Y-90 radioembolisation for large unresectable hepatocellular carcinoma as a bridge to surgery - A 5-year single institute’s experience in Hong Kong

Yan Lilian CHAN,Wai Hung CHEUNG,Chung Yan Justin CHAN,Tak Wing LAI 한국간담췌외과학회 2022 Annals of hepato-biliary-pancreatic surgery Vol.26 No.-

Donki: Decoding The Secret Behind Donki’s Global Success

Chan Wing Yin Winnie,SHEK Man Yan,LO Wai Man,LAW Yu Ho,YEUNG Tak Hin Academy of Asian Business (AAB) 2022 Academy of Asian Business Review Vol.8 No.2

Japan's largest discount retail chain, Don Don Donki, continues to pursue its policy of rapid global expansion amid the Covid-19 pandemic, one of the bright spots in an otherwise bleak retail landscape. This case study showcases Donki's unconventional business practices and unique marketing philosophy. The first section begins with an overview of the company, its current situation, and the competitive environment. The second section focuses on the major turning points that Donki has reached, addressing how Donki has responded to challenges with marketing and branding strategies and the results of its achievements. The third section details Donki's critical success factors. The fourth section describes the current challenges and potential recommendations to improve the company's business performance. Finally, the case study ends with a conclusion and valuable lessons learned from Donki. The discussion offers managerial and practical implications for business leaders and policymakers interested in running a business in Asian markets. It also serves as insightful teaching material for students to develop a deeper, multi-faceted understanding of a real-life application of a theoretical concept or solution.

Serum fibrosis index-based risk score predicts hepatocellular carcinoma in untreated patients with chronic hepatitis B

( Lilian Yan Liang ),( Hye Won Lee ),( Vincent Wai-sun Wong ),( Terry Cheuk-fung Yip ),( Yee-kit Tse ),( Vicki Wing-ki Hui ),( Grace Chung-yan Lui ),( Henry Lik-yuen Chan ),( Grace Lai-hung Wong ) 대한간학회 2021 Clinical and Molecular Hepatology(대한간학회지) Vol.27 No.3

Background/Aims: Serum fibrosis scores comprised of common laboratory tests have high utility to assess severity of liver fibrosis. We aimed to derive and validate a hepatocellular carcinoma (HCC) risk score based on serum fibrosis scores to predict HCC in treatment-naive chronic hepatitis B (CHB) patients. Methods: Fifteen thousand one hundred eighty-seven treatment-naive adult CHB patients were identified to form the training cohort in this retrospective study. Individual fibrosis score was included to construct a new HCC prediction score. The score was externally validated in an independent treatment-naive Korean CHB cohort. Results: 180/15,187 patients (1.2%) in training cohort and 47/4,286 patients (1.1%) in validation cohort developed HCC during a mean follow-up of 52 and 50 months, respectively. The newly developed HCC risk score, Liang score, is composed of gender, age, hepatitis B virus DNA, fibrosis-4 (FIB-4) index, and ranges from 0 to 22. Area under the time-dependent receiver operating characteristic curve of Liang score was 0.79 (95% confidence interval, 0.70-0.89). A cutoff value of nine provided an extremely high negative predictive value of 99.9% and high sensitivity of 90.0% at 5 years in the validation cohort. Patients with Liang score ≤9 had HCC incidence <0.2% per year in both training and validation cohorts, in whom HCC surveillance might be exempted. Conclusion: A novel HCC risk score, Liang score, based on FIB-4 index, is applicable and accurate to identify treatment-naive CHB patients with very low risk of HCC to be exempted from HCC surveillance. (Clin Mol Hepatol 2021;27:499-509)

Defining Optimal Surgical Treatment for Recurrent Hepatocellular Carcinoma: A Propensity Score Matched Analysis

( Ka Wing Ma ),( Kenneth Siu Ho Chok ),( Albert Chi Yan Chan ),( James Yan Yue Fung ),( Chung Mau Lo ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1

Aims: Salvage liver transplantation (sLT) and repeated resection (RR) are effective treatment for recurrent hepatocellular carcinoma (HCC), comparison of the oncological outcomes between these two modalities were scarce. Methods: Consecutive patients admitted for either sLT or RR for recurrent HCC were recruited. All patients in the present series received either prior hepatectomy, ablative therapy or both before RR and sLT. Paedatric patients and patients treated by non-curative approach were excluded. Patient demographic, perioperative and outcome data were analyzed. Survival analysis was performed after propensity score matching. Results: There were 277 eligible patients recruited, 67 and 210 of them underwent sLT and RR respectively. Significant difference in preoperative haemoglobin, albumin, hepatitis B carrier status, MELD score, and tumor number were found (all P<0.001) between sLT and RR group. Multivariate analysis revealed that type of treatment (P=0.002, OR=2.13 95%CI 1.2-3.2), lapse time from last curative treatment (P=0.022, OR=0.994 95%CI 0.988-0.999), alpha fetal protein (AFP) (P=0.01 OR=1.00 95%CI 1.00-1.00) and tumor number (P<0.001, OR=1.23 95%CI 1.14-1.32) were independent factors associated with overall survival. After 1:3 PS matching, there were 36 sLT and 108 RS patients for comparison. The median age, MELD, AFP, tumor size and umber of the matched population were 57, 7.5, 16U/ml, 2.5cm and 1 respectively. There was no difference in the hospital mortality and complication rate (Clavien IIIa or above) between the groups, while the blood loss (P<0.001), operation time (P<0.001) and hospital stay (P=0.002) were significantly more in the sLT group. Patients in sLT group had significantly longer disease free (140 vs 49 months, P=0.031) and overall survival (176 vs 55.3 months, P=0.026). Conclusions: Salvage LT is superior to repeated resection for treatment of recurrent HCC and is associated with more than two fold increase in long term survival.

Trends in contemporary advanced heart failure management: an in-depth review over 30 years of heart transplant service in Hong Kong

Yue Yan Katherine Fan,Ka Lam Wong,Ka Lai Cally Ho,Tai Leung Daniel Chan,Oswald Joseph Lee,Chi Yui Yung,Kin Shing Lun,Mo Chee Elaine Chau,Shui Wah Clement Chiu,Lik Cheung Cheng,Wing Kuk Timmy Au 대한이식학회 2022 Korean Journal of Transplantation Vol.36 No.4

Background: The year 2022 marks the 30th anniversary of heart transplant service in Hong Kong (HK). In this study, we describe prevailing trends and outcomes of advanced heart failure (AHF), including heart transplantations (HTx), in HK over the past 30 years. Methods: Trends in heart failure prevalence in HK from 1993 to 2021 were analyzed based on data from the Hospital Authority Clinical Data and Reporting System. All AHF patients referred for HTx consideration between 1992 and 2021 were reviewed. The bridge-to-transplant (BTT) utilization of short-term mechanical circulatory support (ST-MCS) devices, including venoarterial extracorporeal membrane oxygenation (VA-ECMO) and durable left ventricular assist devices (LVADs), from 2010 to 2021 was reviewed. Results: Overall, 237 heart transplants were performed in HK, with 10-year posttransplant and median survival of 68.1% and 18.7 years, respectively. An increase in AHF clinic referrals was correlated with increasing heart failure prevalence (R2=0.635, P<0.001). In total, 146 referrals were made for ST-MCS, and an observed increase in ST-MCS referrals was correlated with increasing VA-ECMO utilization (R2=0.849, P<0.001). Among 62 patients accepted for AHF therapy, those with durable LVAD implementation had better 1-year survival (71.5%) than those receiving an extracorporeal CentriMag (Levitronix) device as BTT (40%, P=0.008). In total, 143 LVADs were implanted, with 130 as BTT or bridge-to-candidacy (BTC) methods. The survival rate among the 130 BTT/BTC LVAD patients resembled that of HTx recipients (73.8% vs. 69.8% at 9 years, P=0.296). Conclusions: The burden of AHF management has increased and gained complexity over the past 30 years in Hong Kong.

Improving mobility in the intensive care unit with a protocolized, early mobilization program: observations of a single center before-and-after the implementation of a multidisciplinary program

Laptin Ho,Joe Hin Cheung Tsang,Emmanuel Cheung,Wing Yan Chan,Ka Wai Lee,Sweetie R Lui,Chung Yau Lee,Alfred Lok Hang Lee,Philip Koon Ngai Lam 대한중환자의학회 2022 Acute and Critical Care Vol.37 No.3

Background: Early intensive care unit (ICU) protocolized rehabilitative programs have been described previously, yet with differing starting time points and mostly on mechanically ventilated patients. We extended the concept to all admitted ICU patients and investigate the efficacy of early mobilization in improving mobility of the critically ill, address issues surrounding the timing and intensity of an early rehabilitative program.Methods: Prospective cohorts of patients admitted consecutively before-and-after (control, n=92; intervention, n=90) the introduction of an early mobilization program in a single center, general hospital ICU. Improvement in mobility as assessed by ICU mobility score, on ICU admission and upon ICU discharge, was measured as a primary outcome.Results: Those receiving early mobilization in the intensive care unit had higher ICU mobility score (2.63; 95% confidence interval, 0.65–4.61; P<0.001) upon discharge from the intensive care, with earlier out of bed mobilization on day 5 compared to the control group of day 21 (P<0.001). No differences were found in terms of mortality, intensive care hospitalization and subsequent hospitalization duration after discharge from ICU.Conclusions: Here, we report that improvement in mobility score earlier in the course of intensive care hospitalization with the introduction of a protocolized early rehabilitative program.

Comparison of Serum Ketone Levels and Cardiometabolic Efficacy of Dapagliflozin versus Sitagliptin among Insulin-Treated Chinese Patients with Type 2 Diabetes Mellitus

Chi-Ho Lee,Mei-Zhen Wu,David Tak-Wai Lui,Darren Shing-Hei Chan,Carol Ho-Yi Fong,Sammy Wing-Ming Shiu,Ying Wong,Alan Chun-Hong Lee,Joanne King-Yan Lam,Yu-Cho Woo,Karen Siu-Ling Lam,Kelvin Kai-Hang Yiu 대한당뇨병학회 2022 Diabetes and Metabolism Journal Vol.46 No.6

Background: Insulin-treated patients with long duration of type 2 diabetes mellitus (T2DM) are at increased risk of ketoacidosis related to sodium-glucose co-transporter 2 inhibitor (SGLT2i). The extent of circulating ketone elevation in these patients remains unknown. We conducted this study to compare the serum ketone response between dapagliflozin, an SGLT2i, and sitagliptin, a dipeptidyl peptidase-4 inhibitor, among insulin-treated T2DM patients.Methods: This was a randomized, open-label, active comparator-controlled study involving 60 insulin-treated T2DM patients. Participants were randomized 1:1 for 24-week of dapagliflozin 10 mg daily or sitagliptin 100 mg daily. Serum β-hydroxybutyrate (BHB) levels were measured at baseline, 12 and 24 weeks after intervention. Comprehensive cardiometabolic assessments were performed with measurements of high-density lipoprotein cholesterol (HDL-C) cholesterol efflux capacity (CEC), vibration-controlled transient elastography and echocardiography.Results: Among these 60 insulin-treated participants (mean age 58.8 years, diabetes duration 18.2 years, glycosylated hemoglobin 8.87%), as compared with sitagliptin, serum BHB levels increased significantly after 24 weeks of dapagliflozin (P=0.045), with a median of 27% increase from baseline. Change in serum BHB levels correlated significantly with change in free fatty acid levels. Despite similar glucose lowering, dapagliflozin led to significant improvements in body weight (P=0.006), waist circumference (P=0.028), HDL-C (P=0.041), CEC (P=0.045), controlled attenuation parameter (P=0.007), and liver stiffness (P=0.022). Average E/e’, an echocardiographic index of left ventricular diastolic dysfunction, was also significantly lower at 24 weeks in participants treated with dapagliflozin (P=0.037).Conclusion: Among insulin-treated T2DM patients with long diabetes duration, compared to sitagliptin, dapagliflozin modestly increased ketone levels and was associated with cardiometabolic benefits.