After a peak in the late 1980s, cancer mortality in Europe has declined by ∼10% in both sexes up to the early 2000s. We provide an up-to-date picture of patterns and trends in mortality from major ...cancers in Europe.
We analyzed cancer mortality data from the World Health Organization for 25 cancer sites and 34 European countries (plus the European Union, EU) in 2005–2009. We computed age-standardized rates (per 100 000 person-years) using the world standard population and provided an overview of trends since 1980 for major European countries, using joinpoint regression.
Cancer mortality in the EU steadily declined since the late 1980s, with reductions by 1.6% per year in 2002–2009 in men and 1% per year in 1993–2009 in women. In western Europe, rates steadily declined over the last two decades for stomach and colorectal cancer, Hodgkin lymphoma, and leukemias in both sexes, breast and (cervix) uterine cancer in women, and testicular cancer in men. In central/eastern Europe, mortality from major cancer sites has been increasing up to the late 1990s/early 2000s. In most Europe, rates have been increasing for lung cancer in women and for pancreatic cancer and soft tissue sarcomas in both sexes, while they have started to decline over recent years for multiple myeloma. In 2005–2009, there was still an over twofold difference between the highest male cancer mortality in Hungary (235.2/100 000) and the lowest one in Sweden (112.9/100 000), and a 1.7-fold one in women (from 124.4 in Denmark to 71.0/100 000 in Spain).
With the major exceptions of female lung cancer and pancreatic cancer in both sexes, in the last quinquennium, cancer mortality has moderately but steadily declined across Europe. However, substantial differences across countries persist, requiring targeted interventions on risk factor control, early diagnosis, and improved management and pharmacological treatment for selected cancer sites.
Objectif Le dépistage des autoanticorps anti-H+/K+ ATPase n’est pas couramment recommandé chez les jeunes ayant un diabète de type 1 (DT1) et leur présence est généralement asymptomatique. Nous ...rapportons les résultats de la recherche de ces anticorps chez des jeunes DT1, ainsi que deux cas où des symptômes cliniques ont conduit au diagnostic de gastrite auto-immune. Patients et méthodes Différents autoanticorps ont été recherchés chez 337 enfants et adolescents DT1 : autoanticorps spécifiques de la cellule bêta (ICA, anti-IAA, anti-GAD, anti-IA2, anti-ZnT8), antithyroperoxydase (TPO), antithyroglobuline (TG), anti-H+/K+ ATPase, anti-transglutaminase, anti-Saccharomyces Cerevisiae (ASCA), anti-cytoplasme des polynucléaires neutrophiles (ANCA), anti-AIE 75 (entéropathie auto-immune). Résultats Sur 337 patients (garçons/filles, 51/49 %) ayant au moins un anticorps spécifique de la cellule bêta, 23 (6,8 %) présentaient des autoanticorps anti-H+/K+ ATPase (garçons/filles, 35,6/68,4 %). Huit patients (35 %) présentaient au moins un autre autoanticorps : anti-TPO et/ou anti-TG chez 22 %, anti-transglutaminase chez 4,4 %, anti-ASCA dans deux cas. Chez deux patients, les anticorps anti-H+/K+ ATPase ont été trouvés associés à des symptômes cliniques. Un garçon de 11 ans (HLA DQB0201), présentant un DT1 depuis 5,5 ans, des anticorps anti-GAD et anti-ZnT8, a développé des douleurs épigastriques évoquant une gastrite. Chez la 2e patiente de 13 ans (HLA DR 4–4), présentant un DT1 depuis 4,5 ans, des anticorps anti-GAD, anti-IA2 et antithyroide (TSH 4,3 mU/l), une anémie ferriprive a été découverte fortuitement et la fibroscopie a montré des signes de gastrite auto-immune. Conclusion La gastrite auto-immune associée au DT1 est généralement asymptomatique (marquée seulement par la présence d’autoanticorps anti-H+/K+ ATPase), mais peut parfois être révélée par des douleurs épigastriques ou une anémie ferriprive. L’association de multiples autoanticorps reflète une perte de tolérance immunitaire vis-à-vis d’un large répertoire d’autoantigènes et pourrait permettre de définir des sous-populations différentes de patients présentant un DT1.
Between the 1970s and 2000 mortality in most of Latin America showed favorable trends for some common cancer sites, including stomach and male lung cancer. However, major concerns were related to ...mortality patterns from other cancers, particularly in women. We provide an up-to-date picture of patterns and trends in cancer mortality in Latin America.
We analyzed data from the World Health Organization mortality database in 2005–2009 for 20 cancer sites in 11 Latin American countries and, for comparative purposes, in the USA and Canada. We computed age-standardized (world population) rates (per 100 000 person-year) and provided an overview of trends since 1980 using joinpoint regression models.
Cancer mortality from some common cancers (including colorectum and lung) is still comparatively low in Latin America, and decreasing trends continue for other cancer sites (including stomach, uterus, male lung cancers) in several countries. However, there were upward trends for colorectal cancer mortality for both sexes, and for lung and breast cancer mortality in women from most countries. During the last decade, lung cancer mortality in women rose by 1%–3% per year in all Latin American countries except Mexico and Costa Rica, whereas rises of about 1% were registered for breast cancer in Brazil, Colombia and Venezuela. Moreover, high mortality from cancer of the cervix uteri was recorded in most countries, with rates over 13/100 000 women in Cuba and Venezuela. In men, upward trends were registered for prostate cancer mortality in Brazil and Colombia, but also in Cuba, where the rate in 2005–2009 was more than twice that of the USA (23.6 versus 10/100 000).
Tobacco control, efficient screening programs, early cancer detection and widespread access to treatments continue to be a major priority for cancer prevention in most Latin American countries.
Aims/hypothesis The aim of the study was to examine the 48 month outcome of treating recent-onset type 1 diabetic patients for 6 days with humanised CD3-antibody, ChAglyCD3. Methods Eighty patients, ...aged 12-39 years, were recruited for a phase 2 multicentre trial and randomised to placebo (n = 40) or ChAglyCD3 (n = 40) treatment by a third party member; participants and care-givers were blinded. The change in insulin dose (U kg⁻¹ day⁻¹) over 48 months was chosen as primary endpoint and compared in 31 placebo- and 33 ChAglyCD3-treated patients. Adverse events were followed in 35 and 38 patients, respectively. Results Treatment with ChAglyCD3 delayed the rise in insulin requirements of patients with recent-onset diabetes and reduced its amplitude over 48 months (+0.09 vs +0.32 U kg⁻¹ day⁻¹ in the placebo group). Using multivariate analysis this effect was correlated with higher baseline residual beta cell function and a younger age. It was associated with better outcome variables in subgroups selected according to these variables. In the ChAglyCD3 subgroup with higher initial beta cell function, 0/11 patients became C-peptide-negative over 48 months vs 4/9 in the corresponding placebo subgroup. In the subgroup aged <27 years old, antibody treatment preserved initial beta cell function for 36 months (vs >80% decline within 24 months in the placebo subgroup <27 years old), resulted in lower HbA₁c concentrations and tended to reduce glycaemic variability (p = 0.08). No long-term adverse events were observed. Conclusions/interpretation A 6 day ChAglyCD3 treatment can suppress the rise in insulin requirements of recent-onset type 1 diabetic patients over 48 months, depending on their age and initial residual beta cell function. In younger patients this effect is associated with reduced deterioration of metabolic variables. These observations help to define inclusion criteria for prevention trials. Trial registration: ClinicalTrials.gov NCT00627146 Funding: Center grants from the Juvenile Diabetes Research Foundation (4-2001-434, 4-2005-1327) and grants from the Belgian Fund for Scientific Research-Flanders and from Brussels Free University-VUB.
Background
Epidemiological data on infant feeding practices and allergic diseases are controversial. The purpose of this study was to explore the association of early weaning with the occurrence of ...atopic dermatitis (AD).
Methods
We conducted a matched case–control study on incident physician‐diagnosed AD in early childhood including 451 cases and 451 controls. Data on several factors, including feeding practices, were collected through an interviewer‐administered questionnaire. Odds ratios (OR) and the corresponding 95% confidence intervals (CIs) were estimated through logistic regression models, conditioned on study center, age, sex, and period of interview, and adjusted for potential confounders.
Results
Early weaning, defined as the introduction of solid foods at 4 or 5 months of age, was inversely related to the risk of AD, with children weaned at 4 months having lower AD risk (OR = 0.41, 95% CI, 0.20–0.87) compared to those exclusively breastfed. Similar results were observed for weaning started at 5 months of age (OR = 0.39, 95% CI, 0.18–0.83). This association persisted when children with and without family history of allergy were considered separately. Prolonged partial breastfeeding (breastmilk plus milk formulas) was not associated with AD. Consistently, the introduction of a high number of different solid foods reduced the risk of AD (P trend = 0.02 at 4 months of age and P trend = 0.04 at 5 months).
Conclusion
Our data provide evidence against the preventing role of prolonged exclusive (but not partial) breastfeeding in AD occurrence and confirm recent results indicating a beneficial role of early weaning in AD.
The steadily increasing frequency of insulin-dependent diabetes in several countries is best explained today by the decline of infections. Epidemiologic and animal data support this conclusion, ...which, however, requires confirmation by intervention trials in man. The mechanisms of the protective effect of infections on diabetes onset are diverse including competition for homeostatic factors and stimulation of regulatory T cells and of Toll-like receptors. These considerations might have interesting therapeutic applications for the prevention of the disease.
To compare intensivist-diagnosed ventilator-associated pneumonia (iVAP) with four established definitions, assessing their agreement in detecting new episodes.
A multi-centric prospective study on ...pulmonary microbiota was carried out in patients requiring mechanical ventilation (MV). Data collected were used to compare hypothetical VAP onset according to iVAP with the study consensus criteria, the European Centre for Disease Control and Prevention definition, and two versions of the latter adjusted for leukocyte count and fever.
In our cohort of 186 adult patients, iVAPs were 36.6% (68/186, 95% confidence interval 30.0–44.0%), with an incidence rate of 4.64/100 patient-MV-days, and median MV-day at diagnosis of 6. Forty-seven percent of patients (87/186) were identified as VAP by at least one criterion, with a median MV-day at diagnosis of 5. Agreement between intensivist judgement (iVAP/no-iVAP) and the criteria was highest for the study consensus criteria (50/87, 57.4%), but still one-third of iVAP were not identified and 9% of patients were identified as VAP contrary to intensivist diagnosis. VAP proportion differed between criteria (25.2–30.1%).
Caution is needed when evaluating studies describing VAP incidence. Pre-agreed criteria and definitions that capture VAP's evolving nature provide greater consistency, but new clinically driven definitions are needed to align surveillance and diagnostic criteria with clinical practice.
Background: Data and statistics on cancer mortality over the last decades are available for most developed countries, while they are more difficult to obtain, in a standardized and comparable format, ...for countries of Latin America. Patients and methods: Age standardized (world population) mortality rates around the year 2000, derived from the WHO database, are presented for 14 selected cancers and total cancer in 10 countries of Latin America, plus, for comparative purposes, Canada and the USA. Trends in mortality are also given over the period 1970–2000. Results: In 2000, the highest total cancer mortality for males was observed in Argentina and Chile, with rates comparable to those of Canada and the USA, i.e. about 155/100 000. For women, Chile and Cuba had the highest rates in Latin America (114 and 103/100 000, respectively), again comparable to those of North America (around 105/100 000). These reflect the comparatively high mortality from cancer of the stomach (for Chile), lung and intestines (for Argentina) in men, and of stomach and uterus (for Chile), intestines and lung (for Cuba) in women. Colombia, Ecuador and Mexico had the lowest total cancer mortality for men, due to low mortality from stomach, colorectal and lung cancer. For women, the lowest rates were in Brazil and Puerto Rico, reflecting their low stomach and cervical cancer rates. In Argentina, Chile, Colombia, Costa Rica and Venezuela cancer mortality rates tended to decline, particularly in men. Rates were stable in Ecuador and Puerto Rico, and were increasing in Mexico and Cuba. Conclusions: Mortality from some common cancers (including colorectal and lung) is still low in Latin America compared with Canada and the USA, and decreasing trends have been observed in the last decades for some cancer sites (including stomach, uterus, lung and other tobacco-related cancers) in several countries. However, mortality from female lung and breast cancers has been increasing in most countries of Latin America, and several countries still show an extremely elevated mortality from cancer of the cervix. Selected neoplasms amenable to treatment, including testis and leukemias, also show unsatisfactory trends in Latin America.
Assessment of donor-specific alloreactive memory/effector T cell responses using an IFN-gamma Elispot assay has been suggested to be a novel immune-monitoring tool for evaluating the cellular immune ...risk in renal transplantation. Here, we report the cross-validation data of the IFN-gamma Elispot assay performed within different European laboratories taking part of the EU RISET consortium. For this purpose, development of a standard operating procedure (SOP), comparisons of lectures of IFN-gamma plates assessing intra- and interlaboratory assay variability of allogeneic or peptide stimuli in both healthy and kidney transplant individuals have been the main objectives. We show that the use of a same SOP and count-settings of the Elispot bioreader allow low coefficient variation between laboratories. Frozen and shipped samples display slightly lower detectable IFN-gamma frequencies than fresh samples. Importantly, a close correlation between different laboratories is obtained when measuring high frequencies of antigen-specific primed/memory T cell alloresponses. Interestingly, significant high donor-specific alloreactive T cell responses can be similarly detected among different laboratories in kidney transplant patients displaying histological patterns of acute T cell mediated rejection. In conclusion, assessment of circulating alloreactive memory/effector T cells using an INF-gamma Elispot assay can be accurately achieved using the same SOP, Elispot bioreader and experienced technicians in kidney transplantation. Using a set of standardized operating procedures investigators can accurately assess circulating alloreactive memory/effector T cells in the context of kidney transplantation. See more in the CTOT series, pages 1859-1904. PUBLICATION ABSTRACT
La chimiokine CXCL10 induite par l’interféron γ serait impliquée dans la physiopathologie de la pneumopathie interstitielle diffuse (PID) de la sclérodermie systémique (ScS). L’objectif de cette ...étude était d’évaluer les taux sériques de CXCL10 chez des patients ayant une ScS.
CXCL10 a été dosée par méthode Elisa dans le sérum de 23 volontaires sains (médiane : 60,0
ans ; 58,0–67,3) et 29 patients atteints de ScS (63,1 ans ; 60,1–69,4). Ces derniers ont également eu des explorations fonctionnelles respiratoires, un examen tomodensitométrique du thorax et une échographie cardiaque. Les taux de CXCL10 (médiane et interquartile 25–75 %) ont été comparés entre patients et volontaires sains, et entre patients avec et sans PID.
Les patients avaient un taux sérique médian de CXCL10 plus élevé que les volontaires sains (110,0
pg/ml ; 60,8–223,8
pg/ml contre 52,0
pg/ml ; 41,3–65,8 ;
p
<
0,001). Chez les 15 patients ayant une PID à l’imagerie, le taux sérique de CXCL10 était plus élevé que chez les autres patients (210,0
pg/ml ; 115,0–307,5 contre 76,0 ; 55,0–110,0 ;
p
=
0,02).
Ces résultats montrent l’implication de CXCL10 dans la physiopathologie de la ScS et suggèrent plus particulièrement une relation à la PID rencontrée au cours de cette maladie.
CXCL10, a γ-interferon-induced chemokine seems to play a relevant role in lung involvement that occurs in systemic sclerosis (SSc). The objective of this study was to assess the serum level of CXCL10 in interstitial lung disease (ILD) associated with SSc.
Serum level of CXCL10 was assayed in 23 healthy volunteers (60.0 years; 58.0–67.3) and 29 SSc patients (63.1 years; 60.1–69.4) by ELISA method. Pulmonary function tests (PFTs), lung CT-scan and echocardiogram were also performed in the patients. Serum levels from patients and healthy controls were compared and a comparison among SSc patients between those with and without ILD, as documented by lung CT-scan, was also performed.
Median CXCL10 level from patients with SSc was significantly higher than that from healthy volunteers (110.0
pg/ml; 60.8–223.8 versus 52.0; 41.3–65.8;
p
<
0.001). Fifteen out of the 29 patients had ILD on lung CT-scan; the median CXCL10 level from SSc patients with ILD was significantly higher than that from SSc patients without ILD (210.0
pg/ml; 115.0–307.5 versus 76.0; 55.0–110.0;
p
=
0.02).
Our findings suggest that CXCL10 is specifically increased in the lung involvement of SSc and plays a role in scleroderma lung disease.
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