Reproductive and external hormonal factors and the risk of renal cell cancer in the Netherlands Cohort Study

BackgroundSeveral reproductive and hormonal factors, like age at menarche, parity, age at menopause, use of oral contraceptives and postmenopausal treatment, have been associated with the risk of renal cell cancer (RCC) in women, but results have not always been consistent. We therefore investigated the association between these factors and the risk of RCC in postmenopausal women participating in the Netherlands Cohort Study on Diet and Cancer.MethodsInformation on reproductive history, exogenous hormone use and gynecological surgery was obtained through a self-administered questionnaire at baseline in 1986. After 20.3 years of follow-up, 204 cases and 2280 subcohort members were available for case-cohort analysis. Multivariable hazard ratios (HR) were calculated using Cox Proportional Hazard analysis.ResultsWomen who reported a hysterectomy had an increased RCC risk compared to women who did not (HR, 1.42, 95%CI, 1.01–2.00). Women with a natural age at menopause between 45 and 49 years compared to 50–54 years had an increased RCC risk (HR, 1.61; 95%CI, 1.10–2.35). RCC risk was slightly and not statistically significant increased among parous women with three or more children and age at first birth before 25 years compared to nulliparous women (HR, 1.36; 95% confidence interval (CI), 0.84–2.20). No associations were observed with RCC risk for age at menarche, use of oral contraceptives and use of hormonal replacement therapy.ConclusionHysterectomy and age at natural menopause were associated with an increased RCC risk. Other hormonal and reproductive factors and RCC risk were not increased. Further studies are required to establish the mechanism(s) that explain the observed association.     

Trends in colorectal cancer incidence in Ho Chi Minh City,Vietnam (1996–2015): Joinpoint regression and age–period–cohort analyses

BackgroundLittle is known about the trends in colorectal cancer (CRC) in Vietnam. We aimed to investigate the trends in epidemiology and anatomical subsites of CRC in Ho Chi Minh City, Vietnam.MethodsBased on the Ho Chi Minh City Cancer Registry data during 1996–2015, we calculated the average annual percent changes (AAPCs) of the age-standardized incidence rates (ASRs) by sex, age groups, and anatomical subsites, using joinpoint regressions analysis. We further performed age–period–cohort (APC) analysis using the United States National Cancer Institute’s web-based statistical tool to explore the underlying reason for the incidence trend.ResultsOver 20 years the overall ASR of CRC increased from 10.5 to 17.9 per 100,000, a 1.7-fold increase. CRC incidence elevated more rapidly in men (AAPC 4.7, 95%CI 2.2–7.3) than in women (AAPC 2.6, 95%CI 0.6–4.8). The highest and lowest increasing rates of ASRs were observed in the 50–64-year-old age group (AAPC 5.3, 95%CI 2.8–7.9) and < 50-year-old age group (AAPC 1.1, 95%CI –0.7 to 2.9), respectively. Regarding subsites, rectal cancer had the highest rate of increase (AAPC 3.3, 95%CI 1.0–5.7). Furthermore, the APC analysis indicated significant increases in CRC incidence in birth cohorts after 1975 in both genders.ConclusionsThe CRC incidence in Ho Chi Minh City increased, with the more prominent rates being among men and older populations, in rectal subsites, and in people born after 1975. The upward trend of CRC incidence in Ho Chi Minh City may be due to the adoption of a westernized lifestyle.     

Regression analysis of doubly censored failure time data with frailty

In doubly censored failure time data, the survival time of interest is defined as the elapsed time between an initial event and a subsequent event, and the occurrences of both events cannot be observed exactly. Instead, only right- or interval-censored observations on the occurrence times are available. For the analysis of such data, a number of methods have been proposed under the assumption that the survival time of interest is independent of the occurrence time of the initial event. This article investigates a different situation where the independence may not be true with the focus on regression analysis of doubly censored data. Cox frailty models are applied to describe the effects of covariates and an EM algorithm is developed for estimation. Simulation studies are performed to investigate finite sample properties of the proposed method and an illustrative example from an acquired immune deficiency syndrome (AIDS) cohort study is provided.     

Short delay in timing of emergence determines establishment success in Pinus sylvestris across microhabitats

BACKGROUND AND AIMS: The date of emergence may have far-reaching implications for seedling performance. Seedlings emerging early in the growing season often have a greater rate of survival or grow better if early emergence provides advantages with respect to an environmental cue. As a result, the benefits of early emergence may be lost if the environmental stress creating the differences among cohorts disappears. The experimental manipulation under field conditions of the factors that constitute the main sources of stress for seedling establishment is thus a straightforward method to evaluate the impact of date of emergence on seedling establishment under realistic conditions. METHODS: Two field experiments were performed to analyse the effect of emergence date on survival and first-year growth of Scots pine seedlings in natural mountain forests in south-east Spain. Two main environmental factors that determine seedling success in these mountains were considered: (1) microhabitat type (monitoring the effect of date of emergence in the three most common microhabitats where seedlings recruit); (2) summer drought (monitored by an irrigation treatment with control and watered sampling points). KEY RESULTS: Overall, early emergence resulted in a higher probability of survival and better growth in the two experiments and across microhabitats. However, the reduction in summer drought did not diminish the differences observed among cohorts: all cohorts increased their survival and growth, but early cohorts still had a clear advantage. CONCLUSIONS: Date of emergence determines establishment success of Pinus sylvestris seedlings, even if cohorts are separated by only a few days, irrespective of the intensity of summer drought. The experimental design, covering a gradient of light intensity and soil moisture that simulates conditions of the regeneration niche of Scots pine across its geographical range, allows the results to be extrapolated to other areas of the species. Date of emergence is thus likely to have a large impact on the demography of Scots pine across its geographical range.     

河南省部分地区人类免疫缺陷病毒1型耐药性发生和演变的队列研究

目的 了解河南省某地人类免疫缺陷病毒(HIV)耐药性毒株的进化演变规律.方法 将河南省南部某地74例接受齐多夫定(AZT)+去羟肌苷(ddI)+奈韦拉平(NVP)联合抗病毒治疗的艾滋病患者纳入研究队列,分别在抗病毒治疗后3、6、12、18个月进行随访调查,通过逐一访谈了解一般情况、服药方案、服药依从性及保障措施、抗病毒治疗前后的临床表现等,同时采集14 ml EDTA抗凝静脉血,检测CD4/CD8细胞数、病毒载量及基因型耐药性.结果 核苷类反转录酶抑制剂中,发生频率最高的耐药突变位点是:67、118、151和215.治疗3、6、12、18个月时AZT耐药发生率分别为6.76%、13.51%、14.86%和9.46%,ddI的耐药发生率分别为2.70%、6.76%、8.11%和5.45%,AZT的耐药发生率高于ddI,核苷类反转录酶抑制剂的耐药性呈现出先上升后下降的趋势.非核苷类反转录酶抑制剂的耐药发生率高于核苷类反转录酶抑制剂,发生频率最高的耐药突变位点是:103和181.治疗3、6、12、18个月时,NVP耐药发生率分别为9.46%、18.92%、22.97%和32.43%.非核苷类反转录酶抑制剂呈现出持续上升的耐药发生趋势.耐药和不耐药患者的病毒载量和CD4+T淋巴细胞计数无显著性差异.服药依从性差可能是耐药发生的主要影响因素.结论 本组患者中已出现对非核苷类反转录酶抑制剂的高度耐药,服药依从性是耐药发生的主要影响因素.应加强服药的监督管理,改善患者的服药依从性.     

The spatial and temporal distribution of young-of-the-year Osmerus mordax in the Great Bay Estuary

Juvenile smelt, Osmerus mordax, were collected from four eelgrass, Zostera marina, beds in the Great Bay Estuary, two within Great Bay and two located nearer the coast. Lapillar otoliths were used to estimate the ages of the smelt and to calculate daily somatic growth based on the widths of otolith increments. Smelt collected from the Bay sites were consistently younger and shorter in total length than smelt collected from the coastal sites. A repeated measures analysis of variance found significant differences among growth trajectories of smelt grouped by their dates of birth.     

Sample size/power calculation for case-cohort studies

In epidemiologic studies and disease prevention trials, interest often involves estimation of the relationship between some disease endpoints and individual exposure. In some studies, due to the rarity of the disease and the cost in collecting the exposure information for the entire cohort, a case-cohort design, which consists of a small random sample of the whole cohort and all the diseased subjects, is often used. Previous work has focused on analyzing data from the case-cohort design and few have discussed the sample size issues. In this article, we describe two tests for the case-cohort design, which can be treated as a natural generalization of log-rank test in the full cohort design. We derive an explicit form for power/sample size calculation based on these two tests. A number of simulation studies have been used to illustrate the efficiency of the tests for the case-cohort design. An example is provided on how to use the formula.     

Reduced seroprevalence of Kaposi's sarcoma-associated herpesvirus (KSHV), human herpesvirus 8 (HHV8), related to suppression of Anopheles density in Italy

In two formerly malarious parts of Italy, age-related seroprevalence rates of Kaposi's sarcoma-associated herpesvirus [human herpesvirus 8 (KSHV/HHV8)] were determined from local blood donors and correlated with periods of vector control during anti-malaria campaigns. In Veneto, decreased KSHV/HHV8 seroprevalence in the 1951-1955 birth cohort coincides with the peak of DDT house-spraying. In Sardinia, where larviciding augmented indoor DDT-spraying, a significant drop of KSHV/HHV8 seroprevalence between 1945 and 1950 and 1951-1955 birth cohorts (P = 0.0046) coincides with suppression of the malaria vector Anopheles labranchiae Falleroni (Diptera: Culicidae). These results are consistent with age-related association between KSHV/HHV8 seroprevalence rates in native/resident populations and the density of malaria vectors in Veneto and Sardinia. This example supports our 'promoter arthropod' hypothesis on the role of haematophagous insects [putatively blackflies (Simuliidae), sandflies (Phlebotominae) and biting midges (Ceratopogonidae), as well as mosquitoes] when their bites induce hypersensitivity and immunosuppression, potentiate KSHV/HHV8 transmission via human saliva (when insect bite lesions are licked by another person whose saliva carries the virus) and may facilitate Kaposi's sarcoma.     

Analysis of continuous covariables in epidemiological studies: Dose‐response modelling and confounder adjustment

The analysis of continuous covariables with regression models commonly used in epidemiology are reviewed and compared. While some methods have been in use for decades, other more recent methods are not yet common or have not yet been formally described. It is shown that recently developed methods such as fractional polynomials and others are very useful to obtain dose‐response curves or for confounder adjustment. Different methods have their specific merits making it difficult to give general recommendations. The application of some of the methods is demonstrated with real data examples from epidemiological studies. Some suggestions for practical strategies in analysing continuous covariables are given.