Application of Hydrogel in Reconstruction Surgery: Hydrogel/Fat Graft Complex Filler for Volume Reconstruction in Critical Sized Muscle Defects.

Autogenic fat graft usually suffers from degeneration and volume shrinkage in volume reconstruction applications. How to maintain graft viability and graft volume is an essential consideration in reconstruction therapies. In this presented investigation, a new fat graft transplantation method was developed aiming to improve long term graft viability and volume reconstruction effect by incorporation of hydrogel. The harvested fat graft is dissociated into small fragments and incorporated into a collagen based hydrogel to form a hydrogel/fat graft complex for volume reconstruction purpose. In vitro results indicate that the collagen based hydrogel can significantly improve the survivability of cells inside isolated graft. In a 6-month investigation on artificial created defect model, this hydrogel/fat graft complex filler has demonstrated the ability of promoting fat pad formation inside the targeted defect area. The newly generated fat pad can cover the whole defect and restore its original dimension in 6-month time point. Compared to simple fat transplantation, this hydrogel/fat graft complex system provides much improvement on long term volume restoration effect against degeneration and volume shrinkage. One notable effect is that there is continuous proliferation of adipose tissue throughout the 6-month period. In summary, the hydrogel/fat graft system presented in this investigation demonstrated a better and more significant effect on volume reconstruction in large sized volume defect than simple fat transplantation.

A longitudinal examination of the association between nurse staffing levels, the practice environment and nurse-sensitive patient outcomes in hospitals.

BACKGROUND: The level of patient safety and outcomes accomplished depends on the quality of care provided. Previous studies found that nurse-to-patient ratio, practice environment, and nursing education were significant predictors of patient outcomes. However, the outcomes measured in previous studies were mainly inpatient mortality and failure-to-rescue rates. Few nurse-sensitive patient outcomes have been measured that quantify nurses' contribution to patient care. Selecting appropriate outcomes that reflect the clinically relevant effect of nursing care is important. Moreover previous studies were largely cross-sectional and retrospective. These research designs are limited in their ability to explain the casual links between the variables examined. This study is aimed at determining the associations among staffing levels, skill mix of baccalaureate-prepared registered nurses, and practice environment on nurse-sensitive outcomes for medical and surgical patients in public hospitals in Hong Kong. METHOD/DESIGNS: A multi-method research design will be adopted. The sample includes all medical and surgical wards of four major public hospitals that offer 24-h accident and emergency services. Multiple responses from registered nurses who work in the study wards will be collected over 12 months to examine their individual characteristics and perceptions of the practice environment. A 12-month prospective observational study will be performed to determine the association between nurse staffing levels, the practice environment, and nurse-sensitive patient outcomes including pressure ulcers, falls and restraint prevalence, urinary catheter-associated urinary tract infections, and central line catheter-associated bloodstream infections. Multilevel Cox proportional hazards models will be employed to examine the association between these patient outcomes and the explanatory nursing factors of primary interest (nurse staffing levels, education composition, and practice environment), with adjustment for all patient-, ward- and hospital-level potential confounders (age, sex, diagnosis, comorbidities, level of surgical invasiveness, mortality, length of stay, and type of admission). DISCUSSION: It is anticipated that knowledge of the association between nurse staffing levels, the practice environment, and nurse-sensitive outcomes will inform the provision of quality and timely patient care. This study will provide a landmark report that is of relevance and importance to patients and to hospital stakeholders and managers, health policy makers, nurses, and educators who advocate patient benefits. TRIAL REGISTRATION: Clinical Trials Registry CCTCTR CUHK_CCT00460 . Date of trial registration: 02 July 2015.

Is locking plate fixation a better option than casting for distal radius fracture in elderly people?

OBJECTIVES: To compare the outcomes of locking plate fixation versus casting for displaced distal radius fracture with unstable fracture pattern in active Chinese elderly people. DESIGN: Historical cohort study. SETTING: Orthopaedic ward and clinic at Tseung Kwan O Hospital, Hong Kong. PATIENTS: Between 1 May 2010 and 31 October 2013, 57 Chinese elderly people aged 61 to 80 years were treated either operatively with locking plate fixation (n=26) or conservatively with cast immobilisation (n=31) for unstable displaced distal radius fracture. MAIN OUTCOME MEASURES: Clinical, radiological, and functional outcomes were assessed at 9 to 12 months after treatment. RESULTS: The functional outcome (based on the quick Disabilities of the Arm, Shoulder and Hand score) was significantly better in the locking plate fixation group than in the cast immobilisation group, while clinical and radiological outcomes were comparable with those in other similar studies. CONCLUSIONS: Locking plate fixation resulted in better functional outcome for displaced distal radius fracture with unstable fracture pattern in active Chinese elderly people aged 61 to 80 years. Further prospective study with long-term follow-up is recommended.

Voxel-based approach to generate entire human metacarpal bone with microscopic architecture for finite element analysis.

With the development of micro-computed tomography (micro-CT) technology, it is possible to construct three-dimensional (3D) models of human bone without destruction of samples and predict mechanical behavior of bone using finite element analysis (FEA). However, due to large number of elements required for constructing the FE models of entire bone, this demands a substantial computational effort and the analysis usually needs a high level of computer. In this article, a voxel-based approach for generation of FE models of entire bone with microscopic architecture from micro-CT image data is proposed. To enable the FE analyses of entire bone to be run even on a general personal computer, grayscale intensity thresholds were adopted to reduce the amount of elements. Human metacarpal bone (MCP) bone was used as an example for demonstrating the applicability of the proposed method. The micro-CT images of the MCP bone were combined and converted into 3D array of pixels. Dual grayscale intensity threshold parameters were used to distinguish the pixels of bone tissues from those of surrounding soft tissues and improve predictive accuracy for the FE analyses with different sizes of elements. The method of selecting an appropriate value of the second grayscale intensity threshold was also suggested to minimize the area error for the reconstructed cross-sections of a FE structure. Experimental results showed that the entire FE MCP bone with microscopic architecture could be modeled and analyzed on a personal computer with reasonable accuracy.

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.

Translation and validation of the Chinese-Cantonese version of the Exercise of Self-Care Agency Scale.

BACKGROUND: Effective self-care is important in the management of dysmenorrhea. Yet measures of adolescents' capabilities or self-care agency to exercise self-care to cope with dysmenorrhea are limited in the Chinese population. OBJECTIVES: The aims of this study were to translate the Exercise of Self-Care Agency Scale (ESCAS) from English into Chinese-Cantonese, and to evaluate its reliability and validity in the Chinese adolescent girls with dysmenorrhea. METHODS: This study consisted of three phases. In phase 1, the ESCAS was translated into Chinese-Cantonese using Brislin's (1986) translation and back-translation method, the semantic equivalence and content validity were assessed. In phase 2, a cross-over design was used to assess the translation adequacy of the Chinese-Cantonese version. In phase 3, the psychometric properties of the Chinese-Cantonese version were tested with a convenience sample of 477 adolescent girls recruited from three secondary schools. The reliability was assessed by internal consistency and test-retest reliability. The construct validity was tested using exploratory factor analysis. RESULTS: The semantic equivalence and content validity index of the Chinese-Cantonese version of ESCAS was satisfactory. Results also indicated that the Chinese-Cantonese version had a high level of equivalence with the original English version and demonstrated a high internal consistency and test-retest reliability. Exploratory factor analysis revealed the presence of four factors supporting the conceptual dimension of the original instrument. CONCLUSION: The current study provides initial psychometric properties of the Chinese-Cantonese version of the ESCAS and supports it as a reliable and valid instrument to measure self-care agency in adolescent girls with dysmenorrhea. It provides health care professionals with a useful tool to assess the extent to which adolescent girls take action towards their problem of dysmenorrhea.

Epidemiology of occupational hand injury in Hong Kong.

OBJECTIVES: To study the epidemiology of occupational hand injuries and associated social and industrial factors. DESIGN. For this retrospective case series of patients with occupational hand injuries, case records were retrieved to gather data. In addition, all the subjects were interviewed by a single interviewer using a predesigned questionnaire. SETTING: Division of Hand Surgery, Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong. PATIENTS: A total of 250 patients with occupational hand injuries were treated during the period from 1999 to 2001. This period was chosen to obtain 10 years of follow-up data to assess return to work and any secondary injuries. MAIN OUTCOME MEASURES: Personal particulars (gender, age, marital status, education level, length of stay in Hong Kong, type of employment, wage system, personal habits, family size, number of breadwinners, income), type of industry and mode of injury, causes of injury according to the worker, work conditions, type of injury, and treatment given. RESULTS: Two groups of workers in our study had more occupational hand injuries, namely those with less than 1 year of experience on a new job and immigrants from China. Factors associated with a large proportion of occupational hand injuries were male gender with personal risk factors (smoking and regular consumption of alcohol, long working hours), and in the case of machine operators, inadequate training and use of safety devices. CONCLUSION: Occupational hand injuries lead to loss of working hours and compensation. For prevention, the workplace should be made into a safer and work-friendly environment. Workers should also have sufficient training.

Validation study of the Chinese Identification Pain Questionnaire for neuropathic pain.

OBJECTIVES: For diagnosing neuropathic pain, a simple 6-item patient-completed identification pain questionnaire has been validated among Caucasians. We aimed to study the validity and reliability of this questionnaire among Hong Kong Chinese patients. DESIGN: Questionnaire survey. SETTING: Two pain clinics and two neurology clinics in Hong Kong. PATIENTS: Patients with either neuropathic pain or nociceptive pain were recruited randomly from the four clinics. The patients completed the questionnaire themselves and the diagnosis of neuropathic pain and nociceptive pain was made by the pain specialists. We determined the optimal cutoff, positive and negative predictive values, sensitivity, specificity, the area under the receiver operating characteristic curve, and test-retest reliability of the translated version. RESULTS: Among the 92 participants, 60 (65%) had neuropathic pain and 32 (35%) had nociceptive pain. At an optimal cutoff score of 3 or higher, the positive predictive value was 87% while the negative predictive value was 55%, and it correctly classified 71% of cases. The specificity and sensitivity were 81% and 65%, respectively. The area under the curve was 0.78 (P<0.001). Test-retest reliability in the 10 randomly selected patients showed a good intraclass correlation of 0.72. CONCLUSION: The Chinese Identification Pain Questionnaire is a valid and reliable scale that may be used as an initial diagnostic tool for neuropathic pain among Hong Kong Chinese patients.

The development of a strength-focused mutual support group for caretakers of children with cerebral palsy.

OBJECTIVE: To examine the efficacy of a strength-focused mutual support group for reducing stress and enhancing psychological well-being of the caretakers of children with cerebral palsy. METHODS: This pre- and post-intervention outcome study, conducted by Department of Orthopaedics and Traumatology, Duchess of Kent Children's Hospital, recruited 12 primary caretakers of children with cerebral palsy in Hong Kong. A strength-focused support group manual was developed to help such caretakers to identify and cultivate the character strengths of their children and enhance their own positive emotions. Participants were asked to complete a full set of questionnaires at 3 time-points: before and immediately after the intervention (consisting of 4 weekly sessions), and after the 1-month follow-up booster session. Two additional questionnaires were administered before each session to check mood. Parenting stress, anxiety, depression, social support, hope, and other psychological well-being measures were also assessed. RESULTS: Half of the caretakers (n = 6) who had attended the full intervention programme were included in the data analysis. Participants exhibited a significantly lower level of parental stress and higher hope level both after the 4 intervention sessions and at the booster session. Their perceived social support was significantly increased when the group was ongoing but not after it ended. CONCLUSION: This group intervention programme could effectively help caretakers reduce their parenting stress and enhance their hopefulness. Launching a similar programme with more sessions and regular follow-up sessions might help maintain positive effects and establish a social support network.

Theoretical risk assessment of magnesium alloys as degradable biomedical implants.

The theoretical tolerable implant masses for ten magnesium alloys as degradable biomedical implant materials are evaluated in this study. Dose-response assessment is conducted using toxicological data from authoritative public health agencies such as the US Agency for Toxic Substances and Disease Registry and the USEPA Integrated Risk Information System, and assuming 1 year of even corrosion. Uncertainty factors adopted by the agencies are used. The tolerable limits corresponding to various component elements in an alloy are considered separately, and the lowest tolerable limit is selected as the tolerable limit of the alloy. The results show that aluminum is usually the component element with the lowest tolerance, and the tolerable mass for Al-containing magnesium alloys fall to around or below 1g per person per year, while the limit for other magnesium alloys can well exceed 10 g. Deficits in the toxicological data of some component elements are noted. This study illustrates that toxicological calculations should be taken into consideration when developing novel degradable metallic implants.

A review of necrotising fasciitis in the extremities.

OBJECTIVE: To review currently available evidence on the epidemiology and methods of management for necrotising fasciitis, with particular reference to Hong Kong. DATA SOURCES AND STUDY SELECTION: Medline, PubMed, and Cochrane Library searches of local and internationally published English language journals, from 1990 to July 2008 using the terms 'necrotising fasciitis', 'Hong Kong', 'diagnosis', 'epidemiology', 'vibrio', 'streptococci', 'clostridia', and 'management'. DATA EXTRACTION: All articles involving necrotising fasciitis in Hong Kong were included in the review. DATA SYNTHESIS: The incidence of necrotising fasciitis in Hong Kong and around the world has been increasing. This rapidly progressive infection is a major cause of concern, due to its high morbidity and mortality. Up to 93% of affected patients at our hospital were admitted to the Intensive Care Unit and many still died from septic complications, such as pneumonia and multi-organ failure. Radical debridements in the form of amputations and disarticulations were considered vital in 46% of the patients. Early recognition and treatment remain the most important factors influencing survival. Yet, early diagnosis of the condition is difficult due to its similarities with many other soft tissue disorders such as cellulitis. Repeated surgical debridement or incisional drainage continues to be essential for the survival of sufferers from necrotising fasciitis. Many authorities have reported that carrying out the first fasciotomy and radical debridement within 24 hours of symptom onset was associated with significantly improved survival, which also emphasises the importance of early diagnosis. CONCLUSION: Clinicians must adopt a high index of suspicion for necrotising fasciitis. Empirical antibiotics must be started early and repeated physical examinations should be performed, while maintaining a low threshold for tissue biopsy and surgery. The timing of the first fasciotomy and radical debridement within a window of 24 hours from symptom onset is associated with significantly improved survival.

Overprotection and the psychological states of cerebral palsy patients and their caretakers in Hong Kong: a preliminary report.

OBJECTIVE: To examine the relation between perceived overprotection and the psychological states of cerebral palsy patients and their primary caretakers in Hong Kong. DESIGN: Cross-sectional survey, in which data of 14 pairs of cerebral palsy patients and their caretakers were analysed. SETTING: Duchess of Kent Children's Hospital, Hong Kong. PARTICIPANTS: Cerebral palsy patients and their primary caretakers in Hong Kong. MAIN OUTCOME MEASURES: Perceived overprotection and psychological states. RESULTS: Nearly two thirds of the 14 patients (mean age of 15 years) and 86% of the 14 primary caretakers (mean age of 47 years) perceived various levels of overprotection. For both patients and caretakers, perceived overprotection was positively associated with anxiety and unhappiness. The patients' and caretakers' psychological states and perception of overprotection were not related to the actual motor ability of the patients. Perceived overprotection of the patients was not related to that of the caretakers. CONCLUSION: Caretakers should be mindful that a well-meaning move may have undesirable consequences. More support and child-rearing education should be considered for caretakers.

Occupational repetitive strain injuries in Hong Kong.

OBJECTIVE: To review currently available evidence on the epidemiology and management of occupational repetitive strain injuries with particular reference to Hong Kong. DATA SOURCES AND STUDY SELECTION: Medline, PubMed and Cochrane Library searches of local and internationally published English journals from 1990 to 2007 regarding repetitive strain injuries. DATA EXTRACTION: All articles involving occupational repetitive strain injuries in Hong Kong were included in this review. DATA SYNTHESIS: There were 16 articles contributing data on the impact of repetitive strain injuries both in Hong Kong and around the world. There were seven articles dealing with the problem of computer station set-ups and methods for improving the workstation environments. CONCLUSION: Currently there were significant data on the impact of repetitive strain injuries in Hong Kong. The data took the form of compensation claims, days away from work, and cost of medical consultations. Other articles described proper workplace adjustments to help prevent repetitive strain injuries. However, there were no figures in the current literature showing the impact of these adjustments in reducing the incidence of repetitive strain injuries. More research could help to delineate the relationship between different types of interventions and occupational repetitive strain injuries.

Accessory radial collateral vascular bone graft for the management of nonunion of humeral shaft fracture after intramedullary nailing.

SUMMARY: An easy pedicle vascular bone graft technique for the management of nonunion of humeral shaft fracture is described. The distal and lateral part of the humerus, including the lateral epicondyle, is transferred to the nonunion site of the humerus. This vascular bone graft is based on the accessory radial collateral artery. It promotes healing of the nonunion.

Trans-triquetral dorsal perilunate fracture dislocation.

A rare case of trans-triquetral dorsal perilunate dislocation is described. It differs from the Mayfield and Johnson theory of progressive perilunar instability in greater arc injuries which states that the injury passes from the radial to the ulnar carpal bones and soft tissues in stages. This injury supports the concept of a reverse greater arc injury from ulnar to radial being possible with the radial carpal bones being spared in some cases.

Dynamic treatment for proximal phalangeal fracture of the hand.

PURPOSE: To assess a protected mobilisation programme (dynamic treatment) for proximal phalangeal fracture of the hand, irrespective of the geometry. METHODS: Clinical and radiological results of 32 consecutive patients with proximal phalangeal fracture of the hand treated from January 2001 to February 2007 were evaluated. Our supervised rehabilitation programme was strictly followed to gain full range of movement of the proximal interphalangeal joint and to prevent the development of an extension lag contracture. Patients were followed up for a mean period of 15 (range, 13-16) months. Results were evaluated using the Belsky classification. RESULTS: The results were excellent in 72% of the patients, good in 22%, and poor in 6%. Some patients defaulted follow-up, which made long-term assessment difficult. The poor results may have been related to patient non-compliance or default from rehabilitation. Many good results upgraded to excellent following further rehabilitation. CONCLUSION: Skeletal stability, not rigidity, is necessary for functional movements of the hand. Proximal phalangeal fractures can be effectively treated by closed methods, using the stabilising effect of soft tissues (zancolli complex-metacarpophalangeal retention apparatus) and external devices (metacarpophalangeal block splint), thus enabling bone healing and movement recovery at the same time.