Evaluation of biological, psychosocial, and interventional predictors for success of a smoking cessation programme in Hong Kong.

INTRODUCTION: Predictors for smoking cessation have been identified in different studies but some of the predictors have been variable and inconsistent. In this study, we reviewed all the potential variables including medication, counselling, and others not commonly studied to identify the robust predictors of smoking cessation. METHODS: This historical cohort study was conducted in smoking cessation clinics in Hong Kong. Subjects who volunteered to come for free treatment between January 2010 and December 2011 were reviewed. Those under the age of 18 years, or who were mentally unstable or cognitively impaired were excluded. Counselling and quit-smoking medications were provided to the participants. The outcome measure was self-reported 7-day point prevalence abstinence rate at week 26. RESULTS: Univariate analysis showed that the following were significant predictors of quitting: (1) psychosocial variables such as feeling stressed, feeling depressed, confidence in quitting, difficulty in quitting, importance of quitting, Smoking Self-Efficacy Questionnaire score; (2) smoking-related variables such as number of cigarettes smoked per day, Fagerström Test for Nicotine Dependence score, number of high-risk situations encountered; (3) health-related variable of having mental illness; (4) basic demographics such as age, marital status, and household income; and (5) interventional variables such as counselling and pharmacotherapy. Multiple logistic regression showed that the independent predictors were age, having mental illness, daily cigarette consumption, Fagerström Test for Nicotine Dependence score, reasons for quitting, confidence in quitting, depressed mood, external self-efficacy, intervention with counselling and medications. CONCLUSIONS: This clinic-based local study offers a different perspective on the predictors of quitting. It reminds us to adopt a holistic approach to deal with nicotine withdrawal, to enhance external self-efficacy to resist temptation and social influences, to provide adequate counselling, and to help smokers to cope with mood problems.

Effects of built environment on walking among Hong Kong older adults.

1. Reliable and valid interviewer-administered questionnaires were developed to investigate associations of perceived neighbourhood attributes of Hong Kong older adults with their walking for transportation and recreation. 2. Access to and availability of different types of services and destinations, provision of facilities for resting/sitting in the neighbourhood, and easy access to/from residential buildings may help maintain an active lifestyle by facilitating walking for transport in the neighbourhood. 3. Access to services, indoor places for walking, environmental aesthetics, low traffic, and absence of physical barriers may promote recreational walking..

Ischemic colitis due to a dissecting aneurysm of the superior rectal artery.

Ischemic injury to the bowel is a disease entity that has a wide spectrum of pathological and clinical findings. Patients with chronic ischemia present with colicky abdominal pain, obstructive symptoms and signs of ischemic colonic stricture. We reported the first case of ischemic colitis arising from a superior rectal artery (SRA) aneurysm. Colonoscopy showed non-resolving colitis complicated by sigmoid stricture. CT angiogram with 3D reconstruction showed a dissecting SRA aneurysm measuring 2 cm by 1.2 cm by 1.3 cm. The patient underwent laparoscopic-assisted low anterior resection, which was converted to open because of adhesions and made a full recovery.

Influenza vaccination and hospitalisation in Elderly Health Centres.

1. A cohort of Elderly Health Centres was examined to determine whether influenza vaccination decreased hospitalisation and mortality. 2. In the influenza season, influenza vaccination reduced all-cause mortality by half and cardiorespiratory hospitalisation by a quarter. The extent to which influenza vaccination protects older people from serious morbidity and mortality needs to be confirmed in appropriately designed studies, so that scarce health care resources can be used effectively

Colonic perforation caused by direct trauma during computed tomographic colonography performed via end colostomy.

We report the case of a woman with a history of abdominoperineal resection for cancer, who had an inadvertent perforation during screening computed tomographic colonography performed via end colostomy. Revision of the stoma was promptly performed, which prevented a full laparotomy. We reviewed the literature on the subject and found that such perforations may be more common than previously thought. With appropriate precautions, such occurrences can be minimised in the future.

Structural health monitoring using polymer-based capacitive micromachined ultrasonic transducers (CMUTs).

Transducers based on a capacitive micromachined ultrasonic transducer (CMUT) design have been fabricated using a rapid prototyping technique. This results in a device that is constructed principally from polymers, in a process which is simple and inexpensive. The resultant devices can be attached to the surfaces of solids. Their peak sensitivity is in the 80-100 kHz range, making them ideal for applications such as acoustic emission and structural health monitoring. Good low frequency sensitivity leads to applications in vibration monitoring.

Single-incision laparoscopic surgery for right hemicolectomy: our initial experience with 10 cases.

BACKGROUND: Published data has confirmed the oncological safety and efficacy of laparoscopic colorectal surgery. Continued surgical innovation has seen the recent resurgence of single-port laparoscopic surgery. We present a series of 10 cases of single-incision laparoscopic surgery (SILS) for right hemicolectomy, with the aim of reaffirming the feasibility and favourable short-term results of this technique. METHODS: Ten patients underwent SILS for right hemicolectomy using the SILS port, between June 2009 and August 2009. A longitudinal periumbilical incision was used as the access point for all cases. Data analysed included age, gender, American Society of Anaesthesiology score, body mass index (BMI), location of disease, duration of surgery, length of incision and duration of hospital stay. Inclusion criteria were no prior abdominal surgery, no intra-abdominal sepsis, no distant metastases and a BMI of <30. RESULTS: All 10 cases of right hemicolectomy were successfully performed using the SILS port through a single periumbilical incision. The median age of patients was 64 years (range 48-83 years), with a median body mass index of 21.5 kg/m(2) (range 18.9-25.6 kg/m(2)). The median duration of surgery and hospital stay was 83 min (range 60-125 min) and 6 days (range 5-11 days), respectively. No morbidity or mortality was associated with this technique, and all patients recovered uneventfully. CONCLUSION: This case series illustrates that SILS for right hemicolectomy is feasible and safe. However, the routine use of this innovative technique in malignant disease cannot be recommended without further large-scale prospective trials.

Radiation proctitis: a decade's experience.

INTRODUCTION: Pelvic radiotherapy is an essential component of potentially curative therapy for many pelvic malignancies; however, the rectum consequently often sustains collateral injury. METHODS: The researchers retrieved patient data that was prospectively gathered over a ten-year period between January 1995 and December 2004. The relevant details, including gender, age, pelvic pathology for which radiotherapy was administered, the presenting symptoms, the interval between radiotherapy and the onset of symptoms, the mode of diagnosis, treatments received, length of hospital stay and duration of follow-up, were analysed. RESULTS: During the period under review, 77 patients were admitted for the treatment of radiation proctitis, with a median follow-up period of 14 (range 1-61) months. There were 23 male and 54 female patients, with a median age of 63.9 (range 37-89) years. The most common underlying cancers were gynaecological (63.6 percent), prostate (18.2 percent) and colorectal (15.6 percent) cancer. The most common presenting symptom was bleeding per rectum (89.6 percent), with a change in bowel habits a distant second (10.4 percent). The median latent period between the completion of radiotherapy and the onset of symptoms was 24 (range 3-68) months. The majority of the patients (72.5 percent) received non-surgical treatment, most commonly using topical 4 percent formalin solution to arrest the bleeding, with more than half the patients requiring repeat treatments. 14 (18.2 percent) patients required colorectal resections for intractable bleeding, intestinal obstruction or intra-abdominal sepsis. CONCLUSION: Radiation proctitis can be a therapeutic challenge, even in the most experienced hands. The majority of patients who present with per rectal bleeding can be treated using topical modalities, while surgery may offer the only chance of relief from life-threatening symptoms.

Genome-wide scan identifies a copy number variable region at 3q26 that regulates PPM1L in APC mutation-negative familial colorectal cancer patients.

Familial adenomatous polyposis (FAP) is an autosomal dominantly inherited form of colorectal cancer (CRC) caused by mutation in the adenomatous polyposis coli (APC) gene. However, APC mutations are not detected in 10-50% of FAP patients. We searched for a new cancer gene by performing genome-wide genotyping on members of an APC mutation-negative FAP variant family and ethnicity-matched healthy controls. No common copy number change was found in all affected members using the unaffected members and healthy controls as baseline. A 111 kb copy number variable (CNV) region at 3q26.1 was shown to have copy number loss in all eight polyps compared to matched lymphocytes of two affected members. A common region of loss in all polyps, which are precursors to CRC, is likely to harbor disease-causing gene in accordance to Knudsen's "two-hit" hypothesis. There is, however, no gene within the deleted region. A 2-Mb scan of the genomic region encompassing the deleted region identified PPM1L, coding for a novel serine-threonine phosphatase in the TGF-beta and BMP signaling pathways. Real-time PCR analyses indicate that the 3'UTR of PPM1L transcript was down-regulated more than two-folds in all six polyps and tumors compared to matched mucosa of the affected member. This down-regulation was not observed in APC mutation-positive FAP patients. Our results suggest that the CNV region at 3q26 harbors an element that regulates the expression of an upstream candidate tumor suppressor, PPM1L, thus providing a novel mechanism for colorectal tumorigenesis in APC mutation-negative familial CRC patients.

Optimal combination of nested clusters by a greedy approximation algorithm.

Given a set of clusters, we consider an optimization problem which seeks a subset of clusters that maximizes the microaverage F-measure. This optimal value can be used as an evaluation measure of the goodness of clustering. For arbitrarily overlapping clusters, finding the optimal value is NP-hard. We claim that a greedy approximation algorithm yields the global optimal solution for clusters that overlap only by nesting. We present a mathematical proof of this claim by induction. For a family of n clusters containing a total of N objects, this algorithm has an {\rm O}(n;{2}) time complexity and O(N) space complexity.

Robotic-assisted surgery for low rectal dissection: from better views to better outcome.

INTRODUCTION: The use of robotics in colorectal surgery is relatively new. The first few cases of colonic surgery using da Vinci Surgical System were reported in 2002. Since then, several centres had reported on their experience, with favourable outcomes. Our department started to embark on robotics in colorectal surgery in December 2007. The aim of our paper was to share our early experience with robotics in colorectal surgery and provide an update on the current status of robotics. METHODS: Preparations included formal training with the da Vinci Surgical System, certification of the surgeons, and obtaining Hospital Ethics committee approval. We used a hybrid technique of laparoscopic and robotic assistance in the resection of mid- to low-rectal cancer (total mesorectal excision). Laparoscopic approach was used to isolate the inferior mesenteric artery and for mobilisation of the left colon. The da Vinci robot was used in the dissection of the rectum down to the pelvic floor. We reviewed the outcomes of our early experience with emphasis on feasibility and safety. RESULTS: Over a period of three months, we performed eight cases of robotic-assisted colorectal surgery for cancer. The median age of the patients was 55 (range 42-80) years. The median operating time was 192.5 (range 145-250) minutes. There were no intraoperative or postoperative complications related to the use of robotics. The median length of hospital stay was five (range 4-30) days. CONCLUSION: Robotic-assisted laparoscopic colorectal surgery is a safe and feasible procedure.

Colorectal cancer mass screening event utilising quantitative faecal occult blood test.

INTRODUCTION: Colorectal cancer (CRC) is a leading cause of morbidity and mortality with human and financial costs. Screening by faecal occult blood test (FOBT) has proven to be effective in decreasing mortality from CRC in both randomised trials and case-control studies. We report on the results of a CRC screening event using quantitative FOBT (QFOBT) held in Singapore. METHODS: The mass screening event was held over two days, and participants 40 years or older without prior screening performed in the preceding year were eligible. Those with significant symptoms or medical comorbidities were excluded. Stool sampling was done with two issued immunochemical QFOBT kits, and participants with positive stool samples with equal or greater than 100 ng haemoglobin/ml sample solution in any two samples were advised to have a colonoscopy screening conducted. RESULTS: A total of 1,048 participants took part in the screening event. 222 (21 percent) of the participants claimed to have some abdominal symptoms prior to screening. 49 participants (26 males, 23 females) tested positive for QFOBT and 47 were evaluated. 10 (21 percent) had polyps and one case of colorectal cancer was detected. Seven of these cases had significant neoplasia (lesions 1 cm or larger) and were treated. Two patients required surgery. CONCLUSION: Our study demonstrates wide variation in the attitudes of participants who turned up for screening. In addition, the number of significant colorectal neoplasia patients (14 percent) in those with positive QFOBT provides further evidence of the importance of screening with a potential reduction in CRC mortality. Continuous education of the public in events such as this, is essential to improving attitudes towards screening.

Modality of physical exercise and cognitive function in Hong Kong older Chinese community.

OBJECTIVE: We reported the association between modality of Physical Exercise and cognitive function in 782 older Chinese adults assessed in the second phase of a population survey for dementia in Hong Kong. METHODS: Profiles of physical exercise was measured by a questionnaire (no exercise, stretching, aerobic and mind-body exercise). Cognitive Assessments included the CMMSE, ADAS-Cog, and Category Verbal Fluency Test (CVFT). RESULTS: The aerobic and mind body exercise groups with longer exercise habits (>5 years) had higher scores in most cognitive tests (Kruskal Wallis tests, p < 0.01). Beneficial effects were more significant in the young old group from 65- 75 years. CONCLUSIONS: Possible age related specific effects of aerobic and mind body exercise on cognitive reserve are worthy of further exploration.

Screening of mild cognitive impairment in Chinese older adults--a multistage validation of the Chinese abbreviated mild cognitive impairment test.

OBJECTIVE: To develop a short cognitive test for screening mild cognitive impairment (MCI) in Hong Kong Chinese older adults. METHODS: The Chinese Abbreviated MCI (CAMCI) test was developed with a multistage process. In phase 1, a short version of the cognitive test comprising a 1-min animal fluency test and a 10-min delayed word list recall was developed and tested in 578 volunteers (community-dwelling active elderly persons). In phase 2, the CAMCI test was validated in an independent and randomly recruited sample of 459 participants in a community survey. Additionally, the predictive significance of the CAMCI test was evaluated in a group of 196 subjects assessed in phase 1 for conversion to clinical dementia at 20 months' follow-up. The discriminating power of the CAMCI test in differentiating MCI from normal control (NC) and mildly demented subjects was compared with Mini Mental State Examination (MMSE) and Alzheimer's Disease Assessment Scale-Cognitive (ADAS-Cog) subscales. RESULTS: The CAMCI test was found to have high discriminating power in differentiating NC from MCI and mildly demented subjects in the phase 1 volunteer sample. The receiver operating characteristics (ROC) revealed an area under the curve (AUC) of 0.91. The ROC were further validated in the phase 2 sample. The AUC of the CAMCI test was compared with MMSE and ADAS-Cog subscales. The short MCI test was comparable to the ADAS-Cog subscale in discriminating NC from MCI and demented subjects (chi(2) test, p = n.s.). Logistic regression analysis was carried out to determine significant baseline predictors for conversion to dementia at phase 3 follow-up. Both ADAS-Cog total [Exp(B) = 1.115, p = 0.028] and CAMCI [Exp(B) = 0.88, p = 0.045] scores were significant predictors for dementia status at follow-up. CONCLUSION: The CAMCI test is able to discriminate NC from MCI and mild dementia in Hong Kong Chinese older adults. Its potential for large-scale community screening for early detection of cognitive impairment in late life should be emphasized and explored.

Adenocarcinoma of the anal transitional zone after double stapled ileal pouch-anal anastomosis for ulcerative colitis.

The development of adenocarcinoma in the anal transitional zone, after restorative proctocolectomy for ulcerative colitis, is rare. We report the first Asian and sixth known case. A 41-year-old Indian lady had a long standing history of ulcerative colitis. Restorative proctocolectomy and stapled ileal pouch-anal anastomosis without mucosectomy was performed. She remained asymptomatic until 3 years later when she complained of discomfort on defecation. A poorly differentiated adenocarcinoma in the anal transition zone was diagnosed and she subsequently underwent an abdomino-perineal resection. The previously reported cases in the literature are reviewed. We also discuss the suggested surveillance for high-risk patients who have undergone an ileal-anal pouch anastomosis.

A 6-year review of surgical morbidity and oncological outcome after high anterior resection for colorectal malignancy with and without splenic flexure mobilization.

OBJECTIVE: High anterior resection (HAR) for colorectal cancer is traditionally performed with routine mobilization of the splenic flexure. This is a retrospective review of mortality and morbidity following HAR in which the splenic flexure has been preserved. METHOD: From a prospective database, all patients who had undergone elective HAR for colorectal cancer between 1999 and 2005 were identified. Morbidity, mortality, pathology and survival data for patients having HAR with and without splenic flexure mobilization were analysed. RESULTS: A total of 707 patients were identified. Five hundred and thirty-one had HAR with preservation of the splenic flexure. In these patients outcome was: anastomotic leak (0.4%), wound infection (3.6%), anastomotic stricture (0.4%) and 30-day mortality (0.9%). No statistical significant difference was found for postoperative morbidity (P = 0.1926), 30-day mortality (P =0.3285), lymph node harvest (P = 0.2127) or survival (P = 0.1457) compared with patients in whom the splenic flexure was mobilized. Longitudinal resection margins were greater following HAR with splenic flexure mobilization (P < 0.0001). CONCLUSION: No morbidity, oncological or survival disadvantage in performing splenic flexure preserving HAR was found.

Micro-stereolithography as a transducer design method.

This paper investigates the use of micro-stereolithography, a rapid prototyping technique, in the manufacture of transducers. It is illustrated for the production of electromagnetic acoustic transducer (EMATs) coils in both meander-line and spiral configurations. A synthetic aperture focussing technique (SAFT) has been applied to the ultrasonic signals from these devices to reconstruct images in metallic objects.

A prospective study assessing anal plug for containment of faecal soilage and incontinence.

OBJECTIVE: Faecal incontinence is a common and embarrassing problem for many individuals. Some patients remained symptomatic despite the availability of different treatments. There is a limited range of commercially available products designed to cope with faecal incontinence. The anal plug has been developed to contain the loss of stool. This study aimed to evaluate the use of anal plug in Asian patients with intractable faecal soilage and incontinence judged by clinical and functional outcomes. METHOD: A prospective study of consecutive patients with intractable faecal incontinence was carried out. Suitable patients tested the anal plug for 3 weeks. They completed a structured questionnaire on its use including the ASCRS quality of life questionnaire for faecal incontinence. RESULTS: Thirty patients, median age 63 (interquartile range 52-70) years, participated in the trial. Nineteen of 30 patients were comfortable wearing the plug, seven patients withdrew from the study because of discomfort, and four had tolerable discomfort and managed to complete the trial protocol. Patients who tolerated the plug found that it was highly successful in controlling faecal incontinence. Twenty-one of 30 patients wished to continue to use the plug regularly after the study. There was a trend toward improvement in quality of life scores during the study. CONCLUSION: The anal plug was effective in containing faecal incontinence and was well tolerated in the majority of patients selected for this treatment.

Prevalence of clinically significant depressive symptoms in an epidemiologic sample of community-dwelling elders with milder forms of cognitive impairment in Hong Kong SAR.

BACKGROUND: Depression and cognitive impairment in later-life have great bearings on public health. The two conditions often co-occur and have mutual implications on short-term risk and long-term prognosis. METHOD: A two-phase epidemiologic survey on the prevalence of dementia in elders aged 60 and over was conducted in Hong Kong in 2005-2006. In the first phase, 6,100 randomly selected community dwelling elders were assessed with Cantonese version of Mini-Mental State Examination (C-MMSE) and Abbreviated Memory Inventory for Chinese (AMIC). Two thousand and seventy-three subjects were screened positive and invited for second phase cognitive and psychiatric assessment. 35.5% of screen-positive subjects participated in Phase 2 assessment conducted by psychiatrists for diagnosis of dementia. Severity of dementia was determined using Clinical Dementia Rating Scale (CDR). Cornell Scale for Depression in Dementia (CSDD) and a structured bedside cognitive battery were also administered to each subject. RESULTS: 1.7% of subjects with CDR 0.5 and 5.9% of subjects with CDR 1 had clinically significant depressive symptoms (>or= 8 on CSDD). Score on CSDD correlated positively with duration of cognitive symptoms, scores on CIRS and CMMSE in linear regression model. In a logistic regression model, male gender, duration of cognitive symptoms, CIRS and CMMSE was associated with increased risk for clinically significant depressive symptoms. CONCLUSIONS: In our sample, milder forms of cognitive impairment were associated with increased risk for depression in the presence of other risk factors such as male gender, higher physical illness burden and longer duration of cognitive symptoms.