Obesity-Induced Peritoneal Dissemination of Ovarian Cancer and Dominant Recruitment of Macrophages in Ascites

One-fifth of cancer deaths are associated with obesity. Because the molecular mechanisms by which obesity affects the progression of ovarian cancer (OC) are poorly understood, we investigated if obesity could promote the progression of OC cells using the postmenopausal ob/ob mouse model and peritoneal dissemination of mouse ID8 OC cells. Compared to lean mice, obese mice had earlier OC occurrence, greater metastasis throughout the peritoneal cavity, a trend toward shorter survival, and higher circulating glucose and proinflammatory chemokine CXCL1 levels. Ascites in obese mice had higher levels of macrophages (Mφ) and chemokines including CCL2, CXCL12, CXCL13, G-CSF and M-CSF. Omental tumor tissues in obese mice had more adipocytes than lean mice. Our data suggest that obesity may accelerate the peritoneal dissemination of OC through higher production of pro-inflammatory chemokines and Mφ recruitment.

Chemokine Network and Overall Survival in TP53 Wild-Type and Mutant Ovarian Cancer

Ovarian cancer (OC) has the highest mortality rate among gynecological malignancies. Because chemokine network is involved in OC progression, we evaluated associations between chemokine expression and survival in tumor suppressor protein p53 (TP53) wild-type (TP53WT) and mutant (TP53m) OC datasets. TP53 was highly mutated in OC compared to other cancer types. Among OC subtypes, CXCL14 was predominantly expressed in clear cell OC, and CCL15 and CCL20 in mucinous OC. TP53WT endometrioid OC highly expressed CXCL14 compared to TP53m, showing better progression-free survival but no difference in overall survival (OS). TP53m serous OC highly expressed CCL8, CCL20, CXCL10 and CXCL11 compared to TP53WT. CXCL12 and CCL21 were associated with poor OS in TP53WT serous OC. CXCR2 was associated with poor OS in TP53m serous OC, while CXCL9, CCL5, CXCR4, CXCL11, and CXCL13 were associated with better OS. Taken together, specific chemokine signatures may differentially influence OS in TP53WT and TP53m OC.

Erratum: Relationship between Right Ventricular Longitudinal Strain, Invasive Hemodynamics, and Functional Assessment in Pulmonary Arterial Hypertension

The authors have decided to remove one of the authors, Serpil C. Erzurum, MD, who was cited as the 5th author on the original manuscript.

Balance of Autonomic Nervous System Predicts Who Benefits from a Self-management Intervention Program for Irritable Bowel Syndrome

BACKGROUND/AIMS: To determine if potential biomarkers can be used to identify subgroups of people with irritable bowel syndrome (IBS) who will benefit the most or the least from a comprehensive self-management (CSM) intervention. METHODS: In a two-armed randomized controlled trial a CSM (n = 46) was compared to a usual care (n = 46) group with follow-up at 3 and 6 months post randomization. Biomarkers obtained at baseline included heart rate variability, salivary cortisol, interleukin-10 produced by unstimulated peripheral blood mononuclear cells, and lactulose/mannitol ratio. Linear mixed models were used to test whether these biomarkers predicted improvements in the primary outcomes including daily abdominal pain, Gastrointestinal Symptom score and IBS-specific quality of life. RESULTS: The nurse-delivered 8-session CSM intervention is more effective than usual care in reducing abdominal pain, reducing Gastrointestinal Symptom score, and enhancing quality of life. Participants with lower nighttime high frequency heart rate variability (vagal modulation) and increased low frequency/high frequency ratio (sympathovagal balance) had less benefit from CSM on abdominal pain. Salivary cortisol, IL-10, and lactulose/mannitol ratio were not statistically significant in predicting CSM benefit. Baseline symptom severity interacts with treatment, namely the benefit of CSM is greater in those with higher baseline symptoms. CONCLUSIONS: Cognitively-focused therapies may be less effective in reducing abdominal pain in IBS patients with higher sympathetic tone. Whether this a centrally-mediated patient characteristic or related to heightened arousal remains to be determined.

Relationship between Right Ventricular Longitudinal Strain, Invasive Hemodynamics, and Functional Assessment in Pulmonary Arterial Hypertension

BACKGROUND AND OBJECTIVES: Right ventricular longitudinal strain (RVLS) is a new parameter of RV function. We evaluated the relationship of RVLS by speckle-tracking echocardiography with functional and invasive parameters in pulmonary arterial hypertension (PAH) patients. SUBJECTS AND METHODS: Thirty four patients with World Health Organization group 1 PAH (29 females, mean age 45+/-13 years old). RVLS were analyzed with velocity vector imaging. RESULTS: Patients with advanced symptoms {New York Heart Association (NYHA) functional class III/IV} had impaired RVLS in global RV (RVLS(global), -17+/-5 vs. -12+/-3%, p<0.01) and RV free wall (RVLS(FW), -19+/-5 vs. -14+/-4%, p<0.01 to NYHA class I/II). Baseline RVLS(global) and RVLS(FW) showed significant correlation with 6-minute walking distance (r=-0.54 and r=-0.57, p<0.01 respectively) and logarithmic transformation of brain natriuretic peptide concentration (r=0.65 and r=0.65, p<0.01, respectively). These revealed significant correlations with cardiac index (r=-0.50 and r=-0.47, p<0.01, respectively) and pulmonary vascular resistance (PVR, r=0.45 and r=0.45, p=0.01, respectively). During a median follow-up of 33 months, 25 patients (74%) had follow-up examinations. Mean pulmonary arterial pressure (mPAP, 54+/-13 to 46+/-16 mmHg, p=0.03) and PVR (11+/-5 to 6+/-2 wood units, p<0.01) were significantly decreased with pulmonary vasodilator treatment. RVLS(global) (-12+/-5 to -16+/-5%, p<0.01) and RVLS(FW) (-14+/-5 to -18+/-5%, p<0.01) were significantly improved. The decrease of mPAP was significantly correlated with improvement of RVLS(global) (r=0.45, p<0.01) and RVLS(FW) (r=0.43, p<0.01). The PVR change demonstrated significant correlation with improvement of RVLS(global) (r=0.40, p<0.01). CONCLUSION: RVLS correlates with functional and invasive hemodynamic parameters in PAH patients. Decrease of mPAP and PVR as a result of treatment was associated with improvement of RVLS.

Impaired Global Right Ventricular Longitudinal Strain Predicts Long-Term Adverse Outcomes in Patients with Pulmonary Arterial Hypertension

BACKGROUND: New 2-dimensional strain echocardiography enables quantification of right ventricular (RV) mechanics by assessing global longitudinal strain of RV (GLSRV) in patients with pulmonary arterial hypertension (PAH). However, the prognostic significance of impaired GLSRV is unclear in these patients. METHODS: Comprehensive echocardiography was performed in 51 consecutive PAH patients without atrial fibrillation (40 females, 48 +/- 14 years old) with long-term follow-up. GLSRV was measured with off-line with velocity vector imaging (VVI, Siemens Medical System, Mountain View, CA, USA). RESULTS: GLSRV showed significant correlation with RV fractional area change (r = -0.606, p or = -15.5%) was associated with lower event-free survival (HR = 4.906, p = 0.001) and increased mortality (HR = 8.842, p = 0.005). CONCLUSION: GLSRV by VVI showed significant correlations with conventional echocardiographic parameters indicating RV systolic function. Lower GLSRV (> or = -15.5%) was significantly associated with presence of adverse clinical events and deaths in PAH patients.

Assessment of the Knowledge and Utilization of the Partograph among Non-physician Obstetric Care Givers in the University of Calabar Teaching Hospital, Calabar, Nigeria.

Background: Obstructed labour and ruptured uterus contribute a significant proportion to the alarming maternal mortality ratio in sub-Saharan Africa. Proper management of labour by using the partograph, a simple tool that is designed to detect early signs of abnormal progress, can significantly reduce incidence and complications of prolonged labour. Objective: The objective of this study was to assess the knowledge and utilization of the partograph among non-physician obstetric health care providers in University of Calabar Teaching Hospital (UCTH). Methods: This was a descriptive cross-sectional survey which employed the use of a semi-structured self-administered questionnaire with purposive sampling conducted among 132 consenting non-physician obstetric health care providers in UCTH. Results: The mean age of the respondents was 37.84±9.38 years. About 66% of them used partograph but only 13.6% of those who had used partograph were very confident with the tool in monitoring labour. Fifty-six percent of them had received formal training on partograph. Only 34 percent of those surveyed could correctly interpret various sections of the partograph, like the cervicogram. The main reasons for non-utilization of the partograph were inadequate knowledge (73.5%), non-availability (46.2%) and shortage of manpower (34.8%). Knowledge of the partograph (X2=38.1, P=.00) and partograph availability (X2=52.5, P=.00) significantly affected its utilization. Years of experience did not significantly influence partograph use. Conclusion: The knowledge and utilization of the partograph in our hospital can be enhanced by periodic training and retraining of obstetric care givers, developing protocols, ensuring its availability, as well as increasing the staff strength in the delivery units.

Developing competency - based accreditation for health promotion in Europe / Desenvolvimento de um sistema de acreditação baseado emcompetências para promoção da saúde na Europa

Background: In April 2013, the inaugural meeting of the Board and Committees of the IUHPE European Health Promotion Accreditation System was held in Paris. The meeting heralded the implementation of an innovative competency-based accreditation system for health promotion in Europe. The System aims to promote quality assurance and competence in health promotion through a Europe-wide accreditation system which is designed to be flexible and sensitive to different contexts while maintaining robust and validated criteria. The System builds on the international literature on competency-based approaches to health promotion and on global capacity development initiatives such as the Galway Consensus Conference Statement ‘Toward Domains of Core Competency for Building Global Capacity in Health Promotion’1. The System is designed to provide validated mechanisms for assuring quality in health promotion practice, education and training and a foundation for capacity development in Europe based on shared concepts and a formalised system of professional recognition.The competencies and professional standards that underpin the System are premised on the core concepts and principles of health promotion as defined in the Ottawa Charter for Health Promotion2 and successive World Health Organisation charters and declarations3-8. The System is currently undergoing intensive piloting and will be fully operational in 2014. Methods: The System builds on a competency-based accreditation framework developed as part of the CompHP Project. The CompHP Project development processes employed a phased, multiple-method approach to facilitate consensus-building with key stakeholders in health promotion across Europe. The piloting process for the System includes establishing and testing the governance structures, application processes, reporting policies and procedures to ensure that they are equitable, feasible, open and transparent...

Introdução: Em abril de 2013, a reunião inaugural do Conselho de Administração e Comitês do Sistemade Acreditação de Promoção da Saúde Europeu da União Internacional de Promoção e Educação em Saúde (UIPES) foi realizada em Paris. A reunião anunciou a implementação de um sistema inovador para a promoção da saúde na Europa, baseado em competências. O sistema tem como objetivo promover a garantiade qualidade e competência na promoção da saúde através de um sistema de acreditação a nível europeu, que foi projetado para ser flexível e sensível a diferentes contextos, mantendo critérios robustos e validados. O sistema baseia-se na literatura internacional sobre as abordagens baseadas em competências para a promoção da saúde e em iniciativas de desenvolvimento de capacidades globais, tais como a Declaração consensuada da Conferência de Galway (“Toward Domains of Core Competence for Building Global Capacity in Health Promotion”)1. O Sistema é projetado para fornecer mecanismos validados que garantam a qualidade às práticas da promoção, da educação em saúde bem como da formação e do desenvolvimento de capacidades na Europa, basedo em conceitos compartilhados e em um sistema formalizado de reconhecimento profissional. As competências e os padrões profissionais que sustentam o Sistema têm como premissa os principais conceitos e princípios da promoção da saúde definidosna Carta de Ottawa2 e sucessivas cartas e declarações(3-8) da Organização Mundial de Saúde. Atualmente, o Sistema está passando por estudos pilotos intensivos, com operacionalização plena prevista para 2014. Métodos: O Sistema baseia-se em um quadro de acreditação baseado em competências, desenvolvido como parte do Projeto CompHP. O desenvolvimento do CompHP empregou uma abordagem em etapas, com vários métodos para facilitar a construção de um consenso com as pessoas-chave da promoção da saúde em toda a Europa. O piloto para o Sistema inclui o estabelecimento e a testagem das estruturas...

Interstitial Cystitis/Painful Bladder Syndrome: Prevalence Estimates, Quality of Life and Depression among Older Adult Korean Women / 여성건강간호학회지

Interstitial Cystitis/Painful Bladder Syndrome: Prevalence Estimates, Quality of Life and Depression among Older Adult Korean Women. What is already known about the topic? 1) Interstitial Cystitis/Painful bladder syndrome (IC/PBS) is a chronic, painful, inflammatory condition of the bladder wall. 2) Previous studies examining the prevalence and impact were focused on middle life women and not elderly women. 3) Epidemiologic studies of IC/PBS have been predominantly conducted in Western countries and little research reported in Asian countries.

Long term effects of separation on the children of overseas contract workers

This study was undertaken to consider the impact of migration on the relationship between the OFW and the family. The general objectives was to determine the long-term effects of separation from the OFW parent on children in two selected barangays with specific objectives: (1) to determine the psychiatric morbidity among children; (2) to determine their behavioral patterns; (3) to describe the demographic data of the said population. The design of the study was a cross-sectional survey done in 2 barangays with a high density of OFWs. The Reporting Questionnaire for Children (RQC) which is an instrument designed to screen psychiatric disturbances in children and adolescents less than 18 years of age was used. A total 385 children took part in the study. Results showed that adaptive and maladaptive modes of coping were utilized by the children left behind by parents.

The prevalence of psychiatric disorders among the chronically-ill medical patients in selected tertiary hospitals in the Philippines

OBJECTIVE: This study was conducted to document the prevalence of psychiatric morbidity among chronically ill medical patients in selected hospitals in the Philippines. METHODS: This is a cross-sectional study of the chronically medically ill patients seen in selected Primary are Evaluation of Mental Disorders (PRIME-MD), 774 patients were screened for mental disorders. The prevalence of each of the psychiatric disorders were calculated using the formula for estimation of a proportion for stratified random sampling. The differences in the sample size from each of the study sites were taken into consideration in the estimation of the sitespecific prevalence of mental disorders. The 95 percent confidence intervals of the prevalence rates were computed. RESULTS: Almost half of the patients (47.8 percent) were diagnosed with at least one of the psychiatric disorders elicited from the PRIME-MD. Thirty two percent had depressive disorder, followed by anxiety disorder, somatoform disorders, alcohol-related disorder and eating disorder. According to hospital site, the overall prevalence rate of psychiatric disorder was noted to be highest at the Davao Medical Center. CONCLUSION: The overall prevalence of psychiatric disorder noted in this study was higher than that described in foreign literature, the most common of which was depression.