Identifying the potential long-term survivors among breast cancer patients with distant metastasis.

BACKGROUND: We aimed to develop a prediction model to identify long-term survivors after developing distant metastasis from breast cancer. PATIENTS AND METHODS: From the institution's database, we collected data of 547 patients who developed distant metastasis during their follow-ups. We developed a model that predicts the post-metastasis overall survival (PMOS) based on the clinicopathologic factors of the primary tumors and the characteristics of the distant metastasis. For validation, the survival data of 254 patients from four independent institutions were used. RESULTS: The median duration of the PMOS was 31.0 months. The characteristics of the initial primary tumor, such as tumor stage, hormone receptor status, and Ki-67 expression level, and the characteristics of the distant metastasis presentation including the duration of disease-free interval, the site of metastasis, and the presence of metastasis-related symptoms were independent prognostic factors determining the PMOS. The association between tumor stage and the PMOS was only seen in tumors with early relapses. The PMOS score, which was developed based on the above six factors, successfully identified patients with superior survival after metastasis. The median PMOS for patients with a PMOS score of <2 and for patients with a PMOS score of >5 were 71.0 and 12 months, respectively. The clinical significance of the PMOS score was further validated using independent multicenter datasets. CONCLUSIONS: We have developed a novel prediction model that can classify breast cancer patients with distant metastasis according to their survival after metastasis. Our model can be a valuable tool to identify long-term survivors who can be potential candidates for more intensive multidisciplinary approaches. Furthermore, our model can provide a more reliable survival information for both physicians and patients during their informed decision-making process.

Real-time polymerase chain reaction in bronchial aspirate for rapid detection of sputum smear-negative tuberculosis.

SETTING: The real-time polymerase chain reaction (RT-PCR) has increasingly been used for the detection of various micro-organisms, including mycobacteria. OBJECTIVE: To determine the role of RT-PCR in confirming the diagnosis of tuberculosis (TB) when acid-fast bacilli (AFB) smear results in sputum samples were not available (i.e., no sputum or negative smear results). DESIGN: We analysed the data of consecutive patients whose bronchial aspirate (BA) was tested for RT-PCR for the diagnosis of TB from January 2006 to April 2008. Computed tomography (CT), bronchoscopy and tissue biopsies were performed in all patients for confirmatory diagnosis, and BA was collected for microbiological analyses and RT-PCR. Final diagnoses were based on microbiological or clinicopathological criteria. RESULTS: Final diagnoses were made in 136 patients, and TB was confirmed in 77 (including 65 culture-positive patients). RT-PCR was positive in 51.9% (40/77) of the confirmed TB patients. More TB patients (20.8%) were detected using RT-PCR than using BA-AFB stain (40 vs. 20, P < 0.001). Of the 77 TB patients, 44 (57.1%) were detected within a few days using a combination of BA-AFB and RT-PCR. CONCLUSION: Real-time RT-PCR of bronchial aspirate seems to be useful for the rapid diagnosis of TB in suspects with smear-negative TB sputum or no sputum.

Effect of postnatal catch-up growth on blood pressure in children at 3 years of age.

Size at birth and early postnatal growth rates appear to be important determinants of cardiovascular diseases. We examined whether intrauterine growth restriction or the subsequent catch-up postnatal weight gain leads to higher blood pressure in early life to confirm that size at birth and early postnatal growth rates appear to be important determinants of blood pressure changes in early life. Of 407 children born between December 2001 and November 2002 in hospital based-birth cohorts, 102 were followed up at 3 years of age (24.2%) at Ewha Womans University Hospital in Seoul, Korea. At 3 years of age, those who had a low birth weight still belonged in the lower-weight group than the others. The subjects' systolic blood pressure was correlated with their current weight (r=0.41) and weight gain (r=0.39), but not with their birth weight. Those with a higher current weight and higher weight gain based on birth weight (conditional weight gain) had the highest blood pressure. Systolic blood pressure increased by 0.2 mm Hg for every 100-g increase in weight at 3 years and, independently, by 1.5 mm Hg for every 100-unit increase in conditional weight gain. This study suggests that birth weight is not directly associated with blood pressure, but accelerated growth, which occurs mostly in those born with a low birth weight, seems to affect blood pressure in early life.

Effect and mechanism of lipopolysaccharide on allergen-induced interleukin-5 and eotaxins production by whole blood cultures of atopic asthmatics.

Interleukin (IL)-5 and eotaxin families regulate the development of eosinophilic inflammation of asthma in a co-operative manner. The exposure to airborne lipopolysaccharide (LPS) induces varying degrees of airflow obstruction and neutrophilic airway inflammation. Production of IL-5 and eotaxin subfamily chemokines was analysed in response to Dermatophagoides pteronyssinus allergen (D.p.) according to the presence of specific IgE to D.p., and investigated the mechanism underlying their LPS-mediated regulation of these cytokines in response to the specific allergen. Peripheral blood cells (PBCs) from asthmatics with (group 1) or without (group 2) specific IgE to D.p. and from non-asthmatics with (group 3) or without (group 4) were stimulated with D.p. or LPS. For LPS-mediated inhibition of IL-5 and eotaxin-2 production, LPS-induced cytokines were added to the D.p.-stimulated PBCs. IL-5 and eotaxin-2, but not eotaxin-1 and 3, were significantly increased by D.p.-stimulated-PBCs from group 1, while only eotaxin-2 was elevated in group 3. Eotaxin-2 production was found in monocytes and correlated with the level of specific IgE to D.p. LPS treatment resulted in the decrease in eotaxin-2 and IL-5 production by the D.p.-stimulated PBCs. LPS-induced IL-10 completely inhibited D.p.-stimulated production of eotaxin-2 and IL-5. The differential responses of the eotaxin family to specific antigens suggest that the predominant role of eotaxin-2 and LPS may attenuate eosinophilic inflammation by inhibiting IL-5 and eotaxin-2 synthesis through IL-10 production.

Determinants of psychological distress over time among older Korean immigrants and Non-Hispanic White elders: evidence from a two-wave panel study.

The purpose of this study is to examine racial/ethnic differences in the change of psychological distress as measured by CES-D over time and its associated factors between older Korean immigrants and non-Hispanic White elders, based on a social stress perspective. Data come from a two-wave panel survey of 172 older Korean immigrants and 157 non-Hispanic White elders, with a follow-up period of 12 to 15 months. The sample was drawn from a three-stage probability sampling method. Ordinary least square regressions in a hierarchical process and change score method were used to analyze the two-wave panel data. Older Korean immigrants reported higher levels of psychological distress than the non-Hispanic White elderly at both Time 1 and Time 2. Changes in self-assessed health status and functional limitations were significantly associated with change in psychological distress for both ethnic groups. Increased social support significantly decreased psychological distress at Time 2, for older Korean immigrants only. This study discusses practice and policy implications for service and interventions for older immigrants to assist their adjustment to a host society.