OBJECTIVE: To evaluate the efficacy of acupuncture in treating chronic fatigue syndrome (CFS) in Hong Kong. METHODS: A single-blinded, randomized controlled trial design was adopted. Participants meeting inclusion criteria were randomly assigned to a treatment and a control group according to 1:1 ratio, resulting in an effective sample size of 99, with 50 and 49 patients in treatment and control group respectively. The same set of acupuncture points, which were selected according to traditional Chinese medicine theories, was applied in both groups, while conventional needle acupuncture was applied in treatment group and sham acupuncture (without skin penetration) was applied in control group. Schedule of treatment was the same in both groups, i.e. twice a week for 4 weeks. Key outcome measures were Chalder's Fatigue Scale, diagnostic criteria for CFS of the US's Centre for Disease Control and SF-12 health-related quality of life (HQOL) questionnaire. Adverse events, if any, were recorded. RESULTS: Improvements in physical and mental fatigue and HQOL in both groups were observed, but the improvements in treatment group were significantly bigger than in control group (P<0.01 or P<0.05). No adverse events occurred. CONCLUSION: Acupuncture is a safe, effective treatment for CFS.

Background/Aims: Sigmoidoscopy is performed in most medical centers to evaluate the distal colons of young adults presenting with hematochezia who are at risk of developing proximal lesions. Colonoscopies offer more complete evaluations but are associated with a higher incidence of complications and possible low yield. Methods: An analysis was conducted on colonoscopies performed in our center on patients 40 years of age or younger. The study population was sub-divided into 2 age groups for analysis: <30 years of age and 30–39 years of age. Results: We recruited 453 patients for the study. Patients were 115 and 338 individuals that were <30 and 30–39 years of age, respectively. Hemorrhoids was identified as the cause of bleeding in the majority of cases. The overall incidence of polyps was 6.5%; this was significantly higher in the 30–39 age group (7.4% vs. 1.7%, p=0.026). There were two cases of advanced/malignant polyps. While the majority of the polyps were in the distal colon, 28% of the polyps in the older age group were found in the proximal colon. There was one case of colonic perforation. Conclusions Colonic polyps are more prevalent in patients aged 30–39. Colonoscopies should be considered for patients over the age of 30 with rectal bleeding.

Methods: Study participants were recruited from Shuguang East Hospital, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, and Shanghai Municipal Hospital of Traditional Chinese Medicine, affiliated with Shanghai University of Traditional Chinese Medicine, from April 15 to September 15, 2021. They were categorized into three groups: healthy controls (Group 1), CHD patients without a history of ischemic stroke (Group 2), and CHD patients with a history of ischemic stroke (Group 3). The wrist pulse signals of the study participants were non-invasively collected using a pulse diagnosis instrument. The linear time-domain features and nonlinear time-series multiscale entropy (MSE) features of the pulse signals were extracted using time-domain analysis and the MSE methods, which were subsequently compared between groups. Based on these extracted features, a recognition model was developed using a random forest (RF) algorithm. The classification performance of the models was evaluated using metrics, including accuracy, precision, recall, and F1-score derived from confusion matrix as well as the area under the receiver operating characteristics (ROC) curve (AUC). Results: A total of 189 participants were enrolled, with 63 in Group 1, 61 in Group 2, and 65 in Group 3. Compared with Group 1, Group 2 showed significant increases in pulse features H2/H1, H3/H1, W1, W2, and W2/T, and decreased in MSE1 – MSE7 (P < 0.05), while Group 3 showed significant increases in pulse features T5/T4, T, H1/T1, W1, W2, AS, and Ad, and decreased in MSE1 – MSE20 (P < 0.05). Compared with Group 2, Group 3 demonstrated notable increases in H1/T1 and As (P < 0.05). The RF model achieved precision of 80.00%, 61.54%, and 61.54%, recall of 74.29%, 60.00%, and 68.97%, F1-scores of 70.04%, 60.76%, and 65.04%, and AUC values of 0.92, 0.74, and 0.81 for Groups 1, 2, and 3, respectively. The overall accuracy was 67.69%, with micro-average AUC of 0.83 and macro-average AUC of 0.82. Conclusion Differences in pulse features reflect variations in arterial compliance, peripheral resistance, cardiac afterload, and pulse signal complexity among healthy individuals, CHD patients without a history of ischemic stroke, and those with such a history. The developed pulse-based recognition model holds the potential in distinguishing between these three groups, offering a novel diagnostic reference for clinical practice.

Purpose: This study was performed to evaluate the outcome of implementation of transanal total mesorectal excision (TaTME) for low rectal cancer in a regional hospital and in comparison to laparoscopic (Lap) TME. Methods: Consecutive patients with low rectal cancer of which the lowest border of the tumour was located beween 1 and 5 cm from the puborectalis who underwent TME at North District Hospital between January 2013 and December 2019 were included. Clinical, operative, and pathologic outcomes were compared between Lap TME and TaTME. The primary end point was complication profile. Results: Thirty-five patients underwent Lap TME and 45 patients underwent TaTME for low rectal cancer. The conversion rate of the TaTME group was significantly lower than that of the Lap TME group (4.4% vs. 20%, P=0.029), but the operating time was longer (259 minutes vs. 219 minutes, P=0.009). The tumour location was significantly lower in the TaTME group, but the distal resection margins were adequate and not different between both groups. The TaTME group had higher incidence rates of prolonged ileus and urinary tract infection, but the other complications were similar between the two groups. The resection margin positivity rates of the TaTME and Lap TME groups were 2.2% and 5.7%, respectively (P=0.670). At a median follow up of 39 months, no abnormal early recurrence was detected. Conclusion It is technically feasible and oncologically safe to perform TaTME in a medium-volume colorectal unit. Patients with difficult pelvic anatomy can benefit by reducing the risk of conversion and margin positivity rate.

We present an unusual case of advanced ovarian carcinoma with postoperative complications of ischemia and perforation of the rectum as a result of tumor embolism. The interval progression from ischemia to infarction of the rectum was captured in repeated sigmoidoscopies. A brief discussion on tumor embolism and management of this case is also included.
Carcinoma* ; Infarction ; Ischemia* ; Neoplastic Cells, Circulating* ; Ovarian Neoplasms ; Postoperative Complications ; Rectum ; Sigmoidoscopy

INTRODUCTIONWe conducted a single-centre, prospective randomised clinical trial to investigate the analgesic efficacy of transversus abdominis plane (TAP) block in adult patients undergoing laparoscopic appendicectomy.

METHODSPatients undergoing urgent laparoscopic appendicectomy under general anaesthesia alone (control group) and general anaesthesia supplemented by TAP block (TAP intervention group) were compared. All patients received a multimodal analgesia regime, which included postoperative morphine via a patient-controlled analgesia device. The primary endpoints were morphine consumption at 12 hours and 24 hours postoperatively. Secondary endpoints included pain scores, incidence of nausea and vomiting, and time to hospital discharge. A total of 58 patients were recruited, with 29 patients in each group.

RESULTSMean postoperative morphine consumption at 12 hours (control group: 11.45 ± 7.64 mg, TAP intervention group: 9.79 ± 8.09 mg; p = 0.4264) and 24 hours (control group: 13.38 ± 8.72 mg, TAP intervention group: 11.31 ± 8.66 mg; p = 0.3686) for the control and TAP intervention groups were not statistically different. Secondary outcomes were also not different between the two groups. Length of stay in the post-anaesthesia care unit was significantly shorter for the TAP intervention group, with a trend toward faster hospital discharge being observed.

CONCLUSIONTAP block, a regional anaesthetic procedure performed immediately prior to skin incision for laparoscopic appendicectomy, did not significantly improve postoperative analgesia outcomes.

OBJECTIVES: This study aimed to evaluate the benefits of ClearVoice strategy on speech perception in noise and in everyday listening situations in Cantonese-speaking cochlear implant users. METHODS: Twelve experienced adult users of the Harmony implant and HiRes 120 sound processing participated in the study. The study employed a prospective within-subjects design wherein speech recognition in adults using HiRes 120 without ClearVoice turned on (control option) was compared to their performance with HiRes 120 with ClearVoice turned on. Each subject was evaluated with two different ClearVoice gain settings: -12 dB (ClearVoice medium) and -18 dB (ClearVoice high) after one-week of use. The Cantonese hearing in noise test and a questionnaire were used as the outcome measures. RESULTS: Subjects performed significantly better with ClearVoice medium than with control option in noise. No significant difference in performance was noted among the 3 settings in quiet. Most subjects reported high level of satisfaction with ClearVoice in daily listening situations and preferred to keep ClearVoice on. CONCLUSION: ClearVoice can help cochlear implant recipients to hear better in noise.
Adult ; Cochlear Implantation ; Cochlear Implants ; Hearing ; Humans ; Noise ; Prospective Studies ; Speech Perception ; Surveys and Questionnaires

OBJECTIVETo explore the personality-adjusting effect of electro-acupuncture treatment for depression and compared this treatment with paroxetine treatment.

METHODSA non-blinded, randomized controlled trial was adopted. Sixty depressed patients, who met trial criteria, were randomly assigned to the treatment and the control groups. In the treatment group, electro-acupuncture treatment was used, and paroxetine treatment was used in the control group. During the 24-week study period, 12 patients dropped out and 48 patients completed the study. The Minnesota Multiple Personality Inventory (MMPI) was adopted as the evaluation tool. At the same time, the Self-rating Depression Scale (SDS), Self-rating Anxiety Scale (SAS) and Montgomery-Asberg Depression Rating Scale (MADRS) were used to evaluate the psychological state. Evaluations were done before and after treatment.

RESULTSAfter treatment, patients' psychological state improved significantly in both groups (P<0.01). For the treatment group, within-group comparison between baseline and after 24 weeks of treatment showed that severity of depression had significantly decreased (P<0.01). MADRS and SDS scores decreased significantly (P<0.05) and MMPI subscale scores for hypochondriasis, depression, psychopathic deviate, psychasthenia, social introversion and fake decreased significantly (P<0.05). For the control group, severity of depression also decreased significantly. MADRS and SDS scores decreased significantly (P<0.05); and MMPI subscale scores for hypochondriasis, depression, hysteria, paranoia, and psychasthenia decreased significantly (P<0.05). Between-group comparison demonstrated that for the MMPI subscales paranoia and social introversion, the decrease of score was greater in the treatment group than in the control group (P<0.05). However, there were no other significant differences between the control group and the treatment group.

CONCLUSIONElectro-acupuncture is effective for treating depression and affects personality traits.

Case-Control Studies ; Demography ; Depression ; drug therapy ; psychology ; therapy ; Electroacupuncture ; Female ; Humans ; Male ; Middle Aged ; Paroxetine ; therapeutic use ; Patient Dropouts ; Personality ; Personality Inventory ; Psychiatric Status Rating Scales

INTRODUCTION: Self-expanding metal stents (SEMS) can be used as a bridge to surgery (BTS) or for palliation in the treatment of malignant large bowel obstruction. This case series evaluates the short-term outcomes of SEMS and success rates over time. METHODS: A total of 75 consecutive patients who underwent colonic stenting for malignant colonic obstruction over a period of six years were included. This time period was subdivided into two equal parts for analysis. The procedure was carried out by a single surgeon from a tertiary institution in Singapore. RESULTS: Technical success was reported in 93.3% of cases and clinical success in 81.3% of cases, with better success rates in the second half of the study (89.2% vs. 73.7%; p < 0.05). There were seven cases of inadequate decompression and two cases of colonic perforation. The median duration from stent insertion to surgery was ten days, and the median postoperative length of stay was six days. CONCLUSION SEMS are a safe and effective way of relieving malignant large bowel obstruction, including those that are proximal. The improvement in success over time reflects the importance of having an experienced endoscopist carry out the procedure to ensure optimum success rates.

STUDY DESIGN: A retrospective review of patients who underwent 2-level anterior cervical discectomy and fusion (ACDF) with standalone polyetheretherketone (PEEK) cages for cervical spondylotic myelopathy (CSM). PURPOSE: To evaluate the efficacy of stand-alone PEEK cage in 2-level cervical interbody fusion for CSM. OVERVIEW OF LITERATURE: ACDF is a standard surgical procedure to treat degenerative disc disease. However, the use of additional anterior plating for 2-level ACDF remains controversial. METHODS: We reviewed outcomes of patients who underwent 2-level ACDF with stand-alone PEEK cages for CSM over a 7-year period (2007–2015) in a regional hospital. Japanese Orthopaedic Association (JOA) score, fusion rate, subsidence rate, cage migration, and cervical alignment by the C2–7 angle as well as the local segmental angle (LSA) of the cervical spine were assessed. RESULTS: In total, 31 patients (mean age, 59 years; range, 36–87 years) underwent 2-level ACDF with a cage-only construct procedure between 2007 and 2015. The minimum follow-up was 24 months; mean follow-up was 51 months. C3–5 fusion was performed in 45%, C4–6 fusion in 32%, and C5–7 fusion in 23%. Mean JOA score improved from 10.1±2.2 to 13.9±2.1 (p<0.01) at the 24-month follow-up. Fusion was achieved in all patients. Subsidence occurred in 22.5% of the cages but was not associated with differences in JOA scores, age, sex, or levels fused. Lordosis of the C2–7 angle and LSA increased after surgery, which were maintained for up to 1 year but subsequently disappeared after 2 years, yet the difference was not statistically significant. No cage migration was noted; two patients developed adjacent segment disease requiring posterior laminoplasty 3 years after ACDF. CONCLUSIONS: The use of a stand-alone PEEK cage in a 2-level cervical interbody fusion achieves satisfactory improvements in both clinical outcomes and fusion.
Animals ; Asian Continental Ancestry Group ; Diskectomy ; Follow-Up Studies ; Humans ; Laminoplasty ; Lordosis ; Retrospective Studies ; Spinal Cord Diseases ; Spine