Objective To investigate the value of Standardized Swallowing Assessment (SSA) in the screening for aspiration after stroke.Methods 81 patients with acute stroke received examinations of both SSA and Fiberoptic Endoscopic Examination of Swallowing (FEES). The SSA was then measured against the FEES study for sensitivity, specificity, positive predictive value and negative predictive value for aspiration in acute stroke patients. The relation between the Results of SSA and pneumonia post-stroke was analyzed.Results Sensitivity, specificity, positive predictive value and negative predictive value of SSA for aspiration were 95.0%, 53.7%, 66.7% and 91.7%, respectively. The patients with positive result on SSA had a higher incidence of pneumonia ( P＜0.05).Conclusion SSA is a valid and valuable screening tool for aspiration in acute stroke patients.

Background: Clinical clerkship in a busy hospital environment forms an important part of undergraduate medical training. Regular objective assessment of this activity with feedback would be expected to improve outcome. Methods: We implemented fortnightly clinical assessments using modified OSLER (Objective Structured Long Examination Record), and over a 6-week clinical rotation. Modifications included provision of individualized feedback. The assessment process was evaluated by both students and teachers via a questionnaire measuring their perceived educational impact, feasibility and acceptability. Results: Students agreed that the patient spectrum was appropriate and fair, resulting in improved history taking and presentation skills (96.6%), clinical examination skills (89%) and clinical reasoning skills (90.7%). It was graded to have helped learning “tremendously” and “moderately” by 64.7% and 32.8% of students respectively. Perceived improvement was attributable mainly to the repetitive nature of the assessments since only 63% of students were provided with feedback. 96.6% of students and 94.1% of assessors perceived the format created a stressful but positive learning environment. 52.9% of assessors agreed that the exercise consumed significant time and resources but 88.2% rated it as manageable and supported its continuation. Conclusion: Frequent and regular in-course clinical assessments with emphasis on individual feedback is feasible, acceptable and has significant positive educational impact.

Aneurysm, False ; surgery ; Heart Aneurysm ; Heart Ventricles ; surgery ; Humans

Cardiac Catheterization ; instrumentation ; methods ; Echocardiography, Three-Dimensional ; instrumentation ; methods ; Heart Valve Prosthesis ; adverse effects ; Hemodynamics ; Humans ; Hypertension, Pulmonary ; Male ; Middle Aged ; Mitral Valve ; pathology ; Mitral Valve Insufficiency ; pathology ; therapy

Non-alcoholic fatty liver disease (NAFLD) affects around 30% of the global adult population and is an important cause of cirrhosis and hepatocellular carcinoma. Compared with other chronic liver diseases, NAFLD is mostly seen by primary care physicians and non-hepatologists. Though the absolute number is huge, only a small fraction of patients will eventually develop liver-related complications. Therefore, it is important to use noninvasive tests wisely and develop a care model that involves not only hepatologists but also other colleagues seeing patients with NAFLD. With this background, the American Gastroenterological Association commissioned a multidisciplinary group to provide guidance on a clinical care pathway for identifying patients with advanced liver fibrosis due to NAFLD. The 4 key steps of this pathway include ① identifying patients at risk at primary care or non-hepatology settings, ② initial assessment with history taking and physical examination, ③ screening for advanced fibrosis using simple fibrosis score, and ④ specific fibrosis test such as vibration controlled transient elastography in patients with indeterminate fibrosis scores. This article discusses the rationale of the recommendations and highlights areas needing further data and refinement.

Nonalcoholic fatty liver disease (NAFLD) is currently the most common chronic liver disease worldwide. Although it has become one of the leading causes of cirrhosis and hepatocellular carcinoma in the Western world, the proportion of NAFLD patients developing these complications is rather small. Therefore, current guidelines recommend noninvasive tests for the initial assessment of NAFLD. Among the available non-invasive tests, transient elastography by FibroScan® (Echosens, Paris, France) is commonly used by hepatologists in Europe and Asia, and the machine has been introduced to the United States in 2013 with rapid adoption. Transient elastography measures liver stiffness and the controlled attenuation parameter simultaneously and can serve as a one-stop examination for both liver steatosis and fibrosis. Liver stiffness measurement also correlates with clinical outcomes and can be used to select patients for varices screening. Although obesity is a common reason for measurement failures, the development of the XL probe allows successful measurements in the majority of obese patients. This article reviews the performance and limitations of transient elastography in NAFLD and highlights its clinical applications. We also discuss the reliability criteria for transient elastography examination and factors associated with false-positive liver stiffness measurements.

Objective:The therapeutic approach of traditional chinese Medicine (TCM) in autism spectrum disorder (ASD) is a functional one.To study the efficacy,safety and functional brain change from the use of tongue acupuncture (TAC) on ASD children.Methods:21 autistic boys (3-16 years old) were randomly assigned to TAC group (TAC:n =12;receiving daily TAC for 8 weeks) or control (C:n =9;no acupuncture).Primary outcome mea-sures included Autism Treatment Evaluation Checklist (ATEC),Reynell Language Develop-mental Scale,Symbolic Play Test (SPT),Functional Independence Measure for Children(WeeFIM),Clinical Global Impression (CGI) Scale and Cerebral FDG Metabolism by PET.Results:There were significant improvement in speech domain of ATEC (p =0.030),Self-care domain of WeeFIM (p =0.021),cognition domain of WeeFIM (p =0.001) and Total score domain of WeeFIM (p =0.001) in TAC group compared to the C group.There were significant difference in positive clinical response between C and TAC group in language (p =0.0211),functional (p =0.0011),parental Impression criteria (p =0.0003) and overall cerebral glucose metabolism (p =0.0451) using ROC criteria.No significant association of PET Glucose Meta-bolism with Clinical response was found.None of the children developed any side-effects.Conclusion:A short course of TAC can improve specific functions in children with autism spec-trum disorder,especially speech and cognition function.No statistical significant association of PET Glucose Metabolism with Clinical response.Larger scale with more sample size trial should be done for further investigation.

BACKGROUNDChildhood cancer survivors were at risk of development of second malignant neoplasms. The aim of this study is to evaluate the incidence, risk factors and outcome of second malignant neoplasms in childhood cancer survivors in a tertiary paediatric oncology centre in Hong Kong, China.

METHODSWe performed a retrospective review of patients with childhood cancer treated in Children's Cancer Centre in Prince of Wales Hospital, Hong Kong, China between May 1984 and June 2009. Case records of patients who developed second malignant neoplasms were reviewed.

RESULTSTotally 1374 new cases aged less than 21-year old were treated in our centre in this 25-year study period. Twelve cases developed second malignant neoplasms with 10-year and 20-year cumulative incidence of 1.3% (95% confidence interval 0.3% - 2.3%) and 2.9% (95% confidence interval 1.1% - 4.7%) respectively. Another 4 cases were referred to us from other centres for the management of second malignant neoplasms. In this cohort of 16 children with second malignant neoplasms, the most frequent second malignant neoplasms were acute leukemia or myelodysplastic syndrome (n = 6) and central nervous system tumor (n = 4). Median interval between diagnosis of primary and second malignant neoplasms was 7.4 years (range 2.1 - 13.3 years). Eight patients developed second solid tumor within the previous irradiated field. Radiotherapy significantly increased the risk of development of second solid tumor in patients with acute lymphoblastic leukemia (P = 0.027). Seven out of 16 patients who developed second malignant neoplasms had a family history of cancer among the first or second-degree relatives. Nine patients died of progression of second malignant neoplasms, mainly resulted from second central nervous system tumor and osteosarcoma.

CONCLUSIONSCumulative incidence of second cancer in our centre was comparable to western countries. Radiotherapy was associated with second solid tumour among patients with acute lymphoblastic leukemia. Patients who developed second brain tumor and osteosarcoma had a poor outcome.

Adolescent ; Adult ; Child ; Child, Preschool ; China ; epidemiology ; Female ; Hong Kong ; epidemiology ; Humans ; Infant ; Infant, Newborn ; Male ; Neoplasms ; epidemiology ; Neoplasms, Second Primary ; epidemiology ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Retrospective Studies ; Survivors ; statistics & numerical data ; Young Adult

BACKGROUNDWhether the sequential treatment with bortezomib plus dexamethasone (BD) followed by autologous hematopoietic stem cell transplantation (ASCT) could extend the overall survival period in multiple myeloma patients is still not clear. Few large case studies about this therapeutics in multiple myeloma were reported in China. Our purpose was to assess the efficacy and adverse effects of sequential treatment with BD chemotherapy and ASCT in patients with multiple myeloma.

METHODSFifty-three patients with newly diagnosed or relapsed/refractory multiple myeloma received BD as induction therapy before ASCT. Stem-cell mobilization was undertaken with cyclophosphamide 3 - 5 g/m(2) plus granulocyte colony-stimulating factor 300 µg/d. Target yield was 2.0×10(6) CD34(+) cells/kg. Conditioning for ASCT consisted of melphalan 200 mg/m(2). Thalidomide and/or a-interferon was used as post-transplantation maintenance treatment.

RESULTSThe BD chemotherapy before transplantation was effective in 86.7% of the 53 patients, including 22.6% with complete remission (CR), 39.6% with near complete remission (nCR), and 24.5% with partial remission (PR). The best effect was achieved after two treatment courses. Most bortezomib-related adverse effects were classes 1 - 2. All patients were successfully mobilized after BD for autologous peripheral blood stem cell transplantation. The ASCT was effective in 96.3% of patients, including 49.1% with CR, 32.1% with nCR, and 15.1% with PR. The CR rate was significantly increased (49.1% vs. 22.6%, P < 0.05) by sequential ASCT. Within 27 (range, 6 - 53) months of follow-up, the efficacy of ASCT was maintained in 29 patients and further enhanced by post-transplantation maintenance treatment in four patients. Eleven patients died after transplantation. Among the patients undergoing BD/ASCT treatment, overall survival (OS) was significantly better in newly diagnosed patients in comparison to relapsed/refractory patients (P = 0.046).

CONCLUSIONSBD chemotherapy can be used as an induction therapy prior to ASCT in patients with multiple myeloma. Its rate of effectiveness is high and it alleviates symptoms quickly without affecting peripheral blood stem cell collection. The majority of adverse effects are mild (tolerable). Sequential BD with ASCT is the preferred option for transplant patients. First-line ASCT could prolong survival of newly diagnosed patients rather than delayed ASCT.

Adult ; Aged ; Boronic Acids ; administration & dosage ; adverse effects ; therapeutic use ; Bortezomib ; Dexamethasone ; administration & dosage ; adverse effects ; therapeutic use ; Female ; Hematopoietic Stem Cell Transplantation ; methods ; Humans ; Male ; Middle Aged ; Multiple Myeloma ; drug therapy ; therapy ; Pyrazines ; administration & dosage ; adverse effects ; therapeutic use ; Treatment Outcome

OBJECTIVETo establish the fingerprints of the active fractions from Tian-wang-bu-xin-wan decoction by HPLC, and to explain the role of Radix Platycodi in the decoction prescription.

METHODThe experimental conditions of the HPLC method were established as follows: Hanbon Lichrospher C18 column (4.6 mm x 250 mm, 5 microm), mobile phase were methanol and 0.012 5 mol L(-1) ammonium acetate/acetic acid buffer, eluted with a linear gradient, flow rate was 1.0 mL min(-1), the photodiode array detector (PDA) and evaporative light scattering detector (ELSD) were connected in series.

RESULTIn the same conditions and used same method, the extract amount of whole prescription was higher than that of excepting Radix Platycodi. The method provided two kinds of fingerprints with satisfied separation, which were the HPLC-PDA (Max Plot) fingerprint and the HPLC-ELSD fingerprint. And, they had good correlation and complementaritiy.

CONCLUSIONThe Radix Platycodi can enhance the decoction yield of the prescription; and increase the dissolution and the contents of some ingredients in the decoction.

Chromatography, High Pressure Liquid ; Drugs, Chinese Herbal ; chemistry ; Light ; Scattering, Radiation