Effect of a financial incentive on the acceptance of a smoking cessation programme with service charge: a cluster-controlled trial.

INTRODUCTION: Frontline health care professionals in Hong Kong may encounter high refusal rates for the Hospital Authority's Smoking Counselling and Cessation Programme (SCCP) when smokers know it is subject to a service charge. We compared SCCP booking and attendance rates among smokers with or without a financial incentive. METHODS: In this multicentre non-randomised cluster-controlled trial, adult smokers who attended one of six general out-patient clinics between November 2015 and April 2016 were invited to join an SCCP. Attendees in the three intervention-group centres but not the three control-group centres received a supermarket coupon to offset the service charge. RESULTS: A total of 173 smokers aged 18 years or older (92 in the intervention group and 81 in the control group) were recruited into the study. In the intervention group, 47 smokers (51%) agreed via a questionnaire that they would join the SCCP, compared with only 23 smokers in the control group (28%). The booking rates were 83% (n=39) in the intervention group and 83% (n=19) in the control group. Among those who had booked a place, 19 (49%) intervention-group participants and 11 (58%) control-group participants attended an SCCP session. Multivariable logistic regression revealed that offering a coupon was associated with agreeing to join an SCCP (odds ratio=4.963, 95% confidence interval=2.173-11.334; P<0.001) and booking an SCCP place (odds ratio=4.244, 95% confidence interval=1.838-9.799; P<0.001). CONCLUSION: Provision of a financial incentive was positively associated with agreement to join an SCCP and booking an SCCP place. Budget holders should consider providing the SCCP free of charge to increase smokers' access to the service.

Synthesis and Characterization of Iron Complexes based on Bis-Phosphinite PONOP and Bis-Phosphite PONOP Pincer Ligands.

A series of bis-phosphinite and bis-phosphite PONOP iron complexes were prepared and characterized by NMR and IR spectroscopy. Bis-phosphinite PONOP iron dichloride complexes (RPONOP)FeCl2 (RPONOP = 2,6-(R2PO)2(C5H3N) and R = iPr, tBu) were prepared through complexation of the free ligands with FeCl2 and their solid-state structures were determined. Bis-phosphite PONOP iron complexes (OEtPONOP)Fe(PMe3)2 and (CatPONOP)Fe(PMe3)2 (Cat = catechol) were synthesized through complexation of the free ligands to Fe(PMe3)4. Carbonyl complexes of both bis-phosphinite and bis-phosphite PONOP were prepared and characterized by IR. The monocarbonyl (iPrPONOP)Fe(CO)Cl2 was accessed through exposure of (iPrPONOP)FeCl2 to an atmosphere of CO and the CO stretching frequency was observed at 1969 cm-1. Dicarbonyl complexes (iPrPONOP)Fe(CO)2 and (OEtPONOP)Fe(CO)2 were accessed through reduction of the corresponding chloride complexes with sodium amalgam under a CO atmosphere. Carbonyl stretching frequencies for (iPrPONOP)Fe(CO)2 and (OEtPONOPFe)(CO)2 were observed at 1824 and 1876 cm-1, and at 1871 and 1927 cm-1 respectively. The bis-phosphite PONOP complexes exhibit a less electron rich metal center than the bis-phosphinite PONOP complexes, as would be expected based on the stronger π-acceptor character of these ligands. The electronic properties of the bis-phosphinite PONOP and bis-phosphite PONOP iron complexes are intermediate between previously reported PNP and PDI iron complexes, with the PONOP ligands exhibiting stronger electron donating ability than PDI ligands, but promoting a less electron rich metal center than found in analogous PNP iron complexes.

Primary hyperaldosteronism among Chinese hypertensive patients: how are we doing in a local district in Hong Kong.

OBJECTIVES: To estimate the point prevalence of primary hyperaldosteronism in a government out-patient setting and to compare associated patient characteristics with those having essential hypertension. DESIGN: Case series with external comparison. SETTING: A single public hospital (Caritas Medical Centre) and all five associated general out-patient clinics in Sham Shui Po district in Hong Kong. PATIENTS: All patients with confirmed primary hyperaldosteronism and randomly selected patients with essential hypertension from a medical specialist clinic and general out-patient clinics, retrieved from a computer database for the period January 2007 to December 2008. MAIN OUTCOME MEASURES: Estimated point prevalence of primary hyperaldosteronism among hypertensive patients treated in the public sector of Sham Shui Po district. Patient age when hypertension was diagnosed, number of antihypertensive drugs used for treatment, and the presence of target organ damage in the patients with primary hyperaldosteronism and those with essential hypertension were compared. RESULTS: Among the 46 012 patients receiving antihypertensive treatment, 49 were confirmed to have primary hyperaldosteronism. The estimated point prevalence of primary hyperaldosteronism among these hypertensive patients was 0.106% only, which was far smaller than figures from other countries. When compared with the 147 patients with essential hypertension by multivariate analysis, those with primary hyperaldosteronism were: (1) associated with longer durations of hypertension (odds ratio=1.14; 95% confidence interval, 1.06-1.24) despite being younger at the time of study, (2) likely to be taking three or more antihypertensive drugs (odds ratio=2.51; 95% confidence interval, 1.59-3.95), and (3) more likely to have left ventricular hypertrophy (odds ratio=5.01; 95% confidence interval, 1.83-13.69). All primary hyperaldosteronism patients studied presented with hypokalaemia. The need for antihypertensive drugs was markedly reduced after adrenalectomy for adrenal adenoma. CONCLUSIONS: Primary hyperaldosteronism, which is potentially a surgically curable cause of hypertension, appeared to be underdiagnosed in our locality. Screening by aldosterone-renin ratio of high-risk individuals may help improve patient outcomes.

The expression of rac1 pseudogene in human tissues and in human brain tumors.

BACKGROUND: Recent studies have demonstrated that Rac is a regulator of cell morphology and growth. Rac1 gene appears to have involvement in tumorigenesis and metastatic potential. In our previous study of rac1 gene in 45 human brain tumors, rac1 pseudogene was found. The rac1 pseudogene is an intronless pseudogene and has a similarity of 86% with rac1 nucleotide sequence. The rac1 pseudogene contains 579 nucleotides and only 46 amino acids can be translated. Little is known about the expression of rac1 pseudogene in human tissues or tumors. MATERIALS AND METHODS: The expression of rac1 gene and rac1 pseudogene in different human tissues and brain tumors was investigated by the use of reverse transcriptase-polymerase chain reaction and Northern blotting. RESULTS: The rac1 gene is apparently expressed in these 8 human tissues. The rac1 pseudogene is also apparently expressed in human tissues except for brain tissue. The overexpression of rac1 gene in brain tumors was 8% (2/25) and the overexpression of rac1 pseudogene was 76.9% (20/26). Only two astrocytomas had overexpression of rac1 gene, compared with normal brain tissues. The overexpression of rac1 pseudogene was 6 of 9 in meningiomas, 7 of 9 in astrocytomas, and 7 of 8 in pituitary adenomas. CONCLUSIONS: High frequency of overexpression of rac1 pseudogene was detected in the human brain tumors when compared with that expressed in the normal brain tissues. Our study suggested that the rac1 pseudogene may play an important role of the tumorigenesis of brain.

Use of developmental language scales in Chinese children.

The Reynell Developmental Language Scale (RDLS) and Symbolic Play Test (SPT) have been useful language tests for assessing the language age of children. Both tests have been validated in English-speaking children. However, there have been no studies conducted for Chinese children, whether Mandarin (Northerners) or Cantonese (Southerners) is used as the main dialect. As the Chinese population is the largest ethnic group in the world, and Chinese emigration occurred to nearly all parts of the world, it is essential to test whether these language tools can be applied for this ethnic group. The objective of this research was to study whether RDLS and SPT are useful in assessing the language age of Chinese children. Both RDLS (Chinese version) and SPT are conducted for 116 Chinese (Cantonese-speaking) children, aged 13-59 months, in Hong Kong. There is a significant positive correlation of the language age using RDLS and SPT with the chronological age of Chinese children. Both RDLS and SPT can be adopted in determining the language/mental age of Chinese (Cantonese-speaking) children.

Rac1 gene mutations in human brain tumours.

AIMS: Rac1 is a member of the Ras superfamily of small GTPase and plays a fundamental role in cytoskeleton reorganization, regulation of gene expression and cell proliferation, and cellular transformation. Though recent studies point to an involvement of rac1 in tumorigenesis, little is known about the alteration of rac1 gene in human brain tumours. METHODS: Reverse transcription-polymerase chain reaction (RT-PCR), TA cloning, and DNA sequencing were performed to detect rac1 gene mutations in the surgical specimens of 45 human brain tumours. RESULTS: Twelve of 45 cases had base changes in the rac1 gene. The frequency of rac1 alterations was seven of 18 meningiomas, three of 14 astrocytomas, one of seven pituitary adenomas, and one of four metastatic brain tumours. No mutation was detected in acoustic neurilemomas. The subtypes of seven meningiomas include three meningotheliomatous, two atypical, one transitional and one angioblastic meningioma. Three astrocytomas had rac1 gene mutation, including one grade II, one grade III, and one grade IV astrocytoma. All of single base changes were transitions, five of them being T to C transitions. Sites of rac1 mutation were found in codons 34, 41 (two cases), 42 (two cases), 43, 44, 46 and 58. These mutations are mainly localized in the putative effector-domain of rac1 gene and may enhance the activity of rac1, which increases the survival of brain tumours. CONCLUSION: Our results suggest that rac1 gene may play a role in some brain tumours of divergent histogenesis and that the alterations of rac1 gene may contribute to tumorigenesis and/or metastasis.

Cloning and characterization of a novel human ninein protein that interacts with the glycogen synthase kinase 3beta.

Using human glycogen synthase kinase 3beta (GSK-3beta) as bait in the yeast two-hybrid system, we identified a novel human centrosome associated protein, hNinein. When the full length cDNA of hNinein was sequenced, it showed that an open reading frame encoded a protein consisting of 2047 amino acids with a predicted molecular mass of 239 kDa. The features of this protein include a potential GTP binding site, a large coiled-coil domain together with four leucine zipper domains and a GSK-3beta binding site. Fluorescence microscopy experiment showed that hNinein is localized in the pericentriolar matrix of the centrosome. In addition, hNinein also showed to react with centrosomal autoantibody sera. Our findings suggest that hNinein may be involved in the formation of centrosome matrix and interacts with the GSK-3beta, implying that it may also be regulated by GSK-3beta phosphorylation signaling.

Clinical significance of distribution patterns of P53 immunoreactivity in astrocytic tumors.

The difference of prognosis in patients with the same WHO grade of astrocytic tumors suggests that such tumors comprise a heterogeneous group in biological behavior. The correlation between p53 immunoreactivity and prognosis has often been reported but remains controversial. From the perspective of clonal expansion of p53 immunopositive cells, the distribution patterns of p53 immunoreactivity can be divided into four types: negative, scattered, focally clustered, and diffusely clustered. The survival rate was evaluated by classifying the p53 immunoreactivity into two groups: the significantly immunopositive patterns (focally and diffusely clustered types) and the significantly immunonegative patterns (negative and scattered types). The survival analysis showed a highly significant difference between these two patterns within the same WHO grade of astrocytic tumors (p = 0.0185). Our studies demonstrate that the distribution patterns of p53 immunoreactivity, which reflect the trends of clonal expansion of p53 immunopositive cells, are significantly valuable in predicting the prognosis of patients with the same WHO grade of astrocytic tumors.

A patient with three kidneys: a correlative imaging case report.

A man with three fully developed and well functioning kidneys was studied using correlative imaging. Renal scintigraphy and the renogram not only played a role in identifying the existence of three kidneys but also determined the level of function of each kidney. The use of renal scintigraphy and renography is pivotal in the diagnosis of supernumerary kidneys. An abbreviated review of embryogenesis is also given.

Expression and mutation analysis of the p53 gene in astrocytoma.

The role of p53 gene mutations in the formation or progression of human astrocytic tumors is controversial. We studied the distribution pattern of p53 immunoreactivity and analyzed p53 gene mutations to define the significance of p53 gene mutations in astrocytoma tumorigenesis or malignant progression. Twenty-three astrocytic tumors were evaluated with immunohistochemistry, single-strand conformation polymorphism (SSCP) analysis, and sequence analysis. We also searched MEDLINE to collect data on p53 gene mutation frequencies in astrocytic tumors in order to evaluate the association of p53 mutations and tumor grade. Strong immunoreactivity with a diffuse clustering pattern was found in three of five glioblastomas and seven of 12 anaplastic astrocytomas. Three of four low-grade astrocytomas were immunonegative. The p53 immunopositive cells in the only positively staining low-grade astrocytoma in our study appeared sparsely scattered. The results of immunostaining suggested that clonal expansion was associated with astrocytoma progression. Mutations of the p53 gene were detected in four of the 23 astrocytomas (one glioblastoma and three anaplastic astrocytomas). In the genetic data analysis, 76 of 367 astrocytomas had p53 gene mutations. A significantly greater p53 gene mutation frequency was found in anaplastic astrocytomas or glioblastomas than in the low-grade astrocytomas. The results of these immunohistochemical and genetic studies support the view that p53 gene mutation is associated with the malignant progression from low-grade to high-grade astrocytomas rather than with tumor initiation or promotion.

The evolutional stage changes in sarcoidosis on gallium-67 scintigraphy.

UNLABELLED: Gallium-67 scintigraphy has been proven as the imaging modality of choice in monitoring the presence of active disease in sarcoidosis. The purpose of this study is to analyze the patterns of evolutional stage changes of sarcoidosis while on steroid therapy by Ga-67 scintigraphy. METHODS: Eighty-six consecutive patients with biopsy-proved sarcoidosis are evaluated by Ga-67 scintigraphy. Thirty-six of 86 patients have had a baseline and one to eight follow-up Ga-67 scintigraphs (total 136 studies). The initial follow-up scintigraphs are obtained on average about 4-12 months after the baseline study. RESULTS: Seventeen of 36 patients (47.2%) are in stage IV at the time of the baseline study. Following their first course of corticosteroid therapy, 13 patients remained in the same stage and activity distribution pattern while 13 patients have shown reversion to other stages, eight patients showed complete remission while two patients became active from inactive stage. CONCLUSION: Evolutional stage changes are seen in 23 patients (63.9%), including eight patients (22.2%) who showed complete scintigraphic remission. The evolutionary stage changes remain quite variable and unpredictable. This, however, should not detract from the usefulness of Ga-67 scintigraphy in the diagnosis and prognostic evaluation of sarcoidosis, particularly when extrapulmonary involvement (Stage IV disease) is present.

Current trends in the treatment of hypospadias.

The surgical treatment of hypospadias continues to inspire urologists to develop new techniques. Views on the physiopathology of hypospadias have changed a great deal over the last ten years. Treatment techniques have also changed over the last ten years. An analysis of current trends in the treatment of hypospadias therefore appears justified.

Buccal absorption of testosterone and its esters using a bioadhesive tablet in dogs.

PURPOSE: As the oral bioavailability of testosterone is very low because of its high first pass effect, buccal administration might present a viable alternative. In this study a buccal bioadhesive tablet was used in order to sustain the delivery and bypass the liver. METHODS: Testosterone and testosterone acetate, propionate, enanthate and decanoate were investigated. The influence of the concentration of testosterone (10-50%) and testosterone esters (30%) on in vitro bioadhesion was investigated. The absolute (i.v.) and relative (oral) bioavailability of 60 mg testosterone or an equivalent amount of testosterone ester was determined in castrated male dogs. RESULTS: Both the in vitro detachment force and the work of adhesion decreased gradually with an increasing amount of testosterone and for an increasing chain length of the esters, except in the case of testosterone enanthate. The in vivo results revealed that the bioavailability of testosterone was significantly higher (p < 0.05) than that of the esters, which is probably due to the lower solubility of the esters. The mean absolute bioavailability of testosterone from the bioadhesive tablet was 14.1%, while the mean relative bioavailability was 1370%. The buccal administration of testosterone via the bioadhesive tablet allowed the maintenance of the plasma level at above 3 ng/ml for 15 to 24 h. CONCLUSIONS: Buccal absorption of testosterone was significantly higher than that of its esters.

The GAP (glans approximation procedure) for distal hypospadias. Technical aspects.

We present some technical aspects of the GAP procedure for distal hypospadias repair. About 20 GAP procedures have been performed to date. Although immediate postoperative results were very encouraging with only 2 fistulae and 1 meatal stenosis, follow-up is too short to conclude on the validity of the technique. In particular the cosmetic result of this technique based on our preliminary experience, makes it an extra tool for the surgeon interested in hypospadias repair. We therefore want to present some of the technical aspects.

The Arap modification of the MAGPI: experience in 72 patients.

Since july 1991 the Arap modification of the Meatal Advancement Glanduloplasty Incorporated (MAGPI) is used for repair of minor anterior hypospadias. Seventy-two boys have been treated by this technique since then. Follow-up is longer than 2 years in half of the patients. The functional and cosmetic result, as estimated by the surgeon and an urologist who did not perform the operation was excellent in 64 patients (89%). In 3 patients the functional result is good but the cosmetic result is poor. In 2 patients meatal stenosis developed of which 1 was treated by dilatation and 1 by meatotomy. In 3 patients there was complete loss of the suture lines resulting in hypospadias which was repaired by other techniques. Ten patients underwent praeputioplasty with the procedure. In 4 patients the sutureline lost partially necessitating circumcision. The Arap modification of the MAGPI is presented as a good technique for the repair of minor anterior hypopadias.

[Which technic for which form of hypospadias?]. / Quelle technique pour quel hypospadias?

Based on our experience of 700 interventions for hypospadias from 1980 to 1995, the author describes the important factors to take in consideration to decide upon the ultimate technique to use. This choice is quiet easy for a mild or severe hypospadias, and is essentially based on the use of the Transverse Island Flap, used as a tube or as on Onlay, depending the existence of chordee and curvature, the surface of the prepuce and the length of the urethral defect. For cases of distal hypospadias, the choice of the right technique is even more difficult. Factors to be considered are, chordee or not, aspect and localisation of the meatus, the shape and the volume of the glans, the quality of skin recovering the distal urethra and presence or not of corpus spongiosum at the level of the distal urethra. The author discusses the importance of all this parameters, combined or not, in the choice of which technique for which hypospadias.

[Trans-glandular urethral advancement for distal hypospadias. A 16-year experience]. / Avancement uréthral transglandaire (A.U.T.) pour hypospadias distal. Seize ans d'expérience.

Eighty six patients where operated by the urethral transglanular advancement technique. During this period, we modified the reconstruction of the meatus to prevent the uncosmetic appearance of the meatus, resulting from the initial technique. The results were excellent. In 40 patients (23 adults and 17 adolescents) we were able to judge the appearance and function of their adult penis with a follow-up of at least 7 to 16 years after the intervention. In conclusion, we think that the fear of ischaemia and retraction or even necrosis, with secondary late chordee, after extensive urethral mobilisation, is unjustified.