High Estimated 24-Hour Urinary Sodium Excretion Is Related to Symptomatic Knee Osteoarthritis: A Nationwide Cross-Sectional Population-Based Study.

OBJECTIVES: High salt intake results in various harmful effects on human health including hypertension, cardiovascular disease, and reduced bone density. Despite this, there are very few studies in the literature that have investigated the association between sodium intake and osteoarthritis (OA). Therefore, we aimed to explore these associations in a Korean population. METHODS: This study used cross-sectional data from adult subjects aged 50-75 years from two consecutive periods of the Korean National Health and Nutrition Examination Survey V-VII (2010-2011 and 2014-2016). The estimated 24-hour urinary sodium excretion (24HUNa) was used as a surrogate marker of salt intake. In the 2010-2011 dataset, knee OA (KOA) was defined as the presence of the radiographic features of OA and knee pain. The association between KOA and salt intake was analysed using univariable and multivariable logistic regression methods. For the sensitivity analysis, the same procedures were conducted on subjects with self-reported OA (SR-OA) with knee pain in the 2010-2011 dataset and any site SR-OA in the 2014-2016 dataset. RESULTS: Subjects with KOA had significantly lower energy intake, but higher 24HUNa than those without KOA. The restricted cubic spline plots demonstrated a J-shaped distribution between 24HUNa and prevalent KOA. When 24HUNa was stratified into five groups (<2, 2-3, 3-4, 4-5 and ≥5 g/day), subjects with high sodium intake (≥5 g/day) had a higher risk of KOA (odds ratio [OR] = 1.64, 95% confidence interval [CI] 1.03-2.62) compared to the reference group (3-4 g/day) after adjusting for covariates. The sensitivity analysis based on SR-OA with knee pain showed that high sodium intake was also significantly associated with increased prevalence of OA (OR = 1.84, 95% CI 1.10-3.10) compared with the reference group. Regarding SR-OA at any site in the 2014-2016 dataset, estimated 24HUNa showed a significantly positive association with the presence of SR-OA after adjusting for potential confounders. CONCLUSIONS: This nationwide Korean representative study showed a significant association between symptomatic KOA and high sodium intake (≥5 g/day). Avoidance of a diet high in salt might be beneficial as a non-pharmacologic therapy for OA.

A systemic lupus erythematosus patient with thunderclap headache: reversible cerebral vasoconstriction syndrome.

Headaches are common in patients with systemic lupus erythematosus (SLE). It is important to identify the exact cause of headaches in SLE to avoid unnecessary steroid or immunosuppressive therapy like in neuropsychiatric SLE. A 35-year-old woman with SLE suddenly developed severe headache. Magnetic resonance angiography showed multifocal segmental narrowing of cerebral arteries, suggestive of central nervous system vasculitis. However, lack of abnormal enhancement in vessel wall imaging indicated reversible cerebral vasoconstriction syndrome (RCVS) rather than central nervous system vasculitis. The patient was treated with oral nimodipine and she recovered over a period of two months. Following magnetic resonance angiography on day 90 was normal. Herein we report a case of reversible cerebral vasoconstriction syndrome in an SLE patient with literature review.

Dietary exposure to non-dioxin-like PCBs of the Hong Kong adult population from a total diet study.

Dietary exposure of Hong Kong adults to the sum of the six indicator PCBs (Σ6 PCBs; PCB 28, 52, 101, 138, 153, and 180) was estimated in this study using the Total Diet Study (TDS) approach. Seventy one commonly-consumed food items of animal origin were sampled in four seasons and prepared as consumed in 2010-2011. The results showed that the main dietary source of Σ6 PCBs to the adult population was 'fish, seafood and their products' which accounted for 84.3% of the total exposure. About 50% of the total exposure was contributed by four fish species: salmon (cooked salmon and salmon sashimi, 19.9%), mandarin fish (14.7%), pomfret fish (8.5%) and yellow croaker (7.5%). Salmon was found to contain the highest mean level of Σ6 PCBs of 5.7 ng g-1 fresh weight at upper bound estimation, ranging from 4.4 to 6.3 ng g-1. The lower bound and upper bound exposure estimates of Æ©6 PCBs to the average consumer of the population were found to be 0.68 and 1.38 ng kg-1 body weight day-1 respectively while for high consumers, the lower bound and upper bound exposure estimates were 3.08 and 3.84 ng kg-1 body weight day-1 respectively. In addition, the dietary exposures to individual indicator PCB congeners were also estimated.

A Single-Port Robotic Platform for Laparoscopic Surgery with a Large Central Channel for Additional Instrument.

A new approach to a surgical robotic platform for single incision laparoscopic or natural orifice transluminal endoscopic surgery is presented in this paper This platform allows insertion of up to four instruments including the robotic arms and the camera through a single cannula at the same footprint. After insertion of all instruments, a large central channel of 15 mm diameter is kept clear for the passage of additional laparoscopic instruments, such as passage or retrieval of suture needles, and/or suction irrigators which greatly facilitates the performance of complex surgical procedures. Phantom and animal trials have been performed to evaluate the insertion and retrieval sequences. These important features were made possible by internally-motorized robotic arms with 7 degrees of freedom and with no external mechanical device connections. The whole platform, together with the 3 degrees of freedom from the swivel system that support the cannula, has altogether 10 degrees of freedom to allow the operation of complex surgeries and access to all quadrants of the abdominal cavity. This new single-port robotic platform paves a new development direction for future non-invasive surgery.

Dietary exposure to organochlorine pesticide residues of the Hong Kong adult population from a total diet study.

Dietary exposure of the Hong Kong adult population to organochlorine pesticide (OCP) residues was estimated using a total diet study (TDS) approach. OCPs listed under the Stockholm Convention as persistent organic pollutants (POPs) including, aldrin, dieldrin, chlordane, chlordecone, dichlorodiphenyltricholroethane (DDT), endosulfan, endrin, heptachlor, hexachlorobenzene (HCB), α-hexachlorocyclohexanes (HCH), ß-HCH, lindane, mirex, pentachlorobenzene and toxaphene, were studied. Out of 600 composite samples, 55% contained one or more OCP residues at detectable levels. The most commonly detected OCP was DDT (32% of all composite samples), followed by HCB (30%) and endosulfan (22%). The lower- and upper-bound mean exposure estimates of OCP residues ranged from 0% to 0.5% and were 0.1-8.4% of their respective health-based guidance values (HBGVs). The lower- and upper-bound 95th percentile exposure estimates ranged from 0% to 1.2% and were 0.1-13.6% of their respective HBGVs. This indicated that dietary exposures to the OCP residues analysed would be unlikely to pose unacceptable health risks to Hong Kong adults.

Dietary exposures to eight metallic contaminants of the Hong Kong adult population from a total diet study.

Dietary exposures to eight metallic contaminants, aluminium (Al), antimony (Sb), cadmium (Cd), lead (Pb), methylmercury (MeHg), nickel (Ni), tin (Sn) and vanadium (V), of the Hong Kong adult population were estimated using the total diet study (TDS) approach. The estimated mean exposures of Al (0.60 mg kg(-1) bw week(-1)), Sb (0.016-0.039 µg kg(-1) bw day(-1)), Cd (8.3 µg kg(-1) bw month(-1)), Pb (0.21 µg kg(-1) bw day(-1)), MeHg (0.74 µg kg(-1) bw week(-1)), Ni (3.1 µg kg(-1) bw day(-1)), Sn (0.029-0.031 mg kg(-1) bw week(-1)) and V (0.13 µg kg(-1) bw day(-1)) were well below the relevant health-based guidance values (HBGVs) where available. However, dietary exposures to MeHg of women aged 20-49 years (child-bearing age) accounted for 150% of the provisional tolerable weekly intake (PTWI) and to Al and Cd of some high consumers were found exceeding or approaching the HBGVs. The major food contributors of MeHg were fish and seafood (90%), of Al were non-alcoholic beverages including tea (33%), and of Cd were vegetables (36%). MeHg exposure during pregnancy was a public health concern in Hong Kong due to potential health risks to the foetus. Results suggest that there is a need to continue monitoring the exposures to metallic contaminants, especially Al, Cd and MeHg, of the Hong Kong population.

The measurement of bone mineral density of bilateral proximal humeri using DXA in patients with unilateral rotator cuff tear.

UNLABELLED: We propose that the measurement of the bone mineral density (BMD) of the proximal humerus be standardized using the dual energy X-ray absorptiometry (DXA) in patients supposed to undergo rotator cuff repair surgery as well as those with the fracture of the proximal humerus as the BMD of the proximal humerus is decreased in these patients. INTRODUCTION: We propose that the measurement of the BMD of the proximal humerus be standardized using the DXA in patients who are supposed to undergo rotator cuff repair surgery as well as those with the fracture of the proximal humerus. METHODS: We conducted the prospective study in 213 patients with unilateral rotator cuff tear but without contralateral shoulder pain or disease. In these patients, we preoperatively measured the BMD of the bilateral proximal humeri with a repeat measurement in 20 patients. We predefined three regions of interest (ROIs) in the proximal humerus with the consideration of the rotator cuff repair surgery as well as proximal humeral fractures. RESULTS: The measurement of the BMD of the proximal humerus using the DXA showed excellent reliability (intraclass correlation coefficient > .90). BMD values of all three ROIs in the affected shoulder were significantly lower than those in asymptomatic shoulder (all p < 0.05). In female patients, the BMD values of ROIs in bilateral shoulder were significantly lower than those in male patients (all p < 0.001). In multiple regressions, however, there were no significant correlations between other clinical characteristics, except for the gender, and the BMD of GT in the affected shoulder. CONCLUSIONS: It is imperative that the bone quality of the proximal humerus be accurately evaluated prior to surgery in patients who are supposed to undergo rotator cuff repair using suture anchors as well as in those with proximal humeral fractures. This is because the BMD of the proximal humerus is decreased in these patients.

Quantitative risk-benefit analysis of fish consumption for women of child-bearing age in Hong Kong.

Maternal fish consumption is associated with both risks from methylmercury (MeHg) and beneficial effects from omega-3 fatty acids to the developing foetal brain. This paper assessed the dietary exposure to MeHg of women of child-bearing age (20-49 years) in Hong Kong, and conducted risk-benefit analysis in terms of the effects in children's intelligent quotient (IQ) based on local data and the quantitative method derived by the expert consultation of FAO/WHO. Results showed that average and high consumers consume 450 and 1500 g of fish (including seafood) per week, respectively. About 11% of women of child-bearing age had a dietary exposure to MeHg exceeding the PTWI of 1.6 µg kg(-1) bw. In pregnant women MeHg intake may pose health risks to the developing foetuses. For average consumers, eating any of the 19 types of the most commonly consumed fish and seafood during pregnancy would result in 0.79-5.7 IQ points gain by their children. For high consumers, if they only ate tuna during pregnancy, it would cause 2.3 IQ points reduction in their children. The results indicated that for pregnant women the benefit outweighed the risk associated with eating fish if they consume different varieties of fish in moderation.

Alteration of ictal and interictal perfusion in patients with paroxysmal kinesigenic dyskinesia.

Although previous cerebral blood flow studies have suggested that the basal ganglia or thalamus are involved in the pathogenesis of paroxysmal kinesigenic dyskinesia (PKD), the precise anatomic substrate or pathophysiological networks associated with PKD remain unclear. Here, ictal and interictal single photon emission computed tomography (SPECT) in 2 patients with idiopathic PKD compared to 6 age-matched normal controls and the perfusion findings of subtraction ictal SPECT co-registered to MRI (SISCOM) in 1 patient are reported. The interictal and ictal perfusion changes were different in each of the patients and there were no consistent anatomic substrates observed. 2 patients had significant perfusion changes in the left frontal/temporal cortices compared to controls, whereas the others showed an increased uptake of 99mTc-ethyl cysteinate dimer (ECD) in the left occipital area on subtraction SPECT imaging. The results of this study suggest that the pathophysiology of PKD cannot be simply explained by lesions of the basal ganglia or thalamus, and that other associated areas of the cortex are likely involved in these movement disorders.

Modelling a turbidity current in Soyang reservoir (Korea) and its control using a selective withdrawal facility.

Persistent turbidity in reservoirs and their downstream after flood events is one of most important environmental issues in Korea. Recently, modification of withdrawal facility and installation of a new selective withdrawal structure (SWS) have been implemented for the mitigation of downstream impact and sediment loading into water treatment facilities. This study was to explore the characteristics of flood density flow induced into Soyang Reservoir and the transport processes of suspended sediments (SS) through application of coupled two-dimensional hydrodynamic and particle dynamic models (TM-1, TM-2 and TM-3). The TM-3 including a turbidity attenuation rate as a lumped parameter showed best performance in reproducing the magnitude and distribution of SS in the reservoir. The validated model was applied to evaluate the effectiveness of SWS, which was designed for the reservoir, with 6 different historical flood events. The magnitude of vertical mixing of the turbidity plume and its persistence within the reservoir were closely correlated to the ratio of the volume of turbidity flow to the total reservoir storage (the theta value). The operation of SWS showed a positive effect as long as theta is between 0.3 and 0.6 but negative when theta = 0.83 for the study reservoir, thus it should be optimized based on the theta value for a better management of the reservoir.

Osteolytic mandible presenting as an initial manifestation of an adult acute lymphoblastic leukaemia.

A case of adult acute lymphoblastic leukaemia is reported. A 35-year-old male presented with an osteolytic lesion of the mandible. There was no definitive involvement in other craniofacial bones. A panoramic radiograph taken 4 months previously showed no bony involvement. A complete blood count showed a slightly decreased red blood cell count, but normal white blood cell count, white blood cell differential count and platelet count. Routine chemistry revealed hypercalcemia with an increased level of parathyroid hormone-related protein. Histopathological examination of bone marrow biopsy confirmed the diagnosis of acute lymphoblastic leukaemia.

Color vision in Parkinson's disease and essential tremor.

BACKGROUND AND PURPOSE: Decreased visual function is one of the non-motor dysfunctions of Parkinson's disease (PD). Recent evidences suggest that essential tremor (ET) is not 'pure' motor disorder and there is growing evidence that this disease is a multiple-system disorder. In some cases, it is difficult to differentiate ET from PD. In addition, there is considerable controversy regarding the relationship between PD and ET. The objective of this study was to compare color discrimination dysfunction amongst patients with PD and ET and to investigate the clinical relevance. METHODS: Case-control comparisons of 54 patients with PD, 36 patients with ET, and 34 age-matched controls were performed. All cases underwent Farnsworth-Munsell 100 Hue test (FMT) and clinical assessments on medication. In addition, the association between color vision abnormalities and motor handicaps was investigated. RESULTS: There were significant differences in the total error scores (TES) of the FMT amongst the three groups; patients with the PD had higher TES than the patients with ET and the controls after adjustments for age. In addition, the motor symptom severity in PD correlated with the FMT abnormalities, especially with regard to the axial symptoms. CONCLUSION: The results of this study suggest that color vision abnormalities may be one of the non-motor clinical characteristics of PD-related dysfunction in contrast to ET. In addition, the severity of axial motor symptoms was closely related to visual dysfunction. Confirmation of these findings as well as the mechanisms underlying these results requires further study.

Ethyl carbamate in fermented foods and beverages: dietary exposure of the Hong Kong population in 2007-2008.

To evaluate the potential public health risk of ethyl carbamate (EC), EC exposure from fermented foods and beverages for Hong Kong population was estimated. In 276 samples analysed, EC was detected (limit of detection (LOD) at 0.4 µg kg(-1)) in 202 samples (73%), with higher levels in fermented red bean curd (150-650 µg kg(-1)) and yellow wine (140-390 µg kg(-1)), while low or non-detected (ND) in preserved vegetables (ND-10 µg kg(-1)) and fermented tea (ND-15 µg kg(-1)). The estimated dietary exposure from all fermented foods and beverages was 8.27 ng kg(-1) bw day(-1), while exposure excluding alcoholic beverages was 5.42 ng kg(-1) bw day(-1), with calculated margins of exposure (MOEs) at 3.6 × 10(4) and 5.5 × 10(4) respectively. The risk of adverse health effects was low for the average population but higher (MOE of 10(3)) for high consumers of alcoholic beverages especially habitual drinkers of alcoholic types with high EC contents.

Metronomic gemcitabine suppresses tumour growth, improves perfusion, and reduces hypoxia in human pancreatic ductal adenocarcinoma.

BACKGROUND: The current standard of care for pancreatic cancer is weekly gemcitabine administered for 3 of 4 weeks with a 1-week break between treatment cycles. Maximum tolerated dose (MTD)-driven regimens as such are often associated with toxicities. Recent studies demonstrated that frequent dosing of chemotherapeutic drugs at relatively lower doses in metronomic regimens also confers anti-tumour activity but with fewer side effects. METHODS: Herein, we evaluated the anti-tumour efficacy of metronomic vs MTD gemcitabine, and investigated their effects on the tumour microenvironment in two human pancreatic cancer xenografts established from two different patients. RESULTS: Metronomic and MTD gemcitabine significantly reduced tumour volume in both xenografts. However, K(trans) values were higher in metronomic gemcitabine-treated tumours than in their MTD-treated counterparts, suggesting better tissue perfusion in the former. These data were further supported by tumour-mapping studies showing prominent decreases in hypoxia after metronomic gemcitabine treatment. Metronomic gemcitabine also significantly increased apoptosis in cancer-associated fibroblasts and induced greater reductions in the tumour levels of multiple pro-angiogenic factors, including EGF, IL-1alpha, IL-8, ICAM-1, and VCAM-1. CONCLUSION: Metronomic dosing of gemcitabine is active in pancreatic cancer and is accompanied by pronounced changes in the tumour microenvironment.

Oral bisphosphonate-related osteonecrosis of the jaw: the first report in Asia.

UNLABELLED: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a serious side effect of bisphosphonate therapy. The incidence of BRONJ is known to be low among patients treated with oral bisphosphonates. We investigated the prevalence, demographics, clinical manifestations, and treatment outcome of 24 patients with oral BRONJ in Asian populations. INTRODUCTION: The long-term safety of oral bisphosphonates is clinically important considering the rare but potentially serious complications such as bisphosphonate-related osteonecrosis of the jaw (BRONJ) versus the effect of reducing and preventing osteoporotic fracture. The incidence of BRONJ is known to be low among patients treated with oral bisphosphonates around the world. However, the prevalence in those taking oral bisphosphonates for osteoporosis in Asian populations is unknown. Moreover, a recent article, showing that the majority of reported patients who received alendronate were Asian American, raised concern about the prevalence of oral BRONJ in Asian populations. The objective of this study was to investigate the estimated prevalence, clinical characteristics, and treatment outcome of oral BRONJ in Asian populations. METHODS: From October 2005 to December 2008, a retrospective review of medical charts identified 24 patients receiving oral bisphosphonates diagnosed as BRONJ at the Department of Oral and Maxillofacial Surgery, Yonsei University Dental Hospital, Seoul, South Korea. RESULTS: The estimated prevalence of oral BRONJ was 0.05-0.07%. The average oral bisphosphonate treatment duration was 43.1 months (range, 5-120 months). Treatment with oral antibiotics and/or surgery including sequestrectomy or alveolectomy showed relatively favorable results. CONCLUSIONS: The prevalence of oral BRONJ in Korea is similar to that reported previously in Western populations. We suggest that recognition of BRONJ and appropriate management pre- and post-dental surgery might reduce the frequency of BRONJ among patients receiving oral bisphosphonates.

Characterization and modeling of turbidity density plume induced into stratified reservoir by flood runoffs.

In monsoon climate area, turbidity flows typically induced by flood runoffs cause numerous environmental impacts such as impairment of fish habitat and river attraction, and degradation of water supply efficiency. This study was aimed to characterize the physical dynamics of turbidity plume induced into a stratified reservoir using field monitoring and numerical simulations, and to assess the effect of different withdrawal scenarios on the control of downstream water quality. Three different turbidity models (RUN1, RUN2, RUN3) were developed based on a two-dimensional laterally averaged hydrodynamic and transport model, and validated against field data. RUN1 assumed constant settling velocity of suspended sediment, while RUN2 estimated the settling velocity as a function of particle size, density, and water temperature to consider vertical stratification. RUN3 included a lumped first-order turbidity attenuation rate taking into account the effects of particles aggregation and degradable organic particles. RUN3 showed best performance in replicating the observed variations of in-reservoir and release turbidity. Numerical experiments implemented to assess the effectiveness of different withdrawal depths showed that the alterations of withdrawal depth can modify the pathway and flow regimes of the turbidity plume, but its effect on the control of release water quality could be trivial.

Trimethylamine oxide, dimethylamine, trimethylamine and formaldehyde levels in main traded fish species in Hong Kong.

Levels of trimethylamine oxide (TMAO), dimethylamine (DMA), trimethylamine (TMA) and formaldehyde (FA) were studied in 266 different fishes, including fresh/frozen raw whole fishes of 89 different species that traded in Hong Kong, China. Determination of TMAO can confirm the source of DMA and FA if present in the sample. These samples were purchased from different commercial outlets between April and August 2007. All samples of raw whole fish were identified for their species by the Agriculture, Fisheries and Conservation Department. The content of TMAO was determined by high-performance liquid chromatography (HPLC) coupled with a chemiluminescent nitrogen detector. The possible decomposition products of TMAO, DMA and TMA were analysed by headspace solid-phase micro-extraction gas chromatography-mass spectrometry (HS-SPME-GC-MS), while FA was conducted by steam distillation then quantified by a HPLC. The range for TMAO of all samples was <5-3800 mg kg(-1) with median of 970 mg kg(-1), while the endogenous enzymatic cleavage products DMA, TMA and FA were in the range of <2-320, <1-190 and <1-160 mg kg(-1), respectively. These cleavage products were mainly found in three fish species, Harpadon nehereus, Saurida elongata and Saurida tumbil, that belong to the family Synodontidae (Lizardfishes) and subfamily Harpadontinae. Besides, freshwater fish species, namely, Micropterus salmoides, Oreochromis niloticus niloticus and Siniperca chuatsi, were found to contain TMAO in the range of 510-760, 85-720 and 400-640 mg kg(-1), respectively.

Diffusion tensor MR imaging and fiber tractography: technical considerations.

This second article of the 2-part review builds on the theoretic background provided by the first article to cover the major technical factors that affect image quality in diffusion imaging, including the acquisition sequence, magnet field strength, gradient amplitude, and slew rate as well as multichannel radio-frequency coils and parallel imaging. The sources of many common diffusion image artifacts are also explored in detail. The emphasis is on optimizing these technical factors for state-of-the-art diffusion-weighted imaging and diffusion tensor imaging (DTI) based on the best available evidence in the literature. An overview of current methods for quantitative analysis of DTI data and fiber tractography in clinical research is also provided.

Diffusion tensor MR imaging and fiber tractography: theoretic underpinnings.

In this article, the underlying theory of clinical diffusion MR imaging, including diffusion tensor imaging (DTI) and fiber tractography, is reviewed. First, a brief explanation of the basic physics of diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) mapping is provided. This is followed by an overview of the additional information that can be derived from the diffusion tensor, including diffusion anisotropy, color-encoded fiber orientation maps, and 3D fiber tractography. This article provides the requisite background for the second article in this 2-part review to appear next month, which covers the major technical factors that affect image quality in diffusion MR imaging, including the acquisition sequence, magnet field strength, gradient amplitude and slew rate, and multichannel radio-frequency coils and parallel imaging. The emphasis is on optimizing these factors for state-of-the-art DWI and DTI based on the best available evidence in the literature.

Dietary exposure to chloropropanols of secondary school students in Hong Kong.

This paper reports levels of 3-monochloropropan-1,2-diol (3-MCPD) and 1,3-dichloro-2-propanol (1,3-DCP) in a wide range of food items and estimates their dietary exposure for secondary school students in Hong Kong. Dietary exposure to chloropropanols was estimated using local food consumption data obtained from secondary school students in 2000 and the concentrations of 3-MCPD and 1,3-DCP in food samples taken from the local market. The dietary exposure to 3-MCPD for an average secondary school student consumer was estimated to be 0.063-0.150 µg kg(-1) body weight (bw) day(-1), whilst that for the high consumer was 0.152-0.300 µg kg(-1) bw day(-1). Both estimates fell below the provisional maximum tolerable daily intake of 2 µg kg(-1) bw established by the Joint Expert Committee on Food Additives (JECFA) and amounted to less than 20% of this safety reference value. The dietary exposure to 1,3-DCP for an average secondary school student consumer was estimated to be 0.003-0.019 µg kg(-1) bw day(-1), whilst that for the high consumer was 0.009-0.040 µg kg(-1) bw day(-1). The resulting margins of exposures were of low concern for human health. It could be concluded that both the average and high secondary school student consumers were unlikely to experience major toxicological effects of 3-MCPD and 1,3-DCP.