Prevalence of Aflatoxin-Associated TP53R249S Mutation in Hepatocellular Carcinoma in Hispanics in South Texas

We aimed to determine whether aflatoxin dietary exposure plays a role in the high incidence of hepatocellular carcinoma (HCC) observed among Hispanics in South Texas. We measured TP53R249S somatic mutation, hallmark of aflatoxin etiology in HCC, using droplet digital PCR and RFLP. TP53R249S mutation was detected in 3 of 41 HCC tumors from Hispanics in South Texas (7.3%). We also measured TP53R249S mutation in plasma cell-free DNA (cfDNA) from 218 HCC patients and 96 Hispanic subjects with advanced fibrosis or cirrhosis, from South Texas. The mutation was detected only in Hispanic and Asian HCC patients, and patients harboring TP53R249S mutation were significantly younger and had a shorter overall survival. The mutation was not detected in any Hispanic subject with advanced fibrosis or cirrhosis. Genes involved in cell-cycle control of chromosomal replication and in BRCA1-dependent DNA damage response were enriched in HCCs with TP53R249S mutation. The E2F1 family members, E2F1 and E2F4, were identified as upstream regulators. TP53R249S mutation was detected in 5.7% to 7.3% of Hispanics with HCC in South Texas. This mutation was associated with a younger age and worse prognosis. TP53R249S was however not detected in Hispanics in South Texas with cirrhosis or advanced fibrosis. Aflatoxin exposure may contribute to a small number of HCCs in Hispanics in South Texas, but the detection of TP53R249S mutation in plasma cfDNA is not a promising biomarker of risk assessment for HCC in subjects with cirrhosis or advanced fibrosis in this population. Cancer Prev Res; 11(2); 103-12. ©2017 AACR

The use of body composition to assess nutritional therapy /

Body composition studies (BC) by a multiple isotope dilution technique were performed for studying nutritional parameters and nutritional support. A group of anthropometric, biochemical and immunological parameters were measured and the data indicated that these parameters were valid measures of the nutritional state for epidemiological studies; but, of little value in assessing the individual's nutritional state. Of 44 morbidly obese patients undergoing jejunoileal bypass, 33 patients lost only body fat. Eleven patients lost both body fat and body cell mass (BCM) thus developing protein malnutrition. Six of these malnourished patients had abnormal liver function tests (LFT), and both the BC and the LFT improved when calorie free amino acids were infused. BC studies were performed on TPN patients receiving one of four solutions. To evaluate the effect of these solutions on the daily repletion of the BCM a multiple linear regression was used. The regression indicated that the repletion of the depleted BCM was related to the lipid (p < .01) and carbohydrate (p < .001) infused, and the nutritional state (p < .001). Carbohydrate was more efficient than lipid, in repleting the BCM, and increasing protein above 1.26 gm/kg/day had no benefit

Calcium channel blockers and the incidence of breast and prostate cancer: A meta-analysis

What is known and objective Breast cancer (BCa) and prostate cancer (PCa), both hormone-dependent cancers, are the second leading cause of death in both women and men, respectively. Calcium channel blockers (CCBs) have been thought to increase the risk of cancer by inhibiting calcium signal-mediated apoptosis, but the evidence for this association remains inconclusive. We have reviewed pertinent literature and pooled data to establish a consensus on the relationship of CCB use and the incidence of these two cancers. Methods PubMed was used to conduct a search for English articles from inception to April 2016. Relevant data including study design, number of total participants and CCB users, total cases of BCa and PCa, age (mean and/or range), follow-up period and statistical outcomes were retrieved. Quality assessment was carried out using Newcastle Ottawa system, with the selection of high-quality studies. Summary effects were obtained using random- and mixed-effects models, followed by sensitivity analysis, and testing for publication bias. Results and discussion This meta-analysis includes 11 relevant studies for BCa and 6 for PCa. The odds ratio (OR) association between BCa and CCB use was 1.14 (95%CI: 1.02, 1.27, P = .02). The OR association between PCa and CCB use was 1.12 (95%CI .94-1.35, P = .21). What is new and conclusion Although a statistically significant association between CCB use and incidence of BCa does exist, the limitations of the individual studies restrict the clinical application of this relationship. Our meta-regression model does newly identify a 9-year latency period of CCB use and a significantly increased risk of BCa. No significant association exists between CCB use and the incidence of PCa. Our meta-regression shows CCB may have a protective effect upon PCa incidence among older populations

Can We Continue to Ignore Gender Differences in Performance on Simulation Trainers?

Background: There are differences between the genders in their innate performances on simulation trainers, which may impair accurate assessment of psychomotor skills. Methods: The performance of fourth-year students with no exposure to the Minimally Invasive Surgical Trainer compared based on gender, and other psychomotor skills. Results: Our study included 16 male and 16 female students. After adjusting for choice of medical specialty ( P <.001), current video game use ( P =.6), and experience in the operating room ( P =.4), female sex was an independent factor for worse performance ( P =.04) in multivariate models. Women took more time than men ( P <.01) and made more errors (29 versus 25 on 3 reps, P <.01). Conclusions: Among medical students with no previous exposure to laparoscopic trainers, female students perform worse than male students after adjusting for confounding factors. This difference must be recognized by training programs while using simulators for training and evaluation

Pneumothorax Following Feeding Tube Placement: Precaution and Treatment

Nasojejunal feeding tubes are being used at an increased frequency, but it is not without complications that could be life-threatening. We report two cases of pneumothorax following small-bore feeding tube insertion into the pleural cavity, resulting in pneumothorax. We further discuss the potential measures that can be taken to prevent and treat this serious complication

Can We Continue to Ignore Gender Differences in Performance on Simulation Trainers?

Background: There are differences between the genders in their innate performances on simulation trainers, which may impair accurate assessment of psychomotor skills. Methods: The performance of fourth-year students with no exposure to the Minimally Invasive Surgical Trainer compared based on gender, and other psychomotor skills. Results: Our study included 16 male and 16 female students. After adjusting for choice of medical specialty ( P <.001), current video game use ( P =.6), and experience in the operating room ( P =.4), female sex was an independent factor for worse performance ( P =.04) in multivariate models. Women took more time than men ( P <.01) and made more errors (29 versus 25 on 3 reps, P <.01). Conclusions: Among medical students with no previous exposure to laparoscopic trainers, female students perform worse than male students after adjusting for confounding factors. This difference must be recognized by training programs while using simulators for training and evaluation