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Background: Completeness of recording for cancer stage at diagnosis is often historically poor in cancer registries, making it challenging to provide long-term stage-specific survival estimates. Stage-specific survival differences are driven by differences in short-term prognosis, meaning estimated survival metrics using period analysis are unlikely to be sensitive to imputed historical stage data.Methods: We used data from the Surveillance, Epidemiology, and End Results (SEER) Program for lung, colon and breast cancer. To represent missing data patterns in less complete registry data, we artificially inflated the proportion of missing stage information conditional on stage at diagnosis and calendar year of diagnosis. Period analysis was applied and missing stage at diagnosis information was imputed under four different conditions to emulate extreme imputed stage distributions.Results: We fit a flexible parametric model for each cancer stage on the excess hazard scale and the differences in stage-specific marginal relative survival were assessed. Estimates were also obtained from non-parametric approaches for validation. There was little difference between the 10-year stage-specific marginal relative survival estimates, regardless of the assumed historical stage distribution.Conclusions: When conducting a period analysis, multiple imputation can be used to obtain stage-specific long-term estimates of relative survival, even when the historical stage information is largely incomplete. [ABSTRACT FROM AUTHOR]

Merkel cell polyomavirus (MCPyV) is the only human polyomavirus currently known to cause human cancer. MCPyV is believed to be an etiological factor in at least 80% of cases of the rare but aggressive skin malignancy Merkel cell carcinoma (MCC). In these MCPyV+ MCC tumors, clonal integration of the viral genome results in the continued expression of two viral proteins: the viral small T antigen (ST) and a truncated form of the viral large T antigen. The oncogenic potential of MCPyV and the functional properties of the viral T antigens that contribute to neoplasia are becoming increasingly well-characterized with the recent development of model systems that recapitulate the biology of MCPyV+ MCC. In this review, we summarize our understanding of MCPyV and its role in MCC, followed by the current state of both in vitro and in vivo model systems used to study MCPyV and its contribution to carcinogenesis. We also highlight the remaining challenges within the field and the major considerations related to the ongoing development of in vitro and in vivo models of MCPyV+ MCC. [ABSTRACT FROM AUTHOR]

Human papillomaviruses (HPVs) cause a substantial amount of human disease from benign disease such as warts to malignant cancers including cervical carcinoma, head and neck cancer, and non-melanoma skin cancer. Our ability to model HPV-induced malignant disease has been impeded by species specific barriers and pre-clinical animal models have been challenging to develop. The recent discovery of a murine papillomavirus, MmuPV1, that infects laboratory mice and causes the same range of malignancies caused by HPVs provides the papillomavirus field the opportunity to test mechanistic hypotheses in a genetically manipulatable laboratory animal species in the context of natural infections. The E6 and E7 proteins encoded by high-risk HPVs, which are the HPV genotypes associated with human cancers, are multifunctional proteins that contribute to HPV-induced cancers in multiple ways. In this review, we describe the known activities of the MmuPV1-encoded E6 and E7 proteins and how those activities relate to the activities of HPV E6 and E7 oncoproteins encoded by mucosal and cutaneous high-risk HPV genotypes. [ABSTRACT FROM AUTHOR]

The Clinical Practice Research Datalink (CPRD) is a widely used data resource, representative in demographic profile, with accurate death recordings but it is unclear if mortality rates within CPRD GOLD are similar to rates in the general population. Rates may additionally be affected by selection bias caused by the requirement that a cohort have a minimum lookback window, i.e. observation time prior to start of at-risk follow-up. Standardised Mortality Ratios (SMRs) were calculated incorporating published population reference rates from the Office for National Statistics (ONS), using Poisson regression with rates in CPRD GOLD contrasted to ONS rates, stratified by age, calendar year and sex. An overall SMR was estimated along with SMRs presented for cohorts with different lookback windows (1, 2, 5, 10 years). SMRs were stratified by calendar year, length of follow-up and age group. Mortality rates in a random sample of 1 million CPRD GOLD patients were slightly lower than the national population [SMR = 0.980 95% confidence interval (CI) (0.973, 0.987)]. Cohorts with observational lookback had SMRs below one [1 year of lookback; SMR = 0.905 (0.898, 0.912), 2 years; SMR = 0.881 (0.874, 0.888), 5 years; SMR = 0.849 (0.841, 0.857), 10 years; SMR = 0.837 (0.827, 0.847)]. Mortality rates in the first two years after patient entry into CPRD were higher than the general population, while SMRs dropped below one thereafter. Mortality rates in CPRD, using simple entry requirements, are similar to rates seen in the English population. The requirement of at least a single year of lookback results in lower mortality rates compared to national estimates. [ABSTRACT FROM AUTHOR]

Background: A lack of available data and statistical code being published alongside journal articles provides a significant barrier to open scientific discourse, and reproducibility of research. Information governance restrictions inhibit the active dissemination of individual level data to accompany published manuscripts. Realistic, high-fidelity time-to-event synthetic data can aid in the acceleration of methodological developments in survival analysis and beyond by enabling researchers to access and test published methods using data similar to that which they were developed on.Methods: We present methods to accurately emulate the covariate patterns and survival times found in real-world datasets using synthetic data techniques, without compromising patient privacy. We model the joint covariate distribution of the original data using covariate specific sequential conditional regression models, then fit a complex flexible parametric survival model from which to generate survival times conditional on individual covariate patterns. We recreate the administrative censoring mechanism using the last observed follow-up date information from the initial dataset. Metrics for evaluating the accuracy of the synthetic data, and the non-identifiability of individuals from the original dataset, are presented.Results: We successfully create a synthetic version of an example colon cancer dataset consisting of 9064 patients which aims to show good similarity to both covariate distributions and survival times from the original data, without containing any exact information from the original data, therefore allowing them to be published openly alongside research.Conclusions: We evaluate the effectiveness of the methods for constructing synthetic data, as well as providing evidence that there is minimal risk that a given patient from the original data could be identified from their individual unique patient information. Synthetic datasets using this methodology could be made available alongside published research without breaching data privacy protocols, and allow for data and code to be made available alongside methodological or applied manuscripts to greatly improve the transparency and accessibility of medical research. [ABSTRACT FROM AUTHOR]

Background: When quantifying the probability of survival in cancer patients using cancer registration data, it is common to estimate marginal relative survival, which under assumptions can be interpreted as marginal net survival. Net survival is a hypothetical construct giving the probability of being alive if it was only possible to die of the cancer under study, enabling comparisons between populations with differential mortality rates due to causes other the cancer under study. Marginal relative survival can be estimated non-parametrically (Pohar Perme estimator) or in a modeling framework. In a modeling framework, even when just interested in marginal relative survival it is necessary to model covariates that affect the expected mortality rates (e.g. age, sex and calendar year). The marginal relative survival function is then obtained through regression standardization. Given that these covariates will generally have non-proportional effects, the model can become complex before other exposure variables are even considered.Methods: We propose a flexible parametric model incorporating restricted cubic splines that directly estimates marginal relative survival and thus removes the need to model covariates that affect the expected mortality rates. In order to do this the likelihood needs to incorporate the marginal expected mortality rates at each event time taking account of informative censoring. In addition time-dependent weights are incorporated into the likelihood. An approximation is proposed through splitting the time scale into intervals, which enables the marginal relative survival model to be fitted using standard software. Additional weights can be incorporated when standardizing to an external reference population.Results: The methods are illustrated using national cancer registry data. In addition, a simulation study is performed to compare different estimators; a non-parametric approach, regression-standardization and the new marginal relative model. The simulations study shows the new approach is unbiased and has good relative precision compared to the non-parametric estimator.Conclusion: The approach enables estimation of standardized marginal relative survival without the need to model covariates that affect expected mortality rates and thus reduces the chance of model misspecification. [ABSTRACT FROM AUTHOR]

Objective: Topical sinonasal rinse therapies may alter the local microbiome and improve disease control in chronic rhinosinusitis (CRS). The objective of this study was to examine microbiome changes in post‐surgical CRS patients when rinsing with commercially available products containing xylitol or Lactococcus lactis. Methods: A crossover‐type protocol with a washout period was designed. Swab samples from anterior ethmoid cavities of CRS patients were collected prospectively at baseline. Subjects were provided packets containing either L. lactis W136 or xylitol in non‐blinded fashion and instructed to add it to their rinse bottles daily for 28 days, after which another swab was taken. A saline wash‐out period was completed and a third swab taken. A final 28‐day regimen of the opposite product was followed by a final swab. DNA extraction and sequencing of the 16S rRNA gene allowed for global microbiome analysis. Results: We enrolled 25 subjects with CRS and 10 controls resulting in 70 adequate samples. Increased detection of Lactococcus was observed after use of L. lactis. No significant trends in alpha or beta diversity as a result of treatment were observed. SNOT‐22 score did not change significantly following treatment with xylitol, L. lactis, or saline. Conclusion: We did not detect any major clinical or microbiome‐level effect due to treatment with two topical rinse products. Further research is needed to elucidate their clinical utility and possible probiotic effect. Level of Evidence: 3. [ABSTRACT FROM AUTHOR]

Background: This paper investigates the difference in survival of melanoma patients across stage and sex by utilising net survival measures. Metrics are presented at both the individual and population level.Methods: Flexible parametric models were fitted to estimate life-expectancy metrics to be applied to a group of 104,938 subjects with a melanoma skin cancer diagnosis from 2000 to 2017. Period analysis was used for better predictions for newly diagnosed patients, and missing-stage information was imputed for 9918 patients. Female relative survival was assigned to male subjects to demonstrate the survival discrepancies experienced between sexes.Results: At the age of 60, males diagnosed at the regional stage lose an average of 4.99 years of life compared to the general population, and females lose 4.79 years, demonstrating the sex variation in expected mortality. In 2017, males contributed 3545 more life years lost than females, and a potential 1931 life years could be preserved if sex differences in survival were eliminated.Conclusions: This study demonstrates the survival differences across population subgroups as a result of a melanoma cancer diagnosis. Females experience better prognosis across age and stage at diagnosis; however, further investigation is necessary to better understand the mechanisms behind this difference. [ABSTRACT FROM AUTHOR]

High entropy alloys (HEA) contain multiple principal alloying elements, and possess unique properties due to the high configurational entropy and lattice strain in the system. Ferromagnetic FeCoNi-based HEAs exhibit dramatic changes in crystal structure and the type of magnetism expressed when adding non-magnetic elements such as Al, Cr, Ga, Ti, etc. Interestingly, Alnico permanent magnets also contain multiple principal alloying elements, such as Fe, Co, Ni, and Al, along with other minor additions. This well-studied system is similar in concept to high entropy alloys (HEAs). In this paper, we investigate the hard magnetic properties of FeCoNiAl-based HEAs with additions of Cu/Ti. The addition of Cu/Ti to an equimolar FeCoNiAl alloy is effective at enhancing coercivity, due to spinodal decomposition, but at the expense of saturation magnetization. By varying the ratio of Fe and Co, however, with respect to the other alloying elements, the saturation magnetization is increased, while generally retaining or improving the coercivity. In particular, the Fe2CoNiAlCu0.4Ti0.4 HEA shows promising hard magnetic properties as an isotropic cast magnet, with an HC of 1,078 Oe and (BH)max of 2.06 MGOe, slightly better than the performance of isotropic cast Alnico 2 magnets. The thermal stability is also sufficient for use at elevated temperatures over 200 °C. There was also an interesting increase in high temperature coercivity observed at temperatures from ∼650-800 °C, where these alloys often exhibited higher coercivity than that measured at RT. [ABSTRACT FROM AUTHOR]

Background: In population-based cancer survival studies, the most common measure to compare population groups is age-standardized marginal relative survival, which under assumptions can be interpreted as marginal net survival; the probability of surviving if it was not possible to die of causes other than the cancer under study (if the age distribution was that of a common reference population). The hypothetical nature of this definition has led to confusion and incorrect interpretation. For any measure to be fair in terms of comparing cancer survival, then differences between population groups should depend only on differences in excess mortality rates due to the cancer and not differences in other-cause mortality rates or differences in the age distribution.Methods: We propose using crude probabilities of death and all-cause survival which incorporate reference expected mortality rates. This makes it possible to obtain marginal crude probabilities and all-cause probability of death that only differ between population groups due to excess mortality rate differences. Choices have to be made regarding what reference mortality rates to use and what age distribution to standardize to.Results: We illustrate the method and some potential choices using data from England for men diagnosed with melanoma. Various marginal measures are presented and compared.Conclusions: The new measures help enhance understanding of cancer survival and are a complement to the more commonly used measures. [ABSTRACT FROM AUTHOR]

Animal models of viral pathogenesis are essential tools in human disease research. Human papillomaviruses (HPVs) are a significant public health issue due to their widespread sexual transmission and oncogenic potential. Infection-based models of papillomavirus pathogenesis have been complicated by their strict species and tissue specificity. In this GEM review, we discuss the discovery of a murine papillomavirus, MmuPV1, and how its experimental use represents a major advancement in models of papillomavirus-induced pathogenesis/carcinogenesis, and their transmission. [ABSTRACT FROM AUTHOR]

Background: Cancer survival statistics are typically reported by using measures discounting the impact of other-cause mortality, such as net survival. This is a hypothetical measure and is interpreted as excluding the possibility of cancer patients dying from other causes. Crude probability of death partitions the all-cause probability of death into deaths from cancer and other causes.Methods: The National Cancer Registration and Analysis Service is the single cancer registry for England. In 2006-2015, 1,590,477 malignant tumours were diagnosed for breast, colorectal, lung, melanoma and prostate cancer in adults. We used a relative survival framework, with a period approach, providing estimates for up to 10-year survival. Mortality was partitioned into deaths due to cancer or other causes. Unconditional and conditional (on surviving 1-years and 5-years) crude probability of death were estimated for the five cancers.Results: Elderly patients who survived for a longer period before dying were more likely to die from other causes of death (except for lung cancer). For younger patients, deaths were almost entirely due to the cancer.Conclusion: There are different measures of survival, each with their own strengths and limitations. Careful choices of survival measures are needed for specific scenarios to maximise the understanding of the data. [ABSTRACT FROM AUTHOR]

In this work, we investigate the effects of substituting Ni/Al for Cr on the thermomagnetic and magnetocaloric properties of FeCoNiCrAl-type high entropy alloys (HEAs). Ni and Al appear to prefer the BCC phase, and increases in the Al composition appear to stabilize the BCC phase. In contrast to Al, Ni content yields an increase in the FCC phase fraction, resulting in a drop off in magnetization. The phase transformation from BCC to FCC was intensified at annealing temperatures of 800 °C and higher due to increased diffusion rates and the resulting spinodal decomposition. A magnetic phase transition around 150 K was found in the FeCoNi1.5Cr0.5Al annealed alloy potentially corresponding to the FCC phase, and a very broad magnetic phase transition was observed in the annealed FeCoNiCrAl alloy, resulting in a high refrigerant capacity of RCFWHM = 242.6 J⋅kg-1 near room temperature. A peak magnetic entropy change of −ΔSM = 0.674 J⋅kg-1⋅K-1 was also obtained at applied fields of ∼70 kOe at 290 K in the FeCoNiCrAl HEA. These magnetocaloric values are comparable to Fe-based metallic glasses such as Fe-Tm-B-Nb and Fe-Zr-B-Co alloys, with a similar transition near room temperature. [ABSTRACT FROM AUTHOR]

Preclinical infection model systems are extremely valuable tools to aid in our understanding of Human Papillomavirus (HPV) biology, disease progression, prevention, and treatments. In this context, rodent papillomaviruses and their respective infection models are useful tools but remain underutilized resources in the field of papillomavirus biology. Two rodent papillomaviruses, MnPV1, which infects the Mastomys species of multimammate rats, and MmuPV1, which infects laboratory mice, are currently the most studied rodent PVs. Both of these viruses cause malignancy in the skin and can provide attractive infection models to study the lesser understood cutaneous papillomaviruses that have been frequently associated with HPV-related skin cancers. Of these, MmuPV1 is the first reported rodent papillomavirus that can naturally infect the laboratory strain of mice. MmuPV1 is an attractive model virus to study papillomavirus pathogenesis because of the ubiquitous availability of lab mice and the fact that this mouse species is genetically modifiable. In this review, we have summarized the knowledge we have gained about PV biology from the study of rodent papillomaviruses and point out the remaining gaps that can provide new research opportunities. [ABSTRACT FROM AUTHOR]

Human papillomaviruses (HPVs) are double-stranded DNA (dsDNA) tumor viruses that are causally associated with human cancers of the anogenital tract, skin, and oral cavity. Despite the availability of prophylactic vaccines, HPVs remain a major global health issue due to inadequate vaccine availability and vaccination coverage. The HPV life cycle is established and completed in the terminally differentiating stratified epithelia, and decades of research using in vitro organotypic raft cultures and in vivo genetically engineered mouse models have contributed to our understanding of the interactions between HPVs and the epithelium. More recently, important and emerging roles for the underlying stroma, or microenvironment, during the HPV life cycle and HPV-induced disease have become clear. This review discusses the current understanding of the bidirectional communication and relationship between HPV-infected epithelia and the surrounding microenvironment. As is the case with other human cancers, evidence suggests that the stroma functions as a significant partner in tumorigenesis and helps facilitate the oncogenic potential of HPVs in the stratified epithelium. [ABSTRACT FROM AUTHOR]

Background: Life expectancy is a simple measure of assessing health differences between two or more populations but current life expectancy calculations are not reliable for small populations. A potential solution to this is to borrow strength from larger populations from the same source, but this has not formally been investigated. Methods: Using data on 451,222 individuals from the Clinical Practice Research Datalink on the presence/absence of intellectual disability and type 2 diabetes mellitus, we compared stratified and combined flexible parametric models, and Chiang's methods, for calculating life expectancy. Confidence intervals were calculated using the Delta method, Chiang's adjusted life table approach and bootstrapping. Results: The flexible parametric models allowed calculation of life expectancy by exact age and beyond traditional life expectancy age thresholds. The combined model that fit age interaction effects as a spline term provided less bias and greater statistical precision for small covariate subgroups by borrowing strength from the larger subgroups. However, careful consideration of the distribution of events in the smallest group was needed. Conclusions: Life expectancy is a simple measure to compare health differences between populations. The use of combined flexible parametric methods to calculate life expectancy in small samples has shown promising results by allowing life expectancy to be modelled by exact age, greater statistical precision, less bias and prediction of different covariate patterns without stratification. We recommend further investigation of their application for both policymakers and researchers. [ABSTRACT FROM AUTHOR]

Background: Age-standardized net survival provides an important population-based summary of cancer survival that appropriately accounts for differences in other-cause mortality rates and standardizes the population age distribution to allow fair comparisons. Recently, there has been debate over the most appropriate method for estimating this quantity, with the traditional Ederer II approach being shown to have potential bias. Methods: We compare lifetable-based estimates (Ederer II), a new unbiased method based on inverse probability of censoring weights (Pohar Perme) and model-based estimates. We make the comparison in a simulation setting; generating scenarios where we would expect to see a large theoretical bias. Results: Our simulations demonstrate that even in relatively extreme scenarios there is negligible bias in age-standardized net survival when using the age-standardized Ederer II method, modelling with continuous age or using the Pohar Perme method. However, both the Ederer II and modelling approaches have some advantages over the Pohar Perme method in terms of greater precision, particularly for longer-term follow-up (10 and 15 years). Conclusions: Our results show that, when age-standardizing, concern over bias with the traditional methods is unfounded. We have also shown advantages in using the more traditional and modelling methods. [ABSTRACT FROM AUTHOR]

The background is given as to how statistical analysis is used by quantitative social scientists. Developing statistical analyses requires substantial effort, yet there are important limitations in current practice. This has motivated the authors to create a more systematic and effective methodology with supporting tools. The approach to modelling quantitative data analysis in the social sciences is presented. Analysis scripts are treated abstractly as mathematical functions and concretely as web services. This allows individual scripts to be combined into high-level workflows. A comprehensive set of tools allows workflows to be defined, automatically validated and verified, and automatically implemented. The workflows expose opportunities for parallel execution, can define support for proper fault handling, and can be realised by non-technical users. Services, workflows and datasets can also be readily shared. The approach is illustrated with a realistic case study that analyses occupational position in relation to health. [ABSTRACT FROM AUTHOR]

Background Methodological development of joint models of longitudinal and survival data has been rapid in recent years; however, their full potential in applied settings are yet to be fully explored. We describe a novel use of a specific association structure, linking the two component models through the subject specific intercept, and thus extend joint models to account for measurement error in a biomarker, even when only the baseline value of the biomarker is of interest. This is a common occurrence in registry data sources, where often repeated measurements exist but are simply ignored. Methods The proposed specification is evaluated through simulation and applied to data from the General Practice Research Database, investigating the association between baseline Systolic Blood Pressure (SBP) and the time-to-stroke in a cohort of obese patients with type 2 diabetes mellitus. Results By directly modelling the longitudinal component we reduce bias in the hazard ratio for the effect of baseline SBP on the time-to-stroke, showing the large potential to improve on previous prognostic models which use only observed baseline biomarker values. Conclusion The joint modelling of longitudinal and survival data is a valid approach to account for measurement error in the analysis of a repeatedly measured biomarker and a time-to-event. User friendly Stata software is provided. [ABSTRACT FROM AUTHOR]

Abstract: Human papilllomaviruses (HPVs) are common human pathogens that infect cutaneous or mucosal epithelia in which they cause warts, self-contained benign lesions that commonly regress. The HPV life cycle is intricately tied to the differentiation of the host epithelium it infects. Mucosotropic HPVs are the most common sexually transmitted pathogen known to mankind. A subset of the mucosotropic HPVs, so-called high risk HPVs, is etiologically associated with numerous cancers of the anogenital tract, most notably the cervix, as well as a growing fraction of head and neck cancers. In these cancers, the HPV genome, which normally exists an a double stranded, circular, nuclear plasmid, is commonly found integrated into the host genome and expresses two viral oncogenes, E6 and E7, that are implicated in the development and maintainance of the cancers caused by these high risk HPVs. Numerous studies, primarily on the high risk HPV16, have documented that the methylation status of the viral genome changes not only in the context of the viral life cycle but also in the context of the progressive neoplastic disease that culminates in cancer. In this article, we summarize the knowledge gained from those studies. We also provide the first analysis of available ChIP-seq data on the occupancy of both epigentically modified histones as well as transcription factors on the high risk HPV18 genome in the context of HeLa cells, a cervical cancer-derived cell line that has been the subject of extensive analyses using this technique. [Copyright &y& Elsevier]

Abstract: Human Papilloma Virus related epithelial cancers have been speculated to derive from virus-infected tissue stem cells. Stem cells also are thought to provide a reservoir of latently infected cells that can persist for long periods. In this study we have examined the effects of HPV16 E6 and E7 oncogenes on multipotent epithelial stem cells, using in vivo systems. Our results show that expression of HPV16 oncogenes reduces the number of bulge label-retaining cells within hair follicles at telogen suggesting aberrant mobilization, a result supported by increased mobilization upon acute anagen induction. Importantly the loss of relative quiescence, a hallmark feature of stem cells, occurs in the absence of a reduction in other stem cell markers. This points to an atypical stem cell compartment in the context of E6 and E7 expression. We hypothesize that this aberrant compartment may have important roles in the viral life cycle and/or ensuing carcinogenesis. [Copyright &y& Elsevier]

Background: Competing risks are a common occurrence in survival analysis. They arise when a patient is at risk of more than one mutually exclusive event, such as death from different causes, and the occurrence of one of these may prevent any other event from ever happening. Methods: There are two main approaches to modelling competing risks: the first is to model the cause-specific hazards and transform these to the cumulative incidence function; the second is to model directly on a transformation of the cumulative incidence function. We focus on the first approach in this paper. This paper advocates the use of the flexible parametric survival model in this competing risk framework. Results: An illustrative example on the survival of breast cancer patients has shown that the flexible parametric proportional hazards model has almost perfect agreement with the Cox proportional hazards model. However, the large epidemiological data set used here shows clear evidence of non-proportional hazards. The flexible parametric model is able to adequately account for these through the incorporation of time-dependent effects. Conclusion: A key advantage of using this approach is that smooth estimates of both the cause-specific hazard rates and the cumulative incidence functions can be obtained. It is also relatively easy to incorporate time-dependent effects which are commonly seen in epidemiological studies. [ABSTRACT FROM AUTHOR]

Abstract: A marked escalation in the rate of discovery of new types of human polyomavirus has occurred over the last five years largely owing to recent technological advances in their detection. Among the newly discovered viruses, Merkel Cell Polyomavirus (MCPyV or MCV) has gained the most attention due to its link with a rare human cancer. Infection with MCPyV is common in the human population, and the virus is detected in several anatomical locations, but most frequently in skin. Study of MCPyV molecular virology has been complicated by the lack of straightforward cell culture models, but recent in vitro studies are making strides towards understanding the virus life cycle, its cellular tropism, and mode of transmission. While MCPyV shares several traditional traits with other human polyomaviruses, the burst of research since its discovery reveals insight into a virus with many unique genetic and mechanistic features. The evidence for a causal link between MCPyV and the rare neuroendocrine cancer, Merkel Cell Carcinoma (MCC), is compelling. A majority of MCCs contain clonally integrated viral DNA, express viral T antigen transcripts and protein, and exhibit an addiction to the viral large T and small t antigen oncoproteins. The MCPyV large T antigen contains MCC tumor-specific mutations that ablate its replication capacity but preserve its oncogenic functions, and the small t antigen promotes an environment favorable for cap-dependent translation. The mechanisms of MCPyV-induced transformation have not been fully elucidated, but the likely etiological role of this new polyomavirus in human cancer provides a strong opportunity to expand knowledge of virus–host interactions and viral oncology. [Copyright &y& Elsevier]

Abstract: Human papillomaviruses (HPV) are small DNA tumor viruses. HPV infection requires entry of virions into epithelial host cells that support the viral life cycle. Here, we used an in vivo mouse model, in which HPV pseudoviruses (PVs) are scored for their ability to transduce reporter genes, to test the role of various cellular proteins in entry. We initially investigated the role of integrin α6β4 in mediating early steps of HPV infection. Deficiency of integrin α6β4 is modestly but significantly suppressed reporter-gene transduction by PVs in conditional integrin β4 knockout mice. We also investigated the role of syndecan 1, a heparin sulfate proteoglycan (HSPG) for its role in HPV infection. We did not see a significant reduction in reporter-gene transduction by PVs in syndecan-1 null mice. This indicates that this HSPG is not essential for early steps in HPV infection, but does not discount a need of other HSPGs in mediating HPV infection. [Copyright &y& Elsevier]

Background: When interested in studying the effect of a treatment (or other exposure) on a time-to-event outcome, the most popular approach is to estimate survival probabilities using the Kaplan-Meier estimator. In the presence of confounding, regression models are fitted, and results are often summarised as hazard ratios. However, despite their broad use, hazard ratios are frequently misinterpreted as relative risks instead of relative rates.Methods: We discuss measures for summarising the analysis from a regression model that overcome some of the limitations associated with hazard ratios. Such measures are the standardised survival probabilities for treated and untreated: survival probabilities if everyone in the population received treatment and if everyone did not. The difference between treatment arms can be calculated to provide a measure for the treatment effect.Results: Using publicly available data on breast cancer, we demonstrated the usefulness of standardised survival probabilities for comparing the experience between treated and untreated after adjusting for confounding. We also showed that additional important research questions can be addressed by standardising among subgroups of the total population.Discussion: Standardised survival probabilities are a useful way to report the treatment effect while adjusting for confounding and have an informative interpretation in terms of risk. [ABSTRACT FROM AUTHOR]

Background: Relative survival is commonly used for studying survival of cancer patients as it captures both the direct and indirect contribution of a cancer diagnosis on mortality by comparing the observed survival of the patients to the expected survival in a comparable cancer-free population. However, existing methods do not allow estimation of the impact of isolated conditions (e.g., excess cardiovascular mortality) on the total excess mortality. For this purpose we extend flexible parametric survival models for relative survival, which use restricted cubic splines for the baseline cumulative excess hazard and for any time-dependent effects. Methods: In the extended model we partition the excess mortality associated with a diagnosis of cancer through estimating a separate baseline excess hazard function for the outcomes under investigation. This is done by incorporating mutually exclusive background mortality rates, stratified by the underlying causes of death reported in the Swedish population, and by introducing cause of death as a time-dependent effect in the extended model. This approach thereby enables modeling of temporal trends in e.g., excess cardiovascular mortality and remaining cancer excess mortality simultaneously. Furthermore, we illustrate how the results from the proposed model can be used to derive crude probabilities of death due to the component parts, i.e., probabilities estimated in the presence of competing causes of death. Results: The method is illustrated with examples where the total excess mortality experienced by patients diagnosed with breast cancer is partitioned into excess cardiovascular mortality and remaining cancer excess mortality. Conclusions: The proposed method can be used to simultaneously study disease patterns and temporal trends for various causes of cancer-consequent deaths. Such information should be of interest for patients and clinicians as one way of improving prognosis after cancer is through adapting treatment strategies and follow-up of patients towards reducing the excess mortality caused by side effects of the treatment. [ABSTRACT FROM AUTHOR]

Background: We investigate methods used to analyse the results of clinical trials with survival outcomes in which some patients switch from their allocated treatment to another trial treatment. These included simple methods which are commonly used in medical literature and may be subject to selection bias if patients switching are not typical of the population as a whole. Methods which attempt to adjust the estimated treatment effect, either through adjustment to the hazard ratio or via accelerated failure time models, were also considered. A simulation study was conducted to assess the performance of each method in a number of different scenarios. Results: 16 different scenarios were identified which differed by the proportion of patients switching, underlying prognosis of switchers and the size of true treatment effect. 1000 datasets were simulated for each of these and all methods applied. Selection bias was observed in simple methods when the difference in survival between switchers and non-switchers were large. A number of methods, particularly the AFT method of Branson and Whitehead were found to give less biased estimates of the true treatment effect in these situations. Conclusions: Simple methods are often not appropriate to deal with treatment switching. Alternative approaches such as the Branson & Whitehead method to adjust for switching should be considered. [ABSTRACT FROM AUTHOR]

The majority of human cervical cancers are associated with the high-risk human papillomavirus (HPV) types. In mouse models for HPV-associated cancers, estrogen is required for the development of cervical and vaginal cancers. The estrogen receptor α (ERα) also is required in mice for these cancers to arise. These data are consistent with the observation in women that long-term use of oral contraceptives or multiple pregnancies significantly increases the risk for cervical cancer in HPV-positive women. In the present study, we examined whether drugs that interfere with the function of ERα are effective in treating and/or preventing cervical cancer in mice. We provide evidence that a complete ER antagonist, ICI 182,780 (ICI). as well as a selective ER modulator, raloxifene, efficiently clear cancer and its precursor lesions in both the cervix and the vagina. Furthermore. ICI was capable of preventing the onset of cancers in mice bearing precursor lesions. These findings point to the potential value of ER antagonists in controlling gynecological disease in the lower reproductive tracts in women. [ABSTRACT FROM AUTHOR]

The electrochemical noise method (ENM) has previously been employed to monitor the corrosion of steel reinforcement in concrete. The development of solid-state Ag/AgCl-based probes and dedicated monitoring technology (ProCoMeter) now offers a wider range of ENM configurations. The present study involves the laboratory investigation of three mortar samples containing steel bars and varying additions of chloride, with a view to future field application. ENM could be used to provide corrosion information on reinforcement without the need to provide direct electrical connections to the steel and without the risk or inducing or increasing corrosion. In addition to half-cell potentials, measurements were made using ENM in three different probe configurations over a total test period of 90 days. The samples were then broken open and the bars extracted and cleaned. A comparison was then made between the calculated metal thickness loss obtained from the Rn values and the actual metal thickness loss. The results showed that each configuration was able to order the results in the expected manner, with the simple single substrate (SSS) arrangement providing the best correlation with direct measurements. The study is ongoing with the intention of measurements being obtained in situ on existing reinforced concrete structures. [ABSTRACT FROM AUTHOR]

Simple Summary: IQ motif-containing GTPase-activating protein 1 (IQGAP1) is a signal scaffolding protein that regulates a range of cellular activities by facilitating signal transduction in cells. IQGAP1 is involved in many cancer-related activities, such as proliferation, apoptosis, migration, invasion and metastases. In this article, we review the different pathways regulated by IQGAP1 during cancer development, and the role of IQGAP1 in different types of cancer, including cancers of the head and neck, breast, pancreas, liver, colorectal, stomach, and ovary. We also discuss IQGAP1′s regulation of the immune system, which is of importance to cancer progression. This review highlights the significant roles of IQGAP1 in cancer and provides a rationale for pursuing IQGAP1 as a drug target for developing novel cancer therapies. Scaffolding proteins can play important roles in cell signaling transduction. IQ motif-containing GTPase-activating protein 1 (IQGAP1) influences many cellular activities by scaffolding multiple key signaling pathways, including ones involved in carcinogenesis. Two decades of studies provide evidence that IQGAP1 plays an essential role in promoting cancer development. IQGAP1 is overexpressed in many types of cancer, and its overexpression in cancer is associated with lower survival of the cancer patient. Here, we provide a comprehensive review of the literature regarding the oncogenic roles of IQGAP1. We start by describing the major cancer-related signaling pathways scaffolded by IQGAP1 and their associated cellular activities. We then describe clinical and molecular evidence for the contribution of IQGAP1 in different types of cancers. In the end, we review recent evidence implicating IQGAP1 in tumor-related immune responses. Given the critical role of IQGAP1 in carcinoma development, anti-tumor therapies targeting IQGAP1 or its associated signaling pathways could be beneficial for patients with many types of cancer. [ABSTRACT FROM AUTHOR]

This article introduces a sociological audience to 'quasi-variances' as a solution to the 'reference category problem'. The reference category problem is associated with the interpretation of the effects of categorical explanatory variables within statistical models, and is especially relevant to sociological applications, where categorical explanatory variables are very common. This article presents a selection of examples (using multiple and logistic regression) to illustrate and comment on quasi-variance calculations for sociological models. In addition, the article is augmented with online materials provided by the authors, which aim to help social researchers practise and apply this technique using the popular data analysis software packages SPSS and Stata. The authors conclude that quasi-variance methods offer an attractive and practicable solution to the reference category problem that can, and should, be routinely operationalized by sociological researchers. [ABSTRACT FROM AUTHOR]

Abstract: Promyelocytic leukemia oncogenic domains (PODs), also called nuclear domain 10 (ND10), are subnuclear structures that have been implicated in a variety of cellular processes as well as the life cycle of DNA viruses including papillomaviruses. In order to investigate the interplay between papillomaviruses and PODs, we analyzed the status of PODs in organotypic raft cultures of human keratinocytes harboring HPV genome that support the differentiation-dependent HPV life cycle. The number of PODs per nucleus was increased in the presence of HPV genomes selectively within the poorly differentiated layers but was absent in the terminally differentiated layers of the stratified epithelium. This increase in PODs was correlated with an increase in abundance of post-translationally modified PML protein. Neither the E2-dependent transcription nor viral DNA replication was reliant upon the presence of PML. Implications of these findings in terms of HPV''s interaction with its host are discussed. [Copyright &y& Elsevier]

The article examines the effect of the toxic baits containing sodium fluoroacetate (1080) on the fish and invertebrate communities in small streams in New Zealand. The ecological effect of 1080 leaching was assessed on three species of native fish and caddisflies in four streams using a before-after control-impact (BACI) experimental design. Based on the results, the 1080 leaching from submerged baits had no demonstrable biological impacts since no specimen died.

Papillomaviruses are small DNA viruses that are associated with benign and malignant epithelial lesions, including >95% of cervical cancers and ≈20% of head and neck cancers. Because papillomavirus replication and virion production are tied to epithelial cell differentiation, infectious papillomavirus virion production has been limited to cumbersome organotypic cultures and mouse xenografts. Consequent difficulties in obtaining useful amounts of wild-type or mutant human papillomavirus (HPV) virions have greatly limited studies on many aspects of papillomavirus biology. To overcome these limitations, we developed a system to encapsidate the full-length papillomaviral genome into infectious virions, independently of viral DNA replication and epithelial differentiation. This transient-transfection-based system produces >1,000 times more infectious virus per cell culture dish than the much more labor-intensive organotypic culture. Furthermore, we show that this method allows the facile generation of infectious particles containing wild-type, mutant, or chimeric papillomaviral genomes, overcoming barriers to studying many facets of replication, host interactions, and vaccine and drug development, which has been limited by the insufficient availability of infectious virions. [ABSTRACT FROM AUTHOR]

Some recently introduced vaccines that have excellent efficacy records have been developed without a clear understanding of their mechanism of protection. In fact, successful vaccines have often emerged out of empirical observations and have only rarely been the result of a rational use of the continuously increasing immunological knowledge available to scientists. However, a posteriori deciphering of the biological bases for the efficacy of successful vaccines should be an essential component of research efforts directed at the development of new vaccines for the most challenging infectious diseases. [ABSTRACT FROM AUTHOR]

Cervical cancer is a leading cause of death by cancer among women worldwide. High-risk human papillomaviruses (HPVs) are the major etiological agents for cervical cancer, but other factors likely contribute to cervical cancer, because these cancers commonly arise decades after initial exposure to HPVI Estrogen is thought to be one such cofactor; however, its temporal requirements in human cervical cancer are not known. Here we evaluate the temporal requirements of estrogen in cervical carcinogenesis in a mouse model for HPV-associated cervical cancer. Tumors arising in HPV16 transgenic mice treated with estrogen for 9 months were greatly increased in their size compared with tumors developing after 6 months of estrogen treatment. HPV16 transgenic mice treated 6 months with estrogen followed by 3 months without exogenous estrogen had significantly fewer tumors and the tu- mors were smaller and less aggressive than those arising in mice treated the full 9 months. Importantly, cervical cancers that arose in the mice treated the first 6 of 9 months with estrogen must have regressed, based upon the reduced incidence of cancers in these mice compared with those treated for 6 months with estrogen, then immediately analyzed. We conclude that estrogen plays a critical role not only in the genesis of cervical cancer but also in its persistence and continued development in this mouse model. These findings raise the clinically relevant possibility that, if human cervical cancer has a similar dependence on estrogen for continued tumor growth, then antiestrogen therapy may be effective in the treatment of cervical cancer. [ABSTRACT FROM AUTHOR]

There is a danger that the Cambridge Scale, which is based on data collected thirty years ago, is becoming out of date. This article considers an alternative basis for a social interaction-based social distance scale, that of marriage (or cohabitation) rather than friendship. This has considerable advantages in terms of the ready, low-cost availability of large-scale, representative data (usually from a census). It also makes easily possible the construction of comparable scales for many other countries. The article discusses the theoretical background to the approach and the justification for expecting that marriage and friendship would reflect equivalent structures of stratification arrangements. In order to provide direct comparability, a new scale was constructed, based on 1971 census data and using more satisfactory statistical techniques, Empirical analyses using this measure fully support the argument that this alternative method of deriving a scale leads to essentially the same results as the original. The way is therefore open for an updating of the scale and its extension to a number of other countries, under the generic heading of CAMSIS. [ABSTRACT FROM AUTHOR]

Derivatives of bovine papillomavirus 1 (BPV1) with temperature-sensitive and dominant-negative mutation the E1 gene were used to determine the requirement for E1 in the maintenance of viral plasmid DNA replication. The abilities of these mutant BPV1 genomes to replicate as nuclear plasmids were monitored at permissive (32°C) and nonpermissive (37°C) temperatures in mouse C127 cells. We found that the temperature-sensitive E1 mutant BPV1 genomes replicate as nuclear plasmids as efficiently as does wild-type BPV1 in C127 cells after shifting to the nonpermissive temperature. These findings indicate that BPV1 does not require E1 for the maintenance of viral plasmids. [Copyright &y& Elsevier]

Highlights several topics discussed during the National Cancer Institute workshop on molecular signatures of infectious agents in the United States. Objectives of the workshop; Contribution of infectious agents in the development of cancer; Emphasis on knowledge deficit related to the identification of cancer etiology.

• Large-grained FeGa alloys exhibited discontinuous yielding. • Despite catastrophic failure, alloy exhibited strains up to 5%. • Strain banding observed during mechanical testing using Digital Image Correlation. • Observed strain is due to twinning induced plasticity. ga1 Fe 100−x Ga x alloys require highly textured samples for optimal magnetostrictive performance, which is often accomplished through directional solidification. In this study, we measure the mechanical properties of commercial Fe 81.6 Ga 18.4 oligocrystals using sub-sized tensile specimens and digital image correlation (DIC). While many samples fractured around 360 MPa (the literature yield/tensile stress), most had discontinuous yielding as low as 186 MPa. Many of the samples also exhibited surprisingly large tensile strains, up to 5%, with substantial specimen-to-specimen variability. In all specimens, DIC showed high strain bands that develop at very defined angles, in agreement with electron back-scattered diffraction, which revealed significant deformation twinning. [ABSTRACT FROM AUTHOR]

Murine papillomavirus, MmuPV1, causes natural infections in laboratory mice that can progress to squamous cell carcinoma (SCC) making it a useful preclinical model to study the role of papillomaviruses in cancer. Papillomavirus can infect cells within hair follicles, which contain multiple epithelial progenitor cell populations, including Lgr5+ progenitors, and transgenic mice expressing human papillomavirus oncogenes develop tumors derived from Lgr5 progenitors. We therefore tested the hypothesis that Lgr5+ progenitors contribute to neoplastic lesions arising in skins infected with MmuPV1 by performing lineage tracing experiments. Ears of 6–8-week-old Lgr5-eGFP-IRES-CreERT2/Rosa26LSLtdTomato mice were treated topically with 4-OH Tamoxifen to label Lgr5+ progenitor cells and their progeny with tdTomato and, 72 h later, infected with MmuPV1. Four months post-infection, tissue at the infection site was harvested for histopathological analysis and immunofluorescence to determine the percentage of tdTomato+ cells within the epithelial lesions caused by MmuPV1. Squamous cell dysplasia showed a low percentage of tdTomato+ cells (7%), indicating that it arises primarily from non-Lgr5 progenitor cells. In contrast, cutaneous SCC (cSCC) was substantially more positive for tdTomato+ cells (42%), indicating that cSCCs preferentially arise from Lgr5+ progenitors. Biomarker analyses of dysplasia vs. cSCC revealed further differences consistent with cSCC arising from LGR5+ progenitor cells. [ABSTRACT FROM AUTHOR]

Presents a study of the sensory hair cells essential for the transduction of mechanical stimuli into hearing and balance signals in the internal ear. Supporting cells in the vestibular sensory epithelia from the ears of mature guinea pigs and adult humans treated in vitro with aminoglycoside antibiotics that cause sensory hair cells to die; New cells after 4 weeks in culture; More.

The glycopeptides containing either the disaccharide or the heteropolysaccharide chains were purified, after enzymatic digestion of glomerular basement-membrane antigens, by gel filtration and ion-exchange chromatography. Their antigenicity was investigated in seven patients with anti-glomerular-basement-membrane antibody-mediated glomerulonephritis, by the leukocyte migration test and radioimmunoassay. The leukocyte migration of the seven patients is inhibited in presence of membrane antigens with both types of oligosaccharide chains. The disaccharide-containing glycopeptide inhibits the leukocyte migration of these patients using 10-times less antigenic material; the heteropolysaccharide-containing glycopeptide does not modify the leukocyte migration of the same patients. Similarly, only the disaccharide-containing glycopeptide decreases the binding of labelled membrane antigens with anti-glomerular-basement-membrane antibodies, using the radioimmunoassay. This glycopeptide carries therefore the major antigenic determinants of humoral and cellular anti-basement-membrane auto-immunization. The amino acid sequence of the glycopeptide is Hyl-Gly-Glu-Asp-Gly the disaccharide prosthetic group being linked to the hydrolysine residue of the peptidic chain; its immunodominant antigenic site is formed by the Galp-Hyl unit. [ABSTRACT FROM AUTHOR]

The glycopeptides containing either the disaccharide or the heteropolysaccharide chains were purified, after enzymatic digestion of glomerular basement-membrane antigens, by gel filtration and ion-exchange chromatography. Their antigenicity was investigated in seven patients with anti-glomerular-basement-membrane antibody-mediated glomerulonephritis, by the leukocyte migration test and radioimmunoassay. The leukocyte migration of tbe seven patients is inhibited in presence of membrane antigens with both types of oligosaccharide chains. The disaccharide-containing glycopeptide inhibits the leukocyte migration of these patients using 10-times less antigenic material; the heteropolysaccharide-containing glycopeptide does not modify the leukocyte migration of the same patients. Similarly, only the disaccharide-containing glycopeptide decreases the binding of labelled membrane antigens with anti-glomerular-basement-membranc antibodies, using the radioimmunoassay. This glycopeptide carries therefore the major antigenic determinants of humoral and cellular anti-basement-membrane auto-immunization. The amino acid sequence of the glycopeptide is Hyl.Gly.Glu-Asp.Gly, the disaccharide prosthetic group being linked to the hydrolysine residue of the peptidic chain ; its immunodominant antigenic site is formed by the Galp-Hyl unit. [ABSTRACT FROM AUTHOR]

Background: Multi-state models are being increasingly used to capture complex disease pathways. The convenient formula of the exponential multi-state model can facilitate a quick and accessible understanding of the data. However, assuming time constant transition rates is not always plausible. On the other hand, obtaining predictions from a fitted model with time-dependent transitions can be challenging. One proposed solution is to utilise a general simulation algorithm to calculate predictions from a fitted multi-state model.Methods: Predictions obtained from an exponential multi-state model were compared to those obtained from two different parametric models and to non-parametric Aalen-Johansen estimates. The first comparative approach fitted a multi-state model with transition-specific distributions, chosen separately based on the Akaike Information Criterion. The second approach was a Royston-Parmar multi-state model with 4 degrees of freedom, which was chosen as a reference model flexible enough to capture complex hazard shapes. All quantities were obtained analytically for the exponential and Aalen-Johansen approaches. The transition rates for the two comparative approaches were also obtained analytically, while all other quantities were obtained from the fitted models via a general simulation algorithm. Metrics investigated were: transition probabilities, attributable mortality (AM), population attributable fraction (PAF) and expected length of stay. This work was performed on previously analysed hospital acquired infection (HAI) data. By definition, a HAI takes three days to develop and therefore selected metrics were also predicted from time 3 (delayed entry).Results: Despite clear deviations from the constant transition rates assumption, the empirical estimates of the transition probabilities were approximated reasonably well by the exponential model. However, functions of the transition probabilities, e.g. AM and PAF, were not well approximated and the comparative models offered considerable improvements for these metrics. They also provided consistent predictions with the empirical estimates in the case of delayed entry time, unlike the exponential model.Conclusion: We conclude that methods and software are readily available for obtaining predictions from multi-state models that do not assume constant transition rates. The multistate package in Stata facilitates a range of predictions with confidence intervals, which can provide a more comprehensive understanding of the data. User-friendly code is provided. [ABSTRACT FROM AUTHOR]

The article presents a self-assessment questionnaire related to continuing medical education (CME) endocrinology.

Background: The occurrence of a range of health outcomes following myocardial infarction (MI) is unknown. Therefore, this study aimed to determine the long-term risk of major health outcomes following MI and generate sociodemographic stratified risk charts in order to inform care recommendations in the post-MI period and underpin shared decision making. Methods and findings: This nationwide cohort study includes all individuals aged ≥18 years admitted to one of 229 National Health Service (NHS) Trusts in England between 1 January 2008 and 31 January 2017 (final follow-up 27 March 2017). We analysed 11 non-fatal health outcomes (subsequent MI and first hospitalisation for heart failure, atrial fibrillation, cerebrovascular disease, peripheral arterial disease, severe bleeding, renal failure, diabetes mellitus, dementia, depression, and cancer) and all-cause mortality. Of the 55,619,430 population of England, 34,116,257 individuals contributing to 145,912,852 hospitalisations were included (mean age 41.7 years (standard deviation [SD 26.1]); n = 14,747,198 (44.2%) male). There were 433,361 individuals with MI (mean age 67.4 years [SD 14.4)]; n = 283,742 (65.5%) male). Following MI, all-cause mortality was the most frequent event (adjusted cumulative incidence at 9 years 37.8% (95% confidence interval [CI] [37.6,37.9]), followed by heart failure (29.6%; 95% CI [29.4,29.7]), renal failure (27.2%; 95% CI [27.0,27.4]), atrial fibrillation (22.3%; 95% CI [22.2,22.5]), severe bleeding (19.0%; 95% CI [18.8,19.1]), diabetes (17.0%; 95% CI [16.9,17.1]), cancer (13.5%; 95% CI [13.3,13.6]), cerebrovascular disease (12.5%; 95% CI [12.4,12.7]), depression (8.9%; 95% CI [8.7,9.0]), dementia (7.8%; 95% CI [7.7,7.9]), subsequent MI (7.1%; 95% CI [7.0,7.2]), and peripheral arterial disease (6.5%; 95% CI [6.4,6.6]). Compared with a risk-set matched population of 2,001,310 individuals, first hospitalisation of all non-fatal health outcomes were increased after MI, except for dementia (adjusted hazard ratio [aHR] 1.01; 95% CI [0.99,1.02];p = 0.468) and cancer (aHR 0.56; 95% CI [0.56,0.57];p < 0.001). The study includes data from secondary care only—as such diagnoses made outside of secondary care may have been missed leading to the potential underestimation of the total burden of disease following MI. Conclusions: In this study, up to a third of patients with MI developed heart failure or renal failure, 7% had another MI, and 38% died within 9 years (compared with 35% deaths among matched individuals). The incidence of all health outcomes, except dementia and cancer, was higher than expected during the normal life course without MI following adjustment for age, sex, year, and socioeconomic deprivation. Efforts targeted to prevent or limit the accrual of chronic, multisystem disease states following MI are needed and should be guided by the demographic-specific risk charts derived in this study. Using hospital records of 34 million adults admitted to hospitals in England, Marlous Hall and team examine the long-term risk of major health outcomes following myocardial infarction. Author summary: Why was this study done?: Myocardial infarction (MI; heart attack) can have major long-term impact on individuals and result in a wide range of further health conditions. Existing studies have focussed on determining the short-term risk of a second heart attack, stroke, or major bleeding, but research describing the long-term risk of major health outcomes for specific age, sex, and deprivation groups was lacking. Nationally representative and robust information of a wide range of long-term health outcomes following a heart attack is critical for the development of treatment recommendations, which take account of an individuals' specific risk. What did the researchers do and find?: From the population of 56 million adults in England, we analysed hospital records for 34 million adults admitted to hospital (constituting 145 million admission records) to investigate the long-term health outcomes following a heart attack compared with individuals without a heart attack. Of 433,361 individuals with a heart attack, up to a third developed heart failure or renal failure, 7% had further heart attacks, and 38% died within the 9-year study period. Heart failure, atrial fibrillation, stroke, peripheral arterial disease, severe bleeding, renal failure, diabetes, and depression occurred more frequently for people who had a heart attack compared with those who did not, but the risk of cancer was lower overall and the risk of dementia did not differ overall. What do these findings mean?: Efforts should be made to prevent or limit the development of long-term health outcomes that follow a heart attack—the likelihood of which differ depending on the age, sex, and deprivation of an individual. These findings are based on the full population of adults admitted to hospital in England, address limitations of previous studies, and can be used to inform preventative strategies tailored to specific individuals surviving a heart attack. The study was limited to hospitalisation data only—therefore, some diagnoses made outside of hospital may have been missed. [ABSTRACT FROM AUTHOR]