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Devising an approach to deterministically position organisms can impact various fields such as bioimaging, cybernetics, cryopreservation, and organism‐integrated devices. This requires continuously assessing the locations of randomly distributed organisms to collect and transfer them to target spaces without harm. Here, an aspiration‐assisted adaptive printing system is developed that tracks, harvests, and relocates living and moving organisms on target spaces via a pick‐and‐place mechanism that continuously adapts to updated visual and spatial information about the organisms and target spaces. These adaptive printing strategies successfully positioned a single static organism, multiple organisms in droplets, and a single moving organism on target spaces. Their capabilities are exemplified by printing vitrification‐ready organisms in cryoprotectant droplets, sorting live organisms from dead ones, positioning organisms on curved surfaces, organizing organism‐powered displays, and integrating organisms with materials and devices in customizable shapes. These printing strategies can ultimately lead to autonomous biomanufacturing methods to evaluate and assemble organisms for a variety of single and multi‐organism‐based applications. [ABSTRACT FROM AUTHOR]

Aim: Fatty acid esters of hydroxy fatty acids (FAHFA) are a class of bioactive lipids with anti‐inflammatory, antidiabetic and cardioprotective properties. FAHFA hydrolysis into its fatty acid (FA) and hydroxy fatty acid (HFA) constituents can affect the bioavailability of FAHFA and its subsequent biological effects. We aimed to investigate FAHFA levels and FAHFA hydrolysis activity in children with or without obesity, and in adults with or without coronary artery disease (CAD). Materials and Methods: Our study cohort included 20 children without obesity, 40 children with obesity, 10 adults without CAD and 28 adults with CAD. We quantitated plasma levels of four families of FAHFA [palmitic acid hydroxy stearic acid (PAHSA), palmitoleic acid hydroxy stearic acid (POHSA), oleic acid hydroxy stearic acid (OAHSA), stearic acid hydroxy stearic acid] and their corresponding FA and HFA constituents using liquid chromatography‐tandem mass spectrometry analysis. Surrogate FAHFA hydrolysis activity was estimated as the FA/FAHFA or HFA/FAHFA ratio. Results: Children with obesity had lower plasma PAHSA (p =.001), OAHSA (p =.006) and total FAHFA (p =.011) levels, and higher surrogate FAHFA hydrolysis activity represented by PA/PAHSA (p =.040) and HSA/OAHSA (p =.025) compared with children without obesity. Adults with CAD and a history of myocardial infarction (MI) had lower POHSA levels (p =.026) and higher PA/PAHSA (p =.041), POA/POHSA (p =.003) and HSA/POHSA (p =.038) compared with those without MI. Conclusion: Altered FAHFA metabolism is associated with obesity and MI, and inhibition of FAHFA hydrolysis should be studied further as a possible therapeutic strategy in obesity and MI. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate demographic and clinical characteristics, treatment patterns, and quality of life in patients with locally advanced or metastatic urothelial carcinoma in Asia. Methods: Data were drawn from the Adelphi Real World Metastatic Urothelial Carcinoma Disease Specific Programme™, a cross‐sectional survey of medical oncologists/urologists and their adult patients in Saudi Arabia, South Korea, Taiwan, and Turkey. Exploratory patient‐reported outcomes included the EQ‐5D visual analog scale, European Organisation for Research and Treatment of Cancer Quality of Life of Patient Questionnaire global health, and Brief Pain Inventory. Analyses were descriptive. Results: Overall, 175 physicians reported data for 988 patients. Mean (standard deviation) patient age was 66.3 (10.8) years, 77% were men, and 82% had bladder tumors at diagnosis. Of patients receiving first‐ (n = 988), second‐ (n = 290), and third‐line (n = 87) treatments, 81%, 35%, and 59% received chemotherapy, respectively, and 17%, 63%, and 34% received programmed cell death protein 1/ligand 1 inhibitors, respectively. Patient‐reported (n = 319) mean (standard deviation) EQ‐5D visual analog scale score was 51.8 (15.6), European Organisation for Research and Treatment of Cancer Quality of Life of Patient Questionnaire global health status score was 44.6 (19.9), and Brief Pain Inventory score was 6.5 (1.9; n = 315). Conclusion: The most common first‐ and second‐line treatments for locally advanced or metastatic urothelial carcinoma were chemotherapy and programmed cell death protein 1/ligand inhibitors, respectively. At third line, 10% of patients received best supportive care alone, underscoring an unmet need for effective third‐line treatment options. Patients in all regions reported quality‐of‐life impairment. [ABSTRACT FROM AUTHOR]

Photodetectors that are intimately interfaced with human skin and measure real‐time optical irradiance are appealing in the medical profiling of photosensitive diseases. Developing compliant devices for this purpose requires the fabrication of photodetectors with ultraviolet (UV)‐enhanced broadband photoresponse and high mechanical flexibility, to ensure precise irradiance measurements across the spectral band critical to dermatological health when directly applied onto curved skin surfaces. Here, a fully 3D printed flexible UV‐visible photodetector array is reported that incorporates a hybrid organic‐inorganic material system and is integrated with a custom‐built portable console to continuously monitor broadband irradiance in‐situ. The active materials are formulated by doping polymeric photoactive materials with zinc oxide nanoparticles in order to improve the UV photoresponse and trigger a photomultiplication (PM) effect. The ability of a stand‐alone skin‐interfaced light intensity monitoring system to detect natural irradiance within the wavelength range of 310–650 nm for nearly 24 h is demonstrated. [ABSTRACT FROM AUTHOR]

Aims: Rivaroxaban is a viable anticoagulant for the management of cancer‐associated venous thromboembolism (CA‐VTE). A previously verified physiologically‐based pharmacokinetic (PBPK) model of rivaroxaban established how its multiple pathways of elimination via both CYP3A4/2J2‐mediated hepatic metabolism and organic anion transporter 3 (OAT3)/P‐glycoprotein‐mediated renal secretion predisposes rivaroxaban to drug–drug–disease interactions (DDDIs) with clinically relevant protein kinase inhibitors (PKIs). We proposed the application of PBPK modelling to prospectively interrogate clinically significant DDIs between rivaroxaban and PKIs (erlotinib and nilotinib) for dose adjustments in CA‐VTE. Methods: The inhibitory potencies of the PKIs on CYP3A4/2J2‐mediated metabolism of rivaroxaban were characterized. Using prototypical OAT3 inhibitor ketoconazole, in vitro OAT3 inhibition assays were optimized to ascertain the in vivo relevance of derived transport inhibitory constants (Ki). Untested DDDIs between rivaroxaban and erlotinib or nilotinib were simulated. Results: Mechanism‐based inactivation (MBI) of CYP3A4‐mediated rivaroxaban metabolism by both PKIs and MBI of CYP2J2 by erlotinib were established. The importance of substrate specificity and nonspecific binding to derive OAT3‐inhibitory Ki values of ketoconazole and nilotinib for the accurate prediction of interactions was illustrated. When simulated rivaroxaban exposure variations with concomitant erlotinib and nilotinib therapy were evaluated using published dose–exposure equivalence metrics and bleeding risk analyses, dose reductions from 20 to 15 and 10 mg in normal and mild renal dysfunction, respectively, were warranted. Conclusion: We established a PBPK‐DDDI model to prospectively evaluate clinically relevant interactions between rivaroxaban and PKIs for the safe and efficacious management of CA‐VTE. [ABSTRACT FROM AUTHOR]

We investigated processes contributing to periodic acidification events in headwater streams of Nee Soon Forest Catchment (NSFC) in Singapore by monitoring hydrochemical changes in response to rainfall inputs. Stream chemistry response to most rainfall events was characterized by decreases in pH from means ranging from 5.1 to 5.3 to below 4.8–5.0 and corresponding increases in specific electrical conductivity from baseflow values of 15–30 to 50–80 μS cm−1, indicative of low‐total dissolved solids in stormflow. The decreases in pH in the streams, which are typically acidic year‐round, were related to occasional highly acidic rainfall inputs (pH ~4.05) and likely the flushing of organic acids into the stream by shallow subsurface flow interacting with surface litter and/or organic‐rich soil horizons. The interaction of rainwater runoff with organic matter in the soil matrix possibly alters the chemical composition of stormflow, influencing pH. Decomposition of instream organic matter also reduces stream water pH. Leaching experiments revealed that the overland flow passing through organic matter and A horizon material has the potential to lower stream water pH by approximately a half unit or more, in part, by flushing nitrates that were produced by microbial decomposition of organic matter and/or precipitated sulphur that enterred the forest by wet or dry atmospheric deposition. The observed periodic acid events are a natural phenomenon in the stream system in this urban environment because of naturally acidic rainfall and granitic soils with low buffering potential. However, acid events are likely amplified in frequency and magnitude by anthropogenic pollution emissions of sulphur and nitrogen species (e.g., SO2 and NOx) from local and regional sources that lower rainfall pH. Although, acid runoff events are typically short‐lived (<12–24 h), further longitudinal monitoring and experimental studies are needed to investigate the long‐term implications on sensitive taxa in the NSFC streams. Finally, understanding the flow pathways of stormflow water in the nested system was critical for deciphering the mechanisms driving stream acid events at the site. [ABSTRACT FROM AUTHOR]

Background: A functional definition of ankyloglossia has been based on assessment of tongue mobility using the tongue range of motion ratio (TRMR) with the tongue tip extended towards the incisive papilla (TIP). Whereas this measurement has been helpful in assessing for variations in the mobility of the anterior one‐third of the tongue (tongue tip and apex), it may be insufficient to adequately assess the mobility of the posterior two‐thirds body of the tongue. A commonly used modification is to assess TRMR while the tongue is held in suction against the roof of the mouth in lingual‐palatal suction (LPS). Objective: This study aims to explore the utility and normative values of TRMR‐LPS as an adjunct to functional assessment of tongue mobility using TRMR‐TIP. Study Design: Cross‐sectional cohort study of 611 subjects (ages: 3‐83 years) from the general population. Methods: Measurements of tongue mobility using TRMR were performed with TIP and LPS functional movements. Objective TRMR measurements were compared with subjective self‐assessment of resting tongue position, ease or difficulty elevating the tongue tip to the palate, and ease or difficulty elevating the tongue body to the palate. Results: There was a statistically significant association between the objective measures of TRMR‐TIP and TRMR‐LPS and subjective reports of tongue mobility. LPS measurements were much more highly correlated with differences in elevating the posterior body of the tongue as compared to TIP measurements (R2 0.31 vs 0.05, P <.0001). Conclusions: This study validates the TRMR‐LPS as a useful functional metric for assessment of posterior tongue mobility. [ABSTRACT FROM AUTHOR]

Background: Lung cancer is a major cause of death in New Zealand. In recent years, targeted therapies have improved outcomes. Aim: To determine the uptake of anaplastic lymphoma kinase (ALK) testing, and the prevalence, demographic profile and outcomes of ALK‐positive non‐small‐cell lung cancer (NSCLC), in New Zealand, where no national ALK‐testing guidelines or subsidised ALK tyrosine kinase inhibitor (TKI) therapies are available. Methods: A population‐based observational study reviewed databases to identify patients presenting with non‐squamous NSCLC over 6.5 years in northern New Zealand. We report the proportion tested for ALK gene rearrangements and the results. NSCLC samples tested by fluorescence in situ hybridisation were retested by next generation sequencing and ALK immunohistochemistry. A survival analysis compared ALK‐positive patients treated or not treated with ALK TKI therapy. Results: From a total of 3130 patients diagnosed with non‐squamous NSCLC, 407 (13%) were tested for ALK gene rearrangements, and patient selection was variable and inequitable. Among those tested, 34 (8.4%) had ALK‐positive NSCLC. ALK‐positive disease was more prevalent in younger versus older patients, non‐smokers versus smokers and in Māori, Pacific or Asian ethnic groups than in New Zealand Europeans. Fluorescence in situ hybridisation, ALK immunohistochemistry and next generation sequencing showed broad concordance for detecting ALK–positive disease under local testing conditions. Among patients with ALK‐positive metastatic NSCLC, those treated with ALK TKI survived markedly longer than those not treated with ALK TKI (median overall survival 5.12 vs 0.55 years). Conclusion: Lung cancer outcomes in New Zealand may be improved by providing national guidelines and funding policy for ALK testing and access to subsidised ALK TKI therapy. [ABSTRACT FROM AUTHOR]

Abstract: Freshwater species often show high levels of endemism and risk of extinction owing to their limited dispersal abilities. This is exemplified by the stenotopic freshwater crab, Johora singaporensis which is one of the world's 100 most threatened species, and currently inhabits less than 0.01 km2 of five low order hill streams within the highly urbanized island city‐state of Singapore. We compared populations of J. singaporensis with that of the non‐threatened, widespread, abundant, and eurytopic freshwater crab, Parathelphusa maculata, and found surprisingly high congruence between their population genomic histories. Based on 2,617 and 2,470 genome‐wide SNPs mined via the double‐digest restriction‐associated DNA sequencing method for ~90 individuals of J. singaporensis and P. maculata, respectively, the populations are strongly isolated (FST = 0.146–0.371), have low genetic diversity for both species (also for COI), and show signatures of recent genetic bottlenecks. The most genetically isolated populations for both species are separated from other populations by one of the oldest roads in Singapore. These results suggest that anthropogenic developments may have impacted stream‐dependent species in a uniform manner, regardless of ubiquity, habitat preference, or dispersal modes of the species. While signs of inbreeding were not detected for the critically endangered species, the genetic distinctiveness and low diversity of the populations call for genetic rescue and connecting corridors between the remaining fragments of the natural habitat. [ABSTRACT FROM AUTHOR]

Aims: To understand differences in patient reported outcomes (PRO) between patients initiating mirabegron or an antimuscarinic using a validated PRO instrument, OAB‐Satisfaction (OAB‐S). Methods: This prospective observational study used real‐time prescription claims from Humana to identify Medicare patients initiating mirabegron or an antimuscarinic to participate in a series of three phone surveys over ninety days. Results: A total of 1897 mirabegron and 2444 randomly selected antimuscarinic initiators were identified; 174 mirabegron and 193 antimuscarinic initiators completed all three surveys. Among responders, mirabegron initiators were slightly older (76 vs 75 years, P = 0.032), included more males (32% vs 23%, P = 0.044), more likely to have prior OAB treatment (21% vs 13%, P = 0.048), and had greater medication burden (number of unique medications: 10.0 vs 8.7, P = 0.014). There were no between‐group differences at any time or on any OAB‐S scale. There were significant within‐group differences at follow‐up compared to baseline for OAB‐S scales: “impact on daily living,” with improvement over the 90‐day survey period for both mirabegron (P = 0.008) and antimuscarinic (P < 0.001); “interruption of day‐to‐day life,” with improvement for both mirabegron (P < 0.001) and antimuscarinic (P < 0.001); and improvement in “OAB control” for mirabegron (P < 0.001) and antimuscarinic (P < 0.001). Conclusions: Mirabegron initiators tended to be older, had a greater number of unique medications and previously tried prescriptions to treat OAB; nonetheless, mirabegron, and antimuscarinic initiators reported similar trends in improvement in PROs over the first 90 days of treatment. Significant improvement in daily impact of OAB was observed after treatment initiation; however, no significant differences between groups were observed. [ABSTRACT FROM AUTHOR]

Intestinal telangiectasia should be considered in pre-pubertal girls with Turner syndrome, gastrointestinal bleeding or severe iron deficiency anaemia. Although Meckel's diverticulum, peptic ulceration and inflammatory bowel disease may present with significant bleeding in children in those with Turner syndrome small bowel telangiectasia has also been seen. [Extracted from the article]

Study Objective To determine the association between Anticholinergic Cognitive Burden ( ACB) score and both cognitive impairment and health care utilization among a diverse ambulatory older adult population. Design Retrospective cohort study. Data Source Medication exposure and other clinical data were extracted from the Regenstrief Medical Record System (RMRS), and cognitive diagnosis was derived from a dementia screening and diagnosis study. Patients A total of 3344 community-dwelling older adults (age 65 yrs and older) who were enrolled in a previously published dementia screening and diagnosis study; of these, 3127 were determined to have no cognitive impairment, and 217 were determined to have cognitive impairment. Measurements and Main Results The study followed a two-phase screening and comprehensive neuropsychiatric examination to determine a cognitive diagnosis, which defined cognitive impairment as dementia or mild cognitive impairment. The ACB scale was used to identify anticholinergics dispensed in the 12 months prior to screening. A total daily ACB score was calculated by using pharmacy dispensing data from RMRS; each anticholinergic was multiplied by 1, 2, or 3 consistent with anticholinergic burden defined by the ACB scale. The sum of all ACB medications was divided by the number of days with any medication dispensed to achieve the total daily ACB score. Health care utilization included visits to inpatient, outpatient, and the emergency department, and it was determined by using visit data from the RMRS. The overall population had a mean age of 71.5 years, 71% were female, and 58% were African American. Each 1-point increase in mean total daily ACB score was associated with increasing risk of cognitive impairment (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.004-1.27, p=0.043). Each 1-point increase in mean total daily ACB score increased the likelihood of inpatient admission (OR 1.11, 95% CI 1.02-1.29, p=0.014) and number of outpatient visits after adjusting for demographic characteristics, number of chronic conditions, and prior visit history (estimate 0.382, standard error [SE] 0.113; p=0.001). The number of visits to the emergency department was also significantly different after similar adjustments (estimate 0.046, SE 0.023, p=0.043). Conclusion Increasing total ACB score was correlated with an increased risk for cognitive impairment and more frequent health care utilization. Future work should study interventions that safely reduce ACB and evaluate the impact on brain health and health care costs. [ABSTRACT FROM AUTHOR]

Aims Nodular fasciitis is known to be a benign mimic of sarcoma, both clinically and histologically. Accurate diagnosis, particularly on small biopsies, remains a challenge, as the morphology can be varied and the immunophenotype is essentially non-specific. Recently, rearrangement of the ubiquitin-specific protease 6 (USP6) gene has been reported as a recurrent and specific finding in nodular fasciitis. The aim of this this study was to evaluate the diagnostic utility of USP6 fluorescence in-situ hybridization ( FISH) analysis in a subset of spindle-cell proliferations in which nodular fasciitis enters into the differential diagnosis. Methods and results A database search was performed at the Middlemore Hospital Histopathology Department. All in-house cases diagnosed between 2002 and March 2014 in which nodular fasciitis was considered as a differential diagnosis were retrospectively identified. Twenty cases were retrieved, reviewed and categorized as 'definite', 'possible' or 'definitely not' nodular fasciitis by consensus morphological opinion of three experienced pathologists. FISH analysis for USP6 rearrangement was performed in each case, with a commercially available break-apart probe. Of seven cases that were morphologically categorized as 'definite' nodular fasciitis, six were FISH-positive and one was FISH-negative. Of four cases categorized as 'possible' nodular fasciitis, one was FISH-positive and three were FISH-negative. Nine cases categorized as 'definitely not' nodular fasciitis were all FISH-negative. In the morphologically definitive cases, FISH analysis for USP6 had a sensitivity of 86% and specificity of 100% for a diagnosis of nodular fasciitis. The positive predictive value was 100%, and the negative predictive value 90%. Conclusions USP6 FISH is a useful ancillary test in cases where nodular fasciitis is a potential diagnostic consideration. [ABSTRACT FROM AUTHOR]

Objectives To examine potentially inappropriate medication ( PIM) use in older adults initiating an antimuscarinic medication for the treatment of overactive bladder ( OAB). Design Retrospective database analysis. Setting Medical and pharmacy claims data. Participants Medicare Advantage Prescription Drug Plan members aged 65 and older newly initiated on an antimuscarinic OAB treatment were identified and assigned to PIM and non- PIM comparison groups based on 2012 American Geriatrics Society Beers Criteria and/or the presence of an anticholinergic medication interaction at the time of initiation of treatment (N = 66,275). Measurements Healthcare costs and OAB medication use. Results Of members initiated on an antimuscarinic OAB medication, 31.1% had a drug-drug or drug-disease or syndrome interaction. Dementia was the most common disease or syndrome interaction (11.3%), followed by constipation (8.6%) and delirium (2.9%). Paroxetine (2.6%), amitriptyline (2.2%), cyclobenzaprine (1.7%), and meclizine (1.6%) were the most common interacting medications. Subjects in the PIM group had greater healthcare costs over 12 months of follow-up ($12,001) than those in the non- PIM group ($9,373) after controlling for baseline characteristics ( P < .001). There was no difference between the PIM and the non- PIM groups in odds of discontinuing OAB treatment at 12 months after controlling for baseline characteristics (odds ratio = 0.98, 95% confidence interval = 0.89-1.07, P = .63). Conclusion Potentially inappropriate medication use was highly prevalent and was associated with greater total healthcare costs. Providers should carefully consider medical history and concurrent medication use when initiating antimuscarinic medication for the treatment of OAB. Development of interventions to reduce potentially inappropriate use of antimuscarinics in individuals with OAB is warranted. [ABSTRACT FROM AUTHOR]

Angiomyofibroblastoma represents a rare, benign mesenchymal tumor with a predilection for the vulvovaginal region. Lipomatous change may occur but rarely comprises a substantial component of the lesion. There are only eight reports in the English language literature describing the lipomatous variant of this tumor. We describe a further lipomatous angiomyofibroblastoma that occurred on the labium majus of a 49-year-old woman. The histopathologic and immunohistochemical features are described, and the collective experience in the literature is reviewed. [ABSTRACT FROM AUTHOR]

Aim To determine the natural history of snoring in children when they reached adolescence and the underlying risk factors for persistence of habitual snoring. Methods A follow-up telephone survey was conducted to determine the natural history of snoring in children who reached adolescence. The targeted interviewees of the follow-up survey were parents of 3047 children. Adolescents who were snoring ≥6 nights a week were defined as habitual snorers. Potential risk factors for persistent and incident habitual snoring were studied, including age, gender, allergic rhinitis, asthma, body mass index ( BMI), sleep duration and daytime sleepiness. Results Of the 3047 subjects, 2005 (65.8%) were successfully interviewed by phone. The prevalence of habitual snorers was 12.7%. Ninety-one adolescents were persistent habitual snorers. Allergic rhinitis, male gender and higher BMI at follow-up were identified as significant risk factors for persistent habitual snoring. A further 163 children were identified as incident habitual snorers. The risk factors for incident habitual snoring included male gender, asthma, higher BMI at follow-up and younger age at the first survey. In the current study, the mean sleep duration was 7.6 ± 1.0 h. Overall, 90% of the current cohort slept less than the lower limit of international recommendations for sleep duration. Conclusions Around 40.6% of habitually snoring children continued to snore habitually as adolescents in the current study, while 9.2% of the initial non-habitual snorers became habitual snorers. Male gender and higher BMI were significant risk factors for both persistent and incident habitual snoring. [ABSTRACT FROM AUTHOR]

ABSTRACT Purpose To validate an algorithm based upon International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) codes for acute myocardial infarction (AMI) documented within the Mini-Sentinel Distributed Database (MSDD). Methods Using an ICD-9-CM-based algorithm (hospitalized patients with 410.x0 or 410.x1 in primary position), we identified a random sample of potential cases of AMI in 2009 from four Data Partners participating in the Mini-Sentinel Program. Cardiologist reviewers used information abstracted from hospital records to assess the likelihood of an AMI diagnosis based on criteria from the Joint European Society of Cardiology and American College of Cardiology Global Task Force. Positive predictive values (PPVs) of the ICD-9-based algorithm were calculated. Results Of the 153 potential cases of AMI identified, hospital records for 143 (93%) were retrieved and abstracted. Overall, the PPV was 86.0% (95% confidence interval; 79.2%, 91.2%). PPVs ranged from 76.3% to 94.3% across the four Data Partners. Conclusions The overall PPV of potential AMI cases, as identified using an ICD-9-CM-based algorithm, may be acceptable for safety surveillance; however, PPVs do vary across Data Partners. This validation effort provides a contemporary estimate of the reliability of this algorithm for use in future surveillance efforts conducted using the Food and Drug Administration's MSDD. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The article presents a case study concerning a 45-year old man with pineal region tumor for over 15 years. It notes that the patient has been said to have headache and vomiting for 15 years. It mentions that he was diagnosed with obstructive hydrocephalus due to a pineal region tumour. It cites that histological examination has shown to have a cellular epithelioid papillary tumour.

Aim: The study aims to examine recent childhood asthma hospitalisation rates in the Asia Pacific countries of Australia, Hong Kong and Singapore. On the background of reported decline in many countries with high asthma prevalence during late 1990s. Methods: Annual asthma hospitalisation (ICD9-CM: 493 or ICD10-AM: J45-46) and population data from 1994 to 2008, of children aged 0-14 years old, were obtained from the Australian National Hospital Morbidity Database, from the Hospital Authority in Hong Kong and from the Ministry of Health in Singapore. Data were stratified in two age groups: 0-4 and 5-14 years old, and also in different periods of calendar years. Time-series regression analyses were used to examine temporal trends. Diagnostic transfer was addressed by examining bronchitis hospitalisations. Results: Significant decreases of up to 6.5% per annum in childhood asthma hospitalisation rates were found over the study period. However, the latter half of the study period showed increases in hospitalisation rates in all countries studied. No evidence of diagnostic transfer was found. Conclusion: Although there has been a decrease in childhood asthma hospitalisation rates since the 1990s, a modest increase was observed from 2003 to 2008. Ongoing monitoring is required. [ABSTRACT FROM AUTHOR]

Bishop, Pek, and Ngau (2005) found a significant interaction in Singapore between anger and nocturnal dipping among Indians but not Chinese and Malays. The current study examines the role of 5-HTTLPR genotype in this relationship. Two hundred thirty-one undergraduates participated in up to 4 days of 24-h ambulatory monitoring, completed the State-Trait Anger Expression Inventory, and provided blood samples for genotyping of 5-HTTLPR. Results indicated individuals with two copies of the short allele (SS) showed reduced dipping when they were high in Outward Anger (OA) but increased dipping when they were low in OA. Further, for Indian men only, dipping was reduced for individuals having the SS genotype when they were low on Anger In and increased when they were high on Anger In. These data provide further evidence for the role of 5-HTTLPR in cardiovascular risk as well as ethnic differences in the 5-HTTLPR-phenotype relationship. They also provide further evidence for 5-HTTLPR as a 'plasticity gene.' [ABSTRACT FROM AUTHOR]

Diabetic retinopathy (DR) is a most severe microvascular complication which, if left unchecked, can be sight-threatening. With the global prevalence of diabetes being relentlessly projected to rise to 438 million subjects by 2030, DR will undoubtedly pose a major public health concern. Efforts to unravel the human genetics of DR have been undertaken using the candidate gene and linkage approaches, while GWAS efforts are still lacking. Aside from evidence for a few genes including aldose reductase and vascular endothelial growth factor, the genetics of DR remain poorly elucidated. Nevertheless, the promise of impactful scientific discoveries may be realized if concerted and collaborative efforts aremounted to identify the genes for DR. Harnessing new genetic technologies and resources such as the upcoming 1000 Genomes Project will help advance this field of research, and potentially lead to a rich harvest of insights into the biological mechanisms underlying this debilitating complication. [ABSTRACT FROM AUTHOR]

Background: Mercury is a well-known neurotoxin. There are three kinds of mercury exposure: elemental mercury poisoning, inorganic mercury poisoning and organomercury poisoning. Organomercury is the most toxic. Twenty-four hour urine for mercury and blood mercury are the gold standards for diagnosis of mercury poisoning, including low-level chronic mercury exposure. Other tests for mercury level are discussed. The purpose of the present paper was to review recent data on the nature, pathophysiology, pharmacokinetics, diagnostic methods, treatment and the linkage to neurodevelopmental disabilities of mercury exposure in children. Methods: A literature search was undertaken of MEDLINE (1980–2003), and American Academy of Pediatrics, American Medical Association, American Dental Association, World Health Organization and Center for Disease Control websites. The search string ‘mercury’ was used in MEDLINE and articles were selected as appropriate by two independent reviewers. All relevant information was reviewed and data were extracted by two independent reviewers. Results: Based on the meta-analysis of the accuracy of hair mercury, hair mercury levels correlated with mercury level in blood (sample size weighted correlation coefficient, = 0.61), with 24 h urine ( = 0.46) and with cord blood ( = 0.64). However, the correlation for hair mercury level with 24 h urine level and blood level was not high enough to replace them in clinical decision-making of individual patient. Epidemiological evidence has shown that low-level mercury poisoning is not a cause of autism (relative risk = 0.49, 95%CI = 0.36–0.66). The risk of neurodevelopmental disabilities from low-level exposure to methylmercury from the regular consumption of fish is still controversial even after combining results from different epidemiological studies worldwide. There is a lack of data in the literature about the effect of chelation therapy in children with neurodevelopmental disabilities. Conclusion: Mercury poisoning should be diagnosed only with validated methods. There is no evidence to support the association between mercury poisoning and autism. [ABSTRACT FROM AUTHOR]

Attendance at outpatient clinics (OPCs) by surgical trainees is intended to be a training and educational activity while providing service provision essential to the delivery of surgical care.1-3 Access to OPCs for surgical education and training (SET) is highly valued and an essential accreditation criterion for hospital training posts.4,5 However, the tenuous balance between service provision and SET remains poorly understood. This value differed depending on the trainee's level of training and varied from 35% to 58% for SET3 trainees to 70-99% for SET5 trainees. [Extracted from the article]

Habitual snoring or daily snoring is a symptom of sleep-disordered breathing (SDB) in children and it is reported in about 10% of children. SDB includes primary snoring, upper airway resistance syndrome (UARS), obstructive hypoventilation syndrome and obstructive sleep apnea syndrome (OSAS). Classification of SDB in a particular snoring child requires an overnight polysomnography (PSG). Manual scoring of PSG is mandatory in children. Risk factors for SDB include allergic rhinitis, passive smoking, obesity, dysmorphic syndromes and neuromuscular disorders. Conclusion: Treatment includes general measures like treatment of allergic rhinitis, weight reduction in obese children, and avoidance of sleep deprivation. Specific measures include removal of adenoid and tonsils. Complications of SDB include neurocognitive impairment, hypertension and failure to thrive. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to compare the effectiveness of an intensive asthma education program (group B) with that of a standard asthma education program (group A). Methods: A prospective randomized single blinded study was conducted in the pediatric department of a public hospital in Hong Kong. Children aged 2–15 years admitted to the pediatric department with an acute attack of asthma were recruited. A standard asthma education program (group A) or an intensive asthma education program (group B) for children were offered. The main outcome measures include the number of visits to the emergency department and the number of hospitalization for asthma during the 3 month follow-up period. Results: A total of 45 children were in group A and 55 in group B. Group B had statistically significant reductions in the number of visits to the emergency department and the number of hospitalizations. Drug compliance was also significantly improved in group B. Parents’ satisfaction rate was also higher in group B. Conclusion: The intensive asthma education program might be more cost effective than the standard asthma education program in the management of asthmatic children admitted to hospital in Hong Kong. [ABSTRACT FROM AUTHOR]

Aim: To identify risk indicators associated with tooth loss and periodontitis in treated patients responsible for arranging supportive periodontal care (SPC). Materials and Methods: Ninety-seven Chinese subjects (34–77 years) who showed favourable responses to periodontal therapy provided in a teaching hospital 5–12 years previously were recalled. They were advised to seek regular SPC on discharge. Background information, general health status, smoking, oral hygiene habits, follow-up dental care, tooth loss, and periodontal parameters were investigated. Multiple regression analysis was performed. Results: Two hundred and fifty-six teeth had been lost, 195 because of self-reported periodontal reasons. Up to 26.8% sites were with pockets ⩾6 mm. Positive correlations were found between total/periodontal tooth loss and (i) smoking pack-years, (ii) time spent on oral hygiene, (iii) years since therapy's conclusion, (iv) age, and negative correlations with (v) inter-dental brush use, and (vi) education levels. Tooth loss by arch was correlated with wearing of removable partial denture in that arch. Percentage sites with pockets ⩾6 mm were significantly negatively correlated with percentage sites without bleeding on probing. Conclusions: Smokers, more elderly patients, removable partial denture wearers, and patients with lower education levels or not using inter-dental brushes ought to be targeted for clinic-based SPC. [ABSTRACT FROM AUTHOR]

Analyzes several children who were found to have pneumonia with evidence of the SARS coronavirus infection. Case reports; Discussion.

Abstract Objective : To report the experience of the use of intramuscular (IM) ketamine for endoscopy sedation in children. Methodology : Children over 6 months of age scheduled for elective endoscopy - esophagogastroduodenoscopy (EGD), bronchoscopy and nasopharyngolaryngoscopy (NPL) were enrolled for (2 mg/kg to 3 mg/kg) intramuscular ketamine sedation. A repeated dose of 2 mg/kg intramuscular ketamine was administered to those who failed the first sedation. Alternative sedation (intravenous midazolam and fentanyl) was given to children who failed ketamine sedation twice. Sedation was regarded as successful if the procedure was completed by endoscopist with a single dose of ketamine. Results : Sixty children were enrolled for the study. Overall success rate in our patients was 78.3%. Failure rate in infants was 50%, i.e. 4 out of 8. For children aged 1-7, the failure rate was 32%. Failure rate dropped markedly to 6.7% for those older than 7 years of age, and it showed significant difference when compared with the other two groups. Two cases of laryngospasm were experienced in the present study. Conclusion : Intramuscular ketamine is an effective medication for sedation in endoscopy undertaken in children over age 7 years, but it should be avoided with children under age 7 because of the high failure rate. [ABSTRACT FROM AUTHOR]

Leukotrienes were found to be raised in respiratory syncytial virus bronchiolitis. Montelukast is a cysteinyl leukotrienes antagonist. We report our experience with the use of montelukast in three young children from 5-months to 20-months old. The first case was a 5-month-old boy with previous good health. He had prolonged respiratory distress secondary to adenovirus type 3 infection. The second case was a 20-month-old boy with bronchopulmonary dysplasia. He had respiratory syncytial virus and an adenovirus type 3 infection leading to prolonged wheeze. The third case was a 20-month-old girl with chronic lung disorder after an episode of severe E. coli pneumonia at 1 month old. She developed acute virus-negative severe wheeze after a few days of running nose and low-grade fever. All three cases responded poorly to inhaled steroids and bronchodilators. Addition of montelukast was associated with marked clinical improvement within 1 week. The three cases were very heterogeneous and differed from usual simple virus-induced acute bronchiolitis. The use of multiple drugs including montelukast did not enable any definite conclusions; however, the addition of montelukast was closely related to clinical improvement. Further studies in the use of montelukast in severe virus-induced bronchiolitis are warranted. [ABSTRACT FROM AUTHOR]

Abstract Background: Bronchopulmonary dysplasia (BPD) is a common problem in premature babies. Long-term sequelae are the main concerns. Methods: A retrospective review of all BPD children born in Queen Mary Hospital, a teaching hospital of the University of Hong Kong, from January 1987 to December 1995 was conducted. Children with cerebral palsy, immunodeficiency, congenital heart disorders, renal or liver failure were excluded from analysis. Chest radiography (CXR), electrocardiogram (ECG) and pulse oximetry were routinely performed. Results: Fifty-five children completed the study. The female to male ratio was 1: 1.1. The mean gestational age was 28 weeks. Twenty-five children were born with a birthweight of less than 1001 g. Mean age at assessment was 5.4 years. Twenty-four children (44%) demonstrated signs or symptoms of current asthma. Only seven children managed to perform the spirometry satisfactorily. One child had low forced vital capacity and one had hyperresponsive airway. The only risk factor found to be associated with current asthma was the birth month, with those children born early in the year at higher risk of developing current asthma. Seventeen of 48 children (35%) had a bodyweight below the third percentile at the corrected age of 1 year. Eleven of these seventeen children (65%) demonstrated catch-up growth at assessment. Abnormal CXR was found in 25 of 40 children (63%). All had normal pulse oximetry and ECG. Conclusions: Bronchopulmonary dysplasia children had a significantly higher risk than the general population of developing current asthma (odds ratio 4.7; 95% confidence interval 3.4–6.5; P<0.0001). The importance of birth month suggests that early life experience is important in the pathogenesis of asthma, even in BPD children. The long-term growth of BPD children was much better than previously reported. [ABSTRACT FROM AUTHOR]

We report the case of an 8-year-old girl suffering from pulmonary tuberculosis complicated by tuberculous laryngitis. She presented with acute onset of fever and stridor with previous apparent good health. Her tuberculous laryngitis and pulmonary tuberculosis responded well to systemic steroid and anti-tuberculosis treatment. Steroid inhalation was found to be effective when stridor recurred after treatment with systemic steroid was stopped. Tuberculous laryngitis is now a rare disorder and only a few publications on childhood tuberculous laryngitis were found in a MEDLINE search from 1966 to 1996. Our patient is one of the youngest patients with tuberculous laryngitis during the past three decades. Paediatricians must remain alert to this disorder as tuberculosis is endemic in this region. The effectiveness of corticosteroid inhalation in relieving the stridor in this patient encourages further study on this aspect. [ABSTRACT FROM AUTHOR]

We review a case of a 50-year-old man with diagnosis of constrictive pericarditis, who underwent pericardial stripping with continuous intraoperative transesophageal echocardiography (TEE). This patient demonstrates the immediate dynamic changes in chamber size after successful surgical removal of pericardium as demonstrated by TEE.(ECHOCARDIOGRAPHY, Volume 22, May 2005) [ABSTRACT FROM AUTHOR]

AbstractThis study was conducted to evaluate children’s and nurses’ preference among the three breath-actuated devices, TurbuhalerTM (Astra), AutohalerTM (3M) and AccuhalerTM (Glaxo-Wellcome). This was an open study conducted in the paediatric in-patient department of Kwong Wah Hospital, Hong Kong. Subjects over 6 years of age who had not previously used any inhalation devices were recruited. The three devices were in random order. The preferences of subjects and nurses were ranked in a three-point scale. The children had a statistically significant preference for AccuhalerTM, while the nurses preferred to teach both AccuhalerTM and AutohalerTM but not the TurbuhalerTM. [ABSTRACT FROM AUTHOR]

The article discusses the used of the technique for rectal adenoma called transanal endoscopic operation (TEO). It mentions that a TEO device was used on the patient in the lithotomy position during the operation. It adds that the TEO technique was already used in 11 patients since 2008, however, two patients developed recurrent adenoma and were successfully removed by colonoscopic polypectomy. Furthermore, it suggests TEO to patients with large mid or upper rectal polyps.

A letter to the editor is presented on the use of scalp hair or breath test for examination of mercury levels.

Recent reports of patients with interstitial deletions involving the long arm of chromosome 12 have led to the proposal of a candidate region for the cardio-facio-cutaneous syndrome (CFCS) at (12)(q21.2q22). We now report a patient with an interstitial deletion, del(12)(q21.1q21.3) that overlaps the proposed critical region. The patient is an 11-year-old female with developmental delay. Her growth was normal but she is microcephalic with low set ears. In common with other patients with deletions in this region, she had fine, sparse head and eyebrow hair and a hyperkeratotic follicular rash, which involved her face and limbs. She does not have the diagnostic features of the CFC syndrome., (Copyright (c) 2005 Wiley-Liss, Inc.)