Purpose Blood eosinophil is a readily available biomarker to reflect the eosinophilic inflammation in chronic obstructive pulmonary disease (COPD) patients, yet its association with exacerbation is inconclusive. It is uncertain which measurement, eosinophil percentage or absolute eosinophil count, should be used and what is the optimal cutoff for exacerbation prediction. Patients and Methods A total of 247 COPD patients were included in this retrospective cohort study. Blood eosinophil during stable disease state, baseline demographics, and clinical characteristics in 12 months after the index complete blood count (CBC) were recorded. Exacerbation frequencies were compared between patients with high and low blood eosinophil percentage using 2% as cut-off. Logistic regression and receiver operating characteristics (ROC) curve analyses were conducted. Results Patients with blood eosinophil ≥2% were associated with more frequent exacerbations than patients with eosinophil <2% in the 12 months after the index CBC (mean exacerbation 1.07 vs 0.34, p < 0.001). Higher blood eosinophil percentage conferred a higher risk of exacerbation. Adjusted odds ratio for exacerbation in 12 months after the index CBC for blood eosinophil ≥2% was 2.98 (95% confidence interval = 1.42–6.25). The area under the ROC curve of eosinophil percentage was significantly higher than that of absolute eosinophil count (0.678 vs 0.640, p = 0.010). The optimal cutoff of blood eosinophil percentage for exacerbation prediction was 2.8%. Conclusion Blood eosinophilia was associated with higher exacerbation risk in COPD patients. Further studies are required to elucidate the mechanism of eosinophilic inflammation in COPD and determine the optimal treatment strategy to reduce exacerbations.

Aim Endoscopic ultrasonography–guided biliary drainage (EUS‐BD) is increasingly used as an alternative therapeutic modality to percutaneous transhepatic biliary drainage (PTBD) for malignant biliary obstruction in patients who fail endoscopic retrograde cholangiopancreatography (ERCP). We conducted a retrospective study comparing the success rate and safety of the two drainage methods. Patients and Methods There were 121 consecutive patients undergoing EUS‐BD or PTBD who had malignant biliary obstruction that failed to be treated by ERCP at Princess Margaret Hospital between August 2015 and May 2021. Thirty‐five patients with biliary obstruction at or proximal to hilar level were excluded from this study. A retrospective cohort study was performed for 26 patients who underwent EUS‐BD (choledochoduodenostomy or hepaticogastrostomy) and 60 patients who underwent PTBD. Their clinical data and endoscopic data, demographic data, diagnosis, laboratory data, complications, number of re‐interventions, in‐hospital death and length of hospitalisation were extracted and compared. Results The clinical success rates for EUS‐BD and PTBD were 25 out of 26 (96.2%) and 43 out of 60 (71.7%), respectively (P = .01). The technical success rates were 25 out of 26 (96.2%) and 57 out of 60 (95.0%), respectively (P > .99). Among those technically successful cases, complications were significantly fewer in the EUS‐BD group (4%) than in the PTBD group (33.3%). There were significantly fewer re‐interventions, shorter length of hospitalisation and fewer in‐hospital death in the EUS‐BD group. No significant difference in stent/PTBD patency was noted between the two groups. Conclusion EUS‐BD is a safe and effective method of BD in patients with malignant biliary obstruction who failed ERCP. EUS‐BD has a higher rate of clinical success, is associated with fewer complications and has a shorter length of in‐hospital stay compared with PTBD. The overall technical success and stent patency are comparable to PTBD.

Background Fabry disease (FD) is an X-linked lysosomal storage disease resulting from mutations of α-galactosidase A gene, and has been emphasized as one of the etiologies of young stroke and leukoencephalopathy. Vertebrobasilar dolichoectasia (VBD) is a highlighted finding in FD. We aim to examine the utility of VBD in Chinese FD by comparing the differences in basilar artery (BA) diameter of Chinese FD patients against age-matched controls with and without stroke. Methods This was a matched case-control study involving 37 Chinese FD patients. The BA diameters were evaluated on axial T2-weighted magnetic resonance imaging and compared to two age-and-gender matched control groups, one with stroke and one without. The association between BA diameter and stroke occurrences and white matter hyperintensities (WMH) were analyzed among all FD patients. Results Patients with FD had significantly increased BA diameter compared to controls with and without stroke (p < 0.001). A BA diameter of 4.16 mm could distinguish FD from controls in the stroke subgroup (ROC AUC 0.870, p = 0.001, sensitivity 80% specificity 100%), and with a cut-off of 3.21 mm in the non-stroke subgroup (ROC AUC 0.846, p < 0.001, sensitivity 77.8% specificity 88.9%). Larger BA diameter had more stroke occurrences and was moderately associated with heavier WMH load in terms of higher total FAZEKAS scores. (Spearman’s rho = 0.423, p = 0.011). Conclusion VBD was also present in Chinese FD patients. BA diameter has high diagnostic utility in identifying FD from a mixed cohort of stroke and normal controls, and carried predictive value in evaluating neurological complications of FD.

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Introduction: T4 nasopharyngeal carcinoma (NPC) with close proximity to critical organs at risk (OARs) is usually underdosed during radiotherapy in order to respect radiation constraints. N3 disease has high risk of distant metastasis. Induction chemotherapy (IC) provides advantages of sparing of OARs during subsequent chemoradiotherapy (CCRT) and early eradication of micrometastasis. However, factors predicting successes of IC in this patient group are not well-studied. Methods: 104 T4 or N3 NPC patients were retrospectively reviewed during 2007-2018. They were planned for IC followed by CCRT using intensitymodulated radiotherapy. Results: In the whole group, five-year failure-free survival (FFS), locoregional failure-free survival (LRFS), distant failure-free survival (DFFS) and overall survival (OS) were 40.9%, 45.7%, 46.9% and 53.6% respectively. Isolated marginal failure rate was 5% (4/80) among patients with primary tumours located close to critical OARs. Pre-IC gross tumour volume primary (GTVp) total volume > 110 cm 3 correlated with worse five-year LRFS (OR 6.37, P = 0.008), DFFS (OR 8.89, P = 0.003) and OS (OR 50.12, P < 0.001). In the T4 subgroup, IC improved D100% GTVp from 61.39 Gy to 64.71 Gy (P < 0.001) and V100% GTVp from 98.78% to 99.28% (P < 0.001). Conclusion: Our study demonstrated improved dosimetric parameters and low isolated marginal failure rate. It supported the use of IC and CCRT for tumours located close to critical OARs. Further research is warranted to compare predictive roles of pre-and post-IC tumour volumes. For high-risk patients being defined by pre-IC volume or other prognostic models, treatment escalation should be considered.