Bronchial anthracofibrosis and tuberculosis: CT features before and after treatment.
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Aged↗
Biomedical subjects
Eric Wong
Publications and source records attributed to Eric Wong.
SARS-related perceptions in Hong Kong.
To understand different aspects of community responses related to severe acute respiratory syndrome (SARS), 2 population-based, random telephone surveys were conducted in June 2003 and January 2004 in Hong Kong. More than 70% of respondents would avoid visiting hospitals or mainland China to avoid contracting SARS. Most respondents believed that SARS could be transmitted through droplets, fomites, sewage, and animals. More than 90% believed that public health measures were efficacious means of prevention; 40.4% believed that SARS would resurge in Hong Kong; and approximately equals 70% would then wear masks in public places. High percentages of respondents felt helpless, horrified, and apprehensive because of SARS. Approximately 16% showed signs of posttraumatic symptoms, and approximately equals 40% perceived increased stress in family or work settings. The general public in Hong Kong has been very vigilant about SARS but needs to be more psychologically prepared to face a resurgence of the epidemic.
Adolescent↗
Neutrophil CD64 is a sensitive diagnostic marker for early-onset neonatal infection.
This prospective study aimed to evaluate the diagnostic utilities of neutrophil CD64 expression for the identification of early-onset clinical infection and pneumonia in term infants and to define the optimal cutoff value so that it may act as a reference with which future studies can be compared. Term newborns in whom infection was suspected when they were <72 h of age were recruited into the study. C-reactive protein (CRP) and expression of CD64 on neutrophils were measured at 0 h (at the time of sepsis evaluation) and 24 h. The sensitivity, specificity, positive predictive value, and negative predictive value (NPV) of CRP, CD64, and the combination of these two markers for predicting neonatal sepsis were determined. A total of 338 infants with suspected clinical sepsis were investigated, 115 of whom were found to be clinically infected. CRP and CD64 in infected infants were both significantly elevated at 0 and 24 h compared with noninfected infants (p < 0.001). The calculated optimal cutoff value for CD64 was 6136 antibody-phycoerythrin molecules bound/cell. CD64 has a very high sensitivity (96%) and NPV (97%) at 24 h. The addition of CRP only marginally enhanced the sensitivity and NPV (97 and 98%, respectively). In conclusion, neutrophil CD64 is a very sensitive diagnostic marker for the identification of early-onset clinical infection and pneumonia in term newborns. The results strongly suggest that measurement of neutrophil CD64 may allow neonatal clinicians to discontinue antibiotic treatment at 24 h in infants who are clinically stable and whose CD64 expressions are below the optimal cutoff level.
Age of Onset↗
The scoring scheme of the informant questionnaire on cognitive decline in the elderly needs revision: results of rasch analysis.
The purpose of this study was to examine the optimal scoring scheme (category use), unidimensionality, item fit, and redundancy of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) in a cohort of Hong Kong Chinese stroke survivors. At 3 months after the index stroke, a research assistant administered the IQCODE to relatives of 284 Chinese patients with acute stroke who were consecutively admitted to a general hospital. A psychiatrist, who was blinded to the IQCODE scores, interviewed all 284 patients and made DSM-IV diagnosis of dementia, which served as the benchmark for judging the performance of IQCODE in screening dementia. The results suggest that the optimal IQCODE scoring scheme has 2 rather than the original 5 categories. Although the IQCODE was unidimensional overall, there was evidence of item redundancy, thus indicating that a shortened version is desirable.
Aged↗
Effects of early corticosteroid treatment on plasma SARS-associated Coronavirus RNA concentrations in adult patients.
BACKGROUND: The effect of corticosteroid treatment on the viral load of Severe Acute Respiratory Syndrome (SARS) patients is unknown. OBJECTIVE: To compare the plasma SARS-CoV RNA concentrations in ribavirin-treated patients who received early hydrocortisone therapy with those who received placebo. STUDY DESIGN: Serial plasma SARS-CoV RNA concentrations measured in the setting of a prospective, randomized double-blinded, placebo-controlled trial designed to assess the efficacy of "early" (<7 days of illness) hydrocortisone use in previously healthy SARS patients were analyzed. SARS-CoV RNA was quantified using a one-step real-time RT-PCR assay targeting the nucleocapsid gene. RESULTS: Among 16 non-ICU cases, SARS-CoV RNA was detected in plasma since day 3-4 after fever onset; viral concentration peaked in the first week, which then rapidly declined in the second week of illness. On days 8, 12, 16, and 20, the cumulative proportion of patients with undetectable virus in plasma was 31%, 69%, 92%, and 100%, respectively. Plasma SARS-CoV RNA concentrations in the second and third week of illness were significantly higher in patients who received initial hydrocortisone treatment (n = 9), as compared to those who received placebo (n = 7)(AUC; Mann-Whitney, P = 0.023). The median time for SARS-CoV to become undetectable in plasma was 12 days (11-20 days) versus 8 days (8-15 days), respectively. CONCLUSION: Our findings suggested "early" corticosteroid treatment was associated with a higher subsequent plasma viral load.
Adrenal Cortex Hormones↗
A simple procedure for the prevention of ureteral injury in laparoscopic-assisted vaginal hysterectomy.
STUDY OBJECTIVE: To introduce a surgical technique to minimize the chance of ureteral injury during laparoscopic-assisted vaginal hysterectomy (LAVH). DESIGN: Retrospective case review (Canadian Task Force classification II-3). SETTING: Show Chwan Memorial Hospital, Changhua, Taiwan. PATIENTS: Two thousand and six women who underwent LAVH between January 1992 and June 2001. INTERVENTION: A simple step of creating a "window" over the anterior and posterior broad ligaments to push inferolaterally the areolar tissue (in which the ureter is embedded) on the posterior broad ligament. MEASUREMENTS AND MAIN RESULTS: No ureteral injury occurred in patients whose cases were reviewed. There were, however, five bladder injuries (0.25%) and three nerve pareses (0.15%). Other minor complications, including fever, abscess or hematoma of the vaginal cuff, subcutaneous emphysema, and delayed vaginal cuff bleeding, occurred in less than 5% of patients. CONCLUSION: The technique proposed is simple and very effective in preventing ureteral injury during LAVH.
Adult↗
Examination of the Philadelphia Geriatric Morale Scale as a subjective quality-of-life measure in elderly Hong Kong Chinese.
PURPOSE: We examine the psychometric properties of the Philadelphia Geriatric Morale Scale (PGMS) in an elderly Chinese population in Hong Kong. DESIGN AND METHODS: The study consisted of two cohorts: (a) 759 participants aged 70 years and older living in the community who were recruited as part of a territory-wide health survey and interviewed in 1993-1994; and (b) 388 participants living in long-term-care institutions in 1995-1996. Participants who were cognitively impaired (Abbreviated Mental Test score less than 7) or who could not answer questions for other reasons were excluded. The 15-item PGMS was administered. The Rasch dichotomous model was used to assess the validity of the PGMS, and the 15-item Geriatric Depression Scale, previously validated in Chinese, was also administered to examine the concurrent validity. RESULTS: A confirmatory factor analysis identified three underlying factors similar to findings among Caucasians; however, not all the goodness-of-fit indices were acceptable. An exploratory factor analysis using principal axis factoring and promax rotation revealed two underlying factors that explained 35% of the total variance: reconciled aging and unstrained affect. Some items were redundant when applied to the institutional sample. Concurrent validity was demonstrated by the good correlation between the reconciled aging and unstrained affect domains and the Geriatric Depression Scale (r = -0.72 and r = -0.56 respectively). Female gender, older age, and residence in institutions were associated with lower morale. IMPLICATIONS: The PGMS is a valid quality-of-life measure in elderly Hong Kong Chinese persons, but its psychometric properties are slightly different from those for Caucasians.
Aged↗
A randomized, single-blind and crossover study of an amino acid-based milk formula in treating young children with atopic dermatitis.
Cow's milk and soy protein allergies are commonly associated with atopic dermatitis (AD) in young children. Amino acid (AA)-based elemental milk formula may improve AD control in these patients. This study investigates the efficacy of AA-based formula in treating young AD patients irrespective of their food allergy status. AD patients younger than 3 yr old were eligible. Sensitization to food allergens was ascertained by skin prick tests and allergen-specific immunoglobulin E (IgE) assay. Patients were then randomly allocated to take either active treatment or pre-existing formulae (placebo) for 6 wk. They were allowed a 6-wk washout period before crossed over to the other intervention for another 6 wk. Fifteen AD patients, with median (interquartile range, IQR) age of 1.4 (0.6-2.6) yr, were recruited. Their median (IQR) SCORAD score was 23.9 (10.5-29.7). Seven of them were sensitized to cow's milk or soybean. Among 11 patients who completed the study, the median changes for all scores and urinary eosinophil protein X (EPX) concentration were not statistically significant. There was also no evidence of carry-over effects for SCORAD and its various components and global health score, except for urinary EPX concentration (p = 0.05). Our results do not support the use of AA-based elemental milk formula in treating young children with AD irrespective of their food allergy status.
Amino Acids↗
SARS transmission among hospital workers in Hong Kong.
Despite infection control measures, breakthrough transmission of severe acute respiratory syndrome (SARS) occurred for many hospital workers in Hong Kong. We conducted a case-control study of 72 hospital workers with SARS and 144 matched controls. Inconsistent use of goggles, gowns, gloves, and caps was associated with a higher risk for SARS infection (unadjusted odds ratio 2.42 to 20.54, p < 0.05). The likelihood of SARS infection was strongly associated with the amount of personal protection equipment perceived to be inadequate, having <2 hours of infection control training, and not understanding infection control procedures. No significant differences existed between the case and control groups in the proportion of workers who performed high-risk procedures, reported minor protection equipment problems, or had social contact with SARS-infected persons. Perceived inadequacy of personal protection equipment supply, infection control training <2 hours, and inconsistent use of personal protection equipment when in contact with SARS patients were significant independent risk factors for SARS infection.
Case-Control Studies↗
Third year in family medicine: headed for disaster?
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Canada↗
Helper T-lymphocyte-related chemokines in healthy newborns.
Atopic disease is characterized by an imbalance in cytokines secreted from Th1 and Th2 lymphocytes. The association between atopy and serum levels of atopy-related chemokines in umbilical cord blood (UCB) has not been evaluated. This study formulates the reference ranges of thymus and activation-regulated chemokine (TARC), macrophage-derived chemokine (MDC), eotaxin (EOX), monocyte chemotactic protein 1 (MCP-1), and interferon-gamma-inducible protein 10 (IP-10) in UCB of term neonates and investigates the relation between these chemokines and the development of atopy during infancy. The concentrations of total IgE and chemokines in UCB serum were measured by microparticle immunoassay and sandwich enzyme immunoassay, respectively. A total of 124 singleton healthy newborns were investigated. Fifty-three (43%) infants had family history of allergic diseases, and 26 (21%) had increased serum total IgE concentrations. The median (interquartile range) serum TARC, MDC, EOX, MCP-1, and IP-10 concentrations, in pg/mL, were 425 (300-639), 786 (561-1050), 36 (28-45), 156 (116-205), and 38 (29-49), respectively. Multiparity was associated with increased serum MDC (p = 0.017). Serum chemokine concentrations were not associated with total IgE levels or family history of allergies. The median (interquartile range) serum MDC concentrations in newborns who developed wheezing during infancy and those without wheezing were 1259 pg/mL (945-1523) and 782 pg/mL (551-992), respectively (p = 0.010). This study provides reference ranges of Th-specific chemokines in UCB serum of singleton term neonates. Increased serum MDC concentrations at birth are associated with the occurrence of wheezing during infancy.
Chemokines↗
Early pituitary-adrenal responses and retinopathy of prematurity in very low birth weight infants.
This longitudinal prospective study aimed to investigate the relationship between pituitary-adrenal responses and severity of retinopathy of prematurity (ROP) in 92 preterm, very low birth weight infants < or = 30 wk gestation. The human corticotropin releasing hormone stimulation test was performed on these infants at D 7 and 14 of postnatal life. Univariate analysis revealed significant associations between severity of ROP and gestational age (r = -0.53, p < 0.0001), birth weight (r = -0.56, p < 0.0001), Apgar score at 1 min (r = -0.27, p < 0.05), Clinical Risk Index for Babies score (r = 0.48, p < 0.0001), duration of mechanical ventilation (r = 0.48, p < 0.0001), oxygen dependency (r = 0.48, p < 0.0001), and length of hospitalization (r = 0.49, p < 0.0001). The stage of ROP was also significantly associated with the basal and peak plasma ACTH (r > -0.22, p < 0.05) and peak serum cortisol (r = -0.21, p = 0.05) at d 7. Multivariate analysis using the classification and regression trees indicated that the two most influential risk factors affecting the development of advanced stages of ROP (> or = stage 3) were i) birth weight and ii) oxygen dependency at 28 d of life or at 36 wk postconceptional age. Our findings suggest that early endogenous or stimulated pituitary-adrenal responses are not independent risk factors associated with the development of severe ROP. Low birth weight and prolonged oxygen exposure are likely to be important factors that influence the degree of damage inflicted on the retina.
Adrenocorticotropic Hormone↗
Human T-cell leukemia virus-I tax oncoprotein functionally targets a subnuclear complex involved in cellular DNA damage-response.
The virally encoded oncoprotein Tax has been implicated in HTLV-1-mediated cellular transformation. The exact mechanism by which this protein contributes to the oncogenic process is not known. However, it has been hypothesized that Tax induces genomic instability via repression of cellular DNA repair. We examined the effect of de novo Tax expression upon the cell cycle, because appropriate activation of cell cycle checkpoints is essential to a robust damage-repair response. Upon induction of tax expression, Jurkat T-cells displayed a pronounced accumulation in G2/M that was reversible by caffeine. We examined the G2-specific checkpoint signaling response in these cells and found activation of the ATM/chk2-mediated pathway, whereas the ATR/chk1-mediated response was unaffected. Immunoprecipitation with anti-chk2 antibody results in co-precipitation of Tax demonstrating a direct interaction of Tax with a chk2-containing complex. We also show that Tax targets a discrete nuclear site and co-localizes with chk2 and not chk1. This nuclear site, previously identified as Tax Speckled Structures (TSS), also contains the early damage response factor 53BP1. The recruitment of 53BP1 to TSS is dependent upon ATM signaling and requires expression of Tax. Specifically, Tax expression induces redistribution of diffuse nuclear 53BP1 to the TSS foci. Taken together these data suggest that the TSS describe a unique nuclear site involved in DNA damage recognition, repair response, and cell cycle checkpoint activation. We suggest that association of Tax with this multifunctional subnuclear site results in disruption of a subset of the site-specific activities and contributes to cellular genomic instability.
Carrier Proteins↗
Fostering interest in family medicine. Focusing on patient-physician relationships.
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Canada↗
Ephrin-A5 restricts topographically specific arborization in the chick retinotectal projection in vivo.
The retinotectal map is the best characterized model system to study how axons respond to guidance cues during the formation of the nervous system. Recent studies have shown that the critical event in forming this map is topographic-specific axon branching. To elucidate the in vivo role of the repulsive cue ephrin-A5 in this event, we used chromophore-assisted laser inactivation (CALI) to generate acute loss of ephrin-A5 function in localized areas of the posterior tectum of chick embryos in ovo and analyzed the resulting changes of retinal projections during initial outgrowth (E11) and when retinal axons arborize in the deep layers in the tectum (E12). We confirmed that ephrin-A5 functions to restrict initial axon outgrowth at E11. At E12, CALI of ephrin-A5 did not affect the extent of axon outgrowth on the tectal surface but instead caused ectopic arborization posterior to the topographically correct site in deeper layers of the tectum. This shows that ephrin-A5 restricts arborization during this critical process for developing the retinotopic map. CALI provides an approach to inactivate in vivo function in higher vertebrates with high temporal and spatial specificity that may have wide application.
Animals↗
Evaluation of an asthma management program for Chinese children with mild-to-moderate asthma in Hong Kong.
There is inconclusive evidence on the efficacy of outpatient clinic-based asthma management programs (AMP) in children. We hypothesized that an AMP based on key symptoms could improve outcome measures of asthma in Chinese children in Hong Kong. This study involved an outpatient clinic-based prospective cohort of Chinese children with asthma. Each patient received one 2-hr session of AMP which was conducted by a pediatric nurse specialist. Asthma outcomes were measured at baseline and at 6 and 12 months after completion of AMP. Demographic data, family history of allergic diseases, and changes in inhaled steroid therapy were also recorded. A total of 106 asthmatic children were enrolled, and they showed a significant decrease in nocturnal cough, wheezing attacks, and subjective assessment of severity at 6 and 12 months following participation in AMP, compared with their baseline status. Acute asthmatic attacks, unscheduled outpatient attendance, emergency room visits, school absenteeism, and number and duration of hospitalizations were also reduced during the follow-up period. Significantly more (21%) children were reported to use inhaled beclomethasone at the end of the study. Nocturnal cough, wheeze, and symptoms due to rhinitis improved significantly after AMP. In conclusion, our cohort of Chinese children with mild-to-moderate asthma used significantly more inhaled corticosteroids and practiced more measures to control house dust mites at the end of the 1-year treatment period. The main reason for better asthma control appeared to be related to the increased use of inhaled steroids, although some additional decrease in nocturnal cough, wheeze, and allergic rhinitis was found after adjusting for the use of inhaled corticosteroids.
Ambulatory Care Facilities↗
An open label trial of sustained-release cytarabine (DepoCyt) for the intrathecal treatment of solid tumor neoplastic meningitis.
Drugs currently available for intrathecal administration are cleared rapidly from the CSF. DepoCyt is a slow-release formulation of cytarabine that maintains cytotoxic concentrations of free cytarabine in the CSF for >14 days following a single injection. DepoCyt was administered to 110 patients with a diagnosis of neoplastic meningitis based on either a positive CSF cytology (76) or neurologic and CT or MRI scan findings sufficient to document neoplastic meningitis (34). Patients were treated with DepoCyt 50mg every 2 weeks for 1 month of induction therapy by either lumbar puncture (LP) or intraventricular (IVT) injection. Patients without neurologic progression were candidates to receive an additional 3 months of consolidation therapy. All patients received dexamethasone 4 mg BID on days 1-5 of each cycle. Median time to neurologic progression was 55 days; median overall survival was 95 days. Among the 76 patients with a positive CSF cytology at baseline, 70 were evaluable for response, and of this group 19 (27%) attained the criteria for response (cytologic response in the absence of neurologic progression). The most important adverse events were headache and arachnoiditis. When drug-related, these were largely low grade, transient, and reversible. Drug-related grade 3 headache occurred on 4% of cycles; grade 3 or 4 arachnoiditis occurred on 6% of cycles. No cumulative toxicity was observed. DepoCyt injected once every 2 weeks produced a response-rate comparable to that previously reported for methotrexate given twice a week. The once in every 2-week-dosing interval offers an advantage over conventional schedules (2-3 doses/week) used for other agents available for intrathecal injection.
Adult↗