A loop of cancer-stroma-cancer interaction promotes peritoneal metastasis of ovarian cancer via TNFα-TGFα-EGFR.

Peritoneum is the most common site for ovarian cancer metastasis. Here we investigate how cancer epigenetics regulates reciprocal tumor-stromal interactions in peritoneal metastasis of ovarian cancer. Firstly, we find that omental stromal fibroblasts enhance colony formation of metastatic ovarian cancer cells, and de novo expression of transforming growth factor-alpha (TGF-α) is induced in stromal fibroblasts co-cultured with ovarian cancer cells. We also observed an over-expression of tumor necrosis factor-alpha (TNF-α) in ovarian cancer cells, which is regulated by promoter DNA hypomethylation as well as chromatin remodeling. Interestingly, this ovarian cancer-derived TNF-α induces TGF-α transcription in stromal fibroblasts through nuclear factor-κB (NF-κB). We further show that TGF-α secreted by stromal fibroblasts in turn promotes peritoneal metastasis of ovarian cancer through epidermal growth factor receptor (EGFR) signaling. Finally, we identify a TNFα-TGFα-EGFR interacting loop between tumor and stromal compartments of human omental metastases. Our results therefore demonstrate cancer epigenetics induces a loop of cancer-stroma-cancer interaction in omental microenvironment that promotes peritoneal metastasis of ovarian cancer cells via TNFα-TGFα-EGFR.

Mothers' attitude to the use of a combined oral contraceptive pill by their daughters for menstrual disorders or contraception.

INTRODUCTION: Mothers' attitude may affect use of combined oral contraceptive pills by their daughters. We explored Chinese mothers' knowledge of and attitudes towards the use of combined oral contraceptive pills by their daughters for menstrual disorders or contraception, and evaluate the factors affecting their attitude. METHODS: This survey was conducted from October 2012 to March 2013, and recruited Chinese women who attended a gynaecology clinic or accompanied their daughter to a gynaecology clinic, and who had one or more daughters aged 10 to 18 years. They completed a 41-item questionnaire to assess their knowledge of and attitude towards use of the combined oral contraceptive pills by their daughters. The demographic data of the mothers and their personal experience in using the pills were also collected. RESULTS: A total of 300 women with a mean age of 45.2 (standard deviation, 5.0) years completed the questionnaire. Only 58.3% of women reported that they had knowledge about the combined oral contraceptive pills; among them, a majority (63.3%) reported that their source of knowledge came from medical professionals. Of a total possible score of 22, their mean knowledge score for risk, side-effects, benefits, and contra-indications to use of combined oral contraceptive pills was only 5.0 (standard deviation, 4.7). If the medical recommendation to use an oral contraceptive was to manage their daughter's dysmenorrhoea, menorrhagia, acne, or contraception needs, 32.0%, 39.3%, 21.0% and 29.7%, respectively would accept this advice. Women who were an ever-user of combined oral contraceptive pills or who were more knowledgeable about combined oral contraceptives had a higher acceptance rate. CONCLUSIONS: Chinese women had a low acceptance level of using combined oral contraceptive pills as a legitimate treatment for their daughters. This was associated with lack of knowledge or a high degree of uncertainty about their risks and benefits. It is important that health caregivers provide up-to-date information about combined oral contraceptive pills to women and their daughters.

Treatment-seeking behavior in Hong Kong Chinese women with urinary symptoms.

A pan-territory telephone survey was conducted in Hong Kong of Chinese women concerning urinary symptoms and their treatment preferences; 1500 women replied. One hundred and ninety-four (13%) of the 1500 subjects had urinary symptoms. Of these 194, 155 (10.3%) had stress incontinence, 64 (4.3%) had urgency, 10 (0.7%) had urge incontinence, 63 (4.2%) had frequency of urination, 64 (4.3%) had nocturia, 2 (0.1%) had enuresis, and 20 (1.3%) had incomplete emptying. Sixty-eight (35.1%) of the 194 symptomatic subjects sought medical advice (group 1) and 126 (64.9%) did not (group 2). In group 1, 28 (41.2%) sought medical advice from general practitioners, 26 (38.2%) from private specialists, 2 (2.9%) from Chinese herbalists and 12 (17.6%) from public hospitals. In group 2, 4 (3.2%) claimed they had no time, 119 (94.4%) did not think their symptoms were serious, and 11 (8.7%) did not know help was available. None of the subjects felt too embarrassed to seek medical advice, or felt that they could not afford medical attention. The strongest predictor for treatment-seeking behavior was the symptom of incomplete emptying (logistic regression, P=0.004). A substantial proportion of Hong Kong Chinese women with urinary symptoms seek medical advice for their symptoms. The symptom of incomplete emptying appears to be the strongest reason for them to do so.

What should be done about postnatal depression in Hong Kong?

Postnatal depression is one of the most common forms of psychiatric morbidity of child-bearing and causes a host of adverse psychosocial complications to the mother, the children, and the family. Recent studies have shown that 12% of local women have postnatal depression and most of them receive no meaningful medical attention. The validation of a local version of the Edinburgh Postnatal Depression Scale has made systematic screening for postnatal depression feasible. However, such a screening programme should be backed up by well-resourced counselling and psychiatric services. Much remains to be done if a reasonable level of post-partum psychological care is to be provided. Additional funding is required to train nurse counsellors and set up postnatal mental health teams, as well as mother and child units.