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Biomedical subjects

N T Cheung

Publications and source records attributed to N T Cheung.

At least 19 recordsLinked to original sources
PubMed2001

Independent association of rheumatoid factor and the HLA-DRB1 shared epitope with radiographic outcome in rheumatoid arthritis.

OBJECTIVE: Findings of a recent study suggested that HLA-DRB1 alleles encoding the rheumatoid arthritis (RA) "shared epitope" (SE) were not predictive of erosive damage at 2 years in patients with early inflammatory arthritis who were rheumatoid factor (RF) positive, but were predictive in those who were RF negative. The present study was undertaken to determine whether RF status was also important in the association between the SE and radiographic outcome in patients with longstanding RA. METHODS: The association between radiographic outcome, HLA-DRBI, and RF status was examined in 299 RA patients with established disease (5-30 years). Radiographic outcome was measured by scoring radiographs of the hands and feet using the standard radiographs of Larsen. HLA-DRB1 typing was performed using polymerase chain reaction methodology. Results were stratified by RF status and analyzed by multiple regression. RESULTS: An association between radiographic severity and the SE was found in RF-, but not RF+, patients. RF- patients carrying an SE allele had higher Larsen scores than RF- patients lacking the SE, although there was no association with SE dosage. The mean Larsen score was significantly higher in RF+ patients than in RF- patients, but there were no differences between RF+ patients with 0, 1, or 2 SE alleles. Multiple regression analysis confirmed independent associations of RF and SE positivity with radiographic outcome. No significant associations were found between RF and the SE, or RF and individual SE alleles. CONCLUSION: Our data indicate that RF and the SE are independently associated with radiographic outcome in RA. In RF+ patients with longstanding RA, there is no apparent association between the presence of the SE and radiographic damage. However, in RF-patients, although radiographic outcome is generally less severe, there is an association between severity and presence of the SE.

Adult↗
PubMed2001

Medical informatics--the state of the art in the Hospital Authority.

Since its inception in 1990, the Hospital Authority (HA) has strongly supported the development and implementation of information systems both to improve the delivery of care and to make better information available to managers. This paper summarizes the progress to date and discusses current and future developments. Following the first two phases of the HA information technology strategy the basic infrastructural elements were laid in place. These included the foundation administrative and financial systems and databases; establishment of a wide area network linking all hospitals and clinics together; laboratory, radiology and pharmacy systems with access to results in the ward. A major push into clinical systems began in 1994 with the clinical management system (CMS), which established a clinical workstation for use in both ward and ambulatory settings. The CMS is now running at all major hospitals, and provides single logon access to almost all the electronically collected clinical data in the HA. The next phase of development is focussed on further support for clinical activities in the CMS. Key elements include the longitudinal electronic patient record (ePR), clinical order entry, generic support for clinical reports, broadening the scope to include allied health and the rehabilitative phase, clinical decision support, an improved clinical documentation framework, sharing of clinical information with other health care providers and a comprehensive data repository for analysis and reporting purposes.

China↗
PubMed2001

Structured data entry of clinical information for documentation and data collection.

Routine databases containing large amounts of clinical data represent a tremendous opportunity for the evaluation of health care practices and outcomes. However, data collected for administrative purposes has limitations in content, accuracy and completeness. Routine entry of clinical information directly into clinical information systems by care providers is one strategy to address this problem. We developed a structured data entry method, the Clinical Data Framework (CDF), which has been used to support the capture of clinical information by clinicians in the normal process of care delivery. A study of the CDF over a two month period showed that it improved the accuracy of completeness of data collection over a coding method which was based on selection of ICD-9-CM codes.

Data Collection↗
PubMed2000

High serum levels of pro-matrix metalloproteinase-3 are associated with greater radiographic damage and the presence of the shared epitope in patients with rheumatoid arthritis.

OBJECTIVE: To determine if there is a relationship between serum pro-matrix metalloproteinase-3 (proMMP-3) levels and radiographic damage in rheumatoid arthritis (RA), and to investigate whether high levels are associated with presence of the HLA-DRB1 shared epitope (SE). METHODS: Serum proMMP-3 levels were measured by ELISA on 45 RA patients with early disease and 292 with established disease. Early RA was arbitrarily defined as disease duration <3 years. Clinical and laboratory measures of disease activity and severity were obtained. Radiographic damage was assessed by scoring radiographs of the hands and feet using the method of Larsen. HLA-DRB1 typing was performed by sequence-specific oligonucleotide probing. Data were analyzed by multiple regression analysis. RESULTS: In all patients, there was a correlation (r = 0.318, p<0.0001) between serum proMMP-3 levels and Larsen scores. Other correlations were found with Health Assessment Questionnaire score (r = 0.261, p<0.0001) and C-reactive protein (CRP) (r = 0.357, p<0.0001) levels. ProMMP-3 levels were significantly higher in SE+/+ patients than in those completely lacking the SE, with the highest levels in patients carrying an HLA-DRI+/DR4+ phenotype. The greatest difference in proMMP-3 levels between SE+/+ and SE-/- patients was in those with a disease duration <3 years (381.6 vs. 71.7 ng/ml; p = 0.02). CONCLUSION: Our data indicate that there is a significant relationship between radiographic damage and serum levels of proMMP-3. As well, higher circulating levels of proMMP-3 are found in patients positive for the SE, particularly in early RA, and this may partly explain the association between the SE and more erosive disease.

Adult↗
PubMed2000

Epidemiology of heart failure in Hong Kong, 1997.

OBJECTIVE: To analyse the epidemiology of heart failure in Hong Kong, 1997. DESIGN: Retrospective study with 1-year follow-up. SETTING: Accident and emergency departments of 11 hospitals of the Hospital Authority, Hong Kong. PATIENTS: All patients admitted to hospital in 1997 with heart failure as the primary diagnosis, as shown in their discharge summaries. MAIN OUTCOME MEASURES: Demographic data, incidence and prevalence of heart failure, and survival status up to 1 year. RESULTS: There were 4589 new and 1614 old cases of heart failure that required hospital admission in 1997. The largest age-group was the 75- to 84-year group; 85% of the patients were older than 65 years and 56% of the patients were female. The incidence of heart disease increased with age, approximately doubling with each decade of age and reaching an annual incidence of 14 per 1000 men and 20 per 1000 women older than 85 years. The 1-year mortality rate also increased with age, reaching 40% for patients older than 85 years (overall, 32%). CONCLUSION: Heart failure is a common problem and has high mortality, especially in elderly patients. Detailed analyses of the aetiology and early preventive measures are needed to alleviate the problem.

Adolescent↗
PubMed1999

The influence of HLA-DRB1 alleles encoding the DERAA amino acid motif on radiological outcome in rheumatoid arthritis.

OBJECTIVES: To investigate the influence of HLA-DRB1 alleles encoding the QK/RRAA shared epitope (SE) on radiological outcome in rheumatoid arthritis (RA), and to determine whether it is modulated by alleles carrying the putative rheumatoid arthritis-protective (RAP) sequence DERAA. Patients and methods. The association between erosive damage and HLA-DRB1 status was examined in 315 RA patients with a disease duration of 5-30 yr. Radiological outcome was measured by scoring X-rays of the hands and feet using the standard radiographs of Larsen (Larsen score). HLA-DRB1 typing was carried out using polymerase chain reaction methodology. RESULTS: Patients with two alleles encoding the QK/RRAA SE had significantly higher Larsen scores than SE-negative patients (96.9 vs 83.3; P=0.04, after correction for multiple testing), with DRB1*0401/*0401 homozygotes demonstrating the greatest radiological damage (99.9). The lowest Larsen score (65.6) was observed in patients carrying the DERAA motif without an accompanying SE allele (RAP+/SE-). This was significantly lower than in patients with RAP+/SE+ (105.6; P=0.04), RAP-/SE- (88.2; P=0.05) and RAP-/SE+ (95.8; P=0.009), after correction for multiple testing. There was no evidence that the RAP sequence was modulating the effect of the SE since radiological outcome in RAP+/SE+ patients was not significantly different to that in RAP-/SE+ individuals. CONCLUSIONS: Our data support a possible role for DRB1 alleles encoding the DERAA motif in protection against severe erosive damage in patients lacking the QK/RRAA SE, but not in patients heterozygous for the SE. This suggests that DRB1 alleles encoding the SE have a dominant influence over 'protective alleles' and are not merely 'non-protective'.

Alleles↗
PubMed1995

Painful knees associated with a septic focus.

The association between gastrointestinal disorders and arthritis is well recognized. We describe a 54-yr-old man who presented with a seronegative oligoarthritis in whom the clinical picture was consistent with a hypertrophic osteoarthropathy. An occult septic focus was identified when a barium enema demonstrated a diverticular abscess, treatment of which led to a complete resolution of symptoms.

Abscess↗
PubMed1995

Use of interferon-2 alpha in the treatment of cryoglobulinaemic leg ulcers.

We report three cases of leg ulcers complicating cryoglobulinaemia which resisted conventional therapy but responded to interferon-2 alpha. All three cases improved with the complete resolution of painful vasculitic lesions and healing of deep ulcers. The dose of interferon to produce ulcer healing was determined by individual response with escalation of the daily dose to 4.5 x 10(6) units per day required in one case. A lower dose of maintenance interferon could be used to prevent subsequent relapses of disease.

Adult↗
PubMed1994

Increased serum proMMP-3 in inflammatory arthritides: a potential indicator of synovial inflammatory monokine activity.

OBJECTIVE: To investigate if the increased concentrations of stromelysin (MMP-3) found in the synovial fluid (SF) of patients with various arthritides reflect the concentrations in the circulation. METHODS: Using a double antibody ELISA, we have measured proMMP-3 concentrations in sera from these patient groups and in others with a heightened acute phase response (APR) as a result of multiple organ failure. RESULTS: The median serum concentration of proMMP-3 was increased by up to ninefold in the inflammatory arthritides, but not in osteoarthritis or in patients with a heightened APR resulting from a non-chronic inflammatory condition. CONCLUSION: In chronic inflammatory diseases such as rheumatoid arthritis, serum proMMP-3 may prove to be a more specific indicator of monokine activity than currently available serum markers.

Acute-Phase Reaction↗
PubMed1994

C3 nephritic factor and SLE: report of four cases and review of the literature.

We present four patients with C3 nephritic factor associated with partial lipodystrophy and/or mesangiocapillary glomerulonephritis type II. Each of these patients subsequently developed features of SLE, with an onset between 2 and 24 years after the development of the lipodystrophy or glomerulonephritis. All four patients had antinuclear antibodies and three of the four had anti-Ro antibodies. These patients bring to six the number of reported cases of this association. Possible explanations for the link between these two conditions are discussed.

Adult↗