Annals of the New York Academy of Sciences
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Ann. N. Y. Acad. Sci. · Dec 2001
Historical ArticleSpecific features of the spread of tuberculosis in Russia at the end of the 20th century.
This study shows the dynamics of the epidemiological process over the last decade and presents the causes of the deterioration in TB control. Explanations are given for the TB mortality rate increase, the trustworthiness of the data, and the factors influencing its formation. The present-day TB epidemiological situation in Russia is characterized by an increase in exogenous infection. ⋯ In the 1990s this trend has changed. TB infection spreads according to trends that are quite similar to those at the beginning of 20th century. The official TB morbidity rate does not reflect the true level of incidence because of undetected TB cases (approx. 10%).
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Ann. N. Y. Acad. Sci. · Dec 2001
Comparative StudyThe MORE trial: multiple outcomes for raloxifene evaluation--breast cancer as a secondary end point: implications for prevention.
Breast cancer is a common disease in the United States and Europe and is therefore a major target for prevention strategies. Estrogen plays a central role in its pathogenesis, and treatment with estrogen deprivation has long been recognized to be an effective therapy. Tamoxifen is the first selective estrogen receptor modulator (SERM) to be widely used for the treatment of breast cancer and has been demonstrated to reduce the risk of breast cancer in high-risk women. ⋯ A second large-scale prevention trial in breast cancer comparing tamoxifen to raloxifene is presently enrolling cancer-free, but high-risk postmenopausal women (the STAR trial). Future directions include combined estrogen blockade of the breast by the addition of an aromatase inhibitor to a SERM. New trial designs, including those based on biochemical changes at the tissue level, will be required to allow future progress in this field with adequate rapidity.
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Ann. N. Y. Acad. Sci. · Dec 2001
ReviewBeyond tamoxifen new endpoints for breast cancer chemoprevention, new drugs for breast cancer prevention.
Although tamoxifen appears to markedly reduce breast cancer risk in women with a prior diagnosis of atypical hyperplasia or in situ carcinoma, it is not clear what other groups of women receive substantial benefit. Major breast chemoprevention priorities are to (1) develop new agents that (a) have fewer side effects, (b) are effective in ER--as well as tamoxifen-resistant precancerous tissue, and (c) are compatible with hormone therapy; and (2) develop efficient clinical strategies including prognostic and predictive morphologic and molecular biomarkers. Breast tissue may be repeatedly sampled for evidence of intraepithelial neoplasia by fine needle aspiration, ductal lavage, or needle biopsy to select candidates at highest short-term risk as well as to monitor response in small proof of principle studies prior to a large cancer incidence trial. ⋯ Retinoids, rexinoids, and deltanoids may be efficacious in ER+ tissue resistant to tamoxifen. Agents which should theoretically have activity in ER- or ER+ precancerous tissue include polyamine synthesis inhibitors, tyrosine kinase inhibitors, combined demethylating agents and histone deacetylase inhibitors, as well as metalloprotease and angiogenesis inhibitors. Sample Phase I and Phase II clinical trial designs are reviewed using modulation of molecular markers and breast intraepithelial neoplasia as the major endpoints.
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Ann. N. Y. Acad. Sci. · Dec 2001
Did God create our universe? Theological reflections on the Big Bang, inflation, and quantum cosmologies.
The sciences and the humanities, including theology, form an epistemic hierarchy that ensures both constraint and irreducibility. At the same time, theological methodology is analogous to scientific methodology, though with several important differences. This model of interaction between science and theology can be seen illustrated in a consideration of the relation between contemporary cosmology (Big Bang cosmology, cosmic inflation, and quantum cosmology) and Christian systematic and natural theology. In light of developments in cosmology, the question of origins has become theologically less interesting than that of the cosmic evolution of a contingent universe.
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Ann. N. Y. Acad. Sci. · Dec 2001
Review Multicenter StudyEarly lung cancer action project: annual screening using single-slice helical CT.
The advent of helical CT imaging held promise for the early diagnosis, and thereby, for enhanced curability of lung cancer--a highly fatal disease. In 1993, the Early Lung Cancer Action Project (ELCAP) was initiated and experimentally screened a cohort of 1,000 high-risk persons. ⋯ CT-based screening (compared to traditional radiology) was clearly shown to enhance the detection of lung cancer at earlier and more curable stages. A discussion follows of the meaning of the results and possible future screening protocols.