Effectiveness of inactivated COVID-19 vaccine CoronaVac in children aged less than 3 years old during Omicron wave in Hong Kong.

The COVID-19 pandemic has affected people of all ages worldwide. However, there is still no information on the vaccine effectiveness (VE) of inactivated COVID-19 vaccines in children aged less than 3 years old. This study highlighted that 2 doses of CoronaVac were effective in preventing COVID-19, with a VE of 83.1 %.

Dynamics of childhood obesity in Hong Kong throughout the COVID-19 pandemic before and after the school closures: a 3-year longitudinal study.

OBJECTIVE: This study is to evaluate if there is any difference in the balance between incidence of and remission from overweight/obesity in Hong Kong school-age children before and during the COVID-19 pandemic over three years. METHODS: This is a retrospective longitudinal study that involved children aged 6-16 years from a database of the School Physical Fitness Award Scheme. RESULTS: 2765 students were longitudinally followed up for two years. The prevalence of childhood overweight/obesity was increased between the 2019 and 2021 academic years (P < 0.001). During the COVID-19 pandemic, the rate of obesity remission significantly reduced by 7.9 % (P = 0.003), at a background of a plateau of obesity among children and adolescents. CONCLUSIONS: Our study provides evidence on the impact of school closure and home confinement as a standard infection control measure for the prevention of COVID-19, which are likely to break the balance between incidence of and remission from childhood obesity.

Postgraduate medical education: see one, do one, teach one and what else?

Postgraduate medical education (PGME) faces many challenges and must evolve. Three principles can guide this evolution. First, PGME apprenticeship, a form of situated learning, is guided by the four dimensions of the Cognitive Apprenticeship Model: content, method, sequence, and sociology. Second, situated learning involves experiential learning and inquiry processes; it is most effective for learners practicing self-directed learning. The promotion of self-directed learning requires consideration of its three dimensions: process, person, and context. Finally, the need for competency-based PGME can be accomplished through holistic models, such as situated learning. The implementation of this evolution should be informed by the characteristics of the new paradigm, inner and outer settings of the organisations, and individuals involved. Implementation encompasses communication to engage stakeholders, training process redesign in accordance with the new paradigm, faculty development to empower and engage involved individuals, and research to enhance the understanding of PGME.

Pathological complete response, long-term outcomes, and recurrence patterns in HER2-low versus HER2-zero breast cancer after neoadjuvant chemotherapy.

BACKGROUND: The interest in HER2-low breast cancer (BC) has increased in recent years with the development of novel anti-HER2 antibody-drug conjugates. Here, we investigated the clinical outcomes and relapse patterns of patients with HER2-low or -zero BCs in an Asian population. METHODS: We retrospectively identified HER2-low or -zero BC patients with stage I-III tumours who were treated with neoadjuvant chemotherapy and underwent curative surgery, between 2014 and 2018 at Asan Medical Center, Seoul, Korea. RESULTS: A total of 818 and 754 HER2-zero and HER2-low BC patients, respectively, were consecutively included in this analysis. The HER2-low group had more hormone receptor [HR]-positive patients (81% versus 56%, P < 0.001). The HER2-zero group had a higher proportion of patients who achieved pathological complete response (pCR) (14.7% versus 9.8%, P = 0.003); however, no significant differences of pCR rate by HER2 status were identified in the HR-positive (P = 0.4) and HR-negative groups (P = 0.3) when analysed separately. The HER2-low BC cases had higher 5-year overall survival (OS) and disease-free survival (DFS) rates (P < 0.001 for OS; P = 0.002 for DFS); however, no differences were observed in terms of OS and DFS by HER2 status in the HR-positive group (P = 0.21 for OS and P = 0.66 for DFS). CONCLUSIONS: Our current findings do not support that HER2-low BC had different biology and clinical features compared to HER2-zero BC in patients who treated with neoadjuvant chemotherapy. However, the prognostic impact of HER2-low status in BC remains controversial; thus warranting further research.

Determination of etomidate and etomidate acid in hair using liquid chromatography-tandem mass spectrometry.

Etomidate, with efficacy similar to that of propofol, has been used as a propofol substitute because propofol is a designated narcotic drug, and an increase in the frequency of illegal distribution and misuse has been reported in Korea. Previous analytical studies on etomidate used blood and urine. For long-term use and timing estimation, a method for etomidate analysis using hair should be developed. Therefore, in this study, an analytical method using LC-MS/MS was developed to determine etomidate and its major metabolite in hair. Human hair samples were segmented after washing to eliminate possible contaminants on the hair and stirred with methanol. The LC-MS/MS conditions were optimized, and the chromatographic separation time was 10 min. Selectivity, linearity, limit of detection, limit of quantification, precision, accuracy, recovery, process efficiency, matrix effect, and stability were evaluated to validate the analytical method. The calibration curves ranged from 0.25 to 50 pg/mg for etomidate and 2-250 pg/mg for etomidate acid; the coefficients of determination were higher than 0.997. The intra- and inter-assay precision results for all the compounds were <15% and satisfied at recovery, process efficiency, matrix effect, and stability. In addition, this method was applied to the hair of 4 rats which are administered with etomidate to evaluate. The etomidate concentrations in the rat hair ranged from 2.60 to 8.50 pg/mg, and the etomidate acid concentrations were 2.06-7.13 pg/mg. Thus, this method can be used as basic data for monitoring etomidate in hair.

Automatic Patient Fall Outcome Extraction Using Narrative Incident Reports.

Patient outcome is one of the key information categories in incident reporting. Being able to extract meaningful patient fall outcomes would allow better analysis of the consequences and possible mitigating actions for in-hospital fall incidents. This study aims to automate the extraction of patient outcomes from narrative fall incident reports by decomposing this into three classification subtasks: injured or not, injury types, and the number of injuries. Implementing an existing incident report classification (IRC) framework, the experimental results demonstrated that oversampling and structured features were effective to achieve better overall performances across all three subtasks. The study further validated the application of an IRC framework to deal with imbalanced classification problems found in fall patient outcome classification and advanced the science of automatic patient outcomes extraction.

Adolescents' attitudes to the COVID-19 vaccination.

Vaccines against COVID-19 are now available for adolescents in Hong Kong but vaccine hesitancy is a major barrier to herd immunity. This survey study explores Hong Kong adolescents' attitudes towards the COVID-19 vaccination. 2609 adolescents from across Hong Kong completed an online survey focused on the intent to vaccinate and the reasons for their choice. 39% of adolescents intended to take the COVID-19 vaccination and significant factors for this decision include: having at least one parent vaccinated, knowing somebody diagnosed with COVID-19 and receiving the influenza vaccine. Adolescents' major concerns were either the safety and efficacy of the vaccine or the risk of infection. This study has proved that even in adolescents the vaccine hesitancy model is prominent with adolescents' intentions highly related to confidence in the vaccine and perception of disease risk. Future interventions should target these specific concerns to ensure adolescents are well educated to overcome vaccine hesitancy.

Evaluating resampling methods and structured features to improve fall incident report identification by the severity level.

OBJECTIVE: This study aims to improve the classification of the fall incident severity level by considering data imbalance issues and structured features through machine learning. MATERIALS AND METHODS: We present an incident report classification (IRC) framework to classify the in-hospital fall incident severity level by addressing the imbalanced class problem and incorporating structured attributes. After text preprocessing, bag-of-words features, structured text features, and structured clinical features were extracted from the reports. Next, resampling techniques were incorporated into the training process. Machine learning algorithms were used to build classification models. IRC systems were trained, validated, and tested using a repeated and randomly stratified shuffle-split cross-validation method. Finally, we evaluated the system performance using the F1-measure, precision, and recall over 15 stratified test sets. RESULTS: The experimental results demonstrated that the classification system setting considering both data imbalance issues and structured features outperformed the other system settings (with a mean macro-averaged F1-measure of 0.733). Considering the structured features and resampling techniques, this classification system setting significantly improved the mean F1-measure for the rare class by 30.88% (P value < .001) and the mean macro-averaged F1-measure by 8.26% from the baseline system setting (P value < .001). In general, the classification system employing the random forest algorithm and random oversampling method outperformed the others. CONCLUSIONS: Structured features provide essential information for categorizing the fall incident severity level. Resampling methods help rebalance the class distribution of the original incident report data, which improves the performance of machine learning models. The IRC framework presented in this study effectively automates the identification of fall incident reports by the severity level.

Quantitative evaluation of symmetry after navigation-guided surgical recontouring of zygomatic fibrous dysplasia: a comparative study.

Zygomatic fibrous dysplasia is a slowly progressive disorder of bone, which commonly causes facial asymmetry. Precise surgical recontouring can effectively improve facial aesthetics. The aim of this study was to quantitatively evaluate the effectiveness of surgical navigation guidance in correcting zygomatic asymmetry. The study included 26 patients with unilateral zygomatic fibrous dysplasia who underwent bony recontouring. They were divided into two groups according to the use of intraoperative surgical navigation (navigation group and conventional group; n=13 in each group). Clinical outcomes were evaluated using three-dimensional computed tomography. Six pairs of landmarks were identified, and the coordinates were used to calculate asymmetry indices. The curvature of protruding regions in the surgical area was measured to determine facial skeletal symmetry in three dimensions. The results were compared between the groups. All patients recovered uneventfully and their facial symmetry and aesthetics improved. For three of the six pairs of landmarks, symmetry was better in the navigation group than in the conventional group (all P≤ 0.02). The postoperative curvature ratios were better (more symmetrical) in the navigation group (P= 0.01). Surgical navigation enhances postoperative facial symmetry. However, the clinical significance of this enhancement when compared to conventional non-navigation surgery needs further investigation.

Comparison of single and dual latent tuberculosis screening strategies before biologic and targeted therapy in patients with rheumatic diseases: a retrospective cohort study.

PURPOSE: Before biologic and targeted synthetic disease-modifying antirheumatic drug (b/tsDMARD) treatment, latent tuberculosis infection (LTBI) screening by tuberculin skin test (TST) or interferon gamma release assay (IGRA) is recommended. However, both tests have reduced reliability in immunosuppressed patients. We investigated whether dual LTBI screening with both tests could reduce the incidence of tuberculosis. METHODS: Consecutive patients receiving b/tsDMARDs for rheumatic diseases in a regional hospital were recruited. All patients underwent either TST/IGRA or both. They were categorised into a single or dual testing group and were followed up for at least 6 months. Isoniazid was prescribed if any one test was positive. RESULTS: In total, 217 patients were included in this study; 121 underwent single LTBI testing and 96 underwent dual testing. Tuberculosis occurred in nine patients in the single testing group and one patient in the dual testing group (7.4% vs 1.0%, P=0.045). However, the difference was not statistically significant when follow-up duration was considered (log rank test). In total, 71 patients tested positive for LTBI with isoniazid treatment (28.9% in the single testing group and 45.8% in the dual testing group, P=0.007). Agreement between the IGRA and TST was 74.4% (Cohen's kappa=0.413); agreement was lower in patients receiving prednisolone. Infliximab use was independently associated with tuberculosis (P=0.032). Mild isoniazid-related side-effects occurred in seven patients. CONCLUSIONS: Dual LTBI testing with both TST and IGRA is effective and safe. It might be useful for patients receiving prednisolone at the time of LTBI screening, or if infliximab therapy is anticipated.

Genomic profiling of the residual disease of advanced high-grade serous ovarian cancer after neoadjuvant chemotherapy.

The goal of our study was to demonstrate the spectrum of genomic alterations present in the residual disease of patients with advanced high-grade serous ovarian cancer (HGSOC) after neoadjuvant chemotherapy (NAC), including matched pretreatment biopsies. During the study period between 2006 and 2017, we collected pre-NAC and post-NAC tumor tissue samples from patients with advanced HGSOC. We performed combined next-generation sequencing and immunohistochemistry to identify actionable targets and pathway activation in post-NAC residual tumors. We also examined whether post-NAC profiling of residual HGSOC identified targetable molecular lesions in the chemotherapy-resistant component of tumors. Among 102 post-NAC samples, 41 (40%) of patients had mutations in homologous recombination repair (HRR) genes (HRR deficiency). Patients with HRR mutations had higher tumor mutation burdens (p < 0.001) and higher alterations in the PI3K-AKT-mTOR pathway (p = 0.004) than patients without these HRR mutations. Nevertheless, we found no significant differences in progression-free survival (p = 0.662) and overall survival (OS; p = 0.828) between the two groups. Most patients (91%) had alterations in at least one of the targetable pathways, and those patients with cell cycle (p = 0.004) and PI3K-AKT-mTOR signaling (p = 0.005) pathway alterations had poorer OS (Bonferroni-corrected threshold = 0.0083, 0.05/6). We showed the genomic landscape of tumor cells remaining in advanced HGSOC after NAC. Once validated, these data can help inform biomarker-driven adjuvant studies in targeting residual tumors to improve the outcomes of patients with advanced HGSOC after NAC.

Medication-rights detection using incident reports: A natural language processing and deep neural network approach.

Medication errors often occurred due to the breach of medication rights that are the right patient, the right drug, the right time, the right dose and the right route. The aim of this study was to develop a medication-rights detection system using natural language processing and deep neural networks to automate medication-incident identification using free-text incident reports. We assessed the performance of deep neural network models in classifying the Advanced Incident Reporting System reports and compared the models' performance with that of other common classification methods (including logistic regression, support vector machines and the decision-tree method). We also evaluated the effects on prediction outcomes of several deep neural network model settings, including number of layers, number of neurons and activation regularisation functions. The accuracy of the models was measured at 0.9 or above across model settings and algorithms. The average values obtained for accuracy and area under the curve were 0.940 (standard deviation: 0.011) and 0.911 (standard deviation: 0.019), respectively. It is shown that deep neural network models were more accurate than the other classifiers across all of the tested class labels (including wrong patient, wrong drug, wrong time, wrong dose and wrong route). The deep neural network method outperformed other binary classifiers and our default base case model, and parameter arguments setting generally performed well for the five medication-rights datasets. The medication-rights detection system developed in this study successfully uses a natural language processing and deep-learning approach to classify patient-safety incidents using the Advanced Incident Reporting System reports, which may be transferable to other mandatory and voluntary incident reporting systems worldwide.

Emergency attendances and hospitalisations for complications after transrectal ultrasound-guided prostate biopsies: a five-year retrospective multicentre study.

INTRODUCTION: Transrectal ultrasound-guided (TRUS) prostate biopsy is an established procedure for diagnosis of prostate cancer. Complications after TRUS biopsy are not well reported in Hong Kong. This study evaluated the 5-year incidences of TRUS biopsy complications and potential risk factors for those complications. METHODS: This was a retrospective review of biopsies performed from 2013 to 2017 in two local hospitals, using data retrieved from electronic medical records. The primary outcome was the occurrence of complications requiring either emergency attendances or hospitalisations within 30 days after biopsy. Potential risk factors were examined using multiple logistic regression analysis. RESULTS: In total, 1699 men were included (mean age ± standard deviation: 67 ± 7 years; median prostate-specific antigen level: 7.9 µg/L [interquartile range, 5.5-12.6 µg/L]); 4.3% had pre-biopsy bacteriuria. Overall, 5.7% and 3.8% of post-biopsy complications required emergency attendances and hospitalisations, respectively. Gross haematuria and rectal bleeding requiring emergency attendances developed in 2.1% and 0.4% of men; 0.8% and 0.4% required hospitalisations. Furthermore, 1.5% of men developed acute urinary retention requiring hospitalisations; 1.9% and 1.2% had post-biopsy infections requiring emergency attendances and hospitalisations, respectively, and 0.9% had urosepsis requiring hospitalisations. Prostate volume >48 cc was associated with an increased risk of post-biopsy retention (odds ratio 2.75, 95% confidence interval: 1.23-4.17). CONCLUSIONS: The rate of overall complications after TRUS biopsy was low. The most common complications requiring emergency attendances and hospitalisations were gross haematuria and acute urinary retention, respectively. Prostate volume >48 cc increased the risk of post-biopsy urinary retention.

Naphthalene degradation by Fe2+/Oxone/UV - Applying an unconventional kinetics model and studying the reaction mechanism.

This study shows the degradation of naphthalene (Nap) in aqueous solution using Oxone process mediated by Fe2+ with UV-A irradiation (FOU). To elucidate the role of different parameters, Fe2+/Oxone (FO), Fe2+/UV (FU), Oxone/UV (OU) and direct photolysis processes were studied, separately. The degradation efficiency under different dosage of Fe2+, Oxone, initial probe compound concentration and solution pH were evaluated. It is concluded that FOU process has significantly better degradation capacity and efficiency. More than 90% of 0.125 mM Nap was removed in 20 min, under the optimal conditions of FOU ([Fe2+]0 = 0.250 mM, [Oxone]0 = 0.250 mM, wavelength = 350 nm and pH = 2.8). A mathematical model is proposed to describe the two-stage reaction kinetics involving Oxone. To alleviate the problems of radical surge at the initial stage and a radical deficit at later stage, a stepwise addition of oxidants was conducted and achieved a higher removal performance. Besides, the decay pathways of Nap under FOU process were proposed by using LC-ESI/MS analysis. The TOC content was found to be increased initially and decreased after 2 h reaction. It is clarified that the TOC increment was contributed by the partially degraded intermediates rather than the persistent Nap, since the latter was not completely combustible in the TOC analyzer, demonstrating that the FOU process is effective in degrading Nap into more degradable products such naphthoic acids and aldehydes.

Dietitian-led lifestyle modification programme for obese Chinese adolescents with non-alcoholic fatty liver disease: a randomized controlled study.

BACKGROUND: The prevalence of non-alcoholic fatty liver disease (NAFLD) in children is increasing. This study evaluated the efficacy of a dietitian-led lifestyle modification programme (D-LMP) to reduce NAFLD in obese adolescents. METHODS: Subjects with intra-hepatic triglyceride content (IHTC) equal to or greater than 5% diagnosed by proton-magnetic resonance spectroscopy (1H-MRS) were enroled and randomly assigned to either the D-LMP intervention or conventional paediatrician-led consultation (P-CON) group. Subjects in the P-CON group received usual care consisting of a consultation by a paediatrician with the child and parents every 16 weeks. Intention-to-treat analysis was used for data analysis. RESULTS: Fifty-two subjects were recruited, with 26 in each group. After the initiation phase (at week-16), there was a greater difference in the change in the IHTC and BMI z-score in the D-LMP group (P = 0.029 and <0.001, respectively) and there was a decrease in dietary intake of fat content (P = 0.019). After 52 weeks of the maintenance phase, both groups had reductions of IHTC to 2-3% and there was no intergroup difference in the rate of reduction. During the maintenance phase, parents' involvement was minimal in the D-LMP group, with only three parents accompanying their children to attend the dietitian sessions. In contrast, over 90% of the parents in the P-CON group regularly accompanied their children to attend the consultations suggesting the possibility that regular parental and paediatrician involvement may contribute to increasing awareness on fatty liver complications. Multivariate analysis showed that only reduction in body fat remained as an independent factor associated with remission of NAFLD at the end of both study phases. CONCLUSIONS: A dietitian-led lifestyle modification intervention reduced IHTC, BMI z-score and body fat in obese Chinese adolescents with NAFLD. To sustain the effect of this intervention, regular parental and paediatrician involvement may be important.

The relationship between health eating and overweight/obesity in Canada: cross-sectional study using the CCHS.

Objective: The relationship between Canada's Food Guide (CFG) adherence and overweight/obesity at the population level is unknown. Our objective was to explore the association between overweight/obesity and CFG adherence in Canada. Methods: Using 24-h dietary recall data from the Canadian Community Health Survey (CCHS), we conducted a cross-sectional analysis of Canadians' consumption of four predefined food types from CFG (grain products, vegetables and fruit, milk and alternatives, meat and alternatives). Respondents aged 18 to 65 years with measured BMI were included. The total number of servings in each food group was compared with the number of recommended servings in CFG to determine adherence. Linear regression was used to explore the association between overweight/obesity and CFG adherence. Results: Participants who met the minimum servings in vegetables and fruit had a lower measured BMI. Also, participants who met the minimum servings in meat and alternatives had a higher measured BMI. These associations were observed for the sample as a whole and for those with overweight/obesity, and, for meat and alternatives, among women. Conclusion: There is evidence that following the CFG recommendation is associated with measured BMI, for some food groups. This relationship needs to be validated using longitudinal data.