published_or_final_version / Dental Surgery / Master / Master of Dental Surgery

published_or_final_version / Public Health / Master / Master of Public Health

Ischemic heart disease (IHD) is the most common cause of death around the world. The underlying cause of IHD is myocardial ischemia as a result of progressive narrowing of coronary arteries due to atherosclerosis with potential thrombotic complications mediated by platelets. In addition to the role in hemostasis, platelets are increasingly recognized as an important mediator in this atherothrombotic disease. Basic management of IHD lies on medical therapy and coronary revascularization procedures. Percutaneous coronary intervention (PCI) is a commonly used revascularization procedure in the treatment of IHD especially for relief and reduction of symptoms. On the other hand, antiplatelet therapy is often administrated to patients undergoing PCI in an attempt to prevent major adverse cardiac events (MACE) following the procedures. However not all patients respond to the same degree of the antiplatelet therapy and some still develop MACE or stent thrombosis in the presence of the treatment with antiplatelet drugs. Recently a flow cytometric-based assay has been developed to monitor the effect of the antiplatelet drug, particularly the P2Y12 receptor antagonist, in patients treated with this kind of drug. This assay measures the activity of platelets as platelet reactivity index (PRI) based on the phosphorylation state of an intracellular platelet protein called vasodilator stimulated phosphoprotein (VASP). The measured value of PRI is inversely related to the response of patient to the antiplatelet drug. In this study, the response of patients to the P2Y12 receptor antagonist Clopidogrel was investigated following PCI. The PRI of patients was found to be significantly lower than normal subjects without taking this drug, indicating the therapeutic effect of this drug on the patients. However nearly one-third of patients (17 out of 59) studied were found to be non-responsive to clopidogrel treatment based on a cut-off established in this study for classifying patients into responders or non-responders. Furthermore, significant difference between the two types of stents used in PCI procedure, namely bare metal stent (BMS) and drug eluting stent (DES), was observed in the study. Patients receiving DES had nearly three times higher percentage of being non-responsive to clopidogrel than the BMS counterpart (45% vs. 16%, p<0.028). This study provides evidence that DES may be implicated in the non-responsiveness or drug resistance of clopidogrel in patient undergoing PCI. / published_or_final_version / Pathology / Master / Master of Medical Sciences

Malignant obstructive jaundice is always encountered in advanced stage. Malignancies include Distal Bile duct Carcinoma, Ampulla of Vater Carcinoma, and Pancreas Carcinoma are sometimes impossible to cure and resect. Therefore, palliative treatments are the only way to relieve the disease for the patients to have a better quality of life in their remaining life- span. Available palliative treatments include stenting and surgical bypass. In our analysis, metallic stenting and double bypass composing hepaticojejunostomy and gastrojejunostomy are studied as they can be considered as the two most efficient palliative methods so far that are widely used in Hong Kong in the management of malignant biliary obstruction. The treatment options depends on both the physicians and the patient. However, patients are often on the horns of a dilemma when they are allowed to choose these palliative treatments. This study hence aim to compare the cost-effectiveness of metallic stenting and surgical double bypass palliative treatment among five factors: 1) Number of hospital stay, 2) Re-admission rate, 3) Overall complication, 4) Change of bilirubin level and 5) Survival rate. A total of 40 patients data are being retrieved from the Queen Mary Hospital as 20 data are form the metallic stenting group, while the other 20 data are from surgical bypass. After collecting the data and finishing the study, it was found that apart from a longer hospital stay, the surgical bypass patient group would generally have a lower re-admission and complication rate. While the parameters include bilirubin change before and after the treatment and the survival rate are not significantly different, which indicated these two parameters may not be the determining factors when deciding the treatment choice. Based on the research outcome, surgical bypass may be a better choice of palliative treatment in the management of Malignant Biliary Obstruction that allows patients to obtain a better quality of life. / published_or_final_version / Medicine / Master / Master of Medical Sciences

Surgical resection is the best option for both liver and kidney cancers, which providing the long term survival. However intraoperative blood loss can be a significant challenge, and is clearly associated with morbidity and mortality. Radiofrequency ablation (RFA) precoagulation has been introduced into liver and kidney surgery. Promising results have already achieved in reduction of intraoperative blood loss. In this thesis, a detailed explanation on precoagulation by RFA has been given. Our group developed a novel bipolar multi-array RFA device ??? InLine (ILRFA). In this thesis, we have investigated the performance in a variety of fields. In the study of ILRFA-assisted laparoscopic liver resection, ILRFA was easily employed through a hand port and achieved significant decrease of blood loss compared to control group (p < 0.05). In the liver trauma study, ILRFA produced a 63.88% reduction of blood loss in peripheral injury and 53.57% in central injury respectively. In postoperative evaluation of ILRFA-assisted liver resection, animals underwent an uneventful recovery, no complications occurred. Histological examination revealed a typical post RFA evolution. In ILRFA-assisted partial nephrectomy, the mean intraoperative blood loss 35 ?? 7 ml in the ILRFA and 152 ?? 94 ml in the control, a 77.0% reduction (P = 0.024). The mean blood loss per centimetre resection area was 2.09 ?? 1.41 ml/cm2 in the ILRFA compared with 12.79 ?? 1.68 ml/cm2 in controls, the reduction was 79.0% (P = 0.019). In ILRFAassisted laparoscopic partial nephrectomy, the mean intraoperative blood loss was 32 ?? 15 ml in the ILRFA and 187 ?? 69 ml in the control group, a 77.0% reduction (P = 0.043). The mean blood loss per centimetre resection area was 2.27 ?? 0.95 ml/cm2 in the ILRFA compared with 26.46 ?? 8.81 ml/cm2 in controls, the reduction was 79.0% (P = 0.047). In the renal trauma experiment, ILRFA also achieved promising results in haemostasis. We believe that ILRFA is a useful device which may help in the treatment of patients with liver and kidney illness.

published_or_final_version / Dentistry / Master / Master of Orthodontics

Surgical resection is the best option for both liver and kidney cancers, which providing the long term survival. However intraoperative blood loss can be a significant challenge, and is clearly associated with morbidity and mortality. Radiofrequency ablation (RFA) precoagulation has been introduced into liver and kidney surgery. Promising results have already achieved in reduction of intraoperative blood loss. In this thesis, a detailed explanation on precoagulation by RFA has been given. Our group developed a novel bipolar multi-array RFA device ??? InLine (ILRFA). In this thesis, we have investigated the performance in a variety of fields. In the study of ILRFA-assisted laparoscopic liver resection, ILRFA was easily employed through a hand port and achieved significant decrease of blood loss compared to control group (p < 0.05). In the liver trauma study, ILRFA produced a 63.88% reduction of blood loss in peripheral injury and 53.57% in central injury respectively. In postoperative evaluation of ILRFA-assisted liver resection, animals underwent an uneventful recovery, no complications occurred. Histological examination revealed a typical post RFA evolution. In ILRFA-assisted partial nephrectomy, the mean intraoperative blood loss 35 ?? 7 ml in the ILRFA and 152 ?? 94 ml in the control, a 77.0% reduction (P = 0.024). The mean blood loss per centimetre resection area was 2.09 ?? 1.41 ml/cm2 in the ILRFA compared with 12.79 ?? 1.68 ml/cm2 in controls, the reduction was 79.0% (P = 0.019). In ILRFAassisted laparoscopic partial nephrectomy, the mean intraoperative blood loss was 32 ?? 15 ml in the ILRFA and 187 ?? 69 ml in the control group, a 77.0% reduction (P = 0.043). The mean blood loss per centimetre resection area was 2.27 ?? 0.95 ml/cm2 in the ILRFA compared with 26.46 ?? 8.81 ml/cm2 in controls, the reduction was 79.0% (P = 0.047). In the renal trauma experiment, ILRFA also achieved promising results in haemostasis. We believe that ILRFA is a useful device which may help in the treatment of patients with liver and kidney illness.

Techniques for the large-scale isolation of Cryptosporidium oocysts and sporozoites, obtained from the feces of experimentally infected Holstein calves, were developed employing discontinuous sucrose gradients and isopycnic Percoll gradients. The three step oocyst recovery method utilized two sequential discontinuous sucrose gradients followed by one Percoll gradient. Recovered oocysts were essentially free of debris and bacteria and represented 34% of the original oocyst suspension. Sporozoites were recovered from excystation mixtures on a single Percoll gradient. Sixty-three percent of the original sporozoites were recovered with 2.2% contamination by intact oocysts and virtually no oocyst walls. Eight anti-oocyst hybridomas were derived from oocyst-immunized mice: five from BALB/c mice and three from RBF/Dn mice. The monoclonal antibody (Mab) OW3 reacted specifically with C. parvum oocysts in immunofluorescent assays (IFA) and was shown to be superior to conventional stains for detecting oocysts in fecal smears from infected individuals. Sixteen anti-sporozoite hybridomas were derived from sporozoite-immunized BALB/c mice. The Mabs appeared to react with cell surface and cytoplasmic antigens by IFA. Two anti-sporozoite Mabs (C8C5, C6B6) reacted with a 20 kDa sporozoite antigen in western blots while the Mab C4A1 reacted with multiple antigens in western blots. These three Mabs (C8C5, C6B6, C4A1) were examined for potential modulation of cryptosporidial infections in vivo by oral Mab administration to oocyst-inoculated neonatal mice. The role for colostrum and breast milk in controlling cryptosporidial infections was examined by immunizing mouse dams and experimentally infecting their neonatal offspring. Colostrum and Mab-treated neonatal mice were sacrificed four days post infection. No difference in infection rates was observed among the treatment groups. Suckling mice treated daily with orally administered mixtures of Mabs (purified or ascitic fluid) showed significantly reduced parasite loads compared to control mice at four days post infection. In vitro cultivation of C. parvum was successful through asexual stages in human fetal lung, bovine turbinate and murine L929 cells. Parasite numbers that developed in the cell cultures varied from infection run to infection run.

published_or_final_version / Public Health / Master / Master of Public Health

Helicobacter pylori (H.pylori) had been confirmed by the World Health Organization (WHO) as Group 1 carcinogens, in which it has been identified to be related with the development of gastric carcinoma. Gastroesophageal reflux disease (GERD) is less commonly found in Asia, while the number of H.pylori infection is considerably to be higher than that of the Western population. The relationship between H.pylori and GERD still remains ambiguous nowadays. One of the contributing factors affecting the level of gastric secretion might be due to the genetic cause. The aim of this review is to assess whether the current first-line therapy on GERD would be effective or not in relieving the symptoms of the patients with H.pylori infection. / published_or_final_version / Community Medicine / Master / Master of Public Health