Predicting dementia diagnosis from cognitive footprints in electronic health records: a case-control study protocol

INTRODUCTION: Dementia is a group of disabling disorders that can be devastating for persons living with it and for their families. Data-informed decision-making strategies to identify individuals at high risk of dementia are essential to facilitate large-scale prevention and early intervention. This population-based case-control study aims to develop and validate a clinical algorithm for predicting dementia diagnosis, based on the cognitive footprint in personal and medical history. METHODS AND ANALYSIS: We will use territory-wide electronic health records from the Clinical Data Analysis and Reporting System (CDARS) in Hong Kong between 1 January 2001 and 31 December 2018. All individuals who were at least 65 years old by the end of 2018 will be identified from CDARS. A random sample of control individuals who did not receive any diagnosis of dementia will be matched with those who did receive such a diagnosis by age, gender and index date with 1:1 ratio. Exposure to potential protective/risk factors will be included in both conventional logistic regression and machine-learning models. Established risk factors of interest will include diabetes mellitus, midlife hypertension, midlife obesity, depression, head injuries and low education. Exploratory risk factors will include vascular disease, infectious disease and medication. The prediction accuracy of several state-of-the-art machine-learning algorithms will be compared. ETHICS AND DISSEMINATION: This study was approved by Institutional Review Board of The University of Hong Kong/Hospital Authority Hong Kong West Cluster (UW 18-225). Patients' records are anonymised to protect privacy. Study results will be disseminated through peer-reviewed publications. Codes of the resulted dementia risk prediction algorithm will be made publicly available at the website of the Tools to Inform Policy: Chinese Communities' Action in Response to Dementia project (https://www.tip-card.hku.hk/)

Surveillance of emerging drugs of abuse in Hong Kong: Validation of an analytical tool

© 2015, Hong Kong Academy of Medicine Press. All rights reserved. Objective: To validate a locally developed chromatography-based method to monitor emerging drugs of abuse whilst performing regular drug testing in abusers. Design: Cross-sectional study. Setting: Eleven regional hospitals, seven social service units, and a tertiary level clinical toxicology laboratory in Hong Kong. Participants: A total of 972 drug abusers and high-risk individuals were recruited from acute, rehabilitation, and high-risk settings between 1 November 2011 and 31 July 2013. A subset of the participants was of South Asian ethnicity. In total, 2000 urine or hair specimens were collected. Main outcome measures: Proof of concept that surveillance of emerging drugs of abuse can be performed whilst conducting routine drug of abuse testing in patients. Results: The method was successfully applied to 2000 samples with three emerging drugs of abuse detected in five samples: PMMA (paramethoxymethamphetamine), TFMPP [1-(3-trifluoromethylphenyl)piperazine], and methcathinone. The method also detected conventional drugs of abuse, with codeine, methadone, heroin, methamphetamine, and ketamine being the most frequently detected drugs. Other findings included the observation that South Asians had significantly higher rates of using opiates such as heroin, methadone, and codeine; and that ketamine and cocaine had significantly higher detection rates in acute subjects compared with the rehabilitation population. Conclusions: This locally developed analytical method is a valid tool for simultaneous surveillance of emerging drugs of abuse and routine drug monitoring of patients at minimal additional cost and effort. Continued, proactive surveillance and early identification of emerging drugs will facilitate prompt clinical, social, and legislative management.Link_to_subscribed_fulltex

Brief report: Decreased expression of CD244 (SLAMF4) on monocytes and platelets in patients with systemic lupus erythematosus

10.1007/s10067-017-3698-2Clinical Rheumatology373811-81

Intra-operative Assessment of Axillary Sentinel Lymph Nodes by Frozen Section—An Observational Study of 260 Procedures

Sentinel lymph node biopsy (SLNB) has become the standard treatment for patients with invasive breast cancer. Intra-operative frozen section allows for the detection of nodal metastases, thereby allowing a simultaneous axillary lymph node dissection (ALND) for those patients with nodal metastases. We herein report the accuracy of frozen section in the detection of SLN metastases. Methods: Patients with operable breast cancer and clinically negative axillae were recruited for SLNB. The SLNs were identified by blue dye, an isotope, or a combination. Enlarged lymph nodes that were not SLNs were also excised. All nodes were examined by intra-operative frozen section. ALND was performed if frozen section was positive. For those without metastases on frozen section, ALND was not performed. All lymph nodes underwent further paraffin sectioning with immuno-histochemical staining. Results: A total of 260 SLNB procedures were performed for invasive carcinoma over a 3-year period. The SLN was identified in 93.5% of patients. Of the 243 successful procedures, 53 had nodal metastases on frozen section. A total of 33 patients had false-negative frozen sections (false-negative rate, 38.4%), and 97% of them were less than 2 mm in size. The false-negative rate for macro-metastases, micro-metastases, and isolated tumour cells_were 2.4%, 57.7%, and 94.4%, respectively (p < 0.0001). A total of 22 patients had delayed ALND, and the re-operation rate was 8.5%. Conclusion: Frozen section was useful for the detection of nodal metastases in the SLNs and allowed for ALND to be performed in the same operation. The main failure of frozen sections was in the detection of micro-metastases

Deletion of CD137 ligand exacerbates renal and cutaneous but alleviates cerebral manifestations in Lupus

10.3389/fimmu.2019.01411Frontiers in Immunology10JUN141

Effectiveness of Wellness Recovery Action Planning (WRAP) for Chinese in Hong Kong

© 2016, Copyright © Taylor & Francis Group, LLC. The present study evaluated the effectiveness of the Wellness Recovery Action Planning (WRAP) in a matched controlled design among individuals in recovery of mental illness in Hong Kong. Feedback from the first batch of WRAP facilitators in Hong Kong was sought for future implementation of WRAP. Participants were recruited from the service units of the largest nongovernmental organization (NGO) serving people in recovery in Hong Kong. Fifty-nine service users were recruited to learn WRAP and 59 service users served as matched controls. The WRAP program consisted of eight weekly sessions delivered by NGO staff who were certified WRAP facilitators. Assessments were completed before, immediately after, and 3 months after the program. Findings based on repeated measures ANOVAs showed that compared with their matched controls, WRAP participants reported significant increase in perceived social support. No significant change was noted in empowerment, hope, self-stigma, social network size, symptom severity, and recovery. Facilitators discussed issues on cultural adaptation and resources needed for future implementation of WRAP for Chinese. Discrepancies between the present findings and those from previous studies were discussed. This is the first quantitative study evaluating the effectiveness of WRAP among Chinese.Link_to_subscribed_fulltex

Clustering and curation of electropherograms: an efficient method for analyzing large cohorts of capillary electrophoresis glycomic profiles for bioprocessing operations

10.3762/BJOC.16.176Beilstein Journal of Organic Chemistry162087-209