Kwong Wah Hospital

<h3>Background</h3> Current guidelines for hepatocellular carcinoma (HCC) screening in patients with chronic liver disease (CLD) recommend ultrasound and/or α-fetoprotein (AFP) testing every 6 months. However, both methods exhibit low sensitivity for early-stage HCC. Building on our previous study that identified a novel blood test signature for HCC, this study aims to develop a routine blood-based artificial intelligence (AI) model for HCC detection. <h3>Patients and methods</h3> Records from 2000 to 2018 were retrieved from Hospital Authority Data Collaboration Laboratory, a territory-wide database. CLD (hepatitis/cirrhosis) patients with and without HCC were identified with International Classification of Diseases codes, anti-viral drug history, virology test, and radiology reports. Decompensated cases were excluded. Blood records within 1 month before the diagnosis of HCC and CLD patients were retrieved. Data from 2000 to 2015 were split into training and testing cohorts in an 80 : 20 ratio, while data from 2016 to 2018 were used as the validation set. Machine learning models were applied and their performances were compared with AFP. <h3>Results</h3> The cohort yielded >75 000 patients including 19 670 patients with HCC. Results from the test set demonstrated promising capabilities in excluding CLD patients, achieving a sensitivity of 80% and a specificity of 81% (area under the receiver operating characteristic curve=0.894) at a cut-off value of 0.43. The AI model outperformed AFP in early-stage detection, maintaining higher sensitivity across all Barcelona Clinic Liver Cancer stages. <h3>Conclusions</h3> This novel AI model, which uses only standard blood test results, shows strong potential for improving the detection of HCC, significantly outperforming the traditional alpha-fetoprotein (AFP) test. Its straightforward design offers a practical and widely accessible screening option that could be integrated into existing healthcare pathways to aid earlier diagnosis.

Objective: Eosinophilic granulomatosis with polyangiitis (EGPA) is a form of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis. Data among Chinese patients is sparse. This multicenter retrospective study aims to assess the presentation, treatment strategies, and outcomes of EGPA in Hong Kong. Methods: Patients with newly diagnosed EGPA who presented to eight participating hospitals in Hong Kong between January 1, 2013 and December 31, 2023 were identified. Clinical history and laboratory parameters were collected and analyzed. Outcomes, including mortality, relapse, and complications from disease and treatment, were assessed. Results: Seventy-six patients were identified. The annual incidence of EGPA was estimated at 1.9 per million population. Regarding the presentation, neurological symptoms (71.1%) were most frequently observed, followed by cutaneous (54%) and pulmonary symptoms (52.6%). The presence of anti-myeloperoxidase antibody (anti-MPO) correlated with a higher Birmingham Vasculitis Activity Score (BVAS) on presentation, more renal involvement, and absence of asthma. While anti-PR3 was associated with cardiovascular manifestations. Treatment mainly involved corticosteroids and cyclophosphamide as induction and azathioprine as maintenance. Biologics were used for induction in 18.4% of cases and for maintenance in 7.9%. Infective complications occurred in 29% of patients; a starting prednisolone dose [Formula: see text] 40 mg daily and a history of diabetes mellitus were identified as risk factors. Relapses occurred in 26.3% of subjects; the mean time to relapse was 39.5 months. Multivariate survival analysis revealed that a history of smoking [Formula: see text] 1 year (HR 20.63, 95% CI 2.76–154.37, [Formula: see text] = 0.03), absence of asthma (HR 0.13, 95% CI 0.02–0.96, [Formula: see text] = 0.045), and absence of neurological involvement on presentation (HR 0.06, 95% CI 0.01–0.45, [Formula: see text] = 0.006) were associated with mortality. Conclusion: This study underscored the heterogeneity of EGPA in the Chinese population and supports categorization based on anti-MPO status. Smoking history and absence of asthma or neurological symptoms were associated with mortality. The findings aim to inform clinical practice and direct future research efforts in managing this complex disease.

Background and ObjectivesInformal caregivers of people with dementia experience significant caregiving stress. Mindfulness-based interventions are effective approaches for alleviating caregiving stress. However, traditional mindfulness training is intensive and challenging to attend due to the substantial caregiving responsibilities of this population, leading to issues with program attrition and adherence. To address this limitation, a novel Mindfulness-Based Dementia Care Program (MBDCP) was developed by simplifying traditional mindfulness training and utilizing a hybrid delivery model tailored to the needs of dementia caregivers. This study aimed to evaluate the effectiveness of the MBDCP in reducing caregiving stress compared with a brief education program.Research Design and MethodsA single-blinded, parallel-group randomized controlled trial was conducted with 127 dementia caregivers (MBDCP: n = 64; Control: n = 63) recruited from three community care centers in Hong Kong. The MBDCP included six weekly 90-min sessions delivered through face-to-face and online formats. Outcomes were assessed at baseline, postintervention, and 6-month follow-up. The primary outcome was perceived stress, whereas secondary outcomes included heart rate variability, mindfulness, depressive symptoms, caregiving burden, dyadic relationships, and neuropsychiatric symptoms of care recipients.ResultsMBDCP significantly improved perceived stress, depressive symptoms, trait mindfulness, and heart rate variability compared with the control group. No significant effects were observed on caregiving burden, dyadic relationships, positive caregiving aspects, or neuropsychiatric symptoms.Discussion and ImplicationsThe MBDCP effectively reduced stress and improved psychophysiological outcomes in dementia caregivers. These findings highlight the potential of simplified, hybrid mindfulness training to enhance accessibility and effectiveness for this population.

Objectives: To investigate the use of intrapartum ultrasound (ITU) under different indications for assisted vaginal delivery, as well as the frequencies of assessment of various ITU parameters, by clinicians in a single hospital.Methods: Medical records of women who underwent assisted vaginal delivery at Kwong Wah Hospital between 3 January 2023 and 2 January 2024 were retrospectively reviewed.Seven ITU parameters were recorded: spine position, head position, angle of progression (AoP), head-perineum distance (HPD), head direction, asynclitism, and size of caput succedaneum.Results: In total, 113 assisted vaginal deliveries were included in the analysis, comprising ventouse extraction (n=94), forceps delivery (n=17), and sequential instrumental birth (n=2).There were no failed assisted vaginal deliveries.Of the 113 assisted vaginal deliveries, 70 (61.9%)had prior ITU for indications of prolonged second stage (n=46), fetal distress (n=20), and maternal medical conditions (n=4); the respective ITU use rates were 92.0%, 35.7%, and 57.1% (p<0.001).Among the 70 assisted vaginal deliveries with prior ITU, 29 (41.4%) had all seven sonographic parameters assessed before making the decision for assisted vaginal delivery.In terms of individual ITU parameters, HPD and AoP were assessed in all cases, followed by spine position (92.9%),size of caput succedaneum (80.0%), asynclitism (78.6%), head position (62.9%), and head direction (42.9%).The frequencies of assessment among parameters differed significantly (p<0.001).Asynclitism and size of caput succedaneum were assessed least frequently than head and spine positions, as well as station and descent (as measured by HPD, AoP, or head direction). Conclusion:The rate of using ITU to assess labour progress prior to assisted vaginal delivery for prolonged second stage was high at our hospital under the opt-out protocol.Sonographic assessment of fetal spine position and head station (via HPD and AoP) was most commonly performed.The opt-out protocol may encourage ITU use, particularly in cases of delayed second stage, while preserving clinicians' independent judgement.

Background: IgG4-related disease (IgG4-RD) is a systemic fibroinflammatory condition characterised by dense lymphoplasmacytic infiltration of IgG4-positive cells, storiform fibrosis, and obliterative phlebitis. Serum IgG4 levels are usually, but not always, elevated. This retrospective study aims to elucidate differences in clinical characteristics between patients with elevated and normal serum IgG4 levels. Methods: Patients diagnosed with IgG4-RD who fulfilled the 2019 ACR/EULAR and/or 2020 Revised Comprehensive Diagnostic (RCD) criteria at the Rheumatology Departments of The Prince of Wales Hospital and Kwong Wah Hospital were included. Seronegative IgG4-RD was defined as serum IgG4 [Formula: see text] 1.35 g/L, in accordance with the 2020 RCD criteria. Patients with less than one year of follow-up were excluded. Variables with a p-value [Formula: see text] 0.1 in univariate analysis were included in a multivariate logistic regression to identify factors independently associated with seronegativity at baseline. Results: Of the 84 IgG4-RD patients, 82 (98%) had serum IgG4 levels measured prior to treatment and were included in the analysis. Of the 82 patients, the most commonly affected organs were the salivary glands (n[Formula: see text]56, 68%), lymph nodes (n[Formula: see text] 33, 40%), and lacrimal glands (n [Formula: see text]28, 34%). Nine patients (11%) had normal serum IgG4 levels, with the lacrimal and salivary glands being the most frequently affected (both n [Formula: see text] 3, 33%). Seronegative patients were more likely to have single-organ involvement and no salivary gland involvement. Other demographic and clinical characteristic differences are summarised in Table 1. Multivariate analysis revealed that seronegativity was independently associated with fewer organs affected (OR [Formula: see text] 0.313, 95% CI [0.098, 1.000], p [Formula: see text] 0.049) and absence of salivary gland involvement (OR [Formula: see text] 0.194, 95% CI [0.038, 0.996]). Treatment patterns and relapse rates were similar between the two groups. Conclusion: According to the two most commonly used diagnostic and classification criteria, elevated serum IgG4 is not required for the diagnosis of IgG4-RD. This study reiterated that serum IgG4 levels can be normal in a subgroup of patients. Clinicians should still consider IgG4-RD as a differential diagnosis even when serum IgG4 levels are within the reference range, particularly in patients with limited systemic involvement.

Detecting EGFR mutations in plasma using droplet digital PCR (ddPCR) assay offers a promising diagnostic tool for lung cancer patients. The performance of plasma-based ddPCR assay relative to traditional EGFR mutation testing in tissue biopsies among Asian patients with suspected lung cancer remains underexplored. Consecutive patients admitted for diagnostic workup for suspected lung cancer were recruited. Peripheral blood samples were collected on the same day of tissue biopsies. Tissue samples were subjected to EGFR mutation analysis via real-time PCR, whereas plasma samples were processed for ddPCR assay to evaluate for EGFR mutation status. The tissue re-biopsy rate was 43.8% while 0.7% of patients failed blood taking. Despite repeat biopsy, 15.2% of patients could not achieve histological diagnosis. Of the 202 patients newly diagnosed with lung cancer, EGFR mutations were detected in 13.4% of plasma samples, compared to 44.3% in tissue samples. Plasma ddPCR for EGFR mutations detection were barely detectable in stages I and II non-small cell lung cancer (NSCLC), but the sensitivity was 25.0%, 56.3%, and 75.0% in stages III, IVA, and IVB NSCLC, respectively. Plasma EGFR mutations were highly specific among all stages of lung cancer. Concordance rates of plasma ddPCR assay also rose with more advanced stages, recorded at 41.9% for stages I and II, 71.9% for stage III, 86.3% for stage IV. In stage IV lung cancer, the false negative rate for the plasma ddPCR assay was 34.4%, whereas that for the tissue testing was 19.2% due to insufficient tissue samples. Plasma-based EGFR genotyping using ddPCR is a non-invasive method that offers early diagnosis and serves as a valuable adjunct to tissue-based testing for patients with advanced-stage lung cancer. However, its usefulness is limited in the context of early-stage lung cancer, indicating a need for further research to improve its accuracy in these patients.

Adult-onset idiopathic inflammatory myopathies (IIMs) are associated with cancer. Guideline on cancer risk stratifications and screening in IIM patients was recently published, but their external validity remains verified. We evaluated its applicability and reliability among a Hong Kong IIM cohort. The longitudinal observational cohort collected data from IIM patients fulfilling relevant classification criteria from eight rheumatology centres in Hong Kong. Demographic, clinical and laboratory data were reviewed from 2004 to 2023. IIM patients were stratified into standard, intermediate or high-risk subgroups according to the IMACS guideline. The occurrence of malignancy at or after IIM diagnosis was analysed. Independent risk factors for cancer were evaluated. A total of 479 patients were included with 327 females (68.3%) and mean age of IIM diagnosis at 54.5 ± 13.6 years. In total, 214 (44.7%) and 238 (49.7%) patients were stratified to high and intermediate risk groups, respectively. Only 5.6% belonged to the standard-risk group. Sixty patients (12.5%) had cancer within 3 years of IIM diagnosis. Nasopharyngeal (25%), lung (21.1%) and breast (10.5%) were the top three cancers. Significantly more patients (44, 20.6%) in the high-risk group developed cancer within 3 years, compared with intermediate (6.7%, P < 0.001) and standard-risk (0%, P = 0.009) groups. Risk factors for cancer included older age (OR: 1.048, 95%CI: 1.019-1.078), Gottron's rash (OR: 2.453, 95%CI: 1.123-5.356), absence of interstitial lung disease (OR 2.695, 95% CI: 1.154-6.295), anti-TIF1g positivity (OR: 4.627, 95% CI: 2.046-10.461) and anti-SAE1 positivity (OR: 5.325, 95% CI: 1.271-22.300). Our real-world study supported the accuracy of cancer risk stratification. The vast majority of IIM patients would be subjected to extensive cancer screening when the guideline was applied.