Excessive tumor-elaborated VEGF and its neutralization define a lethal paraneoplastic syndrome

Vascular endothelial growth factor (VEGF) is a potent endothelial cell mitogen and key regulator of both physiologic and pathologic (e.g., tumor) angiogenesis. In the course of studies designed to assess the ability of constitutive VEGF to block tumor regression in an inducible RAS melanoma model, mice implanted with VEGF-expressing tumors sustained high morbidity and mortality that were out of proportion to the tumor burden. Documented elevated serum levels of VEGF were associated with a lethal hepatic syndrome characterized by massive sinusoidal dilation and endothelial cell proliferation and apoptosis. Systemic levels of VEGF correlated with the severity of liver pathology and overall clinical compromise. A striking reversal of VEGF-induced liver pathology and prolonged survival were achieved by surgical excision of VEGF-secreting tumor or by systemic administration of a potent VEGF antagonist (VEGF-TRAPR1R2), thus defining a paraneoplastic syndrome caused by excessive VEGF activity. Moreover, this VEGF-induced syndrome resembles peliosis hepatis, a rare human condition that is encountered in the setting of advanced malignancies, high-dose androgen therapy, and Bartonella henselae infection. Thus, our findings in the mouse have suggested an etiologic role for VEGF in this disease and may lead to diagnostic and therapeutic options for this debilitating condition in humans.

The Health Behavior Change Competency Checklist (HBCCC): Instrument development and psychometric evaluation.

More than half of morbidity and mortality in the United States can be attributed to behavior-related disease, such as tobacco use, physical inactivity, poor diet and alcohol consumption. Given the increased prevalence of behaviorally related medical health concerns, physician competence in the implementation of effective behavior change strategies is quickly becoming an essential skill. However, only recently have primary care residency programs begun to systematically teach and evaluate motivational interviewing skills critical to influencing health behavior, and use of standardized, objective assessment tools to assess skillfulness has been largely absent. This paper reports the development of a checklist, the Health Behavior Change Competency Checklist (HBCCC). The instrument captures the theoretical model of behavior change, motivational interviewing, in a practical and versatile manner. Psychometric evaluation demonstrated moderate efficacy. Namely, results indicated the HBCCC possesses good reliability, as evidenced by high internal consistency, and adequate construct validity. It also displayed considerable utility and practical application. While these results provide several reasons for confidence in the HBCCC, item revision and additional testing are required in order to establish it as a meaningful and valuable instrument.

Self-rated health and mortality: a follow-up study of a Spanish population

Objectives: Self-rated health (SRH) is known to be a valid indicator for the prediction of health outcomes. The aims of this study were to describe and analyse the associations between SRH and health status, socio-economic and demographic characteristics; and between SRH and mortality in a Spanish population. Study design: Longitudinal study. Methods: A sample of 5275 adults (age ≥21 years) residing in the Valencian Community (Spanish Mediterranean region) was surveyed in 2005 and followed for four years. SRH was categorized into good and poor health. The response variable was mortality (dead/alive), obtained from the local mortality register. Logistic regression models were adjusted in order to analyse the associations between SRH and health status, socio-economic and demographic characteristics; odds ratios were calculated to measure the associations. Poisson regression models were adjusted in order to analyse the associations between mortality and explanatory variables; the relative risk of death was calculated to measure the associations. Results: Poor SRH was reported by 25.9% of respondents, and the mortality rate after four years of follow-up was 3.6%. An association was found between SRH and the presence of chronic disease and disability in men and women. A perception of poor health vs good health led to a mortality risk of 3.0 in men and 2.7 in women. SRH was predictive of mortality, even after adjusting for all other variables. In men and women, the presence of disability provided additional predictive ability. Conclusions: SRH was predictive of mortality in both men and women, and acted as a mediator between socio-economic, demographic and health conditions and mortality.

Trends in diabetes incidence from 1992 to 2015 and projections for 2024: A Portuguese General Practitioner’s Network study

Background: Diabetes is known as a major cause of morbidity and mortality worldwide. Portugal is known as the European country with the highest prevalence of this disease. While diabetes prevalence data is updated annually in Portugal, the General Practitioner’s (GP) Sentinel Network represents the only data source on diabetes incidence. This study describes the trends in Diabetes incidence, between 1992 and 2015, and estimate projections for the future incidence rates in Portugal until 2024. Methods: An ecological time-series study was conducted using data from GP Sentinel Network between 1992 and 2015. Family doctors reported all new cases of Diabetes in their patients’ lists. Annual trends were estimated through Poisson regression models as well as the future incidence rates (until 2024), sex and age group stratified. Incidence rate projections were adjusted to the distribution of the resident Portuguese population given Statistics Portugal projections. Results: The average increase in Diabetes incidence rate was in total 4.29% (CI95% 3.80–4.80) per year under study. Until 1998–2000, the annual incidence rate was higher in women, and from 1998–2000 to 2013–2015 turn out to be higher in men. The incidence rate projected for 2022–2024 was 972.77/105 inhabitants in total, and 846.74/105 and 1114.42/105, respectively, in women and men. Conclusions: This is the first study in Portugal to estimate diabetes incidence rate projections. The disturbing reported projections seem realistic if things continue as in the past. Actually, effective public health policies will need to be undertaken to minimize this alarming future scenario.

Nicaragua, summary of biostatistics. Maps and charts, population, natality and mortality statistics.

Reproduced from type-written copy.

Birth and mortality statistics of the Virgin Islands of the United States. 1901-1919.

On t.-p., seal of Department of the navy, Bureau of medicine & surgery.

Peru, summary of biostatistics. Maps and charts, population, natality and mortality statistics.

Reproduced from type-written copy.

As they liked it : an essay on Shakespeare and mortality.

Bibliography: p. 223-229.

Uruguay, summary of biostatistics. Maps and charts, population, natality and mortality statistics.

Reproduced from type-written copy.

Cuba, summary of biostatistics : maps and charts, population, natality, and mortality, statistics /

Limited cataloging.

Argentina, summary of biostatistics. Maps and charts, population, natality and mortality statistics.

Reproduced from type-written copy.