Queen Mary Hospital Research Articles

Abstract 15 — Lupus Low Disease Activity State: An Underutilised Clinical Target that is Attainable and Protective against Lupus Nephritis Relapse

Background Lupus nephritis (LN) is a significant comorbidity affecting approximately 50-60% of patients with systemic lupus erythematosus (SLE). Complete and partial renal response (CRR/PRR) have been recommended as treatment targets in LN. Lupus low disease activity state (LLDAS) is also associated with favourable clinical outcomes. This study aims to investigate the LLDAS attainment rate and outcomes in patients with LN. Methods Patients with biopsy-proven LN during 2010-2020 in Queen Mary Hospital were included. Baseline demographics, blood parameters and urinalysis results were documented. Renal response and LLDAS attainment were assessed at 12 months after LN diagnosis. CRR was defined as proteinuria [Formula: see text]0.5g/day with a normal estimated glomerular filtration rate (eGFR); PRR was defined as a reduction in proteinuria by [Formula: see text]50% with near normal eGFR. A relapse was defined as a biopsy-proven active LN on histology after an initial treatment response of proteinuria reduction of [Formula: see text]50% or to sub-nephrotic range. Time-to-relapse survival analysis was performed to compare the significance of CRR/PRR and LLDAS attainment. Results 143 LN patients were included, with a median follow-up duration of 10.4 years. At 12 months, 57 (40%), 14 (10%) and 69 (48%) patients achieved CRR, PRR and LLDAS, respectively. Although 39 (27%) patients attained both CRR/PRR and LLDAS, a significant number of 30 (21%) patients reached LLDAS without meeting CRR/PRR (Figure 1). Among 136 patients who achieved the pre-defined treatment response, 30 (22%) patients developed LN relapse after a median of 2.98 years. Patients reaching either CRR/PRR or LLDAS had a significantly lower risk of relapse (CRR/PRR: HR = 0.34, p = 0.02; LLDAS: HR = 0.28, p = 0.003). The attainment of both CRR/PRR and LLDAS was associated with the lowest risk of relapse (Figure 2). Conclusion We advocate LLDAS as a target for LN patients as attaining LLDAS reduces future LN relapse risks.

Plasma interferon-gamma-inducible-protein 10 level as a predictive factor of spontaneous hepatitis B surface antigen seroclearance in chronic hepatitis B patients.

Spontaneous seroclearance of hepatitis B surface antigen (HBsAg) is a rare event that occurs in patients that are chronically infected with the hepatitis B virus. As the functional cure and ultimate treatment endpoint of chronic hepatitis B (CHB), HBsAg seroclearance is an important milestone in the natural history of CHB and serves great clinical value. This study aims to identify host and viral factors associated with HBsAg seroclearance. This is a retrospective study carried out in the Queen Mary Hospital, Hong Kong. By analyzing the plasma retrieved from the serum archive (collected during 2011-2021) of 100 CHB patients attending the hospital's liver clinic, the longitudinal cytokine profiles between the HBsAg-losers and the control groups were compared. Data revealed that plasma levels of IP-10 were significantly lower at 3-5years prior to HBsAg seroclearance compared with patients who remained HBsAg positive (P<0.05). Receiver operating characteristic curve analysis reveals that plasma IP-10 levels at multiple time points before HBsAg seroclearance return area under receivor-operating characteristic curve (AUC) greater than 0.7. Plasma IP-10 levels at 42.39pg/mL produced an AUC=0.723 with 74.0% sensitivity and 75.5% specificity to predict subsequent HBsAg seroclearance in the next 3-5years. Low plasma IP-10 identified 91.4% patients with quantitative HBsAg <100IU/mL who would subsequently develop HBsAg seroclearance, compared with 37% with higher plasma IP-10 levels (P<0.001). Low plasma levels of IP-10 are associated with subsequent HBsAg seroclearance, suggesting potential clinical utilities of measurement of IP-10 in predicting HBsAg seroclearance, especially among patients with low HBsAg.

Circulating Tumor DNA Dynamics as Prognostic Markers in Locally Advanced and Metastatic Esophageal Squamous Cell Carcinoma

Esophageal squamous cell carcinoma (ESCC) is a deadly disease with frequent recurrence. There are unmet needs for prognostic biomarkers for dynamically monitoring disease progression and detecting minimal residual disease. To examine whether circulating tumor DNA is clinically useful as a prognostic biomarker for ESCC recurrence and patient survival. This single-center, population-based cohort study consecutively enrolled 147 patients receiving curative (n = 74) or palliative (n = 73) treatment at the surgery and clinical oncology departments of Queen Mary Hospital in Hong Kong from August 1, 2016, to September 31, 2021. Patients were followed up for 2 years. Plasma samples were collected at different longitudinal time points for a prospective circulating tumor DNA (ctDNA) next-generation sequencing profiling study of 77 actionable genes. Patients were treated with up-front surgery, neoadjuvant chemoradiotherapy plus surgery with or without adjuvant therapy, or palliative chemotherapy (CT). Detection of circulating tumor DNA (ctDNA), progression-free survival (PFS), and overall survival (OS). A total of 478 serial plasma samples from 147 patients with locoregional or metastatic ESCC were prospectively analyzed. Among the 74 patients in the curative group (median [range] age, 66 [46-85] years; 56 [76.0%] male), 44 (59.5%) relapsed and 36 (48.6%) died. For patients receiving curative surgical treatment, a high ctDNA level (hazard ratio [HR], 7.84; 95% CI, 1.87-32.97; P = .005) and ctDNA alterations (HR, 5.71; 95% CI, 1.81-17.97; P = .003) at 6 months postoperation were independently associated with poor OS. Among patients receiving neoadjuvant chemoradiotherapy, postneoadjuvant ctDNA alterations were associated with poor PFS (HR, 3.16; 95% CI, 1.17-8.52; P = .02). In the 73 patients in the palliative group (median [range] age, 63 [45-82] years; 63 [86.0%] male), 71 (97.3%) had disease relapse and 68 (93.2%) died. Detectable pre-CT NFE2L2 alterations were independently associated with PFS (HR, 2.99; 95% CI, 1.35-6.61; P = .007) and OS (HR, 28.39; 95% CI, 7.26-111.03; P = 1.52 × 10-6), whereas high ctDNA levels (HR, 2.41; 95% CI, 1.18-4.95; P = .02) and alterations in pre-cycle III ctDNA (HR, 1.99; 95% CI, 1.03-3.85; P = .04) showed weaker associations with PFS. Alterations in pre-CT ctDNA were independently associated with OS (HR, 4.46; 95% CI, 1.86-10.69; P = 7.97 × 10-4). The findings of this cohort study indicate that prognostic models incorporating ctDNA features are useful in ESCC. Both ctDNA level and NFE2L2 alterations pre-CT and before cycle III were found to be important prognostic factors in palliative groups, and ctDNA alterations after treatment and at 6 months after surgery may define high-risk groups for recurrence in the curative group. High-risk patients can benefit by a timely switch to the next therapeutic options.

Perceptions and Challenges of Telehealth Obstetric Clinics Among Pregnant Women in Hong Kong: Cross-Sectional Questionnaire Study.

Integrating telehealth in an obstetric care model is important to prepare for possible infection outbreaks that require social distancing and limit in-person consultations. To ensure the successful implementation of obstetric telehealth in Hong Kong, it is essential to understand and address pregnant women's concerns. This study aimed to assess pregnant women's attitudes, concerns, and perceptions regarding telehealth obstetric clinic services in Hong Kong. We conducted a prospective cross-sectional questionnaire study at Queen Mary Hospital between November 2021 and August 2022. Utilizing a 5-point rating scale, the questionnaire aimed to capture pregnant women's preferences, expectations, feasibility perceptions, and privacy concerns related to telehealth clinic services. We used statistical analyses, including chi-square tests and multinomial logistic regression, to compare questionnaire responses and investigate the association between advancing gestation and attitudes toward telehealth clinics. The study included 664 participants distributed across different pregnancy stages: 269 (40.5%) before 18 gestational weeks, 198 (29.8%) between 24 and 31 weeks, and 197 (29.7%) after delivery. Among them, 49.8% (329/664) favored face-to-face consultations over telehealth clinics, and only 7.3% (48/664) believed the opposite. Additionally, 24.2% (161/664) agreed that telehealth clinics should be launched for obstetric services. However, the overall preference for telehealth clinics was <20% for routine prenatal checkups (81/664, 12.2%) and addressing pregnancy-related concerns, such as vaginal bleeding (76/664, 11.5%), vaginal discharge (128/664, 19.4%), reduced fetal movement (64/664, 9.7%), uterine contractions (62/664, 9.4%), and suspected leakage of amniotic fluid (54/664, 8.2%). Conversely, 76.4% (507/664) preferred telehealth clinics to in-person visits for prenatal education talks, prenatal and postpartum exercise, and addressing breastfeeding problems. Participants were more comfortable with telehealth clinic tasks for tasks like explaining pregnancy exam results (418/664, 63.1%), self-administering urinary dipsticks at home (373/664, 56.4%), medical history-taking (341/664, 51.5%), and self-monitoring blood pressure using an electronic machine (282/664, 42.8%). %). During the postpartum period, compared to before 18 weeks of gestation, significantly more participants agreed that telehealth clinics could be an option for assessing physical symptoms such as vaginal bleeding (aOR 2.105, 95% CI 1.448-3.059), reduced fetal movement (aOR 1.575, 95% CI 1.058-2.345), uterine contractions (aOR 2.906, 95% CI 1.945-4.342), suspected leakage of amniotic fluid (aOR 2.609, 95% CI 1.721-3.954), fever (aOR 1.526, 95% CI 1.109-2.100), and flu-like symptoms (aOR 1.412, 95% CI 1.030-1.936). They were also more confident with measuring the symphysis-fundal height, arranging further investigations, and making diagnoses with the doctor via the telehealth clinic. The main perceived public health advantage of telehealth clinics was the shorter traveling and waiting time (526/664, 79.2%), while the main concern was legal issues from wrong diagnosis and treatment (511/664, 77.4%). Face-to-face consultation remained the preferred mode of consultation among the participants. However, telehealth clinics could be an alternative for services that do not require physical examination or contact. An increased acceptance of and confidence in telehealth was found with advancing gestation and after delivery. Enforcing stricter laws and guidelines could facilitate the implementation of telehealth clinics and increase confidence in their use among pregnant women for obstetric care.

Prostate health index can stratify patients with Prostate Imaging Reporting and Data System score 3 lesions on magnetic resonance imaging to reduce prostate biopsies.

We aim to evaluate prostate health index as an additional risk-stratification tool in patients with Prostate Imaging Reporting and Data System score 3 lesions on multiparametric magnetic resonance imaging. Men with biochemical or clinical suspicion of having prostate cancer who underwent multiparametric magnetic resonance imaging in two tertiary centers (Queen Mary Hospital and Princess Margaret Hospital, Hong Kong, China) between January 2017 and June 2022 were included. Ultrasound-magnetic resonance imaging fusion biopsies were performed after prostate health index testing. Those who only had Prostate Imaging Reporting and Data System score 3 lesions were further stratified into four prostate health index risk groups and the cancer detection rates were analyzed. Out of the 747 patients, 47.3% had Prostate Imaging Reporting and Data System score 3 lesions only. The detection rate of clinically significant prostate cancer in this group was 15.0%. The cancer detection rates of clinically significant prostate cancer had statistically significant differences 5.3% in prostate health index <25.0, 7.4% in prostate health index 25.0-34.9, 17.9% in prostate health index 35.0-54.9, and 52.6% in prostate health index ≥55.0 (P < 0.01). Among the patients, 26.9% could have avoided a biopsy with a prostate health index <25.0, at the expense of a 5.3% risk of missing clinically significant prostate cancer. Prostate health index could be used as an additional risk stratification tool for patients with Prostate Imaging Reporting and Data System score 3 lesions. Biopsies could be avoided in patients with low prostate health index, with a small risk of missing clinically significant prostate cancer.

P-797 Single-cell analysis sheds light on investigation of epithelial stem/progenitor cells in human endometrial organoid

Abstract Study question How to find endometrial epithelial stem cell (eeSC) in the human endometrial gland? Summary answer Endometrial organoid culture model combined with omics techniques can be a promising platform for investigating eeSC functions and endometrial gland development. What is known already Endometrial stem/progenitor cells are thought to be involved in endometrial regeneration, with endometrial stromal stem cells having already been extensively studied. On the other hand, study of human eeSC is challenging due to the lack of specific markers to isolate and examine their functional properties. In addition, the in vivo phenotype of primary endometrial epithelial cells cannot be maintained for a long duration in two-dimensional culture. The development of three-dimensional endometrial organoid model provides suitable alternatives for studying eeSC, as they can be tailored to be biomimetic and accurately recapitulate the native in vivo scenario of the glandular epithelial cells. Study design, size, duration This is a basic science study of endometrial organoids. Endometrial biopsies were performed on day 2 after the injection of human chorionic gonadotrophin in women undergoing in vitro fertilization treatment (IVF) but having no fresh embryo transfer in Queen Mary Hospital, The University of Hong Kong. Endometrial organoids were derived from human endometrial gland fragments. The established organoids were digested into single cells for droplet-based single-cell sequencing to investigate their cellular population and component. Participants/materials, setting, methods The filtered high-quality single-cell analysis data were clustered and assigned to specific cell types according to their expressions of classical markers. Potential stem cells cluster was identified by trajectory analysis, RNA velocity, CytoTRACE and literature search. The existence of specific eeSC markers was validated by immunofluorescence staining and flow cytometric analysis of primary endometrial tissues/endometrial organoids. The clonogenicity of the isolated eeSCs was determined by clonogenic assay. Main results and the role of chance The endometrial organoid exhibit morphology and marker expression pattern of human endometrial glands. They can also be expanded for long-term culture. The resemblance between in vitro generated organoid and the in vivo endometrial gland was further supported by single-cell RNA-seq analysis. Seurat clustering identifies 8 cell clusters in endometrial organoids. RNA velocity analysis revealed a potential eeSC cluster at the starting point of the differentiation trajectory from the immature cell cluster toward the most mature one. Besides, the eeSC cluster had relatively high expression of known stem-cell markers including Tumor-Associated Calcium Signal Transducer 2 (TACSTD2) and Aldehyde Dehydrogenase 1 Family Member A3 (ALDH1A3). Five genes including Intercellular Adhesion Molecule 1 (ICAM1), L1 Cell Adhesion Molecule (L1CAM), Annexin A2 (ANXA2), Mesothelin (MSLN), Integrin Subunit Alpha 3 (IGTA3) were subsequently identified as potential markers of the eeSC cluster. Further analysis by immunostaining demonstrated the expressions of CD54 and ANXA2 in ∼1% and ∼30% of the whole organoids cell suspensions, respectively. The expressions of CD54 and ANXA2 were also identified in the glandular tissue of human endometrium. Limitations, reasons for caution With basal out/apical in phenotype, the endometrial organoids are not exactly similar to the endometrium in vivo, hampering the exploration of their surface marker in cell interaction experiments. Like other organoid systems, it is inevitable for endometrial organoids to have heterogeneity in cells and inconsistency in expansion and biological performance. Wider implications of the findings Gene manipulation technology like CRISPR-Cas9 could be utilized to genetically alter the eeSc to study their biological properties. The construction of eeSC biobank will offer an opportunity for the development of personalized regenerative medicine with diagnosis, preventive intervention, and treatment approaches for gynecological diseases. Trial registration number Not applicableNot applicable

#4110 BIO-CONDUCTIVITY MEASUREMENTS ENABLE PORTABLE AND SELF-ADMINISTRATED CHRONIC KIDNEY DISEASE SCREENING AND MONITORING

Abstract Background and Aims Chronic kidney disease (CKD) is an escalating health concern. The identification of CKD during mass public screening by laboratory tests constitutes important resource implications. Home-based and self-administrated approach to screen and monitor disease severity in both healthy and CKD subjects are eagerly awaited. Frequency-difference electrical impedance tomography (fdEIT) reconstructs the interior of a body by measuring the electrical responses to a small alternating current applied at the surface of the subject at various frequencies. Kidney fibrosis is a cardinal feature of CKD, which is associated with alterations in renal molecular composition and hence electrical conductivity. Therefore, this study aims to investigate the feasibility of a portable, self-administrated approach to assess CKD severity using fdEIT in the kidney region. Method Clinical subjects are recruited at Queen Mary Hospital, Hong Kong. EIT data was collected via a PVC belt acting as an electrode holder placed circumferentially on the upper abdominal region of the subject. The belt was connected to a portable console to collect EIT data. 24 frequencies ranging from 10KHz to 300KHz are used to stimulate electrical responses in the body. (Figure 1A) Paired blood and urine samples were collected for measured of eGFR. Group source separation was implemented to extract the kidney region of interest (ROI) and extract conductivity features (Figure 1A); these features, together with the age of the subject, are then input into a regression model to estimate the eGFR and the CKD stage of the subject according to the following classification scheme: stage 1 CKD (eGFR &amp;gt; 90) as healthy subjects, stages 3, 4, 5 CKD (eGFR &amp;lt; 60) as unhealthy subjects, stage 2 CKD (60 &amp;lt; eGFR &amp;lt; 90) as borderline cases. Results 75 subjects were recruited (54 with CKD and 21 were healthy volunteers). We obtained an eGFR estimation model with R2 score of 0.40. We also obtained a CKD stage classifier with sensitivity of 87.5% and specificity of more than 99.9%. (Figure 1C) The mean conductivity in the extracted kidney signal comprises 40% weighting in the regression model (Figure 1B), showing comparable importance as the age in predicting the eGFR. Conclusion The results demonstrate that measuring bio-conductivity anomalies through fdEIT is highly accurate and non-invasive, and can be developed into a portable and self-administrable device to screen and monitor CKD

A closer look

Sally Khawaja details the fascinating history of the Gillies Unit at Queen Mary's Hospital.

Identification and evaluation of a reliable, non-invasive diagnostic method using serum microRNA expression to diagnose high-risk colorectal cancer candidates.

e15519 Background: Screening is of paramount importance in early colorectal cancer detection which can significantly reduce its mortality. This study aims to identify a non-invasive diagnostic method using serum microRNA expression to diagnose colorectal cancer patients. Methods: Serum samples were prospectively collected from CRC patients or normal subjects during 2017 to 2021 in Queen Mary Hospital of Hong Kong and divided into 3 study cohorts: Training cohort (n = 129 per group), Validation cohort (n = 200 per group) and Prediction cohort (n = 260). Quantitative PCR was applied to detect the serum level of 20 candidate microRNAs. Multiple linear regression was used to formulate a serum microRNA panel for diagnosing CRC patients. The performance was evaluated by ROC analysis. The cost-effectiveness was investigating by comparing the cost of two CRC diagnostic strategies comprising of (i) colonoscopy alone and (ii) microRNA panel and followed by colonoscopy strategies to microRNA panel tested positive patients. Results: The values of 3 pairs of serum microRNAs, including miR-106b/miR-1246, miR-106b/miR-16 and miR-106b/miR-21 showed statistical significant difference between CRC patients and normal subjects. A serum microRNA panel formulated from these 3 pairs of microRNAs was able to diagnose CRC patients from normal subjects with high accuracy for both training cohort [AUC: 0.9078 (95% CI, 0.9122 To 0.9734; p &lt; 0.0001)] and Validation cohort (AUC: 0.8904), suggesting that this microRNA panel had a consistent performance across different patient cohorts. Our prediction cohort showed that this microRNA panel was able to screen CRC patients with 85.8% sensitivity, 80.95% specificity, 86.9% positive predictive value and 79.4% negative predictive value. Cost-effectiveness analysis revealed that the strategy of combining serum miRNA test and colonoscopy was a more cost-effective approach compared to colonoscopy alone. The average cost saved per patient was around HK$4010. Conclusions: The serum miRNA test was a feasible, promising and cost-effective non-invasive biomarker for diagnosing CRC patients from normal subjects.

Validation of diagnostic coding for bronchiectasis in an electronic health record system in Hong Kong.

Electronic medical record (EMR) databases can facilitate epidemiology research in various diseases including bronchiectasis. Given the diagnostic challenges of bronchiectasis, the validity of the coding in EMR requires clarification. We aimed to assess the validity of International Classification of Diseases, 9th Revision (ICD-9) code algorithms for identifying bronchiectasis in the territory-wide electronic medical health record system of Clinical Data Analysis and Reporting System (CDARS) in Hong Kong. Adult patients who had the diagnosis of bronchiectasis input from Queen Mary Hospital in 2011-2020 were identified using the ICD-9 code of 494 by CDARS. All patients who had high resolution computed tomography (HRCT) were reviewed by respiratory specialists to confirm the presence of bronchiectasis on HRCT. 19 617 patients who had the diagnostic code of bronchiectasis among all public hospitals in Hong Kong and 1866 in Queen Mary Hospital in the same period. 648 cases were randomly selected and validated using medical record and HRCT review by a respiratory specialist. The overall positive predictive value (PPV) was 92.7% (95% CI 90.7-94.7). This was the first ICD-9 coding validation for bronchiectasis in Hong Kong CDARS. Our study demonstrated that using ICD-9 code of 494 was reliable to support utility of CDARS database for further clinical research on bronchiectasis. This article is protected by copyright. All rights reserved.

CORR Insights®: What Is the Prevalence of Clinically Important Findings Among Incidentally Found Osseous Lesions?

1Associate Professor, Johns Hopkins University School of Medicine, Baltimore, MD, USA A. J. Aboulafia, Queen Mary Hospital, Orthopaedics and Traumatology, Hong Kong Island, Hong Kong 9999, Email: [email protected] This CORR Insights® is a commentary on the article “What Is the Prevalence of Clinically Important Findings Among Incidentally Found Osseous Lesions?” by Blackburn and colleagues available at: DOI: 10.1097/CORR.0000000000002630. The author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writer, and do not reflect the opinion or policy of CORR® or The Association of Bone and Joint Surgeons®.

Subspecialty nurses as an essential ingredient for modern vascular service

Surgical PracticeAccepted Articles EDUCATION Subspecialty Nurses as Essential Ingredient for Modern Vascular Service Yiu Che Chan, Corresponding Author Yiu Che Chan [email protected] orcid.org/0000-0003-3764-3782 Division of Vascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, SAR, China Author Correspondence Dr. Yiu Che CHAN MB BS BSc MD FRCS(England) FRCS(General Surgery) FCSHK, Associate Professor, Division of Vascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, South Wing, 14 Floor K Block, Queen Mary Hospital, Pokfulam Road, Hong Kong. Tel: +852-2255-4969, FAX: +852-2255-4967, Email: [email protected]Search for more papers by this authorPo-Ching Chan, Po-Ching Chan Division of Vascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, SAR, ChinaSearch for more papers by this authorPui-Yan Paine Kong, Pui-Yan Paine Kong Division of Vascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, SAR, ChinaSearch for more papers by this authorYee-Ming Tse, Yee-Ming Tse Division of Vascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, SAR, ChinaSearch for more papers by this authorStephen W. K. Cheng, Stephen W. K. Cheng Division of Vascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, SAR, ChinaSearch for more papers by this author Yiu Che Chan, Corresponding Author Yiu Che Chan [email protected] orcid.org/0000-0003-3764-3782 Division of Vascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, SAR, China Author Correspondence Dr. Yiu Che CHAN MB BS BSc MD FRCS(England) FRCS(General Surgery) FCSHK, Associate Professor, Division of Vascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, South Wing, 14 Floor K Block, Queen Mary Hospital, Pokfulam Road, Hong Kong. Tel: +852-2255-4969, FAX: +852-2255-4967, Email: [email protected]Search for more papers by this authorPo-Ching Chan, Po-Ching Chan Division of Vascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, SAR, ChinaSearch for more papers by this authorPui-Yan Paine Kong, Pui-Yan Paine Kong Division of Vascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, SAR, ChinaSearch for more papers by this authorYee-Ming Tse, Yee-Ming Tse Division of Vascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, SAR, ChinaSearch for more papers by this authorStephen W. K. Cheng, Stephen W. K. Cheng Division of Vascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, SAR, ChinaSearch for more papers by this author First published: 25 April 2023 https://doi.org/10.1111/1744-1633.12625 This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/1744-1633.12625. AboutPDF ToolsExport 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 Accepted ArticlesAccepted, unedited articles published online and citable. The final edited and typeset version of record will appear in the future. RelatedInformation

Vascular training and sub‐specialization in mainland China

Surgical PracticeAccepted Articles EDUCATION Vascular Training and Sub-specialization in Mainland China Hai-Lei Li, Hai-Lei Li Division of Vascular Surgery, Department of Surgery, The University of Hong Kong -ShenZhen Hospital, ShenZhen, ChinaSearch for more papers by this authorYiu Che Chan, Corresponding Author Yiu Che Chan [email protected] orcid.org/0000-0003-3764-3782 Division of Vascular Surgery, Department of Surgery, The University of Hong Kong -ShenZhen Hospital, ShenZhen, China Division of Vascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, SAR, China Author Correspondence Dr. Yiu Che CHAN MB BS BSc MD FRCS(England) FRCS(General Surgery) FCSHK, Associate Professor, Division of Vascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, South Wing, 14 Floor K Block, Queen Mary Hospital, Pokfulam Road, Hong Kong. Tel: +852-2255-4969, FAX: +852-2255-4967, Email: [email protected]Search for more papers by this authorStephen W. Cheng, Stephen W. Cheng Division of Vascular Surgery, Department of Surgery, The University of Hong Kong -ShenZhen Hospital, ShenZhen, China Division of Vascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, SAR, ChinaSearch for more papers by this author Hai-Lei Li, Hai-Lei Li Division of Vascular Surgery, Department of Surgery, The University of Hong Kong -ShenZhen Hospital, ShenZhen, ChinaSearch for more papers by this authorYiu Che Chan, Corresponding Author Yiu Che Chan [email protected] orcid.org/0000-0003-3764-3782 Division of Vascular Surgery, Department of Surgery, The University of Hong Kong -ShenZhen Hospital, ShenZhen, China Division of Vascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, SAR, China Author Correspondence Dr. Yiu Che CHAN MB BS BSc MD FRCS(England) FRCS(General Surgery) FCSHK, Associate Professor, Division of Vascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, South Wing, 14 Floor K Block, Queen Mary Hospital, Pokfulam Road, Hong Kong. Tel: +852-2255-4969, FAX: +852-2255-4967, Email: [email protected]Search for more papers by this authorStephen W. Cheng, Stephen W. Cheng Division of Vascular Surgery, Department of Surgery, The University of Hong Kong -ShenZhen Hospital, ShenZhen, China Division of Vascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, SAR, ChinaSearch for more papers by this author First published: 25 April 2023 https://doi.org/10.1111/1744-1633.12627 This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/1744-1633.12627. AboutPDF ToolsExport 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 Accepted ArticlesAccepted, unedited articles published online and citable. The final edited and typeset version of record will appear in the future. RelatedInformation

Vascular Surgery 2023

Surgical PracticeVolume 27, Issue 2 p. 65-65 EDITORIAL Vascular Surgery 2023 Stephen Wing Keung Cheng, Corresponding Author Stephen Wing Keung Cheng [email protected] Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong Correspondence Stephen Wing Keung Cheng, Department of Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong. Email: [email protected]Search for more papers by this author Stephen Wing Keung Cheng, Corresponding Author Stephen Wing Keung Cheng [email protected] Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong Correspondence Stephen Wing Keung Cheng, Department of Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong. Email: [email protected]Search for more papers by this author First published: 30 May 2023 https://doi.org/10.1111/1744-1633.12633 Guest Editorial for May 2023 issue of Surgical Practice. Read 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 No abstract is available for this article. Volume27, Issue2May 2023Pages 65-65 RelatedInformation

Impact of COVID-19 pandemic on preterm delivery.

Controversies exist on whether the pandemic lockdown has resulted in a lower rate of preterm deliveries. A higher stillbirth rate was also reported. This retrospective observational study aimed to examine the rate of preterm delivery and stillbirth in a tertiary hospital in Hong Kong during COVID-19 pandemic. Data from 8787 singleton pregnancies at Queen Mary Hospital between April 2018 to September 2021 were retrieved from the clinical management system and obstetric database. Rates of preterm delivery (<37 weeks), low birth weight infants (<2500 g), and stillbirth in the pre-pandemic (April 2018 to September 2019) and pandemic (April 2020 to September 2021) periods were compared. Total numbers of singleton deliveries during the pre-pandemic and pandemic periods were 5064 and 3723, respectively. Background demographics were comparable, except 3 were higher rates of cesarean sections (30.7% vs. 25.8%; p < 0.05) and hypertensive disorders (1.4% vs. 0.7%; p < 0.05) in the pandemic cohort. Moreover, more women with a spontaneous onset of labor had a history of preterm delivery (3.5% vs. 2.4%; p < 0.05) during the pandemic. Rates of low birth weight infants (8.7% vs. 7.4%; p = 0.03) and spontaneous preterm deliveries (2.6% vs. 1.7%; p = 0.01), particularly spontaneous moderate-to-late preterm delivery (32-36 weeks) (1.9% vs. 1.2%; p = 0.01) were significantly higher during COVID-19. However, no statistical difference was found in stillbirth rates (0.2% vs. 0.4%; p = 0.17). Rates of spontaneous preterm delivery and low birth weight babies increased significantly during the COVID-19 pandemic. This could be related to an increase in maternal stress, or a change in behavioral patterns for pregnant women.

Validation of Diagnostic Coding for Asthma in an Electronic Health Record System in Hong Kong.

Electronic health record (EHR) databases can facilitate epidemiology research into various diseases including asthma. Given the diagnostic challenges of asthma, the validity of the coding in EHR requires clarification. We aimed to assess the validity of International Classification of Diseases, 9th Revision (ICD-9) code algorithms for identifying asthma in the territory-wide electronic medical health record system of the Clinical Data Analysis and Reporting System (CDARS) in Hong Kong. Adult patients who had the diagnosis of asthma input from all public hospitals in Hong Kong and those from Queen Mary Hospital in 2011-2020 were identified using the ICD-9 code of 493 (493.0, 493.1, 493.2, and 493.9) by CDARS. Patients' clinical record and spirometry were reviewed by two respiratory specialists to confirm the presence of asthma in the randomly selected cases. There were 43,454 patients who had the diagnostic code of asthma among all public hospitals in Hong Kong and 1852 in Queen Mary Hospital in the same period. A total of 200 cases were randomly selected and validated using medical record and spirometry review by a respiratory specialist. The overall positive predictive value (PPV) was 85.0% (95% CI 80.1-89.9%). This was the first ICD-9 code validation for CDARS (EHR) in Hong Kong on asthma. Our study demonstrated that using ICD-9 code (493.0, 493.1, 493.2 and 493.9) to identify asthma can result in a PPV that was reliable to support the utility of the CDARS database for further research on asthma among the Hong Kong population.

CORR Insights®: What Are the Functional and Surgical Outcomes of Tibial Turnup-plasty for Salvage in Patients With Chronic Lower Extremity Infection?

1Consultant, Queen Mary Hospital, Orthopaedics and Traumatology, Hong Kong Y. Lam, Queen Mary Hospital, Orthopaedics and Traumatology, Hong Kong, Hong Kong 9999, Email: [email protected] This CORR Insights® is a commentary on the article “What are the Functional and Surgical Outcomes of Tibial Turnup-plasty for Salvage in Patients With Chronic Lower Extremity Infection?” by Ramsey and colleagues available at: DOI: 10.1097/CORR.0000000000002536. The author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writer, and do not reflect the opinion or policy of CORR® or The Association of Bone and Joint Surgeons®.

Thyroid Metastasis from Lung Adenocarcinoma.

HomeRadiology: Imaging CancerVol. 5, No. 2 PreviousNext Images in CancerThyroid Metastasis from Lung AdenocarcinomaTsz-Kit Chow Tsz-Kit Chow Author AffiliationsFrom the Nuclear Medicine Unit, Department of Radiology, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong.Address correspondence to the author (email: [email protected]).Tsz-Kit Chow Published Online:Feb 10 2023https://doi.org/10.1148/rycan.220154MoreSectionsFull textPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In

Defining the surgical management for non-colorectal liver metastases.

Surgical resection is indicated for resectable colorectal liver metastases (CLM), but it is controversial for non-colorectal liver metastases (NCLM). This study aimed to compare survival outcomes of patients with resection of NCLM versus CLM and to identify prognostic factors for resection of NCLM. Consecutive patients who underwent surgical resection of liver metastases at Queen Mary Hospital, Hong Kong from January 1989 to December 2019 were retrospectively reviewed. Patients with resected NCLM were compared to those with CLM. Overall and recurrence-free survival were determined. Subgroup analyses with patients grouped according to the year of liver resection, from 1989 to 2004 and from 2005 to 2019, were conducted. Univariate and multivariate analyses were performed to identify prognostic factors. Among 674 patients included, 151 (22.4%) had NCLM while 523 (77.6%) had CLM. There were no statistically significant differences in median overall survival (65.2 vs 43.6months, p = 0.555) and recurrence-free survival (12.5 vs 11.7months, p = 0.425). The 1-year, 3-year, 5-year and 10-year overall survival rates were 89.8% vs 91.5%, 59.4% vs 58.8%, 50.6% vs 38.7% and 34.1% vs 26.3% in NCLM and CLM groups, respectively. Subgroup analyses demonstrated no statistically significant difference in overall survival between resection of NCLM versus CLM in both time intervals. In the NCLM group, better overall survival was found in liver metastasis of gastrointestinal stromal tumour (GIST) origin (hazard ratio (HR) 0.138, p = 0.003) and with a longer time interval from resection of primary tumour to resection of NCLM (HR 0.982, p = 0.042). Poor prognostic factors were presence of blood transfusion (HR 5.588, p = 0.013) and post-operative complications of Clavien-Dindo Grade IIIa or above (HR 74.853, p = 0.003). Surgical resection of NCLM had comparable survival outcomes with CLM. With appropriate patient selection, the indication of liver resection could be expanded to NCLM.

PP188 [Infections » Infections in the critical care unit]: PREVALENCE AND OUTCOMES OF INFECTIONS IN CRITICALLY ILL PEDIATRIC ONCOLOGY PATIENTS

1Paediatric Intensive Care Unit, Department of Paediatrics and Adolescent Medicine, Hong Kong Children’s Hospital, Hong Kong, China 2Department of Microbiology, Queen Mary Hospital, University of Hong Kong, Hong Kong, China; Carol Yu Centre for Infection, University of Hong Kong, Hong Kong, China 3Department of Pathology, Hong Kong Children’s Hospital, Hong Kong, China