头皮原发性皮肤神经节细胞瘤

神经节细胞瘤是一种神经内分泌肿瘤，其发生与自主神经系统的交感或副交感神经节有关。罕见发生于膀胱、前列腺和子宫。本文作者报道1例发生于儿童头皮的原发性皮肤神经节细胞瘤。对此肿瘤进行了组织学、免疫组化和超微结构研究。该病例可能代表神经嵴细胞向鳃弓发育过程中的一种异常迁移。此外，研究结果还强调在胚胎发育过程中神经嵴和鳃弓／裂之间有复杂的相互作用。     

Temporal trends in early clinical manifestations of perinatal HIV infection in a population-based cohort

Context  The effect of early antiretroviral therapy (ART) on the early progression of perinatal human immunodeficiency virus (HIV) infection is not well defined. Objective  To examine early disease progression and survival in a population-based cohort with perinatal HIV infection in relation to year of birth and use of ART. Design, Setting, and Patients  Retrospective study of temporal trends in early progression of perinatal HIV infection among 205 HIV-infected children in Northern California born between January 1, 1988, and December 31, 2001, and followed up through age 3 years. Main Outcome Measures  Prevalence of and age at progression to a first US Centers for Disease Control and Prevention category C diagnosis relative to year of birth, type of ART, and age at initiation of therapy. Results  Of 205 children, 134 (65%) received ART and/or Pneumocystis jiroveci pneumonia prophylaxis. By age 3 years, 81 (40%) progressed to a category C diagnosis, 41 (51%) of whom died. Untreated children were significantly more likely to progress to a category C diagnosis (62% [44/71] untreated vs 28% [37/134] treated children, P<.001); none of 23 infants who received triple ART progressed to category C. However, even without triple ART, very early mono/dual ART (by age 2 months vs 3-4 months) was associated with delayed and decreased progression to category C (P = .02). Of 33 children born between January 1, 1996, and December 31, 2001, only 7 (21%) progressed to category C (P = .02 compared with 1988-1995), 6 of 7 of whom received no therapy. More recent year of birth and more advanced therapy were associated with improved survival. Conclusions  This population-based cohort demonstrated decreased early HIV progression and improved survival at age 3 years, associated with more advanced therapy. Although limited by small sample size, the findings suggest that very early treatment, even without triple ART, was associated with improved outcome.      

Residential proximity to agricultural pesticide use and incidence of breast cancer in the California Teachers Study cohort

We examined the association between residential proximity to agricultural pesticide use and breast cancer incidence among members of the California Teachers Study cohort, a large study of professional school employees with extensive information on breast cancer risk factors, followed for cancer incidence since 1995. We identified 1552 invasive breast cancer cases, diagnosed between 1996 and 1999, among 114,835 cohort members. We used California Pesticide Use Reporting data to select pesticides for analysis based on use volume, carcinogenic potential, and exposure potential; a Geographic Information System was used to estimate pesticide applications within a half-mile radius of subjects' residences. We applied Cox proportional hazard models to estimate hazard rate ratios (HR) for selected pesticides, adjusting for age, race, and socioeconomic status. We saw no association between residential proximity to recent agricultural pesticide use and invasive breast cancer incidence. HR estimates for the highest compared to the lowest exposure categories for groups of agents were as follows: probable or likely carcinogens (1.07, 95% confidence interval (CI): 0.86-1.32), possible or suggestive carcinogens (1.06, 95% CI: 0.87-1.29), mammary carcinogens (1.15, 95% CI: 0.90-1.48), and endocrine disruptors (1.03, 95% CI: 0.86-1.25). HR estimates for other groups and individual pesticides did not differ from unity, nor was there a trend for any groupings of or individual pesticides examined. Stratifying by menopausal status or family history of breast cancer did not substantially affect our results. Our analyses suggest that breast cancer incidence is not elevated in areas of recent, high agricultural pesticide use in California.     

Validation of self-reported cancers in the California Teachers Study

Self-reported cancer data from the California Teachers Study were validated by using California Cancer Registry data. The California Teachers Study cohort consists of 133,479 active and retired California teachers. In 1995-1996, data from a mailed questionnaire were linked to the California Cancer Registry data. Sensitivity and specificity of 11 types of cancer were calculated. Multivariate analyses were conducted to evaluate correlates of false-positive and false-negative reporting. Sensitivities showed great variation by cancer site. The highest sensitivities were observed for breast (96.4%) and thyroid (92.9%) cancers, whereas the lowest sensitivities were those for cervical (44.3%), endometrial (69.1%), and other skin (53.6%) cancers. The sensitivities for in situ cancers (at the time of diagnosis) were considerably lower than those for invasive cancers in about half of the cancer types surveyed. The specificities for individual cancer sites ranged from 90% to 99%; the highest were those for lung cancer, leukemia, and Hodgkin's disease (all 99.9%). The lowest specificity was for other skin cancer (90.2%). In situ stage at diagnosis and older age were significantly associated with false-positive reporting. Age and non-White race were associated with false-negative reporting. These findings suggest that the feasibility of using self-reported data without verification in epidemiologic studies of cancer varies by site.