Clinical utility of skin cancer and melanoma risk scores for population screening: TRoPICS study.

BACKGROUND: Screening for skin cancer can be cost-effective if focused on high-risk groups. Risk prediction tools have been developed for keratinocyte cancers and melanoma to optimize advice and management. However, few have been validated in a clinical setting over the past few years. OBJECTIVES: To assess the clinical utility of risk assessment tools to identify individuals with prevalent skin cancers in a volunteer-based screening clinic. METHODS: Participants were adults presenting for a skin check at a volunteer-based skin cancer screening facility. We used previously published tools, based on questionnaire responses, to predict melanoma and keratinocyte cancers [KCs; basal cell carcinoma (BCC) and squamous cell carcinoma (SCC)] and classified each participant into one of five risk categories. Participants subsequently underwent a full skin examination by a dermatologist. All suspicious lesions were biopsied, and all cancers were histopathologically confirmed. RESULTS: Of 789 people who presented to the clinic, 507 (64%) consented to the study. Twenty-two BCCs, 19 SCCs and eight melanomas were diagnosed. The proportion of keratinocyte cancers diagnosed increased according to risk category from <1% in the lowest to 24% in the highest risk category (P < 0.001). Subtype analysis revealed similar proportionate increases in BCC or SCC prevalence according to risk category. However, a similar proportion of melanoma cases were detected in the low-risk and high-risk groups. CONCLUSION: The risk prediction model for keratinocyte cancers can reliably identify individuals with a significant skin cancer burden prior to a skin examination in the community setting. The prediction tool for melanoma needs to be tested in a larger sample exposed to a wider range of environmental risk factors.

Untangling Neolithic and Bronze Age mitochondrial lineages in South Asia.

Two key moments shaped the extant South Asian gene pool within the last 10 thousand years (ka): the Neolithic period, with the advent of agriculture and the rise of the Harappan/Indus Valley Civilisation; and Late Bronze Age events that witnessed the abrupt fall of the Harappan Civilisation and the arrival of Indo-European speakers. This study focuses on the phylogeographic patterns of mitochondrial haplogroups H2 and H13 in the Indian Subcontinent and incorporates evidence from recently released ancient genomes from Central and South Asia. It found signals of Neolithic arrivals from Iran and later movements in the Bronze Age from Central Asia that derived ultimately from the Steppe. This study shows how a detailed mtDNA phylogeographic approach, combining both modern and ancient variation, can provide evidence of population movements, even in a scenario of strong male bias such as in the case of the Bronze Age Steppe dispersals.

Interleukin-18 deficiency and its long-term behavioural and cognitive impacts in a murine model of pneumococcal meningitis.

Pneumococcal meningitis often results in death or neurological sequelae, but the underlying pathogenetic mechanisms remain poorly understood. In C57BL/6J mice subjected to intracerebroventricular (icv) challenge with Streptococcus pneumoniae, the chemokine CCL2 and cytokines interferon-γ, interleukin (IL)-1ß, IL-6 and tumour necrosis factor were prominently expressed in the brain during the acute phase of the disease. The upregulation of these immune mediators was markedly diminished in IL-18-deficient mice. Uninfected IL-18(-/-) mice exhibited decreases in anxiety phenotype and licking behaviour, and an increase in behavioural habituation, in an automated monitoring system (the IntelliCage). Without antibiotic intervention, a majority of IL-18(+/+) mice developed irreversible disease after icv S. pneumoniae but this was significantly improved by deleting IL-18 gene function. IL-18(+/+) mice cured of pneumococcal meningitis with four doses of ceftriaxone, initiated at 20 h post-inoculation, showed enduring sequelae. These included abnormal behavioural phenotypes featuring diurnal hypoactivity and nocturnal hyperactivity, light phobia and disrupted cognitive function. While the hyperactive phenotype was absent in the corresponding IL-18(-/-) survivors, cognitive impairments and behavioural deficits were still present. Overall, the results suggest that the high levels of cytokines and/or chemokines released after pneumococcal challenge provoked a series of pathological events, ultimately causing acute death. Furthermore, since only a subset of behavioural phenotypes were ameliorated in the pneumococcus-infected IL-18(-/-) mice, the pathological pathways causing mortality may be, at least in part, distinct from those leading to long-term neurological sequelae.

Public knowledge, attitudes and behavior on antibiotic use: a telephone survey in Hong Kong.

BACKGROUND: This study aimed to examine public knowledge, attitudes and behaviors regarding antibiotic use in the community of Hong Kong. METHODS: A cross-sectional phone survey was conducted in 2006 on people aged 18 or older who were uninstitutionalized Hong Kong residents regarding antibiotic use for upper respiratory tract infections (URTIs). RESULTS: A total of 1,002 respondents participated in the survey and 77%, 72% and 85% of the respondents had adequate knowledge, appropriate attitude/belief and behavior on antibiotic use, respectively. Some respondents (26%) believed that antibiotic was needed for symptoms of URTIs if they felt sick enough to seek medical care and 8% would share antibiotic with family members. Eighty-nine (9%) respondents had acquired antibiotic without a prescription. During the most recent episode of URTI, 78% had completed the antibiotic treatment course. Stepwise multiple logistic showed that higher education level and family income were associated with adequate patient knowledge. Male gender was a predictor of poor behavior on antibiotic use. Appropriate belief was associated with tertiary level of education or above. CONCLUSIONS: Over 70% of the present cohort showed adequate knowledge, appropriate attitudes/beliefs and behavior on antibiotic use. Despite a small percent (8%-9%) of respondents reportedly shared and/or self-prescribed antibiotics, this would translate into the practice of half a million people in Hong Kong. Public education programmes should therefore be developed, targeting specific areas of misconceptions, misuse of antibiotic and vulnerable groups at risk of improper use of antibiotics.

Opacification of artificial intraocular lens: an electron microscopic study.

This paper describes the usefulness of electron microscopy in the investigation of the cause of opacification of an intraocular artificial lens (IOL), which affected both the anterior and posterior surfaces of the IOL. The explanted lenses were remarkably similar and were uniformly opaque, with "reticulated" surfaces under dissecting and ordinary light microscopes. TEM showed that the surfaces of the explanted lenses were irregular, and there was a layer of electron-dense granular deposits that extended to a depth of approximately 5 microm into the lens substance. SEM showed a "cerebriform" lens surface with elevated areas alternating with depressed crevices, which corresponded nicely to the TEM appearance. Energy-dispersive x-ray analysis showed that the deposit was composed of calcium, oxygen, and phosphorus, which was later shown to be calcium hydroxyapatite by x-ray diffraction study. Electron microscopy has proven to be an essential tool in the investigation of the cause of this mysterious outbreak of opacification of the surfaces of the artificial lenses. Apart from directly visualizing the lens surfaces in a 2- and 3-dimensional manner, it also provides information on the elemental composition of the deposit. Such findings enable the clinicians and manufacturer to search for the underlying pathogenesis of the abnormal calcium hydroxyapatite crystals deposit.

Nodular histiocytic/mesothelial hyperplasia: a lesion potentially mistaken for a neoplasm in transbronchial biopsy.

This report describes two examples of nodular histiocytic/ mesothelial hyperplasia as seen in transbronchial biopsy that initially led to serious consideration of neuroendocrine neoplasm or meningioma. The biopsies showed nodular collections of cohesive polygonal or round cells with ovoid or deeply grooved nuclei and a moderate amount of finely granular cytoplasm. Nuclear pleomorphism was mild. Immunohistochemical studies showed few cells staining for cytokeratin and the mesothelial marker HBME-1, whereas most cells were decorated by the histiocytic marker PG-M1 (CD68). This lesion appears to be identical to nodular mesothelial hyperplasia as described in hernia sacs and mesothelial/monocytic incidental cardiac excrescences, and we propose modifying the designation to "nodular histiocytic/mesothelial hyperplasia" to take into account the marked predominance of histiocytes over mesothelial cells. The clues to recognition of the true nature of the lesion are clinicopathologic correlation and identification of strips of low cuboidal (mesothelial) cells in the vicinity, and the diagnosis can be further confirmed by immunohistochemical staining. Nodular histiocytic/mesothelial hyperplasia probably results from irritation to the mesothelial lining by various causes leading to focal aggregation of histiocytes within retraction pockets or crevices of the serosal cavity.

Stabilities of dobutamine, dopamine, nitroglycerin and sodium nitroprusside in disposable plastic syringes.

The solutions of dobutamine hydrochloride (5 mg/ml), dopamine hydrochloride (4 mg/ml), nitroglycerin (1 mg/ml) and sodium nitroprusside (1 mg/ml) in dextrose 5% injection were stable for 24 h when stored at 25 degrees C in 60-ml plastic syringes. For sodium nitroprusside, the syringes must be wrapped with aluminium foil (provided by the manufacturer), otherwise the loss in potency is very high (22%). There was no change in the pH values of dobutamine and dopamine solutions as well as sodium nitroprusside solutions in the prewrapped syringes. However, the pH value of nitroglycerin solutions decreased to 4.3 from 4.6 and that of sodium nitroprusside solutions in unwrapped syringes from 4.2 to 3.5; these solutions had discoloured. The chromatogram also showed new peaks from the products of decomposition. The physical appearances of the other solutions did not change.