Explore the vast range of titles available.

To explore experiences, needs and rehabilitation priorities of patients who had their stroke and the experiences of therapists managing stroke patients during the COVID-19 pandemic. Exploratory qualitative study. Acute, sub-acute and community stroke facilities. Twenty-two participants. Twelve therapists (all female, mean age 38.5 years) and ten patients (9 female, mean age 51.1 years) who were involved in stroke rehabilitation during the pandemic were interviewed. Individual semi-structured interviews were conducted. Interviews were recorded and transcribed before being analysed using a reflexive thematic analysis approach. Four main themes demonstrate the modifications in the care system as a result of COVID-19, impact on the stroke patients at different stage, needs and priorities of stroke rehabilitation, and management strategies that have been used in stroke rehabilitation. Remote rehabilitation and self-management strategies were recommended to deliver care for stroke patients. However, therapists seemed unsatisfied with the quality of care delivered and patients suggested face to face delivery of care with proper personal protection equipment to better address their physical and mental health needs. The findings of this study explored the impact of the pandemic on stroke care from the perspective of the patients and therapists and provides suggestions for improved delivery of care in similar situations. Future research is warranted to examine the long-term effects on people who had inadequate post-stroke rehabilitation during covid pandemic and urgent measures taken to reduce the impact the pandemic has had on the physical and mental issues for these patients.

Objective To explore experiences, needs and rehabilitation priorities of patients who had their stroke and the experiences of therapists managing stroke patients during the COVID-19 pandemic. Design Exploratory qualitative study. Setting Acute, sub-acute and community stroke facilities. Subjects Twenty-two participants. Twelve therapists (all female, mean age 38.5 years) and ten patients (9 female, mean age 51.1 years) who were involved in stroke rehabilitation during the pandemic were interviewed. Methods Individual semi-structured interviews were conducted. Interviews were recorded and transcribed before being analysed using a reflexive thematic analysis approach. Results Four main themes demonstrate the modifications in the care system as a result of COVID-19, impact on the stroke patients at different stage, needs and priorities of stroke rehabilitation, and management strategies that have been used in stroke rehabilitation. Remote rehabilitation and self-management strategies were recommended to deliver care for stroke patients. However, therapists seemed unsatisfied with the quality of care delivered and patients suggested face to face delivery of care with proper personal protection equipment to better address their physical and mental health needs. Conclusion The findings of this study explored the impact of the pandemic on stroke care from the perspective of the patients and therapists and provides suggestions for improved delivery of care in similar situations. Future research is warranted to examine the long-term effects on people who had inadequate post-stroke rehabilitation during covid pandemic and urgent measures taken to reduce the impact the pandemic has had on the physical and mental issues for these patients.

Coronavirus disease 2019 (COVID-19) has a wide spectrum of disease severity from mild upper respiratory symptoms to respiratory failure. The role of neutralizing antibody (NAb) response in disease progression remains elusive. This study determined the seroprevalence of 733 non-COVID-19 individuals from April 2018 to February 2020 in the Hong Kong Special Administrative Region and compared the neutralizing antibody (NAb) responses of eight COVID-19 patients admitted to the intensive care unit (ICU) with those of 42 patients not admitted to the ICU. We found that NAb against SARS-CoV-2 was not detectable in any of the anonymous serum specimens from the 733 non-COVID-19 individuals. The peak serum geometric mean NAb titer was significantly higher among the eight ICU patients than the 42 non-ICU patients (7280 [95% confidence interval (CI) 1468-36099]) vs (671 [95% CI, 368-1223]). Furthermore, NAb titer increased significantly at earlier infection stages among ICU patients than among non-ICU patients. The median number of days to reach the peak Nab titers after symptoms onset was shorter among the ICU patients (17.6) than that of the non-ICU patients (20.1). Multivariate analysis showed that oxygen requirement and fever during admission were the only clinical factors independently associated with higher NAb titers. Our data suggested that SARS-CoV-2 was unlikely to have silently spread before the COVID-19 emergence in Hong Kong. ICU patients had an accelerated and augmented NAb response compared to non-ICU patients, which was associated with disease severity. Further studies are required to understand the relationship between high NAb response and disease severity.

This study evaluates the association between antivirals (Molnupiravir and Nirmatrelvir-Ritonavir) and all-cause and respiratory mortality and organ dysfunction among high-risk COVID-19 patients during an Omicron outbreak. Two cohorts, Nirmatrelvir-Ritonavir versus control and Molnupiravir versus control, were constructed with inverse probability treatment weighting to balance baseline characteristics. Cox proportional hazards models evaluated the association of their use with all-cause mortality, respiratory mortality, and all-cause sepsis (a composite of circulatory shock, respiratory failure, acute liver injury, coagulopathy, and acute liver impairment). Patients recruited were hospitalized and diagnosed with the COVID-19 Omicron variant between February 22, 2022 and April 15, 2022, and followed up until May 15, 2022. The study included 17,704 patients. There were 4.67 and 22.7 total mortalities per 1000 person-days in the Nirmatrelvir-Ritonavir and control groups respectively before adjustment (weighted incidence rate ratio, − 18.1 [95% CI − 23.0 to − 13.2]; hazard ratio, 0.18 [95% CI, 0.11–0.29]). There were 6.64 and 25.9 total mortalities per 1000 person-days in the Molnupiravir and control groups respectively before adjustment (weighted incidence rate ratio per 1000 person-days, − 19.3 [95% CI − 22.6 to − 15.9]; hazard ratio, 0.23 [95% CI 0.18–0.30]). In all-cause sepsis, there were 13.7 and 35.4 organ dysfunction events per 1000 person-days in the Nirmatrelvir-Ritonavir and control groups respectively before adjustment (weighted incidence rate ratio per 1000 person-days, − 21.7 [95% CI − 26.3 to − 17.1]; hazard ratio, 0.44 [95% CI 0.38–0.52]). There were 23.7 and 40.8 organ dysfunction events in the Molnupiravir and control groups respectively before adjustment (weighted incidence ratio per 1000 person-days, − 17.1 [95% CI, − 20.6 to − 13.6]; hazard ratio, 0.63 [95% CI 0.58–0.69]). Among COVID-19 hospitalized patients, use of either Nirmatrelvir-Ritonavir or Molnupiravir compared with no antiviral use was associated with a significantly lower incidence of 28-days all-cause and respiratory mortality and sepsis.

ObjectiveImmune checkpoint blockade (ICB) has improved cancer treatment, yet why most hepatocellular carcinoma (HCC) patients are resistant to PD-1 ICB remains elusive. Here, we elucidated the role of a programmed cell death protein 1 (PD-1) isoform, Δ42PD-1, in HCC progression and resistance to nivolumab ICB.DesignWe investigated 74 HCC patients in three cohorts, including 41 untreated, 28 treated with nivolumab and 5 treated with pembrolizumab. Peripheral blood mononuclear cells from blood samples and tumour infiltrating lymphocytes from tumour tissues were isolated for immunophenotyping. The functional significance of Δ42PD-1 was explored by single-cell RNA sequencing analysis and validated by functional and mechanistic studies. The immunotherapeutic efficacy of Δ42PD-1 monoclonal antibody was determined in HCC humanised mouse models.ResultsWe found distinct T cell subsets, which did not express PD-1 but expressed its isoform Δ42PD-1, accounting for up to 71% of cytotoxic T lymphocytes in untreated HCC patients. Δ42PD-1+ T cells were tumour-infiltrating and correlated positively with HCC severity. Moreover, they were more exhausted than PD-1+ T cells by single T cell and functional analysis. HCC patients treated with anti-PD-1 ICB showed effective PD-1 blockade but increased frequencies of Δ42PD-1+ T cells over time especially in patients with progressive disease. Tumour-infiltrated Δ42PD-1+ T cells likely sustained HCC through toll-like receptors-4-signalling for tumourigenesis. Anti-Δ42PD-1 antibody, but not nivolumab, inhibited tumour growth in three murine HCC models.ConclusionOur findings not only revealed a mechanism underlying resistance to PD-1 ICB but also identified anti-Δ42PD-1 antibody for HCC immunotherapy.

Delimiting species is crucial, especially for threatened and understudied organisms, because unresolved taxonomy can result in unrecognized species diversity and misallocated conservation efforts. In this study, we used an integrative taxonomic approach, incorporating genetic, morphological, and acoustic analyses, to clarify the phylogenetic relationship of the endangered Short-legged Horned Toad (Boulenophrys brachykolos) from South China. We focused on individuals from three geographically separated regions in Hong Kong, one on the mainland (Kowloon) and two on islands (Lantau Island and Hong Kong Island). Our genetic data identified Lantau Island individuals to be an evolutionarily distinct lineage, with a minimum genetic difference of 2.1% from other populations. Acoustic analysis revealed that male B. brachykolos from Lantau Island produce calls with similar frequency, but significantly higher pulse and note rate. However, morphological comparisons did not reveal significant differences among the three regions. To conclude, the B. brachykolos population from Lantau Island may represent a case of speciation in progress, and in the interim, should be treated as a distinct conservation unit.

Background. We compared the clinico-radio-pathological characteristics of breast cancer detected through mammogram (MMG) and ultrasound (USG) and discuss the implication of the choice of imaging as the future direction of our recently launched local screening program. Methods. Retrospective study of 14613 Hong Kong Chinese female patients with histologically confirmed breast cancer registered in the Hong Kong Breast Cancer Registry between January 2006 and February 2020. Patients were classified into four groups based on the mode of breast cancer detection (detectable by both mammogram and ultrasound (MMG+/USG+), mammogram only (MMG+/USG−), ultrasound only (MMG−/USG+), or not detectable by either (MMG−/USG−). Characteristics of breast cancer detected were compared, including patient demographics, breast density on MMG, mode of presentation, tumour size, histological type, and staging. Types of mammographic abnormalities were also evaluated for MMG+ subgroups. Results. 85% of the cancers were detectable by MMG, while USG detected an additional 9%. MMG+/USG+ cancers were larger, more advanced in stage, often of symptomatic presentation, and commonly manifested as mammographic mass. MMG+/USG− cancers were more likely of asymptomatic presentation, manifested as microcalcifications, and of earlier stage and to be ductal carcinoma in situ. MMG−/USG+ cancers were more likely seen in young patients and those with denser breasts and more likely of symptomatic presentation. MMG−/USG− cancers were often smaller and found in denser breasts. Conclusion. Mammogram has a good detection rate of cancers in our local population. It has superiority in detecting early cancers by detecting microcalcifications. Our current study agrees that ultrasound is one of the key adjunct tools of breast cancer detection.

Upregulation of a disintegrin and metalloprotease 9 (ADAM9) is correlated with progression of cancers, such as prostate, bladder, and pancreatic cancers. However, its role in triple-negative breast cancer (TNBC) is still unclear. Our study aimed to investigate whether ADAM9 is upregulated and promoted the aggressiveness in TNBC. Breast cancer cell lines and patient specimens were used to evaluate the ADAM9 expression by western blotting and immunohistochemistry staining, respectively. Compared with the non-TNBC, ADAM9 expression was significantly increased in TNBC cells and TNBC patient specimens. Based on the data acquired from public databases, the correlation between ADAM9 expression and breast cancer patient survival was analyzed by Kaplan-Meier method. It was shown that ADAM9 overexpression was significantly correlated with poorer survival in patients with TNBC. Furthermore, ADAM9 in TNBC cells was knocked down by small interference RNA and then studied by the MTT/colony formation assay, wound healing assay and transwell invasion assay on the cell proliferation, migration, and invasion, respectively. We found that inhibiting ADAM9 expression suppressed TNBC cell proliferation, migration, and invasion by lowering the activation of AKT/NF-κB pathway. Our results demonstrated that ADAM9 is an important molecule in mediating TNBC aggressiveness and may be a potential useful therapeutic target in TNBC treatment.

Viral infections, including those leading to sepsis, are common but often overlooked in clinical practice, yet the treatment strategies for viral sepsis remain inadequately defined. This study aims to investigate the effectiveness of antivirals nirmatrelvir-ritonavir and molnupiravir in the treatment of culture-negative sepsis. This retrospective cohort study was conducted across public hospitals in Hong Kong. We included patients diagnosed with COVID-19 between February 22, 2022, and June 30, 2023, who had no secondary bacterial or fungal infections. Propensity score matching was used to assess the efficacy of the antivirals nirmatrelvir-ritonavir and molnupiravir in patient subgroups with or without organ dysfunction at hospital admission, including circulatory shock, respiratory failure, acute kidney injury, coagulopathy, acute liver impairment, a composite of all organ dysfunctions, or no organ dysfunction. Key outcomes were in-hospital mortality and length of stay, reported as hazard ratios (HR) and mean differences, respectively. The study included 15,599 COVID-19 patients with a mean age of 75.1 (SD 15.9) years. Molnupiravir treatment was associated with a significantly lower risk of mortality in patients in both the presence of any organ dysfunction (HR 0.75, 95% CI 0.58 to 0.96) and without organ dysfunction (HR 0.29, 95% CI 0.15-0.56). Nirmatrelvir-ritonavir was associated with decreased mortality with respiratory failure (absolute risk difference: 9.5%, 95% CI 6.26-12.72) and without organ dysfunction (HR 0.17, 95% CI 0.05-0.56). Antivirals also reduced the length of hospital stay; nirmatrelvir-ritonavir reduced length of stay in respiratory failure by an average of 3.37 (95% CI 2.32-4.42) days, acute kidney injury by 7.25 (95% CI 2.97-11.52) days, and coagulopathy by 7.04 (95% CI 2.99-4.05) days. Molnupiravir reduced the length of stay in acute kidney injury by an average of 6.7 (95% CI 2.39-11.08) days and coagulopathy by 5.68 (95% CI 1.20-10.16) days. Antivirals reduced mortality among hospitalized COVID patients, with the greatest reduction observed in patients without organ dysfunction. Antivirals were also effective in reducing the length of hospital stay.

Patients with type 2 diabetes mellitus (T2DM) and coronary ischemia face an exceptionally elevated risk, and the achievement of complete revascularization (CR) within this population could be challenging. Patients with T2DM and coronary ischemia based on coronary angiography and retrospective angiographic fractional flow reserve analysis between 2014 and 2016 were included. The impact of the extent of revascularization on the improvement of endpoint events by sodium-glucose cotransporter 2 (SGLT2) inhibitors was analyzed. The primary study endpoint was major adverse cardiac events (MACE), while all-cause mortality served as secondary endpoints. Kaplan-Meier analysis and Cox proportional hazards regression model were adopted to assess the association between SGLT2 inhibitors and endpoint incidence. A total of 671 patients were identified. Among them, 206 (30.7%) were prescribed with SGLT2 inhibitors, while 484 (72.1%) achieved CR after the operation. During a mean 36-month follow-up, 100 MACE and 89 all-cause mortality were recorded. SGLT2 inhibitor users demonstrated lower rates of MACE (8.3% vs. 17.8%, P=0.002) and all-cause mortality (6.3% vs. 16.3%, P<0.001) compared to non-users. After adjusting for confounding factors in multivariable Cox analysis, the association between SGLT2 inhibitors and reduced MACE incidence remained consistent both in the CR and incomplete revascularization subgroups (hazard ratio [HR], 0.498; 95% confidence interval [CI], 0.246 to 0.938; P=0.040; and HR, 0.341; 95% CI, 0.123 to 0.805; P=0.023, respectively). SGLT2 inhibitors were found to be associated with a reduced risk of 3-year MACE and all-cause mortality in patients with T2DM and coronary ischemia, regardless of extent of revascularization.