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The control of ovulation helps guarantee the success of reproduction and as such, contributes to the fitness of a species. In mammals, two types of ovulation are observed: induced and spontaneous ovulation. Recent work on camelids, that are induced ovulators, highlighted the role of a factor present in seminal plasma, beta Nerve Growth Factor (β-NGF), as the factor that triggers ovulation in a GnRH dependent manner. In the present work, we characterized alpaca β-NGF (aβ-NGF) and its 3D structure and compared it with human recombinant β-NGF (hβ-NGF). We showed that the β-NGF enriched fraction of alpaca semen and the human recombinant protein, both stimulated spontaneous electrical activity of primary GnRH neurons derived from mouse embryonic olfactory placodes. This effect was dose-dependent and mediated by p75 receptor signaling. P75 receptors were found expressed in vitro by olfactory ensheathing cells (OEC) in close association with GnRH neurons and in vivo by tanycytes in close vicinity to GnRH fibers in adult mouse. Altogether, these results suggested that β-NGF induced ovulation through an increase in GnRH secretion provoked by a glial dependent P75 mediated mechanism. [ABSTRACT FROM AUTHOR]

Purpose: Excessive daytime sleepiness (EDS) in older adults is associated with obstructive sleep apnea, falls, reduced quality of life, and mortality. The Epworth Sleepiness Scale (ESS) is widely used to assess sleepiness. However, EDS assessment with the ESS may not be accurate in older adults. We aimed to (1) describe the responsiveness of nondemented older subjects to the ESS and (2) compare the self-report ESS scores to those of close relatives (CR) proxy and identify factors influencing any discrepancies between them. Methods: This is a cross-sectional observational study including 104 independently living nondemented older subjects with daytime sleepiness complaints and 104 nondemented CRs. Cognitive tests (Mini-Mental State Examination) and the ESS were completed separately by subjects and CRs to assess the subject's daytime sleepiness. Results: Almost 60 % of subjects and CRs were not able to answer at least one question on the ESS. Despite the fact that all subjects complained of EDS, only 24 % of them had an abnormal ESS score (>10). Subjects rated their sleepiness lower (7.10 ± 4.31) than their CR proxy did (9.70 ± 5.14) ( p < 0.0001). In multivariate analysis, an increase in age and a decrease in cognitive status of the subjects appeared related to the difference in ESS between subject and CR. Conclusions: The majority of older adults were not able to answer all of the ESS items. The ESS may underestimate sleepiness severity in older subjects. Despite EDS complaints in all subjects, only one quarter of them had a pathological ESS score. [ABSTRACT FROM AUTHOR]

Little is known about costs related to the surveillance of patients that have undergone curative resection of colorectal cancer. The aim of this study was to calculate the observed surveillance costs for 385 patients followed-up over a 3-year period, to estimate surveillance costs if French guidelines are respected, and to identify the determinants related to surveillance costs to derive a global estimation for France, using a linear mixed model. The observed mean surveillance cost was € 713. If French recommendations were strictly applied, the estimated mean cost would vary between € 680 and € 1,069 according to the frequency of abdominal ultrasound. The predicted determinants of cost were: age, recurrence, duration of surveillance since diagnosis, and adjuvant treatments. For France, the surveillance cost represented 4.4% of the cost of colorectal cancer management. The cost of surveillance should now be balanced with its effectiveness and compared with surveillance alternatives. [ABSTRACT FROM AUTHOR]

Background Evidence from the data provided in numerous published articles indicates that obesity and overweight can have a negative prognosis role in breast cancer. However, different Body Size Indicators (BSI) and cut-points have been employed and may partly explain discrepancies between the findings of various studies. Material and methods 14,709 women were recruited, treated and followed for a first unilateral breast cancer. After randomly splitting the patients’ data into two groups, a maximum statistical outcome approach was used to select optimal BSI cut-points from a “training sample”, when prognosis events were investigated. External validation was then carried out using a “validation sample”, and agreement between the selected optimal BSI cut-points was assessed. Body Mass Index (BMI), weight (W), Ideal Weight Ratio (IWR) and Body Surface Area (BSA) were used, and were assessed at the time of diagnosis. Results The selected optimal BSI cut-points were reliable when overall survival, metastasis recurrence and disease free interval events were investigated. The chosen BMI cut-point values matched the overweight cut-point value given by the World Health Organization. Agreement between defined binary BSI was acceptable; however, it varied from “fair” to “very good”. Analysis of second primary cancer occurrence and contralateral recurrence events was not conclusive. When local and node recurrence events were taken into account, the results were inconsistent and were linked to an unconfirmed relationship between stoutness and these prognosis events. Conclusions Efficient, optimal BSI cut-points indicate a poorer prognosis, illustrated by a shortened overall survival and an increase of metastasis recurrences, from a BMI value of 25 kg/m², a W value of 60 kg, an IWR value of 20% and a BSA value of 1.7 m². Further BSI cut-point investigations are needed, taking into account contralateral recurrence and second primary cancer events. [ABSTRACT FROM AUTHOR]

Background Breast cancer and obesity represent important public health issues in most western countries. A number of studies found a negative prognosis effect of obesity or excess of weight in woman breast cancer. However, to date, this issue remains controversial. The objectives of this study were to confirm the prognosis role of obesity on a large cohort of patients and to investigate a potential independent effect. Materials and methods We constituted a cohort of 14,709 patients who were recruited and treated at the Curie Institute (Paris) from 1981 to 1999. These patients were followed prospectively for a first unilateral invasive breast cancer without distant metastasis. Obesity was defined by a Body Mass Index (BMI) above 30 kg/m2 according to the World Health Organization recommendations. Results Obese patients (8%) presented more extended tumors at diagnosis time suggesting a delayed breast cancer diagnosis. However, obesity appeared as a negative prognosis factor for several events in respectively univariate and multivariate survival analysis: metastasis recurrence (HR = 1.32[1.19–1.48]; HR = 1.12[1.00–1.26]), disease free interval (1.20[1.08–1.32]; 1.10[0.99–1.22]), overall survival (1.43[1.28–1.60]; 1.12[0.99–1.25]) and second primary cancer outcome (1.57[1.19–2.07]; 1.43[1.09–1.89]). Even if obese patients presented more advanced tumors at diagnosis time, multivariate analysis showed that there was a relevant independent effect. Other BMI codings, distinguishing overweight patients or using BMI as a continuous variable, showed a consistent correlation between BMI’s value and prognosis effect. Interaction analysis revealed a more important obesity effect in the presence of tumor estrogen receptors and among limited extent tumors. Conclusions This survey confirms the prognosis role of obesity on one of the largest cohort by investigating several prognosis events. While independent obesity effect linked to hormonal disorders appeared consistent as obesity’s mechanism, we stress that obesity prognosis effect was also related to breast cancer presentation at diagnosis time. [ABSTRACT FROM AUTHOR]

Objective: To evaluate outcomes of patients admitted to the ICU for complications after elective surgery and to assess perceived quality of life (pQOL) in survivors.Design: Two-year prospective case-control study.Setting: Twelve-bed ICU in a university-affiliated hospital.Patients: Patients admitted to the ICU for a complication following elective surgery were included. Six months after discharge, pQOL was assessed using the Nottingham Health Profile (NHP). Results were compared to those of matched controls without complications.Interventions: None.Measurements and Results: Of the 182 patients, 124 were alive after 6 months, among whom 116 had 6-month data and 104 of these had matched controls. Overall pQOL as assessed by the global NHP score was similar in both groups (median, 0.82 and 0.87 in cases and controls; P=0.24). NHP subscores showed significantly worse pain ( P=0.03) and physical impairment ( P=0.02) in the ICU patients. In the multivariate analysis, pQOL was better in patients with cancer as the reason for surgery ( P=0.05). Severity of illness at inclusion had no influence on subsequent pQOL, but cardiovascular dysfunction was associated with decreased energy ( P=0.04).Conclusions: Although overall pQOL was satisfactory after 6 months, patients admitted to the ICU for postoperative complications had worse pain and physical impairment than controls. Whether these outcomes could be improved by early physiotherapy and aggressive pain management deserves investigation. [ABSTRACT FROM AUTHOR]

This paper presents two-sample statistics suited for testing equality of survival functions against improper semi-parametric accelerated failure time alternatives. These tests are designed for comparing either the short- or the long-term effect of a prognostic factor, or both. These statistics are obtained as partial likelihood score statistics from a time-dependent Cox model. As a consequence, the proposed tests can be very easily implemented using widely available software. A breast cancer clinical trial is presented as an example to demonstrate the utility of the proposed tests. [ABSTRACT FROM AUTHOR]

A potential advantage of primary over adjuvant chemotherapy in breast cancer survival had been proposed on theoretical grounds. In 1994, early results of the S6 trial comparing primary chemotherapy vs. adjuvant chemotherapy for operable breast cancer in 390 premenopausal patients had shown significant improvement in survival of the primary chemotherapy arm (p=0.04). An updated analysis conducted in 1995 showed the disappearance of this difference between the two arms (p=0.18). In the present analysis, we investigated the potential short and long term benefits attributable to primary chemotherapy by applying weighted logrank tests designed to assess specifically these effects. Results were compared to those obtained with the classical logrank test. At a median follow up of 105 months, a significant short term survival benefit (p=0.02) in favor of the primary chemotherapy has been shown. However, no long term survival benefit (p=0.36) could be documented. The classical logrank test had revealed no significant difference (p=0.24) between the two groups but the proportional hazard assumption being rejected (p=0.04), the efficiency of this test can be questioned. Results using the present analysis suggested that primary chemotherapy delayed early death rates, without significantly modifying long term event rates. It emphasizes that a short term effect which is not necessarily associated with a long term benefit may be seen at an early evaluation and disappear later on. [ABSTRACT FROM AUTHOR]

The article presents the study which aims to determine the involvement of Na+-K+ ATPhase-inhibitory action in health related toxicity in cadmium. It consisted of 166 urban Caucasian men wherein the hair cadmium and red blood cell pump of men without cadmium exposure were measured. It performed the standard linear regression and analysis of variance technique. Results shows that Na+-K+ pump activity is reciprocal to the hair cadmium of current-smokers.