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Biomedical subjects

V Ho

Publications and source records attributed to V Ho.

At least 19 recordsLinked to original sources

Nuclear ING2 expression is reduced in human cutaneous melanomas.

Cutaneous malignant melanoma is a severe and sometimes life-threatening cancer. The molecular mechanism of melanomagenesis is incompletely understood. Deregulation of apoptosis is probably one of the key factors contributing to the progression of melanoma. The inhibitor of growth (ING) family proteins are candidate tumour suppressors which play important roles in apoptosis. Downregulated expression of ING proteins have been reported in several tumour types, including the loss of nuclear expression of p33ING1b in melanoma. As ING2 exhibits 58.9% homology with p33ING1b, we hypothesized that the aberrant expression of ING2 may be involved in melanomagenesis. Here, we used tissue microarray technology and immunohistochemistry to examine ING2 expression in human nevi and melanoma biopsies. Our data showed that nuclear ING2 expression was significantly reduced in radial growth phase (RGP), vertical growth phase (VGP), and metastatic melanomas compared with dysplastic nevi (P < 0.05). Our data also revealed that nuclear ING2 expression was not associated with patient's gender, age or tumour thickness, ulceration, American Joint Committee on Cancer (AJCC) stage, tumour subtype, location and 5-year survival (P > 0.05). Taken together, our results suggest that nuclear ING2 expression is significantly reduced in human melanomas and that reduced ING2 may be an important molecular event in the initiation of melanoma development.

Adult↗

Comparison of forced-air warming and electric heating pad for maintenance of body temperature during total knee replacement.

We conducted a randomised controlled trial to compare the efficacy of forced-air warming (Bair Hugger(trade mark), Augustine Medical model 500/OR, Prairie, MN) with that of an electric heating pad (Operatherm 202, KanMed, Sweden) for maintenance of intra-operative body temperature in 60 patients undergoing total knee replacement under combined spinal-epidural anaesthesia. Intra-operative tympanic and rectal temperatures and verbal analogue score for thermal comfort were recorded. There were no differences in any measurements between the two groups, with mean (SD) final rectal temperatures of 36.8 (0.4) degrees C with forced-air warming and 36.9 (0.4) degrees C with the electric pad. The heating pad is as effective as forced-air warming for maintenance of intra-operative body temperature.

Aged↗

Twelve years' local experience in ambulatory anaesthesia.

OBJECTIVES: To determine the incidence of adverse events after ambulatory anaesthesia (postoperative nausea and vomiting, postoperative pain, difficulty in movement), and to evaluate the level of satisfaction of patients with our service. DESIGN: Retrospective study with questionnaire survey. SETTING: Tertiary referral centre, Hong Kong. PARTICIPANTS: All patients whose duly completed questionnaires were available. MAIN OUTCOME MEASURES: Incidence of adverse events and level of patient satisfaction. RESULTS: A total of 9197 patients underwent surgery under general anaesthesia or neuraxial blockade by anaesthetists in ambulatory settings from October 1993 to December 2005: questionnaires filled out by 8231 of these patients were analysed, whereas 549 questionnaires were lost, and 417 patients could not be contacted. The response rate was 90%; 59% of the respondents were males, 50% were younger than 15 years and 5% older than 60 years. Fifty-one percent of surgery with anaesthetists' involvement was performed under general anaesthesia and 48.9% under general anaesthesia and regional blocks and 0.1% under neuraxial blockade. There were 3.3% of patients experienced postoperative nausea and vomiting, 60.2% experienced episodes of pain between the time of discharge and the time of interview, and 46% required analgesics. Nonetheless, 80% resumed normal activities within 5 hours after anaesthesia and 97.5% resumed normal diet the following morning. Over 99% rated our service as good or excellent. CONCLUSION: Although ambulatory anaesthesia was associated with minor adverse events, patients could resume normal diet and daily activities quickly and were satisfied with the service.

Adolescent↗

Effect of delay in initiating radiotherapy for patients with early stage breast cancer.

AIMS: For early stage breast cancer, a standard treatment option is partial mastectomy followed by radiation treatment. The 5-year risk of local recurrence ranges from 6-9%. Variable waiting times for radiation treatment of breast cancer in our institution provided an opportunity to evaluate the impact of waiting time on the risk of local recurrence. MATERIALS AND METHODS: Between January 1988 and December 1989, 482 patients with stage I and II breast cancer were treated with radiotherapy in our institution. Information on prognostic factors, such as age, tumour size, histological grade, number of positive lymph nodes and margins of resection, was abstracted from their charts. The interval between date of surgery and date of initial radiation treatment was noted. Dates of local recurrence, metastasis and deaths were recorded. RESULTS: At 5 years, the local recurrence rate was 8%, the metastatic rate 12% and the 'cause-specific' survival rate 90%. In univariate analysis, the risk of local recurrence was associated with younger age, higher histological grade and time to radiation treatment. In the multivariate analysis, the effect of time to radiation treatment on the risk of local recurrence was equivocal. CONCLUSION: Delay in radiation treatment may be associated with an increased risk of local recurrence of breast cancer, at least in our centre. Future research is needed on a larger data set to more accurately estimate the effect of time to radiation treatment on the risk of local recurrence.

Adult↗

Assessment of the factors associated with flavivirus seroprevalence in a population in Southern Vietnam.

Dengue and Japanese encephalitis flaviviruses cause severe disease and are hyperendemic in southern Vietnam. This study assesses associations between sociodemographic factors and flavivirus seroprevalence in this region. Sera were collected from 308 community and hospital-based subjects between April 1996 and August 1997 and tested with an indirect ELISA. The factors associated with seroprevalence were assessed using multivariate logistic regression. In this first report of adjusted prevalence odds ratios (POR) for flavivirus infection in Vietnam, seropositivity was associated with increasing age in children (multiple regression coefficients for a child compared to an adult = -4.975 and for age in children = 0.354) and residence in the city compared to surrounding rural districts. The association with age indicates that subjects were most likely to have acquired infection in early childhood. This is key to the design of Vietnamese health education and immunization programmes.

Adolescent↗

Postoperative sore throat after routine oral surgery: influence of the presence of a pharyngeal pack.

A randomized clinical trial was conducted to investigate the effect of the presence of a pharyngeal pack during endotracheal anaesthesia on the incidence of postoperative sore throat. The patients were anaesthetized with fentanyl, thiopentone and atracurium. Thirty-six patients were anaesthetized without placement of pharyngeal packs while 26 patients had pharyngeal packs inserted. There were no significant differences in the incidence or severity of sore throat postoperatively in the two groups (P=0.23). These results contradict previous studies, which showed an increase in the incidence of postoperative sore throat after the use of pharyngeal packs.

Anesthesia, Dental↗

A fatigue clinic in a comprehensive cancer center: design and experiences.

Cancer-related fatigue is now the most prevalent symptom of cancer, occurring in 60-90% of patients. Fatigue has been identified by cancer patients as a factor influencing functionality and quality of life. Our objectives in developing a fatigue specialty clinic at The University of Texas M. D. Anderson Cancer Center were to improve our patients' quality of life by decreasing fatigue; educate health care providers, patients, and patients' families about cancer-related fatigue; develop an appropriate clinical and diagnostic evaluation for this symptom; correlate objective measures of fatigue with its clinical evaluation; and develop innovative treatment plans for cancer-related fatigue. This article describes the general clinic design and operations and the preliminary analysis of the first 40 patients evaluated in the fatigue clinic.

Adult↗

Specific involvement of G(alphai2) with epidermal growth factor receptor signaling in rat hepatocytes, and the inhibitory effect of chronic ethanol.

We have previously shown that chronic alcohol consumption inhibits liver regeneration by impairing epidermal growth factor receptor (EGFR)-operated phospholipase C-(gamma1) (PLC-(gamma1)) activation and the resultant rise in intracellular [Ca(2+)](i). In hepatocytes, activation of PLC-(gamma1) by EGFR requires involvement of a pertussis toxin-sensitive inhibitory guanine nucleotide-binding regulatory protein (G(alphai)) as an intermediate. In the present study, we first identified the G(alphai) protein isoform associated with the activated EGFR, and then examined whether the toxic effect of alcohol on EGFR signaling and liver cell proliferation was exerted on this association. In cultured hepatocytes from control rats, EGF rapidly induced association between EGFR and G(alphai2) but not other G(alphai) isoforms. In hepatocytes from rats fed alcohol for 16 weeks, EGF failed to stimulate this association of G(alphai2) with the EGFR. The impairment of EGFR-G(alphai2) complex formation caused by alcohol was associated with a decreased level of G(alphai2) in the plasma membrane fraction (approximately 50% control). Pertussis toxin, an inhibitor of G(alphai) function, produced an analogous disruption of the association between G(alphai2) and the EGFR, as well as inhibiting EGF-induced DNA synthesis. It is concluded that, in hepatocytes, G(alphai2) is specific among G(alphai) isoforms in coupling activation of the EGFR to other signaling pathways that control cell proliferation. Impaired coupling of G(alphai2) of EGFR could contribute to the mechanism by which chronic alcohol exposure inhibits liver regeneration.

Adenosine Diphosphate↗

Alveolar soft part sarcoma: clinical course and patterns of metastasis in 70 patients treated at a single institution.

BACKGROUND: Alveolar soft part sarcoma (ASPS) is a rare form of soft tissue sarcoma. Brain metastases have been reported to be a common feature of Stage IV ASPS, and recent practice guidelines recommend routine intracranial imaging as part of the staging evaluation in all patients who present with ASPS. METHODS: The authors performed a comprehensive retrospective review of the clinical presentation, treatment, outcome, and patterns of failure in a consecutive series of patients with localized (American Joint Committee on Cancer [AJCC] Stages II/III) or metastatic (AJCC Stage IV) ASPS who presented to a tertiary care cancer center between 1959 and 1998. RESULTS: Seventy-four patients were identified from the database searches. The anatomic distribution of their primary tumors included: extremities, 44 patients (60%); trunk, 15 patients (20%); head and neck, 9 patients (12%); and retroperitoneum, 6 patients (8%). The median tumor size was 6.5 cm (range, 1.2-24 cm). The AJCC stage at presentation was Stage II or III in 35% of the patients and Stage IV in 65% of the patients. The 5-year actuarial local recurrence free, distant recurrence free, disease free, and overall survival rates among the 22 patients with localized ASPS were 88%, 84%, 71%%, and 87%, respectively. At a median follow-up of 9 years, 2 of 22 patients with localized disease had developed local recurrences and 3 had developed metastatic disease (all to the lung only). Brain metastases were noted in 9 of 48 patients who presented with Stage IV (M1) disease (19%) and always were noted in association with metastasis to other sites. The median survival of patients with M1 disease was 40 months, with a 5-year survival rate of 20%. CONCLUSIONS: Long term follow-up of patients with localized ASPS reveals a relatively indolent clinical course with relatively low rates of local and distant recurrence. In patients with Stage IV ASPS, brain metastases were observed only as part of more disseminated disease. The observations of the current study do not support current practice guidelines for the staging of patients with ASPS and suggest that selective rather than routine intracranial imaging should be used in patients presenting with ASPS.

Adenocarcinoma, Bronchiolo-Alveolar↗

Evolutionary attempts at 4 eyes in vertebrates.

PURPOSE: To understand and compare the optical, histological, and ecological differences among 4 vertebrate species that have had evolutionary attempts toward 4 eyes. METHODS: An evolutionary attempt at 4 eyes in defined as the duplication or one or more structures integral to the refraction or interpretation of the visible spectrum for that animal. We reviewed and compared the known optics, histology, and ecology of each of these vertebrate species with attempts at 4 eyes including Anableps anableps, Dialomnus fuscus, Mnierpes macrocephalus, and Bathylychnops exilis. These animals have developed portions of ancillary eyes that have diverged from the primary globe in 3 different patterns. At least 1 specimen of each of those vertebrate species known to have 4 eyes was examined histologically and compared to the animal's ecology and current cladistic relationship. RESULTS: A anabteps has 2 distinct optical systems in each eye: an upper one for aerial vision and a lower system for aquatic vision. These systems feature separate retinae and an asymmetric lens to achieve focus in the aerial and aquatic vision, but only 1 optic nerve per eye. The visual system is split horizontally to function optimally in a "prone" position in the water. D fuscus is a terrestrial feeder and has a vertically (almost perpendicular to the long axis of the fish) divided cornea using pigment and a condensation of collagen as the divider, a single pupil, and a divided retina. The split cornea allows for the fish to remain vertical with 1 cornea in air and 1 cornea in water. M macrocephalus is probably closely related to D fuscus with a similar split cornea. B exilis is a mesopelagic inhabitant living at approximately 200 to 1,000 m and has an ancillary globe that "buds" off the primary globe. This secondary globe is directed inferiorly toward the ocean floor as compared to the primary globe, which is directed 35 degrees superiorly from the horizontal. Adult species of B exilis have 2 additional scleral bodies suspected to be lenses. If so, these structures would be capable of focusing light from the inferior field onto the superior retina, presumably adding to the panoramic inferior visual field. There are other mesopelagic species, including Styleophorus chordatus, Opisthoproctus grimaldii, Scopelarchus gantheri (or guentheri), Dolichopteryx binocularis, Benthalbella infans, and Evermannella indica, that have other unusual ocular mechanisms, such as retinal diverticulae and lens pads capable of reflection, but do not meet the definition of multiple eyes, as defined for purposes of this work. CONCLUSIONS: D fuscus and M macrocephalus are terrestrial feeders requiring aquatic and aerial vision, and hence have a split cornea for this purpose, and they probably use their anterior corneae for terrestrial vision. A anableps swims at the surface with combined aerial and aquatic vision for feeding and protection from predators. B exilis is a mesopelagic feeder requiring a binocular visual field in the horizontal meridian and above, and simultaneously is a bottom scavenger using an ancillary globe and perhaps scleral lenses for recognition of bioluminescent detritus. Although 2 of these models are related (D fuscus and M macrocephalus), these 4 fish represent 3 separate, distinct, and unrelated convergent evolutionary attempts toward 4 eyes in vertebrates satisfying the ecological needs of each. The 3 different models are unrelated evolutionarily and are found in 3 separate orders.

Animals↗

Changes in the treatment and outcomes of acute myocardial infarction in Quebec, 1988-1995.

BACKGROUND: Few studies have reported population-based information on the treatment trends and outcomes of patients who have had an acute myocardial infarction (AMI). We therefore examined patterns of care and outcomes for AMI patients in Quebec, Canada, between 1988 and 1995. METHODS: Longitudinal data files of hospital admissions in Quebec (Med-Echo database) and inpatient and outpatient services (Régie de l'Assurance Maladie du Québec database) were used to construct cohorts of all AMI patients in the province between 1988 and 1995. Temporal trends in the use of cardiac procedures after an AMI, discharge prescriptions and mortality rates were examined. RESULTS: Between 1988 and 1995 the age- and sex-adjusted rates of AMI in the Quebec population declined (148 per 100,000 in 1988 to 137 per 100,000 in 1995). The use of intensive cardiac procedures increased in the same period; the 1-year cumulative incidence rate of catheterization increased from 28% in 1988 to 31% in 1994, that of angioplasty rose from 8% to 15% and that of coronary artery bypass surgery from 6% to 8%. Prescriptions for ASA, beta-blockers, lipid-lowering agents and angiotensin-converting enzyme inhibitors increased, and prescriptions for nitrates and calcium antagonists decreased. These temporal changes were paralleled by a decrease in mortality rates post-AMI. All-cause 1-year cumulative incidence mortality rates decreased from 23% in 1988 to 19% in 1994. INTERPRETATION: The decrease in AMI-related mortality in Quebec between 1988 and 1995 may be linked to changes in treatment strategies (i.e., increased use of cardiac surgical procedures and medications shown to increase survival).

Age Factors↗

Evolution of the volume-outcome relation for hospitals performing coronary angioplasty.

BACKGROUND: Hospitals performing more surgical procedures tend to yield better outcomes. This study examines the evolution of this volume-outcome relation over time. METHODS AND RESULTS: The relation between the number of percutaneous transluminal coronary angioplasty (PTCA) procedures performed at hospitals (volume) and in-hospital bypass surgery and death for 353 488 patients treated in California between 1984 and 1996 was examined. Descriptive statistics and logistic regression were used to compare outcomes for 3 periods: 1984 to 1987, 1988 to 1992, and 1993 to 1996. The in-hospital mortality rate was 2.5% for hospitals performing <200 PTCA procedures per year but only 1.3% for hospitals performing >400 procedures per year in 1984 to 1987. By 1993 to 1996, mortality rates in these 2 volume categories narrowed to 1.7% and 1.3%, respectively. Bypass surgery rates also narrowed and fell in low-volume (<200 procedures) versus high-volume (>400 procedures) hospitals from 12.4% versus 6.9% in 1984 to 1987 to 4.6% versus 3.3% in 1993 to 1996. In a logistic regression, PTCA procedures significantly predicted in-hospital mortality and bypass surgery rates in all 3 time periods. However, coefficient estimates indicate that improvements over time in outcomes for hospitals performing <200 procedures were comparable to the predicted benefits of increasing volume above 400 procedures within time periods. CONCLUSIONS: Over time, the disparity in outcomes between low- and high-volume hospitals has narrowed, and outcomes have improved significantly for all hospitals. Given these improvements, lower minimum volume standards may be advisable in less populated areas, where the alternative is no angioplasty at all.

Adult↗

Hospital mergers and acquisitions: does market consolidation harm patients?

Debate continues on whether consolidation in health care markets enhances efficiency or instead facilitates market power, possibly damaging quality. We compare the quality of hospital care before and after mergers and acquisitions in California between 1992 and 1995. We analyze inpatient mortality for heart attack and stroke patients, 90-day readmission for heart attack patients, and discharge within 48 h for normal newborn babies. Recent mergers and acquisitions have not had a measurable impact on inpatient mortality, although the associated standard errors are large. Readmission rates and early discharge increased in some cases. The adverse consequences of increased market power on the quality of care require further substantiation.

California↗

Diffuse neonatal haemangiomatosis.

A newborn girl with severe diffuse neonatal haemangiomatosis is described. She was treated with high dose systemic corticosteroids and high dose interferon-alpha-2a, but with fatal outcome. A review of the current literature is presented.

Adrenal Cortex Hormones↗

Multiple approaches to assessing the effects of delays for hip fracture patients in the United States and Canada.

OBJECTIVE: To examine the determinants of postsurgery length of stay (LOS) and inpatient mortality in the United States (California and Massachusetts) and Canada (Manitoba and Quebec). DATA SOURCES/STUDY SETTING: Patient discharge abstracts from the Agency for Health Care Policy and Research Nationwide Inpatient Sample and from provincial health ministries. STUDY DESIGN: Descriptive statistics by state or province, pooled competing risks hazards models (which control for censoring of LOS and inpatient mortality data), and instrumental variables (which control for confounding in observational data) were used to analyze the effect of wait time for hip fracture surgery on postsurgery outcomes. DATA EXTRACTIONS: Data were extracted for patients admitted to an acute care hospital with a primary diagnosis of hip fracture who received hip fracture surgery, were admitted from home or the emergency room, were age 45 or older, stayed in the hospital 365 days or less, and were not trauma patients. PRINCIPAL FINDINGS: The descriptive data indicate that wait times for surgery are longer in the two Canadian provinces than in the two U.S. states. Canadians also have longer postsurgery LOS and higher inpatient mortality. Yet the competing risks hazards model indicates that the effect of wait time on postsurgery LOS is small in magnitude. Instrumental variables analysis reveals that wait time for surgery is not a significant predictor of postsurgery length of stay. The hazards model reveals significant differences in mortality across regions. However, both the regressions and the instrumental variables indicate that these differences are not attributable to wait time for surgery. CONCLUSIONS: Statistical models that account for censoring and confounding yield conclusions that differ from those implied by descriptive statistics in administrative data. Longer wait time for hip fracture surgery does not explain the difference in postsurgery outcomes across countries.

Aged↗

A multicenter, randomized, double-blind study to evaluate the safety, tolerability, and efficacy of OptiMARK (gadoversetamide injection) compared with Magnevist (gadopentetate dimeglumine) in patients with liver pathology: results of a Phase III clinical trial.

The purpose of this study was to evaluate the safety and efficacy of OptiMARK (gadoversetamide injection) compared with Magnevist (gadopentetate dimeglumine) in hepatic MRI of patients with suspected liver pathology. A Phase III, multicenter, randomized, double-blind, parallel group study was performed in adults with suspected liver pathology. All patients underwent contrast-enhanced computed tomography within 3 weeks prior to magnetic resonance scanning. Ninety-nine patients received OptiMARK, and 94 patients received Magnevist at a dose of 0.1 mmol/kg. Precontrast T1- and T2-weighted spin-echo imaging and T1-weighted gradient-echo imaging were performed, followed by T1-weighted gradient-echo imaging at 15-20 seconds, 1 minute, and 5 minutes after intravenous contrast injection. Three primary efficacy endpoints (confidence in lesion diagnosis, level of conspicuity, and lesion border delineation) were evaluated on the precontrast image set and compared with the pre plus postcontrast image set. Vital signs, physical examination, electrocardiograms (ECGs), and laboratory parameters (chemistry, hematology, and urinalysis) were measured at various time points. Adverse events were recorded. The study design and statistical analyses were chosen to demonstrate presumed equivalence of OptiMARK and Magnevist. There were no statistically significant differences in efficacy between OptiMARK and Magnevist as assessed by either blinded readers or the on-site principal investigators. No serious or unexpected adverse events were noted. Of the 193 patients receiving contrast media, 82 experienced a total of 154 adverse events. Thirty-three (21.4%) of these 154 adverse events were felt by the on-site investigators to be probably related to either study agent: 15 events in 9 patients in the OptiMARK group, and 18 events in 13 patients in the Magnevist group. Headache was the most common adverse event, occurring in 10.1% of the OptiMARK patients and 12.8% of the Magnevist patients. No clinically relevant trends were observed in any laboratory parameter or ECG findings in either treatment group. The results demonstrate the safety, efficacy, and equivalence of OptiMARK and Magnevist at a dose of 0.1 mmol/kg in hepatic magnetic resonance imaging of patients with suspected liver pathology.

Contrast Media↗