Age distribution of human papillomavirus infection and cervical neoplasia reflects caveats of cervical screening policies.

Although a second age-related peak of human papillomavirus (HPV) infection is observed in many populations, it does not seem to have any impact on cervical screening policies. We examined the age-specific prevalence of HPV infection among 2,604 women enrolled for cervical screening and correlated the age at diagnosis of 2,491 cervical intraepithelial neoplasia Grade 2/3 (CIN2/3) lesions and 801 invasive cervical cancers (ICC). Two peaks of HPV infection were detected at 26-30 and 46-50 years, respectively. The first infection peak was followed by a CIN2/3 peak and an ICC peak at 5-15 and 15 years later, respectively. The second infection peak was followed by an ICC peak 20 years later, but strikingly no CIN2/3 peak was detected in between and thus eliminated an opportunity of treating the lesions at preinvasive stages. The most plausible explanation is that women at the expected second CIN2/3 peak (50-65 years) are not having Pap smears under the current opportunistic screening program. Furthermore, women of this age may have physiological retraction of the transformation zone, and CIN lesions may remain undetected if an adequate Pap smear sample is not obtained. To combat this problem, the screening program in Hong Kong needs to focus on women aged 50 years and older and a mop-up screening up to 75 years is necessary. Bimodal peaks of HPV infection and cervical cancer are seen in many countries and the analysis of population-specific age distribution of CIN2/3 should be an integral exercise in evaluating the effectiveness of a screening program.

A case-control study of bipolar depression, compared with unipolar depression, in a regional hospital in Hong Kong.

OBJECTIVE: To determine the characteristics of diagnostic conversion from unipolar depression to bipolar depression in psychiatric outpatients, and to compare the profiles of the 2 groups of patients. METHOD: This is a case-control study in which outpatients newly diagnosed with unipolar depression were reviewed. Outpatients who had polarity conversion to bipolar depression were recruited as subjects and control subjects were matched. The diagnostic validity was enhanced by clinical interview, review of case records by an independent specialist psychiatrist, and administration of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Axis I Disorders. Multivariate conditional logistic regression was carried out to identify the predictors of bipolar switch. RESULTS: Eighty-eight subjects among those who maintained regular outpatient clinic follow-up (n = 823) showed bipolar switch during the period under study. The incidence of polarity conversion was 10.7%. Bipolar switch was associated with family history of bipolar affective disorder, use of 3 or more different types of antidepressants in the first 5 years after presentation, an earlier age at presentation of depressive symptoms of less than 37 years, and males. CONCLUSIONS: Change in diagnostic polarity is not uncommon in Chinese psychiatric outpatients initially presenting with unipolar depression. They share some common risk factors as identified in Western studies. These can be helpful to clinicians as guidance for identification of patients with depression at high risk for a bipolar course.

Effects of carbon and nitrogen plasma immersion ion implantation on in vitro and in vivo biocompatibility of titanium alloy.

Growth of bony tissues on titanium biomedical implants can be time-consuming, thereby prolonging recovery and hospitalization after surgery and a method to improve and expedite tissue-implant integration and healing is thus of scientific and clinical interests. In this work, nitrogen and carbon plasma immersion ion implantation (N-PIII and C-PIII) is conducted to modify Ti-6Al-4V to produce a graded surface layer composed of TiN and TiC, respectively. Both PIII processes do not significantly alter the surface hydrophilicity but increase the surface roughness and corrosion resistance. In vitro studies disclose improved cell adhesion and proliferation of MC3T3-E1 preosteoblasts and L929 fibroblasts after PIII. Micro-CT evaluation conducted 1 to 12 weeks after surgery reveals larger average bone volumes and less bone resorption on the N-PIII and C-PIII titanium alloy pins than the unimplanted one at every time point. The enhancements observed from both the in vitro and in vivo studies can be attributed to the good cytocompatibility, roughness, and corrosion resistance of the TiN and TiC structures which stimulate the response of preosteoblasts and fibroblasts and induce early bone formation. Comparing the two PIII processes, N-PIII is more effective and our results suggest a simple and practical means to improve the surface biocompatibility of medical-grade titanium alloy implants.

Antibiotics nonadherence and knowledge in a community with the world's leading prevalence of antibiotics resistance: implications for public health intervention.

BACKGROUND: Community determinants of antibiotics nonadherence, an important contributor of antibiotics resistance, remained unclear. OBJECTIVES: Our objective was to investigate whether deficient antibiotics knowledge could contribute to nonadherence in a community with high prevalence of antibiotics resistance. METHODS: We recruited 465 people by random sampling from 5 urban areas in Hong Kong. A structured questionnaire was used to assess antibiotics knowledge and adherence. Adherence was defined as completing the most recent course of antibiotics entirely according to physicians' instructions. An antibiotics knowledge score ranging from 0 to 3 (highest) was composed based on the number of correctly answered questions. RESULTS: Of the 465 participants interviewed, 96.3% had heard of the term "antibiotics," and 80.6% recalled having previously received antibiotics prescription. Among the eligible 369 subjects, 32.9% showed nonadherence. Percentages of participants with antibiotics knowledge scores of 0, 1, 2, and 3 were 11%, 27%, 33%, and 29%, respectively. There was a higher prevalence of nonadherence among people with lower antibiotics knowledge score (P < .001). Furthermore, people with nonadherence had a significantly lower mean antibiotics knowledge score (1.3 ± 1.0 versus 2.0 ± 0.9, P < .001), with no interaction with education (P < .05). Adjusted for potential confounders, antibiotics knowledge scores of 2, 1, and 0 independently predicted increased risk of nonadherence by 1-fold (odds ratio [OR], 2.00; 95% confidence interval [CI]: 1.01-3.94; P = .047), 4-fold (OR, 4.77; 95% CI: 2.30-9.92; P < .001), and 17-fold (OR, 18.41; 95% CI: 6.92-48.97; P < .001) respectively, compared with the maximum score of 3. CONCLUSION: Lack of antibiotics knowledge is a critical determinant of nonadherence independent of education in the community.

Myocardial post-conditioning with Danshen-Gegen decoction protects against isoproterenol-induced myocardial injury via a PKCε/mKATP-mediated pathway in rats.

BACKGROUND: Danshen-Gegen decoction (DG), a Chinese herbal formula, has been demonstrated to be effective for the treatment of coronary heart disease such as myocardial infarction. In the present study, we investigated the effect of DG post-conditioning on isoproterenol (ISO)-induced myocardial injury in rats. METHODS: ISO was injected intraperitoneally (200 mg/kg) to induce acute (2-6 hours) myocardial injury in adult female rats. DG (4 g/kg) was administered per oral immediately after the injection of ISO in the rats. Extent of myocardial injury was assessed by measurements of plasma enzyme activities. Myocardial mitochondrial glutathione antioxidant status, lipid peroxidation and mitochondrial calcium ion loading and cytochrome c release were also measured. Effects of inhibitors of protein kinase C-epsilon (PKCε) ranslocation and mitochondrial ATP-sensitive potassium channel (mKATP) on myocardial post-conditioning by DG were investigated. RESULTS: ISO inflicted acute myocardial injury in the rats as evidenced by increased plasma enzyme activities. DG post-treatment alleviated the ISO-induced acute myocardial injury. CONCLUSION: DG post-treatment protected the myocardium against ISO-induced acute injury in rats. The myocardial post-conditioning by DG is likely mediated by PKCε/mKATP signaling pathway.

Acute treatment with Danshen-Gegen decoction protects the myocardium against ischemia/reperfusion injury via the redox-sensitive PKCɛ/mK(ATP) pathway in rats.

Danshen-Gegen (DG) decoction, an herbal formulation comprising Radix Salvia Miltiorrhiza and Radix Puerariae Lobatae, is prescribed for the treatment of coronary heart disease in Chinese medicine. Experimental and clinical studies have demonstrated that DG decoction can reduce the extent of atherosclerosis. In the present study, using an ex vivo rat model of myocardial ischemia/reperfusion (I/R) injury, we investigated the myocardial preconditioning effect of an aqueous DG extract prepared from an optimized weight-to-weight ratio of Danshen and Gegen. Short-term treatment with DG extract at a daily dose of 1 g/kg and 2 g/kg for 3 days protected against myocardial I/R injury in rats. The cardioprotection afforded by DG pretreatment was paralleled by enhancements in mitochondrial antioxidant status and membrane structural integrity, as well as a decrease in the sensitivity of mitochondria to Ca²âº-stimulated permeability transition in vitro, particularly under I/R conditions. Short-term treatment with the DG extract also enhanced the translocation of PKCɛ from the cytosol to mitochondria in rat myocardium, and this translocation was inhibited by α-tocopherol co-treatment with DG extract in rats. Short-term DG treatment may precondition the myocardium via a redox-sensitive PKCɛ/mK(ATP) pathway, with resultant inhibition of the mitochondrial permeability transition through the opening of mitochondrial K(ATP) channels. Our results suggest that clinical studies examining the effectiveness of DG extract given prophylactically in affording protection against myocardial I/R injury would be warranted.

Long-term treatment with danshen-gegen decoction protects the myocardium against ischemia/reperfusion injury via the redox-sensitive protein kinase C-ε/mK(ATP) pathway in rats.

Danshen-Gegen (DG) decoction, an herbal formulation comprised of radix Salvia Miltiorrhiza and radix Puerariae Lobata, is prescribed for the treatment of coronary heart disease in Chinese medicine. Experimental and clinical studies have indicated that DG decoction can reduce the extent of atherosclerosis. In the present study, using an ex vivo rat model of myocardial ischemia/reperfusion (I/R) injury, we investigated the myocardial preconditioning effect of an aqueous DG extract prepared from an optimized weight-to-weight ratio of danshen and gegen. Long-term treatment with DG extract at increasing doses (including the equivalent of a human dose) protected against myocardial I/R injury in rats. The cardioprotection afforded by DG pretreatment was paralleled by enhancements in mitochondrial antioxidant status and membrane integrity, as well as a decrease in the sensitivity of mitochondria to Ca(2+)-stimulated permeability transition in vitro, particularly under I/R conditions. Long-term treatment with the DG extract enhanced the translocation of protein kinase C-epsilon (PKCε) from the cytosol to mitochondria in rat myocardium, and this translocation was inhibited by α-tocopherol co-treatment with DG extract in rats. Long-term DG treatment may precondition the myocardium via a redox-sensitive PKCε/mK(ATP) pathway, with resultant inhibition of the mitochondrial permeability transition. The results suggest that clinical studies examining the effectiveness of DG extract given prophylactically in affording protection against myocardial I/R injury would be warranted.