Intimate Partner Violence Before Pregnancy, During Pregnancy, and After Childbirth: A New Conceptualization Highlighting Individual Changes in Violence Against Pregnant Women Over Time.

Intimate partner violence (IPV) against pregnant women is a global public health problem. Yet, the trajectory of IPV during pregnancy and its association with health are unclear. This study set out to investigate the trajectory of IPV by categorizing pregnant women according to changes of IPV exposure before, during, and after pregnancy and to examine the predictive factors of these IPV-related categories. During 2016 and 2017, we conducted a longitudinal study with a sample of 1,083 pregnant women in Hong Kong. Pregnant women reported their IPV experiences, depression, and demographics in the baseline survey (at about 24-week gestation), and their IPV experiences, mental health outcomes, social support, and perceived father's involvement in the follow-up survey (around 4 weeks postpartum). We categorized pregnant women into four groups, including women with (a) sustaining abusive relationship (AR); (b) relationship with decreased violence over pregnancy (DVR); (c) relationship with stress-related violence (SVR); and (d) nonviolent relationship (NVR). Although we found an overall decline of IPV during pregnancy from 24.6% to 14.3%, there were still a considerable proportion of women reporting as a victim of IPV. We observed that a higher proportion of pregnant women were actually suffering from IPV during pregnancy and after childbirth continuously (22.3% of AR and SVR) than experiencing a termination of IPV due to pregnancy (11.4% of DVR). We also observed that more severe maternal depression, lower levels of father's involvement, and poorer social support were significantly associated with the categories that reflected greater severity of IPV over the course of pregnancy. Our findings reflected that the complexity of IPV related to pregnancy should never be overlooked. Mere reporting of prevalence in an aggregate might not sufficiently explain the problem. Father's involvement and social support are two important factors that might help reduce IPV related to pregnancy and childbirth.

Predictive factors for length of hospital stay following primary total knee replacement in a total joint replacement centre in Hong Kong.

INTRODUCTION: The demand for total knee replacement in Hong Kong places tremendous economic burden on our health care system. Shortening hospital stay reduces the associated cost. The aim of this study was to identify perioperative predictors of length of hospital stay following primary total knee replacement performed at a high-volume centre in Hong Kong. METHODS: We retrospectively reviewed all primary total knee replacements performed at Yan Chai Hospital Total Joint Replacement Centre from October 2011 to October 2015. Perioperative factors that might influence length of stay were recorded. RESULTS: A total of 1622 patients were identified. The mean length of hospital stay was 6.8 days. Predictors of prolonged hospital stay following primary total knee replacement were advanced age; American Society of Anesthesiologists physical status class 3; bilateral total knee replacement; in-patient complications; and the need for blood transfusion, postoperative intensive care unit admission, and urinary catheterisation. CONCLUSIONS: Evaluating factors that can predict length of hospital stay is the starting point to improve our current practice in joint replacement surgery. Prediction of high-risk patients who will require a longer hospitalisation enables proactive discharge planning.

Comparison of the GenoFlow human papillomavirus (HPV) test and the Linear Array assay for HPV screening in an Asian population.

High-risk human papillomavirus (HR-HPV) DNA detection in cervical cytology samples is useful for primary screening of cervical cancer and for triage of patients with equivocal cytological findings. The GenoFlow HPV array test (GF assay; Diagcor Bioscience Inc., Hong Kong) was recently developed to detect 33 HPV genotypes by a "flowthrough" hybridization technology. In this study, we assessed the analytical sensitivity and reproducibility of the GF assay and compared its genotyping results with those of the Linear Array (LA) assay (Roche Molecular Diagnostics, Indianapolis, IN), using 400 archived liquid-based cytology samples representing the full range of cytology findings. Genotyping findings of the GF and LA assays were concordant or compatible for 93.44% of tested samples, with a good (κ = 0.797) to very good (κ = 0.812) strength of agreement for assay-common and oncogenic HPV types, respectively. The two assays showed good (κ = 0.635) agreement in detecting infections with multiple HPV genotypes. The lowest detection limits of the GF assay for HPV16 and HPV18 were 25 copies and 20 copies, respectively. Repeat testing of 60 samples by use of two different lots of the GF assay revealed no discordant results, suggesting good reproducibility of the assay. Both assays achieved approximately 80% and 100% sensitivity for identifying cases of atypical squamous cells of undetermined significance (ASC-US) and low-grade squamous intraepithelial lesions (LSIL) with subsequent detection of LSIL+ and high-grade squamous intraepithelial lesions or higher (HSIL+) in 2 years, respectively. Among ASC-US samples, the GF assay achieved the highest specificity (23.08%) for indicating subsequent identification of HSIL compared with the LA (19.23%) and Hybrid Capture 2 (HC2) (8.97%) assays. The GF and LA assays showed significant discrepancy in detecting HPV genotypes 11, 26, 39, 52, and 66. More sensitive detection of HPV52 by GF assay offers an advantage in regions where HPV52 is more prevalent. The sensitivity of the GF assay for detecting patients with HSIL+ was noninferior to that of the LA assay.

Note: Vector network analyzer-ferromagnetic resonance spectrometer using high Q-factor cavity.

A ferromagnetic resonance (FMR) spectrometer whose main components consist of an X-band resonator and a vector network analyzer (VNA) was developed. This spectrometer takes advantage of a high Q-factor (9600) cavity and state-of-the-art VNA. Accordingly, field modulation lock-in technique for signal to noise ratio (SNR) enhancement is no longer necessary, and FMR absorption can therefore be extracted directly. Its derivative for the ascertainment of full width at half maximum height of FMR peak can be found by taking the differentiation of original data. This system was characterized with different thicknesses of permalloy (Py) films and its multilayer, and found that the SNR of 5 nm Py on glass was better than 50, and did not have significant reduction even at low microwave excitation power (-20 dBm), and at low Q-factor (3000). The FMR other than X-band can also be examined in the same manner by using a suitable band cavity within the frequency range of VNA.

Efficacy of Abbott RealTime High Risk HPV test in evaluation of atypical squamous cells of undetermined significance from an Asian screening population.

BACKGROUND: Abbott RealTime High Risk HPV test is a new qualitative real-time PCR assay for the detection of 14 high risk HPV (HR-HPV) types and specific identification of HPV16 and HPV18. For each new HPV DNA test, it is important to validate its clinical performance using established tests as benchmarks. Hybrid Capture 2 (HC2) is the first USA FDA-approved HR-HPV DNA test. OBJECTIVES: To compare the performance of Abbott RealTime High Risk HPV test with that of Hybrid Capture 2 in detecting cytology samples with varying prognosis. STUDY DESIGN: 250 liquid-based cervical cytology samples diagnosed of Atypical Squamous cells of Undetermined Significance (ASC-US) collected from an Asian Screening Population were independently tested with both Abbott RealTime High Risk HPV test and HC2. Their utility in predicting disease progression was evaluated in 82 of the samples for which follow up cytology or colposcropic histology data was available. RESULTS: Good to excellent agreement between the two tests was demonstrated (Kappa=0.800, 95% CI: 0.726-0.874). The sensitivity, specificity, positive (PPV) and negative predictive values (NPV) of the two tests in detecting cases with underlying HSIL/CIN2+ were evaluated (Abbott: 100%, 20.83%, 14.93% and 100% respectively; HC2: 100%, 12.50%, 13.70% and 100% respectively). HPV16/18 genotyping provided by the Abbott test enhanced specific identification of cases with LSIL/CIN1+ (specificity 91.30%, PPV 84.62%) and HSIL/CIN2+ (specificity 86.11%, PPV 23.08%) at follow-up. CONCLUSIONS: The Abbott test performed similarly to HC2 and is unlikely to be affected by ethnicity. Abbott combined HPV detection and HPV 16/18 genotyping is found to provide enhanced sensitivity and specificity for triage of ASC-US.

Management and prevention of spontaneous pneumothorax using pleurodesis in Hong Kong.

BACKGROUND: The practice of pleurodesis for the management and prevention of spontaneous pneumothorax (SP) is uncertain. DESIGN: A retrospective multicentre analysis of patients admitted to 12 hospitals in Hong Kong with SP in 2004 and who subsequently underwent pleurodesis for the same episode. RESULTS: Pleurodesis was performed in 394 episodes. Initial medical chemical pleurodesis was performed for 258 (65.5%) patients ('initial medical group'), while 136 (34.5%) underwent initial surgical pleurodesis ('initial surgical group'). Secondary spontaneous pneumothorax (SSP; 237 episodes, 60.2%) was the most common indication for pleurodesis; it was also performed after a first episode of primary spontaneous pneumothorax (PSP) in 22 episodes (5.6%). Tetracycline derivatives (172 episodes, 66.7%) were the most popular sclerosing agents in the initial medical group. Those in the initial medical group were older and were more likely to be males, have SSP, chronic obstructive pulmonary disease and a history of past pleurodesis (P < 0.05) compared to the initial surgical group. Compared to the tetracycline group, more patients who initially received talc slurry had the procedure performed by surgeons, had larger (≥2 cm) pneumothorax or required suction during initial drainage (P < 0.05). CONCLUSIONS: Despite the availability of international guidelines, there is considerable variation in pleurodesis for SP.

Effectiveness of aroma massage on advanced cancer patients with constipation: a pilot study.

PURPOSE: The purpose of this study was to verify the effect of aroma massage on constipation in advanced cancer patients. METHODS: This study employed a randomized control group pre- and post test design and included an aroma massage group, plain massage group, and control group. To evaluate the effect of aromatherapy, the degree of constipation was measured using a constipation assessment scale, severity level of constipation and the frequency of bowel movements. Data was analyzed by repeated measures of Mann-Whitney U test, Wilcoxon signed ranks test, Spearman's rho and ANOVA using SPSS program. RESULTS: The score of the constipation assessment scale of the aroma massage group was significantly lower than the control group. Apart from the improvement in bowel movements, the results showed significantly improved quality of life in physical and support domains of the aroma massage group. CONCLUSION: The findings of this study suggest aroma massage can help to relieve constipation in patients with advanced cancer.

Minocycline and talc slurry pleurodesis for patients with secondary spontaneous pneumothorax.

SETTING: Few studies have evaluated the sclerosing efficacy of minocycline, and none have specifically compared its sclerosing efficacy and safety profiles with talc slurry in secondary spontaneous pneumothorax (SSP). DESIGN: A retrospective analysis was conducted in patients with SSP who underwent chemical pleurodesis from January to December 2004 with minocycline or talc slurry in 12 public hospitals of Hong Kong. RESULT: There were 121 episodes of minocycline pleurodesis and 64 episodes of talc slurry pleurodesis. Immediate procedural failure were similar in the minocycline and talc slurry groups (21.5% vs. 28.1%, P = 0.31). Presence of interstitial lung disease, ≥ 2 previous episodes of pneumothorax, requiring mechanical ventilation during pleurodesis and persistent air leak before pleurodesis were independently associated with procedural failure. Pain was experienced in respectively 44.6% and 37.5% of the minocycline and the talc slurry groups. Pain was more common in patients receiving high doses of talc (≥ 5 g; P = 0.03). Respiratory distress was found in respectively 1.7% and 1.6% of the minocycline and talc slurry groups. CONCLUSION: Minocycline and talc slurry had comparable sclerosing efficacy in SSP, with immediate success rates of >70%. Pain was the most common adverse effect and respiratory distress was uncommon. Both appeared to be effective and safe for chemical pleurodesis in SSP.

Surgical management of primary non-small-cell carcinoma of lung with synchronous solitary brain metastasis: local experience.

OBJECTIVE: To report the surgical experience in the management of patients with synchronous primary lung cancer and solitary brain metastasis. DESIGN: Retrospective cohort study. SETTING: Regional hospital, Hong Kong. PATIENTS: Seventeen patients with synchronous primary lung cancer and solitary brain metastasis were treated by pulmonary resection and neurosurgical intervention between 1994 and 2007. RESULTS: Median patient survival was 52 months (95% confidence interval, 9-95 months) and the 5-year survival was 27%. The univariate analysis yielded no significant prognostic factor. Four out of six patients who had lymph node metastases developed tumour recurrence. CONCLUSION: In view of encouraging survival results, aggressive therapy including pulmonary resection and neurosurgical intervention should be recommended for patients with synchronous presentation with primary lung cancer and solitary brain metastasis.

Management of patients admitted with pneumothorax: a multi-centre study of the practice and outcomes in Hong Kong.

OBJECTIVE: To examine the management practice of pneumothorax in hospitalised patients in Hong Kong, especially the choice of drainage options and their success rates, as well as the factors associated with procedural failures. DESIGN: Retrospective study. SETTING: Multi-centre study involving 12 public hospitals in Hong Kong. PATIENTS: All adult patients admitted as an emergency in the year 2004 with a discharge diagnosis of 'pneumothorax' were included. Data on the management and outcomes of the various types of pneumothoraces were collected from their case records. RESULTS: Altogether these patients had 1091 episodes (476 primary spontaneous pneumothoraces, 483 secondary spontaneous pneumothoraces, 87 iatrogenic pneumothoraces, and 45 traumatic pneumothoraces). Conservative treatment was offered in 182 (17%) episodes, which were more common among patients with small primary spontaneous pneumothoraces (71%). Simple aspiration was performed to treat 122 (11%) of such episodes, and had a success rate of 15%. Aspiration failure was associated with having a pneumothorax of size 2 cm or larger (odds ratio=3.7; 95% confidence interval, 1.2-11.5; P=0.03) and a smoking history (4.1; 1.2-14.3; P=0.03). Intercostal tube drainage was employed in 890 (82%) episodes, with a success rate of 77%. Failure of intercostal tube drainage was associated with application of suction (odds ratio=4.1; 95% confidence interval, 2.8-5.9; P<0.001) and presence of any tube complications (1.55; 1.0-2.3; P=0.03). Small-bore catheters (<14 French) were used in 12 (1%) of the episodes only. Tube complications were encountered in 214 (24%) episodes. CONCLUSION: Notwithstanding recommendations from international guidelines, simple aspiration and intercostal tube drainage with small-bore catheters were not commonly employed in the management of hospitalised patients with the various types of pneumothoraces in Hong Kong.

Influenza H5N1 virus infection of polarized human alveolar epithelial cells and lung microvascular endothelial cells.

BACKGROUND: Highly pathogenic avian influenza (HPAI) H5N1 virus is entrenched in poultry in Asia and Africa and continues to infect humans zoonotically causing acute respiratory disease syndrome and death. There is evidence that the virus may sometimes spread beyond respiratory tract to cause disseminated infection. The primary target cell for HPAI H5N1 virus in human lung is the alveolar epithelial cell. Alveolar epithelium and its adjacent lung microvascular endothelium form host barriers to the initiation of infection and dissemination of influenza H5N1 infection in humans. These are polarized cells and the polarity of influenza virus entry and egress as well as the secretion of cytokines and chemokines from the virus infected cells are likely to be central to the pathogenesis of human H5N1 disease. AIM: To study influenza A (H5N1) virus replication and host innate immune responses in polarized primary human alveolar epithelial cells and lung microvascular endothelial cells and its relevance to the pathogenesis of human H5N1 disease. METHODS: We use an in vitro model of polarized primary human alveolar epithelial cells and lung microvascular endothelial cells grown in transwell culture inserts to compare infection with influenza A subtype H1N1 and H5N1 viruses via the apical or basolateral surfaces. RESULTS: We demonstrate that both influenza H1N1 and H5N1 viruses efficiently infect alveolar epithelial cells from both apical and basolateral surface of the epithelium but release of newly formed virus is mainly from the apical side of the epithelium. In contrast, influenza H5N1 virus, but not H1N1 virus, efficiently infected polarized microvascular endothelial cells from both apical and basolateral aspects. This provides a mechanistic explanation for how H5N1 virus may infect the lung from systemic circulation. Epidemiological evidence has implicated ingestion of virus-contaminated foods as the source of infection in some instances and our data suggests that viremia, secondary to, for example, gastro-intestinal infection, can potentially lead to infection of the lung. HPAI H5N1 virus was a more potent inducer of cytokines (e.g. IP-10, RANTES, IL-6) in comparison to H1N1 virus in alveolar epithelial cells, and these virus-induced chemokines were secreted onto both the apical and basolateral aspects of the polarized alveolar epithelium. CONCLUSION: The predilection of viruses for different routes of entry and egress from the infected cell is important in understanding the pathogenesis of influenza H5N1 infection and may help unravel the pathogenesis of human H5N1 disease.

Evaluation of testing capabilities for the determination of melamine in milk through an interlaboratory proficiency test programme during the melamine crisis.

An interlaboratory proficiency testing programme for melamine in milk was organized for field laboratories in Hong Kong, China, during the melamine crisis in late September 2008. One blank test sample and three homogenous samples prepared by gravimetric spiking of melamine at the concentration range of zero to 4.5 mg kg(-1) were given to participants in this programme. A total of 13 participants returned the results to the organizer and they used either liquid chromatography-tandem mass spectrometry (LC-MS/MS) or gas chromatography-mass spectrometry (GC-MS) for their determinations. The performance of the participants was assessed by determining z-scores, calculated from the bias from the assigned reference values and Horwitz standard deviation. The median values of pooled data were found to be in good agreement with the reference values and the majority of the participants demonstrated their capabilities in the quantitative measurement of melamine in milk samples. However, four participants gave false-positive results for the blank test sample, probably due to cross-contamination from other samples, and they were requested to investigate the actual causes. In summary, eight participants (or 62%) demonstrated their competence for all the four test samples.

Unusual traumatic triceps tendon avulsion rupture: a word of caution.

Triceps tendon rupture is a rare condition. The usual mechanism of injury is a fall on an outstretched hand, although direct contact injuries have also been reported to cause this injury. A 67-year-old woman presented with injuries caused by direct impact to her right elbow after a fall. X-rays of the elbow demonstrated the cardinal clinical 'gap' and 'flake' signs. It is necessary to be aware of this injury and perform a careful examination at the time of the initial presentation, as the signs of this injury are usually subtle. Most reported primary repairs have been performed with non-absorbable transosseous sutures. In this case report, we show how using suture anchors for reattachment is a technically feasible alternative operative method providing a good surgical outcome.

Pleuroscopy: our initial experience in Hong Kong.

OBJECTIVE: To report our preliminary experience using pleuroscopy for patients with pleural diseases. DESIGN: Prospective cohort study. SETTING: Tertiary referral hospital with service input from respiratory physicians and cardiothoracic surgeons in Hong Kong. PATIENTS: Between April and November 2007, patients with undiagnosed exudative pleural effusions and proven malignant pleural effusions were recruited for diagnostic evaluations and therapeutic interventions, respectively. INTERVENTION: Pleuroscopy with a semi-rigid thoracoscope performed under local anaesthesia and conscious sedation. RESULTS: A total of 20 patients (16 males and 4 females; mean age, 63 years) underwent the procedure and were followed up for a mean of 19 weeks. For the 14 patients having diagnostic pleuroscopy, the yield was 79% (11 patients). The 3-month success rate for the six patients undergoing pleurodesis was 83% (five patients). Complications were mild and included self-limiting fever (20%, four patients) and localised subcutaneous emphysema (20%, four patients). No major complications or mortality were noted. CONCLUSION: Pleuroscopy using a semi-rigid instrument is a safe and efficacious procedure for the management of pleural diseases in suitable patients.

In vitro estrogenic activity of formononetin by two bioassay systems.

AIM: To study the estrogenic activity of formononetin in vitro. METHODS: We have established a highly sensitive bioassay system by placing estrogen-responsive elements upstream of the luciferase reporter gene, and used this assay to determine the estrogenic activity of formononetin. Cell growth was measured by the MTT (3-(4,5-dimethylthioazol-2-yl)-2,5-diphenyltetrazolium bromide) assay and MG-63 cell function was studied by measuring alkaline phosphatase activity. RESULTS: Formononetin activated expression of the estrogen-responsive reporter gene in human breast cell line MCF-7 in a concentration-dependent manner (0.5-500 microM), and this activation was inhibited by estrogen antagonist (ICI 182780 at 100 nM). Furthermore, it induced the proliferation of MCF-7 breast cancer cells and MG-63 osteosarcoma cells, and it also increased the alkaline phosphatase activity in MG-63 cells. CONCLUSION: Formononetin is a phytoestrogen that exhibits variable degrees of estrogen receptor agonism in different test systems.

Ginsenoside Re attenuate beta-amyloid and serum-free induced neurotoxicity in PC12 cells.

AIM: To study the effect of ginsenoside Re on PC12 cell damage induced by serum deprivation and beta-amyloid peptide. METHODS: PC 12 cell survival was measured by MTT and lactate dehydrogenase (LDH) assay. Results Serum-free medium and beta-amyloid peptide (10-100 microM) induced cytotoxicity in PC 12 cells. Ginsenoside Re (0.1-100 microM) attenuated the cytotoxic effects of serum-free medium and beta-amyloid peptide (50 microM) in a concentration-dependent manner. CONCLUSION: Ginsenoside Re prevented PC 12 cells from lesion induced by serum-free medium and beta-amyloid peptide.

Distinction of water-soluble constituents between natural and cultured Cordyceps by capillary electrophoresis.

Cordyceps is an expensive traditional Chinese medicine, which has anti-tumor activity and significant effects on the immune system. In Southeast Asia, Cordyceps is commonly sold in capsule form as a health food product. Most of these products are derived from cultured Cordyceps mycelia. Because of the price difference, some manufacturers claim their products are from natural Cordyceps. In order to distinguish among various types of Cordyceps in the market, the profiles of water-soluble constituents derived from different sources of Cordyceps were determined by capillary electrophoresis (CE). Both natural and cultured Cordyceps showed three peak clusters migrated at 5-7, 9-11 and 12-13 min, and the height and resolution of these peak clusters were rather distinct. Peak cluster at 9-11 min was identified as adenosine, guanosine and uridine, and shared a similarity between natural and cultured products. In contrast, the peak cluster at 5-7 min was characteristic of natural Cordyceps, regardless of hosts and sources. By using the peak characteristics of CE profiles of different Cordyceps samples, hierarchical clustering analysis was performed. The result shows that those samples of natural Cordyceps were grouped together distinct from the cultured and commercial products. Thus, the CE profiles could serve as fingerprints for the quality control of Cordyceps.

Authentication of Panax notoginseng by 5S-rRNA spacer domain and random amplified polymorphic DNA (RAPD) analysis.

The great majority of Panax species are well-known herbal medicines in the Orient, and many of them share a close resemblance in appearance and chemical composition. Among these Panax species, the root of P. notoginseng (Sanqi) is a unique herb that has distinct clinical usage. Here, the 5S-rRNA spacer domains were isolated from P. notoginseng, P. japonicus var. major, P. stipuleanatus, P. quinquefolius, P. ginseng, P. zingiberensis, and P. wangianus, and four common adulterants of P. notoginseng including Curcuma wenyujin, Curcuma longa, Bletilla striata and Gynura segetum. The spacer domains were sequenced and compared, which showed over 75 % DNA identity among all Panax species, but not for the adulterants. In addition, random amplification of polymorphic DNA (RAPD) analysis was used to distinguish different members of Panax genus as well as the morphological variants of P. notoginseng. These molecular methods could be used in the authentic identification of P. notoginseng from other Panax species.

Production of testosterone from phytosterol using a single-step microbial transformation by a mutant of Mycobacterium sp.

A testosterone (TS)-producing mutant, ST2, was derived from a phytosterol-assimilating and androst-4-ene-3,17-dione (AD)-producing bacterium, Mycobacterium sp. B-3805S, using nitrosoguanidine (NTG) mutagenesis. Production of TS from phytosterol using a single-step microbial transformation process by ST2 was investigated in a 5-l surface-aeration microprocessor-controlled fermentor loaded with a synthetic medium supplemented with 0.1% phytosterol, 2% glucose and 1% peptone at 30 degrees C. An increase in dissolved oxygen at the initial stage of fermentation favored the side-chain degradation of phytosterol to AD. Later in the fermentation, a decrease in the dissolved oxygen to zero resulted in a decrease in pH to 6.0 as well as the reduction of AD to TS. Under optimal fermentation conditions, the maximum conversion ratio of phytosterol to TS was 31% after 120 h cultivation. It was concluded that the control of dissolved oxygen in the fermentation culture is the most important parameter for production of TS from phytosterol via AD. TS was isolated from the fermentation culture by addition of Amberlite XAD-7 resin and was further purified by flash chromatography on a silica gel column. After crystallization, TS was obtained as needle crystals with the correct melting point.