BioMed Central - Latest articles

Relationship between multimorbidity and physical activity: secondary analysis from the Quebec health survey

Catherine Hudon, Hassan Soubhi and Martin Fortin — 2008-09-05

Background: Abundant literature supports the beneficial effects of physical activity for improving health of people with chronic diseases. The relationship between multimorbidity and physical activity levels, however, has been little evaluated. The purpose of the current exploratory study was to examine the relationship between a) multimorbidity and physical activity levels, and b) long-term limitations on activity, self-rated general health, psychological distress, and physical activity levels for each sex in adults, after age, education, income, and employment factors were controlled for. Methods: Data from the Quebec Health Survey 1998 were used. The sample included 16,782 adults 18-69 yr of age. Independent variables were multimorbidity, long-term limitations on activity, self-rated general health, and psychological distress. The dependent variable was physical activity levels. Links between the independent and dependent variables were assessed separately for men and women with multinomial regressions while accounting for the survey sampling design and household clustering. Results: About 46% of the participants were men. Multimorbidity was not associated with physical activity levels for either men or women. Men and women with long-term limitations on activity and with poor-to-average self-rated general health were less likely to be physically active. No relationship between psychological distress and physical activity was found for men. Women with high levels of psychological distress were less likely to be physically active. Conclusions: Multimorbidity was not associated with physical activity levels in either sex, when age, education, income, and employment factors were controlled for. Long-term limitations on activity and poor-to-average self-rated general health seem related to a reduction in physical activity levels for both sexes, whereas psychological distress was associated with a reduction in physical activity levels only among women. Longitudinal studies using a comorbidity or multimorbidity index to account for severity of the chronic diseases are needed to replicate the results of this exploratory study.

The Hoover's sign of pulmonary disease: molecular basis and clinical relevance

Chambless R Johnston, Narayanaswamy Krishnaswamy and Guha Krishnaswamy — 2008-09-05

In the 1920's, Hoover described a sign that could be considered a marker of severe airway obstruction. While readily seen at the bedside, it is also as easily missed on physical examination. Hoover's sign refers to the inspiratory retraction of the lower intercostal spaces. It results from alteration in dynamics of diaphragmatic contraction due to hyperinflation, resulting in traction on the rib margins by the flattened diaphragm. The sign is reported to have a sensitivity of 58% and specificity of 86% for detection of airway obstruction. Seen in up to 70% of patients with severe obstruction, this sign is associated with body mass index, dyspnea and frequency of exacerbations. Hoover's sign may provide valuable prognostic information. We present a clinical and molecular review of the Hoover's sign and explain how it could be utilized in the bedside and emergent management of airway disease.

Comparative studies on the pathogenicity and tissue distribution of three virulence variants of classical swine fever virus, two field isolates and one vaccine strain, with special regard to immunohistochemical investigations

2008-09-05

Background: The aim of this study was to compare the tissue distribution and pathogenicity of three virulence variants of classical swine fever virus (CSFV) and to investigate the applicability of various conventional diagnostic procedures. Methods: 64 pigs were divided into three groups and infected with the highly virulent isolate ISS/60, the moderately virulent isolate Wingene'93 and the live attenuated vaccine strain Riems, respectively. Clinical signs, gross and histopathological changes were compared in relation to time elapsed post infection. Virus spread in various organs was followed by virus isolation, by immunohistochemistry, applying monoclonal antibodies in a two-step method and by in situ hybridisation using a digoxigenin-labelled riboprobe. Results: The tissue distribution data are discussed in details, analyzing the results of the various diagnostic approaches. The comparative studies revealed remarkable differences in the onset of clinical signs as well as in the development of the macro- and microscopical changes, and in the tissue distribution of CSFV in the three experimental groups. Conclusions: The present study demonstrates that in the case of highly and moderately virulent virus variants the virulence does not affect the pattern of the viral spread, however, it influences the outcome, the duration and the intensity of the disease. Immunohistochemistry has the advantage to allow the rapid detection and localisation of the virus, especially in cases of early infection, when clinical signs are still absent. Compared to virus isolation, the advantage of this method is that no cell culture facilities are required. Thus, immunohistochemistry provides simple and sensitive tools for the prompt detection of newly emerging variants of CSFV, including the viruses of very mild virulence.

The identification of disease-induced biomarkers in the urine of BSE infected cattle

2008-09-05

Background: The bovine spongiform encephalopathy (BSE) epidemic and the emergence of a new human variant of Creutzfeldt-Jakob Disease (vCJD) have led to profound changes in the production and trade of agricultural goods. The rapid tests currently approved for BSE monitoring in slaughtered cattle are all based on the detection of the disease related isoform of the prion protein, PrPd, in brain tissue and consequently are only suitable for post-mortem diagnosis. Objectives: In instances such as assessing the health of breeding stock for export purposes where post-mortem testing is not an option, there is a demand for an ante-mortem test based on a matrix or body fluid that would permit easy access and repeated sampling. Urine and urine based analyses would meet these requirements. Results: Two dimensional differential gel eletrophoresis (2D-DIGE) and mass spectrometry analyses were used to identify proteins exhibiting differential abundance in the urine of BSE infected cattle and age matched controls over the course of the disease. Multivariate analyses of protein expression data identified a single protein able to discriminate, with 100% accuracy, control from infected samples. In addition, a subset of proteins were able to predict with 85% +/- 13.2 accuracy the time post infection that the samples were collected. Conclusions: These results suggest that in principle it is possible to identify biomarkers in urine useful in the diagnosis, prognosis and monitoring of disease progression of transmissible spongiform encephalopathy diseases (TSEs).

The mental health system in Brazil: policies and future challenges

2008-09-05

Background: The aim of this paper is to assess the mental health system in Brazil in relation to the human resources and the services available to the population.MethodThe World Health Organization Assessment Instrument for Mental Health Systems (WHO AIMS) was recently applied in Brazil. This paper will analyse data on the following sections of the WHO-AIMS: a) mental health services; and b) human resources. In addition, two more national datasets will be used to complete the information provided by the WHO questionnaire: a) the Executive Bureau of the Department of Health (Datasus); and b) the National Register of Health Institutions (CNS). Results: There are 6003 psychiatrists, 18,763 psychologists, 1985 social workers, 3119 nurses and 3589 occupational therapists working for the Unified Health System (SUS). At primary care level, there are 104,789 doctors, 184, 437 nurses and nurse technicians and 210,887 health agents. The number of psychiatrists is roughly 5 per 100,000 inhabitants in the Southeast region, and the Northeast region has less than 1 psychiatrist per 100,000 inhabitants. The number of psychiatric nurses is insufficient in all geographical areas, and psychologists outnumber other mental health professionals in all regions of the country. The rate of beds in psychiatric hospitals in the country is 27.17 beds per 100,000 inhabitants. The rate of patients in psychiatric hospitals is 119 per 100,000 inhabitants. The average length of stay in mental hospitals is 65.29 days. In June 2006, there were 848 Community Psychosocial Centers (CAPS) registered in Brazil, a ratio of 0.9 CAPS per 200,000 inhabitants, unequally distributed in the different geographical areas: the Northeast and the North regions having lower figures than the South and Southeast regions Conclusions: The country has opted for innovative services and programs, such as the expansion of Psychosocial Community Centers and the Return Home program to deinstitutionalize long-stay patients. However, services are unequally distributed across the regions of the country, and the growth of the elderly population, combined with an existing treatment gap is increasing the burden on mental health care. This gap may get even wider if funding does not increase and mental health services are not expanded in the country. There is not yet a good degree of integration between primary care and the mental health teams working at CAPS level, and it is necessary to train professionals to act as mental health planners and as managers. Research on service organization, policy and mental health systems evaluation are strongly recommended in the country. There are no firm data to show the impact of such policies in terms of community service cost-effectiveness and no tangible indicators to assess the results of these policies.

Hen's teeth with enamel cap: from dream to impossibility

Jean-Yves Sire, Sidney C. Delgado and Marc Girondot — 2008-09-05

Background: The ability to form teeth was lost in an ancestor of all modern birds, approximately 100-80 million years ago. However, experiments in chicken have revealed that the oral epithelium can respond to inductive signals from mouse mesenchyme, leading to reactivation of the odontogenic pathway. Recently, tooth germs similar to crocodile rudimentary teeth were found in a chicken mutant. These "chicken teeth" did not develop further, but the question remains whether functional teeth with enamel cap would have been obtained if the experiments had been carried out over a longer time period or if the chicken mutants had survived. The next odontogenetic step would have been tooth differentiation, involving deposition of dental proteins. Results: Using bioinformatics, we assessed the fate of the four dental proteins thought to be specific to enamel (amelogenin, AMEL; ameloblastin, AMBN; enamelin, ENAM) and to dentin (dentin sialophosphoprotein, DSPP) in the chicken genome. Conservation of gene synteny in amniotes allowed definition of target DNA regions in which we searched for sequence similarity. We found the full-length chicken AMEL and the only N-terminal region of DSPP, and both are invalidated genes. AMBN and ENAM disappeared after chromosomal rearrangements occurred in the candidate region in a bird ancestor. Conclusions: These findings not only imply that functional teeth with enamel covering, as present in ancestral Aves, will never be obtained in birds, but they also indicate that these four protein genes were dental specific, at least in the last toothed ancestor of modern birds, a specificity which has been questioned in recent years.

Comfort in big numbers: does over-estimation of doping prevalence in others indicate self-involvement?

2008-09-05

Background: The 'False Consensus Effect' (FCE), by which people perceive their own actions as relatively common behaviour, might be exploited to gauge whether a person engages in controversial behaviour, such as performance enhancing drug (PED) use. Hypothesis: It is assumed that people's own behaviour, owing to the FCE, affects their estimation of the prevalence of that behaviour. It is further hypothesised that a person's estimate of PED population use is a reliable indicator of the doping behaviour of that person, in lieu of self-reports.Testing the hypothesisOver- or underestimation is calculated from investigating known groups (i.e. users vs. non-users), using a short questionnaire, and a known prevalence rate from official reports or sample evidence. It is proposed that sample evidence from self-reported behaviour should be verified using objective biochemical analyses. In order to find proofs of concept for the existence of false consensus, a pilot study was conducted. Data were collected among competitive UK student-athletes (n = 124) using a web-based anonymous questionnaire. User (n = 9) vs. non-user (n = 76) groups were established using self-reported information on doping use and intention to use PEDs in hypothetical situations. Observed differences in the mean estimation of doping made by the user group exceeded the estimation made by the non-user group (35.11% vs. 15.34% for general doping and 34.25% vs. 26.30% in hypothetical situations, respectively), thus providing preliminary evidence in support of the FCE concept in relation to doping. Implications of the hypothesisThe presence of the FCE in estimating doping prevalence or behaviour in others suggests that the FCE based approach may be an avenue for developing an indirect self-report mechanism for PED use behaviour. The method may be successfully adapted to the estimation of prevalence of behaviours where direct self-reports are assumed to be distorted by socially desirable responding. Thus this method can enhance available information on socially undesirable, health compromising behaviour (i.e. PED use) for policy makers and healthcare professionals. The importance of the method lies in its usefulness in epidemiological studies, not in individual assessments.

Microbubbles detection during cardiopulmonary bypass with transoesophageal echocardiography: a case report.

2008-09-05

IntroductionMicroembolic signals are usually detected with transcranial doppler during cardiac surgery. This report focuses on suggesting the transesophageal echocardiography as a different diagnostic approach to detect microemboli during cardiopulmonary bypass.Case presentationA 58 year old male patient, caucasian race, was operated on video assisted minimally invasive mitral valve repair using right minithoracotomy approach. His past medical history included an uncontrolled hypertension, dyslipidemia, insulin dependent diabetes mellitus, carotid arteries stenosis. The extracorporeal circulation was performed with femoral-femoral artery and venous approach. Negative pressure for vacuum assist venous drainage was applied in order to facilitate venous blood return. The patient had a brain monitoring with bilateral transcranial doppler of middle cerebral arteries and a double channels electroencephalogram. A three dimensional transesophageal echocardiography to evaluate the mitral valve repair was performed. During the cardiopulmonary bypass a significant microembolic activity was detected in the middle cerebral arteries spectrum velocities due to gas embolism from venous return. Simultaneous recording of microbubbles was also observed on the descending thoracic aorta transesophageal echo views. Conclusion: During the aortic cross-clamping time the transesophageal echocardiography can be useful as an alternative method to assess the amount of gas embolism coming from cardiopulmonary bypass. These informations can promote immediate interaction between perfusionist, surgeon and anesthesiologist to perform adequate manoeuvres in order to reduce the microembolism during extracorporeal circulation.

An extension of the coevolution theory of the origin of the genetic code

Massimo Di Giulio — 2008-09-05

Background: The coevolution theory of the origin of the genetic code suggests that the genetic code is an imprint of the biosynthetic relationships between amino acids. However, this theory does not seem to attribute a role to the biosynthetic relationships between the earliest amino acids that evolved along the pathways of energetic metabolism. As a result, the coevolution theory is unable to clearly define the very earliest phases of genetic code origin. In order to remove this difficulty, I here suggest an extension of the coevolution theory that attributes a crucial role to the first amino acids that evolved along these biosynthetic pathways and to their biosynthetic relationships, even when defined by the non-amino acid molecules that are their precursors. Results: It is re-observed that the first amino acids to evolve along these biosynthetic pathways are predominantly those codified by codons of the type GNN, and this observation is found to be statistically significant. Furthermore, the close biosynthetic relationships between the sibling amino acids Ala-Ser, Ser-Gly, Asp-Glu, and Ala-Val are not random in the genetic code table and reinforce the hypothesis that the biosynthetic relationships between these six amino acids played a crucial role in defining the very earliest phases of genetic code origin. Conclusions: All this leads to the hypothesis that there existed a code, GNS, reflecting the biosynthetic relationships between these six amino acids which, as it defines the very earliest phases of genetic code origin, removes the main difficulty of the coevolution theory. Furthermore, it is here discussed how this code might have naturally led to the code codifying only for the domains of the codons of precursor amino acids, as predicted by the coevolution theory. Finally, the hypothesis here suggested also removes other problems of the coevolution theory, such as the existence for certain pairs of amino acids with an unclear biosynthetic relationship between the precursor and product amino acids and the collocation of Ala between the amino acids Val and Leu belonging to the pyruvate biosynthetic family, which the coevolution theory considered as belonging to different biosyntheses. Reviewers: This article was reviewed by Rob Knight, Paul Higgs (nominated by Laura Landweber), and Eugene Koonin.

Tracking the evolution of a cold stress associated gene family in cold tolerant grasses

Simen R Sandve, Heidi Rudi, Torben Asp and Odd Arne Rognli — 2008-09-05

Background: Grasses are adapted to a wide range of climatic conditions. Species of the subfamily Pooideae, which includes wheat, barley and important forage grasses, have evolved extreme frost tolerance. A class of ice binding proteins that inhibit ice re-crystallisation, specific to the Pooideae subfamily lineage, have been identified in perennial ryegrass and wheat, and these proteins are thought to have evolved from a leucine-rich repeat phytosulfokine receptor kinase (LRR-PSR)-like ancestor gene. Even though the ice re-crystallisation inhibition function of these proteins has been studied extensively in vitro, little is known about the evolution of these genes on the molecular level. Results: We identified 15 putative novel ice re-crystallisation inhibition (IRI)-like protein coding genes in perennial ryegrass, barley, and wheat. Using synonymous divergence estimates we reconstructed the evolution of the IRI-like gene family. We also explored the hypothesis that the IRI-domain has evolved through repeated motif expansion and investigated the evolutionary relationship between a LRR-domain containing IRI coding gene in carrot and the Pooideae IRI-like genes. Our analysis showed that the main expansion of the IRI-gene family happened ~36 million years ago (Mya). In addition to IRI-like paralogs, wheat contained several sequences that likely were products of polyploidisation events (homoeologs). Through sequence analysis we identified two short motifs in the rice LRR-PSR gene highly similar to the repeat motifs of the IRI-domain in cold tolerant grasses. Finally we show that the LRR-domain of carrot and grass IRI proteins both share homology to an Arabidopsis thaliana LRR-trans membrane protein kinase (LRR-TPK). Conclusion: The diverse IRI-like genes identified in this study tell a tale of a complex evolutionary history including birth of an ice binding domain, a burst of gene duplication events after cold tolerant grasses radiated from rice, protein domain structure differentiation between paralogs, and sub- and/or neofunctionalisation of IRI-like proteins. From our sequence analysis we provide evidence for IRI-domain evolution probably occurring through increased copy number of a repeated motif. Finally, we discuss the possibility of parallel evolution of LRR domain containing IRI proteins in carrot and grasses through two completely different molecular adaptations.

Effects of glatiramer acetate on fatigue and days of absence from work in first-time treated relapsing-remitting multiple sclerosis

Tjalf Ziemssen, Josef Hoffmann, Rainer Apfel and Simone Kern — 2008-09-05

Objectives. Treatment of multiple sclerosis patients with glatiramer acetate has been demonstrated a beneficial effect on disease activity. The objective of this prospective naturalistic study was to evaluate the impact of glatiramer acetate on fatigue and work absenteeism. Methods: 291 treatment-naive patients with relapsing remitting multiple sclerosis were included and treated with glatiramer acetate for twelve months. Relapse rates, disability, fatigue symptoms, days of absence from work and adverse events were monitored. Fatigue was measured with the MFIS scale and with a visual analogue scale. Results: Total MFIS scores decreased by 7.6 +/- 16.4 from 34.6 to 27.0. Significant reductions were observed on all three subscales of the MFIS. Fatigue symptoms, assessed using a visual analogue scale, decreased by 1.04 +/- 2.88 cm from 4.47 cm to 3.43 cm . The proportion of patients absent from work at least once was reduced by a factor of two from 65.1% to 30.1%. Tolerance to treatment was rated as very good or good in 78.3% of patients. Adverse effects, most frequently local injection site reactions, were reported in 15.1% of patients. Conclusion: Treatment with glatiramer acetate was associated with a significant improvement in fatigue symptoms and a marked reduction in absence from work. Treatment was well-tolerated. Such benefits are of relevance to overall patient well-being.

Learning based on patient case reviews: an interview study

Rikke Sand Andersen, Rikke Pilegaard Hansen, Jens Soendergaard and Flemming Bro — 2008-09-05

Background: Recent theories on adult learning recommend that learning is situated in real-life contexts. Learning is considered a continuous process in which every new experience builds on, and integrates with, previously accumulated experiences. Reviewing and reflecting on patient cases is in line with this learning approach. There has, however, been remarkably little research into how patient cases might be applied in professional education. The purpose of this article is to present family physicians' perceptions of the learning process initiated by reviewing patient cases. Methods: Thirteen family physicians, who had all participated in a large project on cancer diagnosis in family practice (the CAP-project), currently carried out at the Research Unit for General Practice, University of Aarhus were interviewed on their experiences of reviewing patient cases. In the CAP-project family physicians (n=467, 81%) in the County of Aarhus (640 000 inhabitants) completed 2,212 (83%) detailed questionnaires on all newly diagnosed patients with cancer encountered in their practices during a one year period (2004-2005). In order to complete the questionnaire the family physicians were required to perform a systematic case review of each patient: they had to consult their records to provide dates of symptom-presentation, investigations and treatments initiated, and to reflect on previous encounters with the patients to give detailed information on his/hers knowledge of the patients' care seeking behaviour, mental health and risk factors. The purpose of this article is to present indebt interview-data on family physicians' perceptions of the learning process initiated by reviewing patient cases, and their evaluations of using patient case reviews as a learning method in family practice. Results: The process of reflection initiated by reviewing patient cases enabled family physicians to reconsider their clinical work procedures which potentially supported the transition from individual competence to personal capability. According to the physicians, they were not only able to identify needed changes, some reported that they were able to transform these ideas into action and do things more effectively. According to our data this transition takes place, because the learning processes initiated were based on real life experiences which equally initiated reflections on what to improve, as well as how to improve their work. Conclusions: Patient case reviews initiate reflective processes providing feedback about performance in real life situations. Family physicians are in favour of learning based on patient case reviews, because they embrace the complexities they encounter in their daily practice and are based on personal experiences.

The effect of a pedometer-based community walking intervention "Walking for Wellbeing in the West" on physical activity levels and health outcomes: a 12-week randomized controlled trial.

2008-09-05

Background: Recent systematic reviews have suggested that pedometers may be effective motivational tools to promote walking. However, studies tend to be of a relatively short duration, with small clinical based samples. Further research is required to demonstrate their effectiveness in adequately powered, community based studies. ObjectiveUsing a randomized controlled trial design, this study assessed the impact of a 12-week graduated pedometer-based walking intervention on daily step-counts, self-reported physical activity and health outcomes in a Scottish community sample not meeting current physical activity recommendations. MethodSixty-three women and 16 men (49.2 years +/- 8.8) were randomly assigned to either an intervention (physical activity consultation and 12-week pedometer-based walking program) or control (no action) group. Measures for step-counts, 7-day physical activity recall, affect, quality of life (n=79), body mass, BMI, % body fat, waist and hip circumference (n=76), systolic/diastolic blood pressure, total cholesterol and HDL cholesterol (n=66) were taken at baseline and week 12. Analyses were performed on an intention to treat basis using 2-way mixed factorial analyses of variance for parametric data and Mann Whitney and Wilcoxon tests for non-parametric data. Results: Significant increases were found in the intervention group for step-counts (p< .001), time spent in leisure walking (p=.02) and positive affect (p= .027). Significant decreases were found in this group for time spent in weekday (p=.003), weekend (p=.001) and total sitting (p=.001) with no corresponding changes in the control group. No significant changes in any other health outcomes were found in either group. In comparison with the control group at week 12, the intervention group reported a significantly greater number of minutes spent in leisure time (p=.008), occupational (p=.045) and total walking (p=.03), and significantly fewer minutes in time spent in weekend (p=.003) and total sitting (p=.022). Conclusion: A pedometer-based walking program, incorporating a physical activity consultation, is effective in promoting walking and improving positive affect over 12 weeks in community based individuals. The discussion examines possible explanations for the lack of significant changes in health outcomes. Continued follow-up of this study will examine adherence to the intervention and possible resulting effects on health outcomes.

Gastrointestinal stromal tumor of the stomach with lymph node metastasis

Aras Emre Canda, Yucel Ozsoy, Olcay Ak Nalbant and Ozgul Sagol — 2008-09-05

Background: Lymph node (LN) metastasis of gastrointestinal stromal tumors (GIST) is unusual. Unlike gastric adenocarcinomas, routine lymphadenectomy is not recommended unless there is no suspicion for LN metastasis. Herein, we report a case of GIST of the stomach with LN metastasis treated with distal gastrectomy with perigastric LN dissection followed by adjuvant imatinib therapy.Case presentationA 32-year-old female presented with anemia. Diagnostic investigations including thoracoabdominopelvic computed tomography (CT) scan and gastroscopy revealed a 8 cm gastric antral submucosal tumor without any metastasis. Enlarged periantral LNs were detected during laparotomy and patient underwent distal gastrectomy with en bloc perigastric LN dissection. Pathologic investigation revealed antral stromal tumor with high mitotic and Ki-67 index. Lymph node metastasis was observed in 7 of 12 resected perigastirc nodes. Immunohistochemically, tumor cells were positive for CD117. She was diagnosed as high grade gastric GIST due to the presence of LN metastasis, large tumor size and unfavorable histopathologic features thus underwent adjuvant imatinib treatment (400 mg, daily). No recurrence or metastasis has been detected during a 12-month of postoperative follow-up. Conclusions: Surgery remains the mainstay of treatment in patients with localized, resectable GISTs. Although lymphatic metastasis rarely occurs in patients with GIST, LN dissection should be considered for patients with any suspicion of nodal metastasis. Adjuvant imatinib treatment is recommended according to the well defined prognostic factors.

The developmental pattern of stimulus and response interference in a color-object Stroop task: an ERP study

Ellen MM Jongen and Lisa M Jonkman — 2008-09-05

Background: Several studies have shown that Stroop interference is stronger in children than in adults. However, in a standard Stroop paradigm, stimulus interference and response interference are confounded. The purpose of the present study was to determine whether interference at the stimulus level and the response level are subject to distinct maturational patterns across childhood. Three groups of children (6-7 year-olds, 8-9 year-olds, and 10-12 year-olds) and a group of adults performed a manual Color-Object Stroop designed to disentangle stimulus interference and response interference. This was accomplished by comparing three trial types. In congruent (C) trials there was no interference. In stimulus incongruent (SI) trials there was only stimulus interference. In response incongruent (RI) trials there was stimulus interference and response interference. Stimulus interference and response interference were measured by a comparison of SI with C, and RI with SI trials, respectively. Event-related potentials (ERPs) were measured to study the temporal dynamics of these processes of interference. Results: There was no behavioral evidence for stimulus interference in any of the groups, but in 6-7 year-old children ERPs in the SI condition in comparison with the C condition showed an occipital P1-reduction (80-140 ms) and a widely distributed amplitude enhancement of a negative component followed by an amplitude reduction of a positive component (400-560 ms). For response interference, all groups showed a comparable reaction time (RT) delay, but children made more errors than adults. ERPs in the RI condition in comparison with the SI condition showed an amplitude reduction of a positive component over lateral parietal (-occipital) sites in 10-12 year-olds and adults (300-540 ms), and a widely distributed amplitude enhancement of a positive component in all age groups (680-960 ms). The size of the enhancement correlated positively with the RT response interference effect. Conclusions: Although processes of stimulus interference control as measured with the color-object Stroop task seem to reach mature levels relatively early in childhood (6-7 years), development of response interference control appears to continue into late adolescence as 10-12 year-olds were still more susceptible to errors of response interference than adults.

S100A4 overexpression proves to be independent marker for breast cancer progression.

Nawfal I Ismail, Gurjeet Kaur, Hasnah Hashim and Mohammed S Hassan — 2008-09-05

Background, Breast cancer is the most common cancer and cause of deaths in women around the world. Oncogene amplification usually occurs late in tumor progression and correlates well with aggressiveness of tumor. In fact the function of the S100A4 protein and its role in metastasis is unclear at present. The purpose of the study was to determine the expression of S100A4 protein in the invasion status and metastatic potential of breast cancer by using tissue microarray and to determine its role in breast cancer based on the expression of S100A4 gene product. Method, S100A4 protein expression was examined by immunohistochemistry (IHC) using commercially available tissue microarray containing malignant and normal breast tissues from 216 patients. Results, negative staining for S100A4 in all normal breast tissues, a similar percentage of cases showed positive staining for S100A4 in Infiltrating ductal carcinoma (IDC) node negative (45.1%) and Infiltrating lobular carcinoma (ILC) node negative (48.8%), Positive expression of S100A4 protein was observed only in 13.2 % of cases of IDC node positive while positive expression of S100A4 protein was observed in 30.4 % of its matched lymph node metastasis. Conclusions, S100A4 protein expression appears widely expressed in early and advanced breast cancer stages comparing with normal breast. Our study suggests S100A4 may play a role in breast cancer progression also S100A4 may prove to be an independent marker of breast cancer which appears to be down regulated in more advanced stages of breast cancer.

Late recurrence of large peri-stomal metastasis following abdomino-perineal resection of rectal cancer

Chandrasekar Vijayasekar, MohamedSaleem Noormohamed and Mark James Cheetham — 2008-09-05

Background: Cutaneous metastasis from colorectal cancer after excision of the primary is a rare occurrence and presents as cutaneous or subcutaneous nodules or as a rash commonly on the anterior abdominal wall. Case presentationThis is a case description of the management of a large fungating peristomal cutaneous metastasis occurring 14 years after abdomino-perineal excision of the primary cancer. The gross appearance initially suggested possibility of a true metachronous cancer with peristomal spread. But histopathology of the resected specimen showed no colonic mucosal involvement suggesting a true large cutaneous peristomal metastasis which has not been reported previously. Literature review of presentation, management and prognosis of cutaneous metastasis from colorectal cancer is described Conclusions: Cutaneous metastasis following colorectal cancer resection is a well-recognised entity though rare. Any unusual skin lesions especially on the abdominal wall skin, previous incision scars or near the stoma should be biopsied early to rule out metastatic disease and systematic work-up should be carried out to rule out any metachronous tumour or metastasis elsewhere in the body

Adherence to antiretroviral therapy in young children in Cape Town, South Africa, measured by medication return and caregiver self-report: a prospective cohort study.

Mary-Ann Davies, Andrew Boulle, Tanzeem Fakir, James Nuttall and Brian Eley — 2008-09-04

Background: Antiretroviral therapy (ART) dramatically improves outcomes for children in Africa; however excellent adherence is required for treatment success. This study describes the utility of different measures of adherence in detecting lapses in infants and young children in Cape Town, South Africa. Methods: In a prospective cohort of 122 HIV-infected children commenced on ART, adherence was measured monthly during the first year of treatment by medication return (MR) for both syrups and tablets/capsules. A questionnaire was administered to caregivers after 3 months of treatment to assess experience with giving medication and self-reported adherence. Viral and immune response to treatment were assessed at the end of one year and associations with measured adherence determined. Results: Medication was returned for 115/122 (94%) children with median age (IQR) of 37 (16 - 61) months. Ninety-one (79%) children achieved annual average MR adherence [greater than or equal to]90%. This was an important covariate associated with viral suppression after adjustment for disease severity (OR=5.5 [95%CI: 0.8 - 35.6], p=0.075), however was not associated with immunological response to ART. By 3 months on ART, 13 (10%) children had deceased and 11 (10%) were lost to follow-up. Questionnaires were completed by 87/98 (90%) of caregivers of those who remained in care. Sensitivity of poor reported adherence (missing [greater than or equal to] 1 dose in the previous 3 days) for MR adherence <90% was only 31.8% (95% CI: 10.7% - 53.0%). Caregivers of 33/87 (38.4%) children reported difficulties with giving medication, most commonly poor palatability (21.8%). Independent socio-demographic predictors of MR adherence [greater than or equal to]90% were secondary education of caregivers (OR=4.49; 95%CI: 1.10 - 18.24) and access to water and electricity (OR=2.65; 95%CI: 0.93 - 7.55). Taking ritonavir was negatively associated with MR adherence [greater than or equal to]90% (OR=0.37; 95%CI: 0.13 - 1.02). Conclusions: Excellent adherence to ART is possible in African infants and young children and the relatively simple low technology measure of adherence by MR strongly predicts viral response. Better socio-economic status and more palatable regimens are associated with better adherence.