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Chung CH. Alarming Pneumomediastinum but Benign Outcome: a Case Report on Oesophageal Perforation by Foreign Body. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790401100408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A case of oesophageal perforation after endoscopic removal of foreign body is described. A 50-year-old female had a sharp fish bone impacted in the cervical oesophagus. After dislodging the bone at endoscopy, she developed neck pain and swelling. Chest X-ray showed alarming pneumomediastinum and subcutaneous emphysema. However, there was no leakage in the water-soluble contrast swallow. She was successfully managed conservatively. Early recognition and proper management of such a well-known complication are important to lower morbidity, especially in view of the fact that endoscopic removal of swallowed foreign bodies is being performed on an outpatient basis in some emergency departments. Special precaution should be given to sharp foreign bodies lodged at the cervical oesophagus.
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Chan KF, Chung CH. X-Ray Quiz: A Lady with Shoulder Injury. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790701400212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Chan CKM, Chiu HS, Chung CH. Delayed Rupture of Occult Splenic Injury: a Case Report. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790301000309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We report on a case of splenic rupture that presented eleven days after a trivial injury. Possible explanations of the delay in presentation and ways for early detection are discussed. Emergency physicians should always bear this entity in mind before discharging patients with left thoracoabdominal injury.
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Lau KH, Chung CH. X-Ray Quiz: A Woman with Knee Pain. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790601300206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Abstract
Body packing of illicit drugs is one of the means of drug trafficking. Asymptomatic suspects may be brought in by law-enforcement officers for body search of possible drug packing inside the body. Symptomatic body packers may present with gastrointestinal obstruction or toxicity of the leaking drugs inside the packets. Management strategies are largely determined by the modes of presentation. Asymptomatic persons must be persuaded with every effort for consent to the body cavity search as well as treatment for the safe passage of any packed drugs to avoid possible complications and medico-legal sequelae. Abdominal X-rays and computed tomography can be helpful in confirming the presence of drug packets and in identifying possible packet leakage. Gastrointestinal decontamination, whole bowel irrigation, use of specific antidote as well as operative intervention may be indicated. Emergency physicians must be conversant with the medical and legal aspects of the management of these body packers.
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Chung CH, Man CY. Drug Abuse and the Emergency Physician. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790901600401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Chung CH. Authorship and Contributorship. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790601300401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Chung CH. Financial, Educational and Cultural ‘Revolutions’ for Emergency Medicine in Hong Kong. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790301000101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Chung CH. X-Ray Quiz: An Elderly Man with Haemoptysis. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790601300311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Yuen WC, Tang WF, Chung CH. Substance Abuse Patient Characteristics: A Scene from an Emergency Department near the Hong Kong – Shenzhen Border. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790100800402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective Drug abuse is an escalating problem in Hong Kong, especially among teenagers and young adults. A study was conducted in order to obtain the characteristics of drug abusers presenting to the Accident & Emergency department of North District Hospital, which is located in the New Territories near the Hong Kong – Shenzhen border. Design Prospective study. Setting Accident and Emergency department of a public general hospital. Patients Drug abusers presenting to the Accident and Emergency department in a six-month period. Main outcome measures Epidemiological data including demographic data, types of drug taken, place of drug abuse and magnitude of cross-border drug abuse were collected and analyzed. Results The sex distribution was male 59 and female 13 (ratio=4.5:1). The mean age was 29.2 (range 14 to 67 years). Of interest, 29.2% abused drugs at home; 29.2% abused drugs in parties such as karaoke, rave and disco; 68% abused drugs in Hong Kong; 32% abused drugs in China and 6.9% claimed themselves first-time drug abusers. The commonest drug taken was ecstasy (40.3%) – the majority (55%) in China and the rest (45%) in Hong Kong. For organic solvent abusers, 57.1% were below 18 years of age. One patient died, resulting in a mortality rate of 1.4%. Conclusion Ecstasy was the commonest drug abused on both sides of the “border”. The majority of substance abusers were teenagers or young adult males. This study confirmed the significant magnitude of psychotropic substance abuse problem among the young population in the North District, indicating the urgent need for clinical and social intervention.
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Abstract
A 33-year-old man developed spontaneous haemopneumothorax after taking ecstasy in a ‘rave party’. Massive haemorrhage occurred after chest drainage and decompression. Both the adverse effects of ecstasy and risk behaviours at the party might have contributed to the development of the spontaneous haemopneumothorax.
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Chung CH. The Challenge of Dizziness. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790601300301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Chan KM, Law KL, Chung CH. Case Report: Thoracic Spinal Epidural Haematoma – an Unusual Cause of Chest Pain. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790601300405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Chest pain is a common presentation to the emergency department. Aetiologies to be considered are usually cardiac or pulmonary in origin. We reported a rare case of thoracic spinal epidural haematoma initially presenting to the emergency department with chest pain. The patient re-attended the emergency department four hours after discharge with symptoms of cord compression. Magnetic resonance imaging of the thoracic spine showed an epidural haematoma causing cord compression. Surgical decompression was performed with gradual resolution of symptoms. Simply ruling out acute coronary syndrome may not be sufficient in patients presenting with chest pain.
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Chung CH, Wong PCY. A Six-Year Prospective Study of Out-of-Hospital Cardiac Arrest Managed by a Voluntary Ambulance Organisation. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790501200303] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To obtain a database on the epidemiology of prehospital cardiac arrest and its management by a voluntary ambulance service, with the view for developing future strategies and service improvement. Design A 6-year prospective study from December 1998 to November 2004, using the Utstein-style template. Setting A voluntary ambulance service in Hong Kong. Subjects and methods Ambulance members had to complete and submit a specially designed data form after managing a cardiac arrest case, together with the ambulance run record and the automated external defibrillator (AED) computer printout, if appropriate. Main outcome measures Survival to hospital discharge and return of spontaneous circulation after resuscitation. Results A total of 72 cardiac arrests occurred during the period, with patients' age ranging from 29 to 106 years (mean 73.4). Most cardiac arrests occurred at home (46 or 63.9%). There were 58 witnessed cardiac arrests (80.5%), but bystander cardiopulmonary resuscitation (CPR) was started in only nine cases (15.5%) before the arrival of the ambulance crew. Six patients had evidence of rigor mortis or dependent lividity on ambulance arrival. For the 61 patients with electrocardiogram strips, the initial presenting rhythm on the AED was asystole in 45 (73.8%), pulseless electrical activity in 5 (8.2%), and ventricular fibrillation (VF) in 11 (18.0%). The median call-to-arrival time for VF cases (4.0 minutes) was significantly shorter than that of non-VF rhythms (8.5 minutes) [Mann-Whitney U test p=0.008]. Five patients had return of spontaneous circulation after resuscitation, but only one survived to hospital discharge. Conclusions Bystander CPR and ambulance response time are two areas requiring urgent improvement in our locality. As the majority of cardiac arrests occurred at home, the cost-effectiveness of public access defibrillation for Hong Kong is unclear. However, strategic placement of AED at high incidence' locations should be seriously considered.
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Cheng SST, Chung CH. A Retrospective Study of Patients Discharged within 24 Hours after Emergency Admission in a Public General Hospital. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790200900304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives To identify the epidemiological characteristics and outcome of patients who were discharged within 24 hours of emergency admission, and to explore methods to reduce inappropriate admission. Design Retrospective study. Setting Emergency admission in a public general hospital in Hong Kong. Patients Four hundred and ninety-one cases collected in a three-month period from 1st April 2000 to 30th June 2000, excluding those who died within 24 hours of admission. Main outcome measures Patients' epidemiological and clinical characteristics, specialty of admission, in-patient procedures performed, diagnosis upon discharge and destination of patients. Results During the study period, 8.8% of the 5,587 emergency admissions were discharged within 24 hours. Most of them were middle-aged males, triaged as category 3 and 4 non-trauma cases. The percentage of emergency Orthopaedic and Surgical admission resulting in discharge within 24 hours was 18.5% and 16.2% respectively, substantially higher than the percentage of emergency Medical and Paediatric admission (5.5% and 4.7% respectively). The most common diagnoses included orthopaedic open soft tissue injuries, orthopaedic closed fractures and dislocations, head injury, drug overdose, abdominal pain, ischaemic heart disease or chest pain and foreign body in throat. Overall, 20.8% of cases received some forms of orthopaedic procedures, 9% had computed tomography (CT) brain done, and 5.5% had OGD performed. Around 90% of cases with orthopaedic open soft tissue injuries and closed fractures or dislocations received intervention, 73% of head injury cases had CT brain done, and around 63% of patients with foreign body in throat received oesophago-gastroduodenoscopy (OGD). Overall, 14% of cases discharged themselves against medical advice or walked away after admission. Up to 9.8% were transferred to other hospitals within 24 hours. Around 54.8% were followed up in hospital after discharge, and re-admission was planned in 2.9% for elective procedures. Only 13 cases (2.6%) were re-admitted through A&E within one week with the same diagnosis into the same specialty. Conclusions The issue of ‘discharge within 24 hours’ should not automatically be regarded as inappropriate emergency admission. Upgrade of professional training and clinical supervision, improvement of administrative arrangement and clinical audit are possible measures to enhance the efficiency of hospital utilization.
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Lam CW, Ng CP, Chung CH. A Fatal Case of Iatrogenic Bilateral Pneumothorax after Acupuncture. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790901600412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We report a case of fatal iatrogenic pneumothorax after acupuncture. A patient with motor neurone disease presented with shortness of breath after acupuncture. Bilateral pneumothoraces were detected. Bilateral chest drains were inserted. However, the patient succumbed 41 days after admission. On reviewing the literature, pneumothorax was not uncommonly seen after acupuncture, and most patients recovered uneventfully. However, fatal cases still happened.
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Chung CH. Extending the Horizons of the Hong Kong Journal of Emergency Medicine. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790401100101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Chan KF, Chung CH. A Case of Disseminated Intravascular Coagulopathy Developing Rapidly after a Suspected Bamboo Snakebite. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790601300307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We present a case of disseminated intravascular coagulopathy developing rapidly after being bitten by a snake suspected to be Trimeresurus albolabris in a 67-year-old man. The unusually fast onset of coagulation disturbances and the later renal complication should alert emergency physicians that snakebites (including Trimeresurus albolabris) can be devastating if not managed promptly.
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Abstract
Clinical audit is the review of clinical performance against agreed standards, and the refining of clinical practice as a result – a cyclical process of quality improvement in clinical care. The different steps of the clinical audit cycle are discussed. Publications on clinical audit in connection with Emergency Medicine are scarce in the medical literature. Clinical audit should be made compulsory for all healthcare professionals providing clinical care, and emergency physicians are no exceptions.
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Abstract
Introduction Serum amylase has all along been used to aid the diagnosis of acute pancreatitis in hospitals in Hong Kong. Another serum marker lipase, on the other hand, has been claimed to have better accuracy in other countries. The aim of this study was to evaluate serum lipase as a diagnostic tool compared to the traditional serum amylase. Methods This was a retrospective study in a district hospital in Hong Kong. The two serum markers were taken from 3451 patients with acute abdominal pain who presented to our emergency department over an eight-month period. Receiver operating characteristic (ROC) curve was used to assess the diagnostic accuracy of both markers. Other diagnostic efficacy modalities, including sensitivity, specificity, positive and negative predictor values were also calculated. Results Both amylase and lipase had high accuracy index in the area under the ROC curve (0.992 and 0.996 respectively). The sensitivity and specificity of amylase at 3-fold above normal limit were 63.6% and 99.4% while those of lipase were 95.5% and 99.2% respectively. Conclusion Both serum enzymes had good diagnostic accuracy in our study but lipase was slightly better than amylase.
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Siu AYC, Chung CH. A Pilot Study on the use of Tramadol Hydrochloride for Pain Control in an Emergency Department. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790401100104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction Tramadol hydrochloride is a synthetic μ,-opioid agonist. It has been used in the control of moderate to severe pain. Most of the studies on tramadol were related to post-operative pain control. Data on acute pain control in the emergency setting were limited. This study reported on the initial evaluation of tramadol for pain control in an emergency department. Materials and methods It was a prospective observational study. Patients aged 16 years or above attending our emergency department with moderate to severe pain were recruited. Patients with known allergy, current psychiatric medication, intake of alcohol, major systemic illness and opioid dependence were excluded. All patients received 100 mg intramuscular tramadol injection. A 10 cm Visual Analogue Scale (VAS) was used to assess the pain severity before injection, 30 minutes and 60 minutes after injection. Vital signs and side effects were also recorded. Results Forty patients (M: 24, F: 16) were recruited from October to December 2002. Their mean age was 53.5 years. The majority of them suffered from acute musculoskeletal pain or arthritis. Tramadol was shown to be effective in pain control. The VAS decreased by 1.90 (p<0.001) and 3.38 (p<0.001) at 30 minutes and 60 minutes respectively. Four patients reported nausea and three patients vomited. Conclusion Tramadol appeared to be a safe drug to be used in the emergency setting. Only a few insignificant side effects were reported. The comparison of efficacy with other analgesics requires further studies.
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Chung CH. Case and Literature Review: Adult Acute Epiglottitis – Rising Incidence or Increasing Awareness? HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790100800407] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective The prevalence of adult acute epiglottitis is probably more common than is generally appreciated. A retrospective case review in a district hospital and a medical literature search may provide baseline information to guide future strategies. Methods Cases of acute epiglottitis in a period of 3 years and 4 months were traced from the hospital computer systems. Medical records were reviewed. Medical literature on “adult acute epiglottitis” was searched through Medline and EMBASE. Relevant full text articles were retrieved through hospital library network. Results From February 1998 to June 2001, 11 cases of acute epiglottitis were identified. The age range was 34–78 (mean 47.5, median 41). There was no paediatric case. The male to female ratio was 9:2. Eight presented with fever, sore throat and dysphagia, one presented with dyspnoea and two presented as foreign body in throat. Nine were treated successfully conservatively. Two were intubated prophylactically. There was no case fatality. Conclusion Adult acute epiglottitis has become much commoner than its paediatric counterpart. Acute epiglottitis should be suspected in all patients with a sore throat and dysphagia, especially if symptoms are out of proportion to the pharyngeal inflammation.
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Siu AYC, Chung CH. Can Tension Haemopneumothorax Have Stable Haemodynamics? HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790301000109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Tension pneumothorax or haemopneumothorax is a clinical diagnosis. Plain radiography is not advised to confirm the diagnosis and may delay definitive treatment. Unstable haemodynamics is one of the prerequisites for the diagnosis. We report a case in which the patient suffered from haemopneumothorax with all the typical radiological features of tension, but without any clinical sign of unstable haemodynamics. Close monitoring of patients suspected to have pneumothorax is recommended, especially in the radiology suite.
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Chung CH. From Quarterly to Bimonthly. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791001700401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Abstract
A study was carried out in a district hospital located close to the Hong Kong - Shenzhen border, in order to get a picture of the epidemiology of diseases and injuries sustained by Hong Kong residents in China. The emergency medical treatment provided and the degree of patient satisfaction were also analysed. The majority of the patients were adult males. Trauma constituted more than 50% of the attendance, with traffic accident and common assault being the leading causes. This group of Hong Kong residents preferred to be treated in Hong Kong hospitals because of perceived better quality of care. There was a high demand on the local ambulance service and this might have financial and resource implications.
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Chung CH. Say No to 24-Hour Public Outpatient Clinics in Hong Kong. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791001700501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Wong MCK, Chung CH. CT Quiz: A Man with Headache and Dizziness. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790501200110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Ng CP, Chung CH. Persistent Fever and Exanthema in a Family: A Case Report of Mediterranean Spotted Fever. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790501200210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Mediterranean spotted fever (also called Boutonneuse fever) is a notifiable disease in Hong Kong, but its diagnosis can be difficult. We report a case of Mediterranean spotted fever in a middle-aged man who presented with persistent fever, headache, and skin rash. Three weeks ago, his daughter had similar presentations. With a history of similar clinical presentation within family members, the possibility of potential exposure to a common disease vector should be suspected. Establishing an early diagnosis may be possible if this important history is obtained. Early recognition of this disease may lead to early therapeutic intervention, resulting in decreased morbidity and shortened duration of hospital stay.
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Chung CH, Tung WK. Providing Emergency Medical Assistance in the Vicinity of the Hospital. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790901600201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Siu AYC, Chung CH. The Use of Ultrasonography to Assess Patients with Right Lower Quadrant Pain in the Emergency Department. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790701400202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Acute appendicitis is always a clinical challenge to emergency physicians. Clinical examination or blood tests are notoriously unreliable in making the diagnosis, especially in the early phase of the disease. Computed tomogram can facilitate the diagnosis, however it is usually not easily accessible to emergency physicians. Bedside ultrasonography is now frequently used by emergency physicians in various situations for the assessment of patients. This study aimed at exploring the potential use of bedside ultrasonography in the diagnosis of acute appendicitis in patients presenting with right lower quadrant abdominal pain.
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Chiu HS, Chan KF, Chung CH, Ma K, Au KW. A Comparison of Emergency Department Admission Diagnoses and Discharge Diagnoses: Retrospective Study. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790301000202] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To study the accuracy of emergency department admission diagnosis and the effect of investigations on diagnostic accuracy. Design Retrospective study in a two-month period. Setting Accident & Emergency Department of a public general hospital, which had four in-patient specialties – Medicine, Surgery, Paediatrics and Orthopaedics. Subjects All cases admitted through the emergency department in the study period. Main outcome measures Degree of correlation between emergency department admission diagnosis and hospital discharge diagnosis. Results Of all admission diagnoses, 71.4% fully or partially matched the final discharge diagnoses. The accuracy of diagnosis was statistically better in traumatic cases, the male sex and young adults. Diagnostic accuracy varied with the specialty involved and investigations taken. Conclusion History and physical examination remained the most important diagnostic tools in the emergency department. In general, simple investigations available at the emergency department were not helpful in improving diagnostic accuracy.
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Chung CH. Closed Reduction Techniques for Acute Anterior Shoulder Dislocation: from Egyptians to Australians. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790401100309] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Acute anterior shoulder dislocation is a common presentation to emergency departments. A standard technique for reduction does not exist. Most dislocations can be reduced by one or more simple manoeuvres involving traction-countertraction, leverage and/or pulsion. The better-known methods are discussed, highlighting the manoeuvres, virtues and drawbacks.
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Cheng CC, Chung CH. A 6-Year Epidemiological Study of Pulmonary Embolism in an Emergency Department. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790501200403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To identify the epidemiology and early clinical features of patients with pulmonary embolism with a view to facilitate making the correct diagnosis. Methodology A retrospective study of patients admitted through the emergency department with a discharge diagnosis of pulmonary embolism in the computerised Clinical Management System from 1st January 1999 to 31st December 2004 in a public emergency general hospital in Hong Kong. Results Twenty-two patients were newly diagnosed to have pulmonary embolism and included in the study. The patients' clinical features and investigation findings were analysed. Old age and immobilisation were the most common risk factors identified. Nine patients were found to have deep vein thrombosis but none of them complained of calf pain during consultation in the emergency department. Most patients had symptoms of shortness of breath and chest pain on presentation. Fourteen patients had type 1 respiratory failure. The electrocardiogram and chest X-ray findings were non-specific. All the patients with D-dimer done showed positive results. CT scans were used in all patients to make the final diagnosis. Nineteen patients received low molecular weight heparin followed by warfarin and three patients had thrombolytic therapy. Conclusion Pulmonary embolism is not a commonly diagnosed disease in Hong Kong. The symptoms are non-specific and it is difficult to make the correct diagnosis in the emergency department.
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Chung CH. Window of the Soul. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790801500401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Siu AYC, Kwok SL, Chung CH, Lai KK. A Rare Cause of Necrotizing Fasciitis: Psoas Abscess. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790501200409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Necrotizing fasciitis always carries very high mortality and morbidity rates. It can be due to group A beta-haemolytic streptococci, which are traditionally described as the flesh-eating bacteria. More commonly, it is related to a mixed growth of bacteria that can be secondary to trauma or surgery. Secondary necrotizing fasciitis due to concomitant soft tissue infection is uncommon. We reported a fatal case of necrotizing fasciitis which was caused by a coexisting psoas abscess. A search for concomitant soft tissue infection is warranted in patients presenting with necrotizing fasciitis. This article also reviewed the clinical tools that may help to make an early diagnosis of the disease.
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Chung CH. Beware of the Anticoagulated Elderly with Minor Head Injury. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790501200202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A 69-year-old man first presented to the emergency department after a fall. He had no history of loss of consciousness or vomiting. He sustained a 3 cm long laceration over the right occipital region of the head. There was no fracture in the X-rays of the skull. He was on warfarin because of cardiac problem. He was discharged after suturing. He re-attended the next morning because of left sided weakness. Non-contrast brain computed tomogram showed acute subdural haematoma. Burr holes were performed subsequently. Special precautions should be undertaken in managing the elderly with minor head injury, with a lower threshold for computed tomography and coagulation profile studies.
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Chung CH, Lai KK. Beware of the Migrating Chest Pain and Widened Mediastinum: Case Series on Aortic Dissection. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790200900206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective Aortic dissection is not a rare life-threatening emergency. Undiagnosed and untreated aortic dissection is associated with a high mortality. A review of cases in the hospital may provide a baseline picture to guide clinical decisions. Design Retrospective case review for a period of 3 years and 4 months. Setting District general hospital near the Hong Kong – Shenzhen ‘border’ with 24-hour Accident & Emergency service but without cardiothoracic surgical capability. Population All cases coded as ‘aortic dissection’ in the computerized ‘Clinical Management System’ of the hospital. Main outcome measures Date, sex, age, history of hypertension, presenting symptoms, pulse deficit, chest X-ray findings, pericardial effusion, A&E diagnosis, type of dissection and patient outcome. Results From August 1998 to November 2001, 26 cases of aortic dissection were identified. There were 19 males and 7 females. Age range was 26 to 90 years (mean 65.04 ± SD 15.04, median 66.50, mode 65). In the plain chest X-rays, widened superior mediastinum (>8 cm) was present in 19 patients (73.1%) and pleural effusion in three (11.5%). Pericardial effusion was found in six patients (23.1%). As regard to outcome, 11 were discharged home (42.3%), 14 were transferred to cardiothoracic surgical unit (where two subsequently died) and one died in the hospital. Conclusion The prevalence of aortic dissection may be more common than is generally appreciated by emergency physicians. Owing to its variable clinical presentations mimicking other diseases, the diagnosis of aortic dissection is easily missed. Higher clinical vigilance should be exercised for this potentially deadly condition.
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Abstract
Objectives To study the characteristics and nature of injuries relating to horse riding in the local setting and to compare the findings with those reported in the medical literature. Methods A prospective survey of patients with horse-related injuries attending the accident and emergency department of a public district hospital in Hong Kong within the year 2002. The data were analysed and compared with previous studies. Results Fifty-five patients were collected in the study. The mean age was 32.7 years. Forty-four (80.0%) of them were riders and 11 (20.0%) were non-riders. Thirteen (23.6%) were grooms. Fifteen patients (27.3%) were admitted and seven (46.7%) of those admitted required operations. There was no fatality. Thirty-nine patients (70.9%) suffered from single injury while the rest (29.1%) had multiple injuries. Most injuries (60.0%) were minor but fractures or dislocations occurred in 16 patients (29.1%). Isolated head and facial injuries occurred in 14.5% of patients. Most were simple concussion. Thirteen patients (23.6%) suffered from isolated upper limb injuries, with more than half sustaining fractures or dislocations. Falling from horse (60.0%) was the most frequent mechanism of injury. Among the non-riding patients, 72.7% were kicked or trodden by horse. There was no association between rider's status, previous riding or injury experiences, or the presence of supervision at the time of riding with the rate of admission. Conclusion Horse riding and working with horses can be an occupation or recreation with potential dangers. In our study, characteristics of patients, mechanisms and types of injuries were similar to other western studies. However, professional riders and those with more riding experiences were not exempted from severe injuries requiring admission. Moreover, previous injury experiences and the presence of supervision did not help reduce the admission rate either. Perhaps, as suggested by other studies, the quality of horsemanship and supervision appeared to be more important to reduce accidents. Further proper large scale controlled epidemiological studies will definitely help to improve the understanding of horse-related injuries.
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Abstract
Psoas abscess is an uncommon clinical entity. It can be a primary infection with no obvious source of infection or a secondary infection from other sites, e.g. gastrointestinal tract or spinal pathology. The triads of presentation: fever, loin pain and limitation of hip movement may not be found in all patients. The correct diagnosis can be made with a vigilant clinical examination and appropriate investigation, for example ultrasonography. We present two cases of psoas abscess. One was a primary case and the other was secondary to carcinoma of caecum. Both of them presented with recent onset of back pain. Emergency physicians consider psoas abscess as one of the differential diagnosis for patient complaining of low back pain.
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Lau KH, Ng CP, Chung CH. Carotid-Cavernous Fistula: An Uncommon and Easily Missed Complication of Head Trauma. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790501200211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A 57-year-old woman attended the emergency department complaining of protrusion of the right eyeball for three days. The history revealed that she had head injury in a road traffic accident about five weeks ago. The accident had caused a fracture of the right angle of the mandible that was fixed internally by the maxillo-facial surgeon. Subsequent angiogram showed a right direct carotid-cavernous fistula. Endovascular therapy was successful in obliterating the fistula. She recovered well. Although carotid-cavernous fistula is an uncommon complication of head injury, emergency physicians should be aware of this condition because of its potential mortality and morbidity.
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Siu AYC, Chung CH. A Case Series of Using Aspiration Catheter for the Management of Spontaneous Pneumothorax. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790301000405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction Catheter aspiration is a relatively new treatment for spontaneous pneumothorax in emergency departments in Hong Kong. It causes less pain and shortens hospitalisation. However, there is limited local experience especially in regard to the target group that can be benefited. We reported on the initial experience of catheter aspiration in the management of spontaneous pneumothorax in our emergency department. Method Patients (age >=16 years) presenting with spontaneous pneumothorax were recruited. Patients with history of asthma or chronic obstructive airway disease were excluded. History of smoking, previous pneumothorax and pleurodesis were recorded. The aspiration catheter was inserted by the Seldinger technique. The extent of pneumothorax was assessed from the chest X-ray and initial aspirated volume. Successful patients were observed in the department and discharged if chest X-rays were reassuring after 12 hours. Factors associated with the outcome of patients were analysed. Result Seventeen patients were recruited from October 1999 to September 2000. Their age ranged from 16 to 40 years (mean 22.6). The overwhelming majority (16) was male. Twelve cases (70.6%) occurred on the left side. Five patients had previous pneumothorax and one had previous pleurodesis. Fifteen succeeded in immediate re-expansion, but seven re-collapsed during observation. The overall success rate was 47.1%. Initial aspiration volume >2,000 ml was associated with early failure (p=0.01). Conclusion Our initial experience did not support catheter aspiration to completely replace chest drain in the initial management of spontaneous pneumothorax. The procedure is likely to fail if the initial aspirated volume is greater than 2,000 ml. Further study is needed to identify the subgroup that may be benefited.
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Ho MK, Chung CH. A Prospective, Randomised Clinical Trial Comparing Oral Diclofenac Potassium and Intramuscular Diclofenac Sodium in Acute Pain Relief. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790401100202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Objectives To compare the efficacy of oral (PO) diclofenac potassium (Cataflam®) and intramuscular (IM) diclofenac sodium (Voltaren®) in acute pain relief, with a hypothesis of equivalence between the two. Patients and methods In this prospective randomised single center clinical study, adult Chinese patients attending the emergency department and suffering from renal colic, acute musculoskeletal injury or arthritis were enrolled. They were randomly assigned either 75 mg of IM Voltaren® or 75 mg of PO Cataflam®. Pain was assessed by the Visual Analogue Scale (VAS) and evaluations were performed at baseline, 30 minutes, 1 hour and 2 hours after treatment. Blood pressure, pulse rate and respiratory rate were also recorded at similar time intervals. Results We recruited 46 cases in the Voltaren® group and 45 cases in the Cataflam® group. Both treatment groups showed statistically highly significant reduction (P<0.0001) in pain VAS, systolic blood pressure and pulse rate compared with the baseline. Voltaren® was statistically more effective in pain relief at 30 minutes (P=0.012) and 1 hour (P=0.010) but not at 2 hours (P=0.311) compared with Cataflam®. The changes in blood pressure, pulse rate and respiratory rate were not statistically significant between the two treatment groups at all time points. Conclusion IM Voltaren® was more effective in acute pain relief compared with PO Cataflam®.
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Kim HM, Lee BR, Lee ES, Kwon MH, Huh JH, Kwon BE, Park EK, Chang SY, Kweon MN, Kim PH, Ko HJ, Chung CH. iNKT cells prevent obesity-induced hepatic steatosis in mice in a C-C chemokine receptor 7-dependent manner. Int J Obes (Lond) 2017; 42:270-279. [PMID: 28811651 PMCID: PMC5803573 DOI: 10.1038/ijo.2017.200] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 06/19/2017] [Accepted: 07/21/2017] [Indexed: 02/08/2023]
Abstract
Non-alcoholic fatty liver disease and non-alcoholic steatohepatitis are characterized by an increase in hepatic triglyceride content with infiltration of immune cells, which can cause steatohepatitis and hepatic insulin resistance. C-C chemokine receptor 7 (CCR7) is primarily expressed in immune cells, and CCR7 deficiency leads to the development of multi-organ autoimmunity, chronic renal disease and autoimmune diabetes. Here, we investigated the effect of CCR7 on hepatic steatosis in a mouse model and its underlying mechanism. Our results demonstrated that body and liver weights were higher in the CCR7−/− mice than in the wild-type (WT) mice when they were fed a high-fat diet. Further, glucose tolerance and insulin sensitivity were markedly diminished in CCR7−/− mice. The number of invariant natural killer T (iNKT) cells was reduced in the livers of the CCR7−/− mice. Moreover, liver inflammation was detected in obese CCR7−/− mice, which was ameliorated by the adoptive transfer of hepatic mononuclear cells from WT mice, but not through the transfer of hepatic mononuclear cells from CD1d−/− or interleukin-10-deficient (IL-10−/−) mice. Overall, these results suggest that CCR7+ mononuclear cells in the liver could regulate obesity-induced hepatic steatosis via induction of IL-10-expressing iNKT cells.
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Aguilar M, Ali Cavasonza L, Ambrosi G, Arruda L, Attig N, Aupetit S, Azzarello P, Bachlechner A, Barao F, Barrau A, Barrin L, Bartoloni A, Basara L, Başeğmez-du Pree S, Battarbee M, Battiston R, Becker U, Behlmann M, Beischer B, Berdugo J, Bertucci B, Bindel KF, Bindi V, Boella G, de Boer W, Bollweg K, Bonnivard V, Borgia B, Boschini MJ, Bourquin M, Bueno EF, Burger J, Cadoux F, Cai XD, Capell M, Caroff S, Casaus J, Castellini G, Cervelli F, Chae MJ, Chang YH, Chen AI, Chen GM, Chen HS, Cheng L, Chou HY, Choumilov E, Choutko V, Chung CH, Clark C, Clavero R, Coignet G, Consolandi C, Contin A, Corti C, Creus W, Crispoltoni M, Cui Z, Dai YM, Delgado C, Della Torre S, Demakov O, Demirköz MB, Derome L, Di Falco S, Dimiccoli F, Díaz C, von Doetinchem P, Dong F, Donnini F, Duranti M, D'Urso D, Egorov A, Eline A, Eronen T, Feng J, Fiandrini E, Finch E, Fisher P, Formato V, Galaktionov Y, Gallucci G, García B, García-López RJ, Gargiulo C, Gast H, Gebauer I, Gervasi M, Ghelfi A, Giovacchini F, Goglov P, Gómez-Coral DM, Gong J, Goy C, Grabski V, Grandi D, Graziani M, Guo KH, Haino S, Han KC, He ZH, Heil M, Hoffman J, Hsieh TH, Huang H, Huang ZC, Huh C, Incagli M, Ionica M, Jang WY, Jinchi H, Kang SC, Kanishev K, Kim GN, Kim KS, Kirn T, Konak C, Kounina O, Kounine A, Koutsenko V, Krafczyk MS, La Vacca G, Laudi E, Laurenti G, Lazzizzera I, Lebedev A, Lee HT, Lee SC, Leluc C, Li HS, Li JQ, Li JQ, Li Q, Li TX, Li W, Li Y, Li ZH, Li ZY, Lim S, Lin CH, Lipari P, Lippert T, Liu D, Liu H, Lordello VD, Lu SQ, Lu YS, Luebelsmeyer K, Luo F, Luo JZ, Lv SS, Machate F, Majka R, Mañá C, Marín J, Martin T, Martínez G, Masi N, Maurin D, Menchaca-Rocha A, Meng Q, Mikuni VM, Mo DC, Morescalchi L, Mott P, Nelson T, Ni JQ, Nikonov N, Nozzoli F, Oliva A, Orcinha M, Palmonari F, Palomares C, Paniccia M, Pauluzzi M, Pensotti S, Pereira R, Picot-Clemente N, Pilo F, Pizzolotto C, Plyaskin V, Pohl M, Poireau V, Putze A, Quadrani L, Qi XM, Qin X, Qu ZY, Räihä T, Rancoita PG, Rapin D, Ricol JS, Rosier-Lees S, Rozhkov A, Rozza D, Sagdeev R, Sandweiss J, Saouter P, Schael S, Schmidt SM, Schulz von Dratzig A, Schwering G, Seo ES, Shan BS, Shi JY, Siedenburg T, Son D, Song JW, Sun WH, Tacconi M, Tang XW, Tang ZC, Tao L, Tescaro D, Ting SCC, Ting SM, Tomassetti N, Torsti J, Türkoğlu C, Urban T, Vagelli V, Valente E, Vannini C, Valtonen E, Vázquez Acosta M, Vecchi M, Velasco M, Vialle JP, Vitale V, Vitillo S, Wang LQ, Wang NH, Wang QL, Wang X, Wang XQ, Wang ZX, Wei CC, Weng ZL, Whitman K, Wienkenhöver J, Wu H, Wu X, Xia X, Xiong RQ, Xu W, Yan Q, Yang J, Yang M, Yang Y, Yi H, Yu YJ, Yu ZQ, Zeissler S, Zhang C, Zhang J, Zhang JH, Zhang SD, Zhang SW, Zhang Z, Zheng ZM, Zhu ZQ, Zhuang HL, Zhukov V, Zichichi A, Zimmermann N, Zuccon P. Precision Measurement of the Boron to Carbon Flux Ratio in Cosmic Rays from 1.9 GV to 2.6 TV with the Alpha Magnetic Spectrometer on the International Space Station. PHYSICAL REVIEW LETTERS 2016; 117:231102. [PMID: 27982618 DOI: 10.1103/physrevlett.117.231102] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Indexed: 06/06/2023]
Abstract
Knowledge of the rigidity dependence of the boron to carbon flux ratio (B/C) is important in understanding the propagation of cosmic rays. The precise measurement of the B/C ratio from 1.9 GV to 2.6 TV, based on 2.3 million boron and 8.3 million carbon nuclei collected by AMS during the first 5 years of operation, is presented. The detailed variation with rigidity of the B/C spectral index is reported for the first time. The B/C ratio does not show any significant structures in contrast to many cosmic ray models that require such structures at high rigidities. Remarkably, above 65 GV, the B/C ratio is well described by a single power law R^{Δ} with index Δ=-0.333±0.014(fit)±0.005(syst), in good agreement with the Kolmogorov theory of turbulence which predicts Δ=-1/3 asymptotically.
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Kang DH, Lee S, Kim YJ, Kim SH, Kim DH, Yun SC, Song JM, Chung CH, Song JK, Lee JW. Long-Term Results of Early Surgery versus Conventional Treatment for Infective Endocarditis Trial. Korean Circ J 2016; 46:846-850. [PMID: 27826345 PMCID: PMC5099342 DOI: 10.4070/kcj.2016.46.6.846] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 05/20/2016] [Accepted: 05/27/2016] [Indexed: 11/11/2022] Open
Abstract
Background and Objectives Compared with conventional treatment, early surgery significantly reduced the composite end point of all-cause death and embolic events during hospitalization, but long-term data in this area are lacking. This study sought to compare long-term outcomes of early surgery with a conventional treatment strategy in patients with infective endocarditis (IE) and large vegetations. Subjects and Methods The Early Surgery versus Conventional Treatment in Infective Endocarditis (EASE) trial randomly assigned patients with left-sided IE, severe valve disease and large vegetation to early surgery (37 patients) or conventional treatment groups (39 patients). The pre-specified end points were all-cause death, embolic events, recurrence of IE and repeat hospitalizations due to the development of congestive heart failure occurring during follow-up. Results There were no significant differences between the early surgery and the conventional treatment group in all-cause mortality at 4 years (8.1% and 7.7%, respectively; hazard ratio [HR] 1.04; 95% CI, 0.21 to 5.15; p=0.96). The rate of the composite end point of death from any cause, embolic events or recurrence of IE at 4 years was 8.1% in the early surgery group and 30.8% in the conventional treatment group (HR, 0.22; 95% CI, 0.06-0.78; p=0.02). The estimated actuarial rate of end points at 7 years was significantly lower in the early surgery group than in the conventional treatment group (log-rank p=0.007). Conclusion There was a substantial benefit in having early surgery for patients with IE and large vegetations whose health was sustained up to 7 years, and late clinical outcome after surgery was excellent in survivors of IE. (EASE clinicaltrials.gov identifier: NCT00750373)
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