Biomedical subjects

D T Lee

Publications and source records attributed to D T Lee.

At least 19 recordsLinked to original sources

PubMed2001

Association between mu opioid receptor gene polymorphisms and Chinese heroin addicts.

Mu opioid receptor (MOR) has been shown to be associated with alcoholism and opioid dependence. The present study examined the involvement of a polymorphism in A118G in exon 1 and C1031G in intron 2 of the MOR gene in 200 Chinese heroin-dependent and 97 control subjects. Results showed a significant association for both A118G and C1031G polymorphisms and opioid dependence. The G allele is more common in the heroin-dependent group (39.5% and 30.8% for A118G and C1031G polymorphisms, respectively) when compared to the controls (29.4% and 21.1% for A118G and C1031G polymorphisms, respectively). This study suggests that the variant G allele of both A118G and C1031G polymorphisms may contribute to the vulnerability to heroin dependence.

Adult↗

PubMed2001

Immediate effect of percutaneous myocardial laser revascularization on hemodynamics and left ventricular systolic function in severe angina pectoris.

Experimental data suggest that myocardial revascularization with a high-energy laser may cause a significant reduction in left ventricular (LV) function immediately after creation of myocardial channels. We sought to determine if percutaneous myocardial laser revascularization (PMR) causes immediate deterioration in hemodynamic parameters or regional LV systolic function. PMR was performed in 40 patients (mean age 62.9 +/- 10.8 years) using the Eclipse Holmium laser (26 had PMR alone; 14 patients underwent PMR plus percutaneous coronary intervention). Intracardiac pressures and left ventriculograms were recorded before and after PMR. Regional wall motion was assessed using the centerline method. A mean of 18 +/- 5 channels were created per patient. There was no significant change in LV ejection fraction immediately after PMR (56 +/- 9% vs 55 +/- 10%, p = 0.25). No deterioration in regional wall motion was demonstrated in the lased region (mean chord motion for anterior wall PMR: -1.5 +/- 0.8 before vs -1.5 +/- 0.8 after the procedure, p = 0.93; inferior wall PMR: -1.5 +/- 0.9 before vs - 1.6 +/- 0.8 after the procedure, p = 0.43). Similarly, there was no change in the number of hypokinetic chords in the treated region. Systemic blood pressure, LV end-diastolic pressure, heart rate, and right-sided heart pressures were not significantly different after laser revascularization. In patients with refractory angina, PMR did not cause immediate deterioration in hemodynamic status or regional LV function.

Aged↗

PubMed2001

Rationales for Food Refusal in Chinese Patients with Anorexia Nervosa.

OBJECTIVE: To study the rationales for food refusal among Chinese patients with typical and atypical anorexia nervosa. METHOD: Forty-eight consecutive patients with broadly defined anorexia nervosa underwent evaluation with a self-report rationale for food refusal questionnaire, the 12-item General Health Questionnaire (GHQ-12), the 21-item Beck Depression Inventory (BDI-21), the Hamilton Depression Rating Scale (HDRS), and other clinical assessments. RESULTS: Fat-phobic patients (N = 32) had a significantly higher premorbid body mass index than non-fat-phobic patients (N = 16), but they did not differ on other clinical parameters, GHQ-12, BDI-21, and HDRS scores. At clinical presentation, 3 months, and 1 year prior to presentation, fat phobia and stomach bloating were the most common rationales for food refusal among fat-phobic and non-fat-phobic patients, respectively. A total of 31% of fat-phobic patients endorsed non-fat-phobic rationales at the time of clinical presentation, whereas non-fat-phobic patients adhered to non-fat-phobic attributions more consistently. DISCUSSION: The rationales used by anorexic patients to explain noneating are more varied than implied in the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders and the ICD-10 Classification of Mental and Behavior Disorders: Clinical Descriptions and Diagnostic Guidelines. A broadened conceptualization of anorexia nervosa may enhance an understanding of patients' illness experiences and enliven research on eating disorders.

Adult↗

PubMed2001

Screening for postnatal depression: are specific instruments mandatory?

BACKGROUND: Few studies have examined the utility of rating scales developed in non-puerperal context in detecting postnatal depression. This study evaluated the utility of the General Health Questionnaire (GHQ) and the Beck Depression Inventory (BDI) in screening for depression among recently delivered women in Hong Kong. METHODS: A prospective cohort of 145 Chinese women completed the GHQ, BDI and Edinburgh Postnatal Depression Scale (EPDS) 6 weeks after delivery. They were then assessed using the non-patient version of the Structured Clinical Interview for DSM-III-R (SCID-NP) to establish psychiatric diagnosis, against which the criterion validity of the GHQ and BDI was evaluated against this clinical diagnosis. The psychometric performance of the GHQ, BDI and EPDS in detecting postnatal depression was assessed using the receiver operating characteristic (ROC) curves. RESULTS: Both Chinese GHQ and BDI had satisfactory sensitivity and positive predictive value in detecting postnatal depression. Their receiver operating characteristic (ROC) curves were comparable to that of the EPDS. LIMITATION: The study was conducted in Chinese women using translated version of the rating scales. CONCLUSIONS: The GHQ and BDI are useful for detecting postnatal depression among recently delivered Chinese women. The results of this study suggest that rating scales developed in non-puerperal context may also be applicable for postnatal depression.

Adolescent↗

PubMed2001

Effects of using videotaped vignettes on enhancing students' critical thinking ability in a baccalaureate nursing programme.

AIM: The aim of this study was to determine the effects of using videotaped vignettes in promoting nursing students' critical thinking abilities in managing different clinical situations. BACKGROUND: The impetus for undertaking this study came from recognition of the need to develop the level of students' critical thinking within clinical nursing practice. Eight videotaped vignettes that simulated clinical situations were developed to promote baccalaureate nursing students' critical thinking abilities in managing clinical situations. Guidelines were also developed to stimulate students' discussion. DESIGN/METHODS: A pre-test/post-test design was employed to determine the effectiveness of videotaped vignettes in promoting critical thinking skills among these students. A final sample of 83 students completed all the pre-test and post-test questionnaires on critical thinking skills and nursing knowledge test specific to a vignette. RESULTS/FINDINGS: The findings indicate that students' post-test knowledge scores were significantly higher than the pre-test knowledge scores. While the post-test critical thinking skill test scores were slightly higher than those of the pre-test for the students, the difference was not significant. One reason for such findings may be the limited exposure students had to these new types of videotaped vignettes. After the course had been completed both students and teachers were asked to reflect and to indicate their level of satisfaction with the new approach. There was overall satisfaction with the new approach to teaching clinical skills as reflected in the interview data from both teachers and students. CONCLUSIONS: While there were positive outcomes in terms of helping students to relate nursing principles to clinical situations, more time for students to learn using videotaped vignette in tutorial hours remains a challenge for teachers in planning the lectures.

Adult↗

PubMed2001

A comparison of the psychologic impact and client satisfaction of surgical treatment with medical treatment of spontaneous abortion: a randomized controlled trial.

OBJECTIVE: The purpose of this study was to compare the psychologic impact and client satisfaction of routine surgical evacuation of the uterus with medical evacuation in cases of spontaneous abortion. STUDY DESIGN: This was a prospective, randomized controlled trial. Two hundred eighteen women who were admitted to a university teaching hospital after spontaneous abortion and who consented to the study were randomized to routine surgical evacuation or medical evacuation of the uterus with the use of misoprostol. General psychologic well-being, level of depression, fatigue symptoms, psychiatric morbidity, social functioning, client satisfaction, and acceptance were measured in the 2 groups. RESULTS: The 2 groups did not differ in any of the measured psychological outcomes. Significantly more participants who experienced successful evacuation of the uterus with the misoprostol protocol would choose the same mode of treatment if they were able to choose again. However, participants for whom the medical treatment failed to evacuate the uterus and subsequent surgical evacuation was required are significantly less satisfied with the treatment. CONCLUSION: Medical treatment of spontaneous abortion with misoprostol is psychologically safe and more compatible with the ethnomedical beliefs of our Chinese participants. Client satisfaction and acceptance should be taken into consideration in the evaluation of treatment outcomes.

Abortion, Spontaneous↗

PubMed2001

Perceptions of Hong Kong Chinese elders on adjustment to residential care.

While there is an increasing number of elders moving into residential care homes in Hong Kong, very little is known about how they adjust to the changes associated with living in such homes. A grounded theory study was therefore conducted to explore the processes through which Chinese elders adjust following a move to residential care. Audiotaped in-depth interviews were conducted with 18 elders one week after residential home admission and then every month until no new information about their adjustment experiences could be discovered. Constant comparative analysis of data revealed that newly admitted elders adjust through the four stages of orienting, normalizing, rationalizing and stabilizing as they struggle to regain normality in a life that is as close to that lived before admission as possible. The purpose of this paper is to report on Chinese elders' normalizing experiences in the second stage of adjustment. It found that a number of experiences suggested in the literature, as barriers to residential living, such as living with rules and regulations, lack of privacy and autonomy, are not regarded as important by Chinese elders. However, establishing relations with other residents and staff appears to be a particular challenge. It concludes that the life experience and socio-cultural values of Chinese elders have to be addressed when trying to effectively help Chinese elders adjust to life in residential care. The findings also highlight the need for better collaboration between nursing and social work staff in their efforts to promote elders' adjustment.

Adaptation, Psychological↗

PubMed2001

Up-regulation of TRPM-2, MMP-7 and ID-1 during sex hormone-induced prostate carcinogenesis in the Noble rat.

Prostate cancer is the most frequently diagnosed malignancy in the Western world and changes in the ratio of testosterone and estrogens with advancing age is one of the potential risk factors in the development of this disease. However, the molecular mechanisms associated with hormone imbalance in prostate carcinogenesis are poorly understood. In this study we induced a high incidence of prostate hyperplasia, dysplasia and adenocarcinoma in the Noble rat using a combination of testosterone and estradiol-17beta. Using this animal model, we studied the gene expression profile during sex hormone-induced prostate carcinogenesis using a cDNA array technique; the results were further confirmed by RT-PCR, western blotting and immunohistochemical analyses. We found up-regulation of TRPM-2 (testosterone-repressed prostatic message-2), MMP-7 (matrix metalloproteinase-7) and Id-1 (inhibitor of differentiation or DNA binding) during development of sex hormone-induced prostate cancer. Increased expression of TRPM-2 and MMP-7 was observed in both premalignant and malignant tissues after sex hormone treatment, indicating their role in the early stages of hormone response and prostate cancer development. In contrast, Id-1 was expressed at relatively low levels in all premalignant samples but increased in malignant cells, suggesting its potential roles as a biomarker for prostate cancer cells. Furthermore, expression of Id-1 appeared to be stronger in poorly differentiated lesions than in well-differentiated carcinomas, suggesting that the levels of Id-1 expression may be correlated with the malignancy of tumors. Our results provide the first evidence of up-regulation of TRPM-2, MMP-7 and Id-1 during sex hormone-induced prostate carcinogenesis and strongly suggest their association with the development of prostate cancer.

Adenocarcinoma↗

PubMed2000

Disposition towards critical thinking: a study of Chinese undergraduate nursing students.

The purpose of this study was to explore empirically whether undergraduate nursing students at a selected university in Hong Kong display a disposition towards critical thinking. The California Critical Thinking Dispositions Inventory (CCTDI) was used to measure the key theoretical aspects of the overall dispositional dimension of critical thinking. A cross-sectional descriptive design was used to examine 122 Chinese students who were completing their 1st, 2nd and 3rd year of a university baccalaureate nursing programme. In the majority of sub-scales of CCTDI, students showed a negative disposition towards critical thinking. A one-way ANOVA indicated that year 3 students scored significantly lower than their junior counterparts (P < 0. 001). Pearson product moment correlation coefficient yielded a significant positive relationship between critical thinking dispositions and term grade point average (P < 0.05). Consistent with the findings of western studies, the students scored lowest on the truth-seeking sub-scale and highest on the inquisitiveness. Discussion of the findings with regard to nursing education, curriculum and research is delineated.

Adult↗

PubMed2000

Aberrant expression of hepatocyte growth factor and its receptor, c-Met, during sex hormone-induced prostatic carcinogenesis in the Noble rat.

Hepatocyte growth factor (HGF) is a multifunctional cytokine which acts as a mitogen, motogen, morphogen and angiogenic factor of epithelial cells. HGF receptor is encoded by a proto-oncogene, c-met, which is overexpressed in various cancers. The role of HGF and c-Met in prostate carcinogenesis, especially in the early stages, is undefined. In this study, prostatic dysplasia and carcinomas were induced by testosterone propionate and 17 beta-estradiol in Noble rats. The expression of HGF and c-Met was assessed at a protein level by immunohistochemistry and western blot analysis. Intense immunostaining for HGF alpha and c-Met beta-chain was co-localized in dysplastic lesions and in primary and metastatic cancer cells. The levels of HGF alpha expression were similar among normal control, dysplastic and cancerous prostate tissues, as determined by western blot analysis. Immunoblot study for c-Met under reducing conditions identified two bands at 145 kDa (beta-subunit of c-Met) and 170 kDa (precursor form of c-Met) in rat liver extracts. However, two bands at approximately 220 and 245 kDa were detected in hormone-treated dysplastic prostate tissues and primary tumors. Overexpression of the 220 kDa band was observed in long-term (10-12 months) hormone-treated prostate and primary tumor extracts. Metastatic tumors consistently exhibited up-regulation of a single 245 kDa band. Under non-reducing conditions, however, protein bands of 220, 280 or 300 kDa were seen in the blots. The hormone-treated prostate tissues and metastatic tumors expressed the 220 and 300 kDa proteins, respectively. The majority of primary tumors expressed the 280 kDa protein. In summary, HGF and its receptor, c-Met, were co-expressed in dysplastic and tumor cells, suggesting that an autocrine mode of action may be involved in prostate carcinogenesis. The close correlation of expression of the high-molecular-weight isoforms of c-Met with different stages of carcinogenesis implicates that they might play differential roles in the onset, progression, growth and metastasis in prostate cancer.

Animals↗

PubMed2000

Thyroid function and psychiatric morbidity in patients with manic disorder receiving lithium therapy.

Euthyroid hyperthyroxinemia as a result of a transient increase in thyroid-stimulating hormone (TSH) levels may contribute to the development of manic disorder. Lithium has a potent short-term antithyroidal effect that may account for its antimanic action. The thyroid function and psychiatric morbidity of 46 adult patients with manic disorder were assessed prospectively before and 1 and 6 months after lithium treatment. At baseline, the free thyroxine level (FT4, 16.23 +/- 3.11 pmol/L) was at the high end of the normal range, whereas the free triiodothyronine (FT3, 4.24 +/- 0.65 pmol/L) and TSH (1.47 +/- 0.73 mIU/L) levels were within the normal range. All patients were clinically euthyroid, but five of them (11%) had elevated FT4 levels. Baseline FT3 and FT4 levels were positively correlated with past psychiatric morbidity. The FT4 level at baseline and after 1 month of treatment was positively correlated with scores on the Brief Psychiatric Rating Scale (p < 0.02) and negatively correlated with scores on the Global Assessment Scale (p < 0.005). During the first month of treatment, the reduction of FT3 and FT4 levels was significantly correlated with a decrease in psychiatric symptoms. By 6 months, the FT3 level was no longer significantly different from that at the baseline, but FT4 levels remained significantly lower. The TSH level increased progressively from baseline to 6 months. Multilevel models showed that FT4 and serum lithium levels were positively and negatively associated with psychiatric symptoms, respectively. The findings of the study lend support to the notion that euthyroid hyperthyroxinemia contributes to acute mania and suggest that lithium's short-term antimanic action may be mediated by its antithyroid effect.

Adult↗

PubMed2000

Role of core temperature as a stimulus for cold acclimation during repeated immersion in 20 degrees C water.

The relative importance of skin vs. core temperature for stimulating cold acclimation (CA) was examined by 5 wk of daily 1-h water immersions (20 degrees C) in resting (RG) and exercising (EG) subjects. Rectal temperature fell (0.8 degrees C; P < 0.05) during immersion only in RG. Skin temperature fell (P < 0.05) similarly in both groups. Physiological responses during cold-air exposure (90 min, 5 degrees C) were assessed before and after CA. Body temperatures and metabolic heat production were similar in both groups with no change due to CA. Cardiac output was lower (P < 0.05) in both groups post-CA (10.4 +/- 1.2 l/min) than pre-CA (12.2 +/- 1. 0 l/min), but mean arterial pressure was unchanged (pre-CA 107 +/- 2 mmHg, post-CA 101 +/- 2 mmHg). The increase in norepinephrine was greater (P < 0.05) post-CA (954 +/- 358 pg/ml) compared with pre-CA (1,577 +/- 716 pg/ml) for RG, but CA had no effect on the increase in norepinephrine for EG (pre-CA 1,288 +/- 438 pg/ml, post-CA 1,074 +/- 279 pg/ml). Skin temperature reduction alone may be a sufficient stimulus during CA for increased vasoconstrictor response, but core temperature reduction appears necessary to enhance sympathetic activation during cold exposure.

Adaptation, Physiological↗

PubMed2000

Psychiatric morbidity and illness experience of primary care patients with chronic fatigue in Hong Kong.

OBJECTIVE: The authors' goal was to examine the prevalence and experience of psychiatric morbidity among primary care patients with chronic fatigue in Hong Kong. METHOD: One hundred adult patients with medically unexplained fatigue for 6 or more months were assessed with the Explanatory Model Interview Catalogue, psychopathological rating scales, and an enhanced version of the Structured Clinical Interview for DSM-III-R. RESULTS: The lifetime prevalence of DSM-III-R depressive and anxiety disorders was 54%. Current depressive and anxiety disorders were identified in 28 patients, who exhibited more psychopathology and functional impairment than other patients. Thirty-three patients had somatoform pain disorder, and 30 had undifferentiated somatoform disorder, but most of them could also be diagnosed as having shenjing shuairuo (weakness of nerves) and, to a lesser extent, ICD-10 neurasthenia. Chronic fatigue syndrome diagnosed according to the 1988 Centers for Disease Control criteria was rare (3%) and atypical. Generally, patients mentioned fatigue if asked, but pains (36%), insomnia (20%), and worries (13%) were the most troublesome symptoms. Most patients attributed illness onset to psychosocial sources. CONCLUSIONS: Psychiatric morbidity was common among primary care patients with chronic fatigue. Subthreshold psychiatric morbidity was very common and was more validly represented by the disease construct of shenjing shuairuo or neurasthenia than somatoform disorder.

Adolescent↗

PubMed2000

Genetic analysis of the CYP2D6 locus in a Hong Kong Chinese population.

BACKGROUND: The cytochrome P450 CYP2D6 enzyme debrisoquine 4-hydroxylase metabolizes many different classes of commonly used drugs, such as tricyclic antidepressants and neuroleptics. Genetic polymorphism of the CYP2D6 gene is responsible for pronounced interindividual and interracial differences in the metabolism of these drugs. The CYP2D6*10 allele and its variants are the most frequent alleles found in Orientals, and they are responsible for diminished debrisoquine 4-hydroxylase activity because of the presence of a C(188)-->T mutation in exon 1. METHODS: One hundred nineteen Hong Kong Chinese subjects were genotyped by means of allele-specific PCR, PCR, and restriction enzyme analysis for 10 CYP2D6 alleles (CYP2D6*1, *2, *4D, *5, *8/*14, *10A, *10B, *15, *16, and J9). RESULTS: CYP2D6*10B was the most prevalent allele, and CYP2D6*10/CYP2D6*10 was the most frequent genotype, representing 41.17% [corrected] of the population. CONCLUSIONS: There was no significant difference in the prevalence of the alleles analyzed between our study and the Chinese populations genotyped previously. This is the largest study in terms of the number of CYP2D6 alleles analyzed in an Oriental population and the first one conducted in a Hong Kong Chinese population.

Alleles↗

PubMed2000

Brief acute psychosis following hysterectomy in ethnopsychiatric context.

The psychiatric morbidity following hysterectomy has received increasing attention. One of the sequelae of hysterectomy has been a brief, acute psychosis with excellent outcome, the etiology and pathomechanism of which is still unclear. Two Chinese patients born of Southeast Asian origin who manifested brief, acute psychosis following hysterectomy are presented. Therapy comprised drug treatment with low dose antipsychotics and benzodiazepines coupled with hypnosis and marital therapy to explore and treat the underlying pathology. Both psychotic states resolved. Follow-up at 12 months revealed stable mental condition in one subject; however, the second patient was lost to follow up. The impact of the womb's removal is explored in the context of the ethnicity of the patients and their sociocultural background.

Acute Disease↗

PubMed2000

Identifying women at risk of postnatal depression: prospective longitudinal study.

OBJECTIVE: To identify psychosocial risk factors for postnatal depression among Hong Kong Chinese women. DESIGN: Prospective longitudinal study involving self-report questionnaires and face-to-face interviews. SETTING: University teaching hospital, Hong Kong. PARTICIPANTS: Two hundred and twenty consecutive Chinese women who were admitted to the postnatal ward of the Department of Obstetrics and Gynaecology from 6 November 1996 to 18 January 1997. MAIN OUTCOME MEASURES: Psychiatric diagnoses were established using the clinician-administered Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders. Psychosocial risk factors were ascertained by conducting face-to-face interviews and using psychometric rating scales. RESULTS: Of the 330 women who delivered during the study period, 220 (66.7%) agreed to participate in the study. The 220 participants had a mean age of 29 years (range, 16-42 years). Postnatal depression was associated with depression during pregnancy, elevated depression score at delivery, and prolonged postnatal 'blues'. Other correlates of postnatal depression were temporary housing accommodation, financial difficulties, two or more induced abortions, past psychiatric disorders (including depression), and an elevated neuroticism score. Postnatal depression was more likely if the spouse was disappointed with the gender of the newborn. CONCLUSION: Some risk factors are similar to those found in the West, whereas others (spouse disappointment and history of abortion) may be unique to the local population. To help identify women who are at particularly high risk of developing postnatal depression, obstetricians and midwives in Hong Kong should consider codifying the identified risk factors into a check-list.

Adolescent↗

PubMed1999

Spontaneous abortion: a randomized, controlled trial comparing surgical evacuation with conservative management using misoprostol.

OBJECTIVE: To compare the efficacy of surgical evacuation of the uterus with medical evacuation using misoprostol in cases of spontaneous abortion. DESIGN: A prospective, randomized, controlled trial. SETTING: A university teaching hospital. PATIENT(S): Six hundred thirty-five women who aborted spontaneously and who consented to pretreatment randomization. INTERVENTION(S): Routine surgical evacuation or medical evacuation of the uterus using misoprostol. MAIN OUTCOME MEASURE(S): Immediate, short-term (2-3 weeks), and medium-term (6 months) medical complications. RESULT(S): There was a significantly lower incidence of immediate and short-term complications in the group treated with misoprostol compared with the surgically treated group. There were also fewer major complications in the 6 months after treatment in the medically treated group. Approximately 50% of the medically treated group subsequently required surgical evacuation, and these subjects required significantly more analgesia. CONCLUSION(S): Treatment with misoprostol can reduce the demand for surgical evacuation in cases of spontaneous abortion, and its use is associated with fewer medical complications.

Abortifacient Agents, Nonsteroidal↗

PubMed1999

Use of physical restraints on elderly patients: an exploratory study of the perceptions of nurses in Hong Kong.

A qualitative study was designed to explore nurses' perceptions of the use of physical restraints on elderly patients in Hong Kong. Content analysis of semi-structured interviews with 20 registered nurses working in medical and geriatric settings of two regional hospitals revealed that although nurses generally had mixed feelings about the use of physical restraints on elderly patients, they did not question this 'routine' practice and their knowledge about the consequences and alternatives to the use of restraint was limited. It was found that nurses had an overriding concern in ensuring elderly patients' physical safety and using restraints therefore provided them with a sense of security. The deleterious impact of restraint on the care received by elderly patients was largely unrecognized. Implications for practice and future studies are discussed in the light of these findings.

Adult↗