Hong Kong domestic health spending: financial years 1989/90 to 2011/12

This report presents the latest estimates of Hong Kong domestic health spending for financial years 1989/90 to 2011/12, cross-stratified and categorized by financing source, provider, and function. Total expenditure on health (TEH) was HK$101 985 million in financial year 2011/12, which represents an increase of HK$8580 million or 9.2% over the preceding year. TEH grew faster relative to gross domestic product (GDP) leading to a rise in TEH as a percentage of GDP from 5.1% in 2010/11 to 5.2% in 2011/12. During the period 1989/90 to 2011/12, total health spending per capita (at constant 2012 prices) grew at an average annual rate of 4.8%, which was faster than the average annual growth rate of per capita GDP by 1.8 percentage points. In 2011/12, public and private expenditure on health increased by 8.3% and 10.0% when compared with 2010/11, reaching HK$49,262 million and HK$52,723 million respectively. Consequently, public share of total health expenditure dropped slightly from 48.7% to 48.3% over the year. Of private spending, the most important source of health financing was out-of-pocket payments by households (34.9% of TEH), followed by employer-provided group medical benefits (7.5%) and private insurance (7.4%). It is worth noting that private insurance will likely take over employers as the second largest private payer if the insurance market continues to expand at the current rate. Of the HK$101,985 million total health expenditure in 2011/12, current expenditure comprised HK$96,572 million (94.7%), whereas HK$5413 million (5.3%) was for capital expenses (ie investment in medical facilities). Analysed by health care function, services of curative care accounted for the largest share of total health spending (65.2%), which was made up of ambulatory services (33.6%), in-patient curative care (26.9%), day patient hospital services (4.1%), and home care (0.5%). Notwithstanding its small share, the total spending for day patient hospital services shows an increasing trend over the period 1989/90 to 2011/12, likely as a result of policy directives to shift the emphasis from in-patient to day patient care. Hospitals accounted for an increasing share of total spending, from 28.2% in 1989/90 to 46.8% in 2002/03 and then dropped slightly to 42% to 44% during the period 2005/06 to 2011/12, which was primarily driven by reduced expenditure of Hospital Authority. As a result of the epidemics which are of public health importance (eg avian flu, SARS, swine flu) and the expansion of private health insurance market in the last two decades, spending on provision and administration of public health programmes, and general health administration and insurance accounted for increasing, though less significant, shares of total health spending over the period. Without taking into account capital expenses (ie investment in medical facilities), public current expenditure on health amounted to HK$45,321 million (46.9% of total current expenditure) in 2011/12 with the remaining HK$51,251 million made up of private sources of funds. Public current expenditure was mostly incurred at hospitals (74.1%), whereas private current expenditure was mostly incurred at providers of ambulatory health care (51.2%). Although both public and private spending were mostly expended on personal health care services and goods (91.1% of total current spending), the distributional patterns among functional categories differed. Public expenditure was targeted at in-patient care (47.3%) and substantially less on out-patient care (27.4%). In comparison, private spending was mostly concentrated on out-patient care (42.7%), whereas in-patient care (24.7%) and medical goods outside the patient care setting (19.9%) comprised the majority of the remaining share. Compared to the Organisation for Economic Co-operation and Development countries, Hong Kong has devoted a relatively low percentage of GDP to health care in the last decade. As a share of total spending, public funding (either general government revenue or social security funds) was also lower than those in most economies with comparable economic development and public revenue collection base. Nonetheless, Hong Kong health care system achieved service quality and health outcome that fared well by global standards, indicating cost efficiency and effectiveness.

Meta-analysis of functional MBL polymorphisms. Associations with rheumatoid arthritis and primary Sjögren's syndrome

OBJECTIVE

The aim of this study was to determine whether functional mannose-binding lectin gene (MBL) polymorphisms are associated with the susceptibility to rheumatoid arthritis (RA) or primary Sjögren's syndrome (pSS).

METHODS

A meta-analysis was conducted to investigate the potential association of RA or pSS with MBL polymorphisms, including the codon 54 (allele B), codon 57 (allele C), and codon 52 (allele D) variants of exon 1, and the - 550 (allele L) and - 221 (allele X) promoter variants.

RESULTS

A total of 12 comparative studies, including eight RA (1623 patients and 1671 controls) and four pSS (280 patients and 516 controls) studies, were included in the meta-analysis. The meta-analysis revealed no association between the MBL B allele and RA in the overall study population (odds ratio [OR] 0.991, 95 % confidence interval [CI] 0.726-1.355, p = 0.957). However, the meta-analysis showed significant associations between the MBL D, H, and X alleles and RA in the overall population (OR 1.708, 95 % CI 1.077-2.707, p = 0.023; OR 1.936, 95 % CI 1.218-3.078, p = 0.005; OR 1.582, 95 % CI 1.216-2.057, p = 0.001, respectively). An association was found between the MBL B allele and pSS in the overall study population (OR 0.691, 95 % CI 0.541-0.917, p = 0.010). Stratification by ethnicity indicated a trend toward an association between the B allele and pSS in European populations, but no association in Asian populations (OR 0.689, 95 % CI 0.465-1.021, p = 0.063; OR 0.896, 95 % CI 0.311-2.562, p = 0.838, respectively).

CONCLUSION

This meta-analysis demonstrated an association between the MBL D, L, and X alleles and the risk of RA. It also demonstrated an association between the MBL B allele and the susceptibility to pSS, suggesting a protective role of the MBL B allele against the development of pSS.

TNF-α -308 A/G and -238 A/G polymorphisms and susceptibility to glaucoma: a meta-analysis

The purpose of this study was to examine whether tu-mor necrosis factor-α (TNF-α) -308 A/G and -238 A/G polymorphisms confer susceptibility to glaucoma. A meta-analysis was conducted ex-amining the association between TNF-α -308 A/G and -238 A/G poly-morphisms and glaucoma. A total of 13 studies on TNF-α -308 A/G and 238 A/G polymorphisms were included in this meta-analysis. The meta-analysis revealed no association between the TNF-α -308 A al-lele and glaucoma [odds ratio (OR) = 1.403, 95% confidence inter-val (CI) = 0.784-2.513, P = 0.254]. Subgroup analysis by disease type revealed no association between the TNF-α -308 A allele and glau-coma. The meta-analysis revealed no significant association between the TNF-α -238 A allele and glaucoma (OR = 1.120, 95%CI = 0.708-1.773, P = 0.628). This meta-analysis showed no association between the A alleles of the TNF-α -308 A/G or -238 A/G polymorphisms and glaucoma.

Associations between the functional CD40 rs4810485 G/T polymorphism and susceptibility to rheumatoid arthritis and systemic lupus erythematosus: a meta-analysis

Objective

The aim of this study was to determine whether the functional CD40 rs4810485 G/T polymorphism is associated with susceptibility to rheumatoid arthritis (RA) or with susceptibility to systemic lupus erythematosus (SLE).

Methods

A series of meta-analyses were conducted to test for association between the CD40 rs4810485 G/T polymorphism and RA or SLE.

Results

A total of 21 comparisons involving 15,095 patients and 27,050 controls for RA, and 1353 patients and 2342 controls for SLE were considered. Meta-analysis showed a significant association between the CD40 rs4810485 T allele and RA in all subjects (odds ratio (OR) 0.890, 95% confidence interval (CI) 0.846–0.936, p = 5.5 × 10−7). After stratification by ethnicity, the CD40 T allele was found to be significantly associated with RA in Europeans (OR 0.879, 95% CI 0.848–0.901, p = 3.0 × 10−9). A similar pattern of association was observed between the CD40 T allele and RA when the analysis was performed using the recessive, dominant, and additive models. Meta-analysis also showed a significant association between the CD40 polymorphism and SLE in Europeans (OR for the T allele 0.715, 95% CI 0.641–0.832, p = 1.4 × 10−6).

Conclusions

Our meta-analyses confirm that the CD40 rs4810485 G/T polymorphism is associated with susceptibility to RA and SLE in Europeans.

The effects of 5-hydroxytryptamine1a receptor agonist, buspirone on the gastric fundus accommodation in an animal model using guinea pigs

BACKGROUND

To date, few animal experiments have been conducted to examine the effects and mechanisms of buspirone in inducing the relaxation of the gastric fundus. The aim of this study is to examine the effects and mechanisms of buspirone, 5-HT(1a) receptor agonist, in the accommodation of gastric fundus muscle in an animal experimental model using guinea pigs.

METHODS

In the current study, we performed an immunohistochemistry for 5-HT(1a) receptors in the tissue samples collected from the stomach of guinea pig, an ex vivo experiment to examine the electrical field stimulation (EFS)-induced relaxation of the circular muscle in the gastric fundus in guinea pigs and an in vivo experiment to measure the intragastric pressure through the insertion of the balloon catheter in the fundus.

KEY RESULTS

Immunohistochemical stains for 5-HT(1a) receptor could confirm the expression of 5-HT(1a) receptor in guinea pig stomach. There was a significant dose-dependent inhibition of the EFS-induced relaxation of fundic muscle strips following the treatment with WAY-100635 (5-HT(1a) antagonist), but this was significantly improved following the treatment with buspirone. An in vivo measurement of the gastric fundic tone showed that there was a significant decrease in the intragastric pressure at same volume by pretreatment with buspirone as compared with the vehicle control, but this could be prevented with the treatment with WAY-100635.

CONCLUSIONS & INFERENCES

Based on our results, it can be concluded that buspirone is effective in relaxing the gastric fundus via 5-HT(1a) receptor pathway in both in vitro and in vivo experimental models using guinea pigs.

Effect of By-product Feed-based Silage Feeding on the Performance, Blood Metabolites, and Carcass Characteristics of Hanwoo Steers (a Field Study)

This study was conducted to determine the effects of feeding by-product feed (BF)-based silage on the performance, blood metabolite parameters, and carcass characteristics of Hanwoo steers. The BF-based silage was composed of 50% spent mushroom substrate, 21% recycled poultry bedding, 15% cut ryegrass straw, 10.8% rice bran, 2% molasses, 0.6% bentonite, and 0.6% microbial additive (on a wet basis), and ensiled for over 5 d. Fifteen steers were allocated to three diets during the growing and fattening periods (3.1 and 9.8 months, respectively): a control diet (concentrate mix and free access to rice straw), a 50% BF-based silage diet (control diet+50% of maximum BF-based silage intake), and a 100% BF-based silage diet (the same amount of concentrate mix and ad libitum BF-based silage). The BF-based silage was fed during the growing and fattening periods, and was replaced with larger particles of rice straw during the finishing period. After 19.6 months of the whole period all the steers were slaughtered. Compared with feeding rice straw, feeding BF-based silage tended (p = 0.10) to increase the average daily gain (27%) and feed efficiency (18%) of the growing steers, caused by increased voluntary feed intake. Feeding BF-based silage had little effect on serum constituents, electrolytes, enzymes, or the blood cell profiles of fattening steers, except for low serum Ca and high blood urea concentrations (p<0.05). Feeding BF-based silage did not affect cold carcass weight, yield traits such as back fat thickness, longissimus muscle area, yield index or yield grade, or quality traits such as meat color, fat color, texture, maturity, marbling score, or quality grade. However, it improved good quality grade (1⁺ and 1⁺⁺) appearance rates (60% for the control group vs 100% for the BF-based silage-fed groups). In conclusion, cheap BF-based silage could be successfully used as a good quality roughage source for beef cattle.

Is gastrointestinal stromal tumor (GIST) originating from the rectovaginal septum GIST or extra-GIST (EGIST)? A case report with literature review

Gastrointestinal stromal tumors (GISTs) are rare tumors of the gastrointestinal (GI) tract that arise from primitive mesenchymal cells. Extragastrointestinal stromal tumors (EGISTs) are extremely rare tumors that show the features of GISTs outside the GI tract. Their most common locations are the omentum, mesentery, and retroperitoneum. The authors report herein a case of a 54-year-old woman with GIST in rectovaginal septum. The patient underwent low anterior resection of the rectum, total abdominal hysterectomy, bilateral salpingo-oophorectomy, and partial resection of the posterior vagina. She received adjuvant therapy with an oral tyrosine-kinase inhibitor. She is presently healthy without any evidence of recurrence at 26 months after surgery. For GISTs arising in the rectovaginal septum, it is difficult to ascertain whether the tumor origin site is the rectum, rectovaginal septum, or vagina. In other words, it is difficult to classify these tumors as GISTs or EGISTs. More consideration for the exact origin should be given to the GIST in the rectovaginal septum for the precise diagnosis (GIST or EGIST) and risk classification in future.

Genome-wide pathway analysis in glioma

The aim of this study was to identify candidate single-nucleotide polymorphisms (SNPs) that may play a role in the susceptibility to glioma, to elucidate their potential mechanisms, and to generate SNP-to-gene-to-pathway hypotheses.A genome-wide association study (GWAS) dataset of glioma including 509,345 SNPs from 1,856 glioma patients and 4,955 control subjects of European descent was used in this study. Identify candidate Causal SNPs and Pathways (ICSNPathway) analysis was applied to the GWAS dataset.ICSNPathway analysis identified 6 candidate SNPs, 5 genes, and 9 pathways, which revealed 5 hypothetical biological mechanisms. The hypothetical mechanisms, beginning with the strongest, are summarized as follows: (i) rs667128 alters the role of taste receptor, type 2, member 8 (TAS2R8) in taste receptor activity and taste transduction pathways (p < 0.001, false discovery rate (FDR) < 0.001; p = 0.001, FDR = 0.012, respectively), (ii) rs619381 modulates the effect of taste receptor, type 2, member 7 (TAS2R7) on taste receptor activity and taste transduction (p < 0.001, FDR < 0.001; p = 0.001, FDR = 0.012), (iii) rs1033583 modulates delta-like protein 1 (DLL1), regulating cell adhesion and segment specification (p < 0.001, FDR = 0.011; p = 0.001, FDR = 0.032), (iv) rs2232580 affects the role of lipopolysaccharide binding protein (LBP) in the response to lipopolysaccharide, positive regulation of interleukin-6 production, acute inflammatory response, and in macrophage activation (0.002 ≤ p ≤ 0.013; 0.012 ≤ FDR ≤ 0.030), and (v) rs4644 and rs4652 regulate lectin, galactoside-binding, soluble, 3 (LGALS3), affecting immunoglobulin binding (p = 0.010; FDR = 0.040).Using the ICSNPathway to analyze glioma GWAS data, 6 candidate SNPs, 5 genes (TAS2R8, TAS2R7, DLL1, LBP, and LGALS3), and 9 pathways that may contribute to the susceptibility of glioma were identified.

KEYWORDS

glioma, genome-wide association study, pathway-based analysis.

Overexpression of the Brassica rapa transcription factor WRKY12 results in reduced soft rot symptoms caused by Pectobacterium carotovorum in Arabidopsis and Chinese cabbage

Chinese cabbage (Brassica rapa L. ssp. pekinensis), an important vegetable crop, can succumb to diseases such as bacterial soft rot, resulting in significant loss of crop productivity and quality. Pectobacterium carotovorum ssp. carotovorum (Pcc) causes soft rot disease in various plants, including Chinese cabbage. To overcome crop loss caused by bacterial soft rot, a gene from Chinese cabbage was isolated and characterised in this study. We isolated the BrWRKY12 gene from Chinese cabbage, which is a group II member of the WRKY transcription factor superfamily. The 645-bp coding sequence of BrWRKY12 translates to a protein with a molecular mass of approximately 24.4 kDa, and BrWRKY12 was exclusively localised in the nucleus. Transcripts of BrWRKY12 were induced by Pcc infection in Brassica. Heterologous expression of BrWRKY12 resulted in reduced susceptibility to Pcc but not to Pseudomonas syringae pv. tomato in Arabidopsis. Defence-associated genes, such as AtPDF1.2 and AtPGIP2, were constitutively expressed in transgenic lines overexpressing BrWRKY12. The expression of AtWKRY12, which is the closest orthologue of BrWRKY12, was down-regulated by Pcc in Arabidopsis. However, the Atwrky12-2 mutants did not show any difference in response to Pcc, pointing to a difference in function of WRKY12 in Brassica and Arabidopsis. Furthermore, BrWRKY12 in Chinese cabbage also exhibited enhanced resistance to bacterial soft rot and increased the expression of defence-associated genes. In summary, BrWRKY12 confers enhanced resistance to Pcc through transcriptional activation of defence-related genes.

Immune responses of different mouse strains after challenge with equivalent lethal doses oftoxoplasma Gondii

Most immunological studies that utilize different strains of inbred mice following T. gondii infection fail to compensate for differences in host susceptibility to the size of the parasite innoculum. To address this concern, susceptible C57BL/6 and resistant CBA/J mice were orally infected with either an equivalent 50% lethal dose (LD50) of brain cysts of the 76K strain of T. gondii (15 cysts in C57BL/6, 400 cysts in CBA/J) or the same dose of parasites in each mouse strain. C57BL/6 mice receiving 400 cysts (LD50 of CBA/J mice) died post infection, whereas CBA/J mice that received 15 cysts (LD50 of C57BL/6 mice) survived. Parasite loads in the brains and serum Toxoplasma-specific IgG1 titers of LD50-infected C57BL/6 mice were significantly higher than those in LD50- or 15 cysts-infected CBA/J mice, whereas splenocyte proliferation to Toxoplasma antigen and the percentage of CD8 alpha+ T cells were reduced in LD50-infected C57BL/6 mice. In contrast, serum IgG2a and IgM titers, the percentage of gamma delta T cells and IFN-gamma expression of spleen of LD50-infected CBA/J mice were higher than those of either 15 cysts-infected CBA/J mice or LD50-infected C57BL/6 mice. These observations demonstrate that the immune response between LD50-infected C57BL/6 and CBA/J mice was more prominent when compared to C57BL/6 or CBA/J mice receiving the same parasite inoculum. These observations would suggest that caution must be excersized in the planning and interpretation of data when the size of the parasite inoculum has not been adjusted for mouse strain.

Eckols reduce dental pulp inflammation through the ERK1/2 pathway independent of COX-2 inhibition

OBJECTIVES

The aim of this study was to elucidate the role of 6-6 bieckol (EB1) and pholorofucofuroeckol-A (EB5) from brown seaweed marine algae (Eisenia bicyclis) on lipopolysaccharide (LPS)-induced inflammation in human dental pulp cells (HDPCs).

METHODS

The cytotoxicity of EB1 and EB5 was examined by MTT assay on LPS-induced human dental pulp cells. Their role on expression of inflammatory, odontogenic, and osteogenic molecules was determined by Western blot analysis. The dentin mineralization was checked by alkaline phosphatase activity.

RESULTS

The five compounds from E. bicyclis have different structure with non-cytotoxic in HDPCs. EB1 and EB5 showed anti-inflammatory properties and inhibited phosphorylated-extracellular signal-regulated kinase (p-ERK1/2) and phosphorylated-c-jun N-terminal kinases (p-JNK) without any cytotoxicity. In particular, EB1 inhibited cyclooxygenase-2 (COX-2) and p-ERK1/2 signaling, and EB5 inhibited only p-ERK1/2 signaling but not COX-2. Both compounds inhibited nuclear factor kappa-B (NF-κB) translocation. Furthermore, EB1 and EB5 increased dentinogenic and osteogenic molecules, and dentin mineralized via alkaline phosphatase activity (ALP) in LPS-induced HDPCs.

CONCLUSIONS

This study elucidates that EB1 and EB5 have different types of anti-inflammatory property and help in dentin formation. Therefore, these compounds derived from marine algae of E. bicyclis may be used as selective therapeutic strategies for pulpitis and oral diseases.

Effects of Supplementing Microbially-fermented Spent Mushroom Substrates on Growth Performance and Carcass Characteristics of Hanwoo Steers (a Field Study)

This study evaluated the effect of dietary supplementation of microbially-fermented spent mushroom substrates (MFSMS) on weight gain, carcass characteristics, and economic efficiency of Hanwoo steers. Highly cellulolytic bacteria (Enterobacter spp. and Bacillus spp.) isolated from spent mushroom substrates (SMS) stacks were inoculated (1% v/v) into the SMS, which was anaerobically fermented and fed to the steers for 12.6 months during the growing and fattening periods. Growing Hanwoo steers were assigned to the control group without supplementation of Microbially-fermented SMS (MFSMS), to a treatment group with 50% of MFSMS (1/2 of the ad libitum group), and to a treatment group with ad libitum access to SMS (the ad libitum group). All the groups were fed the formulated feed and rice straw. The voluntary intake (DM basis) of MFSMS was 1.6 kg/d during the growing period and 1.4 kg/d during the fattening period. The voluntary rice straw intake decreased by 6 to 11%, but the total voluntary DMI increased by 7 to 15% with MFSMS fed. The increased DMI with MFSMS supplementation resulted in a tendency of increased (p = 0.055) live weight gain by 8 to 12% compared with the control group. At slaughtering, the supplementation of MFSMS increased (p<0.05) the ribeye area by an average of 10 cm(2). In conclusion, feeding MFSMS improved growth performance and carcass traits of Hanwoo steers and could successfully replace a part of conventional roughage such as rice straw commonly used in Asian countries.

Attenuation by a Vigna nakashimae extract of nonalcoholic fatty liver disease in high-fat diet-fed mice

A Vigna nakashimae (VN) extract has been shown to have antidiabetic and anti-obesity effects. However, the mechanism underlying the effect of a VN extract on hepatic inflammation and endoplasmic reticulum (ER) stress remains unclear. In the present study, we investigated how a VN extract protects against the development of non-alcoholic fatty liver disease (NAFLD). A VN extract for 12 weeks reduced the body weight, serum metabolic parameters, cytokines, and hepatic steatosis in high-fat diet (HFD)-fed mice. A VN extract decreased HFD-induced hepatic acetyl CoA carboxylase and glucose transporter 4 expressions. In addition to the levels of high-mobility group box 1 and receptor for advanced glycation, the hepatic expression of ATF4 and caspase-3 was also reduced by a VN extract. Thus, these data indicate that a chronic VN extract prevented NAFLD through multiple mechanisms, including inflammation, ER stress, and apoptosis in the liver.

Abstract P2-19-05: Oncoplastic breast conserving surgery with perforator flap in breast cancer patients

Purpose : Oncoplastic breast surgery has been used widely as a treatment protocol for breast cancer. Thoracodorsal artery perforator (TDAP) flap and intercostal artery perforator (ICAP) flap can provide adequate cover without sacrificing any muscle and allow closing of the donor sites in inconspicuous sites. Therefore, among the oncoplastic volume replacement techniques indicated using local flap that can adequately cover the volume of breast, TDAP and ICAP are especially suggested. This study describes the use of TDAP and ICAP flap techniques after breast conserving surgery. Methods : From March 2010 to August 2012, 38 patients with breast cancer received breast reconstruction. All patients who were selected had small- to moderate-sized defects on breasts, middle aged, and were not sensitive to scars. The TDAP flap is the first choice for performing the surgery, but if the perforator of the TDAP flap is not found, a dissection toward the anterior area to find an adequate perforator is made and the serratus anterior artery perforator is normally used. Otherwise after the dissection is performed more anterior, ICAP can be used. If the perforator penetrates the LD muscle, the TDAP flap can be used. The perforator that penetrates from the serratus anterior muscle is also used in the anterior area. Otherwise, ICAP can be used in partial breast reconstruction. The TDAP flap can be applied to any defect site regardless of the size of the defect area. Results : The mean age was 44.9 years and the average follow-up interval was 6 months. The average specimen weight was 98g. Complications developed in 4 cases including 3 cases of venous congestion, though self-limited, and 1 case of wound disruption on the inframammary fold suture area. Majority of the patients were satisfied with the cosmetic result.

Conclusion : Thoracodorsal artery perforator flap (TDAP) and intercostal artery perforator flap (ICAP) techniques can be reliable and useful in correcting breast deformity after breast conservation surgery, especially in patients with small- to moderate-sized defects on breasts.

Key Words : intercostal artery perforator flap, thoracodorsal artery perforator flap Oncoplastic surgery, ICAP, TDAP.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-19-05.

Abstract P5-17-02: Efficiency of methylene blue nanoparticles (nanoMB) as local injectable agent for photodynamic therapy in breast cancer

Photodynamic therapy (PDT), a non-invasive and alternative method for the treatment of cancer, is a light-activated treatment modality for breast cancer. Destruction of cancerous cells by PDT is achieved by a combination of photosensitizer and light of an appropriate wavelength for the photosensitizer.

Methylene blue (MB) is a blue dye clinically being used and is known to show efficient photosensitizing activity with a very high yield of singlet oxygen generation (65%), where singlet oxygen is the actual therapeutic agent for PDT. However MB shows low cell uptake efficiency by itself and thus a low PDT efficacy. In this regard, we developed a nanoformulation of MB (nanoMB) to improve cancer cell uptake efficiency while keeping the high efficiency of singlet oxygen generation. NanoMB is composed of ternary components that are physically assembled in an aqueous milieu.

In this study, we investigated the cellular uptake of nanoMB and cancer cell apoptosis induced by nanoMB PDT in MDA-MB-231 human breast cancer cells in vitro and in vivo.

In vitro, nanoMB was indeed avidly taken up by MDA-MB231 cells, unlike free MB showing negligible cellular uptake. NanoMB formulation preserved the photosensitization activity of MB under laser irradiation at 655 nm. Taken together, it was revealed from the in vitro microscopic observation that nanoMB can efficiently destroy live MDA-MB231 cells even under red lamp illumination. In the control group, cells were treated with free MB and did not show phototoxic influence under the same light.

In vivo phototoxicity evaluation, the locally injected nanoMB was internalized into cancer cells. Upon annexin V treatment after laser irradiation at 655 nm, apoptosis of cancer cells was clearly observed from the spot where nanoMB and laser were applied together. The PDT-induced cell apoptosis was visualized in a simple mouse model by using fluorescently labeled annexinV that has high affinity toward apoptotic cells.

Briefly, cancer cells were inoculated in muscle on opposite sides and nanoMB was applied to both the inoculation sites. After some time, only one side was laser-treated and fluorescent annexinV was injected to both. Only the dual-treated side (nanoMB + laser) showed retention of annexinV after 1 hour, indicating the occurrence of apoptosis by the PDT treatment.

Free MB and nanoMB were applied by subcutaneous injection around an early tumor tissue (not intratumoral injection). After 1 hour, free MB signals disappeared whereas nanoMB was retained at the tumor, implying that nanoMB penetrated into the tumor through the basement membrane.

Laser irradiation was done one hour after sample injection for both free MB and nanoMB. This treatment (sample + laser) was repeated seven times. According to the results, only nanoMB showed the tumor growth suppression effect, demonstrating the potential of nanoMB as a local injectable PDT agent.

In this study, nanoMB (MBOF) presented avid internalization into live cancer cells while keeping the high photosensitizing efficiency of MB. Consequently, highly efficient PDT of cancer cells was demonstrated in vitro and in vivo.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P5-17-02.

Hong Kong domestic health spending: financial years 1989/90 to 2010/11

This report presents the latest estimates of Hong Kong domestic health spending for financial years 1989/90 to 2010/11, cross-stratified and categorised by financing source, provider, and function.Total expenditure on health (TEH) was HK$93 433 million in financial year 2010/11, which represents an increase of HK$5364 million or 6.1% over the preceding year. As a result of a gradual recovery from the financial tsunami in 2008, gross domestic product (GDP) grew faster relative to TEH leading to a drop in TEH as a percentage of GDP from 5.2% in 2009/10 to 5.1% in 2010/11.During the period 1989/90 to 2010/11, TEH per capita (at constant 2011 prices)grew at an average annual rate of 4.8%, which was faster than the average annual growth rate of per capita GDP by 1.8 percentage points.Compared to 2009/10, in 2010/11 public and private expenditure on health increased by 3.7% and 8.5% and reached HK$45 491 million and HK$47 943 million, respectively. Consequently, the public share of TEH dropped slightly from 49.8% to 48.7% over the year. Regarding private spending, the most important source was out-of-pocket payments by households (35.0% of TEH),followed by employer-provided group medical benefits (7.4%), and private insurance (7.2%). It is worth noting that private insurance will likely overtake employer benefits as the second largest private payer if the insurance market continues to expand at the current rate.Of the HK$93 433 million TEH in 2010/11, HK$88 987 million (95.2%) was current expenditure and HK$4446 million (4.8%) was for capital expenses (ie investment in medical facilities). Analysed by health care function, services for curative care accounted for the largest share of TEH (65.8%), which was made up of ambulatory services (34.0%), in-patient curative care (27.0%), day patient hospital services (4.2%), and home care (0.5%). Notwithstanding its small share,the total spending for day patient hospital services shows an increasing trend over the period 1989/90 to 2010/11, which is likely due to shift of policy directives from in-patient to day patient care, and the increasing demand for dialysis and cataract surgery in an ageing population.Hospitals accounted for an increasing share of TEH, from 28.2% in 1989/90 to 46.8% in 2002/03 and then dropped slightly to 43% to 44%during the period 2005/06 to 2010/11, which was primarily driven by reduced expenditure by the Hospital Authority. As a result of several epidemics (e g avian flu, SARS, swine flu) and expansion of the private health insurance market in the last two decades, spending on the provision and administration of public health programmes, and general health administration and insurance accounted for increasing, though less significant, shares of TEH over that period.Without taking into account capital expenses (ie investment in medical facilities), public current expenditure on health amounted to HK$42 264 million(47.5% of total current expenditure) in 2010/11. The remaining HK$46 723 million was from private sources. Public current expenditure was mostly incurred at hospitals (74.7%), whereas private current expenditure was mostly incurred at providers of ambulatory health care (51.0%). Although both public and private spending were mostly expended on personal health care services and goods (91.4%of total current spending), the distributional patterns among functional categories differed. Public expenditure was targeted at in-patient care (47.6%) and substantially less on out-patient care (27.5%). In comparison, private spending was mostly concentrated on out-patient care (43.2%),whereas in-patient care (24.5%) and medical goods outside the patient care setting (19.9%) accounted for most of the remaining share. Compared to the Organisation for Economic Cooperation and Development countries, Hong Kong has devoted a relatively low percentage of GDP to healthcare in the last decade. As a share of TEH, public funding(either general government revenue or social security funds) was also lower than in most economies with comparable economic development and public revenue collection base.

Gene delivery of c-myb increases bone formation surrounding oral implants

Bone regeneration around titanium (Ti) implants is a relatively slow process. The c-myb transcription factor has been associated with high proliferation and differentiation rates in bone. This study analyzed whether c-myb can enhance new bone surrounding the implant. In vitro overexpressed chitosan-gold nanoparticles conjugated with plasmid DNA/c-myb (Ch-GNPs/c-myb)-coated Ti surfaces were associated with enhanced expression of the osteogenic molecules osteopontin (OPN), runt-related transcription factor 2 (RUNX-2), and bone morphogenetic proteins (BMP2/7) in MC-3T3E1 osteoblast cells. Further, to determine its in vivo effect, we inserted Ch-GNPs/c-myb-coated Ti implants into rat mandibles. One and 4 wks post-implantation, mandibles were examined by microcomputed tomography, immunohistochemistry, and hematoxylin & eosin staining. The microcomputed tomography analysis demonstrated that c-myb overexpression increased the density and volume of newly formed bone surrounding the implants, compared with those in controls (p < .05). Further, c-myb increased the number of cells expressing BMP2/7 and aided in the increase of new bone (p < .05). These results support the view that c-myb overexpression accelerates new bone surrounding implants and can serve as a potent molecule in promoting tissue regeneration around dental implants. The recipient rat used in this system provides an excellent in vivo model for studies of bone regeneration.

Factors affecting late displacement following volar locking plate fixation for distal radial fractures in elderly female patients

The purpose of this study was to evaluate the risk of late displacement after the treatment of distal radial fractures with a locking volar plate, and to investigate the clinical and radiological factors that might correlate with re-displacement. From March 2007 to October 2009, 120 of an original cohort of 132 female patients with unstable fractures of the distal radius were treated with a volar locking plate, and were studied over a follow-up period of six months. In the immediate post-operative and final follow-up radiographs, late displacement was evaluated as judged by ulnar variance, radial inclination, and dorsal angulation. We also analysed the correlation of a variety of clinical and radiological factors with re-displacement. Ulnar variance was significantly overcorrected (p < 0.001) while radial inclination and dorsal angulation were undercorrected when compared statistically (p < 0.001) with the unaffected side in the immediate post-operative stage. During follow-up, radial shortening and dorsal angulation progressed statistically, but none had a value beyond the acceptable range. Bone mineral density measured at the proximal femur and the position of the screws in the subchondral region, correlated with slight progressive radial shortening, which was not clinically relevant. Volar locking plating of distal radial fractures is a reliable form of treatment without substantial late displacement.

Hong Kong domestic health spending: financial years 1989/90 to 2009/10

This report presents the latest estimates of Hong Kong domestic health spending for financial years 1989/90 to 2009/10, cross-stratified and categorised by financing source, provider and function. Total expenditure on health (TEH) was HK$88,721 million in financial year 2009/10, which represents an increase of HK$5031 million or 6.0% over the preceding year. As a result of a slow revival in the economy from the financial tsunami in 2008, TEH grew faster relative to gross domestic product (GDP) leading to a marked increase in TEH as a percentage of GDP from 5.0% in 2008/09 to 5.2% in 2009/10. During the period 1989/90 to 2009/10, total health spending per capita (at constant 2010 prices) grew at an average annual rate of 4.9%, which was faster than the average annual growth rate of per capita GDP by 2.0 percentage points. In 2009/10, public and private expenditure on health increased by 6.2% and 5.8% when compared with 2008/09, reaching HK$43,823 million and HK$44,898 million, respectively. Consequently, public and private shares of total health expenditure stayed at similar levels (49% and 51% respectively) in the 2 years. With respect to private spending, the most important source of health financing was out-of-pocket payments by households (34.9% of TEH), followed by employer-provided group medical benefits (7.4%) and private insurance (6.8%). During the period, a growing number of households (mostly in middle to high income groups) have taken out pre-payment plans to finance health care. As such, private insurance has taken on an increasingly important role in financing private spending. Of the HK$88,721 million total health expenditure in 2009/10, current expenditure comprised HK$84,874 million (95.7%), whereas HK$3847 million (4.3%) was for capital expenses (ie investment in medical facilities). Analysed by health care function, services for curative care accounted for the largest share (66.2%), which was made up of ambulatory services (33.5%), in-patient curative care (27.3%), day patient hospital services (4.9%) and home care (0.5%). Notwithstanding the small share of total spending for day patient hospital services, there was an increasing trend over the period 1989/90 to 2009/10, likely as a result of policy directives to shift the emphasis from in-patient to day patient care. Hospitals accounted for an increasing share of total spending, from 28.2% in 1989/90 to 46.8% in 2002/03 and then dropped steadily to 43% to 44% during the period 2005/06 to 2009/10. This trend was primarily driven by reduced expenditure by the Hospital Authority. As a result of epidemics that were of public health importance (eg avian flu, SARS, swine flu) and expansion of the private health insurance market in the last 2 decades, spending on provision and administration of public health programmes, and general health administration and insurance accounted for increasing, though less significant, shares of total health spending over the period. Without taking into account capital expenses (ie investment in medical facilities), public current expenditure on health amounted to HK$40,951 million (48.2% of total current expenditure) in 2009/10. The remaining HK$43,923 expenditure was mostly incurred at hospitals (74.1%), whereas private current expenditure was mostly incurred at providers of ambulatory health care (50.9%). Although both public and private spending were mostly expended on personal health care services and goods (91.0% of total current spending), the distribution patterns among functional categories differed. Public expenditure was targeted at in-patient care (48.9%) and substantially less on out-patient care (26.0%). In comparison, private spending was mostly concentrated on out-patient care (43.4%), whereas in-patient care (23.3%) and medical goods outside the patient care setting (19.5%) accounted for the majority of the remaining share. Compared to the Organisation for Economic Cooperation and Development countries, Hong Kong has devoted a relatively low percentage of GDP to health care in the last decade. As a share of total spending, public funding (either general government revenue or social security funds) was also lower than in most economies with comparable economic development and public revenue collection base.

Bovine spongiform encephalopathy surveillance in the Republic of Korea

National surveillance for bovine spongiform encephalopathy (BSE) began in the Republic of Korea (ROK) in 1996. Surveillance programmes changed overtime to comply with the guidelines of the World Organisation for Animal Health (OIE). Bovine spongiform encephalopathy was designated as a notifiable disease in 1997. From July 2008, the BSE surveillance programme was intensified to test cattle in designated high-risk populations more effectively. New measures included the compulsory testing of all non-ambulatory cattle at abattoirs, and encouraging the testing of all dead cattle examined and recorded under the Mutual Aid Insurance Scheme (fallen stock). In addition, there was a vigorous search for animals suspected of being clinically infected. As a result, a total of 426,919 OIE points were achieved over a period of seven consecutive years to the end of October 2009. This enabled the submission of a successful application to the OIE in 2010 for recognition of the ROK's BSE disease status as being one of controlled risk, in accordance with Chapter 11.5. of the OIE Terrestrial Animal Health Code.

Pre- and post-operative comorbidities in idiopathic carpal tunnel syndrome: cervical arthritis, basal joint arthritis of the thumb, and trigger digit

We retrospectively reviewed 633 hands in 362 patients who had idiopathic carpal tunnel syndrome and underwent carpal tunnel release between 1999 and 2009. Electrophysiological studies and simple radiographs of the wrist, cervical spine, and basal joint of the thumb were routinely checked, and patients were also assessed for the presence of trigger digit or de Quervain's disease before and after surgery. Among 362 patients, cervical arthritis was found in 253 patients (70%), and C5-C6 arthritis was the most common site. Basal joint arthritis of the thumb was observed in 216 (34%) of the 633 hands. Trigger digit or de Quervain's disease was observed in 85 of the 633 hands (13%) before surgery, and developed in 67 hands (11%) after surgery. Cervical arthritis, basal joint arthritis, and trigger digit commonly coexist with idiopathic carpal tunnel syndrome. Patient education about these disorders is very important when they coexist with idiopathic carpal tunnel syndrome.

Evaluation of Chest Compression Depth during Nine Minutes of Hands-Only Cardiopulmonary Resuscitation Performed by a Lone Rescuer and its Effect by Age Group: A Pilot Simulation Study Using a Manikin

Objective

There have been few studies on the use of long-standing hands-only cardiopulmonary resuscitation (CPR) by a lone rescuer. This study aimed to evaluate the long-standing (nine minutes) hands-only CPR by a lone rescuer, and the change of chest compression depth over time. The effect of age of rescuer on chest compression depth was also studied.

Methods

From a total of 404 adult lay-persons who participated in CPR training, 91 subjects were enrolled in the simulation trial of nine minutes of hands-only CPR using a manikin with a Skill-Reporter™. The quality of the chest compression over time and the effects of rescuer age were analysed.

Results

Of the 91 participants, 74 (81%) fully completed the nine minutes of CPR. No significant differences of incomplete CPR rate between each age group were observed. No significant differences in the degree of reduction in effective chest compressions were observed based on the time course among the different age groups. The total number of compressions decreased abruptly from the six-minute time point onwards (five minutes vs. six minutes, p=0.038).

Conclusions

Most trained lay-persons could complete the 9 minutes of hands-only CPR. The rate of chest compression shows a significant decrease after 6 minute. We do not find a significant difference in the decrease of adequate chest compressions over time among various age groups in this pilot simulation study.