Prognostic significance of microvessel density and other variables in Japanese and British patients with primary invasive breast cancer

The purpose of this study is to investigate the associations of microvessel density (MVD) and other pathological variables with survival, and whether they accounted for survival differences between Japanese and British patients. One hundred seventy-three Japanese and 184 British patients were included in the study. British patients were significantly older (56.3±11.4 years vs 52.5±12.9 years; P<0.01) and had smaller tumours (2.2±1.3 vs 2.7±1.8 cm; P<0.01), which were more frequently oestrogen receptor positive (78.8 vs 57.2%, P<0.01), had more grade III tumours (29.9 vs 21.4%, P=0.04) and more infiltrating lobular carcinomas (13.6 vs 4.0%, P<0.01) and a higher MVD compared with Japanese patients (57.9±19.8 vs 53.2±18.6; P=0.01). However, no difference in the prevalence of lymph-node metastasis was found between them (39.1 vs 37.5%, P=0.75). Younger British patients (age <50 years) had the highest MVD compared with Japanese and older British patients (P<0.01). Japanese patients were proportionately more likely to receive chemotherapy than endocrine therapy (P<0.01). British patients had a significantly worse relapse-free survival and overall survival compared with Japanese patients, after statistical adjustment for variables (hazard ratio=2.1, 2.4, P<0.01, P<0.01, respectively), especially, in T2 stage, low MVD and older subgroup (HR: 3.6, 5.0; 3.1, 3.3; 3.2, 3.9, respectively), but only in ER negative cases (P=0.04, P=0.01, respectively). The present study shows that MVD contributes to the Japanese–British disparity in breast cancer. However, the MVD variability did not explain the survival differences between Japanese and British patients

Mortality rate of patients with asymptomatic primary biliary cirrhosis diagnosed at age 55 years or older is similar to that of the general population

Recent routine testing for liver function and anti-mitochondrial antibodies has increased the number of newly diagnosed patients with primary biliary cirrhosis (PBC). This study investigated the prognosis of asymptomatic PBC patients, focusing on age difference, to clarify its effect on the prognosis of PBC patients. The study was a systematic cohort analysis of 308 consecutive patients diagnosed with asymptomatic PBC. We compared prognosis between the elderly (55 years or older at the time of diagnosis) and the young patients (< 55 years). The mortality rate of the patients was also compared with that of an age- and gender-matched general population. The elderly patients showed a higher aspartate aminotransferase-to-platelet ratio, and lower alanine aminotransferase level than the young patients (P < 0.01 and P = 0.03, respectively). The two groups showed similar values for alkaline phosphatase and immunoglobulin M. Death in the young patients was more likely to be due to liver failure (71%), while the elderly were likely to die from other causes before the occurrence of liver failure (88%; P < 0.01), especially from malignancies (35%). The mortality rate of the elderly patients was not different from that of the age- and gender-matched general population (standardized mortality ratio, 1.1; 95% confidence interval, 0.6-1.7), although this rate was significantly higher than that of the young patients (P = 0.044). PBC often presents as more advanced disease in elderly patients than in the young. However, the mortality rate of the elderly patients is not different from that of an age- and gender-matched general population

Population Attributable Fraction of Smoking and Metabolic Syndrome on Cardiovascular Disease Mortality in Japan: a 15-Year Follow Up of NIPPON DATA90

<p>Abstract</p> <p>Background</p> <p>Smoking and metabolic syndrome are known to be related to cardiovascular diseases (CVD) risk. In Asian countries, prevalence of obesity has increased and smoking rate in men is still high. We investigated the attribution of the combination of smoking and metabolic syndrome (or obesity) to excess CVD deaths in Japan.</p> <p>Methods</p> <p>A cohort of nationwide representative Japanese samples, a total of 6650 men and women aged 30-70 at baseline without history of CVD was followed for 15 years. Multivariate-adjusted hazard ratio for CVD death according to the combination of smoking status and metabolic syndrome (or obesity) was calculated using Cox proportional hazard model. Population attributable fraction (PAF) of CVD deaths was calculated using the hazard ratios.</p> <p>Results</p> <p>During the follow-up period, 87 men and 61 women died due to CVD. The PAF component of CVD deaths in non-obese smokers was 36.8% in men and 11.3% in women, which were higher than those in obese smokers (9.1% in men and 5.2% in women). The PAF component of CVD deaths in smokers without metabolic syndrome was 40.9% in men and 11.9% in women, which were also higher than those in smokers with metabolic syndrome (7.1% in men and 3.9% in women).</p> <p>Conclusion</p> <p>Our results indicated that a large proportion of excess CVD deaths was observed in smokers without metabolic syndrome or obesity, especially in men. These findings suggest that intervention targeting on smokers, irrespective of the presence of metabolic syndrome, is still important for the prevention of CVD in Asian countries.</p

Statistical analysis of coverage error in simple global temperature estimators

Background Global mean surface temperature is widely used in the climate literature as a measure of the impact of human activity on the climate system. While the concept of a spatial average is simple, the estimation of that average from spatially incomplete data is not. Correlation between nearby map grid cells means that missing data cannot simply be ignored. Estimators that (often implicitly) assume uncorrelated observations can be biased when naively applied to the observed data, and in particular, the commonly used area weighted average is a biased estimator under these circumstances. Some surface temperature products use different forms of infilling or imputation to estimate temperatures for regions distant from the nearest observation, however the impacts of such methods on estimation of the global mean are not necessarily obvious or themselves unbiased. This issue was addressed in the 1970s by Ruvim Kagan, however his work has not been widely adopted, possibly due to its complexity and dependence on subjective choices in estimating the dependence between geographically proximate observations. Objectives The aim of this work is to present a simple estimator for global mean surface temperature from spatially incomplete data which retains many of the benefits of the work of Kagan, while being fully specified by two equations and a single parameter. The main purpose of the simplified estimator is to better explain to users of temperature data the problems associated with estimating an unbiased global mean from spatially incomplete data, however the estimator may also be useful for problems with specific requirements for reproducibility and performance. Methods The new estimator is based on generalized least squares, and uses the correlation matrix of the observations to weight each observation in accordance with the independent information it contributes. It can be implemented in fewer than 20 lines of computer code. The performance of the estimator is evaluated for different levels of observational coverage using reanalysis data with artificial noise. Results For recent decades the generalized least squares estimator mitigates most of the error associated with the use of a naive area weighted average. The improvement arises from the fact that coverage bias in the historical temperature record does not arise from an absolute shortage of observations (at least for recent decades), but rather from spatial heterogeneity in the distribution of observations, with some regions being relatively undersampled and others oversampled. The estimator addresses this problem by reducing the weight of the oversampled regions, in contrast to some existing global temperature datasets which extrapolate temperatures into the unobserved regions. The results are almost identical to the use of kriging (Gaussian process interpolation) to impute missing data to global coverage, followed by an area weighted average of the resulting field. However, the new formulation allows direct diagnosis of the contribution of individual observations and sources of error. Conclusions More sophisticated solutions to the problem of missing data in global temperature estimation already exist. However the simple estimator presented here, and the error analysis that it enables, demonstrate why such solutions are necessary. The 2013 Fifth Assessment Report of the Intergovernmental Panel on Climate Change discussed a slowdown in warming for the period 1998-2012, quoting the trend in the HadCRUT4 historical temperature dataset from the United Kingdom Meteorological Office in collaboration with the Climatic Research Unit of the University of East Anglia, along with other records. Use of the new estimator for global mean surface temperature would have reduced the apparent slowdown in warming of the early 21st century by one third in the spatially incomplete HadCRUT4 product

Acute effect of carmustine on glucose metabolism in brain and glioblastoma

BACKGROUND: Adjuvant chemotherapy benefits a minority of patients with recurrent glioblastoma; a critical question therefore is how to select such responders. Metabolic reaction of the tumor, studied by positron emission tomography (PET) with [18F]-fluoro-2-deoxy-D-glucose (FDG), may be a suitable test of tumor responsiveness. In an effort to evaluate their prognostic value, the early effects of carmustine on brain and recurrent glioblastoma glucose metabolism were studied. METHODS: Positron emission tomography with [18F]fluoro-2-deoxy-D-glucose was used to study 10 patients with recurrent glioblastoma before and 24 hours after a first dose of carmustine (120 mg/m2). Absolute quantification of glucose metabolism was obtained, and metabolic changes were analyzed and confronted with survival duration. RESULTS: The mean ratios of pre- to postchemotherapy values were 0.98 +/- 0.06 (range, 0.90-1.06) for the cortex and 0.97 +/- 0.06 (range, 0.89-1.09) for the white matter. There was no statistical difference between pre- and post-chemotherapy metabolism. In the glioblastoma, individual ratios of pre- to postchemotherapy values were considerably more scattered than in the nonneoplastic tissues, ranging from 0.76 to 1.51. A significant positive correlation (P < 0.002) was found between post- to pre-chemotherapy ratios of glucose metabolism and survival length. CONCLUSIONS: In patients with recurrent glioblastoma, the first administration of carmustine produces no acute change of glucose metabolism in the noninvolved cerebral tissues. Acute changes of glucose metabolism in tumor tissue in response to this treatment varied, and a hypermetabolic reaction possibly predicts longer survival.Journal ArticleResearch Support, Non-U.S. Gov'tFLWINinfo:eu-repo/semantics/publishe