Side population cell level in human breast cancer and factors related to disease-free survival

Side population (SP) cells have stem cell-like properties with a capacity for self-renewal and are resistant to chemotherapy and radiotherapy. Therefore the presence of SP cells in human breast cancer probably has prognostic value.

OBJECTIVE

To investigate the characteristics of SP cells and identify the relationship between the SP cells levels and clinico-pathological parameters of the breast tumor and disease-free survival (DFS) in breast cancer patients.

MATERIALS AND METHODS

A total of 122 eligible breast cancer patients were consecutively recruited from January 1, 2006 to December 31, 2007 at Yunnan Tumor Hospital. All eligible subjects received conventional treatment and were followed up for seven years. Predictors of recurrence and/or metastasis and DFS were analyzed using Cox regression analysis. Human breast cancer cells were also obtained from fresh human breast cancer tissue and cultured by the nucleic acid dye Hoechst33342 with Verapami. Flow cytometry (FCM) was employed to isolate the cells of SP and non-SP types.

RESULTS

In this study, SP cells were identified using flow cytometric analysis with Hoechst 33342 dye efflux. Adjusted for age, tumor size, lymph nodal status, histological grade, the Cox model showed a higher risk of recurrence and/or metastasis positively associated with the SP cell level (1.75, 1.02-2.98), as well as with axillary lymph node metastasis (2.99, 1.76-5.09), pathology invasiveness type (1.7, 1.14-2.55), and tumor volume doubling time (TVDT) (1.54, 1.01-2.36).

CONCLUSIONS

The SP cell level is independently associated with tumor progression and clinical outcome after controlling for other pathological factors. The axillary lymph node status, TVDT and the status of non-invasive or invasive tumor independently predict the prognosis of breast cancer.

Differences in childhood leukemia incidence and survival between Southern Thailand and the United States: a population-based analysis

BACKGROUND

Childhood leukemia incidence and survival varies globally, and this variation may be attributed to environmental risk factors, genetics, and/or disparities in diagnosis and treatment.

PROCEDURE

We analyzed childhood leukemia incidence and survival trends in children aged 0-19 years from 1990 to 2011 in Songkhla, Thailand (n = 316) and compared these results to US data from the Surveillance, Epidemiology, and End Results (SEER) registry (n = 6,738). We computed relative survival using Ederer II and estimated survival functions using the Kaplan-Meier method. Changes in incidence and 5-year survival by year of diagnosis were evaluated using joinpoint regression and are reported as annual percent changes (APC).

RESULTS

The age-standardized incidence of leukemia was 3.2 and 4.1 cases per 100,000 in Songkhla and SEER-9, respectively. In Songkhla, incidence from 1990 to 2011 significantly increased for leukemia (APC = 1.7%, P = 0.031) and acute lymphoblastic leukemia (ALL) (APC = 1.8%, P = 0.033). Acute myeloid leukemia (AML) incidence significantly increased (APC = 4.2%, P = 0.044) and was significantly different from the US (P = 0.026), where incidence was stable during the same period (APC = 0.3%, P = 0.541). The overall 5-year relative survival for leukemia was lower than that reported in the US (43 vs. 79%). Five-year survival significantly improved by at least 2% per year from 1990 to 2011 in Songkhla for leukemia, ALL, and AML (P < 0.050).

CONCLUSIONS

While leukemia and ALL incidence increased in Songkhla, differences in leukemia trends, particularly AML incidence, may suggest etiologic or diagnostic differences between Songkhla and the US. This work highlights the importance of evaluating childhood cancer trends in low- and middle-income countries.

Differences in cancer incidence among predominantly Muslim and Buddhist subpopulations in Songkhla

BACKGROUND

The population of Songkhla, a province in Southern Thailand, can be divided into a predominantly Muslim subpopulation (PMSP, approximately 70% Muslim) and a predominantly Buddhist subpopulation (PBSP, around 14% Muslim).

OBJECTIVES

This study was conducted to 1) describe the incidence of various cancers in both PMSP and PBSP, and 2) compare the incidence of various cancers between the two subpopulations.

MATERIALS AND METHODS

Cancer cases diagnosed between 1990 and 2010 were drawn from the database of Songkhla Cancer Registry. Population denominators were estimated from the 3 population censuses surveyed by the National Statistical Office of Thailand in 1990, 2000, and 2010.

RESULTS

The age-standardized incidence rates (ASR) of the 5 commonest male cancers among both subpopulations were calculated. In females, a lower incidence of cancers of the cervix and breast in PMSP compared to PBSP, with odds ratios of 0.54 (95% CI: 0.45-0.64) and 0.51 (95% CI: 0.43-0.60) respectively, was observed. In males, the incidence of cancers of the lung, liver, colon-rectum, and some other cancers were significantly different between the two populations in the past, but only prostate cancer showed a lower incidence among males in PMSP in recent years. Independent of sex and year of diagnosis, the incidence of lung, liver, NHL, and colorectal cancers was lower in MPSP compared to BPSP, with odds ratios of 0.75 (95% CI: 0.65-0.85), 0.74 (95% CI: 0.62-0.88), 0.74 (95% CI: 0.60-0.91), and 0.67 (95% CI: 0.56-0.78) respectively.

CONCLUSIONS

The differences in incidence of some cancers and religion- related culture between the two subpopulations need 2 sets of cancer-control plans and goals to fit the unique population context in deep Southern Thailand. This plan can be used in the 3 southernmost provinces of Thailand where the percentage of Muslims is over 85%.

Success of a cervical cancer screening program: trends in incidence in songkhla, southern Thailand, 1989-2010, and prediction of future incidences to 2030

BACKGROUND

Cervical cancer has been a leading female cancer in Thailand for decades, and has been second to breast cancer after 2007. The Ministry of Public Health (MoPH) has provided opportunistic screening with Pap smears for more than 30 years. In 2002, the MoPH and the National Health Security Office provided countrywide systematic screening of cervical cancer to all Thai women aged 35-60 years under universal health care coverage insurance scheme at 5-year intervals.

OBJECTIVES

This study characterized the cervical cancer incidence trends in Songkhla in southern Thailand using joinpoint and age period cohort (APC) analysis to observe the effect of cervical cancer screening activities in the past decades, and to project cervical cancer rates in the province, to 2030.

MATERIALS AND METHODS

Invasive and in situ cervical cancer cases were extracted from the Songkhla Cancer Registry from 1990 through 2010. Age standardized incidence rates were estimated. Trends in incidences were evaluated by joinpoint and APC regression models. The Norpred package was modified for R and was used to project the future trends to 2030 using the power of 5 function and cut trend method.

RESULTS

Cervical cancer incidence in Songkhla peaked around 1998-2000 and then dropped by -4.7% per year. APC analysis demonstrated that in situ tumors caused an increase in incidence in early ages, younger cohorts, and in later years of diagnosis.

CONCLUSIONS

Both joinpoint and APC analysis give the same conclusion in continuation of a declining trend of cervical cancer to 2030 but with different rates and the predicted goal of ASR below 10 or even 5 per 100,000 women by 2030 would be achieved. Thus, maintenance and improvement of the screening program should be continued. Other population based cancer registries in Thailand should analyze their data to confirm the success of cervical cancer screening policy of Thailand.

CPIRD: A successful Thai programme to produce clinically competent medical graduates

The programme titled “Collaborative Project to Increase Production of Rural Doctors” (CPIRD) is a rural medical education project launched in 1994 in Thailand. This study aimed to compare the academic performances in medical study over five years and the pass rates in national medical license examinations (MLE) between students enrolled in CPIRD and two other tracks.

Grade point average (GPA) over five years and results of MLEs for four cohorts of students enrolled from 2003 to 2006 in Prince of Songkla University were collected from the registration department. A longitudinal analysis was used to compare the GPA over time for medical students enrolled in CPIRD and those from the national and direct regional tracks through generalized estimating equation (GEE) models. The MLE pass rates were compared using chi-square and fisher's exact tests as appropriate.

Female students dominated the CPIRD group. GPAs in the first three years in the CPIRD group were significantly lower than those of the other two groups, this disparity narrowed in the fourth and fifth years. For step one of the MLE (basic sciences), cohorts 2003 and 2006 of the CPIRD group had a significantly lower pass rate than the other two groups but there was no significant difference in cohort 2004 and cohort 2005. The CPIRD step two and three MLE pass rates were not significantly different from the national track in all cohorts and lower than the direct track only for step two in cohort 2003 and step three in cohort 2006. The step three pass rate of the CPIRD group in cohort 2004 was significantly higher than the other two tracks.

Despite weaker competency in basic science, the CPIRD was successful in forming clinical competency.

Risky behaviors and helmet use among young adolescent motorcyclists in Southern Thailand

BACKGROUND

In Thailand, road traffic injuries are the leading cause of death for youth ages 15-19 years, with 80% of the injuries and deaths from motorcycle accidents.

OBJECTIVES

To determine the prevalence of child and young adolescent motorcyclists in Hat Yai municipality and their risk behaviors.

METHOD

A cross-sectional study was conducted between June 2011 and March 2012 in which 2,471 students, ages 8 to 18 years, were recruited from 9 primary and secondary schools in Hat Yai municipality. The questionnaire included questions on being a motorcycle rider or passenger, risky behaviors, and helmet use while riding.

RESULTS

Of the total, 1,573 (63.7%) were riders and 898 (36.3%) were pillion passengers. The majority of the riders younger than 15 years rode their motorcycle mainly only in narrow streets for a short trip. Only 30% of the riders wore a helmet every time they rode a motorcycle. About 10% of the participants riding or a passenger on a motorcycle had consumed alcohol at least once before riding their motorcycle. Multiple logistic regression analysis found that motorcycle injuries were significantly associated with speeds greater than 60 km/h, not wearing a helmet while riding, and alcohol consumption before riding (odds ratios 1.63, 1.59, and 3.09, respectively).

CONCLUSION

Nearly two thirds of young adolescents in Hat Yai municipality were motorcycle riders. These young adolescents were at risk of traffic injuries because more than 50% of them had ridden at high speed or not worn a helmet while riding, and some of them had consumed alcohol before riding.

Financial burden on the families of patients with hepatitis B virus-related liver diseases and the role of public health insurance in Yunnan province of China

OBJECTIVE

To investigate the financial burden of patients who had various stages of hepatitis B virus-related diseases and the level of alleviation from financial burden by health insurance schemes in Yunnan province of China.

STUDY DESIGN

A cross-sectional survey.

METHODS

Patients' information was consecutively recorded at the First Affiliated Hospital of Kunming Medical University, from December 2012 to June 2013. Consecutive cases of hepatitis B virus (HBV) (520), compensated cirrhosis (91), decompensated cirrhosis (198) and hepatocellular carcinoma (HCC) (131) were recruited from the outpatient and inpatient departments. The total direct costs, hospital charge, outpatient costs, hospitalization fees being reimbursed and household catastrophic health expenditure were estimated for each disease group.

RESULTS

The average annual direct costs for each disease group were 19,496 RMB for HBV, 28,466 RMB in compensated cirrhosis, 46,061 RMB for decompensated cirrhosis, and 33,044 RMB for HCC patients. Catastrophic health expenditure occurred in all four groups. Health insurance reimbursement released the financial burden incurred by medical expenses of patients under a high level of household economic status. Public health insurance schemes helped the patients to various extents.

CONCLUSIONS

Among these patient groups, direct costs represent a significant economic burden. Health expenditure and financing systems must be considered to prevent the increase of household catastrophe, particularly among the poor.

Radiotherapy for brain metastases in southern Thailand: workload, treatment pattern and survival

PURPOSE

To study the patient load, treatment pattern, survival outcome and its predictors in patients with brain metastases treated by radiotherapy.

MATERIALS AND METHODS

Data for patients with brain metastases treated by radiotherapy between 2003 and 2007 were collected from medical records, the hospital information system database, and a population-based tumor registry database until death or at least 5 years after treatment and retrospectively reviewed.

RESULTS

The number of treatments for brain metastases gradually increased from 48 in 2003 to 107 in 2007, with more than 70% from lung and breast cancers. The majority were treated with whole brain radiation of 30 Gy (3 Gy X 10 fractions) by cobalt-60 machine, using radiation alone. The overall median survival of the 418 patients was 3.9 months. Cohort analysis of relative survival after radiotherapy was as follows: 52% at 3 months, 18% at 1 year and 3% at 5 years in males; and 66% at 3 months, 26% at 1 year and 7% at 5 years in females. Multivariate analysis demonstrated that the patients treated with combined modalities had a better prognosis. Poor prognostic factors included primary cancer from the lung or gastrointestinal tract, emergency or urgent consultation, poor performance status (ECOG 3-4), and a hemoglobin level before treatment of less than 10 g/dl.

CONCLUSIONS

This study identified an increasing trend of patient load with brain metastases. Possible over-treatment and under-treatment were demonstrated with a wide range of survival results. Practical prognostic scoring systems to assist in decision-making for optimal treatment of different patient groups is absolutely necessary; it is a key strategy for balancing good quality of care and patient load.

Reliability of pubertal maturation self-assessment in a school-based survey

AIM

To assess the reliability of pubertal self-assessment of Thai adolescents.

SUBJECTS

Some 927 girls and 997 boys, aged 8-18 years, from nine schools in Hat-Yai municipality.

METHODS

The adolescents evaluated their pubertal status after being shown a line drawing of the five Tanner stages with a short description. Girls assessed their breast and pubic hair development, and boys assessed their pubic hair development. The pubertal self-assessments were compared to pubertal assessments made by a pediatrician who examined the children after their self-assessment. Kappa coefficient and percent agreement were used for statistical analysis.

RESULTS

The percent agreement of breast and pubic hair development between the girl's self-assessments and the assessments by the pediatrician were 60.8% and 78%, respectively. Kappa coefficient for breast assessment was 0.50 (95% confidence interval, CI 0.47-0.53) and for pubic hair 0.68 (95% CI 0.65-0.72). Nearly 30% of girls aged younger than 10 years overestimated their breast development status while 45% of girls aged over 14 years underestimated their breast development (p<0.001). For boys, the percent agreement of pubic hair development between the adolescents and the pediatrician was 76.4%, with a weighted kappa coefficient of 0.68 (95% CI 0.65-0.72).

CONCLUSION

Pubertal self-assessment using line drawings with a short description can be used as a reliable method to assess pubic hair maturation in boys and girls, but can be used with less reliability to assess the breast maturation in young girls.

Unmet needs in continuing medical education programs for rural Chinese township health professionals

PURPOSE

This study aimed to describe the system of continuing medical education (CME) in the Guangxi Zhuang Autonomous Region and to ascertain the perceived needs related to that system, in order to improve the performance of health professionals in Chinese township health centers (THCs).

METHODS

In-depth key informant interviews were conducted to gain insights into the current CME system. A cross-sectional survey using a self-administered structured questionnaire was also carried out from March to August 2014 in order to identify perceived needs among THC personnel in the Guangxi Zhuang Autonomous Region. Logistic regression was used to identify factors related to respondents' interest in pursuing different levels of degree study.

RESULTS

The areas of need perceived by the respondents included general clinical competence and emergency or first aid knowledge. Most respondents wanted to study at medical colleges in order to obtain a higher degree. Respondents aged below 45 years with neutral or positive attitudes about the benefit of degree study for the licensure examination were more likely to attend a bachelor-level CME program than their older peers and respondents with negative attitudes towards degree study. Female respondents and respondents aged below 45 years were more likely to attend a junior college CME program than males and older respondents, respectively.

CONCLUSION

It is necessary to develop degree-linked CME programs to meet the need for young health professionals in Chinese THCs; therefore, this programs can improve the expertise of poorly educated young health workers, who overwhelm rural Chinese heath systems.

Breast cancer screening among women in Thailand: analyses of population-based household surveys

OBJECTIVE

The incidence of breast cancer is the highest among female cancers in Thailand and has been steadily increasing during the past few decades. The present study aimed to determine uptake rates of breast cancer screening including breast self-examination (BSE), clinical breast examination (CBE), and mammography screening, and to identify enabling factors and barriers associated with screening uptake.

MATERIAL AND METHOD

Secondary data from two population-based household surveys were used, the 2007 Health and Welfare Survey that comprised 18,474 women aged 20 years and older and the 2009 Reproductive Health Survey that comprised 26,951 women aged 30 to 59 years. Multivariate logistic regression analyses were performed to identify factors associated with screening.

RESULTS

In 2007, the uptake rate ofBSE was 40.1% (18.4% for monthly BSE), 29.0%for CBE, and 5.9%for mammography In 2009, the uptake rate of any type of breast examination was 57.9%, while the mammography rate among women who had breast examinations was 29.6% (10.1% of all women in 2009). Frequency of CBE wasfound to be positively associated with BSE and mammography screening. Factors independently associated with screening uptake were having education at the bachelor's level or higher being in the richest wealth quintile based on household asset index, and being covered by the Civil Servant Medical Benefit Scheme. Women living in Bangkok metropolis and in the municipal areas ofother provinces had higher rates of mammography, while women living in the north and northeast regions and non-municipal areas were more likely to perform BSE and have CBE performed than those living in Bangkok and municipal areas, respectively. Common factors associated with less screening across the two surveys were age 55 and over being single or widowed, being Muslim or Christian, and having no health insurance. Lack of knowledge and awareness of breast cancer screening were found to be barriers for screening among all women, especially those with low educational levels.

CONCLUSION

A low uptake of monthly BSE and mammography was observed. Early detection and awareness should be encouraged through proper BSE technique and effective CBE. Increased uptake of CBE should lead to a higher rate of mammography Increased knowledge, awareness, and participation in screening activities for selected groups, such as older women, those who are not married, non-Buddhists, and those with low education are recommended.

CA 19-9 in combination with abdominal CT scan for the diagnosis of mass-forming intrahepatic cholangiocarcinoma

Aim

Cholangiocarcinoma (CCA) is a common form of cancer in Thailand. The diagnosis of CCA by pathology is widely accepted. Unfortunately, tissue diagnosis of mass-forming intrahepatic cholangiocarcinoma is difficult to perform due to the risk of the procedure and accessibility. The aim of this study is to assess the diagnostic utility of CA19-9 in combination with CT scan for the diagnosis of mass-forming cholangiocarcinoma.

Materials & methods

The medical records of patients with a diagnosis of CCA and hepatocellular carcinoma (HCC) during January 2005-December 2009 were reviewed. Only cases with pathology and CT scan reports from Maharaj Nakorn Chiang Mai Hospital were included. Demographic data, clinical manifestations and laboratory results, including CA19-9 and CT scans of the liver, were carefully examined in order to establish their diagnostic utility in mass-forming CCA without a pathological diagnosis.

Results

A total of 79 CCA patients and 66 HCC patients were included in CA19-9 cut-off level analyses. A total of 31 CCA patients and 44 HCC patients were included in the CT scan evaluation and scored according to the Chiang Mai CT score for CCA. The specificity of a CA19-9 value of 500 U/ml for the diagnosis of CCA was 95.5% with a sensitivity of 50.6%, positive predictive value of 91.8% and likelihood ratio of positive (LR+) of 11.24. A CT score greater than 2 demonstrates a positive predictive value of more than 90% in diagnosis of CCA. The CA19-9 level of 140 U/ml in combination with a CT score of 2 demonstrated LR+ as high as 57.09. A CA19-9 level of 280 U/ml in combination with a CT score of 1 demonstrated LR+ of 58.4.

Conclusion

A CA19-9 level combined with the Chiang Mai CT score for CCA are good diagnostic tools for the diagnosis of mass-forming cholangiocarcinoma with high specificity, high positive predictive value and high likelihood ratio of positive.

Secular trends of growth and pubertal maturation of school children in Southern Thailand

BACKGROUND

In Thailand, studies of growth date back to 1975, but there have been no studies examining any trends in increasing/decreasing growth.

AIM

To determine if there have been any secular trends of increasing/decreasing growth and/or ages at puberty in Thai children.

METHODS

In 2012, a cross-sectional study of growth was conducted in 3460 children. The median heights and weights and the ages of pubertal maturation were compared with previous studies. Correlations between the secular trends and the health statistics indicators were calculated.

RESULTS

From 1975-2012, the median final height of boys and girls had increased by 1.32 and 0.86 cm/decade and weight by 2.49 and 1.76 kg/decade, respectively. In girls, the age at thelarche and menarche had declined by 0.39 and 0.12 years/decade, respectively. In boys, the age at testicular enlargement Tanner II had declined by 0.15 years/decade. Increased physical growth was positively correlated to life expectancy, per capita income and prevalence of overweight/obesity was negatively correlated to prevalence of malnutrition and under-five mortality rate.

CONCLUSION

The positive secular trend towards an increase in growth and a decline in the age at onset of puberty of Thai children is correlated with improvements in overall living conditions in Thailand.

30 Years of radiotherapy service in Southern Thailand: workload vs resources

BACKGROUND

To study the pattern of patient load, personnel and equipment resources from 30-years experience in Southern Thailand.

MATERIALS AND METHODS

This retrospective study collected secondary data from the Division of Therapeutic Radiology and Oncology and the Songklanagarind Hospital Tumor Registry database, Faculty of Medicine, Prince of Songkla University, during the period of 1982-2012.

RESULTS

The number of new patients who had radiation treatment gradually increased from 121 in 1982 to 2,178 in 2011. Shortages of all kinds of personnel were demonstrated as compared to the recommendations, especially in radiotherapy technicians. In 2011, Southern Thailand, with two radiotherapy centers, had 0.44 megavoltage radiotherapy machines (cobalt or linear accelerator) per million of population. This number is suboptimal, but could be managed cost-effectively by prolonging machine operating times during personnel shortages.

CONCLUSIONS

This study identified a discrepancy between workload and resources in one medical school radiotherapy center in.

Declining age of puberty of school girls in southern Thailand

BACKGROUND

Declines in the onset age of secondary sexual development have been reported in a number of recent studies in western and Asian countries. A study of Hat-Yai school girls in 1994 in Thailand showed that the ages at thelarche and menarche were 9.9 and 12.4 years, respectively. This study was to determine whether there was a decline in the average age of puberty in Hat-Yai school girls from 1994 to 2012.

METHODS

A cross-sectional study was conducted in 2140 healthy Hat-Yai school girls, aged 6-18 years, from June 2011 to March 2012. Breast and pubic hair development was assessed by the Tanner staging method. Probit analysis was used to calculate the median ages of different stages of breast and pubic hair development, and the age of menarche.

RESULTS

The median ages of girls having thelarche and menarche were 9.6 (95% CI, 9.4-9.8) and 12.2 (95% CI, 11.9-12.4) years, which declined from 9.9 (95% CI, 9.7-10.1) and 12.4 years (95% CI, 12.2-12.6) in the 1994 study respectively, however, without statistical significance. The youngest ages of girls who had breast stage 2 and menarche were 7.2 and 9.2 years, respectively. The final height at age 14 years in this cohort (157.3 cm) was 2.3 cm greater than that of girls in 1994 (155.0 cm).

CONCLUSIONS

From 1994 to 2012, the age at onset of thelarche and menarche of girls in Hat-Yai municipality declined by 0.2 and 0.3 years, respectively. The earlier age at onset of puberty had no effect on final adult height.

Escalating burden of breast cancer in southern Thailand: analysis of 1990-2010 incidence and prediction of future trends

BACKGROUND

Thailand is undergoing an epidemiologic transition, with decreasing incidence of infectious diseases and increasing rates of chronic conditions, including cancer. Breast cancer has the highest incidence rates among females both in the southern region Thailand and throughout Thailand. However, there is a lack of research on the epidemiology of this and other cancers.

METHODS

Here we use cancer incidence data from the Songkhla Cancer Registry to characterize and analyze the incidence of breast cancer in Southern Thailand. We use joinpoint analysis, age-period-cohort models and nordpred analysis to investigate the incidence of breast cancer in Southern Thailand from 1990 to 2010 and project future trends from 2010 to 2029.

RESULTS

We found that age-adjusted breast cancer incidence rates in Southern Thailand increased by almost 300% from 1990 to 2010 going from 10.0 to 27.8 cases per 100,000 person-years. Both period and cohort effects played a role in shaping the increase in incidence. Three distinct incidence projection methods consistently suggested that incidence rates will continue to increase in the future with incidence for women age 50 and above increasing at a higher rate than for women below 50.

CONCLUSIONS

To date, this is the first study to examine Thai breast cancer incidence from a regional registry. This study provides a basis for future planning strategies in breast cancer prevention and to guide hypotheses for population-based epidemiologic research in Thailand.

Age of onset of pubertal maturation of Thai boys

BACKGROUND

Data regarding sexual maturation in Thai boys are limited to only one 1999 study done in Bangkok which found that the ages of onset of Tanner 2 testicular enlargement and pubic hair were 10.8 and 12.4 years, respectively.

OBJECTIVE

To determine the age of onset of pubertal maturation and the physical growth of Thai boys at Hat Yai municipality, southern Thailand, in the year 2012.

METHODS

A cross-sectional study was conducted in 1320 healthy boys, aged 6-19 years, during June 2011 to March 2012. Testicular volume and pubic hair development were assessed according to the Tanner staging method. Probit analysis was used to calculate the median age of different stages of testicular enlargement and pubic hair development.

RESULTS

The median ages of boys having Tanner 2 testicular enlargement and Tanner 2 pubic hair were 10.6 [95% confidence interval (CI), 10.4-10.7] and 12.0 (95% CI, 11.8-12.2) years, respectively. The youngest ages of boys who had Tanner 2 testicular enlargement and Tanner 2 pubic hair were 8.2 and 9.7 years, respectively. The final height was attained at age 18 years at 170.3 cm, 3.3 cm greater than the 167.0 cm final height of Hat Yai boys studied in 1994.

CONCLUSIONS

The age of onset of puberty in Hat Yai schoolboys in 2012 was 0.2 years earlier than that of Bangkok schoolboys in 1999. The final adult height of Thai boys increased 3 cm during the two decades.

Identifying the Zheng in psoriatic patients based on latent class analysis of traditional Chinese medicine symptoms and signs

Background

There are approximately five Zhengs reported in psoriatic patients. Systematic data collection and proper analysis for the classification of psoriasis have been lacking. This study aims to cluster the Zhengs in psoriatic patients based on the application of a checklist of traditional Chinese medicine (TCM) symptoms and signs followed by latent class analysis (LCA).

Methods

A cross-sectional study of 507 psoriatic patients aged above 10 years was performed in Yunnan Provincial Hospital of TCM and the First Affiliated Hospital of Kunming Medicine University from October 2010 to September 2011 using a TCM symptoms and signs checklist obtained from 16 TCM experts by the Delphi technique. LCA was applied to obtain the best fitted model for clustering of symptoms and signs that can be interpreted as underlying Zhengs of psoriasis.

Results

The LCA identified three Zhengs: dampness-heat Zheng (35.1%); blood heat Zheng (34.7%); and yin deficiency and blood dryness Zheng (30.2%). The first Zheng was associated with winter, the second with male sex, old age, smoking, and drinking alcohol, and the third with outpatient status, which reflected a mild disease course.

Conclusions

In this study, 507 psoriasis patients were clustered into three Zhengs, which had different associated factors.

Expression of oral cytokines in HIV-infected subjects with long-term use of antiretroviral therapy

OBJECTIVES

The objectives of this study were to determine (i) the expression of oral pro-inflammatory cytokines in HIV-infected subjects compared with non-HIV individuals, (ii) the cytokine expression in the subjects with antiretroviral therapy (ART) compared with those without ART, and (iii) factors associated with the expression of the cytokines.

MATERIALS AND METHODS

Oral examination was performed and saliva samples were collected and analyzed for the expression of pro-inflammatory cytokines using ELISA. Logistic regression analysis was performed to determine the association between HIV/ART status and the cytokine expression.

RESULTS

One hundred and fifty-seven HIV-infected subjects with and without ART, and 50 non-HIV individuals were enrolled. TNF-α and IL-6 in saliva were significantly decreased, while IL-8 was significantly increased in HIV infection (P < 0.05). Changes in the expression of IL-8 were also observed between HIV-infected subjects who were and were not on ART (P < 0.05). Duration of HIV infection and smoking was significantly associated with the expression of pro-inflammatory cytokines in saliva (P < 0.05).

CONCLUSION

Oral innate immunity is affected by HIV infection and use of ART. IL-8 may be the useful biomarker to identify subjects at risk of infection and malignant transformation due to HIV infection and long-term use of ART.