What mediates the racial/ethnic disparity in psychosocial stress among breast cancer patients?

BACKGROUND: Prior studies have observed greater levels of psychosocial stress (PSS) among non-Hispanic (nH) African American and Hispanic women when compared to nH White patients after a breast cancer diagnosis. We aimed to determine the independent and interdependent roles of socioeconomic position (SEP) and unmet support in the racial disparity in PSS among breast cancer patients. METHODS: Participants were recruited from the Breast Cancer Care in Chicago study (n = 989). For all recently diagnosed breast cancer patients, aged 25-79, income, education, and tract-level disadvantage and affluence were summed to create a standardized socioeconomic position (SEP) score. Three measures of PSS related to loneliness, perceived stress, and psychological consequences of a breast cancer diagnosis were defined based on previously validated scales. Five domains of unmet social support needs (emotional, spiritual, informational, financial, and practical) were defined from interviews. We conducted path models in MPlus to estimate the extent to which PSS disparities were mediated by SEP and unmet social support needs. RESULTS: Black and Hispanic patients reported greater PSS compared to white patients and greater unmet social support needs (p = 0.001 for all domains). Virtually all of the disparity in PSS could be explained by SEP. A substantial portion of the mediating influence of SEP was further transmitted by unmet financial and practical needs among Black patients and by unmet emotional needs for Hispanic patients. CONCLUSIONS: SEP appeared to be a root cause of the racial/ethnic disparities in PSS within our sample. Our findings further suggest that different interventions may be necessary to alleviate the burden of SEP for nH AA (i.e., more financial support) and Hispanic patients (i.e., more emotional support).

The very large n2EDM magnetically shielded room with an exceptional performance for fundamental physics measurements.

We present the magnetically shielded room (MSR) for the n2EDM experiment at the Paul Scherrer Institute, which features an interior cubic volume with each side of length 2.92 m, thus providing an accessible space of 25 m3. The MSR has 87 openings of diameter up to 220 mm for operating the experimental apparatus inside and an intermediate space between the layers for housing sensitive signal processing electronics. The characterization measurements show a remanent magnetic field in the central 1 m3 below 100 pT and a field below 600 pT in the entire inner volume, up to 4 cm to the walls. The quasi-static shielding factor at 0.01 Hz measured with a sinusoidal 2 µT peak-to-peak signal is about 100 000 in all three spatial directions and increases rapidly with frequency to reach 108 above 1 Hz.

Sudden unexpected death in epilepsy associated with progressive deterioration in heart rate variability.

We describe a patient with severe epilepsy who underwent serial measurements of heart rate variability (HRV) prior to his death from autopsy-confirmed sudden unexpected death in epilepsy (SUDEP). The significance of low HRV is discussed in relation to SUDEP risk. Progressive deterioration in HRV may be a risk factor for SUDEP.

Persistent and aggressive interactions with the police: potential mental health implications.

AIMS: Little is known about the potential health impact of police encounters despite a ubiquitous police presence in many disadvantaged urban environments. In this paper, we assess whether persistent or aggressive interactions with the police are associated with poor mental health outcomes in a sample of primarily low-income communities of colour in Chicago. METHODS: Between March 2015 and September 2016, we surveyed 1543 adults in ten diverse Chicago communities using a multistage probability design. The survey had over 350 questions on health and social factors, including police exposure and mental health status. We use sex-stratified logistic regression to examine associations between persistent police exposure (defined as a high number of lifetime police stops) or aggressive police exposure (defined as threat or use of police force during the respondent's most recent police stop) and the presence of post-traumatic stress disorder (PTSD) or depressive symptoms. RESULTS: Men reporting a high number of lifetime police stops have three times greater odds of current PTSD symptoms compared with men who did not report high lifetime police stops (OR 3.1, 95% CI 1.3-7.6), after adjusting for respondent age, race/ethnicity, education, history of homelessness, prior diagnosis of PTSD and neighbourhood violent crime rate. Women reporting a high number of lifetime police stops have two times greater odds of current PTSD symptoms, although the results are not statistically significant after adjustment (OR 2.0, 95% CI 0.9-4.2). Neither persistent nor aggressive police exposure is significantly associated with current depressive symptoms in our sample. CONCLUSIONS: Our findings support existing preliminary evidence of an association between high lifetime police stops and PTSD symptoms. If future research can confirm as causal, these results have considerable public health implications given the frequent interaction between police and residents in disadvantaged communities in large urban areas.

Trends in Clinical Breast Density Assessment From the Breast Cancer Surveillance Consortium.

Changes to mammography practice, including revised Breast Imaging Reporting and Data System (BI-RADS) density classification guidelines and implementation of digital breast tomosynthesis (DBT), may impact clinical breast density assessment. We investigated temporal trends in clinical breast density assessment among 2 990 291 digital mammography (DM) screens and 221 063 DBT screens interpreted by 722 radiologists from 144 facilities in the Breast Cancer Surveillance Consortium. After age-standardization, 46.3% (95% CI = 44.1% to 48.6%) of DM screens were assessed as dense (heterogeneously/extremely dense) during the BI-RADS 4th edition era (2005-2013), compared to 46.5% (95% CI = 43.8% to 49.1%) during the 5th edition era (2014-2016) (P = .93 from two-sided generalized score test). Among DBT screens in the BI-RADS 5th edition era, 45.8% (95% CI = 42.0% to 49.7%) were assessed as dense (P = .77 from two-sided generalized score test) compared to 46.5% (95% CI = 43.8% to 49.1%) dense on DM in BI-RADS 5th edition era. Results were similar when examining all four density categories and age subgroups. Clinicians, researchers, and policymakers may reasonably expect stable density distributions across screened populations despite changes to the BI-RADS guidelines and implementation of DBT.

Surgical treatment of fiber-implanted scalps.

The treatment of synthetic fiber-implanted scalp has not been standardized. Eleven cases are reviewed to present our experience in the treatment of this problem. Technical consideration and recent findings are discussed.

Treatment of recurrent earlobe keloids.

The use of complete surgical excision and postoperative pressure with steroid-impregnated tape has been evaluated in fifty-seven patients with recurrent earlobe keloids. All patients underwent conventional treatment previously, which was not curative. In a four-year follow-up of the method described here, four recurrences occurred. Patients' failure to use the recommended pressure earring and alteration in endocrine balance were noted in three of the four patients with recurrent keloids.

Characterization and mapping of RPi-ber, a novel potato late blight resistance gene from Solanum berthaultii.

Phytophthora infestans, the causal agent of late blight, threatens potato production worldwide. An important tool in the management of the disease is the use of resistant varieties. Eleven major resistance genes have been identified and introgressed from Solanum demissum. However, new sources of resistance are continually sought. Here, we report the characterization and refined genetic localization of a resistance gene previously identified as Rber in a backcross progeny of Solanum tuberosum and Solanum berthaultii. In order to further characterize Rber, we developed a set of P. infestans isolates capable of identifying each of the 11 R-genes known to confer resistance to late blight in potato. Our results indicate that Rber is a new resistance gene, different from those recognized in S. demissum, and therefore, it has been named RPi-ber according to the current system of nomenclature. In order to add new molecular markers around RPi-ber, we used a PCR-based mapping technique, named MASP-map, which located RPi-ber in a 3.9 cM interval between markers CT240 and TG63 on potato chromosome X. The location of RPi-ber coincides with an area involved in resistance to different pathogens of potato and tomato.

Computer analysis of the African-American face.

An anthropometric study was devised to examine the facial proportions of the African-American. Two hundred African-American subjects between the ages of 18 and 30 years were studied. Objective data were gathered, and standard proportions of the African-American face were obtained. Previous anthropometric studies were performed using direct measurements of facial proportions. Farkas used direct measurements of young adult North American Caucasians and compared them with those of the neoclassical canons. Xeutong evaluated facial proportions of young adults of the Han nationality by direct measurement. The data derived from these studies are compared with our results. Measurements were obtained by standard photographic technique and scanned onto computer diskette. Computer analysis of the objective data was acquired. Thirteen measurements assessing the facial dimensions were used. We observed similar vertical proportions in the African-American face and the Caucasian face. Horizontal dimensions varied significantly between racial groups. Our conclusions will assist the aesthetic surgeon caring for the African-American patient.

Relation between body mass index and lung cancer risk in men and women never and former smokers.

The authors assessed body mass index (BMI), measured as Quetelet's index (weight in kilograms divided by the square of height in meters), in relation to lung cancer risk in never and former smokers by using data from a population-based, individually matched, case-control study conducted in New York State from 1982 to 1985. To be included in the study, subjects must never have smoked more than 100 cigarettes in their lifetime (never smokers) or not have smoked more than 100 cigarettes during the last 10 years (former smokers). Data on height and weight were complete for 412 of 439 case-control pairs. A positive relation was found between BMI and lung cancer risk for both never smokers (188 case-control pairs) and former smokers (224 pairs). When subjects were combined, those in the eighth (highest) octile (BMI > 30.84) had more than twice the odds of being cases compared with those in the lowest octile (BMI < or =21.26, 95 percent confidence interval: 1.2, 4.4). These study results are consistent with those from studies of BMI and other cancer sites but differ from lung cancer results usually found in predominantly smoking populations.

Endoscopic-assisted midface lift utilizing retrograde dissection.

Endoscopic facial surgery is gaining wide acceptance, as results are providing comparable if not superior to the standard, superficial musculoaponeurotic system rhytidectomy, with minimal scarring. Frontal branch facial nerve injury remains a troublesome complication. The purpose of our study was to determine if a subciliary retrograde dissection would decrease facial nerve injury and allow for more accurate midfacial suspension. Fresh cadaver dissections were performed using endoscopic equipment. Anterograde temporal incisions in the scalp and retrograde subciliary incisions were studied. The anterograde temporal dissection was developed deep to the superficial layer of the deep temporal fascia. Retrograde subciliary dissection was subperiosteal. Forty-nine endoscopic-assisted midface lifts were performed. Midfacial suspension was accomplished with nonabsorbable sutures placed in the suborbicularis oculi fascia, anchored to the deep temporal fascia. Two of three endoscopic-assisted procedures done in the anterograde fashion, without a subciliary incision, experienced transient frontal branch injury, which resolved within 6 weeks. The remaining forty-six patients, operated with a combined subciliary and temporal approach, experienced no frontal branch injuries. We have found that the retrograde dissection through a subciliary incision substantially reduced the incidence of facial nerve injury, provided direct visualization of the suborbicularis oculi fascial layer (allowing more accurate midfacial suspension), and reduced total operative time.

[Exposure to radioactivity in the perinatal period following the reactor accident in Chernobyl]. / Radioaktive Belastung in der Perinatalperiode nach dem Reaktorunfall in Tschernobyl.

After the Chernobyl nuclear accident on 26 April 1986 Europe experienced increased radioactive radiation by contamination of the atmospheric aerosol and the soil. Foods emanating radioactive radiation were ingested by the population to an increased extent via the food chain. This proportion of radioactive radiation accounted for about 80% of the total irradiation exposure and prompted us to examine mother's milk, amniotic fluid and placenta of newborn in respect of their concentrations of radionuclides I-131, Cs-134 and Cs-137. Due to the short half-life of I-131 an increased concentration of this substance was seen only during the first eight weeks after the nuclear accident. On the other hand, however, there was a clear increase in Cs-134 and Cs-137 from this time onward, the highest concentration of these two nuclides being measured only after one year after the accident. Despite the enhanced exposure to radioactivity of mother's milk and amniotic fluid, the guideline values laid down by Federal German legislation were not exceeded.

Glomerular basement membrane turnover in young, old, and streptozotocin-diabetic rats.

Diabetic and senile glomerulosclerosis consists of thickening of the glomerular basement membranes (GBM) and augmentation of the mesangial matrix. The pathogenesis of these alterations is still controversial. Therefore, an in vivo study of the metabolism and the chemical composition of the GBM in streptozotocin-diabetic and old rats reported here was conducted: The turnover rate of the GBM, determined by the incorporation of labeled hydroxyproline, is prolonged in preparations from diabetic and aging rats. This can be explained by the decreased synthesis and delayed degradation of the GBM material found in both experimental groups. The biochemical analyses of the GBM revealed a higher content of hydroxylated amino acids, especially OH-lys, in the old and diabetic animals. The findings suggest that diabetic and senile glomerulosclerosis results from a prolonged turnover of the GBM and GBM-like material under the altered metabolic conditions investigated in this study.

The rational use of drains after cholecystectomy.

A study of patients who had a cholecystectomy compared the use of sump drains and Penrose drains. Sump drains were removed as soon as the indication for the presence of the drain no longer existed. Penrose drains were managed in the traditional way. The safety of early drain removal in selected patients was demonstrated. This technique offers most of the advantage and little of the risk of omitting drains entirely. The length of hospital stay for those patients who underwent a cholecystectomy can be significantly shortened by this technique;

Does ganglionectomy destabilize the wrist over the long-term?

Previous publications have described persistent postganglionectomy symptomatology. One report demonstrated scapholunate instability in a small number of patients. We specifically examined our ganglionectomy patients for wrist instability. Ninety-one consecutive cases of wrist ganglionectomy performed from 1987 through 1993 by the senior author (FMW) were studied. Most patients were contacted by telephone and questioned with a standardized interview format. Postoperative course, job changes and occupational restrictions, and patient satisfaction were queried. Range of motion, grip strength, scaphoid mobility, and radiographs were studied to characterize scapholunate static and dynamic relationships. Seventy-one percent (N = 61) of the operated patients were interviewed at an average postoperative interval of 44 months. Twenty-five percent (N = 21) had wrist symptoms. There was no late ganglion recurrence. Twenty of the 21 symptomatic patients (95%) had normal ranges of motion and no carpal instability. Grip strengths averaged 12% below normal in 45% of the dominant operated hands. Radiographs demonstrated no scapholunate dissociation or dynamic instability patterns. Wrist ganglionectomy does not destabilize the wrist, particularly the scapholunate joint. Thorough and meticulous extirpation of the ganglion is warranted. Additional minor problems, both as consequences of the operation and as unrelated concomitants, do occur and deserve attention. Hand surgeons assume cure of the problematic wrist because of the patient's failure to report tolerable problematic sequelae. A late revisit may reveal (1) treatable problems emanating from the dynamic forces contributing to original ganglion formation; (2) additional, unanticipated, treatable conditions resulting and not resulting from the ganglionectomy itself; and (3) ganglion recurrence.