Imaging patterns of liver uptakes on PET scan: pearls and pitfalls

Objective: PET imaging is becoming increasingly universal, and therefore increased liver uptake is frequently encountered. The purpose of this article is to describe and illustrate the various morphological patterns of increased metabolic activity within the liver with an emphasis on the diagnostic pitfalls and potential limitations.Conclusion: Knowing the pitfalls of PET imaging, correlation with clinical background and findings from other imaging modalities are all important in the correct interpretation of increased hepatic activity on PET imaging

Assay of pleural fluid interleukin-6, tumour necrosis factor-alpha and interferon-gamma in the diagnosis and outcome correlation of tuberculous effusion

AbstractObjective: To assess the usefulness of interleukin-6 (IL-6), tumour necrosis factor-alpha (TNF-α) and interferon-gamma (IFN-γ) in the diagnosis and prediction of outcome of pleural tuberculosis.Patients and methods: Pleural fluid from 32 TB and 34 non-TB patients was sent for assay of IL-6, TNF-α and IFN-γ. Clinical parameters at presentation and residual pleural scarring at completion of treatment were assessed for pleural TB cases.Results: The pleural fluid levels of IL-6, TNF-α and IFN-γ in TB patients were significantly higher than those with non-TB effusions (P values of <0.001, 0.018 and <0.001, respectively by independent t-test). Utility of these cytokines for diagnosis of pleural TB was evaluated using receiver operating characteristic (ROC) curve analysis. The cut-off values for IL-6, TNF-α and IFN-γ determined in this analysis were 4000, 4 and 60pg/ml respectively, and their sensitivity and specificity were 90.6% and 76.5%, 90.6% and 79.4%, 100% and 100%, respectively. The pretreatment pleural fluid IL-6 levels had a positive correlation with the number of febrile days after treatment (Pearson correlation test: r=0.60, P=0.009). A negative correlation was found between the percentage reduction in pleural fluid cytokines after 2 weeks treatment and the extent of residual pleural scarring (IL-6: r=–0.62, P=0.041; TNF-α: r=–0.65, P=0.030; IFN-γ: r=–0.83, P=0.002).Conclusion: Pleural fluid IL-6, TNF-α and IFN-γ assays are useful in the diagnosis of pleural TB. The initial IL-6 level correlates with the number of febrile days. The percentage change of cytokines after 2 weeks of treatment also helps to predict residual pleural scarring

University Staff’s Perceptions of Community College Transfer Students’ Transition Experiences Within a “2+2” Pathway in an Asian Educational Context

Various countries have alternative pathway policies for 2-year community college graduates to articulate to 2-year university study, forming a “2+2” pathway. However, few studies have explored university staff members’ perceptions of this “2+2” transfer pathway and their understanding of transfer students’ (TSs) transition experiences. This descriptive qualitative study addressed this research gap. Forty-two academic and supporting staff participated in the focus group interviews. Specifically, the study explored the assets and challenges of the “2+2” pathway from the university staff perspective in Hong Kong. The articulation pathway and TSs are highly recognized for their prior learning, academic performances, and the value of the second chance. However, while the university staff were sympathetic to the challenges filling these transfer pathways, their offering of help was limited by government funding and policies restrictions. It is recommended that policies should be established at government and university levels to recognize and tackle TSs’ unique needs to alleviate their heavy workloads through better articulation between community college and university studies. Improving articulation will allow TSs time for social involvement in university life and thus enhance their mental well-being

Biophysical and nutritional combination treatment for myosteatosis in patients with sarcopenia: a study protocol for single-blinded randomised controlled trial

Introduction Sarcopenia is characterised by age-related loss of skeletal muscle and function and is associated with risks of adverse outcomes. The prevalence of sarcopenia increases due to ageing population and effective interventions is in need. Previous studies showed that β-hydroxy β-methylbutyrate (HMB) supplement and vibration treatment (VT) enhanced muscle quality, while the coapplication of the two interventions had further improved muscle mass and function in sarcopenic mice model. This study aims to investigate the efficacy of this combination treatment in combating sarcopenia in older people. The findings of this study will demonstrate the effect of combination treatment as an alternative for managing sarcopenia. Methods and analysis In this single-blinded randomised controlled trial, subjects will be screened based on the Asian Working Group for Sarcopenia (AWGS) 2019 definition. 200 subjects who are aged 65 or above and identified sarcopenic according to the AWGS algorithm will be recruited. They will be randomised to one of the following four groups: (1) Control+ONS; (2) HMB+ONS; (3) VT+ONS and (4) HMB+VT + ONS, where ONS stands for oral nutritional supplement. ONS will be taken in the form of protein formular once/day; HMB supplements will be 3 g/day; VT (35 Hz, 0.3 g, where g=gravitational acceleration) will be received for 20 mins/day and at least 3 days/week. The primary outcome assessments are muscle strength and function. Subjects will be assessed at baseline, 3-month and 6-month post treatment. Ethics and dissemination This study was approved by Joint CUHK-NTEC (The Chinese University of Hong Kong and New Territories East Cluster) Clinical Research Management Office (Ref: CRE-2022.223-T) and conformed to the Declaration of Helsinki. Trial results will be published in peer-reviewed journals and disseminated at academic conferences

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Kohlberg and ethical universalism

This dissertation is a study of Kohlberg's moral psychology, which is a six-stage model of moral development. Kohlberg claims that his stages form a universal invariant sequence and that they are hierarchical, i.e., higher stages are better than lower stages. Accordingly, he claims that Stage 6 morality, which centers on justice, is universally valid. This ethic of justice is embodied mainly in respect for persons, fairness, and the procedural principle of ideal role taking. Kohlberg claims not only that Stage 6 values and principles are universally valid, but also that they are determinate. In other words, reasoning in terms of these values and principles guarantees that, for each particular moral problem, there will be a distinct solution on which all morally mature people could agree. By making these claims Kohlberg is advocating a strong and traditional version of universalism, which I call 'paradigm universalism.' The dissertation is divided into five chapters. In the first two chapters I outline Kohlberg's theory and explore its philosophical implications. In Chapter 3 I discuss Kohlberg's debates with two important critics, Gilligan and Flanagan. Gilligan claims that Kohlberg's emphasis on justice rather than care indicates a gender bias in his model. Flanagan, on the other hand, argues that since morality is multifarious it is wrong to equate morality either with justice or care of a combination of both. While these criticism do point out certain shortcomings of Kohlberg's theory, I argue that they do not seriously threaten the universal validity of Stage 6 moral values and principles in general. Chapter 4 introduces the main philosophical arguments of this dissertation. In this chapter I argue that (1) moral psychology is relevant to moral philosophy; (2) that the claim of hierarchy for the Kohlbergian stages does receive significant support from his research; and therefore (3) Stage 6 does plausibly reflect certain universal moral ideals. At the same time I allow (4) that there is clearly certain cultural bias in Kohlberg's theory and (5) that he is excessively optimistic about the determinacy of Stage 6 moral reasoning. In the final Chapter, I reflect on the universalism-relativism debate in light of Kohlberg's theory. I argue that paradigm universalism is too strong for Kohlberg to support, and that universalism is acceptable only in a weakened form which I call 'minimal universalism.' Contrary to the hope of paradigm universalists, this minimal universalism cannot serve as a comprehensive theory for solving moral problems. Neither does it exclude all forms of ethical relativism, but it does set important limits to any acceptable relativist theory.Arts, Faculty ofPhilosophy, Department ofGraduat

An improved test method for characterizing the dynamic liquid moisture transfer in porous polymeric materials

In order to evaluate the moisture management capacity of porous polymeric materials such as fabrics, a new test method and an instrument called the moisture management tester (MMT) have been developed. Derived from the measurement curves, 10 indices are defined to characterize the fabric liquid moisture management properties. In the improved test method, six indices are re-defined. The grading and classification methods are studied to give a direct overall evaluation and result for the liquid moisture management properties of the tested fabrics. Also, an improved sensor design, data processing method and expression of test results for the fabric moisture management properties are introduced. The MMT provides an objective measurement of comfort for those fabrics claimed to have excellent moisture management properties. It also provides a detailed and reliable method for production quality control, new product development and quality assurance by the retailer.Institute of Textiles and Clothin