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Background and Objectives: The prevalence of NAFLD (non-alcoholic fatty liver disease) is increasing, and up to 64% of Asian patients with NAFLD are obese. Non-invasive tests (NITs) for the assessment of liver fibrosis are increasingly being used, but data on their performance in obese Asian patients are lacking. In this pilot cross-sectional study, we aim to compare the distribution of serum and radiological markers of fibrosis between obese Asian biopsy-proven NAFLD patients with and without fibrosis and estimate the diagnostic accuracies of these indices. Materials and Methods: Obese Asian patients with NAFLD and who had undergone a liver biopsy showing histological evidence of NAFLD were invited to participate. Liver fibrosis was assessed using laboratory (APRI, AAR, BARD, FIB4, NFS, and Asia-Pacific NAFLD advanced fibrosis score) and imaging modalities (TE: transient elastography, MRE: magnetic resonance elastography, and SWU: shear wave ultrasonography). Results: A total of 16 patients were included in the final analysis. On liver biopsy, nine patients (56.3%) had significant fibrosis (F2 or higher), and six of these patients had advanced fibrosis (F3 or higher). F4 fibrosis was present in one patient (6.3%). For the laboratory markers, we found that the BARD score correctly identified five out of six patients with advanced fibrosis (83.4%, p value 0.045). Among all the NITs studied, liver stiffness measured by TE had the highest accuracy of 87.5% in its established threshold of 8.5 kPa for the detection of advanced fibrosis. MRE also performed well (81.2% in 3.64 kPa). Conclusions: In conclusion, TE has performed well in the detection of advanced fibrosis in obese Asian patients with biopsy-proven NAFLD in our pilot study. Further large-scale definitive studies are needed to validate the results of our findings.

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Background: Aerosol-generating procedures (AGPs), such as nasoendoscopy, are considered high-risk during the COVID-19 pandemic due to risk of virus aerosol transmission. We aim to evaluate the efficacy of an innovative system in reduction of aerosol contamination. Methods: Pilot study involving 15 healthy volunteers performing aerosol-generating activities with the prototype, compared with and without a standard surgical mask. Results: We found an increased frequency of smaller-sized particle emissions for all four expiratory activities. The particle emission rate with the prototype mask was significantly slower over time for the smallest sized particle (0.3 µm) during breathing, speaking and singing compared with similar activities without the mask (p < .05). We found similar trends for coughing for larger particles but that did not reach statistical significance. Conclusion: The innovation offers good protection against aerosol transmission through the physical barrier of the mask, the negative pressure environment within the mask, and the unit's dual filtration function. Level of evidence: Level 2b.

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OBJECTIVE: To investigate the short-term outcomes at discharge of patients who receive additional postoperative rehabilitative exercises by peer volunteers after total knee arthroplasty (TKA). DESIGN: Retrospective cohort study. SETTING: Tertiary teaching hospital. PARTICIPANTS: A total of 476 adult patients who had undergone a primary elective unilateral TKA (N=467). INTERVENTIONS: An intervention group received a standardized postoperative rehabilitative exercise protocol taught and supervised by peer volunteers in additional to standard physiotherapy (n=309) compared with a control group receiving standard physiotherapy alone (n=167). MAIN OUTCOME MEASURES: Discharge outcomes were the pain score using the Numeric Rating Scale pain score, passive knee flexion and extension range of motion (ROM), length of hospitalization, ability to perform an unassisted straight leg raise of the operated leg, ambulation distance, ability in independent walking, walking aids required, discharge destination, and adverse events. RESULTS: On multivariate analysis, patients in the intervention group had an increased discharge passive knee flexion ROM of 7.89 degrees (95% confidence interval, 5.47-10.33; P<.001). There were no significant differences for the other outcome measures between the intervention and control group. CONCLUSIONS: A rehabilitative exercise program by peer volunteers is feasible and safe after TKA in addition to standard physiotherapy and is associated with improved knee flexion ROM on discharge.

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INTRODUCTION@#Children with solid organ tumours often present for curative surgery. Even with the best surgical technique, micrometastases can occur. Preclinical studies support the postulation that neuraxial anaesthesia maintains the body's immune and inflammatory milieu against metastasis. However, human retrospective adult studies showed varying results, and no study has been done in children. We aimed to find out if intraoperative epidural, perioperative opioid and volatile dose are associated with relapse-free survival (RFS) in children with solid organ tumours.@*METHODS@#This is a retrospective cohort study of 126 children from a tertiary paediatric unit who were diagnosed with solid organ tumours (neuroblastoma, hepatoblastoma or sarcoma) over a 16-year period. RFS, stratified by tumour subtypes, was estimated using the Kaplan-Meier method. Adjusted hazard ratios (aHRs) were obtained from multivariable Cox regression models after taking potential covariates into account.@*RESULTS@#Of 126 children with solid organ tumours (51.6% neuroblastoma, 34.9% sarcoma and 13.5% hepatoblastoma), 53.2% received combined general anaesthesia (GA)/epidural. A total of 21 (31.3%) and 20 (33.9%) patients relapsed during the study period in the combined GA/epidural group and the GA alone group, respectively. Patients with sarcoma receiving combined GA/epidural had a clinically meaningful lower risk of relapse compared to patients receiving GA alone (aHR 0.51, 95% confidence interval 0.14-1.79), although this was not statistically significant.@*CONCLUSION@#Our study demonstrated some clinically meaningful associations, especially in paediatric sarcoma patients. Overall, however, there was no statistically significant association between epidural use and an improved RFS.

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INTRODUCTION@#Cast immobilisation remains the mainstay of treatment for various fractures in paediatric patients, yet patients commonly complain of skin irritation and discomfort. This study aimed to perform a qualitative and quantitative evaluation of the effects of cast immobilisation on the skin of children and adolescents.@*MATERIALS AND METHODS@#Patients aged 6-17 years of age with a fracture treated in a fiberglass short-arm or short-leg cast were recruited. Transepidermal water loss (TEWL), stratum corneum (SC) hydration, hair density and presence of any skin signs were assessed before and after cast. Patients were required to complete a weekly questionnaire to rate itch, malodour, warmth, and dampness of the skin under the cast.@*RESULTS@#A total of 60 subjects completed the study. Thirty-six patients received a short-arm cast; 24 received a short-leg cast. Upon cast removal, TEWL was significantly increased on the volar surface of the arms and legs ( <0.05), and the dorsal surface of the arm ( <0.05). Likewise, SC hydration was significantly increased at most sites ( <0.05), except the volar surface of the leg ( = 0.513). There was no change in hair density. Throughout the duration of casting, there was an increase in itch and malodour scores.@*CONCLUSION@#Moderate but significant changes in TEWL, SC hydration and subjective symptoms were observed during the duration of cast immobilisation, demonstrating that cast immobilisation for up to 4 weeks exerts moderate adverse impact on patients' skin. Further studies to explore the use of better materials for cast immobilisation to improve skin barrier function and overall patient satisfaction are warranted.

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<p><b>INTRODUCTION</b>Although pneumonia is a major complication after acute ischaemic stroke (AIS), pneumonia prediction scores have not been extensively validated. This study aimed to compare the discrimination performance of 5 pneumonia prediction scores in AIS patients.</p><p><b>MATERIALS AND METHODS</b>We retrospectively reviewed all consecutive adult AIS patients whom presented to our emergency department within 4.5 hours of symptom-onset between January 2012 and February 2015. Diagnosis had to be made by a neurologist and infarcts confirmed by neuroimaging. We excluded patients with pneumonia on presentation. Pneumonia predictors were based on the 5 prediction scoring models: Kwon's score, Chumbler's score, Acute Ischaemic Stroke-Associated Pneumonia Score (AIS-APS), ADSscore and ISAN score. The definition of stroke-associated pneumonia was based on the criteria by the Pneumonia in Stroke Consensus Group. Analysis using area under receiver operating characteristics curve (AUROC) was performed.</p><p><b>RESULTS</b>Forty (5.5%) out of 731 patients analysed had stroke-associated pneumonia (SAP). ADSscore had the highest discrimination capacity (AUROC 0.88; 95% CI, 0.84 to 0.92), followed by AIS-APS (AUROC 0.87; 95% CI, 0.83 to 0.91), Kwon's score (AUROC 0.86; 95% CI, 0.82 to 0.92), Prestroke Independence, Sex, Age and National Institutes of Health Stroke Scale (ISAN) score (AUROC 0.85; 95% CI, 0.80 to 0.90) and Chumbler's score (AUROC 0.79; 95% CI, 0.74 to 0.84). However, there was no statistical difference of discrimination capacity among ADSscore, AIS-APS and Kwon's score.</p><p><b>CONCLUSION</b>ADS, AIS-APS and Kwon's scores performed comparably in discriminating SAP in AIS patients.</p>

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BACKGROUND: This study was designed to evaluate predictors of good outcomes following medial unicompartmental knee arthroplasty (UKA) in Asian patients. METHODS: Registry data of patients who underwent primary unilateral medial UKA from 2006 to 2011 were collected. Outcomes studied were the Oxford Knee Score (OKS) and the Physical Component Score (PCS) of the Short Form 36 (SF-36) questionnaire. These outcome scores were collected prospectively, pre- and postoperatively up to 5 years. Good outcome was defined as an overall improvement in score greater than or equal to the minimal clinically important difference (MCID). The MCID for the OKS was 5 while the MCID for the PCS was 10. Regression analysis was used to identify predictors of good outcomes following medial UKA. RESULTS: Primary medial UKA was performed in 1,075 patients. Higher (poorer) preoperative OKS (odds ratio [OR], 1.27; p < 0.001), lower (poorer) preoperative PCS (OR, 1.08; p < 0.001), lower (poorer) preoperative Knee Society Knee Score (KSKS; OR, 1.02; p < 0.001) and higher (better) preoperative SF-36 Mental Component Score (MCS; OR, 1.02; p < 0.001) were significant predictors of good outcomes. CONCLUSIONS: Patients with poorer OKS, PCS and KSKS and better SF-36 MCS preoperatively tended to achieve good outcomes by the MCID criterion at 5 years following the index surgery.

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BACKGROUND: We aimed to identify differences in distribution of risk factors, prevalence, and complications of gestational diabetes (GD) among South Asian (SA) immigrant women, separately for immigrants from India, Bangladesh, Pakistan, and Sri Lanka, relative to US-born non-Hispanic whites (NHW) living in New Jersey. METHOD: We used NJ birth certificate data linked to hospitalization data from 1999 to 2002 (n = 327,069). We compared the distribution of risk factors among these groups using chi-squared test and calculated adjusted odds of GD for SA groups compared to NHW using logistic regression. Among women with GD, we further analyzed the odds of complications for SA groups relative to whites. RESULTS: Sri Lankans were more likely to be of advanced maternal age. Pakistanis and Bangladeshis were more likely to start prenatal care late. Bangladeshis had the highest adjusted odds of GD (aOR = 4.3; 95 % confidence interval (CI) 3.5-5.3), followed by Indians (aOR = 3.9; 95 % CI 3.7-4.2), Sri Lankans (aOR = 3.6; 95 % CI 2.4-5.8), and Pakistanis (aOR = 3.4; 95 % CI 2.9-3.8) relative to NHW. Among women with GD, South Asian groups had lower odds of preterm birth and higher odds of having a small for gestational age infant than whites. DISCUSSION: This study provided evidence of disproportionate risk of GD among four SA groups living in NJ.

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