Duration,frequency, recency,and type of migraine and the risk of ischaemic stroke in women of childbearing age

BACKGROUND: Migraine is recognised increasingly as a risk factor for ischaemic stroke in women of childbearing age. Migraine with aura poses a higher risk than migraine without aura. OBJECTIVE: To investigate further the effect of duration, frequency, recency, and type of migraine on the risk of ischaemic stroke. METHODS: Additional analyses of a previously reported multicentre case-control study of the relation between stroke and migraine in women aged 20-44 years. RESULTS: Among 86 cases of ischaemic stroke and 214 controls, the adjusted risk of ischaemic stroke was significantly associated with: (1) migraine of more than 12 years duration, odds ratio (OR) 4.61 (1.27-16.8); (2) initial migraine with aura, OR 8.37 (2.33-30.1); (3) particularly if attacks were more frequent than 12 times per year, OR 10.4 (2.18-49.4). In no case did correction for oral contraception usage significantly alter these odds ratios. Increasing risk of ischaemic stroke was related to a change to increased frequency of headaches (trend p 相似文献   

Extra-tumoral breast tissue in breast cancer patients: variations with steroid contraceptive use

The association between oral contraceptive (OC) use and benign breast changes in extra-tumoral breast tissue was studied histologically in 1,503 breast cancer patients from The WHO Collaborative Study of Neoplasia and Steroid Contraceptives. The occurrence of ductal hyperplasia, ductal atypia, sclerosing adenosis, cysts, apocrine metaplasia, apocrine hyperplasia, apocrine atypia, adenosis, lobular atypia, duct ectasia, calcifications, inflammatory reaction, lactational metaplasia and a high epithelial-stromal ratio was graded semi-quantitatively. Prevalence odds ratio (POR) for each histologic variable was calculated by logistic regression analyses. Patients who had ever used OC had lower occurrence of ductal hyperplasia than never users (POR 0.72 (95% CI 0.52-0.99)). Current use and more than 8 years of use was also associated with a lower prevalence of ductal hyperplasia (POR 0.40 (0.20-0.81) and POR 0.33 (0.17-0.64), respectively). Age > 35 years at first use was associated with increased prevalence of ductal carcinoma in situ (POR 2.15 (1.05-4.40)), but not of atypical ductal hyperplasia. Our results show that the effects of OC use on ductal hyperplasia in non-neoplastic breast tissue of breast cancer patients are similar to what others have found in patients with benign breast disease only. The increased prevalence of extra-tumoral ductal carcinoma in situ in breast cancer patients who started OC use at high age may possibly be explained by a longer preinvasive phase in these patients.     

Prevalent vertebral fractures among children initiating glucocorticoid therapy for the treatment of rheumatic disorders

Objective

Vertebral fractures are an under‐recognized problem in children with inflammatory disorders. We studied spine health among 134 children (87 girls) with rheumatic conditions (median age 10 years) within 30 days of initiating glucocorticoid therapy.

Methods

Children were categorized as follows: juvenile dermatomyositis (n = 30), juvenile idiopathic arthritis (n = 28), systemic lupus erythematosus and related conditions (n = 26), systemic arthritis (n = 22), systemic vasculitis (n = 16), and other conditions (n = 12). Thoracolumbar spine radiograph and dual x‐ray absorptiometry for lumbar spine (L‐spine) areal bone mineral density (BMD) were performed within 30 days of glucocorticoid initiation. Genant semiquantitative grading was used for vertebral morphometry. Second metacarpal morphometry was carried out on a hand radiograph. Clinical factors including disease and physical activity, calcium and vitamin D intake, cumulative glucocorticoid dose, underlying diagnosis, L‐spine BMD Z score, and back pain were analyzed for association with vertebral fracture.

Results

Thirteen vertebral fractures were noted in 9 children (7%). Of these, 6 patients had a single vertebral fracture and 3 had 2–3 fractures. Fractures were clustered in the mid‐thoracic region (69%). Three vertebral fractures (23%) were moderate (grade 2); the others were mild (grade 1). For the entire cohort, mean ± SD L‐spine BMD Z score was significantly different from zero (?0.55 ± 1.2, P < 0.001) despite a mean height Z score that was similar to the healthy average (0.02 ± 1.0, P = 0.825). Back pain was highly associated with increased odds for fracture (odds ratio 10.6 [95% confidence interval 2.1–53.8], P = 0.004).

Conclusion

In pediatric rheumatic conditions, vertebral fractures can be present prior to prolonged glucocorticoid exposure.

     

Reproductive factors and incidence of breast cancer: an international ecological study

Summary Ecological studies can help in understanding the relation of reproductive history to breast cancer. We analyzed data from 9416 women, comprising the control groups of seven countries (Australia, People's Republic of China, Colombia, (former) German Democratic Republic, Israel, Philippines, and Thailand) from the WHO international, multi-center case-control study of female cancers. Positive correlations with country-specific breast cancer incidence were observed for (median) duration of reproductive life (r0.95, p<0.005), age at menopause (r0.84, p<0.025) and delay to first birth (r0.59, p<0.22) (when People's Republic of China was omitted, r0.85, p<0.07). The association of age at first birth with breast cancer incidence was weakly positive in the whole sample (age-adjusted r=0.18, p=0.73), but weakly negative in the age groups 15–29 and 30–39 years and weakly positive in the age groups 40–49 and 50–64 years. A strong inverse correlation was observed between age at menarche and breast cancer incidence (r–0.84, p<0.03). These international ecological correlations agree with the associations previously reported for single populations, between higher incidence of breast cancer and younger age at menarche, older age at menopause, longer duration of reproductive life, and (possibly) longer delay to first birth. In contrast, age at first birth is only weakly related to breast cancer incidence across populations, indicating that this variable represents different constructs when measured ecologically versus individually.

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Reproduktive Faktoren und Brustkrebsinzidenz: Eine internationale ökologische Studie

Zusammenfassung Ökologische Studien helfen, den Zusammenhang zwischen Ereignissen in der reproduktiven Geschichte und dem Brustkrebsrisiko zu verstehen. Wir analysierten die Daten von 9416 Frauen aus den Kontrollgruppen von sieben Ländern (Australien, Volksrepublik China, Kolumbien, ehemalige Deutsche Demokratische Republik, Israel, Philippinen und Thailand) der internationalen multizentrischen WHO-Fall-Kontroll-Studie zu weiblichen Krebsarten. Positive Korrelationen mit länderspezifischen Brustkrebsinzidenzen wurden gefunden für die Dauer der reproduktiven Lebensphase (Median) (r0,95; p<0,005), das Alter bei der Menopause (r0,84; p<0,025) und die Zeitspanne zwischen Erstmenstruation und Erstgeburt (r0,59; p<0,22) (wenn die VR China nicht mitgerechnet wurde: r0.85, p<0.07). Die Beziehung zwischen dem Alter bei der Erstgeburt und der Brustkrebsinzidenz war schwach positiv im gesamten Sample (korrigiert für Alter: r=0,18; p=0,73), aber schwach negativ in den Altersgruppen der 15- bis 29-Jährigen und der 30- bis 39-Jährigen und schwach positiv in der Altersgruppe der 40- bis 49-Jährigen und der 50- bis 64-Jährigen. Eine starke inverse Korrelation wurde zwischen dem Alter bei der Erstmenstruation und der Brustkrebsinzidenz beobachtet (r–0,84; p<0,03). Diese internationalen ökologischen Korrelationen stimmen mit den Resultaten aus früheren Studien zu Einzelpopulationen überein, wo Beziehungen zwischen höherem Brustkrebsrisiko und jüngerem Alter bei der Erstmenstruation, älterem Alter bei der Menopause, längerer Dauer der reproduktiven Lebensphase und (möglicherweise) grössere Zeitspanne zwischen Erstmenstruation und Erstgeburt gefunden wurden. Im Gegensatz zu Studien, die individuelle Daten analysieren, korreliert das Alter bei der Erstgeburt nur schwach mit der Brustkrebsinzidenz in ökologischen Studien. Dies deutet darauf hin, dass diese Variable unterschiedliche Konstrukte repräsentiert, je nachdem ob sie auf ökologischem oder individuellem Niveau gemessen wird.

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Facteurs reproductives et l'incidence du cancer du sein: Une étude international et écologique

Résumé Les études écologiques peuvent permettre de mieux comprendre la relation entre les événements de l'histoire reproductive et le risque de cancer du sein. A cet effet, nous avons analysé les données de 9416 femmes, représentant les groupes témoins de sept pays (Australie, République Populaire de Chine, Colombie, (ex) République Démocratique Allemande, Israël, Philippines et Thaïlande) de l'étude cas-témoins multicentrique internationale de l'OMS sur les cancers de la femme. Des corrélations positives avec l'incidence du cancer du sein ont été observées pour la durée (médiane) de la vie reproductive (r0.95, p<0.005), l'âge de la ménopause (r0.84, p<.025) et le délai entre la ménarque et la première grossesse (r0.84, p<0.22) (ou lorsque la République Populaire n'est pas incluse, r0.85, p<0.07). L'association entre l'âge de la première naissance et l'incidence du cancer du sein était faiblement positive dans l'échantillon complet (rajusté pour l'âge=0.18, p=0.73), mais légèrement négative dans le groupe d'âge 15–29 ans et 30–39 ans et faiblement positive dans le groupé d'âge 40–49 ans et 50–64 ans. Une forte corrélation inverse est observée entre l'âge de la ménarque et l'incidence de cancer du sein (r–0.84, p<0.03). Ces corrélations écologiques internationales concordent avec les associations au sein de populations uniques montrant un risque accru de cancer du sein en rapport avec une ménarque plus jeune, une ménopause plus âgée, une durée plus longue de la vie reproductive et (possiblement), un plus grand délai entre la ménarque et la première naissance. Contrairement aux études utilisant les données individuelles, l'âge à la première naissance n'est que faiblement associé à l'incidence de cancer du sein à l'échelle interpopulationnelle, suggérant que cette variable a une signification différente au niveau écologique ou individuel.

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See Appendix for details of data collection centers and principal participants.     

Study on the Function of Rabbit Oviductin"DPF-1" by Using Loss of Function Analysis

Some oviduct-specific secretory proteins were assumed to play an important-biological role in early embryo development.In 1 989,Bleau and St.Jacquessuggest-ed these oviduct-specific glycoprotein be called“Oviductins”.In our recent studies,we have gained“loss of function”evidence to prove that the rabbit64k D oviductin( named temporarily developmentpromoting factor-1 ,DPF-1 ) functioned in overcom-ing the developmentblock of early embryo in vitro.Judged by itsbiochemicaland bi-ological c…     

A multinational case-control study of cardiovascular disease and steroid hormone contraceptives : Description and validation of methods

A hospital-based, case-control study of the association between current usage of oral contraceptives and first-time cases of acute myocardial infarction, stroke, or a venous thromboembolic event (deep vein thrombosis or pulmonary embolus) was carried out in 17 countries from four regions (Africa, Asia, Europe, and Latin America). A total of 3792 cases and 10,281 hospitalised controls matched for age were recruited during a 4-year period, ending in June 1993. The study was designed to have sufficient power to detect a relative risk of 2 for developing each of the three study diseases, associated with current oral contraceptive use in each of the four regions, with the exception of acute myocardial infarction (for which all non-European regions were to be combined) and for venous thromboembolic events in Asia, where these disorders are rare.

This report describes the background, pilot study, methods, and the analyses carried out to validate the methods used in the study.