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Intravenous fluid selection rationales in acute clinical management

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World Journal of Emergency Medicine 2018年第1期9卷 13-19页

作者： Wing Yan Shirley Cheung Wai Kwan Cheung Chun Ho Lam Yeuk Wai Chan Hau Ching Chow Ka Lok Cheng Yau Hang Wong Chak Wah Kam Accident and Emergency Department Tuen Mun Hospital

BACKGROUND: Intravenous fluid(IVF) is commonly used in acute clinical management. This study aimed to review the choice and primary considerations in IVF prescriptions and to evaluate the adequacy of guidelines and trainings on it in the New Territories West Cluster(NTWC) of Hong ***: This is a descriptive study based on data collected from an online survey. Data were processed by SPSS for statistical analysis. This study focused on a general description and doctor-nurse between group comparison. Participants were asked the choice of IVF for nine acute clinical scenarios and provide reason. A 1–10 scale was used to assess the sufficiency of guideline, training and information, and time for revision on IVF ***: 0.9% sodium chloride was the most familiar IVF(36%), followed by 5% Dextrose solution(26%). In the nine scenarios, the most chosen IVF was 0.9% sodium chloride(37%–61%). There was significant difference in the choice of IVF between doctors and nurses in 7 cases. The second most chosen IVF for doctors was Plasma-Lyte A while that for nurses was Gelofusine. Departmental practice was the most chosen reason to account for the prescription. The adequacy of guideline, information and training, and time for revision was rated 5. Doctors had significantly more time at work than nurses to update knowledge in IVF prescription(5.41 versus 4.57).CONCLUSION: 0.9% sodium chloride was mostly chosen. The choice of IVF was mainly based on departmental practice. Adequacy of guideline, information and training, and time for revision on IVF prescription were average, indicating significant training deficit.

关键词： Intravenous fluid Acute care Resuscitation

Is hepatic neoplasm-related pyogenic liver abscess a distinct clinical entity?

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World Journal of Gastroenterology 2012年第10期18卷 1110-1116页

作者： Siu-Tong Law Ki Kong Li Division of Gastroenterology and Hepatology Department of Medicine and Geriatrics Tuen Mun Hospital

AIM: To compare the clinical characteristics of pyogenic liver abscess (PLA) in patients with and without hepatic neoplasm (HN). METHODS: We performed a retrospective analysis involving patients with PLA. The demographic, clinical features, laboratory and imaging findings, management and outcome of patients with and without HN were studied. RESULTS: From January 2000 to December 2009 inclusive, 318 patients (35 with HN) had PLA, and mean age and comorbidity were comparable between the two groups. More patients with HN experienced right upper quadrant pain (68.6% vs 52.7%, P < 0.04), developed jaundice (14.3% vs 5.7%, P < 0.03) and hepatomegaly (17.1% vs 3.9%, P < 0.01), and had higher serum total bilirubin level (43.3 μmol/L vs 30.0 μmol/L, P = 0.05). Most patients in both groups had PLAs in the right hepatic lobe, and biliary tract disorder was the most common underlying cause (71.4% and 61.8%). However, more PLAs in the HN group were associated with thicker abscess wall (37.1% vs 19.4%, P < 0.01), septal lobulation (77.1% vs 58%, P < 0.02), gaseous cavitation (17% vs 7.8%, P = 0.03), portal thrombophlebitis (11.4% vs 1.8%, P < 0.01) and aerobilia (25.9% vs 5.5%, P < 0.01). Mixed bacterial growth (40% vs 15.2%, P < 0.01) and Gram-negative bacilli (22.8% vs 60.4%, P < 0.01) were dominant isolates in PLAs with and without HN, respectively. Although incidence of the complications was comparable between the two groups, patients with HN had a higher mortality rate than those without (71.4% vs 8.8%, P < 0.01). Multivariate logistic regression analysis revealed underlying active malignancy [odds ratio (OR): 40.45, 95% CI: 14.76-111.65], hypoalbuminemia (OR: 1.22, 95% CI: 1.14-1.38), disseminated intravascular coagulation (OR: 3.32, 95% CI: 1.19-9.69) and acute coronary syndrome (OR: 4.48, 95% CI: 1.08-17.8) were independent risk factors associated with mortality. However, several HN cases, presented concurrently with PLAs, were found to have curative resectable tumors and

关键词： Pyogenic liver abscess Hepatic neoplasms Hepatic malignancy Liver abscess

Need of integrated dietary therapy for persons with diabetes mellitus and “unhealthy” body constitution presentations

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Journal of Integrative Medicine 2016年第4期14卷 255-268页

作者： Yee Chi Peggy Wong Dietetic Department Tuen Mun Hospital

From a perspective of Chinese medicine （CM）, persons with unregulated ＂unhealthy＂ body constitution （BC） will further develop chronic diseases, such as diabetes mellitus （DM）. Conventional dietary therapy with nutrition component has its limitations in the regulation of ＂unhealthy＂ BC. However, empirical evidence supports that ＂unhealthy＂ BC can be regulated with food natures and flavors from a perspective of CM. Presentations of ＂unhealthy＂ BC types, such as Yin-deficiency, Yang-deficiency and Yin-Yangdeficiency were found in persons with DM. It would be necessary to regulate the ＂unhealthy＂ BC presentations with integration of conventional dietary therapy and Chinese food therapy. The ultimate goal is to either stabilize glycaemic control or prevent the development of other chronic diseases leading to reduction of disease burden, such as disease-related poor quality of life, stress of healthcare professionals and the rising of healthcare cost.

关键词： body constitution diabetes mellitus Yin deficiency Yang deficiency dietary therapy

Semen quality： variations among fathers and effects of moderate alcohol drinking

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Asian Journal of Andrology 2015年第1期17卷 46-47页

作者： Trevor G Cooper tuen mun New Territories Hong Kong SAR China

Semen analysis results from over 750 fathers in the USA demonstrated marked differences in the quality of semen from men at different locations and of different ethnic groups. Another paper failed to demonstrate any effects of moderate alcohol consumption during the week before provision of an ejaculate on semen quality and few on serum hormones, of over 8300 men in Europe and the USA. While these observations are interesting, the reasons for regional and ethnic differences in semen quality of fathers are unclear. Although, there was no attempt to confirm the participant-provided level of alcohol consumption, an increase in serum testosterone in the men at the higher end of alcohol intake is compatible with an alcohol effect on liver metabolism, although whether alcohol intake was the cause of higher testosterone, or men with higher androgen levels consume more alcohol, is not known.

关键词： Semen quality variations among fathers

Epididymal research： more warp than weft？

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Asian Journal of Andrology 2015年第5期17卷 699-703,I0005页

作者： Trevor G Cooper tuen mun NTHong Kong SARChina

From a review of some aspects of epididymal structure, function and research done largely in my research area over the last 50 years, I conclude that more is known than is understood of sperm maturation and storage in the epididymis. Highly qualified technicians have not always applied sophisticated modern techniques in well-considered experiments to physiologically relevant and properly-prepared samples, so that our understanding of the biological problem of the nature of the epididymal epithelial influence on maturing epididymal spermatozoa has not kept pace with the outpouring of data generated, much of which is difficult to interpret. We stand at a crossroads of where to aim our limited resources and personnel： should we continue new technology-led studies in many directions, backtrack to test hypotheses and fill in gaps in our knowledge, or consider more biological directions to our research？

关键词：附睾精子扭曲现代技术技术人员数据生成十字路口多方向成熟

Rare case of intussusception in an adult with acute myeloid leukemia

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World Journal of Gastroenterology 2015年第2期21卷 688-693页

作者： Man Fai Law Cheuk Kei Wong Chun Yin Pang Hay Nun Chan Ho Kei Lai Chung Yin Ha Celia Ng Yiu Ming Yeung Sze Fai Yip Department of Medicine Tuen Mun Hospital Department of Medicine and Therapeutics Prince of Wales Hospital Department of Radiology Kwong Wah Hospital Department of Pathology Tuen Mun Hospital

Intussusception is rarely reported in adult patients with acute leukemia. We report a case of intussusception in a 29-year-old woman with acute myeloid leukemia(AML). She developed right lower quadrant pain, fever, and vomiting on day 16 of induction *** examination showed tenderness and guarding at the right lower quadrant of the abdomen. Abdominal computed tomography(CT) showed distension of the cecum and ascending colon, which were filled with loops of small bowel, and herniation of the ileocecal valve into the cecum. We proceeded to laparotomy and revealed ileocecal intussusception with the ileocecal valve as the leading point. The terminal ileum was thickened and invaginated into the cecum, which showed gangrenous changes. Right hemicolectomy was performed and microscopic examination of the colonic tissue showed infiltration of leukemic cells. The patient recovered after the operation and was subsequently able to continue treatment for AML. This case demonstrates that the diagnosis of intussusception is difficult because the presenting symptoms can be non-specific, but abdominal CT can be informative for preoperative diagnosis. Resection of the involved bowel is recommended when malignancy is suspected or confirmed. Intussusception should be considered in any leukemia patients presenting with acute abdomen. A high index of clinical suspicion is important for early diagnosis.

关键词： Intussusception Acute leukemia Abdominal pain Colo

Looking both ways： new research on old theories

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Asian Journal of Andrology 2015年第5期17卷 764-766页

作者： Trevor G Cooper tuen mun NT Hong Kong SAR China

In the 22 years since its inception this meetingI has become the focus of a still small but growing and devoted group of scientists, meeting purposefully at a leisurely interval of four years, so that only substantial advances are reported. As these meetings approach a quarter of a century of epididymal research, it is time to reflect on the focus of former, and direction of future, epididymal research.

关键词： cyto-chemical datasets leisurely

Concurrent stenoses: A common etiology of stroke in Asians

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World Journal of Clinical Cases 2014年第6期2卷 201-205页

作者： Bik Ling Man Yat Pang Fu Department of Medicine and Geriatrics Tuen Mun Hospital

Atherosclerosis of cerebral vessels is a common cause of stroke. Racial differences in the distribution of cerebrovascular occlusive disease are well *** stenosis is more common in Caucasians,while intracranial stenosis is more common in Asians,Hispanics and African-Americans. Concurrent atherosclerosis of extracranial and intracranial vessels is common in Asians. The incidence of concurrent stenoses ranges from 10% to 48% in patients with symptomatic cerebrovascular disease. The long-term prognosis of these patients is poor and they are at high risk of further vascular events or death. The purpose of this review is to examine the epidemiology, risk factors,stroke mechanism and genetics of concurrent stenoses and to discuss strategies for treatment.

关键词： Atherosclerosis Concurrent stenosis Stroke Asians

Characterization of available automated external def ibrillators in the market based on the product manuals in 2014

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World Journal of Emergency Medicine 2016年第2期7卷 138-146页

作者： Chik Leung Ho Ka Wai Cheng Tze Hang Ma Yau Hang Wong Ka Lok Cheng Chak Wah Kam Department of Accident and Emergency Medicine Tuen Mun Hospital

BACKGROUND: To popularize the wide-spread use of automated external defi brillator(AED) to save life in sudden cardiac arrest, we compared the strength and weakness of different types of AEDs to enable a sound selection based on regional ***: This was a retrospective descriptive study. Different types of AEDs were compared according to the information of AEDs from manuals and brochures provided by the manufacturers. Fifteen types of AEDs were divided into 3 groups, basic, intermediate and ***: Lifeline? AUTO AED had the best performance in price, portability and user-friendly among AEDs of basic level. It required less time for shock charging. Samaritan PAD defi brillator was superior in price, portability, durability and characteristic among AEDs of intermediate level. It had the longest warranty and highest protection against water and dust. Lifeline? PRO AED had the best performance in most of the criteria among AEDs of advanced level and offered CPR video and manual mode for laypersons and clinicians ***: Lifeline? AUTO AED, Samaritan PAD def ibrillator, Lifeline? PRO AED are superior in AEDs of basic, intermediate and advanced levels, respectively. A feasible AED may be chosen by users according to the regional requirement and the current information about the best available products.

关键词： Automated external defi brillator Electrodes Pads Cardiac arrest