The role of complete surgical resection in stage IV neuroblastoma

The purpose of this study was to examine the outcome of attempted radical surgical resection in patients with stage IV neuroblastoma. Between 1989 and 2003, 20 (median age 2.4 years, range 0.5–8.7 years) children with stage IV neuroblastoma were treated at the Department of Pediatrics. Surgery was performed in 7 consecutive children (6 male and 1 female) between July 1997 and February 2002 at the Department of Urology in Bonn. Mean age at diagnosis was 57 months (21–104 months). Mean age at the time of surgery was 54 months (8–390 months). Follow-up was available for all patients (100%) and mean follow-up after the operation was 32.5 months (4–56 months). Primary localization of the tumor was retroperitoneal in all cases; 4 out of 7 patients (57%) also had additional adrenal, 3 out of 7 (42%) paraganglion and 1 out of 7 (14%) thoracic primaries. Bone marrow and lymph node metastases were found in all patients (100%). Surgery led to complete tumor resection in 6 out of 7 patients (85%). Surgical approach was abdominal (chevron incision) in 6 out of 7 (85%) of the patients, in one patient the approach was thoraco-abdominal. After induction chemotherapy and delayed surgery, 6 out of 7 (86%) patients showed a complete remission (CR) and the mean CR lasted for about 27.7 months (range 3.1–55.4 months). At the last time of follow-up 5 out of 7 (71%) patients were alive, 2 had died due to recurrent disease. Mean time to recurrent disease was 24 and 51 months, respectively. Mean overall survival time since diagnosis was 38.3 months (11–64 months) and mean event-free survival was 34.5 months (11–60.3 months). The final outcome, overall survival and event-free survival time was influenced by metastatic or local relapse. Tumor resection is beneficial but the value of surgery can only be judged when we are able to control metastatic disease in stage IV neuroblastoma. The final outcome may rely on the extent of complete surgical resection, but is also related to treatment of metastases. A longer follow-up period is indicated to detect long term outcome.     

Interaction between risk factors for fetal growth retardation associated with abnormal umbilical artery Doppler studies

BACKGROUND: The role of antenatal risk factors associated with the occurrence of fetal growth restriction complicated by abnormal umbilical artery Doppler studies has not yet been studied extensively. We evaluated the role and the interactions of antenatal antecedents of fetal growth restriction complicated by abnormal umbilical artery end-diastolic velocities. METHODS: We compared antenatal variables in 183 pregnancies complicated by fetal growth retardation and abnormal umbilical artery Doppler studies and 549 appropriately grown fetuses with normal end-diastolic velocity waveform in the umbilical artery. Logistic regression was used to evaluate the association between antenatal variables and fetal growth retardation and to test for interaction. RESULTS: In logistic models, increasing maternal age [odds ratio (OR) 1.06, 95% confidence interval (CI) 1.01-1.11], nulliparity (OR 2.2, 95% CI 1.37-3.5), smoking during pregnancy (OR 2.56, 95% CI 1.56-4.22), preeclampsia (OR 27.5, 95% CI 15.1-49.9), first-trimester hemorrhage (OR 2.25, 95% CI 1.32-3.82) and low (< 0.2 kg/week) weight gain in pregnancy (OR 3.48, 95% CI 1.71-3.05) were significantly associated with an increased risk of fetal growth restriction complicated by abnormal Doppler studies. These risk factors were also significantly correlated with the occurrence of absent/reversed end-diastolic blood flow in the umbilical artery. Maternal smoking during pregnancy interacted negatively with preeclampsia but positively with a low weight gain in pregnancy. CONCLUSIONS: The results of this study have shown that antenatal risk factors for intrauterine growth retardation (IUGR) complicated by abnormal Doppler studies are similar to those associated with the birth of a small-for-gestational-age infant. Preeclampsia, maternal smoking and low weight gain in pregnancy play a significant causal role in the origin of fetal growth restriction associated with abnormal uteroplacental blood flow.     

Estrogen receptor alpha gene polymorphisms and risk of myocardial infarction

Context  The role of estrogens in ischemic heart disease (IHD) is uncertain. Evidence suggests that genetic variations in the estrogen receptor (ESR1) gene may influence IHD risk, but the role of common sequence variations in the ESR1 gene is unclear. Objective  To determine whether the ESR1 haplotype created by the c.454-397T>C (PvuII) and c.454-351A>G (XbaI) polymorphisms is associated with myocardial infarction (MI) and IHD risk. Design, Setting, and Participants  In 2617 men and 3791 postmenopausal women from The Rotterdam Study (enrollment between 1989-1993 and follow-up to January 2000), a population-based, prospective cohort study of participants aged 55 years and older, ESR1 c.454-397T>C and c.454-351A>G haplotypes were determined. Detailed interviews and physical examinations were performed, blood samples were obtained, and cardiovascular risk factors were assessed. Main Outcome Measure  The primary outcome was MI and IHD defined as MIs, revascularization procedures, and IHD mortality. Results  Approximately 29% of women and 28.2% of men were homozygous carriers of the ESR1 haplotype 1 (–397 T and –351 A) allele, 49% of women and 50% of men were heterozygous carriers, and 22% of women and 21.4% of men were noncarriers. During a mean follow-up of 7.0 years, 285 participants (115 women; 170 men) had MI, and 440 (168 women; 272 men) had an IHD event, of which 97 were fatal. After adjustment for known cardiovascular risk factors, female heterozygous carriers of haplotype 1 had an increased risk of MI (event rate, 2.8%; relative risk [RR], 2.23; 95% confidence interval [CI], 1.13-4.43) compared with noncarriers (event rate, 1.3%), whereas homozygous carriers had an increased risk (event rate, 3.2%; RR, 2.48; 95% CI, 1.22-5.03). For IHD events, we observed a similar association. In women, the effect of haplotype 1 on fatal IHD was larger than on nonfatal IHD. In men, the ESR1 haplotypes were not associated with an increased risk of MI (event rate, 5.7%; RR, 0.93; 95% CI, 0.59-1.46 for heterozygous carriers; and event rate, 5.1%; RR, 0.82; 95% CI, 0.49-1.38 for homozygous carriers) compared with noncarriers (event rate, 5.8%) and were not associated with an increased risk of IHD. Conclusions  In this population-based, prospective cohort study, postmenopausal women who carry ESR1 haplotype 1 (c.454-397 T allele and c.454-351 A allele) have an increased risk of MI and IHD, independent of known cardiovascular risk factors. In men, no association was observed.      

Failure of High Risk Women to Produce Nipple Aspirate Fluid Does Not Exclude Detection of Cytologic Atypia in Random Periareolar Fine Needle Aspiration Specimens

INTRODUCTION: Evidence of hyperplasia with atypia found both on random periareolar fine needle aspiration (RPFNA) and in nipple aspirate fluid (NAF) fluid are associated with an increased risk for breast cancer. AIM: In this study, we report the correlation of NAF production with cytological assessment of ductal cells obtained by RPFNA. METHODS: 113 women at high risk for development of breast cancer attending the Breast Cancer Prevention Clinic at the University of Kansas Medical Center underwent a single NAF collection attempt and RPFNA. RESULTS: NAF was successfully collected in 51% of women. There was no significant difference in age, 5-year Gail risk assessment, menopausal status, hormone use, family history of breast cancer, history of prior atypical hyperplasia/LCIS or history of contralateral DCIS/invasive breast cancer between women who produced NAF and those that did not. The only significant difference between the two groups was in history of prior lactation (p = 0.018). Twenty-seven of the 113 subjects were found to have hyperplasia with atypia by RPFNA was 31% in women who produced NAF versus 16% in those who did not (p = 0.07). CONCLUSION: Although prevalence of RPFNA atypia was numerically higher in NAF producers than non-producers the difference did not reach statistical significance. Failure to produce NAF does not exclude the presence of hyperplasia with atypia by random periareolar fine needle aspiration.     

Reproducibility of patch tests: comparison of identical test allergens from different commercial sources

The reproducibility of patch tests is an important determinant of the clinical value of this diagnostic procedure. The aim of the present study was to delineate comparatively the efficiency and reproducibility of identical test reagents from 2 different commercial sources. Purchased in duplicate from brial and Boots-Hermal, 30 allergens from the European standard and an extension series were simultaneously applied to Finn Chambers and affixed next to each other. Out of 2070 paired patch tests in 71 patients, 97.2% presented with concordant-negative results. 60 patch tests were classified as allergic with 95% concordant-positive results. From these paired positive patches, a subgroup of 13 (22.8%) corresponding allergens presented with minor differences in the visible strength of the allergic reaction. Generated by cobalt chloride, formaldehyde and 2-bromo-2-nitropropane-1,3-diol in 1 patient each, discordant results, i.e. 1 positive and 1 negative test in parallel, were found in only 5%. Taken together, we were able to demonstrate that patch test preparations from 2 different companies exhibited a high level of reproducibility. This standardized quality of test reagents from different suppliers provides useful information on several aspects of everyday practice.     

Anxiety-related behaviour in C57BL/6 <--> BALB/c chimeric mice

In a previous study on anxiety-related behaviours of the genetically and behaviourally distant inbred mouse strains C57BL/6 and BALB/c using the Elevated plus-maze (EPM) and Open-field (OF) apparatuses, we identified a number of variables, the factorial scores of which were grouped by principal component analysis (PCA) into factors specifically describing each inbred strain [4]. We have now studied the effect of C57BL/6 and BALB/c haploid sets of genes on this behaviour by comparing EPM and OF variables of C57BL/6 and BALB/c versus C57BL/6×BALB/c F1 hybrids (B6CBF1) and chimeric C57BL/6×BALB/c (CHIM) mice. CHIM mice were made by embryo aggregation and the chimerism degree of their brain was inferred from coat black/white distribution. Discriminant analysis of EPM and OF factorial scores of C57BL/6, BALB/c and CHIM mice showed that CHIM mice with an exceeding (≥80%) C57BL/6 or BALB/c coat component had behaviours similar to those of the predominant strain, whereas CHIM mice with intermediate chimerism differed from both inbred strains. Additional MANOVA analysis showed that the anxiety behaviour of CHIM mice with intermediate chimerism was similar to that of B6CBF1 mice as for factors not describing the inbred strains, including a motor activity mostly limited to protected areas, with attempts to approach the anxiogenic areas while processing/storing the external information. We conclude that the balanced presence of both C57BL/6 and BALB/c genetic backgrounds, either when carried by the same cell or by different cells, gives rise to a novel stress coping strategy described by factors different from those of the inbred strains.     

Effects of negative mood induction and impulsivity on self-perceived emotional eating

OBJECTIVE: The current study investigates the influence of negative mood induction and impulsivity on self-perceptions with respect to emotional eating. Negative affect as well as high impulsivity was expected to increase levels of self-perceived emotional eating. METHOD: College students who were high versus low in impulsivity were assigned randomly to either a negative (failure on a quiz) or a neutral mood induction. Their levels of self-perceived emotional eating were measured after and before mood induction. RESULTS: Negative affect appeared to enhance the level of self-perceived emotional eating significantly (p < .01). There was no statistically significant effect of impulsivity. The interaction effect of affect and impulsivity approached significance (p = .08), indicating that highly impulsive subjects compared with subjects low in impulsivity were more strongly influenced by negative affect in self-perceived emotional eating. DISCUSSION: Negative affect substantially influences self-perceptions in terms of emotional eating, which is relevant for both prevention and treatment.     

Use of Fatty Acids to Explain Variability of Organochlorine Concentrations in Eggs and Plasma of Common Terns (Sterna hirundo)

We have studied the breeding parameters, organochlorine compounds (OCs) concentrations, and fatty acid (FA) composition of egg yolks (n = 47) and plasma (n = 90) of common terns (Sterna hirundo) from two colonies (Banya and Fangar) in the Ebro delta, NE Spain. Terns from Banya tend to have smaller clutch size and lower hatching success than terns from Fangar. p,p'-DDE and polychlorinated biphenyls (PCBs) concentrations were almost 2-fold higher in yolks from Banya in 1998 than from Fangar in 1999, and the percentage of n-6 PUFA was positively correlated with these contaminants. Differences between samplings in OCs concentrations in plasma were less evident, and were affected by breeding chronology. The highest OCs concentrations in yolks from Banya may be explained by two processes involving the increased deposition of n-6 PUFA: (1) higher mobilization of endogenous fat due to lower food resources, or (2) differences in the diet between colonies. Birds from Banya may have been feeding at a higher degree on discards of trawling fisheries composed of demersal and benthic fish species that are more exposed to contaminants from sediment and have lower n-3/n-6 ratio, whereas birds from Fangar would feed mostly on pelagic species of small clupeiformes that are less polluted and have higher n-3/n-6 ratios.