Novosti u artroskopskoj kirurgiji ručnog zgloba: od resekcije do rekonstrukcije

One of the major advances in wrist arthroscopy is the development of various therapeutic procedures since the 90’s. Therapeutic procedures are no longer restricted to resection. More specific repair procedures and functional reconstruction involving replenishment of tissue defect and augmentation of vital structures are seen with proven value. In particular, wrist arthroscopy performed under local anaesthetic setting without tourniquet and sedation markedly reduces the risk and cost. This article highlights the common indications and applications of wrist arthroscopy, with emphasis on the latest and significant innovations in reconstructive arthroscopic surgery in Hong Kong. On the resection aspect, common procedures include joint debridement, synovectomy, ganglionectomy, capsular release and osteotomies. Reparative surgery includes ligament repair, arthroscopic assisted reduction and fixation of fracture dislocation and chondroplasty for small chondral lesions. Reconstructive surgery embraces surgical solutions tackling on osseous, soft tissue and cartilage problems. Scaphoid nonunion can be treated by arthroscopic bone grafting and percutaneous fixation with union rate of over 90 %. Partial wrist fusion can be achieved arthroscopically to maximize motion and to enhance union by preserving soft tissue and vascularity. Arthroscopic assisted reconstruction of the radio-ulnar ligaments with tendon graft can be performed to treat chronic distal radioulnar joint instability through bone tunnels in sigmoid notch and ulnar fovea. In chronic scapholunate (SL) instability, the dorsal and palmar portion of the SL interosseous ligament is reconstituted anatomically through arthroscopically assisted reconstruction with tendon graft in a box-like structure. In cartilage reconstruction, post–traumatic chondral lesion can be treated with arthroscopic osteochondral transplant.Od uvođenja artroskopije ručnog zgloba 90-ih godina prošloga stoljeća počinje razvoj i uvođenje brojnih novih terapijskih postupaka. Zahvati više nisu ograničeni samo na resekcije, već se počinje s razvojem reparacijskih i funkcionalnih rekonstrukcija, kao što su popunjavanje defekata i augmentacija vitalnih struktura. Artroskopija ručnog zgloba izvedena u lokalnoj anesteziji i bez Torniquetove poveske značajno smanjuje i cijenu zahvata. U ovom radu istaknute su najčešće indikacije i primjena artroskopija ručnog zgloba s naglaskom na najnoviji zahvat artroskopske rekonstrukcije ručnog zgloba u Hong Kongu. Glede resekcija, najčešći zahvati uključuju debridman zgloba, sinovijektomiju, ganglionekotimiju, opuštanje zglobne čahure i oteotomiju. Reparativni zahvati uključuju rekonstrukcije ligamenata, artroskopski asistirane repozicije i fiksacije prijeloma i luksacija te hondroplastike. Rekonstruktivni zahvati obuhvaćaju zahvate na kostima, mekim tkivima i hrskavici. Nesraštanje skafoidne kosti može se liječiti artroskopski s koštanim presadcima i perkutanim fiksacijama, a uspješnost cijeljenja je veća od 90 %. Djelomične artrodeze mogu se provesti artroskopski kako bi se očuvala pokretljivost ostalih dijelova i pojačalo cijeljenje očuvanjem mekih tkiva i vaskularizacije. Artroskopski asistirana rekonstrukcija radioularnih ligamenata s tetivnim transplantatima može se izvoditi pri kroničnim nestabilnostima distalnog radioulnarnog zgloba. Pri kroničnoj skafolunatnoj nestabilnosti, dorzalni i palmarni dio SL ligamenta mogu se anatomski rekonstruirati tetivnim presadcima. Posttraumatska hrskavična oštećenja mogu se liječiti artroskopski primjenom koštano-hrskavičnih transplantata

Common Sleep Problems and Management in Older Adults

Sleep problems are common among the elderly due to physiological changes and comorbid psychiatric and medical conditions. Sleep architecture changes with age. However, sleep disturbances among older adults should not be seen barely as a result of ageing. Depression and anxiety are important differential diagnoses for elderly patients complaining of sleep disturbance. Dementia and delirium are also common causes of sleep disturbances among older people. Elderly people often carry several medical comorbidities. These medical conditions can both lead to and be exacerbated by sleep problems. Given the frailty, multimorbidity and vulnerability of some of the elderly, the management of sleep problems requires additional considerations compared with younger adult patients. Behavioural modifications and drugs of choice will be discussed

Fuzzy rule based multiwavelet ECG signal denoising

Since different multiwavelets, pre- and post-filters have different impulse responses and frequency responses, different multiwavelets, pre- and post-filters should be selected and applied at different noise levels for signal denoising if signals are corrupted by additive white Gaussian noises. In this paper, some fuzzy rules are formulated for integrating different multiwavelets, pre- and post-filters together so that expert knowledge on employing different multiwavelets, pre- and post-filters at different noise levels on denoising performances is exploited. When an ECG signal is received, the noise level is first estimated. Then, based on the estimated noise level and our proposed fuzzy rules, different multiwavelets, pre- and post-filters are integrated together. A hard thresholding is applied on the multiwavelet coefficients. According to extensive numerical computer simulations, our proposed fuzzy rule based multiwavelet denoising algorithm outperforms traditional multiwavelet denoising algorithms by 30%

Autonomous response of a third-order digital filter with two’s complement arithmetic realized in parallel form

This paper investigates the output and state trajectories of a third-order digital filter with two’s complement arithmetic realized in parallel form. Although the output of the third-order digital filter seems to behave randomly, some regular patterns can be displayed on the plot of versus , where those regular patterns are similar to the second-order case. When the first-order subsystem is operated at the marginally stable points, the output of the third-order system is still mainly dependent on the behaviors of the corresponding second-order digital filter, even though overflow occurs. Explicit equations relating the trajectories of the system to the filter parameters and the initial conditions provide further insights into the behaviors of the system

Fuzzy multiwavelet denoising on an ECG signal

Since different multiwavelets, pre- and post-filters have different impulse and frequency responses characteristics, different multiwavelets, pre- and post-filters should be selected, integrated and applied at different noise levels if a signal is corrupted by an additive white Gaussian noise (AWGN). In this letter, some fuzzy rules on selecting and integrating different multiwavelets, pre- and post-filters together are proposed. These fuzzy rules are setup based on the training results of the denoising performances of applying different multiwavelets, pre- and post-filters at different noise levels. When a new electrocardiogram (ECG) signal is applied, the appropriate multiwavelets, pre- and post-filters are selected and integrated based on fuzzy rules and the noise level of the signal. A hard thresholding is applied on the multiwavelet coefficients. According to an extensive simulation, we found that our proposed fuzzy rule-based multiwavelet denoising algorithm achieves 30% improvement compared to the traditional multiwavelet denoising algorithms

Growth-differentiation factor-8 (GDF-8) in the uterus: its identification and functional significance in the golden hamster

Transforming growth factor-beta superfamily regulates many aspects of reproduction in the female. We identified a novel member of this family, growth-differentiation factor 8 (GDF-8) in the 72 h post coital uterine fluid of the golden hamster by proteomic techniques. Uterine GDF-8 mRNA decreased as pregnancy progressed while its active protein peaked at 72 h post coitus (hpc) and thereafter stayed at a lower level. At 72 hpc, the GDF-8 transcript was localized to the endometrial epithelium while its protein accumulated in the stroma. Exogenous GDF-8 slowed down proliferation of primary cultures of uterine smooth muscle cells (SMC) and endometrial epithelial cells (EEC). In addition, GDF-8 attenuated the release of LIF (leukaemia inhibiting factor) by EEC. As for the embryo in culture, GDF-8 promoted proliferation of the trophotoderm (TM) and hatching but discouraged attachment. Our study suggests that GDF-8 could regulate the behavior of preimplantation embryos and fine-tune the physiology of uterine environment during pregnancy

Bridging dentistry and traditional Chinese medicine : a study on the current mutual understanding among the future practitioners

Objectives: This project aimed to promote the mutual understanding between dental and TCM students. The objectives were to describe the current teaching of dentistry in the TCM schools and that of TCM in the dental school, to describe the TCM students’ knowledge on dentistry and the dental students’ knowledge on TCM, and to produce promotional materials for enhancing the mutual understanding between dental and TCM students. Methods: Information on the current teaching of dentistry in the TCM schools and that of TCM in the dental school was collected through a search on the undergraduate programme syllabus and conducting interviews with the leaders of the schools. Questionnaire surveys were conducted among the final year students of the TCM and the dental schools to collect information on their knowledge of the counter profession. Two leaflets and a short video were produced with the aid of computer software and used in the promotional activities. Results: It was found that very little information on dentistry was covered in the undergraduate programmes of the three TCM schools, and vice versa in the dental school. A total of 39 TCM students and 55 dental students completed the questionnaire survey. Most of the students did not know the basic theories and practice of the counter profession. Less than half of the student knew what types of patient cases may be suitable for cross-referral to the other profession. Conclusions: The TCM and dental schools in Hong Kong do not have scheduled teaching on the counter profession. The TCM students have little knowledge on dentistry and how to collaborate with dental practitioners on patients presented with oral problems. Conversely, it is the same for the dental students. Lastly, informative printed and audio-visual promotional materials can be produced with limited resources and used to facilitate the mutual understanding between TCM and dental practitioners.published_or_final_versio

Service learning and school community partnership

Background Service learning offered university students the opportunity to apply knowledge and skills in social care context while strengthening community health. This paper aimed at highlighting the essential features of the program in achieving sustainable outcomes. Project design and methods Students from different faculty, worked as a team to address the health issues of a less resourceful school. The students were required to plan and develop the related resources and products for matching the learning needs. Through the implementation, students shifted from following an instructive guide to acting on a more self-directed learning process at different stages of service. The health promotion programs could include nutritious breakfast, adequate exercises, healthy beverages and interpersonal communication. Efficacy of the service learning was assessed by the pre and post service survey on the attainment of generic skills of interpersonal effectiveness, problem solving, social responsibility and teamwork. Impact of the service was evaluated by the pre and post program testing. Individual learning experience was collected by the reflective journal writing. Significance and implication School community plays a major role in providing a healthy learning environment for children and adolescents. With the input of subject knowledge and field practice, faculty students attained improvement in generic skills. The school participants increased health knowledge and the importance of healthier lifestyle was reinforced. Both parties owned the program materials for the continuity of practice. The partnership creates initiatives of applying health-promoting school concepts. This project work also built up the ground work for a feasible framework of school health service and practice

Prevalence and correlates of subjective cognitive impairment in Chinese psychiatric patients during the fifth wave of COVID-19 in Hong Kong

IntroductionThe extent of cognitive impairment and its association with psychological distress among people with pre-existing mental illness during COVID-19 is understudied. This study aimed to investigate prevalence and correlates of subjective cognitive impairment (SCI) in Chinese psychiatric patients during fifth-wave of COVID-19 in Hong Kong (HK).MethodsFour-hundred-eight psychiatric outpatients aged 18–64 years were assessed with questionnaires between 28 March and 8 April 2022, encompassing illness profile, psychopathological symptoms, coping-styles, resilience, and COVID-19 related factors. Participants were categorized into moderate-to-severe and intact/mild cognitive impairment (CI+ vs. CI-) groups based on severity of self-reported cognitive complaints. Univariate and multivariate regression analyses were conducted to determine variables associated with CI+ status.ResultsOne-hundred-ninety-nine participants (48.8%) experienced CI+. A multivariate model on psychopathological symptoms found that depressive and post-traumatic-stress-disorder (PTSD)-like symptoms were related to CI+, while a multivariate model on coping, resilience and COVID-19 related factors revealed that avoidant coping, low resilience and more stressors were associated with CI+. Final combined model demonstrated the best model performance and showed that more severe depressive and PTSD-like symptoms, and adoption of avoidant coping were significantly associated with CI+.ConclusionAlmost half of the sample of psychiatric patients reported cognitive complaints during fifth-wave of COVID-19 in HK. Greater depressive and PTSD-like symptom severity, and maladaptive (avoidant) coping were found as correlates of SCI. COVID-19 related factors were not independently associated with SCI in psychiatric patients. Early detection with targeted psychological interventions may therefore reduce psychological distress, and hence self-perceived cognitive difficulties in this vulnerable population

Sleep problems in children with autism spectrum disorder in Hong Kong: a cross-sectional study

BackgroundAutism spectrum disorder (ASD) is a neurodevelopmental disorder with a growing prevalence of sleep problems associated with significant behavioral problems and more severe autism clinical presentation. Little is known about the relationships between autism traits and sleep problems in Hong Kong. Therefore, this study aimed to examine whether children with autism have increased sleep problems than non-autistic children in Hong Kong. The secondary objective was to examine the factors associated with sleep problems in an autism clinical sample.MethodsThis cross-sectional study recruited 135 children with autism and 102 with the same age range of non-autistic children, aged between 6 and 12 years. Both groups were screened and compared on their sleep behaviors using the Children's Sleep Habits Questionnaire (CSHQ).ResultsChildren with autism had significantly more sleep problems than non-autistic children [t(226.73) = 6.20, p < 0.001]. Bed -sharing [beta = 0.25, t(165) = 2.75, p = 0.07] and maternal age at birth [beta = 0.15, t(165) = 2.05, p = 0.043] were significant factors associated with CSHQ score on the top of autism traits. Stepwise linear regression modeling identified that only separation anxiety disorder (beta = 4.83, t = 2.40, p = 0.019) best-predicted CSHQ.ConclusionIn summary, autistic children suffered from significantly more sleep problems and co-occurring separation anxiety disorder brings greater sleep problems as compared to non-autistic children. Clinicians should be more aware of sleep problems to provide more effective treatments to children with autism