The last defence? Surgical aspects of gouty arthritis of hand and wrist

OBJECTIVE: To review the epidemiology, pathophysiology, clinical manifestations, diagnosis, and treatment of gouty arthritis of the hand and wrist, with a focus on the surgical aspects. DATA SOURCES AND EXTRACTION: Electronic databases including MEDLINE, PubMed, and the Cochrane library were searched with the key words of 'gouty arthritis', 'hand', 'wrist', and 'surgical'. STUDY SELECTION: A total of 55 articles were selected for inclusion in this review. DATA SYNTHESIS: There is no existing study for the overall prevalence of gout in Asia, though one study showed that it was 3.1% in Taiwan. Its pathophysiology entails hyperuricaemia, trauma, lower temperatures, and previous diseases. Gouty arthritis of hand and wrist presents as acute wrist pain, subcutaneous or peritendinous tophi, tenosynovitis, entrapment neuropathy, tendon rupture, or even bone destruction. Demonstration of negatively birefringent crystals in the absence of organisms and a normal white cell count in synovial fluid confirm the diagnosis. Medical treatment including non-steroidal anti-inflammatory drugs, colchicines, allopurinol, uricosuric agents, and lifestyle modifications remain the mainstay of treatment. Surgical treatment options for tophaceous gout involve decompression by aspiration, incision and drainage, tenosynovectomy, shaving procedures, and complex surgical approach. CONCLUSION. While medical treatment remains the mainstay of treatment for gouty arthritis of the hand and wrist, 5% of patients may not respond. In this group, surgery is often performed in advanced stages, but yields less-than-satisfactory outcomes. Gouty arthritis is difficult to treat when it starts to cause stiffness and deformities. Although more studies are needed to evaluate the outcomes, the authors suggest that one possible solution is pre-emptive surgery.published_or_final_versio

Gingival bleeding response in smokers and non-smokers

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Use of Dysmorphology for Subgroup Classification on Autism Spectrum Disorder in Chinese Children

Data from 1,261 Chinese Autistic Spectrum Disorder (ASD) patients were evaluated and categorized into dysmorphic (10.79 %) and non-dysmorphic groups (89.21 %) upon physical examination by the presence of dysmorphic features. Abnormal MRI/CT result, IQ scores and epilepsy were significantly associated with the dysmorphic group of ASD children. However, gender, EEG abnormality and family history and recurrence of ASD were not found to be significantly different between group statuses. It is suggested that results collected from the Chinese population generally resembles that found in the Caucasians with ethnical differences still present. Current study supports the result shown in Miles' study (Miles et al. in Am J Med Genet 135A:171-180, 2005), in which heterogeneity subtypes of autism of different genetic origins which could be distinguished by presence of dysmorphic features on the patients.postprin

Validation of the Chinese non-pharmacological therapy experience scale in persons with intellectual disability

202002 bcrcVersion of RecordPublishe

Viral genetic sequence variations in pandemic H1N1/2009 and seasonal H3N2 influenza viruses within an individual, a household and a community

Background: There are few data in the literature on viral sequence variation between host generations/successive transmission events. Relatively little is known about the sequence heterogeneity of the influenza viruses transmitted within families. Objectives: To study the molecular epidemiology of influenza virus and to determine the sequence variation within an individual, a household and a community during the first wave of influenza pandemic in 2009. Study design: A prospective study of household transmission of influenza A in Hong Kong was conducted during the pandemic in 2009. The HA and NA sequences of pandemic and seasonal influenza A viral isolates identified in this household transmission study were sequences and analyzed. Results: Our results indicated that there were multiple introductions of influenza viruses into Hong Kong. Sequence analysis of these isolates suggested that members of these family clusters acquired the infection by household transmissions. Interestingly, unlike those concluded from previous household transmission studies, we observed sequence variations between sequential samples from the same person and also within the same household. Conclusions: Family clusters of influenza A viral infection are predominantly the result of secondary transmission within a household. Our results also suggested that the intra-host viral sequence variation might be more common that than previously thought. © 2011 Elsevier B.V.link_to_OA_fulltex

School-based research agenda on healthcare simulation for nursing education in Hong Kong

Background Healthcare simulation has been used as a pedagogical strategy in nursing education. Evidence has shown one of the positive impacts that simulations replace clinical placement. These wide-ranging initiatives are essential, and they can guide a nursing school’s simulation training. However, researching each innovation in the nursing field is beyond the scope. Methods To focus our research and develop the capacity and capability to incorporate healthcare simulation in nursing education, we used a consensus building process to establish a school’s research agenda. A modified Delphi process was adopted to reach a consensus among 10 nursing faculty members in one university with a visiting professor’s support. Results The three themes were identified as (1) embedding simulation into the baccalaureate in nursing curriculum, (2) designing effective simulation-based education and (3) simulating education in the broader world (adolescents). These themes were further categorised into two areas that used simulation in the educational and community settings. Sixty per cent of the faculty members agreed that the question, ‘How can simulation be incorporated into clinical placements to enhance students’ learning?' should be the highest research priority. Conclusion This study adds understanding to incorporate simulation-based education in the nursing curriculum and community provides insights into future research

The effect of donor age on the outcome of Liver Transplant in patients with Hepatitis B Virus Infection

Poster Session 1 - Outcomes: P-131This free journal suppl. entitled: The ILTS 20th Annual International CongressBACKGROUND: Liver regeneration power has been showed to decrease with advanced age. Large scale analysis for hepatitis B virus infection in this aspect is lacking. Objectives: Since liver donation rate is still very low in many parts of the world, we aim to study whether the use of advanced donor age liver graft has an adverse effect on survival in patients with hepatitis B virus infection. METHODS: 918 patients received liver transplantation in Queen Mary Hospital between January 1996 to December 2011. Patients with hepatitis B virus related pathology who had undergone deceased donor liver transplantation were included and the outcome of liver transplantation were studied. RESULTS: Amongst the 214 patients included, 135 patients were transplanted for cirrhosis, 48 patients for acute on chronic live failure, and 30 patients for acute fl are of hepatitis B virus infection. 57 patients had concomitant hepatocellular carcinoma. The median age of the donor was 54 year (range 2-76). Liver donors were divided in to two groups by the donor age. Group 1 consisted of donor less than or equals to 60 years (n=184). Group 2 consisted of donor age more than 60 years (n=30). The median recipient age for group 1 was 48.5 years. The median recipient age for group 2 was 49 years . (p=0.297) The median MELD score for group 1 was 29 (range 13-56). The median recipient age for group 2 was 24 years. (p=0.436). The median graft weigh was 1032.5g (range 810-1600g) in group 2 which is lower than the median graft weight in group 1 patients (1210g)( range 365-2180g) (p=0.007). The median estimated standard liver volume (ESLV) was 83.3% (range 61.4- 136.6%) in group 2 which is lower than the median ESLV in group 1 patients (98.3%) (Range 31.9%-177.9%) (p=0.013). The 1 year, 3 year and 5 year graft survival for group 1 patients was 93.4%, 88.7%, 88.7% respectively. The 1 year, 3 year and 5 year graft survival for group 1 patients was 90.5%, 90.5%, 90.5% respectively. (p=0.682). The 1 year, 3 year and 5 year overall survival for group 1 patients was 93.4%, 90.2%, 90.2% respectively. The 1 year, 3 year and 5 year graft survival for group 1 patients was 90.5%, 90.5%, 90.5% respectively. (p=0.809). CONCLUSION: Advanced donor age does not seem to have adverse effect on graft and patients survival for transplant patients with hepatitis B virus infection.link_to_OA_fulltex

Entecavir versus lamivudine prophylaxis without hepatitis B immune globulin after liver transplantation for chronic hepatitis B

Oral Presentation - Concurrent Session: Recurrent Disease/Pathology: abstract no. O-126This journal suppl. entitled: Supplement: The ILTS 18th Annual International CongressYoung Investigator Award Winners: James FungBACKGROUND: Oral antiviral prophylaxis without hepatitis B immune globulin (HBIG) has been shown to be effective after liver transplantation for hepatitis B, although the efficacy of different nucleoside/nucleotide analogues is not known. The current study compares the efficacy of entecavir (ETV) versus lamivudine (LAM). PATIENTS AND METHODS: From January 2003 to March 2011, 292 consecutive patients either taking LAM (n=163) or ETV (n=129) as mono-prophylaxis after liver transplantation were included. None of the patients received HBIG …link_to_OA_fulltex

Treatment strategy for recurrent hepatocellular carcinoma: salvage liver transplantation, repeated hepatic resection, or radiofrequency ablation

This journal suppl. entitled: Supplement: The ILTS 18th Annual International CongressOral Presentation - Interactive Concurrent Session 4: HCC Salvage Transplant vs. LDLT vs. Cadaveric OLT: abstract no. O-157INTRODUCTION: The best treatment strategy for recurrent hepatocellular carcinoma(rHCC) remains poorly defined. The purpose of this study is to compare the efficacy of salvage liver transplantation (SLT), repeated hepatic resection (RHR) and radiofrequency ablation(RFA) in patients with intrahepatic recurrence after treatment of primary HCC within Milan criteria, so as to define an efficacious treatment algorithm for this disease entity. METHODS: From June 1997 and June 2010, 504 patients received either hepatic resections or RFA for primary HCC within Milan criteria in our center. In all, 186 patients (37.4%) developed intrahepatic recurrences and 92 of them were selected for SLT (n=19), RHR(n=25) or RFA(n=48). Their clinicopathological data and survival outcomes were reviewed. Survival curves were plotted by Kaplan Meier ...link_to_OA_fulltex