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.     

Relationships of sleep duration with sociodemographic and health‐related factors,psychiatric disorders and sleep disturbances in a community sample of Korean adults

The aim of this study is to examine relationships of sleep duration with sociodemographic and health‐related factors, psychiatric disorders and sleep disturbances in a nationwide sample in Korea. A total of 6510 subjects aged 18–64 years participated in this study. Logistic regression was used to calculate the odd ratios and 95% confidence intervals of the covariates, psychiatric disorders and sleep disturbances across the following sleep duration categories: 5 h or less, 6, 7, 8 and 9 h or more per day. Low levels of education, unemployment and physical illness were associated with sleeping for 5 h or less and 9 h or more. Being older and widowed/divorced/separated, high levels of physical activity, pain/discomfort, obesity and high scores on the General Health Questionnaires were associated with sleeping for 5 h or less. Female, being younger and underweight were associated with sleeping for 9 h or more. Alcohol dependence, anxiety disorder and social phobia were associated significantly with sleeping for 5 h or less and 9 h or more. Other psychiatric disorders were more common in subjects who slept for 5 h or less (e.g. alcohol use disorder, mood disorder, major depressive disorder, dysthymic disorder, obsessive‐compulsive disorder and specific phobia) or 9 h or more (e.g. post‐traumatic stress disorder). In addition, subjects who slept for 5 h or less reported more sleep disturbances than did subjects who slept for 7 h. Short or long sleep is associated with psychiatric disorders and/or sleep disturbance, therefore attention to the mental health of short or long sleepers is needed.     

Data safety and monitoring boards for African clinical trials

The recent increase in funding for diseases endemic in resource-poor countries has led to a progressive rise in the number of trials conducted in Africa for product development purposes or to answer important questions on reduction of disease burden. This causes an increasing demand for data safety monitoring boards (DSMBs) within Africa, where there is currently a shortage of appropriately skilled people. To address this, and in line with capacity-building efforts directed at improved quality research, AMANET invited the authors to create a curriculum and to train selected Africans with the skills required for members of DSMBs. Based on experience, the facilitators made an overview of clinical trial designs, a comprehensive review of data safety monitoring guidelines and other relevant DSMB governance issues. The wealth of guidelines and recommendations available for establishing and running DSMBs focus mainly on trials set in developed countries. The authors drew from these guidelines a practical summary of those relevant for Africa. This interactive process enabled recommendation of a straightforward set of principles to guide the establishment of DSMBs in Africa, which strike that essential balance between protecting trial participants and allowing investigators to answer their scientific questions.     

浅析天然乳胶避孕套监管中的注意事项

天然乳胶避孕套冒牌贴牌多,监管部门多,监管难度大,本文详细阐述了避孕套监管的现状及加强监管的建议。     

335例慢性前列腺炎中西药治疗效果的对比

目的　慢性前列腺炎是目前常见而又难治愈的一种男性疾病 ,为寻求一种治疗快、经济高效的方案。作者随机设置了三组 (中药栓剂肛门给药治疗组、西药前列腺穿刺局部封闭治疗组、中西结合治疗组 )共 335例患者进行治疗对比。结果　中药治疗组治疗 5 8人 ,平均年龄 2 9 6 4岁 ,治愈 5例 ,治愈率 5 1%;西药治疗组治疗 196人 ,平均年龄 2 9 5 8岁 ,治愈 184人 ,治愈率 93 9%,中西结合治疗组治疗 81人 ,平均年龄 30 6 7岁 ,治愈 78人 ,治愈率 96 3%。经统计学t检验 ,中药组与西药组、中西药组差异具有显著性意义 (P <0 0 0 1) ,西药组与中西药组差异无显著性 (P >0 0 5 )。结论　三组的平均年龄无明显差异 ,从治愈率看 ,中药组明显偏低 ,西药组与中西结合组治愈率高而无明显差异 ,所以从治愈率和经济方面考虑单用西药局封前列腺治疗是一种较理想的手段。     

Graft-versus-host reaction affecting lesional skin but not normal skin in a patient with piebaldism

Summary A case of graft-vs.-host disease (GVHD) arising solely within an area affected by piebaldism is described. The patient, a 35-year-old woman with a single hypopigmented patch on the right leg present since birth, had received an allogeneic bone marrow transplant (BMT) from an HLA-identical sibling donor, for treatment of a myelodysplastic syndrome (MDS). Beginning on day + 38 post-BMT, the patch developed changes which were histologically consistent with GVHD. Syngeneic mixed epidermal cell-lymphocyte reaction (MECLR) testing of tissue from the patch, and from adjacent normal skin, showed differences which suggest that piebaldism-affected skin is immunologically different from normal skin. These findings may offer new insight into the pathophysiology of this disorder.     

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