G-protein-coupled estrogen receptor GPER-1 expression in hormone receptor-positive breast cancer is associated with poor benefit of tamoxifen.

BACKGROUND: The role of G-protein-coupled estrogen receptor 1 (GPER-1) in the development of tamoxifen resistance in breast cancer is a highly controversial issue. The aim of this study was to determine the expression of GPER-1 in the clinical routine under conditions of endocrine treatment. PATIENTS AND METHODS: GPER-1 expression was analyzed in 442 patients with primary invasive breast cancer. GPER-1 score of > 3 was determined as positive. Expression data were correlated with clinical and pathological characteristics and patient survival. RESULTS: GPER-1 expression was observed in 352 (80.9%) cases, and positively correlated with estrogen and progesterone receptor status (p = 0.0001). GPER-1 positivity was associated with an increased grade of differentiation (p = 0.0001) and with a low level of Ki-67 expression (p = 0.0001). High GPER-1 expression was associated with a decreased level upon systemic treatment (p = 0.011). In the whole cohort, GPER-1 expression was associated with prolonged disease-free survival (DFS). DFS between tamoxifen- and aromatase inhibitor-treated GPER-1-positive patients was similar (p = 0.090). Notably, after matching the analysis for the most important prognostic factors, DFS for tamoxifen-treated GPER-1-positive patients was 69.1%, which is a percentage that is significantly lower compared to DFS for GPER-1-positive patients treated with aromatase inhibitors (92.7%) (p = 0.005). CONCLUSION: GPER-1 expression is a favorable prognostic factor in breast cancer patients. Its predictive role for poor benefit form tamoxifen treatment should be investigated in further studies.

A modified Hartmann-Shack aberrometer for measuring stray light in the anterior segment of the human eye.

PURPOSE: To examine the use of a modified Hartmann-Shack wave front aberrometer (WASCA; Carl Zeiss Meditec AG, Germany) to measure objective stray light caused by forward light scatter from the anterior segment of the human eye. SETTING: HELIOS Klinikum Erfurt/Institute of Biomedical Engineering and Informatics, Ilmenau University of Technology, Germany. METHOD: Scatter parameters, including the Michelson contrast and cross-sectional area at half height (CAHM) were examined in Hartmann-Shack images from ten subjects with a cataract in one eye and an intraocular lens (IOL) in the other. The parameters were compared between each eye. Light scatter was then measured in 40 healthy subjects (age range, 23-75 years) with spherical ametropia ranging from -0.25 to 0.25 diopters. The subjects were divided into three age groups; 23-35, 36-50, and 51-75 years. Light scatter was also measured using four alternative methods. RESULTS: CAHM and contrast were significantly different between the eyes with the cataract and the IOL (P = 0.007 and P = 0.004, respectively). CAHM (r = 0.557, P < 0.001) and contrast (r = -0.467, P < 0.001) were both significantly correlated with age. There were significant differences in CAHM and contrast between the age groups. CONCLUSION: The modified wave front aberrometer can be used to measure stray light, although its diagnostic sensitivity in individual patients must be improved.

Analysis of optical side-effects of fs-laser therapy in human presbyopic lens simulated with modified contact lenses.

BACKGROUND: In a single-blinded study, optical side-effects of a potential femtosecond (fs)-laser therapy in presbyopic human lenses were tested. Simulation of this therapy was carried out by applying fs-laser patterns into standard contact lenses (CL). METHODS: In the first part of the study, the influence of the numerical aperture on optical side-effects was investigated by comparing a typical fs-LASIK configuration to a fs-presbyopia treatment (n = 11). The second part focused on a possible improvement of visual performance by comparing a regular grid pattern to a randomly chosen spacing of the laser spots (n = 16). Visual acuity was measured with ETDRS charts, contrast sensitivity with F.A.C.T. charts and mesopic vision with Mesotest II. Forward scattered light was measured with the C-Quant (both instruments: Oculus Optikgeräte GmbH, Germany). A questionnaire detected subjective quality of vision. Differences between laser-treated and untreated CL and among the modifications were analyzed. RESULTS: The laser-treated and standard CL indicated no significant difference in visual acuity, contrast sensitivity and mesopic vision without glare. While wearing modified lenses with a regular grid, quality of vision decreased significantly by means of mesopic vision with glare and subjective straylight. These modifications also caused an impairment of subjective quality of vision. In contrast, there was no significant difference between the random pattern and standard CL. CONCLUSION: The increase of optical side-effects was reproducibly dependent on the geometry of the laser-structure. A randomized grid induced the least limitation. The study results are useful for planning possible laser-patterns in fs-laser therapy of the presbyopic lens.

Novel non-contact retina camera for the rat and its application to dynamic retinal vessel analysis.

We present a novel non-invasive and non-contact system for reflex-free retinal imaging and dynamic retinal vessel analysis in the rat. Theoretical analysis was performed prior to development of the new optical design, taking into account the optical properties of the rat eye and its specific illumination and imaging requirements. A novel optical model of the rat eye was developed for use with standard optical design software, facilitating both sequential and non-sequential modes. A retinal camera for the rat was constructed using standard optical and mechanical components. The addition of a customized illumination unit and existing standard software enabled dynamic vessel analysis. Seven-minute in-vivo vessel diameter recordings performed on 9 Brown-Norway rats showed stable readings. On average, the coefficient of variation was (1.1 ± 0.19) % for the arteries and (0.6 ± 0.08) % for the veins. The slope of the linear regression analysis was (0.56 ± 0.26) % for the arteries and (0.15 ± 0.27) % for the veins. In conclusion, the device can be used in basic studies of retinal vessel behavior.

Long-term follow-up of male patients after reconstruction of the bladder-exstrophy-epispadias complex: psychosocial status, continence, renal and genital function.

OBJECTIVE: There is a paucity of knowledge about long-term outcome issues in the bladder-exstrophy-epispadias complex (BEEC). Adult male BEEC patients were investigated in respect of bladder and renal function, fertility, genital function and psychosocial facts. PATIENTS AND METHODS: In a cross-sectional study, 17 adult male BEEC patients (mean age 23.4 years) from a single centre were evaluated with a questionnaire, renal and bladder ultrasound, blood tests, hormonal profile and semen analysis. RESULTS: Phenotypically one patient had complete epispadias and 16 had classical bladder exstrophy. Five patients underwent a one-stage functional reconstruction as a primary and 12 as a redo procedure. After a mean follow-up of 19.4 years, 15 bladders were preserved with 12 voiding per urethram and 3 performing intermittent catheterization; 2 were secondarily diverted. Significant residual urine was present in 10; kidneys were normal in 14 patients. Sixteen patients proved ejaculations, 3 had normospermia, 7 oligoasthenospermia and 6 azospermia. In patients with only one single bladder neck procedure normospermia was statistically significant. CONCLUSION: After functional BEEC reconstruction, long-term bladder function is preserved with mostly normal renal function. The number of bladder neck attempts has a significant influence on andrologic outcome. Detailed analysis may detect multifactorial pathogenesis from the impaired sperm quality in the BEEC.

Reproducibility of the retinal vascular response to flicker light in Asians.

PURPOSE: Dilation of retinal vessels in response to diffuse luminance flicker may reflect endothelial function. Although this has previously been shown to be reproducible in whites, there have been no similar data in Asians. We assess the reproducibility of repeated measurements of this response in Asians. MATERIAL AND METHODS: Healthy Asians (n = 33) with normal vision and no history of glaucoma, age-related macular degeneration, cataract, or retinal arterial/venous occlusion participated in this study. Repeated measures from the same subjects were taken 30-60 min apart using the Dynamic Vessel Analyser (DVA, IMEDOS, Jena, Germany). Modification was made to the shape of the light source for Asian participants. Correlations of the first and second measures were assessed using Pearson correlation (R(2)), and agreement between the two measures was shown using Bland-Altman plots. RESULTS: After modification to the shape of the light source, almost perfect correlation was found between the 1st and 2nd measurements of baseline arteriolar (R(2) = 0.95) and venular diameters (R(2) = 0.98) of arteriolar maximum dilation (R(2) = 0.85). Substantially high correlation between the 1st and 2nd measurements of venular maximum dilation was found (R(2) = 0.80). CONCLUSIONS: Measurements of the dilation response of retinal vessels to diffuse luminance flicker an Asian sample using the DVA show high reproducibility for repeated measures over a short period of time. Such measurements may allow non-invasive quantification of endothelial function to study its association with systemic and ocular diseases.

Genital and reproductive function in males after functional reconstruction of the exstrophy-epispadias complex--long-term results.

OBJECTIVES: Genital and reproductive function have a strong effect on the quality of life of adolescent and adult male patients with the exstrophy-epispadias complex (EEC). According to the limited available data, early exstrophy reconstruction, as well as recurrent infectious or operative trauma, have been responsible for the low fertility rates. METHODS: We evaluated 21 adult male patients with EEC. Of the 21 patients, 17 had undergone single-stage reconstruction, 1 had undergone a staged approach, 2 had primarily undergone urinary diversion, and 1 had only undergone external genital reconstruction of epispadias. All were evaluated with a semistructured questionnaire, clinical examination, ultrasonography, and hormonal and semen analyses. RESULTS: All patients reported erections, and 19 were sure about ejaculation. Of the 21 patients, 18 patients proved antegrade and 1 retrograde ejaculation; 2 patients were not able to retrieve their specimen. Fifteen patients had a regular testicular size, and four had unilateral and two bilateral small testes. Four had irregular intratesticular ultrasound findings. Of these 4 patients, 1 had a testicular intraepithelial neoplasia that was treated with radiotherapy. The hormonal analysis findings were normal for 17 patients and 4 had elevated follicle-stimulating hormone levels. The semen analysis showed normozoospermia in 3, asthenozoospermia in 5, oligo-asthenozoospermia in 6, and azoospermia in 5 patients. The seminal parameters included fructose 1441.8 microg/mL (normal 1200-4500), zinc 43.3 microg/mL (normal 70-250), and alpha-glucosidase 19.13 mU/mL (normal >20). CONCLUSIONS: Single-stage reconstruction with consequent placement of the colliculus seminalis in the posterior urethra results in normal ejaculation in 94.1% of patients with EEC. Because of the severely impaired sperm quality and hormonal findings, patients with EEC should be offered adequate diagnostic and treatment options.

GerES IV pilot study: assessment of the exposure of German children to organophosphorus and pyrethroid pesticides.

Organophosphorus pesticides and pyrethroids are widely used in German agriculture and residential settings. Their occurrence in human biological samples can be used as an indicator for the exposure of children to these compounds. Using multivariate evaluation the routes of exposure can be identified. In the pilot study of GerES IV, metabolites of pyrethroids and organophosporus pesticides were analysed in urine of children aged 2-17 years (n = 396 and 363). The 95th percentiles for the metabolites of the pyrethroids in urine were: cis-DCCA 0.74 microg/l, trans-DCCA 1.7 microg/l, DBCA 0.52 microg/l, F-PBA < 0.1 microg/l, and 3-PBA 2.4 microg/l. 3-PBA was detected in 90% of the samples. The 95th percentiles for the organophosphorus metabolites in urine were: DMP 118 microg/l, DEP 20 microg/l, DMTP 124 microg/l, DETP 11 microg/l, DMDTP 11 microg/l, DEDTP < 1.0microg/l. DMTP was the metabolite most frequently detected in the samples (90%). Based on the metabolites analysed in urine the exposure to organophosphorus pesticides is mainly influenced by age, consumption of fresh fruits and fruit juice, living in an urban area, and season. A rough estimation revealed that the ADI values for organophosphorus pesticides might be exceeded. However, these results require further exploration. The exposure to pyrethroids is influenced by age, sampling location, consumption of boiled vegetables, and the use of biocides indoors at home. In addition, a significant correlation between permethrin in house dust and the metabolite concentrations in urine could be observed. Thus it seems likely that ingestion of house dust contributes to children's exposure.

DEHP metabolites in urine of children and DEHP in house dust.

Urine samples from the 2001/2002 pilot study for the German Environmental Survey on children (GerES IV) were analysed for concentrations of the primary DEHP metabolite MEHP (mono(2-ethylhexyl)phthalate) and two secondary DEHP metabolites SOH-MEHP (2-ethyl-5-hydroxy-hexylphthalate) and 5oxo-MEHP (2-ethyl-5-oxo-hexylphthalate). Urine samples had been taken from 254 children aged 3 to 14. In addition, DEHP was analysed in house dust samples. These samples had been collected with vacuum cleaners in the homes of the children. The geometric mean (GM) was 7.9 microg/l for MEHP in urine, and the GMs for the secondary metabolites 5OH-MEHP and 5oxo-MEHP were 52.1 microg/l and 39.9 microg/l. 5OH-MEHP and 5oxo-MEHP concentrations were highly correlated (r = 0.98). The correlations of 5OH-MEHP and 5oxo-MEHP with MEHP were also high (r = 0.72 and r = 0.70). The concentrations of 5OH-MEHP and 5oxo-MEHP were 8.0-fold and 6.2-fold higher than the concentrations of MEHP. The ratios 5OH-MEHP/Soxo-MEHP and 5oxo-MEHP/MEHP decreased with increasing age. Boys showed higher concentrations than girls for all three metabolites of DEHP in urine. Children aged 13-14 had the lowest mean concentrations of the secondary metabolites in urine. The house dust analyses revealed DEHP contamination of all samples. The GM was 508 mg/kg dust. No correlation could be observed between the levels of any of the urinary DEHP metabolites and those of DEHP in house dust.

German Environmental Survey 1998 (GerES III): environmental pollutants in the urine of the German population.

The German Environmental Survey (GerES) is a cross-sectional probability study to determine the exposure of the general population to environmental contaminants. The study was repeated for the third time in 1998 (GerES III). Again, a stratified random procedure was used to select the study population taking into account the parameters gender, age, community size and place of residence (West- or East-Germany). A total of 4822 persons between 18 and 69 years of age from 120 localities participated in GerES III. Human biomonitoring comprised the determination of arsenic, cadmium, mercury, metabolites of polycyclic aromatic hydrocarbons (PAH), pentachlorophenol (PCP), other chlorophenols, precious metals (gold, platinum, iridium), nicotine, and cotinine in urine.

German Environmental Survey 1998 (GerES III): environmental pollutants in blood of the German population.

The German Environmental Survey was conducted for the third time in 1998 (GerES III). The probability sample of about 4800 subjects was selected to be representative for the German population with regard to region (East-/West-Germany), community size, age (18 to 69 years) and gender. Blood samples were taken from each study participant and questionnaires were used to get exposure-related information. Cadmium, lead, mercury, hexachlorobenzene (HCB), hexachlorocyclohexane (alpha-HCH, beta-HCH, gamma-HCH), 1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene (p, p'-DDE) and polychlorinated biphenyls (PCB-138, PCB-153, PCB-180) were analysed in whole blood to document the extent, distribution, and determinants of exposure of the general population to these substances. The geometric means of Cd, Pb, and Hg in blood amounted to 0.44, 31, and 0.58 microgram/l, respectively. Smokers showed a Cadmium level of 1.1 micrograms/l and non-smokers a level of 0.28 microgram/l. The geometric mean of lead was higher in the blood of males than of females (36 micrograms/l vs. 26 micrograms/l). The concentration of mercury in blood depends on fish consumption and the number of teeth with amalgam fillings. The mean concentrations of HCB and p, p'-DDE in blood were 0.44 microgram/l and 1.6 micrograms/l, respectively. In East-Germany (the former GDR) the DDE concentration in blood was more than twice as high as in West-Germany. Geometric means for PCB were 0.42, 0.68 and 0.44 microgram/l for PCB-138, PCB-153, and PCB-180, respectively. A marked increase of HCB, DDE and PCB levels with age could be observed. alpha-HCH and gamma-HCH could be detected in 1.7% and 5.2% of the samples only. beta-HCH was quantified in 34% of the samples with a 95th percentile of 0.5 microgram/l.