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

Effectiveness of a technology-based injury prevention program for enhancing mothers’ knowledge of child safety: protocol for a randomized controlled trial

Background: Provision of anticipatory guidance for parents is recommended as an effective strategy to prevent injuries among young children. Technology-based anticipatory guidance has been suggested to reinforce the effectiveness of injury prevention and improve parents’ knowledge of child safety. Objective: This study aims to examine the effectiveness of a technology-based injury prevention program with parental anticipatory guidance for enhancing mothers’ knowledge of child safety. Methods: In this randomized controlled trial, 308 mothers will be recruited from the antenatal clinics and postnatal wards of two major public hospitals in Hong Kong. Participating mothers will be randomly assigned into intervention and control groups. Mothers in the intervention group will be given free access to a technology-based injury prevention program with anticipatory guidance, whereas mothers in the control group will be given a relevant booklet on parenting. The injury prevention program, available as a website or on a mobile app, includes behavioral components based on the Theory of Planned Behavior. The primary outcome measure will be the change in the mother’s knowledge of child safety. The secondary outcome measures will be age-appropriate domestic safety knowledge, attitudes, intentions, perceived behavioral control, and self-reported behavior related to home safety practice. We will also determine dose-response relationships between the outcome measures and the website and mobile app usage. Results: Enrolment of participants will begin in October 2016. Results are expected by June 2018. Conclusions: Parents will be able to easily access the domestic injury prevention website to find information regarding child injury prevention. It is anticipated that the technology-based intervention will help parents improve their knowledge of child safety and raise their awareness about the consequences of domestic injuries and the importance of prevention. Trial Registration: Clinicaltrials.gov Clinicaltrials.gov NCT02835768; http://clinicaltrials.gov/ct2/show/NCT02835768 (Archived by WebCite at http://www.webcitation/6lbXYM6b9)

Changing patterns of intimate partner violence against pregnant women: a three-year longitudinal study

Intimate partner violence (IPV) against pregnant women adversely impacts women’s and infants’ health. This study aims to provide longitudinal evidence regarding how pregnant women’s exposure to IPV changes over time. Additionally, we examine the risk and protective factors associated with these changes. In total, 340 pregnant women were recruited from an antenatal clinic in Hong Kong. IPV experiences and health conditions were assessed at pregnancy and at both 4 weeks and 3 years after childbirth. The women also reported adverse childhood experiences (ACEs), their family support, and perceived partner involvement. We found IPV prevalence among the study sample decreased from 22.9% before pregnancy to 13.5% during pregnancy, 14.7% at 4 weeks after childbirth, and 11.8% at 3 years after childbirth. We further found three types of IPV: 11.8% of women had a violent relationship (VR) persistently over time from pregnancy to 3 years after childbirth, 20.6% experienced decreased IPV (DVR), and 67.6% reported a nonviolent relationship (NVR) throughout the study period. VRs were associated with more severe mental health problems and higher ACEs. Family support and partner involvement may be protective factors for decreased IPV. Our present findings highlight the importance of identifying different IPV types over time to provide targeted intervention to the most vulnerable groups

Association of maternal levothyroxine use during pregnancy with offspring birth and neurodevelopmental outcomes: a population-based cohort study

BACKGROUND: The influence of maternal levothyroxine treatment during pregnancy remains unclear. This study aimed to evaluate the associations of maternal levothyroxine treatment during pregnancy with the birth and neurodevelopmental outcomes in offspring. METHODS: This population-based cohort study was conducted among pregnant women using the Hong Kong Clinical Data Analysis and Reporting System. Mother-child pairs in Hong Kong from 2001 to 2015 were included and children were followed up till 2020. We defined the exposure group as mothers who were exposed to levothyroxine during pregnancy. Preterm birth and small for gestational age (SGA) were included as birth outcomes. Attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) were included as neurodevelopmental outcomes. Odds ratios (OR) or hazard ratios (HRs) with a 95% confidence interval (CI) were evaluated to assess the association of gestational levothyroxine use with offspring birth and neurodevelopmental outcomes respectively, using propensity score fine-stratification weighting and a Cox proportional hazards regression model. RESULTS: Among 422,156 mother-child pairs, 2125 children were born from mothers exposed to levothyroxine during pregnancy. A significantly increased risk of preterm birth was observed in children with maternal levothyroxine exposure during pregnancy, when compared to mothers who had no history of thyroid-related diagnoses or prescriptions (weighted OR [wOR]: 1.22, 95% CI: 1.07, 1.39). Similarly, an increased risk of preterm birth was found among children of gestational levothyroxine users, when compared to children of mothers who had used levothyroxine before but stopped during pregnancy (wOR: 2.16, 95% CI: 1.09, 4.25). Sensitivity analysis, by excluding mothers exposed to psychotropic or antiepileptic medications before or during pregnancy, also indicated a similar increased risk of preterm birth regarding the gestational use of levothyroxine (wOR: 1.26, 95% CI: 1.10, 1.45). No significant association was observed for the risk of SGA, ADHD, and ASD. CONCLUSIONS: There is no evidence that gestational use of levothyroxine is associated with SGA, ADHD, or ASD in offspring. Gestational levothyroxine treatment is associated with a higher risk of preterm birth. Such risk might be confounded by the underlying maternal thyroid disease itself, however, we cannot completely exclude the possible effect of gestational L-T4 treatment on offspring preterm birth. Our findings provided support to the current guidelines on the cautious use of levothyroxine treatment during pregnancy. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12916-022-02586-9

The association between intimate partner violence against women and newborn telomere length

Intimate partner violence (IPV) against women negatively impacts infant health. However, its impact on infant’s biology, in particular on telomere length (TL) is unknown. The aim of this study was to examine the association between IPV against women before childbirth and cord blood TL in their newborn. A total of 774 pregnant women in the 20th–24th week of gestation were recruited at a public hospital in Hong Kong. The mothers’ exposure to IPV before childbirth, demographic characteristics, obstetric outcomes, health and mental health were measured at the time of recruitment and 4 weeks after childbirth. Umbilical cord blood was collected by midwives at the time of delivery. The newborn TL was quantified using quantitative PCR method and expressed in T/S ratio (the ratio of telomere repeat copy numbers to single-copy gene numbers). After adjusting for a number of confounding variables, the mothers’ exposure to any IPV before childbirth (β = −0.08, 95% CI = −0.14, −0.01) was associated with shorter TL. Specifically, psychological abuse against women before childbirth (β = −0.08, 95% CI = −0.15, −0.02) and sexual abuse against women before childbirth (β = −0.22, 95% CI = −0.43 to −0.01) were significantly associated with reduced newborn TL. This study is the first to provide evidence of an association between IPV against women before childbirth and TL shortening in their newborns. Through TL- dependent transcription and epigenetic mechanisms, our finding suggests maternal exposure to IPV may exert a life-long impact on the offspring’s health

Adaptive risk prediction system with incremental and transfer learning

Currently, popular methods for prenatal risk assessment of fetal aneuploidies are based on multivariate proba-bilistic modelling, that are built on decades of scientific research and large-scale multi-center clinical studies. These static models that are deployed to screening labs are rarely updated or adapted to local population characteristics. In this article, we propose an adaptive risk prediction system or ARPS, which considers these changing characteristics and automatically deploys updated risk models. 8 years of real-life Down syndrome screening data was used to firstly develop a distribution shift detection method that captures significant changes in the patient population and secondly a probabilistic risk modelling system that adapts to new data when these changes are detected. Various candidate systems that utilize transfer-and incremental learning that implement different levels of plasticity were tested. Distribution shift detection using a windowed approach provides a computationally less expensive alternative to fitting models at every data block step while not sacrificing performance. This was possible when utilizing transfer learning. Deploying an ARPS to a lab requires careful consideration of the parameters regarding the distribution shift detection and model updating, as they are affected by lab throughput and the incidence of the screened rare disorder. When this is done, ARPS could be also utilized for other population screening problems. We demonstrate with a large real-life dataset that our best performing novel Incremental-Learning-Population-to-Population-Transfer-Learning design can achieve on par prediction performance without human intervention, when compared to a deployed risk screening algorithm that has been manually updated over several years.</p

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

The efficacy and safety of Yupingfeng Powder with variation in the treatment of allergic rhinitis: Study protocol for a randomized, double-blind, placebo-controlled trial

Background: Allergic rhinitis (AR) is an upper airways chronic inflammatory disease mediated by IgE, which affects 10%–20% of the population. The mainstay for allergic rhinitis nowadays include steroids and antihistamines, but their effects are less than ideal. Many patients therefore seek Chinese medicine for treatment and Yupingfeng Powder is one of the most common formulae prescribed. In this study, we aim to investigate the efficacy and safety of Yupingfeng Powder with variation for the treatment of allergic rhinitis.Study design: This is a double-blind, randomized, placebo-controlled trial. A 2-week screening period will be implemented, and then eligible subjects with allergic rhinitis will receive interventions of either “Yupingfeng Powder with variation” granules or placebo granules for 8 weeks, followed by post treatment visits at weeks 12 and 16. The change in the Total Nasal Symptom Score (TNSS) will be used as the primary outcome.Discussion: This trail will evaluate the efficacy and safety of Yupingfeng Powder in treating allergic rhinitis. The study may provide the solid evidence of Yupingfeng Powder with variation can produce better clinical efficacy than the placebo granules.Trial registration:ClinicalTrials.gov, identifier NCT04976023

Association between intimate partner violence and leukocyte telomere length: a retrospective cohort study of 144 049 UK Biobank participants

Abstract Aims Intimate partner violence (IPV) is a public health challenge negatively affecting victims’ health. Telomere length (TL), a marker for biological ageing, might be reflective of the mechanisms through which IPV leads to adverse health outcomes. The objective of the current study was to explore the association between IPV and leucocyte TL. Methods We conducted an analysis using a subset of the UK Biobank (N = 144 049). Physical, sexual and emotional IPV were reported by the participants. DNA was extracted from peripheral blood leukocytes. TL was assayed by quantitative polymerase chain reaction. We used multivariable linear regressions to test the associations between IPV and TL adjusted for age, sex, ethnicity, deprivation, education, as well as symptoms of depression and post-traumatic stress disorder in a sensitivity analysis. Results After adjusting for sociodemographic factors, any IPV was associated with 0.02-s.d. shorter TL (β = −0.02, 95% CI −0.04 to −0.01). Of the three types of IPV, physical violence had a marginally stronger association (β = −0.05, 95% CI −0.07 to −0.02) than the other two types. The associations of numbers of IPV and TL showed a dose–response pattern whereby those who experienced all three types of IPV types had the shortest TL (β = −0.07, 95% CI −0.12 to −0.03), followed by those who experienced two types (β = −0.04, 95% CI −0.07 to −0.01). Following additional adjustment for symptoms of depression and PTSD, the associations were slightly attenuated but the general trend by number of IPVs remained. Conclusions Victims of IPV, particularly those exposed to multiple types of IPVs, had shorter TL indicative of accelerated biological ageing. Given that all three types of IPV are linked to TL, clinical practitioners need to comprehensively identify all types of IPV and those who received multiple types. Further studies should explore the association of violence with changes in TL over time, as well as to which extent biological ageing is a mechanistic factor

Increased Genetic Diversity of HIV-1 Circulating in Hong Kong

HIV-1 group M strains are characterized into 9 pure subtypes and 48 circulating recombinant forms (CRFs). Recent studies have identified the presence of new HIV-1 recombinants in Hong Kong and their complexity continues to increase. This study aims to characterize the HIV-1 genetic diversity in Hong Kong. Phylogenetic analyses were performed by using HIV-1 pol sequences including protease and partial reverse transcriptase isolated from 1045 local patients in Hong Kong from 2003 to 2008. For the pol sequences with unassigned genotype, the evidence of recombination was determined by using sliding-window based bootscan plots and their env C2V3 region were also sequenced. Epidemiological background of these patients was further collected. The pol phylogenetic analyses highlighted the extent of HIV-1 genetic diversity in Hong Kong. Subtype B (450/1045; 43.1%) and CRF01_AE (469/1045; 44.9%) variants were clearly predominant. Other genotypes (126/1045; 12.1%) including 3 defined subtypes, 10 CRFs, 1 unassigned subtype and 33 recombinants with 11 different mosaic patterns were observed. Recombinants of subtype B and CRF01_AE were mainly found among local Chinese MSM throughout 2004 to 2008, while the CRF02_AG and subtype G recombinants were circulating among non-Chinese Asian population in Hong Kong through heterosexual transmission starting from 2008. Our study demonstrated the complex recombination of HIV-1 in Hong Kong and the need in developing surveillance system for tracking the distribution of new HIV-1 genetic variants