Upper extremity nerve transfers for acute flaccid myelitis: a systematic literature review.

BACKGROUND: Acute flaccid myelitis (AFM) is a rare disease that commonly affects young children. AFM's pathophysiology involves loss of lower motor neurons following a viral infection and induces acute asymmetric flaccid paralysis most commonly in the upper extremities. Nerve transfers have emerged as a treatment option for these patients with permanent motor deficits. OBJECTIVE: To summarize the literature and report safety and efficacy outcomes following nerve transfers for recovery of shoulder abduction and external rotation, and elbow flexion and extension in pediatric patients with AFM. Recovery of at least antigravity function was defined as a successful outcome. This systematic review was performed according to the PRISMA guidelines. The PubMed, Embase and Cochrane databases were utilized. RESULTS: Five studies comprising 44 patients (median age 2.95 years; 71% male), and 93 upper extremity nerve transfers were included. Thirty-eight patients received 65 nerve transfer procedures aiming for recovery of shoulder abduction and/or external rotation with a transfer to the axillary and/or suprascapular nerve. The recovery of shoulder abduction and external rotation was achieved in 40.7% (n = 11/27) and 60% (n = 6/10) of patients, respectively. Time from injury to surgery showed an inverse relationship with the odds for successful recovery (OR: 0.81; 95% CI: 0.64-1.02; p = 0.07); however, statistical significance was not reached. Successful recovery of elbow flexion with a transfer to the musculocutaneous was reported at a rate of 92.3% (n = 12/13). Successful re-innervation of the radial nerve with recovery of elbow extension was found in 75% (n = 6/8) of patients. No complications were reported. CONCLUSIONS: Upper extremity nerve transfers appear to be promising and safe for AFM patients. Shoulder abduction is the most challenging upper extremity function to recover. Further studies are warranted to identify whether nerve transfers are associated with superior outcomes when performed earlier.

A web-based review of global health programs in U.S. allopathic and osteopathic medical schools.

PURPOSE: There is no current centralized database of structured global health programs at U.S. medical schools and no published review in the past decade. This study aims to describe the prevalence, characteristics, and requirements of non-degree, longitudinal, structured global health programs in U.S. allopathic and osteopathic medical schools. MATERIALS AND METHODS: In July 2021, the authors performed a web-based review of existing structured global health programs for the 154 U.S. allopathic medical schools and 35 U.S. osteopathic medical schools established prior to 2019. RESULTS: Of 189 institutions examined, 74 (39%) had online information about a structured global health program. Forty-three (53%) programs reported coursework requirements, 44 (54%) required a global health experience, and one program required demonstration of language or cultural knowledge. More internally administered programs required experiential work, while more externally administered programs required didactic work. There were few differences in program requirements between allopathic and osteopathic medical schools. CONCLUSIONS: There has been a 75% increase over the past ten years in the number of U.S. allopathic medical schools with websites for structured global health programs. There appeared to be little standardization in their structure and requirements. The findings support the need for a web-based central repository for updated information regarding medical school global health curricula.

Comparison of green pit viper and Agkistrodon halys antivenom in inhibition of coagulopathy due to Trimeresurus albolabris venom: an in-vitro study using human plasma.

INTRODUCTION: There are two antivenoms that may be administered in Hong Kong following a bite by Trimeresurus albolabris: the green pit viper antivenom from the Thai Red Cross Society in Thailand and the Agkistrodon halys antivenom from the Shanghai Institute of Biological Products in China. Both are recommended by the Central Coordinating Committee of Accident and Emergency Services of the Hospital Authority for treating patients with a bite by Trimeresurus albolabris. The choice of which antivenom to use is based on physician preference. This study aimed to compare the relative efficacy of the two antivenoms. METHODS: This in-vitro experimental study was carried out by a wildlife conservation organisation and a regional hospital in Hong Kong. Human plasma from 40 adult health care worker volunteers was collected. The Trimeresurus albolabris venom was added to human plasma and the mixture was assayed after incubation with each antivenom (green pit viper and Agkistrodon halys) using saline as a control. Fibrinogen level and clotting time in both antivenom groups were studied. RESULTS: The mean fibrinogen level was elevated from 0 g/L to 2.86 g/L and 1.11 g/L after the addition of green pit viper antivenom and Agkistrodon halys antivenom, respectively. When mean clotting time was measured, the value was 6.70 minutes in the control, prolonged to more than 360 minutes by green pit viper antivenom and to 19.06 minutes by Agkistrodon halys antivenom. CONCLUSIONS: Green pit viper antivenom was superior to Agkistrodon halys antivenom in neutralisation of the thrombin-like and hypofibrinogenaemic activities of Trimeresurus albolabris venom.

Genome sequence of a polerovirus isolated from wild oat in Australia.

We present the genome sequence of a polerovirus (family Solemoviridae) isolated from wild oat (Avena fatua) in Australia. The genome sequence consists of 5,631 nucleotides and shares 87% nucleotide identity with its closest relative, cereal yellow dwarf virus RPV isolate 010 (GenBank accession number EF521830).

Retrospective review of clinical presentations, microbiology, and outcomes of patients with psoas abscess.

OBJECTIVE: The clinical features of patients with psoas abscess in a local setting, including the microbiology, incidence and aetiologies, have not been well described. This study aimed to review such clinical features and patient outcomes. DESIGN: Retrospective case series. SETTING: Regional hospital, Hong Kong. PATIENTS: Adults (aged ≥18 years) with psoas abscess admitted to Tuen Mun Hospital from 1 January 2006 to 31 December 2010 were included. The clinical presentations, aetiologies, microbiology, treatments, hospital stays, intensive care unit admissions, and outcomes of these patients were reviewed. RESULTS: The series entailed 42 patients, five of whom developed their psoas abscess after admission and seven were intravenous drug abusers. The most common presenting symptom in community-onset cases was back, hip, or thigh pain (43% [16/37]). Fever was present at presentation in 41% (15/37) of these patients, four of whom presented with fever only. The diagnosis was made by computed tomography in 95% (40/42) of these cases. In all, 23 abscesses were considered secondary; the most common aetiology being infective spondylitis or spondylodiscitis. The commonest causative organism for a primary psoas abscess was methicillin-sensitive Staphylococcus aureus, while for secondary abscesses they were more commonly from the gastro-intestinal and genitourinary tracts. Overall in-hospital mortality rate was 14% (6/42). Secondary psoas abscess patients had longer hospital stays (mean, 62 vs 34 days; P=0.007). CONCLUSION: Psoas abscess is an uncommon condition. Most patients presented with only non-specific symptoms leading to difficulty in making an early diagnosis. In more than half of these patients, the psoas abscesses were secondary, the aetiology of which differed from reported overseas experience.

Culturally sensitive, preventive antenatal group cognitive-behavioural therapy for Chinese women with depression.

Postnatal depression (PND) affects 10-15% of postnatal women worldwide, yet it is poorly recognized and managed. Among the psychological interventions, which are used to manage PND, cognitive-behavioural therapy was found to be effective and promising. In the past decade, research efforts have focused on developing effective antenatal interventions to prevent PND. Strong antenatal predictors such as antenatal depressive symptoms have been identified for targeted early intervention or prevention to help reduce the risk of developing depression after childbirth. However, the findings regarding effectiveness of antenatal preventive interventions have been inconsistent. Based on the reports of previous studies, a brief group antenatal intervention using cognitive-behavioural approach is necessary, particularly one with sensitivity for Chinese woman. This paper reports the details of a nurse-led cognitive-behavioural programme developed and tested in, and for use with a sample of Hong Kong pregnant women. The trial run showed that the programme was feasible to be implemented and well received by the participants.

Green pit viper antivenom from Thailand and Agkistrodon halys antivenom from China compared in treating Cryptelytrops albolabris envenomation of mice.

OBJECTIVE: To compare the relative efficacy of the green pit viper antivenom from Thailand and Agkistrodon halys antivenom from China. DESIGN. In-vivo experimental study. SETTING: A wildlife conservation organisation, a university, a poison information centre, and a regional hospital in Hong Kong. MAIN OUTCOME MEASURES: Pre- and post-antivenom lethal dose 50 (LD50) of the Cryptelytrops albolabris venom, median effective dose (ED50) of green pit viper antivenom and Agkistrodon halys antivenom against a lethal dose of the venom. SUBJECTS. Adult mice. RESULTS: The intraperitoneal LD50 of the venom from locally caught Cryptelytrops albolabris was 0.14 microL. After post-exposure treatment with 10 microL of antivenom, it was elevated to 0.36 microL and 0.52 microL by the green pit viper antivenom and the Agkistrodon halys antivenom, respectively. The ED50 was 32.02 microL for green pit viper antivenom and 6.98 microL for Agkistrodon halys antivenom. Both green pit viper antivenom and Agkistrodon halys antivenom ameliorated the lethality of Cryptelytrops albolabris venom in mice. CONCLUSION: The overall superior neutralisation capacity of Agkistrodon halys antivenom over green pit viper antivenom may be related to the geographic proximity of the venoms used for antivenom preparation. The results point towards the need for further comparison of the two antivenoms on protein or immunoglobulin weight basis, and with respect to non-lethal clinically significant toxicities.

The role of cryopreservation in the biomechanical properties of the intervertebral disc.

Implantation of intervertebral disc (IVD) allograft or tissue engineered disc constructs in the spine has emerged as an alternative to artificial disc replacement for the treatment of severe degenerative disc disease (DDD). Establishment of a bank of cryopreserved IVD allografts enables size matching and facilitates logistics for effective clinical management. However, the biomechanical properties of cryopreserved IVDs have not been previously reported. This study aimed to assess if cryopreservation with different concentrations of cryopreservant agents (CPA) would affect the dynamic viscoelastic properties of the IVD. Whole porcine lumbar IVDs (n = 40) were harvested and processed using various concentrations of CPA, 0 % CPA, 10 % CPA and 20 % CPA. The discs were cryopreserved using a stepwise freezing protocol and stored in liquid nitrogen. After four weeks of storage, the cryopreserved IVDs were quickly thawed at 37 °C for dynamic viscoelastic testing. The apparent modulus, elastic modulus (G'), viscous modulus (G") and loss modulus (G"/G') were calculated and compared to a fresh control group. Cryopreserved IVD without cryopreservants was significantly stiffer than the control. In the dynamic viscoelastic testing, cryopreservation with the use of CPA was able to preserve both G' and G" of an IVD. No significant differences were found between fresh IVD and IVD cryopreserved with 10 % CPA or 20 % CPA. This study demonstrated that CPAs at an optimal concentration could preserve the mechanical properties of the IVD allograft and can provide further credence for the application of long-term storage of IVD allografts for disc transplantation or tissue engineered construct applications.

Centipede bite victims: a review of patients presenting to two emergency departments in Hong Kong.

OBJECTIVE. To review the clinical characteristics of patients presenting after centipede bites in Hong Kong. DESIGN. Descriptive case series. SETTING. Emergency departments of two public hospitals in Hong Kong. PATIENTS. Patients presenting after centipede bites between 2006 and 2010. MAIN OUTCOME MEASURES. Demographics, time and locations of bites, symptoms and signs, treatments and outcomes. RESULTS. A total of 46 relevant patient records were retrieved. The bites were frequently at night, indoors, on lower limbs, and consistently resulted in pain. The majority of the victims were treated with analgesia, anti-histamines, and antibiotics. One patient developed necrosis and five re-attended for delayed pruritus and relapsed/recurrent swelling. CONCLUSIONS. Centipede bites are usually uncomplicated, but may lead to necrosis or delayed hypersensitive reactions.

The mushroom ribosome-inactivating protein lyophyllin exerts deleterious effects on mouse embryonic development in vitro.

Earlier investigations disclose that some plant ribosome-inactivating proteins (RIPs) adversely affect mouse embryonic development. In the present study, a mushroom RIP, namely lyophyllin from Lyophyllum shimeji, was isolated, partially sequenced, and its translation inhibitory activity determined. Its teratogenicity was studied by using a technique entailing microinjection and postimplantation whole-embryo culture. It was found that embryonic abnormalities during the period of organogenesis from E8.5 to E9.5 were induced by lyophyllin at a concentration as low as 50 microg/ml, and when the lyophyllin concentration was raised, the number of abnormal embryos increased, the final somite number decreased, and the abnormalities increased in severity. The affected embryonic structures included the cranial neural tube, forelimb buds, branchial arches, and body axis, while optic and otic placodes were more resistant. Lyophyllin at a concentration higher than 500 microg/ml also induced forebrain blisters within the cranial mesenchyme. When the abnormal embryos were examined histologically, an increase of cell death was found to be associated with abnormal structures, indicating that cell death may be one of the underlying causes of teratogenicity of the mushroom RIP. This constitutes the first report on the teratogenicity of a mushroom RIP.

Proteins with antifungal properties and other medicinal applications from plants and mushrooms.

Living organisms produce a myriad of molecules to protect themselves from fungal pathogens. This review focuses on antifungal proteins from plants and mushrooms, many of which are components of the human diet or have medicinal value. Plant antifungal proteins can be classified into different groups comprising chitinases and chitinase-like proteins, chitin-binding proteins, cyclophilin-like proteins, defensins and defensin-like proteins, deoxyribonucleases, embryo-abundant protein-like proteins, glucanases, lectins, lipid transfer proteins, peroxidases, protease inhibitors, ribonucleases, ribosome-inactivating proteins, storage 2S albumins, and thaumatin-like proteins. Some of the aforementioned antifungal proteins also exhibit mitogenic activity towards spleen cells, nitric oxide inducing activity toward macrophages, antiproliferative activity toward tumor cells, antibacterial activity, and inhibitory activity toward HIV-1 reverse transcriptase. In contrast to the large diversity of plant antifungal proteins, only a small number of mushroom antifungal proteins have been reported. Mushroom antifungal proteins are distinct from their plant counterparts in N-terminal sequence. Nevertheless, some of the mushroom antifungal proteins have been shown to inhibit HIV-1 reverse transcriptase activity and tumor cell proliferation.

Nipah virus: a recently emergent deadly paramyxovirus.

A paramyxovirus virus termed Nipah virus has been identified as the etiologic agent of an outbreak of severe encephalitis in people with close contact exposure to pigs in Malaysia and Singapore. The outbreak was first noted in late September 1998 and by mid-June 1999, more than 265 encephalitis cases, including 105 deaths, had been reported in Malaysia, and 11 cases of encephalitis or respiratory illness with one death had been reported in Singapore. Electron microscopic, serologic, and genetic studies indicate that this virus belongs to the family Paramyxoviridae and is most closely related to the recently discovered Hendra virus. We suggest that these two viruses are representative of a new genus within the family Paramyxoviridae. Like Hendra virus, Nipah virus is unusual among the paramyxoviruses in its ability to infect and cause potentially fatal disease in a number of host species, including humans.

Measuring performance to drive improvement: development of a clinical indicator set for general medicine.

BACKGROUND: There are delays in implementing evidence about effective therapy into clinical practice. Clinical indicators may support implementation of guideline recommendations. AIM: To develop and evaluate the short-term impact of a clinical indicator set for general medicine. METHODS: A set of clinical process indicators was developed using a structured process. The indicator set was implemented between January 2006 and December 2006, using strategies based on evidence about effectiveness and local contextual factors. Evaluation included a structured survey of general medical staff to assess awareness and attitudes towards the programme and qualitative assessment of barriers to implementation. Impact on documentation of adherence to clinical indicators was assessed by auditing a random sample of medical records before (2003-2005) and after (2006) implementation. RESULTS: Clinical indicators were developed for the following areas: venous thromboembolism, cognition, chronic heart failure, chronic obstructive pulmonary disease, diabetes, low trauma fracture, patient written care plans. The programme was well supported and incurred little burden to staff. Implementation occurred largely as planned; however, documentation of adherence to clinical indicators was variable. There was a generally positive trend over time, but for most indicators this was independent of the implementation process and may have been influenced by other system improvement activities. Failure to demonstrate a significant impact during the pilot phase is likely to have been influenced by administrative factors, especially lack of an integrative data documentation and collection process. CONCLUSION: Successful implementation in phase two is likely to depend upon an effective data collection system integrated into usual care.

Early upregulation of cyclooxygenase-2 in human papillomavirus type 16 and telomerase-induced immortalization of human esophageal epithelial cells.

BACKGROUND AND AIM: Cyclooxygenase-2 (COX-2) plays an important role in the carcinogenesis of esophageal squamous cell carcinoma (ESCC). However, it is not clear whether COX-2 is involved in the early or late stage of the development of ESCC. The aim of this study was to investigate the role of COX-2 in the carcinogenesis of ESCC by an immortalized esophageal epithelial cell line. METHODS: Human papillomavirus type 16 (HPV16)-E6/E7 and human telomerase reverse transcriptase (hTERT) transfection were used for immortalization of esophageal epithelial cells. COX-2-specific RNA interference was used for the inhibition of COX-2 expression. RESULTS: An immortalized esophageal epithelial cell line, NE6-E6E7/hTERT, was established, which had high proliferation activity but failed to induce colony formation in soft agar. COX-2 expression was upregulated in the early process of immortalization, while COX-2 small interfering RNA (siRNA) decreased the Bcl-2 expression, increased the expression of Bax, and induced cell-cycle arrest at the G0/G1 phase in NE6-E6E7/hTERT cells. Expressions of p53, cyclinD1, and the ratio of hyperphosphorylated-RB/hypophosphorylated-RB were progressively increased after E6E7 and the subsequent hTERT transfections. These changes were accompanied by the alteration of COX-2 expression, but could be reversed by COX-2 siRNA (P < 0.05). P16 expression was significantly downregulated in NE6-E6E7 or NE6-E6E7/hTERT cells (P < 0.05), and was not affected by COX-2 siRNA. CONCLUSIONS: Our results suggest that induction of cyclooxygenase-2 is essential in the human papillomavirus type 16 and hTERT-induced immortalization of human esophageal epithelial cells, and that COX-2 inhibition may be a potential target to block the carcinogenesis of ESCC at the precancerous stage.

On stent-graft models in thoracic aortic endovascular repair: a computational investigation of the hemodynamic factors.

In treating thoracic aortic diseases, endovascular repair involves the placement of a self-expanding stent-graft system across the diseased thoracic aorta. Computational fluid dynamic techniques are applied to model the blood flow by numerically solving the three-dimensional continuity equation and the time-dependent Navier-Stokes equations for an incompressible fluid. From our results, high blood pressure level and high systolic slope of the pressure waveform will significantly increase the drag force on a stent-graft whereas high blood viscosity causes only a mild increase. It indicates that hemodynamic factors might have an important impact on the drag force and thus play a significant role in the risk of stent-graft failure.

Gastric acid secretion is abnormally sensitive to endogenous gastrin released after peptone test meals in duodenal ulcer patients.

We studied 25 duodenal ulcer patients and 14 age- and sex-matched normal controls to determine whether gastric acid secretion in duodenal ulcer patients is abnormally sensitive to stimulation by gastrin endogenously released in response to meals. Acid response to saline and to 0.5, 1.0, 2.0, 4.0, and 8.0% peptone infused into the stomach was measured by 30 min intragastric titration. Total serum gastrin (G-total) and serum heptadecapeptide gastrin (G17), fasting and 30 min after each test meal, were measured by specific radioimmunoassays. In 19 ulcer patients and 11 normal subjects (controls), acid response to graded doses (11, 33, 100, and 300 pmol kg(-1) h(-1)) of G17-I were also measured. Mean acid output in response to each dose of peptone was significantly higher in duodenal ulcer patients than in the controls. Gastrin levels in ulcer patients and controls were not significantly different. Within individual patients and controls, both G-total and G17 were significantly correlated with meal-stimulated acid output regardless of whether the absolute, basal-corrected, or distention-corrected values for acid output were examined (median r ranged from 0.82 to 0.94, P < 0.001). From the individual regression lines, the gastrin concentrations corresponding to half of the highest observed meal-stimulated acid response (D(50m)) were calculated. Mean D(50m) for G-total and G17 were significantly lower in duodenal ulcer patients than in controls both in the overall group and in pairs of ulcer patients and controls matched on the basis of highest observed meal-stimulated acid responses, or on the basis of maximal acid output in response to synthetic human G17. The dose of exogenously administered G17 required for half maximal G17 acid response mean D(50g), was significantly less in patients than in control subjects. In both ulcer and control subjects, D(50g) correlated significantly with D(50m). This and the significant correlation between meal-stimulated G17 and acid response strongly suggest that the endogenously released gastrin was responsible for most, if not all, of the postpeptone acid output.We conclude that after peptone test meals, gastric acid secretion in duodenal ulcer patients was abnormally sensitive to stimulation by endogenously released gastrin.

Efficacy of tegaserod for functional constipation in Chinese subjects: a randomized double-blind controlled trial in a single centre.

BACKGROUND: Tegaserod has been shown to be effective in chronic constipation in Western population. Aim We investigated if tegaserod is equally effective in Chinese population. MATERIALS AND METHODS: Two hundred and fifty patients were randomized to a double-blinded 8-week treatment of tegaserod 6 mg b.d. or placebo. Response during weeks 1-4 was defined as an increase in complete spontaneous bowel motion >/=1/week. Secondary efficacy included response during weeks 1-8, individual symptoms and scores, quality of life and global assessment of bowel habits and constipation. RESULTS: One hundred and nine patients from the treatment group and 107 from the placebo group completed the 8-week treatment. Responder rates was 47.7% vs. 29% for the treatment and placebo groups (P = 0.005). The sustained complete spontaneous bowel motion rate was 29.4% vs. 15.7% in the two groups (P = 0.016). The response rates were higher than that reported previously in the Caucasian studies. There was improvement in the scores for stool form scale, bothersomeness of constipation, abdominal distension/bloating and satisfaction of bowel habit (P < 0.05). The mental score was higher in the treatment group (46.8 +/- 9 vs. 43.6 +/- 10, P = 0.01). CONCLUSIONS: Tegaserod is effective in relieving chronic constipation in Chinese population. The efficacy observed may be higher than that in Western population.

Positive association between gastro-oesophageal reflux disease and irritable bowel syndrome in a Chinese population.

BACKGROUND: Gastro-oesophageal reflux disease and irritable bowel syndrome are common diseases which may be related. AIM: To examine the association between gastro-oesophageal reflux disease and irritable bowel syndrome in Chinese population in Hong Kong. METHODS: Randomly selected ethnic Chinese were invited to participate in a telephone survey in 1996. Gastro-oesophageal reflux disease was defined as subjects having heartburn and/or acid regurgitation once weekly or more. Irritable bowel syndrome was diagnosed according to the Rome I criteria. The association between gastro-oesophageal reflux disease and irritable bowel syndrome was calculated using a statistical model which allows the odds ratio to be measured. RESULTS: One thousand six hundred and forty-nine subjects completed the interview (response rate 62%). The population prevalence of gastro-oesophageal reflux disease and irritable bowel syndrome were 5% and 4%, respectively. Thirteen per cent of subjects with gastro-oesophageal reflux disease and 11% with irritable bowel syndrome suffered from both gastro-oesophageal reflux disease and irritable bowel syndrome. The OR of having gastro-oesophageal reflux disease and irritable bowel syndrome together was estimated to be 3 (95% CI: 1.05, 6.27) indicating a positive association between the two diseases. This association occurred predominantly in male subjects [OR = 9.3, (95% CI: 2.3, 26.2)] but not as strong in females [OR = 1.5, (95% CI: 0.3, 4.3)]. Younger subjects were statistically more prone to the two diseases. CONCLUSIONS: There is a positive association between gastro-oesophageal reflux disease and irritable bowel syndrome, and their association occurs predominantly in male subjects.

Stability of E-cadherin methylation status in gastric mucosa associated with histology changes.

BACKGROUND: We have previously shown reversal of E-cadherin methylation in gastric mucosa from patients with dyspepsia at week 6 after Helicobacter pylori-eradication therapy. But the long-term methylation status of these patients was unknown. AIM: To investigate the methylation status at E-cadherin at year 3 after H. pylori-eradication therapy. METHODS: 35 patients (25 with and 10 without H. pylori eradicated) enrolled in our previous study were recruited into the present study (year 3 analysis). Methylation at E-cadherin was evaluated by methylation-specific polymerase chain reaction method. RESULTS: There was no difference in age and sex distribution in the two groups. Methylation at E-cadherin in patients with H. pylori eradicated at weeks 0, 6 and year 3 were 52%, 20% and 20%, respectively. Concordant methylation status at week 6 and year 3 was 92%. Methylation at E-cadherin in patients without H. pylori at weeks 0, 6 and year 3 were 50%, 60% and 60%, respectively. Concordant methylation status between week 6 and year 3 was 90%. Stability of E-cadherin methylation status was associated with histological changes. No association between E-cadherin methylation status and age was observed. CONCLUSION: The methylation pattern is stable for a long period, thus suggesting the effect of environment on methylation.