Glycaemic control and microvascular complications among paediatric type 2 diabetes mellitus patients in Hong Kong at 2 years after diagnosis.

INTRODUCTION: Type 2 diabetes mellitus (T2DM) is becoming increasingly common among children and adolescents worldwide, including those in Hong Kong. This study analysed the characteristics and prevalence of microvascular complications among paediatric T2DM patients in Hong Kong at diagnosis and 2 years after diagnosis. METHODS: All patients aged <18 years who had been diagnosed with DM at public hospitals in Hong Kong were recruited into the Hong Kong Childhood Diabetes Registry. Data collected at diagnosis and 2 years after diagnosis were retrospectively retrieved from the Registry for patients diagnosed from 2014 to 2018. RESULTS: Median haemoglobin A1c (HbA1c) levels were 7.5% (n=203) at diagnosis and 6.5% (n=135) 2 years after diagnosis; 59.3% of patients achieved optimal glycaemic control (HbA1c level <7%) at 2 years. A higher HbA1c level at diagnosis was associated with worse glycaemic control at 2 years (correlation coefficient=0.39; P<0.001). The presence of dyslipidaemia (adjusted odds ratio [aOR]=3.19; P=0.033) and fatty liver (aOR=2.50; P=0.021) at 2 years were associated with suboptimal glycaemic control. Diabetic neuropathy and retinopathy were rare in our cohort, but 18.6% of patients developed microalbuminuria (MA) within 2 years after diagnosis. Patients with MA had a higher HbA1c level at 2 years (median: 7.2% vs 6.4%; P=0.037). Hypertension was a risk factor for MA at 2 years, independent of glycaemic control (aOR=4.61; P=0.008). CONCLUSION: These results highlight the importance of early diagnosis and holistic management (including co-morbidity management) for paediatric T2DM patients.

Are we making good use of our public resources? The false-positive rate of screening by fundus photography for diabetic macular oedema.

INTRODUCTION: A large proportion of patients diagnosed with diabetic maculopathy using fundus photography and hence referred to specialist clinics following the current screening guidelines adopted in Hong Kong and United Kingdom are found to be false-positive, implying that they did not have macular oedema. This study aimed to evaluate the false-positive rate of diabetic maculopathy screening using the objective optical coherence tomography scan. METHODS: This was a cross-sectional observational study. Consecutive diabetic patients from the Hong Kong West Cluster Diabetic Retinopathy Screening Programme with fundus photographs graded R1M1 were recruited between October 2011 and June 2013. Spectral-domain optical coherence tomography imaging was performed. Central macular thickness of ≥300 µm and/or the presence of optical coherence tomography signs of diabetic macular oedema were used to define the presence of diabetic macular oedema. Patients with conditions other than diabetes that might affect macular thickness were excluded. The mean central macular thickness in various subgroups of R1M1 patients was calculated and the proportion of subjects with central macular thickness of ≥300 µm was used to assess the false-positive rate of this screening strategy. RESULTS: A total of 491 patients were recruited during the study period. Of the 352 who were eligible for analysis, 44.0%, 17.0%, and 38.9% were graded as M1 due to the presence of foveal 'haemorrhages', 'exudates', or 'haemorrhages and exudates', respectively. The mean (±standard deviation) central macular thickness was 265.1±55.4 µm. Only 13.4% (95% confidence interval, 9.8%-17.0%) of eyes had a central macular thickness of ≥300 µm, and 42.9% (95% confidence interval, 37.7%-48.1%) of eyes had at least one optical coherence tomography sign of diabetic macular oedema. For patients with retinal haemorrhages only, 9.0% (95% confidence interval, 4.5%-13.5%) had a central macular thickness of ≥300 µm; 23.2% (95% confidence interval, 16.6%-29.9%) had at least one optical coherence tomography sign of diabetic macular oedema. The false-positive rate of the current screening strategy for diabetic macular oedema was 86.6%. CONCLUSION: The high false-positive rate of the current diabetic macular oedema screening adopted by the United Kingdom and Hong Kong may lead to unnecessary psychological stress for patients and place a financial burden on the health care system. A better way of screening is urgently needed. Performing additional spectral-domain optical coherence tomography scans on selected patients fulfils this need.

Application of transport phenomena analysis technique to cerebrospinal fluid.

The study of hydrocephalus and the modeling of cerebrospinal fluid flow have proceeded in the past using mathematical analysis that was very capable of prediction phenomenonologically but not well in physiologic parameters. In this paper, the basis of fluid dynamics at the physiologic state is explained using first established equations of transport phenomenon. Then, microscopic and molecular level techniques of modeling are described using porous media theory and chemical kinetic theory and then applied to cerebrospinal fluid (CSF) dynamics. Using techniques of transport analysis allows the field of cerebrospinal fluid dynamics to approach the level of sophistication of urine and blood transport. Concepts such as intracellular and intercellular pathways, compartmentalization, and tortuosity are associated with quantifiable parameters that are relevant to the anatomy and physiology of cerebrospinal fluid transport. The engineering field of transport phenomenon is rich and steeped in architectural, aeronautical, nautical, and more recently biological history. This paper summarizes and reviews the approaches that have been taken in the field of engineering and applies it to CSF flow.

Development and validation of a method for determination of residues of 15 pyrethroids and two metabolites of dithiocarbamates in foods by ultra-performance liquid chromatography-tandem mass spectrometry.

This paper reports a novel approach for the detection, confirmation, and quantification of 15 selected pyrethroid pesticides, including pyrethins, and two metabolites of dithiocarbamates in foods by ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS-MS). The proposed method makes use of a modified QuEChERS (quick, easy, cheap, effective, rugged, and safe) procedure that combines isolation of the pesticides and sample cleanup in a single step. Analysis of pyrethroids and dithiocarbamate metabolites was performed by UPLC-MS-MS operated with electrospray and atmospheric pressure chemical ionization, respectively. Two specific precursor-product ion transitions were acquired per target compound in multiple reaction monitoring (MRM) mode. Such acquisition achieved the minimum number of identification points according to European Commission (EC) document no. SANCO/10684/2009, thus fulfilling the EC point system requirement for identification of contaminants in samples. The method was validated with a variety of food samples. Calibration curves were linear and covered from 1 to 800 µg kg(-1) in the sample for all target compounds. Average recoveries, measured at mass fractions of 10 and 100 µg kg(-1) for pyrethroids and 5 and 50 µg kg(-1) for dithiocarbamate metabolites, were in the range of 70-120% for all target compounds with relative standard deviations below 20%. Method limits of quantification (MLOQ) were 10 µg kg(-1) and 5 µg kg(-1) for pyrethroids and dithiocarbamate metabolites, respectively. The method has been successfully applied to the analysis of 600 food samples in the course of the first Hong Kong total diet study with pyrethroids and metabolites of dithiocarbamates being the pesticides determined.

Endoscopic carpal tunnel release: experience of surgical outcome in a Chinese population.

OBJECTIVE: To review the outcomes of endoscopic carpal tunnel release in a Hong Kong public hospital and identify any predictive factors. DESIGN: Retrospective study. SETTING: Regional hospital with a hand surgery service, Hong Kong. PATIENTS: Between January 2001 and December 2007, records of 145 patients (160 carpal tunnel syndromes) having endoscopic release were reviewed. Five major symptom domains (pain, numbness, nocturnal awakening, weakness, and clumsiness) before and after the operation were scrutinised. Functional status was assessed by grading key pinch and hand grip, as well as complications. INTERVENTION: Endoscopic carpal tunnel release using the modified Chow's extrabursal technique under intravenous anaesthesia. RESULTS: After the 160 procedures performed, 124 (78%) and 132 (83%) of them revealed improvement in terms of numbness and nocturnal awakening, respectively. Also, there were significant improvements in terms of average functional grading of pinch power and grip power. No serious complications due to the surgery were encountered. CONCLUSIONS: Experience using the Chow's two-portal endoscopic technique for the treatment of carpal tunnel syndrome in the Chinese population was encouraging. It was a safe and effective method for treating carpal tunnel syndrome. We advocate endoscopic surgical intervention for patients with refractory relief of symptoms following conservative management.

Seasonal and spatial variation of solvent extractable organic compounds in fine suspended particulate matter in Hong Kong.

The results of a 12-month study of more than 100 solvent extractable organic compounds (SEOC) in particulate matter (PM) less than or equal to 2.5 microm (PM2.5) collected at three air monitoring stations located at roadside, urban, and rural sites in Hong Kong are reported. The total yield of SEOC that accounts for approximately 8-18% of organic carbon (OC) determined by a thermal optical transmittance method was 125-2060 ng/m3, which included 14.6-128 ng/m3 resolved aliphatic hydrocarbons, 39.4-1380 ng/m3 unresolved complex mixtures, 0.6-17.2 ng/m3 polycyclic aromatic hydrocarbons, 41.6-520 ng/m3 fatty acids, and < 0.1-12.1 ng/m3 alkanols. Distinct seasonal variations (summer/winter differences) were observed with higher concentrations of the total and each class of SEOC in the winter and lower concentrations in the summer. Spatial variations are also obvious, with the roadside samples having the highest concentrations of SEOC and the rural samples having the lowest concentrations in all seasons. Characteristic ratios of petroleum hydrocarbons, such as carbon preference index, unresolved to resolved components, and carbon number with maximum concentration, suggest that PM2.5 carbon in Hong Kong originates from both biogenic and anthropogenic sources. The proportion of SEOC in PM2.5 from anthropogenic sources is estimated.

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.

Atorvastatin lowers C-reactive protein and improves endothelium-dependent vasodilation in type 2 diabetes mellitus.

Endothelial dysfunction is frequently found in diabetic subjects. This study was performed to investigate whether atorvastatin therapy was able to reverse endothelial dysfunction in type 2 diabetes and, if so, whether the effect was due to its antiinflammatory action. Eighty patients (baseline low density lipoprotein, 4.37 +/- 0.71 mmol/liter) were randomized to atorvastatin (10 mg daily for 3 months, followed by 20 mg daily for 3 months) or placebo in a double blind study. Endothelial function was assessed by high resolution vascular ultrasound, and high sensitivity C-reactive protein (CRP) was assessed by immunoturbidimetric assay. Diabetic patients had higher CRP (P < 0.01) than matched nondiabetic controls, and both endothelium-dependent and independent vasodilation were impaired (P < 0.01). Atorvastatin (10 and 20 mg) lowered plasma cholesterol by 32.9% and 38.0%, triglyceride by 15.4% and 23.1%, and low density lipoprotein by 43.4% and 50.1%, respectively. At 6 months, plasma CRP decreased in the atorvastatin group compared with baseline (P < 0.05). Endothelium-dependent vasodilation improved in the atorvastatin group compared with the placebo group (P < 0.05). The percent change in endothelium-dependent vasodilation at 6 months correlated with the percent change in CRP (r = -0.44; P < 0.05), but not with changes in plasma lipids. In conclusion, treatment with atorvastatin in type 2 diabetes led to a significant improvement in endothelium-dependent vasodilation, which might be partly related to its anti-inflammatory effect.

Day case hematuria diagnostic service: use of ultrasonography and flexible cystoscopy.

OBJECTIVES: To assess the efficacy of a day case diagnostic service employing ultrasonography and flexible cystoscopy in the evaluation of patients presenting with painless gross hematuria. METHODS: From July 1994 to June 1997 a prospective study was conducted for 312 consecutive patients presenting with painless gross hematuria. They were evaluated in a day case diagnostic service setting, where ultrasonography and flexible cystoscopy were performed together with other laboratory investigations. Intravenous urography was subsequently performed for possible additional diagnostic information. RESULTS: Eighty-one urinary malignancies were detected in 78 patients; 51 were carcinoma of the bladder, and the next most common was renal cell carcinoma (n = 15). Definitive diagnoses were made in 68 patients and an abnormality was noted in 9 other patients after the day case workup. The day case diagnostic workup has led to highly selective use of computed tomography scans with high diagnostic yield; intravenous urography only added important diagnostic information, not available from the earlier workup, in 9 patients. CONCLUSIONS: Day case diagnostic service is a feasible arrangement. By combining ultrasonography and flexible cystoscopy, most carcinomas were diagnosed and abnormalities detected. Such a service enhances rapid completion of diagnostic workup, and operations for surgical conditions can be scheduled more promptly.

Traumatic aneurysm from shaken baby syndrome: case report.

OBJECTIVE AND IMPORTANCE: We present a 6-week-old infant who developed a traumatic aneurysm from clearly documented shaken baby syndrome. Despite the theoretical similarity in the mechanism of such injuries, this is the first aneurysm reported that resulted from such a cause. The infant is also the youngest reported patient to have suffered from a traumatic aneurysm. CLINICAL PRESENTATION: Police records documented shaking of the child as well as direct impact on the child's head. Three weeks later, the patient developed an intracerebral hemorrhage, which was revealed by angiography to have resulted from a pericallosal artery aneurysm. TECHNIQUE: The aneurysm was totally resected through a porencephalic cyst, which had developed secondary to ischemic injury to the brain. CONCLUSION: The temporal course, as well as the location of this traumatic aneurysm, is similar to that in older patients.

Reversal of increased intracranial pressure with removal of a torcular epidermoid: case report.

OBJECTIVE AND IMPORTANCE: Venous obstruction has been postulated as a cause of increased intracranial pressure, but it has been documented rarely. We present a case of obstruction of the torcula by a slow-growing epidermoid. The tumor caused increased intracranial pressure, which was relieved when it was excised. In addition, the torcular epidermoid is associated with a bifid straight sinus. CLINICAL PRESENTATION: A 35-year-old man presented with a headache and a lump on the back of the head. Physical examination revealed a firm, bony lesion approximately 4 x 4 cm in size. Lumbar puncture demonstrated an intraspinal pressure of 39 cm H2O. Neuroradiological studies revealed an epidermoid that compressed and almost completely occluded the torcula. INTERVENTION: After the tumor was resected, the intraspinal pressure decreased to 19 cm H2O and remained stable 6 months later. CONCLUSION: Pure venous obstruction causes increased intracranial pressure. Removal of the obstruction relieves the intracranial hypertension. In addition, computed tomographic venography is a safe and easy method of documenting torcular anatomy, and it was useful in the follow-up of this patient. Computed tomographic venography can demonstrate a double straight sinus, which is a congenital variant that may be associated with the epidermoid.

Fatty acids, Part X. Raman spectra of all dimethylene interrupted methyl cis, cis-octadecadienoates and octadecadiynoates.

The Raman spectra of all the dimethylene interrupted methyl cis, cis-octadecadienoates and octadecadiyonates have been studied. The Raman band positions and their relative intensities for the v(C=C),v(C=C),v(C-H) and beta (CH2) modes are recorded. The height intensity of the bands arising from v(C=C) relative to v(C=O) provides a means of determining the number of cis-ethylenic bonds in a mono-ester. In the acetylenic series, the intensity of the bands arising from v(C=C) relative to v(C=O) failed to indicate with certainty the number of acetylenic bonds in the mono-esters studied, due to the weak intensity of the band due to v(C=O). However a better correlation between the relative intensities of the v(C=C) and beta (CH2) bands is established instead. An attempt to correlate the areas under the bands due to v(C=C), (C=C), (C=O) and beta (CH2) failed to produce any significant results. The Raman spectra of the methyl octadec-cis-10-en-5-ynoate and methyl octadeca-5, 10-diynoate are also recorded.

Bilateral hypoglossal nerve injury with occipital condylar fracture.

BACKGROUND: A 20-year-old woman with a right occipital condylar fracture and bilateral hypoglossal nerve injury is presented. Only 17 cases of condylar fracture have been reported in the literature. METHODS: The patient was evaluated with plain films, coronal and axial cut CT, and MRI. RESULTS: MRI showed a severely distorted but otherwise normal medulla and a displaced condylar bone fragment. CONCLUSION: Condylar fracture may cause twelfth nerve palsy by injuring the central or peripheral nerve.

Conservative therapy of atlantoaxial osteomyelitis. A case report.

STUDY DESIGN: A rare case of C1-C2 vertebral osteomyelitis treated conservatively is described. The radiologic findings as well as the follow-up evaluation are reported. OBJECTIVE: To increase knowledge about the pathogenesis and treatment of vertebral osteomyelitis in the high cervical region. SUMMARY OF BACKGROUND DATA: This is one of the first cases reported of successful conservative treatment of osteomyelitis at this level. METHODS: In a 58-year-old man with lumbar staphylococcal infection, a subsequent cervical infection developed. Because the lumbar spondylitis was treated promptly, the cervical osteomyelitis was treated at a very early stage of development. RESULTS: Operative decompression is the treatment most often used in osteomyelitis at the C1-C2 level. This is an extremely unusual circumstance in which early treatment of the infection negated the need for surgery. CONCLUSION: Conservative treatment of osteomyelitis at the C1-C2 level can be efficacious in the correct setting.

Treatment of hemispheric collapse and herniation beneath the falx in a case of shunted hydrocephalus.

A successfully treated case of inversion and herniation of a cerebral hemisphere beneath the falx is reported. This condition resulted from large subdural hematomas as a complication of shunting in advanced hydrocephalus. The subdural collections were evacuated gradually while ventricular cerebrospinal fluid was replenished through the externalized ventricular catheter. The patient showed substantial recovery of neurological function. Tolerance of such massive cerebral herniation demonstrates a remarkable ability of the thin hydrocephalic cortical mantle to function after extreme distortion.

Spinal leptomeningeal metastasis from cerebral glioblastoma. Appearance on magnetic resonance imaging.

A case of circumferential leptomeningeal metastasis to the spinal cord from an intracranial glioblastoma multiforme (spinal meningeal gliomatosis) is presented. The clinical, radiographic, and pathological features are described. Spinal magnetic resonance imaging with gadolinium-diethylenetriaminepentaacetic acid accurately demonstrated the spread of disease when compared with autopsy findings. The value of spinal magnetic resonance imaging in patients with symptoms attributable to cerebrospinal fluid metastases is discussed.

Ultrasonographic analysis of bladder tumors.

To analyze the ultrasonographic features of bladder tumors during transabdominal ultrasonography. Ultrasonograms of consecutive patients diagnosed to have bladder tumors from August 1992 to May 1999 were reviewed retrospectively and correlated with the final histological diagnoses. Various features, including the location, size, multiplicity, shape, surface and presence of calcification, of the bladder tumors were analyzed. Of 109 patients reviewed, 104 had transitional cell carcinoma, 3 adenocarcinoma, 1 carcinosarcoma and 1 prostatic carcinoma. A total of 130 tumors (including 13 multifocal tumors) were detected with 30 (27.5%) patients having more than one tumor in the bladder. Tumor size ranged from 0.5 to 9.7 cm (mean 2.7 cm). The tumor involved the trigone (63, 48.5%), lateral wall (32, 24.6%), posterior wall (17, 13.1%), anterior wall (5, 3.8%) or was multifocal (13, 10%). Sixty-seven (51.5%) tumors were polypoidal, 47 (36.2%) were sessile and 16 (12.3%) plaque-like. The surface was regular in 50 (38.5%) tumors and irregular in 80 (61.5%) tumors. Calcified foci were noted in 54 (41.5%) tumors. There was no statistically significant correlation between ultrasonographic features. The most common appearance is a polypoid lesion arising from the trigone, but there was much variation in the ultrasonographic features of bladder tumors.

Role of ultrasonography in screening for urological malignancies in patients presenting with painless haematuria.

The objective of this study was to determine the efficacy of ultrasonography and urography in evaluating patients presenting with painless gross haematuria for urinary malignancies. From October 1992 to March 1997, 468 consecutive patients presenting with painless gross haematureia were prospectively investigated. Ultrasonography and urography were performed independently, followed by diagnostic cystoscopy and other relevant investigations. One hundred and twenty-five urinary malignancies (26.7%) were detected in 122 patients, 85 being carcinoma of bladder (85/468 patients; 18.2%), followed by renal cell carcinoma (25/468 patients; 5.3%). Ultrasonography was significantly more sensitive (83/85; 98%) in the detection of bladder tumours, compared to urography (42/78; 54%) (P < 0.05). In the upper tract, there was no significant difference in the sensitivity of lesion detection. Ultrasonography is more sensitive than urography for diagnosing urological malignancies in patients presenting with painless gross haematuria, where carcinoma of bladder is the commonest pathology. Its utilisation as an initial screening investigation is recommended. Patients diagnosed to be suffering from carcinoma of bladder by ultrasonography should be scheduled directly and promptly for therapeutic endoscopy.

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.