The role of clinical microbiologists in infectious disease management

All infectious disease consultations directed to the clinical microbiologists at the Queen Mary Hospital in February 1995 were analysed. A total of 95 written and 111 telephone consultations were received. Fifty three percent of the written consultations involved patients with persistent fever despite multiple antimicrobial therapy. Of all written consultations, gram positive bacteria, gram negative bacteria, and fungi were encountered in 39%, 31%, and 19%, respectively. The majority of written consultations (55%) were from surgical units. In contrast, 65% of telephone consultations came from medical and paediatric units. This study indicated that a wide spectrum of infectious disease problems - both diagnostic and therapeutic - were encountered by clinical microbiologists. The unique combination of laboratory skill and clinical infectious disease knowledge gives the microbiologist a distinctive advantage in assisting clinicians to provide optimal care to patients suffering from infection.published_or_final_versio

Reliability of the Design Formula of Blast-Induced Vibrations

Session: Tunneling & ExcavationIn Hong Kong, tremendous amount of rock blasting activity has been carried out in recent years, primarily due to the sharp increase in infrastructure projects. Furthermore, it is expected that more blasting work will be undertaken in foreseeable years/decades owing to the continuing development of the mass transit railway system and the use of rock cavern promoting by the government. Traditionally a simple empirical equation in a logarithm-logarithm space with two fitting parameters is employed by engineers to decide the amount of explosive with a given peak ground vibration limit. At the initial stage of a project when limited blast records are available to obtain the site-specific fitting coefficients, reference is often made to the two fitting coefficients proposed by Li and Ng (1992). In our work, a numerical method is proposed to shed light on the subject from a Bayesian probabilistic perspective. Together with Monte Carlo simulation, the development of site-specific fitting coefficients at an early stage of a blasting project is explored. Data from a site formation project is used as an example to illustrate the performance of the method

Local recurrence of carcinoma of the tongue after glossectomy: Patient prognosis

We conducted a retrospective review of the prognosis for patients with local recurrence after surgical treatment of carcinoma of the tongue. Glossectomy for squamous cell carcinoma of the tongue was performed in 167 patients. Local recurrence developed in 32 patients including 21 with local recurrence alone, 10 with locoregional recurrence and one with locodistant recurrence. The incidence of local recurrence increased with tumor stage (from 16% of T1 tumors to 46% of T4 carcinomas). Eleven (34%) patients underwent surgical salvage for local recurrence, with only one (9%) patient surviving free of carcinoma at 43 months post-surgical salvage. All of the remaining 21 patients with local recurrence were treated palliatively and all died within one year. Patients who underwent surgical salvage had significantly higher survival rates compared to those treated palliatively. Close follow-up after glossectomy is important for early detection of local recurrence amenable to surgical salvage. However, the overall prognosis for patients with local recurrence was poor, with a three-year actuarial survival rate of only 3%. Therefore, prevention of local recurrence with adequate initial surgical treatment is essential.link_to_subscribed_fulltex

Re: Decreased STAT1 expression by promoter methylation in squamous cell carcinogenesis

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Identification of pyruvate kinase type M2 as potential oncoprotein in squamous cell carcinoma of tongue through microRNA profiling

MicroRNAs (miRNAs) are noncoding RNAs with specific regulatory role in gene expression. Recent reports suggested their involvement in human malignancies. Currently, there is no information concerning miRNA expression and functions in squamous cell carcinoma (SCC) of tongue. In this study, we evaluated the expression patterns of 156 mature miRNAs in tongue SCC using Taqman-based microRNA assays. Of these 156 miRNAs, miR-133a and miR-133b were significantly reduced in tongue SCC cells in comparison with the paired normal epithelial cells. Tongue SCC cell lines transfected with miR-133a and miR-133b precursors displayed reduction in proliferation rate. In addition, the number of apoptotic cells was increased in response to the introduction of precursors. Computational target gene prediction suggested that both miR-133a and miR-133b are targeting transcript of pyruvate kinase type M2 (PKM2), a potential oncogene in solid cancers. In tongue SCC cell lines, PKM2 expression was reduced in response to miR-133a and miR-133b precursors transfection. Immunohistochemical staining results of tongue SCC tissues suggested that PKM2 was overexpressed in tongue SCC and was associated with the downregulation of miR-133a and miR-133b. Our results suggested that aberrant reduction of miR-133a and miR-133b was associated with the dysregulation of PKM2 in SCC of tongue. © 2008 Wiley-Liss, Inc.link_to_subscribed_fulltex

Clinical implications of anterolateral thigh flap shrinkage

OBJECTIVE: To evaluate anterolateral thigh flap shrinkage after elevation and to develop a predictive model for flap design. METHOD: A prospective study was conducted in a university teaching hospital. The skin islands from anterolateral thigh flaps were outlined on a transparent sheet before and after the reconstruction procedure. Dimensions of the stretched flaps were also recorded. These three outlines were scanned and the surface areas computed and compared by tracing and use of AutoCAD. Age, sex, flap dimension, and flap thickness were investigated for association with flap shrinkage. RESULTS: Forty-five anterolateral thigh flaps harvested for head and neck soft tissue reconstruction after tumor resection were studied. Flap size ranged from 4 to 14 cm in width and 8 to 22 cm in length; flap area ranged from 30.6 to 151.0 cm. On average, the flaps shrunk by 25.0% (6.2%-52.6%), a highly significant change (P < .01). Flap width and thickness correlated with the reduction in flap size. The average stretched-flap area was 10.1% (0.4%-29.4%) less than the preflap area, a significant reduction (P < .01). The difference between stretched-flap and preflap areas was independent of all variables. We developed a predictive model using a stepwise multiple linear regression method with a coefficient of determination of 0.495. CONCLUSIONS: Anterolateral thigh flaps shrink after harvesting, and flap width and thickness are significant contributing variables. These findings indicate that flap size must take shrinkage into account to ensure sufficient coverage. © The American Laryngological, Rhinological & Otological Society, Inc.link_to_subscribed_fulltex