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A 67 year old Chinese woman presented to her general practitioner with abdominal pain. She had an unremarkable history except for bronchiectasis diagnosed a decade before. Colonoscopy was arranged in [...]

Manystudies have shown that kidney transplant recipients have a higher incidence of cancers when compared with general population. However, most data on the posttransplant malignancies (PTM) are derived from Western literature and large population‐based studies are rare. There is also lack of information about the posttransplant cancer‐specific mortality rate. We conducted a population‐based study of 4895 kidney transplants between 1972 and 2011, with data from the Hong Kong Renal Registry. Patterns of cancer incidence and mortality in our kidney transplant recipients were compared with those of the general population using standardized incidence ratios (SIRs) and standardized mortality ratios (SMRs) respectively. With 40 246 person‐years of follow‐up, 299 PTM was diagnosed. The SIR of all cancers was 2.94 (female 3.58 and male 2.58). Non‐Hodgkin lymphoma (NHL), kidney, and bladder cancers had the highest SIRs. The overall SMR was 2.3 (female 3.4 and male 1.7) and the highest SMR was NHL. The patterns of PTM differ among countries. Increases in cancer incidence can now translate into similar increases in cancer mortality. NHL is important in our kidney transplant recipients. Strategies in cancer screening in selected patient groups are needed to improve transplant outcomes.

Peritonitis complicating peritoneal dialysis represents a major cause of technique failure, hospitalization, and increased mortality. Peritonitis tends to be recurrent and clustered within particular patients at risk. The aim of this review is to evaluate the potential predictive factors for development of peritoneal dialysis-associated peritonitis based on currently available evidence. Risk factors were divided into medical and non-medical ones, and characterized by a schema of fixed versus modifiable factors. A new direction in the landscape change of the risk factors of peritonitis appears to focus on psychosocial aspects and patient training. Identification of these factors have important clinical implications because of the hitherto lack of well-established strategies to prevent peritonitis complicating peritoneal dialysis. It is hoped that better understanding of the risk factors will allow us to take tangible steps toward minimizing the infectious burden from the Achilles' heel of peritoneal dialysis.

AbstractIn this paper, an approach for storing and retrieving the past data by means of a novel Fuzzy Data Window Memory (FDWM) is reported. The data, which is selected for memorization, is based on the highest firing strength of the fuzzy rule. The size of the proposed FDWM is much smaller than traditional window memory with no degradation in performance. A computer simulation study of one of the applications of the proposed FDWM is reported which uses the FDWM to reduce the training data set that will be used in the evaluation module in system identification by Genetic Algorithms (GA).

Background: Meningitis caused by Streptococcus agalactiae(Group B Streptococcus) is rare in adults and usually affects patients with predisposing conditions. Aims: To describe an increase in adult group B streptococcal meningitis occurring in parallel in Hong Kong and Singapore. Methods: All cases of bacterial meningitis admitted to the Prince of Wales Hospital, Hong Kong and Singapore General Hospital in 1998, aged 15 years or above, were reviewed. Medical records for the previous ten years were searched for previous cases of adult group B streptococcal meningitis. Results: In 1998, 29 adult patients with bacterial meningitis were admitted to the two hospitals. S. agalactiaewas isolated in 11 cases, Streptococcus pneumoniaein three cases, Klebsiella pneumoniaein two cases, and Pseudomonas pseudomalleiin one case. In 11 cases no bacteriological diagnosis could be made. Two patients with adult group B streptococcal meningitis had predisposing conditions for infection. One patient died before a definite diagnosis could be established. A ten year review of records revealed one previous case of adult group B streptococcal meningitis in a patient with multiple risk factors. Conclusions: An increase of group B streptococcal meningitis has occurred among adults admitted to two major hospitals in two Southeast Asian cities. In the majority of cases there were no identifiable predisposing conditions. The cause of this increase of group B streptococcal remains unclear.

AbstractA fuzzy identification algorithm with an inherent knowledge generalization mechanism is reported in this paper. In the proposed identification algorithm, a low-resolution fuzzy model is used to mimic the effect of a virtual higher-resolution model. The gradient descent optimization method is then applied to update the rule-base by using the difference between the actual system output and the model output. Simulation studies are included to demonstrate the performance of the algorithm.

<it>Objective</it>. Systemic lupus erythematosus (SLE) is characterized by the aberrant activation of T lymphocytes. Since T-bet and GATA-3 are the principal transcription factors for the differentiation of type-1 and type-2 helper T lymphocytes, respectively, we studied their mRNA expression in the urinary sediment of SLE patients and compared this with their urinary and intra-renal protein expression. <it>Methods</it>. We studied 100 SLE patients and 10 healthy subjects. Urinary mRNA expression of T-bet and GATA-3 were studied by the real-time quantitative polymerase chain reaction. Intra-renal and urinary expressions of T-bet and GATA-3 were studied by immunohistochemistry and western blotting, respectively. <it>Results</it>. The urinary mRNA and protein expressions of T-bet were significantly higher in SLE patients with active nephritis than those with inactive disease (mRNA: <it>P</it><0.001; protein: <it>P</it>=0.004). The urinary mRNA expression of T-bet correlated with the SLE disease activity index (SLEDAI) score (<it>r</it>=0.55, <it>P</it><0.001) and the histological activity index (<it>r</it>=0.48, <it>P</it>=0.03). On the other hand, the urinary mRNA and protein expressions of GATA-3 were significantly lower in SLE patients with active nephritis (mRNA: <it>P</it><0.001; protein: <it>P</it>=0.006), and GATA-3 mRNA expression inversely correlated with the SLEDAI score (<it>r</it>=0.38, <it>P</it><0.001). For the 22 SLE patients with kidney biopsy, tubular expressions of T-bet and GATA-3 significantly correlated with the histological activity index (T-bet: <it>r</it>=0.57, <it>P</it>=0.006; GATA-3: <it>r</it>=−0.79, <it>P</it><0.001). <it>Conclusions</it>. Patients with active lupus nephritis have increased T-bet and depressed GATA-3 expression in the urinary sediment and kidney tissue, indicating a predominant Th1 type of T-lymphocyte activation.