The clinical impact of chromosomal microarray on paediatric care in Hong Kong

Objective To evaluate the clinical impact of chromosomal microarray (CMA) on the management of paediatric patients in Hong Kong. Methods We performed NimbleGen 135k oligonucleotide array on 327 children with intellectual disability (ID)/developmental delay (DD), autism spectrum disorders (ASD), and/or multiple congenital anomalies (MCAs) in a university-affiliated paediatric unit from January 2011 to May 2013. The medical records of patients were reviewed in September 2013, focusing on the pathogenic/likely pathogenic CMA findings and their “clinical actionability” based on established criteria. Results Thirty-seven patients were reported to have pathogenic/likely pathogenic results, while 40 had findings of unknown significance. This gives a detection rate of 11% for clinically significant (pathogenic/likely pathogenic) findings. The significant findings have prompted clinical actions in 28 out of 37 patients (75.7%), while the findings with unknown significance have led to further management recommendation in only 1 patient (p<0.001). Nineteen out of the 28 management recommendations are “evidence-based” on either practice guidelines endorsed by a professional society (n = 9, Level 1) or peer-reviewed publications making medical management recommendation (n = 10, Level 2). CMA results impact medical management by precipitating referral to a specialist (n = 24); diagnostic testing (n = 25), surveillance of complications (n = 19), interventional procedure (n = 7), medication (n = 15) or lifestyle modification (n = 12). Conclusion The application of CMA in children with ID/DD, ASD, and/or MCAs in Hong Kong results in a diagnostic yield of ∼11% for pathogenic/likely pathogenic results. Importantly the yield for clinically actionable results is 8.6%. We advocate using diagnostic yield of clinically actionable results to evaluate CMA as it provides information of both clinical validity and clinical utility. Furthermore, it incorporates evidence-based medicine into the practice of genomic medicine. The same framework can be applied to other genomic testing strategies enabled by next-generation sequencing.published_or_final_versio

Adjunctive mood stabilizer treatment for hospitalized schizophrenia patients: Asia psychotropic prescripton study (2001-2008)

Recent studies indicate relatively high international rates of adjunctive psychotropic medication, including mood stabilizers, for patients with schizophrenia. Since such treatments are little studied in Asia, we examined the frequency of mood-stabilizer use and its clinical correlates among hospitalized Asian patients diagnosed with schizophrenia in 2001-2008. We evaluated usage rates of mood stabilizers with antipsychotic drugs, and associated factors, for in-patients diagnosed with DSM-IV schizophrenia in 2001, 2004 and 2008 in nine Asian regions: China, Hong Kong, India, Korea, Japan, Malaysia, Taiwan, Thailand, and Singapore. Overall, mood stabilizers were given to 20.4% (n=1377/6761) of hospitalized schizophrenia patients, with increased usage over time. Mood-stabilizer use was significantly and independently associated in multivariate logistic modeling with: aggressive behaviour, disorganized speech, year sampled (2008 vs. earlier), multiple hospitalizations, less negative symptoms, younger age, with regional variation (Japan, Hong Kong, Singapore>Taiwan or China). Co-prescription of adjunctive mood stabilizers with antipsychotics for hospitalized Asian schizophrenia patients increased over the past decade, and was associated with specific clinical characteristics. This practice parallels findings in other countries and illustrates ongoing tension between evidence-based practice vs. individualized, empirical treatment of psychotic disorders.published_or_final_versio

Exercise training as a novel primary treatment for localised prostate cancer: a multi-site randomised controlled phase II study

Alternative management strategies for localised prostate cancer are required to reduce morbidity and overtreatment. The aim of this study was to evaluate the feasibility, safety and acceptability of exercise training (ET) with behavioural support as a primary therapy for low/intermediate risk localised prostate cancer. Men with low/intermediate-risk prostate cancer were randomised to 12 months of ET or usual care with physical activity advice (UCwA) in a multi-site open label RCT. Feasibility included acceptability, recruitment, retention, adherence, adverse events and disease progression. Secondary outcomes included quality of life and cardiovascular health indices. Of the 50 men randomised to ET (n=25) or UCwA (n=25), 92% (n=46) completed 12 month assessments. Three men progressed to invasive therapy (two in UCwA). In the ET group, men completed mean: 140 mins per week for 12 months (95% CI 129,152mins) (94% of target dose) at 75% Hrmax. Men in the ET group demonstrated improved body mass (mean reduction: 2.0 kg; 95% CI -2.9,-1.1), reduced systolic (mean: 13 mmHg; 95% CI 7,19) and diastolic blood pressure (mean:8 mmHg; 95% CI 5,12) and improved quality of life (EQ5D mean:13 points; 95% CI 7,18). There were no serious adverse events. ET in men with low/intermediate risk prostate cancer is feasible and acceptable with a low progression rate to radical treatment. Early signals on clinically relevant markers were found which warrant further investigation

A Comprehensive Review on the Emerging Roles of Nanofillers and Plasticizers towards Sustainable Starch-Based Bioplastic Fabrication.

Petroleum-based plastics are associated with environmental pollution problems owing to their non-biodegradable and toxic properties. In this context, renewable and biodegradable bioplastics possess great potential to replace petroleum-based plastics in mitigating these environmental issues. Fabrication of bioplastic films involves a delicate mixture of the film-forming agent, plasticizer and suitable solvent. The role of the plasticizer is to improve film flexibility, whereas the filler serves as a reinforcement medium. In recent years, much research attention has been shifted toward devising diverse methods for enhancing the performance of bioplastics, particularly in the utilization of environmentally benign nanoparticles to displace the conventional hazardous chemicals. Along this line, this paper presents the emergence of nanofillers and plasticizers utilized in bioplastic fabrication with a focus on starch-based bioplastics. This review paper not only highlights the influencing factors that affect the optical, mechanical and barrier properties of bioplastics, but also revolves around the proposed mechanism of starch-based bioplastic formation, which has rarely been reviewed in the current literature. To complete the review, prospects and challenges in bioplastic fabrication are also highlighted in order to align with the concept of the circular bioplastic economy and the United Nations' Sustainable Development Goals

Rapid Ultrasound-Assisted Starch Extraction from Sago Pith Waste (SPW) for the Fabrication of Sustainable Bioplastic Film.

The present study was conducted to optimize the extraction yield of starch from sago (Metroxylon sagu) pith waste (SPW) with the assistance of ultrasound ensued by the transformation of extracted starch into a higher value-added bioplastic film. Sago starch with extraction yield of 71.4% was successfully obtained using the ultrasound-assisted extraction, with the following conditions: particle size <250 µm, solid loading of 10 wt.%, ultrasonic amplitude of 70% and duty cycle of 83% in 5 min. The rapid ultrasound approach was proven to be more effective than the conventional extraction with 60.9% extraction yield in 30 min. Ultrasound-extracted starch was found to exhibit higher starch purity than the control starch as indicated by the presence of lower protein and ash contents. The starch granules were found to have irregular and disrupted surfaces after ultrasonication. The disrupted starch granules reduced the particle size and increased the swelling power of starch which was beneficial in producing a film-forming solution. The ultrasound-extracted sago starch was subsequently used to prepare a bioplastic film via solution casting method. A brownish bioplastic film with tensile strength of 0.9 ± 0.1 MPa, Young's modulus of 22 ± 0.8 MPa, elongation at break of 13.6 ± 2.0% and water vapour permeability (WVP) of 1.11 ± 0.1 × 10-8 g m-1 s-1 Pa-1 was obtained, suggesting its feasibility as bioplastic material. These findings provide a means of utilization for SPW which is in line with the contemporary trend towards greener and sustainable products and processes

Medullary Thyroid Carcinoma in Pregnancy: A Case Report and Literature Review on Maternal and Neonatal Outcome of Delayed Surgery Post-Partum

Abstract Thyroid malignancy poses a challenge especially when diagnosed during pregnancy. Although in papillary thyroid carcinoma, surgery can be safely delayed until the post-partum period, in medullary thyroid carcinoma, there is more urgency to treat. Here, we present a case of a 31-year-old female was diagnosed with medullary thyroid carcinoma during her third trimester. Diagnosis was made by aspiration cytology. Due to the patient’s condition, a CT scan was contraindicated and thus we were unable to make a complete assessment. A decision was made that the surgery was done after delivery, and when a complete assessment can be done. The surgery was successful and there were no complications both for the patient and her baby. In patients whom diagnosis of medullary thyroid carcinoma is made during the third trimester, it appears to be safe for mother and baby that surgery is done during the postpartum period. Keywords: Medullary thyroid carcinoma, MTC, thyroid carcinoma in pregnancy, MTC in pregnanc

Effect of guar gum on the physicochemical, thermal, rheological and textural properties of green edam cheese

In attempts to produce a low-fat cheese with a rheology and texture similar to that of a full-fat cheese, guar gum (within 0.0025–0.01%; w/v, final concentration) was added to low-fat milk. The obtained cheeses were characterised regarding their physicochemical, thermal, rheological and textural properties. Control cheeses were also produced with low and full-fat milk. The physicochemical properties of the guar gum modified cheeses were similar to those of the low-fat control. No significant differences were detected in the thermal properties (concerning the enthalpy and profile of water desorption) among all types of cheeses. The rheological behaviour of the 0.0025% modified cheese was very similar to the full-fat control. Overall, no trend was observed in the texture profile (hardness, cohesiveness, gumminess and elasticity) of the modified cheeses versus guar gum concentration, as well as in comparison with the control groups, suggesting that none of the studied polysaccharide concentrations simulated the textural functions of fat in Edam cheese

In situ production of titanium dioxide nanoparticles in molten salt phase for thermal energy storage and heat-transfer fluid applications

In this study, TiO2 nanoparticles (average particle size 16 nm) were successfully produced in molten salt phase and were showed to significantly enhance the specific heat capacity of a binary eutectic mixture of sodium and potassium nitrate (60/40) by 5.4 % at 390 °C and 7.5 % at 445 °C for 3.0 wt% of precursors used. The objective of this research was to develop a cost-effective alternate method of production which is potentially scalable, as current techniques utilized are not economically viable for large quantities. Enhancing the specific heat capacity of molten salt would promote more competitive pricing for electricity production by concentrating solar power plant. Here, a simple precursor (TiOSO4) was added to a binary eutectic mixture of potassium and sodium nitrate, heated to 450 °C, and cooled to witness the production of nanoparticles

Invasion of ovarian cancer cells is induced by PITX2-mediated activation of TGF-β and Activin-A

Background:Most ovarian cancers are highly invasive in nature and the high burden of metastatic disease make them a leading cause of mortality among all gynaecological malignancies. The homeodomain transcription factor, PITX2 is associated with cancer in different tissues. Our previous studies demonstrated increased PITX2 expression in human ovarian tumours. Growing evidence linking activation of TGF-β pathway by homeodomain proteins prompted us to look for the possible involvement of this signalling pathway in PITX2-mediated progression of ovarian cancer. Methods: The status of TGF-β signalling in human ovarian tissues was assessed by immunohistochemistry. The expression level of TGFB/INHBA and other invasion-associated genes was measured by quantitative-PCR (Q-PCR) and Western Blot after transfection/treatments with clones/reagents in normal/cancer cells. The physiological effect of PITX2 on invasion/motility was checked by matrigel invasion and wound healing assay. The PITX2- and activin-induced epithelial-mesenchymal transition (EMT) was evaluated by Q-PCR of respective markers and confocal/phase-contrast imaging of cells. Results: Human ovarian tumours showed enhanced TGF-β signalling. Our study uncovers the PITX2-induced expression of TGFB1/2/3 as well as INHBA genes (p < 0.01) followed by SMAD2/3-dependent TGF-β signalling pathway. PITX2-induced TGF-β pathway regulated the expression of invasion-associated genes, SNAI1, CDH1 and MMP9 (p < 0.01) that accounted for enhanced motility/invasion of ovarian cancers. Snail and MMP9 acted as important mediators of PITX2-induced invasiveness of ovarian cancer cells. PITX2 over-expression resulted in loss of epithelial markers (p < 0.01) and gain of mesenchymal markers (p < 0.01) that contributed significantly to ovarian oncogenesis. PITX2-induced INHBA expression (p < 0.01) contributed to EMT in both normal and ovarian cancer cells. Conclusions: Overall, our findings suggest a significant contributory role of PITX2 in promoting invasive behaviour of ovarian cancer cells through up-regulation of TGFB/INHBA. We have also identified the previously unknown involvement of activin-A in promoting EMT. Our work provides novel mechanistic insights into the invasive behavior of ovarian cancer cells. The extension of this study have the potential for therapeutic applications in future

Clinical and physiological effects of transcranial electrical stimulation position on motor evoked potentials in scoliosis surgery

<p>Abstract</p> <p>Background</p> <p>During intraoperative monitoring for scoliosis surgery, we have previously elicited ipsilateral and contralateral motor evoked potentials (MEP) with cross scalp stimulation. Ipsilateral MEPs, which may have comprised summation of early ipsilaterally conducted components and transcallosally or deep white matter stimulated components, can show larger amplitudes than those derived purely from contralateral motor cortex stimulation. We tested this hypothesis using two stimulating positions. We compared intraoperative MEPs in 14 neurologically normal subjects undergoing scoliosis surgery using total intravenous anesthetic regimens.</p> <p>Methods</p> <p>Trancranial electrical stimulation was applied with both cross scalp (C3C4 or C4C3) or midline (C3Cz or C4Cz) positions. The latter was assumed to be more focal and result in little transcallosal/deep white matter stimulation. A train of 5 square wave stimuli 0.5 ms in duration at up to 200 mA was delivered with 4 ms (250 Hz) interstimulus intervals. Averaged supramaximal MEPs were obtained from the tibialis anterior bilaterally.</p> <p>Results</p> <p>The cross scalp stimulating position resulted in supramaximal MEPs that were of significantly higher amplitude, shorter latency and required lower stimulating intensity to elicit overall (Wilcoxon Signed Rank test, p < 0.05 for all), as compared to the midline stimulating position. However, no significant differences were found for all 3 parameters comparing ipsilaterally and contralaterally recorded MEPs (p > 0.05 for all), seen for both stimulating positions individually.</p> <p>Conclusions</p> <p>Our findings suggest that cross scalp stimulation resulted in MEPs obtained ipsilaterally and contralaterally which may be contributed to by summation of ipsilateral and simultaneous transcallosally or deep white matter conducted stimulation of the opposite motor cortex. Use of this stimulating position is advocated to elicit MEPs under operative circumstances where anesthetic agents may cause suppression of cortical and spinal excitability. Although less focal in nature, cross scalp stimulation would be most suitable for infratentorial or spinal surgery, in contrast to supratentorial neurosurgical procedures.</p