Treatment outcome of rhabdomyosarcoma in Hong Kong Chinese children

Objectives: To review the treatment outcome of rhabdomyosarcoma in Hong Kong Chinese children. Design: Retrospective review. Setting: University teaching hospital, Hong Kong. Patients: Consecutive cases of rhabdomyosarcoma diagnosed and treated by the Department of Paediatrics and Adolescent Medicine of Queen Mary Hospital between 1989 and 2005. Each patient was staged and treated according to the Intergroup Rhabdomyosarcoma Study guidelines. Main outcome measures: Overall and event-free survival rates, and toxicity data. Results: Of 19 patients (8 males and 11 females), 14 (74%) were younger than 10 years old. The median age at diagnosis was 6 (range, 0.5-17) years. Primary sites of rhabdomyosarcoma included: the head and neck (n=8; 6 classified as cranial parameningeal), genitourinary (3), extremity (3), pelvis (3), and trunk (2). Thirteen (68%) had embryonal and six (32%) had alveolar histology. Two, 2, 9, and 6 were classified as belonging to Intergroup Rhabdomyosarcoma Study groups 1, 2, 3, and 4, respectively. Respective 5-year overall and event-free survival rates of the entire cohort were 49% (95% confidence interval, 26-73%) and 32% (10-55%), with a median follow-up of 3.4 (range, 0.2-16.7) years. In non-metastatic cases (Intergroup Rhabdomyosarcoma Study groups 1-3), the 5-year overall survival rate was 66% (95% confidence interval, 39-93%) and in metastatic cases (group 4) it was 17% (0-46%). The 5-year overall survival rate for patients aged less than 10 years was 60% (95% confidence interval, 33-87%) compared to 20% (0-55%) in those aged 10 years and over. Significant treatment-related toxicities including myelosuppression, infections, peripheral neuropathy, and second cancers were encountered. Conclusions: Treatment outcome of rhabdomyosarcoma in this cohort of Chinese children was less favourable than that reported in international studies. Whilst the main reason could have been related to the high proportion of metastatic cases, also non-metastatic cases faired worse. Improved outcomes may be achieved by advances in multidisciplinary (paediatric oncology, pathology, radiotherapy, and surgery) management and supportive care.published_or_final_versio

Policy and prevention approaches for disordered and hazardous gaming and internet use: an international perspective

Problems related to high levels of gaming and Internet usage are increasingly recognized as a potential public health burden across the developed world. The aim of this review was to present an international perspective on prevention strategies for Internet gaming disorder and related health conditions (e.g., Internet addiction), as well as hazardous gaming and Internet use. A systematic review of quantitative research evidence was conducted, followed by a search of governmental reports, policy and position statements, and health guidelines in the last decade. The regional scope included the United States, United Kingdom, Australia, China, Germany, Japan, and South Korea. Prevention studies have mainly involved school-based programs to train healthier Internet use habits in adolescents. The efficacy of selective prevention is promising but warrants further empirical attention. On an international scale, the formal recognition of gaming or Internet use as a disorder or as having quantifiable harms at certain levels of usage has been foundational to developing structured prevention responses. The South Korean model, in particular, is an exemplar of a coordinated response to a public health threat, with extensive government initiatives and long-term strategic plans at all three levels of prevention (i.e., universal, selective, and indicated). Western regions, by comparison, are dominated by prevention approaches led by non-profit organizations and private enterprise. The future of prevention of gaming and Internet problems ultimately relies upon all stakeholders working collaboratively in the public interest, confronting the reality of the evidence base and developing practical, ethical, and sustainable countermeasures

Psychometric testing of three Chinese online-related addictive behavior instruments among Hong Kong university students

Objective: To validate the Chinese version of the nine-item Internet Gaming Disorder Scales- Short Form (IGDS-SF9), Bergen Social Media Addiction Scale (BSMAS), and Smartphone Application-Based Addiction Scale (SABAS) among Hong Kong university students. Participants and Methods: Participants aged between 17 and 30 years participated in the present study (n=307; 32.4% males; mean [SD] age=21.64 [8.11]). All the participants completed the IGDS-SF9, BSMAS, SABAS, and the Hospital Anxiety and Depression Scale (HADS). Confirmatory factor analyses (CFAs) were used to examine the factorial structures and the unidimensionality for IGDS-SF9, BSMAS, and SABAS. Results: CFAs demonstrated that the three scales were all unidimensional with satisfactory fit indices: comparative fit index = 0.969 to 0.992. In addition, the IGDS-SF9 and BSMAS were slightly modified based on the modification index in CFA. Conclusions: The Chinese IGDS-SF9, BSMAS, and SABAS are valid instruments to assess the addiction levels of internet-related activities for Hong Kong university students

Socializing One Health: an innovative strategy to investigate social and behavioral risks of emerging viral threats

In an effort to strengthen global capacity to prevent, detect, and control infectious diseases in animals and people, the United States Agency for International Development’s (USAID) Emerging Pandemic Threats (EPT) PREDICT project funded development of regional, national, and local One Health capacities for early disease detection, rapid response, disease control, and risk reduction. From the outset, the EPT approach was inclusive of social science research methods designed to understand the contexts and behaviors of communities living and working at human-animal-environment interfaces considered high-risk for virus emergence. Using qualitative and quantitative approaches, PREDICT behavioral research aimed to identify and assess a range of socio-cultural behaviors that could be influential in zoonotic disease emergence, amplification, and transmission. This broad approach to behavioral risk characterization enabled us to identify and characterize human activities that could be linked to the transmission dynamics of new and emerging viruses. This paper provides a discussion of implementation of a social science approach within a zoonotic surveillance framework. We conducted in-depth ethnographic interviews and focus groups to better understand the individual- and community-level knowledge, attitudes, and practices that potentially put participants at risk for zoonotic disease transmission from the animals they live and work with, across 6 interface domains. When we asked highly-exposed individuals (ie. bushmeat hunters, wildlife or guano farmers) about the risk they perceived in their occupational activities, most did not perceive it to be risky, whether because it was normalized by years (or generations) of doing such an activity, or due to lack of information about potential risks. Integrating the social sciences allows investigations of the specific human activities that are hypothesized to drive disease emergence, amplification, and transmission, in order to better substantiate behavioral disease drivers, along with the social dimensions of infection and transmission dynamics. Understanding these dynamics is critical to achieving health security--the protection from threats to health-- which requires investments in both collective and individual health security. Involving behavioral sciences into zoonotic disease surveillance allowed us to push toward fuller community integration and engagement and toward dialogue and implementation of recommendations for disease prevention and improved health security

Liposome-encapsulated 0.5% 5-aminolevulinic acid with intense pulsed light for the treatment of inflammatory facial acne: A pilot study

Background: Liposome used in spray form to encapsulate and deliver 5-aminolevulinic acid (5-ALA) into the pilosebaceous unit lowers the concentration of 5-ALA to 0.5% in photodynamic therapy (PDT) for acne, with low post-treatment photosensitivity. Objective: To investigate the clinical outcome and side effects of PDT using intense pulsed light (IPL) and 0.5% 5-ALA spray for inflammatory facial acne in Asian skin. Methods: Twelve subjects (skin types IV-V) with facial acne received full-face treatment at 3-week intervals with IPL 1 hour after being sprayed with 5-ALA. Lesion counts were assessed using serial standardized photographs taken up to 6 months after treatment. Serial sebum measurement and subjective assessment was conducted. Results: There were mean reductions in inflammatory lesions of 52% at 1 month (p=.02) and 65% at 6 months (p=.04) after treatment. Mean subjective acne score decreased from 6.6 to 4.5 (on a scale from 1 to 10) 1 month after treatment. Significant reduction in sebum production was noted only on the forehead. No significant side effects, including postinflammatory hyperpigmentation and phototoxicity, were observed. Conclusion: Use of 0.5% liposome-encapsulated 5-ALA spray with IPL reduced inflammatory facial acne in Asians, with a low risk of persistent phototoxic effects after PDT in this pilot study. Danish Dermatologic Development, HÃrsholm, Denmark provided the IPL device and liposome-encapsulated 5-ALA spray used in this study. © 2011 by the American Society for Dermatologic Surgery, Inc.link_to_subscribed_fulltex

Treatment of inflammatory facial acne with 1,450-nm diode laser in type IV to v Asian skin using an optimal combination of laser parameters

Background The 1,450-nm diode laser is effective for the treatment of inflammatory acne, but there is a significant risk of postinflammatory hyperpigmentation (PIH) in Asian skin. Objective To determine whether lower fluence and shorter cooling duration of the 1,450-nm diode laser improve acne effectively with minimal PIH in darker skin. Materials and Methods Twenty-six subjects (skin phototypes IV-V) with inflammatory facial acne received four treatments using the 1,450-nm diode laser with 6-mm spot size 3 to 4 weeks apart. We used three passes with a fluence of 8 J/cm2 with dynamic cooling of 25 ms to minimize PIH. Serial blinded assessment of acne lesion counts and sebum measurement were evaluated before and up to 6 months after treatment. Results Four weeks and 6 months after the last treatment, reduction of mean acne lesions was 29% (p<.01) and 40% (p<.03), respectively, from baseline in the group with moderate acne. Significant improvements of sebum production were noted. Four episodes of temporary PIH (3.8%) were observed out of all treatment sessions. Conclusion Use of multiple passes of a 1,450-nm diode laser with lower fluence and shorter dynamic cooling device retains its therapeutic efficacy with substantial reduction of PIH for moderate acne. The nonablative 1,450-nm diode laser was loaned for this study by Candela, Corp., Wayland, Massachusetts. © 2009 by the American Society for Dermatologic Surgery, Inc.link_to_subscribed_fulltex

A comparative study of intense pulsed light alone and its combination with photodynamic therapy for the treatment of facial acne in Asian skin

Background and Objectives: The reaction to intense pulsed light (IPL) on Asian skin often differs from that on Caucasian skin. The study reported herein evaluated the effect on acne vulgaris of IPL alone and when IPL was combined with photodynamic therapy (PDT) using topical methyl aminolevulinate (MAL) in Asians. Study Design/Materials and Methods: Thirty Chinese subjects with phototypes IV or V and moderate acne were enrolled for a randomized, half-facial treatment study with IPL alone, IPL with PDT, or as controls. Sixteen percent MAL cream was applied to half of the face 30 minutes before treatment in the PDT group. The IPL was provided by the Ellipse Flex system (Danish Dermatologic Development, Denmark), which emitted wavelengths of 530 to 750 nm. The subjects were treated four times at 3-week intervals. Single passes of double pulses with a 10 milliseconds delay and a pulse duration of 2.5 milliseconds were used. The assessment of inflammatory and non-inflammatory acne lesions by two blinded investigators was based on standardized photographs that were taken before each treatment, and at 4 and 12 weeks after the final treatment. Results: Twenty-three patients completed the study. The mean reduction of the inflammatory lesion count was 53% in the PDT group, 22% in the IPL group, and 72% in the control group at 4 weeks, and 65% in the PDT group, 23% in the IPL group, and 88% in control group at 12 weeks. The mean clearance of non-inflammatory lesions was 52% in the PDT group, 15% in the IPL group, and 14% in the control group at 4 weeks, and 38% in the PDT group and 44% in the IPL group at 12 weeks, when and an increase of 15% was noted in the control group. Most patients experienced a reduction of inflammatory lesions that was not statistically significant on the PDT-treated side (P = 0.06) or the IPL-treated side (P = 0.82) at 12 weeks after treatment. Pretreatment with MAL resulted in a better clearance of inflammatory acne than IPL alone. There were no statistically significant differences between the intervention groups and the control group in the mean reduction of inflammatory lesions. Significant reductions of non-inflammatory lesions were observed in the MAL-PDT group (38%, P = 0.05) and IPL groups (43%, P = 0.00) 12 weeks after treatment. Twenty-five percent of the subjects in the PDT group withdrew because of intolerance to procedure-related discomfort. Conclusions: MAL-PDT using IPL and MAL in Asians did not lead to significant improvement of moderate inflammatory acne compared with the control group. However, there was a delayed effect on non-inflammatory lesions, with significant reductions in both the PDT and IPL groups. A proportion of patients could not tolerate the discomfort that was related to PDT despite the short MAL incubation. © 2007 Wiley-Liss, Inc.link_to_subscribed_fulltex

Combined infrared light and bipolar radiofrequency for skin tightening in Asians

Background and Objective: As the demand for non-invasive procedures for skin tightening is increasing, combined optical and radiofrequency (RF) devices have recently emerged. The purpose of this study is to evaluate the safety and efficacy of a device that combined broadband infrared (IR) light (700-2000 nm) and bipolar RF (electro-optical synergy [ELOS]) for non-ablative treatment of facial laxity. Design/Materials and Methods: Nineteen Chinese volunteers of skin types III-V, with facial laxity and periorbital rhytides, received three treatments at 3-week intervals with combined IR (700-2000 nm, 10 W/cm 2) and RF energies (70-120 J/cm3). Standardized photographs were taken by the Canfield Visia CR system at baseline and serially for 3 months after the last treatment. Two masked assessors evaluated the photographs to assess the improvement in skin laxity. Patient satisfaction scores were also obtained. Results: At 3 months after the last treatment, 89.5% of the subjects reported moderate to significant subjective improvement in skin laxity of cheek, jowl, periorbital area and upper neck, with a high overall satisfaction rating. Masked observers' assessments were less remarkable. Mild improvement in skin laxity was observed over mid and lower face. There was no serious complication. Conclusion: The combination of broadband infrared light and bipolar radiofrequency produces mild improvement of facial laxity in Asians with no serious adverse sequelae. A high patients' satisfaction is achieved. However, further studies are necessary to demonstrate the long-term effects of the procedure and to optimize treatment parameters. © 2007 Wiley-Liss, Inc.link_to_subscribed_fulltex