Patients' & Healthcare Professionals' Values Regarding True- & False-Positive Diagnosis when Colorectal Cancer Screening by CT Colonography: Discrete Choice Experiment

Purpose

To establish the relative weighting given by patients and healthcare professionals to gains in diagnostic sensitivity versus loss of specificity when using CT colonography (CTC) for colorectal cancer screening.

Materials and Methods

Following ethical approval and informed consent, 75 patients and 50 healthcare professionals undertook a discrete choice experiment in which they chose between “standard” CTC and “enhanced” CTC that raised diagnostic sensitivity 10% for either cancer or polyps in exchange for varying levels of specificity. We established the relative increase in false-positive diagnoses participants traded for an increase in true-positive diagnoses.

Results

Data from 122 participants were analysed. There were 30 (25%) non-traders for the cancer scenario and 20 (16%) for the polyp scenario. For cancer, the 10% gain in sensitivity was traded up to a median 45% (IQR 25 to >85) drop in specificity, equating to 2250 (IQR 1250 to >4250) additional false-positives per additional true-positive cancer, at 0.2% prevalence. For polyps, the figure was 15% (IQR 7.5 to 55), equating to 6 (IQR 3 to 22) additional false-positives per additional true-positive polyp, at 25% prevalence. Tipping points were significantly higher for patients than professionals for both cancer (85 vs 25, p<0.001) and polyps (55 vs 15, p<0.001). Patients were willing to pay significantly more for increased sensitivity for cancer (p = 0.021).

Conclusion

When screening for colorectal cancer, patients and professionals believe gains in true-positive diagnoses are worth much more than the negative consequences of a corresponding rise in false-positives. Evaluation of screening tests should account for this.     

Mutant p53 Attenuates the Anti-Tumorigenic Activity of Fibroblasts-Secreted Interferon Beta

Mutations in the p53 tumor suppressor protein are highly frequent in tumors and often endow cells with tumorigenic capacities. We sought to examine a possible role for mutant p53 in the cross-talk between cancer cells and their surrounding stroma, which is a crucial factor affecting tumor outcome. Here we present a novel model which enables individual monitoring of the response of cancer cells and stromal cells (fibroblasts) to co-culturing. We found that fibroblasts elicit the interferon beta (IFNβ) pathway when in contact with cancer cells, thereby inhibiting their migration. Mutant p53 in the tumor was able to alleviate this response via SOCS1 mediated inhibition of STAT1 phosphorylation. IFNβ on the other hand, reduced mutant p53 RNA levels by restricting its RNA stabilizer, WIG1. These data underscore mutant p53 oncogenic properties in the context of the tumor microenvironment and suggest that mutant p53 positive cancer patients might benefit from IFNβ treatment.     

Relevance of Distinct Monocyte Subsets to Clinical Course of Ischemic Stroke Patients

Background and Purpose

The most common strategy for treating patients with acute ischemic stroke is thrombolytic therapy, though only a few patients receive benefits because of the narrow time window. Inflammation occurring in the central nervous system (CNS) in association with ischemia is caused by immune cells including monocytes and involved in lesion expansion. If the specific roles of monocyte subsets in stroke can be revealed, they may become an effective target for new treatment strategies.

Methods

We performed immunological examinations of 36 consecutive ischemic stroke patients within 2 days of onset and compared the results with 24 age-matched patients with degenerative disorders. The stroke patients were repeatedly tested for the proportions of monocyte subsets in blood, and serum levels of pro- and anti-inflammatory cytokines immediately after admission, on days 3-7 and 12-16 after stroke onset, and on the day of discharge. In addition, immunological measurements were analyzed for relationships to stroke subtypes and complications, including progressive infarction (PI) and stroke-associated infection (SAI).

Results

Monocyte count was significantly increased from 0–16 days after stroke as compared to the controls (p<0.05). CD14^highCD16^- classical and CD14^highCD16⁺ intermediate monocytes were significantly increased from 0-7 and 3-16 days after stroke, respectively (p<0.05), whereas CD14 ^dimCD16^high non-classical monocytes were decreased from 0–7 days (p<0.05). Cardioembolic infarction was associated with a persistent increase in intermediate monocytes. Furthermore, intermediate monocytes were significantly increased in patients with PI (p<0.05), while non-classical monocytes were decreased in those with SAI (p<0.05). IL-17A levels were positively correlated with monocyte count (r=0.485, p=0.012) as well as the percentage of non-classical monocytes (r=0.423, p=0.028), and negatively with that of classical monocytes (r=-0.51, p=0.007) during days 12-16.

Conclusions

Our findings suggest that CD14^highCD16⁺ intermediate monocytes have a role in CNS tissue damage during acute and subacute phases in ischemic stroke especially in relation to cardioembolism.     

The structure of N δ -( N ′-sulfodiaminophosphinyl)- l -ornithine and its binding to ornithine transcarbamoylase: A quantum chemical study

The structure of N i -( N '-Sulfodiaminophosphinyl)- l -ornithine (PSOrn) in complex with the enzyme ornithine transcarbamoylase (OTCase) was recently characterised by Langley et al. [D.B. Langley, M.D. Templeton, B.A. Fields, R.E. Mitchell and C.A. Collyer, J. Biol. Chem., 275 (2000) 20012] using X-ray diffraction techniques. In this work, the interaction of PSOrn with the arginine residues of OTCase is modelled using density functional theory, with an emphasis on characterising the mechanism of binding between PSOrn, an inhibitor, and the enzyme. For the purposes of this study, the interaction of PSO, an analogue of PSOrn (obtained by replacing a (CH 2 ) 3 CH( CO 2 m )( NH 3 + ) side chain by methyl) with one and two arginine (Arg) molecules are investigated. The PSO > (Arg) 2 trimer is found to be strongly bound, by ～171 kJ mol m 1 , due to the presence of four hydrogen bonds in addition to a large ionic interaction between a dinegative PSO 2 m and protonated arginines. The computed geometry is consistent with the X-ray structure and the large binding energy is consistent with the observation that PSOrn is a powerful inhibitor. Furthermore, in agreement with the proposals of Langley et al. , the most stable bound form of PSO is found to be an imino type tautomer. The population analyses that were carried out on PSO suggest that PN, PO, SN and SO bonds, as in a range of other systems, are generally either single or semipolar bonds.     

Americans all: Black and single‐parent families in the inner city

Bette J. Dickerson (ed.), AFRICAN AMERICAN SINGLE MOTHERS: UNDERSTANDING THEIR LIVES AND FAMILIES, Thousand Oaks, CA: Sage Publications, 1995, xxxii + 200 pp., $24.00 (paper).

Linda Gordon, PITIED BUT NOT ENTITLED: SINGLE MOTHERS AND THE HISTORY OF WELFARE 1890–1935, Cambridge, MA: Harvard University Press, 1994, 433 pp., $15.95 (paper).

Joyce A. Ladner, TOMORROW'S TOMORROW: THE BLACK WOMAN, Lincoln, NE: The University of Nebraska Press, 1995, xxiii + 304 pp., $12.00 (paper).

Carl Husemoller Nightingale, ON THE EDGE: A HISTORY OF POOR BLACK CHILDREN AND THEIR AMERICAN DREAMS, New York: Basic Books, 1993, xv + 254 pp., $14.00 (paper).

M. Belinda Tucker and Claudia Mitchell‐Kernan, (eds), THE DECLINE IN MARRIAGE AMONG AFRICAN AMERICANS: CAUSES, CONSEQUENCES AND POLICY IMPLICATIONS, New York: Russell Sage Foundation, 1995, xxiv + 397 pp., $49.95 and $19.95 (paper).     

Oxytocin Increases the Influence of Public Service Advertisements

This paper presents a neurophysiologic model of effective public service advertisements (PSAs) and reports two experiments that test the model. In Experiment 1, we show that after watching 16 PSAs participants who received oxytocin, compared to those given a placebo, donated to 57% more causes, donated 56% more money, and reported 17% greater concern for those in the ads. In Experiment 2, we measured adrenocorticotropin hormone (ACTH) and oxytocin levels in blood before and after participants watched a PSA. As predicted by the model, donations occurred when participants had increases in both ACTH and oxytocin. Our results indicate that PSAs with social content that cause OT release will be more effective than those that do not. Our results also explain why some individuals do not respond to PSAs.