Transcript shortening via alternative polyadenylation promotes gene expression during fracture healing

Maturation of the 3' end of almost all eukaryotic messenger RNAs (mRNAs) requires cleavage and polyadenylation. Most mammalian mRNAs are polyadenylated at different sites within the last exon, generating alternative polyadenylation (APA) isoforms that have the same coding region but distinct 3' untranslated regions (UTRs). The 3'UTR contains motifs that regulate mRNA metabolism; thus, changing the 3'UTR length via APA can significantly affect gene expression. Endochondral ossification is a central process in bone healing, but the impact of APA on gene expression during this process is unknown. Here, we report the widespread occurrence of APA, which impacts multiple pathways that are known to participate in bone healing. Importantly, the progression of endochondral ossification involves global 3'UTR shortening, which is coupled with an increased abundance of shortened transcripts relative to other transcripts; these results highlight the role of APA in promoting gene expression during endochondral bone formation. Our mechanistic studies of transcripts that undergo APA in the fracture callus revealed an intricate regulatory network in which APA enhances the expression of the collagen, type I, alpha 1 (Col1a1) and Col1a2 genes, which encode the 2 subunits of the abundantly expressed protein collagen 1. APA exerts this effect by shortening the 3'UTRs of the Col1a1 and Col1a2 mRNAs, thus removing the binding sites of miR-29a-3p, which would otherwise strongly promote the degradation of both transcripts. Taken together, our study is the first to characterize the crucial roles of APA in regulating the 3'UTR landscape and modulating gene expression during fracture healing.

Spleen Tyrosine Kinase Contributes to Müller Glial Expression of Proangiogenic Cytokines in Diabetes

Purpose

Neuroglial dysfunction occurs early in the progression of diabetic retinopathy. In response to diabetes or hypoxia, Müller glia secrete cytokines and growth factors that contribute to disease progression. This study was designed to examine common signaling pathways activated in Müller glia by both type 1 and pre-/type 2 diabetes.

Methods

RiboTag (Pdgfra-cre;HA-Rpl22) mice were used to compare the impact of streptozotocin (STZ) and a high-fat, high-sucrose (HFHS) diet on ribosome association of mRNAs in Müller glia by RNA sequencing analysis. Human MIO-M1 Müller cells were exposed to either hyperglycemic or hypoxic culture conditions. Genetic manipulation and pharmacologic inhibition were used to interrogate signaling pathways.

Results

Association of mRNAs encoding triggering receptor expressed on myeloid cells 2 (TREM2), DNAX-activating protein 12 kDa (DAP12), and colony stimulating factor 1 receptor (CSF1R) with ribosomes isolated from Müller glia was upregulated in both STZ diabetic mice and mice fed an HFHS diet. The TREM2/DAP12 receptor-adaptor complex signals in coordination with CSF1R to activate spleen tyrosine kinase (SYK). SYK activation was enhanced in the retina of diabetic mice and in human MIO-M1 Müller cell cultures exposed to hyperglycemic or hypoxic culture conditions. DAP12 knockdown reduced SYK autophosphorylation in Müller cells exposed to hyperglycemic or hypoxic conditions. SYK inhibition or DAP12 knockdown suppressed hypoxia-induced expression of the transcription factor hypoxia-inducible factor 1⍺ (HIF1⍺), as well as expression of vascular endothelial growth factor and angiopoietin-like 4.

Conclusions

The findings support TREM2/DAP12 receptor-adaptor complex signaling via SYK to promote HIF1α stabilization and increased angiogenic cytokine production by Müller glia.

Development and Validation of Indicators for Population Injury Surveillance in Hong Kong: Development and Usability Study

BACKGROUND

Injury is an increasingly pressing global health issue. An effective surveillance system is required to monitor the trends and burden of injuries.

OBJECTIVE

This study aimed to identify a set of valid and context-specific injury indicators to facilitate the establishment of an injury surveillance program in Hong Kong.

METHODS

This development of indicators adopted a multiphased modified Delphi research design. A literature search was conducted on academic databases using injury-related search terms in various combinations. A list of potential indicators was sent to a panel of experts from various backgrounds to rate the validity and context-specificity of these indicators. Local hospital data on the selected core indicators were used to examine their applicability in the context of Hong Kong.

RESULTS

We reviewed 142 articles and identified 55 indicators, which were classified into 4 domains. On the basis of the ratings by the expert panel, 13 indicators were selected as core indicators because of their good validity and high relevance to the local context. Among these indicators, 10 were from the construct of health care service use, and 3 were from the construct of postdischarge outcomes. Regression analyses of local hospitalization data showed that the Hong Kong Safe Community certification status had no association with 5 core indicators (admission to intensive care unit, mortality rate, length of intensive care unit stay, need for a rehabilitation facility, and long-term behavioral and emotional outcomes), negative associations with 4 core indicators (operative intervention, infection rate, length of hospitalization, and disability-adjusted life years), and positive associations with the remaining 4 core indicators (attendance to accident and emergency department, discharge rate, suicide rate, and hospitalization rate after attending the accident and emergency department). These results confirmed the validity of the selected core indicators for the quantification of injury burden and evaluation of injury-related services, although some indicators may better measure the consequences of severe injuries.

CONCLUSIONS

This study developed a set of injury outcome indicators that would be useful for monitoring injury trends and burdens in Hong Kong.

Whole-Genome Differentially Hydroxymethylated DNA Regions among Twins Discordant for Cardiovascular Death

Epigenetics is a mechanism underlying cardiovascular disease. It is unknown whether DNA hydroxymethylation is prospectively associated with the risk for cardiovascular death independent of germline and common environment. Male twin pairs middle-aged in 1969–1973 and discordant for cardiovascular death through December 31, 2014, were included. Hydroxymethylation was quantified in buffy coat DNA collected in 1986–1987. The 1893 differentially hydroxymethylated regions (DhMRs) were identified after controlling for blood leukocyte subtypes and age among 12 monozygotic (MZ) pairs (Benjamini–Hochberg False Discovery Rate < 0.01), of which the 102 DhMRs were confirmed with directionally consistent log₂-fold changes and p < 0.01 among additional 7 MZ pairs. These signature 102 DhMRs, independent of the germline, were located on all chromosomes except for chromosome 21 and the Y chromosome, mainly within/overlapped with intergenic regions and introns, and predominantly hyper-hydroxymethylated. A binary linear classifier predicting cardiovascular death among 19 dizygotic pairs was identified and equivalent to that generated from MZ via the 2D transformation. Computational bioinformatics discovered pathways, phenotypes, and DNA motifs for these DhMRs or their subtypes, suggesting that hydroxymethylation was a pathophysiological mechanism underlying cardiovascular death that might be influenced by genetic factors and warranted further investigations of mechanisms of these signature regions in vivo and in vitro.

RISC II is superior to TRISS in predicting 30-day mortality in blunt major trauma patients in Hong Kong

PURPOSE

Hong Kong (HK) trauma registries have been using the Trauma and Injury Severity Score (TRISS) for audit and benchmarking since their introduction in 2000. We compare the mortality prediction model using TRISS and Revised Injury Severity Classification, version II (RISC II) for trauma centre patients in HK.

METHODS

This was a retrospective cohort study with all five trauma centres in HK. Adult trauma patients with Injury Severity Score (ISS) > 15 suffering from blunt injuries from January 2013 to December 2015 were included. TRISS models using the US and local coefficients were compared with the RISC II model. The primary outcome was 30-day mortality and the area under the receiver operating characteristic curve (AUC) for tested models.

RESULTS

1840 patients were included, of whom 1236/1840 (67%) were male. Median age was 59 years and median ISS was 25. Low falls were the most common mechanism of injury. The 30-day mortality was 23%. RISC II yielded a superior AUC of 0.896, compared with the TRISS models (MTOS: 0.848; PATOS: 0.839; HK: 0.858). Prespecified subgroup analyses showed that all the models performed worse for age ≥ 70, ASA ≥ III, and low falls. RISC II had a higher AUC compared with the TRISS models in all subgroups, although not statistically significant.

CONCLUSION

RISC II was superior to TRISS in predicting the 30-day mortality for Hong Kong adult blunt major trauma patients. RISC II may be useful when performing future audit or benchmarking exercises for trauma in Hong Kong.

Findings from the first public COVID-19 temporary test centre in Hong Kong

INTRODUCTION

The Hospital Authority of Hong Kong Special Administrative Region established a coronavirus disease 2019 (COVID-19) temporary test centre at the AsiaWorld-Expo from March 2020 to April 2020, which allowed high-risk individuals to undergo early assessment of potential severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. This study reviewed the characteristics and outcomes of individuals who attended the centre for COVID-19 testing.

METHODS

This retrospective cross-sectional study collected epidemiological and clinical data. The primary outcome was a positive or negative SARS-CoV-2 test result, according to reverse transcription polymerase chain reaction analyses of pooled nasopharyngeal and throat swabs collected at the centre. The relationships of clinical characteristics with SARS-CoV-2 positive test results were assessed by multivariable binary logistic regression.

RESULTS

Of 1258 attendees included in the analysis, 86 individuals tested positive for SARS-CoV-2 infection (positivity rate=6.84%; 95% confidence interval [CI]=5.57%-8.37%). Of these 86 individuals, 40 (46.5%) were aged 15 to 24 years and 81 (94.2%) had a history of recent travel. Symptoms were reported by 86.0% and 96.3% of individuals with positive and negative test results, respectively. The clinical characteristics most strongly associated with a positive test result were anosmia (adjusted odds ratio [OR_adj]=8.30; 95% CI=1.12-127.09) and fever OR_adj=1.32; 95% CI=1.02-3.28).

CONCLUSION

The temporary test centre successfully helped identify individuals with COVID-19 who exhibited mild disease symptoms. Healthcare providers should carefully consider the epidemiological and clinical characteristics of COVID-19 to arrange early testing to reduce community spread.

Geographical accessibility of community social services and incidence of self-harm

OBJECTIVE

The study aimed to explore the association between area-based coverage of community services and the incidence of self-harm, which will provide an evaluation framework for the support of self-harm.

METHODS

Enhanced two-Step floating catchment area method was used to estimate the centersto- population ratio and geographical accessibility adjusted by a distance-decay function. Spearman's rank coefficient was used to examine the association between the self-harm rate and adjusted accessibility index.

RESULTS

There was a significant negative correlation between the accessibility index and selfharm rate in youth (rho = -0.87, P < 0.01) and older adults (rho = -0.87, P < 0.01). The survival curves showed no relationship between self-harm repetition and service accessibility in youth or older adults.

CONCLUSIONS

The uneven spatial accessibility of community social service centers and the independence between spatial accessibility and self-harm highlights the need to explore personal barriers to community service utilization.

Neuroligin3 splice isoforms shape inhibitory synaptic function in the mouse hippocampus

Synapse formation is a dynamic process essential for the development and maturation of the neuronal circuitry in the brain. At the synaptic cleft, trans-synaptic protein-protein interactions are major biological determinants of proper synapse efficacy. The balance of excitatory and inhibitory synaptic transmission (E-I balance) stabilizes synaptic activity, and dysregulation of the E-I balance has been implicated in neurodevelopmental disorders, including autism spectrum disorders. However, the molecular mechanisms underlying the E-I balance remain to be elucidated. Here, using single-cell transcriptomics, immunohistochemistry, and electrophysiology approaches to murine CA1 pyramidal neurons obtained from organotypic hippocampal slice cultures, we investigate neuroligin (Nlgn) genes that encode a family of postsynaptic adhesion molecules known to shape excitatory and inhibitory synaptic function. We demonstrate that the NLGN3 protein differentially regulates inhibitory synaptic transmission in a splice isoform-dependent manner at hippocampal CA1 synapses. We also found that distinct subcellular localizations of the NLGN3 isoforms contribute to the functional differences observed among these isoforms. Finally, results from single-cell RNA-Seq analyses revealed that Nlgn1 and Nlgn3 are the major murine Nlgn genes and that the expression levels of the Nlgn splice isoforms are highly diverse in CA1 pyramidal neurons. Our results delineate isoform-specific effects of Nlgn genes on the E-I balance in the murine hippocampus.

Major trauma care in Hong Kong and Germany: a trauma registry data benchmark study

BACKGROUND

Trauma remains a leading cause of death and effective trauma management within a well-developed trauma system has been shown to reduce morbidity and mortality. A trauma registry, as an integral part of a mature trauma system, can be used to monitor the quality of trauma care and to provide a means to compare local versus international standards. Hong Kong and Germany both have highly developed health care services. We compared the performance of trauma systems including outcomes among major trauma victims (ISS > 15) over a 3-year period (2013-2015) in both settings using trauma registry data.

METHODS

This study was a retrospective analysis of prospectively collected data from trauma registries in Hong Kong and Germany. Data from 01/2013 to 12/2015 were extracted from the trauma registries of the five trauma centers in Hong Kong and the TraumaRegister DGU^® (TR-DGU). The study cohort included adults (≥ 18 years) with major trauma (ISS > 15). Data related to patient characteristics, nature of the injury, prognostic parameters to calculate the RISC II score, outcomes and clinical management were collected and compared.

RESULTS

Datasets from 1,864 Hong Kong and 10,952 German trauma victims were retrieved from respective trauma registries. The unadjusted mortality in Hong Kong (22.4%) was higher compared to Germany (19.2%); the difference between observed and expected mortality was higher in Hong Kong (+ 2.7%) than in Germany (- 0.5%). The standardized mortality ratio (SMR) in Hong Kong and Germany were 1.138 (95% CI 1.033-1.252) and 0.974 (95% CI 0.933-1.016), respectively, and the adjusted death rate in Hong Kong was significantly higher compared to the calculated RISC II data. However, patients in Hong Kong were significantly older, had more pre-trauma co-morbidities, more head injuries, shorter hospital and ICU stays and lower ICU admission rates.

CONCLUSION

Hong Kong had a higher mortality rate and a statistically significantly higher standardized mortality ratio (SMR) after RISC II adjustment. However, multiple differences existed between trauma systems and patient characteristics.

P6443Late outcomes in patients undergoing PCI for ST elevation myocardial infarction with respect to diabetic status and completeness of revascularisation

Objectives

This paper examines the degree to which the poor prognosis of ST elevation myocardial infarction (STEMI) patients with diabetes mellitus (DM) can be attributed to incomplete revascularization (ICR).

Background

Cardiovascular disease is the most common cause of death for patients with DM; patients with DM often have complex coronary disease and ICR. In STEMI the relative impact of DM and ICR is uncertain as these two factors frequently co-exist, the potential for confounding is high.

Methods and results

Of 589 consecutive STEMI patients, 22% had DM, who compared to patients without DM were of similar age (59 years), were more often female, had more hypertension and dyslipidaemia, but less often were smokers. A residual SYNTAX Score (rSS) >8, which defined ICR, occurred in 33%. Late cardiac death [median 3.5 years] was 4% among those without DM and 12% in those with DM (p=0.002) (p<0.001), and was 3% among 396 with rSS≤8 and 12% in 193 patients with rSS>8 (p<0.001). Patients with both ICR and DM accounted for only 8% of the STEMI population but 30% of all cardiac deaths. At final follow up (3.5 years) cardiac death rates (see Figure) were 22% in patients with both DM and ICR; these were significantly higher than rates in patients with ICR but no-DM (9%, p=0.034), and those with DM and rSS≤8 (6%, p<0.019). Multivariable analysis for cardiac death found a HR for ICR of 2.89 (95% CI 1.31–6.37; p=0.009) and a HR for DM of 5.18 (95% CI 2.45–10.97, p<0.001).

Diabetes, cardiac death & rSS

Conclusions

While ICR in DM patients with STEMI predicts a significantly poorer outcome, the poor prognosis seen in patients with DM is not explained by the degree of ICR alone. Both ICR and DM contribute independently to the risk of cardiac death in STEMI patients.

New Service Model for Common Mental Disorders in Hong Kong: a Retrospective Outcome Study

OBJECTIVE

To review the first 8-month outcome of the Common Mental Disorder Clinic model in Hong Kong in terms of patient exit status and improvement in depressive and anxiety symptoms.

METHODS

During the first appointment, patients were interviewed by a multidisciplinary team comprising a psychiatrist, a psychiatric nurse, and an occupational therapist. A multidisciplinary case conference was conducted to discuss clinical observations, diagnosis, issues of concern, and the optimal individualised treatment plan. Low-intensity interventions by nurses and/or occupational therapists were provided, as were optional, time-limited, protocol-based interventions by clinical psychologists for those with mild to moderate depressive and anxiety symptoms. Pharmacological intervention may be used when indicated. Upon completion of the treatment plan, patients were reassessed by the treating psychiatrist. Discharge options included discharge without psychiatric follow-up, step-up to psychiatric outpatient clinics, and step-down services. The self-administered Patient Health Questionnaire-9 (PHQ-9) and Generalised Anxiety Disorder 7-item scale (GAD-7) were used to assess the past 2 weeks' depressive and anxiety symptoms, respectively, at baseline and at each session.

RESULTS

From July 2015 to February 2016, 1325 Chinese patients received the new service. Of them, 170 men and 363 women (mean age, 52.6 years) completed the treatment plan. After treatment, their mean PHQ-9 score decreased from 11.06 to 7.55 (p < 0.001), and the mean GAD-7 score decreased from 9.94 to 6.54 (p < 0.001). After treatment, 42.4% and 48.2% of the patients were within the normal range of PHQ-9 and GAD-7 scores, respectively, compared with 16.9% and 20.8% before treatment. The mean time to implementation of the individualised treatment plan was 82.33 days. Of the patients, 54.4% were discharged without any need for medical or psychiatric follow-up; 28% were stepped up to psychiatric outpatient clinics; and 17.3% were stepped down. The predictors of exit status were whether psychiatric medication was prescribed during initial intake (p = 0.011), whether psychiatric medication was prescribed at last follow-up (p < 0.001), the service period (p = 0.010), and the GAD-7 final score (p = 0.005).

CONCLUSIONS

The first 8-month outcome of the new service model was encouraging, with shortened waiting time, reduced severity of symptoms, and better exit status (high recovery and step-down rates).

Disseminated Sporotrichosis in a Bilby (Macrotis lagotis)

A male bilby (Macrotis lagotis) was presented to the Murdoch University Veterinary Anatomical Pathology Service following humane destruction due to severe lethargy. The bilby was emaciated with a focal ulcerated skin lesion on the dorsal tail base. Multifocal to coalescing foci of pyogranulomatous and often necrotizing inflammation was present within multiple organs, including the tail wound, adrenal glands, kidneys, lungs, brain, testes, lymph nodes, heart, liver, spleen and salivary glands. Admixed were abundant intrahistiocytic and extracellular pleomorphic yeast (round, oval and cigar-shaped) up to 6 μm diameter, often with a thin clear halo and occasional narrow-based budding. The diagnosis of disseminated sporotrichosis was confirmed via culture and sequencing of the internal transcribed spacer region of the causative agent, Sporothrix schenckii sensu lato. The route of entry of infection was considered most likely to have been via cutaneous inoculation of the tail base wound. To the authors' knowledge, this report describes the first known case of sporotrichosis in a native Australian animal.

Self-harm attempters' perception of community services and its implication on service provision

Objective

This study aimed at exploring the attempters’ perception of community social services included any barriers to seeking help and services.

Method

The participants were patients with self-harming behavior aged 15 years or above. A set of guiding questions were designed to explore the general barriers and accessibility to community social services. A voice recording was made, which was later converted into a text transcript and then preceded for content analysis with co-occurrence and similarity matrix interpretation. Two males and nine females with a history of self-harm aged between 24 and 58 years were recruited for the interviews.

Result

The participants had diverse experiences and backgrounds, and attitudes toward community social services. However, there was a shared perception of the need to enhance community social services. There were four main themes and 12 sub themes identified. The main theme included the service availability, service accessibility, affordability and acceptability. For details, participants were unaware of the available types of care/social services in the community, and were unaware about the nearby social services. They also suggested extending service hours and focused services should be offered to help people with different backgrounds and needs. Actually, those with experience of service utilization had both positive and negative perspectives and they gave suggestions for service delivery, mainly extending service hours and offering focused services such as for gambling control and financial planning. In view of interaction with service providers, counseling skills and trust were highly appreciated by the participants.

Conclusion

The results identified common circumstances of falling into financial hardship (gambling) and social fragmentation (divorce, poor family relationships, and poor marital relationships), which also suggested to enhance services on center location, service arrangement, and skill of caregivers.

Choline ameliorates adult learning deficits and reverses epigenetic modification of chromatin remodeling factors related to adolescent nicotine exposure

Earlier initiation of smoking correlates with higher risk of nicotine dependence, mental health problems, and cognitive impairments. Additionally, exposure to nicotine and/or tobacco smoke during critical developmental periods is associated with lasting epigenetic modifications and altered gene expression. This study examined whether adolescent nicotine exposure alters adult hippocampus-dependent learning, involving persistent changes in hippocampal DNA methylation and if choline, a dietary methyl donor, would reverse and mitigate these alterations. Mice were chronically treated with nicotine (12.6 mg/kg/day) starting at post-natal day 23 (pre-adolescent), p38 (late adolescent), or p54 (adult) for 12 days followed by a 30-day period during which they consumed either standard chow or chow supplemented with choline (9 g/kg). Mice then were tested for fear-conditioning and dorsal hippocampi were dissected for whole genome methylation and selected gene expression analyses. Nicotine exposure starting at p21 or p38, but not p54, disrupted adult hippocampus-dependent fear conditioning. Choline supplementation ameliorated these deficits. 462 genes in adult dorsal hippocampus from mice exposed to nicotine as adolescents showed altered promoter methylation that was reversed by choline supplementation. Gene network analysis revealed that chromatin remodeling genes were the most enriched category whose methylation was altered by nicotine and reversed by choline dietary supplementation. Two key chromatin remodeling genes, Smarca2 and Bahcc1, exhibited inversely correlated changes in methylation and expression due to nicotine exposure; this was reversed by choline. Our findings support a role for epigenetic modification of hippocampal chromatin remodeling genes in long-term learning deficits induced by adolescent nicotine and their amelioration by dietary choline supplementation.

The Association Between Fall Frequency, Injury Risk, and Characteristics of Falls in Older Residents of Long-Term Care: Do Recurrent Fallers Fall More Safely?

Background

Although a fall is a necessary prerequisite to a fall-related injury, previous studies suggest that frequent fallers are at lower injury risk for a given fall. We tested the hypotheses that differences in protective responses or the circumstances of falls underlie differences in injury risk with fall frequency.

Methods

We analyzed video footage of 897 falls experienced by 220 long-term care residents (mean age 82 ± 9 years) to identify the cause of imbalance, activity leading to falling, direction of fall initiation, balance recovery and fall protective responses, and occurrence of impact to the head or hip. We further obtained injury information from the facilities' fall registration. We used generalized estimating equation models to examine the association between quartiles of fall frequency, injury risk, and fall characteristics.

Results

Residents with the highest fall frequency group (Q4; ≥5.6 falls/year) were less likely to sustain an injury per fall. They were less likely to fall during walking and more likely to fall during stand-to-sit transfers. Residents in the lowest fall frequency group (Q1; <1.15 falls/year) were more likely to fall during walking, and walking was associated with an increased risk for injury.

Conclusion

When compared to less frequent fallers, more frequent fallers had a lower risk for injury per fall. This appeared to be explained by differences in the circumstances of falls, and not by protective responses. Injury prevention strategies in long-term care should target both frequent and infrequent fallers, as the latter are more mobile and apt to sustain injury.

Impact of IPMOE on nursing tasks in the medical ward: A time-motion study

Introduction

The In-patient Medication Order Entry System (IPMOE) was first implemented in the medical ward of Princess Margaret Hospital, Hong Kong. It was a local developed close-loop system including prescription, dispensing and administration modules. Evaluation on its impact on nursing tasks would be important for practice improvement and subsequent system enhancement.

Objective

The study was conducted to quantify the nursing times across medication-associated tasks for paper-based MAR and computer-based IPMOE, including change in the tasks and time patterns before and after IPMOE implementation.

Methods

This was a prospective observation study in medical wards before (Jan 2014–Jun 2014) and after (Mar 2015–Jun 2015) the implementation of IPMOE. We conducted 8-hr observation studies of individual nurses with a customized application to time various pre-categorized nursing tasks. Statistical inferences and interrupted time series analysis was performed to identify the change in the intercept and trends over time after implementation.

Result

The average number of medication-related tasks was significantly reduced from 61.07 to 29.81, a reduction of 31.26 episodes per duty (P < 0.001, 95% CI 22.9–39.63). The time for the medication-related tasks was reduced from 32 min (SD = 21.57) to 26.57 min (SD = 11.35) and the medication administration time increased from 37.93 min (SD = 14.78) to 44.37 min (SD = 19.45), but there was no overall significant difference in the time spent on each duty (P = 0.315) between the two groups. An improving trend in the delayed effect was observed (P = 0.03), which indicated a run-in period for new application was needed in clinical setting.

Conclusion

Our study had shown the time motion observation could be applied to measure the impact of the IPMOE in a busy clinical setting. Through classification of activities, validation, objective measurement and longitudinal evaluation, the method could be applied in various systems as well as different clinical settings in measure efficiency.

A One-Year Hospital-Based Analysis of Sports Injuries

Objectives

(1) To survey and analyse the pattern of sports injuries; (2) to make implication from the results.

Methodology

Subjects with sports injuries attending the emergency department of Princess Margaret Hospital in 2006 were retrieved via the Injury Surveillance System. The characteristics of the subjects and their injuries were evaluated.

Results

In 2006, 709 subjects had sports injuries, from which 83% were male. The median age was 19. Age below 20 accounted for 53% of the attendance. Football (35%), basketball (25%) and cycling (9%) were the three commonest sport-injury activities. All sports injuries had the maximum AIS ≤3 and 83% had MAIS of 1 only. Overall, 39% had contusion and scrape, 36% with sprain and strain, and 18% had fracture. Nearly half (47%) had lower limb injury; 30% and 24% had upper limb injury and head injury respectively. Contusion and scrape of the head, and sprain and strain of the lower limb were the two commonest injuries in football and basketball. In cycling, two-thirds suffered from contusion and scrape of any body region and 57% of those involved the head.

Conclusion

Sports injury surveillance with characterised patterns of injuries helped to devise prevention measures.

A Retrospective Epidemiological Study of the Traffic-Related Injuries Cases Admitted to a Local Hospital

Road traffic injuries (RTI) are important public health problem globally. Accurate data about RTIs and its subsequent health consequences are essential to monitor the effectiveness of current RTI prevention measures and to readdress policies.

Objective

We presented the surveillance of RTI in Kwai Tsing by integrating data from traffic accident data system (TRADS) and injury surveillance system (ISS) from Princess Margaret Hospital.

Method

Retrospective observational study to examine traffic-related injuries by integrating data from TRADS and ISS databases. A multivariate analysis was performed to identify risk factors associated with hospital admissions in RTI.

Result

A total of 725 patients were included. About 19% of the visits led to hospitalisation and six deaths (0.83%) were reported. Pedestrian elders were significantly more at risk to traffic injury mortality and hospitalisation.

Conclusion

This study demonstrates the feasibility of an integrated surveillance system for RTI based on existing local databases. Special preventive measures should be tailored for pedestrian and elderly to improve their safety by improving the quality of their walking environment.

Clinical Outcomes of Trauma Patients after Implementation of a Standardised Diversion Protocol for Trauma Patients in Two Regional Hospitals in Hong Kong

Introduction

Despite recent advance in prehospital trauma diversion, patients are triaged to the nearest medical facility before transferred to designated trauma centre. A new standardised diversion protocol for trauma patients was implemented on 1st April 2011 to facilitate trauma care. Severely-injured patients were transferred to designated trauma centre directly from emergency department of the regional hospital after initial resuscitation.

Objective

This study was undertaken to examine clinical outcomes of trauma patients after implementation of the new standardised diversion protocol for trauma patients in the emergency department.

Method

This was a before-and-after interventional study on trauma patients presenting to the emergency department in critical or emergency conditions during the study period from 1st April 2011 to 31st March 2012. Patients presented in the two-year period before implementation of the trauma protocol were used as historical control. Medical records of eligible cases were reviewed. Main outcome measures were 30-day mortality, length of hospital stay and time to definitive care. Mortality data was compared with oversea standard by TRISS methodology.

Results

There were 153 eligible patients in the study group and 355 in the historical control group. After new arrangement of trauma diversion, W-statistics improves from -1.26 to 0.09. Z-statistics was -2.03 before and 0.09 after implementation. M-statistics were 0.91 before and 0.88 after the new protocol. Mean time to definitive care was shortened by 33.4 minutes in the subgroup who were transferred to trauma centre after trauma team activation (p=0.005).

Conclusion

A trend of improved outcomes and shorter time to definitive care are observed after implementation of the new trauma diversion protocol. (Hong Kong j.emerg.med. 2015;22:201-209)

How Accurate are Emergency Department Medical Staff in the Interpretation of Head Injury Related Computed Tomography?

Introduction

Computed tomography (CT) brain has become a popular modality to detect head injury related problems for patients seen at the Emergency Departments (ED) in Hong Kong. This study aims to assess the diagnostic accuracy of local ED medical staff in interpretation of head injury related CT and to assess the association between years of working experience of ED medical staff and the diagnostic accuracy of CT brain interpretation.

Methods

This is a retrospective cohort study reviewing all patients attending the ED of Princess Margaret Hospital in three years (from 2008 to 2010) with head injuries requiring CT brain during ED stay. The findings of CT brain by ED medical staff were compared with those by radiologists, the reference standard.

Results

A total of 1716 cases were assessed. The overall sensitivity and specificity for detecting an abnormal CT were 0.66 (95% confidence interval [CI] 0.60-0.71) and 0.96 (95% CI 0.95-0.97), respectively. The sensitivity showed an increasing trend from 0.63 (95% CI 0.54-0.72) in ED staff with 0-3 years of working experience, to 0.71 (95% CI 0.59-0.84) with 4-6 years of experience and 0.75 (95% CI 0.63-0.86) with 7-10 years of experience. It dropped to 0.59 (95% CI 0.47-0.71) with more than 10 years of experience.

Conclusions

The head injury related CT interpretation skill by ED medical staff is suboptimal. More training is necessary. (Hong Kong j.emerg.med. 2015;22:241-247)

The abundance of cis-acting loci leading to differential allele expression in F1 mice and their relationship to loci harboring genes affecting complex traits

Background

Genome-wide surveys have detected cis-acting quantitative trait loci altering levels of RNA transcripts (RNA-eQTLs) by associating SNV alleles to transcript levels. However, the sensitivity and specificity of detection of cis- expression quantitative trait loci (eQTLs) by genetic approaches, reliant as it is on measurements of transcript levels in recombinant inbred strains or offspring from arranged crosses, is unknown, as is their relationship to QTL’s for complex phenotypes.

Results

We used transcriptome-wide differential allele expression (DAE) to detect cis-eQTLs in forebrain and kidney from reciprocal crosses between three mouse inbred strains, 129S1/SvlmJ, DBA/2J, and CAST/EiJ and C57BL/6 J. Two of these crosses were previously characterized for cis-eQTLs and QTLs for various complex phenotypes by genetic analysis of recombinant inbred (RI) strains. 5.4 %, 1.9 % and 1.5 % of genes assayed in forebrain of B6/129SF1, B6/DBAF1, and B6/CASTF1 mice, respectively, showed differential allelic expression, indicative of cis-acting alleles at these genes. Moreover, the majority of DAE QTLs were observed to be tissue-specific with only a small fraction showing cis-effects in both tissues. Comparing DAE QTLs in F1 mice to cis-eQTLs previously mapped in RI strains we observed that many of the cis-eQTLs were not confirmed by DAE. Additionally several novel DAE-QTLs not identified as cis-eQTLs were identified suggesting that there are differences in sensitivity and specificity for QTL detection between the two methodologies. Strain specific DAE QTLs in B6/DBAF1 mice were located in excess at candidate genes for alcohol use disorders, seizures, and angiogenesis previously implicated by genetic linkage in C57BL/6J × DBA/2JF2 mice or BXD RI strains.

Conclusions

Via a survey for differential allele expression in F1 mice, a substantial proportion of genes were found to have alleles altering expression in cis-acting fashion. Comparing forebrain and kidney, many or most of these alleles were tissue-specific in action. The identification of strain specific DAE QTLs, can assist in assessment of candidate genes located within the large intervals associated with trait QTLs.

Electronic supplementary material

The online version of this article (doi:10.1186/s12864-016-2922-9) contains supplementary material, which is available to authorized users.

Constrained inference of protein interaction networks for invadopodium formation in cancer

Integrating prior molecular network knowledge into interpretation of new experimental data is routine practice in biology research. However, a dilemma for deciphering interactome using Bayes' rule is the demotion of novel interactions with low prior probabilities. Here the authors present constrained generalised logical network (CGLN) inference to predict novel interactions in dynamic networks, respecting previously known interactions and observed temporal coherence. It encodes prior interactions as probabilistic logic rules called local constraints, and forms global constraints using observed dynamic patterns. CGLN finds constraint-satisfying trajectories by solving a k-stops problem in the state space of dynamic networks and then reconstructs candidate networks. They benchmarked CGLN on randomly generated networks, and CGLN outperformed its alternatives when 50% or more interactions in a network are given as local constraints. CGLN is then applied to infer dynamic protein interaction networks regulating invadopodium formation in motile cancer cells. CGLN predicted 134 novel protein interactions for their involvement in invadopodium formation. The most frequently predicted interactions centre around focal adhesion kinase and tyrosine kinase substrate TKS4, and 14 interactions are supported by the literature in molecular contexts related to invadopodium formation. As an alternative to the Bayesian paradigm, the CGLN method offers constrained network inference without requiring prior probabilities and thus can promote novel interactions, consistent with the discovery process of scientific facts that are not yet in common beliefs.

Targeting the Epidemic: Interventions and Follow-up Are Necessary in the Pediatric Traumatic Brain Injury Clinic

Traumatic brain injury is a major public health problem in the pediatric population. Previously, management was acute emergency department/primary care evaluation with follow-up by primary care. However, persistent symptoms after traumatic brain injury are common, and many do not have access to a specialized traumatic brain injury clinic to manage chronic issues. The goal of this study was to determine the factors related to outcomes, and identify the interventions provided in this subspecialty clinic. Data were extracted from medical records of 151 retrospective and 403 prospective patients. Relationships between sequelae, injury characteristics, and clinical interventions were analyzed. Most patients returning to clinic were not fully recovered from their injury. Headaches were more common after milder injuries, and seizures were more common after severe. The majority of patients received clinical intervention. The presence of persistent sequelae for traumatic brain injury patients can be evaluated and managed by a specialty concussion/traumatic brain injury clinic ensuring that medical needs are met.

A Retrospective Study of Patients with Minor Head Injury to Compare the Canadian CT Head Rule and the New Orleans Criteria

Objective

To compare the performance of the Canadian CT Head Rule (CCHR) and the New Orleans Criteria (NOC) in minor head injury patients.

Method

This retrospective cohort study collected data and CT head reports of all minor head injury patients from 1 January 2008 to 31 December 2010. We compared the sensitivity, specificity, positive and negative predictive values of both rules in predicting clinically important brain injury on CT and the need of neurosurgical intervention.

Results

We reviewed 474 patients with minor head injury. Seventy seven patients had clinically important brain injury and 11 underwent neurosurgical intervention. The sensitivity of the CCHR and NOC in predicting clinically important brain injury were 80% (95% confidence interval [CI] 70-88%) and 92% (95% CI 86-98%), respectively; and the specificity of the CCHR and NOC were 39% (95% CI 33-44%) and 17% (95% CI 13-21%), respectively. The sensitivity of the CCHR and NOC in predicting the need of neurosurgical intervention were 80% (95% CI 55-100%) and 100% (95% CI 100-100%), respectively; and the specificity of the CCHR and NOC were 36% (95% CI 31-41%) and 15% (95% CI 12-19%), respectively. The negative predictive values (NPV) of the CCHR and NOC for clinically important brain injury were 88% (95%CI 83-94%) and 91% (95%CI 84-98%); and for the need of neurosurgical intervention were 99% (95% CI 96-100%) and 100% (95% CI 100-100%). Amongst those missed cases, 88% in the CCHR group and 83% in the NOC group reported loss of consciousness.

Conclusions

The NOC is more sensitive but less specific than the CCHR in predicting both outcomes. Both rules have excellent NPV to rule out the need of neurosurgical intervention.