Risk assessment for epithelial ovarian cancer: proposing a new approach to a deadly problem.

Presently the majority of women diagnosed with epithelial ovarian cancer (EOC) have advanced stage disease (III-IV) with a poor 5-year survival rate (12-30 %). This significantly contrasts when early stage disease is detected, which has a 5-year survival rate approximating 90 %. Therefore, detection of early stage disease is critical to making an impact on outcome. By using genetic algorithms, modifications of transvaginal ultrasonography and use of novel biomarkers, we propose a risk assessment profile to identify at-risk women and enable ovarian cancer screening to become a reality. Such a novel algorithm starts by applying classic genetic pedigree assessment and uses a panel of multiple biomarkers that identify both phenotypic and genotypic expression of high-risk markers followed with conventional ultrasound and advanced ultrasound techniques such as microvascular contrast-enhancement as a secondary test. We presently employ a multidisciplinary program incorporating genetics, molecular biology, tumor immunology, gynecologic oncology and diagnostic imaging to identify asymptomatic high risk women.

Effects of age, education and gender in the Consortium to Establish a Registry for the Alzheimer's Disease (CERAD)-Neuropsychological Assessment Battery for Cantonese-speaking Chinese elders.

BACKGROUND: The Consortium to Establish a Registry for Alzheimer's Disease Neuropsychological Assessment Battery (CERAD-NAB) offers information on the clinical diagnosis of Alzheimer's disease (AD) and gives a profile of cognitive functioning. This study explores the effects of age, education and gender on participants' performance on eight subtests in the Chinese-Cantonese version of the CERAD-NAB. METHODS: The original English version of the CERAD-NAB was translated and content-validated into a Chinese-Cantonese version to suit the Hong Kong Chinese population. The battery was administered to 187 healthy volunteers aged 60 to 94 years. Participants were excluded if they had neurological, medical or psychiatric disorders (including dementia). Stepwise multiple linear regression analyses were performed to assess the relative contribution of the demographic variables to the scores on each subtest. RESULTS: The Cantonese version of CERAD-NAB was shown to have good content validity and excellent inter-rater reliability. Stepwise multiple regression analyses revealed that performances on seven and four out of eight subtests in the CERAD-NAB were significantly influenced by education level and age, respectively. Age and education had significant effects on participants' performance on many tests. Gender also showed a significant effect on one subtest. CONCLUSIONS: The preliminary data will serve as an initial phase for clinical interpretation of the CERAD-NAB for Cantonese-speaking Chinese elders.

Effect of high-fat enteral nutrition on hepatocyte injury in response to hemorrhagic shock in the rat.

BACKGROUND: High-fat enteral nutrition reduces the inflammatory response following hemorrhagic shock in the rat. AIMS: We hypothesized that this intervention might also ameliorate the remote organ injury to the liver associated with this model. METHODS: Male Sprague-Dawley rats were either starved or fed low-fat or high-fat isocaloric isonitrogenous feed prior to nonlethal hemorrhagic shock induced by a 40% reduction in the blood volume. Animals were sacrificed at 90 minutes or 24 hours after injury. Liver cell damage was assessed by histology and long polymerase chain reaction (PCR) to detect mitochondrial DNA damage. Stress protein expression was measured by Western blot and mRNA expression by real-time PCR and immunohistochemistry. RESULTS: Animals fed a low-fat diet had the same severity of liver injury as starved animals and increased expression of stress proteins. Animals fed a high-fat diet had minimal liver injury, no evidence of mitochondrial DNA damage, and significantly lower expression of stress proteins. This effect is associated with preservation of hepatocellular morphology, attenuation of mitochondrial DNA damage, and a reduced stress protein response to injury. CONCLUSIONS: High-fat enteral nutrition protects the liver from the remote effects of hemorrhagic shock, but the mechanism of this effect is not yet known.

The use of Disabilities of the Arm, Shoulder, and Hand Questionnaire in rehabilitation after acute traumatic hand injuries.

This longitudinal observational prospective study evaluates the use of a self-reported measure Disabilities of the Arm, Shoulder, and Hand (DASH) in assessing traumatic hand injury patients. A total of 146 subjects were invited to fill out a validated questionnaire (DASH) during their first consultation and at discharge from therapy. The findings revealed a significant improvement in DASH scores upon discharge from therapy. The use of Quick DASH, an 11-question shortened version of the full 30-question DASH, also generated similar results with the psychometric properties maintained. Despite the low correlation between DASH and the therapists' measures of recovery of power grip, the results of this study confirmed the effectiveness of using the DASH in assessing traumatic hand injury patients. Clinical implications suggest that the DASH can be used to assess the improvement in the functional status of traumatic hand injury subjects, as well as to enhance therapists' understanding of the subjects' perspective regarding their disability, and to assist in effective treatment planning. Further study on the application of the Quick DASH in larger population, and its association with functional status is suggested.

Grip strength and physical demand of previous occupation in a well-functioning cohort of Chinese older adults.

The grip strength of 214 independently ambulatory Chinese older adults (M age = 75.1 +/- 7.0 yr.) was measured, and preliminary mean values presented. Their previous occupations were recorded, and the physical demands of those occupations in terms of oxygen consumption and work done were classified. Grip strength generally decreased across age groups. The physical demand of individuals' previous occupations had significant associations with grip strength, for example, participants who previously worked as construction site workers had a greater grip strength than those who worked previously as office workers.

Evidence-based practice in splinting the injured hand.

Evidence-based medicine has been practised in the early 1990s in the Western countries and its model has aroused interests in the Asian countries including Hong Kong in the late 1990s. The need for evidence-based practice was called upon by Sackett and his colleagues 14-16 mainly because of the exponential growth of new evidence of treatment effectiveness. There is a great demand for clinicians to search for the best evidence and to incorporate into the daily practice so as to ensure the best quality and standard of treatment. This paper is to review the development and process of evidence-based practice in the area of hand splinting for our local clinicians. Some major problems were identified in the delivery of clinical evidence-based practice, and suggestions have been made to overcome these problems with a view in supporting its model in the local clinical field.

Splinting programmes for tendon injuries.

It is beyond doubt that splinting programmes have often been an integral and important part of the rehabilitation process in tendon injuries. Over the past three decades, hand splints for tendon injuries of various designs and different mobilisation programmes have been developed in the hope of pursuing better clinical and functional outcome for patients. In this paper, the development of different splinting programmes in flexor and extensor tendon injuries and the current practice in some acute hospitals in Hong Kong were discussed.