[Establish a predictive modeling under antiviral therapy for hepatitis B e antigen seroconversion in chronic hepatitis B].

Objective: To explore the predictive factors by demonstrating a predictive modeling under antiviral therapy for hepatitis B e antigen seroconversion in HBeAg-positive chronic hepatitis B patients. Methods: 198 cases with HBeAg-positive chronic hepatitis B were enrolled. Fatty liver, family history of hepatitis B, age, sex, drinking history, HBsAg, HBeAg, HBV-DNA levels, total bilirubin (TBil), CD4/CD8, albumin (ALB), alanine amino transferase (ALT) levels were used as a predictor variables of HBeAg seroconversion. Serological seroconversion of HBeAg was observed at 144 weeks of antiviral therapy. Predictive factors of HBeAg seroconversion was analyzed by logistic regression analysis, and the receiver operating characteristic curve was plotted. Results: HBeAg seroconversion rate was 36.87%. Univariate analysis demonstrated that fatty liver (χ(2) = 35.377; P < 0.001), family history of hepatitis B (χ(2) = 15.687; P < 0.001), the levels of HBeAg (t = 5.034; P < 0.001), HBsAg (t = 3.454; P < 0.001) and HBV-DNA levels (Z = 4.651; P < 0.001) were predictor variables of HBeAg seroconversion. Multivariate analysis showed that family history of hepatitis B, fatty liver, HBV-DNA levels and HBeAg were independent predictors of HBeAg seroconversion. The established logistic regression model for HBeAg through regression analysis was logit P = 9.623-1.228 × family history of hepatitis B - 1.726 × fatty liver - 0.764 × HBV-DNA levels - 0.146 × HBeAg and area under curve was 0.875. When the cut-off value was -0.9350, the sensitivity and specificity were 92.70%, 75.50%, 83.22%, respectively. Conclusion: Family history of hepatitis B, fatty liver, HBV-DNA levels and HBeAg may be independent predictors of HBeAg seroconversion at 144 weeks of antiviral therapy in HBeAg-positive chronic hepatitis B patients.

Does diving affect the hearing of Asian military divers? A study in the Republic of Singapore Navy.

OBJECTIVE: This study examined whether military diving during a National Serviceman's two-year term of service affected his hearing threshold levels. METHODS: A retrospective cohort study was designed to examine the hearing thresholds of divers (mean age 20.9 years) who enlisted between 2001 and 2010 (n = 748). Their pre-enlistment and pre-discharge audiograms were collected. All made dives using scuba dive sets, averaged 200 dives over two years and depths of 30 meters of sea water/msw or less. RESULTS: The divers' hearing levels in the left ear were not affected except for a marginal decrease in hearing level at the 2kHz level. There was a marginal decrease in hearing level in 0.5, 1 and 2 kHz in the right ear. These changes are physiologically insignificant. There were more low-frequency (0.5, 1 and 2 kHz) changes compared to high-frequency (4 and 8 kHz) changes in both ears, with a larger number of changes noted in the right ear, as compared to the left. However, no diver had a hearing threshold increase greater than 20dB or exceeded the hearing threshold levels required of military divers. CONCLUSION: There was no decrease of clinical significance in hearing function of the Republic of Singapore Navy national serviceman naval divers after diving for two years.

MRI findings in cervical spinal cord type II neurological decompression sickness: a case report.

Decompression illness affecting the cervical spinal cord is uncommon. We report a case that presented with mixed signs and symptoms of cervical myelopathy and Type II neurological decompression sickness. This presented a diagnostic dilemma that required the use of magnetic resonance imaging (MRI) scan to elucidate the underlying cause. Cervical spine MRI revealed the presence of tiny hypointensities and edema within the spinal cord that corresponded to the clinical findings. The patient recovered with residual neurological deficits after hy-perbaric oxygen (HBO2) therapy. To our knowledge, these MRI findings have yet to been described in literature and we recommend the use of MRI to assist diving physicians in the management of complex cases as long as it does not delay recompression.

The skin prick test results of 977 patients suffering from chronic rhinitis in Hong Kong.

OBJECTIVES: To evaluate the prevalence of aetiological allergens identifiable by skin prick test alone in patients suffering from chronic rhinitis in Hong Kong, and also compare the clinical history and symptoms of skin prick test-positive versus skin prick test-negative patients. DESIGN: Prospective study. SETTING: Otorhinolaryngology clinic in Queen Mary Hospital of Hong Kong. PATIENTS: A total of 977 patients suffering from chronic rhinitis were recruited into the study. Skin prick test was performed with a panel of allergens including house dust mites, cockroach, cat, dog, moulds, and pollens. MAIN OUTCOME MEASURES: Skin prick test results and their correlation with symptoms. RESULTS: Of the 977 patients, 651 (67%) had positive skin prick test reactions. The commonest allergen was house dust mite which was positive in 63% of the 977 patients and 95% of those 651 skin prick test-positive patients. The other allergens were in order of cockroach (23%), cat (14%), dog (5%), pollen (4%), and mould (3%). Compared with skin prick test-negative patients, skin prick test-positive patients were more likely to have earlier age of onset of the chronic rhinitis, association with asthma, more severe symptom in the morning, more severe symptoms of itchy nose, sneezing, nasal discharge, itchy eye, and watery eye. CONCLUSIONS: Identifiable aeroallergens could be detected in 67% chronic rhinitis patients by skin prick test alone. House dust mites were the most prevalent causative allergen. There were significant differences of patterns of clinical history and symptoms severity between skin prick test-positive and skin prick test-negative patients.

Plasma gastrin measurement cannot be used to diagnose a gastrinoma in patients on either proton pump inhibitors or histamine type-2 receptor antagonists.

BACKGROUND: Patients with a gastrinoma are treated with proton pump inhibitors (PPI) and histamine type-2 receptor antagonists (H2). In order to diagnose a gastrinoma these drugs must be discontinued, but this increases the risk of gastrointestinal perforation. We aimed to determine if a gastrinoma could be diagnosed without cessation of PPI/H2 therapy. METHODS: In all, 90 patients (controls and patients diagnosed with a gastrinoma both on and off PPI/H2 therapy) were recruited, and plasma gastrin measured. RESULTS: Patients with a gastrinoma on PPI/H2 medication had a significantly higher fasting plasma gastrin concentration than control patients on PPI/H2 medication (298+/-33 versus 204+/-30 pmol/L, P = 0.01). However, there was substantial overlap between gastrin levels in these two groups. CONCLUSION: This study confirms that a gastrinoma cannot be diagnosed on the basis of a fasting plasma gastrin assay while patients remain on PPI/H2 therapy.

The Evolution of School Health and Nutrition in the Education Sector 2000-2015 in sub-Saharan Africa.

STUDY OBJECTIVES: To document the progression of school health and nutrition and its integration within the education sector in sub-Saharan Africa between 2000 and 2015. BACKGROUND: School health and nutrition programs have contributed to "Education for All" objectives by helping ensure that children benefit from quality education and reach their educational potential. METHODS: Analysis of education sector plans (ESPs) in terms of the Focusing Resources on Effective School Health (FRESH) framework and the World Bank Systems Approach for Better Education Results (SABER) School Health survey from a set of countries in sub-Saharan Africa. RESULTS: Between 2000 and 2015, the presence and scope of school health and nutrition as reflected in the four FRESH pillars grew substantially in ESPs. Three of these pillars have large, upfront costs. The fourth pillar requires recurring annual budgetary allotments. CONCLUSION: Governments clearly recognize that evidence-based, contextually designed school health and nutrition programs can contribute to education sector goals. Moving into the post-2015 era, these programs can also help draw the last 10% of children into school and enhance their readiness to learn.

Synthesis and evaluation of some stable multisubstrate adducts as specific inhibitors of spermidine synthase.

A new series of aminopropyltransferase inhibitors has been designed in which the nuclephilic aminopropyl acceptor is attached to the aminopropyl donor, S-adenosyl-1-(methylthio)-3-propylamine (decarboxylated S-adenosylmethionine), to form a "multisubstrate adduct". In the present case, S-adenosyl-1,8-diamino-3-thiooctane (2b) and the corresponding methysulfonium salt (3b) have been synthesized. Several compounds of this type were assayed as inhibitors of spermidine synthase, and both 2b and 3b were found to be potent inhibitors of the enzyme. The thioether 2b is the most potent inhibitor of spermidine synthase described to date and is almost totally devoid of inhibitory activity against the closely related aminopropyltransferase, spermine synthase. This type of compound should have use as a specific inhibitor of spermidine biosynthesis in vivo.

Polypoidal choroidal vasculopathy and neovascularized age-related macular degeneration.

OBJECTIVE: To determine the nature and frequency of polypoidal choroidal vasculopathy (PCV) in a series of patients suspected of having neovascularized age-related macular degeneration (AMD). METHODS: A prospective analysis of 167 consecutive, newly diagnosed patients aged 55 years or older with presumed neovascularized AMD was performed. All patients were examined with fundus biomicroscopy as well as fluorescein and indocyanine green angiography. RESULTS: Choroidal neovascularization secondary to AMD was diagnosed in 154 (92.2%) of 167 patients; 13 (7.8%) patients had PCV. The patients affected by PCV were younger than those with AMD (P = .01). Peripapillary choroidal neovascularization was seen in 3 (1.9%) of 154 patients with AMD and 3 (23.1%) of 13 patients with PCV (P = .006). Significant drusen were present in 63 (70%) of 90 fellow eyes with unilateral AMD compared with only 1 (16.7%) of 6 eyes with PCV (P = .02). Only 5 patients with AMD (3.2%) were nonwhite compared with 3 patients with PCV (23.1%) (P = .02). CONCLUSIONS: A measurable number of elderly patients with findings suggestive of neovascularized AMD and serosanguineous macular manifestations will instead have PCV. Polypoidal choroidal vasculopathy can occur in any sex or race, but is more commonly seen in the peripapillary area, without associated drusen, and in nonwhite patients. It is important to differentiate AMD from PCV because there are significant differences in the demographic risk profile, natural course, visual prognosis, and management of these patients.

Biclonal acute monoblastic leukemia showing del(7q) and trisomies 9 and 22.

Cytogenetic biclonality is a rare phenomenon in acute myeloid leukemia. We report a case of acute monoblastic leukemia with biclonal cytogenetic abnormalities, showing an abnormal clone with an unusual occurrence of trisomy 9 and trisomy 22, in addition to a second clone with deletion of the long arm of chromosome 7 as the only abnormality. The significance of these findings in leukemogenesis is discussed.

Translocational rearrangements of 11q23 in acute monoblastic leukemia.

We report the rearrangements of 11q23 in the form of t(6;11)(q27;q23) and t(11;16)(q23;q24) in three cases of acute monoblastic leukemia. The former translocation had only previously been reported in five cases of acute myeloid leukemia, while the latter is hitherto undescribed. In addition to describing a new chromosomal locus 16q24, which may participate in translocational exchanges with 11q23, this report also confirms the close association between 11q23 rearrangement and the involvement of the monocytic lineage in acute myeloid leukemia.

B-cell small lymphocytic lymphoma with circulating granular prolymphocytes and a novel trisomy 15 anomaly.

A 53-year-old man presented with cervical lymphadenopathy and massive splenomegaly. Peripheral blood examination showed many prolymphocytes with cytoplasmic azurophilic granules, giving an initial impression of large granular lymphocytosis. The lymph node biopsy and immunohistochemical study findings, however, were more compatible with a diagnosis of B-cell small lymphocytic lymphoma. The circulating prolymphocytes showed restricted kappa light chain expression similar to the lymphoid infiltrate in the lymph node. Karyotypic analysis revealed trisomy 15, a chromosomal abnormality that has rarely been described in small lymphocytic lymphoma or chronic lymphocytic leukemia.

Stimulatory effects of bombesin-like peptides on suprachiasmatic neurons in brain slices.

The effects of bombesin on hypothalamic suprachiasmatic (SCN) neurons were tested in this study using extracellular single-unit recording in brain tissue slices. Fresh slices containing the SCN were obtained from adult ovariectomized Sprague-Dawley rats. Bombesin in pmol ranges stimulated 75% of irregular firing SCN neurons (n = 113), while it stimulated and inhibited 17% and 34% of regular firing units, respectively. Half of the regular firing SCN units, however, were not responsive to bombesin (49% of 61 units). A dose-dependent (from 5 to 500 pmol) excitatory effect of bombesin on SCN neurons was also observed. Pretreatment with [Leu13-psi(CH2NH)-Leu14]-bombesin, a bombesin receptor antagonist, blocked the action of bombesin in 67% of 18 units responded to bombesin, indicating a specific receptor is involved in the action. Gastrin-releasing peptide, a well-recognized bombesin-like peptide in mammals, behaved almost the same as bombesin did in most SCN neurons tested (same responses in 24 of 25 units). The present finding indicates that bomesin-like peptides may play a significant role in the SCN for the rhythmic control mechanism.

Low calcium/high magnesium medium increases activities of hypothalamic arcuate and suprachiasmatic neurons in brain tissue slices.

Extracellular single-unit recording was conducted in hypothalamic arcuate (ARC) and suprachiasmatic nucleus (SCN) in rat brain slices. The perifusion medium was switched from normal artificial cerebrospinal fluid (ACSF) to ACSF containing low Ca2+ and high Mg2+ to test the effect of extracellular calcium on the spontaneous activities of these neurons and their responses to some test agents. It was found that almost all of the ARC and SCN units tested increased their firing rates in low Ca2+, high Mg2+ ACSF, and exhibited more significant responses to excitatory test agents. The effects of low Ca2+, high Mg2+ ACSF were repeatable and reversible. The results suggest that extracellular Ca2+ is essential in maintaining the membrane stability of most hypothalamic neurons and most agents tested are acting postsynaptically on the unit recorded.

Differential effects of angiotensin II on the activities of suprachiasmatic neurons in rat brain slices.

The effects of angiotensin II (AII) on the firing rates of suprachiasmatic neurons were determined in rat brain slices. AII in pmol ranges stimulated 25% and inhibited another 25% of 52 irregular firing neurons, while it stimulated 23% and inhibited 4% of 30 regular firing neurons. Three "oscillating" neurons whose firing rates oscillated with rather constant amplitudes and periods were recorded. AII induced the occurrence of oscillation in one unit and modulated the oscillation amplitude of the other two. Pretreatment with saralasin, an AII antagonist, effectively blocked (100%) the actions of AII (n = 5). The present findings suggest that AII may act as an important mediator in the suprachiasmatic nucleus and its mode of action may be variable in different neurons.

Involving the general public in priority setting: experiences from Australia.

The discussion over whether community preferences have a legitimate role to play in priority setting has been highly polarised. Skeptics warn of the risk of establishing a 'dictatorship of the uninformed', while advocates proclaim the legitimacy of the participatory process. The one group who appears not to be consulted in this debate is the citizens themselves. In this study, a convenience sample of 373 citizens attending two medical clinics in central Sydney were surveyed about whether the general public has a legitimate role to play in informing priority setting in health care. Respondents were presented with three different levels of priority setting: across health care programmes, across medical procedures, and at a global level. To assist respondents in understanding the choices and trade-offs involved, they were given information about current levels of funding and the cost-effectiveness of each alternative. Respondents were asked whether they felt the preferences of the general public should be used to inform priority setting at each level. Of particular interest was the question of whether their willingness to use public preferences depended on the level of priority setting. Respondents were also asked about who else's preferences should be used to inform priority setting at each level. The results suggest that the public overwhelmingly want their preferences to inform priority-setting decisions in health care. This was seen to be particularly important in informing decisions about how to prioritise across broad health care programmes and about the criteria to be used to allocate funds across different population groups. In contrast, the preferences of medical professionals and health service managers were rated most highly in relation to the prioritisation of different treatments and medical procedures. In most cases, however, respondents did not advocate the use of one particular group's preferences. Even when the preferences of the general public were considered most important, it was felt that any decision-making process needed to be informed by the preferences of a range of groups. The preferences of politicians were viewed as least important to processes of priority setting in health care.

Substance use in high school students in New South Wales, Australia, in relation to language spoken at home.

PURPOSE: To examine for the first time adolescent substance use by ethnicity, given the high proportion of migrants from non-English-speaking countries in New South Wales, (NSW), Australia. METHODS: Data from four surveys of NSW secondary school students in 1983, 1986, 1989, and 1992 were used for this analysis. The prevalence of substance use by whether English was spoken at home was stratified by sex and age using data from the most recent survey year. Adjusted odds ratios and 95% confidence intervals were produced by simultaneous logistic regression, adjusting for sex, age group, and the interaction term of sex and age for each of these substances, and for each survey year separately. Data from 1989 and 1992 were pooled together to examine rates of substance use by ethnic subgroups which reflect migration patterns. RESULTS: The prevalence of smoking and alcohol and illicit drug use was consistently lower among NSW adolescents speaking a language other than English at home, compared with those speaking English at home in all survey years. Only the prevalence of solvent sniffing was higher among younger adolescents speaking a language other than English at home. Students from Southeast Asia showed consistently lower rates of usage of all substances compared to all other groups. CONCLUSIONS: There may be different opportunities for the prevention of adolescent substance use among native English speakers to be gained from non-English-speaking cultures.

What constitutes treatment effectiveness? -- the differential judgements of Chinese Aaustralian patients and doctors.

Analysis of interviews and focus groups with users of traditional Chinese medicine (TCM) and ethnic Chinese general practitioners (GPs) in Sydney, Australia, demonstrated the concept of treatment effectiveness held by users had four aspects: diagnosis, intervention, outcome and prevention of recurrence. Respondents assessed orthodox medicine and TCM utilizing all four aspects. Orthodox medicine was considered effective for diagnosis and valued for the speed of its intervention. However, respondents regretted its failure to use food in treatment. Orthodox medicine was considered best for symptom relief but TCM was considered to be better at dealing with root causes of illness and was consequently better at preventing illness recurring. Respondents saw prevention as illness specific contrasting with the lifestyle prevention espoused by orthodox medicine. Respondents criticized TCM in Australia because of the perceived low expertise of practitioners and poor herb quality. GPs valued accurate diagnosis and symptom relief but were less concerned about root causes of illness and did not see food as a treatment intervention.

Qigong therapy--its effectiveness and regulation.

Qigong has become increasingly popular as a modality in traditional Chinese medical care. It may be effective in treating diseases. However, it is not uncommon to hear complaints about the ineffectiveness of such treatment. This paper attempts to look at the recent promotion of Qigong as an effective form of health care and the regulation of Qigong practitioners in China by a review of literature and interviews with key informants. Although it is premature to conclude that Qigong is another therapeutic modality in traditional Chinese medicine, it is also premature to rule out the possible therapeutic efficacy of Qigong, in particular, internal Qi. Even if medical Qigong is effective, the establishment and enforcement of standards of practice and codes of ethics amongst Qigong masters will remain unresolved as there has not yet been any effective way to assess the competence of a Qigong master. Although a number of control measures have been proposed in this paper, a better understanding of the educational, professional and ethical standards and efficacy of such a practice is required.

A review of 5 existing guidelines for planning focus groups in GP research.

The use of a focus group as a research method has become increasingly common in general practice related studies. Although existing guidelines for planning focus groups are very useful, a review of these guidelines indicate that a few of them are vague and need further elaboration. The authors review five existing guidelines for planning focus groups. These are size, number, duration, format and composition of a focus group. Suggestions have been made to address the uncertainties in these areas when a focus group is used. This paper was a section of manuscript presented at the 2nd International Qualitative Health Research Conference on 11 June 1994, Hershey, Pennsylvania.

Nursing as a career choice: perceptions of school students speaking Arabic, Serbo-Croatian, Spanish, Turkish or Vietnamese at home.

Australia is a multicultural society and nowhere is this more evident than in Sydney where 25% of the population speaks a language other than English. In one of the largest area health services in New South Wales, the five most frequently spoken languages at home are Arabic, Serbo-Croatian, Spanish, Turkish or Vietnamese, with these language groups comprising 12% of Sydney's population. Yet nurses speaking one of these five languages comprise less than 1% of the nursing workforce. A cost-effective method of addressing the shortage of nurses speaking languages other than English is to recruit students who already speak another language into the profession. This study examined high school students' perceptions of nursing in order to determine appropriate methods of recruiting students speaking one of these languages. Implications for the design of recruitment campaigns are also discussed.