PubMed · 11198697
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J T Hart. 2000. Clinical judgment.. https://doi.org/10.1177/014107680009301115
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Cataract prevalence increases with age. As the world's population ages, cataract-induced visual dysfunction and blindness is on the increase. This is a significant global problem. The challenges are to prevent or delay cataract formation, and treat that which does occur. Genetic and environmental factors contribute to cataract formation. However, reducing ocular exposure to UV-B radiation and stopping smoking are the only interventions that can reduce factors that affect the risk of cataract. The cure for cataract is surgery, but this is not equally available to all, and the surgery which is available does not produce equal outcomes. Readily available surgical services capable of delivering good vision rehabilitation must be acceptable and accessible to all in need, no matter what their circumstances. To establish and sustain these services requires comprehensive strategies that go beyond a narrow focus on surgical technique. There must be changes in government priorities, population education, and an integrated approach to surgical and management training. This approach must include supply of start-up capital equipment, establishment of surgical audit, resupply of consumables, and cost-recovery mechanisms. Considerable innovation is required. Nowhere is this more evident than in the pursuit of secure funding for ongoing services.
The effect of adjuvant tamoxifen treatment on bone mineral density (BMD) and bone turnover markers was studied in postmenopausal breast cancer patients. The relationship of tamoxifen's effect with the genetic polymorphisms of estrogen receptor (ER)-alpha and ER-beta gene was also studied. Twenty-one postmenopausal breast cancer patients were given tamoxifen (20 mg/day) as the adjuvant treatment after the surgery. BMD of the lumbar supine (dual emission X-rays absorptiometry) and bone resorption (deoxypyridinoline, aminoterminal telopeptide of type I collagen, and carboxyterminal telopeptide of type I collagen) and formation (propeptide of type I procollagen, osteocalcin, and bone-specific alkaline phosphatase) markers were examined at baseline (before the surgery), 6 and 12 months after the start of tamoxifen treatment. Genetic polymorphisms analyzed were TA dinucleotide repeats polymorphism in the promoter region and PvuII and XbaI restriction fragment length polymorphism for the ER-alpha gene and the CA dinucleotide repeats polymorphism in the intron 5 for the ER-beta gene. Tamoxifen significantly increased BMD of the lumbar spine at both 6 (P<0.01) and 12 months (P<0.01) after the start of tamoxifen as compared with that at baseline. The mean percent increase in BMD was 3.3% at 6 months and 2.7% at 12 months. All bone resorption and formation markers significantly decreased at both 6 and 12 months. Among the four genetic polymorphisms studied, only ER-beta CA repeat polymorphism was found to be significantly associated with BMD at 12 months, i.e. BMD of the 21 CA repeats allele carriers was significantly higher than that of the non-carriers (P=0.025). These results suggest that tamoxifen increases BMD of the lumbar supine by reducing the bone turnover in postmenopausal breast cancer patients, and this bone restoring effect of tamoxifen is more marked in ER-beta 21 CA repeats allele carriers than non-carriers.
The accumulation of polychlorinated biphenyls (PCBs; 34 congeners), sigmaDDT (p,p'-DDT, o,p'-DDT, p,p'-DDD, o,p'-DDD and p,p'-DDE), chlordanes (sigmaCHL; trans-chlordane, cis-chlordane, trans-nonachlor, cis-nonachlor and oxychlordane), hexachlorocyclohexanes (sigmaHCH; alpha-, beta- and gamma-isomers), hexachlorobenzene (HCB) and mirex was investigated in members of a marine food web from the Hvaler and Torbjørnskaer archipelago, south-eastern Norway. The species studied were bullrout (Myoxocephalus scorpius), cod (Gadus morhua), herring gull (Larus argentatus) and harbour seal (Phoca vitulina). Furthermore, hepatic biotransformation enzyme activities (ethoxyresorufin-O-deethylase (EROD), pentoxyresorufin-O-depentylase (PROD) and glutathione S-transferase (GST)) were measured in all species. The objectives of the study were to investigate factors causing intraspecies variation in activities of biotransformation enzymes, as well as in concentrations and compositional patterns of the organochlorines (OCs). High correlations between EROD and PROD activities were found in all species, suggesting a single, common catalyst, CYP1A, and render the PROD assay questionable as biomarker for CYP2B inducers in marine wildlife. Furthermore, GST activities are shown to be dependent on biological factors, such as age (in harbour seal) and sex (in bullrout). In fish, the OC concentrations vary between the sexes, likely due to differences in fat deposition strategies and possibly sex dimorphism. In seals, concentrations and compositional patterns of the OCs vary with age, owing to selective transfer from mother to pup in utero and mainly through lactation, but likely also due to age specific xenobiotic metabolising capacity.