Outcome of severely injured trauma patients at a designated trauma centre in the Hong Kong Special Administrative Region

Background The Hong Kong Special Administrative Region （HKSAR） of the People＇s Republic of China （PRC） has seen significant changes in its trauma service over the last ten years including the implementation of a regional trauma system. The author＇s institution is one of the five trauma centres designated in 2003. This article reports our initial clinical experience. Methods A prospective single-centre trauma registry from January 2004 to December 2008 was reviewed. The primary clinical outcome measure was hospital mortality. The Trauma and Injury Severity Score （TRISS） methodology was used for bench-marking with the North America Major Trauma Outcome Study （MTOS） database. Results There were 1451 patients. The majority （83.9%） suffered from blunt injury. The overall mortality rate was 7.8%. Severe injury, defined as the Injury Severity Score 〉15, occurred in 22.5% of patients, and was associated with a mortality rate of 31.6%. A trend of progressive improvement was noted. The M-statistic was 0.99, indicating comparable case-mix with the MTOS. The Z- and W-statistics of each individual year revealed fewer, but not significantly so, number of survivors than expected. Conclusions Trauma centre designation was feasible in the HKSAR and was associated with a gradual improvement in patient care. Trauma system implementation may be considered in regions equipped with the necessary socio-economic and organizational set-up.     

北京市412例儿童18年后血压纵向对照调查

目的：探讨血压由儿童期至成年期的轨迹变化规律。方法：对1987年开展的"北京地区儿童血压研究"队列人群于2005年进行追访,采用同样的方法测量血压并进行心血管相关因素的健康体检。结果：（1）18年间平均收缩压（SBP）和舒张压（DBP）水平均随年龄增长而增长,增长幅度表现为SBP>DBP ,男性>女性。青春期前,男女血压均随年龄增长而增长,青春期后,血压增长幅度减缓,男性仍随年龄增加而增加,女性随年龄变化趋势不明显。（2）儿童期血压与成年期血压呈现正相关关系,控制成年BMI和身高,男性两时期SBP偏相关系数为0.23（P<0.01）,DBP偏相关系数为0.29（P<0.01）;女性SBP偏相关系数0.38（P<0.01）,DBP偏相关系数为0.19（P<0.01）。（3）分别按儿童SBP/DBP     

Disseminated testicular cancer with bulky disease: results of a phase-II study with cisplatin ultra high dose/VP-16/bleomycin

This is a preliminary analysis of the AIO-Testicular Tumour Study Group trial in patients with disseminated bulky testicular cancer. Treatment plan: cisplatin 35 mg/m2 days 1-5, VP-16 120 mg/m2 days 1-5 (two daily divided doses), bleomycin 15 mg/m2 days 1, 8, 15. Of 98 patients at present evaluable 63% had complete remission or have no evidence of disease (CR/NED), 30% had partial remission (PR) and 7% had no change or progressive disease (NC/P). Relapse-free survival is 93% for the CR/NED group after a median follow up of 2.2 years: the overall survival for the entire patient population is 70%. Toxicity included predominantly granulocytopenic fever and infection with septicaemia, thrombocytopenia, nausea, vomiting, neurotoxicity and lung toxicity, with 7% fatal toxicity. A prospective randomized trial is warranted to evaluate the apparent superior activity of ultra high dose cisplatin in combination with VP-16 and bleomycin.     

Effects of Transfection with the Cu,Zn-Superoxide Dismutase Gene on Xanthine/Xanthine Oxidase-Induced Cytotoxicity in Fibroblasts from Rat Skin

Purpose. The effects of transfection with the human Cu, Zn-superoxide dismutase (hSOD)⁴ gene on active oxygen-induced cytotoxicity in rat skin fibroblasts (FR) were studied for the purpose of developing the novel delivery system of hSOD using hSOD gene. Methods. An expression plasmid for hSOD, pRc/RSV-SOD, was constructed and used to transfect FR cells. Xanthine (X)/xanthine oxidase (XO) system were used to generate active oxygen species. The effects of transfection with the hSOD gene on active oxygen-induced cytotoxicity were assessed by comparing the number of surviving cells and the level of lipid peroxidation in host and transformants after exposure to X/XO system. Results. The cellular SOD activity in RSV-SOD cells transfected with pRc/RSV-SOD was significantly increased in comparison with host or RSV cells transfected with the pRc/RSV plasmid containing no hSOD gene as a control. Furthermore, Western blot analysis using an anti-hSOD antibody indicated the production of hSOD in RSV-SOD cells. On the other hand, although the numbers of surviving cells in both host and RSV-SOD cultures after exposure to X/XO system decreased in a time-dependent manner, the decrease in number of surviving RSV-SOD cells was less than that in host cells. In the presence of catalase, the decreases in number of surviving cells in both host and RSV-SOD cultures after exposure to the X/XO system were also less than those in the absence of catalase. However, the decreases in cell survival in RSV-SOD cultures were significantly less than those in host cells in the presence of catalase. Furthermore, the levels of lipid peroxidation in RSV-SOD cells exposed to the X/XO system in the presence or absence of catalase were lower than those in host cells. These results indicated that the increase in cellular SOD activity by transfection with the hSOD gene protects cells from oxidative stress. Conclusions. Human SOD gene therapy may be useful for treatment of diseases in which oxidative tissue damage is produced.     

自固定式显微椎间盘镜系统治疗腰椎间盘突出症

目的：采用自固定式显微椎间盘镜系统治疗腰椎间盘突出症。方法：从2000年10月采用自固定式显微核间盘镜髓核摘除术共治疗44例腰椎间盘突出症，其中男28例，女16例，年龄22－71岁（平均39．6岁），病程4个月至8年，平均16．4个月。结果：本组经3－10个月随访，优：31例；良：7例；优良率86．4％，可6例。3例出现硬膜囊撕裂，脑脊液漏，1例出现马尾神经损伤引起下肢局部麻木，均发生在早期手术病全，随着临床经验的积累，目前未发生类似并发症，未见椎间盘隙感染的发生。结论：自固定式显微椎间盘镜系统具有手术创伤小，容易操作，术后恢复快的特点，最适用于单侧单节段的椎间盘突出症，伴或不伴有椎管狭窄的病例。     

Cellulitis due to Escherichia coli in three immunocompromised subjects

A case of severe photosensitivity in a girl with the Smith–Lemli–Opitz syndrome is reported. Children with this recessively inherited metabolic disorder of cholesterol metabolism present with a variety of congenital abnormalities of the nervous system and internal organs in association with varying degrees of mental retardation. Photosensitivity is a feature which has previously only briefly been mentioned in the literature in association with this syndrome. However, more recently, it has become apparent that photosensitivity is not uncommon among children with the Smith–Lemli–Opitz syndrome, although the nature of the photosensitivity in these patients has remained undefined. Our patient has suffered from sunlight intolerance since early infancy, with redness and pruritus of sun-exposed skin developing within minutes of sun exposure. Monochromator ultraviolet (UV) radiation and visible light testing revealed an immediate and persistent reaction to low-dose UVA at 350 nm, and an abnormal erythemal response to visible light at 400 nm.     

Seminal leucocyte subpopulations and sperm function in fertile and infertile Chinese men

The level of seminal leucocytes and the prevalence of leucocytospermia was determined in a group of fertile and infertile southern Chinese men in Hong Kong. Sixteen normal fertile semen donors and 49 men with male factor infertility were studied prospectively. None had antisperm antibodies and past or present evidence of genital tract infection. Seminal leucocytes and their subsets were analysed using monoclonal antibodies and an immunocytochemical alkaline phosphatase-anti-alkaline phosphatase conjugate technique. Seminal leucocytes were detectable in 94% and 86% of the fertile and infertile men respectively, with the predominant subset being granulocytes. Leucocytospermia (> 1 × 10⁶ leucocytes/ml) was found in only one of the 49 (2%) infertile men without clinical evidence of genito-urinary infection. Inverse correlations were observed between (1) the percentage of spermatozoa with normal morphology and the number of T-helper/inducer cells, (2) the linearity of sperm movement and the number of T-lymphocytes. In conclusion, the level of seminal leucocytes and the prevalence of leucocytospermia is low in infertile Chinese subjects. The effect of seminal leucocytes on sperm function in these subjects needs further evaluation.     

Loss of testicular volume associated with intratesticular varicocele

Intratesticular varicocele is a rare entity and its clinical significance is not well established. We report a case of left-sided intratesticular varicocele associated with a significant reduction in left testicular volume at follow up. This association has not been previously reported. Incidentally, our patient is also the youngest case reported in the literature to date.