Ovarian cancer screening in the general population.
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England↗
Biomedical subjects
I Jacobs
Publications and source records attributed to I Jacobs.
Patterns in the incidence of age-related ovarian cancer in South East England 1967-1996.
OBJECTIVE: To study the age-related trends in the incidence rates of ovarian cancer in South East England between 1967 and 1996. DESIGN: A retrospective review of systematically collected data on ovarian cancer in South East England. METHODS: Data were obtained from the Thames Cancer Registry on the numbers and rates per 100,000 population of ovarian cancer per five-year age group (0-85+) in the 30-year period from 1967 to 1996 from the 26 health authorities in the Thames region. Linear regression was performed to determine the changes in incidence rates of ovarian cancer per age group over time. MAIN OUTCOME MEASURES: The change in overall incidence of ovarian cancer in South East England, as well as the change in incidence of ovarian cancer in each five-year age groups (20-85+) in the 30-year study period. RESULTS: There was a strong positive correlation between ovarian cancer rates and year of diagnosis in women aged > or = 70 years, and this was particularly marked in women > 85 years of age. There was a negative correlation between rates and year of diagnosis in women aged 45-59 years. The analysis did not demonstrate a significant correlation between ovarian cancer rates and year of diagnosis in women < 44 years of age or women aged 60-69 years. CONCLUSIONS: There have been significant changes in the pattern of ovarian cancer incidence in South East England during the 30-year period studied. The observed changes in ovarian cancer incidence in younger women may, in part, be explained by known reproductive factors. The rise in ovarian cancer rates among the older age group is difficult to explain, but has important implications for the future planning and provision of cancer services.
Adult↗
The accuracy of oral predictive and infrared emission detection tympanic thermometers in an emergency department setting.
OBJECTIVE: To assess the accuracy of an oral predictive thermometer and an infrared emission detection (IRED) tympanic thermometer in detecting fever in an adult emergency department (ED) population, using an oral glass mercury thermometer as the criterion standard. METHODS: This was a single-center, nonrandomized trial performed in the ED of a metropolitan tertiary referral hospital with a convenience sample of 500 subjects. The temperature of each subject was taken by an oral predictive thermometer, an IRED tympanic thermometer set to "oral" equivalent, and an oral glass mercury thermometer (used as the criterion standard). A fever was defined as a temperature of 37.8 degrees C or higher. The subject's age, sex, triage category, and diagnostic group were also recorded. Sensitivity, specificity, positive and negative likelihood ratios, positive and negative predictive values, and corresponding 95% confidence intervals were calculated. Logistic regression was used to identify predictors of fever. RESULTS: The sensitivities and specificities for detection of fever of the predictive and the IRED tympanic thermometers were similar (sensitivity 85.7%/88.1% and specificity 98.7%/95.8%, respectively). The predictive thermometer had a better positive predictive value (85.7%) compared with the IRED tympanic thermometer (66.1%). The positive and negative likelihood ratios for the predictive oral thermometer were 65 and 0.14, respectively, and for the IRED tympanic thermometer 21 and 0.12, respectively, indicating that the predictive thermometer will "miss" 1 in about 7 fevers and the IRED tympanic thermometer will "miss" 1 in about 8 fevers. CONCLUSIONS: Although quick and convenient, oral predictive and IRED tympanic thermometers give readings that cannot always be relied on in the detection of fever. If we are to continue using electronic thermometers in the ED setting, we need to recognize their limitations and maintain the importance of our clinical judgment.
Emergency Service, Hospital↗
Comparison of thermoregulatory responses between men and women immersed in cold water.
Eleven women (age = 24.4 +/- 6.3 yr, mass = 65.0 +/- 7.8 kg, height = 167 +/- 8 cm, body fatness = 22.4 +/- 5.9%, mean +/- SD) were immersed to neck level in 18 degrees C water for up to 90 min for comparison of their thermal responses with those of men (n = 14) in a previous similarly conducted protocol. Metabolic rate increased about three times resting levels in men and women, whereas the rate of rectal temperature cooling (DeltaT(re)/Deltat) in women (0.47 degrees C/h) was about one-half that in men. With use of all data, DeltaT(re)/Deltat correlates with the ratio of body surface area to size and the metabolic rate of shivering correlates inversely to the square root of body fatness. No significant gender differences in total metabolic heat production normalized for body mass or surface area were found among subjects who completed 90 min of immersion (9 women and 7 men). Nor was there a gender difference in the overall percent contribution ( approximately 60%) of fat oxidation to total heat production. Blood concentrations of free fatty acids, glycerol, beta-hydroxybutyrate, and lactate increased significantly during the 90-min immersion, whereas muscle glycogen sampled from the right quadriceps femoris vastus lateralis decreased (free fatty acids, glycerol, and beta-hydroxybutyrate were higher in women). When the subjects were subgrouped according to similar body fatness and 60 min of immersion (6 women and 5 men), no significant gender differences emerged in DeltaT(re)/Deltat, energy metabolism, and percent fat oxidation. These findings suggest that no gender adjustments are necessary for prediction models of cold response if body fatness and the ratio of body surface area to size are taken into account and that a potential gender advantage with regard to carbohydrate sparing during cold water immersion is not supported.
Adipose Tissue↗
Reducing the dose of combined caffeine and ephedrine preserves the ergogenic effect.
BACKGROUND: Ingestion of a combination of 5 mg x kg(-1) caffeine (C), and 1 mg x kg(-1) ephedrine (E) was reported to have an ergogenic effect on high intensity aerobic exercise performance, but 25% of the subjects experienced vomiting and nausea while engaging in hard exercise after the treatment. The present study was undertaken to investigate whether reduced levels of C+E would alleviate the problem and maintain the ergogenic effect. METHODS: Twelve healthy untrained male subjects completed four randomized and double-blind, cycle ergometer trials to exhaustion at a power output equivalent to approximately 85% Vo2peak 1.5-2 hours after ingesting a placebo (P) or a mixture of C+E in the following doses: 5 mg x kg(-1) of C plus 0.8 mg x kg(-1) of E (CLE); 4 mg x kg(-1) of C plus 1 mg x kg(-1) of E (LCE); or 4 mg x kg of C plus 0.8 mg x kg(-1) of E (LCLE). Trials were separated by 1 wk. Venous blood samples were obtained and analyzed for caffeine and ephedrine levels 1.5 h post-drug ingestion. Vo2, Vco2, VE, and RQ were measured every minute throughout the exhaustion ride. Heart rate and perceived exertion (RPE) were also recorded every 5 min and at the end of the exercise session. RESULTS: Plasma levels of C and E immediately before the exhaustion ride were (mean +/- SD): 38.7+/-5.2 micromol x L(-1) C, 1.285+/-0.275 micromol x L(-1) E in the CLE trial; 33.2+/-5.8 micromol x L(-1) C, 1.462+/-0.283 micromol x L(-1) E in the LCE trial; 33.0+/-2.9 micromol x L(-1) C, 1.229+/-0.202 micromol x L(-1) E in the LCLE trial. The times to exhaustion for the treatment trials (CLE = 27.5+/-12.4 min, LCE = 27.6+/-10.9 min, LCLE = 28.2+/-9.3 min) were similar and were significantly greater than placebo (p = 17.0+/-3.0 min). The drugs did not affect Vo2, Vco2, or VE. Heart rates were significantly higher for the drug trials while RPE was lower compared with P. No incidents of nausea or vomiting occurred with the lowest dose of the C+E, LCLE. CONCLUSIONS: A lower dose of C+E resulted in an ergogenic effect similar in magnitude to that reported previously with a higher dose, and with a reduced incidence of negative side effects.
Adult↗
Combination of multiple serum markers using an artificial neural network to improve specificity in discriminating malignant from benign pelvic masses.
A panel of four selected tumor markers, CA 125 II, CA 72-4, CA 15-3, and lipid-associated sialic acid, was analyzed collectively using an artificial neural network (ANN) approach to differentiate malignant from benign pelvic masses. A dataset of 429 patients, 192 of whom had malignant histology, was retrospectively used in the study. A prototype ANN classifier was developed using a subset of the data which included 73 patients with malignant conditions and 101 patients with benign conditions. The ANN classifier demonstrated a much improved specificity over that of the assay CA 125 II alone (87.5% vs 68.4%) while maintaining a statistically comparable sensitivity (79.0% vs 82.4%) in discriminating malignant from benign pelvic masses in an independent validation test using data from the remaining 255 patients which had been set aside and kept blind to the developers of the ANN system. A similar improvement in specificity was observed among patients under 50 years of age (82.3% vs 62.0%). The ANN system was further tested using additional serum specimens collected from 196 apparently healthy women. The ANN system had a specificity of 100.0% compared to that of 94.8% with the assay CA 125 II alone.
Antigens, Tumor-Associated, Carbohydrate↗
Reply to the letter by morton
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Journal Article↗
A comparison of national cancer registry and direct follow-up in the ascertainment of ovarian cancer.
The National Health Service Central Register (NHSCR) and direct follow-up were used to document ovarian and fallopian tube cancers in 22000 women from 1986 to 1993. Direct follow-up identified 47/49 cases (96%) and the NHSCR 38/49 (78%). NHSCR ascertainment was incomplete and direct follow-up provided additional information. These findings have implications for interpretation of national cancer statistics and for use of the NHSCR in research trials.
Cohort Studies↗
Hypopharyngeal perforation after blunt neck trauma: case report and review of the literature.
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Accidents, Traffic↗
Using clinical indicators in emergency medicine: documenting performance improvements to justify increased resource allocation.
OBJECTIVES: To demonstrate how emergency department triage scale and thrombolysis indicator data can be used to document the impact of a substantial increase in resource allocation. METHODS: Descriptive study in an emergency department of an adult tertiary hospital in Perth, Australia during similar periods of the year both before and after a substantial increase in emergency department staff, equipment, and system resources. The study group comprised a total of 11,048 emergency department attendances and all cases of emergency department initiated thrombolysis or acute angioplasty. Outcome was measured using numbers seen and percentage seen within indicator threshold time together with admission rates in each of the five triage categories as well as by using time from presentation to initiation of reperfusion treatment in acute myocardial infarction. RESULTS: The proportion of patients seen within the prescribed indicator time increased by 16.4% (95% confidence interval 14.4% to 18.2%). The increase was most pronounced in triage category 2 (32.7%). Median time to thrombolysis fell by 30 minutes to 37 minutes (p = 0.0002). CONCLUSIONS: Use of the Australasian national triage scale and time to thrombolysis clinical indicator data allows a quantitative assessment of the impact of increased emergency department resource allocation.
Adult↗
Physiological responses of exercised-fatigued individuals exposed to wet-cold conditions.
Thirteen healthy and fit men [age = 27 +/- 8 (SD) yr, height = 177 +/- 5 cm, mass = 75 +/- 7 kg, body fat = 14 +/- 5%, maximal O2 consumption = 51 +/- 4 ml. kg-1. min-1] participated in an experiment designed to test their thermoregulatory response to a challenging cold exposure after 5 h of demanding mixed exercise during which only water was consumed. Subjects expended 7,314 +/- 741 kJ on cycling, rowing, and treadmill-walking machines, performed 8,403 +/- 1,401 kg. m of mechanical work during resistance exercises, and completed 120 inclined sit-ups. Subjects then assumed a seated position in a 10 degrees C air environment while wearing shorts, T-shirt, rain hat, and neoprene gloves and boots. After 30 min the subjects were showered continuously with cold water ( approximately 920 ml/min at 10 degrees C) on their backs accompanied by a 6 km/h wind for up to 4 h. Blood samples were taken from the nondominant arm every 30 min during the exposure and assayed for energy metabolites, hormones, indexes of hydration, and neurotransmitters. Counterbalanced control trials without prior exercise were also conducted. Blood insulin was higher during the control trial, whereas values of glycerol, nonesterified fatty acids, beta-hydroxybutyrate, lactate, cortisol, free triiodothyronine, and thyroxine were lower. Three subjects lasted the maximum duration of 4.5 h for control and fatigue trials, with final rectal temperatures of 36.43 +/- 0.21 and 36.08 +/- 0.49 degrees C, respectively. Overall, the duration of 172 +/- 68 (SD) min for the fatigue trial was not significantly different from that of the control trial (197 +/- 72 min) and, therefore, was not affected by the preexposure exercise. Although duration was positively correlated to body fatness and shivering intensity, the latter was not correlated to any physical characteristic or the fitness level of the individual.
Adult↗
The Philadelphia story: the 22q11.2 deletion: report on 250 patients.
A submicroscopic deletion of chromosome 22q11.2 has been identified in the majority of patients with the DiGeorge, velocardiofacial, and conotruncal anomaly face syndromes, and in some patients with the Opitz G/BBB and Cayler cardiofacial syndromes. We have been involved in the analysis of DiGeorge syndrome and related diagnoses since 1982 and have evaluated a large number of patients with the deletion. We describe our cohort of 250 patients whose clinical findings help to define the extremely variable phenotype associated with the 22q11.2 deletion and may assist clinicians in providing genetic counseling and guidelines for clinical management based on these findings.
Abnormalities, Multiple↗
Combined caffeine and ephedrine ingestion improves run times of Canadian Forces Warrior Test.
The ingestion of a combination of caffeine (C) and ephedrine (E) has been reported to prolong exercise time to exhaustion during cycle ergometry at 85% VO2max. The present study was undertaken to investigate whether this enhancement would occur in a field setting and if drug ingestion on 1 d would affect performance 1 d later. Two hours after ingesting either a combination of 375 mg of C and 75 mg E (C+E), or a placebo (P), 9 healthy male recreational runners completed six balanced and double-blind trials of the Canadian Forces Warrior Test (WT), a 3.2 km run wearing "fighting order" which weighed about 11 kg. The trials were performed in sets of two runs, i.e., two runs were done 24 h apart, and these sets were separated by a minimum of 7 d. The sets were: C+E trial on day 1 (D1), placebo on day 2 (P2); placebo first (P1), C+E second (D2); and placebo first (P3), placebo second (P4). In addition, 1 wk before the treatment trials the subjects performed a control trial WT. During the WT, heart rates (HR) were recorded every minute. Plasma C and E levels immediately before the WT were similar for both C+E trials, but were undetectable for all P trials. Run times (mean+/-SD) were 15.3+/-0.6, 15.4+/-0.9, 15.5+/-1.2, 15.4+/-0.9, 15.4+/-0.9, 14.8+/-0.7, and 14.6+/-0.8 min for control, P1, P2, P3, P4, D1, D2 trials, respectively. The two C+E trial run times were similar and both were significantly faster (p < 0.05) than control and all placebo trials. HR during the WT was significantly higher (p < 0.05) for the C+E trials compared with the other trials. WT performance was not impaired by C+E ingestion 24 h earlier. In conclusion, performance of the WT was improved by ingestion of C+E.
Adult↗
Thermal regulation in the heat during exercise after caffeine and ephedrine ingestion.
BACKGROUND: Ingesting a combination of caffeine and ephedrine (C+E) has been shown to raise metabolic heat production and body temperature. This side effect of C+E ingestion may be positive during a cold stress scenario, however, during heat stress it could prove to be detrimental. Thus, the purpose of this study was to clarify the effect of C+E ingestion on body temperature regulation during moderate exercise in a hot dry environment. METHODS: Ten, healthy, non heat acclimated, males exercised at 50% VO2peak in a 40 degrees C and 30% RH environment until rectal temperature reached 39.3 degrees C; heart rate (HR) remained at 95% of peak value or greater for 3 min, dizziness or nausea precluded further exercise, or 3 h had elapsed. They did this four times at weekly intervals: familiarization (Fam), control (Cont), placebo, and C+E (5 mg . kg(-1) caffeine + 1 mg . kg(-1) ephedrine) trials. The Fam and Cont treatments were done first and sequentially while the placebo and C+E treatments were balanced and double-blind. Tolerance times, mean skin temperature (Tsk), rectal temperature (Tre), Vo2, Vco2, VE, sweat rate (SR), HR, and sensation of thermal comfort were measured. RESULTS: Tolerance times (mean+/-SD in minutes) were similar for the placebo (120.0+/-28.4) and C+E (121.3+/-33.9) trials and both times were significantly longer than Cont (106.6+/-24.0) trial. C+E did not affect Tsk, initial TrC, delta Tre, SR or the sensation of thermal comfort. VO2 and VF, were significantly increased by C+E. HR was elevated by C+E compared with the other trials, but only during the initial 20 min of exercise. CONCLUSION: Although the metabolic rate was slightly increased with C+E treatment, it was sufficiently offset by increased heat loss mechanisms so that internal body temperature was not increased during moderate exercise in a hot, dry environment.
Adult↗
Dietary creatine monohydrate supplementation.
This paper summarizes and interprets the research published about physiological aspects of dietary supplementation with creatine monohydrate and the effects on physical performance. A nitrogenous molecule that occurs naturally in the flesh consumed by meat-eaters, creatine is also synthesized endogenously and is stored primarily in skeletal muscle. The research literature in which direct measurements of muscle creatine content have been reported indicates that most, but not all, subjects respond to "creatine loading" by increasing the total intramuscular concentration of creatine, including the concentration of phosphocreatine. The factors that affect muscle creatine stores are reviewed, as are the widely ranging results on physical performance. The mechanism of action by which increased intramuscular creatine could enhance performance is not yet clear. Original speculation was that increased phosphocreatine levels prior to commencing exercise, in conjunction with higher free creatine concentration, would prolong the time required until performance-limiting levels of phosphocreatine were reached during intense exercise. It was also speculated that restoration of phosphocreatine levels between bouts of such exercise would be more rapid. More recent studies question such speculation. This review includes a discussion of what is known about the health risks and side-effects associated with creatine loading. The paper concludes with speculation about the unprecedented attention given to creatine supplementation by recreational and competitive athletes and the media.
Creatine↗
Cold stress increases lipolysis, FFA Ra and TG/FFA cycling in humans.
BACKGROUND: To characterize the important changes in the selection and mobilization of metabolic fuel during cold stress, six males rested for 3 h at 29 degrees C and at 5 degrees C dressed only in shorts while 2H5 glycerol, 1-13C palmitate and 6,6 2H2 glucose were continuously infused for 3 h in each condition to determine their rate of turnover (Ra). METHODS: Metabolic rate (M) as well as rates of carbohydrate (CHOox) and lipid oxidation (FATox) were assessed by indirect calorimetry whereas all isotopic enrichments were determined by mass spectrometry. RESULTS: Cold exposure decreased rectal and mean skin temperatures and increased M, FATox and CHOox compared with the same test at thermal neutrality (p<0.05). As expected, cold increased plasma glucose Ra and plasma FFA Ra (from 4.58+/-0.19 to 14.69+/-1.07 micromol kg(-1) x min(-1); p < 0.05). However, in absolute terms, plasma FFA Ra in the cold remained more than twice greater than FATox (FATox only increased up to 6.9 +/-0.85 micromol kg(-1) x min(-1)), suggesting an enhanced non-oxidative disposal of fatty acids (i.e., TG/FFA cycling) to account for all FFA Ra. Indeed, cold increased extracellular TG/FFA recycling rate (2.23+/-0.40 vs 7.77+/-1.19 micromol kg(-1) x min(-1); p<0.05) whereas intracellular cycling was unaffected. CONCLUSION: Even though lipolysis and FFA Ra are greatly increased by cold stress in humans, the present results demonstrate that only about half the rate of FFA Ra is ultimately oxidized, suggesting that under the present cold conditions: 1) non-oxidative FFA disposal or TG/FFA cycling is significantly enhanced; 2) white adipose tissue-derived fatty acids could easily account for most of FATox. The results further emphasize the importance of the TG/FFA cycle in amplifying the ability of stored TG to react quickly to major changes in energy expenditure induced by a sustained cold stress.
Adipose Tissue↗
Effects of UV on the migration and function of epidermal antigen presenting cells.
Depletion of epidermal Langerhans cells (LC) and the concomitant depression of the skin immune system after excessive exposure to ultraviolet B light (UVB) has been established in the international literature for some time. Our investigations were intended to determine whether or not these phenomena occurred as a direct result of increased LC migration being triggered by the UVB exposure. To test this hypothesis, a sheep model was established in which the lymphatic vessels draining a defined region of skin were cannulated and the cells migrating towards the regional lymph node continuously collected. Cell populations in these collections were identified and enumerated by indirect immunofluorescence and flow cytometry. These experiments showed there was a significant, dose-dependent increase in the rate of LC migration from sheep skin after exposure to doses of UVB light exceeding 1 minimal erythemal dose (MED). In a series of parallel experiments, the functional characteristics of dendritic cells (DC) migrating from normal or UVB irradiated sheep were studied. To assay them, enriched preparations of DC were collected via cannulated afferent lymphatic vessels and pulsed with antigen prior to incubation with autologous peripheral blood lymphocytes. The relative efficiency of antigen presentation was determined by the ability of DC to induce T cell proliferation. Our data clearly demonstrate that there is a profound loss of normal antigen-presenting cell function after exposure to UVB light. Various experiments were undertaken to determine the mechanism(s) associated with these changes in migration kinetics and cellular function. Electron microscopic examinations of LC migrating from normal or UVB irradiated skin have demonstrated a profound loss of dendritic processes after UVB exposure. This provides a possible explanation for the changes in skin immunity after UVB exposure.
Animals↗
Effects of caffeine, ephedrine and their combination on time to exhaustion during high-intensity exercise.
This study investigated the effects of acute ingestion of caffeine (C), ephedrine (E) and their combination (C+E) on time to exhaustion during high-intensity exercise. Using a repeated-measures, double-blind design, eight male subjects exercised on a cycle ergometer at a power output that led to exhaustion after about 12.6 min during a placebo (P) control trial. They did this 1.5 h after ingesting either C (5 mg x kg[-1]), E (1 mg x kg[-1]), C+E, or P. Trials were separated by 1 week. Venous blood was sampled before and during exercise. The mean (SD) times to exhaustion were 12.6 (3.1) (P), 14.4 (4.1) (C), 15.0 (5.7) (E) and 17.5 (5.8) (C+E) min. Only the C+E treatment significantly increased time to exhaustion compared to P. Oxygen consumption (VO2), carbon dioxide production (VCO2), minute ventilation (VE) and the respiratory exchange ratio (RER) were similar during exercise for all trials. Heart rate during exercise was significantly increased for the C+E and C trials compared to P. Subjective ratings of perceived exertion during exercise were significantly lower after C+E compared to P. All treatments significantly increased lactate levels. Free fatty acid (FFA) levels were significantly increased by C ingestion. Glycerol levels were increased by C+E and C ingestion. Glucose levels were also higher with the drug treatments compared to P. Increased monamine availability after C+E treatment was suggested by measurements of catecholamines and dopamine. In conclusion, the combination of C+E significantly prolonged exercise time to exhaustion compared to P, while neither C nor E treatments alone significantly changed time to exhaustion. The improved performance was attributed to increased central nervous system stimulation.
Adult↗