Excimer laser technology in percutaneous coronary interventions: Cardiovascular laser society's position paper.

Excimer Laser Coronary Atherectomy (ELCA) is a well-established therapy that emerged for the treatment of peripheral vascular atherosclerosis in the late 1980s, at a time when catheters and materials were rudimentary and associated with the most serious complications. Refinements in catheter technology and the introduction of improved laser techniques have led to their effective use for the treatment of a wide spectrum of complex coronary lesions, such as thrombotic lesions, severe calcific lesions, non-crossable or non-expandable lesions, chronic occlusions, and stent under-expansion. The gradual introduction of high-energy strategies combined with the contrast infusion technique has enabled us to treat an increasing number of complex cases with a low rate of periprocedural complications. Currently, the use of the ELCA has also been demonstrated to be effective in acute coronary syndrome (ACS), especially in the context of large thrombotic lesions.

Childhood infectious diseases and risk of multiple myeloma: an analysis of the Italian multicentre case-control study.

Common childhood infectious diseases have been associated with a reduced risk of following haematopoietic malignancies, but investigations on multiple myeloma (MM) are scarce. Information about 213 MM cases and 1128 healthy controls were obtained from a multicentre population-based Italian case-control study. The association between chickenpox, measles, mumps, pertussis and rubella and the MM risk was estimated by unconditional logistic regression, adjusting for age, gender and residence area. No association was found between MM risk and any considered infectious disease. The number of infections was slightly inversely associated with the risk of MM, but statistical significance was not reached (OR 0.87, 95% CI 0.55-1.4 for 1-2 diseases vs. none and OR 0.68, 95% CI 0.41-1.1 for 3-5 diseases, respectively, P = 0.131). We did not find a clear evidence that common infections during childhood are associated with the subsequent risk of developing MM.

Sun protection among Spanish beachgoers: knowledge, attitude and behaviour.

This study aims to investigate the level of awareness on the risks related to sun exposure, attitude towards sun protection and sun protection behaviour in Spanish beachgoers. During the summer of 2009, trained assistants conducted a structured interview with 630 sunbathers at the beaches of Valencia, Spain, via administrating a questionnaire including the following: (a) general data (age, gender, education, profession), (b) "knowledge" and "attitude" items and (c) self-assessed sun sensitivity, sun exposure and sun protection characteristics. The health belief model was used to evaluate factors that may influence on engaging healthy behaviour. The median age was 30 (2-82) years; the M/F ratio was 0.60. Despite the widespread regular ("often" or "always", 80%) use of high (>15) sun-protective factor sunscreens, current recommendations on sun protection were not regularly followed, and a history of sunburns is very common (70%). At multivariate analysis, female gender, age, fair hair, freckles, all-day use of sunscreens and wearing sunglasses were independent factors associated with having sunburn history. A high knowledge and a fairly good attitude emerged (median scores, 6/7 and 22/30, respectively). Age class (p = 0.032), educational level (p < 0.0001), sunscreen use (p = 0.048) and adequate timing of the first application of sunscreens (p = 0.015) were predictors of awareness, while factors associated with a more favourable attitude were educational level (p < 0.0001) and regular use of hats (p = 0.001). Wrong beliefs mainly concern sunscreens (false safety); the attractiveness of a tanned look is the main unfavourable attitude. Physical and motivational barriers are common (80%). The findings by highlighting constitutional and psychosocial factors involved in unhealthy behaviour provide useful information to promote sun-safe interventions in this population.

Improving sun-safe knowledge, attitude and behaviour in parents of primary school children: a pilot study.

Excessive sun exposure, mainly in childhood, represents one of the major skin cancer risk factors. Sun protection habits should start early in life to be effective. The purpose of this study was to investigate knowledge, attitude and sun protection behaviour in parents (P) and in their children (C). The educational intervention addressed the parents of 131 primary school pupils in Valencia, Spain, during the school year 2007-2008. A self-administered pre- and post-intervention questionnaire was handed in during school hours to be filled in by parents. Parents' compliance was very high (88 %). At baseline, regular high-sun-protective-factor (>15) sunscreen use was common (P, 64 %; C, 95 %); wearing clothing (T-shirt: P, 34 %, C, 62 %; hat: P, 29 %, C, 64 %) and sun avoidance at midday (P, 23 %; C, 29 %) were less frequent. Almost 70 % of parents reported difficulties, mainly due to the children's refusal. A high knowledge score (median, 6/7) and a medium/high attitude score (median, 24/30) in parents were observed; however, lifetime sunburn history was generally reported (P, 88 %; C, 24 %). Factors associated with parents' knowledge were a personal history of sunburns and regularly repeating sunscreen application to children (median score: 6 vs 5; p ≤ 0.01) Predictors of a more favourable attitude were female caretakers and having daughters (median score: 30 vs 25 and 25 vs 24, respectively; p ≤ 0.01). A trend towards limited post-intervention positive changes emerged; however, sun avoidance habit decreased (35 vs 20 %, p = 0.01). Despite a high level of parents' knowledge, sun protection in children is not adequate, and sunburns are not uncommon. Unfavourable beliefs and attitudes need to be overcome and quality of messages improved to achieve sun-safe exposure in children.

Unknown primary tumors.

An unknown primary tumor (UPT) is defined by the presence of a metastatic cancer without a known primary site of origin despite a standardized diagnostic workup. Clinically, UPTs show rapid progression and early dissemination, with signs and symptoms related to the metastatic site. The molecular bases of their biology remain largely unknown, with no evidence as to whether they represent a distinct biological entity. Immunohistochemistry remain the best diagnostic tool in term of cost-effectiveness, but the time-consuming "algorithmic process" it relies on has led to the application of new molecular techniques for the identification of the primary site of UPTs. For example, several microarray or miRNA classifications of UPTs have been used, with an accuracy in the prediction of the primary site as high as 90%. It should be noted that validating a prediction of tissue origin is challenging in these patients, since most of them will never have a primary site identified. Moreover, prospective studies to determine whether selection of treatment options based on such profiling methods actually improves patient outcome are still missing. In the last few years functional imaging (i.e. FDG-PET/CT) has gained a main role in the detection of the site of origin of UPTs and is currently recommended by the European Association of Nuclear Medicine. However, despite recent refinements in the diagnostic workup, the site of origin of UPT often remains elusive. As a consequence, treatment of patients with UPT is still empirical and inadequate.

Glycemic index, glycemic load and renal cell carcinoma risk.

BACKGROUND: The risk of renal cell carcinoma (RCC) has been related to refined cereals and starchy foods, but the association has not been studied in terms of glycemic index (GI) and glycemic load (GL). To provide information on this issue, we analyzed data from an Italian multicentric case-control study. MATERIALS AND METHODS: Cases were 767 patients with histologically confirmed, incident RCC. Controls were 1534 subjects admitted to the same hospitals as cases for a wide spectrum of acute, non-neoplastic conditions, unrelated to known risk factors for RCC. Information on dietary habits was derived through a food-frequency questionnaire. Multivariate odds ratios (ORs) and 95% confidence intervals (CIs) for GI and GL intake were adjusted for major relevant covariates. RESULTS: Compared with the lowest quintile, the ORs for the highest quintile were 1.43 (95% CI 1.05-1.95) for GI and 2.56 (95% CI 1.78-3.70) for GL, with significant trends in risk. Compared with the lowest quintile, the risk of RCC for all subsequent levels of GL was higher in never drinkers than in ever drinkers. CONCLUSIONS: We found direct relations between dietary levels of GI and GL and RCC risk. This can be related to mechanisms linked to insulin resistance and sensitivity.

"Self and parent-assessed skin cancer risk factors in school-age children".

OBJECTIVE: To evaluate sunburn, sun sensitivity factors and sun protection behavior in school-age children. METHODS: 2002 to 2004 survey of 2942 children in primary schools of Valencia, Spain, and their parents, using a self-administered questionnaire filled by the children with the help of their parents. RESULTS: Having a fair skin (OR: 2.05; 95% CI: 1.38-3.04), light coloured eyes (OR: 1.38; 95% CI: 1.12-1.68), freckles (OR: 1.32; 95% CI:1.12-1.56), and older age (OR: 2.34; 95% CI:1.96-2.80) were associated with occurrence of sunburns. Hair color, gender, use of sunscreens, wearing T-shirts and sunglasses were not. Wearing hats (OR: 0.64; 95% CI: 0.54-0.75) was inversely associated. Parents were significantly more inclined to protect younger and fair-skinned children with sunscreen and T-shirts. CONCLUSIONS: As expected, phenotype is related to sunburns and appears to influence parent's sun protection behaviours.

Alcohol consumption and renal cell cancer risk in two Italian case-control studies.

BACKGROUND: There is some evidence that alcohol consumption is inversely associated with renal cell cancer (RCC), but the issue is still unclear. PATIENTS AND METHODS: We investigated the relation using data from two Italian multicentric case-control studies conducted from 1985 to 2004, including a total of 1115 incident, histologically confirmed cases and 2582 controls hospitalised with acute, non-neoplastic conditions. RESULTS: Compared with non-drinkers, the multivariate odds ratios (ORs) of RCC were 0.87 [95% confidence interval (CI) 0.73-1.04] for 4 to 8 drinks per day of alcoholic beverages, with a significant inverse trend in risk (P value = 0.01). The ORs were 0.85 (95% CI 0.71-1.02) for wine, 0.84 (95% CI 0.68-1.03) for beer and 0.86 (95% CI 0.70-1.05) for spirits consumption, as compared with abstainers. No trend in risk of RCC emerged with duration (P value = 0.94) and age at starting alcohol consumption (P value = 0.81). Results were consistent in men and women, as well as in strata of age, smoking and body mass index. CONCLUSIONS: This pooled analysis found an inverse association between alcohol drinking and RCC. Risks continued to decrease even above eight drinks per day (i.e. >100 g/day) of alcohol intake, with no apparent levelling in risk.

Alcohol consumption and risk of Hodgkin's lymphoma and multiple myeloma: a multicentre case-control study.

BACKGROUND: Few studies have analysed the association between alcohol intake and Hodgkin's lymphoma (HL) or multiple myeloma (MM) risks. MATERIALS AND METHODS: A multicentre population-based case-control study of 363 HL, 270 MM cases, and 1771 controls offered the opportunity to evaluate the relationship between alcohol and HL/MM risks. Unconditional logistic regression was carried out to estimate odds ratios (ORs) and 95% confidence intervals (CIs), associated with alcohol intake (servings per week, grams per day of ethanol intake) or duration of exposure (year). RESULTS: For HL, considering nonsmokers only, ever drinkers had a significantly decreased risk than never drinkers (OR=0.46). Significantly lower risks in all levels of total alcohol intake were also detected, considering servings per week (OR for one to four servings per week=0.51, 95% CI 0.32-0.82; OR for five to nine servings per week=0.39, 95% CI 0.21-0.73; OR for 10-19 servings per week=0.26, 95% CI 0.12-0.54; OR for >or=20 servings per week=0.34, 95% CI 0.15-0.79) and grams per day of ethanol intake (OR for 0.1-9.0 g/day=0.45, 95% CI 0.27-0.74; OR for 9.1-17.9 g/day=0.52, 95% CI 0.30-0.90; OR for 18.0-31.7 g/day=0.27, 95% CI 0.13-0.57; OR for >31.7 g/day=0.35, 95% CI 0.15-0.79). In the analysis for ever-smoking HL cases and controls, ever drinkers had the same risk as never drinkers. For MM, ever drinkers had a non-significantly decreased risk than non-drinkers (OR=0.74), and ORs in almost all consumption levels were not significant (OR for 0.1-9.0 g/day=0.93; OR for 9.1-17.9 g/day=0.82; OR for 18.0-31.7 g/day=0.47; 95% CI 0.28-0.81; OR for >31.7 g/day=0.68). For HL and MM, the beverage type did not affect the risk significantly, and no consistent dose-response relationships were found, considering intensity or duration of alcohol consumption. CONCLUSIONS: Our study indicates a protective effect of alcohol consumption for nonsmoking HL cases.

History of treated hypertension and diabetes mellitus and risk of renal cell cancer.

BACKGROUND: An increased risk of renal cell cancer (RCC) has been reported in subjects with hypertension. Whether this association may vary according to sex, smoking, obesity, or RCC clinical presentation is unclear. Results on the link between diabetes mellitus and RCC are inconclusive. PATIENTS AND METHODS: We conducted an Italian multicenter case-control study, including 767 (494 men, 273 women) incident cases of RCC, under 80 years of age, and 1534 hospital controls, frequency-matched to cases. Multiple logistic regression models, conditioned to center, sex, and age, and adjusted for period of interview, education, smoking, and body mass were used to estimate odds ratios (OR). RESULTS: Compared with subjects never treated, patients with a history of treated hypertension [OR = 1.7, 95% confidence interval (CI) 1.4-2.1] reported an excess risk of RCC. This pattern was confirmed in different strata of sex, education, smoking habits, body mass, tumor histological type, stage, or grade. The attributable risk of RCC for treated hypertension in this population was 16%. A slight, nonsignificant increased risk was found for history of diabetes mellitus (OR = 1.3, 95% CI 0.9-1.7). CONCLUSION: A possible causal role of hypertension in renal cell carcinogenesis is supported by the consistency of the direct association.

Does an apple a day keep the oncologist away?

BACKGROUND: Apples have commonly been described as a healthy food. To understand better their role on risk of cancer at several sites, we analyzed data from multicenter case-control studies conducted between 1991 and 2002 in Italy. PATIENTS AND METHODS: The studies included 598 patients with incident cancers of the oral cavity and pharynx, 304 of the oesophagus, 460 of the larynx, 1953 of the colorectum, 2569 of the breast, 1031 of the ovary and 1294 of the prostate. The comparison group included a total of 6629 patients admitted to the same network of hospitals as cases for acute, non-neoplastic diseases. Multivariate odds ratios (OR) were obtained with allowance for age, sex, study center, education, body mass index, tobacco smoking, alcohol drinking, total energy intake, vegetable consumption and physical activity. RESULTS: Compared with subjects reporting consumption of <1 apple/day, the ORs for > or =1 apple/day were 0.79 [95% confidence interval (CI) 0.62-1.00] for cancers of the oral cavity and pharynx, 0.75 (95% CI 0.54-1.03) for oesophagus, 0.80 (95% CI 0.71-0.90) for colorectum, 0.58 (95% CI 0.44-0.76) for larynx, 0.82 (95% CI 0.73-0.92) for breast, 0.85 (95% CI 0.72-1.00) for ovary and 0.91 (95% CI 0.77-1.07) for prostate. CONCLUSION: This investigation found a consistent inverse association between apples and risk of various cancers.

Diabetes mellitus and the risk of prostate cancer in Italy.

OBJECTIVE: We investigated the relation between diabetes and the risk of prostate cancer, as epidemiological results are controversial. METHODS: A hospital-based case-control study was conducted in Italy between 1991 and 2002. Cases were 1294 men, aged <75 years, with incident histologically confirmed prostate cancer, and controls were 1451 men, aged <75 years, admitted to hospital for acute non-neoplastic diseases. Odds ratios (OR) and the corresponding 95% confidence intervals (CI) were estimated using unconditional multiple logistic regression models. RESULTS: No material association between diabetes and prostate cancer was observed, with a multivariate OR of 1.02 (95%CI 0.75-1.40). Prostate cancer was not related to time since diagnosis of diabetes (OR 0.82 and 0.97 for <5 and >/=15 years since diagnosis respectively). The OR were respectively 1.63 (95%CI 0.70-3.81) and 0.96 (95%CI 0.68-1.34) in men diagnosed with diabetes at age <45 or >/=45 years. The risk estimates were similar across strata of age at interview, body mass index and, among cases, of Gleason score. CONCLUSIONS: This study shows no material association between diabetes and prostate cancer risk.

Prostate cancer in Italy before and during the 'PSA era': survival trend and prognostic determinants.

The aim of the study was to investigate the variations in prostate cancer prognosis during a period of major diagnostic change, such as the introduction of the prostate-specific antigen (PSA) test. Data were provided by 14 Italian cancer registries (CRs). Incidence and follow-up information was collected for patients diagnosed from 1978 to 1994. Relative survival was computed taking into account incidence period, age, tumour stage and grade at diagnosis. A multivariate analysis was carried out to evaluate the independent simultaneous effect on survival of some prognostic determinants. A large geographical variability was observed: in 1993-1994 Italian survival rates ranged from 76% to 52%, with a north-south gradient. A striking prognostic improvement (up to +27 percentage points) between the late 1980s and the early 1990s occurred in almost all CRs, particularly with regard to younger patients. Multivariate analysis showed a strong influence of incidence period on survival, also after correction by tumour stage. The slowdown of metastatic cancers suggests that the survival improvement could be due both to the introduction of an effective opportunistic screening and to a quantitative change in the application of clinical treatment, even if the effect of the lead-time bias phenomenon has to be taken into account.

Delayed infection, late tonsillectomy or adenoidectomy and adult leukaemia: a case-control study.

In a population-based case-control study among adults in Italy, of 261 lymphoid and 313 myeloid leukaemias and 1718 controls, a later age at adenoidectomy and tonsillectomy (after age 10 years) increased considerably the risk of lymphocytic (but not myeloid) leukaemia (odds ratio 4.2, 95% confidence interval 1.1-16.2). We propose that late infection is a proliferative stimulus for B-cells.

Building a database for survival analysis.

The AIRT built a national data base for survival data, collecting follow up information regarding incident cases from 14 cancer registries and 2 childhood cancer registries operating in Italy. In this study, 210,661 cases incident during the period 1990-1994, followed up until 1999, were analysed. The Veneto Cancer Registry did the data quality checks, the conversion in SAS format and developed a SAS procedure to perform the survival analysis. The procedure allows to select the cancer registry, the period and the cancer site to analyse, running the Hakulinens' software for relative survival analysis and exporting the results in Excel sheet to produce a standard layout.

Smoking and hematolymphopoietic malignancies.

OBJECTIVE: Tobacco use is the most prominent cause of respiratory cancers. Little is known, however, about the influence of smoking on hematolymphopoietic malignancies. To evaluate this relation, a population-based case-control study was carried out in 12 areas of Italy. METHODS: Detailed interviews on tobacco smoking habits were administered to 1450 non-Hodgkin's lymphoma (NHL), 365 Hodgkin's disease (HD), 270 multiple myeloma (MM), and 649 leukemia (LEU) patients occurring from 1990 to 1993, and 1779 population controls. RESULTS: We found a slightly increased risk for NHL in smokers (odds ratio 1.2, 95% confidence interval 1.0-1.4 for ever smokers), but a consistent positive association was shown only for follicular NHL. In this subtype, a significant excess risk was observed for ever versus never smokers, after adjustment for gender, age, geographic residence, education, and respondent (OR = 1.8, 95%, CI 1.3-2.7), with a positive exposure-response gradient for smoking duration (p < 0.01). The risk for follicular NHL was significantly elevated only among women, with ever smokers showing OR = 2.3 (CI 1.4-3.8), while for men we found OR = 1.3 (CI 0.69-2.3). No major differences were shown according to age. Female subjects also showed significant positive exposure-response trends for duration. CONCLUSION: Cigarette smoking could be a risk factor for follicular NHL among women. For HD, MM, or LEU, no clear association was observed.

Childhood melanoma in Europe since 1978: a population-based survival study.

The existence of the EUROCARE database now makes it possible to compare population-based survival for childhood melanoma in different European populations. The database contains verified information, including histological data, from cancer registries in 17 European countries, and as such it represents a particularly important source of survival information on a very rare cancer like childhood melanoma. The aim of the present paper was to describe survival in children with melanoma (MM), by sex, age and subsite, diagnosed during the period 1978--1989, using analysis of the data of the European pool of cases. Five year-survival for childhood MM diagnosed in 1978--1989 in Europe, is relatively good (80%; 95% confidence interval (CI) 47--95 for boys and 78%; 95% CI 58--91 for girls). Analysis by subsite, revealed the survival for MM on the head and neck, legs and arms was generally higher than survival for MM on other cutaneous sites (trunk, neck and scalp). For skin melanomas outcome for girls was better than boys, adjusting for age and sub-site. We suggest that the good survival observed in childhood MM seems to be related to early diagnosis.

A multicenter case-control study in Italy on hematolymphopoietic neoplasms and occupation.

We conducted a population-based, case-control study on hematolymphopoietic malignancies in 12 areas in Italy to investigate associations between different hematolymphopoietic malignancies and exposure to solvents and pesticides. We collected all incident cases 20-74 years of age from 12 areas, with a combined population of approximately 7 million residents. The control group was formed by a random sample of the study population. Data presented in this paper refer to 2,737 interviewed cases of 3,357 eligible cases and to 1,779 of 2,391 eligible controls. We analyzed risks associated with occupation using job-title information to evaluate disease pattern according to job category. An earlier publication presented results for women; here, we report the findings for men and discuss the overall patterns in both genders. The most consistent overall finding was an approximate doubling in relative risk for all four types of malignancies among male managers and related occupations. Several additional occupations were associated with elevated risk of one or more malignancies among men. These included cooks, waiters, and bartenders, and building caretakers and cleaners, for non-Hodgkin's lymphoma; textile workers and machinery fitters for Hodgkin's lymphoma; metal processors, material handlers, rubber workers, and painters for leukemia; and hairdressers, metal processors, tailors, electrical workers, and plumbers for multiple myeloma. The finding of increased risk of non-Hodgkin's lymphoma among both male and female cooks, waiters, and bartenders has not been previously reported; nor has the elevated risk of leukemia among material handlers. Among people engaged in agriculture, those employed as tractor drivers and as "orchard, vineyard, and related tree and shrub workers" appeared to be at increased risk for hematolymphopoietic malignancies.

Delayed infection, family size and malignant lymphomas.

BACKGROUND: The annual incidence of non-Hodgkin's lymphomas (NHL) is increasing by 3%-4% in different parts of the developed world. Excesses of NHL have been observed in populations exposed to immunosuppressants and to HIV, but these causes do not explain the increasing trends. It is suggested that delayed infection could explain NHL trends, through an impairment of the Th1/Th2 lymphocyte patterns. METHODS: In a population-based study on 1388 patients with NHL, 354 with Hodgkin's disease (HD) and 1718 healthy controls, the age of first occurrence of bacterial and viral diseases was investigated. Clinical records were perused in one centre to check the anamnestic data. FINDINGS: The age of occurrence of bacterial and viral diseases was significantly higher among NHL patients than in the controls. The association between later age at first bacterial or viral disease was limited to small families (OR= 1.95; 95% confidence intervals 1.26, 3.00, for age 4-8 at first infection; OR=1.91; 1.19, 3.06, for age 9+, compared with less than 4). The association was more obvious for bacterial diseases (possibly for the lower degree of misclassification). High grade lymphomas showed the strongest association. The later age of occurrence of bacterial or viral diseases in NHL patients is consistent with a higher incidence of lymphomas observed in higher social groups. No clear association was found between HD and age at first bacterial or viral diseases. INTERPRETATION: It is proposed that delayed infection could explain the increasing NHL trends, through an impairment of the Th1/Th2 lymphocyte patterns. The model of delayed infection has been proposed also to explain increasing prevalence rates of asthma.