Cancer pain managment: experience of 702 consecutive cases in a teaching hospital in Hong Kong

Effective pain control is essential in the management of patients with cancer. We present here our experience in the management of 702 patients with cancer pain by the Pain Management Team, Department of Anaesthesiology, Queen Mary Hospital. Patients were discharged from the Pain Management Team with a visual analogue scale of pain (VAS) less than 3 in 87.7% of cases, and more than 90% of patients had improved appetite and sleep on discharge. These promising results were achieved through an emphasis on comfort and function, close liaison among clinicians from different specialties, and a variety of analgesic modalities. Oral drugs remained the mainstay of treatment, supplemented by alternative routes of drug administration such as subcutaneous, intravenous and transdermal delivery. Main side effects observed included nausea (16%) and constipation (8%). Neural blockade, including coeliac plexus blockade, and intercostal nerve blockade, and administration of opioids via subarachnoid or epidural routes were also employed in selected patients.published_or_final_versio

Sudden postpartum collapse

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Tropical carbon sink accelerated by symbiotic dinitrogen fixation

A major uncertainty in the land carbon cycle is whether symbiotic nitrogen fixation acts to enhance the tropical forest carbon sink. Nitrogen-fixing trees can supply vital quantities of the growth-limiting nutrient nitrogen, but the extent to which the resulting carbon–nitrogen feedback safeguards ecosystem carbon sequestration remains unclear. We combine (i) field observations from 112 plots spanning 300 years of succession in Panamanian tropical forests, and (ii) a new model that resolves nitrogen and light competition at the scale of individual trees. Fixation doubled carbon accumulation in early succession and enhanced total carbon in mature forests by ~10% (~12MgC ha−1) through two mechanisms: (i) a direct fixation effect on tree growth, and (ii) an indirect effect on the successional sequence of non-fixing trees. We estimate that including nitrogen-fixing trees in Neotropical reforestation projects could safeguard the sequestration of 6.7 Gt CO2 over the next 20 years. Our results highlight the connection between functional diversity of plant communities and the critical ecosystem service of carbon sequestration for mitigating climate change

Sensing coral reef connectivity pathways from space

Coral reefs rely on inter-habitat connectivity to maintain gene flow, biodiversity and ecosystem resilience. Coral reef communities of the Red Sea exhibit remarkable genetic homogeneity across most of the Arabian Peninsula coastline, with a genetic break towards the southern part of the basin. While previous studies have attributed these patterns to environmental heterogeneity, we hypothesize that they may also emerge as a result of dynamic circulation flow; yet, such linkages remain undemonstrated. Here, we integrate satellite-derived biophysical observations, particle dispersion model simulations, genetic population data and ship-borne in situ profiles to assess reef connectivity in the Red Sea. We simulated long-term (>20 yrs.) connectivity patterns driven by remotely-sensed sea surface height and evaluated results against estimates of genetic distance among populations of anemonefish, Amphiprion bicinctus, along the eastern Red Sea coastline. Predicted connectivity was remarkably consistent with genetic population data, demonstrating that circulation features (eddies, surface currents) formulate physical pathways for gene flow. The southern basin has lower physical connectivity than elsewhere, agreeing with known genetic structure of coral reef organisms. The central Red Sea provides key source regions, meriting conservation priority. Our analysis demonstrates a cost-effective tool to estimate biophysical connectivity remotely, supporting coastal management in data-limited regions

Explicitly searching for useful inventions: dynamic relatedness and the costs of connecting versus synthesizing

Inventions combine technological features. When features are barely related, burdensomely broad knowledge is required to identify the situations that they share. When features are overly related, burdensomely broad knowledge is required to identify the situations that distinguish them. Thus, according to my first hypothesis, when features are moderately related, the costs of connecting and costs of synthesizing are cumulatively minimized, and the most useful inventions emerge. I also hypothesize that continued experimentation with a specific set of features is likely to lead to the discovery of decreasingly useful inventions; the earlier-identified connections reflect the more common consumer situations. Covering data from all industries, the empirical analysis provides broad support for the first hypothesis. Regressions to test the second hypothesis are inconclusive when examining industry types individually. Yet, this study represents an exploratory investigation, and future research should test refined hypotheses with more sophisticated data, such as that found in literature-based discovery research

Liver transplantation from cadaveric and living donors

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Minimum graft volume for successful adult-to-adult living donor liver transplantation for fulminant hepatic failure

The major limitation for adult-to-adult living donor liver transplantation is the adequacy of the size of the graft that can be safely harvested from the donor. The present report describes a 22-year-old woman with stage 4 hepatic coma due to fulminant hepatic failure who was successfully treated using a small-for-size left lobe graft from her father. The graft weight was 0.6% of the recipient's body weight, or 25% of her ideal liver weight. Avoidance of warm ischemia, short cold ischemic time, and early treatment of rejection are important elements in optimizing small-for-size graft function. Since the left lobe represents 23-36% of the total liver volume of an adult, it is possible, in most cases, to harvest a left lobe graft of adequate size from a donor of similar size as the recipient.link_to_subscribed_fulltex

Living donor liver transplantation: The Hong Kong experience

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