Ulnar Artery Perforator Adiposal Flap for Paraffinoma Treatment in a Patient With Leprosy: A Case Report.

Leprosy is a chronic infection in humans that mainly affects the peripheral nerves and skin. Paraffin filling has been previously used for muscle atrophy treatment. However, the formation of paraffin granulomas (paraffinomas) can occur over the long term. We encountered a patient with leprosy who had hypothenar muscle atrophy caused by ulnar neuropathy. The patient was treated with paraffin injection at the hypothenar site for cosmetic appearance 60 years ago. Consequently, the paraffin formed a paraffinoma and a recurrent infected skin ulcer. Thus, paraffinoma removal and transfer of ulnar artery perforator adiposal flap (140 × 20 mm) were performed. The ulnar artery perforator adiposal flap was used for infection control and filling the dead space after paraffin removal. The skin healed without complications. Ultrasound confirmed residual adipose tissue and blood flow at the last follow-up.

Digital artery perforator flap transfer for volar soft tissue defect due to dissociation from joint contracture in camptodactyly.

Camptodactyly is a condition defined by persistent flexion contracture of the proximal interphalangeal joints of the hand. Surgical treatment requires flaps for the dissection of the skin and the resulting soft tissue defect, soft tissue release, and sometimes reconstruction of the extension mechanism. Z-plasty and transposition flap have been reported as methods used in soft tissue defects. In this case, covering the defects of the digits was necessary for keeping the wound clean; thus, we should select a surgical method that facilitates stable and reliable blood flow of the flap. The digital artery perforator flap is pedicled and its transfer does not require the dissection of neurovascular bundles; therefore, it can be used safety and relatively easily. We considered the digital artery perforator flap to be a useful technique in terms of securing stable and reliable blood flow and not twisting the skin. Thus, we performed a digital artery perforator flap transfer for a volar soft tissue defect due to dissociation from proximal interphalangeal joint contracture in camptodactyly.

Volar Locking Plate Fixation for Distal Radius Fractures by Intraoperative Computed Tomographic-Guided Navigation.

Purpose: Unstable distal radius intra-articular fractures require restoration of alignment. Exact fixation of intra-articular fragments is ideal. Here, we employed intraoperative computed tomography (CT) navigation to insert screws accurately in the intra-articular dorsal fragments during treatment with a volar locking plate for distal radius intra-articular fractures. The main purposes of this study were to evaluate the accuracy of this procedure and the postoperative stability of the articular fragments through CT findings, as well as to assess clinical outcomes. Methods: This study included 26 patients with distal radius fractures, who were treated with a volar locking plate using intraoperative CT navigation with a minimum follow-up of 12 months. Mean patient age was 63 years and mean follow-up was 16 months. We examined the position of the inserted distal screws and articular displacement on preoperative, intraoperative, and post-bone union CT images. The 3 distal ulnar screw positions that influence the stability of the dorsoulnar articular fragment were evaluated. The Mayo wrist score and Disabilities of the Arm, Shoulder, and Hand score were also clinically evaluated. Results: Computed tomography evaluation revealed that the distal locking screws were appropriately inserted at the subchondral position, with sufficient length to stabilize the dorsal fragments, and reduction and stability of the articular fragment were acceptable. At the final follow-up, mean Mayo wrist score was 90.8 and mean Disabilities of the Arm, Shoulder, and Hand score was 9.6. Conclusions: Intraoperative CT navigation was successfully used for volar locking plate fixation of intra-articular distal radius fractures. Computed tomography evaluation revealed that the screws were precisely inserted for articular fragments and bone union was achieved, maintaining good intra-articular alignment. The findings demonstrate the accuracy of volar locking plate fixation assisted by intraoperative CT navigation and the good clinical outcomes of this procedure. Type of study/level of evidence: Therapeutic IV.

Self-reported dietary flavonoid intake and serum markers of inflammation: the multiethnic cohort.

PURPOSE: To examine if dietary intake of foods rich in flavonoids, which have been shown to be inversely associated with chronic diseases, is associated with inflammatory processes. METHODS: This analysis includes controls of case-control studies nested within the Multiethnic Cohort (MEC) who completed a validated food frequency questionnaire at cohort entry. Biomarkers were assessed in blood donated during follow-up (mean = 9.6 years). We used multivariate linear regression adjusted for potential confounders to estimate associations between intake of flavanones, flavonols, and isoflavones and levels of adiponectin, leptin, C-reactive protein, interleukin (IL)-1ß, IL-6, IL-10, and tumor necrosis factor-α. RESULTS: Among the 1,287 participants, the respective median intakes of flavanones, flavonols, and isoflavones were 26.5, 12.4, and 1.3 mg/day at cohort entry. With the exception of flavanone intake, which was statistically significantly inversely associated with adiponectin (p = 0.01) and IL-6 concentrations (p = 0.01), none of the examined flavonoids was related with levels of adipokines or inflammatory markers. Heterogeneity by ethnicity was only observed for flavonol intake and IL-10 (pinteraction = 0.04) and may be the result of multiple testing. These null findings were confirmed in a subset of participants who completed a second dietary history within 2.6 years of blood draw. CONCLUSION: The current results do not support a consistent association between dietary intake of flavonoids and markers of inflammatory processes.

Dietary Red and Processed Meat Intake and Markers of Adiposity and Inflammation: The Multiethnic Cohort Study.

OBJECTIVE: The potential influence of dietary factors on inflammation is important for cancer prevention. Utilizing data from control participants (312 men, 911 women) in 2 nested case-control studies of cancer within the Multiethnic Cohort, we examined the associations of red and processed meat intake with serum levels of leptin, adiponectin, C-reactive protein (CRP), tumor necrosis factor (TNF)-α, and interleukin (IL)-6 and the mediator effect of body mass index (BMI) on the above associations (if present). METHODS: Multivariable linear models were applied to assess the association between red and processed meat intake at cohort entry and serum biomarker levels measured 9.1 years later after adjusting for covariates and to determine the mediator effect of BMI. RESULTS: Overall red and processed meat intake was positively associated with serum leptin levels in men (ß = 0.180, p = 0.0004) and women (ß = 0.167, p < 0.0001). In women, higher red and processed meat consumption was significantly associated with higher CRP (ß = 0.069, p = 0.03) and lower adiponectin levels (ß = -0.082, p = 0.005). In mediation analyses with red and processed meat intake and BMI as predictors, the associations of red and processed meat with biomarkers decreased substantially (as indicated by percentage change in effect: leptin in men, 13.4%; leptin in women, 13.7%; adiponectin in women, -4.7%; CRP in women, 7.4%) and were no longer significant (p > 0.05), whereas BMI remained significantly associated with serum leptin (men: ß = 3.209, p < 0.0001; women: ß = 2.891, p < 0.0001), adiponectin (women: ß = -1.085, p < 0.0001), and CRP (women: ß = 1.581, p < 0.0001). CONCLUSION: The current data suggest that the amount of excess body weight or the degree of adiposity may mediate the relations between dietary red and processed meat intake and serum biomarkers associated with obesity and inflammation.

Soy Food Intake and Biomarkers of Breast Cancer Risk: Possible Difference in Asian Women?

Soy foods may protect against breast cancer in Asian but not in Western populations. We examined if the levels of various markers of breast cancer risk and inflammation, as well as the effects of soy food consumption on these markers, differ between Asian and non-Asian premenopausal women in two soy intervention trials. One study randomized 220 women to a 2-yr intervention and the other one randomized 96 women in a crossover design to examine the effects of consumption of 2 daily soy servings on nipple aspirate fluid (NAF) volume; estrogens in serum, NAF, and urine; insulin-like growth factor-1 (IGF-1), IGF-binding protein 3, and inflammatory markers in serum; and mammographic densities. Mixed linear models were applied to assess ethnic differences in biomarkers and response to the soy diet. Serum C-reactive protein, serum leptin, NAF volume, and NAF estrone sulfate were lower, while urinary isoflavones were higher in Asian than in non-Asian women. A significant interaction (pinteraction = 0.05) between ethnicity and soy diet was observed for IGF-1 but not for other biomarkers. The current findings suggest possible ethnic differences in levels of biomarkers for breast cancer risk but little evidence that Asian women respond differently to soy foods than non-Asian women.

Bioimpedence to Assess Breast Density as a Risk Factor for Breast Cancer in Adult Women and Adolescent Girls.

Although high mammographic density is one of the strongest predictors of breast cancer risk, X-ray based mammography cannot be performed before the recommended screening age, especially not in adolescents and young women. Therefore, new techniques for breast density measurement are of interest. In this pilot study in Guam and Hawaii, we evaluated a radiation-free, bioimpedance device called Electrical Breast DensitometerTM (EBD; senoSENSE Medical Systems, Inc., Ontario, Canada) for measuring breast density in 95 women aged 31-82 years and 41 girls aged 8-18 years. Percent density (PD) was estimated in the women's most recent mammogram using a computer-assisted method. Correlation coefficients and linear regression were applied for statistical analysis. In adult women, mean EBD and PD values of the left and right breasts were 230±52 and 226±50 Ω and 23.7±15.1 and 24.2±15.2%, respectively. The EBD measurements were inversely correlated with PD (rSpearman=-0.52, p<0.0001); the correlation was stronger in Caucasians (rSpearman=-0.70, p<0.0001) than Asians (rSpearman=-0.54, p<0.01) and Native Hawaiian/Chamorro/Pacific Islanders (rSpearman=-0.34, p=0.06). Using 4 categories of PD (<10, 10-25, 26-50, 51-75%), the respective mean EBD values were 256±32, 249±41, 202±46, and 178±43 Ω (p<0.0001). In girls, the mean EBD values in the left and right breast were 148±40 and 155±54 Ω; EBD values decreased from Tanner stages 1 to 4 (204±14, 154±79, 136±43, and 119±16 Ω for stages 1-4, respectively) but were higher at Tanner stage 5 (165±30 Ω). With further development, this bioimpedance method may allow for investigations of breast development among adolescent, as well as assessment of breast cancer risk early in life and in populations without access to mammography.

Adherence to cancer prevention recommendations and antioxidant and inflammatory status in premenopausal women.

For cancer prevention, the World Cancer Research Fund and American Institute for Cancer Research (WCRF/AICR) emphasise recommendations to improve individual behaviour, including avoidance of tobacco products, maintaining a lean body mass, participating in physical activity, consuming a plant-based diet, and minimising the consumption of energy-dense foods, such as sodas, red and processed meats and alcohol. In the present study of 275 healthy premenopausal women, we explored the association of adherence scores with levels of three biomarkers of antioxidant and inflammation status: serum C-reactive protein (CRP), serum γ-tocopherol and urinary F2-isoprostane. The statistical analysis applied linear regression across categories of adherence to WCRF/AICR recommendations. Overall, seventy-two women were classified as low ( ≤ 4), 150 as moderate (5-6), and fifty-three as high adherers ( ≥ 7). The unadjusted means for CRP were 2.7, 2.0 and 1.7 mg/l for low, moderate and high adherers (P trend= 0.03); this association was strengthened after adjustment for confounders (P trend= 0.006). The respective values for serum γ-tocopherol were 1.97, 1.63 and 1.45 µg/ml (P trend= 0.02 before and P trend= 0.03 after adjustment). Only for urinary F2-isoprostane, the lower values in high adherers (16.0, 14.5, and 13.3 ng/ml) did not reach statistical significance (P trend= 0.18). In an analysis by BMI, overweight and obese women had higher biomarker levels than normal weight women; the trend was significant for CRP (P trend< 0.001) and γ-tocopherol (P trend= 0.003) but not for F2-isoprostane (P trend= 0.14). These findings suggest that both adherence to the WCRF/AICR guidelines and normal BMI status are associated with lower levels of biomarkers that indicate oxidative stress and inflammation.

Association of estrogen measurements in serum and urine of premenopausal women.

AIMS: We evaluated conjugated and unconjugated urinary estrogen metabolites as surrogate biomarkers for serum levels of unconjugated E1 and E2 in premenopausal women. MATERIALS & METHODS: Repeated blood and urine samples were analyzed for estrogens and their metabolites using radioimmunoassays and liquid chromatography/mass spectrometry. RESULTS: The strongest correlation (r = 0.39) was observed between serum E1 and urinary E1 and E2. The correlations of urinary E2 (r = 0.35), E1 (r = 0.29), all E2 metabolites (r = 0.30), all E1 metabolites (r = 0.23) and total estrogens (r = 0.26) with serum E2 were only moderate although statistically significant. All correlations were substantially stronger for Whites than Asians. CONCLUSION: Urinary E2 emerged as the best predictor for serum E1 and E2, but the large intra-subject variability in urinary estrogen levels limits its use as a biomarker.

Dietary isoflavone intake is not statistically significantly associated with breast cancer risk in the Multiethnic Cohort.

Given the high intake levels of soya and low incidence rates of breast cancer in Asian countries, isoflavones, substances with an oestrogen-like structure occurring principally in soyabeans, are postulated to be cancer protective. In the present study, we examined the association of dietary isoflavone intake with breast cancer risk in 84,450 women (896 in situ and 3873 invasive cases) who were part of the Multiethnic Cohort (Japanese Americans, whites, Latinos, African Americans and Native Hawaiians) with a wide range of soya intake levels. The absolute levels of dietary isoflavone intake estimated from a baseline FFQ were categorised into quartiles, with the highest quartile being further subdivided to assess high dietary intake. The respective intake values for the quartiles (Q1, Q2, Q3, and lower and upper Q4) were 0-< 3·2, 3·2-< 6·7, 6·7-< 12·9, 12·9-< 20·3, and 20·3-178·7 mg/d. After a mean follow-up period of 13 years, hazard ratios (HR) and 95% CI were calculated using Cox regression models stratified by age and adjusted for known confounders. Linear trends were tested by modelling continuous variables of interest assigned the median value within the corresponding quartile. No statistically significant association was observed between dietary isoflavone intake and overall breast cancer risk (HR for upper Q4 v. Q1: 0·96 (95% CI 0·85, 1·08); P trend = 0·40). While the test for interaction was not significant (P=0·14), stratified analyses suggested possible ethnic/racial differences in risk estimates, indicating that higher isoflavone intakes may be protective in Latina, African American and Japanese American women. These results are in agreement with those of previous meta-analyses showing no protection of isoflavones at low intake levels, but suggesting inverse associations in populations consuming high amounts of soya.

Oestrogen levels in serum and urine of premenopausal women eating low and high amounts of meat.

OBJECTIVE: Based on the hypothesis that high-meat diets may increase breast cancer risk through hormonal pathways, the present analysis compared oestrogens in serum and urine by meat-eating status. DESIGN: Intervention with repeated measures. SETTING: Two randomized soya trials (BEAN1 and BEAN2) among premenopausal healthy women. SUBJECTS: BEAN1 participants completed seven unannounced 24 h dietary recalls and donated five blood and urine samples over 2 years. BEAN2 women provided seven recalls and three samples over 13 months. Serum samples were analysed for oestrone (E1) and oestradiol (E2) using RIA. Nine oestrogen metabolites were measured in urine by LC-MS. Semi-vegetarians included women who reported consuming <30 g of red meat, poultry and fish daily, and pescatarians those who reported consuming <20 g of meat/poultry but >10 g of fish daily. All other women were classified as non-vegetarians. We applied mixed models to compute least-square means by vegetarian status adjusted for potential confounders. RESULTS: The mean age of the 272 participants was 41·9 (SD 4·5) years. Serum E1 (85 v. 100 pg/ml, P = 0·04) and E2 (140 v. 154 pg/ml, P = 0·04) levels were lower in the thirty-seven semi-vegetarians than in the 235 non-vegetarians. The sum of the nine urinary oestrogen metabolites (183 v. 200 pmol/mg creatinine, P = 0·27) and the proportions of individual oestrogens and pathways did not differ by meat-eating status. Restricting the models to the samples collected during the luteal phase strengthened the associations. CONCLUSIONS: Given the limitations of the study, the lower levels of serum oestrogens in semi-vegetarians than non-vegetarians need confirmation in larger populations.

Cytology in nipple aspirate fluid during a randomized soy food intervention among premenopausal women.

Because soy food consumption may influence breast tissue activity, we examined its effect on the presence of epithelial cells in nipple aspirate fluid (NAF). In a randomized, crossover design, 82 premenopausal women completed a high-soy and a low-soy diet for 6 mo each, separated by a 1-mo washout period. They provided NAF samples at baseline, 6 mo, and 13 mo during the midluteal phase of the menstrual cycle. Papanicolaou-stained cytology slides (for 33 women at baseline, 24 at low-soy, and 36 at high-soy) were evaluated in women with sufficient NAF. Mixed models evaluated the effect of the high-soy diet on epithelial cytology as compared to baseline and the low-soy diet. At the end of the high-soy diet, cytological subclass had decreased in 8 (24%) and increased in 3 (9%) women as compared to baseline, whereas the respective values were 3 (14%) and 6 (29%) for the low-soy diet samples (P = 0.32). Only the change in subclass indicated a trend in lower cytological class (P = 0.06). Contrary to an earlier report, the number of NAF samples with hyperplastic epithelial cells did not increase after a soy intervention in amounts consumed by Asians.

Prediagnostic serum tocopherol levels and the risk of non-hodgkin lymphoma: the multiethnic cohort.

BACKGROUND: Compromised immunity and chronic inflammation are thought to contribute to the development of non-Hodgkin lymphoma (NHL). Because tocopherols protect cells through antioxidant mechanisms, they may play a role in NHL etiology. METHODS: This nested case-control study within the Multiethnic Cohort examined the association of prediagnostic serum tocopherols levels measured in 271 NHL cases and 538 matched controls by high-pressure liquid chromatography/photodiode array detection with NHL risk. Conditional logistic regression was used to calculate ORs and 95% confidence intervals (CI). RESULTS: We observed U-shaped associations with NHL for total and α-tocopherols [Ptrend < 0.01 for polynomial terms (3 df)]. The ORs (95% CI) for total tocopherols, which consisted primarily of α-tocopherol, were 0.41 (0.25-0.68), 0.52 (0.32-0.85), 0.39 (0.23-0.65), and 0.78 (0.47-1.29) for the second to fifth quintiles as compared with the first. The risk estimates were similar for α-tocopherol but nonsignificant for ß- and γ-tocopherol combined and for γ-tocopherol. Adjustment for serum lipids strengthened the nonlinear associations for total and α-tocopherols. Serum total tocopherol levels were higher for vitamin E supplement users at cohort entry than nonusers (21.32 ± 9.04 vs. 17.72 ± 7.43 µg/mL; P < 0.0001), but supplement use was not associated with NHL risk. No heterogeneity in risk estimates was detected by sex, ethnicity, vitamin E supplement use, or NHL subtype. CONCLUSIONS: Circulating tocopherols, at levels likely reflecting adequate dietary intakes, may be protective against NHL, whereas higher intakes from supplementation may not be beneficial. IMPACT: The association between serum tocopherol levels and NHL risk provides possible new insights into the etiology of NHL.

Non-hodgkin lymphoma and circulating markers of inflammation and adiposity in a nested case-control study: the multiethnic cohort.

BACKGROUND: Because immune dysfunction is thought to underlie the development of non-Hodgkin lymphoma (NHL), obesity and chronic inflammation may be involved in its etiology. We examined the association of prediagnostic inflammatory markers and adipokines with NHL risk. METHODS: We conducted a nested case-control analysis (272 cases and 541 matched controls) within the Multiethnic Cohort. Luminex technology was used to measure a 10-plex panel of cytokines, ELISA assays for adipokines, and an autoanalyzer for C-reactive protein (CRP). ORs and 95% confidence intervals (CI) for tertiles of analytes were estimated by conditional logistic regression. RESULTS: After a median time of 2.7 years from phlebotomy to diagnosis, interleukin (IL)-10 was significantly related to NHL risk (ORT3 vs. T1 = 3.07; 95%CI, 2.02-4.66; Ptrend < 0.001). TNF-α and IL-8 showed borderline elevated risks, whereas IFN-γ, IL-1ß, IL-2, IL-4, IL-5, IL-6, and CRP were not associated with NHL. Leptin but not adiponectin was related to NHL risk (ORT3 vs. T1 = 0.48; 95%CI, 0.30-0.76; Ptrend < 0.001). Adjustment for body mass index did not substantially affect the risk estimates. Stratification by subtype indicated significant associations with IL-10 and leptin for follicular but not for diffuse large B-cell lymphoma. Excluding cases diagnosed less than 1 year after phlebotomy attenuated all associations. CONCLUSIONS: IL-10 was the only cytokine and leptin the only adipokine associated with NHL, but due to the short follow-up time, preclinical effects cannot be excluded. IMPACT: Although markers of inflammation and adiposity may provide new insights into the etiology of NHL, they need to be assessed many years before clinical diagnosis.

Parity and expression of epithelial histopathologic markers in breast tissue.

It is well established that pregnancies protect against breast cancer; however, the mechanism involved is not completely understood. We investigated the influence of parity on hormonal and proliferation markers in benign tissue from tumor blocks of breast cancer cases. Women with breast cancer were recruited from a case-control study nested within the Multiethnic Cohort study. Tissue microarrays of benign tissue cores were available for 159 participants. Immunostaining for estrogen receptor α (ERα) and ERß, progesterone receptor, human epidermal growth factor receptor 2 (Her2/neu), Ki-67, and proliferating cell nuclear antigen (PCNA) in epithelial tissue was evaluated by a pathologic expert. We applied logistic regression models to examine marker expression by parity (0, 1-2, and ≥3 live births with adjustment for age at diagnosis and BMI). Of the 159 women, 24 were nulliparous, 63 had one or two live births, and 72 had three or more live births. Inverse associations were observed between parity and expression of ERα (Ptrend=0.02) and PCNA (Ptrend=0.04). Among nulliparous women, 45.5% were ERα positive in contrast to 18.0 and 18.9% of women with one or two and at least three live births, respectively. The respective values for PCNA were 56.5, 44.3, and 31.1%. No associations were detected for ERß, progesterone receptor, Her2/neu, and Ki-67. The current findings suggest that pregnancies may protect against breast cancer by reducing susceptibility to estrogenic stimuli and proliferative activity as assessed by the expression of ERα and PCNA in breast tissue.

Erythrocyte membrane fatty acid composition, serum lipids, and non-Hodgkin's lymphoma risk in a nested case-control study: the multiethnic cohort.

PURPOSE: Composition of dietary fatty acid intake, which influences cytokine production, may contribute to the development of non-Hodgkin's lymphoma (NHL). Serum lipid levels may serve as biomarkers of inflammation associated with NHL risk. METHODS: We conducted a case-control analysis (275 cases and 549 controls) nested within the Multiethnic Cohort Study (whites, Japanese Americans, Latinos, African Americans, and Native Hawaiians) to examine the association of prediagnostic, erythrocyte membrane phospholipid fatty acid composition, and serum cholesterol and triglyceride (TG) concentrations with the risk of NHL. Conditional logistic regression was used to calculate odds ratios (OR) and 95 % confidence intervals (CI) by tertiles of biomarker concentrations. RESULTS: Higher total saturated fatty acids (SFA) were associated with an increase in NHL risk (OR(T3 vs. T1) = 1.57 [95 % CI: 1.03-2.39]; p(trend) = 0.01), whereas no associations were detected for total n-3 or n-6 polyunsaturated fatty acids. Inverse associations were observed for total cholesterol (TC; OR (T3 vs. T1) = 0.51 [95 % CI: 0.35-0.74]; p(trend) < 0.0001) and high-density lipoprotein cholesterol (HDL-C; OR (T3 vs. T1) = 0.47 [95 % CI: 0.31-0.71]; p(trend) = 0.0001) but not for low-density lipoprotein cholesterol or TG. Adjustment for the use of lipid-lowering medication did not modify the results substantially. CONCLUSIONS: This prospective biomarker investigation offers supportive evidence for an adverse effect of higher erythrocyte membrane SFA levels on NHL risk, but preclinical effects cannot be excluded. Inverse relations between prediagnostic, circulating TC and HDL-C and NHL risk may be due to reverse causation or a result of protective actions of these lipids and lipoproteins.

Prediagnostic circulating carotenoid levels and the risk of non-Hodgkin lymphoma: the Multiethnic Cohort.

This analysis examined the association of non-Hodgkin lymphoma (NHL) with prediagnostic carotenoid levels, a marker for a diet rich in fruits and vegetables. We conducted a nested case-control study within the Multiethnic Cohort with 271 NHL cases and 538 controls matched on sex, ethnicity, location (Hawaii or Los Angeles), birth year, date and time of blood draw, and hours fasting before blood draw. Serum carotenoid levels were obtained by high-pressure liquid chromatography with photodiode array detection. Conditional logistic regression was used to calculate odds ratios (ORs) according to tertiles of serum carotenoids and trend tests using continuous variables. Higher total serum carotenoids (OR(T3 vs T1) = 0.66 [0.46-0.96]; P(trend) = .02), lycopene (OR = 0.54 [0.38-0.78]; P(trend) = .003), and α-cryptoxanthin (OR = 0.53 [0.36-0.78]; P(trend) = .003) were associated with a lower risk of NHL. For retinol (OR = 0.90 [0.61-1.33]; P(trend) = .04), a statistically significant inverse linear trend was detected. Risk estimates remained unchanged with adjustment for NHL risk factors and were similar in analyses stratified by sex and ethnicity; heterogeneity with NHL subtype was detected only for ß-carotene. Other carotenoids, including α-carotene, ß-carotene, lutein, ß-cryptoxanthin, and zeaxanthin, showed no association with risk. These data provide support for a protective role of carotenoid-rich fruits and vegetables in the etiology of NHL.

The relation of urinary estrogen metabolites with mammographic densities in premenopausal women.

BACKGROUND: Mammographic density is a strong predictor of breast cancer risk. The total amount and the metabolism of endogenous estrogens, e.g., the ratio of 2-hydroxyestrone (2-OHE(1)) and 16α-OHE(1) may influence breast cancer risk. This study examined the association of urinary estrogen metabolites with breast density in premenopausal women. METHODS: Urine samples were collected at baseline and after 2 years, analyzed for 11 estrogen metabolites plus progesterone and testosterone by liquid chromatography mass spectrometry, and adjusted for creatinine levels. Mixed-effects regression was applied to examine the association of estrogens with breast density. RESULTS: Total estrogen metabolites (181 ± 113 vs. 247 ± 165 pmol/mg creatinine, p=0.01) and the 2/16α-OH ratio (8.4 ± 10.4 vs. 13.0 ± 17.1, p=0.02) were lower in the 74 Asian than in the 114 non-Asian women. In adjusted models, positive associations of total estrogen metabolites (p=0.002) and the 2/16α-OHE(1) ratio (p=0.08) with percent density were detected in Asians only. In all women, mammographic density was positively associated with the 2-OH pathway (p=0.01), inversely related to the 16α-OH pathway (p=0.01), and not associated with the 4-OH pathway, testosterone, and progesterone. Results for the size of the dense area weakly reflected the findings for percent density, while associations with the non-dense area were in the opposite direction. CONCLUSIONS: The findings that the 2-OH pathway is associated with higher and the 16α-OH pathway with lower breast density contradicts the hypothesized risk profile of these metabolites, but, if a relation between estrogen metabolites and breast cancer risk exists, it may be mediated through pathways other than mammographic density.

Soy foods and urinary isoprostanes: results from a randomized study in premenopausal women.

In addition to their antiestrogenic effects, soy isoflavones may protect against cancer through alternate biological actions, for example, antioxidant properties. This randomized crossover study explored the relationship between dietary isoflavone intake through common soy foods and oxidative stress quantified by urinary isoprostane levels. Eighty-two women aged 39.2 ± 6.1 years were randomly selected to receive a high soy diet of 2 soy food servings per day and a low soy diet of <3 servings per week for 6 months each, separated by a 1-month washout period. Urine samples were collected at baseline and at the end of each dietary period. Urinary isoprostane levels were measured using enzyme-linked immunosorbent assays (ELISA) and adjusted for creatinine levels. Mixed models using log-transformed values were applied to evaluate the effect of the high soy diet. Unadjusted isoprostane excretion levels were lower during the high rather than the low soy diet, but this effect was not statistically significant (p = 0.81). After adjustment for urinary creatinine, isoprostane excretion was slightly higher during the high soy diet (p = 0.02), an observation that was confirmed in a regression analysis between urinary isoflavones and isoprostanes during the high soy diet. The original association remained significant when restricted to adherent participants, however this effect disappeared after exclusion of three extreme values. In agreement with several previous reports, these findings do not support the hypothesis that soy exerts antioxidant effects, as measured by urinary isoprostane excretions, but additional markers of oxidative stress need to be investigated in future studies.