Imaging technologies in breast diagnosis and surgical treatment

The diagnostic and surgical management of breast cancer has changed dramatically over the past 2 decades. All facets in the multidisciplinary management of breast cancer are rapidly evolving and being driven forward by technological advances. Conventional imaging techniques are now being augmented with advances in molecular imaging that probe biological properties of tissue to create images, and optical imaging which reflects physical properties of normal and diseased tissues. Automated computer assisted biopsy techniques are being developed to sample breast tissue with a higher degree of accuracy and patient comfort. As the trend toward minimally invasive breast surgery continues ablative techniques such as radiofrequency ablation, cryoablation, interstitial laser ablation and focused ultrasound ablation are being explored to potentially avoid the need for surgery all together. New intraoperative lesion localization techniques such as 3-dimensional ultrasonographic tumor models, magnetic resonance imaging (MRI)-guided projection and reproduction, radioguided occult lesion localization and optical imaging techniques are being developed to improve surgical guidance. Evaluation of advanced imaging and intraoperative guidance techniques requires more comprehensive histopathological examination of surgical specimens, prompting the development of techniques aimed at to improving upon the current limitations in breast pathology. This review will describe the development of new technologies in breast imaging, tumor ablation, intraoperative surgical guidance and tissue processing aimed at advancing minimally invasive diagnosis and treatment of breast cancer.

Mutation Analysis of the APC Gene in a Chinese FAP Pedigree with Unusual Phenotype

Background and Aim. Germline mutations of the adenomatous polyposis coli (APC) gene cause familial adenomatous polyposis (FAP), an autosomal dominant inherited disease mainly characterized by colorectal adenomatous polyposis. Genetic studies of FAP have shown that somatic APC mutations are dependent on the position of the germline APC mutation. However, the molecular mechanism underlying these genotype-phenotype associations for APC in Chinese remain largely unknown. Patients and Methods. In this study, we investigated the APC gene mutation in a Chinese FAP family by systematic screening with multiplex ligation-dependent probe amplification (MLPA), denaturing high-performance liquid chromatography (dHPLC), and DNA sequencing. Promoter methylation was detected by methylation-specific PCR. Results. The identical germline mutation c.1999 C>T (Q667X) of APC was identified in 5 affected members, among which 2 members carried somatic mutations of APC, one with promoter hypermethylation and the other with loss of wild-type allele in their adenomas. The somatic mutations were shown connected with the disease severity, demonstrating a unique genotype-phenotype association in this FAP pedigree. Conclusion. The study revealed the existence of novel pathogenic mutations in Chinese patients with FAP. Somatic mutations are of particular interest because of the unusual phenotypic features shown by patients.

Advanced glycation endproducts increase EPC apoptosis and decrease nitric oxide release via MAPK pathways

OBJECTIVE

Previous studies have shown that advanced glycation endproducts (AGE) can induce endothelial progenitor cells (EPC) apoptosis, which contributes to the pathogenesis of diabetes mellitus. Nitric oxide (NO) signaling is closely associated with apoptosis. We therefore investigated the effects of AGE on human EPC apoptosis, NO release and related signal transduction pathways.

METHODS

EPC isolated from healthy human subjects were cultured with various concentrations of AGE (0, 2, 20 and 200mg/L) for 0, 24, 48 and 72 h in the presence or absence of various MAPK (ERK/P38/JNK) inhibitors, respectively. EPC apoptosis (detected by flow cytometric analyses) and NO concentration in culture supernatant were determined. The mRNA levels of eNOS, COX-2, Bcl-2 and Bax were assessed by RT-PCR and the protein expressions of NF-kappaB and Caspase-3 assessed by Western blot.

RESULTS

Increased EPC apoptosis and reduced NO release were induced by 200mg/L AGE, accompanied by a downregulation of eNOS and Bcl-2 expressions as well as an elevation in COX-2, Bax, NF-kappaB and Caspase-3 expressions in a time-dependent manner (all P<0.05). These changes were significantly attenuated by pretreatment with various MAPK (ERK/P38/JNK) inhibitors (P<0.05).

CONCLUSIONS

AGE can promote EPC apoptosis and decrease NO release via MAPK pathways.

Cytotoxicity of adenoviruses expressing the wild-type p53 gene to esophageal carcinoma cells is linked with the CAR expression level and indirectly with the endogenous p53 status

We examined cytotoxic effects of adenoviruses (Ad) expressing the p53 gene (Ad-p53) in nine human esophageal carcinoma cell lines with respect to the Ad receptor expression and the endogenous p53 gene status. Ad-p53-mediated cytotoxicity was related with an expression level of the coxsackievirus adenovirus receptor (CAR) but not with that of CD51, both of which are type 5 Ad receptors. Contrary to earlier studies, we found that the cytotoxicity was greater in tumor cells with the wild-type p53 gene than in those with mutated p53. The cytotoxic activity of Ad defective of E1B55kDa molecules (Ad-delE1B55), however, was not linked with the CAR expression level or the endogenous p53 status. We noticed that the tumor cells with the wild-type p53 gene showed greater CAR expression levels, although transduction with Ad-p53 did not upregulate the CAR expression in the mutated cells. We also examined the Ad-53-mediated cytotoxicity in two kinds of paired fibroblasts, parent and immortalized with loss of the p53 functions, and showed that the CAR expression level was more influential than the endogenous p53 status in the cytotoxicity. These data suggest that CAR expression level is a better predictive marker than endogenous p53 status for Ad-p53-mediated cytotoxicity in esophageal carcinoma.

Relationship between vitamin D status, body composition and physical exercise of adolescent girls in Beijing

Little is known about the prevalence of actual vitamin D deficiency in healthy school-aged adolescents, particularly in China. The aim of this study was to examine the prevalence of hypovitaminosis D and to identify whether there was any association between vitamin D status, body composition and physical exercise in 323 Chinese adolescent girls in Beijing, China (40 degrees N).

INTRODUCTION

It is well recognized that persistent severe vitamin D deficiency is associated with the bone abnormalities of rickets and osteomalacia. However, there is now evidence suggesting that low vitamin D status, not previously considered to be a state of deficiency is associated with secondary hyperparathyroidism, increased bone remodelling and other clinical signs thought only to be found in severe vitamin D deficiency. Hypovitaminosis D in healthy children and adolescents has been reported frequently in many countries, especially in winter.

METHODS

We performed a cross-sectional analysis of 323 Chinese adolescent girls in Beijing in winter. Mean age of the subjects was 15.0 (+/-0.4) years. About 32.8%, 68.4% and 89.2% of the subjects were at risk of vitamin D deficiency when defined as plasma concentrations of 25OHD of 25, 37.5 or 50 nmol/L, respectively.

RESULTS

This cross-sectional analysis of 323 Chinese adolescent girls in Beijing in winter showed that hypovitaminosis D was common in these subjects. In addition, body mass index, milk intake, participation in organized sports and total physical activity were all significant independent determinants of vitamin D status. An inverse association was found between plasma 25OHD and intact-parathyroid hormone (iPTH) concentration. Body mass index (BMI), milk intake, participation in organized sports and total physical activity all emerged as major independent determinants of vitamin D status as assessed by plasma 25OHD concentration. Vitamin D status was positively associated with lean body mass (LBM), but there was no association with the degree of body adiposity. Regardless of the concentration of 25OHD in blood used to define vitamin D deficiency, hypovitaminosis D was common in these subjects.

CONCLUSION

It is recommended that policies be developed to prevent vitamin D deficiency in adolescent girls. Further studies are needed to identify the mechanisms whereby vitamin D status is related to exercise and to body composition during growth.

Association between CpG island methylation of the WWOX gene and its expression in breast cancers

OBJECTIVES

The aim of the present study was to evaluate the expression of the WWOX gene in breast carcinoma and to analyze the relationship between its expression and methylation.

METHODS

Methylation of the WWOX promoter and exon 1 as well as WWOX expression were determined by methylation-specific PCR, reverse transcription PCR and immunohistochemistry in 20 breast cancer tissue samples and corresponding nonneoplastic tissues. The expression of WWOX protein was evaluated by immunohistochemistry in 2 breast cancer cell lines.

RESULTS

WWOX mRNA expression was reduced in breast cancer tissues as compared to adjacent tissues (p < 0.001). WWOX mRNA and protein expression was significantly reduced in breast cancer tissues with methylated WWOX CpG islands when compared to tissues without methylation (p < 0.001 and p = 0.008, respectively). Immunohistochemical analysis also showed that WWOX levels were significantly decreased in tissues with WWOX methylation (p = 0.001). WWOX mRNA and protein expression was greatly reduced in MDA-MB-231 cells, partly due to the methylation of WWOX CpG islands, and recovered after hydralazine treatment.

CONCLUSIONS

Differential regulation of the WWOX gene plays an important role in the carcinogenesis of breast cancer, due partially to methylation of the WWOX DNA CpG islands.

The relationship between admission blood glucose levels and hospital mortality

AIMS/HYPOTHESIS

The purpose of this study was to examine the relationship between blood glucose level (BGL) on admission with mortality rates among patients admitted to hospital through the Emergency Department.

METHODS

In a prospective observational study, BGLs were routinely measured on 6,187 consecutive patients requiring blood testing and admitted through the Emergency Department of a tertiary referral hospital. These measurements were matched against demographic data and hospital mortality rates.

RESULTS

Overall in-hospital mortality was 4.8%. Admission BGL was an independent predictor of mortality (HR 1.04 per 1 mmol/l increase, 95% CI 1.02-1.06, p=0.02). There was a significant interaction between diabetes status and increasing BGL on mortality (p<0.001), with higher BGLs being associated with greater mortality among non-diabetic than among diabetic patients. Among non-diabetic patients, the lowest mortality rate (3.0%) was in people with a BGL of 4.0-5.9 mmol/l. Compared with this group, patients with a BGL of 8.0-9.9 mmol/l had increased mortality rate (7.6%, HR 1.56, 95% CI 1.03-2.35, p=0.04, after adjustment for age and sex). The risk increased further at higher glucose levels. In the cohort with diagnosed diabetes, the increase in mortality rates at higher BGL bands was not significant.

CONCLUSIONS/INTERPRETATION

Among people who do not have diabetes, even modest degrees of hyperglycaemia on hospital admission are associated with increased mortality.

Increased expression of osteopontin in patients with triple-negative breast cancer

BACKGROUND

Patients with triple-negative [oestrogen receptor (ER) negative, progesterone receptor (PR) negative, and human epidermal growth factor receptor 2 (HER-2/neu) negative] breast cancer, accounting for about 15% of breast cancer cases, are associated with aggressive histology, poor prognosis and shorter survival. Osteopontin is a chemokine-like phosphorylated glycoprotein that plays important role in cancer progression and is found to be a metastasis-associated protein in breast cancer. The goal of the study was to evaluate osteopontin protein expression levels in triple-negative breast carcinomas to determine if they correlated with clinicopathological parameters, thus providing additional support for osteopontin functioning and better understanding of triple-negative breast cancer.

MATERIALS AND METHODS

A database of 239 patients, in whom all three markers (ER, PR, and HER-2/neu) were available, was reviewed. We performed osteopontin protein expression analyses by means of immunohistochemistry on 117 breast carcinoma tissue samples, and then assessed the mean value of osteopontin expression against triple-negative status and clinicopathological parameters.

RESULTS

Of the 239 patients in the study, 47 were classified as triple negative. Of the 117 osteopontin-test patients in this cohort, mean osteopontin levels were significantly higher in the triple-negative breast cancers than in non-triple-negative subtype (P = 0.035). TNM (tumours, nodes, metastases) stage were significantly associated with osteopontin levels (P = 0.038). Univariate analysis showed tumour cell osteopontin positivity above an optimized cut-point to be significantly associated with decreased disease-free survival, but not overall survival. In the multivariate model, osteopontin was an independent prognostic factor for disease-free survival.

CONCLUSIONS

Patients with osteopontin overexpression develop predominantly triple-negative tumours. Osteopontin overexpression is associated with tumour aggressiveness and poor prognosis.

IL-27-mediated activation of natural killer cells and inflammation produced antitumour effects for human oesophageal carcinoma cells

Interleukin IL-27, composed of p28 and EBV-induced gene 3 subunits, has diverse functions in enhancing cell-mediated immunity and silencing the immunity. We examined whether forced expression of the p28-linked EBI3 gene in human oesophageal carcinoma cells (Eca109) produced antitumour effects in a T cell-defective condition. Tumour growth of Eca109 cells expressing IL-27 (Eca109/IL-27) was retarded in nude mice compared with parental and vector DNA-transduced tumours and survival of the mice inoculated with Eca109/IL-27 cells was prolonged. Expression of the tumour necrosis factor-alpha, IL-1beta and IL-6 genes was up-regulated in Eca109/IL-27 tumour specimens while the tumours remained small in size but the increased transcription was subsequently down-regulated in enlarged tumours. Spleen cells from mice-bearing Eca109/IL-27 tumours produced interferon-gamma and showed YAC-1-targeted cytotoxic activities greater than those of mice inoculated with parental or vector DNA-transducer tumours. Numbers of DX5+CD69+ natural killer cells in spleen of mice-bearing Eca109/IL-27 tumours and those of CD31+ cells within Eca109/IL-27 tumours remained the same as found in mice-bearing parental or vector DNA-transduced tumours. These data collectively suggest that the IL-27-mediated antitumour effects produced in a mature T cell-defective condition were attributable to enhanced interferon-gamma production and natural killer activities.

Physical activity level and its association with metabolic syndrome among an employed population in China

The purpose of the present study was to estimate the association of physical activity level (PAL) with metabolic syndromes among the employed population in China. Using data from the 2002 China National Nutrition and Health Survey, the PAL of 21 834 subjects aged 18-59 years was described, and its relationship with the risk of metabolic syndrome was studied after adjusting for the relative effects of smoking, drinking, diet and socioeconomic status. Information on physical activity was collected by trained investigators using a 1-year physical activity questionnaire. PAL was classified into four categories: sedentary (PAL 1.00-1.39), low active (PAL 1.40-1.59), active (PAL 1.60-1.89) and very active (PAL 1.90-2.50). The definition of metabolic syndrome by the International Diabetes Federation 2005 was applied. The percentage of people being sedentary, low active, active and very active was 12.3%, 13.7%, 20.1% and 53.9% respectively. The crude prevalence of metabolic syndrome in the sedentary, low active, active and very active groups was 9.7%, 6.9%, 5.6% and 4.9% respectively. After adjusting for the effect of other risk factors, the higher the PAL, the lower the relative risk of metabolic syndrome as well as the individual metabolic abnormalities. The risk of overweight/obesity and metabolic syndrome was 50% and 59% less, respectively, in the adults who were very active and whose dietary fat contributed less than 20% to energy intakes when compared with their counterparts who were sedentary and consumed more fat (> or = 30% energy). PAL was an independent risk factor for obesity and multiple metabolic syndrome abnormalities among the employed population in China. The high-risk population were middle-age males living in large cities with high incomes who drink alcohol.

Evaluation of a classroom-based physical activity promoting programme

The purpose of the present study was to evaluate the effect of the Happy 10 programme on the promotion of physical activity, physical growth and development of primary school students, and on obesity control and prevention. Two similar primary schools from one district of Beijing, China were selected, one as an intervention school and the other as a control school. A Happy 10 programme was implemented at least once every school day in the intervention school for two semesters, whereas no intervention was adopted in the control school. The information on energy expenditure and duration of physical activity was collected by a validated 7-day physical activity questionnaire. Height and weight were measured by the trained investigators following standardized procedure. Energy expenditure and intensity of each Happy 10 session were measured by a physical activity monitor. The average energy expenditure and duration of total physical activity per day among students in the intervention school increased significantly from 15.0 to 18.2 kcal kg(-1) and 2.8 to 3.3 h, respectively, whereas the figures significantly decreased in the control school. There was a significant difference in change of weight and body mass index between girls in the intervention and control school (2.4 kg vs. 4.6 kg; 0.47 kg m(-2) vs. 0.66 kg m(-2)). The prevalence of overweight and obesity in the intervention school decreased by 0.4-5.6%, as compared with the increase by 0.6-4.5% in the control school. The average energy expenditure and intensity per 10-min session ranged from 25.0 to 35.1 kcal and from 4.8 to 6.2 kcal kg(-1) h(-1), respectively, in grades 1-5. The Happy 10 programme provides a useful strategy to promote physical activity among school children, and also plays a positive role in building up physical growth and development of girls.

Childhood obesity and its health consequence in China

Analyses of data from the representative 2002 National Nutrition and Health Survey were used to assess the likelihood of metabolic complications of overweight and obesity in Chinese children aged 7-17 years. Chinese criteria for body mass index classification were used for overweight and obesity with the 75th percentile US adolescent values for waist circumferences and all the metabolic criteria for blood pressure, lipids, fasting glucose established for US adolescents. Diabetes in 7-12-year-olds was 0.2% and 0.4% in children aged 12-18 years. Prevalences of dyslipidaemia (61.9%), hypertriglyceridaemia (18.2%) and low high-density lipoprotein cholesterol (56.1%) were high and 16.0% of 15-18 years had hypertension. The overall prevalence of the metabolic syndrome was 3.3% with more than half the children having at least one metabolic abnormality and 19.8% having at least two. All the metabolic parameters were significantly elevated in the overweight and obese children except high-density lipoprotein cholesterol. These data emphasize the marked sensitivity of Chinese children to the metabolic complications of overweight and obesity and amplify the need for early preventive measures.

Effects of surface pressure on the structure of the monolayer formed at the air/water interface by a non-ionic surfactant

The monolayer formed at an air/water interface by the synthetic non-ionic surfactant, 1,2-di-O-octadecyl-rac-glyceryl-3-(omega-methoxydodecakis (ethylene glycol)) (2C18E12) has been characterized using Langmuir trough measurements, Brewster angle microscopy (BAM), and neutron reflectometry. The BAM and reflectometry studies were performed at four different surface pressures (pi) in the range 15-40 mN/m. The BAM studies (which give information on the in-plane organisation of the surfactant layer) demonstrate that the 2C18E12 molecules are arranged on the water surface to form distinct, approximately circular, 5 microm diameter domains. As the surface pressure is increased these domains retain their size and shape but are made progressively more close-packed, such that the monolayer is made more or less complete at pi=40 mN/m. The neutron reflectometry measurements were made to determine the structure of the interfacial surfactant layer at pi=15, 28, 34 and 40 mN/m, providing information on the thickness of the 2C18E12 alkyl chains', head groups' and associated solvent distributions (measured along the surface normal), along with the separations between these distributions, and the effective interfacial area per molecule. Partial structure factor analyses of the reflectivity data show that the effective interfacial area occupied decreases from 217 A2 per 2C18E12 molecule at pi=15 mN/m down to 102 A2 at pi=40 mN/m. There are concomitant increases in the widths of the surfactant's alkyl chains' and head groups' distributions (modelled as Gaussians), with the former rising from 12 A (at pi=15 mN/m) up to 19 A (at pi=40 mN/m) and the latter rising from 13 A (at pi=15 mN/m) up to 24 A (at pi=40 mN/m). The compression of the monolayer is also shown to give rise to an increased surface roughness, some of which is due to the thermal roughness caused by capillary waves, but with a significant contribution also coming from the intrinsic/structural disorder in the monolayer. At all surface pressures studied, the alkyl chains and head groups of the 2C18E12 are found to exhibit a significant overlap, and this increases with increasing pi. Given the various trends noted on how the structure of the 2C18E12 monolayer changes as a function of pi, we extrapolate to consider the structure of the monolayer at pi>40 mN/m (making comparison with its single chain (CnEm) counterparts) and then relate these findings to the observations recorded on the structure and solute entrapment efficiency of 2C18E12 vesicles.

Prevalence of the metabolic syndrome in Chinese adolescents

Since national figures on the occurrence of metabolic syndrome among Chinese adolescents are lacking, this study aims to estimate its prevalence and distribution among Chinese youngsters. The 2002 China National Nutrition and Health Survey is a nationally representative cross-sectional study. Applying the criteria for US adolescents, we estimated the prevalence of metabolic syndrome among 2761 adolescents aged 15 to 19 years. The prevalence of metabolic syndrome among Chinese adolescents overall was 3.7 % (10 % in US adolescents). It was 35.2 %, 23.4 % and 2.3 % among adolescents who were overweight (BMI > or = 95th percentile), at risk of overweight (BMI between 85th and 95th percentile) and normal weight (BMI below the 85th percentile), respectively. Urban boys had the highest rate (5.8 %) compared with girls and rural youngsters. Among adolescents who had a BMI > or = 85th percentile and one or two parent(s) with metabolic syndrome, the prevalence was 46.4 %. A total of 96 % of overweight adolescents had at least one and 74.1 % overweight adolescents had at least two abnormalities of metabolic syndrome. Based on these figures, it is estimated that more than three million Chinese adolescents have metabolic syndrome. Both overweight and metabolic syndrome prevalence among adolescents are still relatively low in China, but the prevalence of metabolic syndrome among Chinese overweight adolescents is similar to those living in the USA.

Prevalence of thyroid disease in an older Australian population

AIM

To determine the prevalence of thyroid disease in an older Australian population in a population-based cross-sectional study.

BACKGROUND

Community-living subjects, aged 49 years or older, in two Blue Mountains postcodes were invited to participate in an eye, nutrition and health study between 1997 and 2000.

METHODS

Three thousand five hundred and nine of the 4489 identified persons participated. Fifty-seven per cent of 3504 who completed questionnaires were women; their mean age was 66.8 years. Thyroid-stimulating hormone (TSH) was measured in 2665 subjects (76% of those completing the questionnaire). The main outcome measures were serum TSH and free thyroxine levels, serum lipids, urate and sugar levels and questionnaire responses.

RESULTS

The prevalence of recognized thyroid disease (either self-reported history of thyroid disease or current thyroxine treatment) was 10% (95% confidence interval (CI) 8.9-11.1%). An additional 3.6% (95%CI 2.9-4.3%) of participants had unrecognized thyroid disease (abnormal TSH). The TSH was abnormal in 7.1% (95%CI 5.8-8.4%) of women and 3.7% (95%CI 2.6-4.8%) of men. Sixty-five per cent of those with an abnormal TSH did not report a history of thyroid disease, whereas 25% of those taking thyroxine replacement therapy had an abnormal TSH level. The prevalence of hypothyroidism increased with increasing age in women. The mean fasting cholesterol was 0.36 mmol/L (95%CI 0.15-0.57) higher in hypothyroid subjects than in euthyroid subjects.

CONCLUSION

Thyroid disease in older Australian women is relatively common and may be undiagnosed. Ongoing monitoring of patients on thyroxine replacement therapy is important, given that 25% of treated patients had an abnormal TSH.

Determinants of childhood overweight and obesity in China

In order to investigate the determinants of childhood overweight and obesity in China, the prevalence of overweight (including obesity) was compared according to different dietary and physical activity patterns and parental body weight status. A total of 6826 children aged 7-17 years from the 2002 China National Nutrition and Health Survey were included in the study. Information for dietary intake was collected using three consecutive 24-h recalls by trained interviewers. The amounts of cooking oil and condiments consumed were weighed. An interview-administered 1-year physical activity questionnaire was used to collect physical activity information. The results showed that the heavier the parental bodyweight, the higher the overweight prevalence in children. The prevalence ratio increased if parent(s) were overweight and/or obese, up to 12.2 if both parents were obese. Overweight children consumed significantly more dietary energy, protein and fat, but less carbohydrate than their normal weight counterparts. On average, overweight children spent 0.5 h less on moderate/vigorous activities and 2.3 h more on low intensity activities per week. The following prevalence ratios were statistically significant: walking to and from school (0.6); moderate/vigorous activities > or =45 min/d (0.8); low intensity physical activities >2 h/d (1.3); the consumption of > or =25 g/d cooking oil (1.4); > or =200 g/d meat and meat products consumption (1.5); > or =100g/d dairy products (1.8). After adjustment for parental body weight status and socioeconomic status, only cooking oil consumption and walking to and from school remained significantly related to child overweight. In conclusion, parental weight status is an import-ant determinant. Fat intake, low intensity activities and active transport to/from school may be suitable entry points for overweight prevention among Chinese school children.

Continued reduction in the incidence of birth trauma and birth asphyxia related to instrumental deliveries after the study period: Was this the Hawthorne effect?

BACKGROUND

The incidence of birth trauma and birth asphyxia related to instrumental deliveries in our obstetric unit was high (2.8%) in 1998-1999. A study was performed in 2000 to identify the risk factors. Unexpectedly, the incidence (0.6%) was reduced significantly during the study period. We attributed this phenomenon to the famous Hawthorne effect (tendency to improve performance because of awareness of being studied).

OBJECTIVES

The objectives were to study whether there is a continued reduction in the incidence of birth trauma and birth asphyxia related to instrumental deliveries in the post-study period (2001-2003) and to investigate the presence of underlying confounding factors apart from the Hawthorne effect.

METHOD

To compare the hospital obstetric statistics among the pre-study period (1998-1999), the study period (2000) and the post-study period (2001-2003), in particular the incidence of birth trauma and birth asphyxia related to instrumental deliveries, the instrumental delivery rate, the overall Caesarean section rate, the Caesarean section rate for no progress of labour, the incidence of failed instrumental delivery, the incidence of attempted instrumental delivery in the operating theatre, and incidence of direct second-stage Caesarean sections.

RESULTS

The incidence of birth trauma and birth asphyxia related to instrumental deliveries (0.6%) during the study period (2000) was significantly lower than that (2.8%) during the pre-study period (1998-1999; RR 0.27, 95% CI 0.11-0.70). This phenomenon continued into the post-study period (2001-2003) when the incidence of 1.0% was similarly lower than that in the pre-study period (RR 0.35, 95% CI 0.20-0.64). The instrumental delivery rate decreased further in the post-study period (13.5%) compared with those in the study (16.6%) and pre-study (19.5%) periods (RR 0.81, 95% CI 0.75-0.89 and RR 0.69, 95% CI 0.65-0.74, respectively). There was a marked increase in the direct second-stage Caesarean section rate in the post-study period (7.1%) compared to those in the study (0.4%) and pre-study (0.7%) periods (RR 15.9, 95% CI 5.05-49.73 and RR 9.77, 95% CI 5.28-18.08, respectively).

CONCLUSION

A change in obstetric practice was identified that may explain the continued reduction in the incidence of birth trauma and birth asphyxia related to instrumental deliveries in the post-study period.

Phytate intake and molar ratios of phytate to zinc, iron and calcium in the diets of people in China

OBJECTIVE

To assess the phytate intake and molar ratios of phytate to calcium, iron and zinc in the diets of people in China.

DESIGN

2002 China Nationwide Nutrition and Health Survey is a cross-sectional nationwide representative survey on nutrition and health. The information on dietary intakes was collected using consecutive 3 days 24 h recall by trained interviewers.

SUBJECTS

The data of 68 962 residents aged 2-101 years old from 132 counties were analyzed.

RESULTS

The median daily dietary intake of phytate, calcium, iron and zinc were 1186, 338.1, 21.2 and 10.6 mg, respectively. Urban residents consumed less phytate (781 vs 1342 mg/day), more calcium (374.5 vs 324.1 mg/day) and comparable amounts of iron (21.1 vs 21.2 mg/day) and zinc (10.6 vs 10.6 mg/day) than their rural counterparts. A wide variation in phytate intake among residents from six areas was found, ranging from 648 to 1433 mg/day. The median molar ratios of phytate to calcium, iron, zinc and phytate x calcium/zinc were 0.22, 4.88, 11.1 and 89.0, respectively, with a large variation between urban and rural areas. The phytate:zinc molar ratios ranged from 6.2 to 14.2, whereas the phytate x calcium/zinc molar ratios were from 63.7 to 107.2. The proportion of subjects with ratios above the critical values of phytate to iron, phytate to calcium, phytate to zinc and phytate x calcium/zinc were 95.4, 43.7, 23.1 and 8.7%, respectively. All the phytate/mineral ratios of rural residents were higher than that of their urban counterparts.

CONCLUSIONS

The dietary phytate intake of people in China was higher than those in Western developed countries and lower than those in developing countries. Phytate may impair the bioavailability of iron, calcium and zinc in the diets of people in China.

Genetics of resistance to two strains of soybean mosaic virus in differential soybean genotypes

There are seven pathotypes of soybean mosaic virus (SMV) representing seven strain groups (G1-G7) in the United States. Soybean genotypes [Glycine max (L.) Merr.] may exhibit resistant (R), susceptible (S), or necrotic (N) reactions upon interacting with different SMV strains. This research was conducted to investigate whether reactions to two SMV strains are controlled by the same gene or by separate genes. Two SMV-resistant soybean lines, LR1 and LR2, were crossed with the susceptible cultivar Lee 68. LR1 contains a resistance gene Rsv1-s and is resistant to strains G1-G4 and G7. LR2 contains the Rsv4 gene and is resistant to strains G1-G7. Two hundred F(2:3) lines from LR1 x Lee 68 and 262 F(2:3) lines from LR2 x Lee 68 were screened for SMV reaction. Seeds from each F2 plant were randomly divided into two subsamples. A minimum of 20 seeds from each subsample were planted in the greenhouse and plants were inoculated with either G1 or G7. G1 is the least virulent, whereas G7 is the most virulent strain of SMV. The results showed that all the F(2:3) lines from both crosses exhibited the same reaction to G1 and G7. No recombinants were found in all the progenies for reactions to G1 and G7 in either cross. The results indicate that reactions to both G1 and G7 are controlled by either the same gene or very closely linked genes. This research finding is valuable for studying the resistance mechanism and interactions of soybean genotypes and SMV strains and for breeding SMV resistance to multiple strains.

Synthesis and antifungal properties of compounds which target the alpha-aminoadipate pathway

Fungi synthesize lysine via the alpha-aminoadipate pathway, which is not found in plants or animals. This pathway has been proposed as a target for antifungal agents, but until now no reports have appeared to test this proposal. Hampering studies on the susceptibility of filamentous fungi such as those of the clinically important genus Aspergillus is the fact that growth quantitation is notoriously difficult. We have used the recently-reported XTT-based method of biomass quantitation to measure the susceptibility of Aspergillus nidulans strain A28 to growth suppression by novel compounds designed to target early steps in the alpha-aminoadipate lysine biosynthesis pathway, specifically those steps involving (R)-homocitrate and (2R,3S)-homoisocitrate. Three compounds show moderate inhibition of fungal growth, which can be partially restored by the presence of lysine in the growth medium.

Relative influence of diet and physical activity on cardiovascular risk factors in urban Chinese adults

OBJECTIVE

The relative influence of dietary factors vs physical activity on cardiovascular risk factors are poorly understood. We investigated these factors in a population whose traditional diet may have both positive (high plant-based) and negative (high refined carbohydrate) aspects, and whose physical activity levels (PALs) vary widely.

DESIGN

Cross-sectional study.

SUBJECTS

A total of 130 weight stable adults aged 35-49 y (BMI 18-35 kg/m(2)) living in urban Beijing, China.

MEASUREMENTS

Dietary intake (by food frequency questionnaire), PAL as the ratio of predicted total to resting energy expenditure), percent body fat (by deuterium oxide dilution), and central adiposity (waist circumference and waist to hip ratio) were assessed. Biochemical parameters (total cholesterol, low- and high-density lipoprotein cholesterol (LDL-C; HDL-C), triglyceride (TG), apolipoproteins A-I and B, glucose, insulin, and homocysteine and its related vitamins), blood pressure and presence of the metabolic syndrome (having >/=3 risk factors of central adiposity, HDL-C, TG, glucose, blood pressure) were also examined.

RESULTS

Mean values for cardiovascular risk factors were relatively low, but 19% of subjects had the metabolic syndrome. Using validated methods for measuring food intake and energy expenditure, we found that an adverse cardiovascular risk profile was associated with a diet high in carbohydrate, low in polyunsaturated fat, and low in fruit and vegetables, independent of body fatness and its distribution. While dietary factors predicted individual cardiovascular risk factors more consistently than PAL, avoidance of low PAL reduced the risk of having the metabolic syndrome.

CONCLUSION

These results suggest that, regardless of total body fatness and fat distribution, multiple unfavorable dietary factors and low physical activity independently increase the risk for cardiovascular disease. Avoidance of a sedentary lifestyle additionally reduces the risk of developing the metabolic syndrome.

Genetic study of a lethal necrosis to soybean mosaic virus in PI 507389 soybean

PI 507389 soybean [Glycine max (L.) Merr.], a large-seeded line from Japan, exhibits a rapid, lethal, necrotic response to strains G1, G2, G5, and G6 of soybean mosaic virus (SMV). Unlike the hypersensitive necrotic reaction, this stem-tip necrosis can be a serious threat to soybean production. To investigate the genetic basis of lethal necrosis (LN), PI 507389 was crossed with the susceptible (S) cv. Lee 68 and with resistant (R) lines PI 96983, cv. York, and cv. Marshall, which carry single dominant genes for SMV resistance at the Rsv1 locus. F(1) plants, F(2) populations, and F(2:3) lines were inoculated with G1 and G6 in the greenhouse or in the field. Results indicated that LN is controlled by a single gene allelic to Rsv1, and this allele in PI 507389 is recessive to R alleles in PI 96983, York, and Marshall. The LN allele is codominant with the allele for S, for the heterozygotes showed a mixed phenotype of both necrosis (N) and mosaic (M) symptoms (NM). The LN allele becomes recessive to the S allele as the mixed NM shifts to S at a later stage in response to more virulent strains. The gene symbol Rsv1-n is assigned for the allele conferring LN in PI 507389. Rsv1-n is the only allele at the Rsv1 locus conditioning N to G1 and no R to any other SMV strains, and thus a unique genotype for SMV strain differentiation. The phenotypic expression of heterozygotes and the dominance relationships among R, N, and S depend on the virulence of SMV strains, source of alleles, and developmental stage.

Phytotoxicity of aluminium to wheat plants in high-pH solutions

Phytotoxicity of aluminium in acid soils is well known. At pH ≥6.3, aluminate [Al(OH)4–] is the principal hydroxo-aluminium species in soil solutions; however, its phytotoxicity has not received much attention. Sodic subsoils in Australia are generally alkaline and have pH above 9. During our survey of 8 subsoils in South Australia, we found aluminate ions at concentrations greater than 0.8 mg/L (29.7 μmol/L of aluminium) in soil solutions when pH was greater than 9, with corresponding high uptake of aluminium by wheat plants. We studied the phytotoxicity of aluminium to wheat plants in solution culture by maintaining the pH of alkaline solutions at 9.2.Relative root lengths of wheat plants, compared with those in reverse-osmosis deionised water, were significantly reduced in alkaline solutions and CO2-free air indicated toxicity of hydroxy, carbonate and bicarbonate ions. Further reduction of root lengths due to aluminate toxicity was also evident. Relative root lengths of wheat plants, when comparing between +aluminium and –aluminium treatments, were reduced up to 50% in alkaline solutions containing as low as 1 mg/L of aluminium. Aluminium accumulated mainly in the roots, thereby reducing their growth. In bicarbonate solutions, aluminium toxicity under alkaline pH was highly significant (P<0.001). However, at the same level of added aluminium in carbonate solutions, relative root length was not reduced. This study concludes that when aluminium species are present at a concentration of about 1 mg/L in soil solutions with pH greater than 9, the growth of wheat plants could be significantly affected.

Energy requirements of urban Chinese adults with manual or sedentary occupations, determined using the doubly labeled water method

OBJECTIVE

To examine total energy expenditure (TEE) in relation to occupation and reported leisure time activities in free-living Chinese adults, and to determine whether measured TEE values differ from current international dietary energy recommendations.

SETTING AND SUBJECTS

Seventy three weight-maintaining adults aged 35-49 y, leading unrestricted lives in urban Beijing, with a wide variety of occupations.

DESIGN AND METHODS

A cross-sectional study in which TEE was determined by doubly labeled water, body composition by deuterium oxide ((2)H(2)O) dilution, resting energy expenditure (pREE) by prediction equations, and occupational and leisure time activities by questionnaire.

RESULTS

For men and women respectively, TEE averaged 12.10+/-0.32 and 9.53+/-0.23 MJ/day (P<0.001), and physical activity level (PAL=TEE/pREE) was 1.77+/-0.04 and 1.66+/-0.02 (P<0.05). Fat-free mass (FFM) was the single best predictor of TEE (adjusted r(2)=0.71, P<0.001). Occupational category (light, moderate and heavy) further predicted TEE, independent of FFM (adjusted multiple r(2)=0.82, P<0.001). Both TEE adjusted for weight and PAL increased with occupational category. Measured TEE was slightly but significantly higher than the 1985 FAO/WHO/UNU estimates for women with light occupations, but did not differ from estimates for men with light occupations, or for adults with moderate or heavy occupations.

CONCLUSION

Level of occupational activity, but not duration or type of leisure activity, significantly predicted TEE in free-living urban Chinese adults. Current energy requirement recommendations slightly underestimated the energy needs of women with light occupations but were accurate for men and women with moderate and heavy occupations.

SPONSORSHIP

NIH grants DK53404 and F32-DK09747.

Sequence analysis and expression of a virus-like particle protein, VLP2, from the parasitic wasp Venturia canescens

Endoparasitoid wasps produce maternal protein secretions, which are transported into the body of insect hosts at oviposition to regulate host physiology for successful development of their offspring. Venturia canescens calyx fluid contains so-called virus-like particles (VLPs) that are essential for immune evasion of the developing parasitoid inside the host. VLPs consist of four major proteins. In this paper, we describe the isolation and molecular cloning of a gene (vlp2) that is a constituent of VLPs and discuss its possible role in VLP structure and function.

Complementary action of two independent dominant genes in Columbia soybean for resistance to Soybean mosaic virus

A stem-tip necrosis disease was observed in the soybean [Glycine max (L.) Merr.] cultivar Columbia and its derivative OX686 when infected with a necrosis-causing strain of Soybean mosaic virus (SMV) in Canada. A dominant gene named Rsv3 was found in OX686 for the necrotic reaction. In the present research we have found that Columbia is resistant to all known SMV strains G1-G7, except G4. Genetic studies were conducted to investigate the inheritance of resistance in Columbia and interactions of resistance gene(s) with SMV strains. Columbia was crossed with a susceptible cultivar, Lee 68, and with resistant lines PI96983, Ogden, and LR1, each possessing a resistance gene at the Rsv1 locus. F(1) individuals, F(2) populations, and F(2:3) lines from these crosses were inoculated with G7 or G1 in the greenhouse. Our inheritance data confirmed the presence of two independent dominant genes for SMV resistance in Columbia. Results from allelism tests further demonstrate that the two genes (referred to as R3 and R4 in this article) in Columbia were independent of the Rsv1 locus. R3 appears to be the same gene previously reported as Rsv3 in OX686, which was derived from Columbia. The R3 gene confers resistance to G7, but necrosis to G1. The other gene, R4, conditions resistance to G1 and G7 at the early seedling stage and then a delayed mild mosaic reaction (late susceptible) 3 weeks later. Plants carrying both the R3 and R4 genes were completely resistant to both G1 and G7, indicating that the two genes interact in a complementary fashion. Plants heterozygous for R3 or R4 exhibited systemic necrosis or late susceptibility, suggesting that the resistance is allele dosage dependent. The R4 gene appeared epistatic to R3 since it masked expression of necrosis associated with the response of R3. The complementary interaction of two resistance genes, as exhibited in Columbia, can be useful in development of soybean cultivars with multiple and durable resistance to SMV.

Re-emergence of iodine deficiency in Australia

Iodine is an essential nutrient for human growth and development. The thyroid gland is dependent upon iodine for production of thyroid hormone. It is a common perception that iodine deficiency is not a major public health concern in mainland Australia, with sporadic studies carried out about a decade ago showing average urinary iodine excretion levels of around 200 microg/day. Recent evidence, however, has shown that the consumption of iodine is declining in Australia. A similar situation has occurred in the USA. The present study was designed to evaluate the urinary iodine excretion (UIE), as the indicator of iodine nutrition, in samples obtained from various demographic groups in the Sydney metropolitian area, namely: schoolchildren, healthy adult volunteers. pregnant women and patients with diabetes. Urinary iodine in spot urine sample was measured in a Technicon II autoanalyser using an in-house, semiautomated method. The results in this communication show that all four study groups had the median UIE below 100 microg/L. the criteria set by the World Health Organization for iodine repletion, and confirm what has been described previously, that iodine deficiency has reemerged in Sydney, Australia. One of the major causes of the reduced iodine intake is the reduction of iodine in milk since the dairy industry replaced iodine-rich cleaning solutions with other sanitisers. Secondly, less than 10% of the population are currently using iodised salt. A national survey into the iodine nutrition status in Australia is urgently required as part of the establishment of a systematic surveillance and legislation is required to iodise all edible salt.

Structure of the dimethyl sulfoxide solvated thallium(III) ion in solution and in the solid state

The structure and vibrational spectra of the dimethyl sulfoxide solvated thallium(III) ion have been studied in a dimethyl sulfoxide solution and in the solid state. X-ray crystallography shows a trigonal unit cell, space group R(-)3 (No. 148), for the [Tl(dmso)(6)](ClO(4))(3) compound with Z = 3, a = b = 11.9764(13) [11.8995(9)] A, c = 20.802(2) [20.467(2)] A, and V = 2584.0(5) [2509.9(4)] A(3) at 295 [150] K. The crystal structure comprises a highly symmetric hexakis(dimethyl sulfoxide)thallium(III) ion, with thallium in a (-)3 symmetry site and a Tl-O bond distance of 2.224(3) A at 295 K. The octahedral TlO(6) kernel is compressed along the threefold axis with an O-Tl-O bond angle of 96.20(11) degrees. The Tl-O-S bond angle of 120.7(2) degrees corresponds to a Tl.S distance of 3.292(2) A. One perchlorate ion centered on the (-)3 axis was described by a statistically disordered model. A low-temperature EXAFS study (10 K) resulted in the Tl-O and Tl.S distances of 2.221(4) and 3.282(6) A, respectively, consistent with a Tl-O-S bond angle of 120(1) degrees. The low Debye-Waller factors confirm a regular coordination without the disorder of the dimethyl sulfoxide ligands, which would have resulted from the alternative choice of space group R3 for the crystal structure. Raman and infrared spectra have been recorded and assigned, with the bands at 435 and 447 cm(-)(1) corresponding to the vibrational frequency of the symmetric and asymmetric Tl-O stretching modes, respectively. EXAFS data of a 0.5 mol dm(-3)thallium(III) trifluoromethanesulfonate in a dimethyl sulfoxide solution were consistent with that of a hexasolvated ion with mean Tl-O and Tl.S distances of 2.22(1) and 3.33(2) A, respectively, which correspond to a mean Tl-O-S bond angle of 124(2) degrees. The anomalously large disorder parameter for the Tl-O distances is consistent with a weak pseudo-Jahn-Teller effect. The (205)Tl, (13)C, and (1)H NMR spectra of the complex in solution show single signals at 1886, 39.5, and 2.3 ppm, respectively.

[Continuous production of nisin by calcium alginate-immobilized Lactococcus lactis subsp. lacits SM526]

The attempts were made to produce nisin by immobilized cells of Lactococcus lactis subsp. lactis SM526 entrapped in calcium alginate beads. The results showed that the immobilized cell beads were intact for 90 hr under 2% of calcium alginate in 10 mmol/L CaCl2 solution. The physical stability of beads was improved by removing phosphate, citrate and acetate salts supplied in SYS3 medium. Repeated-batch fermentation utilizing immobilized cells were performed in mSYS3 medium without agitation at 32 degrees C, the concentration of nisin produced during the third cycles increased to 850 IU/mL, and the beads were still intact with little cell leakage. The immobilized beads were loaded into a sterilized glass column to continuous fermentation, nisin concentration increased to 1150 IU/mL, as high as that obtained in free-cell fermentation, and the high productivity was stable for up to 70 h under a constant supplied of the fresh mSYS3 medium.

Broadband vibrational sum frequency generation spectroscopy of a liquid surface

An important advance in surface science has been the evolution of sum frequency generation to the application of studying surface structure and chemistry of liquid surfaces at the molecular-level by probing the vibrational signatures of surface molecules. Recently, broad-bandwidth sum frequency generation (BBSFG) spectroscopy has become an important tool for investigating gas-solid interfaces. BBSFG spectroscopy allows, theoretically, a surface sum frequency spectrum to be acquired within one pulse of the laser. In this paper, the viability of BBSFG to study inherently small nonlinear response interfaces and the time-resolving capability of this surface-selective technology are demonstrated. Presented here are the first published accounts of spectra from a liquid surface utilizing the broad-bandwidth sum frequency technology with acquisition times as low as 500 milliseconds.

[Influences of rearing style on the intellectual development of infants]

The factors causing the imbalance on intellectual development of infants in the early period after birth were studied and some better styles of rearing infants were found. The developmental quotient in 68 infants of 3-months-old was tested with Gesell Developmental Schedules and the style for rearing infants was obtained by inquiring their parents. The results showed that: (1) the development of adaptive behavior, language and personal--social behavior was better than that of gross motor and fine motor; (2) giving infants opportunity to move could make the development of adaptive behavior, gross motor and fine motor better. The development of fine motor could be hampered if a pair of mitten was put on hands to avoid scratching infant own face. Out doors activities were more important on the development of adaptive behavior, gross motor, fine motor and personal--social behavior; (3) in addition to the mother, with the cooperation of grandparents or father to look after infants was better. The higher education level of parents always associated with a better mental development of infants; (4) the complex structure with more people in a family make the development of language better. It is suggested that if parents have more knowledge on caring infants, give infants more opportunity to move and communicate with other people, it would be beneficial to the development of infants.

[The characterization of pJW566 from L. Lactis subsp. cremoris W56]

The plasmid pJW566 was isolated from L. lactis subsp. cremoris W56, one strain for Danish chadder mixed starter cultures. The strain containing plasmid pJW566 showed resistance against three common phages species 936, c2 and P335 worldwide. It was found that pJW566 encoded for an restriction and modification system, and showed strong resistance to phage CHCP412 when it was introduced into the industrial strain L. lactis CHCC2281 in milk medium. The endonuclease activity analysis indicated that the endonuclease required Mg2+, ATP, and was stimulated by AdoMet.

Elevated potassium intake inhibits neointimal proliferation in the swine coronary artery

BACKGROUND

Previously, we reported that elevated extracellular potassium concentration in vitro inhibited proliferation and migration of vascular smooth muscle cells, formation of free radical compounds by macrophages, and reduced platelet sensitivity to agonists. More recently, we described a reduction in neointimal proliferation after balloon angioplasty injury in the carotid arteries of rats associated with an elevation of dietary potassium intake during a 4-week experiment. In the present study we conducted a similar investigation in the swine coronary artery balloon angioplasty model.

PROCEDURES

Two groups of seven castrated male swine were studied; for 28 days the normal potassium group consumed a diet containing 0.25% potassium and the high potassium group ate diet containing 2.0% potassium. After 14 days on the diet, balloon angioplasty was performed. After an additional 14 days on the same diets the hearts were removed, and normal and lesioned sections of the artery were analyzed histologically.

RESULTS

The neointimal area was markedly less in the high potassium group than in the normal potassium group, 0.33+/-0.04 mm2 v 0.74+/-0.10 mm2 (P < .004). Neointimal area-to-total wall area ratio in the normal potassium group averaged 0.199+/-0.018, significantly greater than the ratio computed for the elevated potassium group, 0.120+/-0.015 (P < .006).

CONCLUSION

These results support the hypothesis that a high level of dietary potassium intake inhibits neointimal proliferation after balloon angioplasty in the swine coronary artery.

Apolipoprotein E polymorphism in the early onset of coronary heart disease

OBJECTIVE

To assess the relationship between apolipoprotein E (apoE) polymorphism and the early onset of coronary heart disease (CHD) and the effect of apoE on lipids and lipoproteins in healthy Chinese subjects.

METHODS

Sixty-eight patients with CHD younger than 55 years (CHD1), 136 patients with CHD older than 65 years (CHD2), and 136 healthy subjects were enrolled, and their plasma levels of triglyceride (TG), total cholesterol (TC) and high density lipoprotein cholesterol (HDL-C) were determined. The apoE genotypes were identified by polymerase chain reaction-restriction fragment length polymorphism.

RESULTS

apoE 3/4 genotype and E4 allele frequency in the CHD1 group were higher than those in the CHD2 group and healthy subjects, while no differences were found between CHD2 and healthy subjects. Meanwhile, the plasma levels of TC and low density lipoprotein cholesterol (LDL-C) were higher in the CHD2 group than in both CHD1 group and healthy subjects. Each apoE isoprotein has variable TC and LDL-C levels that is E2 (E2/2 + E2/3) < E3(E3/3) < E4(E4/4 + E3/4).

CONCLUSION

apoE is one of the genetic factors that affect TC and LDL-C levels, and apoE 4 has a very close relation to CHD, suggesting that apoE 4 is an independent genetic factor of the early onset of CHD.

Office-based esophagoscopy: a preliminary report

OBJECTIVE

Preliminary study that describes unsedated, transnasal esophagoscopy (TNE) in an office setting.

STUDY DESIGN AND SETTING

TNE was prospectively performed on 14 consecutive out-patients with dysphagia whose initial oropharyngeal dysphagia evaluation was insufficient to reveal the cause of their swallowing problem. TNE was carried out without conscious sedation while the patients were sitting in an examining chair. Ease of endoscope insertion, optical quality of images, and examination findings were assessed. Heart rate before and after the procedure and incidence of epistaxis and airway compromise was also determined. Patients were asked to rate the level of discomfort of TNE on a validated 10-point scale (1 representing none/well tolerated and 10 severe/poorly tolerated).

RESULTS

All patients completed TNE with the esophagus readily intubated and esophageal mucosa clearly visualized. Findings included esophageal stricture, patulous upper esophageal sphincter, and Zenker's diverticulum. There were no incidences of epistaxis or airway compromise and no significant changes in heart rate. Overall tolerance of TNE was rated by the patients as 2.0 (SD, 1.2).

CONCLUSIONS

TNE is well tolerated and can be safely performed in patients with dysphagia in an office setting. TNE may have a role in the comprehensive evaluation of the dysphagic patient in the office.

Cost-effectiveness of two types of dysphagia care in head and neck cancer: a preliminary report

We conducted a prospective, preliminary study to compare the cost-effectiveness of two different instrument-based techniques for diagnosing and managing dysphagia in 30 consecutive hospitalized patients with head and neck cancer. The two techniques are videofluoroscopy via modified barium swallow (MBS) and videoendoscopy via flexible endoscopic evaluation of swallowing with sensory testing (FEESST). Medicare was the primary insurer of all patients. Fifteen of these patients had their dysphagia diagnosed and managed by MBS and the other 15 by FEESST. Cost-effectiveness was assessed by determining the average Medicare reimbursement for each procedure. We found that the mean reimbursements were $451.01 (+/- $50.55) for MBS and $321.23 (+/- $3.01) for FEESST. The mean reimbursement for FEESST was significantly lower than that for MBS (p < 0.0001; Mann-Whitney U test). We conclude that FEESST appears to be more cost-effective than MBS for the inpatient management of dysphagia in patients with head and neck cancer.

[The effect of side chain structure on the excitation transfer and charge transfer processes in PPV/C60 composite system]

In this paper, we investigated the effect of side chains on the optical properties of PPV derivatives, the excitation transfer and charge transfer process in the PPV/C60 composite films. The results demonstrate that the absorption and PL emission bands of PPV shift towards lower photon energy with increasing of the length of PPV side chain, which indicates that energy gap of PPV derivatives become narrow with their side chain length increasing. In the PPV/C60 composite films, the emission of PPV derivatives was greatly quenched due to the efficient excitation transfer process between PPV and C60. We observed the absorption band of C60- located at 920 nm in the MD-PPV/C60 composite films, which reveals the existence of charge transfer process in the ground state of the composite films. This results show that the side chains of PPV derivatives not only influence the properties of absorbance and photoluminescence but also influence the electronic affinity of PPV polymers, which means that both physical and chemical properties of PPV can be monitored by controlling its side chain structure.

Polymorphisms of the CYP1A1 and GSTM1 genes in relation to individual susceptibility to lung carcinoma in Chinese population

Cytochrome P450 1A1 (CYP1A1) and glutathione S-transferase M1 (GSTM1) metabolize tobacco-related carcinogens. To investigate the prevalence of CYP1A1 and GSTM1, and their association with increased risk of lung carcinoma in Chinese, allele-specific PCR and multiplex PCR technique were employed to identify the genotypes of CYP1A1 and GSTM1 in a case-control study of 106 lung carcinoma patients with histopathological diagnosis and 106 matched controls free of malignancy in Jiangsu Province, China. Logistic regression analysis was performed to calculate the odds ratio (OR) and 95% confidence intervals (CI). The results showed that individuals with GSTM1 null, and the combined GSTM1 null/CYP1A1 Ile/Val or GSTM1 null/CYP1A1 Val/Val had an elevated risk of lung carcinoma, with the OR, 1.92 (P=0.02; CI, 1.07-3.46), 3.27 (P=0.01; CI, 1.23-8.84) and 9.33 (P=0.04; CI, 1.01-217.42), respectively. Light smokers (<30 pack-years) carrying GSTM1 null genotype were shown to have the increased risk to lung carcinoma (OR=3.47; CI, 1.13-7.57). Our study suggested that the null GSTM1 genotype, independently or in combined with at least one Val allele of CYP1A1, might affect the genetic susceptibility for lung carcinoma in Chinese population.

[Polymorphisms of the CYP1A1 and GSTM1 genes and their combined effects on individual susceptibility to lung cancer in a Chinese population]

OBJECTIVE

To investigate the polymorphisms of CYP1A1 and GSTM1 genes as well as their separate and combined effects on individual susceptibility to lung cancer.

METHODS

In the matched 106 pairs of patients with lung cancer and non-cancer control persons, genomic DNA were prepared from peripheral blood samples. The genotypes of CYP1A1 Ile/Val and GSTM1+/0 polymorphisms were detected by the allele-specific(AS)-PCR and multidifferential(MD)-PCR.

RESULTS

Individuals with genotype Val/Val of CYP1A1, genotype 0/0 of GSTM1, combined genotypes GSTM1 0/0 and CYP1A1 Val/Val, or combined genotypes GSM1 0/0 and CYP1A1 Ile/Val had higher relative risk than those with the corresponding common genotypes and combined genotypes; their odds ratios were 4.02(P=0.03), 1.92(P=0.019), 9.38(P=0.04) and 3.27(P=0.01), respectively.

CONCLUSION

There is a synergy of susceptible genotypes GSTM1 0/0 and CYP1A1 Val/Val or CYP1A1 Ile/Val to enhance the individual susceptibility to lung cancer.