Occult thoraco-abdominal injuries from an airbag and seatbelt

AbstractA combination of a seatbelt and airbags decreases the risk of injury for most body regions in motor vehicle crashes. Although the severity of injuries decreases, injuries still occur. We report a case of occult thoraco-abdominal trauma in a patient who was wearing a three-point seatbelt and had airbag protection. A 59-year-old man presented to the emergency department in shock after a motor vehicle accident. He was protected by a three-point seatbelt and airbag. Chest radiographs and focused assessment with sonography for trauma showed no abnormalities. However, computed tomography revealed multiple injuries in the chest and abdomen. This case report highlights occult thoraco-abdominal trauma in a victim protected by a seatbelt and airbag, which may be a pitfall for emergency physicians. Emergency physicians should understand the limitations of chest radiographs in trauma evaluation and carry out a complete evaluation of patients

Moderate Alcohol Use and Mortality from Ischaemic Heart Disease: A Prospective Study in Older Chinese People

Abstract Background: Moderate alcohol use is generally associated with lower ischaemic heart disease (IHD) mortality but it is difficult to ascertain whether this is due to attributes of moderate alcohol users or the properties of alcohol itself. Evidence from populations with different patterns of alcohol use and IHD can provide crucial evidence. We assessed the association of moderate alcohol use with IHD mortality in older Chinese people from Hong Kong. Methodology We used Cox regression to determine whether moderate alcohol use was associated with IHD mortality in a prospective, population-based cohort study of all 56167 attendees, aged 65 years or over, from July 1998 to December 2000 at all 18 Elderly Health Centers operated by the Department of Health in Hong Kong. Principal Findings After a median follow-up of 4.2 years, there were 406 (188 in men, 218 in women) deaths from IHD in 54,090 subjects (96.3% successful follow-up). Moderate alcohol use in men was not associated with IHD mortality adjusted only for age [Hazard Ratio, HR 1.01 (95% CI 0.55 to 1.84) compared with never drinkers] or additionally adjusted for socioeconomic status and lifestyle. Almost all women were occasional drinkers and their current alcohol use was not significantly associated with IHD mortality [HR 0.88, (95% CI 0.51 to 1.53)]. Conclusions Moderate alcohol use had no effect on IHD mortality in older Chinese men. Lack of replication of the usual protective effect of moderate alcohol use in a setting with a different pattern of alcohol use and IHD could be due to chance or could suggest that the protective effect of alcohol on IHD does not extend to all populations

Reliable and valid NEWS for Chinese seniors: measuring perceived neighborhood attributes related to walking

Background : The effects of the built environment on walking in seniors have not been studied in an Asian context. To examine these effects, valid and reliable measures are needed. The aim of this study was to develop and validate a questionnaire of perceived neighborhood characteristics related to walking appropriate for Chinese seniors (Neighborhood Environment Walkability Scale for Chinese Seniors, NEWS-CS). It was based on the Neighborhood Environment Walkability Scale - Abbreviated (NEWS-A), a validated measure of perceived built environment developed in the USA for adults. A secondary study aim was to establish the generalizability of the NEWS-A to an Asian high-density urban context and a different age group. Methods : A multidisciplinary panel of experts adapted the original NEWS-A to reflect the built environment of Hong Kong and needs of seniors. The translated instrument was pre-tested on a sample of 50 Chinese-speaking senior residents (65+ years). The final version of the NEWS-CS was interviewer-administered to 484 seniors residing in four selected Hong Kong districts varying in walkability and socio-economic status. Ninety-two participants completed the questionnaire on two separate occasions, 2-3 weeks apart. Test-rest reliability indices were estimated for each item and subscale of the NEWS-CS. Confirmatory factor analysis was used to develop the measurement model of the NEWS-CS and cross-validate that of the NEWS-A. Results : The final version of the NEWS-CS consisted of 14 subscales and four single items (76 items). Test-retest reliability was moderate to good (ICC > 50 or % agreement > 60) except for four items measuring distance to destinations. The originally-proposed measurement models of the NEWS-A and NEWS-CS required 2-3 theoretically-justifiable modifications to fit the data well. Conclusions : The NEWS-CS possesses sufficient levels of reliability and factorial validity to be used for measuring perceived neighborhood environment in Chinese seniors. Further work is needed to assess its construct validity and generalizability to other Asian locations. In general, the measurement model of the original NEWS-A was generalizable to this study context, supporting the feasibility of cross-country and age-group comparisons of the effect of the neighborhood environment on walking using the NEWS-A as a tool to measure the perceived built environment

Obesity, Physical Activity, and Mortality in a Prospective Chinese Elderly Cohort

Background In older people, it is unclear whether obesity relates to mortality, which calls into question its etiologic role in disease and its public health relevance. This apparent lack of relationship in older people could be an artifactual result of their diverse health states. Methods We used Cox regression analysis to determine whether the effect of body mass index (BMI) (calculated as weight in kilograms divided by the square of height in meters) or physical activity on mortality varied with health status in a prospective cohort study of Chinese people 65 years or older enrolled from 1998 to 2000 at all of the 18 Elderly Health Centers of the Hong Kong Government Department of Health. Health status was categorized into 5 morbidity groups using a 12- item index covering illnesses, medications, frailty, and smoking. Results After a mean follow-up of 4.1 years, there were 3819 deaths in 54 088 subjects (96.5% successful followup). The effect of BMI on mortality varied with baseline health status (P_.001). In the healthiest group, obese people (BMI _25) had higher mortality (adjusted hazard ratio [HR], 1.54; 95% confidence interval [CI], 1.02- 2.33), but in the unhealthiest group they had lower mortality (HR, 0.55; 95% CI, 0.49-0.63) compared with subjects of normal weight. Daily physical activity was associated with lower mortality compared with inactivity in the unhealthiest group (HR, 0.70; 95% CI, 0.61- 0.81) but not in the healthiest group. Conclusions In the elderly, the relationship between obesity and mortality varies according to the underlying health status. In those with poor health status, obesity is associated with better outcome, whereas in those with initially good health status, obesity is associated with worse outcome

Reactivation of Epstein–Barr virus by a dual-responsive fluorescent EBNA1-targeting agent with Zn2+-chelating function

EBNA1 is the only Epstein–Barr virus (EBV) latent protein responsible for viral genome maintenance and is expressed in all EBV-infected cells. Zn2+ is essential for oligomerization of the functional EBNA1. We constructed an EBNA1 binding peptide with a Zn2+ chelator to create an EBNA1-specific inhibitor (ZRL5P4). ZRL5P4 by itself is sufficient to reactivate EBV from its latent infection. ZRL5P4 is able to emit unique responsive fluorescent signals once it binds with EBNA1 and a Zn2+ ion. ZRL5P4 can selectively disrupt the EBNA1 oligomerization and cause nasopharyngeal carcinoma (NPC) tumor shrinkage, possibly due to EBV lytic induction. Dicer1 seems essential for this lytic reactivation. As can been seen, EBNA1 is likely to maintain NPC cell survival by suppressing viral reactivation

MicroRNA let-7 suppresses nasopharyngeal carcinoma cells proliferation through downregulating c-Myc expression

Aims: This study aimed at evaluating the potential anti-proliferative effects of the microRNA let-7 family in nasopharyngeal carcinoma (NPC) cells. In addition, the association between let-7 suppression and DNA hypermethylation is examined. Materials and methods: Levels of mature let-7 family members (-a,-b,-d,-e,-g, and-i) in normal nasopharyngeal cells (NP69 and NP460) and nasopharyngeal carcinoma cells (HK1 and HONE1) were measured by real-time quantitative PCR. Cell-proliferation assay and c-Myc immunohistochemical staining were performed on NPC cells transfected with let-7 precursor molecules. In addition, expression changes in let-7 family members in response to demethylating agents (5-azacytidine and zebularine) were also examined. Results: In comparison with the normal nasopharyngeal cells, let-7 (-a,-b,-d,-e,-g, and-i) levels were reduced in nasopharyngeal carcinoma cells. Ectopic expression of the let-7 family in nasopharyngeal carcinoma cells resulted in inhibition of cell proliferation through downregulation of c-Myc expression. Demethylation treatment of nasopharyngeal carcinoma cells caused activation of let-7 expression in poorly differentiated nasopharyngeal carcinoma cells only. Conclusion: Our results suggested that miRNA let-7 might play a role in the proliferation of NPC. DNA methylation is a potential regulatory pathway, which is affected when let-7 is suppressed in NPC cells. However, the extent of DNA hypermethylation/hypomethylation in regulating let-7 expression requires further elucidation. © The Author(s) 2010. This article is published with open access at Springerlink.com.published_or_final_versionSpringer Open Choice, 21 Feb 201

Early intervention for incipient insanity: early notions from the 19th century English literature.

AIM: Early intervention programmes in mental illnesses started to bloom in the 1990s, and many programmes have been established worldwide during the past twenty years. However, the concept of early intervention has emerged during the 19th century but it did not make much impact on practice. The aim of this review is to identify the difficulties appeared during that period of time which could provide insight into the modern development of early intervention initiatives. METHODS: A narrative review which focused on English literature about early intervention for insanity during the 19th century was undertaken. RESULTS: Clinicians during the 19th century recognized that treatment would be the most effective at the early stage of the mental illness and they had emphasized the importance of early intervention. However, because of a number of factors, such as the limited roles of asylums, lack of knowledge about mental disorder and the lack of effective treatment, the idea of early intervention did not make impact in clinical service during that period of time. CONCLUSION: During the past two hundred years, understanding towards mental illness has advanced and more effective treatments, such as the use of anti-psychotic medications, have been developed. Reflecting on the past experience and difficulties might shed light on the development of today early intervention in mental disorder.This is the author accepted manuscript. It is currently under an indefinite embargo pending publication by Wiley

Measuring walking within and outside the neighborhood in Chinese elders: reliability and validity

Background : Walking is a preferred, prevalent and recommended activity for aging populations and is influenced by the neighborhood built environment. To study this influence it is necessary to differentiate whether walking occurs within or outside of the neighborhood. The Neighborhood Physical Activity Questionnaire (NPAQ) collects information on setting-specific physical activity, including walking, inside and outside one\u27s neighborhood. While the NPAQ has shown to be a reliable measure in adults, its reliability in older adults is unknown. Additionally its validity and the influence of type of neighborhood on reliability and validity have yet to be explored. Methods : The NPAQ walking component was adapted for Chinese speaking elders (NWQ-CS). Ninety-six Chinese elders, stratified by social economic status and neighborhood walkability, wore an accelerometer and completed a log of walks for 7 days. Following the collection of valid data the NWQ-CS was interviewer-administered. Fourteen to 20 days (average of 17 days) later the NWQ-CS was re-administered. Test-retest reliability and validity of the NWQ-CS were assessed. Results : Reliability and validity estimates did not differ with type of neighborhood. NWQ-CS measures of walking showed moderate to excellent reliability. Reliability was generally higher for estimates of weekly frequency than minutes of walking. Total weekly minutes of walking were moderately related to all accelerometry measures. Moderate-to-strong associations were found between the NWQ-CS and log-of-walks variables. The NWQ-CS yielded statistically significantly lower mean values of total walking, weekly minutes of walking for transportation and weekly frequency of walking for transportation outside the neighborhood than the log-of-walks. Conclusions : The NWQ-CS showed measurement invariance across types of neighborhoods. It is a valid measure of walking for recreation and frequency of walking for transport. However, it may systematically underestimate the duration of walking for transport in samples that engage in high levels of this type of walking