Trends in brain cancers (glioma) in New Zealand from 1995 to 2020, with reference to mobile phone use

BackgroundSome case-control studies have suggested substantial increased risks of glioma in association with mobile phone use; these risks would lead to an increase in incidence over time.MethodsIncidence rates of glioma from 1995 to 2020 by age, sex, and site in New Zealand (NZ) recorded by the national cancer registry were assessed and trends analysed. Phone use was based on surveys.ResultsIn these 25 years there were 6677 incident gliomas, giving age-standardised rates (WHO world standard) of 6.04 in males, and 3.95 in females per 100,000. The use of mobile phones increased rapidly from 1990 to more than 50% of the population from about 2000, and almost all the population from 2006. The incidence of glioma from ages 10–69 has shown a small decrease over the last 25 years, during which time the use of mobile phones has become almost universal. Rates in the brain locations receiving most radiofrequency energy have also shown a small decrease. Rates at ages of 80 and over have increased.ConclusionThere is no indication of any increase related to the use of mobile phones. These results are similar to results in Australia and in many other countries. The increase in recorded incidence at ages over 80 is similar to that seen in other countries and consistent with improved diagnostic methods.     

Systematic reviews and meta-analyses on treatment of asthma: critical evaluation

ObjectiveTo evaluate the clinical, methodological, and reporting aspects of systematic reviews and meta-analyses on the treatment of asthma and to compare those published by the Cochrane Collaboration with those published in paper based journals.DesignAnalysis of studies identified from Medline, CINAHL, HealthSTAR, EMBASE, Cochrane Library, personal collections, and reference lists.StudiesArticles describing a systematic review or a meta-analysis of the treatment of asthma that were published as a full report, in any language or format, in a peer reviewed journal or the Cochrane Library.Results50 systematic reviews and meta-analyses were included. More than half were published in the past two years. Twelve reviews were published in the Cochrane Library and 38 were published in 22 peer reviewed journals. Forced expiratory volume in one second was the most frequently used outcome, but few reviews evaluated the effect of treatment on costs or patient preferences. Forty reviews were judged to have serious or extensive flaws. All six reviews associated with industry were in this group. Seven of the 10 most rigorous reviews were published in the Cochrane Library.ConclusionsMost reviews published in peer reviewed journals or funded by industry have serious methodological flaws that limit their value to guide decisions. Cochrane reviews are more rigorous and better reported than those published in peer reviewed journals.     

Role of vaccinations as risk factors for ill health in veterans of the Gulf war: cross sectional study

ObjectivesTo explore the relation between ill health after the Gulf war and vaccines received before or during the conflict. To test the hypothesis that such ill health is limited to military personnel who received multiple vaccines during deployment and that pesticide use modifies any effect.DesignCross sectional study of Gulf war veterans followed for six to eight years after deployment.Setting UK armed forces.ParticipantsMilitary personnel who served in the Gulf and who still had their vaccine records.Results The response rate for the original survey was 70.4% (n=3284). Of these, 28% (923) had vaccine records. Receipt of multiple vaccines before deployment was associated with only one of the six health outcomes (post-traumatic stress reaction). By contrast five of the six outcomes (all but post-traumatic stress reaction) were associated with multiple vaccines received during deployment. The strongest association was for the multisymptom illness (odds ratio 5.0; 95% confidence interval 2.5 to 9.8).ConclusionAmong veterans of the Gulf war there is a specific relation between multiple vaccinations given during deployment and later ill health. Multiple vaccinations in themselves do not seem to be harmful but combined with the “stress” of deployment they may be associated with adverse health outcomes. These results imply that every effort should be made to maintain routine vaccines during peacetime.     

Against the trend: increasing numbers of breeding Northern Lapwings Vanellus vanellus and Black-tailed Godwits Limosa limosa limosa on a German Wadden Sea island

Capsule The increase in population sizes over the last 30 years cannot be explained by reproductive success.

Aims To establish whether the positive population trends are due to increasing and self-sustaining populations or to immigration.

Methods We studied the population development of breeding lapwings from 1971 until 2005 and of godwits from 1977 until 2005 on Wangerooge, a German Wadden Sea island. Both species increased significantly during the last three decades. For each species we used a logistic growth model to derive the reproductive output required to explain the past population development without assuming immigration. We compare the values derived by this model with empirical findings of reproductive output of the respective populations.

Results For neither lapwings nor godwits can empirical reproductive success explain the observed population development.

Conclusion Our results imply that the increase in breeding pairs of Northern Lapwing and Black-tailed Godwit on Wangerooge Island is not due to reproductive output. We propose that it is mainly caused by immigration onto the island.     

Soil carbon stocks and carbon sequestration rates in seminatural grassland in Aso region,Kumamoto, Southern Japan

Global soil carbon (C) stocks account for approximately three times that found in the atmosphere. In the Aso mountain region of Southern Japan, seminatural grasslands have been maintained by annual harvests and/or burning for more than 1000 years. Quantification of soil C stocks and C sequestration rates in Aso mountain ecosystem is needed to make well‐informed, land‐use decisions to maximize C sinks while minimizing C emissions. Soil cores were collected from six sites within 200 km² (767–937 m asl.) from the surface down to the k‐Ah layer established 7300 years ago by a volcanic eruption. The biological sources of the C stored in the Aso mountain ecosystem were investigated by combining C content at a number of sampling depths with age (using ¹⁴C dating) and δ¹³C isotopic fractionation. Quantification of plant phytoliths at several depths was used to make basic reconstructions of past vegetation and was linked with C‐sequestration rates. The mean total C stock of all six sites was 232 Mg C ha^?1 (28–417 Mg C ha^?1), which equates to a soil C sequestration rate of 32 kg C ha^?1 yr^?1 over 7300 years. Mean soil C sequestration rates over 34, 50 and 100 years were estimated by an equation regressing soil C sequestration rate against soil C accumulation interval, which was modeled to be 618, 483 and 332 kg C ha^?1 yr^?1, respectively. Such data allows for a deeper understanding in how much C could be sequestered in Miscanthus grasslands at different time scales. In Aso, tribe Andropogoneae (especially Miscanthus and Schizoachyrium genera) and tribe Paniceae contributed between 64% and 100% of soil C based on δ¹³C abundance. We conclude that the seminatural, C₄‐dominated grassland system serves as an important C sink, and worthy of future conservation.     

Dolphin-Assisted Therapy: More Flawed Data and More Flawed Conclusions

ABSTRACT

Dolphin-Assisted Therapy (DAT) is an increasingly popular choice of treatment for illness and developmental disabilities by providing participants with the opportunity to swim or interact with live captive dolphins. Two reviews of DAT (Marino and Lilienfeld [1998] and Humphries [2003]) concluded that there is no credible scientific evidence for the effectiveness of this intervention. In this paper, we offer an update of the methodological status of DAT by reviewing five peer-reviewed DAT studies published in the last eight years. We found that all five studies were methodologically flawed and plagued by several threats to both internal and construct validity. We conclude that nearly a decade following our initial review, there remains no compelling evidence that DAT is a legitimate therapy or that it affords any more than fleeting improvements in mood.     

Determinants of End-of-Life Expenditures in Patients with Oral Cancer in Taiwan: A Population-Based Study

BackgroundTo investigate the association of basic demographic data, socioeconomic status, medical services, and hospital characteristics with end-of-life expenditure in patients with oral cancer in Taiwan who died between 2009 to 2011.MethodsThis nationwide population-based, retrospective cohort study identified 5,386 patients who died from oral cancer. We evaluated medical cost in the last month of life by universal health insurance. The impact of each variable on the end-of-life expenditure was examined by hierarchical generalized linear model (HGLM) using a hospital-level random-intercept model.ResultsThe mean medical cost in the last six months of life was $2,611±3,329 (U.S. dollars). In HGLM using a random-intercept model, we found that patients younger than 65 years had an additional cost of $819 over those aged ≥65 years. Patients who had a high Charlson Comorbidity Index Score (CCIS) had an additional $616 cost over those with a low CCIS. Those who survived post-diagnosis less than 6 months had an additional $659 in expenses over those who survived more than 24 months. Medical cost was $249 more for patients who had medium to high individual SES, and $319 more for those who were treated by non-oncologists.ConclusionThis study provides useful information for decision makers in understanding end-of-life expenditure in oral cancer. We found significantly increased end-of-life expenditure in patients if they were younger than 65 years or treated by non-oncologists, or had high CCIS, medium to high individual SES, and survival of less than 6 months after diagnosis.     

Recent changes in the abundance of British upland breeding birds

Capsule Breeding wader populations have more often shown declines than passerine populations during the last 10–20 years.

Aims To determine abundance changes in British upland breeding birds during the last 10–20 years.

Methods We re-surveyed 1348 km², in nine study areas, of the British uplands in 2000 and 2002, which had been previously surveyed between 1980 and 1991. In addition, we included data from recent repeat surveys in four other upland areas, covering approximately 365 km², to broaden the scope of our study.

Results We found evidence of widespread population declines in three species of breeding waders, Lapwing Vanellus vanellus, Dunlin Calidris alpina and Curlew Numenius arquata. Among the passerines, some species declined, including Twite Carduelis flavirostris and Ring Ouzel Turdus torquatus, while others showed strong gains, including Stonechat Saxicola torquata and Raven Corvus corax.

Conclusion Overall, abundance changes were characterized by a high degree of variability across study areas, even when close together. This variability may have been partly due to the different time intervals between the original and repeat surveys. Improved upland breeding bird population monitoring is needed to allow better detection of trends. Action is needed to restore upland breeding bird populations in areas where they have declined.     

Long Term Development of Gut Microbiota Composition in Atopic Children: Impact of Probiotics

Introduction

Imbalance of the human gut microbiota in early childhood is suggested as a risk factor for immune-mediated disorders such as allergies. With the objective to modulate the intestinal microbiota, probiotic supplementation during infancy has been used for prevention of allergic diseases in infants, with variable success. However, not much is known about the long-term consequences of neonatal use of probiotics on the microbiota composition. The aim of this study was to assess the composition and microbial diversity in stool samples of infants at high-risk for atopic disease, from birth onwards to six years of age, who were treated with probiotics or placebo during the first year of life.

Methods

In a double-blind, randomized, placebo-controlled trial, a probiotic mixture consisting of B. bifidum W23, B. lactis W52 and Lc. Lactis W58 (Ecologic® Panda) was administered to pregnant women during the last 6 weeks of pregnancy and to their offspring during the first year of life. During follow-up, faecal samples were collected from 99 children over a 6-year period with the following time points: first week, second week, first month, three months, first year, eighteen months, two years and six years. Bacterial profiling was performed by IS-pro. Differences in bacterial abundance and diversity were assessed by conventional statistics.

Results

The presence of the supplemented probiotic strains in faecal samples was confirmed, and the probiotic strains had a higher abundance and prevalence in the probiotic group during supplementation. Only minor and short term differences in composition of microbiota were found between the probiotic and placebo group and between children with or without atopy. The diversity of Bacteroidetes was significantly higher after two weeks in the placebo group, and at the age of two years atopic children had a significantly higher Proteobacteria diversity (p < 0.05). Gut microbiota development continued between two and six years, whereby microbiota composition at phylum level evolved more and more towards an adult-like configuration.

Conclusion

Perinatal supplementation with Ecologic® Panda, to children at high-risk for atopic disease, had minor effects on gut microbiota composition during the supplementation period. No long lasting differences were identified. Regardless of intervention or atopic disease status, children had a shared microbiota development over time determined by age that continued to develop between two and six years.     

Prejudice and tolerance in a period of increasing ethnic diversity and growing unemployment: Denmark since 1970

Abstract

Since the end of the 1960s Denmark, once an ethnically homogeneous country, has become more heterogeneous as a result of immigration by foreign workers and refugees. The question is how has this development influenced the attitudes in Denmark towards immigrants? The saliency of the immigrant issue has certainly grown, but contrary to expectations, the level of ethnocentrism has changed very little. If anything, the Danish population has become less prejudiced and more tolerant during the last thirty years. This conclusion, based on a number of national surveys, is even more conspicuous as the level of unemployment has increased in the same period.     

Cheyne-Stokes respiration in patients hospitalised for heart failure

BackgroundPrevious studies showing a strong relationship between Cheyne-Stokes respiration and the severity of left ventricular systolic dysfunction have usually been done in selected patient populations with lower age and a higher proportion of males than the "typical" in-hospital patient with heart failure. The purpose of the present study was test the strength of this relationship in unselected patients admitted to hospital due to decompensated chronic heart failure.MethodsWe evaluated 191 patients (32% women), mean age 73 years, ready for discharge from the heart failure unit in the University Hospital of Malmö, Sweden. The patients underwent echocardiography for determination of left ventricular ejection fraction and left ventricular inner diastolic diameter. A respiratory investigation during sleep was performed the last night before discharge.ResultsWe found that 66% of the patients had Cheyne-Stokes respiration more than 10% of the total recording time. Only 7 (3.6%) of the patients had predominantly obstructive apnoeas. There was a significant but very weak relationship between left ventricular ejection fraction and left ventricular inner diastolic diameter on one hand and Cheyne-Stokes respiration on the other. Age was a stronger determinant of Cheyne-Stokes respiration than any of the cardiac or other clinical variables.ConclusionAlthough presence of Cheyne-Stokes respiration indicates left ventricular dysfunction, its severity seems only weakly related to the severity of heart failure. Age was found to be a stronger determinant, which may reflect the underlying age-dependency found also in healthy subjects. Due to age restrictions or other selection criteria, the importance of age may have been underestimated in many previous studies on factors associated with Cheyne-Stokes respiration.     

Long Term Non-Invasive Ventilation in Children: Impact on Survival and Transition to Adult Care

BackgroundThe number of children receiving domiciliary ventilatory support has grown over the last few decades driven largely by the introduction and widening applications of non-invasive ventilation. Ventilatory support may be used with the intention of increasing survival, or to facilitate discharge home and/or to palliate symptoms. However, the outcome of this intervention and the number of children transitioning to adult care as a consequence of longer survival is not yet clear.MethodsIn this retrospective cohort study, we analysed the outcome in children (<17 years) started on home NIV at Royal Brompton Hospital over an 18 year period 1993-2011. The aim was to establish for different diagnostic groups: survival rate, likelihood of early death depending on diagnosis or discontinuation of ventilation, and the proportion transitioning to adult care.Results496 children were commenced on home non invasive ventilation; follow-up data were available in 449 (91%). Fifty six per cent (n=254) had neuromuscular disease. Ventilation was started at a median age (IQR) 10 (3-15) years. Thirteen percent (n=59) were less than 1 year old. Forty percent (n=181) have transitioned to adult care. Twenty four percent (n=109) of patients have died, and nine percent (n=42) were able to discontinue ventilatory support.ConclusionLong term ventilation is associated with an increase in survival in a range of conditions leading to ventilatory failure in children, resulting in increasing numbers surviving to adulthood. This has significant implications for planning transition and adult care facilities.     

Impact of catch-up vaccination on aluminum exposure due to new laws and post social distancing

BackgroundThe COVID-19 pandemic has placed significant stressors on the medical community and on the general public. Part of this includes patients skipping well-child visits to reduce risk of exposure to SARS-CoV-2 virus. Published estimates of the duration of whole-body aluminum (Al) toxicity from vaccines in infants from birth to six months indicate that CDC's recommended vaccination schedule leads to unacceptably long periods of time in which infants are in aluminum toxicity (as measured by %AlumTox).MethodsWe utilize these established clearance and accumulation models to calculate expected per-body-weight whole-body toxicity of aluminum from vaccines considering for children of all ages under CDC's Catch-Up schedule from birth to ten years, assuming social distancing for 6 months. Our updated Pediatric Dose Limit (PDL) model assumes a linear improvement in renal function from birth to two years.ResultsOur results indicate that due diligence in considering alternative spacing and use of non-aluminum containing vaccines when possible will reduce whole body toxicity and may reduce risk of morbidity associated with exposure to aluminum.ConclusionsWhile reduction or elimination of aluminum exposure from all sources is always a good idea, our results indicate that careful consideration of expected aluminum exposures during regular and Catch-Up vaccination is found to be especially important for infants and children below 2 years of age. We urge caution in the mass re-starting of vaccination under CDC’s Catch-Up schedule for children under 12 months and offer alternative strategies to minimize per-day/week/month exposure to aluminum hydroxide following the COVID-19 period of isolation.     

Pneumococcal polysaccharide vaccination in adults undergoing immunosuppressive treatment for inflammatory diseases – a longitudinal study

IntroductionPatients undergoing immunosuppressive therapy are at increased risk of infection. Community-acquired pneumonia and invasive pneumococcal disease account for substantial morbidity and mortality in this population and may be prevented by vaccination. Ideally, immunization to pneumococcal antigens should take place before the start of immunosuppressive treatment. Often, however, the treatment cannot be delayed. Little is known about the efficacy of pneumococcal vaccines during immunosuppressive treatment. The objectives of this study were to determine the percentage of vaccine-naïve, immunosuppressed adults with inflammatory diseases seroprotected against Streptococcus pneumoniae and to assess factors associated with the immunogenicity, clinical impact and safety of 23-valent pneumococcal polysaccharide vaccine (PPV) in seronegative subjects.MethodsThis observational study included patients 18 years of age and older who were receiving prednisone ≥20 mg/day or other immunosuppressive drugs. Exclusion criteria were PPV administration in the previous 5 years, intravenous immunoglobulins and pregnancy. Serum immunoglobulin G (IgG) antibody levels against six pneumococcal serotypes were measured. Seropositivity was defined as IgG of 0.5 μg/ml or greater for at least four of six serotypes. Seronegative patients received PPV, and seropositive patients were included as a comparison group. Vaccine response and tolerance were assessed after 4–8 weeks. Disease activity was evaluated on the basis of the Physician Global Assessment scores. Serology was repeated after 1 year, and information on any kind of infection needing medical attention was collected. Outcomes were the proportion of seropositivity and infections between vaccinated and unvaccinated patients.ResultsOf 201 included patients, 35 received high-dose corticosteroids and 181 were given immunosuppressive drugs. Baseline seronegativity in 60 (30 %) patients was associated with corticotherapy and lower total IgG. After PPV, disease activity remained unchanged or decreased in 81 % of patients, and 87 % became seropositive. After 1 year, 67 % of vaccinated compared with 90 % of observed patients were seropositive (p < 0.001), whereas the rate of infections did not differ between groups. Those still taking prednisone ≥10 mg/day tended to have poorer serological responses and had significantly more infections.ConclusionsPPV was safe and moderately effective based on serological response. Seropositivity to pneumococcal antigens significantly reduced the risk of infections. Sustained high-dose corticosteroids were associated with poor vaccine response and more infections.     

Vibrio cholerae O139 persists in Dhaka,Bangladesh since 1993

BackgroundAfter a multi-country Asian outbreak of cholera due to Vibrio cholerae serogroup O139 which started in 1992, it is rarely detected from any country in Asia and has not been detected from patients in Africa.Methodology/Principal findingsWe extracted surveillance data from the Dhaka and Matlab Hospitals of International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) to review trends in isolation of Vibrio cholerae O139 in Bangladesh. Data from the Dhaka Hospital is a 2% sample of > 100,000 diarrhoeal patients treated annually. Data from the Matlab Hospital includes all diarrhoeal patients who hail from the villages included in the Matlab Health and Demographic Surveillance System. Vibrio cholerae O139 was first isolated in Dhaka in 1993 and had been isolated every year since then except for a gap between 2005 and 2008. An average of thirteen isolates was detected annually from the Dhaka Hospital during the last ten years, yielding an estimated 650 cases annually at this hospital. During the last ten years, cases due to serogroup O139 represented 0.47% of all cholera cases; the others being due to serogroup O1. No cases with serogroup O139 were identified at Matlab since 2006. Clinical signs and symptoms of cholera due to serogroup O139 were similar to cases due to serogroup O1 though more of the O139 cases were not dehydrated. Most isolates of O139 remained sensitive to tetracycline, ciprofloxacin, and azithromycin, but they became resistant to erythromycin starting in 2009.Conclusions/SignificanceCholera due to Vibrio cholerae serogroup O139 continues to cause typical cholera in Dhaka, Bangladesh.     

Social characteristics and fertility: A study of Two Religious Groups in Metropolitan New York

Abstract

Reproductive time lost through marital dissolution is a potential factor in decreased fertility. This study of survey data from six Latin America metropolitan areas shows that, among variables examined, type of marital union is the primary determinant of reproductive time lost. The study establishes that appreciably more reproductive time is lost from consensual unions than from legal ones. It also indicates that this difference cannot be explained by such social‐background characteristics as a woman's place of birth or educational attainment.     

A retrospective analysis of health care utilization for patients with mitochondrial disease in the United States: 2008–2015

Background

Oral cholic acid (CA) replacement has been shown to be an effective therapy in children with primary bile acid synthesis defects, which are rare and severe genetic liver diseases. To date there has been no report of the effects of this therapy in children reaching adulthood. The aim of the study was to evaluate the long-term effectiveness and safety of CA therapy.

Methods

Fifteen patients with either 3β-hydroxy-Δ⁵-C₂₇-steroid oxidoreductase (3β-HSD) (n = 13) or Δ⁴–3-oxosteroid 5β-reductase (Δ⁴–3-oxo-R) (n = 2) deficiency confirmed by mass spectrometry and gene sequencing received oral CA and were followed prospectively.

Results

The median age at last follow-up and the median time of follow-up with treatment were 24.3 years (range: 15.3–37.2) and 21.4 years (range: 14.6–24.1), respectively. At last evaluation, physical examination findings and blood laboratory test results were normal in all patients. Liver sonograms were normal in most patients. Mean daily CA dose was 6.9 mg/kg of body weight. Mass spectrometry analysis of urine showed that excretion of the atypical metabolites remained low or traces in amount with CA therapy. Liver fibrosis scored in liver biopsies or assessed by elastography in 14 patients, after 10 to 24 years with CA therapy, showed a marked improvement with disappearance of cirrhosis (median score < F1; range: F0-F2). CA was well tolerated in all patients, including five women having 10 uneventful pregnancies during treatment.

Conclusions

Oral CA therapy is a safe and effective long-term treatment of 3β-HSD and Δ⁴–3-oxo-R deficiencies and allows affected children to reach adulthood in good health condition without the need for a liver transplantation.

     

Fluctuations in chick diet of the Squacco Heron Ardeola ralloides in southern France: changes over the last 30 years

Capsule The composition varied between colony site, month and year.

Aims To determine the diet composition of chicks and its variations in 2000 and 2001. To look for any changes over the last 30 years.

Methods Chick regurgitates were analysed to determine which Order contributed most to the diet, by frequency and by biomass.

Results During 2000 and 2001 chick diet was dominated by insects (92% and 70% by biomass, respectively), mainly Coleoptera (60% and 41%) and Orthoptera (27% in both years). The dry mass of Orthoptera, Coleoptera adults, Odonata and amphibians differed significantly between breeding sites, months and years.The proportion of invertebrates (in biomass) increased from 36.5% in 1970 and 31% in 1971 to 95% in 2000 and 90% in 2001 whereas the proportion of amphibians decreased in the same time from 49% and 33% in 1970 and 1971 to 5.0% and 9.5% in 2000 and 2001, respectively.

Conclusion The proportion of prey types differed bewteen colony sites and months. Major changes were found in the diet composition between the early 1970s and 2000s. The possible hypotheses for the observed differences are discussed.     

Adaptive radiotherapy in patients receiving neoadjuvant radiation for soft tissue sarcoma

AimThe aim of this study is to evaluate tumor volume changes during preoperative radiotherapy and to assess the role of adaptive radiation.BackgroundContemporary neoadjuvant radiotherapy utilizes image guidance for precise treatment delivery. Moreover, it may depict changes in tumor size and shape.Materials and methodsBetween 2016 and 2018, 23 patients aged ≥18 years with soft tissue sarcoma were treated with neoadjuvant radiation followed by surgical resection. The tumor volumes (cc) were measured using the Pinnacle planning system prior to starting radiotherapy and during treatment, the changes in volume and absolute differences were estimated. Moreover, patient's position on the machine was evaluated to assess setup offsets. The triggers for plan adaptation were >1 cm expansion or unacceptable setup offsets.ResultsThe mean tumors volume at presentation was 810 cc (range, 55–4000). At last cone beam CT the tumor volume had changed in 14 patients (61%); it was stable in nine patients (39%). Disease regression was documented in eight patients (35%), with median shrinkage of −20.5% (range, −2 to −29%), while tumor progression was observed in six cases (26%), the median change was 12.5% (range, +10 to +25%).Adaptive radiation was required in four patients (17%). For the remaining 19 cases (83%), the dose distribution was adequate to cover target volumes.ConclusionsChange in soft tissue sarcoma volume during radiation is not uncommon. Image guidance should be used to reduce setup errors and to detect differences in tumor volume. Image guidance and adaptive radiation are paramount to ensure optimal radiation delivery.     

Association of anal symptoms with anal high grade squamous intraepithelial lesions (HSIL) among men who have sex with men: Baseline data from the study of the prevention of anal cancer (SPANC)

BackgroundThe association between anal high-grade squamous intraepithelial lesion (HSIL) and anal symptoms has not been systematically investigated.MethodsThe Study of Prevention of Anal Cancer is a prospective cohort study of men who have sex with men (MSM) ≥ 35 years old in Sydney, Australia. Self-reported symptoms were collected. Anal cytology and high-resolution anoscopy were undertaken. Using baseline visit data, men negative for squamous intra-epithelial lesion (SIL) were compared with men diagnosed with composite-HSIL (cytology and/or histology). Logistic regression analyses were performed to assess the association of symptoms with HSIL.ResultsAmong 414 MSM included (composite-HSIL (n = 231); negative for SIL (n = 183)), 306 (73.9%) reported symptom(s) within the last 6 months. There was no association between any symptom and composite-HSIL. A significant association between anal lump and a larger burden of HSIL (at least 2 intra-anal octants) (anal lump within last month: p = 0.014; anal lump within last 6 months: p = 0.010) became non-significant after adjusting for HIV-status and recent anal warts (anal lump within last month: p = 0.057; anal lump within last 6 months: p = 0.182).ConclusionsAmong MSM age 35 years and older, most anal symptoms are not a useful marker of anal HSIL.