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Laparoscopic Adjustable Gastric Banding is one of the cardinal bariatric interventions and due to its early safety profile, became the mainstay. Major long-term complications of gastric banding include pouch-herniation-dilation and gastric erosion. A 59-year-old female presented to the emergency department with a 2-week history of progressive central abdominal pain and distention on a background history of a laparoscopic adjustable band insertion 11 years previously. Subsequent computed tomography demonstrated an intragastric band erosion. An exploratory laparotomy demonstrated a gastric band eroded through the stomach sealed by a biofilm. Secondary findings included small bowel ischemia and portal vein thrombosis. The gastric band was extracted, and the stomach was repaired. The ischemic small bowel was resected with primary anastomosis. The patient recovered uneventfully. Gastric band erosion should be considered in all patients presenting with abdominal pain and previous weight loss surgery. Prompt recognition may avoid fatal consequences. [ABSTRACT FROM AUTHOR]

Study Design. Retrospective radiographic study. Objective. To assess whether flexibility as revealed by the supine radiograph, predicts in-brace curve correction. Summary of Background Data. Currently there is no consensus regarding a standard method to assess curve flexibility and immediate brace effectiveness in treating adolescent idiopathic scoliosis (AIS). Brace fabrication methods may be variable but ideally it should achieve maximal curve correction. Curve flexibility governs the degree of curve correction in-brace and hence dynamic radiographs are commonly performed prior to brace fitting. Methods. This was a radiographic analysis of AIS patients treated with underarm bracing. Correlation of pre-brace, supine, and immediate in-brace Cobb angles was performed. Relationship with possible contributing factors including age, sex, body height, weight, age at menarche and Risser staging was studied. Major and minor curves were compared independently for correlation but the regression model was constructed based on the major curve only. Results. From 105 patients with mean age of 12.2 ± 1.2 years at brace fitting, supine Cobb angle measurement has significant correlation with immediate in-brace Cobb angle (r=0.740). Univariate analyses showed no significant relationship with age, weight, height, date of menarche, Risser stage or pre-brace Cobb angle. Our regression model (in-brace Cobb angle=0.809 x supine Cobb angle) had good fit of the data. Conclusion. Supine radiograph predictably determines the flexibility of the scoliotic curve to brace treatment. It can be used as a guideline to determine the amount of correction achievable with brace-wear. The effectiveness of the brace is dependent on the inherent flexibility of the curve rather than its size or type. [ABSTRACT FROM AUTHOR]

Introduction: It is generally agreed that operative intervention is beneficial in carefully selected groups of patients with metastatic spinal cord compression (MSCC). Tokuhashi et al have presented a preoperative scoring system to predict patient survival, which is widely used as a guideline for making a decision on whether to operate or not. However, only limited data are available regarding the validity of the Tokuhashi score in Southern Chinese populations. Materials and methods: We report a series of 128 patients treated in our hospital from 2000 to 2010. All patients were diagnosed to have spinal metastasis of different origins with cord compression. Of the 128, 59 underwent operation and the remaining 69 received conservative treatments. The Tokuhashi score was then calculated retrospectively. The survival rate was analysed and p

Objectives: It is recommended that magnetic resonance (MR) technologists should not work alone due to potential occupational health risks although lone working is legally acceptable. The objective of this study was to investigate the current situation of lone working MR technologists in Western Australia (WA) and any issue against the regulations. Materials and Methods: A questionnaire regarding the issues of occupational health of lone working MR technologists was developed based on relevant literature and distributed to WA MR technologists. Descriptive (percentage of frequency, mean and standard deviation) and inferential statistics (Fisher's exact, Chi2 and t tests, and analysis of variance) were used to analyze the responses of the yes/no, multiple choice and 5 pt scale questions from the returned questionnaires. Results: The questionnaire response rate was 65.6% (59/90). It was found that about half of the MR technologists (45.8%, 27/59) experienced lone working. The private magnetic resonance imaging (MRI) centers were more likely to arrange technologists to work alone (p < 0.05). The respondents expressed positive views on issues of adequacy of training and arrangement, confidence and comfort towards lone working except immediate assistance for emergency (mean: 3). Factors of existence of MRI safety officer (p < 0.05) and nature of lone working (p < 0.001-0.05) affected MR technologists' concerns. Conclusions: Lone working of MR technologists is common in WA especially in private centers. The training and arrangement provided seem to be adequate for meeting the legal requirements. However, several areas should be improved by the workplaces including enhancement on immediate emergency assistance and concern relief.

Background: Laminotomy is one of the surgical treatments for spinal stenosis. Method: We conducted a prospective study including 58 patients with mean follow-up of 37.5 months, successful rate was 72%. Result: There were significant improvement of mean Japanese Orthopaedic Association lumbar score, Oswestry Disability Index(ODI), and visual analogue scale (VAS). Male had significantly better result in ODI and VAS. There was no significant difference regarding to older age (>65) or the presence of preexisting degenerative spondylolisthesis. One patient was found to have increased lumbar instability after operation. The overall reoperation rate was 6.9%.

We describe here the rare condition of compressive thoracic myelopathy and its management in four patients with combined thoracic ossification of the posterior longitudinal ligament and ossification of the ligamentum flavum. One of the four patients underwent decompressive laminectomies only, whereas the other three patients had posterolateral fusion with posterior instrumentation (pedicle screws and rods system) in addition to decompressive laminectomies. All four patients developed transient complete paraplegia after surgery. The three patients who received decompressive laminectomies and posterior instrumentation with posterolateral fusion had improved sensation, motor, and sphincter functions compared with their preoperative neurological state. The patient who underwent laminectomy only showed no neurological gain after 7.5 years. A dural tear was noted in two patients and they recovered without complications after intraoperative repair. Posterior instrumentation with posterolateral fusion in addition to decompression laminectomies and excision of the ossification of the ligamentum flavum seems to have a better outcome than simple decompression laminectomies for this rare cause of compressive thoracic myelopathy.

Selecting fusion levels based on the Luk et al criteria for operative management of thoracic adolescent idiopathic scoliosis (AIS) with hook and hybrid systems yields acceptable curve correction and balance parameters; however, it is unknown whether utilizing a purely pedicle screw strategy is effective. Utilizing the fulcrum bending radiographic (FBR) to assess curve flexibility to select fusion levels, the following study assessed the efficacy of pedicle screw fixation with alternate level screw strategy (ALSS) for thoracic AIS.A retrospective study with prospective radiographic data collection/analyses (preoperative, postoperative 1-week and minimum 2-year follow-up) of 28 operative thoracic AIS patients undergoing ALSS was performed. Standing coronal/sagittal and FBR Cobb angles, FBR flexibility, fulcrum bending correction index (FBCI), trunkal shift, radiographic shoulder height (RSH), and list were assessed on x-rays. Fusion level selection was based on the Luk et al criteria and compared to conventional techniques.In the primary curve, the mean preoperative and postoperative 1 week and last follow-up standing coronal Cobb angles were 59.9, 17.2 and 20.0 degrees, respectively. Eighteen patients (64.3%) had distal levels saved (mean: 1.6 levels) in comparison to conventional techniques. Mean immediate and last follow-up FBCIs were 122.6% and 115.0%, respectively. Sagittal alignment did not statistically differ between any assessment intervals (p>0.05). A decrease in trunkal shift was noted from preoperative to last follow-up (p = 0.003). No statistically significant difference from preoperative to last follow-up was noted in RSH and list (p>0.05). No "add-on" of other vertebra or decompensation was noted and all patients achieved fusion.This is the first report to note that using the FBR for decision-making in selecting fusion levels in thoracic AIS patients undergoing management with pedicle screw constructs (e.g. ALSS) is a cost-effective strategy that can achieve clinically-relevant deformity correction that is maintained and without compromising fusion levels.

Purpose: There is much variation in the choice, timing and duration of antimicrobial prophylaxis for preventing surgical site infections (SSI) but no guideline exists for scoliosis surgery. The aim of study was to compare the efficacy of two antimicrobial prophylaxis (AMP) protocols with cephazolin in preventing SSI in adolescent idiopathic scoliosis (AIS).Methods: A retrospective comparative analysis of two post-operative AMP protocols (two postoperative doses versus continued antibiotics till drain removal) was performed. Patient characteristics, pre-operative, intra- and post-operative risk factors for infection, drain use, generic drug name and number of doses administered were recorded from 226 patients with AIS who had undergone posterior spinal fusion. Details of superficial or deep SSI and wound healing aberrations, and serious adverse events were recorded. Analysis was performed to evaluate differences in the pre-, intra- and post-operative variables between the two groups.Results: 155 patients received 2 postoperative doses of AMP and 71 patients had antibiotics till drain removal. The average follow-up was 43 months. The overall rate of SSI was 1.7 % for the spine wound and 1.3 % for the iliac crest wound. 1.9 % of patients with 2 doses of AMP and 1.4 % of patients with antibiotics till drain removal had SSI. No adverse reactions attributable to cephazolin were observed.Conclusions: This is the first study on the AMP protocol in scoliosis surgery for SSI prevention. Results suggest that two doses of AMP are as effective as continued antimicrobial use until drain removal. Cephazolin appears to be effective and safe for prophylaxis. [ABSTRACT FROM AUTHOR]

Objective: Selecting fusion levels based on the Luk et al criteria for operative management of thoracic adolescent idiopathic scoliosis (AIS) with hook and hybrid systems yields acceptable curve correction and balance parameters; however, it is unknown whether utilizing a purely pedicle screw strategy is effective. Utilizing the fulcrum bending radiographic (FBR) to assess curve flexibility to select fusion levels, the following study assessed the efficacy of pedicle screw fixation with alternate level screw strategy (ALSS) for thoracic AIS. Methods: A retrospective study with prospective radiographic data collection/analyses (preoperative, postoperative 1-week and minimum 2-year follow-up) of 28 operative thoracic AIS patients undergoing ALSS was performed. Standing coronal/sagittal and FBR Cobb angles, FBR flexibility, fulcrum bending correction index (FBCI), trunkal shift, radiographic shoulder height (RSH), and list were assessed on x-rays. Fusion level selection was based on the Luk et al criteria and compared to conventional techniques. Results: In the primary curve, the mean preoperative and postoperative 1 week and last follow-up standing coronal Cobb angles were 59.9, 17.2 and 20.0 degrees, respectively. Eighteen patients (64.3%) had distal levels saved (mean: 1.6 levels) in comparison to conventional techniques. Mean immediate and last follow-up FBCIs were 122.6% and 115.0%, respectively. Sagittal alignment did not statistically differ between any assessment intervals (p>0.05). A decrease in trunkal shift was noted from preoperative to last follow-up (p = 0.003). No statistically significant difference from preoperative to last follow-up was noted in RSH and list (p>0.05). No "add-on" of other vertebra or decompensation was noted and all patients achieved fusion. Conclusions: This is the first report to note that using the FBR for decision-making in selecting fusion levels in thoracic AIS patients undergoing management with pedicle screw constructs (e.g. ALSS) is a cost-effective strategy that can achieve clinically-relevant deformity correction that is maintained and without compromising fusion levels. [ABSTRACT FROM AUTHOR]

This protocol presents a multi-modal neuroimaging approach to explore the potential brain activity associated with repetitive religious chanting, a widespread form of mind training in both Eastern and Western cultures. High-density electroencephalogram (EEG), with its superior temporal resolution, allows for capturing the dynamic changes in brain activity during religious chanting. Through source localization methods, these can be attributed to various alternative potential brain region sources. Twenty practitioners of religious chanting were measured with EEG. However, the spatial resolution of EEG is less precise, in comparison to functional magnetic resonance imaging (fMRI). Thus, one highly experienced practitioner underwent an fMRI scanning session to guide the source localization more precisely. The fMRI data helped guide the selection of EEG source localization, making the calculation of K-means of the EEG source localization in the group of 20 intermediate practitioners more precise and reliable. This method enhanced EEG's ability to identify the brain regions specifically engaged during religious chanting, particularly the cardinal role of the posterior cingulate cortex (PCC). The PCC is a brain area related to focus and self-referential processing. These multimodal neuroimaging and neurophysiological results reveal that repetitive religious chanting can induce lower centrality and higher delta-wave power compared to non-religious chanting and resting state conditions. The combination of fMRI and EEG source analysis provides a more detailed understanding of the brain's response to repetitive religious chanting. The protocol contributes significantly to the research on the neural mechanisms involved in religious and meditative practices, which is becoming more prominent nowadays. The results of this study could have significant implications for developing future neurofeedback techniques and psychological interventions.

The 3',5'-dimethoxybenzoin (DMB) system has been widely investigated as a photoremovable protecting group (PRPG) for the elimination of various functional groups and has been applied in many fields. The photolysis of DMB fluoride leads to a highly efficient photocyclization-deprotection reaction, resulting in a high yield of 3',5'-dimethoxybenzofuran (DMBF) in a MeCN solution, while there is a competitive reaction that produces DMB in an aqueous solution. The yield of DMB increased as the volume ratio of water increased. To understand the solvent effect of the photolysis of selected DMB-based compounds, a combination of femtosecond to nanosecond transient absorption spectroscopies (fs-TA and ns-TA), nanosecond time-resolved resonance Raman spectroscopy (ns-TR 3 ) and quantum chemical calculation was employed to study the photophysical and photochemical reaction mechanisms of DMB fluoride in different solutions. Facilitated by the bichromophoric nature of DMB fluoride with electron-donating and -withdrawing chromophores, the cyclized intermediates could be found in a pure MeCN solution. The deprotection of a cyclic biradical intermediate results in the simultaneous formation of DMBF and a cyclic cation species. On the other hand, in aqueous solution, fs-TA experiments revealed that α-keto cations could be observed after excitation directly, which could easily produce the DMB through the addition of a hydroxyl within 8.7 ps. This work provides comprehensive photo-deactivation mechanisms of DMB fluoride in MeCN and aqueous conditions and provides critical insights regarding the biomedical application of DMB-based PRPG compounds.

Aging often leads to awareness decline and psychological stress. Meditation, a method of modulating consciousness, may help individuals improve overall awareness and increase emotional resilience toward stress. This study explored the potential influence of the Awareness Training Program (ATP), a form of consciousness modulation, on age-related brain wave changes and psychological stress in middle-aged adults. Eighty-five participants with mild stress were recruited and randomly assigned to ATP (45.00 ± 8.00 yr) or control (46.67 ± 7.80 yr) groups, matched by age and gender. Ten-minute resting-state EEG data, obtained while the participants' eyes were closed, were collected using a 128-channel EEG system (EGI). A strong positive Pearson correlation was found between fast-wave (beta wave, 12-25 Hz; gamma wave, 25-40 Hz) EEG and age. However, after the 7-week ATP intervention, this correlation became insignificant in the ATP group. Furthermore, there was a significant reduction in stress levels, as measured by the Chinese version of the 10 item Perceived Stress Scale (PSS-10), in the ATP group. These results suggest that ATP may help modulate age-related effects on fast brain waves, as evidenced by the reduced correlation magnitude between age and gamma waves, and lower psychological stress. This suggests that ATP, as a form of consciousness modulation, may improve stress resilience and modulate age-related gamma wave changes.

Photoremovable protecting groups are of great importance due to their remote control over the liberation of diverse reactive species temporally and spatially, including biologically active compounds and functional groups. Here, an in-depth investigation on the heterolysis-solvolysis reaction mechanisms of a photoremovable protecting group, 3',5'-dimethoxybenzoin (DMB) chloride, has been accomplished. With the aid of transient absorption and time-resolved resonance Raman spectroscopies, the features of the intermediates that emerged from the photolysis process were directly observed. Elaborate optical and theoretical studies on DMB chloride have suggested a long-lived α-keto cation intermediate (0.9 ms) exists as a key intermediate, unlike the radical intermediates that are typically generated in such photocyclization reactions. After undergoing nucleophilic addition and isomerization, the intermediate species eventually leads to the formation of the final product(s).

Newly designed push-pull ligands ( L1 and L2 ) with bithiophene ( bth ) as a donor and phenazine ( phz ) or quinoxalino[2,3- b ]quinoxaline ( qxq ) as acceptors were synthesized and also incorporated with a bipyridyl Ru(II) complex to give Ru1 and Ru2 , respectively. The ultrafast photophysical dynamics of the ligand and their respective Ru(II) complexes were well-characterized using time-resolved spectroscopies and quantum chemical calculations. Photoinduced charger transfer (CT) and intersystem crossing (ISC) processes were directly observed for L1 and L2 . In addition, the interplay of three different triplet excited states was directly observed in the related Ru(II) complexes. The lowest-lying triplet excited states of the ligands and their respective Ru(II) complexes were both attributed to the CT transitions from donor ( bth ) to acceptor ( phz or qxq ) and result in 3 ICT (intramolecular charge transfer) and 3 ILCT (intraligand charge transfer) excited states, respectively. The lifetimes of the lowest-lying triplet excited states of L1 , L2 , Ru1 , and Ru2 were measured to be 21.3, 50.4, 2.75, and 4.16 μs, respectively.

Background: There are data on the safety of cancer surgery and the efficacy of preventive strategies on the prevention of postoperative symptomatic COVID-19 in these patients. But there is little such data for any elective surgery. The main objectives of this study were to examine the safety of bariatric surgery (BS) during the coronavirus disease 2019 (COVID-19) pandemic and to determine the efficacy of perioperative COVID-19 protective strategies on postoperative symptomatic COVID-19 rates., Methods: We conducted an international cohort study to determine all-cause and COVID-19-specific 30-day morbidity and mortality of BS performed between 01/05/2020 and 31/10/2020., Results: Four hundred ninety-nine surgeons from 185 centres in 42 countries provided data on 7704 patients. Elective primary BS (n = 7084) was associated with a 30-day morbidity of 6.76% (n = 479) and a 30-day mortality of 0.14% (n = 10). Emergency BS, revisional BS, insulin-treated type 2 diabetes, and untreated obstructive sleep apnoea were associated with increased complications on multivariable analysis. Forty-three patients developed symptomatic COVID-19 postoperatively, with a higher risk in non-whites. Preoperative self-isolation, preoperative testing for SARS-CoV-2, and surgery in institutions not concurrently treating COVID-19 patients did not reduce the incidence of postoperative COVID-19. Postoperative symptomatic COVID-19 was more likely if the surgery was performed during a COVID-19 peak in that country., Conclusions: BS can be performed safely during the COVID-19 pandemic with appropriate perioperative protocols. There was no relationship between preoperative testing for COVID-19 and self-isolation with symptomatic postoperative COVID-19. The risk of postoperative COVID-19 risk was greater in non-whites or if BS was performed during a local peak., (© 2021. The Author(s).)

Objective: Transitional care is important to successful hospital discharge. Providing patients with a clear and concise summary of medication-related information can help improve outcomes, in particular, among older adults. The present study aimed to propose a framework for the development of salient medication reminders (SMR), which include drug-related risks and precautions, using the Delphi process., Design: Identification of potential SMR statements for 80% of medication types used by older adult patients discharged from geriatric medicine departments, followed by a Delphi survey and expert panel discussion., Settings: Medical and geriatric departments of public hospitals in Hong Kong., Participants: A panel of 13 geriatric medical experts., Outcome Measure: A Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree) points, scoring item relevance, importance and clarity. The minimum of 70% consensus was required for each statement to be included., Results: The expert panel achieved consensus through the Delphi process on 80 statements for 44 medication entities. Subsequently, the SMR steering group endorsed the inclusion of these statements in the SMR to be disseminated among older adults at the time of discharge from geriatric medicine departments., Conclusions: The Delphi process contributed to the development of SMR for older adult patients discharged from public hospitals in Hong Kong. Patient experience with and staff response to the SMR were assessed at four hospitals before implementation at all public hospitals., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Pneumoconiosis is an irreversible chronic disease. With functional limitations and an inability to work, pneumoconiosis patients require support from family caregivers. However, the needs of pneumoconiosis caregivers have been neglected. This study aimed to evaluate the effectiveness of a nurse-led education program, which involved four weekly 90-min workshops led by an experienced nurse and guided by Orem's self-care deficit theory. A single-group, repeated-measure study design was adopted. Caregivers' mental health (Hospital Anxiety and Depression Scale, HADS, four single items for stress, worriedness, tiredness, and insufficient support), caregiving burdens (caregiving burden scale, CBS), and unmet direct support and enabling needs (Carer Support Needs Assessment Tool, CSNAT) were measured at the baseline (T0), immediately after (T1), and one month after intervention (T2); 49, 41, and 28 female participants completed the T0, T1, and T2 measurements. Mean age was 65.9 years old (SD 10.08) with a range between 37 and 85 years old. The program improved the caregivers' mental wellbeing, and reduced their caregiving burdens and their unmet support and enabling needs, both immediately (T1) and one-month after the intervention (T2). In particular, the intervention improved the caregivers' mental wellbeing significantly, specifically depression symptoms, stress, and tiredness immediately after the intervention; and reduced most of their unmet support needs and unmet enabling needs one-month after the intervention. This was the first nurse-led program for pneumoconiosis caregivers and should serve as a foundation for further studies to test the program with robust designs.

Modern medical imaging facilitates the diagnosis and treatment of human diseases. However, few people are aware of the cons of radiation exposure from medical imaging. Emerging evidence reveals that cumulative doses of radiation exposure will increase the morbidity and mortality of pertaining cancer. As a special young population, patients with adolescent idiopathic scoliosis (AIS) suffer more radiation harms from repeated diagnostic imaging, most of which can be avoided in clinical practice. Accumulating evidence highlights reduced cancer risks of radiation exposure for AIS patients with low/zero radiation imaging modalities proposed, amongst which easy conversion from anterior-posterior (AP) to posterior-anterior (PA) projection for whole-spine radiographs should be stressed. It can greatly reduce radiation doses without compromising the quality of diagnostic imaging. Tight collimation combined with PA projection can further reduce radiation harms, and need to be spread to benefit people globally., Competing Interests: Competing Interests: The authors have declared that no competing interest exists., (© The author(s).)

Introduction: Online open book assessment has been a common alternative to a traditional invigilated test or examination during the COVID-19 pandemic. However, its unsupervised nature increases ease of cheating, which is an academic integrity concern. This study's purpose was to evaluate the integrity of two online open book assessments with different formats (1. Tightly time restricted - 50 min for mid-semester and 2. Take home - any 4 h within a 24-h window for end of semester) implemented in a radiologic pathology unit of a Bachelor of Science (Medical Radiation Science) course during the pandemic., Methods: This was a retrospective study involving a review and analysis of existing information related to the integrity of the two radiologic pathology assessments. Three integrity evaluation approaches were employed. The first approach was to review all the Turnitin plagiarism detection software reports with use of 'seven-words-in-a-row' criterion to identify any potential collusion. The second approach was to search for highly irrelevant assessment answers during marking for detection of other cheating types. Examples of highly irrelevant answers included those not addressing question requirements and stating patients' clinical information not from given patient histories. The third approach was an assessment score statistical analysis through descriptive and inferential statistics to identify any abnormal patterns that might suggest cheating occurred. An abnormal pattern example was high assessment scores. The descriptive statistics used were minimum, maximum, range, first quartile, median, third quartile, interquartile range, mean, standard deviation, fail and full mark rates. T-test was employed to compare mean scores between the two assessments in this year (2020), between the two assessments in the last year (2019), between the two mid-semester assessments in 2019 and 2020, and between this and last years' end of semester assessments. A p-value of less than 0.05 was considered statistically significant., Results: No cheating evidence was found in all Turnitin reports and assessment answers. The mean scores of the end of semester assessments in 2019 (88.2%) and 2020 (90.9%) were similar (p = 0.098). However, the mean score of the online open book mid-semester assessment in 2020 (62.8%) was statistically significantly lower than that of the traditional invigilated mid-semester assessment in 2019 (71.8%) with p < 0.0001., Conclusion: This study shows the use of the online open book assessments with tight time restrictions and the take home formats in the radiologic pathology unit did not have any academic integrity issues. Apparently, the strict assessment time limit played an important role in maintaining their integrity., (Copyright © 2020. Published by Elsevier Inc.)

Advances in patient selection, surgical techniques, and postoperative care have facilitated spine surgeons to manage complex spine cases with shorter operative times, reduced hospital stay and improved outcomes. We focus this article on a few areas which have shown maximum developments in management of degenerative cervical myelopathy and also throw a glimpse into the future ahead. Imaging modalities, surgical decision making, robotics and neuro-navigation, minimally invasive spinal surgery, motion preservation, use of biologics are few of them. Through this review article, we hope to provide the readers with an insight into the present state of art in cervical myelopathy and what the future has in store for us., (© 2020 Delhi Orthopedic Association. All rights reserved.)

This article briefly discusses the reactions and responses toward the COVID-19 pandemic in Hong Kong, amid major political strife. The traumatic memories from severe acute respiratory syndrome in 2003 as well as the displease and distrust toward the Hong Kong government have aggravated mental health distress during the pandemic while this adversity has also increased community support. This article discusses the specific challenges of the COVID-19 pandemic in Hong Kong and proposes lessons learned during the pandemic, including strategies for mental health professionals and the community to reduce psychological distress. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

We report the synthesis of a new type of pyrazinopyrazine-fused azaacene molecules by a simple and versatile procedure. 6,9-Dihexyldithieno[3,2-f:2',3'-h]quinoxaline-2,3-diamine was synthesized through the condensation between 2,7-dihexylbenzo[1,2-b:6,5-b']dithiophene-4,5-diamine and bis(2,2,2-trifluoroethyl) oximidate. A series of derivatized molecules with extended two-dimensional aromatic fused-ring structures could be obtained by simple condensation reactions between the quinoxalinediamine intermediate and various diketones. The reaction was proved to be effective for the construction of tetrazaacene derivatives with extended heterocyclic aromatic ring systems. The molecules obtained exhibit low-lying LUMO levels that can be fine-tuned by modifying the molecular structure. Crystallographic results showed that in a solid state, the molecules form "brick wall" structures with a close π-π stacking mode. The stacking between the π-ring systems in the molecules could be further enhanced by expanding the large 2D planar-conjugated structure.

Despite the well-reported MLCT [dπ(M) → π*(CNR)] transitions in the isocyano transition metal complexes, emissive complexes with phosphorescence derived from MLCT [dπ(M) → π*(CNR)] were not extensively studied. To provide insights into the design strategy of phosphorescent rhenium(I) complexes with an emissive 3 MLCT [dπ(Re) → π*(CNR)] excited state, a series of pentaisocyano rhenium(I) complexes have been synthesized. In contrast to most of the reported penta- or hexaisocyano rhenium(I) complexes with unsubstituted or alkyl- or monohalo-substituted phenylisocyanide ligands, which only exhibit photoluminescence in 77 K glassy medium, the solutions of all of these complexes were found to show phosphorescence at room temperature. Detailed study on their emission properties revealed that they are derived from the 3 MLCT [dπ(Re) → π*(CNR)] excited state mixed with LL'CT character. It has been shown that the strong electron-withdrawing substituents on the isocyanide ligands can lower the energy of the MLCT [dπ(Re) → π*(CNR)] state and raise the deactivating ligand-field state. These effects are the crucial criteria to render the pentaisocyano rhenium(I) complexes emissive. Moreover, the emission properties in terms of energy, lifetime, and quantum yields can also be enhanced by the ancillary ligand.

Objective:: There are several limitations with current methods of breast volume measurement; principally relating to assumption of fixed shape forms. This study, utilizing computer aided volume estimates, developed a new method using the digital mapping of breast area and compares results to existing techniques of breast volume measurement and actual breast volume., Methods:: 50 consecutive breast cancer patients had breast volume calculated from mammograms [craniocaudal (CC) and mediolateral oblique views]; using breast height, width, radius, area and compression thickness. Area was recorded using cursor measurement tool for AGFA® Impax™6 software. The new volumetric estimation is based on the basic formula for the volume of a solid. The technique was compared with three known breast volume estimation techniques. Subsequently, 15 patients undergoing mastectomy had pre-op breast volume calculated using this new method and 3 existing techniques; values were compared to fresh mastectomy weights/volumes., Results:: 50 patients, mean age 63.2 ± 14.4 (range 38-88) had breast volume estimation. The CC view appears to provide the best correlation with existing techniques. Scatterplots show a significant correlation of all the methods with the digital breast volume estimation method. Mastectomy volume compared with four breast volume techniques in n = 15, confined to the CC, shows good correlation between the digital technique and real volume. Scatterplots show significant correlation between digital breast volume estimation and mastectomy weight., Conclusion:: This study provided a novel simple tool to estimate breast volume in patients., Advances in Knowledge:: This may aid in planning cosmetic outcome and oncoplastic approaches in breast cancer and breast reduction surgery.

Conjugated polymers incorporated with cycloplatinated complexes (P1-Pt and P2-Pt) were used as dispersants for single-walled carbon nanotubes (SWCNTs). Significant changes in the UV-vis absorption spectra were observed after the formation of the polymer/SWCNT hybrids. Molecular dynamics (MD) simulations revealed the presence of a strong interaction between the cycloplatinated complex moieties and the SWCNT surface. The photoinduced electron transfer processes in these hybrids were strongly dependent on the type of the comonomer unit. Upon photoexcitation, the excited P1-Pt donates electrons to the SWCNT, while P2-Pt accepts electrons from the photoexcited SWCNT. These observations were supported by results from Raman and femtosecond time-resolved transient absorption spectroscopy experiments. The strong electronic interaction between the Pt complexes and the SWCNT gives rise to a new hybrid system that has a controllable photoinduced electron transfer flow, which are important in regulating the charge transport processes in SWCNT-based optoelectronic devices.

Background: Sinew acupuncture is a new modality of acupuncture in which needles are inserted into acupoints, ashi points or spasm points of sinew and muscles along the meridian sinew pathway. A previous observational study revealed that sinew acupuncture has immediate analgesic effects on various soft tissue injuries, including knee injuries. However, no rigorous trials have been conducted. This study aims to examine whether sinew acupuncture can safely relieve pain and symptoms of knee osteoarthritis (KOA) and improve patients' functional movement and quality of life., Methods/design: A randomized, sham-controlled, patient- and assessor-blinded trial will be conducted to compare the efficacy of sinew acupuncture and sham acupuncture. Subjects will be assessed by the physician and acupuncturists. A sample of eighty-six eligible subjects will be randomized into either the sinew acupuncture group or the sham acupuncture group. The intervention will be performed in the Hong Kong Tuberculosis Association Chinese Medicine Clinic cum Training Centre of the University of Hong Kong by acupuncturists with over 3 years of acupuncture experience. Subjects will receive 10 sessions of interventions for 4 weeks, followed by a 6-week follow-up. The visual analogue scale (VAS) score at week 4 will be the primary outcome. The Western Ontario and McMasters University Osteoarthritis Index (WOMAC), Timed Up & Go Test (TUG), 8-step Stair Climb Test (SCT) and the 36-Item Short Form Survey (SF-36) will be secondary outcomes., Discussion: Sinew acupuncture is a potential alternative non-pharmacological therapy for KOA. This rigorous trial will expand our knowledge of whether sinew acupuncture reduces pain intensity and improves symptoms, functional movements, and quality of life of KOA patients., Trial Registration: The study was registered at ClinicalTrials.gov (Identifier: NCT03099317) in March 2017.

Functional polymer/carbon nanotube (CNT) hybrid materials can serve as a good model for light harvesting systems based on CNTs. This paper presents the synthesis of block copolymer/CNT hybrids and the characterization of their photocurrent responses by both experimental and computational approaches. A series of functional diblock copolymers was synthesized by reversible addition-fragmentation chain transfer polymerizations for the dispersion and functionalization of CNTs. The block copolymers contain photosensitizing ruthenium complexes and modified pyrene-based anchoring units. The photocurrent responses of the polymer/CNT hybrids were measured by photoconductive atomic force microscopy (PCAFM), from which the experimental data were analyzed by vigorous statistical models. The difference in photocurrent response among different hybrids was correlated to the conformations of the hybrids, which were elucidated by molecular dynamics simulations, and the electronic properties of polymers. The photoresponse of the block copolymer/CNT hybrids can be enhanced by introducing an electron-accepting block between the photosensitizing block and the CNT. We have demonstrated that the application of a rigorous statistical methodology can unravel the charge transport properties of these hybrid materials and provide general guidelines for the design of molecular light harvesting systems.

Background: Surgery for adolescent idiopathic scoliosis (AIS) is only complete after achieving fusion to maintain the correction obtained intraoperatively. The instrumented or fused segments can be referred to as the "fusion mass". In patients with AIS, the ideal fusion mass strategy has been established based on fulcrum-bending radiographs for main thoracic curves. Ideally, the fusion mass should achieve parallel endplates of the upper and lower instrumented vertebra and correct any "shift" for truncal balance. Distal adding-on is an important element to consider in AIS surgery. This phenomenon represents a progressive increase in the number of vertebrae included distally in the primary curvature and it should be avoided as it is associated with unsatisfactory cosmesis and an increased risk of revision surgery. However, it remains unknown whether any fusion mass shift, or shift in the fusion mass or instrumented segments, affects global spinal balance and distal adding-on after curve correction surgery in patients with AIS., Questions/purposes: (1) To investigate the relationship among postoperative fusion mass shift, global balance, and distal adding-on phenomenon in patients with AIS; and (2) to identify a cutoff value of fusion mass shift that will lead to distal adding-on., Methods: This was a retrospective study of patients with AIS from a single institution. Between 2006 and 2011 we performed 69 selective thoracic fusions for patients with main thoracic AIS. All patients were evaluated preoperatively and at 2 years postoperatively. The Cobb angle between the cranial and caudal endplates of the fusion mass and the coronal shift between them, which was defined as "fusion mass shift", were measured. Patients with a fusion mass Cobb angle greater than 20° were excluded to specifically determine the effect of fusion mass shift on distal adding-on phenomenon. Fusion mass shift was empirically set as 20 mm for analysis. Therefore, of the 69 patients who underwent selective thoracic fusion, only 52 with a fusion mass Cobb angle of 20° or less were recruited for study. We defined patients with a fusion mass shift of 20 mm or less as the balanced group and those with a fusion mass shift greater than 20 mm as the unbalanced group. A receiver operating characteristic (ROC) curve was used to determine the cutoff point of fusion mass shift for adding-on., Results: Of the 52 patients studied, fusion mass shift (> 20 mm) was noted in 11 (21%), and six of those patients had distal adding-on at final followup. Although global spinal balance did not differ significantly between patients with or without fusion mass shift, the occurrence of adding-on phenomenon was significantly higher in the unbalanced group (55% (six of 11 patients), odds ratio [OR], 8.6; 95% CI, 2-39; p < 0.002) than the balanced group (12% [five of 41 patients]). Based on the ROC curve analysis, a fusion mass shift more than 18 mm was observed as the cutoff point for distal adding-on phenomenon (area under the curve, 0.70; 95% CI, 0.5-0.9; likelihood ratio, 5.0; sensitivity, 0.64; specificity, 0.73; positive predictive value, 39% [seven of 18 patients]; negative predictive value, 88% [30 of 34 patients]; OR, 4.8; 95% CI, 1-20; p = 0.02)., Conclusions: Our study illustrates the substantial utility of the fulcrum-bending radiograph in determining fusion levels that can avoid fusion mass shift; thereby, underlining its importance in designing personalized surgical strategies for patients with scoliosis. Preoperatively, determining fusion levels by fulcrum-bending radiographs to avoid residual fusion mass shift is imperative. Intraoperatively, any fusion mass shift should be corrected to avoid distal adding-on, reoperation, and elevated healthcare costs., Level of Evidence: Level II, prognostic study.

Purpose: Patients with pre-existing cervical spinal canal stenosis (CSCS) may have minimal or no symptoms. However, performing preventive decompression is controversial as the incidence of CSCS leading to severe cord injury is unknown. Hence, this study aims to revisit the threshold for surgery in "silent" CSCS by reviewing the neurologic outcomes of patients with undiagnosed CSCS who sustained a cervical spinal cord injury (CSCI)., Methods: Two groups of subjects were recruited for analysis. Firstly, patients with trauma-induced CSCI without fracture or dislocation were included. Pre-existing CSCS was diagnosed by MRI measurements. The second group consisted of asymptomatic subjects recruited from the general population who also had MRIs performed. Canal sizes were compared between this control group and the patient group. Within the patient group, neurological assessments and outcomes by Frankel classification were performed in patients treated surgically or conservatively., Results: 32 patients with CSCS were recruited. The mean spinal canal sagittal diameter (disc-level) of all CSCS cases was 5.3 ± 1.4 mm (1.3-8.2). In comparison, the diameter was 10.5 ± 1.7 mm (6.6-14.6) in the 47 asymptomatic individuals recruited from the general population. Decompression was performed in 17 patients and conservative treatment in 15. Mean follow-up was 19.3 ± 17.0 months (6-84). At the final follow-up, 3 patients (9.3%) returned to their pre-injury Frankel grade, whereas 26 patients (83.3%) lost one or more neurological grade. Three patients (9.3%) died., Conclusions: Majority of patients with "silent" CSCS who sustained cervical cord injuries did not return to their pre-injury neurological status. All of these subjects have pre-existing canal stenosis hence the risk of cord injury. Given the poor neurological outcome of CSCS, a lower threshold for surgery could be indicated to avoid these disastrous injuries. However, before making any conclusive recommendation we must first identify the prevalence of "silent" CSCS in the general population and the risk of developing spinal cord injury with more prospective population-based studies., (Copyright © 2016 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)

Objectives: To identify gaps in Australian sonographer's knowledge and application of as low as reasonably achievable (ALARA) principles during first trimester imaging; Identify relationships between demographic variables and knowledge or application of the Output Display Standard (ODS) value thermal index (TI) and compare Australian sonographers to their international peers., Methods: Australian Sonographer Accreditation Registered ( ASAR)-registered sonographers completed a voluntary questionnaire over September 2015 after institutional ethics approval (RDSE-48-15). Seventeen questions detailed their demographics (5); knowledge of ultrasound bioeffects terminology and ALARA principles (9); behaviour surrounding ALARA and first trimester imaging (2) and continuing bioeffects education (1). Exclusion criteria was non-ASAR status. Descriptive (mode frequency) and inferential statistics (Fisher exact test) were used. Significance level was 95%., Results: Ninety-five valid surveys were collected. Ninety-nine per cent knew the meaning of ALARA, 93.55% correctly defined 'TI' and 85.39% knew where to find the TI value via the ODS. Half never monitor the ODS. No correlation (P = 0.094) was found between experience and ODS monitoring. No statistical difference (P = 0.189) existed between obstetric and non-obstetric sonographers who knew the meaning of TIB (87.18% vs. 76.92%) or those who correctly identified it as the setting for 11-14-week examinations (30.77% vs. 30.77%). When using Doppler during obstetric examinations, no difference existed (P = 0.293), between obstetric and non-obstetric sonographers' knowledge of ASUM/WFUMB guidelines for maximum TI (47.37% vs. 46.15%)., Conclusions: Despite poor ODS usage, Australian sonographers outperform their international peers for ALARA literacy, and show better application of ALARA principles in the first trimester. No relationships were found between demographic variables and knowledge or conscious monitoring of ODS., (© 2016 Australasian Society for Ultrasound in Medicine.)

Purpose: The use of tap water as a wound-cleansing agent is becoming more common in clinical practice, especially in community settings. The aim of this study was to test whether there are differences in wound infection and wound healing rates when wounds are cleansed with tap water or sterile normal saline., Design: Double-blinded randomized controlled trial., Subjects and Setting: Subjects were recruited from the community nursing service of a local hospital in Hong Kong. The target sample included subjects who were aged 18 years or more, and receiving chronic or acute wound care treatment., Methods: Subjects were randomly assigned to wound cleansing with tap water (experimental group) or sterile normal saline (control group). Wound assessment was conducted at each home visit, and an assessment of wound size was conducted once a week. The main outcome measures, occurrence of a wound infection and wound healing, were assessed over a period of 6 weeks., Results: Twenty-two subjects (11 subjects in each group) with 30 wounds participated in the study; 16 wounds were managed with tap water cleansing and 14 were randomly allocated to management with the sterile normal saline group. Analysis revealed no significant difference between the experimental and control groups in the proportions of wound infection and wound healing., Conclusions: Study findings indicate that tap water is a safe alternative to sterile normal saline for wound cleansing in a community setting.

Purpose: Lack of normal reference value of diffusion tensor imaging parameters hinders its application in clinical practice. In this study, we aim to establish a comprehensive normal DTI database of Chinese subjects., Methods: Sixty-five healthy subjects aged 21-61 years were recruited and underwent 3T DTI scan of cervical spine. DTI parameters were measured in whole cord, ventral, lateral and dorsal column from C2 to C7 segments. Regions, segments, gender and age-related changes of DTI parameters were analyzed., Results: No significant difference was found between genders (p > 0.05). DTI parameters significantly differed among different cord levels (p < 0.05). FA value in whole cord, grey matter, dorsal and ventral column showed significant but weak correlation with age (p < 0.05)., Conclusion: A comprehensive normal database of DTI parameters of cervical spinal cord was established. The effect of gender and age-related changes is negligible in DTI analysis of cervical spinal cord disorders.

A new series of cyclometalated iridium(III) complexes with isocyanoborate ligands [Ir(R2ppy)2(L)(CNBR'3)] (R = H or F; L = CNC6H4Cl-4 or PPh3; R' = Ph, C6F5 or C6H4Cl-4), [Ir(biqb)(ppy)(CNBR''3)] (R'' = C6F5 or C6H4Cl-4) and {Ir(ppy)2(CN)n[CNB(C6F5)3]2-n}(-) (n = 0 or 1) have been synthesized and characterized. Three of these complexes have also been structurally characterized by X-ray crystallography. The photophysical and electrochemical properties of these complexes have been investigated. The effects of isocyanoborate ligands on the luminescence properties of these iridium(III) complexes are also described.

Patients who have undergone neck dissection and radiotherapy are at risk of cervical spine infections. Furthermore, previous radiotherapy and cervical spine infections can lead to fistula formation to the subarachnoid space and intracranial infection. This report discusses the serious consequences of a missed cervical spine infection including cerebrospinal fluid fistula formation and persistent central nervous system infection, and serves as a reminder to clinicians of the possible association between cervical spine infections and prior head and neck surgery and radiotherapy. In all such cases, the posterior pharyngeal wall should be inspected during follow-up. Despite the appearance of an intracranial infection, the cervical spine should be investigated, especially if the response to appropriate antibiotics is suboptimal.

Introduction: Computed tomography (CT) dose optimization is an important issue in radiography because CT is the largest contributor to medical radiation dose and its use is increasing. However, CT dose optimization for pediatric patients could be more challenging than their adult counterparts. The purpose of this literature review was to identify and discuss the current pediatric CT dose saving techniques. Optimized pediatric protocols were also proposed., Methods: A comprehensive literature search was conducted using the Medline, ProQuest Health and Medical Complete, PubMed, ScienceDirect, Scopus, Springer Link, and Web of Science databases and the keywords CT, pediatric, optimization, protocol, and radiation dose to identify articles focusing on pediatric CT dose optimization strategies published between 2004 and 2014., Results and Summary: Seventy-seven articles were identified in the literature search. Strategies for optimizing a range of scan parameters and technical considerations including tube voltage and current, iterative reconstruction, diagnostic reference levels, bowtie filters, scout view, pitch, scan collimation and time, overscanning, and overbeaming for pediatric patients with different ages and body sizes and compositions were discussed. An example of optimized pediatric protocols specific to age and body size for the 64-slice CT scanners was devised. It is expected that this example could provide medical radiation technologists, radiologists, and medical physicists with ideas to optimize their pediatric protocols., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objectives: It is recommended that magnetic resonance (MR) technologists should not work alone due to potential occupational health risks although lone working is legally acceptable. The objective of this study was to investigate the current situation of lone working MR technologists in Western Australia (WA) and any issue against the regulations., Materials and Methods: A questionnaire regarding the issues of occupational health of lone working MR technologists was developed based on relevant literature and distributed to WA MR technologists. Descriptive (percentage of frequency, mean and standard deviation) and inferential statistics (Fisher's exact, Chi(2) and t tests, and analysis of variance) were used to analyze the responses of the yes/no, multiple choice and 5 pt scale questions from the returned questionnaires., Results: The questionnaire response rate was 65.6% (59/90). It was found that about half of the MR technologists (45.8%, 27/59) experienced lone working. The private magnetic resonance imaging (MRI) centers were more likely to arrange technologists to work alone (p < 0.05). The respondents expressed positive views on issues of adequacy of training and arrangement, confidence and comfort towards lone working except immediate assistance for emergency (mean: 3). Factors of existence of MRI safety officer (p < 0.05) and nature of lone working (p < 0.001-0.05) affected MR technologists' concerns., Conclusions: Lone working of MR technologists is common in WA especially in private centers. The training and arrangement provided seem to be adequate for meeting the legal requirements. However, several areas should be improved by the workplaces including enhancement on immediate emergency assistance and concern relief.

Using an adjuvant-induced arthritis rat model, we investigated the effects of a lipid extract of Perna canaliculus (Lyprinol(R)) on pain. Radiological examinations, as well as levels of pro- and anti-inflammatory (AI) cytokines, were measured aiming to provide independent objective data to the pain controlling investigation. We confirmed the ability of Lyprinol(R) to control pain at the initial phase of its administration; with similar efficacy to that observed with Naproxen. The pain scores slowly increased again in the group of rats treated with Lyprinol(R) after day 9-14. The Naproxen-treated rats remained pain-free while treated. Both Naproxen and Lyprinol(R) decreased the levels of the pro-inflammatory cytokines TNF-alpha and IFN-gamma, and increased that of IL-10. Extra-virgin olive oil was ineffective on cytokine secretion. Rats treated with Lyprinol(R) were apparently cured after 1 year. This study confirms the AI efficacy of this lipid extract of P. canaliculus, its initial analgesic effect, its perfect tolerance and its long-term healing properties.

The roles of p33ING2 as a tumor suppressor candidate have been shown through regulation of gene transcription, induction of cell cycle arrest, and apoptosis. As p33ING2 shares 58.9% homology with p33ING1b, we hypothesized that p33ING2 shares functional similarities with p33ING1b. We previously found that p33ING1b cooperates with p53 to enhance UVB-induced apoptosis. Here, we report that overexpression of p33ING2 enhanced apoptosis in UVB-irradiated and non-irradiated melanoma MMRU cells. We demonstrate that enhancement of apoptosis by p33ING2 requires the presence of functional p53. Furthermore, we found that overexpression of p33ING2 significantly downregulated the expression of Bcl-2 after UVB irradiation, resulting in an increased Bax/Bcl-2 ratio. Moreover, we found that p33ING2 promoted Bax translocation to mitochondria, altered the mitochondrial membrane potential, and induced cytochrome c release and thus the activation of caspases 9 and 3. In addition, we showed that under non-stress conditions p33ING2 upregulates Fas expression and activates caspase 8. Taken together, we demonstrate that p33ING2 cooperates with p53 to regulate apoptosis via activation of both the mitochondrial/intrinsic and death-receptor/extrinsic apoptotic pathways.

Deregulation of apoptotic processes is likely one of the key factors contributing to the malignant nature of melanoma marked by strong chemoresistance. X-linked inhibitor of apoptosis protein (XIAP) suppresses apoptosis through the inhibition of various caspases. Recently, XIAP-associated factor 1 (XAF1) has been identified as a XIAP-binding protein that antagonizes the anti-apoptotic activity of XIAP. In this study, we sought to determine the role of XAF1 in melanoma progression. Analysis of XAF1 mRNA expression in melanoma cell lines revealed that XAF1 mRNA was downregulated in 15 of 16 cell lines examined. We next evaluated XAF1 protein expression on a tissue microarray representing 40 benign nevi and 70 primary melanomas. Our results showed that XAF1 expression in melanoma tissues was significantly reduced compared with benign melanocytic nevi (p<0.05). Our data also demonstrated that the substantial reduction of XAF1 expression occurred in both nucleus and cytoplasm in the tumor cells (p<0.0001 for both). Reduced XAF1 expression, however, was not significantly correlated with tumor thickness and 5-y patient survival. Further studies are required to understand the molecular mechanisms governing the selective loss of XAF1 expression in the tumor tissue.