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Objective: Patients with type 2 diabetes are at higher risk for fracture risk because of attenuated bone turnover and impaired bone microarchitecture. The comparative effect of warfarin over non-vitamin K antagonist oral anticoagulants (NOACs) on incident fractures among patients with type 2 diabetes comorbid with atrial fibrillation (AF) remains to be elucidated.Research Design and Methods: This was a retrospective, propensity score-weighted, population-based cohort study of adults with type 2 diabetes and AF who were started on warfarin or NOAC between 2005 and 2019 identified from an electronic database of the Hong Kong Hospital Authority. The primary outcome was a composite of major osteoporotic fractures (hip, clinical vertebral, proximal humerus, and wrist). Hazard ratios (HRs) were calculated using Cox proportional hazards regression models.Results: A total of 15,770 patients with type 2 diabetes comorbid with AF were included (9,288 on NOAC, 6,482 on warfarin). During a median follow-up of 20 months, 551 patients (3.5%) sustained major osteoporotic fractures (201 [2.2%] in the NOAC group, 350 [5.4%] in the warfarin group). The adjusted cumulative incidence was lower among NOAC users than warfarin users (HR 0.80; 95% CI 0.64, 0.99; P = 0.044). Subgroup analyses showed consistent protective effects against major osteoporotic fractures among NOAC users across sex, age, HbA1c, duration of diabetes, and history of severe hypoglycemia compared with warfarin users.Conclusions: NOAC use was associated with a lower risk of major osteoporotic fractures than warfarin use among patients with type 2 diabetes comorbid with AF. NOAC may be the preferred anticoagulant from the perspective of bone health. [ABSTRACT FROM AUTHOR]

Background: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have proven cardiovascular benefits in patients with type 2 diabetes (T2D). This self-controlled case series study aims to evaluate whether metformin use and SGLT2i-associated erythrocytosis influence its cardiovascular benefits. Methods: T2D patients with metformin and/or SGLT2i prescriptions between 2015 and 2020 were identified from the Hong Kong population. Study outcomes were composite cardiovascular diseases (CVD), coronary heart disease (CHD), hospitalisation for heart failure (HHF), stroke, and erythrocytosis. Risk periods were patient-time divided into four mutually exclusive windows: (i) 'baseline period' of metformin use without SGLT2i; (ii) pre-SGLT2i period; (iii) exposure to SGLT2i without metformin; and (iv) exposure to the drug combination. Another SCCS model was applied to evaluate the association between erythrocytosis and cardiovascular outcomes regarding SGLT2i exposure. Four mutually exclusive risk periods included (i) SGLT2i exposure with erythrocytosis; (ii) SGLT2i exposure without erythrocytosis; (iii) absence of SGLT2i exposure with erythrocytosis; and (iv) absence of SGLT2i exposure without erythrocytosis. Incidence rate ratios (IRR) of events at different risk periods were estimated using conditional Poisson regression model. Results: Among 20,861 patients with metformin and/or SGLT2i prescriptions, 2575 and 1700 patients with events of composite CVD and erythrocytosis were identified, respectively. Compared to metformin use without SGLT2i, SGLT2i initiation was associated with lower risks of composite CVD, CHD, and HHF—regardless of the presence (CVD: IRR = 0.43, 95% CI 0.37–0.51; CHD: IRR = 0.44, 95% CI 0.37–0.53; HHF: IRR = 0.29, 95% CI 0.22–0.40; all p < 0.001) and absence of concomitant metformin (CVD: IRR = 0.31, 95% CI 0.20–0.48; CHD: IRR = 0.38, 95% CI 0.25–0.59; HHF: IRR = 0.17, 95% CI 0.09–0.31; all p < 0.001); while SGLT2i was neutral on stroke risk. Compared to metformin-SGLT2i combination, exposure to SGLT2i alone was associated with comparable risks of all cardiovascular outcomes (all p > 0.05). Incidence rates of erythrocytosis at baseline, SGLT2i without and with metformin use periods were 0.75, 3.06 and 3.27 per 100 person-years, respectively. SGLT2i users who developed erythrocytosis had lower risk of HHF (IRR = 0.38, 95% CI 0.14–0.99, p = 0.049) than those who did not. Conclusions: Our real-world data suggested that SGLT2i-associated cardiovascular benefits were not attenuated by metformin use. Further studies will delineate the role of erythrocytosis as a surrogate marker of SGLT2i-associated cardiovascular benefit in reducing HHF. [ABSTRACT FROM AUTHOR]

Deep learning has garnered increasing attention in many research fields. However, prior research seldom focused on tourists' perception prediction and prescription towards tourism destinations in turbulence. This study attempts to fill the gap by investigating Mainland Chinese tourists' perception of a turbulent Hong Kong society through deep learning‐based sentiment analytics. This incorporates a convolutional neural network (CNN) model for sentiment prediction and feature frequency analysis for sentiment prescription for 52,950 Chinese travel microblogs about Hong Kong. Results show that the CNN‐based deep learning approach can obtain improved sentiment predictive performance with minimal domain knowledge and human effort. The trend of Mainland Chinese tourists' (MCTs') sentiments about Hong Kong and the unique sentiment features revealed by our approach can provide practitioners with new insights into design customised tourism marketing and development strategies. The MCTs' shared mentalities emerged from sentiment features may help to enhance our theoretical knowledge about tourists' perception in turbulent tourism markets. [ABSTRACT FROM AUTHOR]

Japanese encephalitis virus (JEV) is a mosquitoborne virus endemic to China and Southeast Asia that causes severe encephalitis in <1% of infected persons. Transmission of JEV via blood transfusion has not been reported. We report transmission of JEV via blood donation products from an asymptomatic viremic donor to 2 immunocompromised recipients. One recipient on high-dose immunosuppressive drugs received JEV-positive packed red blood cells after a double lung transplant; severe encephalitis and a poor clinical outcome resulted. JEV RNA was detected in serum, cerebrospinal fluid, and bronchoalveolar lavage fluid specimens. The second recipient had leukemia and received platelets after undergoing chemotherapy. This patient was asymptomatic; JEV infection was confirmed in this person by IgM seroconversion. This study illustrates that, consistent with other pathogenic flaviviruses, JEV can be transmitted via blood products. Targeted donor screening and pathogen reduction technologies could be used to prevent transfusion-transmitted JEV infection in highly JEV-endemic areas. [ABSTRACT FROM AUTHOR]

Aim: The National Surgery Quality Improvement Program (NSQIP) and Portsmouth Physiological and Operative Severity Score for enUmeration of Mortality and Morbidity (P‐POSSUM) are well‐established risk calculators employed by surgeons worldwide to calculate predicted surgical mortality and morbidity. Since 2008, the Hospital Authority has implemented the Surgical Outcomes Monitoring and Improvement Program (SOMIP) for auditing of 30‐day mortality in emergency surgery. In the present study, we aimed to compare the performance of this locally‐developed risk calculator with NSQIP and P‐POSSUM for 30‐day mortality predictions in patients undergoing emergency colectomy. Patients and Methods: The present study was a retrospective study of 119 patients who underwent emergency colectomy between January and December 2014 at the Department of Surgery, Queen Elizabeth Hospital, Hong Kong. The predicted mortality rate was calculated by SOMIP, NSQIP and P‐POSSUM. Data were analysed by the area under the receiver–operator characteristic curve (AUROC). Results: The overall mortality rate was 12.6 per cent (15/119). The AUROC for SOMIP was 0.908 [95 per cent confidence interval (CI): 0.845–0.970, P < 0.05), whereas the the AUROC for NSQIP and P‐POSSUM were 0.903 (95 per cent CI: 0.815–0.990, P < 0.05) and 0.842 (95 per cent CI: 0.743–0.942, P < 0.05), respectively. The SOMIP calculator provided the highest AUROC and was comparable to the other two well‐established international risk calculators. Conclusions: All three risk calculators (SOMIP, NSQIP and P‐POSSUM) showed considerable accuracy in predicting the 30‐day mortality rate. The SOMIP risk calculator was comparable to the well‐established international risk calculators NSQIP and P‐POSSUM. [ABSTRACT FROM AUTHOR]

The Hong Kong Zhuhai Macao Bridge (HZMB) link is currently one of the largest fixed links ever realised. The link comprises various bridges, causeways, artificial islands and tunnels and has a total length of more than 55 km with an investment of about RMB 120billion (approx. €15 billion). The Link accommodates a dual carriageway with three traffic lanes in each direction. The construction of the Link started at the end of 2010 and was opened to traffic in October 2018. The HZMB Link is internationally regarded as one of the most challenging sea crossing projects in China and a demonstration of China's comprehensive breakthrough in technology, scientific research and other related fields. The offshore part of the HZMB Link, crossing the Pearl River Estuary involves one of the world's longest and deepest immersed tunnels. The tunnel was designed and constructed to meet state-of-the-art requirements and challenging structural, geotechnical and marine/offshore conditions. The HZMB tunnel won the ITA Tunnelling Award Major Project of the Year 2018. This paper presents the project from the Client perspective. The paper will give a general introduction of the project, will provide information regarding the challenging environment in which the tunnel had to be realized and the high demanding design criteria that were applicable. Furthermore, the evaluation of the various technical options will be discussed, ultimately leading to the selection of the immersed tunnel option. The paper will also look into the background of selecting the Design & Build contract approach for this project and the experiences that were built up using this type of contract, new to China on this scale. Finally, the paper introduces how operation and maintenance of the tunnel is planned and executed so as to guarantee the 120-year design lifetime. In Ref. (The Islands and Tunnel Project of HZM Link et al., 2022) more details of the project are discussed from the D&B contractors' perspective. [ABSTRACT FROM AUTHOR]