Evaluation of metallothionein and p53 expression as potential prognostic markers for laryngeal squamous cell carcinoma.

The aim of the study was to determine the contribution of metallothionein (MT) and p53 expression in predicting laryngeal squamous cell carcinoma (SCC) recurrence. This was a retrospective study in which MT and p53 immunopositive staining in 32 laryngeal SCC paraffin-embedded sections, were correlated with clinical recurrence. Recurrence was observed in 8 cases with MT expression (42.1%) and 1 case with no expression (7.7%). Moderate and strong MT expression was associated with 14.3% and 58.3% recurrence, respectively. Recurrence was similar for both p53-negative (21.1%) and p53-positive (27.3%) groups. One third of the patients expressing both p53 and MT simultaneously had recurrence. Thus, the combined expression of p53 and MT did not improve the predictive value for recurrence compared to MT alone. MT over-expression may be an independent risk factor for laryngeal SCC recurrence.

High blood pressure knowledge in an urban African-American community.

OBJECTIVE: To determine the level and determinants of knowledge of the risks for hypertension and the potential for its prevention in an urban African-American community. METHODS: In a survey of 397 African-American adults (18-73 years of age) at an urban community fair, we measured high blood pressure knowledge using a 12-item questionnaire designed at NIH for the assessment of high blood pressure knowledge among non-medical persons. RESULTS: The mean high blood pressure knowledge score for the overall sample was 83.1%. There were subgroup differences in the scores with significant associations between high blood pressure knowledge score and level of education (P = .002) and a personal history of hypertension (P = .009). CONCLUSION: We concluded that the participants exhibited a high, but variable, level of high blood pressure knowledge with a higher level of education and/or a personal history of hypertension having a significant association with greater blood pressure knowledge. The effects of the magnitude and mode of acquisition of high blood pressure knowledge on the control of high blood pressure and its related outcomes need to be examined in further studies.

Estrogen replacement therapy use in minority postmenopausal women.

OBJECTIVE: To determine the use of estrogen replacement therapy (ERT), and awareness of relative benefits and risks of ERT in under-served minority postmenopausal women. DESIGN: Survey. SETTING: General medical and geriatric clinics of an acute care teaching hospital in south central Los Angeles. PARTICIPANTS: Convenience sample of 155 postmenopausal women. MEASUREMENTS: Current and past ERT use, awareness of risks and benefits, reasons for not using ERT. RESULTS: Of the 143 African-American and Hispanic postmenopausal women, only 16% reported current ERT use. Of the 111 women who have never taken ERT, 86% responded that their physicians have not discussed ERT with them. Fifteen percent of the women were aware of the coronary artery disease (CAD) benefit, and 22% were aware of the osteoporosis benefit. Eighteen percent were aware of the relative risk of endometrial cancer. CONCLUSION: Over 80% of the under-served postmenopausal women surveyed in our clinics were not receiving ERT, and most were unaware of the benefits and risks of ERT. Lack of physician discussion was cited as the primary reason. Special educational efforts to improve physician counseling practices for ERT in this and similar populations need to be developed.

Computer-aided, case-based diagnosis of mammographic regions of interest containing microcalcifications.

RATIONALE AND OBJECTIVES: The purpose of this study was to evaluate the effectiveness of a mapped-database diagnostic system in reducing the incidence of benign biopsies and misdiagnosed cancers among mammographic regions of interest (ROIs). MATERIALS AND METHODS: A novel neural network was devised (a) to respond to a query ROI by recommending to biopsy or not to biopsy and (b) to map each ROI in the database as a dot on a computer screen. The network was designed so that clusters in the array of dots help the radiologist to find proved ROIs visually similar to the query ROI. This mapped-database diagnostic system was restricted to ROIs with visible microcalcifications. The neural network was trained with a stored database of 80 biopsy-proved ROIs. RESULTS: Four radiologists acting independently on 100 ROIs recommended biopsies for 18, 15, 28, and 18 benign ROIs and misdiagnosed cancers in 11, 12, 7, and eight ROIs, respectively. Interaction with the mapped-database system reduced the numbers of benign biopsies to 11, eight, 18, and 10 cases and of misdiagnosed cancers to eight, seven, four, and three cases, respectively. Statistical analysis indicated that three radiologists achieved significant improvements at P < or = .02 and the fourth achieved a substantial improvement at P < or = .07. CONCLUSION: By using a mapped database of proved mammographic ROIs containing microcalcifications, radiologists may statistically significantly reduce the numbers of benign biopsies and misdiagnosed cancers.

Hormone replacement therapy use in urban older women attending meal sites: associations with sociodemographic and health characteristics and use of preventive services.

OBJECTIVE: To examine sociodemographic, health and preventive health practices associated with hormone replacement therapy (HRT) use in urban community-dwelling older women. DESIGN: Survey. SETTING: Community-based meal sites throughout the city of Los Angeles. PARTICIPANTS: A convenience sample of 705 community-dwelling women older than age 60 who completed questionnaires for the Prevention for Elderly Persons Program. MEASUREMENTS: Demographic and life style characteristics, functional status, preventive practices, and current and past use of HRT. RESULTS: Among the 705 women surveyed, 13% reported current use and 17% reported past use of HRT. Current users were more likely to be younger and more likely to report a history of osteoporosis, hysterectomy, and calcium use than never users. White women were more likely to be current users than black women. CONCLUSIONS: Only a small proportion of the older urban women studied are currently using HRT. In particular, efforts to increase the use of these preventive services need to focus on black women and women who do not have a prior history of osteoporosis.

Comparison of the entropy technique with two other techniques for detecting disease clustering using data from children with high blood lead levels.

The entropy technique was compared with two other case-control techniques for detecting disease clustering using data on blood lead levels of children who were patients at the King/Drew Medical Center in South-Central Los Angeles in 1991 to 1994. The other two methods are the nearest neighbor technique (NNT) and Moran's IPOP technique, a variation of Moran's I test, in which rates are adjusted for population size. Four different blood lead levels (15 microg/dl, 20 microg/dl, 30 microg/dl, 35 microg/dl) were used as cutoff levels to designate cases. Persons with blood lead levels greater than or equal to the cutoff level were designated as cases. The authors found significant clustering for all four cutoff levels using the entropy method, and for the first three cutoff levels using the NNT. They found significant clustering with Moran's IPOP for some scales for two of the cutoff levels. While performance of the entropy technique and the NNT were independent of scale, that of Moran's IPOP was highly scale-dependent.

Zidovudine therapy, CD4+ and CD8+ counts are associated with a longer survival following AIDS onset.

In 60 patients followed from the onset of acquired immunodeficiency syndrome (AIDS) to death, survival was determined by Cox Proportional Hazards Analysis in relationship to seven variables: time-dependent CD4+ and CD8+ peripheral lymphocyte counts, zidovudine treatment, cytomegalovirus (CMV) retinitis, time from AIDS onset, calendar year of AIDS onset (cohort effect), and age. Two significant prognostic variables were identified: zidovudine therapy and either CD4+ or CD8+ counts (the latter could not be distinguished due to concomitant high correlation). Treatment with zidovudine reduced the death rate by 75% compared to no treatment. When included in a proportional hazards regression with all covariates except for the other T lymphocyte count, every increase in CD4+ count of 10 cells was equivalent to a decline in the mortality rate by 13% (p = 0.046), and every increase in CD8+ count of 10 cells lowered the mortality by 1.4% (p = 0.0031). Patients treated with zidovudine and without CMV retinitis showed the slowest decline of both CD4+ and CD8+ counts. Both CD4+ and CD8+ levels are useful predictors of survival in patients with AIDS.

Clustering of giardiosis among AIDS patients in Los Angeles County.

The purpose of this study was to determine the mode of the spread of the enteric parasitic infections among HIV+/AIDS patients attending the AIDS clinic of the King/Drew Medical Center in Los Angeles. Two hundred forty three patients diagnosed with HIV+/AIDS agreed to participate. The study was conducted by several interviews, questionnaires and stool sample collections over a one year period. Stool samples were processed for protozoan cysts and Helminth Ova using standard stool concentration and staining techniques. An indirect immunofluorescence monoclonal antibody technique was also used as an alternate to detect the parasites in samples. Forty three cases were positive for Giardia Lamblia (17.7%) and 10 cases were positive for Cryptosporidium (4%). No Helminth Ova were detected. The majority of the participants were African-American (72.6%) and 27.6% were Hispanic. Clustering studies were performed to determine the mechanism of spread of the parasites among the population study. The Nearest Neighbor Clustering Technique (NNT) was used to determine if there was spatial clustering of positive cases. Geocoding with the MapInfo Program was performed to determine the precise coordinates of the residence of the subjects. Application of the NNT showed a high degree of clustering for Giardia. The NNT statistic for Giardia was significant with the p value for 0.020 using the Simes multiple comparisons correction. Examination of the map plots indicated that there were two areas with high Giardia prevalence, one in Hollywood region, the other in South-Central Los Angeles. The odds ratio for sexual orientation was 14.2 (for homosexuals vs heterosexuals) with a p value of less than 0.001. These findings strongly suggest that male homosexual contact was the main mode of transmission of observed Giardia cases.