Film reading in the East Midlands Breast Screening Programme -- are we missing opportunities for earlier diagnosis?

AIM: To assess whether there are any significant differences in the film-reading histories of interval or screen-detected cancers, and whether this affects stage at diagnosis. MATERIALS AND METHODS: The rates of screen-detected and interval cancers (overall and by radiological categorization) were observed from 268,067 women screened in the East Midlands Breast Screening Programme over 2004-2007 to assess whether there were differences in incidence based on previous film-reading history. Cancers detected at the subsequent screen and film-reading history were analysed to assess whether this affected stage at diagnosis. Analysis undertaken involved cancer detection rates, confidence intervals, and chi-square tests with Monte Carlo simulation. RESULTS: Rates of interval cancers were similar in all groups where at least one reader had indicated recall to assessment (6.1-7.7/1000) and were significantly higher in comparison to women whose previous film-reading outcome was unanimous routine rescreen (2.9/1000; p < 0.001). Four point one percent of interval cancers with no previous recall outcomes were false negatives, which was significantly lower compared to the groups where at least one reader had indicated recall (10.9%; p = 0.005). Cancers detected at the subsequent screen demonstrated no significant difference in prognosis dependent on previous film-reading history (p = 0.503). CONCLUSION: The prognosis of screen-detected cancers was similar and few cancers were false negatives regardless of film-reading history at the previous screen.

Adeno-associated virus vectors show variable dependence on divalent cations for thermostability: implications for purification and handling.

Recombinant adeno-associated virus (rAAV) shows significant promise as a vector for gene transfer in pre-clinical models of human disease, and is currently being evaluated in human clinical trials. As a consequence, increasing attention is being turned to the important tasks of optimizing rAAV titer, purity, and stability. We have observed dramatic variation in divalent cation dependence for thermostability of different rAAV vectors. To further investigate this observation, the thermostability of eight different vector constructs ranging in size from 73 to 107% of wild-type genome size (4.68 kilobases) was determined in the presence and absence of divalent cations. Virions containing smaller genomes (i.e., <85% wild type) were relatively divalent cation independent for thermostability. In contrast, virions containing recombinant genomes close to, or exceeding, wild-type size (i.e., >95% wild type) were dependent on divalent cations for thermostability. Genome sequence also appeared to be a factor in the thermostability of the larger rAAV vectors. These observations are of both practical and theoretical significance. Divalent cations should be included in all buffer solutions used during rAAV purification and storage, and unnecessary heat exposure avoided. These data also demonstrate that different recombinants of a particular virus should not be assumed to possess the same thermostability profile.

Mammographic parenchymal patterns in Asian and Caucasian women attending for screening.

The breast parenchymal patterns were assessed and compared on the screening mammograms of 200 Asian and 400 Caucasian women, matched for age and between 50 and 64 years of age. The breast patterns were allocated according to Wolfe's classification. The results show a significant excess of Asians in the P1 and N1 groups and a deficit in the P2 group. Taking N1 and P1 as a low risk group and P2 and DY as a high risk group, there is a highly significant excess of Asians in the low risk group. These findings are considered in relation to the low incidence of breast cancer in Asian women and their poor acceptance of breast screening.

Management and outcome of severe head injuries in the Trent region 1985-90.

In a five year period, 39 children (29 boys, 10 girls) aged 2 months to 13 years (mean 7.8 years) were studied who had suffered a major head injury (29 road traffic accidents, six falls, and four non-accidental injury). The injury had been assessed clinically and by cranial computed tomography or cranial ultrasound (in a single baby of 2 months). Initial Glasgow coma scores for all subjects ranged from 3-11 (mean 5.5), intact survivors 5-11 (7.4), minor handicap 4-11 (6.1), major handicap 3-6 (4.3), fatalities 3-6 (4.1). All were treated with sedation, paralysis, hyperventilation (arterial carbon dioxide tension 3.0-3.5 kPa), intracranial pressure monitoring and moderate body surface hypothermia to 32 degrees C. Nine children died and 30 survived (nine intact, 13 minor disability, and eight major disability). The worst cerebral perfusion pressure was over 40 mm Hg in all but one survivor, and less than 40 mm Hg in seven of nine fatalities. Severe hypocapnia both in the first 24 hours and overall was correlated with poor outcomes (dead or major disability), as were bilateral contusions or diffuse axonal injury.

Case report: pelvic actinomycosis with the development and resolution of a recto-sigmoid stricture.

Actinomycosis is an unusual intra-abdominal infection, often mistaken for other conditions. We report a case associated with bilateral ureteric obstruction in which a recto-sigmoid stricture developed in previously normal bowel, followed by its complete resolution after treatment with antibiotics, as demonstrated by serial barium enema examinations.