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Objectives: Little is known in the literature about felt experience and supportive care needs of patients with new diagnosis of adult-type diffuse gliomas Central Nervous System WHO grades 3 and 4. The purpose of this study is to influence clinicians' attitudes and facilitate the referral process and the development of support services by better understanding the patient's journey., Methods: Adult patients with a new histopathological diagnosis of high-grade glioma, who underwent radiotherapy, participated in a semistructured, face-to-face interview. Different segments of the patient's journey were explored focusing on patient's emotions, interactions with healthcare providers, satisfaction during the process and access to supports. Descriptive thematic analysis in the tradition of grounded theory was performed., Results: Fifteen patients were interviewed, and four themes were emerged from the analysis. First, information conveyed by the medical team was frequently disconnected from patients' understanding regarding diagnosis and treatment. Second, specific events created a lasting impression that the medical system, and at times medical care providers, lacked empathy. Third, patients' perceptions of shortcomings within the medical system led to decreased trust, particularly regarding the follow-up process. Finally, although respondents identified multiple inadequacies during their journey, they nonetheless acknowledged the great support and quality of services they received., Conclusions: This study provides insight into patients' experiences and perceived shortcomings of the medical system, from the time of presentation until the end of radiotherapy treatment in patients with new diagnosis of high-grade glioma. These findings should influence clinicians' attitudes and guide systematic changes including delivery of information and the referral process., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction : Bracing is one of the first-line treatment for early-onset idiopathic scoliosis (EOIS) to control curves from progression. This study aimed to explore the determinants that govern bracing effectiveness in EOIS. Methods : One hundred and eleven patients with EOIS (mean age of 8.6 ± 1.25 at diagnosis) received bracing treatment and had a final follow-up beyond skeletal maturity were identified from records between 1988 and 2021. Demographic data and clinical features of spinal curvature were obtained for correlation analyses to determine the associations between curve outcomes and clinical features. Results : Most patients were female (85.6%) and had a major curve on the left side (67%). The mean baseline Cobb angle of major curves was 21.73 ± 7.92°, with a mean Cobb angle progression of 18.05 ± 19.11°. The average bracing duration was 5.3 ± 1.9 years. Only 26 (23.4%) of them underwent surgery. The final Cobb angle and curve progression at the final follow-up with a Cobb angle of ≥50° were positively correlated with the initial Cobb angle (r = 0.206 and r = 0.313, respectively) and negatively correlated with maturity parameters. The lumbar curve type was found to correlate with a smaller final Cobb angle. Conclusions : The majority of patients had a final Cobb angle < 50°, which was considered a successful bracing outcome. The final Cobb angle correlated with the initial Cobb angle and curve types observed in EOIS.

Background: Identifying peripheral nerve surgery procedure (PNSP) competencies is crucial to ensure adequate resident training. We examine PNSP training at neurosurgical centers in the US and Canada to compare resident-reported competence, PNSP exposure, and resident technical abilities in performing 3 peripheral nerve coaptations (PNC)., Methods: Resident-reported PNSP competence and PNSP exposure data were collected using questionnaires from neurosurgical residents at North American neurosurgical training centers. Exposure and self-reported competency were correlated with technical skills. Technical PNC variables collected included: time-to-completion, nerve-handling from video-analysis, independent and blinded visual-analog-scale (VAS) PNC quality grading by 3 judges, and training level., Results: A total of 40 neurosurgical residents participated in the study. Although self-reported competency scores correlated with procedural exposure (P < 0.01, rs = 0.88), a discrepancy was found between the degree of self-reported competency and amount of exposure. The discrepancy was greater in senior residents. A significant VAS difference was found between PNC types with the direct-suture and connector-assister groups scoring higher than connector-only (P = 0.02, P < 0.01, respectively). No difference was observed between training level and VAS grading, nor time-to completion (P = 0.33 and 0.25, respectively). No correlation was found between self-reported competency performing PNSPs and PNC VAS scores, nor nerve handling., Conclusions: Despite more exposure and a higher self-reported PNSP competency in senior residents, no difference was seen between senior/junior residents in PNC quality. A discrepancy in PNSP exposure and self-reported competency exists. This information will provide guidance for the direction of resident PNS training., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background: Few studies investigated the mechanisms of treatment-resistant depression (TRD) leading to the worsened survival outcome, and economic evidence was mostly restricted to short follow-ups. We aimed to examine the association and potential mediators between TRD and all-cause mortality, and estimate a longer-term associated health resource utilisation pattern., Methods: This was a population-based cohort study using territory-wide electronic medical records in Hong Kong. Incident depression patients diagnosed in 2014 were followed up from the first diagnosis to death or December 2019 for TRD identification. We matched the TRD cohort 1:4 to the non-TRD cohort on propensity scores estimated by age, sex, history of physical disorders, and history of psychiatric conditions before depression diagnoses., Findings: 18% of incident patients developed TRD within six years of follow-up. Cox model showed that patients with TRD had 1⋅52-fold (95% CI: 1⋅14-2⋅02) greater risk of all-cause mortality, compared with non-TRD patients. Path analysis suggested that post-TRD psychiatric conditions significantly mediated 41⋅6% of mortality in patients with TRD (p=0.003). TRD was associated with 1⋅8-fold (95%CI: 1⋅63-2⋅00) higher healthcare costs compared to non-TRD patients over six years in negative binomial regression, with higher costs for both psychiatric and non-psychiatric services utilisation in all settings., Interpretation: Identifying patients with TRD and subsequent monitoring for post-TRD psychiatric diagnoses could be a way to reduce premature mortality. Multidisciplinary care involving both psychiatric and general medical professionals is also warranted to relieve the multifaceted impacts on healthcare resources and overall cost., Funding: Unconditional educational grant from Janssen., Competing Interests: X Li received research grants from Research Fund Secretariat of the Food and Health Bureau (HMRF, HKSAR), Research Grants Council Early Career Scheme (RGC/ECS, HKSAR), Janssen and Pfizer; internal funding from the University of Hong Kong; consultancy fee from Merck Sharp & Dohme, unrelated to this work; H Luo received research grants Research Grants Council Early Career Scheme (RGC/ECS, HKSAR) unrelated to this work. S Chan received research support from GRF, Research Grant Council; HMRF, Food and Health Bureau. FTT Lai was supported by the RGC Postdoctoral Fellowship 2020/21 (inaugural exercise) funded by the Research Grants Council, University Grants Committee, Hong Kong SAR. J F Hayes was supported by the Wellcome Trust (211085/Z/18/Z), University College London Hospitals NIHR Biomedical Research Centre and the NIHR ARC North Thames Academy. He received consultancy fees from the Wellcome Trust and Juli Health, unrelated to this work. P Ip received research grants from Research Fund Secretariat of the Food and Health Bureau (HMRF, HKSAR), Research Grants Council (GRF and CRF, HKSAR) and project grant from the Hong Kong Jockey Club Charities Trust. EWY Chan received honorarium from the Hospital Authority, research grants from Innovation and Technology Commission of HKSAR, Narcotics Division of the Security Bureau of HKSAR, National Health and Medical Research Council (NHMRC, Australia), National Natural Science Foundation of China (NSFC), Research Fund Secretariat of the Food and Health Bureau (HMRF, HKSAR), Research Grants Council (RGC, HKSAR), Wellcome Trust; Amgen, AstraZeneca, Bayer, Bristol-Myers Squibb, Janssen, Pfizer, RGA, Takeda and Novartis, and consultancy fee from Novartis outside the submitted work. She is also the President of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR), Hong Kong Regional Chapter. ICK Wong received research funding outside the submitted work from Amgen, Bristol-Myers Squibb, Pfizer, Janssen, Bayer, GSK, Novartis, Takeda, the Hong Kong RGC, and the Hong Kong Health and Medical Research Fund, National Institute for Health Research in England, European Commission, National Health and Medical Research Council in Australia, and has also received speaker fees from Janssen and Medice over the past three years. He is also an independent non-executive director of Jacobson Medical in Hong Kong., (© 2022 The Authors.)

Objective: Implementation of residency duty hour standards has led to adoption of different staffing models, such as the "holdover" model, whereby nighttime teams admit patients and transfer their care to daytime teams who provide ongoing care. In contrast, nonholdover teams at our institution are responsible for both admitting patients and providing ongoing care. We sought to determine whether patients admitted by holdover teams experience worse outcomes than those admitted by nonholdover teams., Methods: This is a retrospective cohort study of patients admitted to the internal medicine hospital service at a quaternary care hospital from July 2013 to June 2015. Primary outcomes included hospital length of stay (LOS) and transfer to an intensive care unit within 72 hours of admission. Secondary outcomes were any transfer to an intensive care unit, in-hospital mortality, discharge to home (versus discharge to postacute care facility), and readmission to the health system within 30 days of discharge., Results: We analyzed 5518 encounters, 64% of which were admitted by a holdover team. Outcomes were similar between study groups, except the LOS, which was 5.5 hours longer for holdover encounters in unadjusted analyses (5.18 versus 4.95 days, P = 0.04) but not significantly different in adjusted analyses. The mean discharge time was 4:00 p.m. for both groups, whereas the mean admission times were 12:00 a.m. and 4:00 p.m. for holdover and nonholdover encounters, respectively., Conclusions: Holdover encounters at our institution were not associated with worse patient safety outcomes. A small increase in LOS may have been attributable to holdover patients having earlier admission and identical discharge times., Competing Interests: The authors disclose no conflict of interest., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Spindle cell oncocytoma (SCO) is a rare tumor originating from pituicytes of the neurohypophysis. It typically occurs in the adult population between 50 and 60 years of age and is often misdiagnosed preoperatively as pituitary adenoma because of similar clinical presentation and neuroimaging features. Diffuse nuclear immunoreactivity for TTF-1 (also known as NK2 homeobox 1 factor) is characteristic of SCO and other tumors of the posterior pituitary. We report a case of SCO in a patient who underwent multiple surgical resections for recurrence. The aim of this case report and literature review is to provide an overview of what is currently known about SCO as well as raise the awareness of this entity to endocrinologists, neurologists, neurosurgeons, and neuropathologists. Our case is also unusual in that the tumor displayed immunoreactivity for neuronal markers, which is a very rare occurrence.

Purpose . To report visual performance and quality of life after implantation of a bifocal diffractive multifocal intraocular lens (MIOL) in postmyopic laser in situ keratomileusis (LASIK) patients. Methods . Prospective, observational case series. Patients with prior myopic LASIK who had implantation of Tecnis ZMA00/ZMB00 MIOL (Abbott Medical Optics) at Hong Kong Sanatorium and Hospital were included. Postoperative examinations included monocular and binocular distance, intermediate and near visual acuity (VA), and contrast sensitivity; visual symptoms (0-5); satisfaction (1-5); spectacle independence rate; and quality of life. Results . Twenty-three patients (27 eyes) were included. No intraoperative complications developed. Mean monocular uncorrected VA at distance, intermediate, and near were 0.13 ± 0.15 (standard deviation), 0.22 ± 0.15, and 0.16 ± 0.15, respectively. Corresponding mean values for binocular uncorrected VA were 0.00 ± 0.10, 0.08 ± 0.13, and 0.13 ± 0.10, respectively. No eyes lost >1 line of corrected distance VA. Contrast sensitivity at different spatial frequencies between operated and unoperated eyes did not differ significantly (all P > 0.05). Mean score for halos, night glare, starbursts, and satisfaction were 1.46 ± 1.62, 1.85 ± 1.69, 0.78 ± 1.31, and 3.50 ± 1.02, respectively. Eighteen patients (78%) reported complete spectacle independence. Mean composite score of the quality-of-life questionnaire was 90.31 ± 8.50 out of 100. Conclusions . Implantation of the MIOL after myopic LASIK was safe and achieved good visual performance., Competing Interests: No authors have a financial interest in any aspect of this report. Dr. Chang received travel expenses from Abbott Medical Optics, Inc., Alcon Laboratories Inc., and Technolas Perfect Vision and lecture honorarium from Alcon Laboratories Inc. The other authors declare that there is no conflict of interests regarding the publication of this paper.

Purpose: To compare the refractive and visual outcomes between 2 ablation centration points, 80% and 100% from the pupil center toward the coaxially sighted corneal light reflex., Setting: Hong Kong Sanatorium and Hospital, Hong Kong, China., Design: Retrospective comparative study., Methods: All eyes had myopic laser in situ keratomileusis with the ablation 80% or 100% from the pupil center toward the coaxially sighted corneal light reflex. Three months postoperatively, the refractive and visual outcomes were compared between groups. Subgroup analysis was also performed for the large-angle κ and small-angle κ groups., Results: There were no differences in the preoperative variables between groups. Three months postoperatively, the sphere was significantly more hyperopic in the 80% group than in the 100% group (0.19 diopter [D] versus 0.09 D) (P = .009) and the cylinder was significantly lower in the 80% group (0.25 D versus 0.33 D) (P = .011). More eyes achieved zero astigmatism in the 80% group than in the 100% group (43.9% versus 34.2%), and fewer eyes had astigmatism greater than 0.75 D in the 80% group (0.9% versus 6.1%) (P = .039). The error from the target refraction indicated that the 80% group tended to have significantly less undercorrection (P = .045). There were no significant differences in the other outcomes. Subgroup analysis did not show significant findings for the large-angle κ., Conclusions: Both 80% centration and 100% centration were safe and effective. Compared with the 100% group, the 80% group had less astigmatism and less undercorrection., (Copyright © 2016 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Background. The vision with diffractive toric multifocal intraocular lenses after cataract surgery in long eyes has not been studied previously. Objectives. To report visual performance after bilateral implantation of a diffractive toric multifocal intraocular lens in high myopes. Methods. Prospective, observational case series to include patients with axial length of ≥26 mm and corneal astigmatism of >1 dioptre who underwent bilateral AT LISA 909M implantation. Postoperative examinations included photopic and mesopic distance, intermediate, and near visual acuity; photopic contrast sensitivity; visual symptoms (0-5); satisfaction (1-5); and spectacle independence rate. Results. Twenty-eight eyes (14 patients) were included. Postoperatively, mean photopic monocular uncorrected distance, intermediate, and near visual acuities (logMAR) were 0.12 ± 0.20 (standard deviation), 0.24 ± 0.16, and 0.29 ± 0.21, respectively. Corresponding binocular values were -0.01 ± 0.14, 0.13 ± 0.12, and 0.20 ± 0.19, respectively. One eye (4%) had one-line loss in vision. Under mesopic condition, intermediate vision and near vision decreased significantly (all P ≤ 0.001). Contrast sensitivity at all spatial frequencies did not improve significantly under binocular condition (all P > 0.05). Median scores for halos, night glare, starbursts, and satisfaction were 0.50, 0.00, 0.00, and 4.25, respectively. Ten patients (71%) reported complete spectacle independence. Conclusions. Bilateral implantation of the intraocular lens in high myopes appeared to be safe and achieved good visual performance and high satisfaction.

Purpose: To report the early experience and complications during cataract surgery with a noncontact femtosecond laser system., Setting: Hong Kong Sanatorium and Hospital, Hong Kong Special Administrative Region, China., Design: Retrospective case series., Methods: All patients had anterior capsulotomy or combined anterior capsulotomy and lens fragmentation using a noncontact femtosecond laser system (Lensar) before phacoemulsification. Chart and video reviews were performed retrospectively to determine the intraoperative complication rate. Risk factors associated with the complications were also analyzed., Results: One hundred seventy eyes were included. Free-floating capsule buttons were found in 151 eyes (88.8%). No suction break occurred in any case. Radial anterior capsule tears occurred in 9 eyes (5.3%); they did not extend to the equator or posterior capsule. One eye (0.6%) had a posterior capsule tear. No capsular block syndrome developed, and no nuclei were dropped during irrigation/aspiration (I/A). Anterior capsule tags and miosis occurred in 4 eyes (2.4%) and 17 eyes (10.0%), respectively. Different severities of subconjunctival hemorrhages developed in 71 (43.8%) of 162 eyes after the laser procedure. The mean surgical time from the beginning to the end of suction was 6.72 minutes ± 4.57 (SD) (range 2 to 28 minutes)., Conclusions: Cataract surgery with the noncontact femtosecond laser system was safe. No eye lost vision because of complications. Caution should be taken during phacoemulsification and I/A to avoid radial anterior capsule tears and posterior capsule tears., (Copyright © 2013 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose. To report visual outcomes and patient satisfaction after unilateral or bilateral refractive lens exchange (RLE) with a single-piece bifocal diffractive multifocal intraocular lens (MIOL). Methods. All patients underwent RLE with the ZMB00 MIOL (Abbott Medical Optics). Patient charts were reviewed to evaluate the distance, intermediate, and near visual acuity (VA), contrast sensitivity, extent of visual symptoms (0-5), satisfaction (1-5), and rate of spectacle independence between unilateral and bilateral RLE group. Results. Forty-seven eyes of 28 patients were included. No intraoperative complications developed. Mean monocular uncorrected VA at distance, intermediate (67 cm), and near (30 cm) were 0.01 ± 0.12 (standard deviation), 0.27 ± 0.18, and 0.15 ± 0.11, respectively. No eyes lost >1 line of corrected distance VA. Monocular contrast sensitivity remained at normal level. Median scores of halos, night glare, and starbursts for 27 patients were 2.0, 3.0, and 0.0, respectively. Median score of satisfaction was 4.0. There were no differences in visual symptom scores or satisfaction between unilateral and bilateral group (P > 0.05). Eighty percent of 25 patients reported total spectacle freedom, with similar rate between bilateral (82%) and unilateral group (75%) (P = 1.000). Conclusions. RLE with the bifocal diffractive MIOL was safe in presbyopic patients and resulted in a high rate of spectacle independence.

Background: A meta-analysis on the risk of hepatocellular carcinoma (HCC) among hepatitis B virus (HBV) genotypes is warranted as the current data are conflicting., Aim: To investigate the relative risk of HCC among the four major HBV genotypes (A-D)., Methods: A meta-analysis was performed based on literature search from electronic databases and bibliography between 1950 and 2012. All abstracts with keywords 'hepatitis B', 'hepatocellular carcinoma' and 'genotype' were screened. Studies were included if they reported HBV genotype as an exposure and HCC as an outcome., Results: Nine hundred and eighty-eight abstracts were found through literature search, among them 43 studies were eligible for this meta-analysis. A total of 14,545 patients with an average age of 43 years were included; 71% were male patients and 17% had cirrhosis. In 33 studies, HCC was found in 1541/6060 (25%) genotype C vs. 550/4417 (12%) genotype B HBV-infected patients [odds ratio (OR) = 2.05, 95% confidence interval (CI) = 1.52-2.76, P < 0.001]. No difference in the risk of HCC was found among genotype A (71/517, 14%) vs. genotype D (170/1506, 11%) HBV-infected patients in 14 studies (OR = 0.94, 95% CI = 0.67-1.32). In 10 studies, the risk of HCC was also found higher among genotype C (498/1659, 30%) than genotype A&D (103/1403, 7%) HBV-infected patients (OR = 2.34, 95% CI = 1.63-3.34, P < 0.001). Subgenotype Ce and Cs HBV-infected patients had similar risk on HCC (OR = 1.13, 95% CI = 0.76-1.67, P = 0.54). On funnel plot analysis, there was no significant publication bias in all comparisons., Conclusion: Genotype C hepatitis B virus is associated with a higher risk of hepatocellular carcinoma than other major hepatitis B virus genotypes., (© 2013 Blackwell Publishing Ltd.)

This article derives statistical models relating adolescents' universal human values with their problem and pathological gambling. An adolescent's values are measured by the priority accorded to each value using the Schwartz Values Inventory, whereas problem or pathological gambling, if any, is indicated by his or her answers to the South Oaks Gambling Screen. Among other complex results, statistical analysis suggests that the value subtypes of "non-faith tradition," "faith tradition," and "macro-universalism" and the value type "stimulation" are associated with less problem and pathological gambling. Among other uses, such findings help identify high-risk adolescents.

This article describes the use of neural networks (a type of artificial intelligence) and an empirical data sample of, inter alia, the amounts of bets laid and the winnings/losses made in successive games by a number of cyber-gamblers to longitudinally model gamblers' behavior and decisions as to such bet amounts and the temporal trajectory of winnings/losses. The data was collected by videoing Texas Holdem gamblers at a cyber-gambling website. Six "persistent" gamblers were identified, totaling 675 games. The neural networks on average were able to predict bet amounts and cumulative winnings/losses in successive games accurately to three decimal places of the dollar. A more important conclusion is that the influence of a gambler's skills, strategies, and personality on his/her successive bet amounts and cumulative winnings/losses is almost totally reflected by the pattern(s) of his/her winnings/losses in the few initial games and his/her gambling account balance. This partially invalidates gamblers' illusions and fallacies that they can outperform others or even bankers. For government policy-makers, gambling industry operators, economists, sociologists, psychiatrists, and psychologists, this article provides models for gamblers' behavior and decisions. It also explores and exemplifies the usefulness of neural networks and artificial intelligence at large in the research on gambling.

Transcatheter closure for atrial septal defect (ASD) and patent foramen ovale (PFO) is a promising alternative to surgical closure or anticoagulant therapy. A potential complication is thrombus formation on the device after implantation. From February 2001 to June 2003, 66 patients with atrial communication were treated successfully with the Amplatzer device (16 septal and 20 PFO occluders) or the CardioSEAL device (30). Patients were discharged on antiplatelet medication (aspirin and clopidogrel) and/or anticoagulation. Fifty patients (76%) had transesophageal echocardiography (TEE) 1 month after device implantation (28 +/- 10 days). No patient experienced a thromboembolic episode during follow-up. TEE revealed that thrombus formation occurred more frequently on the CardioSEAL device (5 of 23 patients; 22%) than on the Amplatzer device (0 of 27 patients; 0%) (p = 0.02). Although thrombus disappeared or markedly diminished after additional anticoagulation therapy in 3 patients, 1 patient had surgical explantation of the device due to progressive increase in the size of thrombus with hypermobility despite intensive anticoagulation therapy. There was no variable associated with the presence of thrombus formation on the occluder other than the use of the CardioSEAL device. One month after insertion, the CardioSEAL device is more likely to have thrombus present than the Amplatzer device.