A comparison of the in- and out-patient referral patterns of four tertiary rheumatology centres in Beijing, Hong Kong, Kaohsiung and Los Angeles

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Functional connectivity underlying hedonic response to food in female adolescents with atypical AN: the role of somatosensory and salience networks.

Atypical anorexia nervosa (AN) usually occurs during adolescence. Patients are often in the normal-weight range at diagnosis; however, they often present with signs of medical complications and severe restraint over eating, body dissatisfaction, and low self-esteem. We investigated functional circuitry underlying the hedonic response in 28 female adolescent patients diagnosed with atypical AN and 33 healthy controls. Participants were shown images of food with high (HC) or low (LC) caloric content in alternating blocks during functional MRI. The HC > LC contrast was calculated. Based on the previous literature on full-threshold AN, we hypothesized that patients would exhibit increased connectivity in areas involved in sensory processing and bottom-up responses, coupled to increased connectivity from areas related to top-down inhibitory control, compared with controls. Patients showed increased connectivity in pathways related to multimodal somatosensory processing and memory retrieval. The connectivity was on the other hand decreased in patients in salience and attentional networks, and in a wide cerebello-occipital network. Our study was the first investigation of food-related neural response in atypical AN. Our findings support higher somatosensory processing in patients in response to HC food images compared with controls, however HC food was less efficient than LC food in engaging patients' bottom-up salient responses, and was not associated with connectivity increases in inhibitory control regions. These findings suggest that the psychopathological mechanisms underlying food restriction in atypical AN differ from full-threshold AN. Elucidating the mechanisms underlying the development and maintenance of eating behavior in atypical AN might help designing specific treatment strategies

Intra-articular injection of steroid

Intra-articular steroid injection is a useful technique to acquire for doctors in the field of rheumatology and orthopaedic surgery as well as family medicine. When cautions are taken to avoid sepsis, intra-articular injections of steroid can yield gratifying results in the management in well selected cases of different arthritis. The techniques for common lower and upper limb joint injections are described.link_to_subscribed_fulltex

Co-registration and application of Positron Emission Tomography (PET), Computed Tomography (CT) as sompared with Magnetic Resonance Imaging (MRI) in target localization for undifferentiated Carcinoma of the Nasopharynx (NPC)

Purpose/Objective(s): Accurate target localization is always challenging in Intensity Modulated Radiation Therapy (IMRT). The use of multi-modality imaging tools is believed to improve the accuracy of target localization. The application of PET images for target localization is still preliminary and lacking consensus. In this study, we compare the tumor volumes of the primary site and neck nodes of NPC contoured on PET, CT and MRI images independently. Materials/Methods: 32 patients with newly diagnosed NPC treated with IMRT underwent incorporated PET/CT scan in the treatment position in a single session for planning purposes. 18F-fluorodeoxyglucose (FDG) and intravenous contrast were injected during PET and CT scans respectively. MRI scan was also performed without cast but with the position of the head and neck simulating the actual treatment position. The MRI images were then co-registered with the PET/CT images. Gross tumor volumes (GTV) of both the primary site (GTV-P) and the neck nodes (GTV-N) were contoured on the images of PET, CT and MRI independently by the same oncologist without cross-referencing. The window settings of PET images were fixed at 10000Bq/ml (width) and 0Bq/ml (length). The GTVs contoured on PET, CT, PET combined with CT (PET+CT) and MRI were analyzed and compared. Results: The mean volumes of GTV-P contoured on CT, PET, PET+CT and MRI were 22.81cm3, 24.49cm3, 30.30cm3 and 26.81cm3 respectively. The mean volumes of GTV-N on CT, PET, PET+CT and MRI were 20.37cm3, 22.50cm3, 29.09cm3 and 26.22cm3 respectively. Taking MRI as the gold standard, Pearson correlation revealed a strong correlation in the localization of GTV-P by different imaging tools: (1) MRI vs CT (r=0.990, p=0.000), (2) MRI vs PET (r=0.964, p=0.000) and (3) MRI vs PET+CT (r=0.979, p=0.000). Subgroup analysis stratified into advanced (T3 & T4, AJCC 2002) and early T-stage (T1, T2a & T2b, AJCC 2002) showed that high degrees of correlation for GTV-P were still maintained (MR vs CT, r=0.992, p=0.000; MR vs PET, r=0.969, p=0.000; and MR vs PET+CT, r=0.979, p=0.000). A high degree of correlation was also noted in GTV-N (MRI vs CT, r=0.976, p=0.000), (MRI vs PET, r=0.909, p=0.000) and (MR vs PET+CT, r=0.975, p=0.000). The minimum concentration of FDG in localizing both GTV-P (from 6800 to 7300 Bq/ml) and GTV-N (from 6800 to 7500 Bq/ml) were highly consistent and reproducible. Conclusions: The incorporation of PET scan into the standard MRI and CT co-registration is definitely feasible and helpful in tumor localization. Future efforts should be made to derive the most appropriate algorithm in contouring the GTV on PET images

Multidisciplinary management of painful diabetic peripheral neuropathy: literature review and updated recommendation

Summary The management of painful diabetic peripheral neuropathy (DPN) requires a multidisciplinary approach, encompas sing both pharmacological and non-pharmacological treatment strategies. The Mul t idiscipl inar y Panel on Neuropathic Pain has publ ished recommendat ions on the management of painful DPN and provides here an update that emphasises the importance of good glycaemic control for all patients with diabetes, and includes newly published epidemiological studies and clinical evidence for the management of painful DPN. Based on published clinical evidence and international guidelines, first-line agents for DPN include α2δ-ligands, tricyclic antidepressants and selective serotonin-norepinephrine reuptake inhibitors. If a reasonable trial of a first-line agent does not relieve pain effectively, combination therapy with or switching to another first-line agent should be considered. Tramadol can be considered as a second-line treatment option. 摘要 糖尿病性末梢神經病變引起的疼痛，需由不同學科的醫 療團隊以藥物及非藥物方式進行治療。跨學科研究神經 病變性疼痛小組在最近發表治療糖尿病性末梢神經病變 的建議時，強調所有糖尿病患者在控制血糖水平的重要 性，並引述最新處理糖尿病末梢神經病變性疼痛的流行 病學研究和臨床實證。據已發表的臨床實證和國際指 引，治療糖尿病性末梢神經病變的第一線藥物包括α2δ- 配體、三環類抗抑鬱藥和選擇性血清素及正腎上腺素再 吸收抑制劑。當第一線藥物未能有效紓緩痛楚時，可考 慮轉換另一種第一線藥物或同時使用兩種一線藥物；而 曲馬朵 (tramadol) 可作為第二線治療選擇。link_to_OA_fulltex