Awareness of diagnosis,treatment and risk of late effects in Chinese survivors of childhood cancer in Hong Kong

BackgroundFor survivors of childhood cancer, awareness of personal health risks is a critical component of long‐term health management.ObjectiveTo evaluate the awareness of the diagnosis, treatment and risk of late effects among survivors of childhood cancer in Hong Kong.MethodsBetween June 2019 and March 2020, this cross‐sectional study recruited 155 adult survivors (mean age = 26.9, standard deviation [SD] = 6.4 years) and 45 parents of paediatric survivors (mean age = 11.1, SD = 3.6 years) from a long‐term follow‐up clinic. At >10 years post‐treatment (mean = 13.4, SD = 7.6 years), they completed a structured questionnaire to report their cancer‐specific knowledge. Multiple linear regression analysis was conducted to identify clinical, socioeconomic and behavioural factors associated with poor awareness.ResultsThe majority of participants accurately recalled their diagnoses (73.5%) and major treatment modalities (chemotherapy 92.4%, radiation 82.9% and surgery 88.2%). However, less than half (45%) of the participants recognized more than 25% of the total late effects for which they were at risk. The highest levels of awareness were reported for endocrine problems (49%), neurocognitive impairment (44%) and secondary cancers (43%), and the lowest for peripheral neuropathy (21%) and vision problems (23%). Compared with survivors of haematological malignancies, those of central nervous system (CNS) tumours (standardized estimate [B] = −9.33, 95% confidence interval [95% CI]: −13.41 to −5.26) and non‐CNS solid tumours (B = −8.47, 95% CI: −12.39 to −4.94) had less knowledge about their diagnosis. Retaining medical records (P < .0001) and better medical information‐seeking habits (P = .048) were associated with better awareness.ConclusionsSurvivors of childhood cancer in Hong Kong have deficient awareness of their personal health risks. They may benefit from the provision of a survivorship care plan and personalized education regarding treatment‐related late effects.Patient ContributionPatients contributed in designing the study tools. Results were presented at a non‐governmental organization.     

Rare bone metastases of the olecranon

Abstract Bone metastases are prevalent in patients with cancer, especially with primary lung, breast, renal cell, thyroid, and prostate carcinomas. When looking specifically at primary renal cell carcinoma, approximately 40% of patients will develop bone metastases during the course of their disease. However, distal bony involvement to the appendicular skeleton occurs less frequently, developing below the elbow and knee in approximately 7% of metastatic renal cell carcinoma patients. The incidence of olecranon metastasis is extremely rare in all cancers and so far only two cases have been reported in literature. We report the third case of an olecranon metastasis in a patient with renal cell carcinoma.     

Optimizing the design of visual analogue scales for assessing quality of life: a semi-qualitative study among Chinese-speaking Singaporeans

Objectives Current recommendations for visual analogue scale (VAS) design are largely derived from studies on pain assessment. We evaluated respondent preferences for VAS design for health‐related quality of life (HRQoL) assessment. Methods In‐depth interviews were conducted among Chinese‐speaking rheumatology outpatients and caregivers (age ≥ 21 years) to determine preferences for the following: (1) VAS orientation (horizontal/vertical); (2) length of instructions (long/intermediate/short); (3) scale range (0–10/0–100 points); (4) indicator for computerized touchscreen VAS (bar/column). Responses in subjects expressing a preference were compared using tests of proportions. Results Among 101 subjects, more subjects preferred a horizontal over a vertical format (48 vs. 37, P = 0.23; 16 no preference), and intermediate length over long/short instructions (44 vs. 14 vs. 31, P = 0.004; 12 no preference). A scale range of 0–10 was preferred over 0–100 (62 vs. 21, P < 0.001; 18 no preference). A bar indicator was preferred over a column for computerized touchscreen VAS (54 vs. 44, P = 0.31; 3 no preference). Only presence of chronic medical conditions influenced subject preference [odds ratio (95% confidence interval): 3.9 (1.6–9.6), P = 0.002]. Conclusion Chinese‐speaking subjects preferred a 0–10‐point VAS with intermediate length instructions for HRQoL assessment. Thus, a 0–10‐point VAS with intermediate length instructions may be more useful for HRQoL assessment among Chinese subjects.     

Low-intensity pulsed ultrasound accelerated bone-tendon junction healing through regulation of vascular endothelial growth factor expression and cartilage formation

The purpose of this study was to use our established partial patellectomy rabbit model to study the effects of low-intensity pulsed ultrasound (LIPUS) on patella-patellar tendon (PPT) junction repair through hypothesized pathways including regulation of vascular endothelial growth factor (VEGF) and chondrogenesis. Standard partial patellectomy was conducted in sixty-four 18 wk-old rabbits that were subsequently divided into LIPUS and control group. The PPT complex was harvested at week 2, 4, 8 and 16 postoperatively (n = 8 for each time point) for preparation of sagittal sections that were evaluated for angiogenesis by analyzing VEGF expression and chondrogenesis. Results showed differences in the pattern of VEGF expression between LIPUS and control groups during the entire healing process, i.e., significant differences in the average percentage of VEGF expression found in between the LIPUS and the control groups. At postoperative week 4, the chondrocytes and osteoblasts in woven bone expressed significantly more VEGF in the LIPUS group than that in the control group (35.6% +/- 7.0% versus 28.0% +/- 4.6%, p < 0.05). Compared with the control group, the development of cartilaginous metaplasia was found more advanced in the scar tissue next to the articular cartilage of the remaining patella in the LIPUS group that was expressed with VEGF in the chondrocytes (38.8% +/- 12.3%). However, the specimens in the control group just showed the similar cartilaginous metaplasia region until postoperative week 8. Histomorphometry revealed thicker fibrocartilage zone and larger cartilaginous metaplasia field at PPT healing interface in LIPUS group compared with those of the control group at week 8 and 16. In conclusion, this was the first quantitative study to demonstrate that LIPUS improved B-T junction healing through regulation of VEGF expression in early healing phase and subsequent chondrogenesis.     

Persistent neurochemical changes in neonatal piglets after hypoxia-ischemia and resuscitation with 100%, 21% or 18% oxygen

BACKGROUND: Neonatal hypoxia-ischemia (HI) is a common complication of pregnancy and delivery. Conventional clinical practice is to resuscitate neonates with 100% O2, and evidence is building to suggest resuscitation with lower O2 concentrations is safer. Significant neurochemical changes are associated with HI injury and persistent changes in amino acids are related to cell death, therefore we used a swine survival model of neonatal HI-reoxygenation (HI/R) to investigate the effects of resuscitation with 100%, 21% or 18% O2 on amino acid neurotransmitters. METHODS: In a blinded randomized fashion, following permanent ligation of the left common carotid artery, newborn pigs (1-4 d, 1.7-2.5 kg) received alveolar normocapnic hypoxia (FiO2=0.15, 2h) and were reoxygenated with 18%, 21% or 100% O2. After a 4-day survival period, brain regions were processed for amino acid levels using high-performance liquid chromatography (HPLC). RESULTS: Results showed that resuscitation with different O2 concentrations caused hemispheric and regional changes in all amino acids investigated including glutamate, alanine, gamma-amino butyric acid, glycine and aspartate, 4 days post-HI. Resuscitation with 100% O2 significantly increased glutamate and glycine in the dorsal cortex contralateral to the ligated common carotid artery, compared to piglets resuscitated with 21% O2. Additionally, piglets resuscitated with 21% O2 had significantly lower alanine levels than those resuscitated with 18% O2. CONCLUSION: Significant resuscitation-dependent changes in amino acid neurotransmitters are still evident 4 days post-HI in the newborn piglet. These data suggest that persistent changes in neurochemistry occur 4 days after HI/R and further studies are warranted to elucidate the consequences of this on neonatal brain development.     

Osteogenic effects of low-intensity pulsed ultrasound, extracorporeal shockwaves and their combination - an in vitro comparative study on human periosteal cells

Our previous studies have shown that on human periosteal cells, low-intensity pulsed ultrasound (LIPUS) has an immediate stimulatory effect whereas extracorporeal shockwaves (ESW) have an delayed stimulatory effect. Therefore, we hypothesized that a combined ESW and LIPUS treatment might provide additive or synergistic effects on periosteal cells, by using ESW to trigger a biological activity while using LIPUS to maintain the stimulated activity. Human periosteal cells were subjected to a single session of ESW treatment on day 0 and/or daily LIPUS treatments or no treatment (control). The cell viability, proliferation, and alkaline phosphatase activity on day 6 and day 18 as well as matrix mineralization on day 35 were measured. Results revealed that LIPUS alone had early positive effects on the activities on day 6 only. In contrast, ESW alone had an early destructive effect but exerted delayed stimulatory effects on the cellular activities on day 18. The combined treatment of ESW plus LIPUS produced effects that were comparable to the ESW treatment alone. Although these findings suggest that ESW and LIPUS stimulate the periosteal cells in two different ways and at different times, their additive or synergistic effects could not be proven.     

Scientific impact of women in academic surgery

OBJECTIVE: To evaluate the scientific impact of women in the surgical literature. METHODS: Gender of the principal investigator of every abstract presented at the 2002, 2003, and 2004 annual meetings of the Association for Academic Surgery and Society of University Surgeons was identified by internet search. Resulting publications were identified using PubMed. Journal impact factor and number of article citations were determined using ISI Web of Knowledge. RESULTS: The principal investigator's gender was identified for 649 (98.8%) of the 657 abstracts presented at the 2002--2004 AAS meetings. Women authored 9.1% of abstracts and 11.8% of total resulting publications. The publication rate of abstracts by women was significantly higher than that of men (69.5% versus 52.4%, P = 0.0132). There was a trend toward higher average impact factors of journals in which female authors published (3.265 versus 2.673, P = 0.0626). There was no significant difference in mean number of citations per publication. The principal investigator's gender was identified for all 337 (100%) abstracts presented at the 2002--2004 SUS meetings. Women authored 11.0% of abstracts and 11.2% of resulting publications. Publication rates and average citation numbers were similar for female and male authors. The average impact factors of journals in which women published were significantly higher (4.741 versus 3.348, P = 0.0082). CONCLUSIONS: Although women comprise a small proportion of principal investigators on abstracts presented at these conferences, the quality of their presented work is equal to or better than those of their male counterparts.