Effects of body composition on clinical and quality of life outcomes in kidney transplant recipients

Sarcopenic obesity is common among kidney transplant recipients. Fluid volume status has not been well-investigated following kidney transplantation. This thesis aimed to explore the effects of body composition, including fat mass, muscle mass and fluid volume status, on post-transplantation morbidity and fatigue. These are potential contributing factors to long-term patient- and graft- survival, as well as quality of life. Firstly, the associations between adiposity with inflammation, hepcidin and haemoglobin levels were investigated. Secondly, the effects of hypervolemia on blood pressure and levels of N-terminal fragment of pro-hormone B-type natriuretic peptide (NT-proBNP) were explored. Thirdly, the role of muscle mass and fat mass on all domains of fatigue were studied. Finally, the mechanistic aetiology of physical fatigue was examined by evaluation of muscle mass, muscular and cardiovascular functions, and fatigue perception. This thesis concluded that while adiposity displays significant independent association with inflammation, its role in determining hepcidin and haemoglobin levels remains uncertain. Reduced muscle mass may be correlated with physical fatigue, but independent contribution of fat mass in fatigue remains undefined. Hypervolemia is associated with raised blood pressure and elevated levels of NT-proBNP. The findings from this thesis set the scene for future interventional research and therapeutic strategies

The accessibility of public housing in Hong Kong : an analysis of government policy and action

published_or_final_versionPolitics and Public AdministrationMasterMaster of Public Administratio

An exploratory study of pet raising and health of the elderly people in Hong Kong

Introduction: Pets such as dogs, cats and fish were popular in many other countries (Marx et al., 1988; Gammonley, 1991; Brodie & Biley, 1999; PIAS, 2002). In Hong Kong, pet owners increased to 0.26 million (Census and Statistics Department, 2006). Dating back to 1980s, a research study reported the association between pet ownerships and health benefits for humans (McNicholas et al., 2005). According to the report, domesticated pets brought a sense of companionship and provided pet owners with pleasure. These pets could be tools for enhancing human social relationship and could also provide their owners with emotional comfort. Recent studies also revealed that the influence of the complex and rich relationship between pets and owners might far surpass daily pleasure in terms of improving physical, psychological and mental health of the elderly (Serpell, 1991; Garrity et al., 1989; Murrell et al., 1983). 1.2. Objectives : Not many studies in the literature were to investigate the positive impacts of pet raising on health of the elderly in Hong Kong. If pet raising had a positive impact on older people’s health, there would be important implications to the health services in Hong Kong, with regard to further studies on an in-depth understanding of this issue and policy recommendations for the Hong Kong government to improve the health services of the elderly population. In light of the above rationale, the present study was designed to explore the qualitative impacts of pet raising on well-being of the elderly people in Hong Kong. The specific aims of the study were: To explore the value of pet raising as perceived by the elderly people in Hong Kong; To explore the impacts of pet raising on the physical, psychological and overall life satisfaction of the elderly people in Hong Kong; To identify the critical factors influencing the physical, psychological and overall life satisfaction of the elderly people in Hong Kong; and To make suggestions to policy makers regarding effective health services for the elderly people in Hong Kong

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%

Managing inter-agency co-ordination : an analysis of district level administration in Hong Kong

published_or_final_versionPolitics and Public AdministrationMasterMaster of Public Administratio

The impact of positron emission tomography on primary tumour delineation and dosimetric outcome in intensity modulated radiotherapy of early T-stage nasopharyngeal carcinoma

Background: In intensity modulated radiotherapy (IMRT) of nasopharyngeal carcinoma (NPC), accurate delineation of the gross tumour volume (GTV) is important. Image registration of CT and MRI has been routinely used in treatment planning. With recent development of positron emission tomography (PET), the aims of this study were to evaluate the impact of PET on GTV delineation and dosimetric outcome in IMRT of early stage NPC patients.Methods: Twenty NPC patients with T1 or T2 disease treated by IMRT were recruited. For each patient, 2 sets of NP GTVs were delineated separately, in which one set was performed using CT and MRI registration only (GTVCM), while the other set was carried out using PET, CT and MRI information (GTVCMP). A 9-field IMRT plan was computed based on the target volumes generated from CT and MRI (PTVCM). To assess the geometric difference between the GTVCM and GTVCMP, GTV volumes and DICE similarity coefficient (DSC), which measured the geometrical similarity between the two GTVs, were recorded. To evaluate the dosimetric impact, the Dmax, Dmin, Dmean and D95 of PTVs were obtained from their dose volume histograms generated by the treatment planning system.Results: The overall mean volume of GTVCMP was greater than GTVCM by 4.4 %, in which GTVCMP was slightly greater in the T1 group but lower in the T2 group. The mean DSC of the whole group was 0.79 ± 0.05. Similar mean DSC values were also obtained from the T1 and T2 groups separately. The dosimetric parameters of PTVCM fulfilled the planning requirements. When applying this plan to the PTVCMP, the average Dmin (56.9 Gy) and D95 (68.6 Gy) of PTVCMP failed to meet the dose requirements and demonstrated significant differences from the PTVCM (p = 0.001 and 0.016 respectively), whereas the doses to GTVCMP did not show significant difference with the GTVCM.Conclusion: In IMRT of early stage NPC, PET was an important imaging modality in radiotherapy planning so as to avoid underdosing the PTV, although its effect on GTV delineation was not significant. It was recommended that PET images should be included in the treatment planning of NPC patients.Department of Health Technology and Informatic

Relationship between cortical thickness and neuropsychological performance in normal older adults and those with mild cognitive impairment

Mild cognitive impairment (MCI) has been extensively investigated in recent decades to identify groups with a high risk of dementia and to establish effective prevention methods during this period. Neuropsychological performance and cortical thickness are two important biomarkers used to predict progression from MCI to dementia. This study compares the cortical thickness and neuropsychological performance in people with MCI and cognitively healthy older adults. We further focus on the relationship between cortical thickness and neuropsychological performance in these two groups. Forty-nine participants with MCI and 40 cognitively healthy older adults were recruited. Cortical thickness was analysed with semiautomatic software, Freesurfer. The analysis reveals that the cortical thickness in the left caudal anterior cingulate (p=0.041), lateral occipital (p=0.009) and right superior temporal (p=0.047) areas were significantly thinner in the MCI group after adjustment for age and education. Almost all neuropsychological test results (with the exception of forward digit span) were significantly correlated to cortical thickness in the MCI group after adjustment for age, gender and education. In contrast, only the score on the Category Verbal Fluency Test and the forward digit span were found to have significant inverse correlations to cortical thickness in the control group of cognitively healthy older adults. The study results suggest that cortical thinning in the temporal region reflects the global change in cognition in subjects with MCI and may be useful to predict progression of MCI to Alzheimer's disease. The different pattern in the correlation of cortical thickness to the neuropsychological performance of patients with MCI from the healthy control subjects may be explained by the hypothesis of MCI as a disconnection syndrome

Improvement of myocardial perfusion reserve detected by cardiovascular magnetic resonance after direct endomyocardial implantation of autologous bone marrow cells in patients with severe coronary artery disease

<p>Abstract</p> <p>Background</p> <p>Recent studies suggested that bone marrow (BM) cell implantation in patients with severe chronic coronary artery disease (CAD) resulted in modest improvement in symptoms and cardiac function. This study sought to investigate the functional changes that occur within the chronic human ischaemic myocardium after direct endomyocardial BM cells implantation by cardiovascular magnetic resonance (CMR).</p> <p>Methods and Results</p> <p>We compared the interval changes of left ventricular ejection fraction (LVEF), myocardial perfusion reserve and the extent of myocardial scar by using late gadolinium enhancement CMR in 12 patients with severe CAD. CMR was performed at baseline and at 6 months after catheter-based direct endomyocardial autologous BM cell (n = 12) injection to viable ischaemic myocardium as guided by electromechanical mapping. In patients randomized to receive BM cell injection, there was significant decrease in percentage area of peri-infarct regions (-23.6%, <it>P </it>= <it>0.04</it>) and increase in global LVEF (+9.0%, <it>P </it>= <it>0.02</it>), the percentage of regional wall thickening (+13.1%, <it>P= 0.04</it>) and MPR (+0.25%, <it>P </it>= <it>0.03</it>) over the target area at 6-months compared with baseline.</p> <p>Conclusions</p> <p>Direct endomyocardial implantation of autologous BM cells significantly improved global LVEF, regional wall thickening and myocardial perfusion reserve, and reduced percentage area of peri-infarct regions in patients with severe CAD.</p

The management of municipal solid waste in Hong Kong : a study of civic engagement strategies

published_or_final_versionPolitics and Public AdministrationMasterMaster of Public Administratio