A retrospective study on risk assessment and management of forensic psychiatric inpatients in Hong Kong

The Department of Forensic Psychiatry of Castle Peak Hospital is the only facility in Hong Kong that provides territory-wide forensic psychiatric services for patients with criminal involvement. This retrospective study aimed to explore whether the rehabilitation programs provided by the department could significantly reduce the risks of forensic psychiatric inpatients as measured by the Short-Term Assessment of Risk and Treatability (START). START ratings of inpatients who were hospitalized in the department for more than 3 months and were discharged to the community during the period from 11 April 2015 to 31 March 2019 were analyzed. A total of 79 patients were assessed, of whom 61 (77.2%) were males. Fifty-four (68.4%) patients suffered from schizophrenia. START scores upon admission (strength score = 5.67; vulnerability score = 17.43) and upon discharge (strength score = 6.87, vulnerability score = 11.18) indicated significant reduction of risks among inpatients (p < 0.05).

1050 Normal imaging findings after aortic valve implantation on 18f-fluorodeoxyglucose positron emission tomography with computed tomography and computed tomography angiography

Purpose

Although 18F-Fluorodeoxyglucose (18F-FDG) Positron Emission Tomography (PET) with computed tomography (CT) and cardiac computed tomography angiography (CTA) are essential tools in diagnosing prosthetic heart valve (PHV) endocarditis, the normal imaging findings in the first year after PHV implantation on 18F-FDG-PET/CT and CTA have not been studied prospectively. We prospectively assessed the perivalvular FDG uptake at different time points after aortic PHV implantation and assessed the normal imaging findings on CTA.

Materials and methods

Patients who had undergone uncomplicated aortic PHV implantation were included and underwent 18F-FDG PET/CT and CTA at 5(±1) weeks (group 1), 12(±2) weeks (group 2) or 52(±8) weeks (group 3) after implantation. After a preparatory diet to suppress normal myocardial glucose uptake, FDG uptake in the myocardium as well as around the PHV was scored using the Qualification Visual Score for Hypermetabolism (QVSH) as "none" (&lt; mediastinum), "low" (&gt; mediastinum but &lt; liver), "intermediate" (&gt; liver), or "high" (intense uptake) and quantitative analysis was performed with maximum Standardized Uptake Value (SUVmax) and target to background ratio (SUVratio) on standardized European Association of Nuclear Medicine Research Ltd. (EARL) reconstructions by an experienced nuclear medicine physician. CTA was analysed for image quality, artefacts and stranding of the peri-aortic fat by a cardiac radiologist.

Results

In total 37 patients (group 1: n = 12, group 2: n = 12, group 3: n = 13) (age 66 ± 8 years) were included. Myocardial FDG uptake was intermediate or less in 29/37 scans (78%). QVSH around the PHV was 8/12(67%) low and 4/12(33%) intermediate in group 1, 7/12(58%) low and 5/12(42%) intermediate in group 2 and 8/13(62%) low and 5/13(38%) intermediate in group 3 (p = 0.91). No scan was scored as "none" or "high". EARL SUVmax was 3.48 ± 0.57, 3.50 ± 0.59 and 3.34 ± 0.55 (mean ± SD, p = 0.77) and EARL SUVratio was 2.00 ± 0.29, 1.96 ± 0.41 and 1.71 ± 0.26 (mean ± SD, p = 0.07) for groups 1, 2 and 3, respectively.

One patient in group 3 refused to undergo the additional CTA and one CTA in group 3 could not be analysed for image quality and artefacts due to techniqual difficulties. Overall CTA image quality was "good" or "excellent" with an artefact score of "virtually none" or "mild" in most cases (n = 33, 94%). Stranding of peri-aortic fat was seen in 27/35 (77%) of these patients (group 1: n = 11; group 2: n = 9; group 3: n = 7) with no signs of FDG uptake on PET/CT scan.

Conclusion

Baseline FDG uptake around aortic PHV at 5, 12 and 52 weeks after implantation is similar and mild in the majority of cases with an overall mean SUVmax and SUVratio of 3.44 ± 0.56 and 1.89 ± 0.34 respectively. CTA revealed baseline post-surgical findings in the first year after PHV implantation.

Theoretical assessment of the impact of desert aerosols on the dynamical transmission of meningitidis serogroup A

This paper has been motivated by the following biological question: how influential are desert aerosols in the transmission of meningitidis serogroup A (MenA)? A mathematical model for the dynamical transmission of MenA is considered, with the aim of investigating the impact of desert aerosols. Sensitivity analysis of the model has been performed in order to determine the impact of related parameters on meningitis outbreak. We derive the basic reproduction number [Formula: see text]. We prove that there exists a threshold parameter [Formula: see text] such that when [Formula: see text], the disease-free equilibrium is globally asymptotically stable (GAS). However, when [Formula: see text], the model exhibits the phenomenon of backward bifurcation. At the endemic level, we show that the number of infectious individuals in the presence of desert aerosols is larger than the corresponding number without the presence of desert aerosols. In conjunction with the inequality [Formula: see text] where [Formula: see text] is the basic reproduction number without desert aerosols, we found that the ingestion of aerosols by carriers will increase the endemic level, and the severity of the outbreak. This suggests that the control of MenA passes through a combination of a large coverage vaccination of young susceptible individuals and the production of a vaccine with a high level of efficacy as well as respecting the hygienic rules to avoid the inhalation of desert aerosols. Theoretical results are supported by numerical simulations.

Theoretical assessment of the impact of environmental contamination on the dynamical transmission of polio

A mathematical model for the dynamical transmission of polio is considered, with the aim of investigating the impact of environment contamination. The model captures two infection pathways through both direct human-to-human transmission and indirect human-to-environment-to-human transmission by incorporating the environment as a transition and/or reservoir of viruses. We derive the basic reproduction number [Formula: see text]. We show that the disease free equilibrium is globally asymptotically stable (GAS) if [Formula: see text], while if [Formula: see text], there exists a unique endemic equilibrium which is locally asymptotically stable (LAS). Similar results hold for environmental contamination free sub-model (without the incorporation of the indirect transmission). At the endemic level, we show that the number of infected individuals for the model with the environmental-related contagion is greater than the corresponding number for the environmental contamination free sub-model. In conjunction with the inequality [Formula: see text], where [Formula: see text] is the basic reproduction number for the environmental contamination free sub-model, our finding suggests that the contaminated environment plays a detrimental role on the transmission dynamics of polio disease by increasing the endemic level and the severity of the outbreak. Therefore, it is natural to implement control strategies to reduce the severity of the disease by providing adequate hygienic living conditions, educate populations at risk to follow rigorously those basic hygienic rules in order to avoid adequate contacts with suspected contaminated objects. Further, we perform numerical simulations to support the theory.

Dickkopf-3 links HSF1 and YAP/TAZ signalling to control aggressive behaviours in cancer-associated fibroblasts

Aggressive behaviours of solid tumours are highly influenced by the tumour microenvironment. Multiple signalling pathways can affect the normal function of stromal fibroblasts in tumours, but how these events are coordinated to generate tumour-promoting cancer-associated fibroblasts (CAFs) is not well understood. Here we show that stromal expression of Dickkopf-3 (DKK3) is associated with aggressive breast, colorectal and ovarian cancers. We demonstrate that DKK3 is a HSF1 effector that modulates the pro-tumorigenic behaviour of CAFs in vitro and in vivo. DKK3 orchestrates a concomitant activation of β-catenin and YAP/TAZ. Whereas β-catenin is dispensable for CAF-mediated ECM remodelling, cancer cell growth and invasion, DKK3-driven YAP/TAZ activation is required to induce tumour-promoting phenotypes. Mechanistically, DKK3 in CAFs acts via canonical Wnt signalling by interfering with the negative regulator Kremen and increasing cell-surface levels of LRP6. This work reveals an unpredicted link between HSF1, Wnt signalling and YAP/TAZ relevant for the generation of tumour-promoting CAFs.

Profiling Mentally Ill Offenders in Hong Kong: a 5-year Retrospective Review Study

OBJECTIVES

This study aimed to determine the prevalence of mental illness in offenders referred to psychiatrists from January 2011 to March 2016 and any associations between crime and mental illness in these offenders.

METHODS

Case notes of offenders referred to psychiatrists at the Siu Lam Psychiatric Centre from 1 January 2011 to 31 March 2016 were reviewed. Data on sex, age on admission, educational level, principal psychiatric diagnosis, index offence, source and reason of referral, and outcome were collected.

RESULTS

Case notes were reviewed for 4492 offenders (75% males) aged 14 to 93 (mean, 40.6) years. Of these, 68% were referred by the courts for psychiatric report and 32% were referred by correctional institutions for psychiatric assessment and treatment. Approximately 73% of them had a diagnosable mental disorder. The most common principal psychiatric diagnoses were schizophrenia and related disorders (25%), mental and behavioural disorders due to psychoactive substance use (20%), and mood disorders (9%). The most common index offences were theft and related offences (22%), acts intended to cause injury (20%), and illicit drug offences (11%). Offences involving violence were more prevalent in males than in females (p < 0.001). In terms of the three most common principal psychiatric diagnoses, 'acts intended to cause injury' was most prevalent in those with 'schizophrenia and other related disorders' than in those with the other two diagnoses (31% vs 19% vs 17%, p < 0.001). 'Theft and related offences' was most prevalent in those with mood disorders than in those with other two diagnoses (38% vs 20% vs 18%, p < 0.001). 'Illicit drug offences' was most prevalent in those with 'mental and behavioural disorders due to psychoactive substance' than those with other two diagnoses (22% vs 8% vs 6%, p < 0.001).

CONCLUSIONS

The prevalence of mental disorders among offenders referred to psychiatrists is high. The pattern of associations between crime and mental disorders in these offenders is comparable with that reported in overseas studies. As Siu Lam Psychiatric Centre is the only facility in Hong Kong for mentally ill offenders, our sample is representative, and our results provide cross-sectional pattern of forensic psychiatric service utilisation in Hong Kong.

Regulation of mechanotransduction: Emerging roles for septins

Cells exist in dynamic three‐dimensional environments where they experience variable mechanical forces due to their interaction with the extracellular matrix, neighbouring cells and physical stresses. The ability to constantly and rapidly alter cellular behaviour in response to the mechanical environment is therefore crucial for cell viability, tissue development and homeostasis. Mechanotransduction is the process whereby cells translate mechanical inputs into biochemical signals. These signals in turn adjust cell morphology and cellular functions as diverse as proliferation, differentiation, migration and apoptosis. Here, we provide an overview of the current understanding of mechanotransduction and how septins may participate in it, drawing on their architecture and localization, their ability to directly bind and modify actomyosin networks and membranes, and their associations with the nuclear envelope.

An in vitro model of lissencephaly: expanding the role of DCX during neurogenesis

Lissencephaly comprises a spectrum of brain malformations due to impaired neuronal migration in the developing cerebral cortex. Classical lissencephaly is characterized by smooth cerebral surface and cortical thickening that result in seizures, severe neurological impairment and developmental delay. Mutations in the X-chromosomal gene DCX, encoding doublecortin, is the main cause of classical lissencephaly. Much of our knowledge about DCX-associated lissencephaly comes from post-mortem analyses of patient's brains, mainly since animal models with DCX mutations do not mimic the disease. In the absence of relevant animal models and patient brain specimens, we took advantage of induced pluripotent stem cell (iPSC) technology to model the disease. We established human iPSCs from two males with mutated DCX and classical lissencephaly including smooth brain and abnormal cortical morphology. The disease was recapitulated by differentiation of iPSC into neural cells followed by expression profiling and dissection of DCX-associated functions. Here we show that neural stem cells, with absent or reduced DCX protein expression, exhibit impaired migration, delayed differentiation and deficient neurite formation. Hence, the patient-derived iPSCs and neural stem cells provide a system to further unravel the functions of DCX in normal development and disease.