Estrogen and progesterone receptor concentrations and prevalence of tumor hormonal phenotypes in older breast cancer patients.

We examined the concentrations of estrogen (ER) and progesterone receptors (PR) and the distribution of tumor phenotypes as a function of age in breast cancer patients. ER and PR concentrations were determined in tissue biopsies from 1739 patients with primary breast cancer, using ligand binding assays. Tumors were classified as estrogen receptor positive (ER+) or negative (ER-) and progesterone receptor positive (PR+) or negative (PR-) based on the presence or absence of receptor binding activity. Tumors were stratified into four phenotypes: ER+PR+; ER+PR-; ER-PR+; and ER-PR-. Significant positive associations were found between ER concentration and age (p = 0.0001) and between PR concentration and age (p = 0.0002). The median ER concentrations were statistically different by age groups, with the greatest levels in older versus younger patients. The prevalence of ER+PR+ tumor phenotype increased with age. In contrast, the prevalence of ER-PR- and ER-PR+ tumor phenotypes decreased with age. The median PR-to-ER ratio decreased with age (p = 0.0001), and this trend was attributed to increased ER concentration with age. The prevalence of ER-PR- and ER-PR+ tumor phenotypes is greater in younger patients suggesting that hormonal regulation of ER gene expression may be responsible for the observed age disparity of tumor phenotypes in breast cancer.

Role of school-based health centers in referral completion.

PURPOSE: This study examined referrals from School-based health centers (SBHCs) to a sponsoring hospital to determine factors influencing successful referral completion and to assess SBHCs' ability to coordinate care. METHODS: A total of 138 referrals from eight SBHCs to Boston City Hospital between September 1993 and October 1994 were reviewed via medical records, clinic logs, and hospital registration system. A data extraction tool was used to collect information. Statistical analyses were performed to identify associations between referral completion and study variables. RESULTS: Seventy-five percent of all referrals were completed: 55.4% on the first attempt. Forty-six percent of those referred a second time completed their referrals. Statistically significant associations between referral completion and reason for referral (p = 0.01), visit diagnosis (p = 0.005), and usual source of health care (p = 0.009) were found. Provider documentation, including referral log and patient chart, was also associated with referral completion. Neither gender, race, nor health insurance had any significant association with successful referrals. CONCLUSIONS: This study suggests that SBHCs can significantly contribute to coordinated care for adolescents, especially for the uninsured and those without a source of health care. SBHCs were particularly effective at facilitating referral to specific services including: family planning, tuberculosis prophylaxis, and subspecialty care. Provider action, such as making appointments and documentation, was also an important factor.

Loss of expression of a 55 kDa nuclear protein (nmt55) in estrogen receptor-negative human breast cancer.

We have identified and characterized a 55 kDa nuclear protein (referred to as nmt55) from human breast tumors and MCF-7, human adenocarcinoma breast cell line, using site-directed monoclonal antibodies. Measurements of estrogen receptors (ER) and progesterone receptors (PR), by ligand binding assays, in cytosols of 63 human breast tumors permitted classifications of these tumors into four phenotypes (ER+/PR+, ER+/ PR-, ER-/PR-, ER-/PR+). Nuclear protein (nmt55) expression in these tumors, as determined from Western blot analyses, showed a statistically significant association (p = 0.001) with tumor hormonal phenotype. Review of the pathologic characteristics of tumors analyzed suggested that lack of nmt55 expression was significantly associated with mean tumor size (p < 0.03), mean ER (p = 0.001) and mean PR (p < 0.002), but was not associated with tumor stage, grade, or type. To further study this protein, we cloned and sequenced a 2.5 kb cDNA using a monoclonal antibody to nmt55. The complete predicted open reading frame encodes a protein with 471 amino acids and a calculated molecular mass of 54,169 Da. The deduced amino acid sequence exhibited unique regions rich in glutamine, histidine, arginine, and glutamic acid. Northern blot analysis of RNA from MCF-7 cells and ER+/PR+ human breast tumors showed a 2.6 kb mRNA. Southern blot analysis suggested the presence of a single copy of this gene. Chromosomal mapping, using fluorescent in situ hybridization (FISH), located nmt55 gene to the X chromosome, region q13. The extensive homology between nmt55 and RNA binding proteins suggested that nmt55 may be involved in hnRNA splicing. The strong association observed between expression of nmt55, tumor hormonal phenotype, mean tumor size, mean ER, and mean PR content suggests that loss of nmt55 expression may be related to events involved in hormone insensitivity, tumor differentiation, and unregulated tumor cell growth and metastases.

Assessment of stature in spinal cord injury.

Assessment of stature has been a neglected part of the medical assessment of individuals with spinal cord injury (SCI). In past studies of pulmonary function in SCI, it has not been stated how stature was assessed in order to calculate predicted pulmonary function. As part of a study of respiratory function in SCI, we examined the accuracy of self-report of stature and whether upper extremity measurements could be used to predict stature in 88 individuals with SCI. Although armspan and four other upper extremity measurements were significant predictors of length, recalled height was the best predictor. On average, for any value of armspan, an individual with complete SCI was 2.3 cm shorter than an individual with incomplete SCI. Individuals with complete SCI also had greater differences between recalled height and measured length compared with individuals with incomplete SCI, and this difference was not due to age or years since injury. It is likely that differences in bone demineralization account for the differences in length comparing individuals with complete and incomplete SCI. The 95 percent confidence intervals for predicted values of length based on armspan or recalled height were too wide for accurate calculation of predicted pulmonary function. In order to classify accurately the extent of pulmonary function abnormality, we suggest that measurements of supine length be made part of the medical assessment of individuals with SCI.

Spirometry--acceptability and reproducibility in spinal cord injured subjects.

The American Thoracic Society (ATS) has formulated guidelines for spirometry. We hypothesized that individuals with SCI (SCI), as a result of weak respiratory muscles, would exhibit poor test acceptability and reproducibility. Seventy-eight SCI subjects (39 with complete SCI) answered a respiratory questionnaire and performed spirometry. Of those with complete SCI, the proportion of subjects which met ATS criteria decreased with higher levels of injury. Poor test performance was not associated with age, respiratory symptoms or muscle fatigue. The most common reason for failing to meet ATS criteria for acceptability was excessive back extrapolated volumes (EBEV). Individuals with efforts that were acceptable except for EBEV and/or for exhalation of less than six seconds had values for forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) that were reproducible. If ATS criteria for acceptable spirometry were used in studying subjects with SCI, individuals producing otherwise reproducible values for FVC and FEV1 would be excluded. We found reproducibility similar to what has been reported in other cohorts and conclude that longitudinal study of respiratory function in SCI is feasible.

Food asphyxiation in hospitalized patients.

During a five-year period, food asphyxiation caused 1.3% of all deaths of patients who came to autopsy at a hospital for chronic diseases. Patients died suddendly, during or shortly after meals. Acute myocardial infarction was mistakenly diagnosed in eight of the 14 patients until autopsy was performed. Sedation, old age, and poor dentition predisposed to aspiration. Food asphyxiation is a common problem whenever and wherever people eat. To minimize its occurrence in hospitalized patients, sedatives should be prescribed judiciously, and diets ordered appropriately. Physicians should learn the simple methods of extracting inhaled food.