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In Hong Kong, social distancing has been adopted in order to minimise the spread of COVID-19. This study aims to examine the changes in physical health, mental health, and social well-being experienced by local residents who were homebound during the pandemic. An online questionnaire in both Chinese and English versions was completed by 590 eligible participants from 24 April to 13 May 2020. The questionnaire found that individuals aged 18 to 25 years spent more time resting and relaxing but experienced more physical strain. Working status was associated with social contact, with participants working full-time jobs scoring higher in "maintaining social communication via electronic means" and "avoiding social activities outside the home". Additionally, approximately one third of the participants (29.7%) had moderate to severe depression, and participants aged 18 to 25 were found to have higher scores in PHQ-9. Changes in physical health and social contact were significantly associated with developing depressive symptoms. From the results, it is clear that the COVID-19 pandemic has the potential to exert a negative impact on the mental health status of individuals.

Purpose: This paper aims to illustrate an example of how to set up a work injury database: the Smart Work Injury Management (SWIM) system. It is a secure and centralized cloud platform containing a set of management tools for data storage, data analytics, and machine learning. It employs artificial intelligence to perform in-depth analysis via text-mining techniques in order to extract both dynamic and static data from work injury case files. When it is fully developed, this system can provide a more accurate prediction model for cost of work injuries. It can also predict return-to-work (RTW) trajectory and provide advice on medical care and RTW interventions to all RTW stakeholders. The project will comprise three stages. Stage one: to identify human factors in terms of both facilitators and barriers RTW through face-to-face interviews and focus group discussions with different RTW stakeholders in order to collect opinions related to facilitators, barriers, and essential interventions for RTW of injured workers; Stage two: to develop a machine learning model which employs artificial intelligence to perform in-depth analysis. The technologies used will include: 1. Text-mining techniques including English and Chinese work segmentation as well as N-Gram to extract both dynamic and static data from free-style text as well as sociodemographic information from work injury case files; 2. Principle component/independent component analysis to identify features of significant relationships with RTW outcomes or combine raw features into new features; 3. A machine learning model that combines Variational Autoencoder, Long and Short Term Memory, and Neural Turning Machines. Stage two will also include the development of an interactive dashboard and website to query the trained machine learning model. Stage three: to field test the SWIM system., Conclusion: SWIM ia secure and centralized cloud platform containing a set of management tools for data storage, data analytics, and machine learning. When it is fully developed, SWIM can provide a more accurate prediction model for the cost of work injuries and advice on medical care and RTW interventions to all RTW stakeholders., Ethics: The project has been approved by the Ethics Committee for Human Subjects at the Hong Kong Polytechnic University and is funded by the Innovation and Technology Commission (Grant # ITS/249/18FX).

Background: Volar locking plates were increasing popular as treatment of distal radius fractures. Various distal forearm anatomical variants were encountered during surgery. Flexor carpi radialis brevis (FCRB) was one of the most common and relevant anatomical variants because of its close proximity to fracture site. Methods: This is a retrospective single-centre study. In a 3.5-year period from March 2015 to August 2018, 133 patients who suffered from distal radius fracture requiring volar wrist plating were identified. Operation records and clinical photos were reviewed. All patients were followed up for at least 1 year. Any complications were recorded. Results: 9 patients with FCRB variant were identified. The prevalence was 6.8%. Hypoplastic pronator quadratus were found in 5 cases out of the 9 cases. None of these cases had any neurovascular injuries. No complications were noted during follow-up at 1 year. Conclusions: In Chinese population with volar locking plate done for distal radius fracture, the prevalence of flexor carpi radialis brevis was 6.8%. Surgeons should be aware of the possibility of FCRB variant.

Introduction: Imminent fracture risk, or fractures within 2 years of an initial fracture, is a pressing issue worldwide. Hong Kong is a city with one of the longest life expectancies. The concern of fragility fractures and the imminent risk of a subsequent fracture is becoming a top priority. The objective of this study was to present the epidemiology of incident fragility fractures of all public acute hospitals and the imminent risk of a subsequent fracture in Hong Kong., Methodology: This was a retrospective population-based analysis. Patient records from all acute hospitals in Hong Kong from 1 January 2004 to 31 December 2018 were retrieved for patients ≥ 50 years of age with hip, distal radius, or proximal humerus fractures. Secondary fractures and falls were identified in the subsequent 5 years. Post hoc analysis in recent 2013-2018 period was performed. Overall survival (re-fracture incidence) on age subgroups using Kaplan survival analysis and variables was compared using the log-rank test. Cox proportional hazard regressions, obtaining the hazard ratios (HR) and their respective 95% confidence intervals (CI), were used., Results: There is an overall increasing trend of fragility fractures (hip, distal radius, proximal humerus) from 5596 in 2004 to 8465 in 2018. The average cumulative imminent risk of fractures from recent 5 years is 3.87% at 1 year and 6.50% at 2 years. 49.5% of the patients with a secondary fracture occurred within 2 years since the initial major fragility fracture. Post hoc analysis in recent 2013-2018 period (N = 7039) showed male patients were 1.21 times more likely to have further fractures with time (HR = 1.21 (1.02, 1.45), p = 0.03) compared with female patients. Patients over age 95 were 2.01 times higher than patients of age under 75 to have further fracture over time., Conclusions: Following an initial fracture, prompt treatment strategies should be adopted to avoid imminent risk of fractures. This window of opportunity in the first 2 years is a golden period to treat osteoporosis and prevent falls. Our post hoc analysis has shown that male patients and patients older than 95 are at even higher risk. Clinicians and allied healthcare professionals should be alert on these patients.

Genetic variants are implicated in the development of amyotrophic lateral sclerosis (ALS), but it is unclear whether the burden of rare variants in ALS genes has an effect on survival. We performed whole genome sequencing on 8 familial ALS (FALS) patients with superoxide dismutase 1 (SOD1) mutation and whole exome sequencing on 46 sporadic ALS (SALS) patients living in Hong Kong and found that 67% had at least 1 rare variant in the exons of 40 ALS genes; 22% had 2 or more. Patients with 2 or more rare variants had lower probability of survival than patients with 0 or 1 variant (p = 0.001). After adjusting for other factors, each additional rare variant increased the risk of respiratory failure or death by 60% (p = 0.0098). The presence of the rare variant was associated with the risk of ALS (Odds ratio 1.91, 95% confidence interval 1.03-3.61, p = 0.03), and ALS patients had higher rare variant burden than controls (MB, p = 0.004). Our findings support an oligogenic basis with the burden of rare variants affecting the development and survival of ALS., (Copyright © 2017 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Type II diabetic patients easily develop ulcers over their feet which heal with great difficulties and not infrequently, end up in amputations. In the quest for innovative means to avoid amputation, herbal medicine has been used in China to heal ulcers., Method: A randomized placebo controlled clinical trial involving 80 patients was conducted to test whether a herbal formula taken orally could help to preserve the ulcerated leg. Other parameters measured included granulation maturation time, skin temperature and circulation, and tumor necrosis factor alpha (TNF-α)., Results: showed a 85% limb rescue with the herbal treatment group showing superiority over placebo group. TNF-α decline was observed with gradual ulcer healing and the herbal supplement group showed a more impressive decline (p=0.037)., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Objective: Sports injuries around bone-tendon junctions are not uncommon. This study was designed to perform a quantitative evaluation on healing characteristics at the cartilage-to-tendon (C-T) and the bone-to-tendon (B-T) healing junction in a temporal and spatial manner., Design: Basic science study., Settings: University medical school., Animals: Thirty-two 18-week-old New Zealand white rabbits., Intervention: All rabbits underwent partial inferior patellectomy. The operated patella-patellar tendon (PPT) complex was harvested at 2, 4, 8, and 16 weeks postoperatively (n = 8 for each time point)., Main Outcome Measures: The fusion ratio (ie, the ratio of tissue integration calculated along the length of the healing junction interface at both C-T and B-T junction of sagittal plane of PPT complex)., Results: The fusion ratio at the C-T interface was 69.5% and 85.9%, which was significantly greater as compared with 45.9% and 60.1% at the B-T interface at week 2 and week 4, respectively (P < 0.01 for both). Under polarized light microscope, a small amount of collagen fibers crossing the C-T junction was seen, but none were found at the B-T interface at week 2. At 4 weeks, there was a distinct fibrocartilage zone regenerated at the C-T junction, but there were only limited collagen fibers at the B-T junction. The difference in the fusion ratio, however, was diminished with healing over time between the C-T and B-T junctions at both week 8 (90.2% vs. 80.1%) and week 16 (93.1% vs. 85.3%) (both, P > 0.05)., Conclusion: These findings demonstrated that the C-T junction might have an earlier and faster healing potential as compared with that of the B-T repair. The earlier fusion of the C-T junction might provide earlier stability along the entire PPT healing interface that would form a basis for improved postoperative prognosis of PPT healing complex.

As the incidence of diabetes mellitus is increasing globally, complications related to this endocrine disorder are also mounting. Because of the large number of patients, foot ulcers developing in the feet of diabetics have become a public health problem. The predisposing factors include abnormal plantar pressure points, foot deformities, and minor trauma. Vulnerable feet usually already have vascular insufficiency and peripheral neuropathy. The complex nature of these ulcers deserves special care. The most useful prognostic feature for healing remains the ulcer depth, ulcers heal poorly if they clearly involve underlying tendons, ligament or joints and, particularly, when gangrenous tissue is seen. Local treatment of the ulcer consists of repeated debridement and dressing. No 'miraculous' outcome is expected, even with innovative agents like skin cover synthetics, growth factors and stem cells. Simple surgery like split skin grafting or minor toe amputations may be necessary. Sophisticated surgery like flap coverages are indicated for younger patients. The merits of an intact lower limb with an abnormal foot have to be weighed against amputation and prosthesis in the overall planning of limb salvage or sacrifice. If limb salvage is the decision, additional means like oxygen therapy, and other alternative medicines, might have benefits. The off-loading of footwear should always be a major consideration as a prevention of ulcer formation.

Unlabelled: A lowered bone mineral density (BMD) was observed in trabecular bone in a significant number of AIS patients. The present study aims at investigating whether lower BMD is a systemic phenomenon, which would also be present in the cortical component of long bone., Subjects and Methods: 78 AIS girls (age:15-18y.o) with either moderate (Cobb: 20-40) or severe (Cobb: >40) curve and 44 age-matched controls were recruited. The BMD of the distal region and the mid-shaft of radius were measured with a multi-layer peripheral quantitative computed tomography (pQCT). The trabecular bone and cortical bone BMD and the morphology of mid-shaft were compared., Results: Both trabecular and cortical BMD in severe AIS group was significantly lower than the control by 8.7% and 1.7% (p<0.05 for both), respectively. However, the cortical bone area of the mid-shaft did not show any differences from the normal control subjects., Discussion: This study demonstrates a systemic low BMD including the cortical bone. It is suggested that AIS girls may have disturbance in mineralization and ossification during peripubertal growth.

Adolescent idiopathic scoliosis (AIS) is a serious 3-dimentional deformity of the spine affecting mostly girls. The prevalence rate is 3%-4% in Hong Kong. Generalised osteopenia are found in AIS patients. This study attempted to study whether low bone mineral density (BMD) is related to calcium intake in AIS. 582 AIS patients & 206 healthy controls aged 11-16 years were enrolled. Areal BMD (aBMD) and volumetric BMD (vBMD) were evaluated by DXA (Norland-XR-36) and pQCT (Densiscan-1000) respectively. Calcium and other nutrients intakes were assessed by a food-frequency method. The results showed that absolute calcium intake of the subjects were low (< 500 mg/d). Mean calcium intake of AIS girls was significantly higher than that of controls[(441 +/- 344) mg/d vs. (390 +/- 281) mg/d, P = 0.015]. BMD of AIS was significantly lower than that of controls at most skeletal sites from age 11-16 years (P < or = 0.05). The percentage difference in BMD increased with age between the AIS and control group. Furthermore, calcium intake was significantly correlated with BMD at most skeletal sites from age 15-16 years. However, this association was not found in the controls. Calcium intake was an independent determinant to predict variation of BMD after controlling for confounding variables in multivariate analysis. It is suggested that absolute calcium intake of AIS was low. BMD at various skeletal sites of the AIS was consistently lower than those of controls across different adolescent years, and that the correlation between calcium intake and BMD occurs only in AIS but not in healthy control girls implying the importance of calcium in bone mineral gain among the AIS, and it also reflected an abnormal mechanism of calcium homeostasis and bone turnover in AIS. Further calcium interventional study is warranted to confirm the effect of calcium on BMD acquisition in AIS.