EY1920 Year Book

177 176 Semester 1: Neuroprotective effect of lutein in experimental stroke using Akita mouse models Semester 2: Effect of bracing on disease progression and quality of life of adolescent idiopathic scoliosis patients • Research attachment supervised by Dr Amy Lo at Department of Ophthalmology HKU • Assisted by Dr Brian Tam, Dr Dicky Ng, Ms. Jessica K.W. Tsang and Mr. R.K. Goit Introduction • Stroke is ranked second among the leading causes of death and fourth among the causes of disability globally. There is a pressing need for finding a treatment for stroke. • Pathophysiology of ischaemic stroke includes ischaemia/reperfusion (I/R) injury, inflammation and cerebral oedema . • Lutein , a xanthophyll which is abundant in dark green leafy vegetables, might have protective effect in cerebral I/R injury. • Type 1 DM patients are our subject of interest owing to the relatively poorer outcomes and higher mortality. 0 50 Vehicle only 2mg/kg Lutein Infarct volume (%) I N F A R C T V O L U M E Infarct Volume 0 0.1 0.2 Vehicle only 2mg/kg Lutein Swelling volume (%) S W E L L I N G V O L U M E Swelling volume Results Discussion & Conclusion • The data showed an overall reduction in infarct and swelling volume of lutein-treated groups • However, the results are statistically insignificant. • Given the limitations of my project and data, it would be too early to conclude that lutein is an ineffective neuroprotective agent. • Research attachment supervised by Dr Jason Cheung at Department of Orthopaedics and Traumatology HKU • Assisted by Ms. Prudence Cheung Introduction • Scoliosis can be defined as the lateral curvature of the spine in the coronal plane of more than 10° (measured by the Cobb angle) on an anterior-posterior standing radiograph. • Idiopathic scoliosis was the most common type of scoliosis, found in up to 80% of children with scoliosis. • Adolescent idiopathic scoliosis (AIS) is the most common subtype of idiopathic scoliosis, contributing approximately 80% of the cases. • Possible managements include observation, bracing, scoliosis- specific exercises and surgery. • Bracing is the primary treatment targeted to prevent curve progression before maturity. • Literature review was done to provide a brief summary of current evidence on the effects of bracing on the disease progression and quality of life of AIS patients. Efficacy of bracing in preventing curve progression • A Cochrane systematic review was published in 2010 evaluating the efficacy of bracing in AIS patients. • Among 1285 articles, only 1 randomized controlled trial and 1 prospective controlled trial were selected. • The prospective controlled trial was conducted by Nachemson et al at the Department of Orthopedics and Statistics of Göteborg University in Sweden in the 90s. • Girls with AIS were recruited and followed to investigate the effect of treatment with observation only, an underarm plastic brace and nighttime surface electrical stimulation. • The study concluded that bracing was effective while observation alone and electrical stimulation were not. • Yet, it was non-randomized, non-blinded, with non-adjusted baseline differences between the groups, and the results have not been replicated. • The RCT was conducted by Wong et al, comparing the clinical efficacy and acceptance of a rigid underarm orthosis with an elastic one. The conclusion of which is irrelevant to our topic of interest. • In 2013, Weinstein et al published a paper on the New England Journal of Medicine, with impact factor higher than 40, about the Bracing in Adolescent Idiopathic Scoliosis Trial (BRAIST) to investigate the effectiveness of bracing, as compared with observation, in preventing progression of the curve to 50° or more (a common indication for surgery). • The rate of treatment success was 72% in the bracing group, in contrast with 48% in the observation group . Impact of bracing on patients’ quality of life (QoL) • Studies have given inconsistent conclusions to the question of interest. • Some suggested that bracing can negatively impact an AIS patient’s QoL, jeopardize his or her psychosocial well-being and self-image. • Some reported that there was no difference in terms of QoL between brace-treated patients and patients under observation only. • Some supported that bracing improved patients’ QoL. • According to the meta-analysis conducted by Meng et al, it is concluded that compared with untreated AIS patients, brace- treated patients have higher satisfaction scores and total scores, and therefore, an improved QoL. • However, the study did not have enough data to carry out a subgroup analysis stratified by ethnicity. Discussion & Conclusion • The current available evidence shows that bracing is beneficial for reducing the risk of curve progression and the resulting need for surgery. It also improves quality of life of AIS patients. • Further trials are needed to improve the current bracing indications and guidelines. *References and bibliographycan be found in the research reports Methods • Akita mouse is used, which recapitulates Type 1 diabetic patients as it exhibits a spontaneous and autosomal dominant mutation of the Ins2 gene. • Middle cerebral artery occlusion (MCAo) is done to simulate ischaemic stroke. • Lutein or vehicle was administered by intraperitoneal injection. • Tissues are processed by fixation, dehydration, embedding and sectioning. • Neurological deficits, infarct area, infarct volume and hemispheric swelling are evaluated to assess the neuroprotective effect. MBBS Enrichment Year 2019/20 To Ka Ho Sem 1 < R A - Neuro p rotective effect of lutein in ex p erimental stroke using Akita mouse models at D e p artment of O p hthalmology, HKU, Hong Kong >; Sem 2 < R A - Effect of bracing on disease p rogression and q uality of life of adolescent idio p athic scoliosis p atients at D e p artment of Ortho p aedics and T raumatology, HKU, Hong Kong > To Ka Ho Tsang Ho Nam Semester 1 I studied Mathematics, Physics, Music, Psychology and Korean Language in the University of Waterloo via HKUWW exchange programme. The teachers took an interactive approach when explaining concepts, such as in-class online multiple choices questions, pre- and post-class assignments that only contribute to a few proportion of our grades. It is crucial to provide a stress-free environment for students to enjoy the learning process and boost their academic performance. I also made some new friends in Canada. We had a lot of fun playing board games every Friday night. Once, we prepared our dinner together. It was fun and unforgettable as our efforts paid off. I really cherish the memories of the time we spent together. Semester 2 I had a research attachment with Dr Kendrick Shih studying laser refractive surgery and performed some optic examinations on some patients. Unfortunately, due to the coronavirus, I could only stay at home and meet Dr Shih via Zoom app. It was such a pity that I could not learn more about laser refractive surgery. Then, we decided to do a literature review instead. We did the review step by step and Dr Shih was very kind and helpful in providing invaluable advice. I learnt a lot about writing a comprehensive review and it was a precious experience. MBBS Enrichment Year 2019/20 Tsang Ho Nam Sem 1 < IC - HKUWW Exchange Programme at University of Waterloo, Canada >; Sem 2 < R A - T reatments of Neurotro p hic Kerato p athy for D iabetic Patients at D e p artment of O p hthalmology, HKU, Hong Kong >