Barriers to colorectal cancer screening in Ghana: a qualitative study of patients and physicians.

PURPOSE: The incidence of colorectal cancer (CRC) in Ghana has increased eightfold since the 1960s. In 2011, national guidelines were set forth recommending all patients aged 50-70 years old undergo annual CRC screening with fecal occult blood testing (FOBT), but adherence to these guidelines is poor and screening rates remain low for unclear reasons. METHODS: We performed semi-structured interviews with 28 Ghanaians including physicians (n = 14) and patients (n = 14) from the Komfo Anokye Teaching Hospital in Kumasi, Ghana, to better understand the factors driving screening adherence and perceived barriers identified in an earlier quantitative study. RESULTS: Participants reported sociocultural factors such as reliance on alternative medicine or religion, lack of education, and financial burden as community-level barriers to CRC screening. At the system level, screening was limited by insufficient access to FOBT as well as a perceived lack of national prioritization. This was described as inadequate efforts from the Ministry of Health regarding national education as well as lack of incorporation of CRC screening into the National Health Insurance Scheme. CONCLUSION: Several community- and system-level barriers exist to widespread screening of CRC in Ghana. A multi-level approach will be required to improve rates of CRC screening and ultimately reduce the burden of CRC in Ghana.

Induction of tumor lymphangiogenesis by VEGF-C promotes breast cancer metastasis.

Metastasis of breast cancer occurs primarily through the lymphatic system, and the extent of lymph node involvement is a key prognostic factor for the disease. Whereas the significance of angiogenesis for tumor progression has been well documented, the ability of tumor cells to induce the growth of lymphatic vessels (lymphangiogenesis) and the presence of intratumoral lymphatic vessels have been controversial. Using a novel marker for lymphatic endothelium, LYVE-1, we demonstrate here the occurrence of intratumoral lymphangiogenesis within human breast cancers after orthotopic transplantation onto nude mice. Vascular endothelial growth factor (VEGF)-C overexpression in breast cancer cells potently increased intratumoral lymphangiogenesis, resulting in significantly enhanced metastasis to regional lymph nodes and to lungs. The degree of tumor lymphangiogenesis was highly correlated with the extent of lymph node and lung metastases. These results establish the occurrence and biological significance of intratumoral lymphangiogenesis in breast cancer and identify VEGF-C as a molecular link between tumor lymphangiogenesis and metastasis.

Thrombospondin-1 suppresses wound healing and granulation tissue formation in the skin of transgenic mice.

The function of the endogenous angiogenesis inhibitor thrombospondin-1 (TSP-1) in tissue repair has remained controversial. We established transgenic mice with targeted overexpression of TSP-1 in the skin, using a keratin 14 expression cassette. TSP-1 transgenic mice were healthy and fertile, and did not show any major abnormalities of normal skin vascularity, cutaneous vascular architecture, or microvascular permeability. However, healing of full-thickness skin wounds was greatly delayed in TSP-1 transgenic mice and was associated with reduced granulation tissue formation and highly diminished wound angiogenesis. Moreover, TSP-1 potently inhibited fibroblast migration in vivo and in vitro. These findings demonstrate that TSP-1 preferentially interfered with wound healing-associated angiogenesis, rather than with the angiogenesis associated with normal development and skin homeostasis, and suggest that therapeutic application of angiogenesis inhibitors might potentially be associated with impaired wound vascularization and tissue repair.

Reliability of the Canadian emergency department triage and acuity scale: interrater agreement.

STUDY OBJECTIVE: To determine the rate of interobserver reliability of the Canadian Emergency Department Triage and Acuity Scale (CTAS). METHODS: Ten physicians and 10 nurses were randomly selected to review and assign a triage level on 50 ED case summaries containing presenting complaint, mode of arrival, vital signs, and a verbatim triage note. The rate of agreement within and between groups of raters was determined using kappa statistics. One-way, 2-way analysis of variance (ANOVA) and combined ANOVA were used to quantify reliability coefficients for intraclass and interclass correlations. RESULTS: The overall chance-corrected agreement kappa for all observers was.80 (95% confidence interval [CI] .79 to .81), and the probability of agreement between 2 random observers on a random case was.539. For nurses alone, kappa=.84 (95% CI .83 to .85, P = .598), and for doctors alone, kappa= .83 (95% CI .81 to .85, P = .566). The 1-way, 2-way ANOVA and combined ANOVA showed that the reliability coefficients (84%) for both nurses and physicians were similar to the kappa values. A combined ANOVA showed there was a. 2-point difference with physicians assigning a higher triage level. CONCLUSION: The high rate of interobserver agreement has important implications for case mix comparisons and suggests that this scale is understood and interpreted in a similar fashion by nurses and physicians.

Identification of the origin of double minutes in normal human cells by laser-based chromosome microdissection approach.

Single copies of tiny chromosome fragments, appearing as double minutes, were observed in a high proportion of cells from amniotic fluid cultures of two mothers undergoing prenatal testing because of advanced age. We applied a laser-based chromosome microdissection method to diagnose the origin of the double minutes. The diagnostic procedures consisted of microdissection of double minutes from a single cell, polymerase chain reaction (PCR) amplification of the dissected DNA, and subsequent fluorescence in situ hybridization (FISH) using the PCR products as a probe pool. Metaphase chromosomes from the patients' cells and from a karyotypically normal individual were probed. Using this strategy, we were able to determine that the double minutes originated from the centromere of chromosome 13 or 21 in one case, and from the chromosome 12 centromere in the other. The characterization of such double minutes helps both in the delineation of the nature of these epichromosomal bodies in normal individuals as well as in the clarification of genetic counselling issues.

Electrical Propagation of the Atrium and the Atrial Septum and Effect of Perinodal Cryosurgery

The AV node is a structure in the atrial septum at the atrioventricular junction. The atrial septum is important for various types of supravenricular arrgythmia especially for AV node reentrant tachycardia. In this study, it was aimed to understand the electrical propagation in the atrium and the atrial septum, as well as the effects of perinodal cryosurgery. Eleven mongrel dogs weighing between 26.0kg and 34.5kg were divided into control(d dogs) and cryosurgery(6 dogs) group. The animals were anesthetized with pentobarbital sodium(30 mg/kg) and under a normothermic total cardiopulmonary bypass, endocardial template electrodes(left atrium ; 124, right atrium; 128 bipolar electrodes) were placed into the both atria. The endocardial electrocal activation was recorded using a 256 channel computerized mapping system during normal sinus rhythm, atrial pacing, and ventricular pacing. For the cryosurgery group, the endocardial electrical activation was recorded after eight weeks of discrete perinodal cryosurgery. The results are as followings : 1) The electrical propagation from the SA node to the AV node occurred mainly through thick muscle band of the crista terminalis of the right atrium and anterior limbus fossa ovalis. 2) Electrophysiologically, the atrial septum appeared to be 2 layers. 3) During ventricular pacing, the center of the Koch triangle was the first to respond to activation. When the atrial septum of the AV nodal area was activated, the electrical activations propagated asymmetrically and the activity of the left atrium was propagated through the Bachmann's bundle. The left atrial side of the atrial septum was activated 10-15 msec later than the right side during ventricular pacing. 4) The cryosurgery did not change any significant difference in the AH, HV, AV node effective refractory period and AV node Wenckebach period. However, the ventriculo-atrial conduction was blocked in 50% of the animals. 5) In cryosurgery group, the electrical propagation from the SA nodal area to both atrial was similar to the control group except along side the vertical right atrial incision site. 6) The endocardial activation map in the cryosurgery group showed that the activation was spread out from the lateral atrial tissue outside of the cryolesions. The left atrial side of the atrial septum was was activated 6-19 msec later than the right atrial side. In conclusion, electrophysiologically the atrial septum appears to be composed of 2 layers and there is no direct electrical propagation between the AV node and the left atrial side of the atrial septum. The cryosurgery did not influence the electrial activation sequence from the SA node to the AV node except the site of cryolesion.

Treatment-independent pregnancy among infertile couples.

We analyzed a two- to seven-year follow-up of 1145 infertile couples to determine the frequency of pregnancy occurring independently of treatment. Pregnancy occurred in 246 of 597 treated couples (41 per cent) and in 191 of 548 untreated couples (35 per cent). Thirty-one per cent of the pregnancies in treated couples occurred more than 3 months after the last medical treatment or more than 12 months after adnexal surgery. These pregnancies plus the 191 pregnancies in untreated couples constituted the category of "treatment-independent pregnancies" and accounted for 61 per cent of all pregnancies; for 44 per cent of those among couples with ovulation deficiency; for 61 per cent of those in couples with endometriosis, tubal defects, or seminal deficiencies; and for 96 per cent of those in couples with cervical factors or idiopathic infertility. We conclude that the potential for a spontaneous cure of infertility is high, that treatment for many classes of infertility should be evaluated by randomized clinical trials, and that in such trials random assignment of subjects to untreated control groups would be ethically acceptable.