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Introduction: Takotsubo cardiomyopathy (TTC) is a cardiovascular disease caused by physical/psychological stressors with significant morbidity if left untreated. Because TTC often mimics acute myocardial infarction in the absence of obstructive coronary disease, the condition is often underdiagnosed in the population. Our aim was to discuss the role of artificial intelligence (AI) and machine learning (ML) in diagnosing TTC. Methods: We systematically searched electronic databases from inception until April 8, 2023, for studies on the utility of AI- or ML-based algorithms in diagnosing TTC compared with other cardiovascular diseases or healthy controls. We summarized major findings in a narrative fashion and tabulated relevant numerical parameters. Results: Five studies with a total of 920 patients were included. Four hundred and forty-seven were diagnosed with TTC via International Classification of Diseases codes or the Mayo Clinic diagnostic criteria, while there were 473 patients in the comparator group (29 of healthy controls, 429 of myocardial infarction, and 14 of acute myocarditis). Hypertension and smoking were the most common comorbidities in both cohorts, but there were no statistical differences between TTC and comparators. Two studies utilized deep-learning algorithms on transthoracic echocardiographic images, while the rest incorporated supervised ML on cardiac magnetic resonance imaging, 12-lead electrocardiographs, and brain magnetic resonance imaging. All studies found that AI-based algorithms can increase the diagnostic rate of TTC when compared to healthy controls or myocardial infarction patients. In three of these studies, AI-based algorithms had higher sensitivity and specificity compared to human readers. Conclusion: AI and ML algorithms can improve the diagnostic capacity of TTC and additionally reduce erroneous human error in differentiating from MI and healthy individuals. [ABSTRACT FROM AUTHOR]

Background: Routinely collected health data are increasingly used in clinical research. No study has systematically reviewed the temporal trends in the number of publications and analyzed different aspects of local research practices and their variations in Hong Kong, China, with a specific focus on research ethics governance and approval. Methods: PubMed was systematically searched from its inception to March 28, 2023, for studies using routinely collected healthcare data from Hong Kong. Results: A total of 454 studies were included. Between 2000 and 2009, 32 studies were identified. The number of publications increased from 5 to 120 between 2010 and 2022. Of the investigator-led studies using the Hospital Authority (HA)'s cross-cluster data (n = 393), 327 (83.2%) reported receiving ethics approval from a single cluster/university-based REC, whereas 50 studies (12.7%) did not report approval from a REC. For use of the HA Data Collaboration Lab, approval by a single hospital-based or University-based REC is accepted. Repeated submission of identical ethics applications to different RECs is estimated to cost HK$4.2 million yearly. Conclusions: Most studies reported gaining approval from a single cluster REC before retrieval of cross-cluster HA data. Substantial cost savings would result if repeated review of identical ethics applications were not required. [ABSTRACT FROM AUTHOR]

Introduction: Neutrophil‐to‐lymphocyte ratio (NLR) is a routinely available biomarker that reflects systemic inflammation. The study evaluated the predictive value of NLR for ischemic stroke and atrial fibrillation (AF) in patients with type 2 diabetes mellitus. Methods: This was a population‐based cohort study of patients with type 2 diabetes mellitus and complete blood count tests at baseline between 1 January 1st, 2009, and 31 December, 2009, at government‐funded hospitals/clinics in Hong Kong. Follow‐up was until 31 December, 2019, or death. Results: A total of 85,351 patients (age = 67.6 ± 13.2 years old, male = 48.8%, follow‐up = 3101 ± 1441 days) were included. Univariable Cox regression found that increased NLR at quartiles 2, 3 and 4 was significantly associated with higher risks of new‐onset ischemic stroke (hazard ratio [HR]: 1.28 [1.20–1.37], p <.001, HR: 1.41 [1.32–1.51], p <.001 and HR: 1.38 [1.29–1.47], p <.001) and AF (HR: 1.09 [1.02–1.17], p <.015; HR: 1.28 [1.20–1.37], p <.001; HR: 1.39 [1.31–1.49], p <.001) compared to quartile 1. On multivariable analysis, NLR remained a significant predictor of ischemic stroke risk for quartiles 2 and 3 (quartile 2: HR: 1.14 [1.05, 1.22], p =.001; quartile 3: HR: 1.14 [1.06, 1.23], p <.001) but not quartile 4 (HR: 1.08 [0.994, 1.17], p =.070). NLR was not predictive of AF after adjusting for confounders (quartile 2: HR: 0.966 [0.874, 1.07], p =.499; quartile 3: HR: 0.978 [0.884, 1.08], p =.661; quartile 4: HR: 1.05 [0.935, 1.16], p =.462). Conclusion: NLR is a significant predictor of new‐onset ischaemic stroke after adjusting for significant confounders in Chinese type 2 diabetes patients. [ABSTRACT FROM AUTHOR]

Introduction: Cancer patients may be susceptible to poorer outcomes in COVID‐19 infection owing to the immunosuppressant effect of chemotherapy/radiotherapy and cancer growth, along with the potential for nosocomial transmission due to frequent hospital admissions. Methods: This was a population‐based retrospective cohort study of COVID‐19 patients who presented to Hong Kong public hospitals between 1 January 2020 and 8 December 2020. The primary outcome was a composite endpoint of requirement for intubation, ICU admission and 30‐day mortality. Results: The following study consisted of 6089 COVID‐19 patients (median age 45.9 [27.8.1–62.7] years; 50% male), of which 142 were cancer subjects. COVID‐19 cancer patients were older at baseline and tended to present with a higher frequency of comorbidities, including diabetes mellitus, hypertension, chronic obstructive pulmonary disease, ischemic heart disease, ventricular tachycardia/fibrillation and gastrointestinal bleeding (p < 0.05). These subjects also likewise tended to present with higher serum levels of inflammatory markers, including D‐dimer, lactate dehydrogenase, high sensitivity troponin‐I and C‐reactive protein. Multivariate Cox regression showed that any type of cancer presented with an almost four‐fold increased risk of the primary outcome (HR: 3.77; 95% CI: 1.63–8.72; p < 0.002) after adjusting for significant demographics, Charlson comorbidity index, number of comorbidities, past comorbidities and medication history. This association remained significant when assessing those with colorectal (HR: 5.07; 95% CI: 1.50–17.17; p < 0.009) and gastrointestinal malignancies (HR: 3.79; 95% CI: 1.12–12.88; p < 0.03), but not with lung, genitourinary, or breast malignancies, relative to their respective cancer‐free COVID‐19 counterparts. Conclusions: COVID‐19 cancer patients are associated with a significantly higher risk of intubation, ICU admission and/or mortality. [ABSTRACT FROM AUTHOR]

Congenital long QT syndrome (LQTS) is a type of cardiac ion channelopathy that increases the susceptibility of the affected individuals to spontaneous ventricular tachycardia/fibrillation or even sudden cardiac death. More than 17 subtypes have been identified. This was a systematic review of the published case series or reports on the clinical characteristics, genetic basis, and patient outcomes from Hong Kong with rare genetic variants of LQTS which fall outside the traditional LQTS classification system. PubMed and Zenodo were searched from the corresponding inception until January 15, 2022. Twenty-four studies were identified. Of these, one article met the inclusion criteria. The article included a case series of six patients from a cohort with 134 patients. They had either asymptomatic LQTS with HCN4 mutations (n = 1, c.1471G>A, QTc: 420 ms with prolonged QTc of 670 ms during the recovery phase of treadmill test), RYR2 (n = 1, c.7060G>A, QTc: 480 ms) or SCN10A (n = 2, c.3542C>T, QTc: 439 ms-480 ms), or LQTS with multiorgan syndromes with GATA3 mutations (n = 1, c. 815C>T, Barakat syndrome: Sensorineural deafness, hypoparathyroidism, and renal disease, QTc: 450-489 ms), or SLC6A8 (n = 1, c.691_693del; X-linked creatine transporter deficiency, with c.6065A>G mutation in AKAP9, known modifier of LQTS; QTc: 485 ms). In addition, rare genetic variants in non-LQTS causative genes were identified. Future studies should be conducted to compare the variants and investigate their functional consequences. [ABSTRACT FROM AUTHOR]