Search

This paper reports a study of motivation and strategies toward learning English used by pre-service teachers of Chinese. The aims of the study were to investigate whether pre-service teachers of Chinese are unmotivated to learn English if they are not going to use English substantially in the future and to examine the learning strategies the participants adopt during English lessons. Gardner's (1985) Attitude/Motivation Test Battery was modified and administered to elicit pre-service teachers of Chinese language's motivational orientation to learn English, their preferences and needs to learn English as well as their learning strategies in learning English. Findings from this study pose significant implications to current educational reform in China and may help educators to identify appropriate strategies to facilitate the learning of a second language by non-English major teachers. Appended are: (1) Questionnaire for participants; and (2) Summary Statistics and reliability estimation for the questionnaire.

Abstract: Background: Combined esophageal high‐resolution impedance manometry (HRIM) measures multiple pressures and bolus transit simultaneously, facilitating detailed assessment of esophageal motility. Currently, normative values for water‐perfused HRIM systems for Chinese populations are lacking. Methods: Healthy volunteers were enrolled for comprehensive anthropometric measures, blood biochemistry tests, and an HRIM study using 22 water‐perfused pressure sensors and 12 impedance channels. Ten 5‐mL liquid swallows of saline at 30‐second intervals were conducted. The following parameters were calculated: distal contractile integral (DCI), distal latency (DL), lower esophageal sphincter (LES) basal pressure, 4‐second integrated relaxation pressure (IRP‐4s), and complete bolus transit percentage. Normal values were established based on the 5th and 95th percentiles. Key Results: All 66 participants (34 male, 32 female, aged 21‐64 years) completed the study and tolerated the HRIM procedure well. The upper normal limit (95th percentile) of IRP‐4 second was 20 mmHg. The 5th‐95th percentile range for DCI, DL, and complete bolus transit was 99‐2186 mmHg●s●cm, 6.2‐11.3 second, and 50%‐100%, respectively. Age was negatively correlated with DL. Females had significantly higher upper limits for IRP‐4s and median DCI than males. Multivariate analyses confirmed that IRP‐4s was higher in females, and that higher body mass index and waist circumference were associated with reduced DL and better bolus transit, respectively. Conclusions and Inferences: We established normative values for the water‐perfused HRIM system for a Chinese population. Gender and anthropometric factors may affect various major HRIM parameters and should be taken into account when interpreting HRIM results in clinical practice. [ABSTRACT FROM AUTHOR]

The article discusses the implications of China's transformation for developing and developed countries following the global financial crisis. It states that China has created the longest maintained period of economic growth ever accomplished in world history. Meanwhile, it examines China as a regional and domestic unit, as well as compares the political institutions and economic policies of the country with the European Union (EU). It explores the significance of China as a developing country to other nations. It adds that the political economy of the country might provide lessons or models for others such as those in Western Europe and North America.

UHRF1BP1 encodes a highly conserved protein with unknown function. Previously, a coding variant in this gene was found to be associated with systemic lupus erythematosus (SLE) in populations of European ancestry (rs11755393, R454Q, P=2.22 × 10−8, odds ratio=1.17). In this study, by a combination of genome-wide study and replication involving a total of 1230 patients and 3144 controls, we confirmed the association of this coding variant to SLE in Hong Kong Chinese. We also identified another coding variant in this gene that independently contributes to SLE susceptibility (rs13205210, M1098T, P=4.44 × 10−9, odds ratio=1.49). Cross-population confirmation establishes the involvement of this locus in SLE and indicates that distinct alleles are contributing to disease susceptibility. [ABSTRACT FROM AUTHOR]

Systemic lupus erythematosus (SLE) is a prototypic autoimmune disease with complex genetic inheritance. Recently, single nucleotide polymorphisms (SNPs) in BANK1 and TNFSF4 have been shown to be associated with SLE in Caucasian populations, but it is not known whether they are also involved in the disease in other ethnic groups. Recent data from our genome-wide association study (GWAS) for 314 SLE cases and 920 controls collected in Hong Kong identified SNPs in and around BANK1 and TNFSF4 to be associated with SLE risk. On the basis of the results of the reported studies and our GWAS, SNPs were selected for further genotyping in 949 SLE patients (overlapping with the 314 cases in our GWAS) and non-overlapping 1042 healthy controls. We confirmed the associations of BANK1 and TNFSF4 with SLE in Chinese (BANK1, rs3733197, odds ratio (OR)=0.84, P=0.021; BANK1, rs17266594, OR=0.61, P=4.67 × 10−9; TNFSF4, rs844648, OR=1.22, P=2.47 × 10−3; TNFSF4, rs2205960, OR=1.30, P=2.41 × 10−4). Another SNP located in intron 1 of BANK1, rs4522865, was separately replicated by Sequenom in 360 cases and 360 controls and was also confirmed to be associated with SLE (OR=0.725, P=2.93 × 10−3). Logistic regression analysis showed that rs3733197 (A383T in ankyrin domain) and rs17266594 (a branch point-site SNP) from BANK1 had independent contributions towards the disease association (P=0.037 and 6.63 × 10−8, respectively). In TNFSF4, rs2205960 was associated with SLE independently from the effect of rs844648 (P=6.26 × 10−3), but not vice versa (P=0.55). These findings suggest that multiple independent genetic variants may be present within the gene locus, which exert their effects on SLE pathogenesis through different mechanisms.Genes and Immunity (2009) 10, 414–420; doi:10.1038/gene.2009.16; published online 9 April 2009 [ABSTRACT FROM AUTHOR]

In this study, we compared the association of several newly discovered susceptibility genes for systemic lupus erythematosus (SLE) between populations of European origin and two Asian populations. Using 910 SLE patients and 1440 healthy controls from Chinese living in Hong Kong, and 278 SLE patients and 383 controls in Thailand, we studied association of STAT4, BLK and PXK with the disease. Our data confirmed association of STAT4 (rs7574865, odds ratio (OR) =1.71, P=3.55 × 10−23) and BLK (rs13277113, OR=0.77, P=1.34 × 10−5) with SLE. It was showed that rs7574865 of STAT4 is also linked to hematologic disorders and potentially some other subphenotypes of the disease. More than one genetic variant in STAT4 were found to be associated with the disease independently in our populations (rs7601754, OR=0.59, P=1.39 × 10−9, and P=0.00034 when controlling the effect of rs7574865). With the same set of samples, however, our study did not detect any significant disease association for PXK, a risk factor for populations of European origin (rs6445975, joint P=0.36, OR=1.06, 95% confidence interval: 0.93–1.21). Our study indicates that some of the susceptibility genes for this disease may be population specific.Genes and Immunity (2009) 10, 219–226; doi:10.1038/gene.2009.1; published online 19 February 2009 [ABSTRACT FROM AUTHOR]

This article lays out three different historical perspectives on China's post-1978 economic reform era. It argues that historical perspectives allow us to apprehend features of the Chinese economy as they are formed in particular moments and contexts at the same time as we can appreciate the ways in which the possibilities conceived and achieved both affirm certain past practices and reject others. Without such vantage points it is more difficult to explain the manner in which China's economy has changed in the past 30 years. [ABSTRACT FROM AUTHOR]

Examines various questions about family division and mobility in North China in light of the experience of three north China villages surveyed by Japanese researchers in the 1930s and assesses this evidence in view of other information on landholding patterns. Empirical evidence that reproduction was not uniform across social strata; Why partibility was a viable institution for the long run; Mantetsu survey data; Family division in Dabeiguan; More.

Compares the Chinese and European preindustrial demographic systems. Malthusian propositions about China's demographic systems; China Proper's population figures; Mortality levels in imperial China; Factors affecting the equilibrium of population and resources.

It remains controversial whether administration of exogenous estrogens is safe in systemic lupus erythematosus (SLE). The current study was undertaken to determine the effect of hormone replacement therapy (HRT) on the rate and magnitude of flares in a cohort of postmenopausal SLE patients. Thirty-four patients were prospectively followed. The frequency and severity of disease exacerbations in 11 patients who received HRT was compared with 23 patients who did not receive HRT. Our results showed that both users and non-users of HRT had a comparable age of disease onset, duration of disease, clinical manifestations, and duration of follow-up. No significant increase in the rate (0.12 relapses/patient-year in HRT group vs 0.16 relapses/patient-year in the non-HRT group, p = 0.90) or magnitude (total SLEDAI score increase during flares/patient-year in the HRT and non-HRT groups were 0.55 and 1.22, respectively, p = 0.57) of flares could be demonstrated in patients who received HRT over a median follow-up period of 35 months. We concluded that HRT appeared to be well tolerated and safe in postmenopausal SLE patients. Its potential beneficial effect may outweigh its deleterious effect on disease activity. [ABSTRACT FROM AUTHOR]

Objective: Systemic lupus erythematosus (SLE) is a multisystem disorder that predominately affects women of the reproductive age. Onset of the disease beyond the age of 50 years is unusual. This study was undertaken to compare retrospectively the clinical and laboratory features between early and late onset (onset of disease beyond the age of 50 years) SLE patients in a Chinese population.Methods: Case records of all SLE patients who attended our rheumatology clinics between 1971 and 1997 were reviewed. Patients with a disease onset beyond the age of 50 years were identified. One hundred consecutive SLE patients who had their disease onset before the age of 50 were recruited as controls. The presenting clinical features, autoantibody profile, number of major organs involved, number of major relapses, and the use of cytotoxic agents in the two groups of patients were obtained and compared.Results: 25 patients with late onset SLE were identified. All the female patients in the late onset group were postmenopausal. The female to male ratio was 3.2 to 1, compared with 13.3 to 1 in the control group (p < 0.02). Both groups had a comparable duration of disease. There were no significant differences in the presenting features between the two groups except for a lower prevalence of malar rash (24% v 86%, p < 0.0001) and a higher prevalence of rheumatoid factor (32% v 1%, p < 0.0001) in the late onset patients. On subsequent visits, the late onset group had a lower prevalence of lupus nephritis (4% v 51%, p < 0.001), fewer major organs involved (mean number of major organs involved; 0.3 v 0.9, p < 0.02), fewer major relapses (mean number of major relapses/patient; 0.08 v 0.47, p < 0.002, number of major relapses/patient year; 0.009 v 0.12, p < 0.001), and required fewer cytotoxic agents for disease control (percentage of patients on cytotoxic agents; 32% v 79%, p < 0.002).Conclusion: Late onset SLE in Chinese tends to run a more benign course with fewer major organ involvement and fewer major relapses. The significantly higher incidence of male sex in late onset SLE and the milder disease course in the postmenopausal female patients suggest that oestrogen status may influence disease activity. [ABSTRACT FROM AUTHOR]

In order to evaluate the efficacy of convalescent plasma therapy in the treatment of patients with severe acute respiratory syndrome (SARS), 80 SARS patients were given convalescent plasma at Prince of Wales Hospital, Hong Kong, between 20 March and 26 May 2003. Good outcome was defined as discharge by day 22 following the onset of SARS symptoms. Poor outcome was defined as death or hospitalization beyond 22 days. A higher day-22 discharge rate was observed among patients who were given convalescent plasma before day 14 of illness (58.3% vs 15.6%;P<0.001) and among those who were PCR positive and seronegative for coronavirus at the time of plasma infusion (66.7% vs 20%;P=0.001). [ABSTRACT FROM AUTHOR]

A national hip fracture registry does not yet exist in China. This is the first to recommend a core variable set for the establishment of a Chinese national hip fracture registry. Thousands of Chinese hospitals will build on this and improve the quality of management for older hip fracture patients. The rapidly ageing population of China already experiences over half a million hip fractures every year. Many countries have developed national hip fracture registries to improve the quality of hip fracture management, but such a registry does not exist in China. The study is aimed at determining the core variables of a national hip fracture registry for older hip fracture patients in China. A rapid literature review was conducted to develop a preliminary pool of variables from existing global hip fracture registries. Two rounds of an e-Delphi survey were conducted with experts. The e-Delphi survey used a Likert 5-point scale and boundary value analysis to filter the preliminary pool of variables. The list of core variables was finalised following an online consensus meeting with the experts. Thirty-one experts participated. Most of the experts have senior titles and have worked in a corresponding area for more than 15 years. The response rate of the e-Delphi was 100% for both rounds. The preliminary pool of 89 variables was established after reviewing 13 national hip fracture registries. With two rounds of the e-Delphi and the expert consensus meeting, 86 core variables were recommended for inclusion in the registry. This study is the first to recommend a core variable set for the establishment of a Chinese national hip fracture registry. The further development of a registry to routinely collect data from thousands of hospitals will build on this work and improve the quality of management for older hip fracture patients in China., (© 2023. International Osteoporosis Foundation and Bone Health and Osteoporosis Foundation.)

Introduction: Exposure to high levels of air pollution is associated with poor health, including worse cognitive function. Whereas many studies of cognition have assessed outdoor air pollution, we evaluate how exposure to air pollution from combustion of polluting household fuels relates with cognitive function using harmonized data from India, Mexico, and China., Materials & Methods: We analyze adults age 50+ in three nationally representative studies of aging with common data collection methods: the 2017-2019 Longitudinal Aging Study in India (n = 50,532), 2015 Mexican Health and Aging Study (n = 12,883), and 2013 China Health and Retirement Longitudinal Study (n = 12,913). Use of polluting fuels was assessed by self-report of wood, coal, kerosene, crop residue, or dung for cooking. Cognitive function was measured by performance across several cognitive domains and summarized into a total cognition score. We used linear regression, by country, to test how polluting cooking fuel use relates with cognition adjusting for key demographic and socioeconomic factors., Results: Approximately 47%, 12%, and 48% of respondents in India, Mexico, and China, respectively, relied primarily on polluting cooking fuel, which was more common in rural areas. Using polluting cooking fuels was consistently associated with poorer cognitive function in all countries, independent of demographic and socioeconomic characteristics. Adjusted differences in cognitive function between individuals using polluting and clean cooking fuel were equivalent to differences observed between individuals who were 3 years of age apart in Mexico and China and 6 years of age apart in India. Across countries, associations between polluting cooking fuel use and poorer cognition were larger for women., Conclusions: Results suggest that household air pollution from the use of polluting cooking fuel may play an important role in shaping cognitive outcomes of older adults in countries where reliance on polluting fuels for domestic energy needs still prevails. As these countries continue to age, public health efforts should seek to reduce reliance on these fuels., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Aims: To evaluate the performance of ultrawide field scanning laser ophthalmoscopy (UWF-SLO) for assessing diabetic retinopathy (DR) and diabetic macular oedema (DME) in a Chinese population, compared with clinical examination., Methods: This is a retrospective cohort study. A series of 322 eyes from 164 patients with DM were included. Each patient underwent both dilated fundal examination with DR and DME grading by retina specialist and non-mydriatic 200° UWF-SLO (Daytona, Optos, Dunfermline, UK). The severity of DR and DME from UWF-SLO images was further graded by ophthalmologists, according to both international clinical DR and DME disease severity scales and the standard 7-field Early Treatment Diabetic Retinopathy Study (ETDRS) scale. Any DR, DME and vision-threatening DR (VTDR) were treated as endpoints for this study., Results: 23 out of 322 images (7.14%), including all four cases with proliferative DR on clinical examinations, were determined as ungradable. When the international scale was used for grading UWF-SLO images, the sensitivity of any DR, DME and VTDR was 67.7%, 67.4% and 72.6%, respectively; the specificity of any DR, DME and VTDR was 97.8%, 97.3% and 97.8%, respectively. The agreement with clinical grading in picking up any DR, DME and VTDR was substantial, with κ-values of 0.634, 0.694 and 0.707, respectively. The performance of UWF-SLO was shown to be lower when ETDRS scale was used for grading the images., Conclusion: The performance of non-mydriatic UWF-SLO is comparable in identifying DR with that of clinical examination in a Chinese cohort. However, whether UWF-SLO can be considered as tool for screening DR is still undetermined., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Factors associated with persistent poor glycemic control were explored in patients with type 2 diabetes under the Joint Asia Diabetes Evaluation (JADE) program., Methods: Chinese adults enrolled in JADE with HbA1c ≥8% at initial comprehensive assessment (CA1) and repeat assessment were analyzed. The improved group was defined as those with a ≥1% absolute reduction in HbA1c, and the unimproved group was those with <1% reduction at the repeat CA (CA2)., Results: Of 4458 enrolled patients with HbA1c ≥8% at baseline, 1450 underwent repeat CA. After a median interval of 1.7 years (interquartile range[IQR] 1.1-2.2) between CA1 and CA2, the unimproved group (n = 677) had a mean 0.4% (95% confidence interval [CI] 0.3%, 0.5%) increase in HbA1c compared with a mean 2.8% reduction (95% CI -2.9, -2.6%) in the improved group (n = 773). The unimproved group had a female preponderance with lower education level, and was more likely to be insulin treated. Patients in the improved group received more diabetes education between CAs with improved self-care behaviors, whereas the unimproved group had worsening of health-related quality of life at CA2. Apart from female gender, long disease duration, low educational level, obesity, retinopathy, history of hypoglycemia, and insulin use, lack of education from diabetes nurses between CAs had the strongest association for persistent poor glycemic control., Conclusions: These results highlight the multidimensional nature of glycemic control, and the importance of diabetes education and optimizing diabetes care by considering psychosocial factors., (© 2015 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd.)

Objective: Systemic lupus erythematosus (SLE) is a prototypic autoimmune disease with complex genetic inheritance. CD247 (CD3Z, TCRZ) plays a vital role in antigen recognition and signal transduction in antigen-specific immune responses, and is known to be involved in SLE pathogenesis. Weak disease association was reported for genetic variants in this gene in Caucasian studies for SLE, Crohn's disease and systemic sclerosis, but its role as a genetic risk factor was never firmly established., Methods: In this study, using a collection of 612 SLE patients and 2193 controls of Chinese ethnicity living in Hong Kong in a genome-wide study, single nucleotide polymorphisms (SNPs) in and around CD247 were identified as being associated with SLE. The two most significant SNPs in this locus were selected for further replication using TaqMan genotyping assay in 3339 Asian patients from Hong Kong, Mainland China, and Thailand, as well as 4737 ethnically and geographically matched controls., Results: The association of CD247 with SLE in Asian populations was confirmed (rs704853: odds ratio [OR] = 0. 81, p = 2.47 × 10(-7); rs858543: OR = 1.10, p = 0.0048). Patient-only analysis suggested that rs704853 is also linked to oral ulcers, hematologic disorders and anti-double-stranded DNA (dsDNA) antibody production., Conclusion: A significant association between variants in CD247 and SLE was demonstrated in Asian populations. Understanding the involvement of CD247 in SLE may shed new light on disease mechanisms and development of new treatment paradigms.

Objective: The results of a genome-wide scan suggested that chromosome locus 1p36 might be linked to the etiology of mandibular prognathism (MP) amongst Asian ethnicities. In this study, we performed a two-stage case-control association study to determine whether one or more genes that confer susceptibility to MP are located within this genomic region., Design: In the first stage of the study, we examined 103 single nucleotide polymorphisms (SNPs) on 1p36 across an 8.6Mb critical region and within four candidate genes in 158 cases and 147 controls to identify genes associated with MP. In the second stage of the study, we examined an additional 23 SNPs within the erythrocyte membrane protein band 4.1 (EPB41) gene in 211 cases and 224 controls., Results: Four SNPs located in the EPB41 gene showed possible allelic and genotypic associations with MP (P<0.03 and P<0.05, respectively) in the first stage. In the analysis of single SNPs in the second stage, the allele of rs4654388 showed the strongest significant association with MP (P=0.008) and the rs4654388 G-allele was associated with a significantly increased risk of MP (OR: 1.78, 95% CI: 1.16-2.74). Haplotype analysis revealed that MP was associated significantly with haplotype GTTCAGGT (P(corrected)=0.031), which included the rs4654388 G-allele., Conclusions: An association between genetic polymorphisms in the EPB41 gene and MP has been observed. Although the polymorphisms which may contribute to MP have not been determined, the results of our study suggest that the EPB41 gene could confer susceptibility to MP., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Teeth in casts of a random sample from the Hong Kong Oral Health Survey of 12-year-old children (n=459; 295 boys and 164 girls) were measured in the mesiodistal, buccolingual, and clinical crown height dimensions. Sexual dimorphism was evident in all tooth types in nearly all tooth dimensions, with the exception of the mesiodistal dimension of mandibular central incisors. The Chinese male tooth dimensions were larger than in females in nearly all characters. The measurements were compared with other human groups. Results showed that the Southern Chinese had larger tooth dimensions than the Japanese and than the White Americans. Hence it is important to have data concerning a relevant human group for purposes of clinical diagnosis and planning of treatment. These data may also be useful in forensic dentistry.

We studied the risk factors affecting the functional status of cerebral palsy. A cross-sectional study of 73 children with cerebral palsy was conducted with the Functional Independence Measure for Children (WeeFIM), which assesses functional skills in the domains of self-care, mobility, and cognition. The mean total Functional Independence Measure for Children quotient was 67.5%. The mean subquotients for self-care, mobility, and cognition were 68.3%, 62.7%, and 69.4%, respectively. The risk factors related to the degree of functional dependency were (1) mental retardation (P = .030), (2) epilepsy (P = .005), (3) type of cerebral palsy (P < .001), and (4) severity of cerebral palsy using the Gross Motor Function Classification System (P < .001) (using univariate analysis). However, when using multivariate analysis, only epilepsy (P = .02) and severity status according to the Gross Motor Function Classification System (P < .001) were significantly related. When the etiology was analyzed, only prematurity was significantly associated with better Functional Independence Measure for Children scores using both univariate (P = .022) and multivariate (P = .007) analyses. The functional status of children with cerebral palsy depends on the severity and the presence of epilepsy. Despite impairment, we found that most children with cerebral palsy could achieve functional independence.

Objective: To evaluate the validity, reliability, and cultural relevance of the Arthritis Impact Measurement Scales 2 (AIMS2) as a health assessment tool for Chinese-speaking patients with arthritis., Methods: The cultural relevance, language equivalency, and content validity of the AIMS2, Chinese version (CAIMS2) were evaluated by an expert panel. Measurement performance was tested on 240 subjects (rheumatoid arthritis = 81, osteoarthritis = 77, healthy = 82). Subjects (n = 175) were retested within 2 weeks for testing of reliability., Results: Three items were modified and 2 items were added, as suggested by the expert panel. Interitem reliability was satisfactory (intraclass correlation coefficient 0.8552-0.9594). Test-retest reliability of the CAIMS2 subscales ranged from 0.770 to 0.952 in subjects in whom the CAIMS2 was self administered. Significant score differences between patients with arthritis and healthy subjects were found in all 12 subscales, except for the support from family and friends and tension subscales. CAIMS2 subscale scores correlated with clinical and laboratory measures of disease activity and patients' perceived quality of life as measured using the Chinese version of the World Health Organization Quality of Life instrument., Conclusion: Empirical data support CAIMS2 is a valid and reliable health status measure for Chinese speaking patients with arthritis.

Background: The slow acetylator genotype for N-acetyltransferase 2 (NAT2 genotype) may be associated with PD in white subjects and the genotype is common in both white and Chinese populations. Whether there is a relationship between NAT2 genotype and PD in Chinese subjects is not known., Objective: To investigate the association between the slow acetylator genotype for N-acetyltransferase 2 and PD in a Chinese population., Methods: The authors obtained DNA samples and documented sex, age, and smoking history in 99 Chinese patients with PD and in 126 control subjects from two major Hong Kong hospitals. PCR-restriction fragment length polymorphism was used to identify M1, M2, and M3 mutant polymorphisms of the slow acetylator genotype for N-acetyltransferase 2. Logistic regression analyses were carried out to investigate the relationships between the different variables and PD., Results: The frequency of the slow acetylator genotype for N-acetyltransferase 2 in the PD group was significantly higher than that of the control group (68.7% vs 28.6%) with an OR of 5.53 (95% CI 3.08 to 9.92) after adjusting for age, sex, and smoking history. In a subgroup analysis smoking had no modifying effect on the association between genotype and PD., Conclusions: There is a significant association between PD and the slow acetylator genotype for N-acetyltransferase 2 in Hong Kong Chinese. The OR found is among the highest reported so far in all susceptibility gene studies for PD in both Chinese and white subjects and provides evidence for a possible functional relationship between NAT2 slow acetylator genotype and PD in both racial groups.

Objectives: Many patients with vitamin B12 deficiency do not have anemia or macrocytosis, but the prevalence of B12 deficiency in patients without macrocytosis is not known., Methods: We investigated the prevalence of B12 deficiency among patients with normocytosis and microcytosis and recommended a screening strategy. All patients (n = 3714) with serum B12 measured at the Prince of Wales Hospital in 1996 were reviewed. The prevalence of serum B12 less than 140 pmol/L was determined for the following patient subgroups: younger than 70 y, older than 70 y, anemic, non-anemic, macrocytic, normocytic, microcytic, documented iron deficiency, and documented thalassemia., Results: The prevalence of B12 deficiency (<140 pmol/L) ranged from 4.8% to 9.8% among the different subgroups., Conclusions: Whatever screening criteria were used, a significant number of B12-deficient patients will be missed. Therefore, there may be a case for universal vitamin B12 screening.

Objective: To study the neuropsychiatric (NP) manifestations in a large cohort of southern Chinese patients with systemic lupus erythematosus (SLE) according to the new 1999 American College of Rheumatology (ACR) case definitions and their clinical associations., Method: Patients with SLE who were followed from 1984 to 2000 were retrospectively reviewed. Patients with NP manifestations were ascertained and classified by at least 2 rheumatologists, with the collaboration of neurologists and psychiatrists. The association of NP manifestations with other clinical features and autoantibodies was studied by statistical analysis., Results: Five hundred eighteen patients with SLE were studied. The female to male ratio was 7.8 to 1 and the mean age of disease onset was 29.5 +/- 12.0 years (range 9-80). The mean duration of followup was 7.3 +/- 6.7 years (range 0.3-23.0). Ninety-six patients (19%) had 133 NP events and the mean number of events per patient-year of followup was 0.035. In decreasing order of frequency. these events were: seizure disorder (28%), cerebrovascular disease (19%), acute confusional state (14%), psychosis (11%), myelopathy (8%), mood disorder (6%), headache (4%), movement disorder (2%), cranial neuropathy (3%), demyelinating syndrome (1.5%), anxiety disorder (1.5%), mononeuritis multiplex/mononeuropathy (1.5%), aseptic meningitis (1%), and polyneuropathy (1%). Cognitive dysfunction was not classified because of the lack of standard neuropsychological testing for every patient. Univariate analysis revealed that NP-SLE was associated with a positive lupus anticoagulant (LAC) (p = 0.001), a strongly positive IgG anticardiolipin (aCL) (p = 0.01). leukopenia (p = 0.01), lymphopenia (p = 0.03), thrombocytopenia (p = 0.03), and pulmonary involvement (p = 0.03). Multivariate analysis showed that a strongly positive IgG aCL [RR 3.1 (1.3-7.7), p = 0.01] and a history of cyclophosphamide treatment [RR 4.3 (2.1-9.0), p < 0.001] were independently associated with NP manifestations in our cohort. Among the NP features, cerebrovascular disorder was particularly associated with the presence of LAC [OR 3.3 (1.4-8.0), p = 0.01] and a strongly positive IgG aCL [OR 3.1 (1.1-8.2), p = 0.031]., Conclusion: The point prevalence of overt NP manifestations in our cohort of patients with SLE was 19%. This percentage was likely higher if subtle cognitive dysfunction was included. Seizure and cerebrovascular disorders were the most common NP features. The presence of antiphospholipid antibodies was significantly associated with NP manifestations, especially cerebrovascular disorders.

Objective: To study the effect of chronic steroid therapy on bone mineral density (BMD) in premenopausal women with normal menstrual cycles and its treatment., Methods: A double blind placebo controlled study to evaluate 81 premenopausal women with systemic lupus erythematosus (SLE), aged 31.1 +/- 6 years, taking chronic steroid therapy, with a mean cumulative prednisone dose of 28 +/- 16.2 g. They were randomly allocated to 3 groups: Group 1: 0.5 microg calcitriol and 1200 mg calcium daily; Group 2: 1,200 mg calcium and placebo calcitriol; and Group 3: both placebo calcitriol and placebo calcium., Results: Baseline T score at the lumbar spine was > -1 in 56.8% and < -2.5 in 3.7% of the patients. At the end of 2 years, patients in the calcitriol group exhibited a significant increase of 2.1 +/- 2.4% in BMD at the lumbar spine compared to baseline value (p < 0.05). This change was not significantly different from the respective change in either calcium or placebo group (0.4 +/- 2.9% and 0.3 +/- 3.5%, respectively). No significant changes were observed in any treatment group in BMD at the hip or radius. Alkaline phosphatase increased both in the placebo (baseline: 57.5 +/- 17.5 IU/I; year 2: 60.9 +/- 15.3 IU/A) and the calcium group (baseline: 53.6 +/- 16.6 IU/I; year 2: 59.0 +/- 22.8 IU/1), but this increase reached statistical significance only in the calcium group, while the same variable remained stable in the calcitriol group (baseline: 53.9 +/- 14.1 IU/I; year 2: 54.6 +/- 12.3 IU/I)., Conclusion: Premenopausal women with SLE taking prolonged steroid therapy had lower BMD but showed no significant bone loss over the 2 year study period. The beneficial effect of calcitriol treatment in these premenopausal women was small, at least when it was instituted late in the course of steroid therapy.

Objectives: To study the survival rate and prognostic indicators of systemic lupus erythematosus (SLE) in a southern Chinese population., Methods: One hundred and eighty-six patients with SLE diagnosed between 1992 and 1999 were prospectively followed. Clinical features at presentation, subsequent evolving features, autoantibody profile, damage scores and mortality data were obtained. Prognostic factors for survival were studied by statistical analysis., Results: One hundred and sixty-three female and 23 male SLE patients were studied. The female to male ratio was 7.1 to 1 and the mean age at presentation was 33.6 yr (range 12-75). The mean disease duration was 45.2 months. At diagnosis, arthritis, malar rash and alopecia were the commonest features. During follow-up, the prevalence of nephritis, arthritis, photosensitivity and haematological disease increased significantly. Thirty-one per cent of the patients had organ damage at the time of data analysis and renal disease was the commonest cause. Logistic regression revealed that central nervous system disease, discoid lesions and treatment with high-dose steroid were independent predictors for damage. Nine patients died during the study period (three of disease-related complications and six of infections). The 3-, 5-, and 7-yr survival rates of our cohort were 97, 93 and 93%, respectively. Cox regression analysis revealed that thrombocytopenia and high-dose steroid treatment were independent risk factors for mortality., Conclusions: The survival of SLE in our southern Chinese patients is similar to that of the Caucasian series reported in the 1990s. Although nephritis contributes to organ damage, it is not a major determinant for survival. Infection remains the commonest cause of death. High-dose steroid treatment and thrombocytopenia are independent risk factors for mortality. Judicious use of immunosuppressive agents is necessary to improve the short-term survival of SLE.

Production of cytokines in unstimulated and mitogen-stimulated cultures were evaluated by ELISPOT in 34 SLE patients with low to moderate disease activity and 23 healthy controls. Significantly reduced production of IFN gamma, IL4 and IL12 and significantly increased production of IL6, IL10 and TNF alpha were found in patients with SLE. Regression analysis revealed that production of all six cytokines tended to decrease with increasing disease activity, but negative correlation with SLEDAI was significant (p < 0.05) only for PHA-stimulated IL4, unstimulated and PHA-stimulated IL10 and SAC-stimulated IL6. Negative correlation of stimulated and unstimulated IL6 and TNF alpha production with anti-DNA antibody levels were also significant.

Despite the improvement in survival of patients with systemic lupus erythematosus (SLE) and associated nephritis in the past 20 years, few studies of the long-term outcome of large cohorts of patients with well-defined histological classes of lupus nephropathy are available. We examined the long-term outcome of 183 patients with lupus nephritis (LN) followed up by the Division of Rheumatology at Queen Mary Hospital (Hong Kong) between 1976 and 1997. Their renal biopsies were classified according to World Health Organization (WHO) criteria. There were 27 men and 156 women. Initial renal biopsy showed the following WHO classes of LN: 2 patients (1%), class I; 9 patients (5%), class II; 46 patients (25%), class III; 101 patients (55%), class IV; and 25 patients (14%), class V. The mean duration of follow-up from the renal biopsy was 130.7 +/- 5.9 months (range, 13 to 260 months). The overall 5-, 10-, and 15-year survival and renal survival (survival without dialysis) rates were 98.9%, 94.4%, and 94.4% and 92.1%, 81.2%, and 75.2%, respectively. Univariate analysis showed class IV nephritis, hypertension, impaired renal function (glomerular filtration rate < 50 mL/min), nephrotic syndrome at time of renal biopsy, and failure of complete remission in the first year of treatment were unfavorable predictors for renal survival. Multivariate analysis using the Cox regression model also showed persistent hypertension, class IV nephritis, and incomplete renal remission in the first year were independent risk factors for renal failure. Our results showed the renal survival rate of our patients from South China with LN was similar to that of most reported series of white patients. Prospective randomized studies with well-defined treatment protocols are needed to delineate the optimal treatment strategy for LN.

Objective: To study the clinical characteristics, treatment outcome, and complications of patients with adult onset Still's disease (AOSD) in our local Chinese population., Methods: Patients with AOSD were identified among others who attended our rheumatology clinics from 1967 to 1997 and were followed. Their clinical and laboratory features at presentation, treatment, and outcome were recorded and compared with other reported series., Results: Sixteen patients with AOSD were identified. Eleven (69%) were female. Nine (56%) had onset of the disease between 16 and 35 years of age. The commonest presenting features were fever (100%), arthritis (94%), rash (85%), weight loss (69%), and sore throat (63%). Fifteen patients presented with pyrexia of unknown origin and the median duration of fever before the establishment of the diagnosis was 6 weeks (range 4-75). The acute phase response was marked in all patients with gross elevation of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and complement levels. Hyperferritinemia (> 5 times normal) was present in 90% of cases. Most patients (81%) required corticosteroid therapy and 85% of those steroid treated patients received additional disease modifying agents. The mean duration of followup of our patients was 93.3 months (range 8-362). Five (33%) had monocyclic systemic disease, 6 (40%) had polycyclic systemic disease, and 4 (27%) had frequent relapses that progressed to a chronic arthropathy., Conclusion: AOSD in southern Chinese tends to run a benign course, with few patients evolving into chronic inflammatory arthropathy. A significantly lower incidence of serositis, lung involvement, and enlargement of the reticuloendothelial organs was observed at presentation compared with patients of different ethnic origins.

Rheumatoid arthritis is the commonest connective tissue disease associated with bronchiolitis obliterans, a clinico-pathologic entity of bronchiolar inflammation and fibrosis reflecting injury to the small airways, and presenting with symptoms and signs of small airways obstruction. It may arise de novo or as a complication of therapy due to d-penicillamine, when a distinct histologic picture of bronchiolar constriction without intraluminal inflammatory polyps appeared to be predominant in most reported cases. This condition is associated with a high morbidity and mortality, and apart from cessation of d-penicillamine, there are no standard recommendations for treatment. Response to various immunosuppressive agents, including corticosteroid, azathioprine, and cyclophosphamide, had been variable and unsatisfactory. We report a case of bronchiolitis obliterans in a Chinese female treated with d-Penicillamine for rheumatoid arthritis with the first documented response to corticosteroid alone, and review the literature on this subject.

Objective: To analyze HLA-DR and DQ associations with rheumatoid arthritis (RA) in patients from southern China., Methods: In 66 patients and 45 controls, restriction fragment length polymorphism studies were performed using DRB, DQA, and DQB probes, and DRB allele-specific typing of polymerase chain reaction-amplified DRB DNA:, Results: The frequency of HLA-DR4 was significantly increased among RA patients (42.4% versus 17.8%). Increased frequencies of the DQA3 allele (77.8% versus 48.9%) and the DQB1*0302 allele (71.0% versus 46.3%), which are in linkage disequilibrium with DR4, were also found. Oligonucleotide typing showed that the amino acid sequence LLEQRRAA, spanning amino acid positions 67-74 of the DR beta molecule, was found in 19 of 49 patients and 5 of 32 controls. The main DR4 allelic subtypes found in the population were DRB1*0404 and DRB1*0405, both of which carried the sequence. There was no difference in subtype distribution between patients and controls., Conclusion: Chinese RA patients have an increased frequency of HLA-DR4 alleles which possess the same DRB third allelic hypervariable sequence shown to be associated with susceptibility in Caucasian RA patients.

100 consecutive Chinese patients with SLE were recruited for study of HLA-A, B and DR antigen. Clinical and serological parameters were analysed with respect to the HLA antigens. B5 was associated with presence of other autoimmune diseases (thyrotoxicosis, myasthenia gravis, diabetes mellitus, corrected p less than 0.025); absence of malar rash (corrected p less than 0.025); B35, with male sex (corrected p less than 0.025); DR2 with anti-Ro (anti-SSA) antibody (p less than 0.05). Previous study of association with B13, B17 was not present in our cohort. Except for malar rash, subclassification of disease status with respect to HLA antigen did not reveal significant association.

The Chinese in Southeast Asia are recognized as a population group that has a relatively high prevalence of rapid "acetylators" and a relatively high incidence of systemic lupus erythematosus. This study was designed to evaluate the possibility that there were environmental lupus erythematosus provocative substances eliminated by acetylation that resulted in a preponderance of slow acetylators among patients with the disease. We compared acetylator status in 36 Chinese women with mild, stable, and confirmed lupus erythematosus and 36 healthy control subjects matched for age, sex, and ethnic origin. Acetylator status was determined by use of HPLC to assay 5-acetylamino-6-formylamino-3-methyluracil/methylxanthine (AFMU/MX) and AFMU/(AFMU + MX) ratios in urine 1 to 4 hours after drinking a strong cup of coffee (caffeine). By use of parametric and nonparametric methods of analysis, the frequency distribution of AFMU/MX and AFMU/(AFMU + MX) ratios in both the patients and control subjects were determined to be very similar. Thus there was no association between slow acetylator status and lupus erythematosus in the study subjects.

Hematologic and folate studies were carried out in 116 pregnant Chinese women in Hong Kong. Mean serum folate values fell progressively with pregnancy reaching subnormal levels during the puerperium. Mean red-cell folate values remained normal or high throughout, but showed a significant fall after delivery in women who carried out breast-feeding. Individually, 18 women showed hematologic abnormalities compatible with folate deficiency, but only four had subnormal red-cell folate values satisfying the strict criterion of folate deficiency, giving an overall frequency of 3.4%. Compared to primigravidae and other multiparae, gravida 2 women appeared to be at highest risk of folate deficiency.

Fifteen patients with cryptic miliary tuberculosis seen over a six-year period in a large teaching hospital were reviewed. This form of tuberculosis tended to be difficult to diagnose and was most common in older people and those with underlying diseases such as malignancy or blood dyscrasias. Bacteriological investigation was of the little help in diagnosis while bone marrow and liver biopsies were more useful. The diagnosis was made during life in only seven (47 per cent) of the 15 cases, and the overall mortality was 80 per cent. Tuberculosis should be considered in all cases of pyrexia of unknown origin, and investigations performed to establish or exclude the diagnosis. A prompt and adequate therapeutic trial with antituberculous treatment even in the absence of definite evidence of tuberculosis can be life-saving.

The distribution of HLA-A, B, and DR alleles has been studied in 100 Chinese patients with systemic lupus erythematosus and in 100 healthy Chinese controls. Complement components factor B, C4A and C4B were studied in 72 patients and 61 controls. There was no significant difference between patients and controls in the distribution of HLA-A, HLA-B, factor B and C4B alleles, but there was a significant excess of HLA-DR2 and C4A null in the patients. An unusual variant of C4B was found in 6 patients and 1 control. The possible role of haplotypes is considered in interpreting these results and relating them to previous findings in Chinese.