Recommendations for eligibility criteria concerning bariatric and metabolic surgical and endoscopic procedures for obese Hong Kong adults 2024: Hong Kong Society for Metabolic and Bariatric Surgery Position Statement.

The surgical management of obesity in Hong Kong has rapidly evolved over the past 20 years. Despite increasing public awareness and demand concerning bariatric and metabolic surgery, service models generally are not standardised across bariatric practitioners. Therefore, a working group was commissioned by the Hong Kong Society for Metabolic and Bariatric Surgery to review relevant literature and provide recommendations concerning eligibility criteria for bariatric and metabolic interventions within the local population in Hong Kong. The current position statement aims to provide updated guidance regarding the indications and contraindications for bariatric surgery, metabolic surgery, and bariatric endoscopic procedures.

The role of O-GlcNAcylation mediated by OGT during tooth development.

To understand the mechanisms underlying tooth morphogenesis, we examined the developmental roles of important posttranslational modification, O-GlcNAcylation, which regulates protein stability and activity by the addition and removal of a single sugar (O-GlcNAc) to the serine or threonine residue of the intracellular proteins. Tissue and developmental stage-specific immunostaining results against O-GlcNAc and O-GlcNAc transferase (OGT) in developing tooth germs would suggest that O-GlcNAcylation is involved in tooth morphogenesis, particularly in the cap and secretory stage. To evaluate the developmental function of OGT-mediated O-GlcNAcylation, we employed an in vitro tooth germ culture method at E14.5, cap stage before secretory stage, for 1 and 2 days, with or without OSMI-1, a small molecule OGT inhibitor. To examine the mineralization levels and morphological changes, we performed renal capsule transplantation for one and three weeks after 2 days of in vitro culture at E14.5 with OSMI-1 treatment. After OGT inhibition, morphological and molecular alterations were examined using histology, immunohistochemistry, real-time quantitative polymerase chain reaction, in situ hybridization, scanning electron microscopy, and ground sectioning. Overall, inhibition of OGT resulted in altered cellular physiology, including proliferation, apoptosis, and epithelial rearrangements, with significant changes in the expression patterns of ß-catenin, fibroblast growth factor 4 (fgf4), and sonic hedgehog (Shh). Moreover, renal capsule transplantation and immunolocalizations of Amelogenin and Nestin results revealed that OGT-inhibited tooth germs at cap stage exhibited with structural changes in cuspal morphogenesis, amelogenesis, and dentinogenesis of the mineralized tooth. Overall, we suggest that OGT-mediated O-GlcNAcylation regulates cell signaling and physiology in primary enamel knot during tooth development, thus playing an important role in mouse molar morphogenesis.

Clinical course and mortality in older patients with COVID-19: a cluster-based study in Hong Kong.

INTRODUCTION: Compared with previous waves of the coronavirus disease 2019 (COVID-19) pandemic in Hong Kong, the third wave involved a greater number of frail older patients. Because local healthcare policy required hospitalisation for all older adults with COVID-19, we aimed to investigate the clinical course and outcomes in such patients. METHODS: This retrospective observational study included all patients aged ≥65 years who were admitted to Tuen Mun Hospital for management of COVID-19 between 1 July 2020 and 31 August 2020. We reviewed baseline characteristics, clinical presentation, laboratory results, complications, and outcomes. We also investigated the associations of age and Clinical Frailty Scale (CFS) score with in-patient mortality. RESULTS: In total, 101 patients were included (median age, 73 years); 52.5% were men and 85% had at least co-morbid chronic disease. The most common symptoms were fever (80.2%) and cough (63.4%). Fifty-two patients (51.5%) developed hypoxia, generally on day 8 (interquartile range, 5-11) after symptom onset. Of the 16 patients who required intensive care unit support, 13 required mechanical ventilation. The overall mortality rate was 16.8%. Patients aged 65-69, 70-79, 80-89, and ≥90 years had mortality rates of 9.1%, 10%, 30%, and 25%, respectively. Patients with CFS scores of 1-2, 3-4, 5-6, and ≥7 had mortality rates of 5.7%, 14.7%, 23.5%, and 40%, respectively. A linear relationship was confirmed between the two mortality trends. CONCLUSION: Clinical deterioration was common in older patients with COVID-19; their overall mortality rate was 16.8%. Mortality increased linearly with both age and CFS score.

Use of accelerometry to investigate physical activity in dogs receiving chemotherapy.

OBJECTIVES: To perform a preliminary study to assess whether single-agent palliative or adjuvant chemotherapy has an impact on objectively measured physical activity in dogs. METHODS: Fifteen dogs with neoplasia (treatment group) wore ActiGraph™ accelerometers for 5-day periods before, during and after receiving single-agent adjuvant or palliative chemotherapy. Mean 5-day total physical activity and time spent in three different intensities of activity (sedentary, light-moderate and vigorous) before, during and after receiving chemotherapy were compared to a group of 15 healthy dogs (control group). Results were also compared within the treatment group across time. RESULTS: Prior to chemotherapy, treated dogs tended to be less active than control dogs. Treatment group dogs were slightly more active at restaging than they were prior to treatment but had similar activity levels to control dogs. Marked effects of chemotherapy on physical activity were not detected. Physical activity was slightly lower in treated dogs during chemotherapy when compared to control dogs but there was a slight increase in physical activity of treated dogs during chemotherapy when compared with pretreatment recordings. There was little change in the mean 5-day total physical activity between treated dogs during chemotherapy and at restaging but a mild decrease in time spent sedentary and increase in time spent in light-moderate activity at this comparison of time points. CLINICAL SIGNIFICANCE: Single-agent adjuvant or palliative chemotherapy had minimal impact on physical activity levels in dogs with neoplasia.

Impact of canine overweight and obesity on health-related quality of life.

Canine obesity is increasing in prevalence in the UK and raises concerns about dog welfare. This study compares the health-related quality of life (HRQL) of dogs of varying body condition: overweight and obese (BCS 4 and 5) versus non-overweight dogs (BCS 2 and 3), obese (BCS 5) versus non-overweight (BCS 2 and 3) and an overall comparison between all four BCS (BCS 2, 3, 4 and 5) using a novel, validated HRQL instrument which is both web and mobile tablet/phone app based. Of 271 dog owners who were approached, 174 completed a web-based instrument (2013) or a mobile tablet app instrument (2014) during the summers of 2013 and 2014. Automatically generated scores in four domains of HRQL (energetic/enthusiastic, happy/content, active/comfortable, calm/relaxed) were compared for dogs with each of the body condition scores (BCS 2-5). For all body condition scores a statistically significant difference was found between the HRQL scores in two of the domains: energetic/enthusiastic (p=0.02) and active comfortable (p=0.004). When BCS 2 and 3 were compared to BCS 4 and 5, statistical significance was found in the same two domains - energetic/enthusiastic (p=0.01) and active comfortable (p=0.001) - as it was in comparison of non-overweight (BCS 2 and 3) compared to obese dogs (BCS 5): energetic/enthusiastic (p=0.012) and active comfortable (p=0.004). These results suggest that overweight and obese dogs have a reduced HRQL in two of the domains compared to non-overweight dogs, and that differences in HRQL are detectable between BCS scores 2, 3, 4 and 5.

Validity and practical utility of accelerometry for the measurement of in-hand physical activity in horses.

BACKGROUND: Accelerometers are valid, practical and reliable tools for the measurement of habitual physical activity (PA). Quantification of PA in horses is desirable for use in research and clinical settings. The objective of this study was to evaluate a triaxial accelerometer for objective measurement of PA in the horse by assessment of their practical utility and validity. Horses were recruited to establish both the optimal site of accelerometer attachment and questionnaire designed to explore owner acceptance. Validity and cut-off values were obtained by assessing PA at various gaits. Validation study- 20 horses wore the accelerometer while being filmed for 10 min each of rest, walking and trotting and 5 mins of canter work. Practical utility study- five horses wore accelerometers on polls and withers for 18 h; compliance and relative data losses were quantified. RESULTS: Accelerometry output differed significantly between the four PA levels (P < 0•001) for both wither and poll placement. For withers placement, ROC analyses found optimal sensitivity and specificity at a cut-off of <47 counts per minute (cpm) for rest (sensitivity 99.5 %, specificity 100 %), 967-2424 cpm for trotting (sensitivity 96.7 %, specificity 100 %) and ≥2425 cpm for cantering (sensitivity 96.0 %, specificity 97.0 %). Attachment at the poll resulted in optimal sensitivity and specificity at a cut-off of <707 counts per minute (cpm) for rest (sensitivity 97.5 %, specificity 99.6 %), 1546-2609 cpm for trotting (sensitivity 90.33 %, specificity 79.25 %) and ≥2610 cpm for cantering (sensitivity 100 %, specificity 100 %) In terms of practical utility, accelerometry was well tolerated and owner acceptance high. CONCLUSION: Accelerometry data correlated well with varying levels of in-hand equine activity. The use of accelerometers is a valid method for objective measurement of controlled PA in the horse.

A 6-month observational study of changes in objectively measured physical activity during weight loss in dogs.

OBJECTIVES: To evaluate long-term changes in physical activity and sedentary behaviour during weight loss in dogs. METHODS: Sixteen overweight and obese dogs undergoing a 6-month calorie-controlled weight-loss programme wore Actigraph GT3X accelerometers (Actigraph, FL) for three consecutive days each month for the duration of the programme. Total volume of physical activity and time spent in sedentary behaviour, light-moderate intensity physical activity and vigorous intensity physical activity were extracted from the accelerometer data and compared from baseline to month 6. RESULTS: Valid accelerometry data were returned for 14 of 16 dogs. Mean percentage weight loss over 6 months was 15% of initial bodyweight. There was no marked increase in any of the physical activity outcomes or reduction in sedentary behaviour. CLINICAL SIGNIFICANCE: Substantial weight loss was not associated with a spontaneous increase in physical activity or reduction in sedentary behaviour. Although the dogs in this study lost a substantial amount of bodyweight without a measured increase in physical activity, dog owners should still be encouraged to facilitate increased physical activity in their dogs owing to the wide range of benefits associated with physical activity other than weight loss.

Associations between obesity and physical activity in dogs: a preliminary investigation.

OBJECTIVES: To assess whether obesity has any association with objectively measured physical activity levels in dogs. METHODS: Thirty-nine dogs wore Actigraph GT3X accelerometers (Actigraph) for 7 consecutive days. Each dog was classified as ideal weight, overweight or obese using the 5-point body condition scoring system. Total volume of physical activity and time spent in sedentary behaviour, light-moderate intensity physical activity and vigorous intensity physical activity were compared between body condition categories. RESULTS: Valid accelerometry data were returned for 35 of 39 dogs recruited. Eighteen dogs were classed as ideal weight, 9 as overweight and the remaining 8 as obese. All dogs spent a significant proportion of the day sedentary and obese dogs spent significantly less time in vigorous intensity physical activity than ideal weight dogs (7 ±3 minute/day versus 21 ±15 minute/day, P=0·01). CLINICAL SIGNIFICANCE: Obesity is associated with lower vigorous intensity physical activity in dogs, as is also thought to occur in humans. These preliminary findings will help inform a future, larger study and may also improve our understanding of the associations between obesity and physical activity in dogs.

Brugada syndrome.

As a clinical entity the Brugada syndrome has existed since 1992 and has been associated with a high risk of sudden cardiac death predominately in younger males. Patients can present with symptoms (ie syncope, palpitations, aborted sudden cardiac death) and asymptomatically. Its three characteristic electrocardiographic patterns can occur both spontaneously or after provocation with sodium channel-blocking agents. Risk stratification and the need for treatment depend on the patient's symptoms, electrocardiography, family history, and electrophysiological inducibility to discern if treatment by implantable cardioverter defibrillator, the only effective treatment to date, is appropriate. This review focuses on Brugada syndrome and various aspects of the disease including proposed mechanisms, epidemiology, clinical presentations, genetics, diagnosis, risk stratification, and treatment options.

An investigation into the epidemiology of feline obesity in Great Britain: results of a cross-sectional study of 47 companion animal practises.

Previous epidemiological studies of feline obesity have been restricted to small geographical areas of Great Britain. This study represents the first published description of the prevalence and risk factors for obesity from a nationally distributed population of cats. Data were gathered from 3227 cats through 47 primary companion animal veterinary practises. The overall prevalence of overweight/obesity was 11.5 per cent (95% confidence interval 10.4 per cent to 12.6 per cent) in cats attending the charity's clinics. Cats in Scotland appeared to have a greater age and neutered-adjusted prevalence compared with cats in England. Neutered status, being male and middle age (around 7 years), were all significant risk factors for feline overweight/obesity, although they did not fully explain an individual cat's risk of overweight/obesity. Breed was not found to be a statistically significant risk factor. Partial attributable fractions were calculated from each of the significant risk factors. Neutered status appeared to contribute the most to the prevalence of obesity, followed by prime/mature lifestage (3-10 years of age). Any interpretations of these findings should take into account the multitude of biases inherent in this study. Nevertheless, weight management following neutering appears to be very important to reduce the overall prevalence of overweight/obesity in this population of cats.

A cross sectional study of the prevalence and risk factors for owner misperception of canine body shape in first opinion practice in Glasgow.

The objectives of the study were to investigate whether owners were able to assign the correct body shape to their dog and to assess the dog and owner level factors associated with incorrect owner assessment of dog body shape. Six hundred and eighty questionnaires were administered to dog owners in 5 first opinion practices around Glasgow during July 2007. At the same time, the interviewer and owner assessed the body shape of each dog. The interviewer assessment of body shape was taken as the gold standard. Incorrect owner assessment of dog body shape (misperception) was divided into two groups: underestimation and overestimation. Multinomial logistic regression and classification and regression trees (CART) were used to assess risk factors associated with each type of misperception. Misperception of dog body shape was present in 44.1% of owners with underestimation (i.e. the owner considered the animal to have a leaner body shape from the gold standard assessment) being the most common form of misperception. Risk factors identified by both multinomial logistic regression and CART were gender of owner, age of the dog and dog body shape. The classification tree appeared to have improved predictive ability when compared to the multinomial model.

Ectopic pregnancy in previous Caesarean section scar.

We report two cases of Caesarean scar pregnancies that were managed surgically. The first case was a 33-year-old woman who presented at 21 weeks of gestation with lower abdominal pain. An exploratory laparotomy was performed as she was hypotensive and had a drastic drop in haemoglobin level. Intraoperatively, a ruptured scar ectopic pregnancy with placenta percreta was found. A hysterectomy was performed in view of uncontrolled haemorrhage. The second case was a 30-year-old woman who presented with irregular per vaginal spotting without abdominal pain. Ultrasonography revealed a gestational sac at a previous Caesarean scar, with interval increase in size and development of a yolk sac. On laparoscopy, the diagnosis of scar pregnancy was confirmed, and the gestational sac and surrounding myometrium were excised. Our case report shows that early diagnosis of scar pregnancy is important, as timely intervention can prevent life-threatening complications and preserve fertility.

Validity, practical utility and reliability of Actigraph accelerometry for the measurement of habitual physical activity in dogs.

OBJECTIVES: To test the validity, practical utility, and reliability of the Actigraph GT3-X accelerometer for measurement of habitual physical activity in pet dogs. METHODS: In the validation study, 30 dogs wore the accelerometer for 1 day while being filmed. Accelerometer and film were synchronised and 10-minute periods of the filmed records were extracted with dogs in continuous periods of sedentary behaviour, light intensity physical activity indoors, light to moderate intensity physical activity outdoors and vigorous physical activity outdoors. For the practical utility and reliability studies, 20 dogs wore the GT3-X accelerometers for 1 week: practical utility was quantified as data loss and was also assessed by owner questionnaire; reliability was determined by 2 to 7 days of monitoring using the Spearman-Brown prophecy formula. RESULTS: In the validation study, accelerometry output differed significantly between activity intensities (Friedman test, P<0·01). In the practical utility study, no data were lost from any dogs and dog owners reported that accelerometry was well tolerated. Reliability of accelerometry output was high: for 3 days of wear, it was 91% [95% confidence interval (CI) 82 to 96] and for 7 days of wear, it was 94% (CI 88 to 97). CLINICAL SIGNIFICANCE: The GT3-X accelerometer is valid, practical and reliable for the measurement of habitual physical activity in dogs.

An epidemiological study of environmental factors associated with canine obesity.

OBJECTIVES: To assess the relationships between socioeconomic and other environmental factors with canine obesity. METHODS: This was a cross-sectional questionnaire study of dog owners attending five primary veterinary practices in the UK. Owners were asked about dog age, neuter status, feeding habits, dog exercise, household income and owner age. The body condition score of the dogs was also assessed. Factors hypothesised to be associated with obesity were investigated. RESULTS: In total, data from 696 questionnaires were evaluated. Out of those data evaluated, 35.3% of dogs (n=246) were classed as an ideal body shape, 38.9% (n=271) were overweight, 20.4% (n=142) were obese and 5.3% (n=37) were underweight. Identified risk factors associated with obesity included owner age, hours of weekly exercise, frequency of snacks/treats and personal income. CLINICAL SIGNIFICANCE: Environmental risk factors associated with canine obesity are multifactorial and include personal income, owner age, frequency of snacks/treats and amount of exercise the dog receives. Awareness about health risks associated with obesity in dogs is significantly less in people in lower income brackets. This phenomenon is recognised in human obesity.

Assessment of liver function in dogs using the 13C-galactose breath test.

The aim of this study was to evaluate the application of the 13C-galactose breath test (13C-GBT) in assessing canine liver function by applying it to a group of healthy dogs, and to a group with clinicopathological evidence of liver dysfunction. Breath samples were collected 30 min before ingestion of 13C-galactose, and then at regular intervals thereafter for 6 h. The proportion of 13CO2/12CO2 in the breath samples was measured by isotope-ratio mass spectrometry. There was no significant difference in recovery of 13CO2 in the diseased group, compared to the healthy controls, but there was considerable inter-subject variation in both groups, possibly due to differences in the rate of gastric emptying, which could preclude detection of alterations in hepatic metabolism of galactose. The results of this study do not support the application of the 13C-GBT for assessment of canine liver function.

Feeding practices and the use of supplements for dogs kept by owners in different socioeconomic groups.

The prevalence of feeding practices and supplements for dogs used in private practice (pp) and the non-profit-making People's Dispensary for Sick Animals (pdsa) was evaluated. Questionnaires were completed by 400 pp clients and 400 pdsa clients, of which 27.2 per cent and 29.8 per cent, respectively, gave supplements to their dogs. Fatty acids/oils were given by 10.3 per cent of pp clients and 11.5 per cent of pdsa clients, glucosamine and/or chondroitin by 10.5 per cent and 5.8 per cent, and vitamins by 6.8 per cent and 19.3 per cent, respectively. The supplements were provided daily by 17.8 per cent of the pp clients and 14.3 per cent of the pdsa clients, and the pdsa clients were 50 per cent more likely to provide the supplements only weekly or monthly than the pp clients. A commercially available maintenance or dietetic diet was fed by 98.8 per cent of the pp clients and 94.2 per cent of the pdsa clients.

Inhibition of HIV-1 replication with designed miRNAs expressed from RNA polymerase II promoters.

Small interfering RNA (siRNA) mediates sequence-specific RNA cleavage and represents a potential approach to treat the infection of human immunodeficiency virus (HIV). Expression of a single siRNA species frequently led to the emergence of HIV escape variants. Thus, multiple siRNAs targeted to different regions in the HIV-1 genome may be required. However, overexpression of different anti-HIV siRNA genes from multiple pol III promoters can induce cell toxicity, thus may not be a viable option in the setting of human gene therapy trials. In the current study, we evaluated the strategy of using pol II promoters to drive the expression of siRNAs against HIV-1. We replaced the stem sequence in the stem-loop structure of the well-characterized miR-30a with siRNA sequences and showed that designed microRNA (miRNA) could be expressed from pol II promoters. We demonstrated efficient inhibition of HIV-1 replication with such designed miRNA, but the efficacy was directly correlated with the expression level. Both the vector copy number and the promoter strength directly affected the ability of the siRNA to inhibit HIV-1 replication. We also showed that a combination of pol II and pol III promoters to express two different siRNAs increased the efficacy against HIV-1 replication without comprising cell viability.

Comparison of ultrasonography, radiography and a single computed tomography slice for fluid identification within the feline tympanic bulla.

Evaluation of the tympanic bulla (TB) in cases of acute feline otitis media can be a diagnostic challenge, although a feature often associated with this condition is the accumulation of fluid or material within the middle ear cavity. A technique is reported allowing optimum imaging of the feline TB using ultrasound (US) and recording of the appearance of gas and fluid-filled TB. A random number of bullae in 42 feline cadavers were filled with lubricant and rostroventral-caudodorsal oblique radiographs, single slice computed tomography (CT) images and US images were created and interpreted by blinded operators. The content (fluid or gas) of each TB was determined using each technique and the cadavers were then frozen and sectioned for confirmation. CT remained the most accurate diagnostic method, but US produced better results than radiology. Given the advantages of US over other imaging techniques, these results suggest that further work is warranted to determine applications of this modality in the evaluation of clinical cases of feline otitis media.