Objective:To study the effiacious based on our experience of precise anatomical hemi-hepatectomy strictly guided by the middle hepatic vein (MHV) for regional to treat intrahepatic hepatolithiasis.Methods:A retrospective analysis was conducted on the data of 47 patients with regional hepatolithiasis treated with hemihepatectomy from July 2015 to July 2019 at the Department of Hepatobiliary and Pancreatic Surgery, The University of Hong Kong-Shenzhen Hospital. The study included 15 males and 32 females, aged (42±15) years. The exposure and preservation of the MHV was included in the precision surgery group ( n=26), and failure to fully expose the MHV or damage to the MHV was included in the control group ( n=21). The operation time, intraoperative blood loss and other surgical data and postoperative complications of the two groups were compared. Results:All patients successfully completed the operation. There was no patient who developed liver failure, and no patient died 90 days after the operations. The operation time (5.2±1.8) h and intraoperative blood loss (620.5±450.8) ml of the precision surgery group were not significantly different from those of the control group (4.9±2.3) h and intraoperative blood loss (760.5±540.2) ml ( P>0.05). A total of 19 patients (40.4%) (7 in the precision surgery group and 12 in the control group) developed 36 post operative complications of various types. The postoperative complication rate in the control group was higher than that in the precision surgery group [47.6%(10/21) vs 19.2% (5/26)], the difference was significant ( P<0.05). All 47 patients were followed-up for 6 to 30 months. For postoperative long-term complications: 5 patients in the control group had residual stones, biliary tract infection, liver abscess, and biliary-enteric anastomosis stenosis with recurrence of stones, and only 2 patients in the precision surgery group were found to have residual stones and biliary-enteric anastomotic stenosis. Stone recurrence, (the incidence of long-term complication) in the control group was significantly higher than that in the precision surgery group [23.8% (5/21) vs 7.7% (2/26)], ( P<0.05). Conclusions:Precise anatomical hemi-hepatectomy strictly guided by MHV for regional hepatolithiasis could more fully remove stones and lesions, and reduced the rate of stone recurrence. It was safe and feasible with favorable efficacy.

The greatest burden of hip fractures around the world is expected to occur in East Asia, especially China. However, there is a relative paucity of information on the epidemiology and burden of fractures in East Asia. Osteoporosis is greatly under-diagnosed and under-treated, even among the highest-risk subjects who have already suffered fractures. The accessibility to bone densitometry, the awareness of the disease by professionals and the public, and the use and reimbursement of drugs are some of the areas which need improvement especially. Cost-effective analysis on screening strategy and intervention thresholds based on local epidemiology data and economic status are available only in Japan. In addition, clinical risk factor models for the assessment of fracture probability may be ethnic specific. Further research is needed to develop a cost-effective risk assessment strategy to identify high-risk individuals for screening and treatment based on local data. Moreover, inadequate calcium and vitamin D intake is still an issue faced by this region.
Asia ; Calcium ; China ; Densitometry ; Epidemiology ; Far East* ; Hip Fractures ; Japan ; Mass Screening ; Osteoporosis* ; Risk Assessment ; Risk Factors ; Vitamin D

INTRODUCTIONPeritoneal mesothelioma is a rare neoplasm. Due to the limited understanding of its biology and behaviour, peritoneal mesothelioma poses a diagnostic and management challenge. The management of peritoneal mesothelioma has been controversial; systemic chemotherapy, palliative surgery and cytoreductive surgery (CRS) with intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) have been described.

MATERIALS AND METHODSThis study shares our experience with cytoreductive surgery and HIPEC for 5 out of the 6 cases of peritoneal mesotheliomas treated surgically, at a single institution in Singapore over the past 2 years. Computed tomography (CT) scans, positron emission tomography (PET)-CT scans and tumour markers were performed preoperatively but were not conclusive for the disease. All 6 cases presented to the Department of Surgical Oncology at National Cancer Centre Singapore, were diagnosed by histology of intraoperative biopsies. The combination of aggressive cytoreductive surgery and HIPEC was performed in 5 patients, with abandonment of procedure in 1 with extensive disease, who was treated with systemic chemotherapy instead.

RESULTSMedian duration of surgery, median length of hospital stay, and median follow-up duration were 7.04 hours, 11 days, and 15 months respectively. One postoperative morbidity relating to chemical peritonitis required exploratory laparotomy with good outcome. There were no mortality. All patients are alive at the last follow-up with no evidence of recurrences at 4 to 31 months from the time of their surgery.

CONCLUSIONPeritoneal mesothelioma is a rare disease that requires early diagnosis and can be effectively treated by CRS and HIPEC in selected group of patients.

Adult ; Antineoplastic Combined Chemotherapy Protocols ; administration & dosage ; Chemotherapy, Cancer, Regional Perfusion ; methods ; Cryosurgery ; methods ; Female ; Follow-Up Studies ; Humans ; Hyperthermia, Induced ; methods ; Male ; Mesothelioma ; diagnosis ; therapy ; Middle Aged ; Peritoneal Neoplasms ; diagnosis ; therapy ; Positron-Emission Tomography ; Tomography, X-Ray Computed

INTRODUCTIONWhether fi nal height is associated with quality of life and mental health is a matter of epidemiological and medical concern. Both social and biological explanations have been previously proposed. This study aims to assess the associations in ethnic Chinese in Singapore.

MATERIALS AND METHODSA cross-sectional study of 4414 respondents aged at least 21 years seen at a major polyclinic was performed. Socioeconomic and behavioural features of the sample and the Singapore population of similar ages were comparable. Height was measured by clinic nurses using an ultrasonic height senor. Participants were interviewed for socioeconomic, behavioural, health and quality of life information. Clinical morbidity data was collected from the participants' treating physicians. The SF-6D utility index and its Mental Health domain were the main endpoints. Linear and ordinal logistic regression models were used to analyse the utility index and the Mental Health scores, respectively.

RESULTSHaving adjusted for age and gender, the Mental Health domain (P <0.01) was associated with height but the utility index was not. Further adjustment for health, socioeconomic and behavioural covariates made little difference. Analyses based on height categories showed similar trends.

CONCLUSIONAdult height has a positive association with mental health as measured by the SF-6D among ethnic Chinese in Singapore. Socioeconomic status and known physical health problems do not explain this association. Adult height had no association with SF-6D utility index scores.

Adult ; Aged ; Aged, 80 and over ; Body Height ; ethnology ; China ; ethnology ; Cross-Sectional Studies ; Female ; Health Behavior ; Health Status ; Health Surveys ; Humans ; Linear Models ; Logistic Models ; Male ; Mental Health ; ethnology ; Middle Aged ; Quality of Life ; Singapore ; epidemiology ; Socioeconomic Factors ; Surveys and Questionnaires ; Young Adult

Objectives: To enhance the public awareness and facilitate diagnosis of osteoporosis, we aim to develop a new Chinese Osteoporosis Screening Algorithm (COSA) to identify people at high risk of osteoporosis. Methods: A total of 4747 postmenopausal women and men aged ! 50 from the Hong Kong Osteoporosis Study were randomly split into a development (N ¼ 2373) and an internal validation cohort (N ¼ 2374). An external validation cohort comprising 1876 community-dwelling subjects was used to evaluate the positive predictive value (PPV). Results: Among 11 predictors included, age, sex, weight, and history of fracture were significantly associated with osteoporosis after correction for multiple testing. Age- and sex-stratified models were developed due to the presence of significant sex and age interactions. The area under the curve of the COSA in the internal validation cohort was 0.761 (95% CI, 0.711e0.811), 0.822 (95% CI, 0.792e0.851), and 0.946 (95% CI, 0.908e0.984) for women aged < 65, women aged ! 65, and men, respectively. The COSA demonstrated improved reclassification performance when compared to Osteoporosis Self-Assessment Tool for Asians. In the external validation cohort, the PPV of COSA was 40.6%, 59.4%, and 19.4% forwomen aged < 65, women aged ! 65, and men, respectively. In addition, COSA > 0 was associated with an increased 10-year risk of hip fracture in women ! 65 (OR, 4.65; 95% CI, 2.24e9.65) and men (OR, 11.51; 95% CI, 4.16e31.81). Conclusions We have developed and validated a new osteoporosis screening algorithm, COSA, specific for Hong Kong Chinese.

Objectives: Type 2 diabetes mellitus (T2DM) shares a complex relationship with bone metabolism and few studies investigated the effect of impaired bone health on the risk of T2DM. This study was conducted to investigate the association between hip fractures and the risk of incident T2DM. Methods: This is a retrospective cohort study using data from the real-world hip fracture cohort. Hong Kong Chinese patients aged ≥ 65 years without T2DM who were admitted to public hospitals due to a fall between 2008 and 2015 were included in the study. Patients who sustained falls with and without hip fractures were matched by propensity score (PS) at a 1:1 ratio. Competing risk regression was used to evaluate the association between hip fracture and incident T2DM, with death being the competing event. Results: A total of 23,314 hip fracture cases were matched to 23,314 controls. The median follow-up time was 5.09 years. The incidence rate of T2DM was 11.947 and 14.505 per 1000 person-years for the hip fracture and control group respectively. After accounting for the competing risk of death, the hip fracture group had a significantly lower risk of developing T2DM (HR: 0.771, 95% CI: 0.719–0.827). Similar results were observed in all subgroups after stratification by age and sex. Conclusions Hip fracture was found to be associated with a reduced risk of T2DM. These findings provide insight into the topic of bone and glucose metabolism and prompt further research in evaluating the role of bone health in the management of T2DM.

Objective: To study the application of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in hepatocellular carcinoma with mild-to-moderate liver cirrhosis. Methods: There are 14 patients with hepatocellular carcinoma underwent ALPPS at the Department of Hepatobiliary and Pancreatic Surgery, Hong Kong University-Shenzhen Hospital from April 2014 to December 2017. The clinical data was retrospectively studied. The studying objects consisted of 9 males and 5 females, aged from 26 to 71 years old with the average age of 51, all cases were of Child-Pugh grade A. The degree of liver cirrhosis, operation and postoperative complications were analyzed. Results: All 14 patients completed the ALPPS, 1 patient died post stage 2 operation with liver failure. Comparing the groups with no liver cirrhosis (n=4) with the groups of mild liver cirrhosis (n=5) and moderate liver cirrhosis (n=5), the future liver remnant liver volume growth rates were 58%, 46% and 45.6%, respectively. The average operation intervals were 9.0, 11.2 and 12.8 days, respectively. Postoperative complications occurred in 4 patients: 2 patients with liver failure, 1 patient with intestinal obstruction, and 1 patient with hepatic ascites. Conclusion ALPPS for Child-Pugh grade A, hepatocellular carcinoma with mild-to-moderate liver cirrhosis treatment is safe and feasible.

Although rare, hepatic artery aneurysms are associated with a high morbidity and mortality, necessitating a prompt diagnosis. A significant proportion of hepatic artery aneurysms are pseudoaneurysms, and the major risk factors of which have already been identified in previous literatures. Presentation can be variable, but diagnosis almost relies entirely on computed tomography and digital subtraction angiography. The endovascular approach has progressively become the preferred option due to its better performance when compared to the traditional surgical approach. However, formulation of an endovascular treatment plan for these lesions remains difficult as multiple factors should be considered to identify the best endovascular treatment modality. Five cases of pseudoaneurysm due to recent Whipple operation, hepatobiliary infections, and underlying malignancy are presented in this article to illustrate the effectiveness and complexity of endovascular treatment in this disease entity.

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.

Objective:To study the safety and efficacy on timing of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) stageⅡbased on increase in remnant liver volume.Methods:19 patients (male: female 13: 6; average age 53 years) with liver tumors treated by ALPPS from April 2014 to December 2020 were retrospectively studied. Patients with FLV/ESLV (future liver volume/ estimated standard liver volume) increase of more than 50% within 1 week followed by stageⅡALPPS were included into the rapid group ( n=8). Those who failed to have 50% increase in FLV/ESLV within 1 week were included into the control group ( n=11). The two groups were compared in the ALPPS stage II in operating time, blood loss, postoperative complications, mortality rate and hospital stay. Results:All 19 patients underwent ALPPS stage II uneventfully. One patient in the control group died from liver failure within 30 days of operation. The operation time (3.2±1.8)h, blood loss (554±227) ml and postoperative hospital stay (12.6±2.4) d in the rapid group were significantly better than those in the control group (4.7±2.2) h, [(760±314) ml, (18.2±6.4) d (all P<0.05)]. The two groups had similar complication rates in both post stageⅠ[37.5%(3/8) vs. 45.4%(5/11)] , or stageⅡ [37.5%(3/8) vs. 36.4%(4/11)] (both P>0.05). Conclusion:Rapid increase in FLR volume of more than 50% within a week was safe and feasible to proceed to ALPPS stage II. This conclusion needs to be confirmed by further studies using large sample sizes.