Wilson Sims Fall Risk Assessment Tool Versus Morse Fall Scale in Psychogeriatric Inpatients: a Multicentre Study.

OBJECTIVE: To compare predictive validity of the Wilson Sims Fall Risk Assessment Tool (WSFRAT) with that of the Morse Fall Scale (MFS) in psychogeriatric inpatients. METHODS: Psychogeriatric patients from Shatin Hospital, Tai Po Hospital, Castle Peak Hospital, and United Christian Hospital who had fall incident between April 2019 and April 2020 were identified. Their fall risks were assessed by the WSFRAT and the MFS, and their falls incidents during hospitalisation were recorded. Patients were classified as having high fall risk when their MFS score was ≥45 and when their WSFRAT score was ≥7. Sensitivity, specificity, and positive and negative predictive values of the two scales were calculated. RESULTS: We identified 183 (90 male and 93 female) psychogeriatric patients aged ≥65 years who had fall incident and were assessed by both the WSFRAT and the MFS during the study period. Among the 183 patients, four sustained a fall during hospital stay, giving a prevalence of 2.19%. All four patients were classified as having high risk of fall by WSFRAT, but only two of them were classified so by MFS. The sensitivity of WSFRAT was 100%, which was higher than the 50% by MFS, but specificity of MFS was higher than that of WSFRAT (45.81% vs 54.75%). CONCLUSION: WSFRAT is a better fall risk assessment scale for psychiatric inpatients than MFS, because of higher sensitivity (100% vs 50%). It has items specific to psychiatric patients and should replace MFS in psychiatric settings.

Simulating a Mott Insulator Using Attractive Interaction.

We study the particle-hole symmetry in the Hubbard model using ultracold fermionic atoms in an optical lattice. We demonstrate the mapping between charge and spin degrees of freedom and, in particular, show the occurrence of a state with "incompressible" magnetization for attractive interactions. Our results present a novel approach to quantum simulation by giving access to strongly correlated phases of matter through an experimental mapping to easier detectable observables.

Antiferromagnetic Correlations in Two-Dimensional Fermionic Mott-Insulating and Metallic Phases.

We experimentally study the emergence of antiferromagnetic correlations between ultracold fermionic atoms in a two-dimensional optical lattice with decreasing temperature. We determine the uniform magnetic susceptibility of the two-dimensional Hubbard model from simultaneous measurements of the in situ density distribution of both spin components. At half filling and strong interactions our data approach the Heisenberg model of localized spins with antiferromagnetic correlations. Moreover, we observe a fast decay of magnetic correlations when doping the system away from half filling.

Thermodynamics versus Local Density Fluctuations in the Metal-Mott-Insulator Crossover.

The crossover between a metal and a Mott insulator leads to a localization of fermions from delocalized Bloch states to localized states. We experimentally study this crossover using fermionic atoms in an optical lattice by measuring thermodynamic and local (on-site) density correlations. In the metallic phase at incommensurable filling we observe the violation of the local fluctuation-dissipation theorem indicating that the thermodynamics of the system cannot be characterized by local observables alone. In contrast, in the Mott insulator we observe the convergence of local and thermodynamic fluctuations indicating the absence of long-range density-density correlations.

Six-month Follow-up of Cognitive Impairment and Depressive Symptoms in Late-onset Depression.

OBJECTIVE: To assess cognitive performance in elderly depressed patients following treatment for 6 months. Remission rate of depression after 6 months of treatment was calculated. METHODS: The study was performed in a consecutive group of patients aged ≥ 65 years with late-onset depression. Severity of depression was assessed by the Hamilton Depression Scale, cognitive performance by the Hong Kong Montreal Cognitive Assessment, and functional level by the Instrumental Activities of Daily Living Scale. RESULTS: A total of 52 patients were recruited. In all, 28 (53.8%) were found to have cognitive impairment at baseline and 8 (28.6%) of them had improvement after 6 months. This cognitively impaired group was older and had a lower Instrumental Activities of Daily Living Scale score. The remission rate of depression was 61.5%. CONCLUSIONS: Cognitive impairment constituted a stable feature in a considerable number of elderly patients with depression. About two-thirds of patients achieved remission of depression after 6 months of treatment.

Patients committing suicide whilst under the care of the elderly suicide prevention programme of a regional hospital in Hong Kong.

OBJECTIVE: To examine the risk factors for suicide in elderly Hong Kong Chinese. METHODS: Case notes, mortality reports and hospital records of all the patients, who committed suicide from 1 July 2002 to 31 March 2010 whilst under the active care of the Elderly Suicide Prevention Programme of the Castle Peak Hospital in Hong Kong, were reviewed. RESULTS: A total of 1230 elderly with high risk of suicide were assessed and treated from 1 July 2002 to March 2010. A total of 8 patients in this programme who committed suicide during this period were identified, of whom 63% were male and the most frequent method employed was jumping from a height. All the suicides ensued within the first 6 weeks of treatment under the programme. All these patients were diagnosed to have a depressive illness, and all but 1 had an associated physical illness that possibly precipitated the suicide. They had all been admitted to either a mental or general hospital, about 1 month before committing suicide. CONCLUSIONS: The first 2 months of treatment is associated with the highest risk of suicide. Intensive care and support with proper education about effects of antidepressants, and the building-up of a trusted therapeutic alliance with close relatives are particularly important in this vulnerable period.

Hepatocyte-specific activation of NF-kappaB does not aggravate chemical hepatocarcinogenesis in transgenic mice.

The NF-kappaB signalling pathway plays important roles in liver organogenesis and carcinogenesis. Mouse embryos deficient in IKKbeta die in mid-gestation, due to excessive apoptosis of hepatoblasts. Although activation of the NF-kappaB signalling pathway has been demonstrated in human hepatocellular carcinoma, the role of NF-kappaB is controversial. Here, we have generated transgenic mice in which a constitutively active form of IKKbeta was expressed in a hepatocyte-specific manner. Using electrophoretic mobility shift assay, we documented increased NF-kappaB activities and up-regulated levels of NF-kappaB downstream target genes, Bcl-xL and STAT5, in the transgenic mouse livers. These results confirmed that the NF-kappaB pathway was activated in the livers of the transgenic mice. However, there was no significant difference in tumour formation between transgenic and wild-type mice up to an age of 50 weeks. When we treated the transgenic mice with the chemical carcinogen diethylnitrosamine (DEN), we observed no significant differences in the incidence and size of liver tumours formed in these mice with and without DEN treatment at 35 weeks of age, suggesting that the activated NF-kappaB pathway in the livers of the transgenic mice did not enhance hepatocarcinogenesis. Interestingly, some of the transient transgenic embryos (E12.5) had abnormal excessive accumulation of nucleated red blood cells in their developing livers. In summary, NF-kappaB activation in hepatocytes did not significantly affect chemical hepatocarcinogenesis. In addition, the TTR/IKKCA transgenic mice may serve as a useful model for studying the role of NF-kappaB activation in hepatocarcinogenesis as well as inflammatory and metabolic diseases.

Factors affecting the palpability of breast lesion by self-examination.

INTRODUCTION: This study aims to assess the accuracy of detection of breast lesion by breast self-examination and to assess different factors affecting the accuracy. METHODS: All consecutive Chinese female patients, who attended our breast imaging unit in 2001, completed our questionnaire, had retrievable hard copy films, and had more than three years clinical follow-up, were recruited for this study. Different factors, such as age, menopausal status, previous experience of breastfeeding, family history of breast cancer, previous history of mastectomy or lumpectomy, hormonal therapy, oral contraceptive pills and previous history of mammography, were correlated with accuracy in self-detection of breast lesions retrospectively. The nature, size and location of the lesion, and breast size based on imaging, were also correlated with the accuracy in self-detection of breast lesions. RESULTS: A total of 163 questionnaires were analysed. 111 patients detected a breast lesion themselves and 24 of these lesions were false-positives. A total of 173 lesions (27 cancerous, 146 benign lesions) were documented by either ultrasonography and/or mammography, and confirmed by either histology or three-year clinical follow-up. The overall sensitivity in detecting both benign and malignant breast lesions was 71% when number of breast lesions was used as the denominator, and up to 78% sensitivity was achieved when number of patients was used as the denominator. History of mastectomy, and size and nature of the lesions were found to affect the accuracy of self-detection of breast lesions. CONCLUSION: Overall, breast self-examinations were effective in the detection of breast lesions and factors such as size of lesion, nature of the lesion and history of mastectomy affect the accuracy of the detections. Breast self-examination should be promoted for early detection of breast cancer.

Wound complication of minimally invasive plate osteosynthesis in distal tibia fractures.

Nowadays, the use of minimally invasive plate osteosynthesis (MIPO) in the management of fracture of the distal tibia is common. The various advantages of the MIPO technique, namely, preserving blood supply and better bone healing, have been described extensively in the literature. However, this technique is not without complication. Among all the complications, infection is one of the commonest. In the last 3 years, we have performed 48 cases of MIPO in treating distal tibia fractures. Our study was to evaluate the clinical outcome of these cases, with special attention to the infection rate and our experience in managing these infection cases. Our results showed that the average time until the patient started to bear full weight was 9.4 weeks. The average time for bony union was 18.7 weeks. There were 7 cases of late infection among these 48 cases. The rate was 15%. The presence of late infection had no obvious effect on the time to bony union. Twenty-five patients (52%) had the implants removed and the most common reason was skin impingement by the implant. The clinical presentation and management of these late infections are discussed. In conclusion, MIPO fixation of distal tibia fractures using a metaphyseal locking plate is safe and efficient. However, complications such as late wound infection and impingement are relatively common. The overall clinical outcome is still good despite the presence of these complications.

Minimally invasive plate osteosynthesis in the treatment of proximal humeral fracture.

The management of fractures of the proximal shaft of the humerus has been evolving since the development of new techniques and new implants in recent years. It seems that this kind of fracture has an increasing incidence in the older, osteoporotic population. In the last 2 years, we have operated on 17 patients, with an average age of 65, who had proximal humeral shaft fractures treated by minimally invasive percutaneous osteosynthesis (MIPO) technique using the metaphyseal locking compression plate. Our study evaluated the surgical technique used and the outcome for these patients with regards to their range of movement and shoulder function. Our results showed that all the patients could achieve at least 140 masculine of shoulder abduction in the first 6 months after the operation, except for three patients who had shoulder impingement. These patients had an average Constant score of 76.8. All fractures had bony union at 6 months, except one, which was probably due to poor reduction in the initial operation. Another complication that we encountered was radial nerve neuropraxia. The ways to prevent these complications are discussed. In conclusion, MIPO fixation using the metaphyseal locking compression plate is a good option for the management of proximal humeral shaft fractures. It provides early functional recovery, but we had to pay special attention to some of the surgical details in order to minimise complications.

Association of SNPs and haplotypes in GABAA receptor beta2 gene with schizophrenia.

Disturbances in GABAergic system have been observed in schizophrenics. In the present study, population association analysis was performed on 19 SNPs in the alpha(1), beta(2), gamma(2), epsilon and pi subunit genes of GABA(A) receptor. Five SNPs in GABRB2, namely B2I7G1584T, rs1816071, rs194072, rs252944 and rs187269, were found to be significantly associated, and their haplotypes in linkage disequilibrium, with schizophrenia. This represents the first report on any disease association of SNPs in the human GABA(A) receptor genes, and focuses attention on the GABAergic hypothesis of schizophrenia etiology.

Quantification of naltrexone and 6,beta-naltrexol in plasma and milk using gas chromatography-mass spectrometry. Application to studies in the lactating sheep.

A selective gas chromatography-mass spectrometry method using solid-phase extraction has been developed for the detection and quantification of naltrexone and its metabolite, 6,beta-naltrexol in plasma and milk from humans and sheep at pharmacologically relevant concentrations. Di- or tri-acetyl derivatives were formed and quantified by selected-ion monitoring. Recoveries of naltrexone (30 microg/l) and 6,beta-naltrexol (250 microg/l) from both human plasma and milk were greater than 70%. Intra-assay and inter-day precision ranged from 3 to 21% for naltrexone and 2-18% for 6,beta-naltrexol for all matrices investigated, with an overall mean accuracy of 104% for naltrexone, and 99% for 6,beta-naltrexol. Human samples containing these analytes were stable for at least 3 weeks at -20 degrees C or 6 weeks at -80 degrees C. Analysis of the plasma and milk from the lactating sheep showed mean milk-to-plasma ratios of 55 for naltrexone and 3 for 6,beta-naltrexol.

Modified Brooks posterior wiring technique for three-point C1-C2 arthrodesis.

BACKGROUND: The optimal surgical treatment of atlanto-axial instability remains controversial despite the variety of modifications and supplemental techniques currently available. METHODS: We describe a modification of the Brooks posterior wiring technique supplemented with transarticular screws for C1-C2 instability. RESULTS: This method has been implemented in 30 patients in our institution with no radiological failures. CONCLUSIONS: The modification provides several technical advantages and potentially stronger fixation compared to methods currently in use.

Modified arthroscopic suture fixation of displaced tibial eminence fractures using a suture loop transporter.

Current arthroscopic suture fixation techniques of tibial eminence fractures are time consuming and the number of anchor sutures that can be placed is limited by the cumbersome and repetitive numerous needle threading steps. This occurs at 2 stages: first, when placing anchoring sutures through the avulsed anterior cruciate ligament stump with a suture punch, and second, when there is a need to traverse the tibial bone canal with the suture ends. We describe a modification that reduces the reliance on conventional rigid instruments and instead uses a loop transporter made from readily available suture material. The suture loop transporter being malleable reduces the necessary width of the tibial bone canal to be made and has a further advantage of minimizing the bone loss during the reaming of the bone tunnel. The subsequent potential for a stress fracture at these tunnel sites is also substantially reduced. Our technique is more user friendly, more accurate, and quicker to perform.

Suramin prevents cerebellar granule cell-death induced by dequalinium.

In this study, we demonstrated that an anticancer drug, dequalinium, a bisquaternary ammonium compound, is a potent neurotoxicant with IC(50) of 0.46 microM on the cultured cerebellar granule neurons. Its selective neurotoxicity revealed by 100-fold more toxic than the other two analogs, pancuronium and vecuronium. The mechanisms underlying dequalinium (DQ)-induced neurotoxicity were explored and found to be associated with decreased mitochondrial membrane potential, increased free radical production and ATP depletion. Suramin (a nonselective purinergic P(2) receptor antagonist and an anticancer drug) but not the glutamate receptor antagonists, MK-801, NBQX (1,2,3,4 tetrahydro-6-nitro-2,3-dioxo-benzo[f]quinoxaline-7-sulfonamide disodium), and DNQX (6,7-dinitroquinoxaline-2,3-dione) significantly prevents the DQ-induced neurotoxicity. By means of microfluorometric image-processing technique using the fluorescent probes, fluorescein diacetate/propidium iodide and Hoechst 33258, respectively, we showed that 1 microM DQ for 24 h induced about 53.5% of apoptosis and 37.5% of necrosis. All of these effects of DQ can be completely prevented by suramin. From these results, we conclude that DQ-induced neurotoxicity was not mediated by glutamate receptor, but by increasing free radical productions and cell energy depletion. Suramin with its beneficial antagonistic effects on DQ-induced neurotoxicity may provide an effective approach for neurodegeneration.

Site of action of suramin and reactive blue 2 in preventing neuronal death induced by dequalinium.

Dequalinium (DQ, an anticancer drug) is a potent neurotoxicant in the cultured developing cerebellar granule neurons (CGNs) with an IC(50) of 1.31. M after 24 hr incubation. By utilizing fluorometric technique, we found that DQ initially induced apoptosis and then necrosis associated with a marked decrease in ATP contents. The purinergic P(2) receptor antagonists (suramin, and reactive blue 2) prevented DQ-cytotoxicity, although glutamate ionotropic receptor antagonists (MK 801 and NBQX) could not. Furthermore, we quantitatively determined a reduction of mitochondrial membrane potential and an increase of free radical production induced by DQ. Suramin abolished these detrimental events of DQ. This suggests that neuronal death induced by DQ is mediated, at least in part, through a signaling pathway of free radical production-mitochondrial dysfunction. Further evidence supporting this contention is that CGN progressively became more sensitive to both DQ-induced cytotoxicity and reduced mitochondrial membrane potential. This implies that neuronal mitochondria are apparently one of the target sites for DQ and suramin and directly or indirectly induce neurotoxicity and neuroprotection respectively. The alteration in mitochondrial membrane potential during neuronal maturation may be one of the determinants accounting for the increased susceptibility to neurotoxicants such as DQ.

Activation of transcription factors of nuclear factor kappa B, activator protein-1 and octamer factors in hyperalgesia.

Involvement of c-fos and neuronal nitric oxide synthase (nNOS) in the hyperalgesia induced by complete Freund adjuvant (CFA) has been reported. In this paper, we attempted to investigate whether the transcription factors regulating the gene expression of c-fos and nNOS, including activator protein-1 (AP-1), nuclear factor kappa B (NF-kappa B), and octamer factors (Oct), are activated by CFA during the development of hyperalgesia. The electrophoretic mobility shift assay (EMSA) was used to determine whether there were changes in the transcription factors in the lumbar spinal cord of adult rats following subcutaneous injection of CFA in one hindpaw of the rats. Maximum binding of AP-1, NF-kappa B and Oct was found at 0.5, 1 and 2 h after CFA injection, respectively. These findings suggest that the activation of these transcription factors is pivotal for the expression of c-Fos and nNOS proteins, which reached a peak at 3 and 48 h after CFA injection, respectively. The behavioral testing of hyperalgesia demonstrated that CFA reduced the thresholds for mechanical and thermal algesia, reaching a minimum at 6 h. The thresholds had only partially recovered after 96 h. Based on these findings, we conclude that AP-1, NF-kappa B and Oct are crucial for the expression of c-Fos proteins at an early stage (at 3 h) and for the expression of nNOS at a late stage of hyperalgesia (48 h post-injection) induced by CFA.

Remanipulation of forearm fractures in children.

AIMS: To determine whether operator experience or time of operation affects the outcome of fractures of the forearm in the paediatric age group as measured by the need for remanipulation. METHODS: A retrospective analysis of 1155 children with forearm fractures requiring manipulation was undertaken. RESULTS: The remanipulation rate for these 1155 children was 136 or 11.7%. There was a significant difference in those fractures requiring remanipulation dependent upon the experience of the operator and the time of day the procedure was performed. The lowest rate of remanipulation was obtained by senior registrars operating between the hours of 0800-1700 (6/113 or 5.3%). The highest rate was found to be junior registrars between the hours of 1700-2200 (39/167 or 23.3%). It is especially interesting to note the relatively low rate (31/437 or 7.1%) obtained by junior registrars during the night shift (2200-0800 hours). CONCLUSIONS: The current overall remanipulation rate is acceptable. The low rate between 2200-0800 hours means rescheduling of these patients is unnecessary. The rate for junior registrars between 1700-2200 hours needs to be improved.