Increased stroke risk in Bell's palsy patients without steroid treatment.

BACKGROUND AND PURPOSE: To investigate the risk of stroke development following a diagnosis of Bell's palsy in a nationwide follow-up study. METHODS AND MATERIALS: Information on Bell's palsy and other factors relevant for stroke was obtained for 433218 eligible subjects without previous stroke who had ambulatory visit in 2004. Of those, 897 patients with Bell's palsy were identified. Over a median 2.9 years of follow-up, 4581 incident strokes were identified. We estimated hazard ratios (HR) and 95% confidence intervals [CI] with Cox proportional hazard models adjusting for age, sex, co-morbidities, and important risk factors. Standardized incidence ratio of stroke amongst patients with Bell's palsy was analyzed. RESULTS: Compared with non-Bell's palsy patients, patients with Bell's palsy had a 2.02-times (95% CI, 1.42-2.86) higher risk of stroke. The adjusted HR of developing stroke for patients with Bell's palsy treated with and without systemic steroid were 1.67 (95% CI, 0.69-4) and 2.10 (95%, 1.40-3.07), respectively. CONCLUSIONS: Patients with Bell's palsy carry a higher risk of stroke than the general population. Our data suggest that these patients might benefit from a more intensive stroke prevention therapy and regular follow-up after initial diagnosis.

Complementary and alternative medicine use in England: results from a national survey.

OBJECTIVES: In many countries, recent data on the use of complementary and alternative medicine (CAM) are available. However, in England, there is a paucity of such data. We sought to determine the prevalence and predictors of CAM use in England. DESIGN: Data were obtained from the Health Survey for England 2005, a national household survey that included questions on CAM use. We used binary logistic regression modelling to explore whether demographic, health and lifestyle factors predict CAM use. RESULTS: Data were available for 7630 respondents (household response rate 71%). Lifetime and 12-month prevalence of CAM use were 44.0% and 26.3% respectively; 12.1% had consulted a practitioner in the preceding 12 months. Massage, aromatherapy and acupuncture were the most commonly used therapies. Twenty-nine percent of respondents taking prescription drugs had used CAM in the last 12 months. Women (OR 0.491, 95% CI: 0.419, 0.577), university educated respondents (OR 1.296, 95% CI: 1.088, 1.544), those suffering from anxiety or depression (OR 1.341, 95% CI: 1.074, 1.674), people with poorer mental health (on GHQ: OR 1.062, 95% CI 1.026, 1.100) and lower levels of perceived social support (1.047, 95% CI: 1.008, 1.088), people consuming ≥ 5 portions of fruit and vegetables a day (OR 1.327, 95% CI: 1.124, 1.567) were significantly more likely to use CAM. CONCLUSION: Complementary and alternative medicine use in England remains substantial, even amongst those taking prescription drugs. These data serve as a valuable reminder to medical practitioners to ask patients about CAM use and should be routinely collected to facilitate prioritisation of the research agenda in CAM.

Association between surgeon volume and hospitalisation costs for patients with oral cancer: a nationwide population base study in Taiwan.

OBJECTIVE: Oral cancer leads to a considerable use of and expenditure on health care. Wide resection of the tumour and reconstruction with a pedicle flap/free flap is widely used. This study was conducted to explore the relationship between hospitalisation costs and surgeon case volume when this operation was performed. SETTING: A population-based study. DESIGN: This study uses data for the years 2005-2006 obtained from the National Health Insurance Research Database published in the Taiwanese National Health Research Institute. PARTICIPANTS: From this population-based data, the authors selected a total of 2663 oral cancer patients who underwent tumour resection and reconstruction. MAIN OUTCOME MEASURES: Case volume relationships were based on the following criteria; low-, medium-, high-, very high-volume surgeons were defined by or= 56 resections with reconstruction, respectively. Hierarchical linear regression analysis was subsequently performed to explore the relationship between surgeon case volume and the cost and length of hospitalisation. RESULTS: The mean hospitalisation cost among the 2663 patients was US$ 9528 (all costs are given in US dollars). After adjusting for physician, hospital, and patient characteristics in a hierarchical linear regression model, the cost per patient for low-volume surgeons was found to be US$ 741 (P = 0.012) higher than that for medium-volume surgeons, US$ 1546 (P < 0.001) higher than that for high-volume surgeons, and US$ 1820 (P < 0.001) higher than that for very-high-volume surgeons. After adjustment for physician, hospital, and patient characteristics, the hierarchical linear regression model revealed that the mean length of stay per patient for low-volume surgeons was the highest (P < 0.001). CONCLUSIONS: After adjustment for physician, hospital, and patient characteristics, low-volume surgeons performing wide excision with reconstructive surgery in oral cancer patients incurred significantly higher costs and longer hospital stays per patient than did other surgeons. Treatment strategies adopted by high- and very-high-volume surgeons should be analysed further and utilised more widely.

Bidimensional measurement of nasopharyngeal carcinoma: a simple method to predict outcomes.

OBJECTIVES: To determine whether the standard techniques of measuring tumour size could be applied to the measurement of nasopharyngeal carcinoma. STUDY DESIGN: A retrospective review of case notes from the Buddhist Tzu Chi Dalin General Hospital archives was performed. SETTINGS: The Buddhist Tzu Chi Dalin General Hospital is a teaching hospital in Taiwan. PARTICIPANTS: All patients with nasopharyngeal carcinoma were included. MAIN OUTCOME MEASURES: Ninety-eight patients with newly diagnosed nasopharyngeal carcinoma were treated with high-dose radiotherapy and chemotherapy were enrolled in this study. Computed tomography-derived primary tumour volume, bidimensional measurement and unidimensional measurement were recorded. Intrarater reliability was measured. To examine the validity of various measurements, we estimated the Spearman's correlation co-efficients between those measurements and the gold standard value (primary tumour volume measurement with summation of area techniques). Univariate and multivariate analyses were performed and Kaplan-Meier survival curves constructed. RESULTS: There was a significant association between primary tumour volume and bidimensional measurement with respect to tumour size at diagnosis (Spearman's correlation co-efficient = 0.845, P < 0.001). Using age, gender, chemotherapy status and T-stage as covariate, bidimensional measurement remained an independent prognostic factor for any relapse [Hazard ratio = (HR) 1.066; P = 0.029], and overall survival (HR = 1.097; P = 0.007). Patients with small bidimensional measurement (<10 cm(2)) had better prognosis and fewer recurrences. CONCLUSIONS: When using simple measurement to evaluate nasopharyngeal carcinoma, the bidimensional measurement may be used to measure size at diagnosis. Patients with small bidimensional measurement had better prognosis and fewer recurrences. Bidimensional measurement may be further considered to improve the current staging system.

Epigenetic silencing of the dual-role signal mediator, ANGPTL4 in tumor tissues and its overexpression in the urothelial carcinoma microenvironment.

Urothelial carcinoma (UC) carcinogenesis has been hypothesized to occur through epigenetic repression of tumor-suppressor genes (TSGs). By quantitative real-time polymerase chain reaction array, we found that one potential TSG, angiopoietin-like 4 (ANGPTL4), was expressed at very low levels in all bladder cancer cell lines we examined. Previous studies had demonstrated that ANGPTL4 is highly expressed in some cancers, but downregulated, by DNA methylation, in others. Consequently, owing to these seemingly conflicting functions in distinct cancers, the precise role of ANGPTL4 in the etiology of UC remains unclear. In this study, using methylation-specific PCR and bisulfite pyrosequencing, we show that ANGPTL4 is transcriptionally repressed by DNA methylation in UC cell lines and primary tumor samples, as compared with adjacent noncancerous bladder epithelium. Functional studies further demonstrated that ectopic expression of ANGPTL4 potently suppressed UC cell proliferation, monolayer colony formation in vitro, and invasion, migration, and xenograft formation in vivo. Surprisingly, circulating ANGPTL4 was significantly higher in plasma samples from UC patients than normal control, suggesting it might be secreted from other cell types. Interestingly, our data also indicated that exogenous cANGPTL4 could promote cell proliferation and cell migration via activation of signaling through the Erk/focal adhesion kinase axis. We further confirmed that mouse xenograft tumor growth could be promoted by administration of exogenous cANGPTL4. Finally, immunohistochemistry demonstrated that ANGPTL4 was downregulated in tumor cells but overexpressed in tumor adjacent stromal tissues of muscle-invasive UC tissue samples. In conclusion, our data support dual roles for ANGPTL4 in UC progression, either as a tumor suppressor or oncogene, in response to microenvironmental context.

Evaluation of salivary function by sialoscintigraphy in locally advanced nasopharyngeal cancer patients after intensity modulated radiotherapy.

PURPOSE: This study aimed to evaluate the salivary gland function changes by sialoscintigraphy in locally advanced nasopharyngeal cancer (NPC) after intensity modulated radiotherapy (IMRT). MATERIALS AND METHODS: Salivary function was assessed by sialoscintigraphy. Quantitative sialoscintigraphy was performed in 24 NPC patients prior to and after IMRT. Results were categorized in four groups according to the duration of treatment. The sialoscintigraphy parameters were examined. RESULTS: Sialoscintigraphy showed a significant difference in the secretion of each interval groups. The parameters of scintigraphy, except maximum accumulation (MA) of submandibular glands, decreased first after radiotherapy, and then recovered. However, the MA of submandibular glands was continuously downhill after radiation. CONCLUSIONS: The sialoscintigraphy parameters of each gland changed with the different radiation dose and follow-up intervals. The salivary function was influenced after radiotherapy in locally advanced NPC, especially, in the submandibular gland. Strategies to improve the salivary function should be assessed.

Dose distributions of an ¹9²Ir brachytherapy source in different media.

This study used MCNPX code to investigate the brachytherapy (192)Ir dose distributions in water, bone, and lung tissue and performed radiophotoluminescent glass dosimeter measurements to verify the obtained MCNPX results. The results showed that the dose-rate constant, radial dose function, and anisotropy function in water were highly consistent with data in the literature. However, the lung dose near the source would be overestimated by up to 12%, if the lung tissue is assumed to be water, and, hence, if a tumor is located in the lung, the tumor dose will be overestimated, if the material density is not taken into consideration. In contrast, the lung dose far from the source would be underestimated by up to 30%. Radial dose functions were found to depend not only on the phantom size but also on the material density. The phantom size affects the radial dose function in bone more than those in the other tissues. On the other hand, the anisotropy function in lung tissue was not dependent on the radial distance. Our simulation results could represent valid clinical reference data and be used to improve the accuracy of the doses delivered during brachytherapy applied to patients with lung cancer.

Prognosticators and the relationship of depression and quality of life in head and neck cancer.

BACKGROUND AND PURPOSE: To evaluate the relationship of emotional status and health-related quality of life (HRQOL) in disease-free head and neck cancer (HNC) patients post treatment and to explore their predictive factors. MATERIALS AND METHODS: Seventy-three HNC patients, post treatment at least 1 year, were recruited to complete three questionnaires, EORTC QLQ-C30, EORTC-H&N35 cancer module, and the Beck Depression Inventory-II (BDI-II). RESULTS: Patients with depression demonstrated significantly poor global health status/QoL (score 41.7 vs. 71.9, P<0.001) and almost all functioning, except for role functioning. Besides, depressive patients presented statistically significant worse symptoms in all QLQ-C30 items, except constipation and financial problems, and in all QLQ-H&N35 symptoms except for teeth and coughing problems. Depression was significantly negative correlated with all functional scales and global health status/QoL (r = -0.341 to -0.750, all P<0.05), and was significantly positive correlated with symptom scales (r = 0.348 to 0.793, all P<0.05), except for constipation. Stepwise multiple linear regression analyses showed that physical functioning and physical distressful symptoms play an important role in the perception of HRQOL (total 46% explained). Global health status and impaired social functioning could explain depression in addition to emotional functioning (total 64% explained). CONCLUSIONS: HNC patients with depression were noted to have poorer HRQOL in almost every functioning symptom. HNC patients may get benefit from early interventions to improve HRQOL, emotional status, or both by a more rapid and friendly questionnaire to earlier identify patients with poor HRQOL or depressive status.

Great expectations: what do patients using complementary and alternative medicine hope for?

The aim of this review is to summarize the published evidence regarding the expectations of complementary and alternative medicine (CAM) users. We conducted electronic searches in MEDLINE and a hand search of our own files. Seventy-three articles met our inclusion criteria. A wide range of expectations emerged. In order of prevalence, they included hope to influence the natural history of the disease; disease prevention and health/general well-being promotion; fewer side effects; being in control over one's health; symptom relief; boosting the immune system; emotional support; holistic care; improving quality of life; relief of side effects of conventional medicine; good therapeutic relationship; obtaining information; coping better with illness; supporting the natural healing process; and availability of treatment. It is concluded that the expectations of CAM users are currently not rigorously investigated. Future studies should have a clear focus on specific aspects of this broad question.