ANZ JOURNAL OF SURGERY, Issue 7 2007
Yoke-Fong Chiew
Background: The surveillance of surgical site infections (SSI) has been undertaken in many centres worldwide to ascertain the extent of the problem and where possible, to improve the incidence rates, thereby decreasing the undesirable outcomes. The study investigates the processes and outcomes of total hip replacement SSI surveillance carried out in Dunedin Public Hospital in 2004. Methods: Two hundred and six patients were enlisted in the study and 189 primary replacements and 22 revision replacements were carried out. Four methods of diagnosis of SSI were applied: (i) clinician diagnosis; (ii) ASEPSIS score; (iii) presence of pus cells; and (iv) assessment by a clinical microbiologist. Infection rates were calculated according to the risk indexes. Results: The incidence of infections varies considerably among these four methods. The infection rates for risk index 0 were 4.35% (method 1), 2.61% (method 2), 0.87% (methods 3 and 4); and for risk indexes 1 and 2 were 4.17% (method 1), 2.08% (method 2), 1.04% (methods 3 and 4). Conclusion: There is a need for accurate infection data so that the appropriate follow-up responses, including infection control measures for total hip replacement SSI can be carried out. The preponderance of elderly patients in the study who are frequently on ,polypharmacy' regimens adds pressure to the need to obtain true infection rates. This is because when antimicrobials are prescribed to them, drug interactions, adverse effects of the antimicrobials and the selective pressure of antimicrobials causing resistances may occur. More resources and a multidisciplinary approach are required for future studies of similar nature. [source]

COLONOSCOPIC SURVEILLANCE AFTER CURATIVE SURGERY FOR COLORECTAL CANCER

ANZ JOURNAL OF SURGERY, Issue 5 2005
FRACP, Hooi C. Ee MB BS
No abstract is available for this article. [source]

SIGNIFICANCE OF 18F-FLUORODEOXYGLUCOSE POSITRON-EMISSION TOMOGRAPHY/COMPUTED TOMOGRAPHY FOR THE POSTOPERATIVE SURVEILLANCE OF ADVANCED RENAL CELL CARCINOMA

BJU INTERNATIONAL, Issue 1 2010
Varun Shandal
No abstract is available for this article. [source]

Population-based case,control study of oral ketoconazole treatment for birth outcomes

CONGENITAL ANOMALIES, Issue 1 2005
Zoltán Kazy
ABSTRACT The objective of the study presented here was to check the effect of oral ketoconazole treatment on fetal development. Ketoconazole has been given a teratogenic classification of C by the US Food and Drug Administration, but human controlled epidemiological studies of the treatment's effects have not been reported. The occurrence of ketoconazole use in the second to third months of gestation was compared between cases with congenital abnormalities and their matched controls in the large population-based data set of the Hungarian Case,Control Surveillance of Congenital Abnormalities, 1980,1996. Birth weight and gestational age were evaluated in control newborn infants born to mothers with or without ketoconazole treatment. The case group comprised 22 843 cases with congenital abnormalities, while the control group contained 38 151 newborn infants without any defects. Six infants (0.03%) and 12 controls (0.03%) had mothers who had received oral ketoconazole treatment (prevalence odds ratio: with 95% confidence interval: 0.8, 0.3,2.2). No group of infants with congenital abnormalities had mothers with a higher incidence of use of the drug. The mean gestational age was somewhat longer while birth weight was somewhat larger in controls with ketoconazole treated mothers. Our study failed to demonstrate a higher rate of congenital abnormalities in infants with mothers who had received oral ketoconazole treatment during pregnancy. [source]

Validity and reliability of the guidelines of the Surveillance of Cerebral Palsy in Europe for the classification of cerebral palsy

DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 11 2008
Mary Gainsborough MRCPCH
The validity and reliability of the guidelines of the Surveillance of Cerebral Palsy in Europe (SCPE) for the classification of cerebral palsy (CP) were tested by administering 10 written case vignettes via an interactive web-based link to 30 SCPE partners. There was a moderately good level of agreement (,=0.59) about inclusion as a CP case on the SCPE database. Classification by CP subtype differed in two main areas: assigning spastic versus dyskinetic and judgement of distribution of spastic involvement. Agreement on Gross Motor Function Classification System (GMFCS) level was less good than reported in previous studies. Twenty respondents repeated the test 5 months later and there was good repeatability for case inclusion (,= 0.72) but considerable variation in assignment of CP subtype and GMFCS level. There is a need for further collaborative work and training to improve harmonization of the classification of CP, including examination, application of SCPE guidelines, and register coding. [source]

Surveillance of vision and ocular disorders in children with Down syndrome

DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 7 2007
Elma Stephen MBBS MD MRCPCH
Children with Down syndrome have a high prevalence of ocular disorders. The UK Down's Syndrome Medical Interest Group (DSMIG) guidelines for ophthalmic screening were locally implemented into a protocol that included neonatal eye examination by an opthalmologist and a comprehensive ophthalmological examination (cycloplegic refraction, ophthalmoscopy, and orthoptic assessement) by at least the age of 3 years, followed by preschool follow-up as indicated. We audited retrospectively surveillance for ocular disorders before and after the DSMIG-based guidelines were locally adopted in 1995. Results were compared for children born before and after the implementation of screening guidelines. A total of 81 children (43 females, 38 males) with Down syndrome were identified. After the DSMIG protocol, 34/36 children received a full ophthalmological examination in the neonatal period, compared with 9/27 children before 1995 (p<0.001). Neonatal screening resulted in the detection of cataracts in three infants. Mean age of first comprehensive ophthalmic screening outside the neonatal period was similar in the two groups (1y 6mo before guidelines vs 1y 9mo after), as were the proportion of children receiving preschool eye checks (27/30 before; 17/18 after). Overall, 65.7% children were screened in accordance with the guidelines, improving to 100% in recent years. At school age, 43% of the study population had significant refractive errors, with 27% having hypermetropia and astigmatism. Earlier prescription of glasses for refractive errors was seen (mean age 5y 6mo before guidelines; 3y 6mo after; p<0.001). Prevalence of other ocular disorders included strabismus (34/72, 47%), nasolacrimal duct obstruction (26/73, 35.6%), cataracts (5/64, 7.8%), and nystagmus (12/72, 16%). Establishment of the DSMIG-based local protocol has streamlined ocular surveillance. It is anticipated that this will improve developmental and functional outcomes in Down syndrome. [source]

Informing FDR: FBI Political Surveillance and the Isolationist-Interventionist Foreign Policy Debate, 1939,1945

DIPLOMATIC HISTORY, Issue 2 2000
Douglas M. Charles
First page of article [source]

5-Aminolaevulinic acid-induced photodynamic therapy and photodetection in Barrett's esophagus

DISEASES OF THE ESOPHAGUS, Issue 3 2004
P. E. Claydon
SUMMARY., Barrett's esophagus is a precursor of adenocarcinoma of the esophagus. This cancer has the fastest growing incidence of any solid tumor in the Western world. Surveillance of Barrett's esophagus is routinely undertaken to detect early malignant transformation. However, ablative endoscopic treatments are available and these can obliterate the abnormal epithelium, allowing neosquamous regrowth. Photodynamic therapy using 5-aminolaevulinic acid (ALA) is such a technique. In this non-thermal method of ablation, ALA is metabolized to produce the photosensitizer protoprophyrin IX. This, together with light and oxygen, produces local tissue destruction. Fluorescence detection using ALA has also been used to identify areas of dysplasia and thus enhance positive biopsy yield. The use of ALA in photodynamic therapy and photodetection is reviewed. [source]

Surveillance of vivax malaria vectors and civilian patients for malaria high-risk areas in northern Gyeonggi and Gangwon Provinces near the demilitarized zone, Republic of Korea, 2003,2006

ENTOMOLOGICAL RESEARCH, Issue 4 2010
Jae Chul SHIM
Abstract After re-emergence of malaria in 1993, a continued increase in Plasmodium vivax cases was observed from 1993 to 2006 in northern Gyeonggi and Gangwon Provinces adjacent to the demilitarized zone separating North from South Korea. Annual parasite incidence per 1000 people ranged from 0.33 in 2004 to 0.89 in 2006. While malaria case rates declined (22.6%) in 2004, they increased 75.1% in 2005 and 51.7% in 2006 from the previous years. An initial incorrect diagnosis of 46.8% of malaria cases as common cold resulted in a mean delay of 1.3 days for the detection malarial parasites. Of the total cases, 10.2% from December to May were due to latent intrinsic incubation infections acquired the previous malaria season and the rest of the cases from June to November were either latent or short incubation infections. Overall, the peak anopheline population occurred from July to September, resulting in a similar peak in malaria cases. While malaria cases increased during 2005,2006, anopheline populations, based on trap indices, were not significantly different during 4 years of surveillance. To decrease the malaria patient infective period to mosquitoes, public health centers in Paju and Cheorwon in 2006 prescribed chloroquine + primaquine at days 0,3 after initial malaria diagnosis followed by an additional 11 days of primaquine (early primaquine treatment), rather than chloroquine on days 0,3 and primaquine on days 4,17 (delayed primaquine treatment). A reduction in the malaria parasite incidence during 2007 was recorded for the two locations offering the early primaquine treatment relative to other locations using the delayed primaquine treatment. [source]

Correlation between population dynamics of mosquito larvae and their habitat qualities

ENTOMOLOGICAL RESEARCH, Issue 4 2008
Lalit Mohan RANJEETA
Abstract Surveillance of anopheline and culicine larvae was conducted fortnightly to determine population composition and density at seven sites in the area of the Mathura Refinery, Mathura, India during 2005,2006. The correlation between population of the vectors and their habitat quality was established. Temperature (0.978 and 0.85°C), pH (0.99 and 0.95), conductivity (0.98 and 0.98 mho) and calcium ion hardness (0.978 and 0.85 p.p.m.) were positively correlated with the populations of both larval species. In contrast, the correlation coefficients between the parameters total hardness, magnesium ion hardness, biochemical oxygen demand and chemical oxygen demand varied with the larval species. The anopheline larval population was dominant over the culicine population in the surveillance area. The distribution of anopheline mosquito larvae during the study period was found to be constant, and the average density of anopheline and culicine larvae was 84.70 and 15.30%, respectively, across all seven sites. Thus, the study demonstrated spatial and temporal population differences of mosquito larvae with respect to environmental factors, including water quality. [source]

Seasonal prevalence of mosquitoes collected from light traps in the Republic of Korea in 2003

ENTOMOLOGICAL RESEARCH, Issue 3 2006
Heung Chul KIM
Abstract Surveillance of adult mosquitoes was conducted at 29 US military installations and training sites in six provinces in the Republic of Korea during 2003. Adult mosquitoes were collected in New Jersey light traps and dry ice-baited New Jersey light traps from 1 May to 15 October. Mosquito surveillance was conducted to determine threshold levels to initiate pesticide applications and identify malaria infection rates at selected army installations and training sites. A total of 42 024 adult mosquitoes (32 594 females [77.6%] and 9430 males [22. 4%]) comprising 14 species and Anopheles sinensis s.l. (a complex of five species), representing seven genera, were collected. The most common species were members of the Anopheles sinensis Wiedemann complex (54.9%), followed by Aedes vexans nipponii (Theobald) (19.0%), Culex pipiens Coquillett (14.3%) and Culex tritaeniorhynchus Giles (10.6%). Trap indices varied widely for species over their range, due in part to geographical distribution and degree of association with urban communities. [source]

Surveillance of Infectious Disease Occurrences in the Community: An Analysis of Symptom Presentation in the Emergency Department

ACADEMIC EMERGENCY MEDICINE, Issue 7 2003
Joe Suyama MD
Objectives: To determine the effectiveness of a simulated emergency department (ED)-based surveillance system to detect infectious disease (ID) occurrences in the community. Methods: Medical records of patients presenting to an urban ED between January 1, 1999, and December 31, 2000, were retrospectively reviewed for ICD-9 codes related to ID symptomatology. ICD-9 codes, categorized into viral, gastrointestinal, skin, fever, central nervous system (CNS), or pulmonary symptom clusters, were correlated with reportable infectious diseases identified by the local health department (HD). These reportable infectious diseases are designated class A diseases (CADs) by the Ohio Department of Health. Cross-correlation functions (CCFs) tested the temporal relationship between ED symptom presentation and HD identification of CADs. The 95% confidence interval for lack of trend correlation was 0.0 ± 0.074; thus CCFs > 0.074 were considered significant for trend correlation. Further cross-correlation analysis was performed after chronic and non-community-acquirable infectious diseases were removed from the HD database as a model for bioterrorism surveillance. Results: Fifteen thousand five hundred sixty-nine ED patients and 6,489 HD patients were identified. Six thousand two hundred eight occurrences of true CADs were identified. Only 87 (1.33%) HD cases were processed on weekends. During the study period, increased ED symptom presentation preceded increased HD identification of respective CADs by 24 hours for all symptom clusters combined (CCF = 0.112), gastrointestinal symptoms (CCF = 0.084), pulmonary symptoms (CCF = 0.110), and CNS symptoms (CCF = 0.125). The bioterrorism surveillance model revealed increased ED symptom presentation continued to precede increased HD identification of the respective CADs by 24 hours for all symptom clusters combined (CCF = 0.080), pulmonary symptoms (CCF = 0.100), and CNS symptoms (CCF = 0.120). Conclusions: Surveillance of ED symptom presentation has the potential to identify clinically important ID occurrences in the community 24 hours prior to HD identification. Lack of weekend HD data collection suggests that the ED is a more appropriate setting for real-time ID surveillance. [source]

Postmarketing Surveillance of New Antiepileptic Drugs: The Tribulations of Trials

EPILEPSIA, Issue 9 2002
Jacqueline A. French
First page of article [source]

Impact of nodal ratio on survival in squamous cell carcinoma of the oral cavity

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 9 2009
Mark G. Shrime MD
Abstract Background The association between nodal ratio and survival has not been assessed in squamous cell carcinomas of the head and neck. Methods This is a population-based analysis, using the Surveillance, Epidemiology, and End-Results database, to determine whether nodal ratio impacts survival in patients with oral cavity squamous cell carcinoma. Results Between 1988 and 2005, 2955 new diagnoses of N1 or N2 squamous cell carcinoma of the oral cavity were identified. The mean nodal ratio was 16.9%. Nodal ratio was found to be strongly statistically associated with overall survival in both univariate and multivariate analyses. Patients could be stratified into low- (0% to 6%), moderate- (6% to 12.5%), and high-risk (>12.5%) groups based on nodal ratio. Conclusions In patients with squamous cell carcinoma of the oral cavity, an increased nodal ratio is a strong predictor of decreased survival. Risk of death can be stratified based on nodal ratio. © 2009 Wiley Periodicals, Inc. Head Neck, 2009 [source]

Postradiotherapy surveillance practice for head and neck squamous cell carcinoma,too much for too little?,

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 12 2003
David L. Schwartz MD
Abstract Introduction. Limited information is available regarding surveillance patterns after head and neck cancer radiotherapy. We cataloged follow-up for a specified patient cohort treated at three neighboring university, community, and Veterans Administration institutions. Methods. One hundred fifteen patients were treated with curative intent between 1994,1998 with definitive or postoperative radiotherapy for newly diagnosed squamous cell carcinoma of the oral cavity, oropharynx, larynx, or hypopharynx. One hundred patients had continuous follow-up at their treating institution and were included for analysis. Median follow-up until disease recurrence or censorship was 28.5 months. Results. Median follow-up frequency was 5.7 visits/year and was highly variable. Although visit frequency correlated with disease stage and the presence of high-risk disease features, this association was lost when patients with early recurrences were removed from analysis. Procedure and test utilization closely mirrored visit frequency, resulting in a wide range of estimated yearly charges ($0,15,668/year; median, $1,772/year). Actuarial 3-year overall survival for the study group was 71%. Eighty-six percent (19 of 22) of potentially salvageable locoregional failures were discovered secondary to symptomatic complaint rather than by test results. Disease failure, whether detected by symptom or testing, predicted for poor survival (22% at 24 months after recurrence). Conclusions. Postradiotherapy surveillance for head and neck cancer is inconsistently pursued. A proven correlation between intensive follow-up and improved patient survival is lacking. Surveillance directed by patient symptoms should be investigated as an alternative approach. © 2003 Wiley Periodicals, Inc. Head Neck 25: 000,000, 2003 [source]

The impact of detection and treatment on lifetime medical costs for patients with precancerous polyps and colorectal cancer

HEALTH ECONOMICS, Issue 12 2009
David H. Howard
Abstract Understanding the costs associated with early detection of disease is important for determining the fiscal implications of government-funded screening programs. We estimate the lifetime medical costs for patients with screen-detected versus undetected polyps and early-stage colorectal cancer. Typically, cost,effectiveness studies of screening account only for the direct costs of screening and cancer care. Our estimates include costs for unrelated conditions. We applied the Kaplan,Meier Smoothing Estimator to estimate lifetime costs for beneficiaries with screen-detected polyps and cancer. Phase-specific costs and survival probabilities were calculated from the Surveillance, Epidemiology, and End Results-Medicare database for Medicare beneficiaries aged ,65. We estimate costs from the point of detection onward; therefore, our results do not include the costs associated with screening. We used a modified version of the model to estimate what lifetime costs for these patients would have been if the polyps or cancer remained undetected, based on assumptions about the ,lead time' for polyps and early-stage cancer. For younger patients, polyp removal is cost saving. Treatment of early-stage cancer is cost increasing. Copyright © 2009 John Wiley & Sons, Ltd. [source]

Racial Differences in the Receipt of Bowel Surveillance Following Potentially Curative Colorectal Cancer Surgery

HEALTH SERVICES RESEARCH, Issue 6p2 2003
Gary L. Ellison
Objective. To investigate racial differences in posttreatment bowel surveillance after colorectal cancer surgery in a large population of Medicare patients. Data Sources. We used a large population-based dataset: Surveillance, Epidemiology, and End Results (SEER) linked to Medicare data. Study Design. This is a retrospective cohort study. We analyzed data from 44,768 non-Hispanic white, 2,921 black, and 4,416 patients from other racial/ethnic groups, aged 65 and older at diagnosis, who had a diagnosis of local or regional colorectal cancer between 1986 and 1996, and were followed through December 31, 1998. Cox Proportional Hazards models were used to investigate the relation of race and receipt of posttreatment bowel surveillance. Data Collection. Sociodemographic, hospital, and clinical characteristics were collected at the time of diagnosis for all members of the cohort. Surgery and bowel surveillance with colonoscopy, sigmoidoscopy, and barium enema were obtained from Medicare claims using ICD-9-CM and CPT-4 codes. Principal Findings. The chance of surveillance within 18 months of surgery was 57 percent, 48 percent, and 45 percent for non-Hispanic whites, blacks, and others, respectively. After adjusting for sociodemographic, hospital, and clinical characteristics, blacks were 25 percent less likely than whites to receive surveillance if diagnosed between 1991 and 1996 (RR=0.75, 95 percent CI=0.70,0.81). Conclusions. Elderly blacks were less likely than non-Hispanic whites to receive posttreatment bowel surveillance and this result was not explained by measured racial differences in sociodemographic, hospital, and clinical characteristics. More research is needed to explore the influences of patient- and provider-level factors on racial differences in posttreatment bowel surveillance. [source]

Biopsy Strategies for Endoscopic Surveillance of Pre-malignant Gastric Lesions

HELICOBACTER, Issue 4 2010
Annemarie C. De Vries
Abstract Background:, Endoscopic surveillance of pre-malignant gastric lesions may add to gastric cancer prevention. However, the appropriate biopsy regimen for optimal detection of the most advanced lesions remains to be determined. Therefore, we evaluated the yield of endoscopic surveillance by standardized and targeted biopsy protocols. Materials and Methods:, In a prospective, multi-center study, patients with intestinal metaplasia (IM) or dysplasia (DYS) underwent a surveillance gastroscopy. Both targeted biopsies from macroscopic lesions and 12 non-targeted biopsies according to a standardized protocol (antrum, angulus, corpus, cardia) were obtained. Appropriate biopsy locations and the yield of targeted versus non-targeted biopsies were evaluated. Results:, In total, 112 patients with IM (n = 101), or low-grade (n = 5) and high-grade DYS (n = 6) were included. Diagnosis at surveillance endoscopy was atrophic gastritis (AG) in one, IM in 77, low-grade DYS in two, high-grade DYS in three, and gastric cancer in one patient. The angulus (40%), antrum (35%) and lesser curvature of the corpus (33%) showed the highest prevalence of pre-malignant conditions. Non-targeted biopsies from the lesser curvature had a significantly higher yield as compared to the greater curvature of the corpus in diagnosing AG and IM (p = .05 and p = .03). Patients with extensive intragastric IM, which was also present at the cardia were at high risk of a concurrent diagnosis of dysplasia or gastric cancer. High-grade DYS was detected in targeted biopsies only. Conclusions:, At surveillance endoscopies, both targeted and non-targeted biopsies are required for an appropriate diagnosis of (pre-)malignant gastric lesions. Non-targeted biopsies should be obtained in particular from the antrum, angulus and lesser curvature of the corpus. [source]

Alaska Sentinel Surveillance for Antimicrobial Resistance in Helicobacter pylori Isolates from Alaska Native Persons, 1999,2003

HELICOBACTER, Issue 6 2006
Michael G. Bruce
Abstract Background:, Previous studies in Alaska have demonstrated elevated proportions of antimicrobial resistance among Helicobacter pylori isolates. Materials and Methods:, We analyzed H. pylori data from the Centers for Disease Control and Prevention (CDC)'s sentinel surveillance in Alaska from July 1999 to June 2003 to determine the proportion of culture-positive biopsies from Alaska Native persons undergoing routine upper-endoscopy, and the susceptibility of H. pylori isolates to metronidazole [minimum inhibitory concentration (MIC) of > 8 g metronidazole/mL), clarithromycin (MIC , 1), tetracycline (MIC , 2) and amoxicillin (MIC , 1)] using agar dilution. Results:, Nine-hundred sixty-four biopsy specimens were obtained from 687 participants; 352 (51%) patients tested culture positive. Mean age of both culture-positive and culture-negative patients was 51 years. Metronidazole resistance was demonstrated in isolates from 155 (44%) persons, clarithromycin resistance from 108 (31%) persons, amoxicillin resistance from 8 (2%) persons, and 0 for tetracycline resistance. Metronidazole and clarithromycin resistance varied by geographic region. Female patients were more likely than male subjects to show metronidazole resistance (p < .01) and clarithromycin resistance (p = .05). Conclusions:, Resistance to metronidazole and clarithromycin is more common among H. pylori isolates from Alaska Native persons when compared with those from elsewhere in the USA. [source]

Use of surveillance for hepatocellular carcinoma among patients with cirrhosis in the United States,

HEPATOLOGY, Issue 1 2010
Jessica A. Davila
Surveillance for hepatocellular carcinoma (HCC) in patients with cirrhosis is recommended but may not be performed. The extent and determinants of HCC surveillance are unknown. We conducted a population-based United States cohort study of patients over 65 years of age to examine use and determinants of prediagnosis surveillance in patients with HCC who were previously diagnosed with cirrhosis. Patients diagnosed with HCC during 1994-2002 were identified from the linked Surveillance, Epidemiology, and End-Results registry,Medicare databases. We identified alpha-fetoprotein (AFP) and ultrasound tests performed for HCC surveillance, and examined factors associated with surveillance. We identified 1,873 HCC patients with a prior diagnosis of cirrhosis. In the 3 years before HCC, 17% received regular surveillance and 38% received inconsistent surveillance. In a subset of 541 patients in whom cirrhosis was recorded for 3 or more years prior to HCC, only 29% received routine surveillance and 33% received inconsistent surveillance. Among all patients who received regular surveillance, approximately 52% received both AFP and ultrasound, 46% received AFP only, and 2% received ultrasound only. Patients receiving regular surveillance were more likely to have lived in urban areas and had higher incomes than those who did not receive surveillance. Before diagnosis, approximately 48% of patients were seen by a gastroenterologist/hepatologist or by a physician with an academic affiliation; they were approximately 4.5-fold and 2.8-fold, respectively, more likely to receive regular surveillance than those seen by a primary care physician only. Geographic variation in surveillance was observed and explained by patient and physician factors. Conclusion: Less than 20% of patients with cirrhosis who developed HCC received regular surveillance. Gastroenterologists/hepatologists or physicians with an academic affiliation are more likely to perform surveillance. HEPATOLOGY 2010 [source]

The Impact of Interferon Gamma Receptor Expression on the Mechanism of Escape From Host Immune Surveillance in Hepatocellular Carcinoma

HEPATOLOGY, Issue 3 2000
Mitsuo Nagao M.D.
Interferon gamma (IFN-,) plays an important role in host defense mechanism and participates in the progression of chronic liver disease. IFN-, exerts its pleiotrophic effects by transcriptional regulation of expression of numerous genes, such as major histocompatibility complex (MHC) class I and Fas, through interaction with IFN-, receptor (IFN-,-R). Although hepatocytes in normal liver express weak or no IFN-,-R, those in acute and chronic liver disease up-regulate its expression. A study using IFN-,-R ,-chain knock-out mice revealed the actions of IFN-, on tumor cells as an extrinsic tumor-suppressor mechanism. However, it is unclear whether or how hepatocellular carcinoma (HCC) blocks the signal transduction of IFN-, to evade host immune surveillance. We examined the expression of IFN-,-R and IFN-,,inducible genes in 44 cases with HCC using real-time reverse-transcriptase polymerase chain reaction (RT-PCR) and immunohistochemistry. In noncancerous liver tissues (n = 38), IFN-,-R expression on the cell surface was up-regulated in 27 cases. In IFN-,-R,negative cases (n = 15), tumor size was larger (P = .032), serum ,-fetoprotein (AFP) level was higher (P = .001), intrahepatic and extrahepatic metastasis was more common (P = .044 and .013, respectively), and Ki-67 labeling index (LI) was higher (P = .041), compared with IFN-,-R,positive cases. Accordingly, the evasion mechanism may play an important role in progression, especially metastasis, in HCC. The significant correlation between the status of IFN-,-R and the expression of Fas and MHC implies that the loss of IFN-,-R might contribute to the mechanism of escape from host immune rejection in HCC. [source]

Seasonal and pandemic influenza surveillance considerations for constructing multicomponent systems

INFLUENZA AND OTHER RESPIRATORY VIRUSES, Issue 2 2009
Lynnette Brammer
Abstract, Surveillance for influenza is essential for the selection of influenza vaccine components and detection of human infections with novel influenza A viruses that may signal the start of a pandemic. Virologic surveillance provides the foundation from which this information can be obtained. However, morbidity and mortality data are needed to better understand the burden of disease, which, in turn, can provide useful information for policy makers relevant to the allocation of resources for prevention and control efforts. Data on the impact of influenza can be used to identify groups at increased risk for severe influenza-related complications, develop prevention and control policies, and monitor the effect of these policies. Influenza surveillance systems frequently monitor outpatient illness, hospitalizations, and deaths, but selection of influenza surveillance components should be based on the surveillance goals and objectives of the jurisdiction. [source]

Association of early annual peak influenza activity with El Niño southern oscillation in Japan

INFLUENZA AND OTHER RESPIRATORY VIRUSES, Issue 4 2008
Hassan Zaraket
Background, Seasonality characterizing influenza epidemics suggests susceptibility to climate variation. El Niño southern oscillation (ENSO), which involves two extreme events, El Niño and La Niña, is well-known for its large effects on inter-annual climate variability. The influence of ENSO on several diseases has been described. Objectives, In this study, we attempt to analyze the possible influence of ENSO on the timing of the annual influenza activity peak using influenza-like illness report data in Japan during 1983,2007. Materials, Influenza surveillance data for 25 influenza epidemics, available under the National Epidemiological Surveillance of the Infectious Diseases, was used in this study. ENSO data were obtained from the Japan Meteorological Agency. Results, Influenza-like illness peak week varied largely during the study period, ranging between 4th and 11th weeks (middle of winter to early spring). The average of peak week during ENSO cycles (n = 11, average = 4·5 ± 0·9) was significantly earlier than in non-ENSO years (n = 14, average = 7·6 ± 2·9; P = 0·01), but there was no significant difference in the peak timing between hot (El Niño) and cold (La Niña) phases. Earlier peaks of influenza activity were observed in 16, out of 25, epidemics. These coincided with 10 (90·9%) out of 11 ENSO and 6 (85·7%) out of seven large-scale epidemics. Conclusion, Influenza activity peak occurred earlier in years associated with ENSO and/or large scale epidemics. [source]

Surveillance for highly pathogenic avian influenza in wild birds in the USA

INTEGRATIVE ZOOLOGY (ELECTRONIC), Issue 4 2009
Thomas J. DELIBERTO
Abstract As part of the USA's National Strategy for Pandemic Influenza, an Interagency Strategic Plan for the Early Detection of Highly Pathogenic H5N1 Avian Influenza in Wild Migratory Birds was developed and implemented. From 1 April 2006 through 31 March 2009, 261 946 samples from wild birds and 101 457 wild bird fecal samples were collected in the USA; no highly pathogenic avian influenza was detected. The United States Department of Agriculture, and state and tribal cooperators accounted for 213 115 (81%) of the wild bird samples collected; 31, 27, 21 and 21% of the samples were collected from the Atlantic, Pacific, Central and Mississippi flyways, respectively. More than 250 species of wild birds in all 50 states were sampled. The majority of wild birds (86%) were dabbling ducks, geese, swans and shorebirds. The apparent prevalence of low pathogenic avian influenza viruses during biological years 2007 and 2008 was 9.7 and 11.0%, respectively. The apparent prevalence of H5 and H7 subtypes across all species sampled were 0.5 and 0.06%, respectively. The pooled fecal samples (n= 101 539) positive for low pathogenic avian influenza were 4.0, 6.7 and 4.7% for biological years 2006, 2007 and 2008, respectively. The highly pathogenic early detection system for wild birds developed and implemented in the USA represents the largest coordinated wildlife disease surveillance system ever conducted. This effort provided evidence that wild birds in the USA were free of highly pathogenic avian influenza virus (given the expected minimum prevalence of 0.001%) at the 99.9% confidence level during the surveillance period. [source]

Hypertension is an independent predictor of survival disparity between African-American and white breast cancer patients

INTERNATIONAL JOURNAL OF CANCER, Issue 5 2009
Dejana Braithwaite
Abstract The objective of this study was to determine whether comorbidity, or pre-existing conditions, can account for some of the disparity in survival between African-American and white breast cancer patients. A historical cohort study was conducted of 416 African-American and 838 white women diagnosed with breast cancer between 1973 and 1986, and followed through 1999 in the Kaiser Permanente Northern California Medical Care Program. Information on comorbidity, tumor characteristics and breast cancer treatment was obtained from medical records, and Surveillance, Epidemiology and End Results, Northern California Cancer Center Registry. Associations between comorbidity and survival were analyzed with multiple Cox proportional hazards regression. Over a mean follow-up of 9 years, African Americans had higher overall crude mortality than whites: 165 (39.7%) versus 279 (33.3%), respectively. When age, race, tumor characteristics and breast cancer treatment were controlled, the presence of hypertension was associated with all cause survival [hazard ratio (HR) = 1.33, 95% confidence intervals (CI) 1.07,1.67] and it accounted for 30% of racial disparity in this outcome. Hypertension-augmented Charlson Comorbidity Index was a significant predictor of survival from all causes (HR = 1.32, 95%CI 1.18,1.49), competing causes (HR = 1.52, 95%CI 1.32,1.76) and breast cancer specific causes (HR = 1.18, 95%CI 1.03,1.35). In conclusion, hypertension has prognostic significance in relation to survival disparity between African-American and white breast cancer patients. If our findings are replicated in contemporary cohorts, it may be necessary to include hypertension in the Charlson Comorbidity Index and other comorbidity measures. © 2008 Wiley-Liss, Inc. [source]

Surveillance for endometrial cancer in hereditary nonpolyposis colorectal cancer syndrome

INTERNATIONAL JOURNAL OF CANCER, Issue 4 2007
Laura Renkonen-Sinisalo
Abstract The estimated lifetime risk for endometrial carcinoma (EC) in hereditary nonpolyposis colorectal cancer syndrome (HNPCC) is 32,60%, thus supporting surveillance. The survival rate of EC patients is, however, favourable questioning the need for surveillance. Yet, the effectiveness of gynecological surveillance remains to be shown. The 2 previously published studies were based on transvaginal ultrasound (TVUS) alone. Intrauterine biopsy has not been tested in surveillance for EC in HNPCC families. The effect of gynecological surveillance was evaluated among 175 Finnish mutation carriers. During 759 person years at risk, there were 503 surveillance visits including TVUS and intrauterine biopsy of endometrium at 94% and 74% of the visits, respectively. EC occurred in 14 cases, 11 of which were diagnosed by surveillance, 8 by intrauterine biopsies. TVUS indicated only 4 EC patients but missed 6 other cases. Intrauterine sampling detected 14 additional cases of potentially premalignant hyperplasia. The stage distribution and survival tended to be more favorable in the 14 EC cases of the surveilled group (no deaths) than in the group of 83 symptomatic mutation carriers of whom 6 died of EC, but with no statistical significance. Four cases of ovarian cancer occurred but none was detected by surveillance in TVUS examinations. In conclusion, EC surveillance in HNPCC seems more effective with endometrial biopsies than with TVUS alone. A definite improvement in survival remains to be shown. The detection of early cancer stages and premalignant lesions offers the opportunity to avoid extensive adjuvant treatment. © 2006 Wiley-Liss, Inc. [source]

Cancer incidence patterns among Vietnamese in the United States and Ha Noi, Vietnam,

INTERNATIONAL JOURNAL OF CANCER, Issue 4 2002
Gem M. Le
Abstract Nearly 600,000 persons have immigrated to the United States from Vietnam since the end of the Vietnam War. Despite the rapid growth of the U.S. Vietnamese population, little is known about cancer incidence in this migrant group. Using population-based data from the Surveillance, Epidemiology and End Results program, California Cancer Registry and International Agency for Research on Cancer, we compared cancer incidence rates for Vietnamese in the United States (1988,1992) to rates for residents of Ha Noi, Vietnam (1991,1993); non-Hispanic whites were included to serve as the U.S. reference rates. Lung and breast cancers were the most common among Vietnamese males and females, respectively, regardless of geographic region. Rates of cancers more common to U.S. whites, such as breast, prostate and colon cancers, were elevated for U.S. Vietnamese compared to residents in Ha Noi but still lower than rates for U.S. whites. Rates of cancers more common to Asian countries, such as stomach, liver, lung and cervical cancers, were likewise elevated for U.S. Vietnamese compared to residents of Ha Noi and exceeded corresponding rates for whites. Incidence patterns for stomach, liver, lung and cervical cancers may reflect increased risk of exposures in this migrant population and should be further explored to uncover the relative contributions of environmental and genetic factors to cancer etiology. © 2002 Wiley-Liss, Inc. [source]

Surveillance and measuring trends of stroke in Japan: The Takashima Stroke Registry (1988 , present)

INTERNATIONAL JOURNAL OF STROKE, Issue 2 2007
Yoshikuni Kita
This stroke registry is a population-based, prospective, observational study whose objective is to monitor trends in the incidence and case-fatality of stroke in Japan. Takashima County is located in the rural area of the Shiga prefecture in central Japan, having a stable population of approximately 54,000. It is a farming community with similar cultural values and standards of living throughout the region. The population has remained fairly stable during the 16-year study period. 1750 stroke cases (men 937 and women 813) were registered during 1988,2002. The average ages of the men and women patients were 69.4 and 74.4 years respectively. Stroke diagnostic criteria are established for the Monitoring System for Cardiovascular Disease commissioned by the Ministry of Health and Welfare, Japan. These criteria were based on WHO-MONICA project. Takashima registry system was planned to capture all the cases in the study area by covering all the hospitals of the county. To ensure that eligible patients hospitalized outside the county were not omitted, registration procedures were also conducted at three high-level medical facilities within the Shiga region but outside the county. Due to the high rate of computed tomography use in Japan the identification of stroke cases within the study area is almost complete and stroke diagnosis and classification are accurately recorded. [source]

The French Riots: Questioning Spaces of Surveillance and Sovereignty

INTERNATIONAL MIGRATION, Issue 2 2006
Susan Ossman
ABSTRACT This paper examines the riots in France in late 2005 in terms of how they lead to a reconceptualization of the spaces of danger, culture, territory, and sovereignty. It traces a brief history of danger zones and immigration, noting how these two terms have increasingly overlapped. We analyse key discursive formations - legal, political, social scientific, and media - whose explanation for the emergence of the "immigrant" delinquent is linked to what is identified as a culture of poverty. They provide a sustained examination of recent legal reforms of juvenile law as well as judicial practices within the juvenile justice system to show the systematic exclusionary practices of what is claimed to be a colour blind republican system. They reveal a consensus across the political spectrum and among police, prosecutors, investigating magistrates, and new security experts on the need to privilege accountability, restitution, and retribution in the treatment of juvenile offenders. We present evidence from interviews and ethnographic observation among youths of all backgrounds. Ironically, while the children of immigrants seek to claim a voice in the national community, their peers from more privileged social milieu express increasing distance from national concerns, seeking to lead lives as Europeans or global citizens. We end by arguing that this needs to be taken into account in any analysis of frustrated and disenfranchised suburban youths. A transnational or supra-national sociology that accounts for the itineraries of immigrants of all kinds must be developed. LES ÉMEUTES EN FRANCE: QU'EN EST-IL DES ESPACES DE SURVEILLANCE ET DE LA SOUVERAINETÉ? Les émeutes qui ont éclaté en France fin 2005 conduisent à une reconceptualisation des notions de danger, de culture, de territoire et de souveraineté. Cet article, qui présente un bref historique des zones de danger et de l'immigration, montre combien ces deux concepts ont tendance à se rejoindre. Nous analysons les principales formations discursives - juridique, politique, sociale, scientifique et médiatique - qui expliquent l'émergence du délinquant « immigré » en l'associant à ce qui est décrit comme une culture de la pauvreté. Elles nous offrent un examen soutenu des réformes récentes du droit des mineurs et des pratiques judiciaires au sein du système de justice des mineurs, et montrent les pratiques d'exclusion systématiques d'un système républicain prétendant ignorer les préjugés raciaux. Elles montrent que, d'un bout à l'autre de l'échiquier politique, dans la police, chez les procureurs, les juges d'instruction et les nouveaux spécialistes de la sécurité, il existe un consensus sur la nécessité de privilégier l'obligation de rendre des comptes, la réparation et le châtiment dans le traitement des mineurs délinquants. Nous étayons cet argument à partir d'entretiens et d'observations ethnographiques de jeunes de tous les milieux. De façon assez ironique, alors que les enfants d'immigrés veulent avoir leur mot à dire au sein de la communauté nationale, les enfants de milieux plus privilégiés se disent de moins en moins concernés par les préoccupations nationales et cherchent à mener une vie d'Européen ou de citoyen du monde. En conclusion, nous avançons que cette situation doit être prise en compte dans toute analyse des jeunes des banlieues frustrés et privés de droits. Une sociologie transnationale ou supranationale qui rendrait compte des itinéraires des immigrés, tous milieux sociaux confondus, serait une bonne chose. LAS REVUELTAS FRANCESAS: CUESTIONAMIENTO DE LOS ESPACIOS DE VIGILANCIA Y SOBERANÍA En este artículo se examinan las revueltas de Francia a finales de 2005 en la medida en que conducen a una reconceptualización de los espacios de peligro, cultura, territorio y soberanía. Se traza una breve historia de las zonas de peligro y de la inmigración, señalando a la atención cómo estos dos conceptos han ido solapándose crecientemente. Se analizan formaciones discursivas clave -jurídicas, políticas, propias de las ciencias sociales y mediáticas - cuyas explicaciones de la aparición del delincuente "inmigrante" se vinculan con lo que se ha descrito como una cultura de la pobreza. Se ofrece un examen sostenido de las recientes reformas jurídicas de las leyes sobre los menores, así como de las prácticas judiciales dentro del sistema de justicia de menores para mostrar las prácticas de exclusión sistemática de lo que se considera que es un sistema republicano daltónico. Se revela un consenso entre los políticos y entre la policía, los fiscales, los jueces de instrucción y los nuevos expertos en seguridad sobre la necesidad de dar prelación a la asunción de responsabilidades, la restitución y la retribución en el tratamiento de los menores delincuentes. Se presentan pruebas extraídas de entrevistas y de la observación etnográfica de los jóvenes de todos los ambientes. Irónicamente, mientras los hijos de inmigrantes tienden a reclamar una voz en la comunidad nacional, sus iguales de medios sociales más privilegiados expresan un creciente distanciamiento de las preocupaciones nacionales y prefieren vivir como europeos o ciudadanos del mundo. Se termina arguyendo que es preciso tener en cuenta este factor en cualquier análisis de los jóvenes frustrados y privados de voto que viven en los barrios periféricos. Será preciso desarrollar una sociología transnacional o supranacional que explique los itinerarios de todo tipo de inmigrantes. [source]