香港公立醫院中外陰切開術的應用情況

OBJECTIVE. To review the use of episiotomy during vaginal delivery in Hong Kong public hospitals. DESIGN. Prospective observational survey. SETTING. Public hospitals, Hong Kong. PARTICIPANTS. Women who underwent normal vaginal delivery of a singleton foetus with cephalic presentation. MAIN OUTCOME MEASURES. Number of women having an episiotomy, severe-degree (third- or fourth-degree) tear, other types of tear, blood loss at delivery, postpartum haemorrhage, need for blood transfusion, puerperal pyrexia, wound infection, gaping wound that required suture removal, and drainage or resuturing of a perineal wound. RESULTS. Between 1 January and 31 March 2003, there were 6222 singleton spontaneous normal vaginal deliveries in the public hospitals of Hong Kong. Of the 6167 women in whom the status of the perineum was known, episiotomy was performed in 5274 (85.5%). Primiparous women were more likely to undergo episiotomy at delivery than multiparous women (97.9% vs 71.4%). Women with episiotomy had significantly less perineal tearing of any kind than those without. The occurrence of any type of perineal tear and severe-degree (third- or fourth-degree) tear was significantly lower in primiparous women who had an episiotomy than those without (P<0.05). Women with episiotomy had increased mean blood loss at delivery but other complications were not significantly increased. CONCLUSIONS. In Hong Kong, episiotomy is routinely performed during normal vaginal delivery. It is associated with a significantly lower overall rate of perineal tearing. This study was observational, nonetheless the occurrence of other complications was likely to increase when episiotomy was performed. Firm evidence from several randomised controlled studies shows that routine episiotomy is unjustified and possibly harmful. Routine episiotomy should not be promoted in Hong Kong without further randomised controlled study.published_or_final_versio

Vascular Endothelial Growth Factor and Ischemic Heart Disease Risk: A Mendelian Randomization Study

published_or_final_versio

The estrogen-related receptor alpha upregulates secretin expressions in response to hypertonicity and angiotensin II stimulation

Osmoregulation via maintenance of water and salt homeostasis is a vital process. In the brain, a functional secretin (SCT) and secretin receptor (SCTR) axis has recently been shown to mediate central actions of angiotensin II (ANGII), including initiation of water intake and stimulation of vasopressin (VP) expression and release. In this report, we provide evidence that estrogen-related receptor α (ERRα, NR3B1), a transcription factor mainly involved in metabolism, acts as an upstream activator of the SCT gene. In vitro studies using mouse hypothalamic cell line N-42 show that ERRα upregulates SCT promoter and gene expression. More importantly, knockdown of endogenous ERRα abolishes SCT promoter activation in response to hypertonic and ANGII stimulations. In mouse brain, ERRα coexpresses with SCT in various osmoregulatory brain regions, including the lamina terminalis and the paraventricular nucleus of the hypothalamus, and its expression is induced by hyperosmotic and ANGII treatments. Based on our data, we propose that both the upregulation of ERRα and/or the increased binding of ERRα to the mouse SCT promoter are two possible mechanisms for the elevated SCT expression upon hyperosmolality and central ANGII stimulation. © 2012 Lee et al.published_or_final_versio

Spectroscopic ellipsometry of metal phthalocyanine thin films

Optical functions of cobalt phthalocyanine, nickel phthalocyanine (NiPc), and iron phthalocyanine (FePc) have been determined by use of spectroscopic ellipsometry in the spectral range 1.55-4.1 eV (300-800 nm). The samples were prepared by evaporation onto glass and silicon substrates. The optical functions were determined by point-to-point fit. Absorption spectra were also measured. The index-of-refraction data for NiPc and FePc are reported for the first time to our knowledge. Good agreement with the experimental spectra was obtained for all three materials. © 2003 Optical Society of America.published_or_final_versio

The Fear-Avoidance Model of Chronic Pain: Assessing the Role of Neuroticism and Negative Affect in Pain Catastrophizing Using Structural Equation Modeling

postprin

Chemotherapy of tuberculosis in Hong Kong: a consensus statement

This consensus statement is prepared primarily as a concise reference for tuberculosis chemotherapy in Hong Kong. Treatment should be tailored to patients individually, expert advice should be sought when necessary, and 'directly observed treatment' should be used where possible. A 6-month regimen is recommended as the initial treatment of uncomplicated pulmonary tuberculosis and a 9-month regimen is recommended for retreatment. Patients with disease that is resistant to isoniazid or rifampicin may require modified regimens. Multidrug-resistant tuberculosis should be managed in specialised centres, using multiple drugs as guided by in vitro susceptibility tests. Recommended regimens to treat extrapulmonary tuberculosis are based on limited current evidence, although shorter regimens may be acceptable when better evidence emerges. A longer duration of treatment is required for diabetic, immuno-compromised, or silicotic patients. During pregnancy, streptomycin should be avoided; the safety profiles of second-line drugs have not yet been ascertained. Hepatotoxic drugs should be used with caution in patients with liver dysfunction, and extra caution and dosage reductions are required if streptomycin and ethambutol are used in patients with renal impairment.published_or_final_versio

Emergence of CD26+ cancer stem cells with metastatic properties in colorectal carcinogenesis

published_or_final_versio

Exponential modulation integral observer for online detection of the fundamental and harmonics in grid-connected power electronics equipment

Harmonic current estimation is required in active power filters for compensation purposes. The most efficient way of calculating the total harmonic current up to the infinite order is to subtract the fundamental component from the distorted current. Direct determination of the fundamental component of a distorted current of mains frequency was realized recently with a third-order modulation integral observer. This article shows that using an exponential modulation function (Exp-MF) for the integral observer will: 1) significantly enhance the robustness of the observer against noise and 2) automatically remove the low-frequency envelope arising from the D/A and A/C sampling processes compared to previous polynomial modulation function. These new and advantageous features are supported with detailed analysis and experimental verification. The robust observer can be implemented in grid-connected power electronics circuits that require the instantaneous information of the fundamental and/or harmonic currents. Practical comparative tests with the adaptive notch filter and recursive discrete Fourier transform (DFT) methods in an active power filter have confirmed the good performance under both the steady and dynamic states of the proposed Exp-MF integral observer

Prognostic significance of CD26 in patients with colorectal cancer

Background: CD26, dipeptidyl peptidase IV, was discovered firstly as a membrane-associated peptidase on the surface of leukocyte. We previously demonstrated that a subpopulation of CD26+ cells were associated with the development of distant metastasis, enhanced invasiveness and chemoresistance in colorectal cancer (CRC). In order to understand the clinical impact of CD26, the expression was investigated in CRC patient's specimens. This study investigated the prognostic significance of tumour CD26 expression in patients with CRC. Examination of CD26+ cells has significant clinical impact for the prediction of distant metastasis development in colorectal cancer, and could be used as a selection criterion for further therapy. Methods: Tumour CD26 expression levels were studied by immunohistochemistry using Formalin-fixed paraffin embedded (FFPE) tissues in 143 patients with CRC. Tumour CD26 expression levels were correlated with clinicopathological features of the CRC patients. The prognostic significance of tumour tissue CD26 expression levels was assessed by univariate and multivariate analyses. Result: CD26 expression levels in CRC patients with distant metastasis were significantly higher than those in non-metastatic. High expression levels of CD26 were significantly associated with advanced tumour staging. Patients with a high CD26 expression level had significantly worse overall survival than those with a lower level (p<0.001). Conclusions: The expression of CD26 was positively associated with clinicopathological correlation such as TNM staging, degree of differentiation and development of metastasis. A high CD26 expression level is a predictor of poor outcome after resection of CRC. CD26 may be a useful prognostic marker in patients with CRC. © 2014 Lam et al.published_or_final_versio