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

Association between screen viewing duration and sleep duration, Sleep quality, And excessive daytime sleepiness among adolescents in Hong Kong

© 2014 by the authors; licensee MDPI, Basel, Switzerland. Screen viewing is considered to have adverse impacts on the sleep of adolescents. Although there has been a considerable amount of research on the association between screen viewing and sleep, most studies have focused on specific types of screen viewing devices such as televisions and computers. The present study investigated the duration w ith which currently prevalent screen viewing devices (including televisions, personal computers, mobile phones, and portable video devices) are viewed in relation to sleep duration, sleep quality, and daytime sleepiness among Hong Kong adolescents (N = 762). Television and computer viewing remain prevalent, but were not correlated with sleep variables. Mobile phone viewing was correlated with all sleep variables, while portable video device viewing was shown to be correlated only with daytime sleepiness. The results demonstrated a trend of increase in the prevalence and types of screen viewing and their effects on the sleep patterns of adolescents.Link_to_subscribed_fulltex

Generation of induced pluripotent stem cell lines from 3 distinct laminopathies bearing heterogeneous mutations in lamin A/C

The term laminopathies defines a group of genetic disorders caused by defects in the nuclear envelope, mostly the lamins. Lamins are the main constituents of the nuclear lamina, a filamentous meshwork associated with the inner nuclear membrane that provides mechanical stability and plays important roles in processes such as transcription, DNA replication and chromatin organization. More than 300 mutations in lamin A/C have been associated with diverse clinical phenotypes, understanding the molecular basis of these diseases may provide a rationale for treating them. Here we describe the generation of induced pluripotent stem cells (iPSCs) from a patient with inherited dilated cardiomiopathy and 2 patients with distinct accelerated forms of aging, atypical Werner syndrome and Hutchinson Gilford progeria, all of which are caused by mutations in lamin A/C. These cell lines were pluripotent and displayed normal nuclear membrane morphology compared to donor fibroblasts. Their differentiated progeny reproduced the disease phenotype, reinforcing the idea that they represent excellent tools for understanding the role of lamin A/C in normal physiology and the clinical diversity associated with these diseases

Deficiency of Cks1 leads to learning and long-term memory defects and p27 dependentformation of neuronal cofilin aggregates

In mitotic cells, the cyclin-dependent kinase (CDK) subunit protein CKS1 regulates S phase entry by mediating degradation of the CDK inhibitor p27. Although mature neurons lack mitotic CDKs, we found that CKS1 was actively expressed in post-mitotic neurons of the adult hippocampus. Interestingly, Cks1 knockout (Cks1−/−) mice exhibited poor long-term memory, and diminished maintenance of long-term potentiation in the hippocampal circuits. Furthermore, there was neuronal accumulation of cofilin-actin rods or cofilin aggregates, which are associated with defective dendritic spine maturation and synaptic loss. We further demonstrated that it was the increased p27 level that activated cofilin by suppressing the RhoA kinase-mediated inhibitory phosphorylation of cofilin, resulting in the formation of cofilin aggregates in the Cks1−/− neuronal cells. Consistent with reports that the peptidyl-prolyl-isomerase PIN1 competes with CKS1 for p27 binding, we found that inhibition of PIN1 diminished the formation of cofilin aggregates through decreasing p27 levels, thereby activating RhoA and increasing cofilin phosphorylation. Our results revealed that CKS1 is involved in normal glutamatergic synapse development and dendritic spine maturation in adult hippocampus through modulating p27 stability

Concomitant Hepatorenal Dysfunction and Malnutrition in Valvular Heart Surgery:Long-Term Prognostic Implications for Death and Heart Failure

BACKGROUND: Strategies to improve long-term prediction of heart failure and death in valvular surgery are urgently needed because of an increasing number of procedures globally. This study sought to report the prevalence, changes, and prognostic implications of concomitant hepatorenal dysfunction and malnutrition in valvular surgery. METHODS AND RESULTS: In 909 patients undergoing valvular surgery, 3 groups were defined based on hepatorenal function (the modified model for end-stage liver disease excluding international normalized ratio score) and nutritional status (Controlling Nutritional Status score): normal hepatorenal function and nutrition (normal), hepatorenal dysfunction or malnutrition alone (mild), and concomitant hepatorenal dysfunction and malnutrition (severe). Overall, 32%, 46%, and 19% of patients were classified into normal, mild, and severe groups, respectively. Over a 4.1-year median follow-up, mild and severe groups in-curred a higher risk of mortality (hazard ratio [HR], 3.17 [95% CI, 1.40–7.17] and HR, 9.30 [95% CI, 4.09– 21.16], respectively), cardiovascular death (subdistribution HR, 3.29 [95% CI, 1.14– 9.52] and subdistribution HR, 9.29 [95% CI, 3.09– 27.99]), heart failure hospitalization (subdistribution HR, 2.11 [95% CI, 1.25– 3.55] and subdistribution HR, 3.55 [95% CI, 2.04– 6.16]), and adverse outcomes (HR, 2.11 [95% CI, 1.25– 3.55] and HR, 3.55 [95% CI, 2.04– 6.16]). Modified model for end-stage liver disease excluding international normalized ratio and controlling nutritional status scores improved the predictive ability of European System for Cardiac Operative Risk Evaluation (area under the curve: 0.80 versus 0.73, P<0.001) and Society of Thoracic Surgeons score (area under the curve: 0.79 versus 0.72, P=0.004) for all-cause mortality. One year following surgery (n=707), patients with persistent concomitant hepatorenal dysfunction and malnutrition (severe) experienced worse outcomes than those without.  CONCLUSIONS: Concomitant hepatorenal dysfunction and malnutrition was frequent and strongly linked to heart failure and mortality in valvular surgery

A territory-wide Study of arrhythmogenic right ventricular cardiomyopathy patients from Hong Kong

Background: Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is a hereditary disease characterized by fibrofatty infiltration of the right ventricular myocardium that predisposes affected patients to malignant ventricular arrhythmias, dual-chamber cardiac failure and sudden cardiac death (SCD). The present study aims to investigate the risk of detrimental cardiovascular events in an Asian population of ARVC/D patients, including the incidence of malignant ventricular arrhythmias, new-onset heart failure with reduced ejection fraction (HFrEF), as well as long-term mortality. Methods and Results: This was a territory-wide retrospective cohort study of patients diagnosed with ARVC/D between 1997 and 2019 in Hong Kong. This study consisted of 109 ARVC/D patients (median age: 61 [46–71] years; 58% male). Of these, 51 and 24 patients developed incident VT/VF and new-onset HFrEF, respectively. Five patients underwent cardiac transplantation, and 14 died during follow-up. Multivariate Cox regression identified prolonged QRS duration as a predictor of VT/VF (p <0.05). Female gender, prolonged QTc duration, the presence of epsilon waves and T-wave inversion (TWI) in any lead except aVR/V1 predicted new-onset HFrEF (p <0.05). The presence of epsilon waves, in addition to the parameters of prolonged QRS duration and worsening ejection fraction predicted all-cause mortality (p <0.05). Clinical scores were developed to predict incident VT/VF, new-onset HFrEF and all-cause mortality, and all were significantly improved by machine learning techniques. Conclusions: Clinical and electrocardiographic parameters are important for assessing prognosis in ARVC/D patients and should in turn be used in tandem to aid risk stratification in the hospital setting

Sulfonylurea is associated with higher risks of ventricular arrhythmia or sudden cardiac death compared with metformin: A population-based cohort study

Background Commonly prescribed diabetic medications such as metformin and sulfonylurea may be associated with different arrhythmogenic risks. This study compared the risk of ventricular arrhythmia or sudden cardiac death between metformin and sulfonylurea users in patients with type 2 diabetes. Methods and Results Patients aged ≥40 years who were diagnosed with type 2 diabetes or prescribed antidiabetic agents in Hong Kong between January 1, 2009, and December 31, 2009, were included and followed up until December 31, 2019. Patients prescribed with both metformin and sulfonylurea or had prior myocardial infarction were excluded. The study outcome was a composite of ventricular arrhythmia or sudden cardiac death. Metformin users and sulfonylurea users were matched at a 1:1 ratio by propensity score matching. The matched cohort consisted of 16 596 metformin users (47.70% men; age, 68±11 years; mean follow‐up, 4.92±2.55 years) and 16 596 sulfonylurea users (49.80% men; age, 70±11 years; mean follow‐up, 4.93±2.55 years). Sulfonylurea was associated with higher risk of ventricular arrhythmia or sudden cardiac death than metformin hazard ratio (HR, 1.90 [95% CI, 1.73–2.08]). Such difference was consistently observed in subgroup analyses stratifying for insulin usage or known coronary heart disease. Conclusions Sulfonylurea use is associated with higher risk of ventricular arrhythmia or sudden cardiac death than metformin in patients with type 2 diabetes

Disparities of time trends and birth cohort effects on invasive breast cancer incidence in Shanghai and Hong Kong pre- and post-menopausal women

© 2017 The Author(s). Background: Breast cancer is the leading cause of cancer morbidity among Shanghai and Hong Kong women, which contributes to 20-25% of new female cancer incidents. This study aimed to describe the temporal trend of breast cancer and interpret the potential effects on the observed secular trends. Methods: Cancer incident data were obtained from the cancer registries. Age-standardized incidence rate was computed by the direct method using the World population of 2000. Average annual percentage change (AAPC) in incidence rate was estimated by the Joinpoint regression. Age, period and cohort effects were assessed by using a log-linear model with Poisson regression. Results: During 1976-2009, an increasing trend of breast cancer incidence was observed, with an AAPC of 1.73 [95% confidence interval (CI): 1.54-1.92)] for women in Hong Kong and 2.83 (95% CI, 2.26-3.40) in Shanghai. Greater upward trends were revealed in Shanghai women aged 50 years old or above (AAPC = 3.09; 95% CI, 1.48-4.73). Using age at 50 years old as cut-point, strong birth cohort effects were shown in both pre- and post-menopausal women, though a more remarkable effect was suggested in Shanghai post-menopausal women. No evidence for a period effect was indicated. Conclusions: Incidence rate of breast cancer has been more speedy in Shanghai post-menopausal women than that of the Hong Kong women over the past 30 years. Decreased birth rate and increasing environmental exposures (e.g., light-at-night) over successive generations may have constituted major impacts on the birth cohort effects, especially for the post-menopausal breast cancer; further analytic studies are warranted.Link_to_subscribed_fulltex

Uncoupling Protein-4 (UCP4) Increases ATP Supply by Interacting with Mitochondrial Complex II in Neuroblastoma Cells

Mitochondrial uncoupling protein-4 (UCP4) protects against Complex I deficiency as induced by 1-methyl-4-phenylpyridinium (MPP+), but how UCP4 affects mitochondrial function is unclear. Here we investigated how UCP4 affects mitochondrial bioenergetics in SH-SY5Y cells. Cells stably overexpressing UCP4 exhibited higher oxygen consumption (10.1%, p<0.01), with 20% greater proton leak than vector controls (p<0.01). Increased ATP supply was observed in UCP4-overexpressing cells compared to controls (p<0.05). Although state 4 and state 3 respiration rates of UCP4-overexpressing and control cells were similar, Complex II activity in UCP4-overexpressing cells was 30% higher (p<0.05), associated with protein binding between UCP4 and Complex II, but not that of either Complex I or IV. Mitochondrial ADP consumption by succinate-induced respiration was 26% higher in UCP4-overexpressing cells, with 20% higher ADP:O ratio (p<0.05). ADP/ATP exchange rate was not altered by UCP4 overexpression, as shown by unchanged mitochondrial ADP uptake activity. UCP4 overexpression retained normal mitochondrial morphology in situ, with similar mitochondrial membrane potential compared to controls. Our findings elucidate how UCP4 overexpression increases ATP synthesis by specifically interacting with Complex II. This highlights a unique role of UCP4 as a potential regulatory target to modulate mitochondrial Complex II and ATP output in preserving existing neurons against energy crisis