Divergent breast cancer incidence trends by hormone receptor status in the state of Sarawak, Malaysia

Recent studies from high-risk countries such as the US, Denmark and Ireland have shown rising incidence rates of hormone receptor (HR)-positive and falling rates of HR-negative breast cancers (BC). However, it remains unclear whether a similar pattern occurs in low-risk countries. Detailed clinical and risk factor data were collected from 2,977 female invasive BC patients (≥20 years) in Sarawak General Hospital, Malaysia, representing 93% of the population. The population-at-risk was obtained from the Department of Statistics Malaysia. Secular trends in age-standardized incidence rates were assessed using estimated average annual percent changes. Associations between established BC risk factors and tumor subtypes defined by HR or joint human epidermal growth factor receptor 2 (HR/HER2) status were examined by case-case comparisons using logistic regression. From 2006 to 2015, incidence rates increased for HR-positive cancers by 4.46%/year (95% CI = 2.19-6.78) and decreased for HR-negative cancers by 2.29%/year (95% CI = -4.31 to -0.24). When further stratified by HER2, the most contrasting difference in linear trends was observed between HR+/HER2- and HR-/HER2- subtypes. After controlling for potential confounders, cases with excess body weight (OR_{overweight vs. normal} = 0.82; 95% CI = 0.69-0.98; OR_{obese vs. normal} = 0.62; 95% CI = 0.48-0.80), later age at first birth (OR_{≥26 years vs. <23 years} = 0.82; 95% CI = 0.66-1.02), nulliparity (OR_{nulliparous vs. <23 years} = 0.74; 95% CI = 0.59-0.94) and never-breastfeeding (OR_{never vs. ever} = 0.73; 95% CI = 0.55-0.97) were less frequent among HR-negative cases than among HR-positive cases. Diverging incidence trends by HR expression were similar in Sarawak and Western countries, possibly reflecting changes in the prevalence of risk factors with opposing effects by tumor subtypes in low- and high-risk populations.

When qualitative data contradict quantitative data: diabetes distress in the Chinese-Canadian community

AIMS

To use both quantitative and qualitative approaches to characterize the diabetes distress profile of Chinese-Canadians with Type 2 diabetes and to better understand their experience of living with diabetes.

METHODS

We recruited 40 Chinese-Canadian adults with Type 2 diabetes who completed a Mandarin- or Cantonese-language diabetes education programme in Richmond, British Columbia. Using a mixed-methods sequential explanatory research design, participants first completed a 15-item Chinese version of the Diabetes Distress Scale, which included three subscales: emotional burden, regimen-related distress, and physician distress. The self-report survey was followed by a semi-structured interview that addressed the following diabetes-related topics: perspectives towards the healthcare team, emotional health, diabetes-related concerns and stressors, diabetes diagnosis experience, and sources of social support and diabetes education.

RESULTS

The mean (sd) scores for total distress 1.5 (0.5), emotional burden 1.7 (0.7), regimen-related distress 1.4 (0.5), and physician distress 1.4 (0.9), fell within the 'low distress' range (< 2.0). Qualitative analysis of semi-structured interviews showed that some participants were dissatisfied with diabetes care providers and experienced emotional challenges, particularly early in their diagnosis. Other themes that emerged included eating distress, fear of complications, language barriers, and medication concerns.

CONCLUSIONS

Not only did the qualitative findings from semi-structured interviews capture aspects of diabetes distress that were not included in the quantitative survey, it also uncovered inconsistencies between the two datasets. To more accurately understand the diabetes distress experience of any ethnic community, both quantitative and qualitative approaches contribute unique value.

When's dinner? Does timing of dinner affect the cardiometabolic risk profiles of South-Asian Canadians at risk for diabetes

AIM

To explore the relationship between the time dinner is consumed (dinnertime or timing of dinner) and cardiometabolic risk factors among South-Asian Canadians at risk for diabetes.

METHODS

We recruited 432 South-Asian adults affiliated with Sikh and Hindu Temples in Metro Vancouver. Participants deemed to be at risk of diabetes underwent a clinical and behavioural assessment. Dinnertime was measured via self-report. Clinical endpoints included HbA_1c , apolipoprotein, blood pressure, weight, BMI and waist circumference.

RESULTS

The mean age of participants was 65 years and 59% were male. Dinnertime was categorized into three groups: early (before 18:00 h); average (18:00 to 20:00 h); and late (later than 20:00 h). Among the participants, 19% (n = 79), 44% (n = 187) and 37% (n = 157) reported early, average and late dinnertimes, respectively. Significant differences were found for dinnertime groups and years of residence in Canada, gender and employment. Compared with the early dinnertime group, the late dinnertime group lived in Canada for a shorter duration, comprised a higher proportion of males (66 vs 48%; P = 0.01) and were currently employed (37 vs 22%; P = 0.02). With regard to clinical endpoints, compared with the early dinnertime group, the late dinnertime group had lower systolic blood pressure (135.9 vs 131.7 mmHg; P = 0.03). After controlling for demographic characteristics, this difference was diminished. No significant differences were found between dinnertime and HbA_1c , apolipoprotein, diastolic blood pressure, weight, BMI and waist circumference.

CONCLUSION

Findings suggest that, among this sample of South-Asian Canadians at risk of Type 2 diabetes, there was no association between timing of the evening meal and cardiometabolic profiles.

Rethinking peer support for diabetes in Vancouver's South-Asian community: a feasibility study

AIM

To examine the feasibility and potential health impact of a diabetes self-management education and support intervention involving peer support on glycaemic control and diabetes distress.

METHODS

A total of 41 South-Asian adults with Type 2 diabetes were recruited for a 24-week diabetes self-management education and support pilot intervention involving peer support. The intervention consisted of six weekly education sessions co-facilitated by a certified diabetes educator and two peer leaders, followed by 18 weekly support sessions facilitated by two peer leaders. Education sessions were guided entirely by participants' self-management questions and also emphasized goal setting and action planning. Support sessions were based on empowerment principles and participants discussed self-management challenges, shared emotions, asked self-management questions, problem-solved in a group, set goals, and developed and evaluated action plans. Feasibility outcomes included recruitment and retention. Primary health-related outcomes included HbA1c levels and diabetes distress (measured at baseline, 6 and 24 weeks). Programme satisfaction was also assessed.

RESULTS

Pre-established criteria for recruitment and retention were met. Paired t-tests showed no changes in HbA1c and diabetes distress at 6 weeks. At 24 weeks, HbA1c levels deteriorated [54 mmol/mol (7.1%) vs 61 mmol/mol (7.7%)] while diabetes distress scores improved (2.0 vs 1.7).

CONCLUSIONS

Although feasible, findings suggest this peer-support model may have a positive impact on diabetes distress, but not on HbA1c levels. Culturally responsive modifications (e.g. intervention location) to the pilot model are needed and could lead to more favourable health outcomes for this community. Such a re-designed peer-support model will require further investigation.

Does a 2.5-year self-management education and support intervention change patterns of healthcare use in African-American adults with type 2 diabetes?

AIMS

To investigate the impact of a 2.5-year diabetes self-management education and support intervention on healthcare use and to examine factors associated with patterns of healthcare use.

METHODS

We recruited 60 African-American adults with type 2 diabetes who completed a 2.5-year empowerment-based diabetes self-management education and support intervention. Primary healthcare use outcomes included acute care visits, non-acute care visits and days lost to disability. Acute care was a composite score calculated from the frequency of urgent care visits, emergency department visits and hospitalizations. Non-acute care measured the frequency of scheduled outpatient visits. To examine change in patterns of healthcare use, we compared the frequency of healthcare visits over the 6-month period preceding the intervention with that in the last 6 months of the intervention.

RESULTS

No significant changes in patterns of healthcare use were found for acute care, non-acute care or days lost to disability. Multiple regression models found higher levels of depression (P = 0.001) to be associated with a greater number of non-acute healthcare visits, and found longer duration of diabetes (P = 0.019) and lower levels of diastolic blood pressure (P = 0.025) to be associated with fewer days lost to disability.

CONCLUSIONS

Participation in a long-term diabetes self-management education and support intervention had no impact on healthcare use in our sample of African-American subjects.

Evaluating a diabetes self-management support peer leader training programme for the English- and Punjabi-speaking South-Asian community in Vancouver

AIMS

The purpose of this single-cohort study was to implement and evaluate a programme that trains peers to deliver a diabetes self-management support programme for South-Asian adults with Type 2 diabetes and to assess the perceived efficacy of and satisfaction with this programme.

METHODS

We recruited eight South-Asian adults who completed a 20-h peer-leader training programme conducted over five sessions (4 h per session). The programme used multiple instructional methods (quizzes, group brainstorming, skill building, group sharing, role-play and facilitation simulation) and provided communication, facilitation, and behaviour change skills training. To graduate, participants were required to achieve the pre-established competency criteria in four training domains: active listening, empowerment-based facilitation, five-step behavioural goal-setting, and self-efficacy. Participants were given three attempts to pass each competency domain.

RESULTS

On the first attempt six (75%), eight (100%), five (63%) and five (63%) participants passed active listening, empowerment-based facilitation, five-step behavioural goal-setting, and self-efficacy, respectively. Those participants who did not pass a competency domain on the first attempt were successful in passing on the second attempt. As a result, all eight participants graduated from the training programme and became peer leaders. Satisfaction ratings for programme length, balance between content and skills development, and preparation for leading support activities were uniformly high. Ratings for the instructional methods ranged between effective and very effective.

CONCLUSION

Findings suggest it is feasible to train and graduate peer leaders with the necessary skills to facilitate a diabetes self-management support intervention.

Association between the rs1050450 glutathione peroxidase-1 (C > T) gene variant and peripheral neuropathy in two independent samples of subjects with diabetes mellitus

Glutathione peroxidase-1 (GPx-1) is an endogenous anti-oxidant enzyme. The T allele of the GPx-1 rs1050450 (C > T) gene variant is associated with reduced enzyme activity. Our aim was to examine the association between this gene variant and peripheral neuropathy in two cross-sectional samples of subjects with diabetes: (i) 773 Caucasian subjects were genotyped from the UCL Diabetes and Cardiovascular disease Study (UDACS) and (ii) 382 Caucasian subjects from the Ealing Diabetes Study (EDS). Peripheral neuropathy status (and oxidised-LDL [Ox-LDL:LDL] and plasma Total Ant-ioxidant Status [TAOS] in UDACS), were analysed in relation to genotype. We observed that: (i) In UDACS, the odds ratio (OR) for peripheral neuropathy in the T allele carriers compared to the CC genotype was 1.61 [1.10-2.28], p = 0.01. This remained significant after adjustment for other risk factors. Ox-LDL:LDL ratio was significantly elevated in T allele carriers (CC vs. CT/TT: 16.3 ± 2.4 v 18.0 ± 2.9 U/mmol LDL, p = 0.02). (ii) In EDS, the OR for peripheral neuropathy in the T allele carriers compared to the CC genotype was 1.95 [1.11-3.42], p = 0.02. This remained significant after adjustment for other risk factors. In conclusion, we observed a significant association between the T allele and peripheral neuropathy and LDL oxidation. This is the first paper to examine the rs1050450 variant in two samples of Caucasian subjects with diabetes. Prospective analysis of the gene variant is required in diabetic and healthy cohorts with measured plasma markers of oxidative stress to investigate the described association further.

Abstract P3-13-06: Racial Differences in Breast Cancer Biomarkers in the Three Ethnic Groups of Sarawak, Malaysia

Sarawak, Malaysia

Introduction

The Malaysian state of Sarawak has a mixed ethnic population of Natives, Chinese and Malays. Breast cancer (BC) is the most common cancer. We present preliminary results obtained on a case series of 1034 female BC

patients diagnosed between 2001 and 2009, representative of the Sarawak patient population (as discussed in our previous publication: Devi et al. 2007). Methods

Tumor markers were assessed using immuno-histochemistry, Her2 2+ and Her2 3+ were confirmed using FISH test. Patients were classified as follow:

Luminal A : ER+ PR+ and Fish — Luminal B : ER+, PR+ and Fish + Her2-overexpressing : ER-, PR-and Fish — Triple-negative : ER-, PR-and Fish -

Chi2 comparisons and multivariate logistic regressions were performed using SAS statistical software. The OR presented are adjusted on age and ethnic groups. Results

BC incidence was higher among Chinese (ASR=30.6) than among Malay (ASR=21.2) or Natives (ASR=7.8).

In our series, luminal B, Her2-overexpressing and triple negative subtypes were represented in respectively 12%, 11% and 29% of the patients. The triple negative subtype was more frequent among Natives cases (37%) or Malay cases (33%), significantly higher than among Chinese cases (23%).

Compared to luminal A, triple negative patients were more likely to be Malay (OR = 2.07; 95%CI= [1.44-2.98]) or Natives (OR = 2.13; 95%CI= [1.48-3.04]), to have older age at menopause (OR for menopause &gt;50 years = 1.59 ; 95%CI= [1.01-2.51]) and less likely to have familial history of BC (OR = 0.52; 95%CI= [0.3260.82]) or to have breast fed for 0 to 6 months (OR = 0.60 ; 95%CI= [0.37-0.97]). Malay and Native triple negative patients were more likely to be overweight when pre-menopausal (OR for BMI 25-29 vs. BMI&lt;25 = 2.02; 95%CI=[1.02-3.97]), such a trend did not exist in Chinese patients.

Compared to luminal A, Her2-overexpressing patients were more likely to be Malay (OR = 1.66; 95%CI= [1.01-2.70]) and to have children (OR parous vs nulliparous=1.99; 95%CI= [1.11-3.59]). The number of children did not influence the association. A borderline significant association (p=0.053) was observed with menopausal status

Compared to luminal A, luminal B, were significantly more likely to be Malay (OR=2.10; 95%CI= [1.32-3.33]), to be premenopausal (OR=1.87; 95%CI=[1.13-3.10]) and to be over-weight (OR for BMI 25-29 vs. BMI&lt;25 = 1.64; 95%CI=[1.06-2.53]) especially when premenopausal (OR=1.96; 95%CI= [1.05-3.65]).

Surprisingly, age distribution did not differ between Luminal A, B, Her2- overexpressing and triple-negative patients, however 80% of our patients were &lt;60. Conclusions

The proportion of triple negative patients in our series revealed to be one of the highest ever reported, and was significantly higher than in Caucasian or other Asian cases series. Our results confirm the finding the HER2- overexpression is more frequent in Asians compared to whites or African American. Regarding risk factors our results did not conflict with those reported in the literature for Caucasian populations however some specific patterns were observed that need to be studied further.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P3-13-06.

Association between the rs4880 superoxide dismutase 2 (C>T) gene variant and coronary heart disease in diabetes mellitus

Mitochondrial superoxide dismutase 2 (SOD2) is an endogenous anti-oxidant enzyme. The rs4880 gene variant results in a C>T substitution, influencing SOD enzymatic activity. This variant has been associated with micro- and macro-vascular complications in diabetes mellitus. Our aim was to examine the association between this variant and coronary heart disease (CHD) risk in a cross-sectional sample of subjects with diabetes. 776 Caucasian subjects with diabetes were genotyped. CHD risk, oxidised-LDL and plasma total anti-oxidant status (TAOS) were analysed in relation to genotype. In females, the TT genotype was associated with CHD (CC/CT/TT: No CHD vs. CHD: 22.4/56.0/21.6% vs. 12.0/50.0/38.0%, p=0.03; for CC/CT vs. TT, p=0.01). The odds ratio for CHD associated with the TT genotype compared to CC/CT was 2.22 [95%CI: 1.17-4.24], p=0.01. The TT genotype was also associated with significantly lower plasma TAOS. In males, no association was observed between genotype and CHD risk, but CHD was significantly associated with age, lower HDL, higher triglycerides, higher BMI and cigarette smoking. The TT genotype of this variant is associated with increased CHD risk and lower plasma anti-oxidant defences in females with diabetes. This modest genotype-effect is not apparent in males where traditional risk factors may play a greater role.

A prospective, randomised trial comparing closed intramedullary nailing with percutaneous plating in the treatment of distal metaphyseal fractures of the tibia

We compared the outcome of closed intramedullary nailing with minimally invasive plate osteosynthesis using a percutaneous locked compression plate in patients with a distal metaphyseal fracture in a prospective study. A total of 85 patients were randomised to operative stabilisation either by a closed intramedullary nail (44) or by minimally invasive osteosynthesis with a compression plate (41). Pre-operative variables included the patients' age and the side and pattern of the fracture. Peri-operative variables were the operating time and the radiation time. Postoperative variables were wound problems, the time to union of the fracture, the functional American Orthopaedic Foot and Ankle surgery score and removal of hardware. We found no significant difference in the pre-operative variables or in the time to union in the two groups. However, the mean radiation time and operating time were significantly longer in the locked compression plate group (3.0 vs 2.12 minutes, p < 0.001, and 97.9 vs 81.2 minutes, p < 0.001, respectively).After one year, all the fractures had united. Patients who had intramedullary nailing had a higher mean pain score (40 = no pain, 0 = severe pain), [corrected] but better function, alignment and total American Orthopaedic Foot and Ankle surgery scores, although the differences were not statistically significant (p = 0.234, p = 0.157, p = 0.897, p = 0.177 respectively). Three (6.8%) patients in the intramedullary nailing group and six (14.6%) in the locked compression plate group showed delayed wound healing, and 37 (84.1%) in the former group and 38 (92.7%) in the latter group expressed a wish to have the implant removed. We conclude that both closed intramedullary nailing and a percutaneous locked compression plate can be used safely to treat Orthopaedic Trauma Association type-43A distal metaphyseal fractures of the tibia. However, closed intramedullary nailing has the advantage of a shorter operating and radiation time and easier removal of the implant. We therefore prefer closed intramedullary nailing for patients with these fractures.

Preliminary results from the pilot study on the National Cancer Patient Registry--Cervical Cancer

Carcinoma of the cervix is the most common malignancy in many developing countries. The purpose of this pilot study on cervical cancer patients treated at selected sites in Malaysia is to examine the achievability of collecting information on patients. The data was collected from the medical records of the patients using case report form. The results reveal that more than 90% of the forms had completed data from all sites. The pilot study has demonstrated that it is feasible to register and collect information on cervical cancer patients using the case report forms. Treatment outcome obtained from this data will form the baseline to establish existing clinical practice and will be useful for treating physicians to monitor the treatment outcome and the late complications and with longer followup to measure the disease free and overall survival. In addition, it is an useful tool as the national indicator.

Setting up home-based palliative care in countries with limited resources: a model from Sarawak, Malaysia

BACKGROUND

The provision of palliative care (PC) and opioids is difficult to ensure in remote areas in low- and middle-income countries. We describe here the set up of a home-care program in Sarawak (the Malaysian part of the Borneo Island), where half the population lives in villages that are difficult to access.

METHODS

The establishment of this program, initiated in 1994 by the Department of Radiotherapy of Sarawak General Hospital, consisted of training, empowering nurses, simplifying referral, facilitating access to medication, and increasing awareness among public and health professionals about PC.

RESULTS

The program has been sustainable and cost efficient, serving 936 patients in 2006. The total morphine usage in the program increased from <200 g in 1993 to >1400 g in 2006. The results show that pain medication can be provided even in remote areas with effective organization and empowerment of nurses, who were the most important determinants for the set up of this program. Education of family was also a key aspect.

CONCLUSION

The authors believe that the experience gained in Sarawak may help other regions with low or middle resources in the set up of their PC program especially for their remote rural population.

Patient-provider perceptions of diabetes and its impact on self-management: a comparison of African-American and White patients

AIMS

To compare patient-provider differences in diabetes-related perceptions between African-American and White patients and to examine its association with self-care behaviours.

METHODS

One hundred and thirty patient-provider pairs were recruited from the greater Detroit area. Patients and providers completed a survey assessing perceptions about diabetes-related concepts and demographic background. The Diabetes Semantic Differential Scale was used to measure diabetes-related perceptions. Patients also reported the frequency of performing self-care behaviours, including following a healthy eating plan, engaging in physical activity, blood glucose monitoring, and taking medication and/or insulin.

RESULTS

There were a greater number of patient-provider differences in diabetes-related perceptions for the African-American patients (nine of 18 concepts) compared with the White patients (four of 18 concepts). Stepwise regression analyses found patients' semantic differential scores to be significantly associated with five self-care behaviours for African-American patients and two self-care behaviours for White patients. Providers' semantic differential scores emerged as predictors of self-care behaviours for African-American patients, but not for White patients.

CONCLUSIONS

Our findings suggest that compared with White patients, African-Americans differ in a greater number of diabetes-related perceptions than their providers. Patients' and providers' perceptions of diabetes care concepts have a significant impact on a greater number of self-care behaviours for African-American patients than White patients.

Reperfusion Liver Injury—Induced Superoxide Dismutase and Catalase Expressions and the Protective Effects of N-Acetyl Cysteine

AIM

Reperfusion of the ischemic liver results in the generation of oxygen radicals. In this study, we analyzed if the mRNA and protein expressions of superoxide dismutase (SOD) and catalase increased after ischemia (I) and reperfusion (R) of the rat liver.

MATERIALS AND METHODS

Ischemia was induced by clamping off the common hepatic artery and portal vein of rats for 40 minutes, which were then reperfused for 90 minutes. Blood samples collected prior to I and after R were analyzed for hydroxyl radical (.OH), nitric oxide (NO), and alanine transferase (ALT). Liver tissues were used to analyze the SOD and catalase mRNA and protein expressions by real-time polymerase chain reaction and Western blot.

RESULTS

The results showed that this protocol resulted in elevation of the blood ALT, NO, and .OH levels (P<.001). mRNA (P<.01) and protein expressions (P<.05) of SOD and catalase were all increased. Pretreatment with antioxidant, N-acetyl cysteine, attenuated the liver injury.

CONCLUSION

These results indicate that reperfusion of the ischemic liver induced antioxidant enzymes expressions so that oxygen radicals are scavenged. Oxygen radical scavenger could further attenuate the I/R-induced liver injury.

Reducing by half the percentage of late-stage presentation for breast and cervix cancer over 4 years: a pilot study of clinical downstaging in Sarawak, Malaysia

BACKGROUND

The registry of the Oncology Departmental in Sarawak General Hospital showed that 79% of nasopharyngeal, 77% of breast and 70% of cervix cancer patients were diagnosed at an advanced stage (stages III and IV) for year 1993. Hence, a low cost Early Cancer Surveillance Program was started in 1994, with the intent of downstaging these three most common cancers in Sarawak.

MATERIALS AND METHODS

The program consisted of (i) training health staff in hospital and rural clinics to improve their skills in early cancer detection, (ii) raising public awareness through pamphlets, posters and sensitization by health staff.

RESULTS

Data analysis revealed that the program achieved downstaging in two of the cancers. Breast cancer in stage III and IV was reduced from 60% (1994) to 35% (1998) (P < 0.0001) and cervical cancer in stage III and IV from 60% (1994) to 26% (1998) (P < 0.0001). No reduction was observed for nasopharyngeal cancer at 88% (1994) to 91% (1998).

CONCLUSIONS

The overall cost of this program was <US$34 000. It is cost-effective and easy to implement and would be a valuable alternative in countries where majority of the tumors are found in late stage (III and IV) where screening programs meet important difficulties. Our data analyses revealed important shortcomings in the PAP smear screening program where inadequate groups of women were screened. It resulted in a pick up rate of only 5% of the cases. This finding confirmed the need for the simple and complementary downstaging approach.

A direct high-performance liquid chromatographic method for the determination of therminol 66 contamination in commercial glycerin and fatty acids

A simple and sensitive high-performance liquid chromatographic method for the determination of Therminol 66 thermal heating fluid in glycerin and fatty acids is developed. Sample solutions dissolved in methanol-tetrahydrofuran (50:50, v/v) are injected directly into a reversed-phase C18 column and eluted with a methanol and water mixture (88:12, v/v). The concentration of the thermal heating fluid is monitored by fluorescence detection at 257 nm (excitation) and 320 nm (emission). The calibration graph obtained from various concentrations of the thermal heating fluid in the methanol and tetrahydrofuran mixture is linear (correlation coefficient = 0.999), and the limit of detection is 0.01 microg/mL. Spiked glycerin containing 0.1 to 1.0 microg/g of the thermal heating fluid also gives good linearity with a mean recovery of 95.3%. The mean intra- and interassay precision are 1.80-6.51% and 5.71-9.03%, respectively, at the 0.1-microg/g level. The method is simple and does not require any pretreatment step, thus it is ideal for quality assurance purposes.

Barriers to fecal occult blood testing and sigmoidoscopy among older Chinese-American women

PURPOSE

This study examined factors associated with fecal occult blood test (FOBT) and sigmoidoscopy screening use among Chinese-American women age 60 years and older.

DESCRIPTION OF STUDY

One hundred women were recruited from senior centers in two metropolitan areas on the east coast of the United States. Participants completed a questionnaire that included sections on demographics, health history, health insurance coverage, FOBT and sigmoidoscopy use, common and cultural barriers to colorectal cancer screening, and acculturation.

RESULTS

Logistic regression models found greater acculturation to be a significant predictor of having had a FOBT at least once, and found both greater acculturation and physician recommendation to be significant predictors of having had a sigmoidoscopy at least once. No significant predictors were found for regular adherence to colorectal screening guidelines, which include having undergone an FOBT in the past year and sigmoidoscopy in the past 5 years.

CLINICAL IMPLICATIONS

This study found that older Chinese-American women underuse FOBT and sigmoidoscopy screening, as is recommended by the American Cancer Society colorectal cancer screening guidelines. These findings suggest that cultural factors may influence the initiation of colorectal cancer screening for Chinese-American women but are not predictive of adherence to screening over time. Outreach efforts to promote colorectal cancer screening in this population might target women who are less acculturated to facilitate an initial entry into the Western healthcare system to obtain screening.

A comparison of blacks and whites seeking treatment for chronic pain

OBJECTIVE

Most conceptualizations of chronic pain acknowledge the importance of culture and social circumstances. Cultural and social influences may differ for persons of different racial or ethnic groups, and this circumstance may lead them to experience and adjust differently to pain. The current study compared adjustment to chronic pain by blacks and whites seeking treatment for chronic pain.

SUBJECTS AND MEASURES

Fifty-seven black and 207 white patients completed measures of anxiety, depression, disability, pain, and physical symptoms during their initial visit to a university pain clinic.

RESULTS

Comparisons showed that the groups did not differ with regard to age, sex, education, chronicity of pain, pain location, work status, previous surgeries, medical diagnosis, medication, wage replacement, or involvement in litigation. However, the black group reported higher pain severity, more avoidance of activity, more fearful thinking, more physical symptoms, and greater physical and psychosocial disability. The groups remained significantly different with regard to avoidance, fearful thinking, and physical symptoms after pain severity was statistically controlled for; however, they did not remain different on disability.

CONCLUSIONS

These results show that blacks and whites with chronic pain experience pain differently. Several factors may underlie these differences, including family situation, health care experiences, or other unmeasured behavioral, environmental, or social influences. Other investigators should attempt to replicate these findings and more closely examine variables that may explain them.

Cultural barriers to mammography, clinical breast exam, and breast self-exam among Chinese-American women 60 and older

BACKGROUND

This study examined screening utilization at least once and regular adherence to mammography, clinical breast exam, and breast self-exam among older Chinese-American women.

METHOD

One hundred women were recruited from senior centers in two metropolitan cities. Participants completed a questionnaire that included sections on demographics, health history, health insurance coverage, breast cancer screening, common and cultural barriers to screening, and acculturation.

RESULTS

Logistic regression models found insurance coverage for mammography and acculturation to be significant predictors of having had a mammogram at least once. Low perceived need/lack of physician recommendation and recency of physical examination were significant predictors of having had a mammogram in the past year. Acculturation and modesty were significant predictors of having had a clinical breast exam at least once, while recency of physical examination was a significant predictor of having had a clinical breast exam in the past year. Reliance on medial professionals for screening and forgetting were significant predictors of having performed breast self-exam at least once, and forgetting was a significant predictor of regular performance of breast self-exam.

CONCLUSIONS

These findings suggest that both common and cultural barriers play a role in breast cancer screening among older Chinese-American women, with cultural factors being more influential in the initiation of cancer screening behavior.

[Germ cell apoptosis and regulation in testis]

Both spontaneous and induced germ cell apoptosis occur during the process of germ cell differentiation in testis, which is an important mechanism to remove surplus and abnormal germ cells. It has been known that germ cell apoptosis is under the control of endocrine, cell social association and gene. To elucidate the molecular mechanisms by which germ cell apoptosis is regulated and the elements of the death machinery will provide a basis for effective management of male infertility as well as more targeted approaches to male contraception.

[Pituitary adenylate cyclase activating polypeptide ameliorates the damage and inhibits the increase of intracellular calcium concentration in cultured hippocampal neurons induced by glutamate]

Hippocampal neurons cultured from 7 to 9 d in vitro were used to observe the effect of glutamate. Treatment of glutamate for 24 h greatly decreased neuronal survival and pretreatment with pituitary adenylate cyclase activating polypeptide (PACAP) significantly attenuated hippocampal neuron death induced by glutamate. Moreover, glutamate dose-dependently increased the intracellular calcium concentration in cultured hippocampal neurons, while PACAP inhibited the increase of intracellular calcium concentration induced by glutamate. PACAP 6-38, a specific PACAP type I receptor antagonist, completely inhibited the amelioration of glutamate induced death and the decrease of intracellular calcium concentration induced by PACAP in cultured hippocampal neurons. The data suggest that PACAP has a neuroprotective effect on the hippocampal neuronal damage induced by glutamate, which is related to an inhibition of glutamate-induced increase of intracellular calcium concentration and mediated by PACAP type I receptor.

Ca(2+) oscillations induced by a cytosolic sperm protein factor are mediated by a maternal machinery that functions only once in mammalian eggs

At fertilization in mammals, the sperm activates the egg by inducing a series of oscillations in the intracellular free Ca(2+) concentration. There is evidence showing that this oscillatory event is triggered by a sperm-derived protein factor which diffuses into egg cytoplasm after gamete membrane fusion. At present the identity of this factor and its precise mechanism of action is unknown. Here, we studied the specificity of action of the sperm factor in triggering Ca(2+) oscillations in mammalian eggs. In doing so, we examined the patterns of Ca(2+) signaling in mouse eggs, zygotes, parthenogenetic eggs and maturing oocytes following the stimulation of bovine sperm extracts which contain the sperm factor. It is observed that the sperm factor could induce Ca(2+) oscillations in metaphase eggs, maturing oocytes and parthenogenetically activated eggs but not in the zygotes. We present evidence that Ca(2+) oscillations induced by the sperm factor require a maternal machinery. This machinery functions only once in mammalian oocytes and eggs, and is inactivated by sperm-derived components but not by parthenogenetic activation. In addition, it is found that neither InsP(3) receptor sensitivity to InsP(3) nor Ca(2+) pool size are the determinants that cause the fertilized egg to lose its ability to generate sperm-factor-induced Ca(2+) oscillations at metaphase. In conclusion, our study suggests that the orderly sequence of Ca(2+) oscillations in mammalian eggs at fertilization is critically dependent upon the presence of a functional maternal machinery that determines whether the sperm-factor-induced Ca(2+) oscillations can persist.

Xenopus and chicken sperm contain a cytosolic soluble protein factor which can trigger calcium oscillations in mouse eggs

There is evidence showing that at fertilization the sperm introduces into egg cytoplasm a protein-based cytosolic factor, which serves as the physiological trigger for inducing Ca(2+) oscillations in mammalian eggs. Here we show that sperm of nonmammalian vertebrates also contain a cytosolic protein factor that can induce Ca(2+) oscillations when introduced into mammalian eggs. We have observed that cytosolic extracts derived from Xenopus or chicken sperm could induce mouse eggs to undergo Ca(2+) oscillations similar to those induced by bovine sperm extracts. The factor responsible for inducing Ca(2+) oscillations was of high molecular weight and heat- or proteinase K-labile. We show that 0.5 chicken sperm-equivalents or 1-2 Xenopus sperm-equivalents of the extracts had enough activity to trigger Ca(2+) oscillations in mouse eggs. Our findings illustrate that although Xenopus, chicken, and mammals are evolutionarily divergent species, the function of the sperm protein factor in triggering Ca(2+) oscillations in mammalian eggs appears not to be species specific in vertebrates.

Autostage sperm tracing system for semen evaluation

To overcome the limitation of the microscope field, the study proposed an autostage sperm tracing system (ASTS), which could trace a particular sperm for a long time and distance. The ASTS was constructed by assembling a commercial microscope, an image frame grabber, a personal computer, and a motorized stage. Its performance was tested by evaluating 6 semen samples and by comparing the evaluation with those of other semen evaluations. The ASTS broke through the limitation of the microscope field and traced a particular sperm as long as possible. It analyzed the sperm track and calculated the motility parameters, such as curvilinear velocity (Vcl), straight-line velocity (Vsl), and linearity (L(in)). The sperm quality was then evaluated in real time, and the user could decide to capture or abandon a particular sperm in the IVF The ASTS enables users to evaluate sperm progression for a long time and to have the global quality of a particular sperm in real time. Its open structure has the flexibility for micromanipulating a semen sample, and has the potential application associated with a modern IVF technique.

The anatomy of the extrathoracic intercostobrachial nerve

BACKGROUND

In the past decade surgeons have become increasingly aware of the morbidity caused by the division of the intercostobrachial nerve (ICBN) during axillary dissection. To prevent this problem and also to explain its variable occurrence, a detailed knowledge of the anatomy of the nerve is required.

METHODS

Twenty-eight axillary dissections were performed demonstrating the anatomy of the ICBN.

RESULTS

In all dissections the nerve originated from the second intercostal space, with contributions from the first and third intercostal nerve each on one occasion. The posterior axillary branch was constant but may branch early, simulating a second nerve. The ICBN had a variable relationship to the lateral thoracic vein: anterior, posterior or wrapping around it. In 36% there was a connection to the medial cord of the brachial plexus in the axilla. In the upper arm the nerve lies in the subcutaneous fat; in the majority it supplied at least the proximal half of the arm, and in one-third it reached the level of the elbow joint. In 18% there was a connection to the medial cutaneous nerve of the arm.

CONCLUSION

The ICBN and its main branch (the posterior axillary nerve) were constant in all dissections. But its origin, size, connection to the brachial plexus and medial cutaneous nerve of the arm were variable, as was its ultimate destination in the arm.

The role of cultural variables in breast self-examination and cervical cancer screening behavior in young Asian women living in the United States

This study examined cultural factors as predictors of breast self-examination (BSE) and participation in cervical cancer screening in young Asian and Caucasian women in the United States. Comparisons between Asian and Caucasian samples revealed significant differences in ever performing BSE and obtaining a pap test; the Caucasian women reported higher participation in both behaviors. Factor analysis of cultural barriers to screening revealed four factors: communication with mother, openness around sexuality, prevention orientation, and utilization of Western medicine. Logistic regression predicting BSE performance from demographics, acculturation, and cultural barriers revealed openness around sexuality to be a significant predictor. Pap test participation was predicted by year in college, ever having engaged in sexual intercourse, prevention orientation, and global acculturation. Cultural factors should be considered in programs to enhance participation in cancer screening.

An examination of antecedent traumas and psychiatric comorbidity among male inmates with PTSD

Despite substantially higher rates of posttraumatic stress disorder (PTSD) among male inmates than among men in the general population, there is a dearth of research on PTSD among incarcerated men. The current study addresses traumatic events that precede PTSD and psychiatric disorders that are comorbid with PTSD in an inmate sample. Seeing someone seriously injured or killed, being sexually abused, and being physically assaulted were the three most commonly reported antecedent traumas to PTSD. Lifetime and current rates of mood disorders, anxiety disorders, and antisocial personality disorder were elevated among inmates with a diagnosis of PTSD. Two hundred and thirteen inmates participated in the study. Sixty-nine participants (33%) met lifetime DSM-III-R criteria for PTSD, and 45 (21%) met current criteria. The findings are compared with general population samples, and implications of the findings are discussed.

Liquid chromatographic detection of Dowtherm A contamination in oleochemicals and edible oils

A rapid and direct liquid chromatographic (LC) technique is described for the determination of a eutectic mixture of diphenyl oxide and biphenyl such as Dowtherm A thermal heating fluid (THF) in oleochemicals and palm olein. Analysis is performed with an RP-18 column with fluorescence detection (excitation at 247 nm and emission at 310 nm). The isocratic mobile phase (1.0 mL/min) consists of methanol and water (90 + 10, v/v). A linear calibration model (correlation coefficient = 0.9999) was developed directly from used Dowtherm A THF with the biphenyl peak (4.70 min) as a marker. Average recoveries from spiked glycerin, fatty alcohol mixture, methyl ester mixture, fatty acids, and palm olein were 90.9-108.7%, with a detection limit of 0.1 microgram/mL. The technique requires no prior sample cleanup nor extraction steps and is good for quality assurance purposes.

Cloning of novel temperature-related expressed sequence tags in rat testis during spermatogenesis

Spermatogenesis needs the relatively cool environment of the scrotum in most mammals, it would be arrested when the testis was exposed to abdominal temperature. In this study, we have used a differential display PCR technique (DD-PCR) to screen temperature-related ESTs during spermatogenesis (TRS) in scrotal testes through a unilateral cryptorchid rat model after in situ analysis of testis cell DNA fragmentation. We reported here the cloning and sequencing of three such ESTs: TRS1, TRS3, and TRS4. Northern blot analysis confirmed that they were expressed specifically in scrotal testes. In situ hybridization showed that TRS1 was mainly expressed in the spermatocytes and the round spermatids in scrotal testis. Homology searches revealed that TRS1 and TRS3 were unknown cDNA sequences, and TRS4 was identical to a known EST whose function had not been reported. TRS1, TRS2, and TRS3 were first found to be temperature-related during spermatogenesis.

Spontaneous and fertilization-induced Ca2+ oscillations in mouse immature germinal vesicle-stage oocytes

Mouse germinal vesicle (GV)-stage oocytes not only show Ca2+ oscillations in response to fertilization but also exhibit spontaneous Ca2+ oscillations during meiotic maturation in vitro. Spontaneous Ca2+ oscillations were entirely suppressed by microinjection of heparin (25 microM final intracellular concentration), an antagonist of inositol trisphosphate (IP3) receptor, whereas fertilization-induced Ca2+ oscillations were only partially inhibited by heparin even at a high dosage of 600 microM. Inhibition of endogenous IP3 generation by antagonizing phospholipase C using U73122 (20 microM final concentration) also failed to suppress the generation of fertilization-induced Ca2+ transients, suggesting that the two types of Ca2+ oscillations do not have the same dependence on IP3-induced Ca2+ release. In addition, spontaneous Ca2+ oscillations require the presence of intact GV whereas fertilization-induced Ca2+ oscillations are independent of the GV but require cytoplasm, since enucleation eliminated only spontaneous Ca2+ oscillations but not fertilization-induced Ca2+ oscillations. These results suggest that IP3-induced Ca2+ release is the primary mechanism responsible for spontaneous Ca2+ oscillations. Sperm-induced Ca2+ oscillations, however, may employ more complex mechanisms during fertilization.

Transient myeloproliferative disorder in a Down's neonate with rearranged T-cell receptor beta gene and evidence of in vivo maturation demonstrated by dual-colour flow cytometric DNA ploidy analysis

Neonates with Down's syndrome may develop a transient myeloproliferative disorder (TMPD) which on presentation is indistinguishable from acute leukemia, with the difference manifest only on follow-up. The clinical course is one of spontaneous remission in TMPD and relentless progression in leukemia. We describe a Down's neonate presenting with hyperleucocytosis and circulating blasts which were positive for CD34, myeloid (CD33), megakaryocytic (CD41, CD42b, CD61), and T-lineage (CD3, CD7), but not B-lineage, associated antigens. Clonal rearrangement of the T-cell receptor beta (TCR beta) gene was found, with the immunoglobulin heavy chain gene in germline configuration, showing the disease to be a clonal proliferation of a multipotential stem cell involving the myeloid and T lineages. Dual-colour flow cytometric DNA ploidy analysis of CD41 positive blasts showed initially a predominant 2N population, but polyploidization to 6N and 8N cells was found on follow-up, concomitant with a progressive decrease in circulating blasts, suggesting maturation of the abnormal clone and a provisional diagnosis of TMPD. This was shown by the eventual resumption of normal haemopoiesis with the disappearance of blasts and the clonally rearranged TCR beta gene.

[Analysis of 112 cases of pedicular screw placement]

This article presented 464 pedicular screw placement in 112 patients who were treated with a method of internal spinal fixation system. Radiographic films or CT scans were used to assess the accuracy of the screw insertion into the vertebral body through pedicle and the angle of inserted screw to the end plate of the vertebral body. Results revealed that 88.7% of screw placement were considered excellent and good, 11.3% were acceptable and poor. There was no neurological complication at all. It is concluded that preoperative radiographic films in prone position to determine the point of entry and accurate marking of the pedicle were required for pedicular screw placement even without roentgenoscopic monitoring during operation. The indications and techniques were discussed.

Hook-pin and compression screw in the treatment of femoral neck fractures. Clinical trial and biomechanical study

One hundred and two patients with femoral neck fracture underwent combined hook-pin and compression screw fixation. Eighty-five patients were followed up for over 6 months. The fracture was united in 80 patients. The advantages of this method included less trauma, simple technique and firm internal fixation and early postoperative partial weight-bearing. Biomechanical study showed that this method is superior to Smith-Petersen nailing and two hook-pins methods. The sliding and continuous compression of this method promotes impaction and healing of the fracture.

Intestinal obstruction and perforation following sucralfate administration in a very low birth weight infant

A case of intestinal obstruction and perforation following sucralfate administration in a very low birth weight infant is reported. Potential adverse effects of using sucralfate for prophylaxis of stress ulcer in premature babies are discussed.

[Short segment peduncular fixation in the treatment of thoraco-lumbar fracture]

Thirty cases with unstable fracture of thoracolumbar spine were treated by a method of short segment peduncular fixation with a set of instrument newly designed. The mean values of the pre-operative Cobb's angles and anterior compression angles were 22.4 degrees and 23.1 degrees respectively, while post-operatively, they decreased to be 3.2 degrees and 6.3 degrees accordingly (P less than 0.01). CT scanning done on 16 patients with neurological deficit showed that the sagittal diameter of the fractured vertebrae, on average, was 7.5 mm before operation and was 12.7 mm post-operatively (P less than 0.01). It demonstrated that the fracture deformities i.e. kyphosis, lordosis, rotation, separation and compression had been corrected by procedures with this set of fixation system. Procedures of the operation with this set of instrument were discussed in detail.

Haemorrhagic shock encephalopathy

Three children suffered from acute onset of convulsions and progressive coma associated with hyperpyrexia, profound shock and generalized bleeding tendency. No causative agent could be identified. Despite aggressive resuscitation they all died. Post-mortem examination revealed cerebral oedema, petechial haemorrhages of the gut, lungs and kidneys, and a generalized depletion of lymphocytes in the lymphoid organs. Features were compatible with haemorrhagic shock encephalopathy, which is a highly fatal disease. The possible role of hyperpyrexia in its pathophysiology is discussed. More careful case identification and research in various possible aetiological factors may help elucidate its pathogenesis.