Association between diabetes, diabetes treatment and risk of developing endometrial cancer.

BackgroundA growing body of evidence suggests that diabetes is a risk factor for endometrial cancer incidence. However, most of these studies used case-control study designs and did not adjust for obesity, an established risk factor for endometrial cancer. In addition, few epidemiological studies have examined the association between diabetes treatment and endometrial cancer risk. The objective of this study was to assess the relationships among diabetes, diabetes treatment and endometrial cancer risk in postmenopausal women participating in the Women's Health Initiative (WHI).MethodsA total of 88 107 postmenopausal women aged 50-79 years who were free of cancer and had no hysterectomy at baseline were followed until date of endometrial cancer diagnosis, death, hysterectomy or loss to follow-up, whichever came first. Endometrial cancers were confirmed by central medical record and pathology report review. Multivariate Cox proportional hazards regression models were used to estimate hazard ratios (HRs) (95% confidence interval (CI)) for diagnosis of diabetes and metformin treatment as risk factors for endometrial cancer.ResultsOver a mean of 11 years of follow-up, 1241 endometrial cancers developed. In the primary analysis that focused on prevalent diabetes at enrolment, compared with women without diabetes, women with self-reported diabetes, and the subset of women with treated diabetes, had significantly higher risk of endometrial cancer without adjusting for BMI (HR=1.44, 95% CI: 1.13-1.85 for diabetes, HR=1.57, 95% CI: 1.19-2.07 for treated diabetes). However after adjusting for BMI, the associations between diabetes, diabetes treatment, diabetes duration and the risk of endometrial cancer became non-significant. Elevated risk was noted when considering combining diabetes diagnosed at baseline and during follow-up as time-dependent exposure (HR=1.31, 95% CI: 1.08-1.59) even after adjusting for BMI. No significant association was observed between metformin use and endometrial cancer risk.ConclusionsOur results suggest that the relationship observed in previous research between diabetes and endometrial cancer incidence may be largely confounded by body weight, although some modest independent elevated risk remains

Hard X-ray emission from Eta Carinae

Context : If relativistic particle acceleration takes place in colliding-wind binaries, hard X-rays and gamma-rays are expected through inverse Compton emission, but to date these have never been unambiguously detected. Aims : To detect this emission, observations of Eta Carinae were performed with INTEGRAL, leveraging its high spatial resolution. Methods : Deep hard X-ray images of the region of Eta Car were constructed in several energy bands. Results : The hard X-ray emission previously detected by BeppoSax around Eta Car originates from at least 3 different point sources. The emission of Eta Car itself can be isolated for the first time, and its spectrum unambiguously analyzed. The X-ray emission of Eta Car in the 22-100 keV energy range is very hard (photon index around 1) and its luminosity is 7E33 erg/s. Conclusions : The observed emission is in agreement with the predictions of inverse Compton models, and corresponds to about 0.1% of the energy available in the wind collision. Eta Car is expected to be detected in the GeV energy range.Comment: 5 pages with 2 figures. Accepted as a Letter in Astronomy & Astrophysic

Whole Earth Telescope observations of the hot helium atmosphere pulsating white dwarf EC 20058-5234

We present the analysis of a total of 177h of high-quality optical time-series photometry of the helium atmosphere pulsating white dwarf (DBV) EC 20058-5234. The bulk of the observations (135h) were obtained during a WET campaign (XCOV15) in July 1997 that featured coordinated observing from 4 southern observatory sites over an 8-day period. The remaining data (42h) were obtained in June 2004 at Mt John Observatory in NZ over a one-week observing period. This work significantly extends the discovery observations of this low-amplitude (few percent) pulsator by increasing the number of detected frequencies from 8 to 18, and employs a simulation procedure to confirm the reality of these frequencies to a high level of significance (1 in 1000). The nature of the observed pulsation spectrum precludes identification of unique pulsation mode properties using any clearly discernable trends. However, we have used a global modelling procedure employing genetic algorithm techniques to identify the n, l values of 8 pulsation modes, and thereby obtain asteroseismic measurements of several model parameters, including the stellar mass (0.55 M_sun) and T_eff (~28200 K). These values are consistent with those derived from published spectral fitting: T_eff ~ 28400 K and log g ~ 7.86. We also present persuasive evidence from apparent rotational mode splitting for two of the modes that indicates this compact object is a relatively rapid rotator with a period of 2h. In direct analogy with the corresponding properties of the hydrogen (DAV) atmosphere pulsators, the stable low-amplitude pulsation behaviour of EC 20058 is entirely consistent with its inferred effective temperature, which indicates it is close to the blue edge of the DBV instability strip. (abridged)Comment: 19 pages, 8 figures, 5 tables, MNRAS accepte

The Galactic Centre Source IRS 13E: a Post-LBV Wolf-Rayet Colliding Wind Binary?

IRS 13E is an infrared, mm and X-ray source in the Galactic Centre. We present the first Chandra X-ray spectrum for IRS 13E and show that it is consistent with a luminous and highly absorbed X-ray binary system. Since the X-ray luminosity is too large for a solitary star, our interpretation is that of an early-type long-period binary with strong colliding winds emission. This naturally explains the observed X-ray spectrum and count rate as well as its lack of significant short term variability. Due to the short lifetime of any nebula 0.2 pc from the putative central super-massive black-hole, we argue that the primary of IRS 13E has exited the LBV phase in the last few thousand years

A phase-resolved XMM-Newton Campaign on the Colliding Wind Binary HD 152248

We report the first results of an XMM-Newton monitoring campaign of the NGC 6231 open cluster in the Sco OB1 association. This first paper focuses on the massive colliding wind binary HD 152248, which is the brightest X-ray source of the cluster. The campaign, with a total duration of 180 ksec, was split into six separate observations, following the orbital motion of HD 152248. The X-ray flux from this system presents a clear, asymmetric modulation with the phase and ranges from 0.73 to 1.18 10-12 erg s-1 cm-2 in the [0.5-10.0 keV] energy band. The maximum of the emission is reached slightly after apastron. The EPIC spectra are quite soft and peak around 0.8-0.9 keV. We characterize their shape using several combinations of mekal models and power-law spectra and we detect significant spectral variability in the [0.5-2.5 keV] energy band. We also perform 2-D hydrodynamical simulations using different sets of parameters that closely reproduce the physical and orbital configuration of the HD 152248 system at the time of the six XMM-Newton pointings. This allows a direct confrontation of the model predictions with the constraints deduced from the X-ray observations of the system. We show that the observed variation of the flux can be explained by a variation of the X-ray emission from the colliding wind zone, diluted by the softer X-ray contribution of the two O-type stars of the system. Our simulations also reveal that the interaction region of HD 152248 should be highly unstable, giving rise to shells of dense gas that are separated by low density regions. Finally, we perform a search for short-term variability in the light curves of the system and we show that trends are present within several of the 30 ksec exposures of our campaign. Further, most of these trends are in good .Comment: Accepted by MNRAS; 22 pages; without figures; complete PS version (including figures) on http://vela.astro.ulg.ac.be/Preprints/index.htm

O stars with weak winds: the Galactic case

We study the stellar and wind properties of a sample of Galactic O dwarfs to track the conditions under which weak winds (i.e mass loss rates lower than ~ 1e-8 Msol/yr) appear. The sample is composed of low and high luminosity dwarfs including Vz stars and stars known to display qualitatively weak winds. Atmosphere models including non-LTE treatment, spherical expansion and line blanketing are computed with the code CMFGEN. Both UV and Ha lines are used to derive wind properties while optical H and He lines give the stellar parameters. Mass loss rates of all stars are found to be lower than expected from the hydrodynamical predictions of Vink et al. (2001). For stars with log L/Lsol > 5.2, the reduction is by less than a factor 5 and is mainly due to the inclusion of clumping in the models. For stars with log L/Lsol < 5.2 the reduction can be as high as a factor 100. The inclusion of X-ray emission in models with low density is crucial to derive accurate mass loss rates from UV lines. The modified wind momentum - luminosity relation shows a significant change of slope around this transition luminosity. Terminal velocities of low luminosity stars are also found to be low. The physical reason for such weak winds is still not clear although the finding of weak winds in Galactic stars excludes the role of a reduced metallicity. X-rays, through the change in the ionisation structure they imply, may be at the origin of a reduction of the radiative acceleration, leading to lower mass loss rates. A better understanding of the origin of X-rays is of crucial importance for the study of the physics of weak winds.Comment: 31 pages, 42 figures. A&A accepted. A version of the paper with full resolution figures is available at http://www.mpe.mpg.de/~martins/publications.htm

Hard X-ray identification of Eta Carinae and steadiness close to periastron

Context: The colliding-wind binary Eta Car exhibits soft X-ray thermal emission that varies strongly around periastron, and non-thermal emission seen in hard X-rays and gamma-rays. Aims: To definitively identify Eta Car as the source of the hard X-ray emission, to examine how changes in the 2-10 keV band influence changes in the hard X-ray band, and to understand more clearly the mechanisms producing the non-thermal emission using new INTEGRAL observations obtained close to periastron. Methods: A Chandra observation encompassing the ISGRI error circle was analysed, and all other soft X-ray sources (including the outer shell of Eta Car itself) were discarded as likely counter-parts. New hard X-ray images of Eta Car were studied close to periastron, and compared to previous observations far from periastron. Results: The INTEGRAL component, when represented by a power law (with a photon index of 1.8), would produce more emission in the Chandra band than observed from any point source in the ISGRI error circle apart from Eta Car, as long as the hydrogen column density to the ISGRI source is lower than 1E24 cm^{-2}. Such sources are rare, thus the ISGRI emission is very likely to be associated with Eta Car. The eventual contribution of the outer shell to the non-thermal component also remains fairly limited. Close to periastron, a 3-sigma detection is achieved for the hard X-ray emission of Eta Car, with a flux similar to the average value far from periastron. Conclusions: Assuming a single absorption component for both the thermal and non-thermal sources, this detection can be explained with a hydrogen column density that does not exceed 6E23 cm^{-2} without resorting to an intrinsic increase in the hard X-ray emission. The energy injected in hard X-rays (averaged over a month) appears rather constant as close as a few stellar radii, well within the acceleration region of the wind.Comment: 9 pages with 5 figures. Accepted for publication in Astronomy & Astrophysic

Options for early breast cancer follow-up in primary and secondary care : a systematic review

Background Both incidence of breast cancer and survival have increased in recent years and there is a need to review follow up strategies. This study aims to assess the evidence for benefits of follow-up in different settings for women who have had treatment for early breast cancer. Method A systematic review to identify key criteria for follow up and then address research questions. Key criteria were: 1) Risk of second breast cancer over time - incidence compared to general population. 2) Incidence and method of detection of local recurrence and second ipsi and contra-lateral breast cancer. 3) Level 1–4 evidence of the benefits of hospital or alternative setting follow-up for survival and well-being. Data sources to identify criteria were MEDLINE, EMBASE, AMED, CINAHL, PSYCHINFO, ZETOC, Health Management Information Consortium, Science Direct. For the systematic review to address research questions searches were performed using MEDLINE (2011). Studies included were population studies using cancer registry data for incidence of new cancers, cohort studies with long term follow up for recurrence and detection of new primaries and RCTs not restricted to special populations for trials of alternative follow up and lifestyle interventions. Results Women who have had breast cancer have an increased risk of a second primary breast cancer for at least 20 years compared to the general population. Mammographically detected local recurrences or those detected by women themselves gave better survival than those detected by clinical examination. Follow up in alternative settings to the specialist clinic is acceptable to women but trials are underpowered for survival. Conclusions Long term support, surveillance mammography and fast access to medical treatment at point of need may be better than hospital based surveillance limited to five years but further large, randomised controlled trials are needed

The origin of the runaway high-mass X-ray binary HD153919/4U1700-37

Based on its Hipparcos proper motion, we propose that the high-mass X-ray binary HD153919/4U1700-37 originates in the OB association Sco OB1. At a distance of 1.9 kpc the space velocity of 4U1700-37 with respect to Sco OB1 is 75 km/s. This runaway velocity indicates that the progenitor of the compact X-ray source lost about 7 Msun during the (assumed symmetric) supernova explosion. The system's kinematical age is about 2 +/- 0.5 million years which marks the date of the supernova explosion forming the compact object. The present age of Sco OB1 is <8 Myr; its suggested core, NGC 6231, seems to be somewhat younger (~5 Myr). If HD153919/4U1700-37 was born as a member of Sco OB1, this implies that the initially most massive star in the system terminated its evolution within 30 Msun. With these parameters the evolution of the binary system can be constrained.Comment: 6 pages, latex, 3 embedded ps figures, to appear in A&

Evaluation of the current knowledge limitations in breast cancer research: a gap analysis

BACKGROUND A gap analysis was conducted to determine which areas of breast cancer research, if targeted by researchers and funding bodies, could produce the greatest impact on patients. METHODS Fifty-six Breast Cancer Campaign grant holders and prominent UK breast cancer researchers participated in a gap analysis of current breast cancer research. Before, during and following the meeting, groups in seven key research areas participated in cycles of presentation, literature review and discussion. Summary papers were prepared by each group and collated into this position paper highlighting the research gaps, with recommendations for action. RESULTS Gaps were identified in all seven themes. General barriers to progress were lack of financial and practical resources, and poor collaboration between disciplines. Critical gaps in each theme included: (1) genetics (knowledge of genetic changes, their effects and interactions); (2) initiation of breast cancer (how developmental signalling pathways cause ductal elongation and branching at the cellular level and influence stem cell dynamics, and how their disruption initiates tumour formation); (3) progression of breast cancer (deciphering the intracellular and extracellular regulators of early progression, tumour growth, angiogenesis and metastasis); (4) therapies and targets (understanding who develops advanced disease); (5) disease markers (incorporating intelligent trial design into all studies to ensure new treatments are tested in patient groups stratified using biomarkers); (6) prevention (strategies to prevent oestrogen-receptor negative tumours and the long-term effects of chemoprevention for oestrogen-receptor positive tumours); (7) psychosocial aspects of cancer (the use of appropriate psychosocial interventions, and the personal impact of all stages of the disease among patients from a range of ethnic and demographic backgrounds). CONCLUSION Through recommendations to address these gaps with future research, the long-term benefits to patients will include: better estimation of risk in families with breast cancer and strategies to reduce risk; better prediction of drug response and patient prognosis; improved tailoring of treatments to patient subgroups and development of new therapeutic approaches; earlier initiation of treatment; more effective use of resources for screening populations; and an enhanced experience for people with or at risk of breast cancer and their families. The challenge to funding bodies and researchers in all disciplines is to focus on these gaps and to drive advances in knowledge into improvements in patient care