Clinical Outcomes of Conservative Treatment for Low-Risk Ductal Carcinoma in Situ: A Systematic Review and Pooled Analysis.

AIMS: The current gold standard of treatment for ductal carcinoma in situ (DCIS) is surgical resection with or without adjuvant radiotherapy. However, the increased detection and radical treatment of DCIS did not result in a declined incidence of invasive breast cancers, leading to the debate if DCIS has been overtreated. While ongoing randomised controlled trials on active surveillance of DCIS are still in progress, this systematic review aims to evaluate the best evidence on conservative treatment for DCIS from the literature. MATERIALS AND METHODS: This systematic review was conducted in line with the PRISMA statement. We included all relevant studies published up to June 2022 for analysis. The primary outcomes were overall survival and breast cancer-specific survival (BCSS) of conservative treatment for DCIS. RESULTS: Three studies, with a total of 34 007 women with low-risk DCIS, were included in the analysis. Active and conservative treatments both resulted in excellent 10-year BCSS, with no statistically insignificant difference (98.6% versus 96.0%, 31 478 women). One study comparing 5-year BCSS of active and conservative treatments only in subjects aged over 80 years also reported [AQ1]an insignificant difference (98.2% versus 96.0%, 2529 women). One study measuring 5- and 10-year overall survival between the treatment groups also reported [AQ1]an insignificant difference (5-year: 96.2% versus 92.4%; 10-year: 85.6% versus 86.7%, 31 106 women). CONCLUSION: BCSS between active and conservative treatment for women with low-risk DCIS is both excellent and comparable, suggesting that conservative treatment is a possible alternative without compromising survival.

Risk of nosocomial transmission of coronavirus disease 2019: an experience in a general ward setting in Hong Kong.

BACKGROUND: Coronavirus disease 2019 (COVID-19) was first reported in Wuhan in December 2019 and has rapidly spread across different cities within and outside China. Hong Kong started to prepare for COVID-19 on 31st December 2019 and infection control measures in public hospitals were tightened to limit nosocomial transmission within healthcare facilities. However, the recommendations on the transmission-based precautions required for COVID-19 in hospital settings vary from droplet and contact precautions, to contact and airborne precautions with placement of patients in airborne infection isolation rooms. AIM: To describe an outbreak investigation of a patient with COVID-19 who was nursed in an open cubicle of a general ward before the diagnosis was made. METHOD: Contacts were identified and risk categorized as 'close' or 'casual' for decisions on quarantine and/or medical surveillance. Respiratory specimens were collected from contacts who developed fever, and/or respiratory symptoms during the surveillance period and were tested for SARS-CoV-2. FINDINGS: A total of 71 staff and 49 patients were identified from contact tracing, seven staff and 10 patients fulfilled the criteria of 'close contact'. At the end of 28-day surveillance, 76 tests were performed on 52 contacts and all were negative, including all patient close contacts and six of the seven staff close contacts. The remaining contacts were asymptomatic throughout the surveillance period. CONCLUSION: Our findings suggest that SARS-CoV-2 is not spread by an airborne route, and nosocomial transmissions can be prevented through vigilant basic infection control measures, including wearing of surgical masks, hand and environmental hygiene.

A growth hormone receptor SNP promotes lung cancer by impairment of SOCS2-mediated degradation.

Both humans and mice lacking functional growth hormone (GH) receptors are known to be resistant to cancer. Further, autocrine GH has been reported to act as a cancer promoter. Here we present the first example of a variant of the GH receptor (GHR) associated with cancer promotion, in this case lung cancer. We show that the GHRP495T variant located in the receptor intracellular domain is able to prolong the GH signal in vitro using stably expressing mouse pro-B-cell and human lung cell lines. This is relevant because GH secretion is pulsatile, and extending the signal duration makes it resemble autocrine GH action. Signal duration for the activated GHR is primarily controlled by suppressor of cytokine signalling 2 (SOCS2), the substrate recognition component of the E3 protein ligase responsible for ubiquitinylation and degradation of the GHR. SOCS2 is induced by a GH pulse and we show that SOCS2 binding to the GHR is impaired by a threonine substitution at Pro 495. This results in decreased internalisation and degradation of the receptor evident in TIRF microscopy and by measurement of mature (surface) receptor expression. Mutational analysis showed that the residue at position 495 impairs SOCS2 binding only when a threonine is present, consistent with interference with the adjacent Thr494. The latter is key for SOCS2 binding, together with nearby Tyr487, which must be phosphorylated for SOCS2 binding. We also undertook nuclear magnetic resonance spectroscopy approach for structural comparison of the SOCS2 binding scaffold Ile455-Ser588, and concluded that this single substitution has altered the structure of the SOCS2 binding site. Importantly, we find that lung BEAS-2B cells expressing GHRP495T display increased expression of transcripts associated with tumour proliferation, epithelial-mesenchymal transition and metastases (TWIST1, SNAI2, EGFR, MYC and CCND1) at 2 h after a GH pulse. This is consistent with prolonged GH signalling acting to promote cancer progression in lung cancer.

Atrial fibrillation patients who sustained warfarin-associated intracerebral haemorrhage have poor neurological outcomes: results from a matched case series.

INTRODUCTION: Coagulopathy-associated intracerebral haemorrhage has become increasingly common because of the rising demand in the ageing population for anticoagulation for atrial fibrillation. This study compared the clinical features and neurological outcomes of intracerebral haemorrhage in patients with atrial fibrillation who were prescribed warfarin with those who were not. METHODS: This was a retrospective matched case series of patients with intracerebral haemorrhage from three tertiary hospitals in Hong Kong from 1 January 2006 to 31 December 2011. Patients who developed intracerebral haemorrhage and who were prescribed warfarin for atrial fibrillation (ICH-W group) were compared with those with intracerebral haemorrhage and not prescribed warfarin (ICH-C group); they were matched for age and gender in 1:1 ratio. Clinical features and neurological outcomes were compared, and the impact of coagulopathy on haematoma size was also studied. RESULTS: We identified 114 patients in the ICH-W group with a mean age of 75 years. Both ICH-W and ICH-C groups had a median intracerebral haemorrhage score of 2. There was a non-statistically significant trend of higher intracerebral haemorrhage volume in the ICH-W group (12.9 mL vs 10.5 mL). The median modified Rankin Scale and the proportion with good recovery (modified Rankin Scale score ≤3) at 6 months were comparable. Nonetheless, ICH-W patients had higher hospital mortality (51.8% vs 36.0%; P=0.02) and 6-month mortality (60.5% vs 43.0%; P=0.01) than ICH-C patients. Overall, 60% of ICH-W patients had their admission international normalised ratio within the therapeutic range during intracerebral haemorrhage, and 14% had a subtherapeutic admission international normalised ratio. International normalised ratio at admission was not associated with intracerebral haemorrhage volume or neurological outcome. CONCLUSION: Warfarin-associated intracerebral haemorrhage in patients with atrial fibrillation carried a higher stroke mortality than the non-warfarinised patients.

Recent advances in exploitation of nanomaterial for arsenic removal from water: a review.

Recently, increasing research efforts have been made to exploit the enormous potential of nanotechnology and nanomaterial in the application of arsenic removal from water. As a result, there are myriad of types of nanomaterials being developed and studied for their arsenic removal capabilities. Nevertheless, challenges such as having a complete understanding of the material properties and removal mechanism make it difficult for researchers to engineer nanomaterials that are best suited for specific water treatment applications. In this review paper, a comprehensive review will be conducted on several selected categories of nanomaterials that possess promising prospects in arsenic removal application. The synthesis process, material properties, as well as arsenic removal performance and removal mechanisms of each of these nanomaterials will be discussed in detail. Fe-based nanomaterials, particularly iron oxide nanoparticles, have displayed advantages in arsenic removal due to their super-paramagnetic property. On the other hand, TiO2-based nanomaterials are the best candidates as photocatalytic arsenic removal agents, having been reported to have more than 200-fold increase in adsorption capacity under UV light irradiation. Zr-based nanomaterials have among the largest BET active area for adsorption-up to 630 m2 g-1-and it has been reported that amorphous ZrO2 performs better than crystalline ZrO2 nanoparticles, having about 1.77 times higher As(III) adsorption capacity. Although Cu-based nanomaterials are relatively uncommon as nano-adsorbents for arsenic in water, recent studies have demonstrated their potential in arsenic removal. CuO nanoparticles synthesized by Martinson et al were reported to have adsorption capacities up to 22.6 mg g-1 and 26.9 mg g-1 for As(V) and As(III) respectively. Among the nanomaterials that have been reviewed in this study, Mg-based nanomaterials were reported to have the highest maximum adsorption capacities for As(V) and As(III), at 378.79 mg g-1 and 643.84 mg g-1 respectively. By combining desired properties of different nanomaterials, composite nanomaterials can be made that have superior potential as efficient arsenic removal agents. Particularly, magnetic composite nanomaterials are interesting because the super-paramagnetic property, which allows efficient separation of nano-adsorbents in water, and high adsorption capacities, could be achieved simultaneously. For instance, Fe-Mn binary oxide nanowires have shown promising As(III) adsorption capacity at 171 mg g-1. Generally, nanomaterials used for arsenic removal face severe degradation in performance in the presence of competing ions in water, especially phosphate ions. This study will contribute to future research in developing nanomaterials used for arsenic removal that are highly efficient, environmentally friendly and cost-effective by providing a thorough, structured and detailed review on various nanomaterial candidates that have promising potential.

Outcome of elderly patients who receive intensive care at a regional hospital in Hong Kong.

OBJECTIVE: To evaluate the clinical outcome (180-day mortality) of very elderly critically ill patients (age ≥80 years) and compare with those aged 60 to 79 years. DESIGN: Historical cohort study. SETTING: Regional hospital, Hong Kong. PATIENTS: Patients aged ≥60 years admitted between 1 January 2009 and 31 December 2013 to the Intensive Care Unit of the hospital. RESULTS: Over 5 years, 4226 patients aged ≥60 years were admitted (55.5% total intensive care unit admissions), of whom 32.8% were aged ≥80 years. The proportion of patients aged ≥80 years increased over 5 years. As expected, those aged ≥80 years carried more significant co-morbidities and a higher disease severity compared with those aged 60 to 79 years. They required more mechanical ventilatory support, were less likely to receive renal replacement therapy, and had a higher intensive care unit/hospital/180-day mortality compared with those aged 60 to 79 years. Nonetheless, 71.8% were discharged home and 62.2% survived >180 days following intensive care unit admission. Cox regression analysis revealed that Acute Physiology and Chronic Health Evaluation IV-minus-Age score, emergency admission, intensive care unit admission due to cardiovascular problem, neurosurgical cases, presence of significant co-morbidities (diabetes mellitus, metastatic carcinoma, leukaemia, or myeloma), and requirement for mechanical ventilation independently predicted 180-day mortality. CONCLUSIONS: The proportion of critically ill patients aged ≥80 years increased over a 5-year period. Despite having more significant co-morbidities, greater disease severity, and higher intensive care unit/hospital/180-day mortality rate compared with those aged 60 to 79 years, 71.8% of those ≥80 years could be discharged home and 62.2% survived >180 days following intensive care unit admission. Disease severity, presence of co-morbidities, requirement for mechanical ventilation, emergency cases, and admission diagnosis independently predicted 180-day mortality.

Spatio-temporal analysis of tuberculous infection risk among clients of a homeless shelter during an outbreak.

SETTING: British Columbia (BC) has a low incidence of tuberculosis (TB), with the burden of endogenously acquired disease concentrated among vulnerable populations, including the homeless. In May 2008, a TB outbreak began in a BC homeless shelter, with a single index case seeding multiple secondary cases within the shelter. OBJECTIVE: To use nightly shelter records to quantify the risk of latent tuberculous infection (LTBI) among shelter clients as a function of their sleeping distance from and duration of exposure to the index case. DESIGN: Distance and duration of exposure were visualised and assessed using logistic regression with LTBI status as outcome. We used a novel machine learning approach to establish exposure thresholds that optimally separated infected and non-infected individuals. RESULTS: Of 161 exposed shelter clients, 58 had a recorded outcome of infected (n = 39) or non-infected (n = 19). Only duration of exposure to the index was associated with increased odds of infection (OR 1.26); stays of ⩾ 5 nights put shelter clients at higher odds of infection (OR 4.97). CONCLUSION: The unique data set and analytical approach suggested that, in a shelter environment, long-term clients are at highest risk of LTBI and should be prioritised for screening during an outbreak investigation.

Impedance and structural studies on plasticized PCL-LiSO3CF3-SiO2 polymer electrolytes.

Plasticized polymer electrolytes in this study are consist of biodegradable polycaprolactone (PCL) as a host, ethylene carbonate (EC) as a plasticizer, lithium triflate (LiSO3CF3) as salt and nanocomposite silicon dioxide (SiO2) as filler. Solution cast technique is used in the preparation of the plasticized polymer electrolytes. The electrical properties of the plasticized polymer electrolytes with different composition of lithium salt, plasticizer and nano-sized filler are reported in this paper. Conductivity as high as 4.30 x 10(-3) S cm(-1) is obtained in ambient temperature. Ionic conductivity of the plasticized polymer electrolytes are measured using electrochemistry impedance spectroscopy (EIS). The structural and complex formations are studied by X-ray diffraction (XRD) and Fourier Transform Infrared (FTIR) spectroscopy. The ionic conductivity result can be further verified and supported by XRD and FTIR reading in which the ionic conductivity is directly proportional to the amorphous phase behaviour of the sample.

Hitching the gallbladder in laparoscopic-assisted cholecysto-cholangiography: a simple technique.

Neonatal cholestatic disorder in the late neonatal period requires often cholangiography to differentiate between biliary atresia and other causes of prolonged neonatal jaundice. A simplified method of a laparoscopic-assisted cholecysto-cholangiography is presented. Retrospective chart review was conducted of all patients who from May 2002 to April 2012 underwent a laparoscopic-assisted cholecysto-cholangiography with routine fixation of the fundus of the gallbladder to the lateral aspect of the abdominal wall. A total of 18 infants (8 boys) aged 41-104 (median 64) days underwent laparoscopic-assisted cholecysto-cholangiography for prolonged jaundice. The technique identified ten cases of a patent bile duct system and eight biliary atresias. (Thirty-two cases of suspected biliary atresia were confirmed by laparoscopy alone.) Two cases required suturing of a bile leak at the puncture site. Hitching the gallbladder to the lateral abdominal wall is a simple method allowing an optimal radiographic assessment of the extra- and intra-hepatic bile duct anatomy.

How range shifts induced by climate change affect neutral evolution.

We investigate neutral evolution during range shifts in a strategic model of a metapopulation occupying a climate gradient. Using heritable, neutral markers, we track the spatio-temporal fate of lineages. Owing to iterated founder effects ('mutation surfing'), survival of lineages derived from the leading range limit is enhanced. At trailing limits, where habitat suitability decreases, survival is reduced (mutations 'wipe out'). These processes alter (i) the spatial spread of mutations, (ii) origins of persisting mutations and (iii) the generation of diversity. We show that large changes in neutral evolution can be a direct consequence of range shifting.

A sperm GPI-anchored protein elicits sperm-cumulus cross-talk leading to the acrosome reaction.

The acrosome reaction has long been thought to be induced by the zona pellucida. Here we report the identification and function of a novel human sperm glycosylphosphatidylinositol (GPI)-anchored membrane protein, NYD-SP8. The release of the protein during sperm-egg interaction and its binding to the cumulus, the first layer of egg investment, elicits cross-talk between the gametes and produces calcium dependant release of progesterone, which lead to the acrosome reaction. An in vivo mouse model of NYD-SP8 immunization is also established showing a reduced fertility rate. Thus, contrary to accepted dogma, our study demonstrates for the first time that, prior to reaching the zona pellucida, sperm may release a surface protein that acts on the cumulus cells leading to the acrosome reaction, which may be important for determining the outcome of fertilization.

Disease-associated Glut1 single amino acid substitute mutations S66F, R126C, and T295M constitute Glut1-deficiency states in vitro.

Glucose transporter type 1 deficiency syndrome (Glut1DS) is the result of autosomal-dominant loss-of-function mutation of the glucose transporter type 1 gene (GLUT1) leading to brain energy failure and epileptic encephalopathy. In this study, the protein products of the Glut1DS-associated GLUT1 missense mutations, S66F, R126C, and T295M, were characterized using the Glut1-green fluorescent protein (GFP) fusion expressed in CHO cells. Glut1-GFP expression was confirmed by Western blot and confocal microscopy. The applicability of this Glut1-GFP expression model in reporting Glut1 functional deficits was validated by re-confirming the glucose transport defects of the previously reported pathogenic mutations R126H, R126L, and R333W. While S66F, R126C, and T295M mutants were expressed and targeted to the cell membrane, these Glut1 mutants have significantly diminished membrane association and glucose transport activity (p<0.05) relative to the wild-type Glut1 protein. Consistent with the reduced Glut1 membrane association, glucose transport kinetics studies showed that S66F, R126C, and T295M mutants have significantly reduced (p<0.05) Vmax but not Km. Thus, Glut1 single amino acid substitute mutants S66F, R126C, and T295M impair glucose transport function and constitute Glut1-deficiency states in vitro. These results support the pathogenicity of Glut1 S66F, R126C, and T295M in vivo.

MicroAlbuminuria Prevalence Study (MAPS) in hypertensive type 2 diabetic patients in Hong Kong.

OBJECTIVES: To assess the prevalence of macroalbuminuria and microalbuminuria, and the level of blood pressure control in patients with type 2 diabetes and hypertension in Hong Kong. DESIGN: Cross-sectional clinic-based epidemiological study. SETTING: Six medical centres (including two public hospital diabetes centres) in Hong Kong. PATIENTS: Recruited from the medical centres from April to November 2002, after excluding those with bacteriuria and haematuria. MAIN OUTCOME MEASURES: Body mass index; blood pressure; levels of blood glucose, macroalbuminuria, and microalbuminuria; treatments for hypertension and diabetes. RESULTS: The as per-protocol recruited population of 437 hypertensive type 2 diabetic patients had a mean age of 61.7 (standard error, 0.5) years. Overall, the prevalence of diabetic nephropathy in this population was high; 18.3% had macroalbuminuria (95% confidence interval, 16.5-20.2%) and 24.9% had microalbuminuria (95% confidence interval, 22.9-27.0%). Predictive factors were advanced age, male sex, poor blood pressure control, and existing cardiovascular complications. Whilst almost all patients (96.1%) were receiving treatment for hypertension, only 25.6% had systolic/diastolic blood pressures below the 130/85 mm Hg target. CONCLUSIONS: In Hong Kong, the prevalence of microalbuminuria and macroalbuminuria is high in type 2 diabetic patients with hypertension, particularly in males and those with poorly controlled systolic blood pressure. Tight glycaemic control, antihypertensive therapy, and use of renin-angiotensin system inhibitors/blockers are necessary to retard the progression of nephropathy to advanced renal disease.

Multi-gene epigenetic silencing of tumor suppressor genes in T-cell lymphoma cells; delayed expression of the p16 protein upon reversal of the silencing.

To understand better T-cell lymphomagenesis, we examined promoter CpG methylation and mRNA expression of closely related genes encoding p16, p15, and p14 tumor suppressor genes in cultured malignant T-cells that were derived from cutaneous, adult type, and anaplastic lymphoma kinase (ALK)-expressing T-cell lymphomas. p16 gene was epigenetically silenced in all but one of the 10 malignant T-cell lines examined, p15 gene silenced in roughly half of the lines, and p14 was the least frequently affected. Extensive methylation of the p16 promoter was seen in six out of 10 cutaneous T-cell lymphoma patient samples and corresponded with lack of p16 protein expression in the cases examined. Treatment of cultured T-cells with the DNA methyltransferase inhibitor, 5-aza-2-deoxy-cytidine, resulted in reversal of the p16 gene silencing. However, expression of p16 protein was delayed in relationship to p16 promoter demethylation and required up to 3 weeks to occur, seemingly reflecting late activation of the p16 gene. These findings indicate that epigenetic silencing affects in T-cell malignancies, often simultaneously, several tumor suppressor genes that impact on key cell functions. The observed differential silencing of p16 and p14, and to a lesser degree p15 gene, indicates that the silencing is governed by precise, promoter region-specific mechanisms. The study provides also further rationale for treatment of at least some types of T-cell lymphomas with DNA methyltransferase inhibitors to target the epigenetically silenced tumor suppressor genes.

Rolling over in infants: age, ethnicity, and cultural differences.

A preliminary cross-sectional study of 72 Hong Kong Chinese infants suggested that these infants learn to roll from supine-to-prone before rolling from prone-to-supine i.e. the opposite to teaching in most western texts. Three-hundred and sixty mothers were recruited postpartum and asked to record, on a chart, information related to the developmental milestone of rolling over for their infants (49% male) during the next 9 months. Telephone reminders were given at 4 and 8 months and, by the end of the study, information had been obtained from 240 mothers (67% of original sample, 51% male infants). Mean ages of rolling over were 5.1 months (SD1.5) for supine-to-prone and 5.7 months (SD1.3) for prone-to-supine. Age of rolling over from supine-to-prone was not influenced by usual sleep position, infant's sex, mother's intention to breastfeed infant, number of siblings, marital status, main daytime caregiver, or feeding method over 9 months. Hong Kong Chinese infants roll from supine-to-prone before they roll from prone-to-supine.

Abnormal liver function tests in the symptomatic pregnant patient: the local experience in Singapore.

INTRODUCTION: The causes of abnormal liver function tests in pregnancy are varied and may or may not be pregnancy-related. Often, the diagnosis can be difficult. This study looked at the causes of deranged liver function tests in obstetric patients with significant symptoms and signs. MATERIALS AND METHODS: Data from 50 cases of abnormal liver function tests in pregnant patients, who presented from 1998 to 2001, were analysed. Their presenting symptoms included persistent vomiting (48%), pruritus (14%), jaundice (26%), upper abdominal discomfort (24%) and hypertension (46%). RESULTS: Pregnancy-related causes accounted for 84% of the abnormal liver function tests. Abnormal liver function tests occurred more frequently in the first (34%) and third (58%) trimesters than in the second trimester (8%). Hyperemesis gravidarum (94%) and partial haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome (31%) were the commonest causes in the first and third trimesters respectively. Hepatitis B flare resulted in 2 maternal deaths. Seven patients with pre-eclampsia toxaemia, acute fatty liver of pregnancy or partial/complete HELLP syndrome had their liver function tests measured sequentially before and after delivery. All of them showed rapid improvement postpartum with their alanine aminotransferase (ALT) dropping 50% within 3 days. CONCLUSIONS: The majority of patients with abnormal liver function tests had a cause related to pregnancy, and pregnancy-related causes in the third trimester improved rapidly postpartum. Hepatitis B flare was a significant non-obstetric cause leading to maternal mortality. This diagnosis must therefore be considered in ethnic groups where the incidence of chronic hepatitis B infection is high, especially in chronic hepatitis B carriers with suspected pregnancy-related disease who deteriorate postpartum.

Postnatally disturbed pancreatic islet cell distribution in human islet amyloid polypeptide transgenic mice.

OBJECTIVE: Islet amyloid polypeptide (IAPP)/amylin is produced by the pancreatic islet beta-cells, which also produce insulin. To study potential functions of IAPP, we have generated transgenic mice overexpressing human IAPP (hIAPP) in the beta-cells. These mice show a diabetic phenotype when challenged with an oral glucose load. In this study, we examined the islet cytoarchitecture in the hIAPP mice by examining islet cell distribution in the neonatal period, as well as 1, 3 and 6 months after birth. RESULTS: Neonatal transgenic mice exhibited normal islet cell distribution with beta-cells constituting the central islet portion, whereas glucagon and somatostatin-producing cells constituted the peripheral zone. In contrast, in hIAPP transgenic mice at the age of 1 month, the glucagon-immunoreactive (IR) cells were dispersed throughout the islets. Furthermore, at the age of 3 and 6 months, the islet organisation was similarly severely disturbed as at 1 month. Expression of both endogenous mouse IAPP and transgenic hIAPP was clearly higher in 6-month-old mice as compared to newborns, as revealed by mRNA in situ hybridisation. CONCLUSIONS: Mice transgenic for hIAPP have islets with disrupted islet cytoarchitecture in the postnatal period, particularly affecting the distribution of glucagon-IR cells. This islet cellular phenotype of hIAPP transgenic mice is similar to that of other mouse models of experimental diabetes and might contribute to the impaired glucose homeostasis.

Prediction models for sound leakage through noise barriers.

Two numerical models are presented for the prediction of sound leakage through openings in thin hard barriers. The first numerical method is based on a simple procedure of numerical integration that can be implemented straightforwardly. This model is a more general approach, suitable for barriers with arbitrary gaps. The second model is a new method that permits prediction of sound leakage due to the presence of horizontal gaps in a long barrier. In the new method, effective barriers of appropriate heights represent the edges of the horizontal gaps. The sound diffracted by each effective barrier is calculated by a closed-form analytic expression. The total sound-pressure level is determined from a sum of these diffracted fields. Hence, the new method is fast, simple, and intuitive, allowing the leakage to be assessed accurately. The validity of these two numerical models is confirmed by precise experimental measurements.