Objective: Sudden arrhythmia death syndrome (SADS) accounts for about 30% of causes of sudden cardiac death (SCD) in young people. In Hong Kong, there are scarce data on SADS and a lack of experience in molecular autopsy. We aimed to investigate the value of molecular autopsy techniques for detecting SADS in an East Asian population. Methods:This was a two-part study. First, we conducted a retrospective 5-year review of autopsies performed in public mortuaries on young SCD victims. Second, we conducted a prospective 2-year study combining conventional autopsy investigations, molecular autopsy, and cardiac evaluation of the first-degree relatives of SCD victims. A panel of 35 genes implicated in SADS was analysed by next-generation sequencing.Results: There were 289 SCD victims included in the 5-year review. Coronary artery disease was the major cause of death (35%); 40% were structural heart diseases and 25% were unexplained. These unexplained cases could include SADS-related conditions. In the 2-year prospective study, 21 SCD victims were examined: 10% had arrhythmogenic right ventricular cardiomyopathy, 5% had hypertrophic cardiomyopathy, and 85% had negative autopsy. Genetic analysis showed 29% with positive heterozygous genetic variants; six variants were novel. One third of victims had history of syncope, and 14% had family history of SCD. More than half of the 11 first-degree relatives who underwent genetic testing carried related genetic variants, and 10% had SADS-related clinical features. Conclusion: This pilot feasibility study shows the value of incorporating cardiac evaluation of Sudden arrhythmia death syndrome in young victims: a five-year retrospective review and twoyear prospective molecular autopsy study by nextgeneration sequencing and clinical evaluation of their first-degree relativesNew knowledge added by this study • This study provides important data on the prevalence and types of sudden arrhythmia death syndrome (SADS) among young victims of sudden cardiac death in an East Asian population. • This is the first local feasibility study on the service model incorporating cardiac evaluation of surviving relatives and molecular autopsy by next-generation sequencing into the conventional forensic investigations. Implications for clinical practice or policy • Genomic testing should be conducted on patients with cardiomyopathies and channelopathies.• Clinical assessment should be provided for at-risk family members irrespective of genetic findings.• Molecular autopsy together with conventional autopsy conducted by qualified pathologists should be applied to victims of SADS, sudden unexpected death in epilepsy, or sudden infant death syndrome.
To observe the safety and effectiveness of a topical herbal agent used to promote fracture healing, a herbal patch containing extracts of three herbs, viz., Flos Carthami, Radix Dipsaci, Rhizoma Rhei and Borneolum Syntheticum (an enhancer) was applied on ten subjects with un-displaced fifth metatarsal fractures. Pain scores, foot and ankle function questionnaires and regional swelling were carefully assessed and recorded. Peripheral blood was taken to measure the inflammation cytokines. Assessment checks were performed biweekly to enforce effective patch application and compliance. The results showed that pain improved after two weeks and fracture sites swelling had 20% reduction in thickness when measured with an ultrasonic tool. Foot and ankle functional scores markedly improved after six weeks. Radiological examinations revealed early perfect fracture unions. The topical herbal patch was effective in promoting fracture healing. It was well tolerated by the fracture patients. Larger randomized controlled trials would be indicated.
Biodegradable magnesium-based implants are innovative alternatives that potentially eliminate the need for implant removal. Recent studies have demonstrated the osteogenic properties and bacterial inhibition potentials of magnesium screws. We reported a clinical series of three elbow fracture cases, where magnesium screws were used in the treatment of one radial head and two capitellum fractures. Postoperative clinical courses were uneventful, and fracture healing occurred within 3 months. In all cases, radiolucencies were observed around implants especially in the screw head region at 2 months post-operation, but disappeared with consolidation at 1 year post-operation. All patients achieved near normal range of motion, minimal symptoms and good functional outcomes. No complication such as failure of fixation, loss of reduction, malunion or infection was seen. No implant revision or removal was necessary. Magnesium bioabsorbable screws are shown to be a viable option for these fractures.
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