bluuebunny/crossref_metadata_2025 huggingface dataset:
Body Composition by Three-Compartment Model and Relative Validity of Some Methods to Assess Percentage Body Fat in Mexican Healthy Elderly Subjects
Authors: Alemán-Mateo Heliodoro , Esparza Romero Julián , Macías Morales Nayeli , Salazar Gabriela , Hernández Triana Manuel , Valencia Mauro E.
Published: October 2004

Background: In Mexico, there is scarce information about the body composition in the elderly. Some researchers have measured body fat by anthropometry and bioelectrical impedance. These techniques are practical and can be used in the field; however, proper validation is required. This implies the use of accurate and precise methods. In the elderly, Siri’s three-compartment (3C) model has been proposed as feasible alternative to the gold standard four-compartment model. Objective: To evaluate the body composition by the 3C model and the relative validity of densitometry and hydrometry methods to assess the percentage body fat (%BF) in 37 healthy Mexican elderly subjects. Methods: The body density was measured by air displacement plethysmography, total body water was evaluated by means of an isotopic dilution technique, and two different hydration factors were used to determine the fat-free mass. These measurements were used to calculate %BF by the 3C model. Accuracy and precision of the methods were tested by a two-way analysis of variance and regression procedures and bias by Bland and Altman analysis. Results: In men and women as a whole group, the %BF by the 3C model was 34.4 ± 8.01. Women had higher values of %BF as compared with men (41.7 ± 3.7 vs. 29.4 ± 6.4; p < 0.0001). The regression procedures showed that air displacement plethysmography was accurate and precise only in women and in the whole group. Regression analyses of %BF by total body water (using both hydration factors) and 3C model showed that the intercepts were not different from zero and that the slopes were not different from 1.0 in men and women separately and as group. Conclusion: In this study, the total-body water method revealed a good relative validity (accuracy, precision, and freedom from bias) as compared with the 3C model in men and women both separately and as a group and may be acceptable for the estimation of %BF in individuals or groups of healthy elderly subjects.
Balance Confidence Improves with Resistance or Agility Training
Authors: Liu-Ambrose T. , Khan K.M. , Eng J.J. , Lord S.R. , McKay H.A.
Published: October 2004

Background: While the fear of falling is a common psychological consequence of falling, older adults who have not fallen also frequently report this fear. Fear of falling can lead to activity restriction that is self-imposed rather than due to actual physical impairments. Evidence suggests that exercise can significantly improve balance confidence, as measured by falls-related self-efficacy scales. However, there are no prospective reports that correlate change in balance confidence with changes in fall risk and physical abilities as induced by participating in a group-based exercise program. Objective: The primary purpose of this prospective study was to examine the relationship between the change in balance confidence and the changes in fall risk and physical abilities in older women with confirmed low bone mass after 13 weeks of exercise participation. The secondary purpose of this study was to examine the relationship between the change in balance confidence and the change in physical activity level. Methods: The sample comprised 98 women aged 75–85 years with low bone mass. Participants were randomly assigned to one of three groups: resistance training (n = 32), agility training (n = 34), and stretching (sham) exercises (n = 32). The 50-min exercise classes for each study arm were held twice weekly at a local YMCA community centre. Results: Both resistance training and agility training significantly improved balance confidence by 6% from baseline after 13 weeks. However, the change in balance confidence was only weakly correlated with improved general physical function and not significantly correlated with the changes in fall risk score, postural stability, gait speed, or physical activity level. As well, we observed balance confidence enhancement in the presence of increased fall risk or deterioration in physical abilities. Conclusions: Two different types of exercise training improved balance confidence in older women with low bone mass. This change in balance confidence was significantly correlated with change in general physical function. Because of the observation of discordance between balance confidence change and changes in fall risk and physical abilities, those who design group-based exercise programs for community-dwelling older adults may wish to consider including an education component on factors that influence fear of falling. Objective changes in fall risk factors cannot be assumed to mirror change in fear of falling and physical abilities in older adults in the short-term.
Salivary Cortisol Level, Salivary Flow Rate, and Masticatory Muscle Activity in Response to Acute Mental Stress: A Comparison between Aged and Young Women
Authors: Bakke Merete , Tuxen Anette , Thomsen Carsten Eckhart , Bardow Allan , Alkjær Tine , Jensen Bente Rona
Published: October 2004

Background: Age-related effects on physiological stress reactions regarding changes in salivary cortisol concentration, saliva flow rate, and masticatory muscle activity, as well as the corresponding perceived mental stress and performance in response to acute stressors, have not yet been fully described. Objective: Thus, the aim of this study was to assess the age-related variations in these variables in response to minor acute and naturalistic stressors in terms of computer tasks. Methods: 13 aged (60–70 years old) and 13 young (20–30 years old) women with frequent practice and long experience with computer use were recruited by personal contact and flyers. The subjects were healthy and had full dental arches and no orofacial pain. The computer tasks were randomized and comprised a mentally demanding, modified Stroop colour-word test (CWT) and a less demanding reference test, both with a duration of 20 min and with equal physical demand. Visual analogue scales for global assessment of mental stress and perceived task difficulty and performance, measurements of saliva flow rate and cortisol concentration (unstimulated whole saliva), as well as surface electromyography of the temporalis and masseter muscles were used for assessment, and Spearman correlation analysis and Anova with repeated measures were used for statistical evaluation. Results: The perceived task-related stress and task difficulty were significantly higher and the personal satisfaction with the task performance significantly poorer in the aged women. The cortisol concentration, indicating the stress level, showed a small, but significant increase in response to the tasks. Also the saliva flow rate increased. This response was most pronounced in the aged and during the CWT. The average electromyogram varied significantly between age groups and tasks, with higher levels and shorter relative periods with gaps in the aged women and in the CWT. In addition, the peak activity of the jaw elevator muscles at mouse clicking was significantly elevated as a form of co-activation or attention-related activity. Conclusions: The study showed marked differences in the response to mental demands in aged as compared with young women. The mental stress, reflected by increases of salivary cortisol concentration, saliva flow rate, visual analogue scale ratings, and activity level of the jaw elevator muscles, was more pronounced in the aged women in response to the computer tasks.
Patient Age and Patency Rate after Recanalization of Occluded Peripheral Arteries
Authors: Kröger K. , Strubel G. , Poser M. , Pratikto T. , Renzing-Köhler K. , Rudofsky G.
Published: October 2004

Objectives: Due to an increase in the percentage of older people in industrialized countries there is an increasing demand for medical care for the elderly. With advancing age, a series of structural, architectural and compositional modifications take place in the vasculature. Therefore, we analyzed the influence of patient age on the reocclusion rate of recanalized peripheral arteries. Patients and Methods: 471 patients (mean age ± SD: 62 ± 12 years, range: 28–90 years) successfully treated by interventional recanalization were followed up (mean ± SD: 18 ± 17 months, range:6–48 months). Reocclusion of the recanalized arterial segment could be proven in 175 patients (37%), whereas octogenarians had the highest patency rate i.e. 68%. Univariate analysis, multivariate logistic regression analysis, and ROC analysis were performed. Results: The univariate analysis showed a significant relation between reocclusion and PAOD stage, hyperlipoproteinemia, and total cholesterol level and erythrocyte sedimentation rate (ESR), respectively. Excluding age-related risk factors, the multivariate logistic regression analysis with backward selection reached a significant level for PAOD stage with p = 0.0012 and an odds ratio of 1.63, and for ESR with a p = 0.0013 and an odds ratio of only 1.02. Age did not reach a significant level with a p value of 0.13 and an odds ratio of 0.98. In the ROC analysis, prognostic relevance could be shown for the combination of PAOD stage and ESR adjusted for age and hyperlipidemia, and for PAOD stage and ESR value as a single prognostic factor, but not for patient age. Conclusion: Thus, despite proven and hypothetical differences in the vascular biology of older people compared to younger people, age is not related to middle term patency rates after interventional recanalization of peripheral arterial occlusions.
Field Evaluation of Cycled Coupled Movements of Hand and Foot in Older Individuals
Authors: Capranica Laura , Tessitore Antonio , Olivieri Berardo , Minganti Carlo , Pesce Caterina
Published: October 2004

Background: Age-related deterioration of motor performance has been investigated, often associated to behavioral slowing and to modification in the quality of movement coordination. However, the complexity of laboratory settings restrains sound quantitative evaluation of inter-limb coordination in large-scale clinical assessments, and no information regarding test stability has been provided. Objective: The aims of the present study were to verify in homolateral hand and foot coordination field performances: (1) acceptable test–retest reliability criteria for older adults, and (2) the effects of coordination mode and test velocity at different ages across lifespan. Methods: Seventy-seven individuals, ranging in age from 10 to 87 years, performed simultaneous flexions and extensions of the homolateral wrist and ankle in the sagittal plane with a 1:1 ratio. Two homolateral conditions (preferred and non-preferred limbs) were tested in two coordination modes: in-phase (isodirectional) and anti-phase (nonisodirectional) at three test frequencies (80, 120 and 180 bpm, respectively). Time of correct execution within a maximum of 60 s was recorded for each test condition. Older adults (n = 36) performed the test and the retest with a week interval. Results: High ICCs (range 0.72–0.98) and acceptable limits of agreement were found for the subsample of older adults. Main effects and significant interactions were found for age, coordination mode, and execution frequency. Time of correct execution was longest in younger adults and shortest in older individuals. At all ages, it was longer for the in-phase than in the anti-phase condition and decreased with increasing execution frequency. However, the amplitude of the differences between execution frequencies varied as a function of age and coordination mode. Conclusions: The high test-retest stability coefficients confirm that the present field test represents a reliable tool to quantify older individual’s performance on cyclic coupled movements of hand and foot allowing large-scale evaluations with an inexpensive apparatus. Aging generally harms homolateral inter-limb coordination performance, but a more complex pattern of effects emerges when coordination mode, and frequency of execution are manipulated. In fact, age-related performance impairments were most pronounced during anti-phase movements, that need increased monitoring and attentional allocation in order to inhibit the natural in-phase mode, and at high execution frequencies, that are strongly affected by age-related muscle weakness, prolonged reaction times, and changes in stretch reflexes.
Quality of Life in the Very Elderly after Cardiac Surgery: A Comparison of SF-36 between Long-Term Survivors and an Age-Matched Population
Authors: Sjögren Johan , Thulin Lars I.
Published: October 2004

Background: Octogenarians are the fastest growing section of the population in Western countries. Since health care resources are limited, there is a need for critical evaluations of the long-term surgical outcome and quality of life in the elderly. Objectives: Our aim was to assess the quality of life and long-term survival after cardiac surgery in the very elderly. Methods: Between 1990 and 1993, 117 octogenarians underwent aortic valve replacement, coronary artery bypass grafting or combined surgery at our department. Forty-one patients were still alive at the time of follow-up (mean 8.3 ± 1.9 years). Thirty-nine of the 41 long-term survivors (95%) answered a quality of life questionnaire (SF-36). The scores were compared with an age-matched population. Results: The overall survival at 1, 5 and 9 years was 92.3 ± 2.5, 65.0 ± 4.4 and 37.9 ± 5.2%, respectively. A significant difference was identified between the scores of our patients and the general Swedish octogenarians in two SF-36 headings (Bodily Pain and Physical Functioning). Our patients indicated lower physical function, but less pain in comparison with the general aged population. There was no significant difference in six of the eight SF-36 headings. Conclusions: The overall long-term survival was similar to Swedish octogenarians. Late postoperative quality of life in our long-term survivors was comparable to an age-matched population. Our findings support the view that a selected population of elderly may undergo open heart surgery with good long-term quality of life.
Fall Incidence in Frail Older Women after Individualized Visual Feedback-Based Balance Training
Authors: Sihvonen Sanna , Sipilä Sarianna , Taskinen Sara , Era Pertti
Published: October 2004

Background: The knowledge concerning balance training actually lowering fall rates among frail older persons is limited. Objective: The aim of this study was to examine the effects of a 4-week individualized visual feedback-based balance training on the fall incidence during 1-year follow-up among frail older women living in residential care. Methods: Twenty-seven older women from 2 residential care homes were randomized into exercise (n = 20) and control (n = 7) groups. Balance measurements were carried out before and after a 4-week training period and falls were monitored by monthly diaries for 1 year. An interview about fear of falling and physical activity was completed before and after the intervention and after the 1-year follow-up. Results: A positive effect of balance training on fall incidence was found. A dynamic Poisson regression model showed that during the follow-up the monthly risk of falling was decreased in the exercise group compared to controls (risk ratio 0.398, 95% CI 0.174–0.911, p = 0.029). In addition, the exercise group reported a reduced fear of falling and increased physical activity after a training period but these changes declined during the follow-up period. Conclusion: Individualized visual feedback-based balance training was shown to be a promising method for fall prevention among frail older women. High compliance (97.5%) with the training program showed that carefully targeted training programs can be carried out among older people with health limitations.
Prevention of Late Complications by Half-Solid Enteral Nutrients in Percutaneous Endoscopic Gastrostomy Tube Feeding
Authors: Kanie Jiro , Suzuki Yusuke , Akatsu Hiroyasu , Kuzuya Masafumi , Iguchi Akihisa
Published: October 2004

Background: Percutaneous endoscopic gastrostomy feeding is accompanied by unique complications, which are not easily controlled. Objective: In an attempt to decrease complications, we used half-solid nutrients for percutaneous endoscopic gastrostomy feeding in an 85-year-old woman. The patient had been receiving enteral nutrients via percutaneous endoscopic gastrostomy, and we examined whether this approach can reduce complications. She presented with regurgitation of enteral nutrients and recurrent respiratory infections. Methods: Half-solid enteral nutrients, prepared by mixing liquid enteral nutrients with agar powder, were administered via percutaneous endoscopic gastrostomy. Results: Symptoms of gastroesophageal reflux disappeared immediately after the start of half-solid enteral nutrient feeding. Conclusion: Gastroesophageal reflux and leakage, two intractable late complications of percutaneous endoscopic gastrostomy tube feeding, can be alleviated by the solidification of enteral nutrients. Since this method allows quick administration of nutrients, it is also expected to help prevent the occurrence of decubitus ulcers and reduce the burden to the caregiver.
New Trends in Biomedical Aging Research
Authors: Malavolta Marco , Mocchegiani Eugenio , Bertoni-Freddari Carlo
Published: October 2004

Background: The increasing demand for health care services, the extraordinary results obtained by applying innovative biotechnology, and the intense debate aroused by the possibility that postponement of aging may be in sight should promote public enthusiasm and funding for biomedical aging research aimed at enhancing a healthy life span by healthy productive life. Objective: New trends in biomedical aging research arise from the advancement of knowledge on the basic molecular mechanisms of aging and the availability of advanced biotechnology. Results: The emerging scenario is that, in opposition to the highly publicized, yet unwarranted claims of existing so-called anti-aging treatments, innovative and promising therapies for the treatment and prevention of age-related diseases and intriguing strategies aimed at the postponement of aging are currently in the process of development. Conclusions: Although many problems will remain unsolved for long, it seems that a common consensus has been raised towards the possible serious impact of these strategies on the development of knowledge around the mechanisms of aging.
Protein Kinase C Alpha Expression in Breast and Ovarian Cancer
Authors: Lahn Michael , Köhler Gabriele , Sundell Karen , Su Chen , Li Shuyu , Paterson Blake M. , Bumol Thomas F.
Published: October 2004

In recent years research has focused on the development of specific, targeted drugs to treat cancer. One approach has been to block intracellular signaling proteins, such as protein kinase C alpha (PKC-α). To help support the rationale for clinical studies of a PKC-α-targeted therapy in breast and ovarian cancers, we reviewed publications studying PKC-α expression in these tumors. Since these investigations were mostly performed in cell lines, we supplemented this review with some preliminary findings from studies examining PKC-α expression in tumor tissue biopsies obtained from patients with breast and ovarian cancer. Based on the reviewed publications using representative cell lines and our preliminary findings on tumor tissue of patients with breast cancer, we infer that PKC-α levels may especially be increased in breast cancer patients with low or negative estrogen receptor (ER) levels. Thus, clinical studies determining efficacy of selective or specific inhibitors of PKC-α should include determination of ER status in order to help answer whether blocking PKC-α in patients with low or absent ER can result in clinical benefit.
Prognostic Value of Syndecan-1 Expression in Breast Cancer
Authors: Leivonen Marja , Lundin Johan , Nordling Stig , von Boguslawski Kristina , Haglund Caj
Published: October 2004

Objective: Syndecan-1 is a cell surface heparan sulphate proteoglycan which participates in cell proliferation, cell migration and cell-matrix interactions. Epithelial syndecan-1 expression is reduced in several malignant tumours, but in breast and pancreatic cancer, increased expression has also been described. Loss of epithelial syndecan-1 has been associated with poor prognosis in some forms of cancer, but previous findings in breast cancer have been contradictory. The objective of this study was to evaluate the prognostic value of the immunohistochemical expression of syndecan-1 in a series of 200 patients with invasive breast cancer with a median follow-up of 17 years. Methods: Formalin-fixed paraffin-embedded specimens were stained using a monoclonal antibody against syndecan-1. Results: Syndecan-1 was expressed in the epithelium in 61% and in the stroma in 67% of the tumours. Epithelial syndecan-1 expression was associated with negative oestrogen receptor (ER) status (p < 0.01), and stromal syndecan-1 expression with positive ER status (p = 0.02). The breast cancer-specific 10-year overall survival for patients with epithelial syndecan-1 expression was 65%, compared with 82% for those with loss of epithelial expression (p = 0.02). Ten-year survival was 66% for those expressing stromal syndecan-1 and 83% for those lacking stromal expression (p = 0.15). Patients with both epithelial and stromal expression had a 10-year survival of only 56%, compared to 78% in patients with other expression pattern combinations (p < 0.002). In Cox multivariate analysis, only axillary involvement and tumour size were significant predictors of breast cancer-specific survival. Conclusion: Concomitant expression of syndecan-1 in both epithelium and stroma may be a predictor of unfavourable prognosis in breast cancer, and in contrast with previous studies, loss of epithelial syndecan-1 was associated with a more favourable prognosis.
Prognostic Significance of Tumor Markers in Peritoneal Lavage in Advanced Gastric Cancer
Authors: Yamamoto Manabu , Baba Hideo , Kakeji Yoshihiro , Endo Kazuya , Ikeda Yasuharu , Toh Yasushi , Kohnoe Shunji , Okamura Takeshi , Maehara Yoshihiko
Published: October 2004

Objective: Predicting peritoneal dissemination of cancer is very difficult whatever method of examination is used. Recently, a cytological examination of peritoneal lavage has been shown to be a feasible measure to predict an early state of peritoneal seeding. The predictive value of the levels of tumor markers in peritoneal lavage for peritoneal metastasis from gastric carcinoma was thus studied. Methods: In 229 patients gastric cancer tumor markers, CEA, CA 125, and CA 19-9, in peritoneal lavage were intraoperatively evaluated using a chemiluminescent enzyme immunoassay. Results: CEA in peritoneal lavage at a cutoff level of 0.5 ng/ml showed overall a higher sensitivity of 75.8% at a specificity of 90.8% for a diagnosis of peritoneal dissemination including cytologically positive peritoneal lavage [CY(+)] than CA 125 or CA 19-9 in peritoneal lavage. The CEA level in peritoneal lavage as well as both serosal invasion and the CA 125 level in peritoneal lavage were significant factors for the prediction of peritoneal dissemination including CY(+) with a relative risk of 6.6, 14.1 and 9.4. In patients undergoing curative operations, the recurrence rate for peritoneal dissemination and liver metastasis in cases with CEA levels in peritoneal lavage of ≧0.5 ng/ml was significantly higher than that in cases with CEA levels of <0.5 ng/ml (p < 0.0001, p < 0.002). Conclusions: These finding suggest that the CEA level in peritoneal lavage is thus considered to be a predictor of peritoneal dissemination including CY(+).
Single-Agent Gemcitabine in Previously Untreated Elderly Patients with Advanced Bladder Carcinoma: Response to Treatment and Correlation with the Comprehensive Geriatric
Authors: Castagneto Bruno , Zai Silvia , Marenco Daniela , Bertetto Oscar , Repetto Lazzaro , Scaltriti Laura , Mencoboni Manlio , Ferraris Valentino , Botta Mario
Published: October 2004

Objective: The study aimed at evaluating the activity and toxicity of gemcitabine monochemotherapy in a unselected series of elderly patients with advanced bladder cancer. The secondary objectives were to establish whether there is a correlation between treatment and Comprehensive Geriatric Assessment (CGA) and, in addition, to determine overall patient survival. Methods: Treatment consisted of six courses of chemotherapy with gemcitabine at a dosage of 1,200 mg/m2 on days 1 and 8, every 21 days. CGA, as described by Gruppo Italiano di Oncologia Geriatrica, was assessed for evaluating the functional status of patients before, during, and after treatment. Results: Twenty-five patients were enrolled (M/F 22/3), 22 of these were evaluable for response and 23 for toxicity. Characteristics of patients: median age 76 years (range 71–87); ECOG performance status (PS) 1 in 12 patients and 2 in 13 patients; clinical stage III in 6 patients and IV in 19 patients. At the end of the therapy the parameters of CGA improved in 4 cases (17%), remained unchanged in 17 cases (74%) and worsened only in 2 cases (9%). Two patients were not evaluable. Response evaluation showed 3 (13.5%) complete responses (CRs) and 7 (32%) partial responses (PRs), for an overall response rate of 45.5% [95% confidence interval (CI), 24.3–65.7%]. Three (13.5%) patients had stable disease (SD ) and 9 (41%) disease progression (DP). Median overall survival was 8 months and median time to progression was 5 months. Treatment was generally well tolerated, with 1 patient having grade 3 gastrointestinal toxicity and 3 having grade 4 neutropenia. Conclusions: We conclude that gemcitabine can be safely administered in monochemotherapy, is effective and does not worsen the functional status of elderly patients with advanced bladder cancer.
Preoperative Diagnosis and Treatment Results in 106 Patients with Uterine Sarcoma in Hokkaido, Japan
Authors: Sagae Satoru , Yamashita Kohki , Ishioka Shinichi , Nishioka Yoshihiro , Terasawa Katsuhiko , Mori Mitsuru , Yamashiro Katsushige , Kanemoto Toshitaka , Kudo Ryuichi
Published: October 2004

Objective: The aim of this study was to evaluate the clinicopathological features of uterine sarcoma in Hokkaido, Japan, between 1990 and 1999, and to identify prognostic factors of patients with such malignancies in this area and period. Methods: One hundred and six patients with histologically proven uterine sarcoma were evaluated retrospectively. Results: 93.5% of the patients with carcinosarcoma (CS) were diagnosed as having malignant disease preoperatively, while 65% of those with leiomyosarcoma (LMS) and 75% of those with endometrial stromal sarcoma (ESS) were preoperatively diagnosed as benign leiomyoma. When patients had no residual disease postoperatively, 5-year survival rates in patients with CS and LMS were 78.8 and 73.0%, respectively. ESS cases had a better prognosis (94.7% for stage I cases). In patients with early-stage sarcoma, pelvic lymphadenectomy and adjuvant chemotherapy, with or without cis-diamminedichloroplatinum, failed to show a survival benefit in both CS and LMS cases. Distant metastasis, myometrial invasion, and no residual disease at surgery were significantly associated with risk of death or recurrence in CS and LMS cases. Conclusion: Accurate preoperative diagnosis of uterine sarcoma was difficult, and no residual disease at surgery was the most important prognostic factor in patients with this disease. Postoperative adjuvant therapy had little effect on survival , especially in early-stage disease.
Single-Agent Epirubicin as Primary Chemotherapy in T2–T3, N0–N2, M0 Breast Carcinoma: 6-Year Follow-Up
Authors: Barni S. , Piazza E. , Frontini L. , Visini M. , Ardizzoia A. , Grassi M.M. , Nosenzo M.A. , Mandalà M. , Biasioli R. , Freddi E. , Lucani L. , Recalcati A. , Pravettoni A. , Sala R. , Rezzani C. , Villa S. , Trabucchi E.
Published: October 2004

Objective: Single-agent epirubicin was tested as primary chemotherapy treatment in patients with early breast cancer >3 cm. Methods: 100 women with locally advanced breast cancer >3 cm were treated with three cycles of single-agent epirubicin at a dose of 120 mg/m2. All patients showing tumor shrinkage to less than 3 cm were considered candidates for conservative surgery (quadrantectomy); in the remaining patients modified radical mastectomy was carried out. Postsurgical treatment consisted of CMF chemotherapy except for postmenopausal node-positive, estrogen-positive patients who were assigned to hormonal treatment with tamoxifen and postmenopausal node-negative, estrogen-positive ones who did not receive any treatment. Results: Quadrantectomy was carried out in 71 patients. At the median follow-up time of 69 months, the relapse rate was 29.6% among patients who underwent quadrantectomy (21 out of 71) and 58.6% among patients who underwent modified radical mastectomy (17 out of 29). Conclusions: Single-agent chemotherapy with anthracyclines could appear to be an effective treatment in inducing a tumor downstaging in patients with early breast cancer >3 cm. This treatment can be administered outside clinical trials in patients who desire to preserve their body integrity. Further prospective, randomized trials are needed in order to validate and better define the role of epirubicin in the neoadjuvant strategy of breast cancer patients.
Long-Term Follow-Up of a Pilot Phase II Study with Neoadjuvant Epidoxorubicin, Etoposide and Cisplatin in Gastric Cancer
Authors: Barone C. , Cassano A. , Pozzo C. , D’Ugo D. , Schinzari G. , Persiani R. , Basso M. , Brunetti I.M. , Longo R. , Picciocchi A.
Published: October 2004

Objective: The prognosis in T3–T4 or N+ gastric cancer is dismal, and the role of adjuvant therapy remains uncertain. Neoadjuvant chemotherapy could improve both resectability and survival. Here, we report the results of the long-term follow-up of a pilot study aimed at evaluating a neoadjuvant treatment in a group of patients carefully staged by computed tomography (CT), endoscopic ultrasound and laparoscopy. Methods: Twenty-five stage II–III patients with histologically proven gastric adenocarcinoma were enrolled in the study. All patients gave informed consent and were thoroughly staged. Patients were treated with epidoxorubicin (40 mg/m2 i.v.) on days 1 and 4, etoposide (VP-16; 100 mg/m2) on days 1, 3 and 4 and cisplatinum (80 mg/m2) on day 2, every 21–28 days for 3 pre-operative cycles before CT clinical restaging followed by laparotomy and D2 gastrectomy. Three further cycles of chemotherapy were planned after radical surgery. Results: Twenty-four patients received the planned pre-operative chemotherapy and underwent surgical resection; total (13 patients) or subtotal (7 patients) R0 D2 gastrectomy was possible in 20 patients. One patient died as a result of gastric bleeding. Perioperative complications occurred in 5 patients (failure of anastomosis in 1 patient and wound infection in the other 4). The pathologic response rate included 7 partial responses (29.1%) and 10 patients with stable disease (41.7%). The main toxicity was grade 3/4 neutropenia (68%), which occurred more frequently during the postoperative chemotherapy, and fatigue (68%). Fever or infection, however, were never observed. The median disease-free survival was 37 months, and median survival has not been reached after 40 months of median follow-up. One-, 2- and 3-year survival rates were 80, 64 and 60%, respectively. Conclusion: The notable long-term survival in the present study suggests a comparison between the neoadjuvant approach, including new drug combinations, and adjuvant chemo- or chemoradio-therapy in locally advanced gastric cancer.
Association between Components of the Insulin-Like Growth Factor System and Endometrial Cancer Risk
Authors: Augustin Livia S.A. , Dal Maso Luigino , Franceschi Silvia , Talamini Renato , Kendall Cyril W.C. , Jenkins David J.A. , Vidgen Ed , La Vecchia Carlo
Published: October 2004

Objective: The insulin-like growth factor (IGF) system has been related to cell proliferation, obesity, diabetes, hyperinsulinemia and endometrial cancer risk. We used data from a case-control study conducted in Italy to provide additional information on the relation between the IGF system and endometrial cancer. Methods: A case-control study was conducted between 1999 and 2002 in Italy, including a total of 73 women with incident, histologically confirmed endometrial cancer and 108 controls admitted to the same hospital network for acute, nonneoplastic diseases. All subjects were interviewed using a validated questionnaire. Results: The odds ratios for endometrial cancer comparing the highest versus the lowest tertile of various IGF components were as follows: 0.5 [95% confidence interval (CI) 0.2–1.2] for free IGF-I, 1.1 (95% CI 0.5–2.6) for total IGF-I, 1.2 (95% CI 0.6–2.6) for total IGF-II, 2.4 (95% CI 1.0–5.9) for IGF binding protein (IGFBP)-1 and 0.8 (95% CI 0.4–2.0) for IGFBP-3. Further allowance for all IGF components in the model did not modify the results. The direct relation with IGFBP-1 was stronger and limited to heavier and older women. Conclusions: The present findings suggest a limited effect of the IGF system on endometrial cancer risk. Increasing IGFBP-1 levels seem to be associated with endometrial cancer risk in older women and in women with a higher body mass index.
Prognostic Relevance of Altered pRb and p53 Protein Expression in Surgically Treated Non-Small Cell Lung Cancer Patients
Authors: Dworakowska Dorota , Jassem Ewa , Jassem Jacek , Wiedorn Klaus Hermann , Boltze Carsten , Karmoliński Andrzej , Dworakowski Rafał , Skokowski Jan , Jaśkiewicz Kazimierz , Bosse Alexander , Częstochowska Eugenia
Published: October 2004

Objective: The prognostic value of pRb and p53 altered expression in non-small cell lung cancer (NSCLC) remains debatable. We assessed the occurrence of altered pRb and p53 protein expression, and the prognostic value of these assays considered as separate and combined variables in operable NSCLC. The study group included 195 NSCLC consecutive patients from one institution who underwent curative pulmonary resection between 1994 and 1999. Methods: Expression of pRb and p53 was assessed immunohistochemically with the use of monoclonal antibodies (LM95.1 and Pab 1801, Oncogene Science, respectively). Results: A lack of pRb and abnormal p53 protein expression were found in 57 (29%) and 92 samples (47%), respectively, whereas both abnormalities (pRb–/p53+) occurred in 24 samples (12%). There was no relationship between altered pRb/p53 expression and major clinico-pathological characteristics, neither was there a significant difference in disease-free and overall survival between particular groups of patients with tumors carrying four possible pRb/p53 phenotypes. In uni- and multivariate analysis, the only variable associated with shortened disease-free and overall survival was stage of disease (p < 0.001) and degree of tumor differentiation (p = 0.005). Conclusion: These results suggest that altered pRb and p53 expression does not provide prognostic information in operable NSCLC patients.
Clinicopathological Significance of Stromelysin-3 Expression in Colorectal Cancer
Authors: Skoglund Johanna , Emterling Anna , Arbman Gunnar , Anglard Patrick , Sun Xiao-Feng
Published: October 2004

Objective: Stromelysin-3 (ST3) is a member of the matrix metalloproteinases and suggested to play a role in tissue remodeling observed in growth and metastasis of tumors. ST3 overexpression in breast cancer is associated with a worse outcome. Our aims were to analyze ST3 expression in primary colorectal tumors and metastases, and further to identify relationships of the expression to clinicopathological factors. Materials and Methods: ST3 expression was immunohistochemically analyzed in 200 primary colorectal adenocarcinomas and 36 corresponding lymph node metastases. Results: Scoring was performed by counting the percentages of positive cells and the percentages of positive areas. One hundred and one (51%) cases showed ≤5% positive cells and 99 (49%) >5% positive cells. One hundred and two (51%) cases showed ≤30% positive area and 98 (49%) >30% positive area. ST3 expression determined by both scoring methods was individually related to females, distally located tumors, infiltrative growth pattern and microsatellite stability. No relationship was found with age, Dukes’ stage, differentiation and survival. Conclusions: These results suggest that ST3 protein was more involved in the pathway of colorectal cancer development in females, distal locations, infiltrative growth patterns and microsatellite stability.
Prognostic Significance of Dysadherin Expression in Esophageal Squamous Cell Carcinoma
Authors: Shimada Yutaka , Hashimoto Yosuke , Kan Takatsugu , Kawamura Jun-ichiro , Okumura Tomoyuki , Soma Toshiya , Kondo Kan , Teratani Naoki , Watanabe Go , Ino Yoshinori , Sakamoto Michiie , Hirohashi Setsuo , Imamura Masayuki
Published: October 2004

Objective: Dysadherin is a cancer-associated cell membrane glycoprotein that has been reported to downregulate E-cadherin expression and promote metastasis. To evaluate the role of dysadherin in metastasis of esophageal squamous cell carcinoma (ESCC), we examined dysadherin and E-cadherin expression in patients with this cancer. Methods: Dysadherin and E-cadherin expression was evaluated in 117 ESCC patients (pT1, 31; pT2, 30; pT3, 39; pT4, 17) by immunohistochemistry. The findings were compared with the clinicopathological data of the patients. Results: Both dysadherin and E-cadherin were localized to the cell membrane. Thirty patients (29.1%) had tumors positive for dysadherin and 41 patients (35.0%) had tumors positive for E-cadherin. Tumors showing dysadherin positivity and negative E-cadherin expression had a significantly worse prognosis than other tumors. When the patients with dysadherin- positive tumors were combined with E-cadherin-negative patients, this group had a worse prognosis (p < 0.0001). Cox multivariate analysis revealed that dysadherin expression was an independent prognostic factor for ESCC (p = 0.003), but E-cadherin expression was not. Conclusion: Combined analysis of dysadherin and E-cadherin expression may help to predict the prognosis of patients with ESCC. Our results suggested that expression of dysadherin by this cancer may partly explain the poor prognosis of patients with preservation of E-cadherin expression.
Loss of p16/CDKN2A Protein in Epstein-Barr Virus-Associated Gastric Carcinoma
Authors: Koriyama Chihaya , Kitajima Shin-ichi , Nomoto Mitsuharu , Sueyoshi Kazunobu , Itoh Tetsuhiko , Eizuru Yoshito , Yonezawa Suguru , Akiba Suminori
Published: October 2004

We examined the expression of p16, the CDKN2A gene product, in EBV-associated gastric carcinomas (EBV-GCs). EBV-GCs were identified by detecting EBV-encoded small RNA (EBER) using an in situ hybridization assay of paraffin-embedded tissue. Two non-EBV-GC cases for each EBV-GC case were selected, matched for age, sex, tumor location, and depth of invasion. After excluding cases without sufficient tissue samples for immunohistochemical analysis, 54 EBV-GC and 117 non-EBV-GC cases were available for the present study. The loss of p16 expression was more frequently observed in EBV-GCs (89%) than non-EBV-GC cases (32%; p < 0.001). Among non-EBV-GC cases, the loss of p16 expression was more frequent in female cases (57%) than male cases (29%) (p = 0.042). Expression of p16 was not related to the location of tumor, clinical stage of tumor, age, or prognosis of the patients. In conclusion, the present study suggests that the loss of p16-related cell cycle regulation may be associated with the development of EBV-GC.
Inhibition of Tumor Metastasis by Sodium Caffeate and Its Effect on Angiogenesis
Authors: Xu Feng , Song Danqing , Zhen Yongsu
Published: October 2004

Objective: Sodium caffeate (SC), the sodium salt of caffeic acid, was synthesized in our laboratory. We studied the antimetastatic effect induced by SC and its inhibition of tumor angiogenesis using various in vitro and in vivo metastasis assays. Methods: The in vivo inhibitory effect of SC on metastasis and angiogenesis was examined in the Lewis lung carcinoma pulmonary metastasis model and chicken chorioallantoic membrane (CAM) model, respectively. MTT assay and flow cytometry were used to measure the inhibition by SC of the proliferation of transformed human umbilical vein endothelial cells (ECV304) and the apoptosis induced by SC in ECV304 cells, respectively. A cell attachment assay was used to evaluate inhibition by SC of the adhesion activity of human high metastatic giant cell carcinoma of the lung (PG) cells. A cell invasion assay was used to evaluate the effect of SC on the ability of PG cells to cross tissue barriers. Inhibition by SC of gelatinase secretion in PG cells was determined by zymography. Results: In vivo results showed that SC (1 g/kg i.p. for 14 days) inhibited pulmonary metastasis at a rate of 55%. There were no differences in animal weights among the groups. The angiogenesis of CAM was inhibited by SC (200 µg/egg) at a rate of 70%. In vitro studies showed that SC inhibited the proliferation of ECV304 cells by inducing apoptosis. SC also reduced the adhesion and invasion ability of PG cells and inhibited the secretion of MMP-2 and MMP-9 in PG cells. Conclusion: SC might be a potential antimetastatic agent with an antiangiogenetic effect.
Genes and Languages
Authors: McMahon Robert
Published: October 2004

Reconciling the genetic, linguistic and archaeological histories of humans will require linguists and geneticists to interact in the design and implementation of future research strategies. This paper discusses the issues involved in correlating these disciplines and highlights some of the problems involved. It is argued that correlation cannot be an a priori assumption, but must be proved prior to or as part of each investigation. An urgent need for hierarchical linguistic classifications is established and several possible methods are identified. Case studies include the Indo-European language family and Eurasian populations; the Nostratic hypothesis; and the history of Austronesia. General and specific factors responsible for correlations, or their absence, are considered in relation to autosomal, mitochondrial and Y-chromosome-specific data and human demography.
Family Communication about Genetic Risk: The Little That Is Known
Authors: Wilson Brenda J. , Forrest Karen , van Teijlingen Edwin R. , McKee Lorna , Haites Neva , Matthews Eric , Simpson Sheila A.
Published: October 2004

Although family communication is important in clinical genetics only a small number of studies have specifically explored the passing on of genetic knowledge to family members. In addition, many of these present exploratory or tentative findings based upon small sample sizes, or data collected only a short time after testing. Nevertheless, if health professionals are to develop effective strategies to help patients’ deal with communication issues, we need to know more about what actually happens in families. The aim of this commentary is to identify factors which appear to influence whether patients share information about genetic risk with relatives who are unaware of that risk, with whom they share it and how they go about it. The paper draws upon evidence and thinking from the disciplines of psychology (including family therapy), sociology, medicine and genetic counselling. It is presented under the following headings: disease factors, individual factors, family factors and sociocultural factors. It concludes by highlighting a number of key issues which are relevant for health professionals.
Effects of Individual and Family Functioning on Interest in Genetic Testing
Authors: Bowen Deborah J. , Bourcier Emily , Press Nancy , Lewis Frances M. , Burke Wylie
Published: October 2004

Objective: The present study reports on the important issue of how family communication and support regarding breast cancer risk affects interest in genetic testing and mental health. Methods: Participants (n = 221) were women aged 18–74 who had at least one relative of Ashkenazi Jewish descent, no personal history of breast or ovarian cancer, and lived within 60 miles of Seattle, Wash. Results: Communication about breast cancer risk was reported with very low frequency across all types of relatives. Women talked with their mothers and sisters more often than their fathers, brothers, or children. The only significant predictor of interest in genetic testing was the individual level variable of seeking social support. Conclusion: Social support needs might be a part of the genetic testing process.
Public Experiences, Knowledge and Expectations about Medical Genetics and the Use of Genetic Information
Authors: Henneman Lidewij , Timmermans Danielle R.M. , van der Wal Gerrit
Published: October 2004

Objective: The objectives of this study were (1) to explore public experiences, genetic knowledge, expectations of future medical genetic developments, and the attitudes towards the use of genetic information, and (2) to determine whether there are subject characteristics associated with these variables. Methods: Participants (n = 1,308, age ≧25 years) of a Dutch consumer panel were sent a questionnaire, specifically designed for this study. Results: Response was 63% (817/1,308). A minority of respondents reported to know someone with a hereditary disease (34%) or to have used a genetic test (8%). Overall, 57% perceived a lack of genetic knowledge. In multivariate analyses, high self-rated knowledge, younger age, having heard of genetic testing, high educational level, female gender, having children living at home, being a health professional, and familiarity with genetic testing were positively associated with genetic knowledge. Future expectations of the consequences of developments in medical genetics varied between the subjects. The great majority expected great benefits for medical practice such as an increasing use of genetic aspects of disease for diagnosis or prevention. One fifth, mainly older people, anticipated a negative impact of genetic developments on society. The results also show that most people are reserved to share their genetic information with others, especially with regard to the wider public domain (e.g. industry and insurers) and employers. Remarkably, respondents were more willing to share their genetic information with scientific researchers (68%) than with their relatives (54%). Conclusion: This study suggests that although one fifth anticipates negative consequences of genetic developments, the great majority has high expectations about the increasing use of genetics in prevention, diagnosis and treatment of diseases. In developing educational programmes about genetic innovations in medicine, policymakers will have to take into account pre-existing lay knowledge, views and expectations of different groups of citizens towards these developments.