Pamela Youde Nethersole Eastern Hospital, known as Eastern Hospital or Youde Hospital is a acute district general hospital in Chai Wan, Hong Kong.The hospital opened on 15 October 1993 with 1829 beds and staff of over 3000. It replaced the original Alice Ho Miu Ling Nethersole Hospital in Mid-Levels in Hong Kong Island and moved to Chai Wan. Assigned to the Hong Kong eastern hospital cluster and replaced the other Nethersole hospital, which relocated to the New Territories.It is affiliated with the Li Ka Shing Faculty of Medicine, the University of Hong Kong, providing clinical attachment opportunities for its medical students..
Introduction: Idiopathic sudden sensorineural hearing loss (ISSNHL) is an otologic emergency for which hyperbaric oxygen therapy (HBOT) is a potential treatment. This study aimed to evaluate the effectiveness of HBOT in treating ISSNHL, with a focus on the timing of treatment and its impact on hearing outcomes, while also considering other factors such as demographic characteristics, clinical parameters, and treatment methods. Methods: This retrospective cohort study analysed 70 ISSNHL patients (April 2019 to August 2024) who received steroid treatment (oral, intratympanic or both). Patients were divided into early HBOT (< 12 days), late HBOT (13-22 days), salvage HBOT (> 22 days), and no HBOT groups. Hearing improvement, measured by pure-tone audiometry (PTA), defined the treatment outcome. Results: Significant PTA improvements were observed in most groups (median changes: early HBOT 33.8 dB [n = 15], late HBOT 6.9 dB [n = 16], salvage HBOT 0.0 dB [n = 5], no HBOT 11.9 dB [n = 34]), with early HBOT showing greater gains than late HBOT (P < 0.001), salvage HBOT (P = 0.001), and no HBOT (P = 0.002). Receiver operating characteristic (ROC) analysis indicated that treatment within 10.5 days predicted marked improvement (AUC = 0.883, P < 0.001), and linear regression showed that each day's delay reduced PTA improvement by 0.832 dB (P < 0.001). Conclusions: HBOT is effective in restoring hearing in patients suffering from ISSNHL and early treatment is associated with better outcome.
BackgroundRespiratory epithelial adenomatoid hamartoma (REAH) is a benign tumor-like lesion that appears in the sinonasal tract. Due to the lack of well-defined distinctive features of REAH, specifically clinical and molecular characteristics, this lesion is often misdiagnosed as an inflammatory nasal polyp or sinonasal malignancy.ObjectiveThis study aimed to systematically review the existing literature to determine the distinguishing attributes of REAH.MethodsIn accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a Medline, EMBASE and Web-of-Science literature review was undertaken to evaluate studies published till July 1, 2024. Forest and funnel plots were used to present prevalence and potential small-study effects, respectively. The estimates were calculated using random-effects methodology. The I2 value was determined to assess the interstudy heterogeneity. The quality of the included studies was evaluated using National Heart, Lung, and Blood Institute Study Quality Assessment Tools.ResultsA total of 39 studies were included, of which 10 investigated molecular characteristics. Several studies have shown the involvement of inflammatory processes in REAH. In addition, 37 studies with 1127 patients met the inclusion criteria for the meta-analysis. The findings of these studies showed that REAH was most commonly identified in the olfactory cleft (66.7% [49.8%-83.7%]), often bilaterally (66.4% [54.0%-78.7%]). Furthermore, REAH was associated with enlarged olfactory cleft widths on computed tomography scans, with an estimated width of 10.58 mm [9.41-11.75 mm].ConclusionOur study showed that inflammatory responses likely play a role in REAH. Notably, the symptoms of REAH are often indistinguishable from those of chronic rhinosinusitis with nasal polyposis. Thus, a high index of suspicion is required to diagnose REAH, typically when patients present with bilateral olfactory cleft masses with an enlarged olfactory cleft width on a computed tomography head scan.
BACKGROUND:This study evaluates the performance of a general-purpose (GPT-4) and a medically fine-tuned (Med-LM) large language model (LLM) in classifying liver lesions from unstructured Computed Tomography (CT) reports. METHODS:Consecutive CT reports (2014-2020) from five institutions were input into GPT-4 and Med-LM withsimple (sp)andoptimised (op) prompts. Lesion-andpatient-level performance were benchmarked against LI-RADS scores assigned by two radiologists, and report quality was analysed using a5-point Likert scale. RESULTS:A total of 296 CT reports (mean age, 64.6 years ± 11.3 [SD]; 193 men; 654 lesions) were included. Lesion- and patient-level accuracies for LI-RADS scoring ranged from 40.8% (Med-LMsp) to 61.3% (Med-LMop) and from 27.7% (Med-LMsp) to 52.4% (Med-LMop), respectively. When dichotomized into malignant and benign lesions, lesion- and patient-level accuracies rose to 56.1% (GPT-4sp) - 82.3% (Med-LMop) and 71.3% (Med-LMsp) - 86.5% (Med-LMop). Med-LMop demonstrated the highest performance in all analyses and was statistically superior to other models (all p < 0.001). Non-classification rates ranged between 12.7% (Med-LMop) and 40.5% (GPT-4sp), particularly for benign lesions. Kappa values were weak to moderate between the two reviewers in different aspects of report quality (0.471-0.766), and Likert scores for lesion information differed significantly between correctly and incorrectly classified lesions (all p ≤ 0.04). Repeatability varied widely from 12.7% (Med-LMop) to 39.0% (GPT-4sp). CONCLUSIONS:Med-LM outperforms GPT-4 in classifying liver lesions from unstructured CT reports with both models better at detecting malignancy than full LI-RADS classification. However, high misclassification rates and inconsistent repeatability hinder their clinical use.
Background:Malignant neoplasm of bone and articular cartilage (MNBAC) is a rare malignancy associated with substantial premature mortality and disability, particularly among younger populations. Comprehensive, region‑specific assessments in East Asia remain limited despite evolving demographic and epidemiologic patterns. Therefore, this study provides the first East Asia-specific epidemiological assessment of MNBAC with future projections. Methods:Utilizing estimates from the Global Burden of Disease (GBD) 2023 study, we quantified incidence, prevalence, deaths, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs) attributable to MNBAC in five East Asian countries and territories from 1990 to 2023, with projections extending to 2050 under multiple foresight scenarios. Data are presented as absolute counts and age-standardized rates with 95% uncertainty intervals. Results:Between 1990 and 2023, in East Asia, the number of incident cases increased from 9,054 to 29,877. DALYs rose from 256,249 to 615,434. Over the same period, age-standardized incidence rates per 100,000 population increased modestly, death rates declined from 3.60 to 3.09, and DALY rates decreased from 138.61 to 112.04. Projections indicate that continued increases in absolute deaths (38,467 by 2050 under the reference scenario) and DALYs (804,272), with similar or higher estimates under alternative scenarios. In contrast, age‑standardized death and DALY rates are projected to remain broadly stable or decline slightly across scenarios. Conclusion:The burden of MNBAC in East Asia was increasing, with projections indicating a continuing upward trend through 2050. While declines in age-standardized death and DALYrates suggest improved health outcomes, these metrics do not necessarily reflect substantive changes in healthcare systems. Overall, advancements in population health are unlikely to fully counterbalance the rising MNBAC burden. Targeted treatment strategies focusing on MNBAC, as well as enhancements to registries and data collection, are essential for mitigating future health losses.
