COVID-19 vaccination and transmission patterns among pregnant and postnatal women during the fifth wave of COVID-19 in a tertiary hospital in Hong Kong.

INTRODUCTION: Vaccination is a key strategy to control the coronavirus disease 2019 (COVID-19) pandemic. Safety concerns strongly influence vaccine hesitancy. Disease transmission during pregnancy could exacerbate risks of preterm birth and perinatal mortality. This study examined patterns of vaccination and transmission among pregnant and postnatal women during the fifth wave of COVID-19 in Hong Kong. METHODS: The Antenatal Record System and Clinical Management System of the Hospital Authority was used to retrieve information concerning the demographic characteristics, vaccination history, COVID-19 status, and obstetric outcomes of women who were booked for delivery at Queen Mary Hospital in Hong Kong and had attended the booking antenatal visit from 1 July 2021 to 30 June 2022. RESULTS: Among 2396 women in the cohort, 2006 (83.7%), 1843 (76.9%), and 831 (34.7%) had received the first, second, and third doses of COVID-19 vaccine, respectively. Among 1012 women who had received the second dose, 684 (67.6%) women were overdue for their third dose. There were 265 (11.1%) reported COVID-19 cases. Women aged 20 to 29 years had a low vaccination rate but the highest disease rate (19.1%). The disease rate was more than tenfold higher in women who had no (20.3%) or incomplete (18.8%) vaccination, compared with women who had complete vaccination (2.1%; P<0.001). CONCLUSION: Acceptance of COVID-19 vaccination was low in pregnant women. Urgent measures are needed to promote vaccination among pregnant women before the next wave of COVID-19.

[Perivascular epithelioid cell tumor of the lung: a clinicopathological analysis of eight cases].

Objective: To investigate the clinicopathological features of perivascular epithelioid cell tumor (PEComa) of the lung. Methods: Eight PEComa cases of the lung diagnosed at the First Affiliated Hospital of Soochow University, Suzhou, China from July 2008 to December 2021 were collected and subject to immunohistochemical staining, fluorescence in situ hybridization and next generation sequencing. The relevant literature was reviewed and the clinicopathological features were analyzed. Results: There were 5 males and 3 females, aged from 18 to 70 years (mean 39 years). There were 3 cases of the right upper lung, 3 cases of the left lower lung, 1 case of the left upper lung and 1 case of the right middle lung. Seven cases were solitary and 1 case was multifocal (4 lesions). Seven cases were benign while one was malignant. The tumors were all located in the peripheral part of the lung, with a maximum diameter of 0.2-4.0 cm. Grossly, they were oval and well circumscribed. Microscopically, the tumor cells were oval, short spindle-shaped, arranged in solid nests, acinar or hemangiopericytoma-like patterns, with clear or eosinophilic cytoplasm. The stroma was rich in blood vessels with hyalinization. Coagulated necrosis and high-grade nuclei were seen in the malignant case, and calcification was seen in 2 cases. Immunohistochemically, the tumor cells were positive for Melan A (8/8), HMB45 (7/8), CD34 (6/8), TFE3 (4/7), and SMA (3/8). All cases were negative for CKpan and S-100. TFE3 (Xp11.2) gene fusion was examined using the TFE3 break-apart fluorescence in situ hybridization in 5 cases, in which only the malignant case was positive. The next generation sequencing revealed the SFPQ-TFE3 [t(X;1)(p11.2;p34)] fusion. Follow-up of the patients ranged from 12 to 173 months while one patient was lost to the follow-up. The malignant case had tumor metastasis to the brain 4 years after the operation and then received radiotherapy. Other 6 cases had no recurrence and metastasis, and all the 7 patients survived. Conclusions: Most of the PEComas of the lung are benign. When there are malignant morphological features such as necrosis, high-grade nuclei or SFPQ-TFE3 gene fusion, close follow-up seems necessary.

What can the Interventional Endoscopist Offer in the Management of Upper Gastrointestinal Malignancies?

The therapeutic possibilities of endoscopy have rapidly increased in the last decades and now allow organ-sparing treatment of early upper gastrointestinal malignancy as well as an increasing number of options for symptom palliation. This review contains an overview of the interventional endoscopic procedures in upper gastrointestinal malignancies. It describes endoscopic treatment of early oesophageal and gastric cancers, and the palliative options in managing dysphagia and gastric outlet obstruction. It also provides an overview of the therapeutic possibilities of biliary endoscopy, such as retrograde stenting and radiofrequency biliary ablation. Endoscopic ultrasound-guided therapeutic options are discussed, including biliary drainage, gastrojejunostomy and coeliac axis block. To aid in clinical decision making, the procedures are described in the context of their indication, efficacy, risks and limitations.

[Clinical value of nomogram model in evaluating the prognosis of cholangiocarcinoma after interventional therapy].

Objective: To investigate the clinical value and efficacy of the nomogram model in evaluating the prognosis of cholangiocarcinoma after interventional therapy. Methods: The clinical data of 259 patients with cholangiocarcinoma who received interventional therapy at the First Affiliated Hospital of zhengzhou University from January 2014 to June 2021 were retrospectively analyzed, including 148 males and 111 females, aged from 26 to 91 (65±12) years. They were randomly divided into a training group (181 cases) and a validation group (78 cases) in a ratio of 7∶3. Cox regression analysis was performed in the training group, independent risk factors affecting the prognosis of patients were screened, and a nomogram for 6-month, 1-year, and 2-year survival was constructed. The performance of the nomogram was analyzed by calculating the area under the receiver operating characteristic curve (AUC) value, calibration curve, and decision curve, and the predictive efficacy of the model was evaluated in the validation group. Results: There was no significant difference in baseline data between the training group and the validation group, which was comparable. Regression analysis showed that T stage (T2: HR=0.147,95%CI: 0.077-0.281;T3: HR=0.207,95%CI: 0.122-0.351;T4: HR=0.864,95%CI: 0.537-1.393), tumor diameter (17-33 mm: HR=0.201,95%CI: 0.119-0.341;≥33 mm: HR=0.795,95%CI: 0.521-1.211) and differentiation degree(middle differentiation: HR=3.318,95%CI: 2.082-5.289;highly differentiation: HR=1.842,95%CI: 1.184-2.867) were risk factors affecting the prognosis of interventional therapy for cholangiocarcinoma. The AUC values of the survival curve prediction models were generally consistent between the training and validation groups, and the AUC values of the training group at 6 months, 1 year, and 2 years were 0.925 (95%CI: 0.888-0.963), 0.921 (95%CI: 0.877-0.964) and 0.974 (95%CI: 0.957-0.993), respectively. In the validation group, the 6-month, 1-year, and 2-year AUC values were 0.951 (95%CI: 0.911-0.991), 0.917 (95%CI: 0.857-0.977) and 0.848 (95%CI: 0.737-0.959), respectively, and the AUC values were all greater than 0.8, suggesting that the nomogram had better discrimination ability. The calibration curves of the prediction models of the two groups were basically consistent, and the shape of the calibration curves at 6 months and 1 year fitted the ideal curve, while the fitting degree of the calibration curves at 2 years was relatively poor. The decision curve showed the high clinical utility of this nomogram in predicting the 6-month, 1-year survival of patients with cholangiocarcinoma. Conclusions: T stage, tumor diameter, and differentiation are independent risk factors affecting the prognosis of patients with interventional cholangiocarcinoma, and the nomogram model proposed in this study has good distinguishing ability and exact clinical value for prognosis evaluation.

As-Required Filgrastim for Late-Onset Neutropenia Complicating Long-Term Clozapine Treatment: a Case Report.

Clozapine is considered the most effective antipsychotic for schizophrenia, but it can cause neutropenia and even agranulocytosis. We describe the first case in Hong Kong involving the use of filgrastim, a recombinant form of human granulocyte colony-stimulating factor, to enable clozapine continuation therapy for a severely ill patient with treatment-resistant schizoaffective disorder who developed recurrent neutropenia after almost 20 years of continuous clozapine therapy. Therefore, clinical vigilance is important, regardless of clozapine treatment duration. Filgrastim can facilitate long-term clozapine therapy in patients with clozapine-induced neutropenia.

Disconnect between the effects of serelaxin on renal function and outcome in acute heart failure.

BACKGROUND: We aimed to study whether improvement in renal function by serelaxin in patients who were hospitalized for acute heart failure (HF) might explain any potential effect on clinical outcomes. METHODS: We included 6318 patients from the RELAXin in AHF-2 (RELAX-AHF2) study. Improvement in renal function was defined as a decrease in serum creatinine of ≥ 0.3 mg/dL and ≥ 25%, or increase in estimated glomerular filtration rate of ≥ 25% between baseline and day 2. Worsening renal function (WRF) was defined as the reverse. We performed causal mediation analyses regarding 180-day all-cause mortality (ACM), cardiovascular death (CVD), and hospitalization for HF/renal failure. RESULTS: Improvement in renal function was more frequently observed with serelaxin when compared with placebo [OR 1.88 (95% CI 1.64-2.15, p < 0.0001)], but was not associated with subsequent clinical outcomes. WRF occurred less frequent with serelaxin [OR 0.70 (95% CI 0.60-0.83, p < 0.0001)] and was associated with increased risk of ACM, worsening HF and the composite of CVD and HF or renal failure hospitalization. Improvement in renal function did not mediate the treatment effect of serelaxin [CVD HR 1.01 (0.99-1.04), ACM HR 1.01 (0.99-1.03), HF/renal failure hospitalization HR 0.99 (0.97-1.00)]. CONCLUSIONS: Despite the significant improvement in renal function by serelaxin in patients with acute HF, the potential beneficial treatment effect was not mediated by improvement in renal function. These data suggest that improvement in renal function might not be a suitable surrogate marker for potential treatment efficacy in future studies with novel relaxin agents in acute HF. Central illustration. Conceptual model explaining mediation analysis; treatment efficacy of heart failure therapies mediated by renal function.

[Study of the negative regulation of transforming growth factor beta type II receptor to inhibit the occurrence and development of liver fibrosis with miR-217].

Objective: To observe the effect of miR-217 on angiotensin II (AngII)-induced hepatic stellate cells (HSCs) activation, and carbon tetrachloride (CCl4)-induced overexpression in mice, so as to clarify miR-217 role in liver fibrosis. Methods: HSCs were stimulated with AngⅡ and the changes condition in the expression level of miR-217 were detected. HSCs were divided into control group, AngII-treated group and AngⅡ+miR-217-treated group. The expression levels of alpha-smooth muscle actin, fibroblast-specific protein 1 and collagen Ⅰ (Collagen Ⅰ) in each group were detected. The target gene of mir-217 was screened and verified by Targetscan and Dual luciferase gene reporter assay. Real-time quantitative PCR and Western blot were used to detect the effect of miR-217 on the expression level of transforming growth factor beta type Ⅱ receptor (TGFBR2). A CCl4-induced mouse liver fibrosis model was constructed. Masson staining and Sirius red staining were used to detect the effect of miR-217 overexpression on the progression of liver fibrosis in CCl4 mice. Data of two groups were compared using t-test. Data of multiple groups were statistically analyzed with one-way ANOVA. Results: The expression level of miR-217 was downregulated by AngⅡ-stimulated HSC cells. The expression levels of α-smooth muscle actin, fibroblast-specific protein 1 and Collagen Ⅰ induced by AngⅡ was inhibited by miR-217 mimics transfection. The 3'-UTR of TGFBR2 had specifically bind miR-217. The mRNA and protein expression levels of TGFBR2 was inhibited with miR-217 mimics transfection in HSCs. The overexpression of miR-217 had inhibited the expression levels of Collagen Ⅰ and Ⅲ in CCl4 mice and alleviated the progression of liver fibrosis . Conclusion: miR-217 regulates liver fibrosis by targeting TGFBR2, inhibits AngII-induced HSC activation, and slows down the process of liver fibrosis in CCl4 mice, suggesting that miR-217 may have an inhibitory effect on liver fibrosis.

Wilson Sims Fall Risk Assessment Tool Versus Morse Fall Scale in Psychogeriatric Inpatients: a Multicentre Study.

OBJECTIVE: To compare predictive validity of the Wilson Sims Fall Risk Assessment Tool (WSFRAT) with that of the Morse Fall Scale (MFS) in psychogeriatric inpatients. METHODS: Psychogeriatric patients from Shatin Hospital, Tai Po Hospital, Castle Peak Hospital, and United Christian Hospital who had fall incident between April 2019 and April 2020 were identified. Their fall risks were assessed by the WSFRAT and the MFS, and their falls incidents during hospitalisation were recorded. Patients were classified as having high fall risk when their MFS score was ≥45 and when their WSFRAT score was ≥7. Sensitivity, specificity, and positive and negative predictive values of the two scales were calculated. RESULTS: We identified 183 (90 male and 93 female) psychogeriatric patients aged ≥65 years who had fall incident and were assessed by both the WSFRAT and the MFS during the study period. Among the 183 patients, four sustained a fall during hospital stay, giving a prevalence of 2.19%. All four patients were classified as having high risk of fall by WSFRAT, but only two of them were classified so by MFS. The sensitivity of WSFRAT was 100%, which was higher than the 50% by MFS, but specificity of MFS was higher than that of WSFRAT (45.81% vs 54.75%). CONCLUSION: WSFRAT is a better fall risk assessment scale for psychiatric inpatients than MFS, because of higher sensitivity (100% vs 50%). It has items specific to psychiatric patients and should replace MFS in psychiatric settings.

Brief report: A randomized controlled trial of a compensatory cognitive training to improve prospective memory performance in people with schizophrenia or depression.

People with schizophrenia or depression have prospective memory (PM) deficits, which affect their daily living. Given the paucity of research into training to correct PM deficits, we subjected a group of participants to a Chinese version of the PM module of the Cognitive Compensatory Training (CCT-C-PM) intervention to study its effect on their PM performance. Specifically, we independently randomized two diagnostic cohorts (schizophrenia and depression) into control groups (occupational therapy only) or experimental groups (CCT-C-PM and occupational therapy). The schizophrenia cohort had 17 participants in its control group and 23 participants in its experimental group. The depression cohort had 10 participants in its control group and 12 participants in its experimental group. The sociodemographic information of the participants was collected. Their symptoms and PM performances were measured at baseline and after treatment (after the completion of the CCT-C-PM intervention in the experimental group and the same timeframe in the control group). The treatment effects were examined by a repeated measure analysis of variance/analysis of covariance and a post hoc Scheffé test. The effect sizes (Cohen's d) of treatments against the controls were also calculated. There was no difference between the experimental and control groups in either cohort in terms of sociodemographic data, symptoms, and PM measures at baseline. The sex combination differed across the groups in the depression cohort. We found that the CCT-C-PM improved PM, especially event-based PM, for which large effect sizes were seen. The effect on time-based PM was unclear and requires future study. Our findings suggest that the CCT-C-PM is a viable training method for improving PM.

A radiomics model for determining the invasiveness of solitary pulmonary nodules that manifest as part-solid nodules.

AIM: A nomogram model was developed to predict the histological subtypes of lung invasive adenocarcinomas (IAs) and minimally invasive adenocarcinomas (MIAs) that manifest as part-solid ground-glass nodules (GGNs). MATERIALS AND METHODS: This retrospective study enrolled 119 patients with histopathologically confirmed part-solid GGNs assigned to the training (n=83) or testing cohorts (n=36). Radiomic features were extracted based on the unenhanced computed tomography (CT) images. R software was applied to process the qualitative and quantitative data. The CT features model, radiomic signature model, and combined prediction model were constructed and compared. RESULTS: A total of 396 radiomic features were extracted from the preoperative CT images, four features including MaxIntensity, RMS, ZonePercentage, and LongRunEmphasis_angle0_offset7 were indicated to be the best discriminators to establish the radiomic signature model. The performance of the model was satisfactory in both the training and testing set with areas under the curve (AUCs) of 0.854 (95% confidence interval [CI]: 0.774 to 0.934) and 0.813 (95% CI: 0.670 to 0.955), respectively. The CT morphology of the lesion shape and diameter of the solid component were confirmed to be a significant feature for building the CT features model, which had an AUC of 0.755 (95% CI: 0.648 to 0.843). A nomogram that integrated lesion shape and radiomic signature was constructed, which contributed an AUC of 0.888 (95% CI: 0.82 to 0.955). CONCLUSIONS: The radiomic signature could provide an important reference for differentiating IAs from MIAs, and could be significantly enhanced by the addition of CT morphology. The nomogram may be highly informative for making clinical decisions.

Factors Associated with Falls in Psychogeriatric Inpatients and Comparison of Two Fall Risk Assessment Tools.

OBJECTIVES: Development of a fall prevention programme for psychogeriatric inpatients is required. Therefore, the present study aimed to investigate factors associated with falls in psychogeriatric inpatients and compare two fall risk assessment tools. METHODS: This study had two parts. First, all fall reports involving psychogeriatric inpatients in United Christian Hospital in 2016 were retrospectively reviewed. Factors associated with the falls were identified by comparing patients who had a fall incident and those who did not. Second, in a pilot study, 30 consecutive psychogeriatric inpatients were assessed for fall risk using the Morse Fall Scale (MFS) and the Wilson Sims Fall Risk Assessment Tool (WSFRAT), and outcomes were then compared with the modified Functional Ambulation Classification (MFAC). RESULTS: In 2016, 46 women and 47 men aged 65 to 94 years were admitted to the psychiatric wards (two women and two men were admitted twice). A total of 12 falls involving nine women and two men were reported. Over 66% of falls involved patients with dementia, 75% involved women, and over 50% occurred on the way to the bathroom, mostly during the night shift when the staffing level was low. In the pilot study, of 30 consecutive psychogeriatric inpatients, 20 were classified as high risk by the WSFRAT and 10 of them were also classified as high risk by the MFS. Those classified as high risk by WSFRAT matched perfectly with those classified as high risk by MFAC. However, 30% of those classified as high risk by MFAC were not classified as high risk by MFS. CONCLUSIONS: Patients with dementia and women had higher risk of fall. Extra proportion of at-risk patients are able to benefit from additional fall risk interventions when WSFRAT is used instead of MFS. Further studies are needed to calculate the psychometric properties of WSFRAT.

Respiratory virus infection among hospitalized adult patients with or without clinically apparent respiratory infection: a prospective cohort study.

OBJECTIVES: To determine the viral epidemiology and clinical characteristics of patients with and without clinically apparent respiratory tract infection. METHODS: This prospective cohort study was conducted during the 2018 winter influenza season. Adult patients with fever/respiratory symptoms (fever/RS group) were age- and sex-matched with patients without fever/RS (non-fever/RS group) in a 1:1 ratio. Respiratory viruses were tested using NxTAG™ Respiratory Pathogen Panel IVD, a commercially-available multiplex PCR panel. RESULTS: A total of 214 acutely hospitalized patients were included in the final analysis, consisting of 107 with fever/RS (fever/RS group), and 107 age- and sex-matched patients without fever/RS (non-fever/RS group). Respiratory viruses were detected in 34.1% (73/214) of patients, and co-infection occurred in 7.9% (17/214) of patients. The incidence of respiratory virus was higher in the fever/RS group than in the non-fever/RS group (44.9% (48/107) versus 23.4% (25/107), p 0.001). Influenza B virus, enterovirus/rhinovirus and coronaviruses were detected more frequently in the fever/RS group, whereas parainfluenza virus 4B and adenovirus were detected more frequently in the non-fever/RS group. Among the non-fever/RS group, chest discomfort was more common among patients tested positive for respiratory viruses than those without respiratory virus detected (44% (11/25) versus 22% (18/82), p 0.04). CONCLUSIONS: Respiratory viruses can be frequently detected among hospitalized patients without typical features of respiratory tract infection. These patients may be a source of nosocomial outbreaks.

Saliva as a diagnostic specimen for testing respiratory virus by a point-of-care molecular assay: a diagnostic validity study.

OBJECTIVES: Automated point-of-care molecular assays have greatly shortened the turnaround time of respiratory virus testing. One of the major bottlenecks now lies at the specimen collection step, especially in a busy clinical setting. Saliva is a convenient specimen type that can be provided easily by adult patients. This study assessed the diagnostic validity, specimen collection time and cost associated with the use of saliva. METHODS: This was a prospective diagnostic validity study comparing the detection rate of respiratory viruses between saliva and nasopharyngeal aspirate (NPA) among adult hospitalized patients using Xpert® Xpress Flu/RSV. The cost and time associated with the collection of saliva and nasopharyngeal specimens were also estimated. RESULTS: Between July and October 2017, 214 patients were recruited. The overall agreement between saliva and NPA was 93.3% (196/210, κ 0.851, 95% CI 0.776-0.926). There was no significant difference in the detection rate of respiratory viruses between saliva and NPA (32.9% (69/210) versus 35.7% (75/210); p 0.146). The overall sensitivity and specificity were 90.8% (81.9%-96.2%) and 100% (97.3%-100%), respectively, for saliva, and were 96.1% (88.9%-99.2%) and 98.5% (94.7%-99.8%), respectively, for NPA. The time and cost associated with the collection of saliva were 2.26-fold and 2.59-fold lower, respectively, than those of NPA. CONCLUSIONS: Saliva specimens have high sensitivity and specificity in the detection of respiratory viruses by an automated multiplex Clinical Laboratory Improvement Amendments-waived point-of-care molecular assay when compared with those of NPA. The use of saliva also reduces the time and cost associated with specimen collection.

Epidemiology of Inflammatory Bowel Disease in Southern Peninsular Malaysia.

AIM: To record the incidence and prevalence of inflammatory bowel disease (IBD), its social demographics, clinical characteristics and treatment, in the state of Johor, Malaysia. METHODS: Hospital Sultanah Aminah, Johor Bahru, is the only public hospital in Johor with a Gastroenterology service. Data on all existing and new IBD patients managed by the Gastroenterology Unit in 2016 were collected. Incidence and prevalence of IBD in 2016 were then calculated based on the estimated population of Johor and Johor Bahru. RESULTS: Twenty-five new cases of IBD were diagnosed in 2016. Among the 25 cases, 13 cases were Crohn's disease (CD), 10 were ulcerative colitis (UC) and two were IBD Unclassified (IBDU). The crude incidence of IBD, CD, UC and IBDU were 0.68, 0.36, 0.27, and 0.05 per 100,000 population respectively. Ethnic Indians had the highest incidence of IBD at 4.21 followed by Malays and Chinese at 0.56 and 0.18 per 100,000 population respectively. A total of 156 IBD cases were captured. Amongst them, 85 cases were UC, 68 cases were CD and three cases were IBDU, hence the prevalence of IBD, UC, CD and IBDU were 4.27, 2.33, 1.86 and 0.08 per 100,000 population respectively. Similarly, Indians had the highest prevalence at 16.84, followed by Chinese at 4.06 and Malays at 3.44 per 100,000 population. CONCLUSIONS: The incidence of IBD in Johor is comparable to that of a previous study in northern Peninsular Malaysia. The ethnicity preponderance is similar to the previous studies conducted in Malaysia.

Germocyte lesions caused by porcine circovirus type 2b in Kunming mice.

Porcine circovirus type 2 (PCV2) has been known as a causative agent of reproductive failure in the sow. In the present study mouse model was used to investigate PCV2 infection. In order to investigate whether PCV2 can induce lesions of spermatocytes and oocytes, 6 male and 6 female mice were each inoculated intraperitoneally with PCV2b, and 3 male and 3 female mice mock-infected with cell culture supernatant served as controls. Samples of testes and ovaries from PCV2b-inoculated and mock-infected mice were investigated using PCR, histopathological, ultrastructural and immunofluorescent histochemical methods at 14 and 21 day post infection (dpi). The study revealed that in the virus-inoculated mice leydig cells in testes and granulosa cells in ovaries were degenerated, and a small number of spermatocytes and oocytes showed apoptosis. Positive PCV2b antigen signals were also observed in these apoptotic cells. It can be suggested that PCV2 can cause lesions of spermatocyte and oocyte prior to zygotes formation in its host.