A cohort of 87 SLE female patients underwent non-invasive assessments (e.g., vascular ultrasound, pulse wave analysis with applanation tonometry and echocardiography with TDI). In addition, disease activity, organ damage and SLE-related lab markers were also evaluated. Forty female healthy subjects were included as normal control. / In summary, pulse wave analysis and tissue Doppler imaging are sensitive and accurate to detect premature atherosclerosis and subclinical myocardial dysfunction. The current study demonstrated a close correlation of inflammatory burden (disease activity and organ damage) to premature atherosclerosis and subclinical myocardial dysfunction, which may implicate the importance of routinely monitoring and early treatment to attenuate cardiovascular involvement. / Systemic lupus erythematosus (SLE), an autoimmune-inflammatory disease, results in multi-organ damage of the body. Compared to Caucasian, Chinese in Hong Kong have high prevalence of SLE. Cardiovascular diseases are common manifestations of SLE, which have emerged to be one of main causes of mortality. Detection of premature atherosclerosis, arterial stiffening and subclinical myocardial impairment early in the course of the disease is important as there may be a role of early therapeutic intervention in these patients that might translate into better clinical outcomes. In this regard, newer non-invasive methods, such as, pulse wave analysis and tissue Doppler imaging (TDI), have gained clinical popularity due to their accurate, reliable and reproducible measurements for the early detection of subclinical cardiovascular complications. / The main findings were as follows: (1) Increased arterial stiffness and premature atherosclerosis were demonstrated in SLE patients with mild disease and a low prevalence of end-organ damage and SLE itself was an independent risk factor of early atherosclerosis; (2) The abnormal vascular parameters correlated with disease activity; (3) SLE patients without overt cardiovascular involvement still have abnormal diastolic function with or without elevated LV filling pressure identified by a ratio of mitral Doppler inflow velocity to lateral annulus velocity (lateral E/E'>10) on pulse-wave and tissue Doppler echocardiography; (4) Both pulmonary artery hypertension and organ-damage were the independent predictors of elevated LV filling pressure alter adjustment of traditional risk factors, with the former adding incremental predictive value to the latter; (5) There was evidence of subclinical LV systolic dysfunction in patients with SLE even when LV ejection fraction appeared to be normal; (6) The independent determinants of subclinical LV systolic dysfunction included long disease duration of >10 years, active disease, reduced total arterial compliance as well as abnormal mid-wall fractional shortening, and the assessment of these factors provided incremental predictive value. / This thesis applied the above non-invasive methods to SLE subjects with the following aims: (1) To ascertain whether there is evidence of preclinical atherosclerosis (as indicated by carotid intima-media thickness), and/or increased arterial stiffeness (as reflected by direct and indirect surrogate parameters, including pulse wave velocity, augmentation index and ankle-brachial index) in SLE; (2) To investigate the relationships of these noninvasive vascular parameters to inflammatory disease burden in terms of SLE disease activity and organ damage; (3) To assess whether there is evidence of subclinical myocardial diastolic dysfunction; (4) To determine the associations between various clinical and echocardiographic parameters, including presence of pulmonary arterial hypertension, SLE-related clinical data, and elevated LV filling pressure; (5) To detect whether there is evidence of subclinical myocardial systolic dysfunction by tissue Doppler echocardiography; (6) To determine various clinical and echocardiographic parameters in predicting subclinical LV longitudinal-axis systolic function. / Shang, Qing. / Advisers: Yu Cheuk-man; Tam Lai-Shan; Yip Wai-Kwok. / Source: Dissertation Abstracts International, Volume: 70-06, Section: B, page: 3421. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2008. / Includes bibliographical references (leaves 166-201). / 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. / Abstracts in English and Chinese. / School code: 1307.

Wong, Adrian. / "August 2007." / Thesis (Ph.D.)--Chinese University of Hong Kong, 2007. / Includes bibliographical references (p. 183-221). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in English and Chinese.

Chook Ping. / Publication date from spine. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1995. / Includes bibliographical references (leaves 72-96). / Chapter 1.0 --- Abstract --- p.1 / Chapter 2.0 --- Introduction --- p.3 / Chapter 3.0 --- Aim of Study --- p.7 / Chapter 4.0 --- Patients and Methods --- p.7 / Chapter 4.1.0 --- Patients and Preparations --- p.7 / Chapter 4.2.0 --- Ultrasound Machine --- p.8 / Chapter 4.3.0 --- B-mode Ultrasound Imaging --- p.10 / Chapter 4.3.1 --- Artery Anatomy --- p.10 / Chapter 4.3.2 --- Interface of Arterial Wall --- p.11 / Chapter 4.3.3 --- B-mode Ultrasound Image Orientation --- p.12 / Chapter 4.3.4 --- B-mode Ultrasound Scanning Procedure --- p.13 / Chapter 4.3.5 --- Classification of Atherosclerotic Lesion --- p.16 / Chapter 4.4.0 --- Training of Sonographer --- p.28 / Chapter 4.5.0 --- Reproducibility of B-mode Ultrasonography --- p.28 / Chapter 4.6.0 --- Statistical Evaluation --- p.29 / Chapter 5.0 --- Results --- p.31 / Chapter 5.1.0 --- Assessment of Training of Sonographer --- p.31 / Chapter 5.2.0 --- Reproducibility of Two Ultrasonic Measurements --- p.31 / Chapter 5.2.1 --- Intimal-Media Thickness --- p.31 / Chapter 5.2.2 --- Lumen Diameter --- p.32 / Chapter 5.3.0 --- Clinical Relevance --- p.43 / Chapter 5.3.1 --- Patient's Characteristics --- p.43 / Chapter 5.3.2 --- Relation of Intimal-Media Thickness to Disease and Age Groups --- p.43 / Chapter 5.3.3 --- Prevalence of Atherosclerosis --- p.44 / Chapter 5.3.4 --- Extent of Atherosclerosis --- p.45 / Chapter 6.0 --- Discussion --- p.59 / Chapter 7.0 --- General Remarks and Conclusion --- p.70 / Chapter 8.0 --- Acknowledgment --- p.71 / Chapter 9.0 --- References --- p.72

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Tuberculosis (TB) and an infectious disease caused by Mycobacterium tuberculosis that afflicted mankind since antiquity with reports of up to about 5,000 BC Despite the high efficiency of treatment, TB remains a major health problem. In 2011, an estimated 8.7 million incident cases of TB worldwide. Among the main measures for tuberculosis control are early diagnosis and proper treatment of the disease. Thus, the active search should be performed continuously for all healthcare services (primary, secondary and tertiary). The study aimed to evaluate the benefits of automated methodology for the diagnosis of tuberculosis in different clinical specimens in relation to the methodology manual. This is a descriptive study and experimental evaluation of two diagnostic tests (manual and automated) for which several samples were analyzed. The survey was conducted from July to September 2011. The samples were provided by patients of 15 health units of the State, which needed to confirm or culture tuberculosis control. In the 1520 samples, smear, 188 (12.37%) samples were positive and 1,332 (87.63%) negative. In cultures on solid media (LJ), a manual methodology, 254 (16.71%) samples were positive, 1.156 (76.05%) and 110 negative (7.24%) were contaminated. In automated methodology (MGIT), the result was 258 (16.97%) positive, 1,149 (75.59%) and 113 negative contaminated (7.43%). The median time to positivity in the manual method was 31.95 days, with a mean deviation of 15.01 and automated methodology was 16.53 days, with a standard deviation of 12.39. It was possible to demonstrate concordance between the methods and various advantages that automated methodology presents compared to manual in the laboratory routine. Among them is the decreased time to detection of the disease, representing a breakthrough in the initial treatment of patients, which, in the case of TB, may mean to decrease the number of cases, since people no longer be bacillary patients. / A tuberculose (TB) e uma doenÃa infectocontagiosa causada pelo Mycobacterium tuberculosis que aflige a humanidade desde a antiguidade com relatos de ate cerca de 5.000 a.C. Apesar da alta eficiÃncia do tratamento, a TB continua como um grande problema de saÃde. Em 2011, estimou-se 8,7 milhÃes de casos incidentes de TB no mundo todo. Dentre as principais medidas para o controle da tuberculose estÃo o diagnÃstico precoce e o correto tratamento da doenÃa. Desta forma, a busca ativa deve ser realizada permanentemente por todos os serviÃos de saÃde (nÃveis primÃrio, secundÃrio e terciÃrio). O estudo teve como objetivo geral avaliar os benefÃcios da metodologia automatizada no diagnÃstico da tuberculose em diferentes amostras clÃnicas em relaÃÃo à metodologia manual. Trata-se de um estudo descritivo e experimental para avaliaÃÃo de dois testes diagnÃsticos (manual e automatizado) pelos quais diversas amostras foram analisadas. A pesquisa foi realizada no perÃodo de julho a setembro de 2011. As amostras foram fornecidas por pacientes, de 15 Unidades de SaÃde do Estado, que necessitavam de cultura para confirmaÃÃo ou controle da tuberculose. Em 1.520 amostras, na baciloscopia, 188 (12,37%) amostras apresentaram-se positivas e 1.332 (87,63%) negativas. Nas culturas em meio sÃlido (LJ), por metodologia manual, 254 (16,71%) amostras foram positivas, 1.156 (76,05%) negativas e 110 (7,24%) apresentaram contaminaÃÃo. Na metodologia automatizada (MGIT), o resultado foi de 258 (16,97%) positivas, 1.149 (75,59%) negativas e 113 contaminadas (7,43%). A mediana do tempo necessÃrio para positivaÃÃo no mÃtodo manual foi de 31,95 dias, com desvio mÃdio de 15,01 e na metodologia automatizada foi de 16,53 dias, com desvio padrÃo de 12,39. Foi possÃvel demonstrar concordÃncia entre os mÃtodos e diversas vantagens que a metodologia automatizada apresenta em comparaÃÃo a manual na rotina do laboratÃrio. Dentre elas està a diminuiÃÃo do tempo de detecÃÃo da doenÃa, representando um grande avanÃo no inÃcio do tratamento dos pacientes, o que, no caso da TB, pode significar a diminuiÃÃo do nÃmero de casos, jà que pessoas doentes deixariam de ser bacilÃferas

Prenatal diagnosis is an established obstetrics practice in many countries. Currently available methods to obtain fetal materials for a definitive diagnosis involve invasive procedures such as chorionic villus sampling and amniocentesis. Due to the invasive nature of the procedures, confirmatory testing is usually recommended only for pregnant women who are screened as being high risk of bearing a fetus with abnormalities. There has been an urge to develop safer alternatives in obtaining fetal genetic materials for prenatal assessment. Thus, the discovery of circulating fetal DNA in maternal plasma and serum has opened up new possibilities for noninvasive prenatal diagnosis. / The use of genetic markers such as Y chromosomal sequences from a male fetus or paternally-inherited polymorphic markers has been well-described in the literature. However, there is an obvious limitation on the use of these markers because they are gender- and/or polymorphism-dependent. This thesis focuses on the development of a universal fetal marker, namely SERPINB5 (encoding maspin), based on the intrinsic epigenetic differences between the placenta (the major contributor of fetal genetic materials in maternal plasma) and maternal blood cells (postulated to be the predominant source of cell-free DNA in the circulation). Analysis of the methylation profile of the SERPINB5 promoter in the placenta and maternal blood cells, and the development of methods and protocols to detect the differentially methylated SERPINB5 promoter molecules are described. The application of this epigenetic marker in prenatal assessment of the fetal chromosomal aneuploidy is illustrated by an epigenetic allelic ratio (EAR) approach. Basically, the ratio of a single-nucleotide polymorphism (SNP) on the placenta-derived SERPINB5 molecules is shown to be deviated in the maternal plasma from trisomic pregnancies when compared to the euploid ones. Results described in this thesis show the promising potential for the EAR approach for the noninvasive prenatal detection of fetal chromosomal aneuploidies. In addition, a novel approach for methylation analyses on the amplification and detection of restriction enzyme-digested DNA fragments will be discussed. This thesis has essentially described the evolution of a fetal epigenetic marker from basic science to potential clinical application. / Tong, Yu Kwan. / Adviser: Yuk-Ming Dennis Lo. / Source: Dissertation Abstracts International, Volume: 69-02, Section: B, page: 0953. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2007. / Includes bibliographical references (leaves 149-172). / 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. / Abstract also in Chinese. / School code: 1307.

The management of breast cancer has changed over the last century, with surgeries becoming less invasive and adjuvant therapies becoming indispensible. Sentinel lymph node biopsies (SLNB) have replaced axillary nodal dissections as a method of staging an axilla in early breast cancer. However, 70% of SLNBs are negative. The aim of this study was to determine if wecould decrease the rate of negative sentinel lymph node biopsies? A retrospective review over a 10 month period was undertaken. Patients undergoing a SLNB and who had a documented negative axillary ultrasound report were included. One hundred and fifty onepatients were eligible for inclusion. Patients’ ultrasound reports and initial biopsy specimen characteristics (ER/PR/Her2-neu, LVI, Grade, Location) were compared to their axillary nodal findings on histology. An ultrasound was able to predict a pathologically negative axilla in 71.6% of patients. Exclusion of micrometastasis increased the negative predictive value to82.8%. If the ultrasound was negative in a histologically positive axilla, it was likely that only 3 or less nodes were involved. Nodal metastasis could not be predicted based on the tumour characteristics that were reported on the initial tumour biopsy specimens(ER/PR/Her2- neu, LVI, Grade, Location). LVI and DCIS on the initial biopsy specimens were poorly correlated with the final histology specimen findings.. The results show that an ultrasound cannot currently replace a SLNB as an accurate means of evaluating an axilla. A clear limitation is the inability to detect micrometastasis, however the role of micrometastasis in axillary staging is diminishing. Ultrasonographic evaluation of the axilla is currently reported in a non-standardised manner. Classification systems do exist, and if applied to current reporting will increase the negative predictive value of ultrasonography. In the future, the combination of improved reporting standards of axillary ultrasounds, as well as the surgical conservatism with regard to the management of micrometastasis and small volume metastasis in the axilla will hopefully reduce the rate of negative SLNB’s.

No description available.

This research investigated two groups of patients diagnosed with dementia before the age of sixty-five. The patients were diagnosed with Alzheimer’s Disease (AD, n = 25) and Frontotemporal Dementia (FTD, n = 37). Patients were assessed for approximately 3 years. The study found that FTD is a valid and useful diagnostic category, and can be reliably differentiated from AD. A combination of behavioural, neurological, and neuropsychological assessments were found to be complementary in the early and accurate diagnosis of early-onset dementia, and the differential diagnosis of FTD from AD. FTD patients were found to have relatively preserved visuo-spatial abilities compared to the AD patients. Problems associated with administering neuropsychological tests to early-onset dementia patients were highlighted. FTD patients were found to deteriorate more rapidly than AD patients, and to have significantly increased behavioural disturbances throughout the course of the illness in comparison with the AD patients. Practical guidelines to assist with care and management of early-onset dementia patients were presented. A strengths-based model of care was outlined. Individualised assessments and care plans were recommended for the development and provision of humane services to early-onset dementia patients. Issues surrounding providing palliative care were discussed.

[Truncated abstract] Background: Dementia, largely due to Alzheimer's disease (AD), is a major public health problem. The early identification of disease is an important challenge for clinicians because treatment of AD is now available. A simple and accurate means of stratifying risk for AD and identifying early disease is needed so that risk factor modification and treatment can occur optimally. To date, despite many attempts, an accurate means of standardising an approach to the assessment of subtle cognitive symptoms has not been developed. A subjective complaint of poor memory has been identified as a possible marker for underlying brain disease. This study examines the utility of neuropsychological scores, homocysteine levels, APOE genotyping and brain imaging as predictors of cognitive decline in individuals with subjective memory complaint (SMC). Method Eighty subjects with SMC were recruited from memory clinics and the community (MC: 1). Forty-two control subjects were also examined (MC: 0). CAMDEX was used to describe baseline clinical features. The CAMCOG was used as a global test of cognition and was administered annually for four years. At baseline, neuropsychological testing was administered. Cranial CT scanning, measurement of plasma homocysteine and APOE genotyping were completed. Categorical variables were analysed using chi-square according to Pearson's method. Continuous data was analysed using Student's t-tests and Mann-Whitney tests. A logistic regression model was used to identify independent contributors to the presence of memory complaint. Participants were then matched for age, gender and time to follow-up (up for three years) to determine longitudinal predictors of cognitive decline. ... Baseline CAMCOG scores were greater in the control group (MC:0 = 98.3 ? 2.8, MC:1 94.2 ? 5.5, Z ?4.46, p 0.000). There were no differences in neuropsychological scores, concentration of total plasma homocysteine, APOE genotype or brain scan measurements. Using the Wald stepwise selection method, logistic regression could not be established due to non-convergence regardless of whether or not the continuous variables were re-coded into dichotomous variables. A matching process that created 32 pairs of controls/subjects allowed follow-up analysis. The controls showed significant improvement with time on the CAMCOG unlike subjects (mean ? SD, controls 1.5 ?-3.0, Z - 2.61, p 0.01, subjects 0.2 ? 3.2, Z ? 0.24, p 0.81). The logistic regression analysis showed that group membership could not be defined by any single independent variable. When group membership was abandoned and those with stable scores were compared to those who declined no clear meaningful independent predictors of decline apart from age were identified. Conclusions: Methodological issues such as small sample size and inadequate follow up duration were identified that may have precluded identification of predictive factors for cognitive decline. The results indicate that complaints of memory problems are not associated with established risk factors for Alzheimer's disease and fail to predict objective cognitive decline over three years. Future studies should continue trying to identify robust predictors of cognitive decline in later life.

224 leaves : / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (M.D.)--University of Adelaide, Dept. of Medicine, 1973