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A 68-year old lady present with left ventricular free wall rupture and cardiac arrest post-myocardial infarction. This article illustrates a strategy combining pericardiocentesis with autologous transfusion together with VA-ECMO as a bridge to definitive surgical repair.

This case illustrates step-by-step troubleshooting in difficult axillary access closure. A standard balloon-assisted dry closure technique; escalation of wire support; trial of different closure devices with understanding in their mechanisms of failure; meticulous deployment of closure devices under fluoroscopy; a novel approach in deliverance of Angio-Seal device in a hydrophilic braided sheath all contributed to successful hemostasis.

Among adults, aldosterone and cortisone increases are reported in response to physically taxing forms of competition, enabling individuals to rapidly adapt to variable sociocompetitive contexts. Yet, aldosterone and cortisone responses in juvenile children engaged in less strenuous forms of competition have not been investigated. Here, we sought to measure aldosterone and cortisone responses in children who participated in math and table-tennis competitions. We hypothesized that the responses would significantly vary with respect to the type of competition. Pre- and post-match salivary aldosterone and cortisone were measured in Hong Kongese children, aged 8–11 years, during (1) a mixed-sex, team-based, math competition (N = 45) and (2) a dyadic, table-tennis competition against peers (N = 22). In the math competition, aldosterone and cortisone levels decreased in boys and girls, while members on losing teams had greater match decreases in cortisone levels compared to individuals on winning teams. In the table-tennis competition, time of day led to significant diurnal differences in competitors’ pre-match aldosterone and cortisone concentrations. As a result, each sample was analyzed independently according to match time (8:30 AM and 11:00 AM). Aldosterone levels decreased among the competitors who participated in the 11:00 AM table-tennis matches. Cortisone levels decreased for the majority of competitors, but only significantly decreased in the 8:30 AM sample. These findings highlight that juvenile competitors’ hypothalamic-pituitary-adrenal (HPA) axis and renin-angiotensin-aldosterone system (RAAS) are sensitive to less physically strenuous forms of competition. Further, the differences in the competitive environment likely stimulate the direction of aldosterone (RAAS) and cortisone (HPA) reactive change.

We report a 58-year-old male with sequelae of polio who presented with low back and left buttock pain, and pitting oedema of both legs for four months. The patient had a history of poliomyelitis at the age of 1 year which resulted in bilateral lower leg weakness, particularly on the left side. Magnetic resonance imaging showed cervical spinal stenosis secondary to posterior osteophyte formation, left paracentral disc extrusion at L2/L3 and L3/L4 levels with compression of the traversing L4 nerve root. The findings confirmed a diagnosis of lumbar radiculopathy caused by a herniated disc. The patient subsequently underwent a chiropractic treatment. The painful symptoms and pitting oedema in this case resolved with spinal adjustment in addition to scraping therapy to strengthen bilateral low back and the gluteal muscles. This case provides circumstantial evidence of a scarcely mentioned association between pitting oedema and lumbar radiculopathy caused by disc herniation. The pathophysiological mechanism is elusive, but might involve a complexity of cytokine-mediated inflammation and interconnection between somatic and autonomic nervous systems.

Background Despite an evidence-based protocol to facilitate same-day discharge (SDD) of patients undergoing elective intracoronary procedures, overnight hospitalization remains a routine practice. Objectives This study aimed to determine the frequency of SDD after intracoronary procedures among patients treated before and during the COVID-19 pandemic, and identify factors predictive of a decision for SDD. Methods This retrospective cohort study (N = 680) was based on registry data of a cardiac ambulatory center. Results The frequency of SDD was significantly higher in 2020 relative to 2019 (p

The sensory qualities of brewed coffee are known to be strongly correlated with the total dissolved solids (TDS) and extraction yield (E) of the brew. Here, we derive a predictive model for the TDS and E of full immersion brewed coffee using a pseudo-equilibrium desorption approach. Assuming a single, species-averaged equilibrium constant $$K$$ K yields theoretical predictions indicating that the TDS is approximately inversely proportional to the water/coffee mass brew ratio, while E is independent of the brew ratio. Our experimental results strongly accord with both theoretical predictions, and indicate that E is approximately 21% over a wide range of brew ratios. An analysis of the standard oven-drying method for measuring E indicates that it yields significant underestimates of the true value at equilibrium, due to retained brew within the spent moist grounds. We further demonstrate that $$K$$ K is insensitive to grind size, roast level, and brew temperature over the range 80–99 °C. Taken together, our results indicate that full immersion brewing offers precise control over the TDS at equilibrium but little control over E, and that practitioners should pay careful attention to their brew ratio as the most important parameter for full-immersion brewing.

This study aimed to evaluate the impact of surface-modified biomedical titanium (Ti) dental implant on osseointegration. The surfaces were modified using an innovative dip-coating technique (IDCT, sandblasted, large-grit, and acid-etched, then followed by coating with the modified pluronic F127 biodegradable polymer). The surface morphology and hemocompatibility evaluations were investigated by field-emission scanning electron microscopy, while the contact analysis was observed by goniometer. The IDCT-modified Ti implant was also implanted in patients with missing teeth by single-stage surgical procedure then observed immediately and again four months after placement by cone-beam computerized tomography (CBCT) imaging. It was found that the IDCT-modified Ti implant was rougher than the dental implant without surface modification. Contact angle analysis showed the IDCT-modified Ti implant was lower than the dental implant without surface modification. The hemocompatibility evaluations showed greater red blood cell aggregation and fibrin filament formation on the IDCT-modified Ti implant. The radiographic and CBCT image displayed new bone formation at four months after the IDCT-modified Ti implant placement. Therefore, this study suggests that the IDCT-modified Ti dental implant has great potential to accelerate osseointegration.

Aldosterone and cortisone are released in response to physical and psychological stress. However, aldosterone and cortisone responses in children engaged in physical competition have not been described. We examined salivary aldosterone and salivary cortisone responses among Hong Kongese boys, aged 8-11 years, during (1) a soccer match against unknown competitors (

Aim The current trend on diabetes management advocates replacing the paradigm from a uniform to an individualized patient-centered haemoglobin A 1c (HbA 1c ) target, but there is no consensus on the optimal HbA 1c level. The study aimed at examining the association between HbA 1c and the risk of cardiovascular diseases (CVD) for diabetic patients with different characteristics, in order to identify patient-centered treatment targets. Methods A retrospective cohort study was conducted on 115,782 Chinese adult primary care patients with type 2 diabetes mellitus (DM) but no known CVD history, who were prescribed antidiabetic medications in 2010–2011. The cumulative mean HbA 1c over a median follow-up period of 5.8 years was used to evaluate the relationship between HbA 1c and CVD incidence using Cox analysis. Subgroup analyses were conducted by stratifying different baseline characteristics including gender, age, smoking status, diabetes duration, body mass index, Charlson's comorbidity index and DM treatment modalities. Results For patients with a DM duration of 1c and risk of CVD was identified, suggesting that there was no threshold HbA 1c level for CVD risk. For other diabetic patients, an HbA 1c level of 6.8–7.2% was associated with a minimum risk for CVD and a J-shaped curvilinear association between HbA 1c . The risk of CVD increased in patients with HbA 1c Conclusion Among Chinese primary care patients at the early ( 1c targets ( 1c levels may not necessarily better and can potentially be harmful.

Objectives The aim of this study was to evaluate 1-year clinical safety and efficacy of the dual-therapy COMBO stent in a large, all-comers patient-level pooled cohort. Background The COMBO stent (OrbusNeich Medical, Fort Lauderdale, Florida) is a novel stent with abluminal sirolimus elution from a biodegradable polymer and a luminal pro-healing anti-CD34+ antibody layer, which attracts circulating endothelial progenitor cells. These endothelial progenitor cells can quickly mature into normal endothelium, providing rapid endothelialization. Methods The MASCOT (Multinational Abluminal Sirolimus Coated biO-engineered stenT) (N = 2,614, 61 global sites) and REMEDEE (Randomized study to Evaluate the safety and effectiveness of an abluMinal sirolimus coatED bio-Engineered StEnt Post Market Registry) (N = 1,000, 9 European sites) registries are 2 prospective, multicenter studies evaluating clinical outcomes after attempted COMBO stent placement in all-comer patients undergoing percutaneous coronary intervention. In this patient-level pooled analysis we analyzed 1-year target lesion failure (TLF), a composite of cardiac death, target vessel myocardial infarction, or clinically driven target lesion revascularization. Furthermore, we determined predictors of 1-year TLF. Results A total of 3,614 patients (63.5 ± 11.2 years of age; 23.8% women) were included in this analysis. The prevalence of diabetes mellitus was 29.3%, and 54.3% patients presented with acute coronary syndrome. The primary endpoint of 1-year TLF occurred in 140 (3.9%) patients, with incidence of cardiac death in 1.6%, target vessel myocardial infarction in 1.2%, clinically driven target lesion revascularization in 2.2%, and definite stent thrombosis in 0.5% patients. Insulin-treated diabetes mellitus, chronic renal failure, and American College of Cardiology/American Heart Association lesion type B2/C were independent predictors of 1-year TLF. Conclusions In this large patient-level pooled analysis of patients treated with the dual-therapy COMBO stent excellent results at 1-year were observed. (MASCOT - Post Marketing Registry [MASCOT]; NCT02183454; Prospective Registry to Assess the Long-term Safety and Performance of the COMBO Stent [REMEDEE Reg]; NCT01874002)

The multidisciplinary Risk Assessment and Management Program for patients with diabetes mellitus (RAMP-DM) was found to be cost-saving in comparison with usual primary care over 5 years’ follow-up. This study aimed to estimate the cost-effectiveness of RAMP-DM over lifetime. We built a Discrete Event Simulation model to evaluate the cost-effectiveness of RAMP-DM over lifespan from public health service provider’s perspective. Transition probabilities among disease states were extrapolated from a cohort of 17,140 propensity score matched participants in RAMP-DM and those under usual primary care over 5-year’s follow-up. The mortality of patients with specific DM-related complications was estimated from a cohort of 206,238 patients with diabetes. Health preference and direct medical costs of DM patients referred to our previous studies among Chinese DM patients. RAMP-DM individuals gained 0.745 QALYs and cost US$1404 less than those under usual care. The probabilistic sensitivity analysis found that RAMP-DM had 86.0% chance of being cost-saving compared to usual care under the assumptions and estimates used in the model. The probability of RAMP-DM being cost-effective compared to usual care would be over 99%, when the willingness to pay threshold is HK$20,000 (US$ 2564) or higher. RAMP-DM added to usual primary care was cost-saving in managing people with diabetes over lifetime. These findings support the integration of RAMP-DM as part of routine primary care for all patients with diabetes.

The evidence on the responsiveness of the Short Form-12 Health Survey version 2 (SF-12v2) in patients with type 2 diabetes mellitus (T2DM) is limited. The aim of this study was to examine both the internal and external responsiveness of the SF-12 measures in Chinese patients with T2DM. A prospective longitudinal observational study was conducted on 1443 T2DM patients managed in public primary care clinics between 2012 and 2013. These patients were surveyed at baseline and at 12 months using SF-12v2. The internal responsiveness was evaluated by linear mixed effect models. Meanwhile, the external responsiveness was tested by multiple linear regression models and receiver operating characteristic (ROC) curve analysis. The internal responsiveness of the SF-12v2 to detect negative change was satisfactory among T2DM patients in worsened group, but only the general health domain of SF-12v2 could detect positive change among T2DM patients with improved group. For external responsiveness, the SF-12v2 detected a significant difference-in-difference between patients with worsened and stable/improved group, but not between patients with stable and improved group. The areas under the ROC curve for all domains and summary scales of the SF-12v2 were not statistically different from 0.7. This study showed that the responsiveness of SF-12v2 might not achieve the standard. Despite the wide use of the SF-12v2, we would like to urge that both clinicians and researchers should use it with caution in longitudinal study.

Little psychoneuroendocrine research has focused on steroid hormone responses to non-physical competition in middle childhood. This study sought to observe testosterone, estradiol, dehydroepiandrosterone (DHEA), androstenedione, and cortisol responses in children during a mixed-sex, team, academic competition. Salivary steroid hormones were collected, along with measures of performance, Body Mass Index, and pubertal development in ethnically Chinese boys (n = 18) and girls (n = 27), aged 9–10 years, during a math competition (N = 45). Testosterone and estradiol levels were generally low and unmeasurable. Nearly every competitor experienced decreases in cortisol and cortisol/DHEA molar ratio. Pre- and post-match DHEA and androstenedione did not significantly change. Exploratory analyses revealed a positive correlation between DHEA change and team performance among non-active participants (i.e. did not attempt to answer a question). ANCOVAs revealed differences in percentage change in androstenedione between active (n = 20) and non-active participants (n = 25) and among winners (n = 7) and losers (n = 38), and positive associations with age. Percentage change in cortisol was significantly lower among losers compared to winners. Performance measures were positively correlated with DHEA change and percentage change in androstenedione. Despite girls having higher pre-match androstenedione, both sexes exhibited similar patterned hormone responses. Only cortisol and cortisol/DHEA molar ratio decreased during the competition. However, DHEA, androstenedione, and cortisol match changes were partially related to psychosocial variables (e.g., performance, outcome, participation). These findings provide new insight into factors which may underpin steroid hormone responses during middle childhood non-athletic competition.

OBJECTIVE To estimate the cost-effectiveness of the multidisciplinary Risk Assessment and Management Programme–Diabetes Mellitus (RAMP-DM) in primary care patients with type 2 diabetes in comparison with usual primary care in a cohort with 5 years’ follow-up. RESEARCH DESIGN AND METHODS We conducted a prospective cohort study among 17,140 propensity score–matched participants in RAMP-DM and those under usual primary care. The effectiveness measures were cumulative incidences of complications and all-cause mortality over 5 years. In a bottom-up approach, we estimated the program costs of RAMP-DM and health service utilization from the public health service provider’s perspective. The RAMP-DM program costs included the setup costs, ongoing intervention costs, and central administrative costs. We calculated the incremental cost-effectiveness ratio by dividing the incremental costs by the incremental effectiveness of the RAMP-DM group compared with those of the usual-care group. RESULTS There were significantly lower cumulative incidences of individual on any complications (15.34% vs. 28.65%, P < 0.001) and all-cause mortality (7.96% vs. 21.35%, P < 0.001) in the RAMP-DM group compared with the usual-care group. The mean program cost of RAMP-DM was 157 U.S. dollars (range 66–209) per participant over 5 years. The costs of health service utilization among participants in RAMP-DM group was 7,451 USD less than that of the usual-care group, resulting in a net savings of 7,294 USD per individual. CONCLUSIONS RAMP-DM added to usual primary care was a cost-saving intervention in managing diabetes in patients over 5 years. These findings support the integration of RAMP-DM as part of routine primary care for all patients with diabetes.

The current trend on diabetes mellitus management advocates replacing the paradigm from a uniform to an individualized patient-centered systolic blood pressure (SBP), but there is no consensus on the achieved treatment goals of SBP level. The study aimed at evaluating the association between SBP and the risk of cardiovascular diseases (CVD) and all-cause mortality for diabetic patients to identify patient-centered treatment targets. A retrospective study was conducted on 95 086 Chinese adult primary care patients with type 2 diabetes mellitus and hypertension. Using the average of the annual SBP records (updated SBP) over a median follow-up of 5.9 years, the risks of overall CVD, all-cause mortality, and their composite associated with SBP were evaluated using Cox proportional hazards regression. Subgroup analysis was performed on the incidence of CVD by stratifying patient’s baseline characteristics. The SBP range for the lowest risk of CVD and all-cause mortality was 130 to 134 mm Hg among type 2 diabetes mellitus population. A J-shaped curvilinear relationship was identified between SBP and risk of CVD and all-cause mortality, irrespective of patients’ characteristics. The findings showed that all patients with SBP

OBJECTIVE To evaluate the 5-year effectiveness of a multidisciplinary Risk Assessment and Management Programme–Diabetes Mellitus (RAMP-DM) in primary care patients with type 2 diabetes. RESEARCH DESIGN AND METHODS A 5-year prospective cohort study was conducted with 121,584 Chinese primary care patients with type 2 DM who were recruited between August 2009 and June 2011. Missing data were dealt with multiple imputations. After excluding patients with prior diabetes mellitus (DM)-related complications and one-to-one propensity score matching on all patient characteristics, 26,718 RAMP-DM participants and 26,718 matched usual care patients were followed up for a median time of 4.5 years. The effect of RAMP-DM on nine DM-related complications and all-cause mortality were evaluated using Cox regressions. The first incidence for each event was used for all models. Health service use was analyzed using negative binomial regressions. Subgroup analyses on different patient characteristics were performed. RESULTS The cumulative incidence of all events (DM-related complications and all-cause mortality) was 23.2% in the RAMP-DM group and 43.6% in the usual care group. RAMP-DM led to significantly greater reductions in cardiovascular disease (CVD) risk by 56.6% (95% CI 54.5, 58.6), microvascular complications by 11.9% (95% CI 7.0, 16.6), mortality by 66.1% (95% CI 64.3, 67.9), specialist attendance by 35.0% (95% CI 33.6, 36.4), emergency attendance by 41.2% (95% CI 39.8, 42.5), and hospitalizations by 58.5% (95% CI 57.2, 59.7). Patients with low baseline CVD risks benefitted the most from RAMP-DM, which decreased CVD and mortality risk by 60.4% (95% CI 51.8, 67.5) and 83.6% (95% CI 79.3, 87.0), respectively. CONCLUSIONS This naturalistic study highlighted the importance of early optimal DM control and risk factor management by risk stratification and multidisciplinary, protocol-driven, chronic disease model care to delay disease progression and prevent complications.

Cardiovascular disease(CVD) is the leading cause of mortality among patients with type 2 diabetes mellitus(T2DM), and a risk classification model for CVD among primary care diabetic patients is pivotal for risk-based interventions and patient information. This study developed a simple tool for a 5-year CVD risk prediction for primary care Chinese patients with T2DM. A retrospective cohort study was conducted on 137,935 primary care Chinese T2DM patients aged 18–79 years without history of CVD between 1 January 2010 and 31 December 2010. New events of CVD of the cohort over a median follow up of 5 years were extracted from the medical records. A classification rule of 5-year CVD risk was obtained from the derivation cohort and validated in the validation cohort. Significant risk factors included in decision tree were age, gender, smoking status, diagnosis duration, obesity, unsatisfactory control on haemoglobin A1c and cholesterol, albuminuria and stage of chronic kidney disease, which categorized patients into five 5-year CVD risk groups(

Background The benefit of statin on the management of Type 2 Diabetes Mellitus (T2DM) among Chinese patients in primary care is not clear nor fully implemented in clinical practice. This study aimed to evaluate and quantify the benefit of statin on the overall cardiovascular risk and all-cause mortality in patients with T2DM. Methods Uncomplicated diabetic patients with baseline low-density-lipoprotein cholesterol (LDL-C) > 2.6 mmol/L and without statin use before baseline in 2010 were followed-up for 5 years for cardiovascular disease (CVD) events and all-cause mortality. Propensity score matching analysis was conducted to identify patients who were newly prescribed statin at baseline and then compared to non-statin users with similar baseline characteristics. Subgroup analysis was done within the statin group to detect any difference in outcomes between patients achieving target LDL-C of

Introduction. This study aimed to validate the Hong Kong version of the Knee Injury and Osteoarthritis Outcome Score (HK-KOOS) for patients with knee osteoarthritis.Methods. Content validity was assessed using the Item and Scale Content Validity Index (I-CVI and S-CVI). Test-retest reliability and internal consistency were assessed by the Intraclass Correlation Coefficient (ICC) and Cronbach’s alpha. Dimensionality was assessed by performing exploratory factor analysis (EFA). Convergent and Divergent Validity was performed by examining the correlation between the HK-KOOS and the Chinese version of the Short Form 12 (SF-12) Health Survey, the Chinese Modified Barthel Index (C-MBI), and the Visual Analogue Scale for Pain (VAS-Pain). Ceiling and floor effects were also examined.Results. A total of 125 participants were recruited in this study. In general, all instructions, items, and response options were considered as understandable, indicating a satisfactory cross-cultural adaptation. The I-CVI and S-CVI scores were 0.80-1 and 0.90-1, respectively, indicating excellent content validity in terms of relevance, representativeness, and understandability. The test-retest reliability of all HK-KOOS subscales was satisfactory with ICC exceeding 0.70 for all domains. Cronbach’s alpha exceeded 0.80 for all subscales, indicating satisfactory internal consistency. Medium to strong correlations were found between the HK-KOOS and the VAS-Pain, SF-12, and C-MBI. However, factor analysis indicated a seven-factor structure, rather than the original five-factor structure. Items on pain and activities of daily living were loaded in the same factors. A floor effect was present in the sports and recreation subscale.Discussion and Conclusions. Future studies should further examine the dimensionality of the KOOS. The HK-KOOS is a culturally adapted, reliable, and valid outcome measure instrument to be used in Hong Kong patients with primary knee osteoarthritis.

Little is known about how the patient-reported outcomes is influenced by multidisciplinary-risk-assessment-and-management-programme for patients with diabetes mellitus (RAMP-DM). This paper aims to evaluate the effectiveness of RAMP-DM on patient-reported outcomes. This was a prospective longitudinal study on 1039 diabetes mellitus patients (714/325 RAMP-DM/non-RAMP-DM) managed in primary care setting. 536 and 402 RAMP-DM participants, and 237 and 187 non-RAMP-DM participants were followed up at 12 and 24 months with completed survey, respectively. Patient-reported outcomes included health-related quality of life, change in global health condition and patient enablement measured by Short Form-12 Health Survey version-2 (SF-12v2), Global Rating Scale, Patient Enablement Instrument respectively. The effects of RAMP-DM on patient-reported outcomes were evaluated by mixed effect models. Subgroup analysis was performed by stratifying haemoglobin A1c (HbA1c) (optimal HbA1c

Aims To examine the association of patient volume with quality of diabetes care in the primary care setting. Methods We analyzed population-based data from Hospital Authority administrative database using a Hong Kong representative sample of 187,031 diabetic patients managed in 74 primary care general outpatient clinics between 04/2011 and 03/2012. We assessed the associations between annual clinic-based patient volume and quality of care in terms of adherence to care criteria of process (HbA1c test, renal function test, full lipid profile, urine protein analysis, diabetic retinopathy screening, and appropriate drug prescription) and clinical outcomes (HbA1c ⩽ 7%, BP ⩽ 130/80 mmHg, LDL-C ⩽ 2.6 mmol/L) of care criteria, with and without adjustment for patient and clinic characteristics. Results Patient volume was associated with three of seven process of care criteria; however, when compared to clinics in higher volume quartiles, those in lowest-volume quartile had more odds of HbA1c test (odds ratios (OR): 0.781, 0.655 and 0.646 for quartile from 2 to 4, respectively), renal function test (OR: 0.357, 0.367 and 0.590 for quartile from 2 to 4, respectively), and full lipid profile test (OR: 0.508, 0.612 and 0.793 for quartile from 2 to 4, respectively). There was no significant association between patient volume and the standards of achieving of HbA1c, BP and LDL-C outcome targets. Conclusions Disparities in volume and quality of diabetes care were observed in public primary care setting. Lower patient volumes at clinic level were associated with greater adherence to three process criteria but a volume–outcome association was not present.

To examine the effects of a structured group-based education programme, patient empowerment programme (PEP), compared with usual care on 2-year changes in patient-reported outcomes (PRO) in patients with diabetes mellitus (DM). A prospective observational study of 715 patients (PEP/non-PEP: 390/325) was conducted to complete the baseline PRO survey and followed up for 2 years. Health-related quality of life (HRQOL) was measured using the short-form 12 at baseline and annually at two follow-up assessments, which yielded physical and mental component summary and SF-6D preference-based scores. Perceived control over diabetes and general health status were measured using the patient enablement instrument (PEI) and global rating scale (GRS) at follow-ups. When compared with non-PEP, PEP participants significantly reported improvement in health condition (GRS score 0; 24.55 % vs 10.16 %; odds ratio = 2.502; P = 0.018) in 2 years and enabled the self-perceived control over diabetes (PEI score 0; 72.20 % vs 38.40 %; odds ratio = 3.25; P 0.001) in 1-year follow-up but no sustained effects in year 2 (52.65 % vs 39.04 %; odds ratio = 1.366; P = 0.265). There were no significant differences between PEP and non-PEP groups in the changes in quality of life scores (all P 0.05) at 1 year. Although HRQOL scores deteriorated over 2-year period in both groups, PEP participants reported similar changes in HRQOL scores to that of non-PEP. PEP for DM patients preserved self-perceived disease control and health condition, whereas PEP participants perceived their HRQOL similar to that of non-PEP participants. Findings of PRO should be considered alongside clinical outcomes when evaluating the overall benefits of PEP.

Aims This epidemiological and longitudinal study aimed to confirm the association between BMI and CVD and determine the optimal BMI range for Chinese patients with T2DM. Method A retrospective cohort study was conducted on 113,194 Chinese adult primary care T2DM patients without prior CVD history at baseline, and had a documented BMI in 2008–2010. Using the average of the annual mean of BMI records (updated BMI) over a median follow-up of 4.2years, the risk of CVD associated with BMI by gender, age group, smoking status and presence of chronic kidney disease group was evaluated using multivariable Cox proportional hazard regression adjusted by socio-demographics and clinical characteristics. Results The updated BMI value and the incidence of CVD showed a J-shaped curvilinear relationship. Low ( 2 ) or high (≥25kg/m 2 ) BMI range was associated with higher risk of CVD and the optimal BMI range associated with the lowest likelihood of CVD was 20–22.9kg/m 2 in overall cohort and all selected groups. Conclusions There was no evidence of benefit of underweight or adiposity with regard to the risk of CVD and thus the maintenance of a normal weight should be emphasized as an integral part of preventive intervention in the diabetes management.

A large body of research links testosterone and cortisol to male-male competition. Yet, little work has explored acute steroid hormone responses to coalitional, physical competition during middle childhood. Here, we investigate testosterone, dehydroepiandrosterone (DHEA), androstenedione, and cortisol release among ethnically Chinese boys in Hong Kong (N = 102), aged 8–11 years, during a soccer match (n = 84) and an intrasquad soccer scrimmage (n = 81), with 63 participants competing in both treatments. The soccer match and intrasquad soccer scrimmage represented out-group and in-group treatments, respectively. Results revealed that testosterone showed no measurable change. DHEA increased during both treatments in the majority of participants and the degree of change had no relation to independent variables (e.g., performance, age, treatment, outcome) or covariate measures (Body Mass Index, Pubertal Development Scale). Most boys experienced androstenedione increases during match play, but no significant differences during the intrasquad soccer scrimmage competitions. The magnitude of change differed significantly between treatments and was positively associated with age. These latter findings suggest boys’ androstenedione responses may be sensitive to competitor type (i.e., unknown competitors vs. peers). For most subjects, cortisol significantly increased during match play, decreased during the intrasquad soccer scrimmage, and differed significantly between treatments, suggesting each treatment promoted a different psychological state among competitors. Cortisol/DHEA molar ratio decreased during the intrasquad scrimmage, suggestive of a more relaxed mental state. These data shed new light on potential proximate mechanisms associated with coalitional competition among prepubescent boys, with relevance to adrenarche and life history theory.

OBJECTIVE The objective of this study was to compare the incidence of cardiovascular disease (CVD) among patients with type 2 diabetes mellitus (T2DM) with treated hypertension who achieved systolic blood pressures (SBPs) of RESEARCH DESIGN AND METHODS A retrospective cohort study was conducted on 28,014 primary care adult patients with T2DM with no prior diagnosis of CVD and who achieved SBP readings RESULTS Over a median follow-up period of 4.8 years, the incidence of CVD in patients with achieved SBP measures of CONCLUSIONS Our findings support a SBP treatment target of 140 mmHg and suspect no risk reduction attenuation on CVD for lower SBP targets (

Aims Evidence-based cardiovascular diseases (CVD) risk prediction models and tools specific for Chinese patients with type 2 diabetes mellitus (T2DM) are currently unavailable. This study aimed to develop and validate a CVD risk prediction model for Chinese T2DM patients. Methods A retrospective cohort study was conducted with 137 935 Chinese patients aged 18 to 79 years with T2DM and without prior history of CVD, who had received public primary care services between January 1, 2010 and December 31, 2010. Using the derivation cohort over a median follow-up of 5 years, the interaction effect between predictors and age were derived using Cox proportional hazards regression with a forward stepwise approach. Harrell's C statistic and calibration plot were used on the validation cohort to assess the discrimination and calibration of the models. The web calculator and chart were developed based on the developed models. Results For both genders, predictors for higher risk of CVD were older age, smoking, longer diabetes duration, usage of anti-hypertensive drug and insulin, higher body mass index, haemoglobin A1c (HbA1c), systolic and diastolic blood pressure, a total cholesterol to high-density lipoprotein-cholesterol (TC/HDL-C) ratio and urine albumin to creatinine ratio, and lower estimated glomerular filtration rate. Interaction factors with age demonstrated a greater weighting of TC/HDL-C ratio in both younger females and males, and smoking status and HbA1c in younger males. Conclusion The developed models, translated into a web calculator and color-coded chart, served as evidence-based visual aids that facilitate clinicians to estimate quickly the 5-year CVD risk for Chinese T2DM patients and to guide intervention.

Our aim was to compare health-related quality of life (HRQOL) between end-stage renal disease (ESRD) patients and the Hong Kong general population to identify how the mode of dialysis and other factors were associated with HRQOL. We conducted a cross-sectional study involving 253 hemodialysis (HD) patients and 103 peritoneal dialysis (PD) patients recruited in 2014–2015. Their HRQOL was evaluated using Kidney Disease and Quality of Life-36 (KDQOL-36) sub-scale scores and the Short Form-6 Dimensions (SF-6D) health preference score. One-way analysis of variance was used to analyze the difference in mean KDQOL-36 and SF-6D scores among PD patients, HD patients, and an exact age- and sex-matched general population. Multiple linear regressions were conducted to evaluate factors associated with the KDQOL-36 and SF-6D scores. The physical HRQOL of ESRD patients on dialysis was worse than that of the age- and sex-matched general population (38.4 vs. 49.6), but mental HRQOL was similar (50.7 vs. 52.0). After adjusting for all baseline characteristics, male subjects was associated with higher physical component summary (PCS), SF-6D, and symptom scores. A higher level of education (secondary or tertiary) was associated with higher mental component summary (MCS), SF-6D, symptom, and effects scores. Patients who were female, younger, married, and less educated and had a history of cardiovascular disease (CVD) and did not achieve target hemoglobin and albumin levels were associated with poorer HRQOL outcomes. HD was associated with a greater negative impact of ESRD on daily lives than was PD, which may be a consideration when deciding on the dialysis modality for first-line renal replacement therapy. To improve HRQOL among patients on maintenance dialysis, more attention should be paid to those with demographic risk factors, preventing CVD, and meeting clinical dialysis outcome targets such as hemoglobin and albumin levels.

Background The relative effect of hemoglobin A1c, blood pressure, and low‐density lipoprotein‐cholesterol ( LDL ‐C) (“ ABC ” factors) on the prevention of cardiovascular diseases ( CVD ) among patients with type 2 diabetes mellitus is poorly understood. This study aimed to evaluate the association of key clinical parameters on CVD risk using a multifactorial optimal control approach in Chinese primary care patients with type 2 diabetes mellitus. Methods and Results A population‐based retrospective cohort study was conducted on 144 271 Chinese type 2 diabetes mellitus primary care patients, aged 18 to 79 and without prior clinical diagnosis of CVD in 2008–2011. Cox regressions were conducted to examine the association between the combinations of ABC targets (hemoglobin A1c LDL ‐C CVD (overall), coronary heart disease, stroke, and heart failure. Achieving more ABC targets incrementally reduced the incidence of total CVD and individual disease including coronary heart disease, stroke, and heart failure, irrespective of other patient characteristics. Compared with suboptimal control in all ABC levels, achieving any 1, 2, and all 3 ABC targets reduced the relative risk of CVD by 13% to 42%, 31% to 52%, and 55%, respectively. Among those achieving only 1 ABC target, LDL ‐C reduction was associated with the greatest CVD risk reduction (42%), followed by blood pressure reduction (18%), and hemoglobin A1c reduction (13%). Conclusions To achieve the greatest risk reduction for the incidence of CVD , the ultimate goal of treatment should be to achieve target control of hemoglobin A1c, blood pressure, and LDL ‐C. If it is not possible to achieve all 3 targets, efforts should be prioritized on treating the LDL ‐C to minimize CVD risk.

Background Since diabetes mellitus (DM) is the leading cause of end stage renal disease (ESRD), this study aimed to develop a 5-year ESRD risk prediction model among Chinese patients with Type 2 DM (T2DM) in primary care. Methods A retrospective cohort study was conducted on 149,333 Chinese adult T2DM primary care patients without ESRD in 2010. Using the derivation cohort over a median of 5 years follow-up, the gender-specific models including the interaction effect between predictors and age were derived using Cox regression with a forward stepwise approach. Harrell’s C-statistic and calibration plot were applied to the validation cohort to assess discrimination and calibration of the models. Results Prediction models showed better discrimination with Harrell’s C-statistics of 0.866 (males) and 0.862 (females) and calibration power from the plots than other established models. The predictors included age, usages of anti-hypertensive drugs, anti-glucose drugs, and Hemogloblin A1c, blood pressure, urine albumin/creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR). Specific predictors for male were smoking and presence of sight threatening diabetic retinopathy while additional predictors for female included longer duration of diabetes and quadratic effect of body mass index. Interaction factors with age showed a greater weighting of insulin and urine ACR in younger males, and eGFR in younger females. Conclusions Our newly developed gender-specific models provide a more accurate 5-year ESRD risk predictions for Chinese diabetic primary care patients than other existing models. The models included several modifiable risk factors that clinicians can use to counsel patients, and to target at in the delivery of care to patients. Electronic supplementary material The online version of this article (doi:10.1186/s12882-017-0671-x) contains supplementary material, which is available to authorized users.

Aims To assess whether a structured diabetes education programme, the Patient Empowerment Programme (PEP), was associated with a lower risk of first cardiovascular disease (CVD) event and all-cause mortality in a population-based cohort of patients with type 2 diabetes mellitus (T2DM) in primary care. Methods A Chinese cohort of 27 278 patients with T2DM and without previous CVD events on or before the baseline study recruitment date was linked to the Hong Kong administrative database from 2008 to 2013. The PEP was provided to patients with T2DM treated at primary care outpatient clinics through community trained professional educators. PEP non-participants were matched one-to-one with the PEP participants using a propensity score method with respect to their baseline covariates. Cox proportional hazard regression was performed to estimate the associations of the PEP with the occurrence of first CVD event, coronary heart disease, stroke, heart failure and death from any cause, controlling for baseline characteristics. Results During a median of 21.5 months follow-up, 795 (352 PEP participants and 443 PEP non-participants) patients experienced a first CVD event. After adjusting for confounding variables, PEP participants had a lower rate of all-cause mortality [hazard ratio (HR) 0.564, 95% confidence interval (CI) 0.445–0.715; p

Aims This study aimed to develop and validate an all-cause mortality risk prediction model for Chinese primary care patients with type 2 diabetes mellitus(T2DM) in Hong Kong. Methods A population-based retrospective cohort study was conducted on 132,462 Chinese patients who had received public primary care services during 2010. Each gender sample was randomly split on a 2:1 basis into derivation and validation cohorts and was followed-up for a median period of 5 years. Gender-specific mortality risk prediction models showing the interaction effect between predictors and age were derived using Cox proportional hazards regression with forward stepwise approach. Developed models were compared with pre-existing models by Harrell's C-statistic and calibration plot using validation cohort. Results Common predictors of increased mortality risk in both genders included: age; smoking habit; diabetes duration; use of anti-hypertensive agents, insulin and lipid-lowering drugs; body mass index; hemoglobin A1c; systolic blood pressure(BP); total cholesterol to high-density lipoprotein-cholesterol ratio; urine albumin to creatinine ratio(urine ACR); and estimated glomerular filtration rate(eGFR). Prediction models showed better discrimination with Harrell”'s C-statistics of 0.768(males) and 0.782(females) and calibration power from the plots than previously established models. Conclusions Our newly developed gender-specific models provide a more accurate predicted 5-year mortality risk for Chinese diabetic patients than other established models.

This study evaluated the effectiveness of a structured multidisciplinary risk assessment and management programme for patients with hypertension (RAMP-HT) who were managed in public primary care clinics but had suboptimal blood pressure (BP) control in improving BP, LDL-cholesterol (LDL-C) and predicted 10-year cardiovascular disease (CVD) risk after 12 months of intervention.A total of 10 262 hypertension patients with suboptimal BP despite treatment, aged less than 80 years and without existing CVD were enrolled in RAMP-HT between October 2011 and March 2012 from public general out-patient clinics in Hong Kong. Their clinical outcomes and predicted 10-year CVD risk were compared with a matched cohort of hypertension patients who were receiving usual care in general out-patient clinics without any RAMP-HT intervention by propensity score matching. Multivariable linear and logistic regressions were used to determine the independent effectiveness of RAMP-HT after adjusting for potential confounding variables.Compared with the usual care group after 12 months, significantly greater proportions of RAMP-HT participants achieved target BP (i.e. BP 140/90 mmHg) (OR = 1.18, P 0.01) and LDL-C levels (i.e.3.4 mmol/l for patients with CVD risk ≤20% or2.6 mmol/l for CVD risk20%) (OR = 1.13, P 0.01). RAMP-HT participants also had significantly greater reduction in predicted 10-year CVD risk by 0.44% (coefficient = -0.44, P 0.01).The structured multidisciplinary RAMP-HT was more effective than usual care in achieving target BP, LDL-C and reducing predicted 10-year CVD risk in public primary care patients with suboptimal hypertension control after 12 months of intervention. A long-term follow-up should be conducted to confirm whether the improvement in clinical outcomes can be translated into actual reductions in CVD complications and mortalities and whether such approach is cost-effective.

Aim The aim of this study was to evaluate the 24-month outcomes of a nurse-led continence care service for Chinese primary care patients with lower urinary tract symptoms. Background Most studies evaluating the outcomes of continence care services have had short follow-up durations with limited knowledge on whether benefits are sustained beyond 12 months. Design Twenty-four month cohort study. Methods Two comparison groups were recruited: (1) Patients with lower urinary tract symptoms attending a nurse-led community-based continence care programme; (2) Primary care patients with lower urinary tract symptoms identified by screening, receiving usual medical care. Self-reported symptom severity, health-related quality of life, patient enablement and general health perception were measured at baseline and 24 months. Data collection occurred from March 2013–August 2015. Results Baseline and 24-month data were available for 170 continence care and 158 usual care subjects. After controlling for baseline characteristics, the continence care group was observed to have greater reductions in symptom severity and larger improvements in disease-specific health-related quality of life, patient enablement and general health perception than the usual care group. Deterioration in the mental components of generic health-related quality of life was observed in the usual care group, but not in the continence care group. Conclusion Over 24 months, when compared with usual medical care, nurse-led continence care services were effective in reducing symptom severity and improving health-related quality of life, patient enablement and general health perception and provided protection against deterioration in the mental components of health-related quality of life in patients with lower urinary tract symptoms.

This study aimed to identify the predictors of decline in health-related quality of life (HRQOL) in Chinese patients with type 2 diabetes mellitus (T2DM). A prospective longitudinal observational study was conducted on 1826 Chinese T2DM patients managed in public primary care setting. HRQOL was measured at baseline, 1 and 2 years by the Short Form-12 Health Survey version 2 (SF-12v2) and Chinese (HK) Short Form-6 Dimensions (SF-6D). Linear mixed effect models with forward stepwise method were performed to select the factors associated with SF-12v2 physical (PCS) and mental component summary (MCS) scores and SF-6D value. Over a 2-year observation period, the HRQOL (PCS: −0.626; MCS: −1.869; and SF-6D: −0.017 per year) scores decreased significantly with time. Female, unmarried, current smoker, no regular exercise, obesity, comorbid hypertension, chronic kidney disease (CKD) or cardiovascular disease (CVD) and insulin use were predictors of one or more poorer HRQOL scores after 12 or 24 months. Older age had a negative impact on PCS score and SF-6D value, but had a positive impact on MCS score. The HRQOL of Chinese T2DM patients under primary care declined significantly over time. Obesity, smoking and no regular exercise were found to be modifiable risk factors of the decline in HRQOL in T2DM, which strengthened the importance of these lifestyle changes in diabetes care. More attention should be given to T2DM patients who are female, older, unmarried, or on anti-hypertensive drugs or insulin, or have comorbid hypertension, CKD or CVD in minimizing the negative impact of illness on their life.

Background Haemodialysis (HD) is one of the life-saving options for patients with end stage renal disease but demand for this treatment exceeds capacity in publicly funded hospitals. One novel approach to addressing this problem is through a shared-care model whereby government hospitals partner with qualified private HD service providers to increase the accessibility of HD for needy patients. The aim of this study is to evaluate and enhance the quality of care (QOC) provided in such a shared-care programme in Hong Kong, the Haemodialysis Public-Private Partnership Programme (HD-PPP). Methods/Design This is a longitudinal study based on Action Learning and Audit Spiral methodologies to measure the achievement of pre-set target standards for the HD-PPP programme over three evaluation cycles. The QOC evaluation framework is comprised of structure, process and outcome criteria with target standards in each domain developed from review of the evidence and in close collaboration with the HD-PPP working group. During each evaluation cycle, coordinators of each study site complete a questionnaire to determine adherence with structural criteria of care. Process and clinical outcomes, such as adverse events and dialysis adequacy, are extracted from the patient records of consenting study participants while face-to-face interviews are conducted to ascertain patient-reported outcomes such as self-efficacy and health-related quality of life. Discussion The study relies on the successful implementation of partnership-based action research to develop an evidence-based and pragmatic framework for evaluation of quality of care in an iterative fashion, and to use it to identify possible areas of quality enhancements in a shared-care programme for HD patients. The approach we take in this study emphasizes partnership and engagement with the clinical and administrative programme team, a robust but flexible evaluation framework, direct observation and the potential to realize positive change. The experience will be useful to inform the process of coordinating research studies involving multiple stakeholders and results will help to guide service planning and policy decision making. Trial registration US Clinical Trial Registry NCT02307903 Electronic supplementary material The online version of this article (doi:10.1186/s12882-016-0284-9) contains supplementary material, which is available to authorized users.

AIM: The aim of this study was to evaluate the validity, reliability and sensitivity of the disease-specific items of the Kidney Disease Quality of Life-36 (KDQOL-36) in Chinese patients undergoing maintenance dialysis. METHODS: The content validity was assessed by content validity index (CVI) in ten subjects. 356 subjects were recruited for pilot psychometric testing. The internal construct validity was assessed by corrected item-subscale total correlation. Confirmatory factor analysis (CFA) was used to confirm the factor structure. The convergent validity was assessed by Pearson's correlation test between the disease specific subscale scores and SF-12 version 2 Health Survey (SF-12 v2) scores. The reliability was assessed by the internal consistency (Cronbach's Alpha coefficient) and 2-week test-retest reliability (intraclass correlation coefficient (ICC)). The sensitivity was determined by performing known group comparisons by independent t-test. RESULTS: The CVI on clarity and relevance was â ¥ 0.9 for all items. Corrected item- total correlation scores were â ¥0.4 for all, except an item related to problems with access site. CFA confirmed the 3-factor structure of the disease-specific component of the KDQOL-36. The correlation coefficients between the disease-specific domain scores and the SF-12 v2 physical and mental component summary scores ranged from 0.328 to 0.492. The reliability was good (Cronbach's alpha coefficients ranged from 0.810 to 0.931, ICC ranged from 0.792 to 0.924). Only the effect subscale was sensitive in detecting differences in HRQOL between haemodialysis and peritoneal dialysis patients, with effect size = 0.68. CONCLUSION: The disease-specific items of the KDQOL-36 are a valid, reliable and sensitive measure to assess the health-related quality of life of Chinese patients on maintenance dialysis., published_or_final_version