopia defined as -0.75 D to be 1.55 (95% confidence interval [CI] 1.18-2.04) for two versus no myopic parents. The multivariate RR of myopia for IQ in the third versus first tertile was 1.50 (95% CI, 1.19-1.89). However, the RR of incident myopia was 1.01 (95% CI, 0.97-1.05) for every unit increase in books read per week. Similar results were obtained with definitions of -0.5 and -1.0 D for incident myopia. CONCLUSIONS: These data provide new prospective evidence of essential links between parental myopia, IQ scores and subsequent myopia development. However, reading in books per week was not associated with incident myopia.     

Longitudinal study of anisometropia in Singaporean school children

PURPOSE: The purpose of this study was to document the incidence rates of anisometropia, year-by-year prevalences, changes in the intereye difference in spherical equivalent (SE), and its association with myopia progression and axial length changes in a cohort of Singaporean school children. METHODS: This is a prospective cohort study of Singaporean school children (n = 1979) aged 7 to 9 years who were examined annually with cycloplegic refraction and ultrasonography over a 3-year period. RESULTS: In the 1908 children without anisometropia at commencement, the 3-year cumulative incidence rate of anisometropia (difference in SE at least 1.0 D) was 144 (7.55%; 95% CI: 6.42-8.85). The mean intereye difference in SE in all children at baseline was 0.29 +/- 0.46 D (SD: 0.46) and increased to 0.44 D (0.59) on the last examination. On the initial examination, 3.6% (95% CI: 2.8-4.4) or 71 children had anisometropia. Of the 59 of 71 children who completed all examinations, only 3 (5.1%) had an increase in the intereye difference in SE by at least 0.5 D, whereas 2 (3.4%) had a decrease of at least 0.5D. The mean intereye difference in SE was stable between visits. The change in intereye difference in SE correlated with the change in intereye axial length (r = 0.43). Compared with the isometropic children, each eye of the anisometropic children had a higher rate of progression of myopia. CONCLUSIONS: The 3-year incidence of anisometropia was 7.55% in these young Singaporean children. Although the frequency of anisometropia increased with time, the difference in SE between eyes tended to remain stable.     

Associations between small intestine cancer and other primary cancers: an international population-based study

Cancer of the small intestine is a rare neoplasm, and its etiology remains poorly understood. Analysis of other primary cancers in individuals with small intestine cancer may help elucidate the causes of this neoplasm and the underlying mechanisms. We included 10,946 cases of first primary small intestine cancer from 13 cancer registries in a pooled analysis. The observed numbers of 44 types of second primary cancer were compared to the expected numbers derived from the age-, gender- and calendar period-specific cancer incidence rates in each registry. We also calculated the standardized incidence ratios (SIR) for small intestine cancer as a second primary after other cancers. There was a 68% overall increase in the risk of a new primary cancer after small intestine carcinoma (SIR = 1.68, 95% confidence interval [CI] = 1.47-1.71), that remained constant over time. The overall SIR was 1.18 (95% CI = 1.05-1.32) after carcinoid, 1.29 (1.01-1.63) after sarcoma, and 1.27 (0.78-1.94) after lymphoma. Significant (p < 0.05) increases were observed for cancers of the oropharynx, colon, rectum, ampulla of Vater, pancreas, corpus uteri, ovary, prostate, kidney, thyroid gland, skin and soft tissue sarcomas. Small intestine cancer as a second primary was increased significantly after all these cancers, except after oropharyngeal and kidney cancers. Although some of the excess may be attributable to overdiagnosis, it is plausible that most additional cases of second primary cancers were clinically relevant and were due to common genetic (e.g., defects in mismatch or other DNA repair pathways) and environmental (e.g., dietary) factors.     

Selective targeting of antitumor immune responses with engineered live-attenuated Listeria monocytogenes

Improved immunization and ex vivo T-cell culture strategies can generate larger numbers and more potent tumor-specific effector cells than previously possible. Nonetheless, the capacity of these cells to eliminate established tumors is limited by their ability to efficiently enter tumor-bearing organs and mediate their effector function. In the current study, we show that the administration of an engineered organ-homing microbe selectively targets tumor-specific immune responses to metastases within that organ. Specifically, an attenuated Listeria monocytogenes strain, which preferentially infects the liver following systemic administration, dramatically enhances the activity of a cancer vaccine against liver metastases but not metastases in the lung. This enhanced activity results from both local recruitment of innate immune effectors as well as concentration and increased activation of vaccine-induced antitumor T cells within the liver. These findings show a general approach to focus systemic cancer immunotherapies to specific organs bearing tumor metastases by taking advantage of differential tropisms and the proinflammatory nature of microbes.     

Scrutiny of the glutamine-fructose-6-phosphate transaminase 1 (GFPT1) locus reveals conserved haplotype block structure not associated with diabetic nephropathy

Glutamine-fructose-6-phosphate transaminase 1 (GFAT) is the rate-limiting enzyme of the hexosamine pathway that has been implicated in the pathogenesis of diabetic nephropathy. As such, we hypothesized that GFPT1, which encodes for GFAT, may confer genetic susceptibility to this complication among Caucasians. Screening of all known functional regions of GFPT1 revealed six single nucleotide polymorphisms (SNPs) that were located in the promoter, introns, and 3' untranslated region. The approximately 60 kb GFPT1 locus was encompassed in a single conserved haplotype block, and two tagging SNPs were sufficient to capture >90% of the haplotype diversity. Analysis of these SNPs in a case-control study made up of type 1 diabetic subjects (324 case subjects with diabetic nephropathy and 289 control subjects with normoalbuminuria despite >15 years of diabetes) revealed no significant association even after stratification by sex, diabetes duration, glucose control, and blood pressure. Similar results were obtained among type 2 diabetic subjects (202 case and 114 control subjects). Genetic variation in GFPT1 is thus unlikely to have a major impact on susceptibility to diabetic nephropathy.