The Chinese Behavior Pain Scale for critically ill patients: translation and psychometric testing.

BACKGROUND: Common pain assessment tools might not be the suitable tools to measure ventilated, critically ill patients' pain. The Behavioral Pain Scale measures observable behavior indicative of pain experienced by mechanically ventilated patients. OBJECTIVE: This study was conducted to generate a Chinese-language version of the Behavioral Pain Scale and to test its psychometric properties. DESIGN: This study was a prospective psychometric study. SETTINGS/PARTICIPANTS: : Seventy patients were recruited from two intensive care units in a medical center. METHODS: After instrument translation, psychometric testing which included inter-rater reliability, test-retest reliability, and construct validity was conducted. The construct validity was tested using criterion and discriminant validation strategies. A receiver-operating characteristic curve analysis was conducted to evaluate the ability of the translated tool to correctly detect pain. Measurement of body temperature and endotracheal suctioning were, respectively, selected as the non-painful and painful procedures. Two research nurses observed patients' pain-related behaviors when they were at rest and before/during the non-painful/painful procedures. RESULTS: The Chinese translation captured the content of the original tool with appropriate adaptation to the cultural context. The inter-rater and test-retest reliabilities were confirmed by good Pearson correlations (r=.50-1.00, p<.001) and high agreement percentages (72.9-100.0%). The criterion validity was confirmed by (a) the score during the painful procedure for patients who considered it to be painful being higher than the score for patients who considered it not to be painful (t=2.28, p=.03), and (b) an increase in the score occurred for two (2.9%) patients during the non-painful procedure and for 68 (97.1%) patients during the painful procedure. The discriminant validity was confirmed by post hoc comparisons in a one-way ANOVA: the scores during the painful procedure were higher than the scores on other occasions (F=377.7, p<.001). The receiver-operating characteristic curve analysis showed that the translated tool had moderate accuracy. CONCLUSIONS: The Chinese-language version of the Behavior Pain Scale was shown to be reliable and valid for adult patients on mechanical ventilation in medical intensive care units when exposed to rest, a non-painful procedure, and a painful procedure. An assessment tool including pain-related observable indicators can be used as one source to assess a patient's pain, especially with ventilated or non-communicative patients.

Anticancer activity of botanical alkyl hydroquinones attributed to topoisomerase II poisoning.

Cytotoxic alkyl hydroquinone compounds have been isolated from many plants. We previously isolated 3 structurally similar cytotoxic alkyl hydroquinone compounds from the sap of the lacquer tree Rhus succedanea L. belonging to the sumac family, which have a long history of medicinal use in Asia. Each has an unsaturated alkyl chain attached to the 2-position of a hydroquinone ring. One of these isolates, 10'(Z),13'(E),15'(E)-heptadecatrienylhydroquinone [HQ17(3)], being the most cytotoxic, was chosen for studying the anticancer mechanism of these compounds. We found that HQ17(3) was a topoisomerase (Topo) II poison. It irreversibly inhibited Topo IIalpha activity through the accumulation of Topo II-DNA cleavable complexes. A cell-based assay showed that HQ17(3) inhibited the growth of leukemia HL-60 cells with an EC50 of 0.9 microM, inhibited the topoisomerase-II-deficient cells HL-60/MX2 with an EC50 of 9.6 microM, and exerted no effect on peripheral blood mononuclear cells at concentrations up to 50 microM. These results suggest that Topo II is the cellular drug target. In HL-60 cells, HQ17(3) promptly inhibited DNA synthesis, induced chromosomal breakage, and led to cell death with an EC50 about one-tenth that of hydroquinone. Pretreatment of the cells with N-acetylcysteine could not attenuate the cytotoxicity and DNA damage induced by HQ17(3). However, N-acetylcysteine did significantly reduce the cytotoxicity of hydroquinone. In F344 rats, intraperitoneal injection of HQ17(3) for 28 days induced no clinical signs of toxicity. These results indicated that HQ17(3) is a potential anticancer agent, and its structural features could be a model for anticancer drug design.

Plasma matrix metalloproteinase-9 level is better than serum matrix metalloproteinase-9 level to predict gastric cancer evolution.

PURPOSE: Matrix metalloproteinase-9 (MMP-9) in blood is a promising new tumor marker. The aims of the present study are to compare the usefulness of plasma and serum MMP-9 levels for predicting gastric cancer development, invasion, and survival. EXPERIMENTAL DESIGN: In this nested case-control study, 114 gastric cancer patients and 87 healthy controls were enrolled. MMP-9 levels and activities were quantitatively measured by ELISA assay and zymography. The results were compared with the occurrence, clinicopathologic features, and outcomes of gastric cancer patients. The follow-up time for all patients was at least 5 years. RESULTS: Serum MMP-9 levels were significantly higher than plasma MMP-9 levels. Both plasma and serum MMP-9 levels correlated significantly with active MMP-9 identified by zymography (P = 0.002 and P = 0.048, respectively). Plasma MMP-9 level was significantly elevated in gastric cancer patients when compared with control subjects (P < 0.001). Serum MMP-9 levels did not differ between the groups. Receiver-operator characteristics analysis showed the values of sensitivity (82.5%) and specificity (65.5%) at the maximum accuracy for plasma MMP-9 at >or=60 ng/mL (P < 0.001). Elevated plasma MMP-9 correlated significantly with lymph node metastasis [odds ratio (OR), 3.43; P = 0.019], lymphatic invasion (OR, 7.58; P = 0.009), and venous invasion (OR, 4.14; P = 0.033). Patients with elevated plasma MMP-9 levels had poorer survival rates than those with normal plasma MMP-9 levels (P = 0.038). Serum MMP-9 level did not correlate well with gastric cancer-invasive phenotypes or survival. CONCLUSION: Our results suggest plasma MMP-9 level is a better marker than serum MMP-9 level for predicting gastric cancer development and progression.

Elevated plasma osteopontin associated with gastric cancer development, invasion and survival.

OBJECTIVE: Osteopontin (OPN) has been found to be valuable in diagnosis and predicting the prognosis of a variety of malignancies. The aims of the present study are to evaluate the usefulness of plasma OPN level for predicting gastric cancer development, invasion and survival. PATIENTS AND METHODS: One hundred and thirty two gastric cancer patients and 93 healthy controls were enrolled. Real-time quantitative reverse-transcription polymerase chain reaction and immunohistochemical staining were used to detect OPN expression in gastric cancer tissues. Plasma levels of OPN were measured by enzyme-linked immunosorbent assay. Plasma OPN levels were compared with gastric cancer development, clinicopathological features and outcomes. RESULTS: Expression of OPN mRNA was significantly higher in gastric cancer tissues compared with non-tumour tissues. Most OPN immunoactivity was localised to cancer cells. The median plasma OPN level was significantly higher in patients than in controls (p<0.0001), and significantly higher in patients with advanced stages, serosal invasion, lymph node metastasis, lymphatic invasion, venous invasion and liver metastasis. Logistic regression showed that high plasma OPN level (greater than 67.3 ng/ml) is significantly associated with advanced stages, serosal invasion, lymph node metastasis, lymphatic invasion, venous invasion and liver metastasis. Plasma OPN level demonstrated significant association with patient survival (p<0.0001), especially in the subgroups with invasive phenotypes. On Cox multivariate analysis, elevated plasma OPN level was an independent risk factor for poor survival (p<0.0001). CONCLUSIONS: Elevated plasma OPN level is significantly associated with gastric cancer development, invasive phenotypes and survival. Plasma OPN level may have potential usefulness as a diagnostic and prognostic factor for gastric cancer.