bluuebunny/crossref_metadata_2025 huggingface dataset:
Minimally Invasive Endoscopic Approach to the Cervicothoracic Junction for Vertebral Osteomyelitis
Authors: Morimoto Tadatsugu , Tsukamoto Masatsugu , Yoshihara Tomohito , Sonohata Motoki , Mawatari Masaaki
Published: December 2017

The selection of an anterior, lateral, or posterior approach to the cervicothoracic junction for surgical treatment of vertebral osteomyelitis is still a matter of debate. These ordinary approaches generally require an extensile exposure. This article describes a less invasive approach case of a vertebral osteomyelitis of T2/3 using a video-assisted operating technique of thoracic surgery (VATS). A 78-year-old female underwent anterior debridement and interbody fusion with bone graft at T2/3 using a lateral surgical approach through a right thoracotomy with VATS. The VATS through two small skin incisions in the axillary region provides a good view without requiring elevation of the scapula with extensile muscle dissection and rib resection. There was no complication without partial lobectomy due to pleural adhesion during the perioperative period. Currently, at 1 year after operation, the patient has no back pain with neurologically normal findings and no inflammation findings (CRP was 0.01 mg/dl). Although the operating field of the upper thoracic level in the lateral approach is generally deep and narrow, the VATS provides a good view and allows us to perform adequate debridement and bone fusion at the T2/3 level with a less invasive approach than those previously described anterior or laterally or posterior approach.
La Ambición de Adam Smith
Authors: Ponce Carlos
Published: December 2017

El objetivo de esta nota es presentar y discutir los principales ejes que articulan el funcionamiento de lo que, usualmente, se conoce como libre mercado. Se enfatizan tanto las condiciones bajo las cuales la asignación de recursos resultante es eficiente como los problemas que originan los denominados fracasos de mercado.
Association of –1082A>G Polymorphism in the Interleukin-10 Gene with Estimated Glomerular Filtration Rate in Type 2 Diabetes
Authors: Polina Evelise Regina , da Silva Pereira Bruna Letícia , Crispim Daisy , Sbruzzi Renan Cesar , Canani Luis Henrique , dos Santos Kátia Gonçalves
Published: December 2017

Background/Aims: The -1082A>G polymorphism (rs1800896) in the interleukin-10 (IL10) gene has been associated with type 2 diabetes and diabetic retinopathy, but its relationship with diabetic kidney disease (DKD) is uncertain. The aim of this case-control study was to investigate whether the -1082A>G polymorphism is associated with DKD in white Brazilians with type 2 diabetes mellitus. Methods: Genotyping was done by real-time polymerase chain reaction for 597 type 2 diabetic outpatients. The definition of DKD was based on estimated glomerular filtration rate (eGFR) and albuminuria, and the patients were grouped in three categories: no DKD (n=249), mild to moderate DKD (n=222), and severe DKD (n=126). Results: The frequency of the minor (G) allele in subjects without DKD did not differ from that observed in subjects with DKD (0.35 vs 0.39, respectively; P = 0.192). Genotype frequencies in subjects without DKD were not significantly different from those observed among patients with mild to moderate DKD or severe DKD. However, considering only the eGFR categories as an indicator of renal function, the AG genotype was independently associated with an increased risk of mildly to moderately decreased eGFR (G3a category) and GG genotype was independently associated with increased risk of kidney failure (G5 category) as compared with AA genotype. Conclusion: Our findings support the hypothesis that the -1082A>G polymorphism in the IL10 gene might be associated with DKD in white Brazilians with type 2 diabetes.
The Legislation of Leviticus 12 in Light of Ancient Embryology
Authors: Thiessen Matthew
Published: December 2017

Interpreters have provided numerous unsatisfactory reasons for why priestly literature stipulates that women endure a longer impurity after the birth of a girl than they endure after the birth of a boy. This article situates Leviticus 12 within a wide range of medical discourses, found in Hittite, Greek, Roman, Jewish, and Christian literature, in order to illuminate the priestly rationale behind this legislation. It demonstrates that these differing periods of ritual impurity relate to ancient medical beliefs that females developed more slowly than did males. These different articulation rates were believed to result in different lengths of postpartum lochial discharge, which meant that the new mother suffered different lengths of ritual impurity based on the sex of the newborn child.
Edom, Judah, and Converse Constructions of Israeliteness in Genesis 36
Authors: Nash Dustin
Published: December 2017

Genesis 36 contains a distinctively large and heterogeneous body of genealogical materials pertaining to Esau and the kingdom of Edom. The present study suggests that the chapter reached its unique shape as the result of a specifically Judahite discursive project. In particular, a scribe expanded a preexisting priestly genealogy of Esau in order to create a robust boundary between entities defined as Edom and Israel. New interpretations of archaeological evidence from southern Jordan and the Negev reveal the context of dynamic interaction and fluid identities that likely prompted this expansion. The resulting text rejects memories of affiliation between Negevite and south Jordanian peoples in order to elevate Judah’s claim to the name and identity of Israel.
In Search of True-ness: Dialogue Between Political Localism and Theological Ecumenism in Post-Umbrella Movement
Authors: Kung Lap Yan
Published: December 2017

Seeking for true-ness is the core concern of the people of Hong Kong during the Umbrella Movement. That search starts from the political structure (true universal suffrage), and continues through into the formation of identity (true Hongkongese). This article illustrates how the Umbrella Movement has provided the people of Hong Kong with an experience of a truthful politics which is different from the current realpolitik. It sets out to see Hong Kong as their homeland, while developing a new language in terms of political localism. Nevertheless, there is a tendency for such political localism to become too narrow, exclusive and sentimental. The ecumenicity of the church interpreted in the light of Wolfhart Pannenberg’s theology is a different social imaginary. It can challenge both the inclination to narrowness and exclusivism of political localism, and the authoritarianism of the Chinese authorities. It possesses the potential to enrich the people of Hong Kong by allowing them to see that the unity of humankind (creation) is the ground of politics.
Blueprints of Totalitarianism: How Racist Policies in Fascist Italy Inspired and Informed Nazi Germany
Authors: Bernhard Patrick
Published: December 2017

Racism, especially anti-Semitism, is typically seen as a crucial point of distinction between Nazi Germany and Fascist Italy. Based on a range of new materials, this article shows that Nazi policies of social exclusion were inspired by Mussolini’s regime. The main thesis is that racist thought and action were intrinsic elements of both regimes and constituted a unifying element between them. The paper looks at the way the National Socialists used Fascist Italy as a foil for their own dreams of racial regeneration before Hitler’s rise to power. It also examines the cooperation between the two regimes following the 1936 Axis alliance, especially in terms of policing and the exchange of information about ‘Aryanisation’. Conceptually speaking, the article argues that the methods of cultural history are highly useful for shedding new light on Axis relations.
Special Issue: International Investment Arbitration in Southeast Asia
Authors: Nottage Luke , Thanitcul Sakda
Published: December 2017

The dynamic economies of the Association of Southeast Asian Nations (ASEAN) have individually concluded many standalone bilateral investment treaties (BITs) and a growing number of bilateral and regional free trade agreements (FTAs), supplemented by intra-ASEAN and ‘ASEAN+’ agreements. These aim to facilitate and protect burgeoning foreign direct investment (FDI) flows, outlined in Part 2, including large outflows recently from several states. Part 3 outlines treaty-making trends, including considerable consistency from many member states as well as some interesting innovations, against the backdrop of persistent problems of poor governance. Part 4 highlights nonetheless the relative paucity of investor-state dispute settlement (ISDS) claims against ASEAN member states, with only a few adverse awards, which helps explain why treaty-based ISDS has not been abandoned. Part 5 also notes several contributions from this ISDS case law to international investment law, and Southeast Asia’s potential to keep influencing its trajectory.
International Investment Arbitration in Myanmar: Bounded Rationality, But Not as We Know It
Authors: Bonnitcha Jonathan
Published: December 2017

In 2011, following almost fifty years of one-party military rule, Myanmar began a process of transition toward democracy. Alongside this process, the Government of Myanmar is pursuing a variety of reforms in the hope of attracting new foreign investment. This article examines elements of the national and international legal environment governing foreign investment in Myanmar. The focus is on Myanmar’s current approach to investment treaties and Myanmar’s experience of investor-state arbitration under such treaties to date, although the article also reviews Myanmar’s national laws that are relevant to international investment arbitration, notably its laws on foreign investment and on arbitration. The article highlights Myanmar’s position to date as a ‘rule-taker’ in the investment treaty regime. It draws attention to important differences between Myanmar’s experience with investment treaties and the experiences of other developing countries, as well as possible points of similarity.
Drone Deaths Violate Human Rights: The Applicability of the iccpr to Civilian Deaths Caused by Drones
Authors: Corsi Jessica Lynn
Published: December 2017

This article argues that the thousands of lethal drone strikes conducted since 2001 violate the International Covenant on Civil and Political Rights (iccpr), and in particular, the right to life. The analysis provided is also applicable to the right to life enshrined in customary international law and regional human rights treaties. While most legal and academic commentary on deaths caused by drones has focused on an international humanitarian law (ihl) framework—perhaps because the primary weaponised drone user, the United States, insists that this is the appropriate legal context—this article argues that a human rights framework for assessing lethal drone strikes is preferable, useful, and necessary. Not only is it likely that the so-called war on terror is a semantic rather than a legal war, the iccpr continues to apply during conflict. Moreover, opacity surrounds most lethal drone strikes, which the Trump administration appears likely to increase, while simultaneously reducing Obama-era safeguards. In that context, a human rights assessment, which will be inherently more stringent towards fatalities than an ihl framework, is urgently needed. The article concludes that the right to life attaches to everyone regardless of the territory in which they are targeted; that effective jurisdiction and control is satisfied upon ability to lethally target an individual; that relevant iccpr rights apply in ungoverned territories as well; and that the threat of terrorism does not displace these rights or the applicability of the iccpr.
Living Testaments: How Catholic and Baptist Women in Ministry Both Judge and Renew the Church
Authors: Campbell-Reed Eileen R.
Published: December 2017

In 2014 women constituted 15.8% of u.s. clergy. They led 10% of u.s. congregations. While the numbers have increased dramatically in fifty years, this data invites a deeper question. What does women’s entry into ministry (lay and ordained) mean for ecclesiology, the life and doctrines of the church? Four case studies from two qualitative investigations of ministry illustrate women’s pastoral leadership from the margins of Roman Catholic and Southern Baptist churches, showing how women called to ministry are: living testaments to a renewed vision for church that embraces the fullness of humanity; living judgments on harms and shortcomings of the church; embodied revisions to ecclesial practices. Each case study bears witness to situated possibility of the Spirit’s work; exposes and challenges sins of sexism; shows every day dilemmas over resisting and subverting power; and reframes doctrine and practice from the margins, renewing ecclesial vision for the church.
Rethinking Classical Dialectical Traditions
Authors: Freschi Elisa , Coquereau Elise , Ali Muzaffar
Published: December 2017

This essay debates the way Daya Krishna reinterpreted some dialectic elements of classical Indian philosophy, with a special focus on “dialogue” and “counterposition.” The essay subsequently analyses the consequence of this reinterpretation on contemporary Indian philosophy.1
Self-Other Relationship, History and Interpretation
Authors: Sarma Arup Jyoti
Published: December 2017

This paper offers a critical appraisal of Gadamer’s dialogical philosophy of the self-other relationship within the context of interpretation and historical consciousness. According to Gadamer hermeneutics is a theory of interpretation or, rather, the art of interpretation. The task of philosophical hermeneutics is to narrate an ontology of human understanding with the ethical intent of restoring to interpretation a greater sense of “integrity.” The “hermeneutic universe” belongs to the individual worldviews whose structure and content are constructed on the basis of historical precedents. Gadamer situates these precedents in historicity and the tradition of culture, which are resources for their unique interpretations. Gadamer claims that interpretative understanding encounters the other in the dialogical “play” (Spiel) of an ever-unfinished event. The self and the other belong to the horizon of historical consciousness, and it is through this common horizon that the alterity of the other comes into expression.
A new species of the conidial fungal genus Spegazzinia (Pleosporales, Didymosphaeriaceae) collected on sugarcane in Cuba
Authors: MENA-PORTALES JULIO , CANTILLO-PÉREZ TAIMY , MINTER DAVID W.
Published: December 2017

Spegazzinia affinis sp. nov. collected on dead leaves of sugarcane from Cuba is described and illustrated. It is characterized by lobed and echinulate, brown to mid brown type "b" conidia. Its differences and affinities with S. flabellata, S. sundara and S. tessarthra are discussed and a key to known species of the genus is provided.
Phytolacca exiensis, a new species of Phytolaccaceae from west of Hubei province, China
Authors: XIE DAN , QIAN DAN , ZHANG MENG-HUA , WANG YE-QING , WU YU , HUANG LU-QI , ZHANG DAI-GUI
Published: December 2017

Phytolacca exiensis, a new species of Phytolacca which was discovered from west of Hubei province, China, is discribed and illustrated in this paper. The placement of this new species is accessed based on molecular phylogenetic analysis of the nuclear ribosomal ITS and one chloroplast regions (psbA-trnH) sequences together with mophorlogical comparison. This new species can be easily distinguished from other related species by its carpers connate and plants dioecious.
Description of five new coral associated Barnacles of the genus Trevathana (Balanomorpha: Pyrgomatidae) in Pacific Waters
Authors: CHAN BENNY KWOK KAN , CHEN YI-YANG , ACHITUV YAIR , LIN HSIU-CHIN
Published: December 2017

Five new species of coral inhabiting barnacles of the genus Trevathana (Balanomorpha: Pyrgomatidae), T. dongshaensis sp. nov., T. conica sp. nov., T. doni sp. nov., T. longidonta sp. nov. and T. taiwanus sp. nov., are described. These species are found in West Pacific waters including Japan, Taiwan (mainland and adjacent outlying islands including Dongsha Atoll) and Papua New Guinea. The species exhibit morphological differences in the scutum, the tergum, and cirri II and III, and form distinct clades in a phylogenetic tree based on DNA sequences of two genes, 12S rDNA and cytochrome C oxidase subunit I. Three of the five species, T. dongshaensis sp. nov., T. conica sp. nov. and T. taiwanus sp. nov., have relatively narrow distribution ranges and were recorded from the Dongsha Atoll (T. dongshaensis sp. nov. and T. conica sp. nov.) and the Taiwanese mainland (T. taiwanus sp. nov.). Trevathana longidonta sp. nov. and T. doni sp. nov. have wider distributions. Trevathana longidonta sp. nov. was collected from Japan, Taiwan and Dongsha Atoll and T. doni sp. nov. was collected from Taiwan, Dongsha Atoll and Papua New Guinea. In the waters of Japan, Taiwan and Dongsha Atoll, all the recorded Trevathana species inhabit corals of the family Merulinidae. However, in Papua New Guinea, T. doni sp. nov. is also recorded in the coral Oxypora, belonging to the family Lobophylliidae, and individuals living on Lobophyllidae and Merulinidae did not exhibit great variation in the divergence of the COI and 12S genes.
A new species of freshwater crab of the genus Oziotelphusa Müller, 1887 (Crustacea: Decapoda: Brachyura: Gecarcinucidae) from Tamil Nadu, southern India
Authors: RAJ SMRITHY , KUMAR APPUKUTTANNAIR BIJU , NG PETER K. L.
Published: December 2017

A new species of gecarcinucid freshwater crab of the genus Oziotelphusa Müller, 1887, is described from stationary or slow-flowing bodies of water in Keeriparai near Nagercoil, in the state of Tamil Nadu in southern India. Oziotelphusa ravi, new species, is distinguished from its congeners by several distinct characters: the median tooth of the posterior margin of epistome forms a distinct bilobed tip in frontal view, the male pleonal somite 6 is narrowly trapezoidal and slightly wider than long with the lateral margins concave, the terminal segment of the male first gonopod is distinctly bent laterally (along the longitudinal axis) at an angle of about 45°, and the proximal part of the outer margin of the subterminal segment of the male first gonopod has a prominent deep concavity.
Spiders of the São Paulo state islands, Brazil: redescription of Stenoterommata rassimana (Mello-Leitão, 1923) n. comb. (Araneae, Nemesiidae)
Authors: BERTANI ROGÉRIO , MORI ANDRÉ , FUKUSHIMA CAROLINE SAYURI
Published: December 2017

Spiders of the islands on the coast of the state of São Paulo, Brazil are poorly known. Herein, we redescribe and discuss the taxonomic position of Psalistops crassimanus Mello-Leitão, 1923, described from Alcatrazes Island and formerly included in the Barychelidae. This species is, herein, transferred to the genus Stenoterommata Holmberg, 1881, Nemesiidae, and the new combination Stenoterommata crassimana (Mello-Leitão, 1923) n. comb. is established. Stenoterommata crassimana males are diagnosed by the very slender and long apical portion of embolus having a strong curvature close to its apex. The females have the spermathecae with single elongate lobe bearing two receptacles. This species is probably endemic to the Alcatrazes Archipelago and Queimada Grande and Queimada Pequena Islands, on the coast of the state of São Paulo, Brazil.
Using the Juvenile Sex Offender Assessment Protocol–Revised to Assess Psychopathy: A Preliminary Investigation
Authors: Wijetunga Charity , Nijdam-Jones Alicia , Rosenfeld Barry , Martinez Ricardo , Cruise Keith R.
Published: December 2017

Assessment of sexual and nonsexual recidivism risk is important for juveniles who have offended sexually (JSOs). It is unclear whether clinicians who assess risk for both types of recidivism should use a JSO-specific measure alone or in combination with an assessment of other potential risk factors, such as psychopathy. Using a sample of 72 JSOs, this study examined the reliability and validity of a scale (Scale P) intended to assess psychopathic traits comprised of seven items from the Juvenile Sex Offender Assessment Protocol–Revised (J-SOAP-II). Scale P demonstrated adequate internal consistency and was significantly correlated with the Hare Psychopathy Checklist–Youth Version (PCL:YV). In addition, Scale P significantly predicted nonsexual and sexual recidivism as well as the PCL:YV and was a significantly stronger predictor of nonsexual recidivism than several of the preexisting J-SOAP-II scales. These preliminary findings suggest that Scale P may enhance the clinical utility of the J-SOAP-II.
“Here Lies”: Sincerity and Insincerity in Early Modern Epitaphs Onstage
Authors: Newstok Scott L.
Published: December 2017

In early modern England, theatrical performance was charged with undermining sincerity, while epitaphic writing was praised as upholding it. Given that epitaphs and plays were perceived to occupy contrasting positions with respect to the contemporary discourse surrounding sincerity, it is striking how often epitaphs are invoked in the dramas of the period: the preeminently “sincere” genre within the preeminently “insincere” genre. I suggest that the epitaphic genre provided dramatists with an unexpected vehicle for exploring the limits of sincerity; the repeated convergence of the two genres provides a kind of mutual critique.
Turn Away the World: How a Curious Fifteenth-Century Spiritual Guidebook Shaped the Contours of the Reformation and Taught Readers to Turn Inward
Authors: Magill R. Jay
Published: December 2017

This paper contains a compact narrative history of the life of theologian Thomas à Kempis (1380–1471) and his curious spiritual guidebook The Imitation of Christ. It then continues with a brief analysis of how The Imitation shaped the contours of the Reformation, harkened back to the early Christian tradition of contemptus mundi, and eventually helped form modern ideas of intimacy and inwardness in the West.
Satire, Sincerity, and Swift’s “Exploded” Gospel
Authors: Galbraith Jeffrey
Published: December 2017

This essay examines Jonathan Swift’s satire An Argument against Abolishing Christianity in order to re-evaluate the conventions of sincerity. Whereas the Argument is typically recognized as satirizing insincere Christian belief, my literary-historical approach focuses on Swift’s references to public opinion and the speaker’s claim that the Gospel “is generally antiquated and exploded.” For Swift, public opinion has a distorting effect on communication, and yet he participates in the public sphere nevertheless. This performative contradiction provides an instructive addition to Christian debates concerning the moral dangers of assimilation and taking on a role.
Near-infrared hyperspectral imaging of lamination and finishing processes in textile technology
Authors: Mirschel Gabriele , Daikos Olesya , Scherzer Tom , Steckert Carsten
Published: December 2017

This paper highlights the potential of large-area hyperspectral imaging for process and quality control in established manufacturing and modification processes of technical textiles. In particular, it is focused on applications in lamination and impregnation of textiles. In case of lamination, NIR chemical imaging was applied to monitor the thickness of the adhesive layers inside the textile laminates and to detect lamination errors, whereas it was used to monitor the homogeneity of the functional finishes applied by impregnation. In both cases, low application weights ranging from only a few to several tens or hundreds grams per square meter have to be detected, which poses a challenge to the sensitivity of the method.
Time Delays in Instituting Thrombolysis in Acute Myocardial Infarction ‐ a Singapore Perspective
Authors: Tiru M , Goh SH
Published: December 2017

The reduction of mortality from acute myocardial infarction has been achieved mainly through the use of thrombolysis. In large scale studies, mortality and the extent of myocardial salvage are directly related to how early thrombolysis or reperfusion is instituted. This study was done to highlight the factors resulting in time delays that need to be targeted for change: (a) Pre‐hospital delays (recognition of symptoms suggesting an acute myocardial infarction and the presentation to the A&E Department); (b) Delays that occur within the A&E Department; and (c) Delays after leaving the Accident & Emergency Department. We identified the areas contributing to significant delays in each of these areas with a view of proposing that a subgroup of these patients may be identified for a fast track approach in initiating thrombolysis within the Accident & Emergency Department.
Acute Non‐Traumatic Knee Pain in the Elderly ‐ Osteoarthritis?
Authors: Tan TH , Ong KL , Cocks RA
Published: December 2017

We describe a patient with spontaneous osteonecrosis of the knee presenting with acute knee pain. This condition is less often thought of especially among elderly patients who present with knee pain and with no accompanying history of trauma. They are often assumed to be suffering from osteoarthritis. However, we believe that radionuclide bone scan is helpful especially when the plain radiographs are of little or no diagnostic value.
Why did Patients Default Follow‐Up at Accident and Emergency Department and Ways to Reduce Default Rate? ‐ A Retrospective Study
Authors: Man CY
Published: December 2017

The follow‐up clinic of the accident and emergency department is important in terms of risk management and quality assurance. Its purpose is defeated if patients do not return for the scheduled follow up. In this study, the reasons why some patients defaulted were investigated by telephone enquiry. It was found that about 30% of patients defaulted each day. Among those who could be contacted, almost one third said their illnesses have recovered or improved. A significant proportion of them suffered from sprains, minor burns or scald. The personal, familial or socio‐economic factors also prevented some of them from returning. There were patients who did not come back because they have been admitted to hospital before the appointment, suggesting that patients with certain conditions are not suitable candidates for follow‐up. The telephone enquiry of these defaulted patients provide a good opportunity for the patient to voice their views and opinions on the service they received and patient satisfaction can be enhanced by telephone enquiry. Based on the findings of this study, recommendations on service improvement has been proposed including a detailed study on the feasibility of the telephone follow‐up system, and rescheduling the time and date of follow‐up for the convenience of the patients.
Air Medical Service: a Review on its Cost-Effectiveness, the Role of in-Flight Physician and Safety
Authors: Pang Pkm
Published: December 2017

A literature review of recent articles on helicopter aeromedical services (HEMS) was carried out. The methods used included a Medline search using the key words ‘air ambulance’ and ‘helicopter EMS’. Other sources of information were also obtained from internet web-sites such as www.aams.org , www.info.gov.hk/gfs/performctx.htm and eMedicine.com free online textbook. The results show that HEMS is cost-effective with a good safety record, and it is also evident that in-flight physicians are particularly useful in improving the survival of severely injured patients. Strict criteria to select patients for HEMS operations must be publicised and followed by both callers and the HEMS dispatcher.
Rhabdomyolysis after Marathon Run
Authors: Wong Sk , Yeung Sd
Published: December 2017

We describe an athelete who presented with red colour urine after a marathon run. She was subsequently found to have myoglobinuria and rhabdomyolysis. Excessive muscular activity is a well-documented cause of rhabdomyolysis but is uncommonly seen in Hong Kong. A high index of suspicion is necessary to make the diagnosis.
A Comparison of Ketoprofen and Diclofenac for Acute Musculoskeletal Pain Relief: a Prospective Randomised Clinical Trial
Authors: Ng P , Kam Cw , Yau Hh
Published: December 2017

Objectives

To compare the efficacy and adverse effects of Ketoprofen and Diclofenac in the treatment of acute musculoskeletal pain.

Methods

In a prospective randomised clinical trial, patients admitted to an emergency department with acute musculoskeletal injuries requiring intramuscular (IM) injection for pain treatment were enrolled. The target study patients were Chinese adults who suffered from any musculoskeletal injuries of less than 12 hours. They received either 100 mg of Ketoprofen or 75 mg of Diclofenac. Pain was assessed by a 10-point visual analog score (VAS) and evaluations were performed at 30-minute intervals from treatment. Rescue analgesic was given if insufficient analgesia was achieved by one hour. The outcomes and the adverse effects were recorded.

Results

We recruited 77 cases in the Diclofenac group and 74 cases in the Ketoprofen group. The demographic data with regards to age, sex and patterns of injury were comparable in both groups. Following the administration of treatment, both groups showed highly statistically significant (P<0.001) reduction in pain level at 30-minute and 60-minute intervals. Comparing the mean decrease of pain level, there was no statistically significant difference between the two groups at 30-minute interval (P=0.6) and 60-minute interval (P=0.5). In each group, there was one patient experiencing skin rash after treatment. Four patients in the Ketoprofen group and one in Diclofenac group required rescue medicine. With respect to the number of admission following treatment, there was no statistically significant difference between the two groups.

Conclusions

Ketoprofen and Diclofenac are equally effective and safe in the treatment of acute musculoskeletal pain in Hong Kong Chinese population.
An Undiagnosed Myasthenia Gravis Presented with Acute Respiratory Failure
Authors: Siu Ayc , Wong Tw , Lau Cc
Published: December 2017

Acute respiratory failure is an uncommon initial presentation of myasthenia gravis. We present a case of unrecognised myasthenia gravis. She initially presented with dysphonia and was managed by speech therapy and ENT surgeons for a year. The diagnosis was finally made after the patient presented with acute respiratory failure.
Initial Experience of Ultrasonographic Assessment for Paediatric Patients with Hip Pain in the Emergency Department
Authors: Siu Ayc , Wong Tw , Lau Cc , Poon Akc , Lam Ck , Ip Fk
Published: December 2017

Introduction

Hip pain is a common paediatric presentation to the emergency department. Plain radiographs have been the main imaging modality of choice in the past. There is a lack of published local emergency department experience on the assessment of non-traumatic hip pain in children using ultrasound. We undertake to describe our initial experience.

Method

Patients less than 12 years presenting with non-traumatic hip pain or knee pain suspected to be referred from hip were recruited. A 7.5 mHz linear ultrasound probe was used to detect hip effusion. Hip effusion was defined as an anterior capsular distance (ACD) of greater than 5 mm measuring from the neck of femur and a difference of greater than 2 mm from the normal side. Patients with effusion were advised admission and those not admitted would be followed up in the Emergency Department.

Result

45 patients (Male: 32; Female: 13) with a mean age of 5.4 years were recruited from November 1997 to October 1998. Hip pain and limping gait were reported in 34 and 22 patients respectively. The initial scan detected hip effusion in 31 cases (69%). Thirty four patients were admitted and the others were followed up in A&E. All patients who had hip effusion were diagnosed to have transient synovitis. Nine out of 14 patients (64.3%) who did not have hip effusion were also presumed to be due to transient synovitis in the in-hospital record. The sensitivity and specificity for ultrasound assessment of hip pain were 76.9% and 93.3% respectively. No septic arthritis was found.

Conclusion

Our experience supports ultrasound evaluation as an important evaluation tool for children presenting with irritable hip in the emergency department.
Upper Airway Obstruction as a Presentation of Taro Poisoning
Authors: Yuen E
Published: December 2017

We describe a case of Taro poisoning presenting as severe buccal and throat pain, which later progress to cause upper airway obstruction. Chinese Taro is not normally consumed as food in Hong Kong, though it is readily found growing wild in the countryside. The chemical responsible for the poisoning is Oxalate, which is also found in other species of plant. (Hong Kong j.emerg.med. 2001;8:163–165)
Knowledge and Beliefs of Parents of Asthmatic Children Presenting to an Emergency Department
Authors: Wong E , Wong TW , Chung M , Lau CC
Published: December 2017

This is a survey on the knowledge and beliefs of 100 parents or guardians of asthmatic children presenting to the emergency department with an asthmatic attack and staying in the observation ward for treatment. The parents were asked to fill in a questionnaire on their knowledge and beliefs about asthma. Demographic data and data related to routine asthma care were also collected. The mean age of the children was 6.2± 3.2. The mean duration of asthma was 3.4 year (±2.6). In the preceding 6 months the mean attendance frequency at our accident and Energency department was 1.5±1.4. The majority of respondent (79%) agreed that asthma is caused by bronchoconstriction but only 42% understood that mucosal oedema is involved during an acute attack. Many people (82%) believed that asthma is just sensitive bronchus. Less than half (40%) believes asthma is a hereditary disease. It was a common belief that asthmatic attack can be precipitated by a change of weather (89%) and cold food/drink (77%). Over 75% agreed that carpet in the house is undesirable for an asthmatic child. The majority of parents (69%) disagreed that an asthmatic child should avoid physical exercise and only 13 would not allow the child to attend physical exercise class. Over half (54%) of the respondents believed that asthma could be cured. Only a minority (17%) believed that antibiotics are useful in shortening the attack. Thirty (30%) respondents also used alternative means of therapy for example crocodile meat. Parents' knowledge of preventive medication was inadequate. Understanding common beliefs among parents is beneficial in patient and parental education.
Case and Literature Review: Adult Acute Epiglottitis – Rising Incidence or Increasing Awareness?
Authors: Chung CH
Published: December 2017

Objective

The prevalence of adult acute epiglottitis is probably more common than is generally appreciated. A retrospective case review in a district hospital and a medical literature search may provide baseline information to guide future strategies.

Methods

Cases of acute epiglottitis in a period of 3 years and 4 months were traced from the hospital computer systems. Medical records were reviewed. Medical literature on “adult acute epiglottitis” was searched through Medline and EMBASE. Relevant full text articles were retrieved through hospital library network.

Results

From February 1998 to June 2001, 11 cases of acute epiglottitis were identified. The age range was 34–78 (mean 47.5, median 41). There was no paediatric case. The male to female ratio was 9:2. Eight presented with fever, sore throat and dysphagia, one presented with dyspnoea and two presented as foreign body in throat. Nine were treated successfully conservatively. Two were intubated prophylactically. There was no case fatality.

Conclusion

Adult acute epiglottitis has become much commoner than its paediatric counterpart. Acute epiglottitis should be suspected in all patients with a sore throat and dysphagia, especially if symptoms are out of proportion to the pharyngeal inflammation.
Vibrio Parahaemolyticus: A Leading Cause of Infectious Diarrhoea in Hong Kong
Authors: Chan Ssw , Ng Kc , Cheung Wl , Rainer Th
Published: December 2017

Vibrio parahaemolyticus is one of the commonest pathogens responsible for infectious diarrhoea in Asia. This article highlights recent findings from a retrospective study in an A&E Department in Hong Kong, and reviews current literature in regard to the epidemiological features and laboratory investigations. Prevention, prompt diagnosis and treatment are discussed. Vibrio parahaemolyticus gastroenteritis causes significant morbidity, and is much more prevalent in the summer season. Compared to other bacterial gastroenteritis, patients with this condition may present relatively sooner after the onset of diarrhoea. To ensure prompt detection of outbreaks, an appropriate stool culture medium specific for Vibrio spp. should be used.
A Review Article on Nerve Agents
Authors: Tang SYH , Chan JTS
Published: December 2017

The incidence of Tokyo subway attack by the Aum Shinrikyo cult in 1995 had raised the concern of the use of nerve agent as a weapon in terrorist attack. The recent event in World Trade Centre in New York city had further brought our attention to the possibility of terrorist attacks using these agents. In view of the high possibility of nerve agents being used as chemical weapon, medical personnel should have a clear knowledge of these agents. This article aim to provide a detailed discussion of these agents.
Liver Abscess Caused by a Fish Bone
Authors: Fan KL
Published: December 2017

Fish bone ingestion is a common problem in the emergency department. Most cases have uneventful outcome. But occasionally it can cause serious complications if the gastrointestinal tract is perforated. A case of liver abscess caused by a fish bone is presented. It highlights the importance of maintaining a high level of clinical acumen in managing this apparently benign problem.
Retropharyngeal Abscess
Authors: Chu FKC
Published: December 2017

Retropharyngeal abscess is a condition commonly seen in children but not so common in adult. In this case report, we describe an adult case of retropharyngeal abscess who presented to us with symptoms of sore throat and dysphagia for 1 month.
Confidence Test for Personal Protective Equipment
Authors: Chan JTS , Lau WHK , Wu YF
Published: December 2017

After the sarin attack in Tokyo Subway in 1995 and terrorist attack in World Trade Center of New York City in 2001, many countries are alerted by the risk of terrorist attack. International experiences show that many victims would arrive at hospital by their own transport. Staff safety is an important issue to be addressed. This study is to determine the skin and respiratory protection of a model of level C personal protective equipment which is currently available in Hong Kong.
A Case Series of Candle Wax Burns during the Lantern Festival in Hong Kong
Authors: Lee PC , Ching WM , Kam CW , Yau HH
Published: December 2017

Every year there was significant number of burn cases during the Lantern (Mid-Autumn) Festival in Hong Kong because children liked to play with fire on that day. They would either burn the lantern or boil the wax from candles in a pot over a fire. When the wax has melted, they poured cold water into it, causing a small explosion with water vapour and wax droplets. Children and adolescents were more common than adults to be burnt by the hot vapour, fire or hot wax. The majority sustained partial thickness burns involving the face. Such burn injuries should be preventable by education and legislation.
Clinical Audit on Short Stay Emergency Medical Admission
Authors: Lo CM , Leung SH , Lam CS , Yau HH
Published: December 2017

The growth rate of emergency department visit locally is disproportionate to the population growth. The number of emergency hospital admission has also increased leading to congested ward environment. A retrospective clinical audit on short stay (discharged within 24 hours) emergency medical and geriatric admission was done to look at the appropriateness of our emergency medical and geriatric admission. This study was carried out in April 2000. The Appropriateness Evaluation Protocol was employed as an objective tool for initial assessment. A peer panel, composed of Fellows from the Colleges of Physicians and Emergency Medicine, was formed to check for appropriateness of admission for those cases without objective admission criteria. Thirteen out of the 177 cases (7.3%) available for analysis were considered as “inappropriate” admission. If we assume that those emergency admissions that stayed for longer than 24 hours were appropriately admitted, the “inappropriate” admission rate for medical and geriatric cases would be 0.67% (13 out of 1930). Suggestions for further improvement include: (1) longer and intensive observation for selected patients before admission; (2) access to early specialist outpatient review; (3) ad‐hoc clinics to be run by other specialists for selected “old” cases; and (4) strengthening of the primary health care service.
Review of the role of Magnesium Sulphate in the Management of Asthma patient at A&E Setting
Authors: Yan YY , Ng MH
Published: December 2017

Controversial views exist with regards to the use of intravenous magnesium sulphate in patient with severe asthmatic attack. The benefit of intravenous magnesium sulphate may be masked by the pooling of patients with different pathophysiology. The subsets of patients with severe asthmatic attack who have not responded to nebulised bronchodilator therapy and intravenous steroid therapy may benefit from intravenous magnesium sulphate therapy.
Two Pregnant Women Presenting with Umbilical Cord Prolapse
Authors: Hung CY , Ng P , Yau HH , Kam CW
Published: December 2017

Cord prolapse is an obstetric emergency as delay in management is associated with significantly increased neonatal morbidity and mortality. If the accident occurred outside the hospital, many babies would be dead or severely asphyxiated upon arrival in the hospital. The role of Accident & Emergency (A&E) department is to arrive at this diagnosis promptly and deliver appropriate intervention. Immediate cesarean delivery is the treatment of choice. The clinical presentations of two cases with umbilical cord prolapse presenting to our A&E department within two weeks were described. The pathophysiology, risk factors, diagnosis, management as well as outcome were discussed.
Case Report: Necrotising Fasciitis with Epidural Abscess
Authors: Sia YS , Wong YT
Published: December 2017

Necrotising fasciitis is relatively uncommon in Hong Kong. Its rapid progression and deterioration is the reason for high mortality. We report a patient who presented with this condition which was complicated with epidural abscess after incision and drainage. Early recognition is the key to save the patient.
Role of Laryngeal Mask Airway in Emergency Department and Pre‐Hospital Environment
Authors: Chu FKC
Published: December 2017

LMA and Intubating LMA (LMA‐Fastrach) have been widely used by anesthesiologists in operation theaters and have achieved great success. Its use in the emergency department and pre‐hospital setting by EMS has recently been proven to be very successful. It is also a very useful tool in providing a quick airway in case of failed intubation and failed ventilation situations. In this article, some of its use in emergency departments and pre‐hospital setting are discussed.
Delays in the Presentation of Stroke Patients to Hospital and Possible Ways of Improvement
Authors: Lau KK , Yeung KM , Chiu LH , Sheng B , Choi KW , Shih YN
Published: December 2017

Objective

Stroke patients often came late to hospital and arrived beyond the therapeutic time window for thrombolytic therapy. We studied the time from stroke onset to arrival at Accident and Emergency (A&E) department and examined what barred them from early medical attendance.

Methods

All acute stroke patients attending A&E between 15 March 1999 to 14 June 1999 were recruited. For those brought in by ambulance, their time intervals were divided into three: phase I was between stroke onset to call 999; phase II was between call 999 to A&E arrival; and phase III was between A&E arrival to being seen by doctor. For those who did not come by ambulance, they were divided into two groups: those who consulted other doctors and those who did not consult other doctors before coming to A&E. Their time lags from stroke onset to A&E consultation were compared.

Results

One hundred and fifteen stroke patients were consecutively recruited. Sixty‐five ambulance users had median time for phase I as 151 minutes, for phase II as 32 minutes, for phase III as 17 minutes. The total median time lag was 190 minutes. Fifty were ambulance non‐users. For those who did not consult other doctors before A&E attendance, the median time lag was 641 minutes. For those who consulted others doctors before A&E attendance, their median time lag was 3,672 minutes. As a group their median time lag was 950 minutes. For the 65 ambulance users, we further studied the time intervals between A&E arrival and being seen by doctors; and the median waiting time for doctors was 17 (range 0 to 60) minutes.

Conclusions

Public education was of paramount importance. Some common stroke signs could be widely propagated for recognition. Phase I should be less than 80 minutes. The median time for phase II would likely remain to be 32 minutes. Further shortening could be achieved in phase III. As category III & IV patients were most likely potential candidates for thrombolysis, they should be seen within 15 minutes. This would leave only 53 minutes for clinical assessment, CT brain and preparation of thrombolytic agent. These measures could increase the chance of providing thrombolytic treatment within the therapeutic time window.
A Profile of Bicycle‐Related Injuries in Tai Po
Authors: Lee LLY , Yeung KL , Chan JTS , Chen RCI
Published: December 2017

Background

Implementation of prevention programs for bicycle safety should be based on a good understanding of the profile of bicycle accidents. The objective of this study was to investigate the differences in the severity of bicycle‐related injuries when comparing with various risk factors, and to utilize this information to formulate the intervention measures.

Methods

A retrospective review was conducted on all patients (n=116) who were treated for bicycle‐related injuries within a period of 66 days at the emergency department of a district hospital in Tai Po, New Territories.

Results

School‐aged children, especially boys, were more commonly injured. The head and lower extremities were the common sites of injuries. Female gender (χ2=4.39; P<0.05) and injuries involving head and upper extremities (χ2=12.61; P<0.05) were associated with higher chance of serious injury.

Conclusion

Tai Po district had a high incidence of bicycle accidents due to its geographical location. Population at a greater risk for bicycle injury was the male gender school‐aged children and therefore prevention program should be targeted at them.
The Way to a Successful Employment or Promotion Interview for Doctors
Authors: Chung CH , Cameron PA
Published: December 2017

Interview skills traditionally receive little emphasis in the medical profession, in contrast to clinical and technical skills. However, good interview skills have a major impact on a doctor's career. Unfortunately, there is hardly any reference in the medical literature on employment interview skills. This is a review of the preparation, expectation, etiquette and presentation for interviews from ‘management sources’ and is equally applicable to the medical profession.