Even though the combined use of ultrasound (US) and alpha-fetoprotein (AFP) is recommended for the surveillance of hepatocellular carcinoma (HCC), the utilization of AFP has its challenges, including accuracy dependent on its cut-off levels, degree of liver necroinflammation, and etiology of liver disease. Though various studies have demonstrated the utility of protein induced by vitamin K absence II (PIVKA-II) in surveillance, treatment monitoring, and predicting recurrence, it is still not recommended as a routine biomarker test. A panel of 17 experts from Asia-Pacific, gathered to discuss and reach a consensus on the clinical usefulness and value of PIVKA-II for the surveillance and treatment monitoring of HCC, based on six predetermined statements. The experts agreed that PIVKA-II was valuable in the detection of HCC in AFP-negative patients, and could potentially benefit detection of early HCC in combination with AFP. PIVKA-II is clinically useful for monitoring curative and intra-arterial locoregional treatments, outcomes, and recurrence, and could potentially predict microvascular invasion risk and facilitate patient selection for liver transplant. However, combining PIVKA-II with US and AFP for HCC surveillance, including small HCC, still requires more evidence, whilst its role in detecting AFP-negative HCC will potentially increase as more patients are treated for hepatitis-related HCC. PIVKA-II in combination with AFP and US has a clinical role in the Asia-Pacific region for surveillance. However, implementation of PIVKA-II in the region will have some challenges, such as requiring standardization of cut-off values, its cost-effectiveness and improving awareness among healthcare providers.

Humans ; Diabetes Mellitus, Type 2/therapy* ; Self Care ; Renal Insufficiency, Chronic/complications*

Background and Objectives: We compared real-world clinical outcomes of patients receiving intravascular lithotripsy (IVL) versus rotational atherectomy (RA) for heavily calcified coronary lesions. Methods: Fifty-three patients who received IVL from January 2017 to July 2020 were retrospectively compared to 271 patients who received RA from January 2017 to December 2018.Primary endpoints were in-hospital and 30-day major adverse cardiovascular events (MACE). Results: IVL patients had a higher prevalence of acute coronary syndrome (56.6% vs 24.4, p<0.001), multivessel disease (96.2% vs 73.3%, p<0.001) and emergency procedures (17.0% vs 2.2%, p<0.001) compared to RA. In-hospital MACE (11.3% vs 5.9%, p=0.152), MI (7.5% vs 3.3%, p=0.152), and mortality (5.7% vs 3.0%, p=0.319) were not statistically significant. 30-day MACE was higher in the IVL cohort vs RA (17.0% vs 7.4%, p=0.035). Propensity score adjusted regression using IVL was also performed on in-hospital MACE (odds ratio [OR], 1.677; 95% confidence interval [CI], 0.588–4.779) and 30-day MACE (OR, 1.910; 95% CI, 0.774–4.718). Conclusions These findings represent our initial IVL experience in a high-risk, real-world cohort. Although the event rate in the IVL arm was numerically higher compared to RA, the small numbers and retrospective nature of this study preclude definitive conclusions. Theseclinical outcomes are likely to improve with greater experience and better case selection, allowing IVL to effectively treat complex calcified coronary lesions.

Knee pain (KP) is commonly reported among workers, especially those in non-managerial occupations such as carpenters, miners and construction workers. However, few studies have been conducted on KP among the teacher population. Therefore, this study aimed to determine the prevalence of KP among school teachers and to explore its association with individual characteristics, lifestyle, work factors, and presence of health conditions. A cross-sectional survey was conducted among teachers at public secondary schools in Selangor, Malaysia. A self-reported questionnaire was utilised to elicit information on socio-demographic characteristics, lifestyle, body mass index, work-related factors, and health-related quality of life (HRQoL). Associations with KP were analysed by logistic regression and reported as odds ratios (ORs) at a 95% confidence interval (CI). The results revealed that the 12-month prevalence of KP was 54.4%. The multivariate analysis showed that age (OR 3.55, 95% CI: 1.92–6.54), kneeling or squatting >1 hour in total (OR 1.48, 95% CI: 1.06–2.08), and physical HRQoL (OR 0.94, 95% CI: 0.92–0.96) were significantly associated with the occurrence of KP. In conclusion, the prevalence of KP among secondary school teachers is high. Age, work-related physical practises, and physical health were found to be significantly associated with KP. Therefore, appropriate strategies should be implemented to address these factors in order to reduce the occurrence of KP, especially among the older teacher population.
Body mass index

INTRODUCTION: This study aimed to evaluate the LITE (Lifestyle Intervention for TEenagers) group programme, a family-based behavioural lifestyle intervention for overweight and obese adolescents. METHODS: We conducted a two-arm randomised controlled trial that recruited overweight and obese adolescents who attended a tertiary care weight management clinic. Participants were randomised to the LITE programme or usual care. The primary outcome assessed was body mass index (BMI) z-score. Secondary outcomes of anthropometric measurements, metabolic profile, parenting and adolescents' perception of family support were measured at baseline, three months and six months. Feasibility and acceptability of the LITE programme were also evaluated. RESULTS: 61 adolescents were enrolled, with 31 in the LITE programme and 30 in usual care. At three months, participants in the programme had a greater reduction in weight (-0.18 ± 2.40 kg vs. 1.48 ± 1.97 kg; p = 0.107), waist circumference (-1.0 ± 3.1 cm vs. 2.4 ± 2.7 cm; p = 0.016), waist-height ratio (-0.01 ± 0.02 vs. 0.01 ± 0.02; p = 0.040) and systolic blood pressure (-3.8 ± 13.7 vs. 5.7 ± 13.1; p = 0.119) compared to the usual care group. There was no significant difference in BMI z-score. At six months, there were significant improvements in adolescents' perception of family support for eating habits in the LITE group compared to the usual care group. The LITE programme had a good attendance rate of 67.7% and was well received. CONCLUSION The LITE programme showed feasibility and short-term clinical effectiveness in improving some clinical outcomes and improved adolescents' perception of family support.

Retrospective cohort study.

Retrospective cohort study.

This study aimed to assess the validity and reliability of the Bahasa Malaysia (BM) version of European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire core (QLQ-C30) (version 3.0) in Malaysian patients with colorectal cancer. A cross sectional study design was used to obtain data from patients receiving treatment at two teaching hospitals in Kuala Lumpur, Malaysia. Self-administered method was used. Statistical analysis included reliability, convergent and discriminant validity and known-groups comparisons. Statistical significance was based on p value ≤ 0.05. The internal consistency Cronbach’s alpha coefficient (α) was acceptable (> 0.70) in all scales but cognitive (α = 0.56) and pain in patients with stoma bag (α = 0.35). Test-retest coefficients were high (r = 0.93 to 1.00). All items showed adequate convergent validity (r > 0.40) except for questionnaire item 5 “needs help in eating/dressing/washing”. Similarly, criteria for discriminant validity were achieved in all but item 10 “need rest”. Patients with high Karnofsky Performance Scores (KPS) scores reported significantly less dyspnoea (p = 0.021) and appetite loss (p = 0.047) compared to patients with low KPS scores. There was no significant difference between patients with and without stomas. The psychometric properties of the BM version of the QLQ-C30 were comparable to previous studies in other settings. Therefore, the questionnaire could be used to measure quality of life in Malaysian patients with colorectal cancer.