Kowloon Hospital

The use of chimeric antigen receptor (CAR) T-cell therapy for T-cell malignancies is limited by fratricide, antigen-escape, lack of functional endurance and adverse events such as multilineage cytopenia. To address these limitations, we developed a simple single-step CD7-depletion process followed by transduction with a lentiviral vector encoding a CCR4/CD7 bispecific CAR. CD7-negative (CD7N) CCR4/CD7 CAR-T cells could expand without experiencing fratricide, unlike the bulk CCR4/CD7 CAR-T cells. The CD7N CAR-T exhibited robust cytotoxicity against malignant T-cell lines with heterogeneous CD7 and CCR4 expression in vitro and in vivo. Incorporation of EGFRt in the CAR construct allowed elimination by cetuximab in case of adverse events, whereas inclusion of c-Jun in the construct reduced functional exhaustion after repeated tumor challenges in vitro. In comparison to non-transduced CD7N cells and Bulk CAR-T cells, scRNA-seq analysis of CD7N CAR-T cells revealed a unique AQP3+ CD4+ T-cell subset following exposure to tumor cells. This cell subset exhibited broad activation of the Src/Ras/ERK and Bcl-2 pathways, high levels of SOS1 and KLF2 expression, and specific ligand-receptor interactions within the tumor necrosis factor superfamily. Collectively, these results suggest that further clinical development of CCR4/CD7 bispecific CD7N CAR-T cells is warranted, including the AQP3+ subset with SOS1/KLF2 modulation.

This research examines the representations and influence of Arabic literature in the poetry of Muhammad Iqbal, renowned as the poet of the East. Despite never traveling to Arab lands, Iqbal's profound mastery of the Arabic language and literature profoundly shaped his poetic style, themes, and symbolism. The study employs a literary-analytical approach to identify how Iqbal drew from classical Arabic poetry, Quranic texts, and Arab cultural history. Through close reading of poems such as "The Mosque of Córdoba" and "Khidr-e-Rah," the analysis reveals his extensive use of Arabic vocabulary, adaptation of motifs like ruins and longing (al-atlal), and symbolic references to Arab figures and history. The findings demonstrate that Iqbal creatively reshaped these elements to formulate a modern poetic discourse centered on Islamic revival and civilizational renewal. His work thus serves as a bridge between classical Arabic literary traditions and contemporary Islamic thought. This study highlights the centrality of Arabic heritage in Iqbal's vision and contributes to understanding the intertextual connections within the Islamic literary sphere.

ABSTRACTThis report describes a rare case of a bilio‐bronchial fistula in a 60‐year‐old man with a complex history of hepatocellular carcinoma, treated with resection, trans‐arterial chemoembolisation and microwave ablation. Following ablation, a pre‐existing sterile liver seroma became infected, forming an abscess that eroded through the diaphragm, culminating in a fistula between the biliary tree and the bronchial system. The pathognomonic presentation of bilioptysis (bilirubin‐rich sputum) confirmed the diagnosis, which was further visualised on endoscopic retrograde cholangiopancreatography. Management successfully focused on biliary system decompression via endoscopic stent placement into the culprit duct. This intervention resulted in the immediate cessation of bilioptysis and subsequent fistula healing, thereby avoiding high‐risk surgical repair. This case highlights that bilio‐bronchial fistula is a potential complication of liver ablation therapies and underscores the critical role of endoscopic biliary drainage as a first‐line, minimally invasive treatment to reduce intrabiliary pressure and promote spontaneous closure.

Obtaining arterial access is one of the most technically challenging aspects of pediatric angiography and endovascular interventions. Due to anatomic and physiologic differences, pediatric arteries are small and prone to vasospasm and dissection. Together with the lack of dedicated pediatric-specific equipment, the risks for arterial occlusion and thrombotic complications are significantly higher in children: up to 16% in those who weigh less than 15 kg. Detailed preprocedural planning, including selection of an appropriate arterial access site, periprocedural optimization, use of US guidance for arterial puncture, and meticulous postaccess care can help improve the success rate and reduce adverse outcomes. Although the transfemoral approach remains the conventional access route for the majority of pediatric angiographic examinations and transarterial interventions, alternative access routes including umbilical, radial, brachial, or axillary arteries can be useful in certain clinical scenarios. In neonates, the umbilical vessels are the preferred access site, and their use may prevent access-related complications in the extremities. In steno-occlusive aortoiliac conditions or in complex interventions involving downward-sloping visceral arteries, upper extremity access (eg, radial, brachial, and axillary, depending on artery size) can aid in the delivery of interventional devices. Compared with traditional transfemoral access, transradial access also has the advantage of allowing early ambulation. Use of intraprocedural unfractionated heparin and vasodilators can help reduce vasospasm and thrombosis in small arteries. The mainstay of treatment of arterial thrombosis is systemic anticoagulation therapy, while catheter-directed thrombolysis or thrombectomy is reserved for patients with critical limb ischemia resistant to anticoagulation medication. ©RSNA, 2025 Supplemental material is available for this article.

Optimizing aerodynamic performance is paramount for enhancing the energy efficiency of electric vehicles. Reducing aerodynamic drag directly extends driving range and lowers battery consumption, making aerodynamics a fundamental element in modern electric-vehicle design. This study numerically investigates the influence of tire geometry on the aerodynamic performance of a Formula-style electric race car, with a specific focus on the aspect ratio of tire diameter to width. High-resolution computational fluid dynamics simulations of the full vehicle were conducted to analyze the effects of tire aspect ratio, ranging from 1.5 to 2.5, on the vehicle’s aerodynamic characteristics. The results show that, at a constant tire aspect ratio, larger-diameter tires yield lower aerodynamic drag and downforce (i.e., less negative lift), as well as reduce the lift-to-drag ratio. A clear correlation between tire aspect ratio and aerodynamic coefficients was established: small-diameter tires are favorable for improving lap-speed performance, whereas large-diameter tires are better suited for endurance applications. These findings provide practical guidance for the aerodynamic design of race cars, particularly in tire-selection strategies to achieve desired performance outcomes while maintaining equivalent aerodynamic efficiency.

Osteosarcoma (OSA) is the most common primary bone neoplasm affecting dogs and the appendicular bones are frequently affected, accounting for up to 80% of reported cases. After tumor diagnosis and staging, surgery followed by adjuvant chemotherapy is the standard treatment of care. The purpose of this narrative literature review is to describe the anatomical landmarks and amputation techniques performed in the treatment of canine appendicular OSA, also using cadaveric models to demonstrate it. Surgical treatment options may include amputation of the affected limb, considered the standard of care. For thoracic limbs anterior quarter amputation, amputation with shoulder disarticulation, and midhumeral amputation. For pelvic limbs, amputation with hemipelvectomy, amputation with hip disarticulation, and midfemoral amputation. Anatomical knowledge is fundamental for performing a meticulous and correct technique, which allows a lower risk of recurrence and intra-operative and post-surgical complications.

IntroductionNeutropenic fever (NF) has a crude mortality rate of 3–18%. International guidelines recommend that all patients with NF receive ultrabroad-spectrum antibiotics (UBSAs) within 1 hour of emergency department (ED) registration. However, over 70% patients presenting to hospital with suspected NF (sNF) cannot access absolute neutrophil count (ANC) result within 1 hour, do not have NF and do not require UBSAs. In ED and hospitalised patients with sNF, we hypothesise that the ASTERIC protocol effectively and safely reduces the use of UBSAs compared with standard care alone.Methods and analysisThis pragmatic, parallel, multicentre, type 1, hybrid effectiveness-implementation, stepped-wedge, before-and-after, cluster randomised controlled trial aims to evaluate whether antibiotic prescribing can be safely reduced through implementing a multifaceted antibiotic stewardship intervention (ASTERIC) in adult patients with sNF presenting to EDs. The sNF was defined as a fever with a single oral temperature of ≥38.3°C (101°F) within 24 hours before ED registration or a temperature of ≥38.0°C (100.4°F) sustained over a 1-hour period, following last chemotherapy or targeted therapy within 6 weeks for any solid tumour, or in any period following therapies against leucaemia, lymphoma, myelodysplastic syndrome, aplastic anaemia, multiple myeloma or recipient of HSCT. The study will involve eight hospitals in Hong Kong with variable baseline practice. We will include 704 adult patients (352 patients in pre-implementation and post-implementation periods, respectively) with sNF (tympanic temperature ≥38.3°C) and 48 staff participants (6 staff participants in each hospital). Healthcare professionals will receive a multifaceted stewardship intervention consisting of risk assessment tools, fast-track ANCs, a decision tool for patient management and antibiotic use, supported by an educational package and staff interaction programmes (ASTERIC protocol). Patients’ blood ANC, and cancer therapy and chronic illness therapy scores will be measured. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) and Proctor conceptual frameworks will be followed for evaluation of implementation. The main outcome measures are the mean total dose of UBSAs prescribed in 7 days and serious adverse events at 30 days. Data analysis will incorporate intention-to-treat, per-protocol and as-treated analyses for service outcomes (effectiveness, safety, quality of life assessments and cost-effectiveness) and mixed methods for implementation outcomes, informed by the Theoretical Domains Framework. We expect that the study results will inform health policy with improvement in hospital services in treating stable sNF, evidenced by improved safe antibiotic stewardship, early antibiotic de-escalation and reduced costs and length of stay.Ethics and disseminationThe institutional review boards of all study sites approved this study. This study will establish the ASTERIC protocol safely improves antibiotic stewardship and clinical management in adult patients with sNF. We will disseminate the findings through peer-reviewed publications, conference presentations and educational activities. All patients with sNF will be influenced by the new protocol which is agreed at hospital level. Randomisation is at hospital level, not patient level. Patient consent is sought for follow-up and data access, not for treatment. Staff consent is sought for interviewing.Trial registration numberNCT06794320.

Background and Clinical Significance: Psoriasis, a chronic immune-mediated inflammatory disease, can affect musculoskeletal structures, including the Achilles tendon. Achilles pain in psoriasis patients may arise from tendinitis or neuropathic pain due to peripheral nerve dysfunction, such as sural nerve (SN) involvement, a condition frequently misdiagnosed due to limitations in conventional diagnostics. Fascial tissues are critical in nerve compression syndromes. This case explores the application of a novel quantitative Sonoguide Digital Palpation (SDP) protocol and ultrasound (US)-guided hydrodissection (HD) for SN dysfunction mimicking Achilles tendinopathy in a psoriasis patient. Case Presentation: A 41-year-old male with psoriasis presented with acute onset of right heel stiffness and paresthesia. Physical examination, radiographs, and ultrasound were performed. SDP, employing a validated four-criterion diagnostic framework (including fascial mobility quantification and concordant pain provocation), identified crural fascia restriction affecting SN and reproduced patient’s concordant Achilles pain. High-resolution ultrasonography provided key morphological evidence, revealing a 2.6-fold enlargement of the sural nerve’s cross-sectional area (CSA) on the affected side (13 mm2) compared to the asymptomatic side (5 mm2). Notably, a positive Tinel’s sign was elicited over the psoriatic plaque. US-guided HD was performed using 50 cc of 5% dextrose in water (D5W) without local anesthetic below the psoriatic lesion. Post-HD, the patient reported immediate and significant pain relief (Numeric Pain Rating Scale (NPRS) score reduction from 8 to 2), confirming the prompt correction of a clinically important fascial restriction, associated with improved SN mobility, objectively verified by a post-procedure SDP assessment. At 24-month follow-up, sustained symptom relief and complete functional recovery were reported. Conclusions: This case highlights SDP’s ability to objectively visualize and confirm fascial restriction as a cause of nerve dysfunction by quantitatively reproducing concordant pain. The objective finding of nerve swelling provides sonographic substantiation for the functional diagnosis of nerve dysfunction. This integrated diagnostic approach, combining dynamic functional assessment with morphological confirmation, offers a novel paradigm for evaluating peripheral nerve disorders. US-guided HD of the SN with D5W without local anesthetic shows promise as both a diagnostic confirmatory tool and therapeutic intervention for neuropathic Achilles pain in psoriasis patients with SN involvement, aligning with its efficacy in other peripheral neuropathies. The significant nerve swelling (13 mm2) provides robust morphological corroboration of the functional impairment diagnosed by SDP, offering a more comprehensive diagnostic paradigm.