An analysis of factors determining the use of breast conserving surgery for treating early-stage breast cancer.

To determine the trend of breast conserving surgery (BCS) in West Virginia and to identify patient, hospital and surgeon factors associated with use of BCS, we conducted a study of all cases of Stage I and II invasive breast cancer treated surgically in West Virginia from 1991 through 1995 (N = 2411). These records were obtained from the State Cancer Registry. Multiple logistic regression was used to generate odds ratios (or) and 95% confidence intervals (CI) to determine factors associated with BCS. Our results showed the rate of BCS increased from 25% in 1991 to 37% in 1994 and 33% in 1995, with an overall rate of 33%. Multiple logistic regression identified the following factors associated with BCS: tumor size less than 1 cm (or = 1.47, 95% C1 = 1.4, 1.5), hospital bed size > 300 beds (or = 1.3, 95% C1 = 1.05-1.6) and a surgeon who had graduated from medical school since 1981 (or = 1.2, 95% C1 = 1.0, 1.36). We conclude the rate of BCS in West Virginia still remains low and that the women least likely to have BCS were women with tumors > 2 cm treated at small hospitals by older physicians.

Treating cardiovascular disease with antimicrobial agents: a survey of knowledge, attitudes, and practices among physicians in the United States.

To assess physicians' knowledge, attitudes, and prescribing behaviors with regard to the association between Chlamydia pneumoniae and cardiovascular disease, we surveyed 750 physicians in Alaska, 1172 in West Virginia, and 569 infectious disease (ID) specialists in a nationwide network during February-May 1999. Eighty-five percent knew of the association between C. pneumoniae and atherosclerosis, but this awareness was more common among ID specialists and cardiologists than among generalists (96% vs. 77%; P<.001). Knowledge scores were significantly higher among ID specialists and cardiologists (P<.001) and among physicians who saw relatively more patients who had myocardial infarction and/or were at risk of atherosclerotic disease. Four percent of physicians had treated or recommended treating cardiovascular diseases with antimicrobial agents; this percentage was significantly higher among cardiologists, physicians who empirically treat patients with peptic ulcers with antimicrobial agents, and physicians with a relatively high knowledge score.

Long-term trends in cancer mortality rates for West Virginia.

Using data on death certificates, we examined age-adjusted cancer mortality rates for West Virginia men and women from 1980-1994. The leading causes of cancer deaths among men in the state in 1994 were cancers of the lung, prostate, colon, and pancreas, and non-Hodgkin's lymphoma. Among West Virginia women in 1994, cancer deaths were most often due to cancers of the lung, breast, colon, pancreas, and ovary. Based on polynomial regression analyses, many of the leading cancer mortality rates significantly increased during 1980-1994. The most striking increase was a 76% rise in lung cancer mortality among West Virginia women. These mortality data underscore the continuing need for tobacco control and other cancer control practices. Even though barriers to medical care challenge the state's health care professionals, the burden of cancer in West Virginia can be reduced by prevention, early detection, and appropriate treatment.

A multistate outbreak of oyster-associated gastroenteritis: implications for interstate tracing of contaminated shellfish.

In November 1993, clusters of gastroenteritis in six states following oyster consumption were investigated to identify common features, and stool samples were obtained to identify a pathogen. Efforts were made to account for all potentially contaminated oysters using harvest tags and the interstate recall system. Consumption of oysters was associated with illness in 10 clusters; no other food was implicated. A Norwalk-like virus was detected by electron microscopy in 9 of 18 samples and by reverse transcription-polymerase chain reaction in 20 of 26 samples from 6 clusters. Nucleotide sequences of a 123-bp fragment from all specimens were identical, consistent with a common source outbreak. Implicated oysters were harvested from the Louisiana coast between 9 and 12 November. Although some were recalled and destroyed, most oysters harvested from the area during this time remain unaccounted for. Current regulations and commercial practices need to be revised to permit thorough tracing and recall of contaminated oysters and to improve control of future epidemics.

Purification of hexabrachion (tenascin) from cell culture conditioned medium, and separation from a cell adhesion factor.

We describe a protocol for purifying hexabrachion from conditioned medium of cell cultures, using gel filtration chromatography on Sephacryl 500, followed by anion-exchange chromatography on a Mono Q column, followed optionally by a second gel filtration or zone sedimentation on glycerol gradients. The protocol has several advantages over previous procedures based on affinity chromatography on monoclonal antibodies. Perhaps foremost, the protein is never exposed to the denaturing solvents that are required for elution from the antibody column. The Mono Q column also separated hexabrachion from a prominent cell adhesion activity that eluted with the hexabrachion on the first gel filtration, and co-sedimented with hexabrachions on glycerol gradients. The cell adhesion fractions showed several bands between 190 and 400 kDa. A single band at 220 kDa stained prominently with a polyclonal antibody against mouse EHS laminin, and a band at 190 kDa stained with a monoclonal antibody against s-laminin. The purification protocol gave hexabrachion at high concentration and with no detectable contamination by fibronectin or laminin. The highest yield of hexabrachion (1-4 mg from 400 ml of conditioned medium) was from human glioblastoma cell cultures, but the same procedure allowed us to purify and characterize the rat hexabrachion. Protein purified from primary cultures of rat embryo fibroblasts showed approximately equal amounts of three subunit sizes: 280, 230, and 220 kDa. These different subunits, presumably derived from alternative RNA splicing, appeared to be segregated into large and small hexabrachions, which could be separated on glycerol gradients.

Characterization of nerve growth factor receptor in neural crest tumors using monoclonal antibodies.

The nerve growth factor (NGF) receptor was characterized by using a new series of anti-receptor monoclonal antibodies (MAbs). These MAbs (i) showed significantly greater reactivity with a melanoma cell line expressing higher levels of NGF receptor, (ii) inhibited the binding of 125I-labeled NGF to its receptor, and (iii) immunoprecipitated both metabolically labeled and 125I-labeled NGF affinity-labeled receptor. These experiments defined the receptor as a 75-kDa cell-surface protein. The NGF receptor was visualized by immunoperoxidase staining in tissue sections of human nevi, melanomas, neurofibromas, a pheochromocytoma, and peripheral nerves. Uniform staining of the cytoplasm suggests that, in addition to cell-surface NGF receptors, there is a population of intracellular receptors.