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Alpha B-crystallin (CRYAB) maps within the nasopharyngeal carcinoma (NPC) tumor-suppressive critical region 11q22-23 and its downregulation is significantly associated with the progression of NPC. However, little is known about the functional impact of CRYAB on NPC progression. In this study we evaluated the NPC tumor-suppressive and progression-associated functions of CRYAB. Activation of CRYAB suppressed NPC tumor formation in nude mice. Overexpression of CRYAB affected NPC progression-associated phenotypes such as loss of cell adhesion, invasion, interaction with the tumor microenvironment, invasive protrusion formation in three dimensional Matrigel culture, as well as expression of epithelial-mesenchymal transition-associated markers. CRYAB mediates this ability to suppress cancer progression by inhibition of E-cadherin cytoplasmic internalization and maintenance of ß-catenin in the membrane that subsequently reduces the levels of expression of critical downstream targets such as cyclin-D1 and c-myc. Both ectopically expressed and recombinant CRYAB proteins were associated with endogenous E-cadherin and ß-catenin, and, thus, the cadherin/catenin adherens junction. The CRYAB α-crystallin core domain is responsible for the interaction of CRYAB with both E-cadherin and ß-catenin. Taken together, these results indicate that CRYAB functions to suppress NPC progression by associating with the cadherin/catenin adherens junction and modulating the ß-catenin function.

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A middle-aged man presented with bone pain at multiple sites due to tumour-induced osteomalacia. The underlying occult phosphaturic mesenchymal tumour was identified by octreotide scan 5 years after presentation and confirmed by computed tomography. Tumour resection resulted in normalisation of blood chemistry and bone densitometry. Clinico-radiologico-pathological correlation and ultrastructural studies of the tumour threw light on the pathogenesis and pathophysiology of this rare disease.

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AIMS: To study the morphology and immunohistochemical expression of nasopharyngeal intraepithelial lesions and to understand their place in nasopharyngeal carcinogenesis. METHODS AND RESULTS: Nine cases of nasopharyngeal intraepithelial lesion (NPIL) were diagnosed during nasopharyngeal biopsy screening for nasopharyngeal carcinoma (NPC). Two cases were associated with early invasion. All cases demonstrated specific histological features and consistent positivity on in-situ hybridization for Epstein-Barr virus (EBV)-encoded RNA. Pure NPIL lesions showed low-grade morphology while lesions associated with early invasion were high grade. Immunohistochemical studies showed increased expression of bcl-2 and essentially negative findings for BZLF1 and LMP1. High-grade lesions had relatively stronger expression of bcl-2 and p53. CONCLUSIONS: NPIL harbours latent EBV infection and has malignant potential. Multiple steps are involved in its occurrence and progression. Low-grade and high-grade lesions should be managed differently.

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OBJECTIVE: To estimate the incidence and determine the characteristic features of venous thromboembolism in the Hong Kong Chinese population. DESIGN: Retrospective study. SETTING: Regional hospital, Hong Kong. SUBJECTS AND METHODS: Data were collected during a period of four years (1997-2000). Patients with duplex doppler ultrasonography or venography-documented venous thromboembolism and new episodes of deep vein thrombosis were identified from Department of Diagnostic Radiology records. Patients with high-probability ventilation-perfusion scans were identified from Department of Nuclear Medicine records and these scans were taken as evidence of pulmonary embolism. Patients with intermediate-probability ventilation-perfusion scans, with pulmonary embolism documented by either pulmonary angiography or spiral computed tomography scan, were also included in the study. Patients with autopsy-verified fatal pulmonary embolism were identified from Department of Pathology records. Patients with deep vein thrombosis at other sites were sought from patient discharge diagnostic coding data. Medical records were reviewed for patient characteristics and conditions associated with the development of venous thromboembolism. RESULTS: Three hundred and seventy-six Chinese patients had venous thromboembolism during the study period. Of these, 352 had peripheral deep vein thrombosis, five had deep vein thrombosis at other sites (cerebral sinus and portal vein thrombosis), 40 had pulmonary embolism (26 had concomitant deep vein thrombosis), and six had fatal pulmonary embolism shown at autopsy. CONCLUSION: The calculated annual incidence of venous thromboembolism in Hong Kong Chinese people was estimated at 16.6 events per 100,000 population, which is lower than incidence rates reported in Caucasians. The four conditions most commonly associated with venous thromboembolism were medical illness, malignancy, orthopaedic surgery, and intravenous drug use. Conditions associated with venous thromboembolism in patients younger than 45 years included intravenous drug use, thrombophilia, pregnancy, and the use of oral contraceptives.

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The Asian/Pacific Islander (API) population in the United States is majority immigrant, diverse ethnically, and resides predominately in urban settings. It is possible that urban APIs face health-threatening environmental hazards that differ in form or magnitude from environmental concerns of other definable subpopulations or the overall population in the United States. To date, little or nothing is known about this topic. Spurred by the complaints of one such community, in Boston Chinatown, which is also of low socioeconomic status, we conducted a first-stage survey of randomly chosen residents about environmental health concerns. Despite a small sample size, we were able to document several environmental factors of potential concern that were worthy of further study. These included exhaust and noise from motor vehicle traffic and dust from construction projects, and factors originating inside the home. Pedestrian safety and lack of open/green space emerged as primary community concerns, while residents' knowledge of environmental hazards, such as lead paint, was found to be weak. We conclude that standard surveys of "environmental justice" in communities such as this one require tailoring of methods to specific conditions in order to be effective. For example, our survey preferentially missed working-age men, and about half of all randomly selected persons were not interviewed despite bilingual/bicultural interviewers, support letters from the local health clinic, and in-person attempts at residences.

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The aim of this study was to investigate the origin of globus pharyngis with particular reference to esophageal disorders such as gastroesophageal reflux disease (GERD), motility disorders, structural abnormalities, other gastrointestinal tract diseases, and psychological profile. Previous studies on this subject using 24-hour pH monitoring give conflicting results and are hampered by the high background prevalence of asymptomatic GERD in the normal Western population. The local Chinese population is known to have a very low background level of GERD and therefore is an ideal study population. Twenty-six patients with globus pharyngis underwent 24-hour ambulatory pH monitoring, esophageal manometry, and esophagogastroduodenoscopy with lower esophageal biopsy. A control group of 20 patients presenting with non-ulcer dyspepsia was similarly investigated. Personality profiles of the globus pharyngis subjects and an appropriate control group were assessed. Eight of the globus pharyngis group (30.7%) had evidence of GERD, whereas only one of the controls (5%) demonstrated GERD on 24-hour esophageal pH monitoring (P < 0.05). The manometric and personality profile studies did not show significant differences between study and control groups. We concluded that the finding of GERD in patients with globus pharyngis is not a coincidental finding but that there is a true association between GERD and globus pharyngis.

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AIMS: Osteoblastoma is a rare bone tumour and differentiation from osteosarcoma is occasionally a diagnostic problem. The difficulty is further compounded when such a lesion microscopically shows cytological or architectural atypia. METHODS AND RESULTS: A case of pseudomalignant osteoblastoma occurring in the left iliac crest of a 34-year-old Chinese woman is presented. Radiographic findings were non-diagnostic, but favoured a benign yet locally aggressive lesion. Histologically the diagnosis was based on the findings of classical osteoblastoma areas harbouring pseudomalignant osteoblasts in the absence of mitoses, but there were co-existing atypical architectural features also. CONCLUSION: The significance and pathogenesis of the 'permeative pattern' are discussed. Difficulties in differentiating borderline lesions are emphasized.

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PIP: This study investigated the criteria chosen by male and female Chinese public servants (clinical psychologists, social workers, police officers, physicians, nurses, teachers, and lawyers) in Hong Kong to classify and define violence against women. Data were gathered via questionnaires completed by 2589 (686 male) public servants from 10,476 polled (response rate 24.7%). The questionnaires included a 14-item check-list of various behaviors constituting violence against women and a 10-item check-list of criteria that could be used to categorize behavior as violence against women. It was found that for this population, use of physical force and lack of consent were the main determinants of violence against women. Only half of respondents considered murder a form of violence against women, the rest categorized it as a crime that was "not merely violence." Most respondents defined sexual harassment, rape, and unwanted physical contact as forms of violence against women. The female public servants were more likely to define behaviors as violence against women and to use more criteria to define violence against women. Public servants who worked with the law enforcement and legal system were more likely than others to choose narrow definitions and rigid criteria.^ieng

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Sexual harassment of Chinese college students with a focus on their awareness, experiences, responses, and expectations of institutional intervention to the problem was examined. 358 male and 491 female Chinese college students in Hong Kong participated. There were no gender differences in students' awareness of the phenomenon. Students' own experiences were less frequent than what they had heard about sexual harassment. Peer harassment occurred twice as frequently as faculty harassment. Compared to men, twice as many women said they had been sexually harassed. About one in four women students experienced various forms of sexual harassment and 1% were coerced into sexual activities during their college years by either teachers or peers. Students typically avoided and ignored the harassers and felt that the university should take up active roles in combating the problem. Comparisons with U.S. studies suggested that Chinese college students had a lower awareness and experience level in sexual harassment than U.S. students.

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BACKGROUND: Epithelial-myoepithelial carcinoma (EMC) of the salivary gland is a low-grade carcinoma. It has been widely accepted as a clinicopathologic entity only in the past decade. Histologically, the classical bimodal differentiation of inner eosinophilic ductal cells and outer layer of clear myoepithelial cells has been well documented by many authors. However, the proportion of each component may vary in different tumors or within the same tumor, and different histologic patterns have been described. The clinicopathologic findings of an epithelial-myoepithelial carcinoma of the parotid gland in a 73-year-old man are presented. METHODS: Light microscopy including immunohistochemistry and ultrastructural studies were done. RESULTS: The various histologic patterns and bimodal differentiation of the tumor were noted. CONCLUSIONS: The present case demonstrates the myriad of histologic patterns that can occur in epithelial-myoepithelial carcinoma. Differentiation from malignant mixed tumor is essential and possible. The importance of the awareness of its histologic variants is emphasized.

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A community campaign against the establishment of psychiatric half-way house in Shatin District, Hong Kong was examined in terms of fear toward mental patients and problems in community relations. Failure of the Government to prepare for the community reintegration of mental patients pointed to lessons to be learned in Community Psychology. The apparent conflict between community empowerment and community care for the disabled was discussed. Suggestions for resolving the paradox included early community mental health education, involvement of community leaders in the planning, application of the knowledge and skills of Social Psychology in dealing with public panic, and cooperation with the mass media to reach the public.

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Despite its origin in Western psychiatry, neurasthenia has become a popular concept in Chinese folk medicine, referring to a variety of somatic and psychological symptoms. Review of Chinese medicinal materials and patent medicines shows that neurasthenia is associated more often with somatic symptoms in tonic type medicine and with psychological and psychosomatic symptoms in sedative and tranquilizer type medicine. Popular Chinese books on neurasthenia suggest that causes might be attributed to lifestyle, psychological factors, and health problems. Recommendations on treatment emphasize self-help approaches through changing lifestyle, examining attitudes, tonic care, and relaxation. As a broad term used loosely by professionals and the lay public in Hong Kong, neurasthenia serves the important function of destigmatizing psychiatric disorders. Psychosexual problems may also be conveyed discreetly through somatic presentation. The indigenization of neurasthenia exemplifies how an originally Western concept acquires cultural meaning. Implications of illness conceptualization and the medical paradigm are discussed.

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This paper points out how political motives behind community research may affect the outcome. The case of public opposition to psychiatric halfway houses in Hong Kong is used as an illustration. These mass surveys related to the issue are reviewed to show how the different public opinions expressed may be affected by the objectives, context, sample, and content of the surveys.

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Problem conceptualizations of Chinese psychiatric patients were studied in relation to the patterns of help-seeking and ways of coping. Patients who conceptualized their initial problems in purely psychological terms were more likely to use self-directed psychological coping methods, delay initial professional consultation, and approach mental health professionals. Patients who used only somatic concepts were least likely to approach mental health professionals initially or any time during their previous consultation history, and tended to approach medical resources to cope with their problems. Patients who conceptualized their problems in mixed terms approached professional help early on and reached psychiatric resources soonest. These results provide a clearer perspective to understand the somatization tendency among Chinese patients.

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We report a patient with large intracerebral chloromas while in systemic remission from acute myelogenous leukemia. A favourable outcome resulted from surgical debulking and radiotherapy. Review of other reported cases in the literature showed a uniform female occurrence. We believe that intracerebral chloromas represent reactivation of sanctuary deposits in the central nervous system. The treatment of intracerebral chloroma is discussed.

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Chinese university students were asked to indicate their inclination to seek help and the resources for consultation on the 22 problems listed on the Langner Scale. Results showed that the Chinese students were generally not inclined to seek help and when they did, would most often seek help from medical doctors. However, when items were grouped in terms of clinical content, it was found that friends were predominantly preferred for psychological problems while the doctor was preferred for psychophysiological, physiological, and ambiguous problems. More female than male students tended to rely on friends and family members while the reverse pattern was found in the preference for doctors. The mental health professional was rarely cited as a resource for any of the problems. The results provide some explanation for observations made in previous studies on symptom presentation and help-seeking behavior among Chinese psychiatric patients.

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In order to document the prevalence of atherosclerosis of the major coronary arteries among Hong Kong Chinese, a study on material from autopsies done during the year 1981 in Queen Mary Hospital was carried out. The narrowest part of the proximal coronary arteries was studied by light microscopy and morphometrically by electronic digitizer. We found an onset of atherosclerosis in young adult males and a linear progression with age. Females had a delayed onset with a sharp rise after menopause. We were surprised to find an incidence of atherosclerosis among Hong Kong Chinese comparable with that in western populations, as distinct from Chinese in Mainland China. However, mortality due to ischemic heart disease remained relatively low. Racial factors may contribute to this partial dissociation between coronary atherosclerosis and ischemic heart disease.

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