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To investigate the role of Jagged2 in triple negative breast cancer (TNBC) and its underlying mechanism.Breast cancer tissues of patients diagnosed with TNBC in Fujian Medical University Affiliated MinDong Hospital from January 2015 to September 2017 were selected. TNBC patients were divided into the paclitaxel-resistant group (n=34) and non-resistance group (n=11). Jagged2 expression in paclitaxel-resistant group and non-resistance group before and after treatment was detected by quantitative Real-time-polymerase chain reaction (qRT-PCR), respectively. After Jagged2 knockdown in paclitaxel-resistant MDA-MB-231 cells (MDA-MB-231/TXR), expression of CD44+CD24-ESA+ subset was detected by flow cytometry. MicroRNA-200 expression was detected after Jagged2 knockdown in MDA-MB-231/TXR cells.Jagged2 was highly expressed in paclitaxel-resistant TNBC tissues and cells. Jagged2 expression was found to be associated with cancer stem cell (CSC) properties of TNBC cells. Knockdown of Jagged2 inhibited CSC properties and paclitaxel resistance, whereas upregulated microRNA-200 expression. The inhibited CSC properties and paclitaxel resistance induced by Jagged2 knockdown were reversed by microRNA-200 knockdown.Jagged2 maintains CSC properties of TNBC cells and paclitaxel resistance via regulating microRNA-200.

In recent years, procalcitonin and C-reactive protein have been used as important indexes in the detection of inflammation. In order to analyze the combined detection of procalcitonin and C-reactive protein in infected patients, 57 subjects in the Clinical Laboratory of Zhengzhou Maternal and Child Health Hospital with a bacterial infection were selected as the observation group. Correspondingly, 57 non-infected subjects were selected for the control group. The procalcitonin and C-reactive protein levels in the included cases were analyzed and compared by extracting peripheral blood. The results showed that the two indexes of C-reactive protein (46.13±8.24 mg/L) and procalcitonin (6.61±3.45 ug/L) of the observation group were significantly higher than those of the control group (P less than 0.05). The positive rates of C-reactive protein (71.93%) and procalcitonin (91.23%) of the observation group were significantly higher than those of the control group (P less than0.05). Within the observation group, the C-reactive protein and procalcitonin levels in the infected patients after 2 and 3 days of treatment, decreased significantly (P less than 0.05). This study indicates that the combined detection of procalcitonin and C-reactive protein in patients with bacterial infections is effective and can be used in clinical settings.

Objective. This study was designed to compare the effects of metformin and repaglinide on the fasting plasma glucose (FPG) and glycated haemoglobin (HbA1c) in newly diagnosed type 2 diabetes in China.Methods. A total of 107 newly diagnosed type 2 diabetic patients (46 women and 61 men) participated in the study. All patients received 3-month treatment of metformin or repaglinide. Fasting blood glucose and HbA1c were determined at baseline and at the end of the 3-month of treatment.Results. FPG and HbA1c decreased in both metformin and repaglinide groups after 3 months treatment (P<0.01). The reduction of HbA1c was significantly greater in the repaglinide group(P<0.01). Metformin decreases fasting insulin concentration and HOMA-IR(P<0.01), and repaglinide improves HOMA-β (P<0.01). Triglycerides (TG) were reduced in both groups(P<0.01in metformin group;P<0.05in repaglinide group), but total cholesterol (TC) and low-density lipoprotein (LDL) were decreased only after metformin treatment(P<0.05).Conclusions. Both repaglinide and metformin were effective in glycaemic control in new onset patients with type 2 diabetes in China. Repaglinide had no effect on insulin sensitivity, but it improvedβ-cell function.

The methylation of tumor suppressor genes has been shown to be involved in many human cancers. 5-Aza-2'-deoxycytidine (5-Aza-CdR) can reactivate the expression of methylated tumor suppressor genes. In our study, 2 human cervical cancer cell lines, HeLa and SiHa, were treated with different concentrations (20, 10, 5, and 2.5 μM) of 5-Aza-CdR for 24, 48, and 72 h. After incubation, cells were analyzed by 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2H-tetrazolium bromide assay and flow cytometry. The expression of RASSF1A and APAF-1 was detected by RT-PCR. 5-Aza-CdR inhibited the growth of HeLa and SiHa cells at different concentrations. The strongest inhibition and apoptosis rates were obtained after incubation for 72 h (5.63 ± 1.38 and 8.24 ± 2.40%, respectively). No significant difference in the expression of RASSF1A was found upon drug treatment, while APAF-1 expression increased in HeLa cells after treatment (0.790 ± 0.056%). Our results suggest that the tumor-suppressive effect of 5-Aza-CdR may result from the reactivation of silenced APAF-1 through demethylation.

The genus Diapus Chapuis was erected (Chapuis 1865) for four species of pinhole borer (Curculionidae: Platypodinae) from the Oriental region and New Guinea. It was distinguished from other platypodine genera primarily by the widely separated procoxae (Chapuis 1865). Hopkins (1914) designated Diapus quadrispinatus Chapuis, 1865 as the type species of the genus. The genus is currently placed in the platypodine tribe Tesserocerini, subtribe Diapodina (Alonso-ZarazagaLyal 2009). Only two genera are included in the Diapodina, Diapus and Genyocerus Motschulsky (Alonso-ZarazagaLyal 2009, Jordal 2015). Diapus is distinguished from Genyocerus by the following characters (Wood 1993, BeaverLiu 2007): 1. In Diapus, the scutellum is narrower and more sunken, not flush with the elytral surface posteriorly as it is in Genyocerus. 2. The mycangial pores of Diapus are sometimes fused to form a transverse or crescentic bar on each side of the midline of the pronotum. This does not occur in Genyocerus. 3. The antennal club of Diapus sometimes has a median testaceous strip lacking sensillae on the anterior face. This strip is never present in Genyocerus. 4. The males of Diapus never possess a membranous extension of the apical margin of the fourth abdominal ventrite, present in some species of Genyocerus. 5. The females of Diapus often bear deciduous mandibular appendages, which are never present in Genyocerus (BeaverLiu 2007).

Lung cancer is the leading cause of cancer-related death in the world, particularly in major cities in China. We aimed to determine the benefit of survival and toxicity of Conformal Radiotherapy (CRT) combined with erlotinib-based multimodality therapy in newly diagnosed metastatic non-small-cell lung cancer (NSCLC).Newly diagnosed metastatic NSCLC patients were treated with CRT and erlotinib, with or without chemotherapy matched protocol. The patients received CRT with a dose of 30-66 Gy. Erlotinib was used at least one 28-day cycle. The primary end point was overall survival (OS).Thirty-two patients were analyzed. The median OS was 517 days. Patients with only one metastasis showed longer survival than patients with multi-metastases (986 vs. 380 days, n = 8 vs. 24, p = .009). Patients with multiple metastases in brain conferred worse survival for patients without and with sole brain metastasis (321 vs. 700 days, n=11 vs 21, p = .006). There was no significant difference in median survival whether erlotinib was used as a first-, second- or third-line therapy (380 vs. 700 vs. 310 days, n = 10 vs. 15 vs 7, respectively. p = .179). Patients with TTCRT90 days had longer OS than patients with TTCRT ≤ 90 days (749 vs. 322 days, n = 11 vs. 21, p = .012). Patients tolerated treatment with limited Grade 1/2 toxicity.In this study, patients with newly diagnosed metastatic NSCLC had survival benefits when erlotinib was used combined with CRT. Further prospective trials are needed to derive maximal benefit from the drug treatment.

Objective: To understand the conceptualization of child abuse and attitudes on reporting behaviors of Hong Kong adults. Methods: Cross-sectional telephone survey of 1,001 randomly selected subjects. Main Results: There is a discrepancy between perceived prevalence and the ability to name different child abuse types without prompting: 79.9% named physical abuse, while 41.2% felt it was common; 21.0% named child neglect, while 76.9% felt it was common; 13.4% named psychological abuse, while 47.4% felt it was common; 6.8% named sexual abuse, while 23.5% felt it was common. Most respondents classified severe physical abuse situations as abusive (e.g., “severely injuring a child”). Other scenarios such as “mildly injuring a child” and neglect and psychological abuse scenarios (e.g., “leaving a young child alone at home” and “shouting at a child often”) were often not classified as abusive. As regards case-reporting behavior, only about 40% would report abuse cases to authorities. Those who would not report abuse were less likely to classify abuse situations as abusive and more likely to think that seeking help is difficult, troublesome and unhelpful. Conclusions: The official reported prevalence figures for child abuse in Hong Kong should be interpreted with care, because underreporting is likely to be serious. Hong Kong people’s conceptualization and awareness of what comprises child abuse is found to differ from official definitions. They are reluctant to report abuse cases, due to their perceived low efficacy of case reporting. Both the difference in conceptualization and the reluctance to report might partly be attributable to Chinese culture. Objetivo: Entender la forma en que se define el maltrato infantil y las actitudes hacia la notificacion del mismo en adultos de Hong-Kong. Metodo: Se llevo a cabo una entrevista telefonica a un total de 1001 sujetos seleccionados aleatoriamente. Resultados: Se observa una discrepancia entre la prevalencia percibida y la capacidad para nombrar diferentes tipos de maltrato sin ayuda: un 79.9% nombro el maltrato fisico, a pesar de que un 41.2% penso que era el mas frecuente; un 21% nombro el abandono fisico, a pesar de que un 76.9% penso que era el mas frecuente; un 13.4% nombroel mattrato psicologico, a pesar de que un 47.4% penso que era el mas frecuente; y un 6.8% nombro el abuso sexual, a pesar de que un 23.5% penso que era le mas frecuente. La mayoria de los sujetos clasificaron las situaciones severas de maltrato como maltrato (p.e., lesion severa en un nino). Otras sistuaciones, tales como “dano medio en un nin,” abandono o maltrato psicologico (p.e., “dejar a un nino solo en casa,” o “chillar a menudo a un nin”) a menudo no fueron clasificadas como maltratantes. En relacion con la conducta de notificacion de casos, unicamente un 40% notificarian casos de maltrato a las autoridades. Aquellos que no notificarian situaciones de maltrato fueron menos proclives a clasificar las situaciones de maltrato como maltratantes y ma proclives a pensar que la busqueda de ayuda es dificil, problematica y poco eficaz. Conclusiones: Las cifras oficiales de prevalencia basadas en las notificationes de casos de maltrato infantil en Hong-Kong deben ser interpretadas con precaucion, porque es posible que la infranotificaion sea importante. La definicion y la consideracion de lo que es maltrato infantil por parte de la poblacio de Hong-Kong difiere de las definiciones oficiales. Hay sujetos que son rechazantes a la notificacion de casos de maltrato infantil debido a la baja eficacia percibida de dicha notificacion. Tanto la diferencia en la conceptualizacion del maltrato como el rechazo a la notificacion pueden ser parcialmente atribuibles a factores relacionados con la cultura china.

Although Hong Kong's infant mortality is among the lowest in the world, there may still be subgroups in the population with unusually high and possibly avoidable mortality rates. We conducted an ecological study on the relationship between socioeconomic deprivation and infant mortality in Hong Kong by using government data from three periods: 1979-83, 1984-88 and 1989-93. The study population comprised all infant births in 65 modified districts in Hong Kong in the period 1979-93. Infant, neonatal and post-neonatal mortality rates (IMRs, NMRs and PNMRs) were used as the health indicators. An F score was derived from highly correlated socioeconomic variables by factor analysis and used as a summary index of socioeconomic status. In 1979-83, socioeconomic deprivation was found to be significantly associated with high IMRs and high NMRs in both sexes, while in 1984-88 this association was observed only in baby girls. None of the observed associations were significant in 1989-93. Overall, the territory's infant mortality rates fell from 10.2 per thousand live births in 1979-83 to 5.6 per thousand live births in 1989-93. Individual-based studies are needed to ascertain whether this apparent disappearance of the socioeconomic relationship with infant and neonatal mortality is real.This study determined the relationship between socioeconomic deprivation and infant mortality in Hong Kong by using government data from three periods: 1979-83; 1984-88; 1989-93. The study population comprised all infant births in 65 modified districts in Hong Kong. Infant mortality rates (IMR), neonatal mortality rates (NMR) and postneonatal mortality rates were used as the health indicators. A factor score for each modified district was calculated using factor analysis to provide a summary indicator of the socioeconomic variables. Findings demonstrated that in 1979-83 socioeconomic deprivation was significantly associated with high IMR and high NMR in both sexes, while in 1984-88 this association was observed only for baby girls. None of the observed associations were significant in 1989-93. Overall, the territory's infant mortality rates fell from 10.2/1000 live births in 1979-83 to 5.6/1000 live births in 1989-93. Further studies based on individuals are needed to confirm that the link between socioeconomic factors and infant mortality no longer exists, since a group-based study such as this is potentially vulnerable to the usual problems of confounding and ecologic fallacies.

Background Chronic obstructive pulmonary disease (COPD) is common. Telehealthcare, involving personalised health care over a distance, is seen as having the potential to improve care for people with COPD. Aim To systematically review the effectiveness of telehealthcare interventions in COPD to improve clinical and process outcomes. Design and setting Cochrane Systematic Review of randomised controlled trials. Methods The study involved searching the Cochrane Airways Group Register of Trials, which is derived from the Cochrane Central Register of Controlled Trials, MEDLINE®, embase™, and CINAHL®, as well as searching registers of ongoing and unpublished trials. Randomised controlled trials comparing a telehealthcare intervention with a control intervention in people with a clinical diagnosis of COPD were identified. The main outcomes of interest were quality of life and risk of emergency department visit, hospitalisation, and death. Two authors independently selected trials for inclusion and extracted data. Study quality was assessed using the Cochrane Collaboration’s risk of bias method. Meta-analysis was undertaken using fixed effect and/or random effects modelling. Results Ten randomised controlled trials were included. Telehealthcare did not improve COPD quality of life: mean difference –6.57 (95% confidence interval [CI] = –13.62 to 0.48). However, there was a significant reduction in the odds ratios (ORs) of emergency department attendance (OR = 0.27; 95% CI = 0.11 to 0.66) and hospitalisation (OR = 0.46; 95% CI = 0.33 to 0.65). There was a non-significant change in the OR of death (OR = 1.05; 95% CI = 0.63 to 1.75). Conclusion In COPD, telehealthcare interventions can significantly reduce the risk of emergency department attendance and hospitalisation, but has little effect on the risk of death.

Data were collected from 3814 patients in this postmarketing surveillance study to assess the efficacy and tolerability of moxifloxacin.Improvement was observed in 69.1% of the patients after 3 days of moxifloxacin treatment and in 90.4% after 5 days. Full recovery had occurred in 71.3% by 7 days and in 86.8% by 10 days. A total of 129 adverse events occurred in 74 (1.9%) patients and mainly involved either the gastrointestinal or nervous system. All events were mild or moderate, and most resolved or improved after stopping treatment. Physicians rated moxifloxacin as 'good' or 'very good' in 92% of patients for efficacy and in 90.8% of the patients for tolerability. Of the 936 patients who completed a questionnaire, 94.7% stated that moxifloxacin had helped them, 95.5% reported an improvement in symptoms after 5 days and 97.7% reported symptom improvement after 10 days.Moxifloxacin performs well in the 'real world', and is acceptable to both patients and physicians.

Objectives: To review for acute abdominal pain (AAP), the diagnostic accuracies of combining decision tools (DTs) and doctors aided by DTs compared with those of unaided doctors. Also to evaluate the impact of providing doctors with an AAP DT on patient outcomes, clinical decisions and actions, what factors are likely to determine the usage rates and usability of a DT and the associated costs and likely cost-effectiveness of these DTs in routine use in the UK. Design: Electronic databases were searched up to 1 July 2003. Review methods: Data from each eligible study were extracted. Potential sources of heterogeneity were extracted for both questions. For the accuracy review, meta-analysis was conducted. Among studies comparing diagnostic accuracies of DTs with unaided doctors, error rate ratios provided estimates of the differences between the false-negative and false-positive rates of the DT and unaided doctors' performance. Pooled error rate ratios and 95% confidence intervals (CIs) for false-negative rates and false-positive rates were computed. Metaregression was used to explore heterogeneity. Results: Thirty-two studies from 27 articles, all based in secondary care, were eligible for the review of DT accuracies, while two were eligible for the review of the accuracy of hospital doctors aided by DTs. Sensitivities and specificities for DTs ranged from 53 to 99% and from 30 to 99%, respectively. Those for unaided doctors ranged from 64 to 93% and from 39 to 91%, respectively. Thirteen studies reported false-positive and false-negative rates for both DTs and unaided doctors, enabling a direct comparison of their performance. In random effects meta-analyses, DTs had significantly lower false-positive rates (error rate ratio 0.62, 95% CI 0.46 to 0.83) than unaided doctors. DTs may have higher false-negative rates than unaided doctors (error rate ratio 1.34, 95% CI 0.93 to 1.93). Significant heterogeneity was present. Two studies compared the diagnostic accuracies of doctors aided by DTs to unaided doctors. In a multiarm cluster randomised controlled trial (n = 5193), the diagnostic accuracy of doctors not given access to DTs was not significantly worse (sensitivity 28.4% and specificity 96.0%) than that of three groups of aided doctors (sensitivities of 42.4-47.9%, and specificities of 95.5-96.5%, respectively). In an uncontrolled before-and-after study (n = 1484), the sensitivities and specificities of aided and unaided doctors were 95.5% and 91.5% (p = 0.24) and 78.1% and 86.4% (p < 0.001), respectively. The metaregression of DTs showed that prospective test-set validation at the site of the tool's development was associated with considerably higher diagnostic accuracy than prospective test-set validation at an independent centre [relative diagnostic odds ratio (RDOR) 8.2; 95% CI 3.1 to 14.7]. It also showed that the earlier in the year the study was performed the higher the performance (RDOR 0.88, 0.83 to 0.92), that when developers evaluated their own DT there was better performance than when independent evaluators carried out the study (RDOR = 3.0, 1.3 to 6.8), and that there was no evidence of association between other quality indicators and DT accuracy. The one eligible study of the impact study review, a four-arm cluster randomised trial (n = 5193), showed that hospital admission rates of patients by doctors not allocated to a DT (42.8%) were significantly higher than those by doctors allocated to three combinations of decision support (34.2-38.5%) (p < 0.001). There was no evidence of a difference between perforation rates (p = 0.19) and negative laparotomy rates in the four trial arms (p = 0.46). Usage rates of DTs by doctors in accident and emergency departments ranged from 10 to 77% in the six studies that reported them. Possible determinants of usability include the reasoning method used, the number of items used and the output format. A deterministic cost-effectiveness comparison demonstrated that a paper checklist is likely to be 100-900 times more cost-effective than a computer-based DT under stated assumptions. Conclusions: With their significantly greater specificity and lower false-positive rates than doctors, DTs are potentially useful in confirming a diagnosis of acute appendicitis, but not in ruling it out. The clinical use of well-designed, condition-specific paper or computer-based structured checklists is promising as a way to improve impact on patient outcomes, subject to further research. © Queen's Printer and Controller of HMSO 2006. All rights reserved.

OBJECTIVE: To estimate the economic burden of coronary heart disease in the UK using both direct and indirect costs. DESIGN AND SETTING: A prevalence based approach was used to assess coronary heart disease related costs from the societal perspective. PATIENTS: All UK residents in 1999 with coronary heart disease (ICD 9 codes 410-414 and ICD10 codes I20-I25). MAIN OUTCOME MEASURES: Direct health care costs were estimated from spending on prevention, accident and emergency care, hospital care, rehabilitation, and drug treatment. Direct non-health service costs were estimated from data on informal care. "Friction period" adjusted productivity costs were estimated using the human capital approach from lost earnings attributable to coronary heart disease related mortality and morbidity. The friction period is the period of employees' absence from work before the employer replaces them with other workers. Failure to adjust for this factor would overstate production loss. RESULTS: Coronary heart disease cost pound 1.73 billion to the UK health care system in 1999: pound 2.42 billion in informal care and pound 2.91 billion in friction period adjusted productivity loss; 24.1% of production losses were attributable to mortality and 75.9% to morbidity. The total annual cost of all coronary heart disease related burdens was pound 7.06 billion, the highest of all diseases in the UK for which comparable analyses have been done. CONCLUSIONS: Coronary heart disease is a leading public health problem in the UK in terms of the economic burden from disease. Cost estimates would be substantially understated if informal care/productivity costs were excluded.

Objective: The objectives were to estimate the prevalence and correlates of physical abuse-related outcomes in the family setting in Hong Kong’s adolescent population. Method: A cross-sectional study design was used. A randomly selected sample of 3,355 secondary school students in Kwai Tsing District of Hong Kong was surveyed. The response rate was 98%. Results: The prevalence rates of corporal punishment, being beaten by parents for no apparent reason, being beaten to injury by family members in the past 3 months and any one of the above three were 4.9% (95% CI , 4.2% to 5.6%), 2.0% (95% CI , 1.5% to 2.5%), 1.1% (95% CI , .98% to 1.2%) and 6.6% (95% CI , 5.7% to 7.5%), respectively. Students who had experienced the above physical abuse-related outcomes were at a significant disadvantage for a wide range of morbidity indicators, including self-perceived bad health, anxiety and stress, somatic illnesses (such as asthma and epigastric pain), injuries and accidents, and hospitalization. They were more likely to have poor familial relations and coping skills, and to take up habits which potentially put their health at risk, such as smoking, alcohol consumption, and fighting with others. Conclusions: Our prevalence estimates of physical abuse in the family setting for a student population in Hong Kong is an improvement over previous local estimates of physical abuse occurrence, which were mainly based on case notifications and clinical samples. The results also show that the abused adolescents are growing up in an environment filled with physical, psychological, and familial adversities.

To study the mechanism of delaying senility by using the principle of replenishing Qi and promoting blood circulation(RQPBC).The following determinations were carried out in the natural-senile animals which have Qi deficiency and blood stasis Syndrome(24 month old rat) after the treatment. Hemorheological indexes, brain noradrenaline (NE), adrenocorticotropine(ACTH), beta endorphin, cortisol, estradiol, testosterone, interleukin-II (IL-2), tumour necrosis factor (TNF) in the blood, and rat spleen's lymphocyte transformation and induction of IL-2 and the activity of natural killer cells (NKC).The senile rat's above indexes decreased obviously (control: young rats), and by using this principle, all indexes were improved respectively. But these indexes in the young rats cannot be changed by applying this principle.The results indicated that this principle could improve senile body's regulation of neuro-immuno endocrinologic network and keep homeostasis.

This study is a retrospective analysis of the clinical data of 67 very low birth weight infants (VLBWI) with symptomatic patent ductus arteriosus (PDA); all were admitted to four neonatal intensive care units (NICU) from January 1, 1996 through December 31, 1996. The mean gestational age was 27.9 +/- 2.4 weeks, the mean birth weight was 1078 +/- 193 g. Fifty-six infants (83.6%) had RDS, and 53 infants (79%) received artificial surfactant. The NICU at a regional hospital used CVD scoreor =3 as the sole criteria and the remaining three NICUs used color Doppler echocardiogram to confirm a symptomatic PDA and to treat it; sometimes LA/AOor = 1.3 was used as the criteria for indomethacin treatment. Two of these three hospitals sometimes used the pulsed Doppler echocardiogram as well as color Doppler examination as the treatment criteria. Seven infants (10.5%) had contraindication for indomethacin treatment; four of them closed after conservative treatment, and another three were subjected to surgical ligation. Of the remaining 60 infants, 3 were treated with oral indomethacin and 57 were treated with intravenous indomethacin. The mean age when initial treatment given was 3.8 +/- 1.5 days (range, 8 hours approximately 20 days). Among them 10 (16.7%) were within 24 hours after birth, 25 (41.7%) were between 24 and 48 hours, and 25 (41.7%) were beyond 48 hours. The dosage of indomethacin was 0.2 mg/kg per dose intravenously every 12 to 24 hours for three doses as a full course, if not contraindicated. The mean dose of indomethacin was 2.8 +/- 1.5; 10 infants (16.7%) received 1 dose, 15 (25%) received 2 doses, 27 (45%) received 3 doses, 3 (5%) received 4 doses and 5 (8.3%) received 6 doses. Among them, 51 infants (85%) PDA closed (including 2 treated with oral indomethacin), 9 (15%) failed to close and 6 of them received surgical ligation (including 1 treated with oral indomethacin). The complications associated with indomethacin treatment were hypoglycemia (52%), decreased urine output (42%) and gastrointestinal hemorrhage (32%). The infants with RDS had an earlier mean age of initial treatment than non-RDS infants (3.3 +/- 2.5 vs. 7.6 +/- 5.6 days; p0.05), and also had a higher closure rate (89% vs. 57%; p0.05). There was a closure rate of 85% in this multicenter retrospective analysis. Even though the infants received only one or two doses, they still had a good chance of ductal closure (21/25, 84%). To minimize the complications associated with indomethacin treatment in VLBWI, the protocol of indomethacin treatment should be re-evaluated.

The practice of Traditional Chinese Medicine (TCM) is largely unregulated in Hong Kong. Yet, as previous studies have shown, a sizable segment of the population consults TCM practitioners for health problems. This paper uses health care utilization data from a telephone health survey of 847 adult subjects in Tai Po District who had suffered from acute illness in the past month, to examine the profile of TCM users in the District. Women, older residents, unemployed workers, low skill laborers, current smokers and subjects dissatisfied with the quality of private sector clinics were significantly more likely to consult TCM practitioners.

Intrasplenic metastasis of ovarian malignancies are uncommon. From 1986 to 1992 only 12 such cases were diagnosed, being 1.2% of the total number of patients with ovarian malignancies treated in tumor hospital during the same period. Of the 12 metastasis, 6 were poorly differentiated. Diagnosis was made through imaging techniques or surgery. The median interval from the diagnosis of the primary disease to intrasplenic involvement was 28 months. The metastatic lesions, presented themselves as single or multiple nodes within the cortex of the spleen. Clinical features were not remarkable. It was thought that the occurrence of intrasplenic involvement might be due to greater tumor bulk, poor differentiation and decreased host immuno-competence caused by chemotherapy. Most of the intrasplenic metastasis was found after liver metastasis or simultaneously with the latter. The main route of the tumor spread might be via blood vessels. Sole intrasplenic metastasis can be treated by surgery with a temporarily good result. Poor prognosis and high mortality characterize intrasplenic metastasis. The median survival was only 7 months.

For analysing the injurious mechanism of Trichosanthin (TCS) on trophoblast cells, cytotrophoblast cells were separated from placental villi in human early pregnancy and cultured on millipore filters coated with collagen in dual-environmental culture chambers. After 7-10 days culture the cells grew into confluent monolayer. A lot of multinucleated giant cells (synthetial like) could be found under light microscopy. Cytotrophoblast cells and the giant one were characterized as epithelial type by indirect immuno-fluorescent staining with anti-keratin. Because the procedure of separation of trophoblast cells is laborious and the choriocarcinoma cells (JAR) were as sensitive as trophoblast cells to trichosanthin, so the choriocarcinoma cells were used instead of the trophoblast cells in the later experiments. The internalization and distribution of TCS conjugated to 15 nm (in diameter) gold particles were examined. Electron microscopy showed that the TCS-gold particles were bound to the cell membrane and entered via coated pit and then internalized into coated vesicles (endosomes) within 30-60 minutes after treatment. Nevertheless, a number of free TCS-gold particles entered into the cell membrane nonspecifically. In the series of 60-120 minutes treatment, the TCS-gold particles presented in the multivesicular bodies. It is worthy to emphasize that the TCS-gold particles entered the cytosol from the endosomes and distributed nearby the rough endoplasmic reticulum (RER) and ribosomes within 120-180 minutes. In the meanwhile, the cells showed pathological changes markedly. With the same method, human liver carcinoma cells (BE 7402), kidney cells of African green monkey (CV-1) and rat embryonic liver epithelial cells (LW 13) were treated by TCS-gold particles as control. However, no particles had been found on the cell surface or in the cytosol within 60-120 minutes (see Table 1). In addition, trophoblast cells were treated by BSA-gold particles and transferrin-gold particles separately there still no particles could be found. (See Table 2). It is more interesting that TCS-Hepama-1-gold particles internalized into the choriocarcinoma cells with the same manner as TCS-gold entered, and it could not be affected by pretreatment with Hepama-1 an hour. But, TCS-Hepama-1-gold particles bound to the microvilli of human liver carcinoma cells, and it can be inhibited competitively by pretreatment with Hepama-1 for an hour (see Table 3). These results indicated consistently that trichosanthin possesses a high affinity to the membrane of trophoblast cells and choriocarcinoma cells, and the internalization of this plant toxic protein into its target cells characterized by receptor-mediated endocytosis.(ABSTRACT TRUNCATED AT 400 WORDS)

Fifty three patients with evaluatable ovarian cancer were conducted a clinical trial of a new antineoplastic drug, carboplatin (cp) made in China. Apart from 1 case of stage Ic and 3 cases of stage II, all the remainders had advanced disease including stage III, IV or recurrences, and mainly consisting of epithelial carcinoma (44 cases). Thirty two patients were treated with single cp at the dose of 260-410 mg/m2 and twenty one were treated with combination chemotherapy of cp at a dose of 180-350 mg/m2 plus adriamycin and cyclophosphamide by intravenous infusion without hydration, repeated every 4 weeks, 2-4 courses. The response rate was 56% (18/32) and 48% (10/21), respectively. There were obviously different response rates in patients with previous chemotherapy (25% and 23% in cp single and combination chemotherapy groups) and without chemotherapy (67% and 88% in single and combination groups). It showed that cp was effective in treatment of ovarian cancers with advantages that gastrointestinal reaction was less severe in cp group than in the group using drugs including cis-platin, and no renal toxicity. However, cp showed more marked myelosuppression and hepatic injury in small number of the patients.

Serum CA125 levels were monitored in 30 patients with epithelial ovarian cancer prior to second-look laparotomy. All patients had undergone cytoreductive surgery and multiple courses of chemotherapy and with no clinical and radiologic evidence of tumor. All ten patients who had had negative second-look finding gave normal serum CA125 levels (less than or equal to 35 u/ml). Of the 20 patients who were positive in second-look, 11 had normal CA125 levels, with a false negative rate of 55% including 67% (4/6) patients with microscopic evidence of tumor and 50% (7/14) patients with gross residual tumor. All 9 patients with elevated serum CA125 levels were positive in their second-look. 73% (8/11) patients with residual tumor having greatest diameter less than or equal to 2 cm had normal CA125 with a median value of 13 u/ml. 33% (3/9) patients with tumors having the greatest diameter greater than 2 cm had normal CA125 and the CA125 median value was 114 u/ml. These results show that the size of the residual tumor found in second-look was related to the serum CA125 level. As CA125 level within normal limits gave more false negatives, the necessity of second-look can not be judged by serum CA125 assay though elevated CA125 levels do predict the presence of tumor.

Between 1981-1988, 23 patients with epithelial ovarian cancer underwent second-look laparotomy after initial surgery followed by multiple courses of chemotherapy. There was no evidence of tumor before operation. Six patients (26%) had gross tumor and 5 (22%) had microscopic tumor. One of 3 patients with stage I or II and 50% (10/20) of patients with stage III and recurrent disease had positive second-look. Two of 7 (29%) patients with no residual tumor after initial surgery and 9 of 16 (56%) with residual tumor had positive second-look. It showed that the results of second-look were correlated with stage and residual tumor left after initial surgery. Sixteen patients had CA125 serum immunoassay prior to second-look. CA125 level was in normal limits (less than or equal to 65 U/ml) in 12 patients. Positive second-look findings were observed in 7 patients (58%), of which 5 had microscopic tumors. The results indicate that the second-look laparotomy is probably the best way to evaluate residual tumor in the abdominal cavity.

To determine the effectiveness and acceptability of general practitioners'opportunistic antismoking interventions by examining detailed accounts of smokers' experiences of these.Qualitative semistructured interview study.South Wales.42 participants in the Welsh smoking intervention study were asked about initial smoking, attempts to quit, thoughts about future smoking, past experiences with the health services, and the most appropriate way for health services to help them and other smokers.Main emerging themes were that subjects already made their own evaluations about smoking, did not believe doctors' words could influence their smoking, believed that quitting was down to the individual, and felt that doctors who took the opportunity to talk about smoking should focus on the individual patient. Smokers anticipated that they would be given antismoking advice by doctors when attending for health care; they reacted by shrugging this off, feeling guilty, or becoming annoyed. These reactions affected the help seeking behaviour of some respondents. Smokers were categorised as "contrary," "matter of fact," and "self blaming," depending on their reported reaction to antismoking advice.Doctor-patient relationships can be damaged if doctors routinely advise all smokers to quit. Where doctors intervene, a patient centred approach-one that considers how individual patients view themselves as smokers and how they are likely to react to different styles of intervention-is the most acceptable.

Twenty seven patients with dysgerminoma of the ovary were treated in our hospital from 1959 to 1982. 18 of them had no prior treatment and the other 9 had undergone operation and were admitted for recurrence. Among these 18 untreated patients, all were successfully operated. Apart from 4, the others were supplemented by radiotherapy and/or chemotherapy. 17 (94%) were free of disease from 3 to 24 years, only one died of tumor recurrence within 5 years after the initial treatment. The 5 year survival rate was 94%. However, among the 9 recurrent patients, 6 were treated by operation, supplemented by postoperative radiotherapy and/or chemotherapy but only 3 survived for 7, 14 and 15 years respectively without any evidence of disease. The 5 year survival rate was 33%. As those patients who received conservative operation initially gave a high recurrence rate, the authors propose that the patients be treated individually according to the condition of disease. The choice of treatment for the individual patient is discussed.

62 patients with advanced epithelial ovarian adenocarcinoma (37 stage III, 4 stage IV and 22 recurrent lesions) were treated in our hospital from 1977 to 1981, 38 patients underwent surgery. 25 with inoperable tumor initially received preoperative chemotherapy (VCF protocol: vincristine + cyclophosphamide + fluorouracil chiefly) followed by surgery. The response rate of chemotherapy was 48%. Apart from 1 progressive tumor during chemotherapy, 24/25 were explored. There were 10/24 with residual tumor less than 2 cm in diameter, giving a resection rate of 41.7% as compared with the resection rate of 42.1% (16/38) in the operation group. It is shown that the preoperative chemotherapy improves the resection rate. 44 patients received postoperative chemotherapy and 12, radiotherapy combined with chemotherapy or radiotherapy only. The overall 2.3 and 5 year survival rates of these 63 patients were 39.7%, 31.7% and 23.8%. The 2 and 3 year survivals were 41.9% and 32.3% in 31 patients with postoperative chemotherapy using VCF protocol. The results indicate that VCF protocol is effective for advanced epithelial ovarian cancer, especially patients with residual tumor less than 2 cm in size. Chemotherapy with more than 3 courses has better effect.

Seven patients with primary melanoma of the vagina, five untreated and two recurrent, are reported. The ages ranged from 25-55 years, with an average of 42.3 years. The common symptoms were vaginal bleeding and a vaginal mass, and the most common site was the posterior wall of the vagina (three of seven patients). Two patients survived for more than five years.

Fifty-seven patients with metastatic ovarian cancer arising from extra-genital sites are analysed. 80.8%, 14% and 5.3% of the primary cancers were from gastrointestinal tract (GI), breast and lung, respectively. The primary carcinoma was diagnosed before the discovery of ovarian tumor in 24 patients. The ovarian and primary carcinomas were found simultaneously in 11 patients (including one autopsy), while in 22 patients, the primary cancer was not discovered until the ovarian tumor had been resected. Both ovaries were involved in 60% of GI cancer and 12.5% of breast cancer. 91.2% of the patients were found to have metastasis to other tissues and organs outside the ovary. Of patients with GI cancer, 80.8% had metastasis to the abdomino-pelvic cavity, 73.7% had ascites and 52.2% had lymphatic metastasis. The majority of the patients with breast cancer had lymphatic (75%) and hematogenous (50%) metastases. In this series, the prognosis was poor in all the patients with an average survival time of 11 months. 63.2% and 86% of the patients died within 1 and 2 years. These facts indicate that ovarian involvement may be an important part of widespread dissemination from the primary cancer.