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Inappropriate c-MET signaling in cancer can enhance tumor cell proliferation, survival, motility, and invasion. Inhibition of c-MET signaling induces apoptosis in a variety of cancers. It has also been recognized as a novel anticancer therapy approach. Furthermore, reports have also indicated that constitutive expression of P-glycoprotein (ABCB1) is involved in the HGF/c-MET-related pathway of multidrug resistance ABCB1-positive human hepatocellular carcinoma cell lines. We previously reported that elevated expression levels of PKC δ and AP-1 downstream genes, and HGF receptor (c-MET) and ABCB1, in the drug-resistant MES-SA/Dx5 cells. Moreover, leukemia cell lines overexpressing ABCB1 have also been shown to be more resistant to the tyrosine kinase inhibitor imatinib mesylate. These findings suggest that chemoresistant cancer cells may also develop a similar mechanism against chemotherapy agents. To circumvent clinical complications arising from drug resistance during cancer therapy, the present study was designed to investigate apoptosis induction in ABCB1-overexpressed cancer cells using c-MET-targeted RNA interference technology in vitro and in vivo . The results showed that cell viability decreased and apoptosis rate increased in c-MET shRNA-transfected HGF/c-MET pathway-positive MES-SA/Dx5 and MCF-7/ADR2 cell lines in a dose-dependent manner. In vivo reduction of tumor volume in mice harboring c-MET shRNA-knockdown MES-SA/Dx5 cells was clearly demonstrated. Our study demonstrated that downregulation of c-MET by shRNA-induced apoptosis in a multidrug resistance cell line.

Gamma-hydroxybutyrate overdose can cause drowsiness, respiratory depression, or coma.1Gamma-hydroxybutyrate and its pro-drug gamma-butyrolactone are dangerous drugs within the meaning of the Dangerous Drugs Ordinance.2 1,4-Butanediol, an industrial solvent, is converted to GHB by hepatic alcohol dehydrogenase and aldehyde dehydrogenase.3 Generally, its onset of action is 5 to 20 minutes after ingestion with effects lasting for 2 to 3 hours.4 Nonetheless there is inter-individual variability in its metabolism to GHB, mainly due to differences in alcohol dehydrogenase activity.3 Importantly, concurrent ethanol intake inhibits conversion of 1,4-butanediol to GHB.5With a delayed onset of GHB-related desirable effects, inadvertent overdose may occur in those whose intention was to ingest GHB rather than 1,4-butanediol.3 6 At the time or writing, 1,4-butanediol is not listed as a dangerous drug. Gamma-hydroxybutyrate (GHB), 1,4-butanediol (1,4BD), and gamma-butyrolactone (GBL) intoxication: a state-of-the-art review. Drug & Chemical Evaluation Section, Diversion Control Division, Drug Enforcement Administration, US Department of Justice. 1,4-Butanediol.

From 2009 to 2017, we identified only seven instances.2 Subsequently, an additional six cases were recorded between 2018 and 2022 (unpublished data, 2022). Since its identification in toxicology samples in the United States in 2021, the abuse of N,N-dimethylpentylone has become increasingly prevalent.3 This substance has also been detected in New Zealand and Spain through on-site pill testing, analysis of seized materials, and wastewater-based epidemiological investigations.4 The use and abuse of synthetic cathinones can result in a sympathomimetic toxidrome characterised by agitation, tachycardia, hyperthermia, convulsions, rhabdomyolysis, cardiovascular collapse, and ventricular arrhythmias. Author contributions All authors had full access to the data, contributed to the study, approved the final version for publication, and take responsibility for its accuracy and integrity. HS Leung 1,2; Magdalene HY Tang 1,2; HF Tong 1,2; YK Chong 1,2 1 Hospital Authority Toxicology Reference Laboratory, Hong Kong SAR, China 2 Chemical Pathology Laboratory, Department of Pathology, Princess Margaret Hospital, Hong Kong SAR, China

Hong Kong has a great diversity of plants, many of which are toxic to humans. The aim of this study was to identify the plant species most commonly involved in cases of plant poisoning in Hong Kong and to provide clinicians with a reference tool for the diagnosis and management of plant poisoning. We retrospectively reviewed all plant poisoning cases referred to the Hospital Authority Toxicology Reference Laboratory from 1 January 2003 to 31 December 2017. Demographics, clinical presentation, laboratory findings, treatment and outcomes of patients, as well as morphological identification and analytical testing of the plant specimens, were investigated. A total of 62 cases involving 26 poisonous plant species were identified, among which (Giant Alocasia), (Graceful Jessamine), and (Azalea) species were the three most commonly encountered. Gastrointestinal toxicity (n=30, 48%), neurological toxicity (n=22, 35%), and hepatotoxicity (n=6, 10%) were the three most common clinical problems. Forty-nine (79%) and eight (13%) patients had mild and moderate toxicity, respectively; they all recovered shortly with supportive treatment. The remaining five (8%) patients experienced severe toxicity requiring intensive care support. Most patients (n=61, 98%) used the plants intentionally: as a medicinal herb (n=31), as food (n=29), and for attempting suicide (n=1). Reasons for using the poisonous plants included misidentification (n=34, 55%), unawareness of the toxicity (n=20, 32%), and contamination (n=6, 10%). Although most plant exposure resulted in a self-limiting disease, severe poisonings were encountered. Epidemiology of plant poisonings is geographically specific. Clinicians should be aware of local poisonous plants and their toxicities.

To the Editor—Ketamine analogues are new psychoactive substances that share the arylcyclohexylamine backbone of ketamine and produce dissociative effects through antagonistic activity at the N-methyl-D-aspartate receptor.1Ketamine and its analogues have plagued Hong Kong over the last two decades. Analysis or interpretation of data: TM Han 1,2; Magdalene HY Tang 1,2; HF Tong 1,2; YT Cheung 1,2; Jeremiah SB Tseung 1,2; MK Yip 1,2; CK Ching 1,2; YK Chong 1,2 1 Hospital Authority Toxicology Reference Laboratory, Hong Kong SAR, China 2 Chemical Pathology Laboratory, Department of Pathology, Princess Margaret Hospital, Hong Kong SAR, China

Purpose This study delves into the broader implications of artificial intelligence (AI) text generation technologies, including large language models (LLMs) and chatbots, on the scientific literature of otolaryngology. By observing trends in AI-generated text within published otolaryngology studies, this investigation aims to contextualize the impact of AI-driven tools that are reshaping scientific writing and communication. Methods Text from 143 original articles published in JAMA Otolaryngology – Head and Neck Surgery was collected, representing periods before and after ChatGPT’s release in November 2022. The text from each article’s abstract, introduction, methods, results, and discussion were entered into ZeroGPT.com to estimate the percentage of AI-generated content. Statistical analyses, including T-Tests and Fligner-Killeen’s tests, were conducted using R. Results A significant increase was observed in the mean percentage of AI-generated text post-ChatGPT release, especially in the abstract (from 34.36 to 46.53%, p  = 0.004), introduction (from 32.43 to 45.08%, p  = 0.010), and discussion sections (from 15.73 to 25.03%, p  = 0.015). Publications of authors from non-English speaking countries demonstrated a higher percentage of AI-generated text. Conclusion This study found that the advent of ChatGPT has significantly impacted writing practices among researchers publishing in JAMA Otolaryngology – Head and Neck Surgery, raising concerns over the accuracy of AI-created content and potential misinformation risks. This manuscript highlights the evolving dynamics between AI technologies, scientific communication, and publication integrity, emphasizing the urgent need for continued research in this dynamic field. The findings also suggest an increasing reliance on AI tools like ChatGPT, raising questions about their broader implications for scientific publishing.

Transgenic rhesus monkeys carrying the green fluorescent protein (GFP) gene were produced by injecting pseudotyped replication-defective retroviral vector into the perivitelline space of 224 mature rhesus oocytes, later fertilized by intracytoplasmic sperm injection. Of the three males born from 20 embryo transfers, one was transgenic when accessible tissues were assayed for transgene DNA and messenger RNA. All tissues that were studied from a fraternal set of twins, miscarried at 73 days, carried the transgene, as confirmed by Southern analyses, and the GFP transgene reporter was detected by both direct and indirect fluorescence imaging.

To the Editor—A recent press release issued by the Department of Health of the Hong Kong SAR Government urged public not to buy or consume an oral health supplement “HemoHIM”.1 This product has been withdrawn from the market in Hong Kong, Taiwan and Singapore. Several plant species used in traditional Chinese medicine have been reported to contain psoralens,5 including Fructus Psoraleae (補骨脂, the dried seeds of Psoralea corylifolia), which contains a relatively high concentration of psoralens.2 3 Frontline doctors should be vigilant to patients presenting with symptoms of liver injury after consumption of HemoHIM or other supplements containing Fructus Psoraleae. CK Chan 1; Raymond SM Wong 2; Jones CM Chan 2; YK Chong 3; Jamie Au Yeung 4; TH Yung; B in Chinese Medicine4 1 Hong Kong Poison Information Centre, United Christian Hospital, Hong Kong 2 Prince of Wales Hospital Poison Treatment Centre, Hong Kong 3 Hospital Authority Toxicology Reference Laboratory, Hong Kong 4 Hospital Authority Chief Pharmacist’s Office, Hong Kong

Sudden arrhythmia death syndrome (SADS) accounts for about 30% of causes of sudden cardiac death (SCD) in young people. In Hong Kong, there are scarce data on SADS and a lack of experience in molecular autopsy. We aimed to investigate the value of molecular autopsy techniques for detecting SADS in an East Asian population. This was a two-part study. First, we conducted a retrospective 5-year review of autopsies performed in public mortuaries on young SCD victims. Second, we conducted a prospective 2-year study combining conventional autopsy investigations, molecular autopsy, and cardiac evaluation of the first-degree relatives of SCD victims. A panel of 35 genes implicated in SADS was analysed by next-generation sequencing. There were 289 SCD victims included in the 5-year review. Coronary artery disease was the major cause of death (35%); 40% were structural heart diseases and 25% were unexplained. These unexplained cases could include SADS-related conditions. In the 2-year prospective study, 21 SCD victims were examined: 10% had arrhythmogenic right ventricular cardiomyopathy, 5% had hypertrophic cardiomyopathy, and 85% had negative autopsy. Genetic analysis showed 29% with positive heterozygous genetic variants; six variants were novel. One third of victims had history of syncope, and 14% had family history of SCD. More than half of the 11 first-degree relatives who underwent genetic testing carried related genetic variants, and 10% had SADS-related clinical features. This pilot feasibility study shows the value of incorporating cardiac evaluation of surviving relatives and next-generation sequencing molecular autopsy into conventional forensic investigations in diagnosing young SCD victims in East Asian populations. The interpretation of genetic variants in the context of SCD is complicated and we recommend its analysis and reporting by qualified pathologists.

Somatic cell nuclear transfer in nonhuman primates could accelerate medical research by contributing identical animals for research and clarifying embryonic stem cell potentials. Although rhesus embryos begin development after embryonic cell nuclear transfer, there has only been one report of rhesus births after ECNT and that report has not been replicated.