Gastrointestinal bleeding in patients on novel oral anticoagulants: Risk, prevention and management

Novel oral anticoagulants (NOACs), which include direct thrombin inhibitor (dabigatran) and direct factor Xa inhibitors (rivaroxaban, apixaban and edoxaban), are gaining popularity in the prevention of embolic stroke in non-valvular atrial fibrillation as well as in the prevention and treatment of venous thromboembolism. However, similar to traditional anticoagulants, NOACs have the side effects of bleeding, including gastrointestinal bleeding (GIB). Results from both randomized clinical trials and observations studies suggest that high-dose dabigatran (150 mg b.i.d), rivaroxaban and high-dose edoxaban (60 mg daily) are associated with a higher risk of GIB compared with warfarin. Other risk factors of NOAC-related GIB include concomitant use of ulcerogenic agents, older age, renal impairment, Helicobacter pylori infection and a past history of GIB. Prevention of NOAC-related GIB includes proper patient selection, using a lower dose of certain NOACs and in patients with renal impairment, correction of modifiable risk factors, and prescription of gastroprotective agents. Overt GIB can be managed by withholding NOACs followed by delayed endoscopic treatment. In severe bleeding, additional measures include administration of activated charcoal, use of specific reversal agents such as idarucizumab for dabigatran and andexanent alfa for factor Xa inhibitors, and urgent endoscopic management.published_or_final_versio

Magnetism in clean energy and environment

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Efficient Communication of Sensors Monitoring Overhead Transmission Lines

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Epidemiology and Natural History of Primary Biliary Cholangitis in the Chinese: A Territory-Based Study in Hong Kong between 2000 and 2015

OBJECTIVES: Studies on the epidemiology of primary biliary cholangitis (PBC) in the Chinese population are lacking. We aimed to determine the epidemiology of PBC in Hong Kong (HK) with a population of 7.3 million. METHODS: We retrieved data from the electronic database of the HK Hospital Authority, the only public healthcare provider in Hong Kong. PBC cases between 2000 and 2015 were identified by International Classification of Diseases (ICD)-9 code. We estimated the age-/sex-adjusted incidence rate and prevalence of PBC, and analyzed the adverse outcomes (hepatocellular carcinoma (HCC), liver transplantation, and death). RESULTS: One thousand and sixteen PBC patients aged >/=20 years were identified (female-to-male ratio 4:1; median age 60.6 years, interquartile range (IQR) 51.8-72.6 years; median follow-up 5.6 years, IQR 1.6-8.7 years). The average age/sex-adjusted annual incidence rate and prevalence were 8.4 per million person-years and 56.4 per million, respectively. Between 2000 and 2015, the age/sex-adjusted annual incidence rate increased from 6.7 to 8.1 per million person-years (Poisson P=0.002), while age/sex-adjusted prevalence increased from 31.1 to 82.3 per million (Poisson P<0.001). Fifty patients developed HCC, and 49 underwent liver transplantation. Case fatality risk decreased from 10.8 to 6.4% (Poisson P=0.003). The 5- and 10-year overall survival rates were 81.5 and 78.3%, whereas the transplant-free survival rates were 78.0% and 74.3%, respectively. Increasing age, cirrhosis and being treatment-naive were associated with lower transplant-free survival. CONCLUSIONS: There is a considerable increase in the incidence and prevalence of PBC in the Chinese population over the past 16 years, with significant morbidity and mortality.published_or_final_versio

Prognostic Factors for Transplant-Free Survival and Validation of Prognostic Models in Chinese Patients with Primary Biliary Cholangitis Receiving Ursodeoxycholic Acid

OBJECTIVES: We aimed to validate the prognostic models for primary biliary cholangitis (PBC) in Chinese patients receiving ursodeoxycholic acid (UCDA), and to compare their performances in predicting the long-term survival. METHODS: Chinese patients with PBC from a tertiary center were identified via electronic search of hospital medical registry. Risk factors associated with adverse events (liver transplantation or death from liver-related causes including hepatocellular carcinoma (HCC) and liver decompensation) were determined. Transplant-free survival was defined as survival free of liver-related death or transplantation. RESULTS: Of the 144 patients, 41 (28.5%) had baseline cirrhosis. The median age at diagnosis was 57.8 years. During a median follow-up of 7.0 years, 40 patients died (21 liver-related; 19 non-liver-related), 12 developed HCC, and 10 underwent transplantations. The 5-, 10-, and 15-year transplant-free survival probabilities were 91.0%, 78.1%, and 58.9%, respectively. Independent risk factors for adverse events were increasing age (hazard ratio (HR) 1.05), cirrhosis (HR 8.53), and suboptimal treatment response (HR 3.06). Aspartate aminotransferase/platelet ratio index at 1 year (APRI-r1) in combination with treatment response optimized the risk stratification. The performances of the GLOBE, UK-PBC scores, Rotterdam criteria, and APRI-r1 were comparable in predicting adverse events. The area under receiver operating curves within 5, 10, and 15 years were as follows-GLOBE score: 0.83, 0.85, and 0.85, respectively; UK-PBC score: 0.89, 0.83, and 0.79, respectively; Rotterdam criteria: 0.82, 0.76, and 0.80, respectively; APRI-r1: 0.80, 0.83, and 0.77, respectively. CONCLUSIONS: The UK-PBC, GLOBE scores, Rotterdam criteria, and APRI-r1 had good and comparable prognostic prediction values for Chinese PBC patients receiving UCDA.published_or_final_versio

Consensus statement on ischaemic stroke care in Hong Kong

Objective. To issue guidelines for the care of acute stroke in Hong Kong, with the target audience of all health care professionals who are involved in acute stroke care. Participants. The Hong Kong Neurological Society and the Hong Kong Stroke Society. Evidence. The panel applied the 'rule of evidence' used by the United States Agency for Health Care Policy and Research. When there is insufficient evidence, the recommendation was based on customary practice and was circulated among the members and fellows of the two societies before coming to a consensus. Consensus process. Group meetings were held in 2002 to review the literature about acute care for patients with ischaemic stroke and to issue a consensus statement with reference to the local health care system. Participants of the meetings were appointed by the councils of The Hong Kong Neurological Society and the Hong Kong Stroke Society. The draft statement was circulated among the members and fellows of the two societies for comments before it was finalised. Conclusions. Ischaemic stroke is a heavy health care burden to Hong Kong. The current consensus statement provides a framework to establish a multidisciplinary approach towards its acute management.published_or_final_versio

Turning mobile phones into a mobile quiz platform to challenge players' knowledge: An experience report

In the past few years, many new mobile technologies including the 3G, WiFi or mobileTV have created unprecedented learning opportunities on mobile devices. Furthermore, such technologies continuously fuel the rapid growth of new fields of research like the edutainment for educational entertainment. In a recent project awarded by the Hong Kong Wireless Development Center, we have developed a mobile quiz game system on 3G mobile phone networks in China, Hong Kong or other countries to facilitate learning anytime and anywhere. Our developed mobile quiz system is so generic that it can be readily extended to any wireless network. In this paper, we discuss about the design and possible uses of our quiz system in mobile learning, and also share the relevant experience in system development with the evaluation strategies carefully examined. After all, our work shed light on many interesting directions for future exploration. © 2008 IEEE.published_or_final_versionThe 8th IEEE International Conference on Advanced Learning Technologies (ICALT 2008), Santander, Cantabria, Spain, 1-5 July 2008. In Proceedings of the 8th ICALT, 2008, p. 943-94

Transient ischaemic attack patients are often underevaluated: Authors' reply

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A mobile quiz platform to challenge players’ knowledge on mobile devices

Many new mobile technologies including the 3G, WiFi or mobile TV have opened up unprecedented learning opportunities on mobile devices. In addition, such technologies empower the rapid growth of new fields of research like the edutainment for educational entertainment. In a project awarded by the Hong Kong Wireless Development Center, we developed a mobile quiz game system on 3G mobile phone networks in China, Hong Kong or other countries to facilitate learning anytime and anywhere. Our developed mobile quiz system is so generic that it can be readily extended to any wireless network. In this paper, we discuss about the design and possible uses of our quiz system in mobile learning, and also share the relevant experience in system development with the evaluation strategies carefully examined. In 2008, our project also received the Bronze Award of the Hong Kong ICT Awards – Best Lifestyle. After all, our work shed light on many interesting directions for future exploration.published_or_final_versionAlternate journal title: The IEEE Learning Technology Newslette