Pamela Youde Nethersole Eastern Hospital Research Articles

Prediction of hospital mortality among critically ill patients in a single centre in Asia: comparison of artificial neural networks and logistic regression-based model.

This study compared the performance of the artificial neural network (ANN) model with the Acute Physiologic and Chronic Health Evaluation (APACHE) II and IV models for predicting hospital mortality among critically ill patients in Hong Kong. This retrospective analysis included all patients admitted to the intensive care unit of Pamela Youde Nethersole Eastern Hospital from January 2010 to December 2019. The ANN model was constructed using parameters identical to the APACHE IV model. Discrimination performance was assessed using area under the receiver operating characteristic curve (AUROC); calibration performance was evaluated using the Brier score and Hosmer-Lemeshow statistic. In total, 14 503 patients were included, with 10% in the validation set and 90% in the ANN model development set. The ANN model (AUROC=0.88, 95% confidence interval [CI]=0.86-0.90, Brier score=0.10; P in Hosmer-Lemeshow test=0.37) outperformed the APACHE II model (AUROC=0.85, 95% CI=0.80-0.85, Brier score=0.14; P<0.001 for both comparisons of AUROCs and Brier scores) but showed performance similar to the APACHE IV model (AUROC=0.87, 95% CI=0.85-0.89, Brier score=0.11; P=0.34 for comparison of AUROCs, and P=0.05 for comparison of Brier scores). The ANN model demonstrated better calibration than the APACHE II and APACHE IV models. Our ANN model outperformed the APACHE II model but was similar to the APACHE IV model in terms of predicting hospital mortality in Hong Kong. Artificial neural networks are valuable tools that can enhance real-time prognostic prediction.

Clinical characteristics and mortality prediction of patients admitted to the Hong Kong East Cluster intensive care units in the COVID‐19 fifth wave

AbstractIntroductionCOVID‐19 has been threatening global public health since 2019. To address the overwhelming caseload, several tools were developed to predict prognosis and aid triage of critically ill patients for intensive care. Currently, there is a lack of local data on the validity of such tools.ObjectiveThe objective of this study is to identify the predictors of intensive care unit (ICU) mortality in COVID‐19 patients in Hong Kong and externally validate the different scoring systems.MethodsA retrospective cohort analysis of patients admitted to the HKEC ICUs from 1 January 2022 to 30 April 2022 was performed. We collected data on patient demographics, vaccination status, laboratory parameters, and clinical outcomes including need for organ support and mortality. Clinical severities were estimated by Sequential Organ Failure Score, 4C Mortality Score, COVID‐Gram score, and Acute Physiology and Chronic Health Evaluation (APACHE) IV score based on the original studies. Comparison between individual scoring systems' performance on hospital mortality was conducted and summarized.ResultsIn these four months, 137 patients with COVID‐19 admitted to ICUs of Ruttonjee Hospital and Pamela Youde Nethersole Eastern Hospital were recruited. 64 patients (46.7%) were admitted for COVID‐19 related respiratory failure, among which mortality was 66.7%. The overall hospital and ICU mortality were 21.9% and 13.1%, respectively. Invasive mechanical ventilation (IMV) (OR 3.221, p 0.034), high flow nasal cannula (HFNC) oxygen therapy (OR 3.107, p 0.039), and higher APACHE IV score (OR 1.043, p &lt; 0.001) were independent predictors of hospital mortality using multivariate analysis. The scoring systems had good performance in mortality prediction in our population. The APACHE IV score (AUROC 0.79, 95% CI 0.698–0.894) and 4C Mortality Score (AUROC 0.751, 95% CI 0.657–0.844) outperformed other scoring systems in predicting hospital mortality.ConclusionIn patients with COVID‐19, the use of IMV or HFNC and APACHE IV score were independent risk factors for hospital mortality. The APACHE IV and the 4C Mortality Score were most useful in our population for predicting ICU and hospital mortality.

Clinical characteristics and outcomes of peritoneal dialysis (PD)-related peritonitis after colonoscopy.

Colonoscopy is known to be associated with peritonitis in peritoneal dialysis (PD) patients. Antibiotic prophylaxis is recommended before colonoscopy. This study aims to investigate the clinical characteristics and outcomes of patients with PD-related peritonitis after colonoscopy. PD patients who were followed up in Pamela Youde Nethersole Eastern Hospital, with colonoscopy done from 1 January 2009 to 31 December 2019, were included for record review retrospectively. During this period, 74 patients underwent 115 colonoscopies. Fourteen patients (12.2%) developed PD-related peritonitis within 1 week after colonoscopy. There was no statistically significant difference in mean age, PD vintage, PD modality and history of PD-related peritonitis between patients with or without colonoscopy-related peritonitis. Polypectomy was more common in patients who developed peritonitis (78.6%) compared to those without peritonitis (35.6%) (p = 0.006). Ten of the 14 PD patients who had colonoscopy-related peritonitis responded to medical treatment while 4 patients required PD catheter removal. Two patients converted to maintenance haemodialysis and two died. Only 33% of Gram-negative bacteria isolated were sensitive to intravenous cefuroxime which was given as prophylactic antibiotic before colonoscopy. In conclusion, the overall risk of PD patients developing peritonitis post colonoscopy was 12.2%. Polypectomy was associated with higher risk of colonoscopy-related peritonitis. Large-scale study is needed to delineate effective antibiotic prophylaxis for colonoscopy-related peritonitis.

Single or double? A comparison of evisceration techniques.

We compared the rates of implant exposure and extrusion after evisceration with single and double scleral closure techniques. This retrospective cohort study included all patients who underwent evisceration with an implant insertion over the past 18years at Tung Wah Eastern Hospital and Pamela Youde Nethersole Eastern Hospital. Clinical documents and operation records were reviewed. A total of 81 ethnic Chinese patients (44 male) who underwent evisceration with primary implant insertion were reviewed. 39 (48%) patients underwent the double scleral closure technique with an implant placed posterior to the posterior sclera, and 42 (52%) patients underwent the single scleral closure technique with an implant inserted in the intra-scleral cavity. The follow-up interval was 70months. The surgical indications were endophthalmitis (35%), painful blind eye (23%), traumatic disfigured globe (22%) and phthisis bulbi (20%). Silicone was the most used implant material (69%). The patients who underwent double scleral closure had a larger size of the implant (19.7 vs 17.9mm, p < 0.05). Both implant exposure (26% vs 3%, p < 0.05) and implant extrusion (26% vs 0%, p < 0.05) were more common in patients who underwent single scleral. Double scleral closure technique allows a larger implant, and it is associated with a lower rate of implant exposure and extrusion. The double scleral closure technique is a superior technique of choice in these patients with primary implant placement.

Patients with heat-related illness admitted to an intensive care unit in Hong Kong: A single-centre retrospective study (2009–2020)

Introduction: In Hong Kong, heat-related illness (HRI) represents an important cause of morbidity and mortality among healthy adults engaging in outdoor activities during summer. It can result in intensive care unit (ICU) admission. This retrospective study aimed to profile critically ill patients with HRI and identify potential risk factors for mortality. Methods: This retrospective case series included adults with HRI from 1 January 2009 to 30 June 2020 admitted to the ICU of Pamela Youde Nethersole Eastern Hospital (PYNEH). Demographics, admission severity, co-morbidities, and laboratory investigations were analysed. Outcome data studied included mortality, ICU length of stay (LOS), ventilator days, and hospital LOS. Results: Among the 38 individuals included, 97% were hikers. About 92.1% of patients survived, while 7.9% expired. The median age of the patients was 48 years, and 78.9% were men. Hypertension was the most frequent concurrent disorder. Most cases were presented during the hot summer months of May (29%), July (24%) and August (18%). The localities’ median peak temperature and humidity were 33.2°C and 88%, respectively. Ninety-two percent of patients were airlifted to the hospital by helicopters. The median peak body temperature was 40.3°C. Central nervous system derangement (Glasgow Coma Scale (GCS) score ⩽ 8) was the top presenting feature (65.7%). About 57.9% of patients required vasopressor support, followed by mechanical ventilation (50%) and renal replacement therapy (31.6%). Conclusions: Most critically ill patients suffering from HRI were hikers and middle-aged adults. Mortality was 7.9% despite advanced life support in ICU. Raising public awareness of the associated risk with hiking in hot summer is essential for the prevention of HRI.

Development and validation of bone-suppressed deep learning classification of COVID-19 presentation in chest radiographs.

Coronavirus disease 2019 (COVID-19) is a pandemic disease. Fast and accurate diagnosis of COVID-19 from chest radiography may enable more efficient allocation of scarce medical resources and hence improved patient outcomes. Deep learning classification of chest radiographs may be a plausible step towards this. We hypothesize that bone suppression of chest radiographs may improve the performance of deep learning classification of COVID-19 phenomena in chest radiographs. Two bone suppression methods (Gusarev et al. and Rajaraman et al.) were implemented. The Gusarev and Rajaraman methods were trained on 217 pairs of normal and bone-suppressed chest radiographs from the X-ray Bone Shadow Suppression dataset (https://www.kaggle.com/hmchuong/xray-bone-shadow-supression). Two classifier methods with different network architectures were implemented. Binary classifier models were trained on the public RICORD-1c and RSNA Pneumonia Challenge datasets. An external test dataset was created retrospectively from a set of 320 COVID-19 positive patients from Queen Elizabeth Hospital (Hong Kong, China) and a set of 518 non-COVID-19 patients from Pamela Youde Nethersole Eastern Hospital (Hong Kong, China), and used to evaluate the effect of bone suppression on classifier performance. Classification performance, quantified by sensitivity, specificity, negative predictive value (NPV), accuracy and area under the receiver operating curve (AUC), for non-suppressed radiographs was compared to that for bone suppressed radiographs. Some of the pre-trained models used in this study are published at (https://github.com/danielnflam). Bone suppression of external test data was found to significantly (P<0.05) improve AUC for one classifier architecture [from 0.698 (non-suppressed) to 0.732 (Rajaraman-suppressed)]. For the other classifier architecture, suppression did not significantly (P>0.05) improve or worsen classifier performance. Rajaraman suppression significantly improved classification performance in one classification architecture, and did not significantly worsen classifier performance in the other classifier architecture. This research could be extended to explore the impact of bone suppression on classification of different lung pathologies, and the effect of other image enhancement techniques on classifier performance.

Effect of the underlying malignancy on critically ill septic patient's outcome.

Sepsis is an important cause of mortality and morbidity among critically ill patients with underlying malignancy. Patients with sepsis admitted to the intensive care unit (ICU) of the Pamela Youde Nethersole Eastern Hospital from January 1, 2010 to April 30, 2019 were recruited. Demographics, laboratory parameter, and outcome were analyzed. Those with underlying malignancy were matched with those without malignancy based on their severity of organ failure (defined by the sequential organ failure assessment [SOFA] score) and septic source. Two hundred sixty-three patients with underlying active malignancy were matched with 259 patients without malignancy. Those with malignancy had higher APACHE IV score (89 vs. 83), lower albumin (22.1 vs. 24.4), neutrophil count (6.0 vs. 9.3), hemoglobin (8.0 vs. 9.8), platelet count (113 vs. 133), less use of mechanical ventilation (35.7% vs. 45.9%), renal replacement therapy (22.1% vs. 28.2%) and vasopressor (66.2% vs. 74.9%), higher 30-day (34.2% vs. 24.3%) ICU (22.4% vs. 18.9%), and 1-year (62.4% vs. 36.7%) mortality compared with those without malignancy. A higher APACHE IV score and pulmonary sepsis were predictors of 30-day mortality by Cox regression analysis. Disease severity and pulmonary sepsis, but not underlying malignancy, predicted short-term mortality among critically ill septic patients.

Prone positioning in non‐intubated patients with coronavirus – A single‐centre experience in Hong Kong

Introduction:Significant ventilator‐associated pneumonia and mortality were found in COVID‐19 patients who required mechanical ventilation which calls for non‐invasive means in managing respiratory failure.Methods:We retrospectively reviewed patients admitted to the intensive care unit of Pamela Youde Nethersole Eastern Hospital in Hong Kong with severe acute respiratory syndrome coronavirus 2 infection from 28 November to 15 December 2020. Patients’ laboratory, respiratory parameters and outcome data were recorded and analysed.Results:Eleven received prone ventilation. The median age was 67 (inter‐quartile range: 59–72) years, and median COVID‐19 GRAM score was 151 (inter‐quartile range: 133–181), representing a high‐risk group. There were significant improvements 1 h after awake proning in SpO2 (95% vs 92%, p = 0.008), FiO2 (0.4 vs 0.5, p = 0.003), SpO2/FiO2 (240 vs 184, p = 0.005), respiratory rate (19 vs 26, p = 0.006) and respiratory rate – oxygenation index (13.22 vs 7.67, p = 0.003; Table 1). Although not reaching statistical significance, the median PaO2, PaCO2 and PaO2/FiO2 improved after proning. The overall intubation rate was 22% and intensive care unit mortality was 22%, which is in contrast to 65.5% and 27.6%, respectively, in the first three waves. Although did not reach statistical significance, those received prone ventilation tend to have a lower ICU mortality (9.1% vs 42.9%, p = 0.245) and hospital mortality (18.2% vs 42.9%, p = 0.326).Conclusion:Awake proning potentially minimizes complications from invasive ventilation and provides a low‐cost low‐risk treatment option in COVID‐19 patients with respiratory failure. This is particularly important when healthcare resources are strained at times of a pandemic.

An External Validation of Scoring Systems in Mortality Prediction in Veno-Venous Extracorporeal Membrane Oxygenation.

Veno-venous extracorporeal membrane oxygenation (VV ECMO) offers the last resort in the treatment of acute respiratory distress syndrome (ARDS). Various scoring systems have been established, yet external validation of these scoring systems in the Asian population remains scarce. We aim to identify factors associated with hospital mortality and to validate various scoring systems in the prediction of hospital mortality. A retrospective analysis of adults admitted to Pamela Youde Nethersole Eastern Hospital intensive care unit who received VV ECMO from January 1, 2010 to June 30, 2019 was performed. Demographics, ventilation strategies, rescue therapies, and clinical outcomes were compared. The primary outcome was hospital mortality and secondary outcomes were intensive care unit (ICU) mortality, ICU, and hospital length of stay. There were 122 VV ECMO performed for ARDS, of which 78 survived and 44 died. VV ECMO performed for viral pneumonitis was significantly associated with better survival (55.1% vs. 25%, p = 0.001) compared with other causes. As for prediction scores, the PREdiction of Survival on ECMO Therapy-Score had the highest area under receiver operator curve of 0.733 (95% confidence interval [CI]: 0.643-0.823), whereas that of PRedicting dEath for SEvere ARDS on VV ECMO score was 0.662 (95% CI: 0.561-0.764), Respiratory Extracorporeal Membrane Oxygenation Survival Prediction score was 0.657 (95% CI: 0.553-0.761), Sequential Organ Failure Assessment score was 0.652 (95% CI: 0.547-0.757), and VV ECMO mortality score was 0.637 (95% CI: 0.532-0.742). In our cohort, VV ECMO performed for viral pneumonitis was associated with a higher hospital survival. Prediction scores are helpful in our population and provide a useful reference to hospital mortality.

Use of music in reducing pain during outpatient hysteroscopy: Prospective randomized trial.

To evaluate the effect of music in reducing pain during outpatient hysteroscopy under no anesthesia. We conducted a prospective randomized controlled trial From June 2019 to December 2019 in Pamela Youde Nethersole Eastern Hospital in Hong Kong. A total of 107 patients were randomized to music group (n = 54) or non-music group (n = 53). Music was played during outpatient hysteroscopy in the music group. Patients in the non-music group had the procedure done in the same setting without music. Primary outcome was the level of pain measured using the visual analog scale (VAS) score before and during the procedure. Secondary outcomes were vital parameters that reflect the level of pain including blood pressure and heart rate. Patients in the music group experienced significantly less pain during outpatient hysteroscopy (VAS score 4.54 ± 2.89 vs 5.88 ± 2.90; P = 0.02). The anticipated pain level was similar in both groups (VAS score 5.59 ± 2.27 vs 6.11 ± 2.43; P = 0.27). There was no statistically significant difference between the two groups in all the vital parameters. Listening to music during outpatient hysteroscopy under no anesthesia significantly reduces pain in a well-matched Chinese population. Music is easy to provide with low-cost equipment and manpower. We recommend the routine use of music during outpatient hysteroscopy to improve patient care.

Burden of pneumococcal disease: 8-year retrospective analysis from a single centre in Hong Kong.

Streptococcus pneumoniae is a common pathogen involved in community-acquired pneumonia. Invasive pneumococcal disease is often associated with higher co-morbidity rates, but mortality-related findings have been inconclusive. This study investigated predictors of 30-day mortality and invasive pneumococcal disease. This retrospective analysis included adults with pneumococcal disease who were admitted to Pamela Youde Nethersole Eastern Hospital from 1 January 2011 to 31 December 2018. Demographics, microbiological characteristics, and outcomes were compared between 30-day survivors and non-survivors, and between patients with invasive disease and those with non-invasive disease. Intensive care unit (ICU) subgroup analysis was performed. The primary outcome was 30-day all-cause mortality; secondary outcomes were ICU and hospital mortalities, and ICU and hospital lengths of stay. In total, 792 patients had pneumococcal disease; 701 survived and 91 (11.5%) died within 30 days. Notably, 106 (13.4%) patients had invasive pneumococcal disease and 170 (21.5%) patients received intensive care. Vasopressor use (odds ratio [OR]=4.96, P<0.001), chronic kidney disease (OR=3.62, P<0.001), positive urinary antigen test results (OR=2.57, P=0.001), and advanced age (OR=2.19, P=0.010) were independent predictors for 30-day mortality by logistic regression analysis. Among critically ill patients, chronic kidney disease (OR=4.64, P<0.001), higher APACHE IV score (OR=3.73, P=0.016), and positive urinary antigen test results (OR=2.94, P=0.008) were predictors for 30-day mortality. Logistic regression analysis revealed that chronic kidney disease (OR=3.10, P<0.001) was a risk factor for invasive pneumococcal disease. Advanced age, vasopressor use, chronic kidney disease, and positive urinary antigen test results were independent predictors for 30-day mortality in patients with pneumococcal disease.

Prognostic nomogram for refining the prognostication of the proposed 8th edition of the AJCC/UICC staging system for nasopharyngeal cancer in the era of intensity-modulated radiotherapy.

The objective of this study was to develop a nomogram for refining prognostication for patients with nondisseminated nasopharyngeal cancer (NPC) staged with the proposed 8th edition of the American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) staging system. Consecutive patients who had been investigated with magnetic resonance imaging, staged with the proposed 8th edition of the AJCC/UICC staging system, and irradiated with intensity-modulated radiotherapy from June 2005 to December 2010 were analyzed. A cohort of 1197 patients treated at Fujian Provincial Cancer Hospital was used as the training set, and the results were validated with 412 patients from Pamela Youde Nethersole Eastern Hospital. Cox regression analyses were performed to identify significant prognostic factors for developing a nomogram to predict overall survival (OS). The discriminative ability was assessed with the concordance index (c-index). A recursive partitioning algorithm was applied to the survival scores of the combined set to categorize the patients into 3 risk groups. A multivariate analysis showed that age, gross primary tumor volume, and lactate dehydrogenase were independent prognostic factors for OS in addition to the stage group. The OS nomogram based on all these factors had a statistically higher bias-corrected c-index than prognostication based on the stage group alone (0.712 vs 0.622, P <.01). These results were consistent for both the training cohort and the validation cohort. Patients with <135 points were categorized as low-risk, patients with 135 to <160 points were categorized as intermediate-risk, and patients with ≥160 points were categorized as high-risk. Their 5-year OS rates were 92%, 84%, and 58%, respectively. The proposed nomogram could improve prognostication in comparison with the TNM stage group. This could aid in risk stratification for individual NPC patients. Cancer 2016;122:3307-3315. © 2016 American Cancer Society.

Predictors of psychiatric rehospitalization among elderly patients

The population of Hong Kong and the proportion of elderly people have been increasing rapidly. The aim of this retrospective cohort study is to determine predictive factors for psychiatric rehospitalization within 2 years among elderly patients who were discharged from psychiatric wards, in attempt to reduce their rehospitalization rate and to reintegrate them into the community. Patients aged 65 and over, who were discharged from psychiatric wards of Pamela Youde Nethersole Eastern Hospital from 1 March 2010 to 29 February 2012, were identified. Rehospitalization within 2 years after discharge was the primary outcome measure, and the time to rehospitalization was measured as the secondary outcome. Patients were subgrouped into readmitted and non-readmitted groups. Logistic regression and Cox regression analyses were applied to the potential predictive factors with odds ratios and hazard ratios obtained, respectively, for the significant findings. Kaplan-Meier survival curves were plotted for graphical representation of the study results in survival analysis. 368 individuals satisfying the study criteria were identified. The same four factors were shown to be significantly associated with rehospitalization in both multiple logistic regression and Cox regression survival analysis. Referral to other psychiatric disciplines upon discharge (p< 0.001, OR=0.325, HR=0.405) was associated with a lower rehospitalization risk and correlated to a longer time to rehospitalization. History of suicidal behaviors (p< 0.001, OR=4.906, HR=3.161), history of violent behaviors (p< 0.001, OR=5.443, HR=3.935) and greater number of previous psychiatric admissions (p< 0.001, OR=1.250, HR=1.121) were associated with a higher rehospitalization risk and predicted earlier rehospitalization. The rehospitalization rate of elderly patients was 5.2% at 1 month, 9.5% at 3 months, 15.0% at 6 months, 17.1% at 1 year, 18.8% at 1.5 year and 20.9% at 2 years.

Predictors of psychiatric rehospitalization among elderly patients.

The population of Hong Kong and the proportion of elderly people have been increasing rapidly. The aim of this retrospective cohort study is to determine predictive factors for psychiatric rehospitalization within 2 years among elderly patients who were discharged from psychiatric wards, in attempt to reduce their rehospitalization rate and to reintegrate them into the community. Patients aged 65 and over, who were discharged from psychiatric wards of Pamela Youde Nethersole Eastern Hospital from 1 March 2010 to 29 February 2012, were identified. Rehospitalization within 2 years after discharge was the primary outcome measure, and the time to rehospitalization was measured as the secondary outcome. Patients were subgrouped into readmitted and non-readmitted groups. Logistic regression and Cox regression analyses were applied to the potential predictive factors with odds ratios and hazard ratios obtained, respectively, for the significant findings. Kaplan-Meier survival curves were plotted for graphical representation of the study results in survival analysis. 368 individuals satisfying the study criteria were identified. The same four factors were shown to be significantly associated with rehospitalization in both multiple logistic regression and Cox regression survival analysis. Referral to other psychiatric disciplines upon discharge (p< 0.001, OR=0.325, HR=0.405) was associated with a lower rehospitalization risk and correlated to a longer time to rehospitalization. History of suicidal behaviors (p< 0.001, OR=4.906, HR=3.161), history of violent behaviors (p< 0.001, OR=5.443, HR=3.935) and greater number of previous psychiatric admissions (p< 0.001, OR=1.250, HR=1.121) were associated with a higher rehospitalization risk and predicted earlier rehospitalization. The rehospitalization rate of elderly patients was 5.2% at 1 month, 9.5% at 3 months, 15.0% at 6 months, 17.1% at 1 year, 18.8% at 1.5 year and 20.9% at 2 years.

Angiographic factors associated with haemorrhagic presentation of brain arteriovenous malformation in a Chinese paediatric population.

To identify specific angiographic factors associated with haemorrhagic presentation of brain arteriovenous malformation in Chinese paediatric patients. Retrospective cross-sectional observational study. Four locoregional tertiary neurosurgical centres in Hong Kong: Queen Elizabeth Hospital, Tuen Mun Hospital, Kwong Wah Hospital, and Pamela Youde Nethersole Eastern Hospital. Patients aged 18 years or younger who underwent pretreatment digital subtraction angiography for brain arteriovenous malformation between 1 January 2005 and 31 July 2013 were included. Patients were divided into haemorrhagic and non-haemorrhagic groups based on the initial presentation. Pretreatment digital subtraction angiographies were independently reviewed by two experienced neuroradiologists. The following parameters were evaluated for their association with haemorrhagic presentation by univariate and multivariate analyses: nidus location, nidus size, nidus morphology (diffuse or compact); origin and number of arterial feeders; venous drainage; number of draining veins; presence of aneurysms, venous varices, and venous stenosis. A total of 67 children and adolescents (28 male, 39 female) with a mean age of 12 years were included. Of them, 52 (78%) presented with haemorrhage. Arteriovenous malformation size (P=0.004) and morphology (P=0.05) were found to be associated with haemorrhagic presentation by univariate analysis. Small arteriovenous malformation nidus size and diffuse nidal morphology were identified as independent risk factors for haemorrhage by multivariate analysis. Smaller arteriovenous malformation size and diffuse nidal morphology are angiographic factors independently associated with haemorrhagic presentation. Bleeding risk is important in determining the therapeutic approach (aggressive vs conservative) and timeframe, particularly in paediatric patients.

Management of ruptured abdominal aortic aneurysm in endovascular era

Surgical PracticeVolume 17, Issue 2 p. 40-42 Leading Article Management of ruptured abdominal aortic aneurysm in endovascular era Renny Yien, Corresponding Author Renny Yien Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong Author to whom all correspondence should be addressed. Email: [email protected]Search for more papers by this author Renny Yien, Corresponding Author Renny Yien Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong Author to whom all correspondence should be addressed. Email: [email protected]Search for more papers by this author First published: 07 February 2013 https://doi.org/10.1111/1744-1633.12010Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume17, Issue2May 2013Pages 40-42 RelatedInformation

A case series of Paget's disease of bone in Chinese

OBJECTIVE. To report a series of patients with Paget's disease of bone that is rarely diagnosed in the Chinese, and to describe their presentations and clinical characteristics. DESIGN. A retrospective case series and literature review. SETTING. A regional public hospital in Hong Kong. PATIENTS. Patients with a diagnosis of Paget's disease of bone (or osteitis deformans) documented in the Clinical Management System of the Hospital Authority and being followed up in the medical endocrine clinic of the Pamela Youde Nethersole Eastern Hospital were identified in July 2011. This was performed using the Clinical Data Analysis and Reporting System of the Hospital Authority. Corresponding case notes and radiological imaging data were retrieved and reviewed. Patients with diagnostic X-ray or computed tomography findings of Paget's disease of bone were included in this series. The demographic data, clinical features, and investigation results of the cases were retrieved, recorded, and analysed. RESULTS. Seven Chinese patients (5 men and 2 women; mean age, 66 years) diagnosed to have Paget's disease of bone from 2000 to 2010 were identified. All but one were asymptomatic and presented as an incidental finding (isolated raised serum alkaline phosphatase level or abnormal X-ray). The most commonly involved sites were the skull and pelvis. The majority (71%) of the patients had polyostotic disease. During follow-up, there were no disease-related complications, nor was malignant transformation identified. None reported positive family history. CONCLUSION. In this series of seven Chinese patients with Paget's disease, most were asymptomatic and presented with an isolated raised serum alkaline phosphatase level during routine testing. The disease was predominantly found in males and the elderly, and commonly involved the skull and pelvis.

Meta-analysis Followed by Replication Identifies Loci in or near CDKN1B, TET3, CD80, DRAM1, and ARID5B as Associated with Systemic Lupus Erythematosus in Asians

Systemic lupus erythematosus (SLE) is a prototype autoimmune disease with a strong genetic involvement and ethnic differences. Susceptibility genes identified so far only explain a small portion of the genetic heritability of SLE, suggesting that many more loci are yet to be uncovered for this disease. In this study, we performed a meta-analysis of genome-wide association studies on SLE in Chinese Han populations and followed up the findings by replication in four additional Asian cohorts with a total of 5,365 cases and 10,054 corresponding controls. We identified genetic variants in or near CDKN1B, TET3, CD80, DRAM1, and ARID5B as associated with the disease. These findings point to potential roles of cell-cycle regulation, autophagy, and DNA demethylation in SLE pathogenesis. For the region involving TET3 and that involving CDKN1B, multiple independent SNPs were identified, highlighting a phenomenon that might partially explain the missing heritability of complex diseases.

Clinicopathological survey of 23 patients with lacrimal fossa lesions in Hong Kong.

To survey the clinicopathological correlations of lacrimal fossa lesions in the Hong Kong population. A total of 23 patients with lacrimal fossa lesions were identified radiologically. The mean age at the time of diagnosis was 52 year-old. The medical records of patients diagnosed with lacrimal fossa lesions and subsequently underwent radiological investigations were collected and reviewed retrospectively throughout a six years period from 2000 to 2006 from three regional hospitals (Tung Wah Eastern Hospital, Pamela Youde Nethersole Eastern Hospital and Queen Mary Hospital) belonging to the Hong Kong Mega Cluster. Patient demographics, presenting signs and symptoms, imaging modalities, pathological reports and subsequent management were recorded. The most common initial presenting symptom was upper lid swelling (83%) followed by proptosis (13%). 19 patients (83%) had benign lacrimal fossa lesion and 4 patients (17%) had malignancy. Three of the malignancies were lymphomas and one was adenoid cystic carcinoma. Age is an important factor in considering the differential diagnosis of lacrimal fossa lesion. Lymphoproliferative diseases have the highest incidence in patients over 60 years of age while inflammatory lesions are more common in younger patients in Hong Kong.

Clinical Outcomes and Patterns of Failure After Intensity-Modulated Radiotherapy for Nasopharyngeal Carcinoma

To study and report the clinical outcomes and patterns of failure after intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma (NPC). The treatment outcomes of NPC patients treated with IMRT at Pamela Youde Nethersole Eastern Hospital between 2005 and 2007 were reviewed. The location and extent of locoregional failures were transferred to the pretreatment planning computed tomography for dosimetry analysis. Statistical analyses were performed on dose coverage and locoregional failures. A total of 193 NPC patients were analyzed; 93% had Stage III/IV disease. Median follow-up was 30 months. Overall disease failure (at any site) developed in 35 patients. Among these, there were 23 distant metastases, 16 local failures, and 9 regional failures. Four of the locoregional failures were marginal. Dose conformity with IMRT was excellent. Patients with at least 66.5 Gy to their target volumes had significantly less locoregional failure. The 2-year local progression-free, regional progression-free, distant metastasis-free, and overall survival rates were 95%, 96%, 90%, and 92%, respectively. Intensity-modulated radiotherapy provides excellent locoregional control for NPC. Distant metastasis remains the most difficult challenge, and more effective systemic agents should be explored for patients presenting with advanced locoregional diseases.