Temporal lobe resection for intractable epilepsy: review of 11 cases

OBJECTIVE. To review the management of medically intractable epilepsy by performing temporal lobe resection. DESIGN. Retrospective study. SETTING. University teaching hospital, Hong Kong. PATIENTS. Eleven patients: seven women and four men (mean age, 28 years; range, 19-49 years) who underwent temporal lobe resection for intractable epilepsy from 1994 through 1998. MAIN OUTCOME MEASURES. Preoperative and operative aspects of treatment, postoperative complications, mortality, and seizure control before and after surgery. RESULTS. All but one patient had long-standing medically intractable temporal lobe epilepsy; the duration between the onset of seizure and surgery ranged from 12 to 27 years (mean, 17.2 years). A total of 12 resections were performed without any mortalities or major postoperative complications. After surgery, two patients became seizure-free without the need for antiepileptic medication; six patients were seizure-free but required medication; and two patients showed >90% of improvement in seizure control, whereas one patient showed between 50% and 90% of improvement. Nine (81%) of the 11 patients reported significant improvement in their social life and performance of daily activities. Two (18%) patients, including one with improved seizure control, reported no improvement in their performance of daily functions. CONCLUSIONS. Temporal lobe resection can produce significant improvements in patients who have medically intractable epilepsy. The risks of surgery are relatively small and justifiable.published_or_final_versio

Outcome analysis of epilepsy surgery in Queen Mary Hospital

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Dynamic Random Effects Models for Times between Repeated Events

We consider recurrent event data when the duration or gap times between successive event occurrences are of intrinsic interest. Subject heterogeneity not attributed to observed covariates is usually handled by random effects which result in an exchangeable correlation structure for the gap times of a subject. Recently, efforts have been put into relaxing this restriction to allow non-exchangeable correlation. Here we consider dynamic models where random effects can vary stochastically over the gap times. We extend the traditional Gaussian variance components models and evaluate a previously proposed proportional hazards model through a simulation study and some examples. Besides, semiparametric estimation of the proportional hazards models is considered. Both models are easily used. The Gaussian models are easily interpreted in terms of the variance structure. On the other hand, the proportional hazards models would be more appropriate in the context of survival analysis, particularly in the interpretation of the regression parameters. They can be sensitive to the choice of model for random effects but not to the choice of the baseline hazard function.postprin

When will youth smokers make a quit attempt and resume smoking after receiving telephone counseling? A longitudinal study

Paper Session 10 - Adolescent Smoking Cessation: PA10-1OBJECTIVE: To examine the pattern of youth smokers who received telephone smoking cessation intervention and who would initiate a quit attempt and subsequently resume smoking. METHODS: We collected data from a toll-free smoking cessation hotline “Youth Quitline” in Hong Kong from September 2005 to December 2007. The Youth Quitline is a peer-led hotline with multiple telephone counseling sessions at baseline, 1-week and 1-month and successive telephone follow-ups at 3- and 6-months, to help youth smokers aged 12 – 25 quit smoking. We applied non-parametric Kaplan-Meier method to explore the time trend prior to initiating a quit attempt as well as smoking resumption. RESULTS: The study included 408 youth callers, and 282 started quitting within the follow-up period. About 30% of the youth smokers (95%CI = 26 ￢– 35%) would initiate a quit attempt within 7 days after receiving the baseline telephone intervention. For the 282 callers who quit within the follow-up period, two-thirds (67%, 95%CI = 44 – 56%) resumed smoking within the first 7 days after their quit attempt. CONCLUSIONS: This is the first study using survival analysis techniques to evaluate how soon youth smokers initiate their quit attempts and resume smoking, after receiving telephone counseling. Youth smokers who intend to quit initiate a quit attempt shortly after receiving the telephone intervention. Smoking cessation counselors should provide subsequent follow-ups promptly after the baseline intervention to capitalize on the quitting intentions of the smokers.postprintThe 16th Annual Meeting of the Society for Research on Nicotine and Tobacco (SRNT 2010), Baltimore, MD., 24-27 February 2010. In Proceedings of the SRNT, 2010, p. 2

An alternative to a randomised control design for assessing the efficacy and effectiveness of bracing in adolescent idiopathic scoliosis

Randomised controlled trials (RCTs) that assessed the efficacy of bracing for adolescent idiopathic scoliosis have suffered from small sample sizes, low compliance and lack of willingness to participate. The aim of this study was to assess the feasibility of a comprehensive cohort study for evaluating both the efficacy and the effectiveness of bracing in patients with adolescent idiopathic scoliosis. Patients with curves at greater risk of progression were invited to join a randomised controlled trial. Those who declined were given the option to remain in the study and to choose whether they wished to be braced or observed. Of 87 eligible patients (5 boys and 63 girls) identified over one year, 68 (78%) with mean age of 12.5 years (10 to 15) consented to participate, with a mean follow-up of 168 weeks (0 to 290). Of these, 19 (28%) accepted randomisation. Of those who declined randomisation, 18 (37%) chose a brace. Patients who were more satisfied with their image were more likely to choose bracing (Odds Ratio 4.1; 95% confidence interval 1.1 to 15.0; p = 0.035). This comprehensive cohort study design facilitates the assessment of both efficacy and effectiveness of bracing in patients with adolescent idiopathic scoliosis, which is not feasible in a conventional randomised controlled trial.postprin

Kawasaki disease in Hong Kong, 1994 to 2000

OBJECTIVE. To describe the epidemiology, clinical characteristics, and management of Kawasaki disease in children in Hong Kong. DESIGN. Retrospective survey of medical records from July 1994 to June 1997, and prospective data collection from July 1997 to June 2000. SETTING. Hospitals with a paediatric unit in Hong Kong. PATIENTS. Patients diagnosed with Kawasaki disease between July 1994 and June 2000 in public hospitals in Hong Kong. MAIN OUTCOME MEASURES. Incidence of Kawasaki disease and coronary artery aneurysm rates. RESULTS. A total of 696 cases of Kawasaki disease were reported. There were 435 (62.5%) boys and 261 (37.5%) girls giving a male to female ratio of 1.7:1. The age ranged from 1 month to 15 years 5 months with a median of 1.7 years. Infants (<1 year) constituted the largest group of patients (223,32.0%) and overall, 638 (91.7%) were younger than 5 years. Skin rash, conjunctivitis, and oral signs were among the principal clinical features present in over 80% of cases. Prominent cervical lymph nodes larger than 1.5 cm were less commonly found (24%). Coronary artery aneurysms or ectasia were present in 15.7% (109/696), 8.5% (59/696), and 5.0% (35/696) of patients at 2, 4, and 8 weeks, respectively. The incidence of Kawasaki disease per 100 000 children under 5 years was significantly higher in the prospective study period than in the retrospective period (39 vs 26, <0.001). CONCLUSION. The incidence of Kawasaki disease is high in Hong Kong and is 39 per 100 000 children below 5 years of age. The coronary artery aneurysm prevalence is 5%. Intravenous gamma-globulin and high-dose aspirin is the mainstay of treatment.published_or_final_versio

Motor neuron disease in Hong Kong Chinese: Epidemiology and clinical picture

This study documents the clinical features, incidence and prevalence of motor neuron disease (MND) in Hong Kong Chinese. Patients with MND who were alive between 1989 and 1992 were recruited by retrieval of medical records from the four major hospitals in Hong Kong, and by referral of neurologists, neurosurgeons and medical consultants. Mortality statistics was provided by the Census and Statistics Department. A total of 84 cases were identified with a male preponderance of 1.98:1. The average annual period incidence was 0.31/100,000 and the point prevalence on December 31, 1992, was 0.95/100,000. The mean age at onset was 55.5 years (range 19-81) with a peak observed from 55 to 65 years. The clinical features are similar to other reported series of MND. The incidence and mortality of MND in Hong Kong are therefore lower than the worldwide figures of 2.0/100,000 and 1.5/100,000, respectively.published_or_final_versio

Wideband-tuneable, nanotube mode-locked, fibre laser

Ultrashort-pulse lasers with spectral tuning capability have widespread applications in fields such as spectroscopy, biomedical research and telecommunications1–3. Mode-locked fibre lasers are convenient and powerful sources of ultrashort pulses4, and the inclusion of a broadband saturable absorber as a passive optical switch inside the laser cavity may offer tuneability over a range of wavelengths5. Semiconductor saturable absorber mirrors are widely used in fibre lasers4–6, but their operating range is typically limited to a few tens of nanometres7,8, and their fabrication can be challenging in the 1.3–1.5 mm wavelength region used for optical communications9,10. Single-walled carbon nanotubes are excellent saturable absorbers because of their subpicosecond recovery time, low saturation intensity, polarization insensitivity, and mechanical and environmental robustness11–16. Here, we engineer a nanotube–polycarbonate film with a wide bandwidth (>300 nm) around 1.55 mm, and then use it to demonstrate a 2.4 ps Er31-doped fibre laser that is tuneable from 1,518 to 1,558 nm. In principle, different diameters and chiralities of nanotubes could be combined to enable compact, mode-locked fibre lasers that are tuneable over a much broader range of wavelengths than other systems

Advances in using PARP inhibitors to treat cancer

The poly (ADP-ribose) polymerase (PARP) family of enzymes plays a critical role in the maintenance of DNA integrity as part of the base excision pathway of DNA repair. PARP1 is overexpressed in a variety of cancers, and its expression has been associated with overall prognosis in cancer, especially breast cancer. A series of new therapeutic agents that are potent inhibitors of the PARP1 and PARP2 isoforms have demonstrated important clinical activity in patients with breast or ovarian cancers that are caused by mutations in either the BRCA1 or 2 genes. Results from such studies may define a new therapeutic paradigm, wherein simultaneous loss of the capacity to repair DNA damage may have antitumor activity in itself, as well as enhance the antineoplastic potential of cytotoxic chemotherapeutic agents