Annals of the New York Academy of Sciences
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West Nile virus, first isolated in 1937, is among the earliest arthropod-borne viruses discovered by humans. Its broad geographical distribution, not uncommon infection of humans, transmission by mosquitoes, and association with wild birds as enzootic hosts were well documented by the mid-1960s. However, West Nile virus was not considered to be a significant human pathogen because most infections appeared to result in asymptomatic or only mild febrile disease. ⋯ In addition the epidemic in the northeastern United States was unusual in the association of West Nile virus infection with fatal disease of birds, suggesting a change in the virulence of the virus toward this host. Understanding the risk factors that contributed to these three urban epidemics is important for minimizing the potential for future occurrences. This review will attempt to compare observations on the biology of West Nile virus made over about 60 years prior to the recent epidemics to observations made in association with these urban epidemics.
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Ann. N. Y. Acad. Sci. · Dec 2001
ReviewBreast cancer prevention with selective estrogen receptor modulators: a perspective.
Chemoprevention for breast cancer is both old and new. It has long been appreciated that early ovarian ablation dramatically reduces the incidence of breast cancer in premenopausal women. It was subsequently demonstrated, in the Early Breast Cancer Trialists' Collaborative Group (EBCTCG) overview, that tamoxifen results in a 40% or greater reduction in the incidence of contralateral breast cancer. ⋯ Raloxifene, a newer selective estrogen receptor modulator (SERM) originally developed for osteoporosis, also appears to have a major preventive effect on breast cancer incidence. Limitations in the design and patient population of raloxifene trials, however, have made it difficult to as yet recommend raloxifene for risk reduction of breast cancer. The randomized Study of Tamoxifen and Raloxifene (STAR) study, which will compare raloxifene to tamoxifen in over 20,000 postmenopausal women at increased risk of breast cancer, as well as ongoing and proposed placebo-controlled studies of tamoxifen, the aromatase inhibitor anastrazole, and other antiestrogens in high- or average-risk postmenopausal women, will provide further results on optimal prevention strategies.
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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
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
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.