Biliary cystadenoma: A rare occurrence.

Biliary cystadenoma is a rare benign tumour with the potential to transform into malignant carcinoma of the biliary ductal system. There is difficulty in differentiating a benign one from a malignant biliary cystadenoma, and therefore these lesions should always be completely resected. We report a case of biliary cystadenoma which underwent a complete resection.

Motion corrected LV quantification based on 3D modelling for improved functional assessment in cardiac MRI.

Cine MRI is a clinical reference standard for the quantitative assessment of cardiac function, but reproducibility is confounded by motion artefacts. We explore the feasibility of a motion corrected 3D left ventricle (LV) quantification method, incorporating multislice image registration into the 3D model reconstruction, to improve reproducibility of 3D LV functional quantification. Multi-breath-hold short-axis and radial long-axis images were acquired from 10 patients and 10 healthy subjects. The proposed framework reduced misalignment between slices to subpixel accuracy (2.88 to 1.21 mm), and improved interstudy reproducibility for 5 important clinical functional measures, i.e. end-diastolic volume, end-systolic volume, ejection fraction, myocardial mass and 3D-sphericity index, as reflected in a reduction in the sample size required to detect statistically significant cardiac changes: a reduction of 21-66%. Our investigation on the optimum registration parameters, including both cardiac time frames and number of long-axis (LA) slices, suggested that a single time frame is adequate for motion correction whereas integrating more LA slices can improve registration and model reconstruction accuracy for improved functional quantification especially on datasets with severe motion artefacts.

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.

Quantitative risk-benefit analysis of fish consumption for women of child-bearing age in Hong Kong.

Maternal fish consumption is associated with both risks from methylmercury (MeHg) and beneficial effects from omega-3 fatty acids to the developing foetal brain. This paper assessed the dietary exposure to MeHg of women of child-bearing age (20-49 years) in Hong Kong, and conducted risk-benefit analysis in terms of the effects in children's intelligent quotient (IQ) based on local data and the quantitative method derived by the expert consultation of FAO/WHO. Results showed that average and high consumers consume 450 and 1500 g of fish (including seafood) per week, respectively. About 11% of women of child-bearing age had a dietary exposure to MeHg exceeding the PTWI of 1.6 µg kg(-1) bw. In pregnant women MeHg intake may pose health risks to the developing foetuses. For average consumers, eating any of the 19 types of the most commonly consumed fish and seafood during pregnancy would result in 0.79-5.7 IQ points gain by their children. For high consumers, if they only ate tuna during pregnancy, it would cause 2.3 IQ points reduction in their children. The results indicated that for pregnant women the benefit outweighed the risk associated with eating fish if they consume different varieties of fish in moderation.

Dietary exposure of Hong Kong adults to fatty acid esters of 3-monochloropropane-1,2-diol.

A total of 290 individual food samples were collected in Hong Kong, China, for 3-monochloropropane-1,2-diol (3-MCPD) fatty acid esters analysis. Most samples were processed food and in ready-to-eat form. The results show that the levels of 3-MCPD fatty acid esters were high in biscuits, fats and oils, snacks and Chinese pastry with mean bound 3-MCPD levels of 440, 390, 270 and 270 µg kg⁻¹, respectively. The dietary exposures to bound 3-MCPD of average and high adult consumers were estimated to be 0.20 and 0.53 µg kg bw⁻¹ day⁻¹, respectively. The primary toxicological concern of 3-MCPD fatty acid esters is its potential to release 3-MCPD in vivo during digestion in the gastrointestinal tract. 3-MCPD would affect the kidney, the central nervous system and the male reproductive system of rats. Assuming that 100% of the 3-MCPD was released from 3-MCPD fatty acid esters by hydrolysis in the digestive system, the dietary exposures to 3-MCPD for average and high adult consumers were only 10% and 26% of the provisional maximum tolerable daily intake (PMTDI) of 3-MCPD established by the Joint Food and Agriculture Organization/World Health Organization Expert Committee on Food Additives (JECFA) (2 µg kg bw⁻¹ day⁻¹), respectively. The results suggest that both average and high adult consumers are unlikely to experience major toxicological effects of 3-MCPD.

Simulation of left ventricle flow dynamics with dilated cardiomyopathy during the filling phase.

Dilated cardiomyopathy (DCM) is a common cardiac disease which leads to the deterioration in cardiac performance. A computational fluid dynamics (CFD) approach can be used to enhance our understanding of the disease, by providing us with a detailed map of the intraventricular flow and pressure distributions. In the present work, effect of ventricular size on the intraventricular flow dynamics and intraventricular pressure gradients (IVPGs) was studied using two different implementation methods, i.e. the geometry-prescribed and the fluid structure interaction (FSI) methods. Results showed that vortex strength and IVPGs are significantly reduced in a dilated heart, leading to an increased risk of thrombus formation and impaired ventricular filling. We suggest FSI method as the ultimate method in studying ventricular dysfunction as it provides additional cardiac disease prognostic factors and more realistic model implementation.

Fluid structure interaction simulation of left ventricular flow dynamics under left ventricular assist device support.

For patient's receiving mechanical circulatory support, malfunction of the left ventricular assist device (LVADs) as well as mal-positioning of the cannula imposes serious threats to their life. It is therefore important to characterize the flow pattern and pressure distribution within the ventricle in the presence of an LVAD. In this paper, we present a 2D axisymmetric fluid structure interaction model of the passive left ventricle (LV) incorporating an LVAD cannula to simulate the effect of the LVAD cannula placement on the vortex dynamics. Results showed that larger recirculation area was formed at the cannula tip with increasing cannula insertion depth, and this is believed to reduce the risk of thrombus formation. Furthermore, we also simulated suction events (collapse of the LV) by closing the inlet. Vortex patterns were significantly altered under this condition, and the greatest LV wall displacement was observed at the part of the myocardium closest to the cannula tip.

Trimethylamine oxide, dimethylamine, trimethylamine and formaldehyde levels in main traded fish species in Hong Kong.

Levels of trimethylamine oxide (TMAO), dimethylamine (DMA), trimethylamine (TMA) and formaldehyde (FA) were studied in 266 different fishes, including fresh/frozen raw whole fishes of 89 different species that traded in Hong Kong, China. Determination of TMAO can confirm the source of DMA and FA if present in the sample. These samples were purchased from different commercial outlets between April and August 2007. All samples of raw whole fish were identified for their species by the Agriculture, Fisheries and Conservation Department. The content of TMAO was determined by high-performance liquid chromatography (HPLC) coupled with a chemiluminescent nitrogen detector. The possible decomposition products of TMAO, DMA and TMA were analysed by headspace solid-phase micro-extraction gas chromatography-mass spectrometry (HS-SPME-GC-MS), while FA was conducted by steam distillation then quantified by a HPLC. The range for TMAO of all samples was <5-3800 mg kg(-1) with median of 970 mg kg(-1), while the endogenous enzymatic cleavage products DMA, TMA and FA were in the range of <2-320, <1-190 and <1-160 mg kg(-1), respectively. These cleavage products were mainly found in three fish species, Harpadon nehereus, Saurida elongata and Saurida tumbil, that belong to the family Synodontidae (Lizardfishes) and subfamily Harpadontinae. Besides, freshwater fish species, namely, Micropterus salmoides, Oreochromis niloticus niloticus and Siniperca chuatsi, were found to contain TMAO in the range of 510-760, 85-720 and 400-640 mg kg(-1), respectively.

Seroprevalence of toxoplasmosis among migrant workers from different Asian countries working in Malaysia.

A serologic study of Toxoplasma antibodies among 501 foreign migrant workers in Malaysia was conducted in a plantation and detention camp. The highest prevalence rate of 46.2% was among Nepalese workers. Statistical analysis indicated the IgG positivity rate among local residents was significantly higher than the migrants studied (p < 0.05). The IgM positivity rate showed no significant difference between the two groups (p > 0.05). No significant difference in the prevalence rate was noted between the migrants and the local workers when grouped by agricultural and non-agricultural occupations (p > 0.05). The continuous introduction of these infections may influence the epidemiology and further compromise efforts in control and prevention. It is therefore important to monitor of non-notifiable diseases.

Relationship between annual volume of patients treated by admitting physician and mortality after acute myocardial infarction.

CONTEXT: Acute myocardial infarction (AMI) is a common condition that is treated by physicians with varying levels of clinical experience, but whether the level of experience affects outcome remains uncertain. OBJECTIVE: To evaluate the relationship between the average annual volume of cases treated by admitting physicians and mortality after AMI. DESIGN, SETTING, AND PATIENTS: Retrospective cohort study using linked administrative databases containing patient admission information for 98 194 patients treated by 5374 physicians between April 1, 1992, and March 31, 1998, in Ontario, Canada. MAIN OUTCOME MEASURES: Mortality risk rates for 30 days and 1 year post-AMI, adjusted by physician volume and patient, physician, and hospital characteristics. RESULTS: The 30-day mortality rate was 13.5% and the 1-year mortality rate was 21.8%. A strong inverse relationship between the average annual volume of AMI cases treated by the admitting physician and mortality after an AMI was observed. The 30-day risk-adjusted mortality rate was 15.3% for physicians who treated 5 or fewer AMI cases per year (lowest quartile) compared with 11.8% for physicians who treated more than 24 AMI cases annually (highest quartile; P<.001). The 1-year risk-adjusted mortality rate was 24.2% for physicians who treated 5 or fewer AMI cases per year (lowest quartile) compared with 19.6% for physicians who treated more than 24 AMI cases annually (highest quartile; P<.001). CONCLUSION: Patients with AMI who are treated by high-volume admitting physicians are more likely to survive at 30 days and 1 year.

Determination of volatile components in peptic powder by gas chromatography-mass spectrometry and chemometric resolution.

Gas chromatography-mass spectrometry (GC-MS) coupled with chemometric resolution upon two-dimensional data was proposed as a method for the analysis of volatile components in a traditional Chinese medicinal preparation peptic powder which contains Rhizoma Atractylodis, Pericarpium Citri Reticulatae, Cortex Magnoliae Officinalis and Radix Glycyrrhizae. Ninety-three components were separated and 65 of them were qualitatively and quantitatively analyzed which represented about 90.28% of the total content. With the help of chemometric resolution, the data were resolved into a pure chromatogram and a mass spectrum of each chemical component. The accuracy of qualitative and quantitative results was greatly improved by using the two-dimensional comprehensive information of chromatograms and mass spectra. The example showed that chemometric resolution could greatly enhance separation ability. This makes it possible to analyze complicated practical systems like traditional Chinese medicinal preparations with the help of coupled instruments and chemometric resolution methods.

[Effect of new zhengtian pill on expression of whole blood platelet membrane adhesion molecules in patients of migraine].

OBJECTIVE: To investigate the effect of New Zhengtian Pill (NZTP) on expression of whole blood platelet membrane adhesion molecules (PMAM) in patients of migraine. METHODS: Sixty-eight patients were divided into two groups, the 35 patients in the treated group treated by NZTP orally and the 33 patients in the control group treated by Fuguiqin Capsule with a therapeutic course of 30 days for both groups. Changes of PMAM GP II b/III a(CD41) and P-selectin (CD62P) were observed by flow-cytometry and compared with those in healthy persons. RESULTS: The markedly effective rate and total effective rate in the treated group was higher than those in the control group respectively (P < 0.05 and P < 0.01). The PMAM expression was also higher in patients, both at onset stage and intermittent stage, than in healthy persons (P < 0.01), NZTP treatment could reduce their increased expression significantly (P < 0.01). CONCLUSION: NZTP could reduce the PMAM expression and inhibit the activation of platelet.

Specificity and sensitivity of a rapid dipstick test (Brugia Rapid) in the detection of Brugia malayi infection.

A total of 753 serum samples from 6 institutions in 3 countries (Malaysia, Indonesia and India) were used to evaluate an immunochromatographic rapid dipstick test, Brugia Rapid, for diagnosis of Brugia malayi infection. The samples comprised sera from 207 microfilaria-positive individuals and 546 individuals from filaria non-endemic areas. The latter consisted of 70 individuals with soil-transmitted helminth infections, 68 with other helminth infections, 238 with protozoan infections, 12 with bacterial and viral infections and 158 healthy individuals. The dipstick is prepared with a goat anti-mouse antibody control line and a B. malayi recombinant-antigen test line. First, the dipstick is dipped into a well containing diluted patient serum, thus allowing specific anti-filarial antibody in the serum to react with the recombinant antigen. Then the dipstick is placed into an adjacent well containing reconstituted anti-human IgG4-gold. After 10 min, development of 2 red-purplish lines denotes a positive result and one line indicates a negative reaction. The overall results of the evaluation showed 97% sensitivity, 99% specificity, 97% positive predictive value and 99% negative predictive value. Brugia Rapid is thus a promising diagnostic tool for detection of B. malayi infection, and would be especially useful for the brugian filariasis elimination programme.

Asthma in children: Management practices among paediatricians and family physicians.

OBJECTIVE: To ascertain the variation in asthma management practices among paediatricians and family physicians to determine how to improve care. DESIGN: Questionnaire study of paediatricians and family physicians that focused on the use of beta(2)-agonists, inhaled corticosteroids, patient asthma education, quantitative measurements of airflow and diagnostic investigations for asthma. Case scenarios were used in the questionnaire. RESULTS: The response rate was 66% (415 of 632) among paediatricians and 42% (1156 of 2750) among family physicians. In general, both groups followed consensus guidelines. There were some differences in management practices among paediatricians and family physicians. Paediatricians were more likely to develop an action plan and less likely to use xanthines or inhaled anticholinergic agents. However, family physicians were more likely to use spirometry or home peak expiratory flow rates to make a diagnosis of asthma. CONCLUSION: Family physicians and paediatricians require a different focus on educational interventions to improve the care of children with asthma.

Physician asthma management practices in Canada.

OBJECTIVES: To establish national baseline information on asthma management practices of physicians, to compare the reported practices with the Canadian Consensus recommendations and to identify results potentially useful for interventions that improve physician asthma management practices. DESIGN: National, stratified cross-sectional survey. SETTINGS: The 10 provinces and two territories of Canada, from 1996 to 1997. PARTICIPANTS: Questionnaires were sent to 4489 physicians stratified by province/territory and specialty group (family/general practice, respirology, internal medicine, pediatrics and allergy/immunology); 2605 responses were received. OUTCOME MEASURES: Methods for the diagnosis, treatment, education and follow-up of patients with asthma ('asthma management practices'). RESULTS: Significant variations existed among the five specialty groups in asthma management practices. A low use of objective measures of airflow limitation to assist with diagnosis was found among some respondents (mostly family physicians). Up to 40% of physicians regarded the daily fixed dosing (three or four times a day) of inhaled, short acting beta2-agonist as 'first-line therapy' for moderate to severe asthma. A minority of physicians reported using written action plans for patients or referring them to other health professionals for asthma education. Insufficient time during appointments and a perceived lack of appropriate educational materials were frequently cited as reasons for not providing asthma education. The perceived knowledge of the Canadian Consensus recommendations varied among physicians but was lowest among nonspecialists. CONCLUSIONS: The survey showed variations in certain aspects of the management of asthma by physicians. The findings will help to target specific areas for future physician education programs and other behavioural change strategies.

Patterns of use of the bone mineral density test in Ontario, 1992-1998.

BACKGROUND: There is ongoing controversy about who should be referred for bone mineral density (BMD) testing to estimate fracture risk and diagnose osteoporosis. The purpose of this study was to examine patterns of use of BMD testing in Ontario between 1992 and 1998. METHODS: All physician claims from the Ontario Health Insurance Plan (OHIP) claims database for BMD testing between Jan. 1, 1992, and Dec. 31, 1998, were categorized by age and sex of the patient and the specialty of the physician who ordered the test. Time trends and regional rate variation analyses were also performed. To examine the prevalence of repeat testing, an inception cohort of women who had a BMD test in 1996 was followed for 2 years from the date of first test. RESULTS: From 1992 to 1998 the number of BMD tests performed per year in women increased from 34,402 to 230,936 and in men from 2,162 to 13,579. In 1998 most tests were being ordered by family physicians (80.2% in 1998 v. 52.1% in 1992). Approximately 1 in 7 women aged 55-69 years had BMD tests done in 1998. Within a 2-year period 29.3% of these women had the test repeated; the mean time between tests was 16 months. Regional rate variation analyses of BMD tests performed in 1996-1998 indicated a 235-fold variation in BMD test rates across counties in Ontario, with a range from 0.2 to 47.1 per 1000 women in the population. INTERPRETATION: The number of BMD tests performed each year in Ontario is increasing rapidly. However, the significant variation between rates of testing in different regions indicates that the diffusion of this technology may not be taking place according to population need.