Clinical practice guidelines and real-life practice on hepatocellular carcinoma: the Hong Kong perspective

Hepatocellular carcinoma (HCC) is a major public health burden in Hong Kong, and chronic hepatitis B is the most common HCC etiology in our region. With the high case load, extensive local expertise on HCC has been accumulated. This article summarized local guidelines and real-life practice on HCC management in Hong Kong. For HCC surveillance, liver ultrasound and serum alpha-fetoprotein for periodic screening is recommended in viral hepatitis or cirrhotic patients, and this is adhered to in clinical practice. HCC diagnosis is not covered in local guidelines, yet our practice is in-line with regional guidelines, where diagnosis is usually achieved by cross-sectional imaging and without the need for histology. Our guidelines recommend using the Hong Kong Liver Cancer Staging for pre-treatment staging, yet we routinely use other widely-adopted systems such as the Barcelona Clinic Liver Cancer Staging and the Tumor-Node-Metastasis Staging as well. Our local guidelines have provided clear treatment algorithms for the whole range of HCC therapies, including resection, ablation, transplant, transarterial chemoembolization, transarterial radioembolization, stereotactic body radiation therapy, targeted therapy, and immunotherapy. Real-life treatment choices are largely in line with the guidelines, although treatment protocols are individualized, and availability of specific therapies can vary between centers. Overall, HCC guidelines in Hong Kong are tailored based on local expertise and our unique patient population. The guidelines are up-to-date and provide practical pathways to assist our routine practice. Regular updates of local guidelines are warranted to account for the rapidly evolving paradigm of HCC management

Efeitos do tratamento com captopril e losartan em ratos Wistar e ratos espontaneamente hipertensos submetidos a hipertensão arterial pulmonar com monocrotalina

A hipertensão arterial pulmonar (HAP) é uma doença que se inicia com o aumento da resistência das arteríolas pulmonares. Após a sua instalação, sucedem-se várias alterações sobre os sistemas cardiovascular, respiratório e autonômico. Apesar dos trabalhos disponíveis na literatura, o desenvolvimento desta doença em modelos experimentais de hipertensão arterial sistêmica permanece ainda por ser estudado, bem como os efeitos terapêuticos de bloqueadores do sistema renina-angiotensina na reversão desta doença. Os objetivos deste estudo foram avaliar os efeitos cardiovasculares, autonômicos e respiratórios promovidos pela HAP induzida pela monocrotalina (MCT) em ratos Wistar e SHR e os efeitos terapêuticos do tratamento crônico com captopril e losartan na reversão da HAP. Para tanto, foram utilizados ratos Wistar (150-180g) e SHR (150-180g), divididos nos seguintes grupos: Wistar controle tratado com salina ou MCT (WIS-CON-SAL e WIS-CON-MCT, respectivamente), SHR controle tratado com salina ou MCT (SHR-CON-SAL e SHR-CON-MCT, respectivamente), Wistar tratados com Captopril + salina ou MCT (WIS-CPT-SAL e WIS-CPT-MCT, respectivamente), SHR tratados com Captopril + salina ou MCT (SHR-CPT-SAL e SHR-MCT-CPT, respectivamente), Wistar tratados com Losartan + salina ou MCT (WIS-LOS-SAL e WIS-LOS-MCT, respectivamente), SHR tratados com Losartan + salina ou MCT (SHR-LOS-SAL e SHR-LOS-MCT, respectivamente). Os animais tratados com MCT receberam uma única injeção subcutânea (60 mg/Kg SC) e os controles receberam o mesmo volume de salina (~0,8 mL). Ao término da 3ª senama, quando os animais MCTs controle apresentaram HAP, foi feito o tratamento com captopril (100 mg/Kg/mL) ou losartan (30 mg/Kg/mL) na água de beber por 2 semanas no volume diário de 30 mL. Após o tratamento com captopril ou losartan, foram realizados os registros cardiovasculares, respiratórios, gasométricos e a histologia pulmonar. Os resultados mostraram um significativo aumento do Índice Pulmonar nos animais controles tratados com MCT (Wistar e SHR) quando comparados com seus respectivos controles. As pressões ventriculares (PSmáx, PDI e PDF) também foram significativamente aumentadas nos grupos MCTs, bem como os valores de pressão arterial sistólica and diastólica, frequência cardíaca, pressão de pulso e labilidade da pressão arterial média. O tratamento com captopril normalizou todos os parâmetros estudados, no entanto, o losartan se mostrou ineficiente em normalizar os parâmetros hemodinâmicos. As análises morfométricas mostraram um espessamento da camada média dos dos ramos distais da artéria pulmonar e uma diminuição do lúmen nos grupos tratados com MCT. O tratamento com captopril e losartan normalizou estes parâmetros, embora o grupo tratado com losartan tenha sido menos eficaz que o captopril, pois os tratamentos mostraram diferenças significativas entre si. Quanto a avaliação autonômica, os animais MCT mostraram aumento do tônus simpático cardíaco e redução do tônus parassimpático cardíaco. Novamente, o tratamento com captopril normalizou estes parâmetros, enquanto que o losartan foi ineficaz em normalizá-los. Quanto aos parâmetros respiratórios, observamos aumentos no volume corrente, na frequência respiratória, na ventilação minuto e na ventilação alveolar dos animais controles tratados com MCT. Apenas o tratamento com captopril normalizou estes parâmetros. A avaliação gasométrica mostrou que os grupos controles tratados com MCT apresentaram redução da pressão parcial de O2 (hipóxia), aumento da pressão parcial de CO2 (hipercapnia), queda da porcentagem de saturação da hemoglobina (% Hb), aumento do bicarbonato (HCO3-) e acidose. O tratamento com captopril normalizou todos os parâmetros gasométricos, enquanto que o mesmo não foi observado com o losartan para os animais SHR submetidos a HAP. Nossos resultados mostraram que a MCT induziu ao quadro de HAP nos animais Wistar e SHR, bem como importantes alterações cardiovasculares, autonômicas, respiratórias, gasométricas e morfológicas pulmonares. Os tratamentos com captopril e losartan foram capazes de reverter a HAP em animais Wistar e SHR, porém, o captopril se mostrou mais eficiente em normalizar esses parâmetros quando comparados ao losartan. Estes resultados sugerem que o uso de bloqueadores do sistema renina angiotensina pode ser uma opção terapêutica para o tratamento da HAP. Palavras chave: hipertensão arterial pulmonar; monocrotalina; SHR; captopril; losartan

Enterovirus 71-associated hand, foot and mouth diseases with neurologic symptoms, a university hospital experience in Korea, 2009

PurposeHand-foot-mouth disease (HFMD) is a common viral illness in children, which is usually mild and self-limiting. However, in recent epidemics of HFMD in Asia, enterovirus 71 (EV71) has been recognized as a causative agent with severe neurological symptoms with or without cardiopulmonary involvement. HFMD was epidemic in Korea in the spring of 2009. Severe cases with complications including death have been reported. The clinical characteristics in children with neurologic manifestations of EV71 were studied in Ewha Womans University Mokdong Hospital.MethodsExaminations for EV71 were performed from the stools, respiratory secretion or CSF of children who presented neurologic symptoms associated with HFMD by realtime PCR. Clinical and radiologic data of the patients were collected and analyzed.ResultsEV71 was isolated from the stool of 16 patients but not from respiratory secretion or CSF. Among the 16 patients, meningitis (n=10) was the most common manifestation, followed by Guillain-Barré syndrome (n=3), meningoencephalitis (n=2), poliomyelitis-like paralytic disease (n=1), and myoclonus (n=1). Gene analysis showed that most of them were caused by EV71 subgenotype C4a, which was prevalent in China in 2008.ConclusionBecause EV71 causes severe complications and death in children, a surveillance system to predict upcoming outbreaks should be established and maintained and adequate public health measures are needed to control disease

Lupus nephritis in Chinese children--a territory-wide cohort study in Hong Kong

We report a multicenter study of Chinese children in Hong Kong with systemic lupus erythematosus (SLE) nephritis. Children were included if: they fulfilled the ACR criteria, had significant proteinuria or casturia, were Chinese and younger than 19 years and had been diagnosed with SLE between January 1990 and December 2003. Investigators in each center retrieved data on clinical features, biopsy reports, treatment and outcome of these patients. There were 128 patients (eight boys, 120 girls; mean age: 11.9+/-2.8 years). About 50% presented with multisystem illness and 40% with nephritic/nephrotic symptoms. Negative anti-dsDNA antibodies were found in 6% of the patients. Renal biopsy revealed WHO Class II, III, IV and V nephritis in 13 (10%), 22 (17%), 69 (54%) and 13 (10%) patients, respectively. The clinical severity of the nephritis did not accurately predict renal biopsy findings. The follow-up period ranged from 1 to 16.5 years (mean+/-SD: 5.76+/-3.61 years). During the study five patients died (two from lupus flare, one from cardiomyopathy, two from infections). Four patients had endstage renal failure (ESRF) (one died during a lupus flare). All deaths and end-stage renal failure occurred in the Class IV nephritis group. Chronic organ damage was infrequent in the survivors. The actuarial patient survival rates at 5, 10 and 15 years of age were 95.3, 91.8, and 91.8%, respectively. For Class IV nephritis patients, the survival rates without ESRF at 5, 10, and 15 years were 91.5, 82.3 and 76%, respectively. The survival and chronic morbidity rates of the Chinese SLE children in the present study are comparable to those of other published studies.postprin

Effects of Post-Resuscitation Treatment with N-acetylcysteine on Cardiac Recovery in Hypoxic Newborn Piglets

AIMS: Although N-acetylcysteine (NAC) can decrease reactive oxygen species and improve myocardial recovery after ischemia/hypoxia in various acute animal models, little is known regarding its long-term effect in neonatal subjects. We investigated whether NAC provides prolonged protective effect on hemodynamics and oxidative stress using a surviving swine model of neonatal asphyxia. METHODS AND RESULTS: Newborn piglets were anesthetized and acutely instrumented for measurement of systemic hemodynamics and oxygen transport. Animals were block-randomized into a sham-operated group (without hypoxia-reoxygenation [H-R, n = 6]) and two H-R groups (2 h normocapnic alveolar hypoxia followed by 48 h reoxygenation, n = 8/group). All piglets were acidotic and in cardiogenic shock after hypoxia. At 5 min after reoxygenation, piglets were given either saline or NAC (intravenous 150 mg/kg bolus + 20 mg/kg/h infusion) via for 24 h in a blinded, randomized fashion. Both cardiac index and stroke volume of H-R controls remained lower than the pre-hypoxic values throughout recovery. Treating the piglets with NAC significantly improved cardiac index, stroke volume and systemic oxygen delivery to levels not different from those of sham-operated piglets. Accompanied with the hemodynamic improvement, NAC-treated piglets had significantly lower plasma cardiac troponin-I, myocardial lipid hydroperoxides, activated caspase-3 and lactate levels (vs. H-R controls). The change in cardiac index after H-R correlated with myocardial lipid hydroperoxides, caspase-3 and lactate levels (all p<0.05). CONCLUSIONS: Post-resuscitation administration of NAC reduces myocardial oxidative stress and caused a prolonged improvement in cardiac function and in newborn piglets with H-R insults

Inhibition of Enterovirus 71 (EV-71) Infections by a Novel Antiviral Peptide Derived from EV-71 Capsid Protein VP1

Enterovirus 71 (EV-71) is the main causative agent of hand, foot and mouth disease (HFMD). In recent years, EV-71 infections were reported to cause high fatalities and severe neurological complications in Asia. Currently, no effective antiviral or vaccine is available to treat or prevent EV-71 infection. In this study, we have discovered a synthetic peptide which could be developed as a potential antiviral for inhibition of EV-71. Ninety five synthetic peptides (15-mers) overlapping the entire EV-71 capsid protein, VP1, were chemically synthesized and tested for antiviral properties against EV-71 in human Rhabdomyosarcoma (RD) cells. One peptide, SP40, was found to significantly reduce cytopathic effects of all representative EV-71 strains from genotypes A, B and C tested, with IC50 values ranging from 6–9.3 µM in RD cells. The in vitro inhibitory effect of SP40 exhibited a dose dependent concentration corresponding to a decrease in infectious viral particles, total viral RNA and the levels of VP1 protein. The antiviral activity of SP40 peptide was not restricted to a specific cell line as inhibition of EV-71 was observed in RD, HeLa, HT-29 and Vero cells. Besides inhibition of EV-71, it also had antiviral activities against CV-A16 and poliovirus type 1 in cell culture. Mechanism of action studies suggested that the SP40 peptide was not virucidal but was able to block viral attachment to the RD cells. Substitutions of arginine and lysine residues with alanine in the SP40 peptide at positions R3A, R4A, K5A and R13A were found to significantly decrease antiviral activities, implying the importance of positively charged amino acids for the antiviral activities. The data demonstrated the potential and feasibility of SP40 as a broad spectrum antiviral agent against EV-71

Towards a global partnership model in interprofessional education for cross-sector problem-solving

Objectives A partnership model in interprofessional education (IPE) is important in promoting a sense of global citizenship while preparing students for cross-sector problem-solving. However, the literature remains scant in providing useful guidance for the development of an IPE programme co-implemented by external partners. In this pioneering study, we describe the processes of forging global partnerships in co-implementing IPE and evaluate the programme in light of the preliminary data available. Methods This study is generally quantitative. We collected data from a total of 747 health and social care students from four higher education institutions. We utilized a descriptive narrative format and a quantitative design to present our experiences of running IPE with external partners and performed independent t-tests and analysis of variance to examine pretest and posttest mean differences in students’ data. Results We identified factors in establishing a cross-institutional IPE programme. These factors include complementarity of expertise, mutual benefits, internet connectivity, interactivity of design, and time difference. We found significant pretest–posttest differences in students’ readiness for interprofessional learning (teamwork and collaboration, positive professional identity, roles, and responsibilities). We also found a significant decrease in students’ social interaction anxiety after the IPE simulation. Conclusions The narrative of our experiences described in this manuscript could be considered by higher education institutions seeking to forge meaningful external partnerships in their effort to establish interprofessional global health education

Вихретоковый анизотропный термоэлектрический первичный преобразователь лучистого потока

Представлена оригинальная конструкция первичного преобразователя лучистого потока, который может служить основой для создания приемника неселективного излучения с повышенной чувствительностью