Prevention-Focused Care: The Potential Role of Chiropractors in Hong Kong's Primary Healthcare Transformation.

Hong Kong's healthcare system is moving toward preventive and primary care to address the complicated demands of the aging population. Chiropractic professionals are in an advantageous position to support a prevention-focused strategy by identifying musculoskeletal problems early, reducing risks, and promoting healthy lifestyles. This article examines how the involvement of chiropractors in public health programs could improve population health in Hong Kong and boost primary care. The inclusion of chiropractors in district health centers and other initiatives would offer safer and more cost-effective choices for treating functional problems and chronic pain. Chiropractors should be involved in policymakers' attempts to create a sustainable healthcare system that meets Hong Kong's long-term healthcare requirements.

Recognizing Hong Kong Chiropractors' Sick Leave Authority: Valuing a Conservative Approach to Workers' Compensation.

Although registered under Hong Kong's legislative framework, chiropractors are not able to certify sick leave, restricting the effectiveness of their services for patients with musculoskeletal issues requiring time away from work. This paper explores the evolution of chiropractic regulation in Hong Kong, the growth of the profession, and the tardy recognition of chiropractors' power to issue sick leave certificates. The chiropractic profession and its patients have long lobbied for this authority, but the government has been slow to respond. This document presents a comprehensive analysis of the benefits and restrictions of allowing chiropractors prescriptive authority for sick leave and requests that this change in policy be considered. Developing responsible criteria for chiropractors to prescribe sick leave within their scope of practice could legitimize chiropractic's position in the population's health and interdisciplinary pain care while lowering the burden on injured workers.

Regulation of cell proliferation and adhesion by means of a novel region of drosophila merlin interacting with Sip1.

BACKGROUND: The tumor suppressor protein merlin is thought to regulate cell proliferation and cell adhesion through interaction with protein partners. Loss of merlin is associated with Neurofibromatosis Type 2 (NF2) tumors. NHERF1 or EBP50 is a scaffolding protein that functions in apical organization of polarized cells. Merlin and NHERF1 have been shown to interact in vitro in vertebrates. We investigate how the Drosophila NHERF1 orthologue, Sip1, and Merlin function to regulate cell proliferation and adhesion. RESULTS: We identify two conserved arginine residues (R325 and R335) in Merlin which, in addition to the FERM domain, are required for interaction with Sip1. Mutation of the arginine residues result in reduced Sip1 binding to Merlin and loss of Merlin growth suppressor function. Over-expression of Merlin(R325A) and/or Merlin(R335L) in Drosophila wings result in increased proliferation in the adult wing (increase in size), which is rescued by co-over-expression of constitutively active Merlin protein. Reduced Sip1 binding to Merlin also produces defects in adhesion in follicle epithelial cells. CONCLUSIONS: Sip1 facilitates the activation of Merlin as a tumor suppressor protein. Thus, our work provides insight into how Merlin functions as a tumor suppressor and in adhesion and this provides insight into the mechanism of NF2 pathogenesis.

The PP1 phosphatase flapwing regulates the activity of Merlin and Moesin in Drosophila.

The signalling activities of Merlin and Moesin, two closely related members of the protein 4.1 Ezrin/Radixin/Moesin family, are regulated by conformational changes. These changes are regulated in turn by phosphorylation. The same sterile 20 kinase-Slik co-regulates Merlin or Moesin activity whereby phosphorylation inactivates Merlin, but activates Moesin. Thus, the corresponding coordinate activation of Merlin and inactivation of Moesin would require coordinated phosphatase activity. We find that Drosophila melanogaster protein phosphatase type 1 ß (flapwing) fulfils this role, co-regulating dephosphorylation and altered activity of both Merlin and Moesin. Merlin or Moesin are detected in a complex with Flapwing both in-vitro and in-vivo. Directed changes in flapwing expression result in altered phosphorylation of both Merlin and Moesin. These changes in the levels of Merlin and Moesin phosphorylation following reduction of flapwing expression are associated with concomitant defects in epithelial integrity and increase in apoptosis in developing tissues such as wing imaginal discs. Functionally, the defects can be partially recapitulated by over expression of proteins that mimic constitutively phosphorylated or unphosphorylated Merlin or Moesin. Our results suggest that changes in the phosphorylation levels of Merlin and Moesin lead to changes in epithelial organization.

Arthroscopic hemitrapeziectomy with tendon interposition for arthritis at the first carpometacarpal joint.

The first carpometacarpal (CMC) joint, also referred to as trapeziometacarpal joint, is the area of the hand most commonly symptomatic of osteoarthritis. Although there are a variety of surgical techniques that treat this condition, this article focuses on the technical aspects of arthroscopic hemitrapeziectomy with tendon interposition. Furthermore, this study evaluated the use of arthroscopy to treat CMC arthritis, with the expectation that an arthroscopic procedure would lead to low morbidity, quick recovery of function, rapid resolution of pain, and satisfactory results in patients' strength, range of motion, and pain relief. Early outcomes data indicate that all patients experienced statistically significant improvement in their pain scale rating at a mean of 11 months after the operation. All patients were satisfied with the outcome of their surgery. All patients would choose to have this surgery again. This study supports arthroscopic hemitrapeziectomy with tendon interposition as a safe and effective treatment for CMC arthritis.

Evaluation of two techniques of partial urethral obstruction in the male rat model of bladder outlet obstruction.

OBJECTIVES: To perform a comparison to determine which of two methods of partial urethral ligation produces the most consistent outcome and fewest side effects. Such a study has not been previously reported. Partial urethral ligation is a means of causing reproducible bladder outlet obstruction. In the male rat model, partial urethral obstruction can be performed either by perineal incision and bulbous urethral ligation or retropubic incision and midprostatic obstruction. METHODS: Fifteen male Sprague-Dawley rats were studied. Five were selected for bulbous urethral obstruction through a perineal incision, five for midprostatic obstruction using a retropubic approach, and five for a sham operation through a perineal incision. RESULTS: The operative time was shorter and morbidity lower with the perineal approach compared with the retropubic approach. Inflammation or infection, or both, were seen in the prostate, bladder, proximal urethra, ureters, and kidneys in the rats in which a midprostatic obstruction was performed. The proximal urethra and prostate were mildly inflamed in those rats that underwent bulbous obstruction. Sham-operated rats exhibited mild prostatitis only. CONCLUSIONS: The perineal approach to the bulbous urethra is the method of choice for creating a partial urethral obstruction model of bladder outlet obstruction in the male rat.

Radical perineal prostatectomy: a more optimal treatment approach than laparoscopic radical prostatectomy in obese patients?

In comparison with laparoscopic radical prostatectomy (LRP), the perineal approach to radical prostatectomy offers specific technical advantages related to obesity and its unique surgical challenges. Radical perineal prostatectomy (RPP) reduces operative time and its associated risk of complication, which may be more pronounced in obese men. It allows for low blood loss, low postoperative use of narcotics for pain, short hospital stays, and requires only 1 small perineal incision. With a proven history of success, RPP presents obese men with an advantageous surgical option.

Critical surgical techniques for radical perineal prostatectomy.

PURPOSE: Radical perineal prostatectomy was historically the surgical treatment of choice for localized adenocarcinoma of the prostate until the 1980s when radical retropubic prostatectomy began to gain popularity. Nevertheless, the perineal approach possesses advantages that prompt resurgence in the interest of this classic operation. We review the relevant anatomy and our modified technique of performing a successful radical perineal prostatectomy. MATERIALS AND METHODS: The English literature pertaining to the different surgical approaches to radical perineal prostatectomy was reviewed through PubMed. Attention was paid to its indications, anatomical significance and various surgical techniques. RESULTS: Studies demonstrate no difference in the incidence of positive surgical margins and biochemical recurrence between radical retropubic and perineal prostatectomies. Furthermore, the perineal approach avoids the dorsal venous complex and better facilitates the vesicourethral anastomosis in the face of minimal pain and requirement for transfusion. We use a modified Belt approach, aiming to yield the most optimal outcome with minimal morbidity. A meticulous anatomical approach is warranted if complications such as rectal injury, incontinence and erectile dysfunction are to be minimized. CONCLUSIONS: With careful preoperative evaluation, selected patients should benefit from radical perineal prostatectomy for the management of localized prostate cancer. Familiarity with this specialized technique should be an immeasurable addition to any armamentarium in the therapy of prostatic diseases.

Dental implants in reconstructed jaws: implant longevity and peri-implant tissue outcomes.

PURPOSE: The study aimed to evaluate the clinical status and survival of dental implants inserted in reconstructed jaws, with particular reference to the peri-implant tissues. MATERIALS AND METHODS: We conducted a clinical follow-up study based on 29 rehabilitated patients after oral tumor surgery, who received autogenous bone grafts from the ilium and endosseous implants (14 maxillary and 15 mandibular cases; 140 implants) for functional jaw reconstruction between 1988 and 1999. Clinical records of the patients were reviewed retrospectively. Clinical parameters of plaque index, probing pocket depth, and bleeding on probing were assessed around the implants and control teeth at 4 locations (mesiobuccal, distobuccal, mesiolingual, and distolingual). Implant mobility was assessed clinically and objectively using a Periotest (Gulden; Siemens, Bensheim, Germany) equipment for those implants supporting removable prostheses. Radiographically, the proportion of implant length remained osseointegrated was measured. RESULTS: With a mean follow-up time of 50 months, 90.7% of the 140 implants placed were functional in supporting dental prostheses; 4.3% of implants failed in osseointegration and the remaining 5.0% implants were osseointegrated but nonfunctional. A total of 493 sites of 127 functional implants and 392 sites of 98 control teeth were assessed. No significant difference was found between the implants and control teeth parameters, except on the probing pocket depth. The mean peri-implant probing depth was 3.5 mm, and 52.7% of the measured sites were 3 mm or less. More than one third of the implants (35.9%) presented with increased probing depth (> or =4 mm), and this was significantly higher than in the control teeth (P <.001, chi(2) test). Bleeding on probing was found in 19.3% of the measured peri-implant sites, corresponding to 42.2% of the dental implants. Of the implants, 28.9% were completely free from plaque and 9.4% show visible plaque accumulation. Mobility assessment was feasible on 32 implants and no mobility was detected. Radiographically, the mean implant length remained in bone was 81.1%, with 82.6% in the maxilla and 79.4% in the mandible. Implant survival rate calculated using the Kaplan-Meier method was 86.9% for 5 years. Based on the defined criteria, the success rate of implants placed in reconstructed jaws in this study was 90.7%. CONCLUSION: Endosseous implants can be successfully placed in reconstructed jaws for oral rehabilitation with maintenance of reasonable health status of the peri-implant tissues in the long-term.

Dental implants in reconstructed jaws: patients' evaluation of functional and quality-of-life outcomes.

PURPOSE: To evaluate the quality-of-life aspect of treatment outcome following functional jaw reconstruction and dental implants in the maxilla or mandible. MATERIALS AND METHODS: This cross-sectional study used a questionnaire interview of 28 rehabilitated patients who received autogenous bone grafts from the ilium and endosseous implants (14 maxillary and 14 mandibular cases; 134 implants) for functional jaw reconstruction between 1988 and 1999. A questionnaire was developed to assess the quality-of-life outcome for those patients who had finished their rehabilitation at least 6 months prior to the interview. Responses to the questions were recorded by means of visual analog scales. RESULTS: In general, patients gave positive comments on the restoration of their orofacial appearance and function (mastication and speech). The majority (85.7%) found no problem in various daily social activities, including dining in public. DISCUSSION: The overall level of satisfaction with the treatment outcome and the degree of recommendation of the treatment to others were both favorable (mean scores 8.6 and 8.7 out of 10, respectively). CONCLUSION: Oral rehabilitation using functional jaw reconstruction can reach a satisfactory level of esthetics, function, and psychosocial well being of patients, thus improving their quality of life.

Advances in the staging of renal cell carcinoma.

Renal cell carcinoma is increasingly being diagnosed at an earlier stage owing to medical advances. Since the pathologic stage is the most crucial predictor of patient outcome, an accurate and universal tumor staging system is of utmost importance. The TNM staging system, after multiple revisions, has evolved into a more precise system that correlates with cancer specific survival. Renal cell carcinoma staging systems have important clinical implications pertaining to nephron sparing surgery and the need for adrenalectomy or lymphadenectomy.