COMORBIDITY OF DEPRESSION IN THE ELDERLY—AN EPIDEMIOLOGICAL STUDY IN A CHINESE COMMUNITY

This is an epidemiological study on the comorbidity of depression in a random sample of 1062 elderly Chinese aged 65 and over in Singapore, using the Geriatric Mental State (GMS) schedule and the data analysed by the computerized diagnostic program AGECAT. The overall prevalence of current (30-day) depression was estimated to be 6.0% (males 5.9%, females 6.1%). There were comorbid psychiatric disorders, predominantly anxiety, in 45.3% of depressed elderly. Using DSM-III-R criteria, the prevalence of major depression was 5.2% and dysthymia 0.2%, with comorbid psychiatric disorders, mainly generalized anxiety disorder, in 40% of major depression. The risk factor profile of the elderly with pure and comorbid depression showed significant differences. A past history of depression and lower level of education were risk factors for comorbid depression—but there was no significant difference between the two groups in sex, age, marital status or living arrangement.     

Lymphovascular space involvement in early stage well-differentiated endometrial cancer is associated with increased mortality

Objective  To study the relationship between lymphovascular space involvement (LVSI) in stage 1a or 1b well-differentiated endometrial cancer and survival.
Design  Retrospective study consisting of a search of an oncology database to identify women with endometrial cancer between January 1990 and December 2004.
Setting  Tertiary referral centre, Dublin, Ireland.
Sample  Women who had well-differentiated stage 1a or 1b endometrial cancer.
Methods  During the period 1990–2004, 226 patients with endometrial cancer were treated in the National Maternity Hospital, Dublin. We looked at all patients who had well-differentiated endometrioid adenocarcinoma of the endometrium with invasion of <50% thickness of the myometrium. Forty-one patients fulfilled these inclusion criteria. The presence or absence of LSVI was determined by review of haematoxylin and eosin sections. Patients were followed for 5 years or till death if earlier. Mortality was calculated. Statistical analysis was performed using Fisher's exact test. An odds ratio and 95% confidence interval was calculated using fixed effect Mantel–Haenszel model.
Main outcome measures  Death from recurrence of endometrial cancer.
Results  Of the 41 patients, five (12%) were found to have (LVSI). Of the five patients with LVSI, three (60%) patients died of recurrence. All patients with recurrence died of disease and none of the patients without LVSI died (0 of 36). Overall, the survival rate was 92.7%. The presence of LVSI was a highly significant predictor of recurrence ( P  < 0.001).
Conclusion  In patients with early stage well-differentiated adenocarcinoma of the endometrium, the presence of LVSI is associated with a high risk of death.     

Comparison of percent density from raw and processed full-field digital mammography data

Introduction

Mammographic density has been established as a strong risk factor for breast cancer, primarily using digitized film mammograms. Full-field digital mammography (FFDM) is replacing film mammography, has different properties than film, and provides both raw and processed clinical display representation images. We evaluated and compared FFDM raw and processed breast density measures and their associations with breast cancer.

Methods

A case-control study of 180 cases and 180 controls matched by age, postmenopausal hormone use, and screening history was conducted. Mammograms were acquired from a General Electric Senographe 2000D FFDM unit. Percent density (PD) was assessed for each FFDM representation using the operator-assisted Cumulus method. Reproducibility within image type (n = 80) was assessed using Lin''s concordance correlation coefficient (r_c). Correlation of PD between image representations (n = 360) was evaluated using Pearson''s correlation coefficient (r) on the continuous measures and the weighted kappa statistic (κ) for quartiles. Conditional logistic regression was used to estimate odds ratios (ORs) for the PD and breast cancer associations for both image representations with 95% confidence intervals. The area under the receiver operating characteristic curve (AUC) was used to assess the discriminatory accuracy.

Results

Percent density from the two representations provided similar intra-reader reproducibility (r_c= 0.92 for raw and r_c= 0.87 for processed images) and was correlated (r = 0.82 and κ = 0.64). When controlling for body mass index, the associations of quartiles of PD with breast cancer and discriminatory accuracy were similar for the raw (OR: 1.0 (ref.), 2.6 (1.2 to 5.4), 3.1 (1.4 to 6.8), 4.7 (2.1 to 10.6); AUC = 0.63) and processed representations (OR: 1.0 (ref.), 2.2 (1.1 to 4.1), 2.2 (1.1 to 4.4), 3.1 (1.5 to 6.6); AUC = 0.64).

Conclusions

Percent density measured with an operator-assisted method from raw and processed FFDM images is reproducible and correlated. Both percent density measures provide similar associations with breast cancer.     

Thyroid hormone β receptor activation has additive cholesterol lowering activity in combination with atorvastatin in rabbits,dogs and monkeys

Background and purpose:

Thyroid hormone receptor (TR) agonists are in clinical trials for the treatment of hypercholesterolaemia. As statins are the standard of clinical care, any new therapies must have adjunctive activity, when given in combination with statins. As already known for the statins, the cholesterol lowering effect of TR activation involves increased expression of the low-density lipoprotein receptor. Using animal models, we tested whether TR activation would have additive cholesterol lowering activity in the presence of effective doses of a statin.

Experimental approach:

We evaluated the activity of a liver-targeted prodrug, MB07811, of a novel TH receptor β agonist, MB07344, as monotherapy and in combination with atorvastatin in rabbits, dogs and monkeys.

Key results:

In rabbits, MB07344 (i.v.) decreased total plasma cholesterol (TPC) comparable to that achieved with a maximally effective dose of atorvastatin (p.o.). The addition of MB07344 to atorvastatin resulted in a further decrease in TPC. Similarly, the addition of MB07811 (p.o.) to atorvastatin treatment decreased TPC beyond the level achieved with either agent as monotherapy. In dogs and monkeys, atorvastatin and MB07811 were administered as monotherapy or in combination. Consistent with the rabbit studies, the combination treatment caused a greater decrease in TPC than either MB07811 or atorvastatin administered as monotherapy.

Conclusions and implications:

We conclude that the effects of MB07811 and atorvastatin in lowering cholesterol are additive in animals. These results would encourage and support the demonstration of similarly improved efficacy of combination versus monotherapy with such agents in the clinic.     

Influence of anesthetic management on quality of magnetoencephalography scan data in pediatric patients: a case series

Background:  Magnetoencephalography (MEG) is increasingly used in the presurgical evaluation of pediatric seizure patients. Many pediatric patients require sedation or anesthesia to tolerate these exams. However, the available literature on anesthetic management in this population is very limited.
Methods:  We retrospectively reviewed the records of all patients who underwent MEG scanning at our institution with regard to the interaction of anesthetic management and quality of scan data.
Results:  High-dose propofol infusions (≥200 μg·kg⁻¹·min⁻¹) were associated with high frequency artifacts that interfered with the identification of epileptiform discharges. Lower-dose propofol infusions (≤100 μg·kg⁻¹·min⁻¹) did not produce artifacts but required co-administration of fentanyl to prevent patient motion. Dexmedetomidine infusions were not associated with signal artifacts and prevented patient motion very well in our initial patients and became our standard technique.
Conclusion:  In our experience, dexmedetomidine infusions are preferable to propofol-based techniques for pediatric MEG scans due to the absence of adverse effect on interictal activity.     

The cBio cancer genomics portal: an open platform for exploring multidimensional cancer genomics data

The cBio Cancer Genomics Portal (http://cbioportal.org) is an open-access resource for interactive exploration of multidimensional cancer genomics data sets, currently providing access to data from more than 5,000 tumor samples from 20 cancer studies. The cBio Cancer Genomics Portal significantly lowers the barriers between complex genomic data and cancer researchers who want rapid, intuitive, and high-quality access to molecular profiles and clinical attributes from large-scale cancer genomics projects and empowers researchers to translate these rich data sets into biologic insights and clinical applications.     

Seroprevalence of HBV and HIV co-infection in children and outcomes following highly active antiretroviral therapy (HAART) in Uyo,South-South Nigeria

Background

Human Immunodeficiency Virus/Hepatitis B Virus (HIV/HBV) co-infection in Nigerian children has emerged as a major concern with the advent of HAART. Its impact on the immune system and liver has not been extensively studied in children.

Objectives

To determine the prevalence of HBV seropositivity among HIV positive children on HAART and its effect on immune response and liver enzymes.

Methods

All consecutive HIV positive children aged two months to seventeen years on HAART constituted the study population. Age and gender; CD4+ count, ALT, creatinine and HBsAg were tested and documented at enrolment and 12months.

Results

One hundred and seventy one patients were seen over this period. Seventy-two (43.4%) were males while 94 (56.6%) were females giving a male: female ratio of 1:1.3. The mean age of the patients was 63±43.4 months. Prevalence of HIV/HBV co-infection was 6.02% (95% CI 2.4–9.7). There was no significant effect of HBV status on elevation of ALT levels with 12 months of HAART. Co-infected patients had an odds ratio of achieving immune response of 0.14 (95% CI 0.02–0.79).

Conclusion

HIV/HBV co-infection rates in our children are comparable to other localities. ALT levels do not worsen with HAART and immune response of the co-infected children on HAART is lower.