Cancer morbidity in workers at aluminum foundries and secondary aluminum smelters

In a Swedish cohort of workers (n = 6,454) from seven aluminum foundries and three secondary aluminum (scrap) smelters there was no overall excess risk of cancer among male or female workers less than 85 years of age (males: 325 observed cases, standardized incidence ratio (SIR) 1.02, 95% confidence interval (CI) 0.91–1.13; females: 22 cases, SIR = 0.95, 95% CI = 0.60–1.44). In male workers, however, significantly elevated risk estimates were observed for cancer of the lung (51 cases; SIR = 1.49, 95%CI = 1.11–1.96), anorectal cancer (33 cases; SIR 2.13, 95%CI = 1.47–2.99), and sinonasal cancer (4 cases; SIR = 4.70, 95%CI = 1.28–12.01). There was no increase of urinary bladder or liver cancer. Lung cancer risks were highest in workers with a short duration of employment (<5 years) suggesting determinants of risk related to socioeconomic factors rather than the occupational environment under study, but there were also indications of a lung cancer hazard from sand casting of aluminum for 10 years or more (SIR = 2.10, 95%CI = 1.01–3.87). The increase in anorectal cancer could not be etiologically related to occupational determinants of risk. Sand casting of aluminum aside, the cancer risk in secondary aluminum smelting seems to be lower than in primary aluminum smelting and in iron and steel founding, respectively. Am. J. Ind. Med. 32:467–477, 1997. © 1997 Wiley-Liss, Inc.     

Neuroendocrine differentiation in carcinomas of the prostate: Do neuroendocrine serum markers reflect immunohistochemical findings?

The aim of the present study was to examine the correlation between the immunohistochemical findings and the serum markers for neuroendocrine (NE) cells in patients with carcinoma of the prostate. Preoperative serum values of chromogranin A (CgA), chromogranin B (CgB), pancreastatin (Pst), neuron-specific enolase (NSE), and prostatic specific antigen (PSA) were determined in 22 patients. The tissue specimens were obtained by a palliative transurethral resection of the prostate (TURP) because of urinary outflow obstruction. Immunohistochemistry was performed by using antibodies against CgA, CgB, NSE, serotonin, thyroid-stimulating hormone (TSH), and somatostatin. Tumor cells with NE differentiation were found in 91% of the cases. No patient had elevated serum values of NSE, despite the presence of NSE-positive tumor cells in 77% of the tumors. Neither did CgB in serum correlate with the immunohistochemical findings. Elevated serum values of CgA were found in 59% of patients. A positive correlation between the number of CgA-staining cells and the serum values of CgA was found, as seven out of eight patients with groups of CgA-positive tumor cells had elevated serum values of CgA. We conclude that CgA, in contrast to NSE, CgB, and Pst, seems to be a useful serum marker in predicting the extent of NE differentiation in prostatic tumors. Prostate 30:1–6, 1997 © 1997 Wiley-Liss, Inc.     

Invasiveness in vitro and biological markers in human primary glioblastomas

Invasion of spheroids from 20 human primary glioblastomas into precultured fetal rat brain tissue in culture has been studied and quantified. Between 30 and 98 percent of the normal brain tissue was destroyed by invading glioma cells within 4 days. The degree of invasion did not correlate with patient survival. A slightly higher invasiveness and shorter survival was seen in tumors with EGF receptor overexpression, and the opposite pattern was found for tumors with a TP53 mutation.The degree of invasiveness in vitro was far higher than would be expected from the dynamics of clinically observed tumor spread. This suggests that mechanisms suppressing invasion may be operative in the normal brain; alternatively the differences may be due to a higher permissiveness of the fetal brain tissue for invasion in vitro.     

Intraoperative dynamic susceptibility contrast MRI (iDSC-MRI) is as reliable as preoperatively acquired perfusion mapping

DSC-MRI was applied intraoperatively during human brain tumor removal. Immediately after complete tumor resection was presumed, MRI including a dynamic susceptibility contrast T2?-weighted EPI sequence was performed in 30 patients while the skull was still open using a flexible two-channel coil system at an intraoperative 1.5-Tesla MR scanner. Maps of relative regional blood flow (rCBF), blood volume (rCBV), and mean transit time (MTT) were calculated, and ratios of these maps were compared to preoperatively acquired DSC-MRI data. The extent of the resection was compared with the postoperative MRI performed 24 h after the operation. In 8 of these patients residual tumor tissue was depicted at the time of intraoperative MRI. In corresponding regions ratios for rCBV and rCBF did not differ significantly between pre- and intraoperatively acquired data (two-tailed t-test). Furthermore, we found a high correlation between ratios created from pre- and intraoperatively measured data for both rCBV and rCBF, respectively (Pearson correlation; r²_rCBV = 0.86, p ≤ 0.01; r²_rCBF = 0.86, p ≤ 0.01). DSC-MRI is a powerful tool for the differential diagnosis of brain lesions. Its use intraoperatively provides pathophysiologic information that is up-to-date, independently of an intraoperative brain shift and also independently of the known leakage phenomenon caused by surgical manipulation. It can assist in the decision to depict residual tumor burden beyond conventional imaging. Our data demonstrate that iDSC-MRI is as reliable as preoperatively acquired data.     

The preeclampsia biomarkers soluble fms-like tyrosine kinase-1 and placental growth factor: current knowledge, clinical implications and future application

Preeclampsia is a leading cause of maternal and fetal/neonatal morbidity and mortality worldwide. Currently there is no single reliable parameter for the diagnosis of preeclampsia and attention has turned towards identifying non-invasive testing methods, including Doppler sonography and blood-borne or urinary biomarkers in women who go on to develop preeclampsia. Biomarkers of angiogenesis are currently at the most advanced state of development for the diagnosis of preeclampsia. In this article we will highlight the diagnostic potential of the novel biomarkers soluble fms-like tyrosine kinase-1 and placental growth factor and discuss the opportunities and challenges involved in bringing these preeclampsia biomarkers from bench to bedside.     

Flow‐Evoked Vasodilation Is Blunted in Penile Arteries from Zucker Diabetic Fatty Rats

IntroductionEndothelium‐derived relaxing factors such as nitric oxide (NO), prostanoids, and endothelium‐derived hyperpolarizing factor (EDHF) are thought to play an important role in vasodilation of penile arteries.AimThe present study investigated the mechanisms involved in flow‐ and acetylcholine‐induced vasodilation in penile arteries, and whether acetylcholine‐ and flow‐mediated vasodilation is altered in Zucker diabetic fatty (ZDF) rats, a model of type 2 diabetes. Moreover, it was addressed whether enhanced myogenic tone may explain impaired flow‐evoked vasodilation in arteries from ZDF rats.MethodsPenile dorsal arteries obtained from lean control and ZDF rats were suspended in a pressure myograph, and flow‐ and acetylcholine‐evoked vasodilation was measured as changes in arterial diameter.Main Outcome MeasureChanges in penile arterial diameter.ResultsIncubation with an inhibitor of NO synthase, asymmetric dimethyl‐L‐arginine (ADMA), and of cyclooxygenase, indomethacin, reduced acetylcholine but not flow‐evoked vasodilation in penile arteries, while both responses were abolished by endothelial cell removal. Iberiotoxin, a blocker of large‐conductance calcium‐activated K⁺ (BK_Ca) channels, inhibited flow‐evoked vasodilation. Flow‐evoked vasodilation was reduced in arteries from ZDF rats in the absence, but not in the presence, of indomethacin plus ADMA. Elevation of intraluminal pressure increased myogenic tone, which was reduced in arteries from ZDF rats.ConclusionThe present findings show that flow evokes endothelium‐dependent EDHF‐type vasodilation involving BK_Ca channels in penile arteries. Flow‐evoked vasodilation is reduced and only of EDHF‐type in penile arteries from type 2 diabetic rats suggesting modulation of this pathway may restore endothelial function and preserve erection in diabetes. Schjørring O, Kun A, Flyvbjerg A, Kirkeby HJ, Jensen JB, and Simonsen U. Flow‐evoked vasodilation is blunted in penile arteries from Zucker diabetic fatty rats. J Sex Med 2012;9:1806–1817.     

Minimal transmission of SARS-CoV-2 from paediatric COVID-19 cases in primary schools,Norway, August to November 2020

An intense debate on school closures to control the COVID-19 pandemic is ongoing in Europe. We prospectively examined transmission of SARS-CoV-2 from confirmed paediatric cases in Norwegian primary schools between August and November 2020. All in-school contacts were systematically tested twice during their quarantine period. With preventive measures implemented in schools, we found minimal child-to-child (0.9%, 2/234) and child-to-adult (1.7%, 1/58) transmission, supporting that under 14 year olds are not the drivers of SARS-CoV-2 transmission.     

Association of right-to-left shunt with frontal white matter lesions in T2-weighted MR imaging of stroke patients

Introduction  Cardiac right-to-left shunt (RLS), mainly due to patent foramen ovale (PFO), is a risk factor for paradoxical embolism and stroke. Results of studies about brain lesions in diffusion-weighted imaging (DWI) in PFO patients were controversial. DWI only detects acute ischemic lesions. We assessed the hypothesis that, in T2-weighted magnetic resonance imaging (T2WI) of stroke patients, RLS is associated with a typical distribution of small white matter lesions. Materials and methods  In this retrospective case–control study, T2WI images of 162 stroke patients were evaluated. From stroke patients admitted between 1999 and 2003, 81 stroke patients with RLS were identified with contrast-enhanced transcranial Doppler (bubble test). Controls were 81 age-matched stroke patients without RLS (negative bubble test). In T2WI images, small lesions (<2 cm) were categorized depending on their location in subcortical white matter, peritrigonal white matter, deep and paraventricular white matter, and basal ganglia. Additionally, larger territorial infarcts were rated. Results  In T2WI frontal or predominantly frontal-located subcortical small white matter, lesions are significantly associated with RLS (p < 0.0001, chi-square test). Forty-three patients with RLS (53%) and only 19 control patients (23%) showed this frontal dominance. Odds ratio is 3.7 (95% confidence interval = 1.9–7.1) for having a RLS when T2WI shows this lesion pattern in a stroke patient. No patient of the RLS group and 6% of the control group had parietal dominance. Distribution of small lesions in other locations like basal ganglia or deep white matter showed no significant difference for the groups. Conclusion  A distribution of mainly frontal subcortical small white matter lesions in T2WI is significantly associated with RLS in stroke patients.     

Idiopathic Increased Anteversion of the Femoral Neck: Radiological and Clinical Study in Non-operated and Operated Patients

The development of femoral neck angles in children with idiopathic increased anteversion was investigated. The anteversion (AV) angle in 16 non-operated patients (n = 32) decreased from a mean of 45 degrees at the age of 7.3 years (median) to 31 degrees at the age of 15.7 years. The neckshaft (CCD) angle remained unchanged.

A subtrochanteric derotational osteotomy was performed in 24 patients (n = 48) aged 7.7 years (median). The AV angle was corrected from 47 to 3 degrees, and the CCD angle from 134 to 124 degrees. At follow-up at the age of 16.5 years the AV and the CCD angles had increased to 14 and 135 degrees respectively. The internal rotation of the hip was increased to the same extent in the two patient groups. The degree of external rotation as well as total rotation was significantly larger in the non-operated patients compared to the patients who needed an operation.

At follow-up the rotational movements of the hip and the external torsion of the leg/foot were measured and compared with the corresponding measurements for a control group of 26 healthy subjects whose median age was 16.3 years. In the non-operated patients the internal rotation was reduced at a rate corresponding to the spontaneous reduction of the femoral anteversion, while the external rotation was unchanged. In the operated patients the rotational movements were normalized, as was the anteversion of the femoral neck. No differences in external torsion of the leg/foot were found in the three groups.

Based on these results we conclude that cases of idiopathic increased anteversion of the femoral neck are not corrected spontaneously as the child grows up. With a subtrochanteric derotational osteotomy slight overcorrection may be indicated, but simultaneous varus correction of the femoral neck seems to be unnecessary. The degree of external rotation of the hip determines gait symptoms in patients with increased femoral anteversion. No regular compensatory external torsion of the leg/foot develops during growth.