Melanoma risk assessment based on relatives’ age at diagnosis

Purpose

The aim of this study was to determine risk for melanoma among individuals who have a first- or second-degree relative with a history of melanoma, based on the unaffected individual’s age and age at diagnosis of the relative.

Methods

The study employed a case–control design using a statewide database linked with a Surveillance Epidemiology and End Results cancer registry. A population-based sample of individuals who received at least one diagnosis of first primary, malignant melanoma (n?=?14,281), as well as their first- and second-degree relatives, was included. Control individuals with no history of melanoma (n?=?70,889) were matched to cases on birth year, gender, race/ethnicity, and county at birth.

Results

Risk for melanoma among relatives of melanoma patients declined with relative’s age and age at diagnosis. Individuals between ages 40 and 49 who are first-degree relatives of melanoma patients diagnosed between ages 40 and 49 had the greatest risk for melanoma compared with individuals without a first-degree relative with a melanoma history (HR 4.89; 95% CI 3.11–7.68). Increased melanoma risk among second-degree relatives of patients was typically lower than that for first-degree relatives.

Conclusions

Risk for melanoma, at earlier ages than expected, is increased among relatives of individuals with a history of melanoma, particularly if the melanoma case was diagnosed at a young age. Further research on the relationship between age at diagnosis and relative’s melanoma risk could inform melanoma screening recommendations for individuals with a family history of the disease.

     

Success in Mating: A Coordinated Approach to Fitness Through Genotypes Incorporating Genes for Stress Resistance and Heterozygous Advantage Under Stress

Natural populations are normally exposed to substantial environmental stress. In these circumstances, an association occurs between success in mating and extremes of sexual ornaments, rapid development, long life span, and low fluctuating morphological asymmetry. This association between important fitness traits depends on high metabolic efficiency underlain by genes for stress resistance and heterozygous advantage. In particular, the high energy demands from the development and maintenance of sexual ornaments imply that the good genes favored in the sexual selection process should be stress resistant. However, the generalized heterozygous advantage under stress suggests that many interacting genes are involved in promoting metabolic efficiency, so that the good genes approach should be replaced by a good genotypes approach. This good genotype approach has predictive power for incorporating additional fitness traits, especially where metabolic consequences can be perceived.     

A prospective comparison of the costs of reusable and limited-reuse laparoscopic instruments

Objective

To compare the cost and performance of 2 types of laparoscopic instrumentation: reusable laparoscopic hook cautery instruments and curved scissors, or limited-reuse laparoscopic hook cautery instruments and curved scissors.

Design

A randomized trial.

Setting

The operating room of a tertiary care hospital.

Method

All general surgeons performing laparoscopic procedures at the hospital were randomized to be supplied with either reusable or limited-reuse hook cautery and curved scissors. Instrument use was recorded, together with principal outcome measures.

Outcome measures

Life expectancy of the instruments, the number of cases for which they were used, the number, nature and cost of repairs, their purchase cost and surgeon satisfaction.

Results

Reusable hook cautery instruments were less expensive than their limited-reuse counterparts. Excellent surgeon satisfaction was reported with the use of this type of instrument. The limited-reuse curved scissors arm of the study was terminated early because of a breach in study protocol.

Conclusions

Reusable hook cautery instruments were better than their limited-reuse counterparts. Rigorous attempts to compare the cost of laparoscopic instruments may be limited by their rapid evolution in design and the availability of many types of instruments on the market.     

Transurethral microwave thermotherapy in the treatment of benign prostatic hyperplasia: results obtained with the Urologix T3 device

The objective of this study was to assess the efficacy and safety of a new transurethral microwave thermotherapy device, T3, in the treatment of symptomatic benign prostatic hyperplasia. A total of 155 patients were recruited at 3 sites and treated using an identical protocol. The mean AUA symptom score decreased by 58% at 12 months, by 61% at 24 months and by 56% at 36 months. The increase in mean peak flow rates at these time points was 3.9 (47%), 3.4 (44%) and 5.1 ml/s (67%), respectively. Adverse events were minor and the patients' satisfaction with treatment was high. Transurethral microwave thermotherapy with the T3 device provides a safe, effective treatment for symptomatic benign prostatic hyperplasia.     

Cost of health care: impact on poor elders in America

Despite the enormity of the challenges encountered in providing health care, Tennessee ranks near the top nationally for receiving federal and state money spent on caring for elderly and disabled persons in their own homes according to the Tennessee Health Care Association. Citizens and health care professionals are in a unique position to share the advantages of keeping the persons in their homes for as long as possible from both a personal and fiscal standpoint.     

Hospital CEOs, CFOs, and nurse executives: opportunities for a new alliance

This article examines the involvement of Utah acute care hospital nurse executives (NEs) in financial management roles. The authors surveyed NEs and their career supporters and hinderers. Findings suggest that NFs: 1. lack financial management skills, support, involvement, and satisfaction; 2. recognize financial management's importance and desire to improve performance; and 3. consider chief executive officers (CEOs) as their major supporters and chief financial officers (CFOs) their major hinderers in financial management. These "supporters" and "hinderers" of NEs showed consensus regarding the primacy of NEs' leadership and patient advocacy roles. These findings contrast with major professional association policy directives and expert opinions that advocate expanded financial management roles for NEs that will enable them to fully realize their executive potential. CEOs are positioned to establish norms that balance the traditional leadership-patient advocacy roles of NEs with newer financial management roles. CEOs can offer NEs and CFOs opportunities to improve NEs' financial management participation and performance. CEOs can provide empowerment and encourage CFOs to offer NEs "power tools" (for example, information, expertise, resources, and support). The three groups, however, must negotiate reasonable expectations for NEs in financial management and adequate preparation for these consequent responsibilities. Together, CEOs, CFOs, and NEs can successfully take hospitals into the future by leading them in ongoing learning and change.     

Leishmania gp63 molecule implicated in cellular adhesion lacks an Arg-Gly-Asp sequence

The parasitic protozoa Leishmania are intracellular pathogens which enter host cells through largely undefined mechanisms. One molecule thought to play an important role in this process is gp63, the major glycoprotein on the surface of the infective promastigote form. We have cloned and analyzed the gp63 gene from Leishmania chagasi, an etiologic agent of acute visceral leishmaniasis. The predicted amino acid sequence is highly homologous to that reported for Leishmania major, with the exception of a 56-amino-acid region. This region in L. major was predicted to contain an arginine-glycine-aspartic acid (RGD) sequence that was subsequently hypothesized to be involved in binding to the host cell. The L. chagasi gene lacks this sequence or indeed any RGD sequence, and further studies failed to confirm the existence of an RGD sequence in the L. major gp63 gene. Binding to the host cell surface must therefore be mediated by other sequences in gp63 or by other components of the Leishmania promastigote.     

Ligament Mechanics During Three Degree-of-Freedom Motion at the Acromioclavicular Joint

The development of effective treatment and reconstruction procedures for injuries to the soft tissues around the acromioclavicular (AC) joint relies on a comprehensive understanding of overall joint function. The objective of this study was to determine the magnitude and direction of the in situ forces in the AC capsular and coracoclavicular ligaments as well as the resulting joint kinematics during application of three external loading conditions while allowing three degree-of-freedom joint motion. A robotic/universal force-moment sensor testing system was utilized to determine the in situ forces in the soft tissue structures and the resulting joint kinematics. The clavicle translated 5.1±2.0, 5.6±2.2, and 4.2±1.9 mm during application of a 70 N load in the anterior, posterior, and superior directions, respectively, representing almost a 50% increase over previous studies using similar load magnitudes. In response to an anterior load, the magnitude of in situ force in the superior AC ligament (35±18 N) was found to be greater (p<0.05) than the force in the trapezoid and conoid ligaments. In contrast, the magnitude of in situ force in the conoid (49±22 N) was significantly greater (p<0.05) than all other ligaments in response to a superior load. Additionally, the directions of the force vector representing the conoid and trapezoid were different, being located in opposing quadrants of the posterior axis of the scapula with this loading condition. Our data suggest that the kinematic constraints placed on the AC joint during loading affect the resulting joint motion and that the magnitude and direction of force in each ligament are affected by the coupled motions that occur. Based on the differences in magnitude and direction of the in situ force in the coracoclavicular ligaments with each loading condition, surgical procedures should reconstruct these ligaments in a more anatomical manner or treat them separately to prevent joint degeneration. © 2000 Biomedical Engineering Society. PAC00: 8719Rr, 8719Ff, 8719St, 8780Rb