Diurnal temperature range and emergency room admissions for chronic obstructive pulmonary disease in Taiwan

The objective of this study was to assess the relationship between diurnal temperature range (DTR) and emergency room (ER) admissions for chronic obstructive pulmonary disease (COPD) in an ER in Taichung City, Taiwan. The design was a longitudinal study in which DTR was related to COPD admissions to the ER of the city’s largest hospital. Daily ER admissions for COPD and ambient temperature were collected from 1 January 2001 to 31 December 2002. There was a significant negative association between the average daily temperature and ER admissions for COPD (r =  −0.95). However, a significant positive association between DTR and COPD admissions was found (r = 0.90). Using the Poisson regression model after adjusting for the effects of air pollutants and the day of the week, COPD admissions to the ER increased by 14% when DTR was over 9.6°C. COPD patients must be made aware of the increased risk posed by large DTR. Hospitals and ERs should take into account the increased demand of specific facilities during periods of large temperature variations.     

Ambient temperature and emergency room admissions for acute coronary syndrome in Taiwan

Acute coronary syndrome (ACS) is an important public health problem around the world. Since there is a considerable seasonal fluctuation in the incidence of ACS, climatic temperature may have an impact on the onset of this disease. The objective of this study was to assess the relationship between the average daily temperature, diurnal temperature range and emergency room (ER) admissions for ACS in an ER in Taichung City, Taiwan. A longitudinal study was conducted which assessed the correlation of the average daily temperature and the diurnal temperature range to ACS admissions to the ER of the city’s largest hospital. Daily ER admissions for ACS and ambient temperature were collected from 1 January 2000 to 31 March 2003. The Poisson regression model was used in the analysis after adjusting for the effects of holiday, season, and air pollutant concentrations. The results showed that there was a negative significant association between the average daily temperature and ER admissions for ACS. ACS admissions to the ER increased 30% to 70% when the average daily temperature was lower than 26.2°C. A positive association between the diurnal temperature range and ACS admissions was also noted. ACS admissions increased 15% when the diurnal temperature range was over 8.3°C. The data indicate that patients suffering from cardiovascular disease must be made aware of the increased risk posed by lower temperatures and larger changes in temperature. Hospitals and ERs should take into account the increased demand of specific facilities during colder weather and wider temperature variations.     

Population trends in emergency cancer diagnoses: The role of changing patient case-mix

BackgroundDiagnosis of cancer through an emergency presentation is associated with worse clinical and patient experience outcomes. The proportion of patients with cancer who are diagnosed through emergency presentations has consequently been introduced as a routine cancer surveillance measure in England. Welcome reductions in this metric have been reported over more than a decade but whether reductions reflect true changes in how patients are diagnosed rather than the changing case-mix of incident cohorts in unknown.MethodsWe analysed ‘Routes to Diagnosis’ data on cancer patients (2006–2015) and used logistic regression modelling to determine the contribution of changes in four case-mix variables (sex, age, deprivation, cancer site) to time-trends in emergency presentations.ResultsBetween 2006 and 2015 there was an absolute 4.7 percentage point reduction in emergency presentations (23.8%–19.2%). Changing distributions of the four case-mix variables explained 19.0% of this reduction, leaving 81.0% unexplained. Changes in cancer site case-mix alone explained 16.0% of the total reduction.ConclusionChanges in case-mix (particularly that of cancer sites) account for about a fifth of the overall reduction in emergency presentations. This would support the use of adjustment/standardisation of reported statistics to support their interpretation and help appreciate the influence of case-mix, particularly regarding cancer sites with changing incidence. However, most of the reduction in emergency presentations remains unaccounted for, and likely reflects genuine changes during the study period in how patients were being diagnosed.     

Chest pain in the emergency room: value of the HEART score

Background. Chest pain is one of the most common causes of presentation to the emergency room. The diagnosis of non-ST-elevation acute coronary syndrome typically causes uncertainty. Classical considerations for risk stratification are History, ECG, Age, Risk factors and Troponin (HEART). Each can be scored with zero, one or two points, depending on the extent of the abnormality. The HEART score is the sum of these five considerations. Methods. Clinical data from 122 patients referred to the emergency room for chest pain were analysed. The predictive value of the HEART score for reaching an endpoint was evaluated in 120/122 patients. Results. Twenty-nine patients reached one or more endpoints: an acute myocardial infarction was diagnosed in 16 patients, 20 underwent revascularisation and two died. The HEART score in the patients with and without an endpoint was 6.51±1.84 and 3.71±1.83 (p<0.0001) respectively. A HEART score of 0-3 points holds a risk of 2.5% for an endpoint and supports an immediate discharge. With a risk of 20.3%, a HEART score of 4-6 points implies admission for clinical observation. A HEART score ≥7points, with a risk of 72.7%, supports early invasive strategies. Conclusion. The HEART score facilitates accurate diagnostic and therapeutic choices. The HEART score is an easy, quick and reliable predictor of outcome in chest pain patients. (Neth Heart J 2008;16:191-6.)     

Molecular modulation of autophagy: New venture to target resistant cancer stem cells

Autophagy is a highly regulated catabolic process in which superfluous,damaged organelles and other cytoplasmic constituents are delivered to the lysosome for clearance and the generation of macromolecule substrates during basal or stressed conditions. Autophagy is a bimodal process with a context dependent role in the initiation and the development of cancers. For instance,autophagy provides an adaptive response to cancer stem cells to survive metabolic stresses, by influencing disease propagation via modulation of essential signaling pathways or by promoting resistance to chemotherapeutics. Autophagy has been implicated in a cross talk with apoptosis. Understanding the complex interactions provides an opportunity to improve cancer therapy and the clinical outcome for the cancer patients. In this review, we provide a comprehensive view on the current knowledge on autophagy and its role in cancer cells with a particular focus on cancer stem cell homeostasis.     

On immunotherapies and cancer vaccination protocols: A mathematical modelling approach

In this paper we develop a new mathematical model of immunotherapy and cancer vaccination, focusing on the role of antigen presentation and co-stimulatory signaling pathways in cancer immunology. We investigate the effect of different cancer vaccination protocols on the well-documented phenomena of cancer dormancy and recurrence, and we provide a possible explanation of why adoptive (i.e. passive) immunotherapy protocols can sometimes actually promote tumour growth instead of inhibiting it (a phenomenon called immunostimulation), as opposed to active vaccination protocols based on tumour-antigen pulsed dendritic cells. Significantly, the results of our computational simulations suggest that elevated numbers of professional antigen presenting cells correlate well with prolonged time periods of cancer dormancy.     

基因表达谱芯片及核酸测序技术在癌症研究中的应用现状

基因表达谱芯片和核酸序列数据在癌症研究中占有很重要的地位。基因表达谱芯片被广泛的应用在医学研究中,它的主要优势在于灵敏快速成本低,缺点只能对现有基因进行研究,无法进行新基因发现以及变异等方面的研究;而核酸序列数据在这方面则具有很大优势。总体来说,二者在癌症研究中都发挥着巨大的作用。随着精准医学的不断发展,对这些高通量数据的深入研究可以有助于人们进一步了解癌症的分子机制,从而加速个体化治疗的进程。     

Trace elements under the spotlight: A powerful nutritional tool in cancer

Cancer is the second leading cause of death worldwide. Research on the relationships between trace elements (TE) and the development of cancer or its prevention is a field that is gaining increasing relevance. This review provides an evaluation of the effects of TE (As, Al, B, Cd, Cr, Cu, F, I, Pb, Li, Mn, Hg, Mo, Ni, Se, Si, Sn, V and Zn) intake and supplementation in cancer risk and prevention, as well as their interactions with oncology treatments. Advancements in the knowledge of TE, their dietary interactions and their main food sources can provide patients with choices that will help them to improve their quality of life and therapy outcomes. This approach could open new opportunities for treatments based on the integration of conventional therapies (chemotherapy, radiotherapy, and immunotherapy) and dietary interventions that provide advanced personalized treatments.     

Potential impact of the Affordable Care Act's preventive services provision on breast cancer stage: A preliminary assessment

IntroductionThe Affordable Care Act's (ACA) preventive services provision (PSP) removes copayments for preventive services such as cancer screening. We examined: 1) whether a shift in breast cancer stage occurred, and 2) the impact of the provision on racial/ethnic disparities in stage.Materials and methodsData from the National Cancer Database were used. The pre- and post-PSP periods were identified as 2007–2009 and 2011–2013, respectively. Proportion differences (PDs) and 95% confidence Intervals (CIs) were calculated.ResultsAll three racial/ethnic groups experienced a statistically significant shift toward Stage I breast cancer. Pre-PSP, the black:white disparity in Stage I cancer was −9.5 (95% CI: −8.9, −10.4) and the Latina:white disparity was −5.2 (95% CI: −4.0, −6.1). Post-PSP, the disparities improved slightly.DiscussionPreliminary data suggest that the ACA's PSP may have a meaningful impact on cancer stage overall and by race/ethnicity. However, more time may be needed to see reductions in disparities.     

Unstaged cancer in a population-based registry: Prevalence,predictors and patient prognosis

Purpose: Information on cancer stage at diagnosis is critical for population studies investigating cancer care and outcomes. Few studies have examined the factors which impact (1) staging or (2) outcomes for patients who are registered as having unknown stage. This study investigated (1) the prevalence of unknown stage at diagnosis on the New Zealand Cancer Registry (NZCR); (2) explored factors which predict unknown stage; (3) described receipt of surgery and (4) survival outcomes for patients with unknown stage. Methods: Patients diagnosed with the most prevalent 18 cancers between 2006 and 2008 (N = 41,489) were identified from the NZCR, with additional data obtained from mortality and hospitalisation databases. Logistic and Cox regression were used to investigate predictors of unknown stage and patient outcomes. Results: (1) Three distinct groups of cancers were found based on proportion of patients with unknown stage (low = up to 33% unknown stage; moderate = 33–64%; high = 65%+). (2) Increasing age was a significant predictor of unknown stage (adjusted odds ratios [ORs]: 1.18–1.24 per 5-year increase across groups). Patients with substantive comorbidity were more likely to have unknown stage but only for those cancers with a low (OR = 2.65 [2.28–3.09]) or moderate (OR = 1.17 [1.03–1.33]) proportion of patients with unknown stage. (3) Patients with unknown stage were significantly less likely to have received definitive surgery than those with local or regional disease across investigated cancers. (4) Patients with unknown stage had 28-day and 1-year survival which was intermediate between regional and distant disease. Discussion: We found that stage completeness differs widely by cancer site. In many cases, the proportion of unknown stage on a population-based register can be explained by patient, service and/or cancer related factors.     

A Risk Assessment Approach for Policy Evaluation: New Jersey Case Studies

Monitoring environmental policy progress often focuses on contaminant concentrations while policy goals address health. To bridge this gap, we developed policy evaluation case studies applying risk assessment methods to explore population health risks of chemical exposures before and after policy implementation. Beginning in the 1970s the New Jersey Department of Environmental Protection provided some of the United States' first data on contaminants including trichloroethylene in drinking water and polychlorinated biphenyls (PCBs) in fish. These data provide a unique opportunity to evaluate environmental policies. The 1979 PCB manufacturing ban succeeded in reducing exposure and risk, but the persistence of these compounds in local fish requires continued state and local consumption advisories. The positive impact of drinking water standards for trichloroethylene was reflected in declining detection in public water supplies from the late 1970s to 2005, although maximum concentrations in a small percentage of supplies remain above standards. Our case studies show success and progress, and the need for multiple policies in combination when conditions warrant. Tracking specific policies and contaminants using risk assessment methods can be a valuable tool for policy evaluation and can foster population-based environmental health research. Pollution prevention policies are warranted for chemicals that persist in the environment.     

Cryosurgical technique: assessment of the fundamental variables using human prostate cancer model systems

Cryosurgery offers a promising therapeutic alternative for the treatment of prostate cancer. While often successful, complete cryoablation of cancerous tissues sometimes fails due to technical challenges. Factors such as the end temperature, cooling rate, duration of the freezing episode, and repetition of the freezing cycle have been reported to influence cryosurgical outcome. Accordingly, we investigated the effects of these variables in an in vitro prostate cancer model. Human prostate cancer PC-3 and LNCaP cultures were exposed to a range of sub-zero temperatures (−5 to −40 °C), and cells were thawed followed by return to 37 °C. Post-thaw viability was assessed using a variety of fluorescent probes including alamarBlue™ (metabolic activity), calceinAM (membrane integrity), and propidium iodide (necrosis). Freeze duration following ice nucleation was investigated using single and double freezing cycles (5, 10, and 20 min). The results demonstrated that lower freezing temperatures yielded greater cell death, and that LNCaP cells were more susceptible to freezing than PC-3 cells. At −15 °C, PC-3 yielded 55% viability versus 20% viability for LNCaP. Double freezing cycles were found to be more than twice as destructive versus a single freeze–thaw cycle. Both cell types experienced increased cell death when exposed to freezing temperatures for longer durations. When thawing rates were considered, passive (slower) thawing following freezing yielded greater cell death than active (faster) thawing. A 20% difference in viability between passive and active thawing was observed for PC-3 for a 10 min freeze. Finally, the results demonstrate that just reaching −40 °C in vitro may not be sufficient to obtain complete cell death. The data support the use of extended freeze times, multiple freeze–thaw cycles, and passive thawing to provide maximum cell destruction.     

Studying health histories of cancer: A new model connecting cancer incidence and survival

The results of recent experimental and epidemiological studies provide evidence on the connection between carcinogenesis, cancer progression, and aging. Existing models, however, are traditionally focused only on one of these aspects of health deterioration. In this paper, we derive a new model of cancer, which describes the connection between the ages at disease onset, the duration of disease, and life span of respective individuals. The model combines ideas used in the two hits model of carcinogenesis with those used in the Le Bras multistate model of aging with constant transition intensities. The model is used in the joint analyses of the US demographic mortality data and SEER data for selected cancers. The results show that the developed approach is capable of explaining links among health history data and provides useful insights on mechanisms of cancer occurrence, disease progression, other aging-related changes, and mortality. Further developments of this model are discussed.     

Tumor suppressor microRNAs: A novel non-coding alliance against cancer

Tumor initiation and progression are the outcomes of a stepwise accumulation of genetic alterations. Among these, gene amplification and aberrant expression of oncogenic proteins, as well as deletion or inactivation of tumor suppressor genes, represent hallmark steps. Mounting evidence collected over the last few years has identified different populations of non-coding RNAs as major players in tumor suppression in almost all cancer types. Elucidating the diverse molecular mechanisms underlying the roles of non-coding RNAs in tumor progression might provide illuminating insights, potentially able to assist improved diagnosis, better staging and effective treatments of human cancers. Here we focus on several groups of tumor suppressor microRNAs, whose downregulation exerts a profound oncologic impact and might be harnessed for the benefit of cancer patients.     

Evaluation of PAHs concentration and cancer risk assessment on human health in a roadside soil: A case study

Abstract

An explanatory study was carried out to divulge the sources, contamination level of different classes of Polycyclic Aromatic Hydrocarbons (PAHs) distribution and the impact of vehicular traffic on the roadside soil by assessing incremental lifetime cancer risk at each site to understand the potential health risk of nearby residents along the National Highway-2 Delhi–Kolkata India. Comparison of the cancer risk assessment was performed using Monte Carlo simulation for the entire study area. The results revealed 90% cancer risk value of 6.40?×?10^?5 and 6.5?×?10^?5 for children and adults, respectively, whereas, without simulation the Total Cancer Risk (TCR) for adults was 6.925?×?10^?5 and 6.220?×?10^?5 for children, observed maximum at the location (S5). The dilemma of risk assessment indicating profoundly contaminated soil. Comparison of PAHs concentration with the background values of PAHs ranged from 1.478 to 27.493?mg kg^?1. The (IP/BgP) ratio specified that the PAHs content of the highway roadside sample is preponderate by diesel vehicle emission, biomass combustion and coal combustion. The study clearly revealed and advocated the influence of organic and inorganic pollution, which aggravates and causes health issues to the nearby inhabitants. This study could also be advantageous to similar consequences seen elsewhere in the world.     

Epigenetic regulation of autophagy: A key modification in cancer cells and cancer stem cells

Aberrant epigenetic alterations play a decisive role in cancer initiation and propagation via the regulation of key tumor suppressor genes and oncogenes or by modulation of essential signaling pathways. Autophagy is a highly regulated mechanism required for the recycling and degradation of surplus and damaged cytoplasmic constituents in a lysosome dependent manner. In cancer, autophagy has a divergent role. For instance, autophagy elicits tumor promoting functions by facilitating metabolic adaption and plasticity in cancer stem cells (CSCs) and cancer cells. Moreover, autophagy exerts pro-survival mechanisms to these cancerous cells by influencing survival, dormancy, immunosurveillance, invasion, metastasis, and resistance to anti-cancer therapies. In addition, recent studies have demonstrated that various tumor suppressor genes and oncogenes involved in autophagy, are tightly regulated via different epigenetic modifications, such as DNA methylation, histone modifications and non-coding RNAs. The impact of epigenetic regulation of autophagy in cancer cells and CSCs is not well-understood. Therefore, uncovering the complex mechanism of epigenetic regulation of autophagy provides an opportunity to improve and discover novel cancer therapeutics. Subsequently, this would aid in improving clinical outcome for cancer patients. In this review, we provide a comprehensive overview of the existing knowledge available on epigenetic regulation of autophagy and its importance in the maintenance and homeostasis of CSCs and cancer cells.     

Resistin: A journey from metabolism to cancer

Resistin, a small secretory molecule, has been implicated to play an important role in the development of insulin resistance under obese condition. For the past few decades, it has been linked to various cellular and metabolic functions. It has been associated with diseases like metabolic disorders, cardiovascular diseases and cancers. Numerous clinical studies have indicated an increased serum resistin level in pathological disorders which have been reported to increase mortality rate in comparison to low resistin expressing subjects. Various molecular studies suggest resistin plays a pivotal role in proliferation, metastasis, angiogenesis, inflammation as well as in regulating metabolism in cancer cells. Therefore, understanding the role of resistin and elucidating its’ associated molecular mechanism will give a better insight into the management of these disorders. In this article, we summarize the diverse roles of resistin in pathological disorders based on the available literature, clinicopathological data, and a compiled study from various databases. The article mainly provides comprehensive information of its role as a target in different treatment modalities in pre as well as post-clinical studies.