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The aim of the present study was to evaluate the ameliorative potential of quercetin (QC) against paracetamol (PCM)- induced oxidative stress and biochemical alterations in mice blood. A total of 36 mice were randomly allocated into six groups, six mice in each. Group I served as healthy controls, while groups II and III were administered with N-acetylcysteine (NAC) and QC alone respectively. Group IV was administered with PCM alone. Groups V and VI were administered with PCM on day 0 followed by NAC and QC, respectively, for 6 consecutive days. On day 7th blood samples were obtained and subjected for the assays of oxidative stress and serum biochemical panels. Erythrocytic lipid peroxides contents of alone PCM-intoxicated mice were significantly higher, while reduced glutathione contents were found to be significantly lower in comparison with the healthy controls. The activities of antioxidant enzymes were also found to be singnificantly lower in these mice. Additionally, significantly increased activities of serum aspartate transaminase, alanine transaminase and alkaline phosphatase, as well as levels of bilirubin, urea and creatinine were revealed by these mice. Postadministration with QC remarkably alleviated the over production of MDA and improved GSH levels in PCM-intoxicated mice blood. In addition, antioxidant enzymes; glutathione peroxidase, glutathione-S-transferase, superoxide dismutase and catalase activities were also improved significantly in these mice. QC had also considerably ameliorated the altered biochemical parameters toward normalcy. Thus, it can be concluded that QC may constitute a remedy against PCM-induced oxidative stress and reno-hepatic injuries.

Licorice is the root of Glycyrrhiza uralensis, which is a commonly used herb in traditional Chinese medicine. Licorice extract has been claimed to have anti-cancer, anti-viral, anti-inflammatory and anti-diabetic activities. This study evaluated the estrogenic effect of licorice root water extract on Ishikawa cells and related it to its effect on cell proliferation using various cell lines in comparison to glycyrrhizic acid (GA). This study showed that licorice root extract exhibited estrogenic property while decreasing cell proliferation thus suggesting possible use in estrogen replacement agent with anti-proliferative property. Even though GA is the most studied active component in licorice, these two properties were not seen in the cell lines tested; hence suggesting that GA is not responsible for these activities. These results showed that licorice could be further studied as an estrogen replacement agent as it does not cause an increase in cell proliferation in the breast and uterus.

Congenital increase in cardiac outflow tract resistance would lead to chronic ventricular pressure overloading, and eventually ventricular hypertrophy and dysfunction. Conventional echocardiographic assessment of global ventricular systolic and diastolic function is far from ideal because of the lack of sensitivity. There is a pressing need in developing a clinical tool to unveil the degree of myocardial dysfunction as well as to monitor the treatment effect in these patients. M-mode and tissue Doppler recordings of the left and right atrioventricular rings' motion in a longitudinal cardiac axis allowed us to assess segmental ventricular function in a more sensitive and specific way. This thesis aimed to assess ventricular long axis function in patients with congenital outflow tract obstructions. It is based on the anatomical observation that a major part of long axis function is subtended by subendocardial fibers, and the hypothesis that the function of these fibers might be more sensitive to effect of pressure overload than circumferential ones., Normal values for left and right ventricular (RV) long axis function (in left, septal and tricuspid sites of atrioventricular rings) were first established by studying normal healthy volunteers without cardiovascular diseases with M-mode and pulse wave (PW) tissue Doppler Imaging (TDI). These values included, 1) M-mode derived systolic amplitude of motion (displacement), 2) Any long axis incoordination (long axis shortening after end of ejection which was reported as a sign of coronary ischemia after excluding interventricular conduction abnormalities), 3) TDI-derived peak systolic and diastolic velocities., The following groups of patients with congenital outflow tract obstructions were therefore studied, 1) Congenital aortic valve stenosis and subaortic stenosis (21 patients, study 1)., 2) Congenital coarctation of aorta (23 patients, study 2)., 3) Congenital pulmonary valve stenosis (43 patients, study 3)., Study 1 investigated the presence of "isolated" diastolic disease, defined as reduced long axis early diastolic velocity with normal systolic velocity in 21 young patients with congenital aortic valve stenosis (AVS). Most patients with normal left ventricular (LV) ejection fractions in fact had depressed long axis systolic velocities. This work demonstrated the selective sensitivity of long axis function in unveiling myocardial dysfunction in AVS patients. Moreover, good correlation was found between long axis systolic and diastolic velocities which suggested isolated diastolic disease is unlikely., Patients with coarctation of aorta (CoA) are often less symptomatic (fewer reported chest pain or heart failure) that AVS patients despite having similar degree of outflow resistance. Study 2 addressed such phenomenon by studying the long axis function in 23 CoA patients and the results were compared to 23 AVS patients and normal controls. This work again confirmed the presence of LV long axis impairment in patients with chronic increase in LV afterload. Moreover, a worse deterioration of LV long axis function and a higher prevalence of long axis incoordination independent of LV outflow resistance is seen in patients with proximally increased LV afterload (AVS) compared with distal disease (CoA) that might account for their difference in clinical behavior., Data are scant to address the impact of chronic increase in RV outflow resistance on RV diastolic performance. Study 3 evaluated the relationship of restrictive RV physiology (defined as the presence of antegrade pulmonary arterial flow in late diastole measured by conventional PW Doppler echocardiography) to RV long axis function and patients' symptoms in 43 patients with pulmonary valve stenosis (PVS). Restrictive RV physiology was found in 42% studied patients who were more symptomatic and had more severe RV long axis dysfunction. This work implied regular follow-up of adult PVS patients using simple qualitative RV Doppler echocardiographic measurements should guide toward early identification of myocardial dysfunction and the need for removal of outflow tract obstruction before irreversible damage occurs., Given the selective sensitivity of long axis function in assessing myocardial damage In patients with pressure overloaded ventricle, I further studied the effect of interventions on change of long axis behavior in patients with CoA, 1) Before and 14 month after successful endovascular stenting (21 patients, study 4)., 2) Long term follow up after surgical correction, by either angioplasty or endovascular stenting (80 patients, study 5)., Study 4 prospectively evaluated the effect of endovascular stenting on intermediate-term biventricular function in 21 adults with CoA and the results were compared with surgically repaired patients and normal controls. LV long axis disturbances were improved with sparing of RV long axis function after intervention. Subclinical myocardial dysfunction was observed in both stented and repaired patients compared with normal controls. This work supported aortic stenting in patients with anatomically suitable lesions. It also prompted further studies on the clinical significance of persistent myocardial dysfunction in "corrected" CoA patients., In study 5, I went on to examine the prevalence of LV long axis diastole dysfunction (defined as septal PW TDI early diastolic velocity 8cm/s) in a relatively large cohort of CoA patients (n=80) and its relationships to patient demo graphics and aortic elastic properties. Forty-seven patients (59%) were found to have LV long axis dysfunction. As a group, they were older when received treatment and had higher ascending aortic stiffness indices despite similar systemic blood pressure, prevalence of anti-hypertensive use and associated bicuspid aortic valve as compared to other CoA patients. This work addressed the age at intervention and increased aortic stiffness are important determinants of persistent myocardial dysfunction after intervention. Intervention at an early age before structural damage to proximal aorta and appropriate medications to reduce central aortic stiffness might preserve LV long axis function in "corrected" CoA patients and further improve their long term prognosis., CONCLUSIONS, In conclusion, conventional global echocardiographic assessment is inadequate for assessing patients with congenital outflow tract obstructions. Segmental ventricular long axis function is frequently abnormal at rest in these patients. The site of these disturbances corresponds to the ventricle that is subjected to pressure overloading. Assessment of long axis function is simple and sensitive. It has considerable potential in investigating the natural course of myocardial damage, to clarify the basis of abnormal ventricular function, particularly during diastole and to evaluate treatment effect on myocardial recovery in patients with congenital outflow tract obstructions. Further studies should focus on the role of long axis function in determining prognosis for these patients., Lam, Yat Yin., "November 2011.", Thesis (M.D.)--Chinese University of Hong Kong, 2012., Includes bibliographical references (leaves 134-160)., p.1, Chapter PART1 --- HISTORIC REVIEW --- p.5, Chapter Chapter1 --- VENTRICULAR OUTFLOW TRACT OBSTRUCTION SYNDROME --- p. 6, Chapter 1.1 --- BACKGROUND --- p.7, Chapter 1.2 --- AORTIC VALVULAR STENOSIS --- p.8, Chapter 1.2.1 --- Anatomy pathophysiology and clinical features --- p.8, Chapter 1.2.2 --- Investigations --- p.9, Chapter 1.2.3 --- Treatment --- p.9, Chapter 1.3 --- COARCTATION OF AORTA --- p.9, Chapter 1.3.1 --- Anatomy pathophysiology and clinical features --- p.9, Chapter 1.3.2 --- Investigations --- p.11, Chapter 1.3.3 --- Treatment --- p.11, Chapter 1.4 --- PULMONARY VALVULAR STENOSIS --- p.12, Chapter 1.4.1 --- Anatomy pathophysiology and clinical features --- p.12, Chapter 1.4.2 --- Investigations --- p.13, Chapter 1.4.3 --- Treatment --- p.13, Chapter Chapter2 --- VENTRICULAR RESPONSE TO HIGH AFTERLOAD --- p.14, Chapter 2.1 --- VENTRICULAR ADAPTATION IN AORTIC VALVULAR STENOSIS --- p.15, Chapter 2.2 --- VASCULAR STIFFENING AORTIC COARCTATION --- p.17, Chapter 2.3 --- VENTRICULAR ADAPTATION IN PULMONARY VALVULAR STENOSIS --- p.18, Chapter 2.4 --- LIMITATIONS OF CONVENTIONAL ECHOCARDIOGRAPHY --- p.19, Chapter Chapter3 --- MYOCARDIAL FIBER ARCHITECTURE AND LONG AXIS FUNCTION --- p.21, Chapter 3.1 --- MYOCARDIAL FIBER STRUCTURE AND LONG AXIS FUNCTION --- p.22, Chapter 3.2 --- NOMRAL LONG AXIS EXCURSION AND TIMING --- p.25, Chapter 3.3 --- QUANTIFICATION OF LONG AXIS MOTIONS --- p.26, Chapter 3.3.1 --- M-mode --- p.26, Chapter 3.3.2 --- Clinical applications of atrio-ventricular plane displacement --- p.27, Chapter 3.3.3 --- Tissue Doppler Imaging --- p.28, Chapter 3.3.4 --- Clinical application of tissue Doppler imaging --- p.30, Chapter 3.3.5 --- Limitations of M-mode and TDI in the assessment of long axis function --- p.31, Chapter Chapter4 --- HYPOTHESIS AND SPECIFIC OBJECTIVES OF THE THESIS --- p.32, Chapter 4.1 --- INTRODUCTION --- p.33, Chapter 4.2 --- HYPOTHESIS --- p.34, Chapter Chapter5 --- METHODOLOGY --- p.35, Chapter 5.1 --- STUDY PATIENTS --- p.36, Chapter 5.1.1 --- Patients with ventricular outflow tract obstruction --- p.36, Chapter 5.1.2 --- Normal controls --- p.36, Chapter 5.2 --- CLINICAL ASSESSMENT --- p.37, Chapter 5.3 --- ECHO CARDIOGRAPHIC ASSESSMENT --- p.37, Chapter 5.3.1 --- Imaging acquisition protocol --- p.37, Chapter 5.3.2 --- Assessment of severity of outflow tract obstruction --- p.38, Chapter 5.3.3 --- Assessment of global ventricular structure and function --- p.40, Chapter 5.3.4 --- Assessment of long axis function --- p.42, Chapter 5.3.5 --- Evaluation of restrictive RV physiology in PVS patients --- p.42, Chapter 5.3.6 --- Determination of aortic elastic properties in CoA patients --- p.43, Chapter 5.3.7 --- Reproducibility --- p.45, Chapter 5.4 --- CARDIAC CATHETERIZATON AND ENDOVASCULAR STENTING FOR COARCTATION OF AORTA --- p.45, Chapter 5.5 --- STATISTICS --- p.46, Chapter PART 2 --- CLINICAL STUDIES --- p.48, Chapter Chapter6 --- "ISOLATED" DIASTOLIC DYSFUNCTION IN LEFT VENTRICULAR OUTFLOW TRACT OBSTRUCTION --- p.49, Chapter 6.1 --- INTRODUCTION --- p.50, Chapter 6.2 --- METHODS --- p.50, Chapter 6.2.1 --- Study population --- p.50, Chapter 6.2.2 --- Echocardiographic examination --- p.51, Chapter 6.2.3 --- Reproducibility --- p.51, Chapter 6.2.4 --- Statistics --- p.51, Chapter 6.3 --- RESULTS --- p.52, Chapter 6.3.1 --- Baseline characteristics --- p.52, Chapter 6.3.2 --- Echocardiographic measurements --- p.52, Chapter 6.3.3 --- Correlation analysis between long axis variables --- p.55, Chapter 6.3.4 --- Reproduci bility --- p.58, Chapter 6.4 --- DISCUSSION --- p.58, Chapter 6.4.1 --- Selective sensitivity oflong axis function --- p.58, Chapter 6.4.2 --- Close coupling of long axis systolic and diastolic function --- p.59, Chapter 6.4.3 --- Limitations --- p.60, Chapter 6.5 --- CONCLUSIONS --- p.61, Chapter Chapter7 --- EFFECT OF CHRONIC AFTERLOAD INCREASE ON LEFT VENTRICULAR MYOCARDIAL FUNCTION IN PATIENTS WITH CONGENITAL LEFT-SIDED OBSTRUCTIVE LESIONS --- p.62, Chapter 7.1 --- INTRODUCTION --- p.63, Chapter 7.2 --- METHODS --- p.63, Chapter 7.2.1 --- Study population --- p.63, Chapter 7.2.2 --- Echocardiographic examination --- p.64, Chapter 7.2.3 --- Reproducibility --- p.65, Chapter 7.2.4 --- Statistics --- p.65, Chapter 7.3 --- RESULTS --- p.66, Chapter 7.3.1 --- Baseline characteristics --- p.66, Chapter 7.3.2 --- Patients versus controls --- p.66, Chapter 7.3.3 --- Aortic valvular stenosis versus coarctation patients --- p.70, Chapter 7.3.4 --- Reproducibility --- p.70, Chapter 7.4 --- DISCUSSION --- p.72, Chapter 7.4.1 --- Long axis function in patients with increased LV afterload --- p.72, Chapter 7.4.2 --- Difference between aortic valvular stenosis and coarctation patients --- p.72, Chapter 7.4.3 --- Limitations --- p.74, Chapter 7.5 --- CONCLUSIONS --- p.74, Chapter Chapter8 --- RESTRICTIVE RIGHT VENTRICULAR PHYSIOLOGY: ITS PRESENCE AND SYMPTOMATIC CONTRIBUTION IN PATIENTS WITH PULMONARY STENOSIS --- p.75, Chapter 8.1 --- INTRODUCTION --- p.76, Chapter 8.2 --- METHODS --- p.77, Chapter 8.2.1 --- Study population --- p.77, Chapter 8.2.2 --- Echocardiographic examination --- p.77, Chapter 8.2.3 --- Reproducibility --- p.78, Chapter 8.2.4 --- Statistics --- p.78, Chapter 8.3 --- RESULTS --- p.79, Chapter 8.3.1 --- Baseline characteristics --- p.79, Chapter 8.3.2 --- Patients versus controls --- p.81, Chapter 8.3.3 --- Comparison between patient groups --- p.81, Chapter 8.3.4 --- Predictors for symptoms --- p.84, Chapter 8.3.5 --- Reproducibility --- p.85, Chapter 8.4 --- DISCUSSION --- p.85, Chapter 8.4.1 --- Main findings --- p.85, Chapter 8.4.2 --- Characterization of diastolic performance in pulmonary valvuar stenosis patients --- p.85, Chapter 8.4.3 --- Mechanism for restrictive RV physiology in PVS patients --- p.87, Chapter 8.4.4 --- Study inlplications --- p.89, Chapter 8.4.5 --- Limitations --- p.90, Chapter 8.5 --- CONCLUSIONS --- p.90, Chapter Chapter9 --- EFFECT OF ENDOVASCULAR STENTING OF AORTIC COARCTATION ON BIVENTRlCULAR FUNCTION IN ADULTS --- p.91, Chapter 9.1 --- INTRODUCTION --- p.92, Chapter 9.2 --- METHODS --- p.92, Chapter 9.2.1 --- Study population --- p.92, Chapter 9.2.2 --- Implantation procedure --- p.93, Chapter 9.2.3 --- Echocardiographic examination --- p.94, Chapter 9.2.4 --- Reproducibility --- p.94, Chapter 9.2.5 --- Statistics --- p.95, Chapter 9.3 --- RESULTS --- p.95, Chapter 9.3.1 --- Baseline characteristics --- p.95, Chapter 9.3.2 --- Blood pressure data --- p.96, Chapter 9.3.3 --- Echocardiographic measurements --- p.97, Chapter 9.3.3.1 --- Pre-stenting versus post-stenting (group 1) --- p.97, Chapter 9.3.3.2 --- Stenting (group 1) versus post-surgical repair (group 2) --- p.101, Chapter 9.3.3.3 --- Coarctation patients (group 1 post-stenting and group 2) versus control (group 3) --- p.101, Chapter 9.3.4 --- Reproducibility --- p.101, Chapter 9.4 --- DISCUSSION --- p.103, Chapter 9.4.1 --- Main findings --- p.103, Chapter 9.4.2 --- Potential impact of stenting on cardiovascular outcome --- p.103, Chapter 9.4.2.1 --- BP control --- p.103, Chapter 9.4.2.2 --- LV mass and long axis function --- p.104, Chapter 9.4.3 --- RV function after stenting --- p.105, Chapter 9.4.4 --- Subclinical LV myocardial function in coarctation patients --- p.105, Chapter 9.4.5 --- Limitations --- p.106, Chapter 9.5 --- CONCLUSIONS --- p.107, Chapter Chapter10 --- LEFT VENTRICULAR LONG AXIS DYSFUNCTION IN ADULTS WITH "CORRECTED" AORTIC COARCTATION IS RELATED TO AN OLDER AGE AT INTERVENTION AND INCREASED AORTIC STIFFNESS --- p.108, Chapter 10.1 --- INTRODUCTION --- p.109, Chapter 10.2 --- METHODS --- p.110, Chapter 10.2.1 --- Study population --- p.110, Chapter 10.2.2 --- Echocardiographic examination --- p.111, Chapter 10.2.3 --- Reproducibility --- p.111, Chapter 10.2.4 --- Statistics --- p.112, Chapter 10.3 --- RESULTS --- p.112, Chapter 10.3.1 --- Patients versus controls --- p.112, Chapter 10.3.2 --- Patients with long axis dysfunction (LAD) versus without LAD --- p.113, Chapter 10.3.3 --- Predictors of LAD --- p.117, Chapter 10.3.4 --- Reproducibility --- p.120, Chapter 10.4 --- DISCUSSION --- p.120, Chapter 10.4.1 --- Main findings --- p.120, Chapter 10.4.2 --- LV dysfunction and adverse remodeling in "corrected" aortic coarctation --- p.120, Chapter 10.4.3 --- Mechanism behind LV dysfunction in "corrected" aortic coarctation --- p.121, Chapter 10.4.4 --- Study implications --- p.124, Chapter 10.4.5 --- Limitations --- p.124, Chapter 10.5 --- CONCLUSIONS --- p.125, Chapter Chapter 11 --- DISCUSSION --- p.126, Chapter 11.1 --- DISCUSSION --- p.127, Chapter 11.2 --- LIMITATIONS --- p.129, Chapter 11.3 --- THE FUTURE --- p.129, Chapter Chapter12 --- CONCLUSIONS --- p.131, APPENDIX --- p.133, BIBLIOGRAPHY --- p.134, http://library.cuhk.edu.hk/record=b5549673, Use of this resource is governed by the terms and conditions of the Creative Commons “Attribution-NonCommercial-NoDerivatives 4.0 International” License (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Racial differences in the distribution of cerebrovascular occlusive disease are well documented. Extracranial stenosis is more common in Caucasian while intracranial stenosis is more common in Asian, Hispanic and African-American. The prevalence of asymptomatic intracranial stenosis in middle age and elderly general population in China was about 7%. The frequency of intracranial atherosclerosis among patients with stroke and TIA is 40 to 50% in Chinese populations. Concurrent extracranial and intracranial stenoses is common in Asian, the incidence range from 10 to 39% in patients with stroke. The current population of China is 1.3 billion and it was estimated that 30% of the population will be aged 60 and above by 2050 in China. The incidence of stroke in China is 215 per 100000 which is one of the highest among the world and this burden is expected to escalate in the coming decades. However, studies of concurrent stenoses among Chinese are scarce. The aim of this precis is to present my studies that were conducted mainly among Chinese stroke patients on this particular field. The scope of the studies covers the following 4 areas: (1) Identification of Long-term prognosis of patients with concurrent stenoses; (2) Long-term prognosis of patients with concurrent stenoses and ischemic heart disease; (3) Lesion pattern and stroke mechanisms in concurrent stenoses; and (4) genetic polymorphisms of ischemic stroke patients with concurrent stenoses. The background, objectives, subjects, methods, results, and conclusions of these studies will be presented in this precis., Man, Bik Ling., Adviser: Lawrence K.S. Wong., Source: Dissertation Abstracts International, Volume: 73-06, Section: B, page: ., Thesis (M.D.)--Chinese University of Hong Kong, 2011., Includes bibliographical references (leaves 144-184)., Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web., Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web., isbn: 9781267214164, Use of this resource is governed by the terms and conditions of the Creative Commons “Attribution-NonCommercial-NoDerivatives 4.0 International” License (http://creativecommons.org/licenses/by-nc-nd/4.0/)

I found that 2.6ml of 0.5% levobupivacaine had similar clinical characteristics as the same volume of 0.5% bupivacaine in spinal anaesthesia. Both were effective for spinal anaesthesia in urological surgery, when a sensory block up to at least T10 dermatome was required. In comparing the use of levobupivacaine alone and levobupivacaine with fentanyl, there were no significant differences in haemodynamic changes and quality of sensory and motor block, when 2.6ml of levobupivacaine alone or 2.3ml of levobupivacaine with fentanyl 15mcg (0.3ml) were used in spinal anaesthesia. Both were effective for spinal anaesthesia in urological surgery. In comparing the use of ropivacaine 10mg and bupivacaine 10mg, both with fentanyl 15mcg in spinal anaesthesia for urological surgery, all the patients achieved adequate level of sensory block up to T10 dermatome or higher. The two drugs were similar in the onset time of motor block, the characteristics of sensory block and haemodynamic changes; however, the duration of motor block was shorter with ropivacaine. I concluded that both studied solutions, ropivacaine-fentanyl and bupivacaine-fentanyl, were effective for spinal anaesthesia in urological surgery and the duration of motor block was shorter with the ropivacaine-fentanyl solution. The dose-response relationship of ropivacaine in spinal anaesthesia for lower limb surgery requiring a sensory block up to at least the T12 dermatome was defined. Anaesthesia was successful in 0, 0, 42, 83 and 100% when ropivacaine at doses of 2, 4, 7, 10 and 14mg respectively were given. The derived values for ED50 and ED95 were 7.6mg and 11.4mg respectively. The cephalic level of sensory block and the degree of motor block increased with larger doses of ropivacaine. Finally, the median effective dose (ED50) of bupivacaine, levobupivacaine and ropivacaine in spinal anaesthesia for lower limb surgery were defined as 5.50mg (95% CI: 4.90--6.10mg), 5.68mg (95% CI: 4.92--6.44mg), and 8.41mg (95% CI: 7., In this series of studies, I have shown that levobupivacaine and ropivacaine are effective local anaesthetic agents for spinal anaesthesia in lower limb and urological surgery. This proved my hypothesis. Both are suitable alternatives to bupivacaine for spinal anaesthesia. Furthermore, these studies showed that ropivacaine is less potent than levobupivacaine and bupivacaine and the potency is similar between levobupivacaine and bupivacaine at median effective dose., Levobupivacaine and ropivacaine are two relatively new local anaesthetics which were developed in view of their potential for less cardiotoxicity in comparison with bupivacaine, the most common local anaesthetic used in spinal anaesthesia for many years. Both are produced in pure S(-) enantiomer form in contrast to bupivacaine which is a racemic mixture. They have been shown to be effective in peripheral nerve blocks, and epidural analgesia and anaesthesia; nevertheless, experience of their use in spinal anaesthesia is limited. The objective of this thesis was to evaluate their use in spinal anaesthesia for surgery in non-obstetric patients. My hypothesis was that levobupivacaine and ropivacaine are effective local anaesthetic agents for spinal anaesthesia in lower limb and urological surgery. In order to test this hypothesis, I conducted five clinical studies on 269 patients who had urological surgery or lower limb surgery under spinal or combined spinal-epidural anaesthesia. First, I investigated the efficacy and clinical characteristics of levobupivacaine and the mixture of levobupivacaine with fentanyl in spinal anaesthesia. Next, I compared the use of ropivacaine-fentanyl with bupivacaine-fentanyl in spinal anaesthesia. Finally, I defined the dose-response relationship of ropivacaine in spinal anaesthesia using traditional dose-response methodology and defined the relative potency among levobupivacaine, ropivacaine and bupivacaine by comparing the defined ED50 in spinal anaesthesia using up-down sequential allocation method., Lee, Ying Yin., Source: Dissertation Abstracts International, Volume: 73-06, Section: B, page: ., Thesis (M.D.)--Chinese University of Hong Kong, 2011., Includes bibliographical references (leaves 133-150)., Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web., Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web., isbn: 9781267199485, Use of this resource is governed by the terms and conditions of the Creative Commons “Attribution-NonCommercial-NoDerivatives 4.0 International” License (http://creativecommons.org/licenses/by-nc-nd/4.0/)

not available., Hui, Mamie., "Dec 2010.", Source: Dissertation Abstracts International, Volume: 73-04, Section: B, page: ., Thesis (M.D.)--Chinese University of Hong Kong, 2011., Includes bibliographical references (leaves 209-236)., Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web., Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web., isbn: 9781267099594, Use of this resource is governed by the terms and conditions of the Creative Commons “Attribution-NonCommercial-NoDerivatives 4.0 International” License (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Nasopharyngeal cancer (NPC) is endemic in Southern China and Hong Kong. It has traditionally been treated by local radiotherapy with great success especially for early stage disease. However the treatment outcome in advanced stage disease is unsatisfactory., Results from this series of combined clinical, translational and laboratory studies have redefined the role of hypoxia, angiogenesis and metastasis as new therapeutic targets in NPC. Novel biomarkers and new therapeutic approaches were developed based on these targets., To develop new therapies in NPC, we demonstrated in a randomized controlled phase 2 clinical trial that sequential therapy of neoadjuvant chemotherapy followed by chemoradiotherapy was well tolerated with a manageable toxicity profile that allowed subsequent delivery of full dose chemoradiotherapy. This strategy reduced distant metastasis which translated into improved patient survival. In preclinical studies, the antiangiogenesis agent sunitinib demonstrated potent in vitro and in vivo growth inhibition in NPC. In a phase 2 clinical trial, sunitinib demonstrated modest clinical activity in heavily pretreated NPC patients. However, the unexpected high incidence of severe hemorrhage from upper aero-digestive tract in NPC patients who received prior high dose RT to the region is of concern. We propose to exclude NPC patients with disease recurrence within previous radiation field and/or with vascular invasion from future antiangiogenesis therapy., To investigate potential new therapeutic targets and biomarkers in NPC, we first confirmed from the Hong Kong NPC study group of 2915 patients' database that distant metastasis was the leading cause of NPC failure after primary radiotherapy. We further showed that hypoxia induced broad changes of both up- and down-regulated gene expressions involved in diverse biological processes in NPC cells. Over-expression of biomarkers of hypoxia and angiogenesis (including HIF-1alpha, CA IX and VEGF) is common in NPC and is associated with poor prognosis. Elevated plasma osteopontin is a biomarker of distant metastasis, and pre-treatment plasma osteopontin level may be a useful biomarker of response to radiotherapy in NPC., Hui, Pun., "September 2010.", Adviser: Anthony Chan., Source: Dissertation Abstracts International, Volume: 73-04, Section: B, page: ., Thesis (M.D.)--Chinese University of Hong Kong, 2011., Includes bibliographical references (leaves 269-293)., Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web., Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web., isbn: 9781267099600, Use of this resource is governed by the terms and conditions of the Creative Commons “Attribution-NonCommercial-NoDerivatives 4.0 International” License (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Inflammatory bowel disease (IBD) is associated with lifetime morbidity and the onset of disease frequently occurs in early life. Although IBD manifests throughout all ethnic groups, there has been marked heterogeneity in its incidence, prevalence, manifestation, and outcome. We sought to study the incidence, prevalence, and survival of ulcerative colitis (UC) and to examine the evolution and prognostic predictors of Crohn's disease (CD) and UC among Hong Kong Chinese. A total of 4 studies were performed to address these issues. One longitudinal cohort study examined the incidence, prevalence, survival and phenotypic changes of UC. Two other longitudinal cohort studies evaluated the phenotypic evolution of CD. One of them specifically compared the course of disease between patients with and patients without upper gastrointestinal tract phenotype. The final retrospective study identified clinical factors that predicted the occurrence of corticosteroid dependency and refractoriness in patients with IBD. The annual age-standardized incidence rate and point prevalence of UC per 100,000 Hong Kong Chinese in 2006 were 2.1 (95% CI: 1.1-3.7) and 26.5 (95% CI: 22.6-30.9), respectively. Incidence of UC has increased 6 times over the past two decades. The overall survival of UC patients was similar to the expected survival of the Hong Kong population. Phenotypic changes in CD also occurred in Chinese patients in the same way as the white patients with respect to disease behavior, though at a slower rate. Similar to the white CD patients, the location of disease remained relatively stable over the course of disease. Chinese CD patients had more upper gastrointestinal tract phenotype which predicted the need of surgery and subsequent hospitalization. On the other hand, the rate of proximal extension of UC was less than 25% after 10 years. In CD, thrombocytosis predicted, whereas colonic disease negatively predicted corticosteroid dependency. Stricturing CD was associated with cor, Chow, Kai Lai., "May 2009.", Advisers: Francis KL Chan; Joseph JY Sung., Source: Dissertation Abstracts International, Volume: 72-01, Section: B, page: ., Thesis (M.D.)--Chinese University of Hong Kong, 2010., Includes bibliographical references (leaves 193-235)., Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web., Electronic reproduction. Ann Arbor, MI : ProQuest Information and Learning Company, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web., isbn: 9781124357249, Use of this resource is governed by the terms and conditions of the Creative Commons “Attribution-NonCommercial-NoDerivatives 4.0 International” License (http://creativecommons.org/licenses/by-nc-nd/4.0/)

not available., by Wong Lai-hung, Grace., Source: Dissertation Abstracts International, Volume: 72-04, Section: B, page: ., Thesis (Ph.D.)--Chinese University of Hong Kong, 2010., Includes bibliographical references (leaves 218-252)., Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web., Electronic reproduction. Ann Arbor, MI : ProQuest Information and Learning Company, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web., isbn: 9781124497815, Use of this resource is governed by the terms and conditions of the Creative Commons “Attribution-NonCommercial-NoDerivatives 4.0 International” License (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Opportunistic infection is always a potentially life threatening complication in pediatric oncology patients and hematopoietic stem cell transplant recipients. With the advances in various disease treatment protocols, the overall and event-free survivals of this high risk population improve significantly. In this thesis, the author reported a number of original studies to discuss different strategies in prevention of this serious complication. Firstly, the author demonstrates that pediatric oncology patients are still vulnerable to various vaccine-preventable infectious diseases up to 18 months after stopping chemotherapy. For those vaccine-preventable infectious diseases, pediatric oncology patients can mount a significant and persistent immune response to common inactivated vaccine (namely diphtheria-tetanus-pertussis vaccine). For non-vaccine preventable infectious diseases, regular monitoring of plasma viral load and strategic use of antiviral agents as pre-emptive or prophylactic agent is an effective approach to prevent infection. In hematopoietic stem cell transplant setting, adoptive transfer of acquired immunity from donor to recipient and incorporation of this parameter in donor selection process can be considered. The findings of the studies can be applied to clinical setting. The future direction of our studies includes the immune responses of other common vaccines namely pneumococcal vaccine and pandemic influenza vaccine in high risk population. The role of transfer of donor's varicella zoster immunity in prevention of herpes zoster infection in transplant recipient can be further explored. With the advances in supportive care of our vulnerable patients, the survival rate is expected to be further improved in the future., by Frankie Wai Tsoi, Cheng., Source: Dissertation Abstracts International, Volume: 73-01, Section: B, page: ., Thesis (M.D.)--Chinese University of Hong Kong, 2010., Includes bibliographical references (leaves 193-208)., Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web., Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web., isbn: 9781124999760, Use of this resource is governed by the terms and conditions of the Creative Commons “Attribution-NonCommercial-NoDerivatives 4.0 International” License (http://creativecommons.org/licenses/by-nc-nd/4.0/)

(1) Were among the antihypertensive drugs with the lowest likelihood of discontinuation implying a potentially superior tolerability profile (2) Had similar odds of short and long term rates of add-on pharmacotherapy implying a similar efficacy with other drug classes (3) Were associated with statistically similar all cause and CVS mortality (4) Had similar odds of presenting with impaired fasting glucose in the short-term. (5) Had higher odds of presenting with hypercholesterolemia in the short-term but the absolute increase in cholesterol was minimal (in the magnitude of 0.14 mmol/1). > (6) Had similar odds of presenting with hyponatremia and hypokalemia in the short-term., Due to the large sample size these studies are likely to be representative and are new findings among ethnic Chinese patients presenting with uncomplicated hypertension. These results point towards thiazide diuretics as a favorable first-line antihypertensive agent in the management of uncomplicated hypertension in Hong Kong primary practice, in addition to favorable public health considerations including affordability. These studies are in support of guidelines from international authorities recommending thaizide diuretics as the best choice of first-line antihypertensive agent, and suggest that such international guidelines may be generalizable to patients of Chinese race. (Abstract shortened by UMI.), In these studies we have characterized the major antihypertensive drug classes in terms of their prescription patterns, efficacy, tolerability and association with adverse clinical as well as biochemical outcomes. The completeness of CDARS and e-CMS of the Hospital Authority allows retrieval and comparison of these clinical outcomes of the commonly used antihypertensive agents. The present studies showed that prescription of CCB and BB were high compared with international trends and that of thiazide particularly low and showed a declining trend. Yet when compared with other drug classes, thiazide diuretics, Wong Chi Sang., Adviser: Stewart William Mercer., Source: Dissertation Abstracts International, Volume: 70-09, Section: B, page: ., Thesis submitted in: September, 2008., Thesis (M.D.)--Chinese University of Hong Kong, 2009., Includes bibliographical references (leaves 223-260)., Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web., Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web., School code: 1307., isbn: 9781109401899, Use of this resource is governed by the terms and conditions of the Creative Commons “Attribution-NonCommercial-NoDerivatives 4.0 International” License (http://creativecommons.org/licenses/by-nc-nd/4.0/)

not available., Pak Wai Martin., Adviser: Charles Andrew van Hasselt., Source: Dissertation Abstracts International, Volume: 72-10, Section: B, page: ., Thesis (M.D.)--Chinese University of Hong Kong, 2009., Includes bibliographical references (leaves 245-269)., Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web., Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web., isbn: 9781124821047, Use of this resource is governed by the terms and conditions of the Creative Commons “Attribution-NonCommercial-NoDerivatives 4.0 International” License (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Among NAFLD patients without known diabetes or high fasting plasma glucose at or above 7.0 mmol/I, 21% had undiagnosed diabetes and 29% had impaired glucose tolerance. In this population, post-challenge hyperglycemia was associated with NASH and liver fibrosis. Oral glucose tolerance test should be considered in the evaluation of NAFLD patients., NAFLD is closely related to metabolic syndrome. Using the ethnic-specific IDF criteria, 70% of NAFLD patients had metabolic syndrome, compared to 7% of the general population. A significant proportion of NAFLD patients had body mass index between 23 and 25 kg/m2. The diagnosis of NAFLD may predate the development of different components of metabolic syndrome., NAFLD patients have lower serum adiponectin level than healthy controls. NASH patients have higher serum tumor necrosis factor alpha (TNF-alpha) level than those with simple steatosis. The differences in adipokines remained significant after adjustment for traditional metabolic risk factors. These suggest that abnormalities in adipokines may be involved in the pathogenesis of NAFLD and NASH. On the other hand, genetic polymorphisms of the adiponectin and TNF-alpha genes are not associated with histological severity., Since advanced fibrosis is less common in Chinese NAFLD patients, performing liver biopsies on every NAFLD patient for disease staging does not appear to be essential or cost-effective. Recently, the NAFLD fibrosis score is developed using 6 clinical parameters including age, BMI, impaired fasting glucose or diabetes, AST/ALT ratio, platelet count and albumin. The score had high negative predictive value of 91% in excluding advanced fibrosis in Chinese NAFLD patients. It may also reduce the burden of liver biopsies in the majority of cases., Through a series of clinical studies in Chinese nonalcoholic fatty liver disease (NAFLD) patients in Hong Kong, we demonstrated that nonalcoholic steatohepatitis (NASH) and advanced fibrosis do occur in Chinese, with around 10% of NAFLD patients having advanced fibrosis, and 80% having necroinflammation. Importantly, up to half of the patients had progression of liver fibrosis upon long-term follow-up., by Wong Wai Sun., Adviser: Lik Yuen Henry Chan., Source: Dissertation Abstracts International, Volume: 70-09, Section: B, page: ., Thesis submitted in: May 2008., Thesis (M.D.)--Chinese University of Hong Kong, 2009., Includes bibliographical references (leaves 219-263)., Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web., Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web., School code: 1307., isbn: 9781109401905, Use of this resource is governed by the terms and conditions of the Creative Commons “Attribution-NonCommercial-NoDerivatives 4.0 International” License (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Conclusions. The growing epidemic of type 2 diabetes and its cardiorenal complications place a major burden on our health care system. Diabetic kidney disease is of particular importance in Asian populations including Chinese. In this series of studies, using a large prospective cohort established since 1995, I confirmed the powerful predictive value of albuminuria on cardio-renal complications. Inhibition of the RAAS interacted with both modifiable and genetic factors, notably the ACE I/D polymorphism, on the development of cardio-renal complications. In addition, it was found that CKD predicts CVD independent of albuminuria. Based on two prospective studies, I confirmed the effectiveness of global risk-factor control using structured care protocol to prevent these devastating complications. (Abstract shortened by UMI.), I then examined the possible independent and interactive effects of CKD and albuminuria on cardio-renal outcomes in the original cohort of 5,004 patients. Glomerular filtration rate was estimated (eGFR) by the Modification of Diet in Renal Disease equation. The frequency of CKD as defined by eGFR <60ml/min/1.73m 2 was 15.8% in the cohort at baseline, when 6% of patients had serum creatinine ≥150mumol/L., In collaboration with colleagues, I have conducted a series of studies to examine the prognostic factors for cardio-renal complications in Chinese type 2 diabetic patients. The modulating effects of RAAS inhibition and the effectiveness of rnuitidisciplinary care to prevent ESRD are also examined., Research Hypotheses. (1) Albuminuria is a prognostic factor on cardio-renal outcomes in type 2 diabetes patients; (2) Chronic Kidney Disease is associated with other metabolic risk factors and phenotypes and is a prognostic factor on cardio-renal outcomes in type 2 diabetes patients; (3) Angiotensin-converting-enzyme insertion/deletion polymorphism is a prognostic factor on cardio-renal outcomes in type 2 diabetes patients, and has an effect on treatment responses with RAAS blockage with ACE inhibitors; (4) Structured care models by risk stratification using various prognostic factors and adherence to care protocol can improve cardio-renal outcome in type 2 diabetes patients., Results. In a prospective cohort of 5,004 patients, I examined the effect of albuminuria and ACE inhibition on survival and cardio-renal outcomes in 3,773 patients who had been observed for at least 6 months with a mean follow up period of 35.8 months., Taken together, measurement of serum creatinine alone without GFR estimation may underestimate the frequency of CKD in Chinese type 2 diabetic patients. Estimated GFR was inversely associated wit-29h an increasing frequency of micro- and macrovascular complications cross-sectionally and an increased risk of all-cause mortality prospectively, independent of albuminuria and metabolic control., So Wing Yee., Source: Dissertation Abstracts International, Volume: 70-06, Section: B, page: 3422., Thesis (M.D.)--Chinese University of Hong Kong, 2008., Includes bibliographical references (leaves 203-243)., Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web., Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web., School code: 1307., isbn: 9781109224993, Use of this resource is governed by the terms and conditions of the Creative Commons “Attribution-NonCommercial-NoDerivatives 4.0 International” License (http://creativecommons.org/licenses/by-nc-nd/4.0/)

A direct bone tendon junction consists of four zones: tendon, uncalcified fibrocartilage, calcified fibrocartilage, and bone. The uncalcified and calcified fibrocartilage together forms the transition zone. This organization ensures a gradual transition in stiffness and material properties, and protects the junction from failure. Transition zone regeneration during bone tendon junction healing is important to restore this unique protective mechanism., Bone tendon junction repair is involved in many orthopaedic reconstructive procedures. Healing is observed to be slow. The junction often heals by fibrous tissue formation. Previous attempts to enhance bone tendon junction healing have resulted in increased bone formation. However, fibrocartilage transition zone is not restored., This thesis describes a series of studies on transition zone regeneration in bone tendon junction healing using two partial patellectomy animal models. The healing process inside a bone trough was first studied and characterized. Little transition zone regeneration was observed except near the articular cartilage cut surface. The possibility of using articular cartilage to stimulate transition zone regeneration was explored. Both articular cartilage autograft and allogeneic cultured chondrocyte pellet implantations resulted in significantly increased fibrocartilage transition zone regeneration. Cell tracking indicated that the regenerated tissue likely originated from host cells. To elucidate the mechanism of stimulation by allogeneic cultured chondrocyte pellet, the role of cellular and matrix component needed to be differentiated. Freezing and rapid freeze thaw cycles permanently devitalized the allogeneic cultured chondrocyte pellet, but retained its structural integrity and matrix contents. Preliminary results indicated that implantation of the devitalized allogeneic cultured chondrocyte pellet could still increase fibrocartilage transition zone regeneration. Cellular activity seemed not to be essential for the stimulatory effect., With further research and development, it is envisioned that a cartilage-based stimulation method for fibrocartilage transition zone regeneration in bone tendon junction healing will be developed for clinical application., Wong Wan Nar, Margaret., Source: Dissertation Abstracts International, Volume: 70-06, Section: B, page: 3423., Thesis (M.D.)--Chinese University of Hong Kong, 2008., Includes bibliographical references (leaves 216-231)., Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web., Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web., s in English and Chinese., School code: 1307., isbn: 9781109225006, Use of this resource is governed by the terms and conditions of the Creative Commons “Attribution-NonCommercial-NoDerivatives 4.0 International” License (http://creativecommons.org/licenses/by-nc-nd/4.0/)

In general, AD is diagnosed based on Hanifin and Rajka's diagnostic criteria or the UK working diagnostic criteria. The atopic status of study participants was evaluated clinically by (1) the presence of atopic symptoms including allergie rhinitis, asthma or hyperactive airway disease in patients, parents, and/or siblings, (2) measuring the concentrations of total and allergen-specific IgE in their peripheral blood, and/or (3) positive skin prick tests to common aeroallergens or food allergens. The severity of AD was assessed either clinically by validated disease scores, objective serum parameters such as serum chemokine levels, or physiological parameters such as nocturnal wrist movements. Quality of life (QoL) is assessed with the Cantonese version of the Children's Dermatology Life Quality Index (CDLQI). Although not a gold standard, ail assessment tools were compared against SCORAD., Research Hypotheses or aims: (1) To investigate if AD severity as determined by a 12-month-severity score correlates with a validated acute severity score. The research aims to establish a chronic severity scores for local use in AD research. (2) To explore if correlations exist between objective and subjective symptoms. (3) To evaluate if quality of life (QoL) correlates with disease severity. (4) To assess if age and gender may affect quality of life. (5) To explore if serum markers (CTACK, IL-18, BDNF, and substance P.) correlate with disease severity or quality of life score. (6) To evaluate if urine LTE4 as a non-serum marker correlates with disease severity. (7) To evaluate if nocturnal wrist movements correlate with various clinical and laboratory markers. (8) To evaluate if skin hydration (SH) and transepidermal water loss (TEWL) correlate with severity and QoL. (9) In a final chapter, we give a number of clinical studies to illustrate the application of these methods in clinical research., The objectives of the MD thesis are to explore various clinical scores, quality of life evaluation, laboratory tests, and mechano-physiological parameters as assessment tools for the evaluation of AD. The research hypotheses are that many aspects of the disease can be objectively measured by these new scores and markers. The application of some of these assessment tools in clinical trials will be described. In all of the studies reported, I am the principal investigator and the first author of the publications in indexed medical journals., Kam Lun Ellis Hon., Source: Dissertation Abstracts International, Volume: 70-06, Section: B, page: 3419., Thesis (M.D.)--Chinese University of Hong Kong, 2008., Includes bibliographical references (leaves 192-213)., Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web., Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web., School code: 1307., isbn: 9781109224962, Use of this resource is governed by the terms and conditions of the Creative Commons “Attribution-NonCommercial-NoDerivatives 4.0 International” License (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Childhood OSA is increasingly recognized to be associated with a variety of complications including neurocognitive and cardiovascular diseases. The intermediate link between OSA and end organ damage has been suggested to be inflammation, and both local airway and systemic inflammation have been described in adults with OSA. A non-invasive technique of sputum induction was utilised to show that children with OSA also have airway inflammation, as characterized by a significant increase in neutrophils, and the severity of OSA also correlated significantly with the degree of neutrophilic inflammation (Chapter 7). This finding may lead to research on the use of anti-inflammatory therapeutic agents or antibiotics for the treatment of childhood OSA. Another marker of inflammation, C-reactive protein (CRP) was measured in a cohort of children with OSA before and after treatment (Chapter 8). Children with OSA had higher CRP levels compared to their non-OSA counterparts, and the raised CRP decreased significantly following treatment suggesting that the inflammatory response is potentially reversible. The cardiovascular risk factors of insulin levels and blood pressure (BP) were evaluated and children with OSA had higher serum insulin and greater systolic and diastolic BP compared to healthy controls (Chapters 9 and 10). These findings suggest that children with OSA may be at risk of developing metabolic syndrome and its devastating consequence. (Abstract shortened by UMI.), The original research studies undertaken were based on nocturnal sleep examinations to explore childhood OSA in two main aspects, namely its assessment, and a better understanding of its complications in children. The gold standard for diagnosing OSA is overnight polysomnography (PSG), which is an expensive investigation that is not routinely available at all public hospitals in Hong Kong. Alternative valid assessment tools for OSA that are more cost-effective are needed. The feasibility of using radiographic techniques to assess severity of OSA was explored, and the size of the upper airway, as reflected by the tonsillar pharyngeal (TP) ratio obtained from lateral neck radiograph, correlated well with the severity of OSA (Chapter 4). A defined TP cutoff could accurately predict moderate-to-severe OSA with high sensitivity and specificity. This method could be used in clinical practice to prioritize patients with suspected OSA for further evaluation. A locally applicable questionnaire scale was examined for its validity and accuracy in diagnosing children with OSA (Chapter 5). The presence of three symptoms (snoring, mouth breathing and nocturnal sweating) was found to have high predictive value in correctly identifying children with the condition. The question of whether a single night PSG study is adequate in diagnosing OSA was examined together with the assessment for the presence of night-to-night variability in PSG and respiratory parameters in childhood sleep (Chapter 6). Forty-four obese children and 43 age and sex-matched healthy controls underwent two consecutive nights PSG examination. Although a first night effect was clearly documented, a single night PSG study would have correctly identified over 80% of children with OSA. This finding has significant resource implications., Albert Martin Li., Adviser: Tony Nelson., Source: Dissertation Abstracts International, Volume: 70-06, Section: B, page: 3420., Thesis (M.D.)--Chinese University of Hong Kong, 2008., Includes bibliographical references (leaves xxxv-lxxx)., Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web., Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web., in English only., School code: 1307., isbn: 9781109224986, Use of this resource is governed by the terms and conditions of the Creative Commons “Attribution-NonCommercial-NoDerivatives 4.0 International” License (http://creativecommons.org/licenses/by-nc-nd/4.0/)

(1) MRI is shown to be an accurate test for detecting NPC and one which has the potential to be used in screening to (a) screen out normal patients who do not require endoscopie biopsy; and (b) identify small tumours that would be missed on endoscopy., (2) At diagnosis staging NPC by MRI reveals that oropharyngeal and maxillary sinus invasion are markers of more advanced disease than reflected in current staging system. Tumour involvement of the preclival/prevertebral region, skull base and retropharyngeal nodes are more common than previously recognised by computed tomography, while parapharyngeal tumour invasion is less common. The latter resuits from the superior ability of MRI to differentiate primary tumours with true parapharyngeal invasion from those contained within the nasopharynx which are causing bowing of the wall or lie adjacent to a retropharyngeal node., (3) Post treatment complications were detected by MRI in over 50% of patients. Neural damage, especially to the temporal lobes and 12th cranial nerves, was the most frequent complication (48%), followed by osteoradionecrosis (20%) involving the mandible, upper cervical spine and skull base, the latter including destruction of the roof of the nasopharynx. Malignant tumours and unusual benign masses (6%) showed radiological features useful in the differential diagnosis from NPC recurrence. Malignant tumours were mainly squamous cell carcinomas or sarcomas showing a predilection for the maxillary region, tongue and external auditory canal. The unusual benign masses were found in the nasopharynx/sphenoid sinus., (4) Finally functional MRI using DWI and 1H-MRS are feasible in the technically challenging region of the head and neck. Choline ratios and ADC values of NPC are established. The successful demonstration of differences between the biomarkers of NPC and those of lymphoma and squamous cell carcinoma, show that functional MRI is a new tool for the evaluation of NPC, opening up the possibility that these biomarkers can be used for monitoring NPC treatment response in the future., Magnetic resonance imaging (MRI) provides excellent anatomical detail and functional information about cancer. This thesis explores the role of MRI in the assessment of nasopharyngeal carcinoma (NPC) from detection through to the long term complications of radiotherapy treatment., Ann D King., Source: Dissertation Abstracts International, Volume: 70-06, Section: B, page: 3468., Thesis (M.D.)--Chinese University of Hong Kong, 2008., Includes bibliographical references (leaves 180-191)., Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web., Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web., s in English only., School code: 1307., isbn: 9781109224979, Use of this resource is governed by the terms and conditions of the Creative Commons “Attribution-NonCommercial-NoDerivatives 4.0 International” License (http://creativecommons.org/licenses/by-nc-nd/4.0/)

The effect of CRT on incidence of AF development in patients with severe HF was explored by comparing 36 patients with conventional indication for the CRT to 36 HF patients without CRT, matched for age, sex and LV systolic function (Publication 5). After a follow up of 3 years, the annual incidence of AF in the CRT group was 2.8%, which was significantly lower than the control group (10.2%). Moreover, the echocardiographic benefit by CRT was compared between these 36 patients with SR and 15 patients with persistent AF. The results showed that the echocardiographic response was similar between the two groups. These findings suggested that CRT may have the potential to reduce AF burden in patients with severe HF and that patients with persistent AF may also benefit from CRT., The objective of the study (Publication 1) was to assess the feasibility of using non-contact LV mapping to delineate the LV endocardial activation pattern in 7 HF patients in NYHA class III, with low LVEF and wide QRS complex (>120ms). Non-contact mapping was safely performed and there were two endocardial conduction patterns identified, namely homogenous (Type I) and conduction block (Type II). The second part of the study (Publication 2) was to determine the implication of these two distinct activation patterns to echocardiographic and clinical response to CRT. 23 patients in NYHA class III, with LVEF <35% and QRS duration >120ms were recruited in this study. 15 patients had Type II pattern and 8 Type I. The QRS duration between the two types of conduction patterns were comparable. Patients with Type II pattern had a more favourable echocardiographic and clinical response to CRT than those with Type I. It was concluded that, despite the similar QRS duration between the two types of LV endocardial activation patterns, patients with Type II pattern had a more favourable response to CRT., The significance of baseline renal function in CRT was assessed in 85 consecutive patients with conventional indication for the CRT (Publication 7). There was no significant relationship between baseline renal function and significant LV reverse remodeling after CRT, suggesting baseline renal insufficiency probably would not affect the response to CRT. (Abstract shortened by UMI.), This study (Publication 3) was to determine the effect of CRT in patients with narrow QRS complex and evidence of mechanical dyssynchrony as determined by TDI. 51 patients in NYHA class III or IV, with LV ejection fraction <35%, and QRS duration <120ms were recruited for the CRT. The effect of the device therapy on LV systolic function in this cohort was compared to 51 patients who fulfilled the current criteria with wide QRS complex. CRT significantly improved the LV systolic function, NYHA class and exercise capacity in those with narrow complex to a similar extent in those with wide complex. With co-existing mechanical dyssynchrony determined by TDI, patients in both narrow and wide QRS complex groups showed more favourable response to CRT than those without significant mechanical dyssynchrony. This confirmed that QRS was a poor marker of mechanical dyssynchrony and the current selection criteria are probably not adequate to include more potential responders to the therapy., This study (Publication 4) was to determine the role of optimal medical therapy in CRT recipients before implantation. The echocardiographic and clinical effect of CRT in 30 patients without the optimal combination of ACEi or ARB and beta-blockers was compared to 30 patients matched for age, sex, NYHA class and HF etiology. Patients with optimal medical therapy had significantly better echocardiographic and clinical response to CRT. The results confirmed that optimal medical therapy is necessary to achieve maximal response by CRT., This study (Publication 6) was to determine if patients with moderate LV systolic function and wide QRS complex would benefit from the CRT. Significant improvement in LV systolic function was observed in 15 patients with LVEF between 35 and 45%, NYHA class III and QRS duration >120ms after CRT, suggesting that presence of LV systolic dysfunction and cardiac dyssynchrony may be the major determining factors for favourable CRT response. Therefore, patients with less advanced HF may also benefit from the CRT., "May 2007.", Adviser: Yu Cheuk Man., Source: Dissertation Abstracts International, Volume: 69-08, Section: B, page: 4657., Thesis (M.D.)--Chinese University of Hong Kong, 2007., Includes bibliographical references (p. 133-151)., Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web., Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web., School code: 1307., isbn: 9780549773979, Use of this resource is governed by the terms and conditions of the Creative Commons “Attribution-NonCommercial-NoDerivatives 4.0 International” License (http://creativecommons.org/licenses/by-nc-nd/4.0/)

For the nervous system, there is evidence of relative shortening of the spinal cord, reflected by both reduced cord length to vertebral column ratio and a change in cross-sectional morphology of the cord. The cerebellar tonsils are low-lying in AIS subjects while significant regional volume differences in the brain are also evident between AIS subjects and controls., From the results of this series of study, AIS girls are found to have morphological difference in multiple aspects when compared with age- and sex-matched normal controls., Idiopathic scoliosis is a common worldwide problem and has been treated for many decades; however, there still remain uncertain areas about this disorder. Its involvement and impact on different parts of the human body remain underestimated due to lack of technology in imaging for objective assessment in the past., In the skeletal system, AIS girls have generalized osteopenia and abnormal growth of the appendiceal skeleton. For the axial skeleton, abnormal ossification patterns have been found affecting both the longitudinal growth and axial growth pattern of the vertebral column. There is overgrowth of the anterior vertebral column, reversed asymmetry of the neural arch and smaller pedicle at the concavity of the scoliotic curve in AIS, suggestive of asynchronous growth between membraneous and endochondral ossifications. In the skull, both calvarium and basicranium are found have regional difference (including foramen magnum) between AIS subjects and controls, which is again probably reflecting a systemic process of asynchronous growth between membraneous and endochondral ossification., It was concluded that the hypothesis "In adolescent idiopathic scoliosis, advanced magnetic resonance imaging techniques can be used to identify systemic features which are suggestive of asynchronous neuro-osseous growth of the disorder" was confirmed. (Abstract shortened by UMI.), Taking together, the abnormalities in the skeletal system and nervous system are likely to be inter-related and reflecting a systemic process of asynchronous neuro-osseous growth. The above findings help to explain a number of well documented neurological abnormalities in AIS: Anatomically, there is increased incidence of Chiari malformation and syringomyelia in AIS subjects, while functionally, abnormal somatosensory evoked potential (SSEP) results, impaired postural balance, poor performance on combined visual and proprioceptive testing and spatial orientation testing as well as reports of abnormal nystagmus response to caloric testing are known to be associated with AIS., The advances in imaging technique and image analysis technology have provided a novel approach for the understanding of the phenotypic presentation of neuro-osseous changes in AIS subjects as compared with normal controls. Dynamic imaging also assists in functional assessment of pulmonary function and respiratory mechanism in AIS subjects., The hypothesis to be tested in this series of studies is: "In adolescent idiopathic scoliosis, advanced magnetic resonance imaging techniques can be used to identify systemic features which are suggestive of asynchronous neuro-osseous growth of the disorder". This thesis was based on a series of eight studies which were aimed to explore the "unknown" anatomical features in the skeletal and neural systems in AIS by the application of new advanced technique of MR imaging and sophisticated image analysis programs., We are the first group who has undertaken a comprehensive morphological assessment of the skeletal and nervous systems in AIS subjects based on imaging findings which have not been reported previously. For the first time in literature, the spinal cord and vertebral column, brain and skull were thoroughly analyzed in AIS subjects and compared with age- and sex-matched normal controls. Detailed correlations with clinical information, neurological tests have also been made. As an appendix, MR imaging findings of the pulmonary system in AIS, including the lung, chest wall and diaphragms are also presented at the end of the thesis., Chu Chiu-wing, Winnie., Source: Dissertation Abstracts International, Volume: 69-02, Section: B, page: 0976., Thesis (M.D.)--Chinese University of Hong Kong, 2007., Includes bibliographical references (p. 248-267)., Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web., Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web., School code: 1307., isbn: 9780549480020, Use of this resource is governed by the terms and conditions of the Creative Commons “Attribution-NonCommercial-NoDerivatives 4.0 International” License (http://creativecommons.org/licenses/by-nc-nd/4.0/)

In part ONE of this thesis, including the most up to date information on SARS virology, disease transmission, pathogenesis and laboratory diagnosis will be summarized and presented, including the results of many studies in which I have participated (these references will be underlined as they appear in text). This of course summarizes knowledge that is now known in 2006 but was largely unknown during the initial outbreak. In part TWO, six original clinical studies performed at PWH will be presented: study (1) describes the clinical manifestations and severity of SARS, and its potential to cause major hospital outbreaks; (2) demonstrates the importance of epidemiological linkage in diagnosing SARS; (3) reports the clinical outcomes of a stepwise treatment protocol, which includes the use of corticosteroid therapy as an immunomodulant; (4) demonstrates that corticosteroid therapy can retard viral clearance, and should be used judiciously; (5) demonstrates that a more robust humoral response is associated with severe SARS, thus indicating that passive immunity treatment strategies seem only suitable either during early illness or as prophylaxis; and (6) shows that SARS has few early discriminating laboratory features compared to other causes of community-acquired pneumonia, thus a high index of suspicion is needed to recognize this infection in the absence of worldwide transmission. A thorough review of the relevant published material will be included in the discussion section of each study., Severe Acute Respiratory Syndrome (SARS) is an emerging infectious disease caused by a novel coronavirus. It caused a global outbreak in 2003, resulting in more than 8000 infections, 700 deaths, and major social and economic disruption. In the initial phase of the SARS outbreak, the medical profession had no knowledge regarding the responsible pathogen, nor the clinical manifestations of SARS and the course of illness. There was no reliable diagnostic tool and no known effective therapy. But for the first time in medical history, we witnessed the rapid accumulation of knowledge on a disease as it evolved, which in turn assisted its management and control., Since conducting randomized-controlled trials during the 2003 crisis was almost impossible, most of the presented studies are either descriptive or case-controlled in design. However, these studies have laid foundations for recent and future research into the clinical diagnosis and management of SARS. Moreover, the construction of the SARS clinical database has contributed to the work of other investigators, which has resulted in over thirty-six publications. It is my hope that these research endeavors can contribute to the understanding of this emerging, deadly disease., Lee Lai Shun, Nelson., "April 2006.", Source: Dissertation Abstracts International, Volume: 69-01, Section: B, page: 0205., Thesis (M.D.)--Chinese University of Hong Kong, 2007., Includes bibliographical references (p. 264-292)., Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web., Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web., s in English and Chinese., School code: 1307., isbn: 9780549401520, Use of this resource is governed by the terms and conditions of the Creative Commons “Attribution-NonCommercial-NoDerivatives 4.0 International” License (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Allogeneic haematopoietic stem cell transplantation (HSCT) has been used successfully to treat children and adults with high-risk or relapsed hematopoietic malignancies, marrow failure syndromes, and hereditary immunodeficiency disorders. When initially developed, allogeneic HSCT was conceived as a method of rescuing patients from the toxic side effects of dose-intensive chemoradiotherapy. Due to transplant-related toxicities, the application of myeloablative allogeneic HSCT has been limited to younger patients without organ dysfunctions. Since the early 1990s many groups of investigators have explored strategies using less intensive preparative regimens that would allow engraftment of hematopoietic progenitor cells from either identical or non-identical donors. These reduced-intensity conditioning (RIC) regimens result in less tissue damage, less inflammatory cytokine secretion, and possibly lower rates of graft-versus-host disease (GVHD) and non-relapse mortality (NRM). Such non-myeloablative approach, or "mini-transplant", has been suggested to benefit older patients as well as in conditions in which traditional myeloablative conditioning regimens are associated with high rates of non-relapse mortality., Allogeneic HSCT is the only curative therapy for many patients with myeloid malignancies or myelodysplastic syndrome (MDS). The development of reduced-intensity preparative regimens may allow the extension of this form of treatment to older and patients with coexisting medical illness. On the other hand, relapse after transplantation remains the most important cause of treatment failure in patients with refractory acute myeloid leukemia (AML) or MDS, and is associated with poor survival. Evaluation of prognostic factors may help to improve the results of myeloablative and RIC allogeneic HSCT in this group of patients. Furthermore, the impact of comorbidities on outcomes of RIC allogeneic HSCT in this group of patients with refractory AML or MDS needs to be defined., The application of embryonic and adult stem cells in regenerative and reparative therapies of non-hematopoietic diseases is emerging rapidly. Human umbilical cord blood (UCB) is a rich source of hematopoietic stem cells and mesenchymal progenitor cells. Although clinical experience to date with UCB has focused on hematological application, early preclinical studies support the hypothesis that multipotential stem cells derived from UCB exhibit functional characteristics similar to that observed in adult marrow-derived stem cells in mediating vascular and organ regenerative capabilities. However, the application of these preclinical findings in clinical setting needs to be further studied. Mini-transplant of human UCB may be an effective approach to repair organ damage in patients with non-hematological diseases., Wong Siu Ming Raymond., Adviser: Joseph J.Y. Sung., Source: Dissertation Abstracts International, Volume: 73-01, Section: B, page: ., Thesis (M.D.)--Chinese University of Hong Kong, 2006., Includes bibliographical references (leaves 187-223)., Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web., Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web., isbn: 9781124988351, Use of this resource is governed by the terms and conditions of the Creative Commons “Attribution-NonCommercial-NoDerivatives 4.0 International” License (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Endometrial carcinoma is the most common gynaecologic cancer in the United States with about 41,200 new cases projected to occur in 2006. It often presents with abnormal uterine bleeding and spreads to the cervix in 10 to 20% of cases. Whilst early diagnosis is essential for optimal disease treatment, the best investigation for abnormal uterine bleeding remains uncertain. Although hysteroscopy has been reported to have high accuracy in predicting normal or abnormal endometrial histopathology, its accuracy varies with the underlying pathology. The highest accuracy occurs in the diagnosis of intrauterine anatomical pathology such as endometrial polyp whereas it is at its lowest in microscopic histopathology such as endometrial hyperplasia. Hysteroscopy is also potentially useful for detecting tumour spread to the uterine cervix that helps in staging and surgical planning. However, the role of hysteroscopy with guided biopsy in detecting endometrial cancer and the choice of distension medium remain to be determined. As the uterine cavity is a collapsed space, hysteroscopy requires its distension with a gaseous or liquid medium to allow complete visualization of the uterine cavity. The use of such media to rinse the uterine cavity raises the concern that when the endometrium harbours endometrial carcinoma cells, there is a potential risk of retrograde dissemination of these cells into the peritoneal cavity. The work in this thesis has addressed four major issues of diagnostic hysteroscopy in the management of patients with endometrial carcinoma. Firstly, the role of diagnostic hysteroscopy and guided biopsy is limited especially in microscopic tumours. Secondly, the role of diagnostic hysteroscopy to detect cervical invasion in preoperative staging of endometrial carcinoma is proven and the usage of normal saline is more accurate than that which uses carbon dioxide. Thirdly, hysteroscopic dissemination occurs more frequent when using normal saline as opposed to carbon d, Lo, Wing Kit Keith., "May 2006.", Source: Dissertation Abstracts International, Volume: 68-09, Section: B, page: 5873., Thesis (M.D.)--Chinese University of Hong Kong, 2006., Includes bibliographical references (167-193)., Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web., Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web., School code: 1307., isbn: 9780549230830, Use of this resource is governed by the terms and conditions of the Creative Commons “Attribution-NonCommercial-NoDerivatives 4.0 International” License (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Conclusion 1. The results of the research partly supported hypothesis 1a. There was a significant reduction in both endothelium-dependent arterial relaxation following a surgical menopause. The results of the research partly supported hypothesis 1b. There was a significant reduction in endothelium-dependent arterial relaxation but no significant effect on endothelium-independent arterial relaxation., Conclusion 2. The results of the research partly supported hypothesis 2a. The addition of unopposed oestrogen significantly improved endothelium-dependent but not endothelium-independent arterial relaxation. The results of the research supported hypothesis 2b. The addition of oestradiol combined with progestogen (norethisterone acetate) reversed the reduction in arterial relaxation caused by a surgical menopause. The results of the research partly supported hypothesis 2c. The addition of tibolone reversed the reduction endothelium-dependent but not endothelium-independent arterial relaxation. The results of the research partly supported hypothesis 2d. The addition of oestradiol combined with a progestogen (norethisterone acetate) reversed the reduction in endothelium-dependent but not endothelium-independent arterial relaxation., Conclusion 3. The results of the research partly supported hypothesis 3a. Endothelium-dependent arterial relaxation but no endothelium-independent arterial relaxation was improved after the addition of menopausal hormone therapy using oestrogen combined with a progestogen in a continuous manner. The results of the research did not support hypothesis 3b. Neither endothelium-dependent arterial relaxation nor the endothelium-independent arterial relaxation was improved by cyclical menopausal HT., Conclusion 4. The results of the research did not support hypothesis 4. The addition of menopausal hormone therapy using combined oestrogen with progestogen did not improve arterial relaxation in postmenopausal women with established coronary heart disease., Hypothesis 2. This hypothesis examined three different types of commonly used menopausal HT. That unopposed oestrogen (2a), oestrogen combined with a progestogen (2b and 2d) or a synthetic steriod that has oestrogenic, progestogenic as well as androgenic activity (tibolone, 2c), reverse the reduction in arterial relaxation following menopause in Hong Kong Chinese women., Hypothesis 3. That menopausal hormone therapy using oestrogen combined with progestogen given in either continuous (3a) or cyclical (3b) regimens improves arterial relaxation in postmenopausal Hong Kong Chinese women., Hypothesis 4. That menopausal hormone therapy using combined oestrogen with progestogen improves arterial relaxation in postmenopausal Hong Kong Chinese women with established coronary heart disease., Menopausal HT can in general at least partially reverse changes in arterial relaxation in postmenopausal women. Different types of menopausal HT exhibit different effects on arterial relaxation. In healthy vessels, menopause HT mainly reverses the endothelium-dependent vascular effect, but it remains unclear how menopausal HT affects the endothelium-independent vascular effect. However, with established coronary heart disease, menopausal HT cannot reverse the changes in vascular reactivity., Summary. Menopause results in a reduction in arterial relaxation. However, GnRHa temporarily induced menopause in young women, the endothelium-independent vasodilatation was not impaired. This difference can be partly explained by the difference in age as vascular reactivity is age dependent. Secondly, GnRHa works with an initial phase of increase in oestrogen production resulting in a shorter duration of hypo-oestrogenism resulting in the lack of impairment on endothelium-independent vasodilatation., This thesis tested the following hypotheses: Hypothesis 1. That vascular reactivity decreases after the menopause as shown in premenopausal Hong Kong Chinese women with either a surgical (1a) or a medically induced (1b) menopause., This thesis will examine the effects of menopause and menopausal HT on arterial reactivity which is an indirect measurement of vascular function. Previous studies have shown that oestrogen is a potent coronary artery vasodilator, and this effect may be mediated via both endothelium-dependent and endothelium-independent mechanisms. One method of assessing vascular reactivity is to use ultrasound measurement of changes in brachial artery diameter in response to certain stimuli. Using this technique, changes in both endothelium-dependent and endothelium-independent vasodilatation can be measured. Increased rather than decreased arterial relaxation after stimulus can be viewed as a favourable response., Yim, So-fan., Adviser: C. J. Haines., Source: Dissertation Abstracts International, Volume: 68-09, Section: B, page: 5873., Thesis (M.D.)--Chinese University of Hong Kong, 2006., Includes bibliographical references (p. 159-194)., Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web., Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web., School code: 1307., isbn: 9780549230823, Use of this resource is governed by the terms and conditions of the Creative Commons “Attribution-NonCommercial-NoDerivatives 4.0 International” License (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Focal liver lesions are commonly encountered in clinical practice. To be able to differentiate potentially life-threatening lesions from clinically insignificant lesions, and to be able to treat them effectively are the two basic problems of a clinician who comes across such lesions. Percutaneous intervention of the liver with a needle enables a clinician to solve the above two problems in a minimally invasive manner. To date, there is a diversity of needle-related percutaneous interventional procedures that are applicable to the clinical management of patients with liver lesions, such as biopsy of focal lesions, drainage of abscesses, and ablation of tumors. Despite a reasonable safety and efficacy associated with these procedures, there are always grounds of further improvement in techniques and technology of needle-related percutaneous procedures to achieve an even better outcome. It was hypothesized that the application of needle-related interventional radiology to clinical management of focal liver lesions could be facilitated and extended with advancement and refinement in needle-related techniques and technology. This thesis was based on a series of nine studies that aimed to explore the potential of needle-related percutaneous interventions in the clinical management of focal liver lesions and to study the effect of the introduction of innovations in needle-related techniques and technology on such clinical applications. It was concluded that the hypothesis was confirmed., Yu Chun Ho., "April 2006.", Adviser: Anil Ahuja., Source: Dissertation Abstracts International, Volume: 68-08, Section: B, page: 5176., Thesis (M.D.)--Chinese University of Hong Kong, 2006., Includes bibliographical references (p. 219-235)., Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web., Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web., School code: 1307., isbn: 9780549177807, Use of this resource is governed by the terms and conditions of the Creative Commons “Attribution-NonCommercial-NoDerivatives 4.0 International” License (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Chapter 2 evaluates the effectiveness of two simple and widely applied self-report psychometric questionnaires: the 12-item General Health Questionnaire (GHQ-12) and Beck Depression Inventory (BDI) in detecting psychological morbidity after miscarriage. Both GHQ-12 and BDI demonstrated satisfactory psychometric properties and both questionnaires were found to be effective in detecting general psychiatric disorders and depression respectively., Chapter 3 reports the application of GHQ-12 and BDI in assessing the psychological well-being of 280 miscarrying women over a one-year longitudinal course after the loss. The psychometric outcomes were also compared with a community cohort unexposed to pregnancy loss. The study confirmed that although psychological distress reduces over time, the psychological impact following miscarriage is significant and could be enduring. Patients who were more distressed immediately after miscarriage continued to be at a higher risk of psychological morbidity at a later stage., Chapter 4 assesses the possible underlying risk factors associated with psychological morbidity following miscarriage over a one-year longitudinal course. It has demonstrated that while a poor marital dyad and psychological distress experienced immediately after miscarriage are consistent predisposing factors, some obstetric variables such as the type of medical management, a history of abortion and prior ultrasound evidence of fetal viability contribute to the development of psychological morbidity at various time points along its evolutionary course., Chapter 5 reports a randomised controlled trial involving 280 miscarrying women in assessing the effectiveness of a psychological counselling programme in reduction of psychological morbidity. A 30% reduction in the proportion of patients with psychological morbidity was found three months after miscarriage in the counselling group, suggesting a potential clinical beneficial effect, albeit not statistically significant. This potential effect was more profound for selected patients who were initially more distressed after miscarriage., Chapter 6 reports our exploratory findings of the psychological reaction of 83 male partners after miscarriage and it reports the gender differences over a one-year longitudinal course. A significant proportion of men were found to report psychological distress and depressive symptoms immediately after miscarriage. When compared with their female partners, the psychological impact was less intense and less enduring., Chapter 7 concludes the thesis and proposes directions for future research., Miscarriage (spontaneous abortion) is the most common complication of pregnancy with 15-20% of clinically recognised pregnancies aborting spontaneously. It is also one of the commonest gynaecological conditions leading to hospitalisation, accounting for more than 10% of gynaecological admissions in Hong Kong. The common occurrence and the procedural simplicity involved in the medical management, however, may tend to obscure its psychological impact. While emerging evidence has suggested that miscarriage could be associated with significant and possibly enduring psychological consequences, many questions remain unanswered, such as how to detect and screen for psychological morbidity after miscarriage; how long the symptoms last or when do they resolve; what are the underlying risk factors throughout its longitudinal course; what is the psychological impact on the male partner; and whether psychological intervention is helpful. In addition, nearly all studies have been conducted in Caucasian societies with the effect on other ethnic groups remaining largely unexplored., This thesis specifically addresses the following aspects in assessing and managing psychological morbidity following miscarriage: Chapter 1 firstly introduces the clinical aspects of miscarriage, including the definition, incidence, risk factors, clinical manifestations and the current management options. It then discusses the current evidence available on the psychological aspects of miscarriage and outlines the deficiency in current knowledge. Finally, the hypotheses for this thesis are proposed., Lok Hung Ingrid., "May 2006.", Source: Dissertation Abstracts International, Volume: 68-03, Section: B, page: 1567., Thesis (M.D.)--Chinese University of Hong Kong, 2006., Includes bibliographical references (p. 248-276)., Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web., Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web., School code: 1307., http://library.cuhk.edu.hk/record=b6074244, Use of this resource is governed by the terms and conditions of the Creative Commons “Attribution-NonCommercial-NoDerivatives 4.0 International” License (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Dose-related adverse cardiopulmonary events associated with conventional intravenous sedation accounted for most of the complications during colonoscopy. This thesis described clinical trials to look for a safer sedative method (patient-controlled sedation, PCS) and possible ways to reduce the need of sedative medications during colonoscopy., One hundred elderly patients (over 65 years old) were randomised to receive either PCS (a combination of propofol and alfentanil) or conventional intravenous sedation (a combination of diazemuls and pethidine) during colonoscopy. The patients in the PCS group experienced significant less adverse cardiopulmonary events. Other parameters, however, were similar in both groups. The use of PCS for colonoscopy thus appeared safer when compared to conventional intravenous sedation. In a subsequent large scale prospective study (N=500), twenty-two percent of the patients were unwilling to use PCS for colonoscopy; and that the younger patient (<50 years old), female gender, a higher mean dose of sedatives consumed, a lower satisfaction score expressed, and the presence of delayed side effects were independent factors identified to predict the unwillingness of using PCS for colonoscopy., The use of adjunct sedation such as audiovisual distraction was proposed as a way to reduce sedative requirements during colonoscopy. By using PCS as a quantitative outcome measure, audio distraction (in the form of music) was found to be able to decrease sedative requirements by 28%. The use of visual distraction alone, however, failed to decrease the sedative requirements; but nonetheless improved the acceptance of colonoscopy. Finally, a randomised comparison on the use of conventional endoscopes with that of the newly available variable stiffness endoscope used for colonoscopy was performed; and found that the latter was associated with less procedure-related pain and hence the consumption of sedative medications., To conclude, PCS for colonoscopy was safe, feasible and acceptable. The use of adjunct sedation (audio distraction) and the newly available variable stiffness endoscope might decrease the need of sedative medications during the procedure., Lee Wai Hung, Danny., "September 2005.", Adviser: S. C. S. Chung., Source: Dissertation Abstracts International, Volume: 67-07, Section: B, page: 3694., Thesis (M.D.)--Chinese University of Hong Kong, 2005., Includes bibliographical references (p. 256-280)., Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web., Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web., School code: 1307., isbn: 9780542763045, Use of this resource is governed by the terms and conditions of the Creative Commons “Attribution-NonCommercial-NoDerivatives 4.0 International” License (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Research interest in cerebral small vessel disease, which is manifested as lacunar infarct and white matter changes, has surged in the last decade. Small vessel disease has been increasingly recognized via neuroimaging to be highly prevalent among the elderly and more importantly; it is associated with cognitive impairment. Since the population worldwide is ageing, the cognitive burden associated with small vessel disease is foreseen to rise. This burden will be particularly great in China where the population is vast. However, data of cognitive impairment related to small vessel disease among Chinese is scarce., The methods and results of these studies will be presented in the thesis. In brief, the author concluded that (1) among Chinese stroke patients with relevant subcortical lacunar infarct, underlying intracranial large artery disease should be looked for before attributing that the lacunar infarct is due to small vessel disease because of its not uncommon association with lacunar infarcts among Chinese; (2) half of the patients with stroke associated with small vessel disease complain of varying severity levels of cognitive impairment 3 months poststroke and executive dysfunction also affects functional activities; (3) thalamic lacunar infarct and left frontal lobe atrophy have small yet significant influences on cognitive performances; (4) cerebral atrophy predicts prestroke cognitive impairment; and (5) Chinese frontal assessment battery is a moderately valid, while executive clock drawing test is not a valid test in the evaluation of executive dysfunction among Chinese with small vessel disease., This thesis aimed to present studies that were conducted by the author among Chinese stroke patients on this particular field. The aims of the studies were to evaluate the (1) frequency of relevant intracranial large artery disease among Chinese stroke patients having subcortical lacunar infarcts; (2) frequency and impact of cognitive impairment after stroke associated with small vessel disease; (3) neuroimaging determinants of cognitive performances after stroke associated with small vessel disease; (4) determinants of prestroke cognitive impairment in stroke associated with small vessel disease; and the (5) validity of frontal assessment battery and executive clock drawing test in assessing executive dysfunction among Chinese patients with small vessel disease., Mok Chung Tong Vincent., "April 2005.", Adviser: Lawrence Ka Sing Wong., Source: Dissertation Abstracts International, Volume: 67-07, Section: B, page: 3695., Thesis (M.D.)--Chinese University of Hong Kong, 2005., Includes bibliographical references (p. 180-197)., Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web., Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web., School code: 1307., isbn: 9780542763144, Use of this resource is governed by the terms and conditions of the Creative Commons “Attribution-NonCommercial-NoDerivatives 4.0 International” License (http://creativecommons.org/licenses/by-nc-nd/4.0/)

A following study on vancomycin demonstrated the differing pharmacokinetics during the course of a septic insult, day 2 pharmacokinetics differing from day 7., An important study showed that some septic patients with "normal" serum creatinines can have very high creatinine clearances. It follows that drugs which are renally excreted will have high clearances and illustrates why many of the above patients had low serum levels of antibiotic, a reason why some ICU patients require different dosing to ward patients., Due to the required fluid loading and inotropic use in septic patients, creatinine clearances and drug clearances are often raised. This results in low serum concentrations at the end of a standard dosing interval., My beta-lactam antibiotic work has repeatedly demonstrated low serum levels at the end of the standard dosing interval. In view of beta-lactam time-dependent kill characteristics we designed a continuous infusion protocol which we validated in a follow-up paper., The inflammatory response of infections involves endothelial damage and capillary permeability. With associated fluid shifts of severe sepsis and treatment thereof, the volume of distribution (Vd) of antibiotics that distribute into the extracellular space (aminoglycosides, glycopeptides) is high. Peak serum levels for these antibiotics are therefore lower than those found in non-critically ill and in normal volunteers. It is noteworthy that this change in Vd is not apparent with drugs that have good tissue penetration (e.g. ciprofloxacin)., This thesis is a compilation of 11 of my prospectively designed studies plus extracts from 5 published reviews, focusing on pharmacokinetic (PK) aspects of antibiotics in ICU patients, all published in internationally peer-reviewed journals., Two large PK studies on ciprofloxacin (a drug that has excellent tissue penetration) designed to address possible PK differences over time, could not demonstrate this difference in adults nor in two groups of paediatric patients where differences in body water are significant., Two papers investigated the pharmacokinetics of amicakin in adult and paediatric patients documenting the benefit of extended interval dosing., We automatically assume that antibiotic prescribing data, collated from healthy volunteers and not so ill patients, can be transcribed into the Intensive Care Unit. This is not so., Jeffrey Lipman., "April 2005.", Source: Dissertation Abstracts International, Volume: 68-03, Section: B, page: 1548., Thesis (M.D.)--Chinese University of Hong Kong, 2005., Includes bibliographical references (p. 235-254)., Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web., Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web., School code: 1307., http://library.cuhk.edu.hk/record=b6074245, Use of this resource is governed by the terms and conditions of the Creative Commons “Attribution-NonCommercial-NoDerivatives 4.0 International” License (http://creativecommons.org/licenses/by-nc-nd/4.0/)

External cephalic version (ECV) involves turning a fetus in utero by manipulation through the maternal abdomen and the uterine wall., Many clinicians and patients, however, still decline ECV in favour of Caesarean section. This could be due to the lack of experience of ECV, and fear of complications or pain during the version., Summary. The force applied during ECV can be measured and analysed using a customized pair of gloves incorporating piezo-resistive pressure sensors and suitable analytical software. The degree of force required for a successful version is highly variable. Failure of version is not usually due to insufficient force. Uterine tone is the most important factor affecting the degree of force applied during a version attempt. The degree of force applied is associated with the changes in fetal cerebral blood flow after ECV, and the amount of pain perceived by the patients. (Abstract shortened by UMI.), The lack of information in this area is primarily due to the lack of a suitable device that would allow measurements of the force applied without interfering with the ECV. A suitable device would therefore have to be sufficiently robust so that it could be worn on the hands, durable so that it could be used repeatedly, incorporate multiple individual sensors, each of which is capable of making dynamic and mutually independent measurements during the version procedure., There is no report in the literature on quantification of the force applied during ECV. It is also unknown whether the degree of force applied is related to the version outcome. In particular, it is unclear whether a failed attempt is related to insufficient force, or whether an increase in force may help to achieve version after a failure. Furthermore, it is also not known if any patients' factors may influence how much force is applied through the operator's hands. Although the chance of successful version could be predicted by some clinical factors, whether these factors may also affect the degree of applied force is not known., This thesis reports on the design and development of a suitable measuring device fulfilling the requirements described above. In addition, it will test a number of hypotheses relating to the degree of force applied during ECV and clinical feto-maternal parameters and outcomes, in a study cohort of 92 patients., Leung Tak Yeung., "April 2005.", Source: Dissertation Abstracts International, Volume: 67-07, Section: B, page: 3717., Thesis (M.D.)--Chinese University of Hong Kong, 2005., Includes bibliographical references (p. 155-174)., Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web., Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web., School code: 1307., isbn: 9780542763083, Use of this resource is governed by the terms and conditions of the Creative Commons “Attribution-NonCommercial-NoDerivatives 4.0 International” License (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Background. Medical imaging has played an important role in the diagnosis, progress monitoring and follow-up of most disease entities, in particular chest infections. The emergence of a novel chest disease poses an immediate challenge to the pillars of imaging, namely chest radiography and computed tomography. The characteristic imaging appearances, differential diagnoses and diagnostic pitfalls need to be established for correct diagnosis and appropriate management. The sensitivity and utility of the different imaging modalities will also need to be addressed., In the event of an outbreak or epidemic, these challenges are made more difficult by an overwhelming number of patients and limited resources. In March 2003, we were faced with such a situation in our institution and the disease was later termed Severe Acute Respiratory Syndrome (SARS)., Patients in Hong Kong were treated with a combination of an antiviral agent and corticosteroids in addition to respiratory support. The majority of patients improved with treatment, although between 20--36% required treatment in an intensive care unit., Problems and importance. This novel disease of high infectivity, morbidity and mortality posed a major threat to public health and a challenge to health authorities both locally and internationally. With regard to medical imaging, the following research questions were identified: (1) What are the imaging signs of this new disease? (2) Does chest imaging provide a high degree of sensitivity for diagnosing the infection? (3) Are the imaging signs disease-specific or are they similar to other pathology? (4) Does the progressive evolution of the imaging appearance correlate with the clinical status of the patient? (5) Could the imaging appearance be useful for predicting the final outcome? (6) Are there complications that require detection by imaging?, The lung parenchyma is the main site of infection and the resultant microscopic pathology included: pulmonary exudate, sequestration of macrophages, diffuse alveolar damage, proliferation of epithelial cells and hyaline membrane formation. Macroscopic features include alveolar consolidation in the early stages and later, organizing pneumonia or bronchiolitis obliterans organizing pneumonia., These answers to these questions are essential to our understanding of the disease and to increase our diagnostic ability. (Abstract shortened by UMI.), This newly emerged disease is a respiratory infection with a high morbidity/mortality and was found to be caused by a coronavirus (SARS CoV). By the end of the outbreak a total of 8098 probable cases of infection were reported worldwide, with a mortality rate of 9.6% (774 deaths). Hong Kong was one of the hardest hit regions, totaling 1755 probable cases of infection and 299 deaths by the end of the outbreak., Antonio Gregory Ernest., "September 2005.", Source: Dissertation Abstracts International, Volume: 67-07, Section: B, page: 3745., Thesis (M.D.)--Chinese University of Hong Kong, 2005., Includes bibliographical references (p. 245-258)., Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web., Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web., School code: 1307., isbn: 9780542763007, Use of this resource is governed by the terms and conditions of the Creative Commons “Attribution-NonCommercial-NoDerivatives 4.0 International” License (http://creativecommons.org/licenses/by-nc-nd/4.0/)

1. Study on improving the diagnostic accuracy of treatment-naive nasopharyngeal carcinoma., 2. Study on diagnostic accuracy of EBV-DNA on recurrent nasopharyngeal carcinoma., 3. Studies on EBV-DNA as a screening tool for nasopharyngeal carcinoma. Part 1. To define the detection rate of NPC and the false-positive rate of IgA-VCA in an IgA-VCA-based screening problem, and to define the specificity of IgA-EA in IgA-VCA-positive screenees. Part 2. To define the specificity of EBV-DNA in IgA-VCA-positive screenees. Part 3. To define the sensitivity of IgA-EA, and EBV-DNA in IgA-positive NPC patients., 4. Studies on pre-therapy prognostication of nasopharyngeal carcinoma Study Part 1. Objective. To assess the role of EBV-DNA in pre-therapy prognostication of early-stage NPC., Background. The specific association between nasopharyngeal carcinoma (NPC) and the Epstein-Barr virus (EBV) had been exploited to develop a spectrum of EBV-antibodies-based blood markers. Among these markers, the Immunoglobulin A antibody against the viral capsid antigen (IgA-VCA) of the EBV has been the most popularly employed marker to assist diagnosis of NPC. There is however a relative paucity of data on the application of blood markers for screening, for detection of relapse, and for prognostification of patient cohorts managed in present-day therapy oncology protocols. Peripheral blood EBV-DNA, measured by quantitative polymerase chain reaction assay, is a newly-developed marker, and represents a prototype model of a nuclei acid-based, as opposed to antibody-based, EBV tumor marker for NPC. The present thesis describes the translation of this basic scientific advance into clinical applications, through several prospective and retrospective studies that address the diagnosis of treatment-naive NPC, the detection of recurrent NPC, the screening of individuals at risk of NPC, the pre-therapy prognostication for NPC to guide for choice of therapy. The role of integration of conventional markers and EBV-DNA in clinical applications was also examined., Study Part 2. Objectives. To assess whether incorporation of EBV-DNA data to TNM staging improves prognostic discrimination of patients subsets within individual cancer stage, to assess if EBV-DNA is an independent prognostic factor for survival after ontological therapy. (Abstract shortened by UMI.), Leung Sing-fai., "February 2005.", Source: Dissertation Abstracts International, Volume: 67-07, Section: B, page: 3695., Thesis (M.D.)--Chinese University of Hong Kong, 2005., Includes bibliographical references., Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web., Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web., School code: 1307., isbn: 9780542763069, Use of this resource is governed by the terms and conditions of the Creative Commons “Attribution-NonCommercial-NoDerivatives 4.0 International” License (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Background. With increasing personal affluence and changes in lifestyle, there is rising prevalence of type 2 diabetes mellitus in Hong Kong. Approximately 60% of diabetic subjects in Hong Kong are asymptomatic and previously undiagnosed. Since diabetes carries significant mortality and morbidity risk, it is important to diagnose these subjects early for intervention. There are many known factors associated with development of type 2 diabetes. Some are remediable such as obesity, dyslipidaemia, hypertension, while some are non-remediable such as age and past history of gestational diabetes. Identifying high-risk subjects will increase the yield and cost-effectiveness of screening program for diabetes and related risk factors and provide useful epidemiological information on the natural history of these diseases., Methods. I used data from several cross-sectional and prospective studies of which I was the principal investigator or one of the co-investigators to test these hypotheses. The studies include mainly the following: (1) A public utility company workforce survey on cardiovascular risk factors in 1990 (n=1513). (2) Chinese subjects with risk factors for diabetes who underwent 75 gram oral glucose tolerance test (OGTT) screening at the Prince of Wales Hospital (PWH) between 1988 and 1995 (n=3718). (3) The 'United Christian Nethersole Community Health Service' (UCNCHS) primary health screening program database in 1997 (n=17764)., Objectives & hypothesis. I aimed to study the various factors associated with the development of type 2 diabetes in Hong Kong Chinese. With this information, I can design a screening method to early identify those subjects who are at high-risk for diabetes. I hypothesize the following: (1) Many risk factors for diabetes in Caucasians are also applicable to Hong Kong Chinese. (2) The presence of multiple factors increases the risk of diabetes in a linear fashion. (3) Chinese subjects are at risk of developing diabetes at a lower threshold of obesity, which is one of the most important risk factors for type 2 diabetes., Results. Based on a cohort of 1513 asymptomatic subjects from a workforce survey, those in the top quartile of body mass index (BMI), as compared to those in the lowest quartile, had a 4 to 10-fold increased risk of diabetes and a 2.5 to 5-fold increased risk of impaired glucose tolerance (IGT) for men and women. (Abstract shortened by UMI.), Ko Tin Choi., "May 2005.", Source: Dissertation Abstracts International, Volume: 67-01, Section: B, page: 0173., Thesis (M.D.)--Chinese University of Hong Kong, 2005., Includes bibliographical references (p. 264-283)., Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web., Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web., School code: 1307., isbn: 9780542515675, Use of this resource is governed by the terms and conditions of the Creative Commons “Attribution-NonCommercial-NoDerivatives 4.0 International” License (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Colorectal cancer is one of the commonest malignancies worldwide. Its prevention, diagnosis and treatments have attracted multidisciplinary attention. Surgery is the mainstay of treatment for colorectal cancer. It was estimated that up to 85% of colorectal cancer were amenable to surgical treatment, whether curative or palliative. Not surprisingly laparoscopic resection of colorectal cancer was reported soon after cholecystectomy. However, with the appearance of early port site recurrence, most authorities were concerned about the adequacy of tumour clearance and the long-term survival after laparoscopic resection., In this thesis, comparative and randomized studies were conducted to answer the above questions. It was concluded that, as compared to conventional open surgery, laparoscopic assisted resection of recto-sigmoid carcinoma was less painful and allowed earlier post-operative recovery. Tissue trauma, as reflected by systemic cytokines response, was less after laparoscopic assisted resection. Some cellular components of immune system were also less suppressed. Most importantly, laparoscopic resection did not jeopardize the survival and disease control of patients. The justification of adopting laparoscopic technique would depend on the societal value of its effectiveness in improving the short-term post-operative outcomes., Laparoscopic technology and its application may be the biggest advancement in nearly all surgical specialties in the last decade. Since the introduction of laparoscopic cholecystectomy, enthusiastic surgeons have attempted laparoscopic approach in almost every type of operations, and many of the techniques have gained public acceptance within a very short time. However, most of these developments were not based on good scientific evidence from comparative study. While laparoscopic cholecystectomy was shown to cause less pain and allow patients to recover earlier after operation, these benefits may or may not be conferred to other procedures and diseases., Therefore, to justify the use of laparoscopic assisted colorectal resection for carcinoma, two criteria must be satisfied. Firstly the long term survival and the disease free interval of patients should not be adversely affected, as these are the most important endpoints in the success of tumour surgery. Secondly, the proposed benefits of minimally invasive surgery must be demonstrated, otherwise it is not worthwhile to adopt a new technique., Leung Ka Lau., "July 2005.", Source: Dissertation Abstracts International, Volume: 67-01, Section: B, page: 0174., Thesis (M.D.)--Chinese University of Hong Kong, 2005., Includes bibliographical references (p. 122-155)., Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web., Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web., School code: 1307., isbn: 9780542515682, Use of this resource is governed by the terms and conditions of the Creative Commons “Attribution-NonCommercial-NoDerivatives 4.0 International” License (http://creativecommons.org/licenses/by-nc-nd/4.0/)

PDSE are common (19.6%) in the local stroke population. Both premorbid factors as well as stroke-related factors contribute to the development of PRSD and PSDE. The application of different diagnostic criteria for PSDE will affect the frequency and the associated radiological characteristics. As regards the screening methods of PSDE, a more specific instrument should supplement the IQCODE or MDRS-IP in a two-stage screening procedure., PSD is also common (16--17%) among local stroke survivors. Both psychosocial factors and the location of cerebrovascular lesions play an important role in the development of PSD. PSD in local Chinese seems to have a favorable short-term outcome in comparison with their Caucasian counterparts. With regard to the screening of PSD in Chinese, we found that both the GDS and HADS depression subscale have a satisfactory response rate and accuracy in detecting PSD. However, due to the relative low frequency of PSD in the local stroke population, a more specific instrument should supplement the GDS in a two-stage screening procedure. Finally, the familiarity of the rater with the subjects based on a preexisting therapeutic relationship did not influence the accuracy of screening for PSD in Chinese patients., There has been a paucity of data on the frequency, clinical correlates and methods of screening of poststroke dementia (PSDE) and depression (PSD) in Chinese populations. The objective of this thesis is to examine the prevalence, diagnostic criteria and clinical correlates of PSDE and PSD in Chinese stroke patients in Hong Kong. A series of studies were all carried out; the author of the thesis had interviewed all the subjects 1--3 months after their index stroke and made the diagnosis of dementia and depression according to the DSM-IV criteria., Tang Wai Kwong., "July 2005.", Adviser: Gabor S. Ungvari., Source: Dissertation Abstracts International, Volume: 67-01, Section: B, page: 0177., Thesis (M.D.)--Chinese University of Hong Kong, 2005., Includes bibliographical references (p. 136-191)., Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web., Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web., School code: 1307., isbn: 9780542515699, Use of this resource is governed by the terms and conditions of the Creative Commons “Attribution-NonCommercial-NoDerivatives 4.0 International” License (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Background: Asthma is characterized by chronic airway inflammation in which leukocytes are attracted into the inflamed airway under the influence of chemokines. Molecular studies and allergen bronchoprovocation suggested that chemokines such as thymus and activation-regulated chemokine (TARC), macrophage-derived chemokine (MDC), eotaxin and regulated upon activation normal T-cell expressed and secreted (RANTES) were involved in the airway responses to allergen exposure., Conclusions: Chemokines are important mediators in the pathophysiology of asthma and atopy. TARC in plasma and MDC in EBC appear to be useful biomarkers for assessing childhood asthma. Besides, MDC concentrations in UCB may predict the susceptibility to develop wheezing during infancy., Methods: Asthmatic patients, non-allergic controls and healthy singleton newborns were recruited from attendants of a university teaching hospital. Atopy-related chemokines in peripheral blood and EBC were measured by enzyme-linked immunosorbent assays. Genomic DNA from asthmatics and controls was genotyped by restriction fragment length polymorphism to characterize single nucleotide polymorphisms (SNPs) in the genes encoding TARC, RANTES, interleukin-13 and CD14., Objectives: This thesis investigated the relation between chemokines and asthma and atopy by: (a) measuring their concentrations in peripheral blood and exhaled breath condensate (EBC); (b) performing case-control association studies for genes encoding atopy-related chemokines and related molecules; and (c) analyzing chemokines in umbilical cord blood (UCB) in relation to wheezing phenotypes during infancy., Results: Plasma TARC concentrations were higher in children with chronic asthma than controls, and also correlated with plasma total IgE. Among children with asthmatic exacerbation, plasma TARC concentrations showed inverse correlation with peak expiratory flow rates at presentation. When measured in EBC, MDC but not TARC or eotaxin was higher in asthmatics than controls. In our genetic association studies, SNPs in IL13, RANTES and TARC were associated with serum total and/or allergen-specific IgE. TARC C-431T was also linked to peripheral eosinophilia. However, none of these polymorphisms was associated with physician-diagnosed asthma. Interestingly, C-159T in CD14 was also associated with serum total IgE, but only among atopic asthmatic children. In the last part involving 124 singleton healthy newborns, MDC concentrations in UCB were significantly increased in newborns who wheezed during infancy., Leung Ting-fan., Adviser: Gary W.K. Wong., Source: Dissertation Abstracts International, Volume: 73-01, Section: B, page: ., Thesis (M.D.)--Chinese University of Hong Kong, 2004., Includes bibliographical references (leaves 196-231)., Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web., Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web., isbn: 9781124988382, Use of this resource is governed by the terms and conditions of the Creative Commons “Attribution-NonCommercial-NoDerivatives 4.0 International” License (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Crohn's disease (CD) and ulcerative colitis (UC) are inflammatory bowel diseases (IBD) that result in considerable morbidity and impaired quality of life. Although IBD is ubiquitous, heterogeneity in incidence is noted geographically and among different ethnicities, presumably due to genetic and environmental factors. The incidence and prevalence of IBD has plateaued in many Western countries but are increasing in developing nations. There is a lack of data on IBD pertaining to the Chinese population., Studies were conducted to determine the characteristics of IBD in the Chinese population. The incidence of IBD in the Chinese population is a fifth to a tenth of Western societies but has risen sharply over the past decade. Several distinct demographic and phenotypic features were noted in the Chinese IBD population. Genetically, Chinese CD patients do not harbour the NOD2/CARD15 polymorphisms unlike Caucasian CD subjects. ANCA and ASCA are serologic markers that are highly specific for UC and CD respectively in the Chinese but ANCA sensitivity in Chinese UC is significantly lower than in Caucasian UC, while quantitative IgG ASCA (and not IgA) is a moderately sensitive test for CD. These markers are useful in differentiating UC from CD. A Chinese translation of the Inflammatory Bowel Disease Questionnaire (IBDQ) was developed and validated to be reliable, sensitive to change and reproducible. A prospective cross-sectional survey of the disease-related knowledge of Chinese and Australian IBD patients identified a low level of IBD-knowledge but with a similar quality of life as Caucasians with IBD. There was a similar but high rate of use of complementary alternative medicines in both populations., These studies were instrumental in: describing IBD in the Chinese population; developing a Chinese IBD database; acquiring techniques of investigating genetic polymorphisms and ASCA serology; devising the Chinese IBDQ to open up IBD trials to Hong Kong; and identifying knowledge deficiencies to help plan a targeted education programme., Leong Rupert Wing-Loong., Adviser: Joseph J.Y. Sung., Source: Dissertation Abstracts International, Volume: 73-01, Section: B, page: ., Thesis (M.D.)--Chinese University of Hong Kong, 2004., Includes bibliographical references., Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web., Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web., isbn: 9781124988375, Use of this resource is governed by the terms and conditions of the Creative Commons “Attribution-NonCommercial-NoDerivatives 4.0 International” License (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Objectives: This study has been conducted to determine the levels of inappropriate use of the A&E for conditions that could be treated by GPs, the nature of the morbidity pattern of those conditions, the reasons why primary care services were not being utilized, and also examined the validity (i.e. sensitivity and specificity) of patient classifications undertaken by nurses at the time of admission within this local context. Study design and setting: A cross sectional study was conducted over a one year period and subjects were randomly selected from four A&E departments located across the four principle geographic regions of Hong Kong by stratified, two-stage sampling. Main outcome measure: The gold standard in differentiating true emergency cases and GP cases was based on a retrospective record review conducted independently by a panel of emergency physicians. A random sub-sample of those classified as GP cases was interviewed and compared to a matched (via morbidity status) sample of primary care patients who had attended a hospitals' GOPC in order to determine factors distinguishing these two patient groups. Multiple Logistic Regression was used to distinguish the difference between GP cases and matched GOPC primary care patients on significance and odds ratios of the variables. The morbidity pattern according to ICPC was tabulated and analysed for the 'true' A&E cases and non-urgent cases. Sensitivity, specificity and positive predictive values were computed for both non-weighted and weighted conditions. Results: The level of GP cases was found to be 57% with a significant higher proportion of patients in younger age group, and late evening. The morbidity pattern of those top 10 diagnoses of non-urgent cases was very similar to the Hong Kong general practice morbidity pattern for self limiting conditions. Closure of the clinic was the main reason for GP cases attending A&E. Other major reasons were deterioration of symptoms, GPs' inability to diagnose efficient, Albert Lee., Source: Dissertation Abstracts International, Volume: 73-01, Section: B, page: ., Thesis (M.D.)--Chinese University of Hong Kong, 2004., Includes bibliographical references (leaves 137-151)., Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web., Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web., Appendix 4 in Chinese., isbn: 9781124987217, Use of this resource is governed by the terms and conditions of the Creative Commons “Attribution-NonCommercial-NoDerivatives 4.0 International” License (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Both VEGF and its receptor proteins were localized by immunostaining technique in the luminal epithelium, smooth muscle cells and blood vessels within the oviduct. Moreover, by means of semi-quantitative reverse transcriptase-polymerase chain reaction (RT-PCR) techniques, it has been demonstrated that mRNA of VEGF and its receptors in both healthy and diseased oviduct is expressed preferentially at the time and place where the amount of oviduct fluid is prominent. This supports the notion that VEGF may be a regulator of oviductal secretion. This thesis has consistently demonstrated a modulation pattern of flt-1 expression that is similar to its ligand VEGF in both physiological and pathological conditions. This suggests that flt-1 may be the main receptor responsible for the action of VEGF in the oviduct. As illustrated in both the in-vivo and in-vitro models, the expression of VEGF and flt-1 in the human oviduct is stimulated directly by gonadotropins without the influence of ovarian sex hormones., Increased knowledge on the regulatory mechanisms of oviductal fluid formation, the first environment that human embryos are exposed to, will be valuable from the clinical management point of view., Oviductal fluid is a complex mixture of plasma-derived constituents and proteins synthesized by the oviduct epithelium. It has been postulated that vascular endothelial growth factor (VEGF), a known permeability promoter, may be an important regulator of oviductal fluid secretion by stimulating vascular permeability and so serum transudation. However, little is known about the expression of VEGF in the human oviduct. This thesis investigated the modulation of VEGF and its receptors (flt-1 and KDR) in the healthy oviducts, from fertile women undergoing tubal sterilization for unwanted fertility or hysterectomy for benign gynecological conditions, as well as in the hydrosalpinges from sterile women undergoing salpingectomy before the treatment of in-vitro fertilization and embryo transfer., Lam Po Mui., Adviser: Christopher J. Haines., Source: Dissertation Abstracts International, Volume: 73-01, Section: B, page: ., Thesis (M.D.)--Chinese University of Hong Kong, 2004., Includes bibliographical references (leaves 147-179)., Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web., Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web., isbn: 9781124987224, Use of this resource is governed by the terms and conditions of the Creative Commons “Attribution-NonCommercial-NoDerivatives 4.0 International” License (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Lai Shiu-Ming, Jimmy., "January 2004.", Thesis (M.D.)--Chinese University of Hong Kong, 2004., Includes bibliographical references (p. 157-163)., Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web., Mode of access: World Wide Web., http://library.cuhk.edu.hk/record=b6073640, Use of this resource is governed by the terms and conditions of the Creative Commons “Attribution-NonCommercial-NoDerivatives 4.0 International” License (http://creativecommons.org/licenses/by-nc-nd/4.0/)

However, this is by no means the limit. More knowledge on macular hole is needed. Continuous research in Hong Kong and other scientific communities are indispensable. A multicentre, multi-surgeon study should be contemplated and carried out prior to the generalization or application of this technique to all patients., Over the last few years, we have collected essential clinical and laboratory data on indocyanine green (ICG) assisted internal limiting membrane (ILM) peeling in macular hole surgery in Hong Kong. With the intraoperative use of a small volume and low concentration of ICG, we have shown the usefulness and safety of this technique in improving the surgical outcomes, both antomically and functionally, in patients with macular hole of idiopathic type or in severely myopic eyes. Our randomized controlled trial demonstrated higher anatomical closure rate and better visual outcome with ICG assisted ILM peeling compared with no ILM peeling in primary idiopathic macular hole surgery. Our case-control study also demonstrated that ICG assisted ILM removal in macular hole surgery of severely myopic eyes gives promising anatomical closure rate and visual outcome comparable to emmetropic ones., Kwok Kwan-ho., Source: Dissertation Abstracts International, Volume: 73-01, Section: B, page: ., Thesis (M.D.)--Chinese University of Hong Kong, 2003., Includes bibliographical references (leaves 201-214)., Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web., Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web., isbn: 9781124988528, Use of this resource is governed by the terms and conditions of the Creative Commons “Attribution-NonCommercial-NoDerivatives 4.0 International” License (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Li Kam-tao, Philip., "January 2003.", Thesis (M.D.)--Chinese University of Hong Kong, 2003., Includes bibliographical references (p. 252-281)., Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web., Mode of access: World Wide Web., http://library.cuhk.edu.hk/record=b6073641, Use of this resource is governed by the terms and conditions of the Creative Commons “Attribution-NonCommercial-NoDerivatives 4.0 International” License (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Chan Yu-leung., "Nov 2003.", Thesis (M.D.)--Chinese University of Hong Kong, 2005., Includes bibliographical references (p. 179-193)., Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web., Mode of access: World Wide Web., http://library.cuhk.edu.hk/record=b6073639, Use of this resource is governed by the terms and conditions of the Creative Commons “Attribution-NonCommercial-NoDerivatives 4.0 International” License (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Ng Heung-ling, Margaret., "April 2003.", Thesis (M.D.)--Chinese University of Hong Kong, 2003., Includes bibliographical references (p. 216-237)., Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web., Mode of access: World Wide Web., http://library.cuhk.edu.hk/record=b6073642, Use of this resource is governed by the terms and conditions of the Creative Commons “Attribution-NonCommercial-NoDerivatives 4.0 International” License (http://creativecommons.org/licenses/by-nc-nd/4.0/)

by Chan Lik-yuen, Henry., Thesis (M.D.)--Chinese University of Hong Kong, 2001., Includes bibliographical references (p. 192-217)., Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web., Mode of access: World Wide Web., http://library.cuhk.edu.hk/record=b6073373, Use of this resource is governed by the terms and conditions of the Creative Commons “Attribution-NonCommercial-NoDerivatives 4.0 International” License (http://creativecommons.org/licenses/by-nc-nd/4.0/)

by Wai-keung Leung., Thesis (M.D.)--Chinese University of Hong Kong, 2001., Includes bibliographical references (p. 217-232)., Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web., Mode of access: World Wide Web., http://library.cuhk.edu.hk/record=b6073374, Use of this resource is governed by the terms and conditions of the Creative Commons “Attribution-NonCommercial-NoDerivatives 4.0 International” License (http://creativecommons.org/licenses/by-nc-nd/4.0/)

by Wu Che-yuen Justin., "September 2000 (amendment).", Thesis (M.D.)--Chinese University of Hong Kong, 2000., Includes bibliographical references (p. 237-267)., Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web., Mode of access: World Wide Web., http://library.cuhk.edu.hk/record=b6073292, Use of this resource is governed by the terms and conditions of the Creative Commons “Attribution-NonCommercial-NoDerivatives 4.0 International” License (http://creativecommons.org/licenses/by-nc-nd/4.0/)

by Lai Bo San Paul., "April 1997.", "Revised May 1998.", Thesis (M.D.)--Chinese University of Hong Kong, 1998., Includes bibliographical references (p. 175-228)., Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web., Mode of access: World Wide Web., in Chinese., http://library.cuhk.edu.hk/record=b6073122, Use of this resource is governed by the terms and conditions of the Creative Commons “Attribution-NonCommercial-NoDerivatives 4.0 International” License (http://creativecommons.org/licenses/by-nc-nd/4.0/)