Smoking and Lung Cancer Risk in American and Japanese Men: An International Case-Control Study

Rates of lung cancer in American men have greatly exceeded those in Japanese men for several decades despite the higher smoking prevalence in Japanese men. It is not known whether the relative risk of lung cancer associated with cigarette smoking is lower in Japanese men than American men and whether these risks vary by the amount and duration of smoking. To estimate smoking-specific relative risks for lung cancer in men, a multicentric case-control study was carried out in New York City, Washington, DC, and Nagoya, Japan from 1992 to 1998. A total of 371 cases and 373 age-matched controls were interviewed in United States hospitals and 410 cases and 252 hospital controls in Japanese hospitals; 411 Japanese age-matched healthy controls were also randomly selected from electoral rolls. The odds ratio (OR) for lung cancer in current United States smokers relative to nonsmokers was 40.4 [95% confidence interval (CI) = 21.8-79.6], which was >10 times higher than the OR of 3.5 for current smokers in Japanese relative to hospital controls (95% CI = 1.6-7.5) and six times higher than in Japanese relative to community controls (OR = 6.3; 95% CI = 3.7-10.9). There were no substantial differences in the mean number of years of smoking or average daily number of cigarettes smoked between United States and Japanese cases or between United States and Japanese controls, but American cases began smoking on average 2.5 years earlier than Japanese cases. The risk of lung cancer associated with cigarette smoking was substantially higher in United States than in Japanese males, consistent with population-based statistics on smoking prevalence and lung cancer incidence. Possible explanations for this difference in risk include a more toxic cigarette formulation of American manufactured cigarettes as evidenced by higher concentrations of tobacco-specific nitrosamines in both tobacco and mainstream smoke, the much wider use of activated charcoal in the filters of Japanese than in American cigarettes, as well as documented differences in genetic susceptibility and lifestyle factors other than smoking

Testicular Dysgenesis Syndrome and the Estrogen Hypothesis: A Quantitative Meta-Analysis

BACKGROUND: Male reproductive tract abnormalities such as hypospadias and cryptorchidism, and testicular cancer have been proposed to comprise a common syndrome together with impaired spermatogenesis with a common etiology resulting from the disruption of gonadal development during fetal life, the testicular dysgenesis syndrome (TDS). The hypothesis that in utero exposure to estrogenic agents could induce these disorders was first proposed in 1993. The only quantitative summary estimate of the association between prenatal exposure to estrogenic agents and testicular cancer was published over 10 years ago, and other systematic reviews of the association between estrogenic compounds, other than the potent pharmaceutical estrogen diethylstilbestrol (DES), and TDS end points have remained inconclusive. OBJECTIVES: We conducted a quantitative meta-analysis of the association between the end points related to TDS and prenatal exposure to estrogenic agents. Inclusion in this analysis was based on mechanistic criteria, and the plausibility of an estrogen receptor (ER)-–mediated mode of action was specifically explored. RESULTS: We included in this meta-analysis eight studies investigating the etiology of hypospadias and/or cryptorchidism that had not been identified in previous systematic reviews. Four additional studies of pharmaceutical estrogens yielded a statistically significant updated summary estimate for testicular cancer. CONCLUSIONS: The doubling of the risk ratios for all three end points investigated after DES exposure is consistent with a shared etiology and the TDS hypothesis but does not constitute evidence of an estrogenic mode of action. Results of the subset analyses point to the existence of unidentified sources of heterogeneity between studies or within the study population

Гемодинамические нарушения в магистральных сосудах глаза и орбиты при эндокринной офтальмопатии как фактор риска развития оптической нейропатии

PURPOSE: The search and identification of factor revealing the hemodynamic disturbances in magistral ocular and orbital blood vessels in endocrine ophthalmopathy (EOP) increasing the risk of the optic neuropathy development. METHODS: 86 patients with EOP were examined. EOP was associated with Graves' disease (GD, n=72, 144 orbits) and autoimmune thyroiditis (AIT, n=14, 28 orbits). All patients were examined by an ophthalmologist and an endo-crinologist. The diagnostic of GD and AIT was based on the medical history, examination, the level of thyroid hormones (free T4, free T3), thyroid-stimulating hormone (TSH), rTSH antibodies and thyroid sonography. Normal range for TSH levels was 0.25-3.5 mlU/l; free Т4 - 9.0-20.0 pmol/L; free ТЗ - 4.26-8.1 pmol/L. Patients with EOP were evaluated using the EUGOGO protocol. Every orbit was assessed separately. Ophthalmic examination included patients history and clinical assessment of EOP. All patients underwent similar eye examination (visometry, perimetry, biomicroscopy, tono-metry, ophthalmoscopy, Hertel exophthalmometry). Orbit pathology was verified by multispiral computed tomography. Orbit echography was carried out for all patients. Eyeball, retrobulbar space and magistral vessels were the anatomic objects of investigation. Blood flow was examined by ultrasound diagnostic system Voluson 730 PRO («Kretz», Austria) in regimen of triplexic screening (B-regimen, CDK in combination with impulse value dopplrography). Hemodynamic indices were analysed in a. ophthalmica, a. et v. retinae centralis, a. ciliaris posterior brevis et longae. Thyroid dysfunction type, endocrine disease duration, patient's age, orbital inflammation and the compressive factor were considered as factors of hemodynamic orbit disturbances. RESULTS: Different hemodynamic disturbances were present in all patients with EOP (100%). Statistic correlative analysis showed, that thyroid dysfunction is one of the most important factors, determining hemodynamic disturbances of orbit blood flow. The severity of these disturbances depended on the type of thyroid dysfunction. The obtained data showed that the age of the patient and the duration of the endocrine disease is the important factor of the hemodynamic disturbances of orbit blood flow in EOP. The age (over 50) and the duration of the disease result in hemodynamic disturbances, reaching the value of «chronic eye ischemic syndrome». The intensity of autoimmune inflammation was revealed to determine the depth of hemodynamic disturbances in orbit. At the same time the severity of EOP reflected intraorbital pressure that may cause hemodynamic disturbances changing the blood flow in the orbit. CONCLUSION: Factors determining the character of hemo-dynamic disturbances in main vessels of the eye and orbit in EOP are found and identified such as thyroid dysfunction type, orbital inflammation intensity, compressive factor, endocrine disease duration and the age of the patient.ЦЕЛЬ. Поиск и идентификация факторов, определяющих гемодинамические нарушения в магистральных сосудах глаза и орбиты при эндокринной офтальмопатии (ЭОП), повышающие риск развития оптической нейропатии. МЕТОДЫ. Обследованы 86 пациентов с ЭОП, ассоциированной с диффузным токсическим зобом (ДТЗ, 72 человека, 144 орбиты) и аутоиммунным тиреоидитом (АИТ, 14 человек, 28 орбит). Все пациенты были осмотрены офтальмологом и эндокринологом. Диагноз ДТЗ и АИТ устанавливали на основании анамнеза, осмотра, уровня тиреоидных гормонов (св.Т4, св.ТЗ), тирео- тропного гормона (ПТ), показателей АТ к рТТГ, АТ-ТПО, АТ-ТГ, эхографии щитовидной железы. Границы нормы для базального уровня ТТГ - 0,25-3,5 мЕд/л; св.Т4 - 9,0-20,0 пмоль/л; св.ТЗ - 4,26-8,1 пмоль/л. ЭОП верифицировали по протоколу EUG0G0. Каждую орбиту оценивали отдельно. Офтальмологический осмотр включал: сбор жалоб, анамнез, клиническую оценку ЭОП. Всем пациентам проводили: визометрию, периметрию, биомикроскопию, тонометрию, офтальмоскопию, экзофтальмометрию по Гертелю. Структуры орбиты исследовали мультиспиральной компьютерной томографией. Всем пациентам проводили эхографию орбиты. Анатомическими объектами исследования служили: глазное яблоко, ретробульбарное пространство и его магистральные сосуды. Кровоток исследовали на ультразвуковой диагностической системе Voluson 730 PRO («Kretz», Австрия) в режиме триплексного сканирования (В-режим, ЦДК в комбинации с импульсно-волновой допплерографией). Анализировали гемодинамические показатели в a. ophthalmica, a. etv. retinae centralis, a. ciliaris posterior brevis et longae. В качестве факторов, определяющих гемодинамические нарушения в орбите, рассматривали: уровень тиреоидных гормонов и ТТГ, длительность заболевания щитовидной железы, возраст пациента, орбитальное воспаление, компрессионный фактор. РЕЗУЛЬТАТЫ. У всех пациентов с ЭОП (100%) присутствовали различные гемодинамические нарушения. Статистический корреляционный анализ показал, что отклонение уровня тиреоидных гормонов и ТТГ от нормы - один из наиболее значимых факторов, определяющих гемодинамические нарушения орбитального кровотока. Выраженность этих нарушений зависит от вида дисфункции щитовидной железы. Полученные результаты свидетельствовали о том, что возраст и длительность заболевания щитовидной железы являются важными факторами, определяющими гемодинамические нарушения орбитального кровотока при ЭОП. С увеличением возраста (после 50 лет) и длительности заболевания гемодинамические нарушения усиливаются, достигая значений, укладывающихся в понятие «хронического глазного ишемического синдрома». Выявили, что интенсивность аутоиммунного воспаления определяет глубину гемодинамических нарушений в орбите. Наряду с этим тяжесть ЭОП отражает интраорбитальное давление, что также может вызывать гемодинамические нарушения, изменяя кровоток в орбите. ЗАКЛЮЧЕНИЕ. Найдены и идентифицированы факторы, определяющие характер гемодинамических нарушений в магистральных сосудах глаза и орбиты при ЭОП. К ним относятся: вид дисфункции щитовидной железы, интенсивность орбитального воспаления, компрессионный фактор, длительность заболевания щитовидной железы и возраст пациента

Knowledge, Perceptions and Information about Hormone Therapy (HT) among Menopausal Women: A Systematic Review and Meta-Synthesis

BACKGROUND: The use of hormone therapy (HT) by menopausal women has declined since the Women's Health Initiative randomized trial (WHI) in 2002 demonstrated important harms associated with long-term use. However, how this information has influenced women's knowledge and attitudes is uncertain. We aimed to evaluate the attitudes and perceptions towards HT use, as well as specific concerns and information sources on HT since the WHI trial. METHOD/RESULTS: We did a systematic review to assess the attitudes and knowledge towards HT in women, and estimate the magnitude of the issue by pooling across the studies. Using meta-synthesis methods, we reviewed qualitative studies and surveys and performed content analysis on the study reports. We pooled quantitative studies using a random-effects meta-analysis. We analyzed 11 qualitative studies (n = 566) and 27 quantitative studies (n = 39251). Positive views on HT included climacteric symptom control, prevention of osteoporosis and a perceived improvement in quality of life. Negative factors reported included concerns about potential harmful effects, particularly cancer risks. Sources of information included health providers, media, and social contact. By applying a meta-synthesis approach we demonstrate that these findings are broadly applicable across large groups of patients. CONCLUSIONS: Although there are clear hazards associated with long-term HT use, many women view HT favorably for climacteric symptom relief. Media, as a source of information, is often valued as equivalent to health providers

Alternative Strategies to Reduce Maternal Mortality in India: A Cost-Effectiveness Analysis

A cost-effectiveness study by Sue Goldie and colleagues finds that better family planning, provision of safe abortion, and improved intrapartum and emergency obstetrical care could reduce maternal mortality in India by 75% in 5 years