Vascular control by infrarenal aortic cross-clamping in placenta accreta spectrum disorders: description of technique.

We describe a novel surgical technique in 31 women with histopathologically confirmed placenta accreta spectrum (PAS) disorders managed by a multidisciplinary team using a prophylactic infrarenal abdominal aortic cross-clamping technique during caesarean hysterectomy. We conclude that this new surgical procedure is a relatively safe technique to potentially control operative blood loss. Our work may stimulate others to develop protocols assessing this innovative technique to improve the surgical outcome of PAS disorders.

Maintaining breast cancer care in the face of COVID-19.

The battle of COVID-19 is currently at different levels of intensity in each country and even each city. The authors have prepared succinct recommendations regarding the care of patients with breast cancer, divided into phases that can easily be adapted to each units' needs and resources, and stepped up or stepped down according to escalating and de-escalating circumstances. The structure can also be transposed easily to different cancer types, enabling continued provision of best standards of care despite unprecedented stressors. Surgery must go on.

Family medicine vocational training and career satisfaction in Hong Kong.

BACKGROUND: Postgraduate vocational training in family medicine (FM) is essential for physicians to build capacity and develop quality primary care. Inadequate standards in training and curriculum development can contribute to poor recruitment and retention of doctors in primary care. This study aimed to investigate: 1) the satisfaction level of doctors regarding vocational training in family medicine and associated demographics; and 2) the satisfaction level of doctors regarding their family medicine career and associated factors. METHOD: This is a cross sectional study of all family medicine physicians across all government-funded primary care clinics (GOPCs). The study questionnaire consisted of items from a standardized and validated physician survey named the Physician Worklife Survey (PWS) (Konrad et al., Med Care, 1999). We selected three scales (7 items) relating to global job satisfaction, global career satisfaction and global specialty (family medicine) satisfaction with additional items on training and demographics. All significant variables in bivariate analyses were further examined using stepwise logistic regression. RESULTS: Out of 424 eligible family medicine physicians, 368 physicians successfully completed the questionnaire. The response rate was 86.8%. Most participants were male (52.6%), were aged between 35 and 44 years (55.5%), were FM specialists (42.4%), graduated locally (86.2%), and had postgraduate qualifications. Eighty-two percent (82%) of participants were satisfied with their training. Having autonomy and protected time for training were associated with satisfaction with FM training. Satisfaction with family medicine as a career was correlated with physicians' satisfaction with their current job. Doctors who did not enroll in training (p < 0.001) and physicians who were older (p = 0.023) were significantly less satisfied. Stepwise multivariate regression showed that doctors who subjectively believed their training as "broad and in depth' had higher career satisfaction (p < 0.001). CONCLUSION: Overall, the satisfaction level of physicians on current family medicine training in Hong Kong was high. Having autonomy and protected time for training is associated with higher training satisfaction levels. Perceiving FM training as "broad and in-depth" is associated with higher family medicine career satisfaction.

Ductal carcinoma in-situ arising within benign phyllodes tumours.

Ductal carcinoma in situ arising within a benign phyllodes tumour is a rare neoplasm of the breast. We present a case of a 19-year-old woman who had a right breast lump for six months with the above diagnosis together with a mini-review of the literature. Ultrasound revealed a 5-cm breast lump and core biopsy revealed ductal carcinoma in situ. She underwent wide local excision of the breast lump with clear margins. Final histology confirmed ductal carcinoma in situ within a fibroepithelial lesion consistent with a benign phyllodes tumour. To our knowledge, this is the youngest case of ductal carcinoma in situ arising in a phyllodes tumour to have been reported so far.

Spinal cord stimulation for chronic non-cancer pain: a review of current evidence and practice.

Spinal cord stimulation provides analgesia through electrical stimulation of the dorsal column of the spinal cord via electrode leads placed into the epidural space. In traditional tonic stimulation, a painful sensation is replaced with paraesthesia. Spinal cord stimulation is effective in reducing neuropathic pain, enhancing function, and improving quality of life in different chronic pain conditions. Currently, there is most evidence to support its use for failed back surgery syndrome when multidisciplinary conventional management is unsuccessful. Temporary trial leads are inserted in carefully selected patients to test their responsiveness prior to permanent implantation. Newer neuromodulation modalities are now available. These include burst stimulation, high-frequency stimulation, and dorsal root ganglion stimulation. Results are encouraging to date, and they may provide superior analgesia and cover for deficiencies of traditional tonic stimulation. Although complications are not uncommon, they are rarely life threatening or permanently disabling. Nonetheless, device removal is occasionally needed.

Surveillance for malaria outbreak on malaria-eliminating islands in Tafea Province, Vanuatu after Tropical Cyclone Pam in 2015.

The risk of malaria outbreak surfaced in Vanuatu after Tropical Cyclone (TC) Pam in March 2015. In June and July 2015 we conducted malariometric surveys on the islands of Tanna, Aneityum, and Erromango in Tafea Province, where malaria elimination had been targeted, to determine if malaria incidence had increased after TC Pam. No Plasmodium infection was detected by microscopy and PCR in 3009 survey participants. Only 6·3% (190/3007) of participants had fever. Spleen rates in children aged ⩽12 years from Aneityum and Tanna were low, at 3·6% (14/387) and 5·3% (27/510), respectively. Overall bed net use was high at 72·8% (2175/2986); however, a significantly higher (P < 0·001) proportion of participants from Aneityum (85·9%, 796/927) reported net use than those from Tanna (67·1%, 751/1119) and Erromango (66·8%, 628/940). A recent decrease in malaria incidence in Tafea Province through comprehensive intervention measures had reduced the indigenous parasite reservoir and limited the latter's potential to spur an outbreak after TC Pam. The path towards malaria elimination in Tafea Province was not adversely affected by TC Pam.

Association between dietary fibre intake with cancer and all-cause mortality among 15 740 adults: the National Health and Nutrition Examination Survey III.

BACKGROUND: Few prospective studies have examined the longitudinal associations of total dietary fibre intake and water insoluble and soluble fibres with cancer and all-cause mortality. The present study aimed to examine these associations. METHODS: We studied the effects of total dietary fibre intake and water insoluble and soluble fibres on cancer and all-cause mortality, using data from 15 740 adult participants [mean (SD) age: 44.53 (19.22) years, 46.60% male] in the National Health and Nutrition Examination Survey (NHANES) III, 1988-1994, who had completed a 24-h dietary recall. Death certificate data were obtained up to 2006. Participants had been followed for 13.74 years on average. Cox regression was used to estimate the hazard ratios (HRs) of total dietary, insoluble and soluble fibres on cancer and all-cause mortality, with the first quartile as the reference group, adjusted for demographics, lifestyle and dietary factors. RESULTS: Relative to those in the first quartile of total fibre intake, only the third quartile was associated with all-cause mortality, with an adjusted HR of 0.87 [95% confidence interval (CI) = 0.79, 0.97, P = 0.021], and cancer mortality, with an adjusted HR of 0.77 (95% CI = 0.61, 0.99, P = 0.05). The third quartile of insoluble fibre intake was associated with cancer mortality, with an adjusted HR of 0.76 (95% CI = 0.60, 0.96, P = 0.023), and colorectal-anal cancer mortality (in grouped data as provided for public use), with an adjusted HR of 0.42 (95% CI = 0.19, 0.91, P = 0.03). CONCLUSIONS: Dietary fibre showed protective benefits in terms of mortality risk. Investigating the mechanisms and components of dietary fibres underlying the different protective benefits remains an important consideration for research on fibre-mortality risk.

Validation of the Eating Disorder Examination Questionnaire: an online version.

BACKGROUND: Internet-based interventions can facilitate an anonymous environment for the management of eating disorders and there is a need for online assessment tools to be readily available. The present study aimed to validate an online version of the Eating Disorder Examination Questionnaire (EDE-Q) and to compare the goodness-of-fit of five models of EDE-Q data, using a sample of university students in Hong Kong. METHODS: The EDE-Q data were collected online from 310 Hong Kong university students. Confirmatory factor analysis was used to compare the validity of the original four-factor EDE-Q with that of the three-factor, two-factor, one-factor and brief one-factor models. The superior model was further examined for scale reliability, convergent validity and construct validity using contrast-group comparisons. RESULTS: The brief one-factor model consisting of eight Weight and Shape Concern items was the only model to provide an acceptable fit to the data. Estimations of internal consistency and scale validity were conducted using contrast-group comparisons and convergent validity, with satisfactory results. CONCLUSIONS: The brief one-factor model was the only one among the alternate models that provided good fit to the data. The brief model is promising for use in research and has good practical application because the model was satisfactorily tested in terms of internal consistency, ability to discriminate between genders, and good association with other measures of similar constructs. By validating an online version of the EDE-Q using a university sample with a cultural background different from Western culture, the present study complements findings from previous research on the EDE-Q.

Uptake of breast screening and associated factors among Hong Kong women aged ≥50 years: a population-based survey.

OBJECTIVE: To examine the uptake of breast screening and its associated factors among Hong Kong Chinese women aged ≥50 years. STUDY DESIGN: Cross-sectional population-based survey. METHODS: A sample of Hong Kong Chinese women was recruited through telephone random-digit dialling. The survey consisted of six sections: perceived health status, use of complementary medicine, uptake of breast screening, perceived susceptibility to cancer, family history of cancer and demographic data. The factors associated with uptake of breast screening were analysed using logistic regression analysis. RESULTS: In total, 1002 women completed the (anonymous) telephone survey. The mean age was 63.5 (standard deviation 10.6) years. The uptake rate of breast screening among Hong Kong Chinese women aged ≥50 years was 34%. The primary reasons for undertaking breast screening were as part of a regular medical check-up (74%), prompted by local signs and symptoms (11%) and a physician's recommendation (7%). Higher educational level, married or cohabiting, family history of cancer, frequent use of complementary therapies, regular visits to a doctor or Chinese herbalist, and the recommendation of a health professional were all independently and significantly associated with increased odds of having had a mammogram. CONCLUSIONS: This study provides community-based evidence of the need for public health policy to promote broader use of mammography services among this target population, with emphasis on the active involvement of health care professionals, through the development and implementation of appropriate evidence-based and resource-sensitive strategies.

Effect of laser treatment on the attachment and viability of mesenchymal stem cell responses on shape memory NiTi alloy.

The objectives of this study were to investigate the effect of laser-induced surface features on the morphology, attachment and viability of mesenchymal stem cells (MSCs) at different periods of time, and to evaluate the biocompatibility of different zones: laser-melted zone (MZ), heat-affected zone (HAZ) and base metal (BM) in laser-treated NiTi alloy. The surface morphology and composition were studied by scanning electron microscope (SEM) and X-ray photoemission spectroscopy (XPS), respectively. The cell morphology was examined by SEM while the cell counting and viability measurements were done by hemocytometer and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) colorimetric assay. The results indicated that the laser-induced surface features, such as surface roughening, presence of anisotropic dendritic pattern and complete surface Ni oxidation were beneficial to improve the biocompatibility of NiTi as evidenced by the highest cell attachment (4 days of culture) and viability (7 days of culture) found in the MZ. The biocompatibility of the MZ was the best, followed by the BM with the HAZ being the worst. The defective and porous oxide layer as well as the coarse grained structure might attribute to the inferior cell attachment (4 days of culture) and viability (7 days of culture) on the HAZ compared with the BM which has similar surface morphology.

Perceptions of coronary heart disease: the development and psychometric testing of a measurement scale.

Individuals' perceptions of coronary heart disease (CHD) have implications for the ways in which they respond to the disease, process risks, make decisions, and take action to reduce CHD risks. This study aimed to develop and evaluate the psychometric properties of the perceptions of coronary heart disease scale (PCS) among a Hong Kong Chinese population. A cross-sectional study was conducted using a convenient sample (n = 232) of participants recruited from a variety of catchments including public domains, a cardiac unit, and a cardiac rehabilitation and prevention center. Exploratory factor analysis identified a nine-item, two-factor model that accounted for 52.5% of the total explained variance. The two factors were the perceived risk (five items) and perceived seriousness (four items) of CHD. The PCS demonstrated good content validity; acceptable total, and subscale internal consistency (.73, .61 - .81); and significant contrast-group differences with higher levels of CHD perceptions among males (p = .002), younger participants (p < .001), and those with higher educational levels (p < .001), suggesting excellent construct validity. The newly developed PCS demonstrates acceptable psychometric properties as a short measurement scale, which supports its use in future research. Future validation of this scale is warranted.

Psychometric properties of the Chinese version of Sexual Function After Gynecologic Illness Scale (SFAGIS).

PURPOSE: This study aims to develop the Chinese version of the Sexual Function after Gynecologic Illness Scale (SFAGIS) and to establish its psychometric properties in Hong Kong Chinese patients with gynecological cancer. METHODS: A Chinese version of SFAGIS was developed using the Brislin model of translation and guidelines for cross-cultural adaptation of scales. The content validity and semantic equivalence were assessed by an expert panel. The translated version of SFAGIS was administered to 150 Hong Kong Chinese women with gynecological cancer to test the scale's psychometric properties and to assess its feasibility. The convergent validity of the Chinese scale was tested by correlating it with the Chinese version of the sex relations subscale of the Psychosocial Adjustment to Illness Scale Self-Report (PAIS-SR). RESULTS: The average completion time for the Chinese SFAGIS was 16.2 ± 6.6 min. The internal consistency of the Chinese SFAGIS was 0.93. Test-retest reliability was also high with an interclass correlation coefficient 0.76. A Pearson product-moment correlation found strong correlations among the Chinese SFAGIS and the Chinese version of the sex relations subscale of the PAIS-SR, indicating that both scales measure the same as or has a similar construct. CONCLUSIONS: The Chinese version of SFAGIS is a reliable and valid instrument which can be used in clinical practice and research for assessing sexual function problems in Chinese patients with gynecological cancer and to identify those in need of attention.

In vitro mesenchymal stem cell responses on laser-welded NiTi alloy.

The biocompatibility of NiTi after laser welding was studied by examining the in vitro (mesenchymal stem cell) MSC responses at different sets of time varying from early (4 to 12h) to intermediate phases (1 and 4 days) of cell culture. The effects of physical (surface roughness and topography) and chemical (surface Ti/Ni ratio) changes as a consequence of laser welding in different regions (WZ, HAZ, and BM) on the cell morphology and cell coverage were studied. The results in this research indicated that the morphology of MSCs was affected primarily by the topographical factors in the WZ: the well-defined and directional dendritic pattern and the presence of deeper grooves. The morphology of MSCs was not significantly modulated by surface roughness. Despite the possible initial Ni release in the medium during the cell culture, no toxic effect seemed to cause to MSCs as evidenced by the success of adhesion and spreading of the cells onto different regions in the laser weldment. The good biocompatibility of the NiTi laser weldment has been firstly reported in this study.

The immediate effect of a novel audio-visual cueing strategy (simulated traffic lights) on dual-task walking in people with Parkinson's disease.

BACKGROUND: Gait deficits are exacerbated during the addition of a concurrent cognitive task in individuals with Parkinson's disease (PD). The provision of auditory and/or visual cues has been reported to facilitate gait performance in these patients. AIM: To investigate whether individuals with PD could use traffic lights as an audio-visual cueing strategy to enhance dual-task walking performance. DESIGN: Cross-sectional comparative study. SETTING: The Hong Kong Polytechnic University. POPULATION: Fifteen PD and 13 healthy individuals. METHODS: All participants were instructed to walk at their natural pace, followed by 2 randomized conditions: 1) walking while doing serial subtractions of three, starting from a random number between 60 to 100; 2) doing the same tasks with the addition of traffic lights signals as audio-visual cues. Primary outcomes included stride length, cadence and gait velocity. RESULTS: Individuals with PD had more deterioration in all gait parameters than healthy controls for both single- and dual-task walking. With the use of traffic lights, individuals with PD showed significant increases in stride length (by 8.8%), cadence (by 9.6%), and gait velocity (by 21.0%, P=0.000). CONCLUSION: Traffic lights could be used as combined preparatory and ongoing audio-visual cues to enhance dual-task walking performance in people with PD. CLINICAL REHABILITATION IMPACT: Positive findings from the present study suggest a promising treatment intervention to benefit people with PD, who often have to conduct concurrent cognitive task during walking in their daily activities.

Associations of uric acid and gamma-glutamyltransferase (GGT) with obesity and components of metabolic syndrome in children and adolescents.

BACKGROUND: The combined effect of uric acid, gamma-glutamyltransferase (GGT) and cardiovascular risk factors clustering in the youth remains under-explored. OBJECTIVE: The objective of this study was to examine the association between uric acid, GGT, obesity and the individual components of metabolic syndrome in children and adolescents. METHODS: We performed a cross-sectional observational study of 2067 children and adolescents (875 boys and 1192 girls) aged 6-20 years who were healthy volunteers and were recruited from primary and secondary schools in Hong Kong between 2007 and 2008. Subjects were divided into two strata (75th percentile as cut-off) for comparison between odds of cardiovascular risk factors. RESULTS: After adjustment by multivariable logistic regression, subjects in upper stratum, i.e., >75th percentile, of either serum uric acid or GGT levels were associated with obesity, low high-density lipoprotein cholesterol (HDL-C) level and high blood pressure (adjusted odds ratios [AOR] ranged from 1.63 to 5.82, all P < 0.005) compared with those in the lower stratum. There were combined effect for upper stratum of both uric acid and GGT in the association with obesity, low HDL-C and high blood pressure (AOR ranged from 2.60 to 10.69, all P < 0.05) after adjustment for age, sex and body mass index z-score (except for obesity status) as well as body height (for high blood pressure). CONCLUSION: Uric acid and GGT have combined effect in association with obesity and other cardiovascular risk factors in children and adolescents.

Quality-of-life among head and neck cancer survivors at one year after treatment--a systematic review.

BACKGROUND: The importance of quality-of-life (QoL) research has been recognised over the past two decades in patients with head and neck (H&N) cancer. The aims of this systematic review are to evaluate the QoL status of H&N cancer survivors one year after treatment and to identify the determinants affecting their QoL. METHODS: Pubmed, Medline, Scopus, Sciencedirect and CINAHL (2000-2011) were searched for relevant studies, and two of the present authors assessed their methodological quality. The characteristics and main findings of the studies were extracted and reported. RESULTS: Thirty-seven studies met the inclusion criteria, and the methodological quality of the majority was moderate to high. While patients of the group in question recover their global QoL by 12 months after treatment, a number of outstanding issues persist - deterioration in physical functioning, fatigue, xerostomia and sticky saliva. Age, cancer site, stage of disease, social support, smoking, feeding tube placement and alcohol consumption are the significant determinants of QoL at 12 months, while gender has little or no influence. CONCLUSIONS: Regular assessments should be carried out to monitor physical functioning, degree of fatigue, xerostomia and sticky saliva. Further research is required to develop appropriate and effective interventions to deal with these issues, and thus to promote the patients' QoL.