Tumor immune microenvironment is influenced by frameshift mutations and tumor mutational burden in gastric cancer.

PURPOSE: Immunoscore can effectively predict prognosis in patients with colon cancer; however, its clinical application is limited. We modified the Immunoscore and created a tumor immune microenvironment (TIM) classification system for gastric carcinoma. Unlike previous studies that used small sample sizes or focused on particular immune-cell subtypes, our simplified system enables pathologists to classify gastric carcinomas intuitively using H&E-stained sections. METHODS: Samples from 326 patients with advanced gastric carcinoma were reviewed and analyzed by pathologists using simple determination and digital image analysis. Comprehensive results of cancer-panel sequencing, Epstein-Barr‒virus (EBV) status, and PD-L1, HER2, ATM, PTEN, MET, FGFR2, and EGFR immunohistochemistry were evaluated with respect to the TIM class. RESULTS: The TIM was classified as "hot" (n = 22), "immunosuppressed" (n = 178), "excluded" (n = 83), or "cold" (n = 43). TIM category was significantly associated with numbers of frameshift mutations (P < 0.001) and high tumor mutational burden (P < 0.004), and predicted overall survival. It was also significantly associated with age, histological type, degree of fibrosis, PD-L1 expression, loss of ATM and PTEN expression (P < 0.001), sex, EBV positivity, and HER2 overexpression (P < 0.04). "Hot" tumors were frequent in PD-L1 expressing and EBV-positive samples, and in those with ATM and PTEN loss. "Excluded" tumors were frequent in HER2-positive cases, whereas "cold" tumors were more frequent in younger patients with poorly cohesive histology and high fibrosis levels. CONCLUSIONS: TIM classification system for gastric carcinoma has prognostic significance and results in classes that are associated with molecular characteristics.

Adjuvant concurrent chemoradiation therapy in patients with microscopic residual tumor after curative resection for extrahepatic cholangiocarcinoma.

PURPOSE: We investigated the role of adjuvant concurrent chemoradiation therapy (CCRT) in patients with a microscopically positive resection margin (R1) after curative resection for extrahepatic cholangiocarcinoma (EHCC). METHODS/PATIENTS: A total of 84 patients treated with curative resection for EHCC were included. Fifty-two patients with negative resection margins did not receive any adjuvant treatments (R0 + S group). The remaining 32 patients with microscopically positive resection margins received either adjuvant CCRT (R1 + CCRT group, n = 19) or adjuvant radiation therapy (RT) alone (R1 + RT group, n = 13). RESULTS: During the median follow-up period of 26 months, the 2-year locoregional recurrence-free survival (LRRFS), disease-free survival (DFS), and overall survival rates (OS) were: 81.8, 62.6, and 61.5% for R0 + S group; 71.8, 57.8, and 57.9% for R1 + CCRT group; and 16.8, 9.6, and 15.4% for R1 + RT group, respectively. Multivariate analysis revealed that the R1 + CCRT group did not show any significant difference in survival rates compared with the R0 + S group. The R1 + RT group had lower LRRFS [hazard ratio (HR) 3.008; p = 0.044], DFS (HR 2.364; p = 0.022), and OS (HR 2.417; p = 0.011) when compared with the R0 + S and R1 + CCRT group. CONCLUSIONS: A lack of significant survival difference between R0 + S group and R1 + CCRT group suggests that adjuvant CCRT ameliorates the negative effect of microscopic positive resection margin. In contrast, adjuvant RT alone is appeared to be inadequate for controlling microscopically residual tumor.

Genome-wide expression analysis of a rice mutant line under salt stress.

Salinity is a major environmental stress to plants. In this study, the ability of plants to tolerate salt was investigated by studying growth, physiological characteristics, and expression levels of genes related to the salt-stress response in the salt-tolerant rice mutant (Till-II-877), which was derived from γ-ray irradiation. Compared to plants grown under normal conditions, the height and root length of wild type (WT) were reduced by approximately 40 and 29% following exposure to salt stress for 3 weeks, whereas Till-II-877 line showed 29 and 23% reductions in plant height and root length, respectively. No significant changes were observed in total chlorophyll content, and the malondialdehyde content of the mutant increased less than that of the WT under salt treatment. Gene expression was compared between the WT and mutant lines using microarray analysis. An unbiased analysis of the gene expression datasets allowed us to identify the pathways involved in salt-stress responses. Among the most significantly affected pathways, changes in gene expression were observed in α-linolenic acid and linoleic acid metabolism (in lipid metabolism), fructose and mannose metabolism and glycolysis-gluconeogenesis (in carbohydrate metabolism), cysteine and methionine metabolism (in amino acid metabolism), and carbon fixation (in the energy metabolism of photosynthetic organisms) under salt stress. These results show that the differential response of plants subjected to salt stress was due to changes in multiple metabolic pathways. These findings increase our understanding of the effects of salt stress in rice and may aid in the development of salt-tolerant rice cultivars.

Chemical and genetic diversity of high-seed-yield sorghum (Sorghum bicolor M.) germplasms.

This study evaluated the chemical and genetic diversity of high-seed-yield sorghum germplasms from Korea, the United States, and South Africa. We identified significant differences in the chemical contents of whole plants at the heading stage in all cultivars, including differences in crude protein, fat, fiber, ash, neutral detergent fiber, acid detergent fiber, mineral, and fatty acid contents. Our results suggest that Banwoldang is the most appropriate cultivar for roughage because of its high protein yield. We identified significant differences in the tannin, flavonoid, amylose, mineral, crude fat, fatty acid, and 3-deoxyanthocyanin contents in the whole grain from all cultivars, but not in the mineral or crude fat contents. Tannin levels were generally low. IS645 contained the highest levels of flavonoids and linolenic acid compounds, and Moktak had the highest amylose and deoxyanthocyanidin content in the grain. To assess genetic diversity, we used 10 simple sequence repeat (SSR) primer sets to identify 38 alleles with 3-8 alleles per locus. Based on phylogenetic analysis of the SSR markers, the sorghum cultivars were divided into three major groups. Comparison of clusters based on chemical compositions with those based on SSRs showed that the groups formed by the three native Korean cultivars clustered similarly in molecular dendrograms. Association analysis was conducted for the 10 SSR marker; 48 chemical and growth traits were present for two marker traits (seed color and whole plant fatty acid content) with significant marker-trait associations. These markers could be used to select sorghum cultivars for breeding programs.

Development of a transposon-based marker system for mutation breeding in sorghum (Sorghum bicolor L.).

Under certain circumstances, transposable elements (TE) can create or reverse mutations and alter the genome size of a cell. Sorghum (Sorghum bicolor L.) is promising for plant transposon tagging due to its small genome size and its low content of repetitive DNA. We developed a marker system based on targeted region amplification polymorphisms (TE-TRAP) that uses the terminal inverted repeats (TIRs) of transposons. A total of 3816 class 2 transposons belonging to the PIF/Harbinger family were identified from the whole sorghum genome that produced five primers, including eight types of TIRs. To define the applicability and utilization of TE-TRAP, we used 21 individuals that had been bred after ɤ-ray irradiation. In total, 31 TE-TRAP, 16 TD, and 21 AFLP primer combinations generated 1133, 223, and 555 amplicons, respectively. The percent polymorphic marker was 62.8, 51.1, and 59.3% for the TE-TRAP, TD, and AFLP markers, respectively. Phylogenetic and principal component analyses revealed that TE-TRAP divided the 21 individuals into three groups. Analysis of molecular variance suggested that TE-TRAP had a higher level of genetic diversity than the other two marker systems. After verifying the efficiency of TE-TRAP, 189 sorghum individuals were used to investigate the associations between the markers and the ɤ-ray doses. Two significant associations were found among the polymorphic markers. This TE-based method provides a useful marker resource for mutation breeding research.

Comparative genomic hybridization analysis of rice dwarf mutants induced by gamma irradiation.

Comparative genomic hybridization (CGH) is a powerful tool used to analyze changes in copy number, polymorphisms, and structural variations in the genome. Gene copy number variation (CNV) is a common form of natural diversity in the genome, which can create new genes and alter gene structure. Thus, CNVs may influence phenotypic variation and gene expression. In this study, to detect CNVs, we irradiated rice seeds with gamma rays (300 Gy) and selected two dwarf mutagenized plants, GA-III-189 and -1052, in the M3 generation. These plants were subjected to CGH analysis using Agilent's RICE CGH array. Most of the CNVs identified were less than 10 kb in length. We detected 90 amplified and 18 deleted regions in GA-III-189, and 99 amplified and 11 deleted regions in GA-III-1052. Of note, CNVs were located on chromosome 12 in both GA-III-189 and -1052, which contained 39 commonly amplified regions in 29 genes. The commonly amplified genes included six genes encoding F-box domain-containing proteins. Alterations in these F-box domain-containing genes were confirmed by quantitative RT-PCR. Integration of CGH and gene expression data identified copy number aberrations and novel genes potentially involved in the dwarf phenotype. These CGH and gene expression data may be useful for uncovering the mechanisms underlying the dwarf phenotype.

Pre-harvest foliar application of ethephon strengthens gibberellins-induced fruit expansion in Pyrus pyrifolia.

To identify the roles of ethylene in fruit development in Japanese pear Pyrus pyrifolia 'Niitaka', one of the non-climacteric genotypes, source-sink strength and fruit development during fruit expansion were investigated when ethephon was applied after a conventional gibberellic acid (GA) lanolin paste treatment on the pedicel. The results demonstrate that the conventional GA treatment during the early stage of fruit expansion resulted in larger fruit size and advanced fruit maturation, but pre-harvest foliar application of ethephon only advanced fruit maturation. However, pre-harvest foliar application of ethephon with a preceding conventional GA treatment during the early stage of fruit expansion dramatically improved fruit size and advanced fruit maturation over GA or ethephon alone. Moreover, the early foliar application of ethephon showed a better efficacy in increasing fruit size than the late spraying. A further study revealed that when ethephon was applied after the conventional GA treatment, it improved source-sink strength associated with leaf photosynthesis and the specific rate of [13C] accumulation in fruit, and also strengthened cell expansion more than did GA or ethephon alone.

Polymorphisms in the promoter regions of the CXCL1 and CXCL2 genes contribute to increased risk of alopecia areata in the Korean population.

Alopecia areata (AA) is a common disease, which causes hair loss in humans. AA has a genetically complex inheritance. This study investigated the possible correlations between single nucleotide polymorphisms (SNPs) in the promoter regions of the chemokine (C-X-C motif) ligand 1 (melanoma growth stimulating activity, alpha) (CXCL1) and chemokine (C-X-C motif) ligand 2 (CXCL2) genes and the development of AA in the Korean population. Two hundred and thirty-five AA patients and 240 control subjects were recruited. The specific SNPs occurring in the promoter regions of the CXCL1 and CXCL2 genes (rs3117604, -429C/T and rs3806792, -264T/C, respectively) were genotyped. All data obtained was evaluated using the SNPStats, SPSS 18.0, and the Haploview v.4.2 software platforms. The Odd's ratios (OR), 95% confidence intervals (CI), and P values were calculated using multiple logistic regression models. Analyses of the genetic sequences obtained revealed a significant correlation between the two SNPs and the development of AA (rs3117604, P = 0.0009 in co-dominant model 1, P = 0.01 in co-dominant model 2, P = 0.004 in the dominant model, P = 0.005 in the log-additive model, P = 0.012 in allele distribution; rs3806792, P = 0.036 in co-dominant model 2, P = 0.0046 in the log-additive model). The TT and CC haplotypes were also observed to show a significant association with increased risk of AA (TT haplotype, P = 0.0018; CC haplotype, P = 0.0349). Our data suggests that the CXCL1 and CXCL2 genes may be associated with AA susceptibility.

Assessment of CASP gene polymorphisms in periodontal disease.

Caspases (CASP) are intracellular proteases that play roles as mediators of apoptosis. Activation of caspase 3 is enhanced in chronic periodontitis. Thus, we hypothesized that single nucleotide polymorphisms (SNPs) of CASP genes might be associated with this condition in the Korean population. To investigate whether such polymorphisms might be involved in the development of periodontal disease, 51 patients and 33 control subjects were assessed. A total of 201 CASP gene SNPs were analyzed with genotypes being determined using and Axiom(TM) genome-wide human assay. SNPStats and SPSS 18.0 were used for the analysis of genetic data and logistic regression models were utilized to evaluate odds ratios, 95% confidence intervals, and P values. Of the 201 SNPs, only three (rs12108497, rs4647602, and rs113420705, all in the CASP3 gene) were significantly associated with chronic periodontitis (P < 0.05). The minor allele frequencies of these SNPs were higher in the patient group than in the control group. In addition, the TC and GT haplotypes formed by rs4647602 and rs113420705 were found to be associated with chronic this disease (TC haplotype, P = 0.0039; GT haplotype, P = 0.002). These results suggest that CASP3 gene polymorphisms may be associated with susceptibility to periodontal disease in the Korean population.

Polymorphic microsatellite loci isolated from Cervus unicolor (Cervidae) show inbreeding in a domesticated population of Taiwan Sambar deer.

Primers for eight microsatellites were developed; they successfully amplified DNA from 20 domesticated Formosan Sambar deer (Cervus unicolor swinhoei). All loci were polymorphic, with 10-19 alleles per locus. The average observed heterozygosity across loci and samples was 0.310, ranging from 0 to 0.750 at each locus. All loci but one, CU18, deviated from Hardy-Weinberg equilibrium due to excessive homozygosity in these domesticated broodstocks, reflecting inbreeding. These microsatellite loci will be useful, not only for assessment of population structure and genetic variability, but also for conservation of wild deer populations in Taiwan.

Validation of the Jamaican maternal sexual role modelling questionnaire / Validación del cuestionario sobre la modelación del rol sexual materno en Jamaica

OBJECTIVE: Urban Jamaican adolescent girls face significant risk for sexually transmitted infections including HIV. Studies from the United States of America have found that parents influence adolescents' sexual risk attitudes and behaviours through parent-child sexual communication and monitoring/ supervision. Data from an ongoing mother-daughter HIV risk reduction intervention study in Kingston, Jamaica identified an additional influence of adolescent girls' sexual risk - maternal sexual role modelling (MSRM). As no reliable and valid questionnaires existed to measure MSRM, one was developed. The objective of the current study was to evaluate the psychometric properties of the Jamaican Maternal Sexual Role Modelling questionnaire. METHOD: Data were collected from 209 Jamaican female adolescents recruited from Kingston, St Andrew and St Catherine parishes. RESULTS: The final 19-item Jamaican MSRM questionnaire was found to have excellent internal reliability (Cronbach's alpha = 0.89). Content validity expert ratings and modified kappa statistics were all 1.0. Principal component analysis identified a three-factor structure that accounted for 53.7% of the variance. Greater MSRM scale scores, indicating more positive and protective maternal sexual role modelling, were associated with less sexual experience, lower intentions to have sex, greater intentions to use condoms if having sex and greater condom use self-efficacy among adolescent girls. CONCLUSION: The MSRM scale was found to be a reliable and valid measure of Jamaican adolescent females' perceptions of their mothers' sexual role modelling. Further research is needed to assess the reliability and validity of the instrument with other populations.

OBJETIVO: Las jóvenes adolescentes urbanas de Jamaica, enfrentan un riesgo significativo de infecciones de trasmisión sexual, incluyendo el VIH. Estudios de los Estados Unidos de América han encontrado que los padres influyen en las conductas y actitudes de riesgo sexual de los adolescentes a través de la comunicación entre padres e hijos sobre asuntos de sexo, acompañada de supervisión y monitoreo. Datos obtenidos a partir de un estudio de intervención que se desarrolla actualmente en Kingston, Jamaica, para reducir el riesgo de VIH madre-hija, identificaron una influencia adicional de riesgo sexual entre las adolescentes: la modelación del rol sexual materno (MRSM). Como que no existían cuestionarios válidos y fiables para medir la MRSM, se desarrolló uno a propósito de este trabajo. El objetivo del presente estudio fue evaluar las propiedades psicométricas del cuestionario de la modelación del rol sexual materno jamaicano. MÉTODO: Se recopilaron datos de 209 adolescentes jamaicanas reclutadas en los distritos de Kingston, St Andrew y St Catherine. RESULTADOS: Se halló que el cuestionario final MRSM jamaicano de 19 ítems poseía excelente fiabilidad interna (alfa de Cronbach = 0.89). Las valoraciones (ratings) de los expertos con respecto a la validez del contenido, así como las estadísticas Kappa modificadas, fueron todas 1.0. El análisis del componente principal identificó una estructura de tres factores que daba cuenta del 53.7% de la varianza. Mayores puntuaciones de la escala MRSM, que indicaban una modelación del rol sexual materno más positiva y protectora, estuvieron asociadas con menor experiencia sexual, menos intenciones de tener sexo, más intenciones de usar condón a la hora de mantener relaciones sexuales, y mayor auto-eficacia en el uso de condón entre las adolescentes. CONCLUSIÓN: Se halló que la escala MRSM es fiable y constituye una medida válida de las percepciones que las adolescentes jamaicanas tienen en relación con la modelación del rol sexual de sus madres. Se necesita continuar las investigaciones a fin de evaluar la fiabilidad y validez del instrumento con otras poblaciones.

Validation of the Jamaican Maternal Sexual Role Modelling Questionnaire.

OBJECTIVE: Urban Jamaican adolescent girls face significant risk for sexually transmitted infections including HIV Studies from the United States ofAmerica have found that parents influence adolescents' sexual risk attitudes and behaviours through parent-child sexual communication and monitoring/supervision. Data from an ongoing mother-daughter HIVrisk reduction intervention study in Kingston, Jamaica identified an additional influence of adolescent girls' sexual risk - maternal sexual role modelling (MSRM). As no reliable and valid questionnaires existed to measure MSRM, one was developed. The objective of the current study was to evaluate the psychometric properties of the Jamaican Maternal Sexual Role Modelling questionnaire. METHOD: Data were collected from 209 Jamaican female adolescents recruited from Kingston, St Andrew and St Catherine parishes. RESULTS: The final 19-item Jamaican MSRM questionnaire was found to have excellent internal reliability (Cronbach's alpha = 0.89). Content validity expert ratings and modified kappa statistics were all 1.0. Principal component analysis identified a three-factor structure that accounted for 53.7% of the variance. Greater MSRM scale scores, indicating more positive and protective maternal sexual role modelling, were associated with less sexual experience, lower intentions to have sex, greater intentions to use condoms if having sex and greater condom use self-efficacy among adolescent girls. CONCLUSION: The MSRM scale was found to be a reliable and valid measure of Jamaican adolescent females'perceptions of their mothers'sexual role modelling. Further research is needed to assess the reliability and validity of the instrument with other populations.

Pathotypes and genetic relationship of worldwide collections of Elsinoë spp. causing scab diseases of citrus.

Two scab diseases are recognized currently on citrus: citrus scab, caused by Elsinoë fawcettii, and sweet orange scab, caused by E. australis. Because the two species cannot be reliably distinguished by morphological or cultural characteristics, host range and molecular methods must be used to identify isolates. Four pathotypes of E. fawcettii and two of E. australis have been described to date based on host range. The host specificity and genetic relationships among 76 isolates from Argentina, Australia, Brazil, Korea, New Zealand, and the United States were investigated. Based on pathogenicity tests on eight differential hosts, 61 isolates were identified as E. fawcettii and 15 as E. australis. Of 61 isolates of E. fawcettii, 24 isolates were identified as the Florida broad host range (FBHR) pathotype, 7 as the Florida narrow host range (FNHR) pathotype, 10 as the Tryon's pathotype, and 3 as the "Lemon" pathotype. Two new pathotypes, the "Jingeul" and the satsuma, rough lemon, grape-fruit, clementine (SRGC), are described, and four isolates did not fit into any of the known pathotypes of E. fawcettii. Of the 15 isolates of E. australis from Argentina and Brazil, 9 belonged to the sweet orange pathotype and 6 from Korea to the natsudaidai pathotype. E. fawcettii and E. australis were clearly distinguishable among groups by random amplified polymorphic DNA-polymerase chain reaction (RAPD-PCR) assays and the E. fawcettii group was divided into three subgroups, A-1, A-2, and A-3. The A-1 group was composed of the FBHR, FNHR, and SRGC pathotypes; some Lemon pathotypes; and the uncertain isolates. The A-2 subgroup included all of the Tryon's pathotype isolates and one of the three Lemon pathotype isolates and the A-3 group contained the Jingeul pathotype isolates. E. australis was differentiated into two groups: B-1, the natsudaidai pathotype isolates, and B-2, the sweet orange pathotype isolates. Isolates of E. fawcettii and E. australis were clearly distinguishable by sequence analysis of the internal transcribed spacer (ITS) region and the translation elongation factor 1 alpha (TEF) gene. There were also fixed nucleotide differences in the ITS and TEF genes that distinguished subgroups separated by RAPD-PCR within species. We confirmed two species of Elsinoë, two pathotypes of E. australis, and at least six pathotypes of E. fawcettii and described their distribution in the countries included in this study.

First Report of Phytophthora palmivora, Causal Agent of Black Pod, on Cacao in Puerto Rico.

Black pod or Phytophthora pod rot is the most economically important and widespread disease of cacao, Theobroma cacao L. Total losses due to Phytophthora exceed $400 million worldwide (1), and several species are known to attack cacao with P. palmivora (E.J. Butler) E. J. Butler as the most common. All plant parts are infected, but pod infections are particularly damaging. Symptoms resembling those of black pod disease were observed at the National Plant Germplasm Collection System of cacao at the USDA-ARS Tropical Agriculture Research Station (TARS) in Mayaguez, Puerto Rico for a number of years. During May of 2005, to determine the etiology of the disease, small, surface disinfested sections of pod lesions were placed on water agar and incubated for 4 days. The formation of papillate, deciduous, ellipsoidal to ovoid sporangia produced on sympodial sporangiophores on fruits, fit the description of P. palmivora and the identification was confirmed on cultures on water agar (2). Chlamydospores were readily observed in diseased pods and observed in pure cultures on V8 agar (2). Eight, single hyphal tips were transferred to potato dextrose agar (PDA) (Sigma-Aldrich, St. Louis, MO) and maintained as stock cultures. For pathogenicity tests, healthy mature pods were surface disinfested and placed in a humidity chamber lined with moist paper towels. Eight isolates were tested on four fruits per isolate and the pathogenicity test was repeated once. Inoculum was prepared by growing each isolate on PDA for 5 days with irradiation at 24°C, adding approximately 3.0 ml of water to each plate, dislodging the sporangia with a glass rod, mixing the suspension, estimating spore numbers with a hemacytometer, and adjusting to 104 sporangia per ml. A small, sterile scalpel was used to make an approximately 20.0 mm cut on the fruit epidermis, and approximately 0.2 ml of inoculum was placed on the wound. Pods were evaluated daily for 2 weeks. For molecular analysis, each of the eight cultures were grown in 50% potato dextrose broth to produce mycelia for DNA extraction using the FastDNA kit (Q-Biogen1, Irvine, CA). The internal transcribed spacer (ITS) region of the ribosomal RNA gene cluster was amplified, purified, and sequenced for all eight isolates. The ITS sequences of GenBank Accession Nos. DQ987915 to DQ987922 were identical and exhibited strong similarity (>99% identity) to that of three previously described isolates of P. palmivora from cacao (GenBank Accession Nos. AF 228097, AF467093, and AF467089). P. palmivora has been reported on citrus, coconut, black pepper, and Arracacia xanthorrhiza in Puerto Rico (2,3) and inoculum may have originated from these host or imported on cacao planted into the cacao collection before 2000. USDA-ARS-TARS is the official site for the cacao germplasm collection, thus, a detailed integrated pest management plan that includes the evaluation for resistance, sanitation measures, and use of fungicides to reduce disease levels has been implemented. Decreasing incidence and severity of this disease is a top priority. To our knowledge, this is the first report of P. palmivora on cacao in Puerto Rico. References: (1) M. C. T. Braga et al. Agrotropica 1:108, 1989. (2) D. Erwin and O. K. Ribeiro. Phytophthora Diseases Worldwide. The American Phytopathological Society. St. Paul, MN, 1996. (3) E. Rosa-Marquez. J. Agric. Univ. P. R. 84:53, 2000.

Factors associated with emergency department visits due to acute asthma

It is important to identify characteristics related to poor disease control and frequent visits to the emergency department (ED). The objective of the present study was to compare the characteristics of patients attending the adult ED for treatment of asthma exacerbation with those attending an asthma specialist clinic (AC) in the same hospital, and to determine the factors associated with frequent visits to the ED. We conducted a cross-sectional survey of consecutive patients (12 years and older) attending the ED (N = 86) and the AC (N = 86). Significantly more ED patients than AC patients reported ED visits in the past year (95.3 vs 48.8 percent; P < 0.001) and had difficulty performing work (81.4 vs 49.4 percent; P < 0.001. Significantly more AC than ED patents had been treated with inhaled corticosteroids (75.6 vs 18.6 percent; P < 0.001) used to increase or start steroid therapy when an attack was perceived (46.5 vs 20.9 percent; P < 0.001) and correctly used a metered-dose inhaler (50.0 vs 11.6 percent; P < 0.001). The history of hospital admissions (odds ratio, OR, 4.00) and use of inhaled corticosteroids (OR, 0.27) were associated with frequent visits to the ED. In conclusion, ED patients were more likely than AC patients to be dependent on the acute use of the ED, were significantly less knowledgeable about asthma management and were more likely to suffer more severe disease. ED patients should be considered an important target for asthma education. Facilitating the access to ambulatory care facilities might serve to reduce asthma morbidity.

Factors associated with emergency department visits due to acute asthma.

It is important to identify characteristics related to poor disease control and frequent visits to the emergency department (ED). The objective of the present study was to compare the characteristics of patients attending the adult ED for treatment of asthma exacerbation with those attending an asthma specialist clinic (AC) in the same hospital, and to determine the factors associated with frequent visits to the ED. We conducted a cross-sectional survey of consecutive patients (12 years and older) attending the ED (N = 86) and the AC (N = 86). Significantly more ED patients than AC patients reported ED visits in the past year (95.3 vs 48.8%; P < 0.001) and had difficulty performing work (81.4 vs 49.4%; P < 0.001. Significantly more AC than ED patents had been treated with inhaled corticosteroids (75.6 vs 18.6%; P < 0.001) used to increase or start steroid therapy when an attack was perceived (46.5 vs 20.9%; P < 0.001) and correctly used a metered-dose inhaler (50.0 vs 11.6%; P < 0.001). The history of hospital admissions (odds ratio, OR, 4.00) and use of inhaled corticosteroids (OR, 0.27) were associated with frequent visits to the ED. In conclusion, ED patients were more likely than AC patients to be dependent on the acute use of the ED, were significantly less knowledgeable about asthma management and were more likely to suffer more severe disease. ED patients should be considered an important target for asthma education. Facilitating the access to ambulatory care facilities might serve to reduce asthma morbidity.

Integrating qualitative and quantitative methods: comparing HIV-related risk behaviors among Puerto Rican drug users in Puerto Rico and New York.

A dual site project was conducted to assess determinants of injection and sex-related risk behaviors among Puerto Rican drug users. The project focused on injection drug users and crack smokers, and was conducted in East Harlem, NY and Bayamón, PR in 1996-2000. Qualitative methods included ethnographic mapping, focus groups, in-depth interviews, and observations. A survey component (East Harlem, n = 800; Bayamón, n = 400) was also conducted. Procedures to ensure integration of methodologies and comparability of data were developed. This paper describes the qualitative and survey methods used, and presents the comparative HIV risk behaviors. The integration of the two methodologies served multiple functions: each component identified issues to be addressed in the other, enhanced cross-site comparability of data, and assisted in interpretation of findings. The survey data showed high levels of risk behaviors in both communities, with significantly higher levels of risk reported in Bayamón. Conducting studies of similar ethnic groups in different communities provides opportunities to examine diverse sources of influence on risk behaviors. The integration of qualitative and quantitative methods can enhance comparability and understanding of findings, particularly when there are differences in behaviors between communities.

Residential status and HIV risk behaviors among Puerto Rican drug injectors in New York and Puerto Rico.

This article investigates the association between residential status and human immunodeficiency virus (HIV) risk behaviors among island and New York Puerto Rican injection drug users (IDUs). We assigned 561 subjects from New York City and 312 from Puerto Rico to five residential status categories: living in parent's home, living in own home, living in other's home, living in temporary housing (hotel, single-room occupancy [SRO] hotels), and homeless (living in streets/shelters). Dependent variables included injection- and sex-related risk behaviors (sharing syringes, sharing other injection paraphernalia, shooting gallery use, and having paid sex). Chi square, t tests, and multivariate logistic analysis tests were performed separately by site. About one-quarter of the sample in each site was homeless. Island Puerto Ricans were more likely to live with their parents (44% vs. 12%, p < .001), and more New York IDUs lived in their own home (30% vs. 14%, p < .001). In New York, gallery use and paid sex were associated with living in other's home, living in parent's home, and being homeless. Sharing paraphernalia was related to living in other's home, living in temporary housing, and being homeless. In Puerto Rico, having paid sex was associated with homelessness. High-risk behaviors were more likely among homeless IDUs in both sites. Programs to provide housing and target outreach and other prevention programs for homeless IDUs would be helpful in reducing HIV risk.

Helicobacter pylori-associated iron-deficiency anemia in adolescent female athletes.

OBJECTIVE: The objective was to investigate the role of Helicobacter pylori infection in iron-deficiency anemia (IDA) of pubescent athletes. STUDY DESIGN: Blood sampling and a questionnaire survey were performed on 440 regular high school students and 220 athletes of a physical education high school. Hemoglobin, serum iron, total iron-binding capacity, ferritin, and immunoglobulin G antibody to H. pylori were measured to compare the prevalence of IDA and H. pylori infection in the groups. Nutritional analysis and a questionnaire survey for socioeconomic status were undertaken to compare and control for other risk factors that might influence IDA and H. pylori infection in the groups. In those with IDA coexistent with H. pylori infection, we also determined whether IDA can be managed by H pylori eradication. RESULTS: The prevalence rates of IDA, H pylori infection, and H. pylori -associated IDA in female athletes were higher than in the control group. The relative risk of IDA was 2.9 (95% CI, 1.5 to 5.6) for those with H. pylori infection. Athletes who exhibited H. pylori -associated IDA showed significant increases in hemoglobin, iron, and ferritin levels after H. pylori eradication. The subjects in the control group who were treated orally with iron alone showed no significant changes. CONCLUSION: Adolescent female athletes may have development of H. pylori -associated IDA, which can be managed by H. pylori eradication.

Between-city variation in frequency of injection among Puerto Rican injection drug users: East Harlem, New York, and Bayamon, Puerto Rico.

Frequency of injection has been consistently found to be higher among Puerto Rican Injection drug users (IDUs) than among other groups of IDUs. Several explanations have been suggested, but an empirical explanation has yet to be presented. This study compares the frequency of injection of Puerto Rican IDUs in East Harlem, New York, with that of IDUs in Bayamon, Puerto Rico. Study subjects comprised 521 Puerto Rican IDUs from East Harlem and 303 IDUs from Bayamon. The mean frequency of injection among IDUs in East Harlem was 2.8, the corresponding mean in Bayamon was 5.4. Younger IDUs reported a higher number of daily injection episodes than older IDUs, and the IDU group in Bayamon was 5 years younger than the group in East Harlem. The drug use variables accounted for a greater portion of the between-city difference than the demographic and psychosocial variables. Use of noninjected drugs, as well as the use of prescribed methadone, were found to be associated with a lower number of daily injections. Conversely, injection of cocaine, injection of cocaine mixed with heroin ("speedball"), and injection of larger amounts of drug solution were found to be associated with a higher number of daily injections.