Influenza vaccine effectiveness against hospitalizations associated with influenza A(H3N2) in Hong Kong children aged 9 months to 17 years, June-November 2023

A test negative study was carried out from 13 June through to 15 November 2023 enrolling 3183 children hospitalized with acute respiratory illness in Hong Kong. Influenza A and B viruses were detected in 528 (16.6%) children, among which 419 (79.4%) were influenza A(H3N2). The overall vaccine effectiveness against hospitalization associated with any influenza virus infection was estimated as 22.4% (95% CI: -11.7%, 46.1%), and against influenza A(H3N2) specifically was 14.3% (95% CI: -29.2%, 43.2%). Despite the moderate to low VE estimated here, which could be a result of waning immunity and antigenic drift, influenza vaccination remains an important approach to reduce the impact of influenza in children.

Influenza Vaccine Effectiveness Against Influenza-Associated Hospitalization in Hong Kong Children Aged 9 Months to 17 Years, March-June 2023

In March-June 2023, we conducted a test-negative study in 1671 children who were hospitalized with acute respiratory illness in Hong Kong. Two hundred and eighty-six children (17.2%) were tested positive for influenza virus including 188 with A(H1N1). We estimated influenza vaccine effectiveness against influenza-associated hospitalization as 69.6% (95% confidence interval: 49.3%, 81.7%).

Evaluating the Performance of ChatGPT at Breast Tumor Board

PURPOSE/OBJECTIVE(S)

Chat Generative Pre-trained Transformer (ChatGPT) is a chatbot built on the GPT-3 language model. We sought to determine whether it can contribute to tumor board discussions by comparing the accuracy and clarity of its answers to challenging breast radiation oncology questions with that of human specialists.

MATERIALS/METHODS

Twenty consecutive breast radiation oncology questions between January and February 2023 that received at least one human answer were curated from theMedNet, a physician-only Q&A platform for expert answers to real-world clinical situations. These questions were posed to ChatGPT, and its answers were paired with the first chronological human response. Breast radiation oncologists at one academic institution were asked to rate from 1 (strongly disagree) to 5 (strongly agree) the extent to which they agreed with each answer (accuracy score) and whether they felt the response provided clear and specific guidance relevant to the original question (clarity score). Wilson score intervals with continuity correction were used to estimate the proportion of answers on which ChatGPT receives a higher median accuracy or clarity score than human responders. The Wilcoxon signed-rank test was used to compare median accuracy and clarity scores across all of the 20 questions.

RESULTS

Six board-certified breast radiation oncologists evaluated answers to the 20 questions, resulting in 120 distinct assessments of each of ChatGPT and human responders. The evaluators agreed or strongly agreed with ChatGPT responses on 49 (41%) of assessments and human responders on 66 (55%) of assessments. ChatGPT achieved a higher median accuracy score than human responders on 7 (35%; 95% Wilson score CI, 16-59%) questions whereas humans outperformed ChatGPT on 8 (40%) questions; there was no significant difference in median scores (Wilcoxon signed-rank p = 0.3). There was agreement or strong agreement that ChatGPT provided clear and specific guidance on 38 (32%) of assessments compared to 45 (38%) assessments of human answers. No differences were detected in median clarity score across all questions (Wilcoxon signed-rank p = 0.8). On 3 questions (15%; 95% Wilson score CI, 4-39%), ChatGPT surpassed human responders on both median accuracy score and median clarity score. Human responders similarly outperformed ChatGPT in both metrics on 3 (15%) questions.

CONCLUSION

There was no detectable difference in the accuracy or clarity of answers provided by ChatGPT and human responders in this sample of 20 challenging breast radiation oncology questions. ChatGPT outperformed human responders in the accuracy and clarity of its answers to some questions, suggesting that it has the potential to contribute meaningfully to discussions about real-world clinical problems.

Crowdsourcing Deep Learning Algorithms to Automatically Contour GI Luminal Organs on Serial MRIs

PURPOSE/OBJECTIVE(S)

A major barrier to a sustainable real-time adaptive MR-guided radiotherapy workflow is the time-consuming process of contouring the target and organs-at-risk (OARs) before the delivery of each fraction. While auto-contouring algorithms perform relatively well for many solid organs, the performance on luminal organs in the abdomen remain difficult due to the variability between patients and variability in daily shape and position. The purpose of this study is to evaluate the performance of crowdsourced deep learning algorithms to automatically contour GI luminal organs on serial MRIs.

MATERIALS/METHODS

The stomach, small intestines, and large intestines were manually contoured on MRIs from patients who had undergone radiotherapy on an MR-Linac by a team of radiation therapists and medical physicists and were verified by a board-certified radiation oncologist. The MRIs and the contours were de-identified and uploaded to Kaggle, an online machine learning competition platform with portion of the data open to the public as training data and the remaining data hidden as a test set. Prize money was offered to teams submitting the best auto-contouring algorithms based on the Dice coefficient and Hausdorff distance evaluation metrics. The average performance of the winning algorithm and of manual contours were compared using unpaired t-test.

RESULTS

Four hundred sixty-seven MRIs were collected from 107 patients who underwent 1-5 serial MRI sessions between 2015 and 2019. The most common anatomic site of treatment was the pancreas with 41 patients, followed by the liver with 38 patients. The manual contours of the stomach, small intestines, and large intestines on 4 representative MRIs had mean and standard deviation Dice coefficient of 0.90 +/- 0.02, 0.76 +/- 0.04, and 0.85 +/- 0.03 respectively and Hausdorff distance of 18.0 +/- 6.9, 35.5 +/- 12.6, and 32.3 +/- 12.3 mm respectively. The Kaggle competition was held from April to July 2022 and 1548 teams submitted algorithms for evaluation. The auto-contouring performance of the winning solution on the stomach, small intestines, and large intestines, when evaluated on a hold-out test set with 188 MRIs, had mean and standard deviation Dice coefficient of 0.92 +/- 0.04, 0.80 +/- 0.09, 0.85 +/- 0.08 respectively and Hausdorff distance of 15.2 +/- 11.2, 33.9 +/- 15.2, 34.8 +/- 20.3 mm respectively. Unpaired t-test was performed to compare the average performance across three organs of the human (N = 120) and of the algorithm (N = 564). The results suggest that average algorithm performance was statistically superior to manual contours for Dice (p = 0.01), yet not for Hausdorff (p = 0.64).

CONCLUSION

Crowdsourced deep learning algorithms to auto-contour GI luminal organs on serial MRIs perform superiorly compared to manual contours when using a Dice coefficient metric but not when using a Haudorff distance metric. These auto-contouring algorithms may be used to efficiently adapt radiotherapy plans according to the anatomy of the day for patients with abdominal tumors on MR-Linacs.

Preterm postnatal complications and risk of attention-deficit/hyperactivity disorder

AIM

To investigate the association between the risk of attention-deficit/hyperactivity disorder (ADHD) and preterm birth and determine how postnatal complications in children born preterm is associated with the risk of ADHD.

METHOD

This population-based cohort study used data from the Hong Kong electronic medical records. We followed 359 614 children (48% female; 6-17 years old, mean 11 years 7 months, SD 3 years 2 months) born in public hospitals in Hong Kong from 1st January 2004 to 31st December 2014 and collected medical records and demographic details for mothers and children until 11th November 2020.

RESULTS

The risk of ADHD was 4.0% in children born at term and 5.1% in children born preterm. The odds ratio for ADHD was 2.08 (95% confidence interval [CI] 1.64-2.64) for children born extremely preterm, 1.64 (95% CI 1.46-1.85) for children born very preterm, and 1.15 (95% CI 1.08-1.23) for children born late preterm. Among preterm postnatal complications, only early respiratory disease, retinopathy of prematurity (ROP), and intraventricular haemorrhage were significant predictors of ADHD after controlling for preterm birth, other risk factors, and sociodemographic variables. The excess risk of ADHD among children born very preterm or late preterm could be partly explained by respiratory disease. ROP partially mediated the risk of ADHD in children born very preterm.

INTERPRETATION

Children born preterm in all subcategories, from extremely preterm to late preterm, have increased risk of ADHD. Early respiratory infection partially mediates the risk of ADHD in children born preterm.

Childhood Wheeze, Allergic Rhinitis, and Eczema in Hong Kong ISAAC Study from 1995 to 2015

BACKGROUND

The prevalence of allergic diseases has been increasing in developing areas but has reached a plateau in many developed areas. Regular surveys are imperative to assess the disease burden for the prioritization of resource allocation.

OBJECTIVES

We examined the change in the prevalence of wheezing, allergic rhinitis (AR), and eczema in school-aged children with possible associative factors and possible health effects of school air quality.

METHODS

This was the third repeated cross-sectional study conducted in 2015-2016 using the International Study of Asthma and Allergies in Childhood (ISAAC) protocol. Our first and second surveys were conducted in 1994-1995 and 2000-2001, respectively. Regarding the third survey, we recruited 3698 children aged 6-7 from 33 local schools in 18 districts. Air quality, temperature, and humidity were also measured. The changes in prevalence, multiple regression, and GLIMMIX procedure were analyzed.

RESULTS

From our first survey to our third survey, the increased prevalences for lifetime wheeze, current wheeze, lifetime rhinitis, current rhinitis, current rhinoconjunctivitis, lifetime chronic rash, and current chronic rash were 4.2%, 2.1%, 12.5%, 12.6%, 14.2%, 3.9%, and 4.1%, respectively. Increased prevalence of parental atopy had the strongest association with an increased prevalence of each of these seven health outcomes. There was no significant association between school air pollutant levels and the prevalence of health outcomes.

CONCLUSIONS

There was an increase in the prevalence of wheezing, allergic rhinitis, and eczema across the surveys. The most important associated risk factor identified was the increased prevalence of a parental history of atopy.

Asthma admission among children in Hong Kong during the first year of the COVID-19 pandemic

BACKGROUND

Multiple nonpharmaceutical interventions (NPIs) had been introduced in Hong Kong during coronavirus disease 2019 (COVID-19) pandemic. The impact on asthma admission, which was closely related to viral infection, was of concern.

OBJECTIVE

The study aimed to identify the impact of NPIs on pediatric asthma admissions and their association with respiratory viruses.

METHODS

We conducted a retrospective observational study to compare the difference in pediatric asthma hospital admission rates between pre-COVID-19 and COVID-19 periods. Information on demographics, nasopharyngeal specimen results, ventilatory support, intensive care admission, hospital stay duration, asthma control therapy, and previous admission episodes was collected. Weather parameters including temperature, rainfall, humidity, and air quality data that was reflected by the air quality health index were recorded.

RESULTS

A total of 1808 pediatric asthma admissions were recorded during the pre-COVID-19 period while there were 62 admissions during COVID-19 period, among which 54 admissions from the pre-COVID-19 period and 4 admissions from COVID-19 period were excluded. Weekly pediatric asthma admissions per total pediatric admissions during COVID-19 was one-third of that during the pre-COVID-19 period (0.3% vs. 0.9%, p < 0.001). During COVID-19 period, a significantly lower percentage of respiratory virus isolates was noted (58.6% vs. 72.6%, p = 0.019). Poisson regression analysis showed that the COVID-19 period (odds ratio [OR] = 0.202, 95% confidence interval  [CI, 0.16-0.26]; p ≤ 0.001), summer vacation period (OR = 0.512, 95% CI [0.43-0.62]; p ≤ 0.001), and humidity (OR = 0.99, 95% CI [0.98-1.00]; p = 0.004) were independent protective factors for asthma admission.

CONCLUSIONS

There was a significant reduction in pediatric asthma hospitalizations and respiratory virus isolates in the first year of COVID-19 pandemic in Hong Kong with the implementation of NPIs. Rhinovirus remained the key respiratory virus isolate. Incorporation of appropriate NPIs in long run could reduce virus infection-related pediatric asthma admission.

Functional Evaluation and Genetic Landscape of Children and Young Adults Referred for Assessment of Bronchiectasis

Bronchiectasis is the abnormal dilation of the airway which may be caused by various etiologies in children. Beyond the more recognized cause of bacterial and viral infections and primary immunodeficiencies, other genetic conditions such as cystic fibrosis and primary ciliary dyskinesia (PCD) can also contribute to the disease. Currently, there is still debate on whether genome sequencing (GS) or exome sequencing reanalysis (rES) would be beneficial if the initial targeted testing results returned negative. This study aims to provide a back-to-back comparison between rES and GS to explore the best integrated approach for the functional and genetics evaluation for patients referred for assessment of bronchiectasis. In phase 1, an initial 60 patients were analyzed by exome sequencing (ES) with one additional individual recruited later as an affected sibling for ES. Functional evaluation of the nasal nitric oxide test, transmission electron microscopy, and high-speed video microscopy were also conducted when possible. In phase 2, GS was performed on 30 selected cases with trio samples available. To provide a back-to-back comparison, two teams of genome analysts were alternatively allocated to GS or rES and were blinded to each other’s analysis. The time for bioinformatics, analysis, and diagnostic utility was recorded for evaluation. ES revealed five positive diagnoses (5/60, 8.3%) in phase 1, and four additional diagnoses were made by rES and GS (4/30, 13%) during phase 2. Subsequently, one additional positive diagnosis was identified in a sibling by ES and an overall diagnostic yield of 10/61 (16.4%) was reached. Among those patients with a clinical suspicion of PCD (n = 31/61), the diagnostic yield was 26% (n = 8/31). While GS did not increase the diagnostic yield, we showed that a variant of uncertain significance could only be detected by GS due to improved coverage over ES and hence is a potential benefit for GS in the future. We show that genetic testing is an essential component for the diagnosis of early-onset bronchiectasis and is most effective when used in combination with functional tools such as TEM or HSVM. Our comparison of rES vs. GS suggests that rES and GS are comparable in clinical diagnosis.

Mental health & maltreatment risk of children with special educational needs during COVID-19

BACKGROUND

Children with special educational needs (SEN) are more vulnerable during the COVID-19 pandemic with risk of poor mental wellbeing and child maltreatment.

OBJECTIVE

To examine the impact of COVID-19 on the mental health of children with SEN and their maltreatment risk.

PARTICIPANTS AND SETTING

417 children with SEN studying at special schools and 25,427 children with typical development (TD) studying at mainstream schools completed an online survey in April 2020 in Hong Kong during school closures due to COVID-19.

METHOD

Emotional/behavioural difficulties, quality of life and parental stress of children with SEN were compared with typically developed children using mixed effect model. Linear regression analyses were performed to explore factors associated with child emotional/behavioural difficulties and parental stress during the pandemic. Chi-square test was performed to detect the differences in maltreatment risk before and during COVID-19.

RESULTS

Children with SEN had significantly poorer overall quality of life (68.05 vs 80.65, p < 0.01). 23.5% of children had at least one episode of severe physical assault and 1.9% experienced very severe physical assault during COVID-19. Rates of physical assault increased significantly (59.8% vs. 71.2% p < 0.001) while children with mental disorders had increased risk of severe physical assault comparing to those without mental disorders (RR = 1.58, ꭓ² = 5.19 p = 0.023).

CONCLUSION

Children with SEN had poorer mental health than typically developed children during the COVID-19 pandemic. Maltreatment risk for children with SEN is higher in comparison to pre-COVID-19 era. Surveillance of child maltreatment, continuity of medical and rehabilitation care to support children with SEN are essential during a disease pandemic.

Predictions of arrhythmic, heart failure and mortality outcomes in pericarditis using automatic electrocardiogram analysis: a retrospective cohort study

Funding Acknowledgements

Type of funding sources: None.

Introduction

 Pericarditis is a relatively rare disease with a global burden. Despite its strong association with adverse cardiovascular outcomes, identification of patients at risk of future heart failure or arrhythmic events is difficult. In the following study, automated electrocardiogram (ECG) variables were used to predict new onset ventricular tachycardia/fibrillation (VT/VF), atrial fibrillation (AF) and heart failure with reduced ejection fraction (HF) in an Asian cohort of pericarditis patients.

Purpose

Assessing the use of automated ECG parameters to predict prognosis in pericarditis patients.

Methods

Consecutive patients admitted to a single tertiary center in China, for a diagnosis of pericarditis between 1st January 2005 and 31st December 2019, were included. Patients with existing AF or HF were excluded. The follow-up period was until the 31st December 2020, or death. Cox regression was applied to identify significant predictors of the incident VT/VF, AF or HFrEF.

Results

A total of 874 patients were included. The cohort was 57% male and had a median age of 59 (IQR: 50-70) years old. During follow-up, 57 patients (6.5%), 156 (17.8%) and 168 (19.2%) suffered from VT/VF, AF and HF, respectively. Cox regression identified baseline VT/VF, terminal angle of the QRS vector in the transverse plane, mean QRS duration and mean QTc intervals as significant predictors of incident VT/VF events, with only the foremost maintaining significance in multivariate analysis. In contrast, baseline age, prior diagnoses of hypertension, malignancy and atrial flutter, initial angle and magnitude of the QRS vector in the transverse plane, P-wave and QRS axis in the frontal plane, ST segment axis in the frontal and horizontal planes, mean PT interval, mean PR segment duration and QTc intervals were all univariate predictors of incident AF, albeit only baseline age and initial angle of the QRS vector in the transverse plane retained significance after multivariate adjustment. As it pertains to new-onset HFrEF, several clinical and electrocardiographic parameters demonstrated an association in univariate analysis, with history of hypertension, history of sudden cardiac death (SCD), initial QRS angle in transverse plane, initial 40ms QRS complex axis, ST-segment axis in the horizontal plane, T-wave frontal axis and atrial rate all showcasing significant relationships in multivariate analysis.

Conclusions

AF and HFrEF are relatively common complications, whilst VT/VF occurs less frequently in the context of pericarditis. Different clinical and ECG predictors of these outcomes were identified. Future studies are still needed to evaluate their use for risk stratification in the clinical setting.

Infected pancreatic pseudocyst following severe dengue infection

Severe dengue infection is life threatening as it can result in fatal complications such as intractable bleeding from coagulopathy, multiorgan failure from shock and haemophagocytic syndrome. There have been case reports of atypical manifestation of severe dengue infection such as pancreatitis, Guillian-Barre's syndrome, perforated viscus and myocarditis. However, to our knowledge, pancreatic pseudocyst from dengue-related pancreatitis has never been reported in the literature. We hereby report a case of infected pancreatic pseudocyst in a patient with persistent pyrexia, abdominal pain and raised inflammatory markers 10 weeks from the onset of severe dengue infection. Endoscopic ultrasound (EUS) guided transluminal drainage of the infected pancreatic pseudocyst with lumen-apposing metallic stent (LAMS) was performed with good clinical and radiological outcome.

Identification of a wide spectrum of ciliary gene mutations in nonsyndromic biliary atresia patients implicates ciliary dysfunction as a novel disease mechanism

Background

Biliary atresia (BA) is the most common obstructive cholangiopathy in neonates, often progressing to end-stage cirrhosis. BA pathogenesis is believed to be multifactorial, but the genetic contribution, especially for nonsyndromic BA (common form: > 85%) remains poorly defined.

Methods

We conducted whole exome sequencing on 89 nonsyndromic BA trios to identify rare variants contributing to BA etiology. Functional evaluation using patients’ liver biopsies, human cell and zebrafish models were performed. Clinical impact on respiratory system was assessed with clinical evaluation, nasal nitric oxide (nNO), high speed video analysis and transmission electron microscopy.

Findings

We detected rare, deleterious de novo or biallelic variants in liver-expressed ciliary genes in 31.5% (28/89) of the BA patients. Burden test revealed 2.6-fold (odds ratio (OR) [95% confidence intervals (CI)]= 2.58 [1.15–6.07], adjusted p = 0.034) over-representation of rare, deleterious mutations in liver-expressed ciliary gene set in patients compared to controls. Functional analyses further demonstrated absence of cilia in the BA livers with KIF3B and TTC17 mutations, and knockdown of PCNT, KIF3B and TTC17 in human control fibroblasts and cholangiocytes resulted in reduced number of cilia. Additionally, CRISPR/Cas9-engineered zebrafish knockouts of KIF3B, PCNT and TTC17 displayed reduced biliary flow. Abnormally low level of nNO was detected in 80% (8/10) of BA patients carrying deleterious ciliary mutations, implicating the intrinsic ciliary defects.

Interpretation

Our findings support strong genetic susceptibility for nonsyndromic BA. Ciliary gene mutations leading to cholangiocyte cilia malformation and dysfunction could be a key biological mechanism in BA pathogenesis.

Funding

The study is supported by General Research Fund, HMRF Commissioned Paediatric Research at HKCH and Li Ka Shing Faculty of Medicine Enhanced New Staff Start-up Fund.

Functional analysis and evaluation of respiratory cilia in healthy Chinese children

BACKGROUND

To aid in the diagnosis of Primary Ciliary Dyskinesia (PCD) and to evaluate the respiratory epithelium in respiratory disease, normal age-related reference ranges are needed for ciliary beat frequency (CBF), beat pattern and ultrastructure. Our aim was to establish reference ranges for healthy Chinese children.

METHODS

Ciliated epithelial samples were obtained from 135 healthy Chinese children aged below 18 years by brushing the inferior nasal turbinate. CBF and beat pattern were analysed from high speed video recordings. Epithelial integrity and ciliary ultrastructure were assessed using transmission electronic microscopy.

RESULTS

The mean CBF from 135 children studied was 10.1 Hz (95% CI 9.8 to 10.4). Approximately 20% (ranged 18.0-24.2%) of ciliated epithelial edges were found to have areas of dyskinetically beating cilia. Normal beat pattern was observed in ciliated epithelium from all subjects. We did not find any effect of exposure to second hand smoke on CBF in our subjects. Microtubular defects were found in 9.3% of all of the cilia counted in these children, while other ciliary ultrastructural defects were found in less than 3%.

CONCLUSIONS

We established the reference range for CBF, beat pattern and ultrastructure in healthy Chinese children. Using similar methodology, we found a lower overall mean CBF than previously obtained European values. This study highlights the need to establish normative data for ciliary function in different populations.

Resistant hypertension during antituberculosis treatment: how is rifampicin implicated?

A 67-year-old mental institute resident was treated for smear-positive pulmonary tuberculosis. His background history included chronic essential hypertension which was well-controlled with amlodipine 10mg daily. However, his blood pressure became suboptimal one week into antitubercular treatment, necessitating escalation of antihypertensive therapy up to six medications. Following completion of antitubercular treatment, his blood pressure improved markedly. The number of antihypertensives was able to be reduced to only two after a month. We postulate that rifampicin has attenuated the therapeutic effect of amlodipine via potent induction of hepatic CYP3A4 but the failure to control the blood pressure even with medications unrelated to cytochrome P450 pathways raises the spectre of an additional interaction.

Immuno-oncology for surgeons

Cancer has traditionally been treated with surgery, cytotoxic chemotherapy and/or radiotherapy. The focus of treatment has been the mutated neoplastic cell. Critical advances in genomic and molecular techniques herald the potential for personalized treatments. Incremental breakthroughs in immunology have translated to a step-change in care by providing a mechanistic understanding of the immune system and how it may be mobilized to target cancer cells. As a result, clinical trials of immune-modifying agents have increased at an exponential rate and are revolutionizing cancer care. It is increasingly likely that the surgical oncologist will find themself caring for patients who have had immuno-oncology therapies as part of their neoadjuvant or adjuvant treatment. This review provides an update on immuno-oncology for the surgeon, covering the mechanisms of action of the agents in use. Emerging and surgically relevant toxicities are discussed, and available data on combining and sequencing cancer surgery with immuno-oncology treatments are summarized.

Observation of Anomalous Meissner Screening in Cu/Nb and Cu/Nb/Co Thin Films

We have observed the spatial distribution of magnetic flux in Nb, Cu/Nb, and Cu/Nb/Co thin films using muon-spin rotation. In an isolated 50-nm-thick Nb film, we find a weak flux expulsion (Meissner effect) which becomes significantly enhanced when adding an adjacent 40 nm layer of Cu. The added Cu layer exhibits a Meissner effect (due to induced superconducting pairs) and is at least as effective as the Nb to expel flux. These results are confirmed by theoretical calculations using the quasiclassical Green's function formalism. An unexpected further significant enhancement of the flux expulsion is observed when adding a thin (2.4 nm) ferromagnetic Co layer to the bottom side of the Nb. This observed cooperation between superconductivity and ferromagnetism, by an unknown mechanism, forms a key ingredient for developing superconducting spintronics.

In utero exposure to gestational diabetes and adiposity: does breastfeeding make a difference?

BACKGROUND/OBJECTIVES

Short-term breastfeeding from mothers with gestational diabetes (GDM) may programme metabolism and increase offspring diabetes risk. We examined the association of in utero GDM exposure with adiposity from infancy to adolescence, and whether any association was modified by breastfeeding during early infancy.

METHODS

In the prospective Chinese birth cohort "Children of 1997" (n = 7342, 88% follow-up rate), generalised estimate equations with multiple imputation were used to assess associations of in utero GDM exposure with age- and sex-specific body mass index (BMI) z-score during infancy (3 and 9 months), childhood (2- < 8 years) and adolescence (8-16 years), adjusted for sex, parity, maternal age, birth place, preeclampisa, smoking, and family socio-economic position. We also tested whether the associations differed by mode of infant feeding (always formula-fed, mixed, always breastfed) during the first three months of life.

RESULTS

In utero GDM exposure (7.5%) was associated with a lower BMI z-score during infancy (-0.13, 95% confidence interval (CI) -0.22, -0.05) but higher BMI z-scores during childhood (0.14, 95% CI 0.03, 0.25) and adolescence (0.25 95% CI 0.11, 0.38). Breastfeeding for the first three months did not modify the association of in utero GDM status with subsequent BMI (all p values for interaction >0.4).

CONCLUSIONS

In utero GDM exposure was associated with greater adiposity during childhood and adolescence. Breastfeeding in early infancy from mothers with GDM was not associated with greater adiposity in children and thus should still be encouraged.

Okur-Chung neurodevelopmental syndrome: Eight additional cases with implications on phenotype and genotype expansion

Okur-Chung syndrome is a neurodevelopmental condition attributed to germline CSNK2A1 pathogenic missense variants. We present 8 unreported subjects with the above syndrome, who have recognizable dysmorphism, varying degrees of developmental delay and multisystem involvement. Together with 6 previously reported cases, we present a case series of 7 female and 7 male subjects, highlighting the recognizable facial features of the syndrome (microcephaly, hypertelorism, epicanthic fold, ptosis, arched eyebrows, low set ears, ear fold abnormality, broad nasal bridge and round face) as well as frequently occurring clinical features including neurodevelopmental delay (93%), gastrointestinal (57%), musculoskeletal (57%) and immunological (43%) abnormalities. The variants reported in this study are evolutionary conserved and absent in the normal population. We observed that the CSNK2A1 gene is relatively intolerant to missense genetic changes, and most variants are within the protein kinase domain. All except 1 variant reported in this cohort are spatially located on the binding pocket of the holoenzyme. We further provide key recommendations on the management of Okur-Chung syndrome. To conclude, this is the second case series on Okur-Chung syndrome, and an in-depth review of the phenotypic features and genomic findings of the condition with suggestions on clinical management.

Childhood Obesity and Physical Activity-Friendly School Environments

OBJECTIVE

Childhood obesity may be related to school environment, but previous studies often focused on food environment only. This study aimed to examine the relationship between school physical activity environment and childhood obesity.

STUDY DESIGN

This is a cross-sectional study with multilevel data collected on school physical activity environment using teacher questionnaires, students' growth, and obesity status from electronic health records, and neighborhood socioeconomic status from census data.

RESULTS

This study included 208 280 students (6-18 years of age) from 438 schools (45% of Hong Kong). Prevalence of obesity was 5.0%. After controlling for socioeconomic status and intraschool correlation, robust Poisson regression revealed a reduced obesity risk associated with higher teachers' perceived physical activity benefits (risk ratio 0.96, 95% CI 0.94-0.99, P = .02), physical activity teaching experience (0.93, 0.91-0.96, P < .001), school campus size (0.93, 0.87-0.99, P = .02), physical activity ethos (0.91, 0.88-0.94, P < .001), number of physical activity programs (0.93, 0.90-0.96, P < .001), and physical activity facilities (0.87, 0.84-0.90, P < .001). Students in schools with at least 3 physical activity-friendly environmental factors (11.7%) had a much lower risk of obesity (0.68, 0.62-0.75, P < .001) than those without (23.7%).

CONCLUSIONS

A physical activity-friendly school environment is associated with lower risk of obesity. School physical activity environment should be considered in future epidemiologic and intervention studies.

Perforated gastric ulcer in severe dengue infection: A case report

Abdominal pain is one of the common presentations in severe dengue infection. We report a rare case of perforated gastric ulcer in a young man diagnosed with severe dengue infection and the challenges we faced in managing this patient. Perforated gastric ulcer need to be considered if there are signs of peritonitis and persistent abdominal pain that does not conform to the natural history of dengue. Proper imaging and early surgical intervention in perforated gastric ulcer is vital in preventing further complication and reducing the risk of mortality.

Infection associated haemophagocytic syndrome in severe dengue infection - a case series in a district hospital

Haemophagocytic lymphohistiocytosis (HLH) is a potentially fatal disorder resulting from uncontrolled hyperinflammatory response. There had been increase in cases of one of the secondary form of HLH, i.e., infectionassociated haemophagocytic syndrome (IAHS) in severe dengue in recent years. However, the condition remains under diagnosed due to lack of awareness compounded by the lack of validated diagnostic criteria. Severe hepatitis with prolonged cytopenias, severe hyperferritinemia, hypofibrinogenemia and persistent fever were evident in all four cases reported. All the subjects survived with supportive care and adjuvant steroid therapy. Prospective controlled studies are needed to develop diagnostic criteria and management protocol for IAHS in severe dengue.

CFTR founder mutation causes protein trafficking defects in Chinese patients with cystic fibrosis

Background

Cystic fibrosis (CF) is a rare condition in Asians. Since 1985, only about 30 Chinese patients have been reported with molecular confirmation.

Method

Using our in‐house next‐generation sequencing (NGS) pipeline for childhood bronchiectasis, we identified disease‐causing CFTR mutations in CF patients in Hong Kong. After identifying p.I1023R in multiple patients, haplotype analysis was performed with genome‐wide microarray to ascertain the likelihood of this being a founder mutation. We also assessed the processing and gating activity of the mutant protein by Western hybridization and patch‐clamp test.

Results

Molecular diagnoses were confirmed in four patients, three of whom shared a missense mutation: CFTR:c.3068T>G:p.I1023R. The results suggested that p.I1023R is a founder mutation in southern Han Chinese. In addition, the processing and gating activity of the mutant protein was assessed by gel electrophoresis and a patch‐clamp test. The mutant protein exhibited trafficking defects, suggesting that the dysfunction is caused by reduced cell surface expression of the fully glycosylated proteins.

Conclusion

Together with other previously reported mutations, the specific founder mutation presented herein suggests a unique CFTR mutation spectrum in the southern Chinese populations, and this finding has vital implications for improving molecular testing and mutation‐specific treatments for Chinese patients with CF.

Sleep Duration and School Readiness of Chinese Preschool Children

OBJECTIVES

To examine the average sleep duration in Chinese preschoolers and to investigate the association between sleep duration and school readiness.

STUDY DESIGN

This is a cross-sectional study that included 553 Chinese children (mean age = 5.46 years) from 20 preschools in 2 districts of Hong Kong. Average daily sleep duration in the last week was reported by parents and school readiness as measured by the teacher-rated Chinese Early Development Instrument (CEDI).

RESULTS

Most Chinese preschoolers had 9-10 hours of sleep per day. Only 11% of preschoolers had the recommended 11-12 hours of sleep per day. This group was associated with more "very ready" CEDI domains. Sleep deprivation (≤7 hours per day) was associated with a lower CEDI total score, lower scores in the emotional maturity and language/cognitive domain, and prosocial behaviors subdomain but a greater score in the hyperactivity/inattention subdomain. Children with a lower family socioeconomic index, lower maternal education level, infrequent parent-child interactions, and who used electronic devices for more than 3 hours per day had shortened sleep durations.

CONCLUSIONS

Optimal sleep duration was associated with better school readiness in preschool children, whereas sleep deprivation was associated with lower school readiness, more hyperactivity and inattention, and less prosocial behavior.

Childhood physical activity body contact risk: feasibility of a novel technique for objective measurements of impact speed, frequency, and intentionality

INTRODUCTION

Children at risk for bleeding injuries are restricted from body contact during physical activity but current recommendations are based on expert opinion.

AIM

Evaluate high-speed digital video recording as an objective measure of body contact risk during physical activity.

METHODS

Observational study of physical activities among healthy children, grouped according to participation in teams (vs. individual) and on their perceived risk of injury (high/low). High speed digital video recordings documented the collision target (floor/ground/ice, people, wall, equipment), estimated speed, and impact rates for team and individual activities, with and without expected body contact.

RESULTS

Among 348 participating children (3-16 years, 51% female), 32% to 78% experienced at least one contact. Impact type varied significantly (chi-square, p < 0.001) by activity category. Unstructured and Team high risk activity impacts were primarily with the floor/ground, whereas Individual low risk activities were characterized by equipment impacts. Impact speeds were typically 1.0 to 2.1 m s(-1) . Higher impact speeds occurred during instructional classes (2.1 m s(-1) ), unstructured free swim (1.9 m s(-1) ) and ball hockey (1.7 m s(-1) ). Impact rates were higher during Team high risk and Team low risk sports (3.0 and 1.8 impacts per minute, respectively) compared to Individual (high or low risk) or Unstructured activities (0.2-0.3 impacts per minute).

CONCLUSIONS

High speed video recordings of childhood physical activity are a feasible method for characterizing the frequency, type, direction and speed of impacts. Quantifying the impacts that occur during childhood physical activity could inform the guidelines for physical activity participation among children with identified bleeding risks.

Thermodynamic phase transitions in a frustrated magnetic metamaterial

Materials with interacting magnetic degrees of freedom display a rich variety of magnetic behaviour that can lead to novel collective equilibrium and out-of-equilibrium phenomena. In equilibrium, thermodynamic phases appear with the associated phase transitions providing a characteristic signature of the underlying collective behaviour. Here we create a thermally active artificial kagome spin ice that is made up of a large array of dipolar interacting nanomagnets and undergoes phase transitions predicted by microscopic theory. We use low energy muon spectroscopy to probe the dynamic behaviour of the interacting nanomagnets and observe peaks in the muon relaxation rate that can be identified with the critical temperatures of the predicted phase transitions. This provides experimental evidence that a frustrated magnetic metamaterial can be engineered to admit thermodynamic phases.

Review of evolution of clinical, training and educational services and research program for autism spectrum disorders in Hong Kong

The evolution of a local fragmented model of services for children with autism in Hong Kong emerged gradually over the past three decades with lack of government funding or support. This had been due to increasing number of children with autism being detected and referred for earlier assessment. With increasing pressure from parents due to long waiting time for assessment and training services and the increasing polarization by mass media there had been a gradual increasing public awareness over the past five years. Though still highly fragmented in the availability of services, there is a growing "business model" available in the community due to increasing need and lack of public funding for support. There is a lack of strategic planning for medical diagnostic and management issues in Hong Kong. Our University of Hong Kong based Autism Research Program was pioneered in 1985 based on the increasing load of autism cases referred for assessment for other developmental problems and diagnosed as Autism in the Duchess of Kent Children's Hospital. As the first author has been the staff of the University of Hong Kong, this program flourished as a research based program. The benefits of early identification and intervention of autism spectrum disorder (ASD) had been increasingly recognized, and with the increased public awareness and increasing trend of earlier diagnosis, there has been a continuously high demand from parents for earlier assessment and training for children suspected to have ASD. This model had not received extra funding for this integrated program for research, teaching and training in autism. We had to apply for various donations and grants to support the development of this pioneer program. The research output and organization of forums for public education and awareness are reviewed. The latter part of the paper reports the summary of clinical profile of autism cases (N=1441) assessed from 1985 to 2010 June under the University of Hong Kong. As the waiting time for initial developmental assessment for any children in Hong Kong is 12-24 months, we also report our preliminary experience with a newly launched triaging service provision for children suspected to be ASD since 2009, including multi-disciplinary assessment and parallel interim training in our university affiliated child assessment centre in Hong (N=89).

Clinical efficacy of transcatheter embolization of visceral artery pseudoaneurysms using N-butyl cyanoacrylate (NBCA)

PURPOSE

Transcatheter endovascular embolization within a reasonable time before rupture or deterioration of a patient's general condition is an important procedure for managing visceral pseudoaneurysms. N-butyl 2-cyanoacrylate (NBCA, enbucrilate) is an embolic material used in the blockade of visceral pseudoaneurysms. This study evaluated the clinical efficacy of transcatheter embolization of visceral artery pseudoaneurysms using NBCA.

PATIENTS AND METHODS

Between June 2004 and February 2014, 13 patients (9 males and 4 females; age range, 26-80years; mean, 57.9years) with 14 pseudoaneurysms were treated by transcatheter embolization using NBCA. NBCA was mixed with iodized oil at a 1:3 ratio to control its polymerization time and to render it radiopaque. Pseudoaneurysms were located on the gastroduodenal artery (n=1), pancreaticoduodenal artery (n=2), dorsal pancreatic artery (n=1), proximal jejunal artery (n=1), colic artery (n=1), splenic artery (n=3), renal artery (n=4; two in one patient), and hepatic artery (n=1).

RESULTS

All patients recovered immediately following the embolization procedure, and two patients showed minor complications that required only medical observation.

CONCLUSIONS

Transcatheter embolization using NBCA for the treatment of visceral pseudoaneurysms is a safe, effective, and low-cost treatment method with a high success rate.

Relevance of hepatoduodenal ligament lymph nodes in resectional surgery for gastric cancer

BACKGROUND

Hepatoduodenal lymph node (HDLN) positivity is considered distant metastasis in gastric cancer according to the seventh American Joint Committee on Cancer (AJCC) classification. In contrast, the International Union Against Cancer seventh edition and the Japanese Gastric Cancer Association both consider HDLN as a regional lymph node that can be included in the context of a curative resection. The purpose of this study was to determine whether there was justification for considering HDLN involvement as a distant metastasis for which resectional surgery could not have survival benefit.

METHODS

This study enrolled consecutive patients with gastric cancer having D2 or greater resections, with removal and pathological assessment of the HDLN, between 1989 and 2009. The pathological stage of all patients was determined based on the seventh AJCC criteria, with HDLN included as a regional lymph node.

RESULTS

A total of 1872 patients had their HDLN removed, of whom 68 had a metastatic lymph node in the hepatoduodenal ligament. The 5-year survival rate of these 68 patients was 30 per cent, compared with 47·7 per cent for those with stage III (P < 0·001) and 9·8 per cent for those with stage IV (P = 0·007) HDLN-negative tumours. The 5-year survival rate of 41 patients with HDLN metastasis and no evidence of distant metastasis at any other site was significantly higher than that among 120 patients with stage IV disease without HDLN metastasis (P < 0·001), whereas 5-year survival did not differ between the 41 patients with stage I-III disease with HDLN metastasis and 568 patients with stage III tumours without HDLN metastasis (P = 0·184). HDLN metastasis was not a significant factor for survival in multivariable analysis.

CONCLUSION

It is inappropriate to include the HDLN in the distant metastatic lymph node group in gastric cancer. The seventh AJCC criteria for node grouping should be revised.

Planning for EVAR: the role of modern software

Endovascular intervention has revolutionized the treatment of aortic disease, extending the cohort of patients eligible for repair. Accurate planning for endovascular aortic repair is essential. Recent advances in modern software have demonstrated potential for improving outcomes and enhancing the decision making process beyond 3D measurements and intraoperative navigation techniques. With increasing uptake and complexity of endovascular therapies requiring multidisciplinary collaborations, it has become apparent that planning must extend to the preparation of entire interventional teams and support the early identification and prevention of potentially harmful events. This paper will examine recent advances not only in morphological planning and computational modelling, but also the role of software in the preparation of teams and prevention of error.

Parkinson disease loci in the mid-western Amish

Previous evidence has shown that Parkinson disease (PD) has a heritable component, but only a small proportion of the total genetic contribution to PD has been identified. Genetic heterogeneity complicates the verification of proposed PD genes and the identification of new PD susceptibility genes. Our approach to overcome the problem of heterogeneity is to study a population isolate, the mid-western Amish communities of Indiana and Ohio. We performed genome-wide association and linkage analyses on 798 individuals (31 with PD), who are part of a 4,998 member pedigree. Through these analyses, we identified a region on chromosome 5q31.3 that shows evidence of association (p value < 1 × 10(-4)) and linkage (multipoint HLOD = 3.77). We also found further evidence of linkage on chromosomes 6 and 10 (multipoint HLOD 4.02 and 4.35 respectively). These data suggest that locus heterogeneity, even within the Amish, may be more extensive than previously appreciated.

Successful use of BiPAP in infants with congenital myotonic dystrophy

Reported herein are two cases of severe phenotype of congenital myotonic dystrophy (CDM) with presentation of respiratory insufficiency at birth. The infants were successfully managed with bi-level positive airway pressure (BiPAP) via nasal mask. The use of BiPAP in infants with CDM has not been reported before. The rationale for using BiPAP is discussed. BiPAP may be more effective than continuous positive airway pressure in managing respiratory insufficiency, especially in infants with the more severe phenotype of CDM.

Muon-spin rotation measurements of an unusual vortex-glass phase in the layered superconductor Bi2.15Sr1.85CaCu2O8+δ

Muon-spin rotation measurements, performed on the mixed state of the classic anisotropic superconductor Bi(2.15)Sr(1.85)CaCu(2)O(8+δ), obtain quantities directly related to two- and three-body correlations of vortices in space. A novel phase diagram emerges from such local probe measurements of the bulk, revealing an unusual glassy state at intermediate fields which appears to freeze continuously from the equilibrium vortex liquid but differs both from the lattice and the conventional high-field vortex glass state in its structure.

Chronic health problems and health-related quality of life in Chinese children and adolescents: a population-based study in Hong Kong

OBJECTIVE

We examined the association of different chronic physical and mental conditions, individually or comorbidly on health-related quality of life (QoL) in Chinese children aged ≤14 years in Hong Kong.

DESIGN

Population-based cross-sectional survey.

PARTICIPANTS

Approximately 7500 Chinese children aged <14 years in Hong Kong.

INTERVENTIONS

Nil.

PRIMARY AND SECONDARY OUTCOME MEASURES

Various health concepts of validated Chinese version of Child Health Questionnaire (CHQ), a health-related QoL questionnaire in children.

RESULT

There was significant association of physical and mental health conditions, either individually or comorbidly, on the various concepts of CHQ. Children with mental health problems were apparently more affected than those with physical health problems. Chronic renal disease and congenital malformation were the physical health conditions associated with the lowest scores in CHQ concepts in children aged 5-10 years and aged 10-14 years, respectively. Behavioural problem was the mental health condition associated with the lowest score in CHQ concepts in both age groups.

CONCLUSIONS

Our study shows important information concerning the prevalence of different health conditions and its association, either individually or comorbidly on the QoL in a representative sample of Chinese children in HK.

Sleep and academic performance in Hong Kong adolescents

BACKGROUND

Sleep problems may have different influences on students' academic performance. We investigated the prevalence of sleep patterns, naps, and sleep disorders, and their associations with academic performance in Hong Kong adolescents.

METHODS

In 2007-2008, 22,678 students aged 12-18 (41.6% boys) completed a questionnaire on sociodemographic characteristics, sleep patterns and problems, and lifestyle factors including exercise, smoking, alcohol drinking, and academic performance.

RESULTS

The prevalence of having >8 hours of sleep was higher on holiday nights (86.4%) than on school-day nights (27.4%). Sleeping after midnight was more common before holidays (49.3%) than before school days (19.9%). Symptoms of insomnia and obstructive sleep apnea (OSA) were reported by 21.5% and 34.4% of students. Having >2 hours of weekend sleep delay was associated with poor academic performance with an odds ratio (OR) (95% confidence interval) of 1.46 (1.29-1.65). However, having 1-2 hours and >2 hours of weekend wake-up delay were both associated with less likelihood of poor academic performance with ORs of 0.64 (0.56-0.73) and 0.69 (0.59-0.80). Other factors associated with poor academic performance included >2 hours of sleep debt, OR of 1.17 (1.03-1.33); having any insomnia symptoms in the past 30 days, OR of 1.27 (1.17-1.37); and having any OSA symptoms at least weekly, OR of 1.23 (1.14-1.32). Napping in the past 5 school days was only marginally associated with poor school performance with an OR of 1.08 (1.00-1.16).

CONCLUSION

Poorer academic performance was associated with sleep debt, and symptoms of insomnia and OSA. Sleep compensation but not naps may be a protective factor of poor academic performance.

Foetal exposure to maternal passive smoking is associated with childhood asthma, allergic rhinitis, and eczema

Objective. We examined the hypothesis that foetal exposure to maternal passive smoking is associated with childhood asthma, allergic rhinitis, and eczema. Methods. The study was a population-based cross-sectional survey of Hong Kong Chinese children aged ≤14 years carried out in 2005 to 2006. Results. Foetal exposure to maternal passive smoking was significantly associated with wheeze ever (OR 2.05; 95% CI 1.58–2.67), current wheeze (OR 2.06; 95% CI 1.48–2.86), allergic rhinitis ever (OR 1.22; 95% CI 1.09–1.37), and eczema ever (OR 1.61; 95% CI 1.38–1.87). Foetal exposure to maternal active smoking was significantly associated with asthma ever (OR 2.10; 95% CI 1.14–3.84), wheeze ever (OR 2.46; 95% CI 1.27–4.78), and current wheeze (OR 2.74; 95% CI 1.24–6.01) but not with allergic rhinitis ever (OR 1.01; 95% CI 0.70–1.46) or eczema ever (OR 1.38; 95% CI 0.87–2.18). The dose response relationship between wheeze ever and current wheeze with increasing exposure, from no exposure to maternal passive smoking and then to maternal active smoking, further supports causality. Conclusion. There is significant association between foetal exposure to maternal passive smoking and maternal active smoking with childhood asthma and related atopic illnesses. Further studies are warranted to explore the potential causal relationship.

Clinicians' knowledge, beliefs and acceptance of intravenous-to-oral antibiotic switching, Hospital Pulau Pinang

A cross-sectional study was conducted to explore clincians' baseline knowledge, practice beliefs and acceptance of intravenous (IV)-to-oral antibiotic switching practice in Hospital Pulau Pinang. The factors most highly rated for antibiotic conversion were the ability to maintain oral intake (85.6%) and microbiology etiology (85.0%). Majority of the clinicians (76%) agreed with the traditional clinical rule that "patient should be afebrile for 24 hours before IV-to-oral switch". Specialists and consultants had the highest knowledge score among the clinicians. However, they were generally less positive about a guideline being integrated into practice.

Exposure to alcohol in utero: Influence on cognitive function and learning in a northern elementary school population

OBJECTIVES

To establish the prevalence of fetal alcohol exposure; to compare physical, behavioural and learning patterns of children with significant alcohol exposure in utero with those of a group of children exposed to minimal alcohol; to assess the usefulness of a fetal alcohol syndrome (FAS)/fetal alcohol effect (FAE) score; and to provide feedback to parents, schools and communities.

DESIGN

Parent questionnaire, complete physical examinations of children, psychometric tests of the children using elements of the Pediatric Early Elementary Examination (PEEX) and the Pediatric Examination of Educational Readiness (PEER), ADD-H comprehensive teachers rating scale (ACTeRS) score, the newly developed FAS/FAE Score, and the Brigance Comprehensive Inventory of Basic Skills to assess language and mathematical achievement. Testers were blinded to the results of the assessments and questionnaires.

SETTING

Grades 1 to 3 at Sir Alexander MacKenzie School in Inuvik, Northwest Territories.

RESULTS

Twenty-four per cent of mothers reported frequent or binge drinking, and 76% of mothers reported abstinence or moderate alcohol intake. There were significant ethnic differences; none of the Caucasian mothers reported frequent or binge drinking during pregnancy compared with 40% of Inuvialuit and 33% of Indian mothers. Children with exposure to frequent or binge drinking in utero had smaller palpebral fissures (2.3+/-0.1 cm versus 2.5+/-0.3 cm, P<0.01), smaller palpebral fissure to intercanthal distance ratios (0.77+/-0.05 versus 0.86+/-0.10, P<0.01) and smaller head circumferences (52.1+/-1.6 cm versus 53.6+/-1.6 cm, P<0.01) than those exposed to moderate drinking or abstinence. Children exposed to frequent or binge drinking in utero also demonstrated poorer coordination (P<0.005) and cortical function (P<0.01), attention problems, hyperactivity (ACTeRS), and poorer scholastic achievement in language (P<0.001) and mathematics (P<0.01) than their minimally exposed counterparts. In children in grades 2 and 3, a significant negative correlation was found between FAS/FAE scores and language (r=-0.55, P<0.001) and mathematical achievement (r=-0.28, P=0.20).

CONCLUSIONS

The prevalence of drinking during pregnancy in the northern population studied was high, and exposure in utero was associated with physical abnormalities, difficulties with coordination and cortical function, and significant delays in language and mathematical achievement. The FAS/FAE score may be useful in predicting success or failure in language development.

Influence of epidermal growth factor supplementation during in vitro maturation on nuclear status and gene expression of canine oocytes

This study evaluated the effect of epidermal growth factor (EGF) supplementation during in vitro maturation on the meiotic status and the expression of EGF receptor (EGFr), luteinizing hormone receptor (LHr) and gap junction protein α 5 (GJA5) in canine cumulus-oocyte-complexes (COCs). COCs of ≥110 μm diameter, exhibiting dark pigmentation and completely surrounded by three or more layers of cumulus cells collected from anestrus stage ovaries in natural cycle were matured in TCM-199 supplemented with 10% fetal bovine serum, 0.57 mM cysteine, 10 μg/ml LH and FSH, and different concentrations of EGF (0, 10 and 30 ng/ml). Oocytes cultured for 72 h were fixed to assess the nuclear maturation. Expression of EGFr, LHr and GAJ5 was assessed by immunocytochemistry and real-time PCR. Proportion of metaphase II status of oocytes cultured in in vitro maturation (IVM) medium supplemented with 10 ng/ml EGF for 72 h was significantly (P<0.05) higher than 0 and 30 ng/ml EGF supplemented IVM medium (9.8% vs. 6.5% and 5.2%). In both cumulus cells and oocytes, EGFr protein was undetectable, LHr protein level of expression was low and a strong expression of GJA5 protein was observed. The relative abundance (RA) of EGFr transcript revealed low levels and the LHr expression decreased steadily with addition of EGF. However it did not vary among different concentrations of EGF supplementation. The RA of GJA5 transcript exhibited lower level at 10 ng/ml EGF supplementation. In conclusion, the supplementation of 10 ng/ml EGF in IVM media exerted a positive influence on the progression of maturation to MII phase and the expression level of GJA5 at 72 h, but did not demonstrate any stimulatory role on the expression of EGFr and LHr during the maturation of the canine IVM oocytes.

Pollen Abortion in T Cytoplasmic Male-Sterile Corn (Zea mays): A Suggested Mechanism

A rapid replication of mitochondria (20- to 40-fold increase) occurs between the precallose and tetrad stages in the tapetum of N and T corn (Zea mays) anthers, followed by mitochondrial, tapetal, and pollen breakdown in T anthers. It is suggested that the altered DNA in T mitochondria may malfunction under these stress conditions.

Foetal peak systolic velocity in the middle cerebral artery: an Asian reference range

INTRODUCTION

The aim of this study was to establish reference values of peak systolic blood flow velocity measurement in the foetal middle cerebral artery (MCA-PSV) in the local Asian obstetric population and to compare our reference ranges with those of previously-published studies.

METHODS

329 normal pregnant women attending the outpatient antenatal clinics of the Department of Obstetrics and Gynaecology in the Singapore General Hospital underwent Doppler ultrasonography at least once between 16 and 40 weeks' gestation. The blood flow velocity recordings from the foetal middle cerebral artery were obtained. New reference ranges were constructed by regressing each parameter on gestational age.

RESULTS

New reference ranges for foetal middle cerebral artery with gestation were constructed for an Asian population. Our reference curves were compared with that of a previously-constructed one.

CONCLUSION

MCA-PSV increases with advancing gestational age. There appear to be differences between Asian and non-Asian reference ranges for MCA-PSV.

Evidence for a competition between the superconducting state and the pseudogap state of (BiPb)2(SrLa)2CuO6+delta from muon spin rotation experiments

The in-plane magnetic penetration depth lambda ab in optimally doped (BiPb)2(SrLa)2CuO6+delta (OP Bi2201) was studied by means of muon-spin rotation. The measurements of lambda ab(-2)(T) are inconsistent with a simple model of a d-wave order parameter and a uniform quasiparticle weight around the Fermi surface. The data are well described assuming the angular gap symmetry obtained in ARPES experiments [Phys. Rev. Lett. 98, 267004 (2007)], which suggest that the superconducting gap in OP Bi2201 exists only in segments of the Fermi surface near the nodes. The remaining parts of the Fermi surface, which are strongly affected by the pseudogap state, do not contribute significantly to the superconducting condensate.

A genome-wide scan in an Amish pedigree with parkinsonism

The identification of familial Parkinson Disease (PD) genes is yielding important molecular pathogenetic insights. In an effort to identify additional PD genes, we studied an eight generation Amish pedigree with apparent autosomal dominant parkinsonism with incomplete penetrance. Phenotypic variability ranged from idiopathic PD to progressive supranuclear palsy (PSP), with the average age at onset 53 years (range of 39 to 74 years). We identified markers on chromosome 3 and 7 that were significant at a genome-wide level by parametric and nonparametric criteria, lod > 3 and non-parametric P-value < 0.10, respectively. We also identified markers on chromosomes 10 and 22 with lod > 3. These data suggest that parkinsonism in this pedigree is genetically complex, with contributions from several loci.

Ultrasonographical features of morbidly-adherent placentas

Morbidly-adherent placentas manifest as placenta accreta, increta or percreta, depending on the depth of placental invasion. These conditions present high risks of severe obstetrical haemorrhage at delivery. The underlying pathology is due to defects in the decidua basalis caused by a variety of insults, such as previous surgery, excessive curettage or infection. The incidence of morbidly-adherent placentas is rising as the frequency of caesarean sections increase. Imaging plays an important role in the antenatal detection of this condition. Based on the case series seen at our local institution, we describe the imaging characteristics of this condition as seen on grayscale ultrasonography, colour/power Doppler ultrasonography, three-dimensional ultrasonography and magnetic resonance imaging.

Primary aneurysmal bone cyst of the patella: a case report

Aneurysmal bone cysts account for less than 1% of primary bone tumours and have a predilection for the metaphyses of the long bones of the leg. Only 1% of all aneurysmal bone cysts occur in the patella. We report on a 30-year-old man with a primary aneurysmal bone cyst in the right patella treated with curettage. The defect was filled with demineralised bone matrix and allogeneic cancellous bone graft. At the 1.5-year follow-up, the bone graft was well incorporated, the patient experienced no pain or tenderness and had a full range of knee movement.

Cultural condition affecting the growth and production of β-galactosidase by Bifidobacterium longum CCRC 15708 in a jar fermenter

In the present study, the growth and production of beta-galactosidase by Bifidobacterium longum CCRC 15708 in a 5-L jar fermenter as influenced by cultivation temperature (27-42 degrees C), medium pH (4.5-7.5) and agitation speed (5-200 rpm) were evaluated. In general, it was found that a cultivation temperature of 37 degrees C proved optimal for both growth and beta-galactosidase production by the test organism. Although the growth of the test organism was the highest in the culture with pH controlled at 4.5-6.5, the culture with pH controlled at 6.5 resulted in the highest production of beta-galactosidase. Further, agitation at 100 rpm or more was found to enhance both the growth and production of beta-galactosidase. Fermentation conducted in a jar fermenter having the pH of the culture medium, the cultivation temperature, and the agitation speed controlled at 6.5, 37 degrees C, and 100 rpm, respectively, a maximum beta-galactosidase activity of 36.7 U/ml and a maximum transgalactosylation activity of 0.49 U/ml was achieved in 10 h of fermentation. There are ca 2.0 and 12.3 fold greater than the reported maximum beta-galactosidase and transgalactosylation activity, respectively, produced by B. longum CCRC 15708 in a flask culture system.