Yan Chai Hospital

BackgroundThe Coronal Plane Alignment of the Knee (CPAK) classification describes knee phenotypes based on limb alignment and joint-line obliquity (JLO). This study evaluates CPAK distribution in the Hong Kong population and assesses how prosthesis design affects CPAK reproducibility and clinical outcomes.MethodsThis retrospective study included patients who underwent navigated total knee arthroplasty (TKA) with adjusted mechanical alignment in a single institution in 2021. First, we analyzed the epidemiology of CPAK phenotypes in our population. Second, patients were divided into 2 propensity score-matched groups based on implant design: Journey II BCS TKA (JLO prothesis) vs Persona PS TKA (joint line neutral prothesis). Radiological outcomes (mechanical hip–knee–ankle angle, lateral distal femoral angle, medial proximal tibial angle) and clinical outcomes (range of motion, Knee Society Knee Score, Western Ontario and McMaster Universities Osteoarthritis Index score, Forgotten Joint Score) assessed preoperatively and at 6 and 12 months postoperatively.ResultsOur CPAK distribution was comparable to that of other East Asian populations. The Journey II BCS TKA more effectively restored JLO and CPAK phenotypes compared to the Persona PS TKA. However, there was no statistically significant clinical correlation between the restoration of JLO, arithmetic HKA, and CPAK.ConclusionsAlthough radiological restoration improves with JLO prostheses, short-term clinical outcomes remain unaffected.

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.

The incidence of deep vein thrombosis (DVT) following total hip arthroplasty (THA) without chemoprophylaxis could be as high as 50% in Caucasians. However, according to several subsequent studies, the incidence of venous thromboembolic events (VTE) in Asians was much lower. The routine use of chemoprophylaxis, which could potentially cause increased bleeding, infection, and wound complications, has been questioned in low-incidence populations. The objective of this study is to determine the incidence of VTE after primary THA without chemoprophylaxis in an Asian population using a fast-track rehabilitation protocol and to verify the safety profile for use of 'mechanical prophylaxis alone' in patients with standard risk of VTE. This is a retrospective cohort study of 542 Hong Kong Chinese patients who underwent primary THA without chemoprophylaxis. All patients received intermittent pneumatic compression and graduated compression stockings as mechanical prophylaxis. Multimodal pain management was applied in order to facilitate early mobilisation. Routine duplex ultrasonography was performed between the fourth and seventh postoperative day for detection of proximal DVT. All patients were Chinese (mean age, 63.0±11.9 years). Six patients developed proximal DVT (incidence rate, 1.1%). None of the patients had symptomatic or fatal pulmonary embolism. The incidence of VTE after primary THA without chemical prophylaxis can be low in Asian populations when following a fast-track rehabilitation protocol. Mechanical prophylaxis alone can be regarded as a reasonably safe practice in terms of a balanced benefit-to-risk ratio for Asian patients with standard risk of VTE.

Acquired cystic kidney disease (ACKD) can occur in patients with chronic kidney disease and kidney failure, and its incidence increases with the duration of dialysis. In adults, ACKD is less common in the pre-dialysis group (~ 7%), but its incidence can be as high as 80% for those who are on dialysis for more than ten years. There is, however, very little information about the prevalence of ACKD in children. We report a case of malignant transformation of ACKD following a kidney transplant, highlighting the importance of surveillance of the native kidneys in paediatric patients who have been in long-term kidney replacement therapy.

Background: Patients with adult-onset idiopathic inflammatory myopathy (IIM) were at risk of cancer. While the recently published international guideline on cancer screening suggested cancer risk stratification in patients with newly diagnosed IIM, the difference in clinical and serological risk profile among patients with cancer diagnosed before and after IIM diagnosis remained uncertain. Methods: MyoHK was a longitudinal observational cohort that collected data from patients with rheumatologist diagnosis of IIM from 8 rheumatology centres in Hong Kong. Data were reviewed from 2004-2023 for this study. Patients with unavailable myositis specific antibody (MSA) were excluded from analysis. Occurrence of cancer 3 years before to 3 years after the diagnosis of IIM were documented. Patients with active cancer 3 years before diagnosis of IIM were classified to “Prior cancer” group and patients with cancer diagnosed at or within 3 years after IIM diagnosis were classified to “subsequent cancer” group. Patients were stratified to high, intermediate and standard cancer risks. Risk profile between the “prior cancer” and “subsequent cancer” groups were compared. Results: 501 patients were included in analysis. 82 patients had cancer within 3 years, in which 21 patients (25.6%) had cancer within 3 years preceding IIM diagnosis and 61 patients (74.4%) developed cancer at or within 3 years after IIM diagnosis. Nasopharyngeal, lung and breast cancers accounted for the top 3 cancers in both groups. In the “Prior cancer” group, patients were more likely to be female (85.7% vs 55.7%, p = 0.014) and were MSA-negative (33.3% vs 9.8%, p = 0.011). No patient in the “Prior cancer” group developed interstitial lung disease (0% vs 18.0%, p = 0.037) or fulfilled criteria for anti-synthetase syndrome (0% vs 13.1%, p = 0.062). Anti-TIF1g antibody was the most identified MSA in the two groups (42.9% vs 54.1%, p = 374). Myositis-associated-antibody (14.3% vs 42.6%, p = 0.019) and anti-Ro52 antibody (14.3% vs 37.7%, p = 0.047) were more common in the “subsequent cancer” group. In the overall cohort, 228 (45.5%), 246 (49.1%) and 27 (5.4%) of IIM patients were stratified into high, intermediate and standard cancer risk. Two-thirds of the “Prior cancer” group were stratified into high-risk while the remaining one-third being intermediate-risk, compared to 73.8% (p = 0.532) and 26.2% (p = 0.532) in the “subsequent cancer” group. Mortality between the two groups were comparable (38.1% vs 42.6%, p = 0.716). Conclusion: Compared to IIM patients with cancer detected at or after IIM diagnosis, patients with prior cancer were more likely to be female, negative for MSA and absence for ILD.

Background: Difficult cannulation represents a common challenge for successful endoscopic retrograde cholangiopancreatography (ERCP).Available solutions include conventional precut papillotomy and transpancreatic precut sphincterotomy.The study aim is to evaluate the safety and efficacy of the two precut methods.Methods: A total of 113 consecutive cases with precut papillotomy performed during ERCP between the period July 2020 to December 2022 in Yan Chai Hospital were enrolled in this study.Cases are divided into transpancreatic precut sphincterotomy (TPS) group (n = 55) and conventional precut papillotomy (CPP) (n = 58) only group.The primary outcome is successful biliary cannulation.Secondary outcome is post ERCP complication rate.Results: Transpancreatic precut sphincterotomy group (n = 55) has a successful cannulation rate of 83.6% ± 5.0% (p = 0.102) while conventional precut papillotmy group (n = 58) has a successful cannulation rate of 70.7% ± 6.0%.Adverse event rates were evaluated.Major bleeding occurs in 5.5% ± 3.1% vs. 12.0% ± 4.3% (p = 0.215) in TPS and CPP group and pancreatitis occurs in 7.7% ± 3.7% vs. 7.8% ± 3.8% (p = 0.97) in TPS and CPP group respectively.Logistic regression analysis revealed altered anatomy to be risk factor associated with unsuccessful cannulation.Conclusions: Both transpancreatic precut sphincterotomy and conventional precept papillotomy are effective methods to tackle difficult biliary cannulations with an ensuring safety profile.

Tracheostomy is a common surgical procedure for securing a patent airway. Anatomical variations of major vessels overlying the trachea may pose significant bleeding risk during the procedure. Hence, thorough preoperative assessment of the neck and surgeon’s intraoperative vigilance are essential. Open tracheostomy is a safer option than percutaneous dilatational tracheostomy. Extra caution with stoma wound care and change of tracheostomy tube are necessary postoperatively if any major vessel is detected in close proximity with the tracheal stoma.

BackgroundThe clinical utility of personal genomic information in identifying individuals at increased risks for dyslipidemia and cardiovascular diseases remains unclear.MethodsWe used data from Biobank Japan (n = 70,657–128,305) and developed novel East Asian-specific genome-wide polygenic risk scores (PRSs) for four lipid traits. We validated (n = 4271) and subsequently tested associations of these scores with 3-year lipid changes in adolescents (n = 620), carotid intima-media thickness (cIMT) in adult women (n = 781), dyslipidemia (n = 7723), and coronary heart disease (CHD) (n = 2374 cases and 6246 controls) in type 2 diabetes (T2D) patients.ResultsOur PRSs aggregating 84–549 genetic variants (0.251 < correlation coefficients (r) < 0.272) had comparably stronger association with lipid variations than the typical PRSs derived based on the genome-wide significant variants (0.089 < r < 0.240). Our PRSs were robustly associated with their corresponding lipid levels (7.5 × 10− 103 < P < 1.3 × 10− 75) and 3-year lipid changes (1.4 × 10− 6 < P < 0.0130) which started to emerge in childhood and adolescence. With the adjustments for principal components (PCs), sex, age, and body mass index, there was an elevation of 5.3% in TC (β ± SE = 0.052 ± 0.002), 11.7% in TG (β ± SE = 0.111 ± 0.006), 5.8% in HDL-C (β ± SE = 0.057 ± 0.003), and 8.4% in LDL-C (β ± SE = 0.081 ± 0.004) per one standard deviation increase in the corresponding PRS. However, their predictive power was attenuated in T2D patients (0.183 < r < 0.231). When we included each PRS (for TC, TG, and LDL-C) in addition to the clinical factors and PCs, the AUC for dyslipidemia was significantly increased by 0.032–0.057 in the general population (7.5 × 10− 3 < P < 0.0400) and 0.029–0.069 in T2D patients (2.1 × 10− 10 < P < 0.0428). Moreover, the quintile of TC-related PRS was moderately associated with cIMT in adult women (β ± SE = 0.011 ± 0.005, Ptrend = 0.0182). Independent of conventional risk factors, the quintile of PRSs for TC [OR (95% CI) = 1.07 (1.03–1.11)], TG [OR (95% CI) = 1.05 (1.01–1.09)], and LDL-C [OR (95% CI) = 1.05 (1.01–1.09)] were significantly associated with increased risk of CHD in T2D patients (4.8 × 10− 4 < P < 0.0197). Further adjustment for baseline lipid drug use notably attenuated the CHD association.ConclusionsThe PRSs derived and validated here highlight the potential for early genomic screening and personalized risk assessment for cardiovascular disease.

Abstract Background: Hypovitaminosis D can be observed in most fragility hip fracture patients. However, measurement of 25-hydroxyvitamin D (25(OH)D) level is costly and may not be available in some centers. Without the baseline serum 25(OH)D level, the appropriate dose of vitamin D supplementation is not known. The aim of this study was to evaluate the effectiveness and safety of vitamin D supplementation in fragility hip fracture patients compared between high- and low-dose vitamin D supplementation. Methods: A total of 140 patients diagnosed with fragility hip fracture were randomly allocated to either the high-dose (60,000 IU/week) or low-dose (20,000 IU/week) vitamin D2 supplementation group for 12 weeks. The number of patients who achieved optimal vitamin D level (serum 25(OH)D &gt; 30 ng/mL), the proportion of patients who developed hypercalcemia, and the functional outcome were compared between groups. Results: Of the 140 patients who were enrolled, 21 patients were lost to follow-up during the study period. The remaining 119 patients (58 and 61 in the high- and low-dose group, respectively) were included in the final analysis. The high-dose group had a higher rate of serum 25(OH)D restoration to optimal level than the low-dose group (82.8% vs 52.5%, respectively; p &lt; 0.001). Approximately 3.4% and 1.6% of patients in the high- and low-dose groups, respectively, had mild transient hypercalcemia, but none developed moderate, severe, or symptomatic hypercalcemia. There were no differences in functional outcome scores between groups.Conclusions: In treatment settings where baseline serum 25(OH)D level can’t be evaluated in older adults with fragility hip fracture, we recommend high-dose vitamin D2 of approximately 60,000 IU/week for 12 weeks, with subsequent switch to a maintenance dose. This regimen effectively restored serum vitamin D to an optimal level in 82.8% of patients without causing symptomatic hypercalcemia.

ObjectivesCases of injury on duty (IOD) are common in Hong Kong, but literature on this group of patients is limited. This study aims to describe local IOD cases’ epidemiological characteristics and identify factors affecting return to work (RTW) outcomes.MethodsThis is a retrospective epidemiological study of IOD patients in the orthopedic and traumatology center of Yan Chai Hospital in 2016, using the hospital’s electronic clinical record analysis and reporting system; 323 out of the 10 730 patients (M:F = 206:117; mean age 46.9 ± 11.3) were included. Data on demographics, the injury episode, administrative procedures, treatment and rehabilitation were collected. Outcomes were measured by “RTW” and “time to RTW from injury.”ResultsAround 80% of patients had a successful RTW and the mean time to RTW was 10.6 ± 9.0 months. Patients who were female, divorced or widowed and living alone in a public rental flat were less likely to RTW. Psychiatric consultations (OR 13.70, P < .001), legal disputes (OR 8.20, P < .001) and more than 5 months of waiting time for physiotherapy (OR 3.89, P = .002) were the strongest among the numerous risk factors for non‐RTW. An increase in one visit to the general outpatient clinic and the presence of legal disputes had lengthened the time to RTW by 4.8 days (P < .001) and 18.0 months (P < .001), respectively.ConclusionsSeveral demographic, psychosocial and administrative factors were negatively associated with RTW in the local population. Recommendations were made for healthcare providers and policymakers accordingly.