Examining methodology to identify patterns of consulting in primary care for different groups of patients before a diagnosis of cancer: An exemplar applied to oesophagogastric cancer

BackgroundCurrent methods for estimating the timeliness of cancer diagnosis are not robust because dates of key defining milestones, for example first presentation, are uncertain. This is exacerbated when patients have other conditions (multimorbidity), particularly those that share symptoms with cancer. Methods independent of this uncertainty are needed for accurate estimates of the timeliness of cancer diagnosis, and to understand how multimorbidity impacts the diagnostic process.MethodsParticipants were diagnosed with oesophagogastric cancer between 2010 and 2019. Controls were matched on year of birth, sex, general practice and multimorbidity burden calculated using the Cambridge Multimorbidity Score. Primary care data (Clinical Practice Research Datalink) was used to explore population-level consultation rates for up to two years before diagnosis across different multimorbidity burdens. Five approaches were compared on the timing of the consultation frequency increase, the inflection point for different multimorbidity burdens, different aggregated time-periods and sample sizes.ResultsWe included 15,410 participants, of which 13,328 (86.5 %) had a measurable multimorbidity burden. Our new maximum likelihood estimation method found evidence that the inflection point in consultation frequency varied with multimorbidity burden, from 154 days (95 %CI 131.8–176.2) before diagnosis for patients with no multimorbidity, to 126 days (108.5–143.5) for patients with the greatest multimorbidity burden. Inflection points identified using alternative methods were closer to diagnosis for up to three burden groups. Sample size reduction and changing the aggregation period resulted in inflection points closer to diagnosis, with the smallest change for the maximum likelihood method.DiscussionExisting methods to identify changes in consultation rates can introduce substantial bias which depends on sample size and aggregation period. The direct maximum likelihood method was less prone to this bias than other methods and offers a robust, population-level alternative for estimating the timeliness of cancer diagnosis.     

Pre-diagnostic cigarette smoking and risk of second primary cancer: The Melbourne Collaborative Cohort Study

Enhanced survival following a diagnosis of cancer has led to a steep rise in the number of individuals diagnosed with a second primary cancer. We examined the association between pre-cancer cigarette smoking and risk of second cancer in 9785 participants diagnosed with first invasive cancer after enrolment in the Melbourne Collaborative Cohort Study. Follow-up was from date of first invasive cancer until diagnosis of second primary invasive cancer, death, or 31 July 2019, whichever came first. Data on cigarette smoking was collected at enrolment (1990–94) along with information on other lifestyle factors including body size, alcohol intake and diet. We estimated hazard ratios (HR) and 95 % confidence intervals (CI) for incident second cancer with several smoking measures, adjusted for potential confounders. After a mean follow-up of 7.3 years, 1658 second cancers were identified. All measures of smoking were associated with increased risk of second cancer. We observed a 44 % higher risk of second cancer for smokers of ≥ 20 cigarettes/day (HR=1.44, 95 % CI: 1.18–1.76), compared with never smokers. We also observed dose-dependent associations with number of cigarettes smoked (HR=1.05 per 10 cigarettes/day, 95 % CI: 1.01–1.09) and duration of smoking (HR=1.07 per 10 years, 95 % CI: 1.03–1.10). The risk of second cancer increased by 4 % per 10 pack-years of smoking (HR=1.04, 95 % CI: 1.02–1.06; p < 0.001). There was suggestive evidence of stronger associations with number of cigarettes smoked and pack-years of smoking for women (p_interaction<0.05), particularly for the highest risk categories of both variables. These associations with pre-diagnostic smoking were markedly stronger for second cancers known to be smoking-related than for others (p_homogeneity<0.001). Our findings for pre-diagnostic cigarette smoking indicated increased risk of second primary cancer for cancer sites considered smoking-related, highlighting the importance of assessing smoking habits in cancer survivors.     

Growth,chlorophyll and mineral nutrient studies on phalaris arundinaceae L. in three scottish lochs

Growth, chlorophyll and mineral nutrients studies were made in Phalaris arundinaceae L. in three Scottish lochs of varying nutrient status from March to November in 1975. The maximum shoot height and shoot dry weight attained by the plants were approximately 160 cm and 4 g respectively. Seasonal changes in the chlorophyll levels in the Phalaris leaf were studied and two peaks were found, one in April and the other in June–July. Maximum chlorophyll level attained was 9 mg g^–1 leaf dry weight. The changes in the mineral levels in the root, stem, leaf and inflorescence parts of the plants from the three lochs were also assayed throughout the growing season. A total of eight mineral elements were studied, including carbon, nitrogen, phosphorus, potassium, sodium, calcium, magnesium and iron. Variations in both the mineral concentrations and their pattern of changes during the study period among the plants from the lochs were observed and discussed.     

A Golgi study of the hypothalamus of Actinopterygii

Summary The posterior hypothalami of the polypteriform, Calamoichthys, and of the teleost, Anguilla, were studied by means of the Golgi technique. In Calamoichthys, the lateral lobes are not developed and the median lobe is simple. In Anguilla, the median (tuberal) lobe shows lophodendritic, CSF-contacting cells and horizontal cells in the periventricular grey and some reticular elements directed toward the cell-poor lateral areas. In the lateral lobes the periventricular grey is formed by multipolar neurons and a diffuse population of multipolar cells of uncertain identity. The nucleus diffusus lobi lateralis is formed by scarce multipolar neurons, often placed next to the external surface of the brain. The organization of the lateral lobes in Actinopterygii is reminiscent of highly developed integrative regions.Work performed under CNR Project Biology of Reproduction     

Potentiation of the destructive effect of heat (42°C) on synchronized cancer cells in culture by cell specific antiserum

1. 1. A kinetic study was made of the effects of hyperthermia and cell specific antibody on non-synchronized lag phase cultures and synchronized exponentially growing cultures of a malignant cell line. The effects on the degree of cell synchrony were also investigated.

2. 2. Hyperthermic treatment of synchronized SDB monolayer cell populations with maximum replication rate sensitized the cells to subsequent destruction by cell specific antibody.

3. 3. Hyperthermic treatment of SDB monolayer cultures with low replication rate and varying degrees of metabolic activity produced no such sensitization.

4. 4. Hyperthermia was disruptive to a synchrony procedure involving a blockade of DNA synthesis by excess thymidine.

Hormonal requirement and tissue competency for shoot organogenesis in two cultivars of Brassica napus

An investigation of the regeneration ability of explants taken from the floral stem of Brassica napus var. oleifera was performed in the winter cultivars Darmor and Bienvenu. Our purpose was to compare the regeneration ability of the two genotypes, to compare the competence of the different tissues of the stem and then to study histologically the regeneration of shoots. A strong genotypic effect was observed between the two cvs; Bienvenu had a poorer ability to produce shoots when cultured in the presence of benzyladenine: regeneration commenced later; the percentage of explants producing shoots and the number of shoots per regenerating explant were much lower. The comparison between the regeneration ability of different explants, i.e stem segments, internal stem segments, thin cell layer and peels, showed that the superficial tissues were able to regenerate roots but not shoots. Contrariwise, internal stem segments regenerated only shoots. The origin of shoots was investigated in stem segments of cv. Darmor. A kinetic histological analysis showed the basic role played by phloem and phloem-associated cells in shoot formation.     

The effect of hydration on the mobility of phospholipids in the gel state. A proton nuclear magnetic resonance spin echo study

Proton nuclear magnetic resonance (NMR) dipolar echo studies are presented for the gel state of dipalmitoylglycerophosphocholine (dipalmitoyl-GPC) — heavy water dispersions. The mobility and the mean order of the chains and the head group of dipalmitoyl-GPC were determined for different water concentrations and temperatures. For smaller than 5 mol D₂O per mol dipalmitoyl-GPC the molecule undergoes temperature- and hydration-dependent restricted rotational oscillations about the long axis of the molecule. For hydration numbers equal or larger than 5 mol D₂O per mol dipalmitoyl-GPC the molecules rotate effectively about their long axes and intermolecular dipolar interactions between proton groups of neighbour molecules are averaged. The onset of the lateral diffusion of dipalmitoyl-GPC is observed which averages out all intermolecular dipolar interactions. Deviations of the individual segments of the chains from the all-trans state have to be considered. The widely accepted model that the dipalmitoyl-GPC molecules rotate about their long axes with stiff all-trans chains should be modified. The polar head groups of dipalmitoyl-GPC effectively rotate about the bilayer-normal and restricted rotations about single bonds in the head group are allowed. An order parameter of about 0.6 for the head group was obtained for fully hydrated dipalmitoyl-GPC molecules at ambient temperature.     

Direct and Indirect Classification in Clinical Research

We investigate if the use of a priori knowledge allows an improvement of medical decision making. We compare two frameworks of classification – direct and indirect classification – with respect to different classification errors: differential misclassification, observed misclassification and true misclassification. We analyze general behaviors of the classifiers in an artificial example and furthermore as being interested in the diagnosis of early glaucoma we adapt a simulation model of the optic nerve head. Indirect classifiers outperform direct classifiers in certain parameter situations of a Monte‐Carlo study. In summary, we demonstrate that indirect classification provides a flexible framework to improve diagnostic rules by using explicit a priori knowledge in clinical research.     

Logit effect values and efficiency of significance tests when a noncollapsible variable is omitted

For linear models, randomization of the assignment to the levels of a variable A is a sufficient condition to obtain correct estimates of the effect of A on another variable B. For logit models, the omission of a relevant variable Z often results in invalid estimates of the effect of A and in a loss of power of the significance test. The values of this underestimation and of the loss of power are evaluated here asymptotically and from simulation studies. Consequences for practical use of logit models in randomized settings are underlined.     

Sterically stabilized liposomes as a potent carrier for shikonin

The ability of pegylated liposomes (sterically stabilized liposomes-SSL) to localize in solid tumors via the enhanced permeability and retention (EPR) effect, partly depends on their long circulating properties which can be achieved by grafting polyethylene glycol (PEG) to the liposomes’ surface. Alkannin and shikonin (A/S) are naturally occurring hydroxynaphthoquinones with a well-established spectrum of wound healing, antimicrobial, anti-inflammatory, antioxidant, and recently established antitumor activity. The purpose of this work was to prepare and characterize shikonin-loaded pegylated liposomes as a new drug carrier for shikonin, as a continuation of authors’ previous work on conventional shikonin-loaded liposomal formulations. Three new pegylated liposomal formulations of shikonin (DSPC-PEG₂₀₀₀, EPC-PEG₂₀₀₀, and DPPC-PEG₂₀₀₀) were prepared and characterized in terms of physicochemical characteristics, pharmacokinetics, and stability (at 4?°C, for 28?d) and compared with the corresponding conventional ones. Particle size distribution, ζ-potential, entrapment efficiency, and release profile of the entrapped drug were measured. Results indicated the successful incorporation of shikonin into liposomes alongside with their good physicochemical characteristics, high entrapment efficiency, satisfactory in vitro release profile, and good physical stability. The results are considered promising and could be used as a road map for designing further in vivo experiments.