Lobular breast cancers lack the inverse relationship between ER/PR status and cell growth rate characteristic of ductal cancers in two independent patient cohorts: implications for tumor biology and adjuvant therapy

BACKGROUND: Although invasive lobular carcinoma (ILC) of the breast differs from invasive ductal carcinoma (IDC) in numerous respects - including its genetics, clinical phenotype, metastatic pattern, and chemosensitivity - most experts continue to manage ILC and IDC identically in the adjuvant setting. Here we address this discrepancy by comparing early-stage ILC and IDC in two breast cancer patient cohorts of differing nationality and ethnicity. METHODS: The clinicopathologic features of 2029 consecutive breast cancer patients diagnosed in Hong Kong (HK) and Australia (AUS) were compared. Interrelationships between tumor histology and other clinicopathologic variables, including ER/PR and Ki67, were analysed. RESULTS: Two hundred thirty-nine patients were identified with ILC (11.8%) and 1790 patients with IDC. AUS patients were older (p 0.7). Moreover, whereas IDC tumors exhibited a strongly negative relationship between ER/PR and Ki67 status (p 0.6). CONCLUSION: These data imply that the primary adhesion defect in ILC underlies a secondary stromal-epithelial disconnect between hormonal signaling and tumor growth, suggesting in turn that this peritumoral feedback defect could reduce both the antimetastatic (adjuvant) and tumorilytic (palliative) efficacy of cytotoxic therapies for such tumors. Hence, we caution against assuming similar adjuvant chemotherapeutic survival benefits for ILC and IDC tumors with similar ER and Ki67, whether based on immunohistochemical or gene expression assays.published_or_final_versio

Chronic hepatitis B: whom to treat and for how long? Propositions, challenges, and future directions

Recent guidelines of the American Association for the Study of Liver Diseases, the European Association for the Study of the Liver, and the Asian Pacific Association for the Study of the Liver 2008 update of the “Asian-Pacific consensus statement on the management of chronic hepatitis B” offer comprehensive recommendations for the general management of chronic hepatitis B (CHB). These recommendations highlight preferred approaches to the prevention, diagnosis, and treatment of CHB. Nonetheless, the results of recent studies have led to an improved understanding of the disease and a belief that current recommendations on specific therapeutic considerations, including CHB treatment initiation and cessation criteria, particularly in patient populations with special circumstances, can be improved. Twelve experts from the Asia-Pacific region formed the Asia-Pacific Panel Recommendations for the Optimal Management of Chronic Hepatitis B (APPROACH) Working Group to review, challenge, and assess relevant new data and inform future updates of CHB treatment guidelines. The significance of and controversy about reported findings were discussed and debated in an expert meeting of the Working Group in Beijing, China, in November 2008. This review paper attempts to identify areas requiring improved CHB management and provide suggestions for future guideline updates, with special emphasis on treatment initiation and duration

A brief cognitive behavioural therapy psychoeducational group for Chinese people with chronic illnesses: an evaluation study

This pilot study attempted to examine the effectiveness of a brief cognitive behavioural therapy (CBT) psychoeducational group for Chinese people with chronic illness in Hong Kong. It adopted a single group design, and 52 participants joined the group. A questionnaire with three outcome measures, measuring general mental health, quality of life and dysfunctional attitudes and beliefs, was administered to participants at pre-test, post-test and six month follow-up. Repeated measures ANOVAs were employed and revealed positive changes in most of the outcome measures across the three time points. Cohen’s d showed a moderate to large effect size for most outcome measures. From a step care perspective, a culturally attuned brief CBT psychoeducational group may serve as an early intervention and a triage to attract suitable people with chronic illness to engage in the treatment process

Evaluating the effectiveness of a group CBT for parents of ADHD children

Improvements in parenting skills do not necessarily lead to improvements in child and parent outcomes for children with attention deficit and hyperactivity disorder (ADHD). Cognitive factors such as parental cognitions and parenting self-efficacy may influence such outcomes. Clinical research on the effects of cognitive-behaviour therapy (CBT) on parental cognitions, parenting self-efficacy and mental health in Chinese parents of children with ADHD is lacking. This quasi-experimental study intended to assess the effects of a culturally attuned group CBT treatment on the mental health and quality of life of Chinese parents aged 26-58 years, with children with ADHD in Hong Kong. Participants in the experimental group received group CBT and standard treatment and their counterparts in the control group received standard treatment. Primary outcome variables of mental health and quality of life and process variables including parenting stress, parenting efficacy and dysfunctional attitudes were measured at baseline, post-treatment and three-month follow-up. Data were analysed using 2 × 3 ANCOVAs, Cohen’s d statistics and multiple mediation analyses. Group by time interactions were found for most outcome variables. Effect size statistics indicated that group CBT had small to moderate effects on most outcome variables at post-treatment and follow-up assessments. The effect of CBT on mental health was mediated by the reduction in parenting stress and the effect of CBT on quality of life was mediated by the reductions in parenting stress and dysfunctional attitudes. Given its potential benefit, it is worth considering incorporating this group CBT programme into interventions for Chinese parents with ADHD children

Evaluating Effectiveness of Cognitive–Behavior Therapy for Hong Kong Adolescents With Anxiety Problems

Objectives: The aims of this study were to examine the effects of group cognitive–behavior therapy (CBT) on improving anxiety symptoms and enhancing personal growth among adolescents at risk of developing anxiety disorders in school settings in Hong Kong. Method: A total of 26 participants received an eight-session CBT group and 20 received treatment as usual in the waitlist control condition. Instruments measuring anxiety symptoms, types of anxiety in children, dysfunctional thoughts, and personal growth were used to assess the changes in severity of anxiety symptoms, dysfunctional thoughts, and personal growth among the participants. Results: A 2 × 2 mixed model analyses of variance were employed, results demonstrated significantly greater improvements in overall anxiety symptoms, generalized anxiety symptoms, and personal growth—use of resources in the participants of the CBT group compared to the control group. Conclusion: Group CBT may potentially improve anxiety symptoms of adolescents in school settings in Hong Kong

Road to better health and integration: A Delphi study on health service models for Hong Kong migrants

In Hong Kong, migrants arriving from Mainland China often have multiple roles and responsibilities while adapting to new lives in their host destination. This paper explored the factors that contribute to the inequity in health services utilisation experienced by these migrants; and, identified the elements that could constitute an effective health delivery model to address the service gap. METHODS: Site visits and a focus group discussion (n = 13) were held with both public and private health providers before a number of innovative health delivery models were formulated. They were then circulated among the panel in two further rounds of Delphi survey (n = 11) from March-April 2012 to systematically collect opinions and select the most endorsed health service models to serve this target population. RESULTS: Focus group members perceived that most migrants were unaware of, or even ignored, their own physical and mental health needs, and had low utilisation of healthcare services, because of their pre-occupation with daily chores and hardship as well as differing health values, practices and expectations. They further identified that the structural issues such as the healthcare setting or the operation of current service provisions had failed to meet migrants' health needs. Consequently, four new service models that incorporated professional advice and empowerment, which were identified as the two most important elements, were put forward. Thus, the model of having a nurse with social work training, supported by volunteer groups, was selected as the best option to familiarise and empower patients within the labyrinth of local healthcare services. CONCLUSION: Implementation of a social empowerment model by way of targeted support and specific health information is recommended. Further evaluation of this model is needed to understand its effectiveness for improving health literacy and health status in this disadvantaged group in the long term

Recurrence after VATS pleurodesis for primary spontaneous pneumothorax: can surgeons minimize the risk?

Poster no. P27Conference Theme: Surgery for Tomorrow's AsiaThis FREE journal suppl. entitled: Special Issue: RCSEd/CSHK Conjoint Scientific Congress 2015, ASA 20th Asian Congress of SurgeryOBJECTIVE: A minority of patients experience recurrence following pleurodesis via video-assisted thoracoscopic surgery (VATS) for primary spontaneous pneumothorax (PSP). To reduce recurrence, its risk factors must first be identified. METHODS: VATS bleb staple-excision and mechanical pleurodesis was performed in 315 consecutive patients with PSP. Patients with previous pleurodesis and/or secondary pneumothorax were excluded. Recurrence was defined as any new clinically or radiographically detected ipsilateral pneumothorax following surgery. RESULTS: The cohort included 284 males (90.2%), and had a median age of 21 years (range: 15–40). After a median follow-up of 72.4 months (range: 32.5–106.8 months), recurrent pneumothorax occurred in 41 patients (13.0%), including 19 requiring re-intervention (6.0%). Survival analysis demonstrated significant association of recurrence with: age ≤ 25 years (HR = 2.82, 95% CI 1.43–5.56, p = 0.023); operation time > 60 minutes (HR = 2.39, 95% CI 0.97–5.90, p = 0.020); and residual inter-pleural air space on chest X-ray after chest drain removal (HR = 1.99, 95% CI 1.05–3.79, p = 0.024). A trend of association of recurrence with a pain score > 2 (10-point visual analog scale) on coughing on post-op day 1 was observed (HR = 2.46, 95% CI 1.18–6.47, p = 0.082). Other patient factors (including sex, smoking history, symptoms), intraoperative factors (including laterality, surgery performed by trainee, needlescopic VATS, adjunct chemical pleurodesis) and postoperative factors (including air leak, chemical pleurodesis, stopping suction before drain removal, prolonged drain durations) did not show association with recurrence. CONCLUSION: Risk factors associated with recurrence after VATS for PSP may potentially be controllable by the surgeon. Expeditious surgery, careful drain removal to prevent residual air space, and aggressive postoperative pain control may help to minimize recurrence risk.link_to_OA_fulltex

The acceptance and feasibility of breast cancer screening in the East

Breast cancer, traditionally a disease prevalent among women in the West, has become an increasing disease burden in the East. In Hong Kong, breast cancer is the number one incident cancer in women. In Asian countries, due to the lower incidence rate, population screening is still controversial. Most screening programs are not population-based, and are either self-financed privately or partially subsidized by the government. Since the first government-subsidized screening program was set up in 1991 in Hong Kong, numerous private and government health centres for women have been set up. A dedicated private Breast Care Centre was set up at the Hong Kong Sanatorium and Hospital (HKSH) in 1999. Over an 8-year period from October 1999 to September 2006, 14,596 women were screened, of whom 11,408 were asymptomatic. This study aims to produce the first report on breast screening experience in the largest cohort of asymptomatic Chinese women in the private sector. An overall malignancy detection rate of 2.3 per 1000 screens and a recall rate of 9.2% were found. Despite culture differences and differences in breast characteristics (denser and smaller breasts), breast screening is feasible and acceptable in the East. © 2007 Elsevier Ltd. All rights reserved