What Matters to Chinese and Korean American Dementia Caregivers: Navigating Cultural Influences in Dementia Care from Caregivers' Perspectives.

Background: Chinese and Korean Americans are among the fastest-growing minority groups in the US but face disparities in income and limited English proficiency, leading to health inequities in Alzheimer's disease and related dementias (ADRD) care. Objective: This study aims to understand cultural influences in ADRD care from the perspectives of Chinese and Korean American caregivers to inform culturally sensitive support for caregivers in Asian immigrant populations. Methods: We conducted a study that was part of a broader project aimed at informing the cultural adaptation of the NYU Caregiver Intervention-Enhanced Support (NYUCI-ES) program specifically for Chinese and Korean American caregivers managing multiple chronic conditions. In our interviews with 14 Chinese American and 11 Korean American caregivers, we focused on how their roles as primary caregivers were influenced by cultural and family expectations, the impact of caregiving on their personal and emotional well-being, and the specific barriers they face in accessing healthcare for themselves and their relatives with dementia. Results: Cultural beliefs and values significantly influenced the perceptions and utilization of support systems among Chinese and Korean American caregivers. Family stigma and adherence to cultural norms impacted their caregiving experiences. The study also highlighted the added burden during the pandemic and the potential benefits of telehealth and information technology in ADRD care. Conclusions: Developing culturally tailored, person-centered programs is crucial to meeting the unique needs of Chinese and Korean American caregivers. This research contributes to understanding and supporting this vulnerable population, promoting healthcare equity for ADRD patients and caregivers.

Genome sequencing reveals underdiagnosis of primary ciliary dyskinesia in bronchiectasis.

BACKGROUND: Bronchiectasis can result from infectious, genetic, immunological and allergic causes. 60-80% of cases are idiopathic, but a well-recognised genetic cause is the motile ciliopathy, primary ciliary dyskinesia (PCD). Diagnosis of PCD has management implications including addressing comorbidities, implementing genetic and fertility counselling and future access to PCD-specific treatments. Diagnostic testing can be complex; however, PCD genetic testing is moving rapidly from research into clinical diagnostics and would confirm the cause of bronchiectasis. METHODS: This observational study used genetic data from severe bronchiectasis patients recruited to the UK 100,000 Genomes Project and patients referred for gene panel testing within a tertiary respiratory hospital. Patients referred for genetic testing due to clinical suspicion of PCD were excluded from both analyses. Data were accessed from the British Thoracic Society audit, to investigate whether motile ciliopathies are underdiagnosed in people with bronchiectasis in the UK. RESULTS: Pathogenic or likely pathogenic variants were identified in motile ciliopathy genes in 17 (12%) out of 142 individuals by whole-genome sequencing. Similarly, in a single centre with access to pathological diagnostic facilities, 5-10% of patients received a PCD diagnosis by gene panel, often linked to normal/inconclusive nasal nitric oxide and cilia functional test results. In 4898 audited patients with bronchiectasis, <2% were tested for PCD and <1% received genetic testing. CONCLUSIONS: PCD is underdiagnosed as a cause of bronchiectasis. Increased uptake of genetic testing may help to identify bronchiectasis due to motile ciliopathies and ensure appropriate management.

Evaluation of mandibular contour in patients with significant facial asymmetry.

Most previous studies on facial asymmetry have not specifically differentiated mandible deviation from structural asymmetry of the mandible. The purpose of this study was to assess the symmetry of the mandible by examining its contour in a cohort of patients with significant facial asymmetry. Eleven cases of facial asymmetry with chin deviation ≥10mm were enrolled. A voxel-paired median plane (optimal symmetry plane, OSP) and two landmark-based median planes were generated. The OSP was created by computing the best pairing of the bony voxels on the two sides. One side of the mandibular contour was mirrored onto the other side using the test plane. The contour differences were measured by distance and by area ratio. They were examined both in frontal and frontal downward inclined view. The contour symmetry of the mandible was that revealed by the plane that presented the best symmetry. The results showed that the OSP worked best in bisecting the contour into two symmetrical halves. Contour analysis showed relatively small discrepancies between the two sides. In conclusion, the mandibles retained an acceptable contour symmetry despite the presence of significant mandibular deviations. It is suggested that proper mandibular alignment be the primary objective in the correction of facial asymmetry.

Prediction of recurrence-free survival using a protein expression-based risk classifier for head and neck cancer.

Loco-regional recurrence in 50% of oral squamous cell carcinoma (OSCC) patients poses major challenge for oncologists. Lack of biomarkers that can predict disease aggressiveness and recurrence risk makes the scenario more dismal. On the basis of our earlier global proteomic analyses we identified five differentially expressed proteins in OSCC. This study aimed to develop protein biomarkers-based prognostic risk prediction model for OSCC. Sub-cellular expression of five proteins, S100A7, heterogeneous nuclear ribonucleoproteinK (hnRNPK), prothymosin α (PTMA), 14-3-3ζ and 14-3-3σ was analyzed by immunohistochemistry in test set (282 Indian OSCCs and 209 normal tissues), correlated with clinic-pathological parameters and clinical outcome over 12 years to develop a risk model for prediction of recurrence-free survival. This risk classifier was externally validated in 135 Canadian OSCC and 96 normal tissues. Biomarker signature score based on PTMA, S100A7 and hnRNPK was associated with recurrence free survival of OSCC patients (hazard ratio=1.11; 95% confidence interval 1.08, 1.13, P<0.001, optimism-corrected c-statistic=0.69) independent of clinical parameters. Biomarker signature score stratified OSCC patients into high- and low-risk groups with significant difference for disease recurrence. The high-risk group had median survival 14 months, and 3-year survival rate of 30%, whereas low-risk group survival probability did not reach 50%, and had 3-year survival rate of 71%. As a powerful predictor of 3-year recurrence-free survival in OSCC patients, the newly developed biomarkers panel risk classifier will facilitate patient counseling for personalized treatment.

Serum albumin and hemoglobin are associated with physical function in community-living older persons in Singapore.

OBJECTIVES: Albumin and hemoglobin are viewed as markers of nutritional and inflammatory status. This study examined the associations of serum albumin and hemoglobin with physical function in community-living older adults. DESIGN: Population-based cross-sectional and longitudinal study. SETTING: The Singapore Longitudinal Aging Studies (SLAS), a community-based study in urban Singapore. PARTICIPANTS: 2762 older adults aged 55 and above assessed at baseline, and 1829 at follow up 1-2 years later. MEASUREMENTS: Serum albumin and hemoglobin, Performance Oriented Mobility Assessment (POMA), knee extension strength at baseline, and Instrumental Activities of Daily Living (IADL) at baseline and follow up. RESULTS: In cross-sectional multivariate analyses that adjusted for haemoglobin and other confounders, albumin showed a significant linear association (p<0.001) with POMA balance score (b=0.06, SE=0.02) and knee extension strength (b=0.70, SE=0.10). Independently of albumin, hemoglobin also showed a significant linear association with POMA balance score (b=0.09, SE=0.04). In longitudinal analyses, albumin was significantly associated with IADL decline (IADL total score drop>=1 during follow-up), OR= 0.92 (0.87 - 0.97), p=<0.01. CONCLUSION: The findings suggest that low levels of albumin and hemoglobin are potentially useful risk markers of physical functional decline in older adults. Further research should investigate whether improvements in the levels of albumin and hemoglobin alter the level of functional disability and risk of functional decline.

Disease modeling by gene targeting using microRNAs.

Zebrafish have proved to be a popular species for the modeling of human disease. In this context, there is a need to move beyond chemical-based mutagenesis and develop tools that target genes that are orthologous to those that are implicated in human heritable diseases. Targeting can take the form of creating mutations that are nonsense or mis-sense, or to mimic haploinsufficiency through the regulated expression of RNA effector molecules. In terms of the latter, we describe here the development and investigation of microRNA (miRNA)-based directed gene silencing methods in zebrafish. Unlike small interfering RNAs (siRNAs), miRNA-based methods offer temporal and spatial regulation of gene silencing. Proof-of-concept experiments demonstrate the efficacy of the method in zebrafish embryos, which provide the foundation for developing disease models using miRNA-based gene-targeting.

Immunoglobulin G4-related sclerosing disease: experience with this novel entity in a local hospital.

OBJECTIVE: To review the site of involvement, clinical presentation, and treatment outcome of patients having immunoglobulin G4-related sclerosing disease in a local regional hospital. DESIGN: Retrospective case series. SETTING: Pamela Youde Nethersole Eastern Hospital, Hong Kong. PATIENTS: All patients with a diagnosis of immunoglobulin G4-related sclerosing disease in the hospital diagnosed in the period from April 2008 to March 2010. RESULTS: A total of 12 patients with involvement of various organs were identified. There was a male predominance (male-to-female ratio=5:1). The mean age at diagnosis was 65 years. The salivary glands, biliary tract, pancreas, and cervical lymph nodes were the commonest involved sites. The immunoglobulin G4 level was elevated in 83% of the patients. Patients usually appeared to respond well to steroid treatment. CONCLUSION: Immunoglobulin G4-related sclerosing disease is a systemic disease and can involve various systems.

Zebrafish as a model for long QT syndrome: the evidence and the means of manipulating zebrafish gene expression.

Congenital long QT syndrome (LQT) is a group of cardiac disorders associated with the dysfunction of cardiac ion channels. It is characterized by prolongation of the QT-interval, episodes of syncope and even sudden death. Individuals may remain asymptomatic for most of their lives while others present with severe symptoms. This heterogeneity in phenotype makes diagnosis difficult with a greater emphasis on more targeted therapy. As a means of understanding the molecular mechanisms underlying LQT syndrome, evaluating the effect of modifier genes on disease severity as well as to test new therapies, the development of model systems remains an important research tool. Mice have predominantly been the animal model of choice for cardiac arrhythmia research, but there have been varying degrees of success in recapitulating the human symptoms; the mouse cardiac action potential (AP) and surface electrocardiograms exhibit major differences from those of the human heart. Against this background, the zebrafish is an emerging vertebrate disease modelling species that offers advantages in analysing LQT syndrome, not least because its cardiac AP much more closely resembles that of the human. This article highlights the use and potential of this species in LQT syndrome modelling, and as a platform for the in vivo assessment of putative disease-causing mutations in LQT genes, and of therapeutic interventions.

Longitudinal study of Chinese patients with pernicious anaemia.

BACKGROUND: The survival of whites who have been treated for pernicious anaemia (PA) is unaffected, apart from incurring a greater risk of gastric cancers. The long term outcome of PA in Chinese is unknown. METHODS: A hospital based prospective longitudinal study of Chinese PA patients was conducted. Patients with known cancers were excluded. RESULTS: From 1994 to 2007, 199 intrinsic factor antibody (IFA) positive and 168 IFA negative patients were recruited. Both cohorts had similar baseline characteristics, except the IFA positive patients had more severe haematological findings and more thyrogastric immune features; also more IFA negative patients had type 2 diabetes mellitus and gastrointestinal (GI) disease or GI surgery. Both cohorts had a good haematological response but an unsatisfactory neurological response to treatment. Hypothyroidism developed in patients of both cohorts during follow-up. 24 IFA positive patients and 7 IFA negative patients developed cancers (p = 0.007) during follow-up. 20% of all cancers were gastric carcinoma. Mean survival of both cohorts was similar. Mean survival of IFA positive patients with and without cancers was 64 and 129 months, respectively (p<0.001), and that of IFA negative patients 36 and 126 months, respectively (p<0.001). Death rates were 31% in the IFA positive cohort and 21% in the IFA negative cohort (p = 0.028). Cancer related death rates of IFA positive and IFA negative cohorts were 37% and 14%, respectively (p = 0.014). CONCLUSION: The survival period of Chinese with PA who have received treatment is good, but there is an increased risk of gastric cancers. IFA positive patients have a higher risk of developing all types of cancers and cancer related deaths than IFA negative patients.

The attachment, proliferation, and wound healing of endothelial and smooth muscle cells on nitinol thin film in vitro.

Nitinol (TiNi) thin film is a potentially useful material for various clinical applications, e.g., vascular stents. In this study we examined the biological functions of bovine endothelial cell (BAEC) and bovine smooth muscle cells (BSMC) on 1-mum thick amorphous TiNi films. BAEC and BSMC both attached on TiNi film, and exhibited increased cell spreading in the presence of serum containing media. Both cell types had decreased cell proliferation on TiNi as compared to glass control; however, BAEC had significantly greater proliferation rate than BSMC on TiNi. In an in vitro wound model, BSMC migrated faster than BAEC, resulting in a quicker closure of the monolayer. These results provide important insights into the interactions of vascular cells and TiNi thin film, and will help us to optimize the surface properties of TiNi film for applications in the vascular system.

Observer agreement in the grading of oral epithelial dysplasia.

OBJECTIVES: To determine the extent of observer agreement in diagnosis of oral epithelial dysplasia (OED). Published studies of OED examiner agreement report relatively low agreement levels; however, these studies were limited by the methodologies employed. METHODS: For this study, 64 slides were each independently examined twice by three oral pathologists. Consistency was assessed by determining intra- and interexaminer agreement. Conformity was assessed by using the modal diagnosis as a gold standard. RESULTS: The group showed moderate interobserver agreement when grading the presence or absence of OED with a group-simple kappa (Ks) of 0.51 (95% CI = 0.42-0.61), and substantial agreement when using a 5-point ordinal scale with a group-weighted kappa (Kw) of 0.74 (95% CI = 0.64-0.85). The group showed fair to substantial intraexaminer agreement when assessing the presence or absence of OED, with Ks ranging from 0.22 to 0.78, and showing almost a perfect agreement using a 5-point ordinal scale, with Kw ranging from 0.82-0.96. Conformity with the comparison standard modal diagnosis was almost perfect, with pairwise Kw ranging from 0.81 to 0.92. CONCLUSION: Overall, there was substantial intra- and interobserver consistency and almost perfect conformity in the grading of OED. Appropriate statistical methods are necessary to determine the degree of observer agreement.

Considerations in the assessment and management of older people with chronic pain.

INTRODUCTION: The aim of the paper is to describe the philosophical underpinnings and methodologies in the management of chronic pain in older people. METHODS: The paper represents a summary of the data concerning the management of pain in older people. These data have been gleaned from various sources, including textbooks, reviews, original papers and conference reports. RESULTS: Persistent pain affects approximately 50% of the older population above 65 years. Chronic pain describes a syndrome of persistent pain and accompanying adverse psychosocial consequences and functional disabilities. This is believed to be an inaccurate appraisal of the nociceptive stimulus by the patient. Assessment is based on a multidisciplinary cognitive-behavioural model. Management consisting of a seamless blend of pharmacological, physical and psychological therapies is likely to yield the best results. CONCLUSION: Chronic pain in older people is an emerging problem in the specialty of geriatric medicine. The traditional multidisciplinary approach is likely to give good results.

Is increasing age associated with mortality in the critically ill elderly.

INTRODUCTION: Age has been cited as a predictor of mortality in the intensive care unit (ICU) and suggested as a criterion for rationing resources. We investigated the association of age with both ICU mortality and hospital mortality. MATERIALS AND METHODS: Patients admitted in 1998 to our Medical ICU (MICU) were retrospectively analysed by stratifying them into four groups: the reference group (55-64 years), the young old (65-74 years), the old old (75-84 years) and the oldest old (more than 85 years). The statistical association of age with ICU mortality and total hospital mortality was determined whilst controlling for the APACHE II(M) score (APACHE II score modified to exclude points for age), the number of organ failures and the presence of a high risk admitting diagnosis. RESULTS: After controlling for disease severity, the ICU mortality and the total hospital mortality were not associated with age. The total hospital mortality was associated with the APACHE II(M) score (Odds ratio (OR), 1.08; 95% Confidence intervals (CI), 1.04-1.12), the number of organ failures (OR, 2.03; CI, 1.50-2.67) and the presence of a high risk diagnosis (OR, 3.50; CI 1.93-6.37). The ICU mortality was also associated with the APACHE II(M) score (OR, 1.07; CI, 1.03-1.11), the number of organ failures (OR, 1.63; CI, 1.26-2.09) and the presence of a high risk diagnosis (OR, 3.22; CI 1.81-5.76). CONCLUSIONS: We did not find a statistically significant association between age and mortality. We recommend that age should not be used as a criterion for admission.

Epstein-Barr virus detection in non-Hodgkin's lymphoma of the oral cavity: an immunocytochemical and in situ hybridization study.

OBJECTIVE: The purpose of this study was to histologically characterize a series of oral non-Hodgkin's lymphomas (NHLs) and to investigate latent and lytic Epstein-Barr virus (EBV) infection in these. STUDY DESIGN: The revised European-American Lymphoma classification system (41) was used to categorize 58 cases of oral NHL, which included 9 immunosuppression-related NHLs. EBV infection was determined by in situ hybridization for Epstein-Barr virus-encoded RNA and by immunohistochemistry for the EBV antigens latency membrane protein, Epstein-Barr nuclear antigen-2 (EBNA2) and Z EBV replication activator protein. RESULTS: Most tumors were B-cell lymphomas (78%), but the proportion of T-cell lymphomas was surprisingly high (22%). The most common histologic subtypes were diffuse large B-cell lymphomas (45%), peripheral T-cell lymphomas (19%), and follicle center lymphomas (14%). Two thirds of the known immunosuppression-related NHLs were T-cell lymphomas. All of the immunosuppression-related tumors were EBV-infected, whereas the EBV infection rate in the NHLs of the remaining patients presumed to be immunocompetent was only 9%. Most EBV-positive tumors expressed neither of the latent antigens (ie, latency membrane protein and Epstein-Barr nuclear antigen-2), and coexpression of the 2 was observed only in immunosuppressed patients. Z EBV replication activator protein expression, which is indicative of replicative infection, occurred only in immunosuppressed individuals. CONCLUSIONS: Diffuse large B-cell lymphomas were the most common histologic subtype of oral NHLs, but T-cell lymphomas were relatively common and frequently occurred in states of immunosuppression. EBV may play a limited role in the initiation of lymphoma in the immunocompetent patient, but the virus may be of importance in progression of the disease in those patients with more aggressive tumors, as immunosuppression occurs.

The sleeper Bostrichthys sinensis (family Eleotridae) stores glutamine and reduces ammonia production during aerial exposure.

Bostrichthys sinensis inhabits brackish water, living in the crevices of the river mouths of Shang Xi and Guangdong, China. In its natural habitat, it may encounter aerial exposure frequently during low tides, and it usually remains quiescent in the absence of water. Upon aerial exposure in the laboratory, the ammonia excretion rate decreased to one-fourth that of the submerged control. Although all the enzymes of the ornithine-urea cycle were detected in the liver of this fish, the activity of hepatic carbamoyl phosphate synthetase was too low for the cycle to be functioning. Indeed, ammonia accumulated in the tissues and was not converted to urea. Results indicate that ammonia produced through amino acid catabolism was detoxified to glutamine during the first 24 h of aerial exposure. The excess amount of glutamine stored in the muscle during this period couldaccount approximately for the reduction in ammonia equivalent excreted. There was indeed a significant increase in the activity of glutamine synthetase from the liver of specimens exposed to terrestrial conditions. In contrast to the production of alanine, formation of glutamine is energetically expensive. Since B. sinensis remained relatively inactive on land, the reduction in energy demand for muscular activity might provide it with the opportunity to exploit glutamine formation as a means to detoxify ammonia. After 72 h of aerial exposure, B. sinensis reduced internal ammonia production, possibly through reductions in proteolysis and amino acid catabolism, to avoid excessive accumulation of ammonia.

The practice of foregoing life support in the critically ill "old old": a Singapore perspective.

OBJECTIVE: To study the practice of foregoing life support (FLS) therapy between the young old and the old old. PATIENTS AND METHODS: This is a retrospective case-control study of case records for FLS events and illness characteristics among young old patients (55 to 74 years) and old old patients (75 years and older) admitted in 1998 to the medical intensive care unit (MICU). RESULTS: Fifty-seven out of 282 patients (20.2%) had FLS orders. There was no statistical difference in the use of FLS orders between the young old and the old old (17.1% versus 27.0%, P = 0.06), although there was a trend towards more frequent use in the old old. APACHE II(M) score (APACHE II score calculated without inclusion of points for age) and a high risk admitting diagnosis correctly predicted 80.5% of FLS events. A higher frequency of relatives of old old patients (20.8%) initiated FLS discussions compared to the young old (6%). In both groups, the child was the main surrogate decision-maker (n = 38, 66.7%). Medical futility/poor prognosis was the most common reason for FLS, accounting for 86.9% of patients. Withdrawing or withholding of mechanical ventilation was the most common mechanism (66.7%) of FLS. The majority (61.4%) died in the MICU after FLS. Of the 57 patients who had FLS orders, 1 young old and 3 old old survived till hospital discharge. CONCLUSION: Illness severity, as reflected by the APACHE II(M) score and the presence of a high-risk diagnosis, rather than age, predicted FLS orders.

Computer analysis of prolonged lower oesophageal sphincter pressure recordings.

The aim of the study was to validate a recently developed computer program for the analysis of prolonged recordings of lower oesophageal sphincter pressure. Thirty 1-hour stretches were selected from sets of 24-h pressure signals recorded from the pharynx, oesophagus, lower oesophageal sphincter (LOS) and stomach in 10 ambulant patients with gastrooesophageal reflux disease. Three experienced investigators visually analysed end-expiratory LOS pressures and transient lower oesophageal sphincter relaxations (TLOSRs), using published criteria. A computer program was developed for calculation of an end-expiratory pressure curve and detection of TLOSRs using the same criteria. Although the results showed an maximum deviation from the mean of 11.1% and 14.8% for manually calculated LOS pressures and visually detected TLOSRs, respectively only 62.1% of the detected TLOSRs were detected by all three observers. LOS pressure as measured by the computer closely approximated the mean of the LOS pressures calculated by the three observers. Although the total number of TLOSRs was comparable to that assessed by visual analysis, the computer detected only 46% of the TLOSRs detected by each observer and 56.8% of the TLOSRs detected by all observers. It is concluded that automated calculation of end-expiratory LOS pressure is feasible and yields reliable results, whereas automated detection of TLOSRs could not be satisfactorily accomplished. Our study showed that improvement of computer algorithms for TLOSR detection is desirable. However, the previously described criteria for detection of TLOSRs are insufficiently precise; further refinement of these criteria will be necessary to reduce the large discrepancies between the outcome of detection of TLOSRs by computer and by humans, and to reduce the equally large discrepancies between the results of detection by different human observers.

Oxygen deficit determinations for a major river in eastern Hong Kong, China.

Determination of oxygen deficit in the Hong Kong Shing-Mun River was based on the oxygen uptake by water, algal respiration and river sediment and the oxygen supplied to the river by surface reaeration and algal photosynthesis. A systematic study was conducted to examine the effect of water temperature, flow velocity and water depth on both the oxygen demands and the oxygen supplies. The oxygen budget of a water column in a selected section of the river was modeled. The results of the oxygen budget analysis showed that when water temperature was around 10 degrees C (the lowest temperature in the river), no deficit was observed. When water temperature was 10 degrees C to 20 degrees C, a small oxygen deficit appeared, especially in the deeper water. At the highest water temperature (30 degrees C), the oxygen deficit was maximal, -6.84 g O2/m2/day, in the night-time during the Spring tide period.

Expression of bone sialoprotein and osteopontin in breast cancer bone metastases.

Bone sialoprotein (BSP) and osteopontin (OPN) are prominent, mineral-associated proteins in the extracellular matrix of bone that have been implicated in the metastatic activity of cancer cells. The expression of BSP, which is normally restricted to mineralizing tissues, has been observed in cancers with a high propensity for forming bone metastases. To investigate the relationship between BSP expression and the formation of bone metastases we have conducted an initial study of the expression of BSP in 10 intraductal breast carcinoma bone metastases using immunostaining and in situ hybridization, and compared the expression with OPN. The metastases were characterized by the infiltration of tumour cells into bone with extensive bone resorption evident. Moderate to strong staining for BSP was observed in all (100%) carcinomas, which also expressed BSP mRNA as determined by in situ hybridization. Variable staining for BSP was also observed in the mineralized bone and expression of BSP mRNA could be observed in osteoblastic cells on the bone surface and in some osteocytes at sites of bone remodelling. Contrary to a previous report, BSP expression could be demonstrated by PCR in three breast cancer cell lines, MCF-7, T47-D and MDA-MB-231. Moreover, in sub-cutaneous tumours formed by MDA-MB-231 breast cancer cells injected into athymic mice, higher immunostaining for BSP was seen in large ulcerating tumours in which mineral deposits were formed. In contrast to BSP, staining for OPN in bone metastases was generally restricted to the interface between tumor cells and bone surface of the carcinomas. While OPN staining was also observed in the cytoplasm of osteoclasts, which showed strong hybridization to a digoxygenin-labelled OPN cRNA probe, expression of OPN was not clearly detectable in the tumour cells. These studies provide the first demonstration of BSP expression by tumour cells in bone metastases and support the concept that BSP may have a role in targeting metastatic cells to bone. Expression of OPN in bone metastases appears to be related to increased bone resorptive activity by osteoclasts.

Cancer of the tongue.

Squamous cell carcinoma of the tongue is the most common intraoral malignancy. It may be preceded by visible precursor lesions showing hyperkeratosis, erythroplakia or a combination of these conditions. The clinical appearance is highly variable, and ranges from asymptomatic white patches to large fungating, infiltrating lesions. Earlier detection of squamous cell carcinoma of the tongue should improve survival rates for this malignancy, which have not appreciably increased over the past several decades. The oral cavity is an accessible site and the dentist has an important role to play in early detection.