Alice Ho Miu Ling Nethersole Hospital (AHNH) is an acute district general hospital managed under the New Territories East Cluster of the Hospital Authority in Hong Kong. Established by the former London Missionary Society in 1887, it was the first teaching hospital in Hong Kong to train Cantonese locals in Western medical science. It moved to its current location in Tai Po in 1997.
ABSTRACT Purpose Ligament tension balance is essential for successful and long‐term implant survival of total knee arthroplasty (TKA). Conventional manual tensioning methods are subjective and vary with the surgeon experience. This study evaluated the inter‐ and intra‐rater reliability of pre‐resection ligament tension assessments using an imageless robotic‐assisted TKA system. Methods In this prospective study, 24 patients (30 knees) with end‐stage knee osteoarthritis underwent CORI‐assisted TKA from September 2024 to February 2025. Three specialist and three trainee surgeons each performed three repeated varus and valgus stress assessments across flexion and extension. Each medial and lateral gap measurement was recorded. Intraclass correlation coefficients (ICCs) were calculated with a two‐way mixed‐effects and two‐way random‐effects model. Results Both specialists and trainees demonstrated excellent intra‐ and inter‐ rater reliability (ICC > 0.90) for medial and lateral gaps in extension and medial gap in flexion. Flexion lateral reliability was good‐to‐excellent for trainees (ICC = 0.873, 95% CI: 0.784–0.933) and moderate‐to‐excellent for specialists (ICC = 0.838, 95% CI: 0.729–0.913). Conclusions Pre‐resection ligament tension assessment with an imageless robotic system yields high inter‐ and intra‐rater reliability, reducing variability linked to surgeon experience. Digital tensioners may standardize soft tissue balancing in TKA, potentially improving surgical outcomes and reproducibility. Evidence Level Level III, prospective quasi‐experimental study.
Abstract BackgroundAutism spectrum disorder (ASD) not only affects a person’s social communication and behaviors, but also has an impact on their parents, who encounter different challenges during caregiving. Interventions developed for parents of children with ASD often focus on improving child outcomes and seldom consider the well-being of parents and families. Interventions leveraging mindfulness-based approaches have been developed to support parents of children with ASD, but the costs, inflexibility, and scarcity of resources may limit their accessibility. App-based interventions can be an accessible, scalable, and economical way of providing interventions at a primary health care level. ObjectiveThe aim of this study was to develop an evidence-based digital intervention that complements existing, overloaded psychiatric services, to provide mindfulness-based psychoeducation for parents of children with ASD to improve their mental well-being. MethodsThe app development process follows the systematic approach of intervention mapping. Needs assessment was first conducted through semistructured qualitative interviews with health care professionals. Performance and change objectives were specified; theory-based and practical application methods were selected, followed by the design of the curriculum for a structured intervention. A pilot waitlist randomized controlled trial was conducted to evaluate the feasibility, acceptability, and preliminary efficacy of the app with parents of children with ASD recruited from a tertiary child psychiatric service in Hong Kong. ResultsThe resulting intervention, the TRIP app, is a 6-week structured intervention consisting of 6 sessions per week (each session lasting 15‐20 minutes), covering topics on ASD parenting skills and mindfulness practices. The six weekly themes include (1) cultivating curiosity in parenting, (2) mindfulness of the breath and body, (3) management of core and associated features of ASD, (4) managing conflicts and setting boundaries, (5) perspective taking, and (6) cultivating self-compassion. The curriculum was designed to target the determinants of parental stress, including parents’ knowledge, skills, emotions, and attitudes. App content and features were designed to incorporate behavioral change techniques, social cognitive theory, and elaboration likelihood model, to enhance efficacy and promote long-term usage. The app was found to be feasible and acceptable in the pilot randomized controlled trial (n=40), with greater long-term usage among parents of children on the waiting list who were yet to receive diagnostic assessment and clinical management, when compared with parents of children who have already been receiving clinical care. ConclusionsThe TRIP app was developed based on knowledge and expertise across psychiatry, public health, behavioral science, and implementation science. It caters to the unmet needs for improving caregiver well-being in the holistic care model for families of children with ASD. The clinical efficacy of the TRIP app is yet to be evaluated through clinical trials.
Anxiety and sensory hyperresponsiveness are common in children with autism spectrum disorder (ASD), but effective treatments are lacking. Targeting the microbiota-gut-brain axis is a promising strategy. This open-label pilot study evaluated SCM06, a novel synbiotic designed to target anxiety and sensory hyperresponsiveness, in 30 children with ASD (mean age 8.2 years, 22 males). We assessed symptom improvement, compliance, and safety, and collected stool samples for metagenomics and metabolomic analysis over 12 weeks. SCM06 was safe and well-tolerated, and significant improvements were observed in anxiety, sensory hyperresponsiveness, and abdominal pain. Following SCM06 treatment, increase in Bifidobacterium pseudocatenulatum was associated with improved functional abdominal pain (p = 0.0011, p_adj = 0.054), while the abundances of valeric acid and butyric acid increased (p_adj = 0.004 and p_adj = 0.072). Key microbial species, Coprococcus comes and Veillonella dispar, were candidate mediators of symptom improvements. Further randomised controlled trials are warranted to confirm its clinical efficacy.
OBJECTIVE:This study aims to evaluate changes in the epidemiology of major osteoporotic fractures (MOF) stratified by diabetes status over 15 years in a population-based cohort. METHODS:Individuals aged ≥50 years who sustained MOF between 2009 and 2023 identified from territory-wide electronic health database, stratified by diabetes status. Records of HbA1c, hypoglycemic episodes, and osteoporosis screening and treatments were retrieved. Ratios of rates of MOF, osteoporosis screening and treatments between the diabetes and nondiabetes groups were calculated to reflect the disparity between 2 groups. Secular trends were reported in average annual percentage change (AAPC) using joinpoint regression. All rates were age-standardized to the 2021 Hong Kong Census mid-year population. RESULTS:86 263 hip fractures and 124 268 nonhip fractures were recorded during the study period. Although annual age-standardized incidence of hip fractures decreased, rate ratios between diabetes and nondiabetes remained static at 4.1 for women (AAPC: -0.16%, 95% CI: -0.65 to +0.35, P = .54) and 2.5 for men (AAPC: +0.07%, 95%CI: -0.58 to 0.71, P = .83), suggesting persistent gap of diabetes-specific excess fracture risk. This gap was similarly observed for nonhip fractures. Over the years, age-standardized mean HbA1c improved from 59 mmol/mol (7.5%) to 53 mmol/mol (7%), along with fewer severe hypoglycemic episodes. Prevalence of individuals with screening dual-energy x-ray absorptiometry performed increased, more so in women with diabetes. Anti-osteoporosis medication prescriptions increased in both diabetes and nondiabetes, but increased to a lesser extent in the diabetes population. CONCLUSION:Diabetes-specific excess fracture risk persisted despite improved glycemic control. Despite increasing efforts of osteoporosis screening in diabetes, this has not translated into more aggressive treatment of bone fragility in diabetes.
Background Acute Stanford type A aortic dissection may mimic left main coronary artery occlusion on electrocardiography (ECG) yet requires fundamentally different management. Case Summary A 63-year-old woman presented with sudden chest pain, collapse, and cardiogenic shock. ECG showed ST-segment elevation in aVR with diffuse precordial ST-segment depression, suggesting left main coronary occlusion and prompting consideration of urgent coronary angiography. Examination revealed severe aortic regurgitation and a carotid intimal flap. Echocardiography and computed tomography aortography confirmed extensive Stanford type A dissection from the aortic root to the renal arteries with patent coronary ostia. Discussion This case shows that global subendocardial ischemia from acute severe aortic regurgitation, shock, and malperfusion can reproduce a “left main” ECG pattern without epicardial coronary occlusion. Take-Home Messages When ECG suggests left main coronary artery occlusion, meticulous clinical assessment and urgent imaging are essential to exclude aortic dissection. The Aortic Dissection Detection Risk Score is a useful tool for identifying high-risk features of acute aortic dissection.
