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The study objective was to investigate the association of polypharmacy and medications with patient falls resulting in hip fractures among community-living geriatric patients. A case-control study was conducted at an acute public hospital in Hong Kong. The study population was community-living Chinese patients aged 65 years and above who were admitted for falls resulting in hip fractures during an 18-month study period. Each of these patients was matched to a control patient with the same age and sex, but without falls and fractures. Data were collected from electronic patient record. Data of 170 cases and 170 controls were eventually collected. The following variables associated with increased risk of falls resulting in hip fractures remained statistically significant after multivariate logistic regression, including benign prostatic hyperplasia [odds ratio (OR) = 2.654; 95% confidence interval (CI), 1.105-6.378; P = 0.029], first-generation antihistamines (OR = 3.176; 95% CI, 1.044-9.664; P = 0.042), antiparkinson medications (OR = 3.754; 95% CI, 1.158-12.169; P = 0.027), osteoporosis (OR = 3.159; 95% CI, 1.167-8.552; P = 0.024), and use of walking aids (OR = 2.543; 95% CI, 1.544-4.188; P < 0.001). In conclusion, this study identified various medications and comorbidities, rather than polypharmacy based on the number of medications, as predictors associated with increased risk of falls resulting in hip fractures for local geriatric patients. The findings provided insights into the potential medication-related fall prevention strategies, including clinical medication review, adverse drug event monitoring, and drug optimization.

Background: Myocardial injury after noncardiac surgery (MINS) was defined as prognostically relevant myocardial injury due to ischemia that occurs during or within 30 days after noncardiac surgery. The study's four objectives were to determine the diagnostic criteria, characteristics, predictors, and 30-day outcomes of MINS., Methods: In this international, prospective cohort study of 15,065 patients aged 45 yr or older who underwent in-patient noncardiac surgery, troponin T was measured during the first 3 postoperative days. Patients with a troponin T level of 0.04 ng/ml or greater (elevated "abnormal" laboratory threshold) were assessed for ischemic features (i.e., ischemic symptoms and electrocardiography findings). Patients adjudicated as having a nonischemic troponin elevation (e.g., sepsis) were excluded. To establish diagnostic criteria for MINS, the authors used Cox regression analyses in which the dependent variable was 30-day mortality (260 deaths) and independent variables included preoperative variables, perioperative complications, and potential MINS diagnostic criteria., Results: An elevated troponin after noncardiac surgery, irrespective of the presence of an ischemic feature, independently predicted 30-day mortality. Therefore, the authors' diagnostic criterion for MINS was a peak troponin T level of 0.03 ng/ml or greater judged due to myocardial ischemia. MINS was an independent predictor of 30-day mortality (adjusted hazard ratio, 3.87; 95% CI, 2.96-5.08) and had the highest population-attributable risk (34.0%, 95% CI, 26.6-41.5) of the perioperative complications. Twelve hundred patients (8.0%) suffered MINS, and 58.2% of these patients would not have fulfilled the universal definition of myocardial infarction. Only 15.8% of patients with MINS experienced an ischemic symptom., Conclusion: Among adults undergoing noncardiac surgery, MINS is common and associated with substantial mortality.

Objectives: To test the individual effect of artificial food colorings (AFCs) and a preservative on the behavior of the general Chinese population., Method: One hundred thirty children (70 boys and 60 girls) in Hong Kong with a mean age of 8.64 years were enlisted to the study with a within-subject crossover between AFCs, a preservative (sodium benzoate), and a placebo capsule. Two behavior scores were used including the strengths and weaknesses of attention deficit hyperactivity disorder and normal behavior rating scale and the child behavior checklist-teacher report form., Results: Capsule A containing AFCs and Capsule B containing sodium benzoate had no significant adverse effect compared with placebo in both behavior scores. This result persisted when analysis was restricted to children with 85% consumption of capsule (per protocol analysis)., Conclusion: There seem to be no significant associations between AFCs and a preservative on Chinese children's behavior at the age of 8 to 9 years. Future directions and implications of this research are discussed.

Lipid changes with statin treatments vary greatly between individuals for reasons which are largely unknown. This study was performed to examine the genetic determinants of lipid responses to rosuvastatin in Chinese patients. A total of 125 polymorphisms in 61 candidate genes from 386 Chinese patients were analyzed for association with the lipid responses to rosuvastatin 10 mg daily. The polymorphisms most highly associated with the low-density lipoprotein cholesterol (LDL-C) response were 421C>A in the ATP-binding cassette G2 gene (P=9.2×10), followed by 18281G>A (V257M) in the flavin-containing monooxygenase 3 gene (P=0.0002), 1421C>G in the lipoprotein lipase gene (P=0.002), and rs4420638 in the apolipoprotein E/C-I/C-IV/C-II gene cluster (P=0.004). Patients with familial hypercholesterolemia had 2.6% smaller reductions in LDL-C compared with patients without familial hypercholesterolemia. This study identified some genetic determinants of LDL-C response to rosuvastatin in Chinese patients, which need to be replicated in other populations.

Background: Target of rapamycin inhibitors (TOR-I) have a novel mode of action but uncertain clinical role. We performed a systematic review of randomized trials where immunosuppressive regimens containing TOR-I were compared with other regimens as initial therapy for kidney transplant recipients., Methods: Databases (inception, June 2005) and conference proceedings (1996-2005) were searched. Two independent reviewers assessed trials for eligibility and quality. Results at 1 year, are expressed as relative risk (RR), where values<1 favor TOR-I, or lower dose of TOR-I, and for continuous outcomes are expressed as weighted mean difference (WMD), both expressed with 95% confidence intervals (CI)., Results: Thirty-three trials (142 reports) were included (27 trials of sirolimus, 5 of everolimus, and 1 of head-to-head comparison). When TOR-I replaced calcineurin inhibitors (CNI) (8 trials with 750 participants), there was no difference in acute rejection (RR, 1.03; 95% CI, 0.74-1.44), but serum creatinine was lower (WMD, -18.31 micromol/L; 95% CI, -30.96 to -5.67) and bone marrow more suppressed (leukopenia: RR 2.02; 95% CI, 1.12-3.66; thrombocytopenia: RR, 6.97; 95% CI, 2.97-16.36; and anaemia: RR, 1.67; 95% CI, 1.27-2.20). When TOR-I replaced antimetabolites (11 trials with 3966 participants), acute rejection and cytomegalovirus infection (CMV) were reduced (RR, 0.84; 95% CI, 0.71-0.99; RR, 0.49; 95% CI, 0.37-0.65, respectively), but hypercholesterolemia was increased (RR, 1.65; 95% CI, 1.32-2.06). When low- was compared with high-dose TOR-I, with equal CNI dose (10 trials with 3,175 participants), rejection was increased (RR, 1.23; 95% CI, 1.06-1.43) but calculated glomerular filtration rate (GFR) higher (WMD, 4.27 mL/min; 95% CI, 1.12-7.41), and when lower-dose TOR-I and standard-dose CNI were compared with higher-dose TOR-I and reduced CNI, acute rejection was reduced (RR, 0.67; 95% CI, 0.52-0.88), but calculated GFR was also reduced (WMD, -9.46 mL/min; 95% CI, -12.16 to -6.76). There was no significant difference in mortality, graft loss, or malignancy risk for TOR-I in any comparison., Conclusions: TOR-I have been evaluated in four different primary immunosuppressive algorithms: as replacement for CNI and antimetabolites, in combination with CNI at low and high doses, and with a variable dose of CNI. Generally, surrogate endpoints for graft survival favor TOR-I (lower risk of acute rejection and higher GFR), and surrogate endpoints for patient outcomes are worsened by TOR-I (bone marrow suppression and lipid disturbance). Long-term hard-endpoint data from methodologically robust randomized trials are still required.

Purpose: To compare the amount of protein deposits adhering to human-worn soft contact lenses, using the untreated contact lens from the contralateral eye as controls, to investigate the capabilities of the No Rub contact lens cleaning systems in protein removal from soft contact lenses., Methods: New 1 Day Acuvue soft contact lenses were worn on a daily-wear basis by 16 Hong Kong Chinese volunteers on 5 separate days. Four right lenses of each subject were treated with No Rub contact lens cleaning systems (Alcon Opti-Free Express, Alcon Opti-Free Express No Rub Lasting Comfort Formula, B and L ReNu MultiPlus, and Ciba Vision SOLO Care Plus). The total amount of protein was extracted from all contact lenses and analyzed by the Bradford assay., Results: Among the contralateral contact lenses, there was no significant difference in the total protein extracted (TPE; 11.2 +/- 3.8 vs. 12.6 +/- 5.2 mg/ml, p = 0.20). There was a significant positive correlation in TPE between two lenses worn by the same volunteer (R(2) = 0.84, y = 0.79 x + 1.3, p < 0.001). Lenses treated with Opti-Free Express and Opti-Free Express No Rub Lasting Comfort Formula solutions had significantly less TPE (7.3 +/- 5.2 and 6.7 +/- 4.1 mg/ml, respectively, p < 0.001) than the untreated contralateral lenses (12.7 +/- 6.8 and 13.2 +/- 5.3 mg/ml, respectively). No statistical difference in TPE was detected in the lenses treated with ReNu MultiPlus (13.0 +/- 7.8 mg/ml, p = 0.49) and Solo Care Plus (12.1 +/- 8.7 mg/ml, p = 0.99) solutions when compared with their untreated contralateral lenses (13.0 +/- 7.8 and 12.1 +/- 8.7 mg/ml, respectively)., Conclusions: Not all no-rub contact lens solutions were shown capable of removing the protein deposit from soft contact lenses.

Purpose: To compare the pattern of retinal nerve fiber layer (RNFL) damages in high-tension and normal-tension primary chronic open-angle glaucoma using optical coherence tomography (OCT)., Methods: Age- and refractive error-matched patients with normal-tension glaucoma (NTG) (n = 38) and high-tension glaucoma (HTG) (n = 48) and normal subjects (n = 48) were recruited. All subjects underwent complete eye examinations and OCT RNFL assessments., Results: No statistically significant difference was found between eyes with HTG and NTG for any OCT RNFL thickness parameters (p > 0.05). Inferotemporal thickness values were significantly lower than the superotemporal thickness values in both glaucoma groups (p < 0.001), but no difference was observed in the normal group. Compared with the results from normal subjects, several OCT parameters, including average, superior, inferior, inferotemporal, and superotemporal values, were significantly lower in patients with HTG and NTG (p < 0.01)., Conclusions: A mixture of diffuse RNFL damage (superotemporal and inferotemporal regions) and local damage in inferotemporal region was observed in patients with HTG and NTG, suggesting that HTG and NTG may undergo same pathological process.

Purpose: To investigate whether increasing the number of scans per examination would improve the reproducibility of retinal nerve fiber layer (RNFL) measurements by optical coherence tomography (OCT) in healthy and glaucomatous eyes., Methods: A total of 28 eyes of 28 healthy subjects and 20 eyes of 20 patients with primary chronic open-angle glaucoma were recruited. OCT RNFL assessments were obtained in one randomly selected eye. Each subject underwent seven scans on five separate occasions within a 1-month period., Results: In the healthy group, the intervisit mean coefficient of variations (COV's) for the average RNFL thickness (100 sampling points) and the quadrant RNFL measurements (25 sampling points) were similar in a series of three, five, and seven scans per examination (p > 0.05), but COV's for the two clock-hour segment measurements (seven sampling points, superotemporal and inferotemporal) were significantly lower in a series of five and seven scans per examination than that of three scans per examinations (p < 0.01). In the glaucoma groups, COV's for the two quadrant (superior and inferior) and five clock-hour segment RNFL measurements (superior, superotemporal, temporal, inferotemporal, and superonasal) were significantly lower in a series of five and seven scans per examination than that of three scans per examination (p < 0.01). There was no statistical difference in the COV's between a series of five scans and that of seven scans per examination in all OCT RNFL thickness parameters in healthy and glaucomatous eyes (p > 0.05). Similar results were observed with intravisit COV comparisons., Conclusion: Increasing the number of scans per examination may improve the reproducibility of quadrant and clock-hour segment OCT RNFL measurements in healthy and glaucomatous eyes. A series of five scans per examination is recommended for OCT RNFL measurements.

In an attempt to identify a group of blunt trauma victims with asymptomatic myocardial contusion (MC) who do not benefit from intensive cardiac monitoring, we prospectively divided 336 patients admitted to the SICU with possible MC following blunt trauma in the 6 years prior to January 1990 into three groups: Group 1 (n = 155, age 30.5 +/- 9 years) consisted of those patients admitted for mechanism of injury, J-point elevation, with or without minor chest injury. None developed arrhythmias. Their SICU length of stay (LOS) was 2.41 +/- 0.77 days. Group 2 (n = 43, age 31.5 +/- 10 years) patients had the same admission criteria as the patients in group 1 plus an abnormal emergency department ECG, i.e., arrhythmia, heart block, ischemia. None had cardiac complications. Their SICU LOS was 2.47 +/- 0.94 days. Group 3 (n = 138, age 40 +/- 20 years) patients had four or more rib fxs, a pulmonary contusion, a flail chest, or extra-thoracic injuries or were greater than 60 years of age. All required SICU admission for their non-cardiac injuries. Nineteen patients had cardiac complications requiring treatment. None had a cardiac death. Their SICU LOS was 10 +/- 22 days. We conclude that young patients with minor blunt thoracic trauma and a normal or minimally abnormal ECG do not benefit from cardiac monitoring.

Radionuclide angiography is a valuable screening test for arteriovenous (AV) fistulas. A case is presented of a young man with a post-traumatic AV fistula involving the renal artery and vein initially diagnosed by radionuclide imaging and subsequently confirmed by angiography. In the patient described dynamic flow studies showed concentration at the site of an AV fistula which was successfully treated operatively. We now recommend radionuclide angiography in patients with penetrating abdominal trauma and unexplained abdominal findings.

Fifteen patients with congestive cardiomyopathy (six idiopathic and nine alcoholic) manifested by heart failure (New York Heart Association class III or IV) were randomly assigned to a protocol in which dobutamine (n = 8) or 5% dextrose in water (n = 7) was infused continuously for 72 hr. The dose of dobutamine was titrated to increase cardiac output to twice the baseline values. The patients were evaluated before infusion, shortly after infusion, and 1, 2, and 4 weeks thereafter. Functional class improved in six of eight dobutamine-treated patients but in only two of seven control patients during the 4 week observation period. Maximal exercise time and left ventricular ejection fraction increased significantly above baseline only in the dobutamine group. However, neither dobutamine nor placebo infusion produced significant changes shortly after infusion in heart rate, cardiac index, or total peripheral vascular resistance at rest or during exercise at similar workloads. The group receiving dobutamine did show a reduction in systemic systolic and pulmonary arterial mean and diastolic pressure at rest (123 +/- 5 to 108 +/- 6, 32 +/- 5, to 24 +/- 3, and 26 +/- 4 to 20 +/- 2 mm Hg, respectively). In addition, total body oxygen consumption during similar workloads was lower after dobutamine infusion than before.(ABSTRACT TRUNCATED AT 250 WORDS)

Twenty-one patients with hepatocellular carcinoma who had gallium scans were retrospectively reviewed. Four of them demonstrated iso-intense gallium uptake compared to the adjacent liver parenchyma. The importance is therefore emphasized of using radiocolloid scan with tracer angiogram performed at the same time in order to avoid the potential diagnostic pitfall of not recognizing the tumor on gallium scan alone.