Gender differences in the impact of poverty on health: disparities in risk of diabetes-related amputation.

AIMS: To assess the combined impact of socio-economic status and gender on the risk of diabetes-related lower extremity amputation within a universal healthcare system. METHODS: We conducted a population-based cohort study using administrative health databases from Ontario, Canada. Adults with pre-existing or newly diagnosed diabetes (N = 606 494) were included and the incidence of lower extremity amputation was assessed for the period 1 April 2002 to 31 March 2009. Socio-economic status was based on neighbourhood-level income groups, assigned to individuals using the Canadian Census and their postal code of residence. RESULTS: Low socio-economic status was associated with a significantly higher incidence of lower extremity amputation (27.0 vs 19.3 per 10,000 person-years in the lowest (Q1) vs the highest (Q5) socio-economic status quintile. This relationship persisted after adjusting for primary care use, region of residence and comorbidity, and was greater among men (adjusted Q1:Q5 hazard ratio 1.41, 95% CI 1.30-1.54; P < 0.0001 for all male gender-socio-economic status interactions) than women (hazard ratio 1.20, 95% CI 1.06-1.36). Overall, the incidence of lower extremity amputation was higher among men than women (hazard ratio for men vs women: 1.87, 95% CI 1.79-1.96), with the greatest disparity between men in the lowest socio-economic status category and women in the highest (hazard ratio 2.39, 95% CI 2.06-2.77 and hazard ratio 2.30, 95% CI 1.97-2.68, for major and minor amputation, respectively). CONCLUSIONS: Despite universal access to hospital and physician care, we found marked socio-economic status and gender disparities in the risk of lower extremity amputation among patients with diabetes. Men living in low-income neighbourhoods were at greatest risk.

Fast atom-trap analysis of 39Ar with isotope pre-enrichment.

We demonstrate fast analysis of 39Ar/Ar at the 10-16 level using a mass spectrometer for isotope pre-enrichment and an atom trap for counting. An argon gas sample first passes through a dipole mass separator that reduces the dominant isotope 40Ar by two orders of magnitude while preserving both the rare tracer isotope 39Ar and a minor stable isotope 38Ar for control purposes. Measurements of both natural and enriched samples with atom trap trace analysis demonstrate that the 39Ar/38Ar ratios change less than 10%, while the overall count rates of 39Ar are increased by one order of magnitude. By overcoming the analysis-speed bottleneck, this advance will benefit large-scale applications of 39Ar dating in the earth sciences, particularly for mapping ocean circulation.

An atom trap system for 39Ar dating with improved precision.

Cosmogenic 39Ar dating is an emerging technique in dating mountain glacier ice, mapping ocean circulation, and tracing groundwater flow. We have realized an atom-trap system for the analysis of the radioactive isotope 39Ar (half-life = 269 years) in environmental samples. The system is capable of analyzing small (1-5 kg) environmental water or ice samples and achieves a count rate of 10 atoms/h for 39Ar at the modern isotopic abundance level of 8 × 10-16. By switching frequently between counting 39Ar atoms and measuring the stable and abundant isotope 38Ar, drift effects in the trapping efficiency are largely suppressed, leading to a more precise measurement of the isotope ratio 39Ar/38Ar. Moreover, cleaning techniques are developed to alleviate cross-sample contamination, reducing the background 39Ar count rate down to <0.5 atoms/h. These advances allow us to determine the 39Ar age in the range of 250-1300 years with precisions of <20%.

An electromagnetic separation system for the enrichment of 39Ar.

An isotope enrichment system for 39Ar has been developed at the Institute of Modern Physics, which is designed to increase the abundance of 39Ar in the incident sample gas. With intense Ar+ beams produced by a 2.45 GHz electron cyclotron resonance ion source and a high mass resolution spectrometer system, Ar isotopes are evidently separated on the target plane and selectively collected by an Al target. The separated Ar isotopes have been identified on the target plane, which is consistent with the simulations. According to the recent cross-checked results with atom trap trace analysis, a high enrichment factor of 39Ar has been successfully achieved. This paper will present the design and test results of this system.

Potential of cyclodextrin complexation and liposomes in topical delivery of ketorolac: in vitro and in vivo evaluation.

The objective of this investigation was to evaluate the effect of delivery strategies such as cyclodextrin complexation and liposomes on the topical delivery of ketorolac acid (KTRA) and ketorolac tromethamine. Ketorolac acid-hydroxypropyl-beta-cyclodextrin solid dispersions (KTRA-CD) were prepared by kneading method. The liposomes containing ketorolac tromethamine (KTRM) and KTRA-CD were prepared. The in vitro permeation of KTRM solution, KTRA solution, KTRA-CD, and liposomes containing KTRM or KTRA-CD through guinea pig skin was evaluated. The anti-inflammatory activity of the topically applied KTRA-CD gel (containing 1% w/w KTRA) was compared to that of orally delivered KTRM solution. The KTRA-CD demonstrated significantly higher transdermal transport of ketorolac as compared to all other systems whereas liposomes significantly reduced the transport of ketorolac. The anti-inflammatory activity of the topically applied KTRA-CD gel was similar to that of the orally administered KTRM. Thus, cyclodextrin complexation enabled effective transdermal delivery of the ketorolac.

Cadherin 26 is an alpha integrin-binding epithelial receptor regulated during allergic inflammation.

Cadherins (CDH) mediate diverse processes critical in inflammation, including cell adhesion, migration, and differentiation. Herein, we report that the uncharacterized cadherin 26 (CDH26) is highly expressed by epithelial cells in human allergic gastrointestinal tissue. In vitro, CDH26 promotes calcium-dependent cellular adhesion of cells lacking endogenous CDHs by a mechanism involving homotypic binding and interaction with catenin family members (alpha, beta, and p120), as assessed by biochemical assays. Additionally, CDH26 enhances cellular adhesion to recombinant integrin α4ß7 in vitro; conversely, recombinant CDH26 binds αE and α4 integrins in biochemical and cellular functional assays, respectively. Interestingly, CDH26-Fc inhibits activation of human CD4+ T cells in vitro including secretion of IL-2. Taken together, we have identified a novel functional CDH regulated during allergic responses with unique immunomodulatory properties, as it binds α4 and αE integrins and regulates leukocyte adhesion and activation, and may thus represent a novel checkpoint for immune regulation and therapy via CDH26-Fc.

Religious Scholars' Attitudes and Views on Ethical Issues Pertaining to Pre-Implantation Genetic Diagnosis (PGD) in Malaysia.

Pre-Implantation Genetic Diagnosis (PGD) represents the first fusion of genomics and assisted reproduction and the first reproductive technology that allows prospective parents to screen and select the genetic characteristics of their potential offspring. However, for some, the idea that we can intervene in the mechanisms of human existence at such a fundamental level can be, at a minimum, worrying and, at most, repugnant. Religious doctrines particularly are likely to collide with the rapidly advancing capability for science to make such interventions. This paper focuses on opinions and arguments of selected religious scholars regarding ethical issues pertaining to PGD. In-depth interviews were conducted with religious scholars from three different religious organizations in the Klang Valley, Malaysia. Findings showed that Christian scholars are very sceptical of the long-term use of PGD because of its possible effect on the value of humanity and the parent-children relationship. This differs from Islamic scholars, who view PGD as God-given knowledge in medical science to further help humans understand medical genetics. For Buddhist scholars, PGD is considered to be new medical technology that can be used to save lives, avoid suffering, and bring happiness to those who need it. Our results suggest that it is important to include the opinions and views of religious scholars when it comes to new medical technologies such as PGD, as their opinions will have a significant impact on people from various faiths, particularly in a multi-religious country like Malaysia where society places high value on marital relationships and on the traditional concepts of family.

Primary conjunctival mantle cell lymphoma on 18F-FDG PET/CT Scan: A case report

@#18F-Fluorodeoxyglucose (18F-FDG) PET/CT scan is a vital imaging modality in the majority of oncologic situations. It is proven useful in staging, management and monitoring of lymphomas. Numerous subtypes of lymphomas exist; however, we present the first documented case of a 56-year-old, Filipino, male patient who is diagnosed with mantle cell lymphoma of the conjunctiva (MCL). MCL is an extremely rare type of extranodal non-Hodgkin lymphoma and has an aggressive nature with an estimated incidence of 2-4/1,000,000. This case highlights the critical role that PET/CT scans play in directing treatment decisions and monitoring the response of conjunctival MCL to therapy.

Comparative estimation of octopamine in the aortic smooth muscle, plasma and red blood cells of spontaneously hypertensive and Wistar Koyoto control rats.

Octopamine is an alpha agonist, the levels of which vary with age and in pathophysiological conditions. The levels of octopamine were found to be higher in the aortic smooth muscle and red blood corpuscles, but lower in the plasma of spontaneously hypertensive rats (SHR) than in the Wistar Koyoto rats. The importance of these variations are discussed.

Immunological status in tuberous sclerosis.

Cellular and humoral immunity, and lymphoid organ pathology, have been investigated in 10 institutionalized patients with tuberous sclerosis and 10 institutionalized matched controls without the disease. Type and incidence of infections and tumours were reviewed for each group, as was current medication. Elevated serum IgM levels were found in the patients with tuberous sclerosis, but no immunological deficiency of either cellular of humoral immunity was found, nor was there a difference in infection between the groups. Only patients with tuberous sclerosis had evidence of neoplasia. No morphological or histological abnormalities of lymph nodes, spleen or thymus were present. Explanations for the difference between tuberous sclerosis and ataxia telangiectasia are discussed, together with the effect of immuno-surveillance on the development of malignancy.