SYNAPSEJANUARY 2011 RESTRICTED TO MEMBERS ONLY

Photographer Professor Richard YH Yu SYNAPSE

CONTENTS

Special Articles 3 The President´s Annual Report 2010 − KN Lai 6 The President’s Address at the Fellowship Conferment Ceremony 2010 − KN Lai 8 The 15 th AJS McFadzean Oration 2010 − Geoffrey Ma The Search for the Right Balance : A Question of Judgement 12 Council News Scientific Section 17 Sir David Todd Lecture − HF Tse New Era of Regenerative Medicine for Cardiovascular Diseases 19 Best Thesis – Gold Award Winner − YL Lau Good Collateral Circulation Predicts Better Outcome in Patients with Intracranial Large Artery Occlusive Disease 20 Best Thesis – Silver Award Winner − YT Au Yeung Tests Used in the Subtype Classification and Outcome of Treatment in Primary Aldosteronism 21 Best Thesis – Bronze Award Winner − L Li A Prospective Study on the Significance of Quality of Life Measurement and Clinical Factors in Prediction of Survival in Chinese Patients with Hepatocellular Carcinoma

22 Events and Announcements

25 Examinations and Results

25 Training

Room 603 Hong Kong Academy of Medicine Jockey Profile Doctor Club Building 27 Professor Zhong Nan-Shan − John Mackay 99 Wong Chuk Hang Road Aberdeen Hong Kong

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Synapse Editorial Board

Editor : Dr Carolyn PL KNG

Assistant Editor : Dr John MACKAY

Co-Editors : Dr TF CHAN Dr Johnny WM CHAN Dr Jenny YY LEUNG Dr ML SZETO

Ex Chief-Editor : Prof Philip KT LI Prof Mathew MT NG

All Copyrights reserved by the Hong Kong College of Physicians No part of Synapse can be reproduced without the prior approval from the Hong Kong College of Physicians. SPECIAL ARTICLES

The President´s Annual Report 2010

KN Lai President, HKCP

n the year of the Tiger and busier working hours, the This Annual Report outlines the 2010, the Hong Kong SAR promotion prospect in Medicine various events and achievements Isustained peaceful progress is less despite our devoted and of all the College Committees in her politics. With a vigilant relatively stable workforce. We that deserve the attention of and attentive approach, our must proactively address these our Members and Fellows. medical community successfully issues in order to maintain our My heartiest gratitude and smothered the threat of Swine flu. attraction to the fresh medical appreciation goes to all Chairmen, At times of crisis, our profession graduates. I sincerely hope the Members of the Committee, the always proves its quality, alertness incoming President will discuss Boards and the Secretariat for and readiness. thoroughly with the Hospital having done such a magnificent This is my last annual report Authority on these issues. Any job. Briefly, I would like to since elected to the Office in Department of Medicine with highlight some of the important 2004. I appreciate greatly the less than appropriate manpower changes. support from the Council and I and resources can compremise would like to thank all Fellows the service in the hospital Education and and Members for having given me within a short time. The new Accreditation Committee the opportunity and honor to serve Chief Executive of the Hospital Under the very capable you. While our College continues Authority should be aware of this. Chairmanship of Dr. Loretta to flourish with fellowship Meanwhile, our College maintains Yam, the committee further exceeding 1,350, we must not be strong academic and collegiate improved the examination format, complacent as we have noticed links with overseas physician scoring system, remedial training less applications for physician colleges in London, Edinburgh, program, and written guideline of training over the last two to Glasgow, Australasia, Malaysia the dissertation thesis. Several three years. Physician training and Singapore. Our interaction new developments in training is demanding both in time and with physician societies in China were established in the last 12 skill. Nowadays, most specialties remains active directly through months. in Hospital Authorities hospitals the College and indirectly through can adopt a five-day week our specialty societies. Our 1. To raise awareness about arrangement as they have few College continues to improve clinical risk among our emergency admissions but this our computerization system in trainees and improve is not the case in Medicine. All training and examination matters clinical management, the medical units admit emergency allowing paper documentation to College collaborated with patients seven days a week and be conducted from the desktop the Hospital Authority to 52 weeks a year. Not only longer computer using the Web. develop a Self Learning Tool

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(SLT). In essence, SLT is assessment for another 106 of Medicine at the University an educational e-learning candidates. of Auckland, has been tool which tests Basic and elected President of the Royal Advanced Internal Medicine 5. The current CME/CPD cycle Australasian College of Physicians (AIM) trainees using clinical will end on 31 December in May 2010. Dr Jennifer scenarios in the form of 2010. The College decided Alexander, CEO of the RACP, multiple choice questions to continue to adopt the visited the College Chamber on with scenario development current “Principles and September 3, 2010. and appropriate explanations. Guidelines on CME/CPD These questions are 2008” and “CME/CPD Examination Committee administered through a Operational Guidelines 2008” tailor-made software and for the new CME/CPD cycle Annually, two written Part I, three information technology to commence from 1 January written Part II, and two clinical system hosted online by the 2011. PACES examination are now Hospital Authority. The SLT held in Hong Kong. The local is expected to be applied National and International PACES examination centres have to all three years of Basic Liaison Committee increased to ten. Prof Matthew Physician Training. Ng (the Chairman) is serving Under the dedicated the MRCP(UK) Part I Examining 2. In accordance with the Chairmanship of Professor W.K. Board as HK representative training structure stated in the Lam, the committee continued while Prof KN Lai is the HK Guidelines on Postgraduate to liaise with national and representative at the MRCP (UK) Training in Internal Medicine, international professional bodies Part II Examining Board and , Fourth Edition, July 2007 in Medicine on matters of mutual Policy Board. it is mandatory for Palliative interest, including postgraduate Medicine and Rehabilitation training, professional A new format of station 5 was to be trained concurrently examinations, scientific and commenced in the October 2009 with AIM and AIM or Geriatric academic interaction and PACES examination. Candidates Medicine respectively. It continuous professional were required to undertake a therefore follows that trainees development in the practice of focused history and targeted who pass the Exit Assessment Internal Medicine. examination pertinent to the in Palliative Medicine or presenting problem. Rehabilitation as the first Our College continued to provide The College has proposed to specialty cannot be accredited input and professional assessment the MRCP(UK) Central Office to in the respective specialty to the three Royal Colleges of invite UK PACES examiners to until they have passed the Physicians in United Kingdom Exit Assessment in AIM or with regard to local clinicians deliver lectures on Stations 1 and Geriatric Medicine. nominated for College Fellowship. 3 on a Training Day, to be held on the Saturday after one of the 3. The College was satisfied Dr Neil Dewhurst, Consultant two PACES examinations. The that there are now sufficient Cardiologist and General first training day is scheduled for numbers of Fellows and Physician, Perth Royal Infirmary, March 2011. Trainers in Medical Oncology and Honorary Senior Lecturer in to merit Specialty Board Medicine, University of Dundee, Scientific Committee status, such that the specialty is the new President of the can become independent Edinburgh College with effect The Scientific Committee under from the Specialty Board from 1 March 2010. the chairmanship of Professor in Haematology and Y.L. Kwong organized a Scientific Mr. Ian WR Anderson, has been Haematological Oncology. Meeting of Hong Kong College elected as the President of the The Specialty of Medical of Physicians on October 9-10, Glasgow College for three years. Oncology thus became an 2010 with over 450 participants. Sir Richard Thompson KCVO independent Specialty Board The Gerald Choa Memorial DM FRCP has been elected as with effect from April 2010. Lecture was delivered by the new President of the London 4. The Specialty boards had Professor T.F. Fok. Hon Chief College. conducted annual assessment Justice Geoffrey Ma gave the AJS for 260 trainees and exit Professor John Kolbe, Professor McFadzean Oration.

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Research Committee general medical affairs this year. Sir Neil Douglas as profile doctors A career talk was delivered to who have contributed vastly to The Research Committee under medical students of the University medicine in China and in the the chairmanship of Professor of Hong Kong in November United Kingdom. K.S. Wong selected four young 2009. Our College also drafted investigators for Distinguished a position paper to the Food and Research Paper Award. All were Administration and Finance Health Bureau on a consultation invited to present their papers Committee paper entitled: “Introduction of in the Annual Scientific Meeting the concept of advance directives We are grateful to our Hon of the College in October 2010, in Hong Kong”. Treasurer for his very shrewd with a medal award for the best book-keeping such that the presenter. Synapse College remains in a healthy state financially. Membership Committee Synapse under the editorship of Dr. C. Kng continued its important Finally no word of appreciation or Under the chairmanship of Dr. role of fostering communication thanks can express my gratitude Patrick Li, 44 applicants were between the College and its to the two Vice-Presidents, proposed for Membership and 54 Fellows, Members and trainees. Chairpersons of different applicants for Fellowship as of 31 Updated statistics on the number committees, College Council August 2010. of Higher Physician Trainees in members, and the previous all Medical Specialties in Hong Presidents for their invaluable Professional and General Kong were published regularly as support and advice. My final Affairs Committee a reference for trainees deciding vote of thanks goes to all the very on their career pathway. hardworking secretaries of the The Committee under the College who have maintained our chairmanship of Dr. C.P. Wong During the past year, Synapse engine running smoothly. continued to handle issues was greatly privileged to interview related to professional and Professor Leishi Li and Professor

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The President´s Address at the Fellowship Conferment Ceremony 2010 KN Lai President, HKCP

oday is a great day for master, which meant a foreman is a good boss and what are the the College. Seventy-five on a ship. From the Oxford and differences between a leader and Tphysicians will be admitted to Cambridge dictionaries, a boss is a a boss? Let me first address the the Fellowship and another 54 to our person in charge of workers or an issue of a good boss versus a lousy Membership, following their success organization; someone in control of manager. Paradoxically, one may in qualifying examinations. Let me a group or situations; and someone not recognize a good manager while extend the College’s congratulation who tells others what to do, gives working under him or her. More to the new members and fellows. orders, makes decisions and exerts frequently, one only appreciates This is my last presidential speech authority. In simple terms, one retrospectively how good the boss after six years in office. In the expects the boss who is a manager was when working under the next previous five years’ conferment with outstanding leadership and incoming management. Then, what ceremonies, I spoke about different experience, and will be willing to is the quality of a good manager? issues including the virtue of take up and share the responsibility Just as said by Lao Tzu in his naiveness, the clinician-scientist including criticism and blame. Not Principle of Ethics: “A leader is career path, the media, medical infrequently, this may not always best when people barely know he exists, not so good when people obey ethics and health reform. On this be true, especially in public sectors and acclaim him, worse when they occasion, I will address the issue of with tenured as well as appointed despise him. But of a good leader human resource management or the positions. In such circumstances, a who talks little when his work is skill of leadership. Now that you manager may be chosen or appointed done, his aim fulfilled, they will say: have achieved your training goals just by being obedient or willing to We did it ourselves.” A lousy manager and become a specialist or will be compromise, and even worse, simply admitted for specialist training, I can lacks confidence and demands the person is not bright enough and loyalty. Some even say laugh heartily envisage, in the not distant future, pose less threat to the administration you will progress as a leader of your at all the jokes your boss tells as it above. field, be it a division or department maybe a test of loyalty. What a pity? head, or even a chief of service or I must admit that I have been lucky Robert Townsend, an Afro-American an academician – what the layman in working under excellent bosses in writer once said: “A good manager or your colleagues call ‘The Boss’. Australia, United Kingdom and Hong doesn’t try to eliminate conflict; The word “Boss” originated in North Kong. After practicing medicine he tries to keep it from wasting the America around 1640-1650 and for 35 years, I have just begun to energies of his people. If you’re the was derived from Dutch word – baas have some vague ideas about who boss and your people fight you openly

6 SYNAPSE • JANUARY 2011 SPECIAL ARTICLES when they think that you are wrong leader is interested in the group.” the art of getting someone else to do -- that’s healthy.” Let me rephrase it Similarly, Gordon Selfridge, an something you want done because he neatly, a real leader faces the music, American magnate famous for his wants to do it.” even when he doesn’t like the tune. saying “The customer is always right” Finally, let me address the issue of wrote in his book, The Romance of Before moving to the issue of power or authority. People often Commerce and I quote : “The boss leadership, let me spell out the equate leadership with power and drives people; the leader coaches four basic prerequisites or qualities them. The boss depends upon this is not always true. As the of a competent manager in our proverb says, “Power lasts ten years; medical profession. First, there is authority; the leader on good will. The boss inspires fear; the leader influence not more than a hundred.” active involvement and personal We must realize that leadership participation. In other words, inspires enthusiasm. The boss says ”I”; the leader, “We.” The boss fixes is the wise use of power. Power is who that has not served cannot the capacity to translate intention command. Example: SARS in the blame for the breakdown; the into reality and sustain it. Again, year 2003. Second, only ask your leader fixes the breakdown. The boss President Eisenhower once remarked: team to deliver if you, yourself, can knows how it is done; the leader “Pull the string, and it will follow perform. Example: A university shows how. The boss says “Go”; the wherever you wish. Push it, and it academic sought approval from his leader says “Let’s go!” Along similar will go nowhere at all”. Kar Neng departmental head for promotion lines, President Theodore Roosevelt application. This chairman asked: said: “People ask the difference LAI, your President and an amateur “What is your achievement? Have between a leader and a boss. The golfer only now realizes after playing you published in the New England leader works in the open, and the the game for 15 years that “Power of Medicine or Lancet?” This boss in covert.” President Dwight is like a golfswing, hit harder from department chairman has neither Eisenhower also said: “Leadership is above and the shorter the drive”. published in these journals and his or her achievement at similar stage of promotion was finishing a MD degree – nowadays, a minimal requirement for a junior faculty appointment. President Dwight Eisenhower put this succinctly: “You do not lead by hitting people over the head — that’s assault, not leadership” The third quality is courtesy. Example: “Punishment of the Casualty Chief in the Caritas Medical Center event. Max De Pree, founder the Max De Pree Center for Leadership, wrote in his book: Leadership is an Art said: “The first responsibility of a leader is to define reality. The last is to say thank you. In between, the leader is Now after hearing my annotation of you are the boss unless your team a servant.” And he further added: the qualities of a good leader and a wholeheartedly endorses you. “Leaders don’t inflict pain — they decent manager, please formulate Finally, let me finish by blessing you share pain.” The last quality is team your own opinion and set your own spirit and modesty. A good leader standard should you be promoted to with a saying from the late President takes a little more than his share of such a position. With the structural John Fitzgerald Kennedy in his the blame, a little less than his share training program supervised by 1960 election: “It is time for a new of the credit. the College, you should form a generation of leadership, to cope with formidable force to provide good new problems and new opportunities. Now I like to address the difference management of our healthcare For there is a new world to be won.” between a true leader and a boss by system and its human resources. using a few quotes. Russell Ewing, With this, I will say goodbye and Please remember you should always a 19th century British journalist wish you every success in your future observe the courtesy of respecting said: “A boss creates fear, a leader career and a very pleasant evening. your patients and colleagues. There confidence. A boss fixes blame, a is no point reminding others that Thank you. leader corrects mistakes. A boss knows all, a leader asks questions. A good leader takes a little more than his A boss makes work drudgery, a leader makes it interesting. A boss share of the blame, a little less than his is interested in himself or herself, a share of the credit.

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The 15th AJS McFadzean Oration 2010 The Search for the Right Balance: A Question of Judgment The Honourable Chief Justice Geoffrey Ma

r President, Distinguished have put their doctrines in terms in the human body, and to the Doctors and Guests, of absolutes: deviations, much work of Jenner, Pasteur, Fleming MLadies and Gentlemen, less contradictions here are non- not forgetting Crick and Watson. I am grateful to the College and existent. Science promulgates Incidentally, it is appropriate to much honoured to be invited to absolutes as an end in itself: water mention William Harvey in the deliver this, the 15th McFadzean becomes a gas at 100 Celsius, a context of this Oration : Professor Oration. This Oration – like the solid at 0 Celsius, etc. Medicine McFadzean was a specialist in Harveian Oration in London – is in terms of science also and haematology at Glasgow University a venerable institution. Many rightly points to the existence of prior to his arriving in Hong Kong distinguished speakers have absolutes. There is a historical in 1948. preceded me. I am humbled to be basis for this: from Galen (the I readily concede as an argument invited to follow them. physician of Marcus Aurelius that absolutes do exist, at It is part of human nature to and his son, Commodus) and his least until the next absolute is think in terms of absolutes and discovery of the function of organs, discovered. But the existence that only absolutes represent to the great anatomical discoveries of absolutes does not justify the truth. We would like to of the Flemish physician, Vesalius, an approach to life in terms believe that absolute answers to in the early sixteenth century, of absolutes, that there is only all questions exist, just simply through the birth of modern day one answer to problems that we waiting to be discovered. Through medicine in the work of Vesalius’ encounter daily. Most of the time, the ages, religions the world over grand pupil William Harvey in the life and our professional work are and philosophies as plentiful as seventeenth century discovering for not like that at all. there are different nationalities, the first time how blood circulated Life is often not about absolutes

8 SYNAPSE • JANUARY 2011 SPECIAL ARTICLES or even the truth but arriving at posed, but I do know that, however interpretation. Nevertheless, at the right balance. In the practice difficult the decision, one has times, a difficult balancing of of medicine, one can perhaps to be made. It is not an option rival interests has challenged the easily identify extremely difficult to refuse to make that decision courts. decisions that have to be made: because, while passing the buck Some rights are regarded as the extent to which treatment may at times be possible, sooner inviolable: no one is to be should be advised for a seriously, or later you will have to face the subjected to torture or to cruel, even terminally, ill patient; how challenge head on and make inhumane or degrading treatment far any course of treatment is that decision yourself. When the or punishment (Article 3 of the determined by the costs involved, ultimate responsibility falls on Bill of Rights), no one is to be held and so the list of situations goes you, you do not look the other way. in slavery (Article 4 of the Bill of on. Being wrong is better than not Rights), the right to be presumed taking responsibility at all. Furthermore, when one is innocent until proven guilty of a discussing difficult decisions to I am not qualified to speak about criminal offence (Article 11 of the be made, we are of course talking medical decisions or indeed what Bill of Rights). most of the time about matters ought to be a doctor’s approach. I Yet, there are other rights set out of judgment. My premise is that am more confident discussing the in the Bill of Rights which contain the exercise of a judgment almost law in this context. Here, there in-built limits, limits which call for invariably involves a question of are indeed few absolutes. Many a difficult and delicate balancing balance. decisions of judges (all in some way or another affecting the lives exercise by the courts. Article 16 Where an exercise of judgment of those who are before us) require of the Bill of Rights guarantees takes place, the decision maker the freedom of opinion and will have to balance between expression, but that same article perhaps a number of choices that states that this freedom maybe can each be entirely reasonable My premise is that subject to restrictions which are and plausible, yet which are the exercise of a “necessary” for the respect of the diametrically opposed to one rights or reputation of others (for another in their result. This is the judgment almost example here, libel laws) or for the world where both black and white invariably involves protection of national security, of can be reasonable solutions to a public order, of public health or problem. There are no absolutes a question of morals. here. How is the decision maker In one of the earliest decisions to choose, what principles help balance. on the freedom of opinion and him choose and does truth play expression, the courts (right up a part at all? All these questions the striking of a right balance to the Court of Final Appeal) arise in the exercise of judgment. between rival (but reasonable) were faced with a citizen’s wish I have no doubt at all that as contentions. Sometimes, the to exercise this freedom (he doctors, you have all had to make difference between decisions at was protesting against the lack difficult decisions and exercise different levels of court can be as of democracy in the Mainland) your judgment when there were fine as a different balance being by defacing the national flag. presented to you two or more struck. Let me try to illustrate Defacing the flag is a criminal alternative solutions, each this. offence. The defence was that reasonable but which can yield It is in relation to human rights the offence breached the freedom dramatically different results. I where we see perhaps the most of expression and therefore, have already referred to one: the common area of the law where constitutionally, had to be struck decision to advise whether or not a critical balancing exercise can down. He relied on decisions to continue giving treatment to a take place. of the US Supreme Court in seriously or terminally ill patient. which legislation criminalizing The Basic Law and the Bill of A number of reasonable answers desecration of the American flag Rights (contained in the Hong may present themselves, some was struck down as breaching this Kong Bill of Rights Ordinance result in life (or a longer life), freedom. Cap. 383) give Hong Kong people while others may result in the substantial and significant rights The Court of Final Appeal, in termination of life. and liberties. The courts have a unanimous decision, held in I am not so bold or rash, and time and again reiterated that such favour of the Government. It was certainly not wise enough, to offer rights and liberties are to be given recognized that while the freedom an answer to the dilemma just a wide, purposive and generous of expression was to be given a

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wide interpretation and effect, Many of you will know that where was held she was time-barred: the there was a counter argument medical negligence is alleged by a significant injury was said to be the (which won the day for the patient, the limitation period is 3 removal of her breast and this had Government) that at that stage of years. This cut off point balances taken place some 15 years earlier. Hong Kong’s development (1999, the rights of the patient to have This result has always seemed to soon after the resumption of the a reasonable time within which me to be unfair: the poor woman exercise of sovereignty in 1997), to prepare and mount a claim for had no means of knowing that a societal and community interests negligence against the interests, wrong had been committed until lay in the protection of the national first, of the doctor properly to 15 years after the operation. The flag as a unique symbol of the defend himself and secondly, of significant injury was not simply Hong Kong SAR. the court in adjudicating on stale the removal of her breast, but the cases. The 3 years run from the removal of a healthy breast. The Some may perhaps argue that this date of the injury or from the date current analysis of that case is was an obvious result. In my view, the patient first knew of significant along these lines and this analysis far from it. The Court of Final injury (for example the effects of seems to me to be right. There Appeal was faced with effectively a drug causing latent damage), is of course a difficult balance to a difficult balancing exercise, whichever is later. be struck between the doctor’s especially given the established position (defending a case an approach of the courts to construe The determination by a court of the point when an injury is known extremely lengthy period after rights and liberties widely, the operation) and the patient’s and, correspondingly, to read to be significant can be said at times to involve a balancing predicament of not having known restrictions on such rights narrowly. the truth until that same period It is perhaps of some note that at of different interests. Take a real case that faced the English had elapsed. There is no easy the Court of Appeal level, which is answer to these conflicting, yet one level below the Court of Final courts (Dobbie v Medway Health rational, arguments. Perhaps Appeal, the Government had lost. Authority [1994] 1 WLR 1234). the answer ultimately lies in the This demonstrates the difficulties In this case, a woman had had her exercise of commonsense and an of having to balance competing, breast surgically removed. She underlying sense of justice. but entirely reasonable, points had been advised by the surgeon of views. Even in the United that there was a malignant tumor. Even in the area of medicine, States, those Supreme Court 15 years later, she discovered that we see the relevance at times decisions which struck down laws there was in fact no tumor; the of human rights, and the criminalizing the desecration of surgeon had not even tested for it. balancing exercise that has to the US flag, were not unanimous In the English Court of Appeal, it be undertaken. A few years ago but were 5 to 4 decisions. Sometimes, the difference between a result one way or the other, can be as fine as that: 2 entirely reasonable and plausible points of view, yet diametrically opposed results. Away from human rights and into the area of medicine, we also see balances having to be struck. For example, in legislation, a balance is struck between, on the one hand, the obvious benefits of organ transplants or reproductive technology and, on the other, the commercial exploitation of this:- see Cap. 4651 and 5612. Another piece of legislation References 1. Human Organ Transplant Ordinance Cap. 465 affecting the medical profession 1. Organ transplant can save lives. But there is a balance to be struck between commercial exploitation and this benefit. which again highlights the 2. Commercial exploitation is prohibited : s. 4. 3. Limits as donors : must be genetically related (s. 5(1)(i)) or a spouse of 3 years or more (s. 5(1)(ii)). difficulties that may arise in 4. Donor must also be 18 years old (s.5(4)(b)(i)) or 16 if married (s.5(4)(b)(ii)). balancing interests is the limitation 2. Human Reproductive Technology Ordinance Cap. 561 1. Balance : To enable childless couples to have children but also to prevent commercial exploitation. statute (in Hong Kong, this is the 2. The need of a licence : s. 13. Limitation Ordinance Cap. 347). 3. Cannot commercially exploit surrogacy arrangements.

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(in Kwok Hay Kwong v Medical If what we do in life echoes Again, the Hippocratic Oath Council of Hong Kong [2008] 3 in eternity, wisdom requires assists in that part that urges HKLRD 524), the Court of Appeal us to listen to those echoes. a doctor to “use my power in Hong Kong had to consider the The reverse of this coin is to help the sick to the best limits to the freedom of expression that one should not hesitate of my ability and judgment”. belonging to doctors to advertise to share one’s experience and In the 13th AJS McFadzean their services. This can be a knowledge. The Hippocratic Oration in 2008, Dr York Chow very difficult balancing exercise Oath (in its original form) said this (and I cannot put it indeed: on the one hand, the stated a requirement that “by better):- public interest in enabling doctors precept, lecture, and every “Medical care is a professional to inform members of the public mode of instruction, I will service provided by people: of available medical services so impart a knowledge of the Art people with knowledge, that informed choices can be [of medicine] to my own sons, expertise and experience. made; on the other, a rival public and those of my teachers.” More importantly, it relies on interest against excessive and The Oath of Hippocrates professionals who possess perhaps even undignified forms (a Greek physician born in strong compassion, and high of advertising, worse still dubious about 460 B.C.) used to be standards of honesty and information being provided to required to be taken by many morality…. Let us treasure the public. What is or is not doctors after graduating from those values and principles, acceptable is a matter for the medical school, but obviously and continue to develop young profession’s governing body (The now contains a number of doctors to be capable, caring, Medical Council) to determine and requirements which are conscientious and confident I recognize at once the difficulties outdated (for example, the professionals. Let them enjoy of adjudicating between the trust and respect of our diametrically opposed positions citizens.” in which the proponents each Wisdom consists fervently believe in the correctness 4. The dignity and rights of of their own arguments. in part of knowing the individual pervade every aspect of society, and rightly I mentioned at the outset the that there are so. These rights are not to necessity of making decisions, be sacrificed even if at times however difficult the balancing others wiser than against the majority view or, process may involve and however you, from whom perhaps more accurately, what fine the dividing line between competing interests. In the you can learn. is regarded as the view of the law, we are guided by notions majority, unless powerful and of justice, the respect for the compelling arguments prevail. dignity of the individual in the bar on abortion). However, When one read recently about enforcement of fundamental rights it contains many more facets the medical experiments and liberties, commonsense and which, I believe, are still carried out on Guatemalans experience. relevant; indeed it is still back in the 1940s, the reaction required to be taken by some is one of shock. Competing It is with much diffidence that I medical schools albeit in a arguments no doubt existed venture to suggest that in arriving more modern form. there, but most right thinking at difficult decisions, the guides are people would regard this perhaps similar for doctors. One 2. Use your commonsense. episode with utter abhorrence. ultimately goes back to basics:- We all have it; it is just that some people try to Lastly a sense of balance requires 1. Learn from your own suppress it for some reason. wisdom, but wisdom can only experience and the experience Using your commonsense come from hard work and study. I of others. I have earlier requires confidence in wish you all wisdom in all that you mentioned the great medical your own abilities. Do not do and in every difficult decision scientists – Galen, Vesalius, underestimate yourself. that you will all no doubt face in Harvey, Jenner, Pasteur, the future. It is impossible to Fleming, Crick and Watson – 3. If you always bear in mind please everyone all the time when there are many more around just why you are here in the you have to make an important you, many in this room. first place, in other words decision. That (pleasing everyone) Wisdom consists in part your mission, you will then is not the obligation. The of knowing that there are have realized the importance obligation is to do your best and to others wiser than you, from of the dignity and rights of do it wisely. whom you can learn. the patient. This is not new.

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ANNUAL SCIENTIFIC MEETING (9-10 OCTOBER 2010)

The theme of the meeting was “Novel therapeutics in medical practice” with updates in advances relevant to current medical practice, particularly in cardiology and oncology. New treatment approaches to hepatitis C, diabetes, autoimmune rheumatic diseases and myeloid neoplasms were covered during the two days of lectures. The Gerald Choa Memorial Lecture was delivered by Professor Fok Tai Fai who shared with the audience valuable lessons learned from the history of neonatology. The second day of the meeting featured the outstanding scientific achievements of local researchers. Recipients of the Best Thesis Award and the Distinguished Research Paper Award for Young Investigators 2010 presented their papers. The prestigious Sir David Todd Lecture was presented by Professor Tse Hung Fat on his exciting stem cell research in cardiology. As in the previous year, the annual scientific meeting owed its success to Professor Kwong Yok Lam and the organizing committee.

PROF KAO JIA-HORNG FROM TAIWAN SPOKE ON NOVEL APPROACHES TO PROFESSOR RICHARD YU WITH LECTURERS FOR THE CANCER SYMPOSIUM HEPATITIS C TREATMENT – DR JANICE TSANG, DR CONRAD LEE AND PROF WINNIE YEO

PROF CM YU, BOTH CHAIRMAN AND SPEAKER FOR THE NOVEL A WARM HANDSHAKE AS PROF R YU PRESENTED THE 2010 GERALD CHOA THERAPEUTICS SESSION IN CARDIOLOGY. MEMORIAL LECTURE MEDAL TO PROF TF FOK.

COUNCIL MEMBERS APPRECIATIVE OF PROF JOSEPH SUNG’S MANY PROF CS LAU ON NOVEL THERAPEUTICS IN RHEUMATOLOGY CONTRIBUTIONS AND LONG SERVICE TO THE HKCP

12 SYNAPSE • JANUARY 2011 COUNCIL NEWS

NEW HKCP ANNUAL 23RD ANNUAL GENERAL MEETING, FELLOWSHIP 12TH CONGREGATION AND SUBSCRIPTION FOR 24TH COLLEGE DINNER

2011 At the AGM held on the 9 October 2010, Professor KN Lai delivered his last report as he stepped down from serving as President of our College since 2004. He The College has recently reviewed the summarised the work and achievements of the College’s various subcommittees annual Fellowship subscription. At our in the past year and reported on maintaining strong academic ties with physician recent Council Meeting, the Council noted colleges, both nationally and internationally. The ceremony proceeded with the that the Fellowship subscription has conferral of Fellowships and Memberships to 70 doctors, efficiently coordinated by not been revised since 2008. With the the public orator, Professor Philip Li and officiated by a distinguished platform party. complexity of the College, the running cost of our Secretariat is increasing. As a result, Two stalwart Councillors retired from their duties in their HKCP Council after many the Council decided to increase the annual years of devoted service and noteworthy contributions to the College. Prof WK Lam Fellowship subscription from HK$1,200.00 served as Vice President from 2004 – 2010. Prior to that, he was Chairman of the to HK$1,500.00 from the year 2011 Examination Committee for 12 years and Chairman of National and International onwards. The Membership subscription Liaison Committee for 11 years. His precise coordination of the MRCP examinations will remain unchanged at HK$800.00. in Hong Kong was widely admired by both UK and local examiners. Prof Joseph At the same time, the training fees for Sung chaired the Scientific Committee from 1998 to 2003 and laid the foundation for Basic Physician Training and Higher the Annual Scientific Meeting in 1998. The Council extends heartfelt appreciation for Physician Training remain unchanged their devoted service. at HK$3,000.00 and HK$6,000.00 The annual dinner concluded the first day of the meeting. Over a feast of fine food respectively for the whole training period. and wine, honourable guests, fellows and members enjoyed fellowship with new Please note that our current subscription and old friends. The highlight of the evening was the AJS McFadzean Oration. The is still relatively low compared with that of audience enjoyed an eloquent and thought provoking speech by The Hon Chief other Academy Colleges. Thank you for Justice Geoffrey Ma on the matter of exercising judgement in the face of difficult your understanding and continued support decisions posed to both doctors and judges alike. to the College.

THE FELLOWSHIP CONFERRAL CEREMONY AND HKCP ANNUAL COLLEGE DINNER 2010 Celebrates YEARS of extraordinary 25 achievements The Hong Kong College of Physicians will be celebrating its 25th anniversary this year. Founded in December 1986, our College has grown hugely and now has an impressive membership of a

total of 1377 Fellows, 329 Members, PROF JOSEPH SUNG AND PROF WK LAM RECEIVED THE HKCP PLAQUE FROM THE PRESIDENT AS 391 trainees. Indeed, we have A TOKEN OF APPRECIATION FOR THEIR LONG SERVICE TO THE COUNCIL many achievements we are proud of celebrating on our Silver Jubilee anniversary. A special committee will organize celebrations and a commemorative publication to mark this grand occasion. The highlight will be the Annual College Dinner scheduled for 8 October 2011. May we invite you to record this event in your diary now.

PROFESSORS KN LAI AND WK LAM SHARING A PROF SIR DAVID TODD AND THE HON CHIEF LAUGH WITH BROTHERS HON CHIEF JUSTICE Save the date! JUSTICE GEOFFREY MA WHO DELIVERED THE GEOFFREY MA AND DR JOHN MA AT THE AJS MCFADZEAN ORATION ANNUAL DINNER.

SYNAPSE • JANUARY 2011 13 COUNCIL NEWS

THE PRESIDENTIAL PHOTO: DR PATRICK LI, THE NEWLY ELECTED PRESIDENT, TOGETHER WITH THE PAST PRESIDENTS OF THE COLLEGE, PROF RICHARD YU (1998-2004), PROF SIR DAVID TODD (1986-1992), PROF TK CHAN (1992-1998) AND PROF KN LAI (2004-2010)

PRESIDENT KN LAI WITH THE OFFICIATING PLATFORM PARTY AT THE 12TH CONGREGATION FOR NEW FELLOWS

FROM LEFT TO RIGHT: DR PATRICK LI, PROF V CHAN, PROF J SUNG, PROF R YU, PROF SIR DAVID TODD, PROF TK CHAN, PROF KN LAI, PROF WK LAM, PROF P LI & DR L YAM

14 SYNAPSE • JANUARY 2011 COUNCIL NEWS

The HKCP Council 2010-2011

President Dr Li Chung Ki Patrick Vice-Presidents Prof Matthew Ng The Council appointed the following Dr Yam Yin Chun Loretta Chairmen of various Committees: Honorary Secretary Prof Li Kam Tao, Philip National and International Liaison Committee Honorary Treasurer Dr Tse Tak Fu Prof Matthew Ng Council Members Prof Chan Tak Cheung, Anthony Education and Accreditation Committee Dr Chan Wai Man Johnny Dr Loretta Yam Dr Kng Poey Lyn, Carolyn Professional and General Affairs Committee Prof Kwong Yok Lam Dr CP Wong Dr Lai Sik To, Thomas Scientific Committee Prof Lau Chak Sing Prof YL Kwong Dr Leung Man Fuk, Edward Membership Committee Dr Li Chun Sang Dr CS Li Dr Tong Kwok Lung, Matthew Dr Tse Man Wah, Doris Examination Committee Dr Wong Chun Por Prof CS Lau Prof Wong Ka Sing, Lawrence Administration and Finance Committee Prof Yu Cheuk Man Dr TF Tse Co-opted Council Members Prof Chan Ka Leung Working Group in Traditional Chinese Medicine Dr Tsoi Tak Hong Dr TF Tse Research Committee Founding President Prof Sir David Todd Prof Lawrence Wong Past President Prof Lai Kar Neng Synapse Senior Advisor Prof Yu Yue Hong Richard Dr Carolyn Kng

SYNAPSE • JANUARY 2011 15 COUNCIL NEWS

Distinguished Research Paper Award for Young Investigators 2010 The following doctors received the awards at the Annual Scientific Meeting.

Dr Bik Ling Man Dr Chung Wah Siu Dr Grace Lai Hung Wong Dr Vincent Wong Department of Medicine & Department of Medicine, Department of Medicine & Department of Medicine & Geriatrics, Tuen Mun Hospital Queen Mary Hospital Therapeutics, Prince of Wales Hospital Therapeutics, Prince of Wales Hospital

INTRAVENOUS DILTIAZEM IS SUPERIOR LESION PATTERNS AND HIGH INCIDENCE TO INTRAVENOUS CLINICAL SCORING STROKE MECHANISMS OF MORTALITY AND AMIODARONE OR SYSTEM TO PREDICT IN CONCURRENT RECURRENT BLEEDING DIGOXIN FOR ACHIEVING HEPATOCELLULAR ATHEROSCLEROSIS IN PATIENTS WITH VENTRICULAR CARCINOMA IN OF INTRACRANIAL HELICOBACTER PYLORI- RATE CONTROL IN CHRONIC HEPATITIS B AND EXTRACRANIAL NEGATIVE IDIOPATHIC PATIENTS WITH ACUTE CARRIERS. VESSELS. BLEEDING ULCERS. UNCOMPLICATED ATRIAL FIBRILLATION.

Man BL. Fu YP. Chan YY. Siu CW. Lau CP. Lee WL. Wong GL. Wong VW. Chan Y. Wong VW. Chan SL. Mo F. Lam W. Hui AC. Leung WH. Lam KF. Tse HF. Ching JY. Au K. Hui AJ. Lai LH. Chan TC. Loong HH. Wong GL. Mok V. Wong KS. Chow DK. Siu DK. Lui YN. Wu Lui YY. Chan AT. Sung JJ. Yeo W. JC. To KF. Hung LC. Chan HL. Chan HL. Mok TS. Sung JJ. Chan FK.

Critical Care Medicine. Gastroenterology. Gastroenterology. Stroke. 40(10):3211-5, 2009 Oct. 37(7):2174-9; 2009 Jul. 137(2):525-31, 2009 Aug. 137(2):525-31, 2009 Aug.

16 SYNAPSE • JANUARY 2011 SCIENTIFIC SECTION Sir David Todd Lecture New Era of Regenerative Medicine for Cardiovascular Diseases Hung Fat Tse Department of Medicine University of Hong Kong

he increasing life expectancy in Treatment of severe Coronary Artery immune rejection with autologous many parts of the world has led Diseases (PROTECT-CAD trial).8 In transplantation, non-tumour forming, Tto an epidemiologic transition this study, we have demonstrated that and have no ethical obstacle. 11 in the leading causes of death BM cells injection were associated However, they are restricted in from infectious diseases and acute with improvement in exercise time, their renewal and differentiation illness to chronic illness, especially functional class, left ventricular potential to become functional cardiovascular diseases. Despite ejection fraction and wall thickening cardiomyocytes. In contrast, human the recent advances in medical and over the target region by 6 months.8 pluripotent stem cells, such as surgical therapies, a large number of On cardiac magnetic resonance embryonic stem cells (ESCs) patients with cardiovascular diseases imaging, myocardial perfusion and can propagate indefinitely while remain severely symptomatic with flow reserve were improved over maintaining their normal karyotypes poor clinical outcomes. Many the target region, suggesting the and pluripotency to differentiate into currently untreatable cardiovascular enhancement of neovascularization all cell types, including functioning disorders arise from disease after bone marrow transplantation.9 cardiomyocytes. 1 2 , 1 3 We h a v e process due to significantly loss Indeed, numerous clinical studies demonstrated that transplantation of of cardiomyocytes that do not in recent years from other centers functional cardiomyocytes derived otherwise regenerate. As a result, have also confirmed that BM from these pluripotent stem cells stem cell and gene therapy has been cells transplantation can improve could improve left ventricular function explored as potential treatment to symptoms and cardiac function, and prevent adverse ventricular limit the progression of diseases and limit infarct size and adverse remodeling after myocardial 14 or to regenerate damaged heart in ventricular remodeling in patients infarction. However, the immature patients with different cardiovascular with acute myocardial infarction, phenotypes, such as calcium diseases. chronic myocardial ischemia and handling and electrophysiological congestive heart failure.10 properties in those cardiomyocytes Stem cell therapy was conceptualized derived from ESC was associated more than a decade ago in the Despite the promising initial clinical with development of fatal ventricular treatment of acute myocardial results, the beneficial effects are tachyarrhythmias. 15-17 Therefore, infarction. 1 - 3 B a s e d o n t h e at best modest, and several major new techniques to drive cardiac initial encouraging results in the issues, such as the optimal timing, differentiation and maturation, experimental studies, 4 we have cell types and mode of delivery such as gene modification18 could initiated the first human clinical need to be addressed in the ongoing ultimately enable the application of study in 2001 on the use of novel clinical trials. Furthermore, additional these human pluripotent stem cells catheter-based intramyocardial strategies should also be developed to regenerate damaged myocardium. transplantation of bone marrow (BM) to improve the efficacy of cell-based stem cells for treatment of chronic therapy for cardiovascular diseases. Recently, the generation of human myocardial ischemia in patients with On of the important obstacle for induced pluripotent stem (iPS) severe coronary artery disease not cardiac regeneration with stem cell cells, via reprogramming of somatic amenable to conventional medical or therapy is the ability to replace any cells has circumvented some of surgical therapies.5 Long-term follow- major loss of cardiomyocytes after the potential technological, social up 6,7 in this initial cohort of patients the initial insult. For instant, more and ethical issue related to ESC.19 suggested that intramyocardial BM that 1 billion of cardiomyocytes Conceptually, iPS cell technology stem cell transplantation was a died after an acute myocardial should provide an unlimited supply safe and feasible treatment option infarction. Currently, adult stem of even specified cells, not limited to in this group of patients. In 2006, cells, such as BM, skeletal myoblast cardiomyocyte, but also hepatocytes, we performed the first Prospective and mesenchymal stem cells (MSC) beta-cells and neurons etc for RandOmized controlled Trial on are the most common cell source tailored made patients-specific the use of direct Endomyocardial for cardiac regeneration in clinical cell-based therapy for treatment implantation of BM Cells for trials as they have no risks of of various human diseases, and to

SYNAPSE • JANUARY 2011 17 SCIENTIFIC SECTION

References: develop human cell based platform 1. Tse HF, Lee PY, Lau CP. Bone Marrow Cell CW, Li RA. Functional consequences of overexpressing Transplantation for Myocardial Regeneration and the gap junction Cx43 in the cardiogenic potential of for drugs screening. Indeed, we Therapeutic Angiogenesis. In Laham R, Balm DS (eds): pluripotent human embryonic stem cells. Biochem Angiogenesis and Direct Myocardial Revascularization. Biophys Res Commun. 2008;377:46-51. have successfully derived functional Totowa, NJ: Humana Press Inc., pp. 261-281, 2005. 14. Au KW, Liao SY, Lee YK, Lai WH, Ng MK, Chan YC, MSC from human iPS cells, and 2. Tse HF, Yiu KH, Lau CP. Bone marrow stem cell Yip MC, Ho CY, Wu EX, Li RA, Siu CW, Tse HF. Effects therapy for myocardial angiogenesis. Curr Vasc of iron oxide naoparticles on cardiac differentriation demonstrated that iPS-dervied Pharmacol 2007;5:103-112. of embryonic stem cells. Biochem Biophys Res 3. Tse HF, Lau CP. Therapeutic angiogenesis with bone Commun. 2009;379:898-903. MSC was superior to BM-MSC in marrow derived stem cells. J Cardiovasc Pharmacol 15. Wang K, Xue T, Tsang SY, Huizen RV, Wong CW, Lai Ther. 2007;12:89-97. KW, Ye Z, Cheng L, Au KW, Zhang J, Li GR, Lau CP, enhancement of neovascularization 4. Tse HF, Siu CW, Zhu SG, Liao S, Zhang QY, Lai WH, Tse HF, Li RA. Electrophysiological properties of in ischemic limb.20 Furthermore, we Kwong YL, Nicholls J, Lau CP. Paracrine effects of pluripotent human and mouse embryonic stem cells. direct intramyocardial implantation of bone marrow Stem Cells. 2005; 23: 1526-34. have also established patient-specific derived cells for enhancement of neovascularization 16. Lieu DK, Liu J, Siu CW, McNerney GP, Abu-Khalil in chronic ischemic myocardium. Eur J Heart Fail. A, Huser T, Tse HF, Li RA. Absence of transverse human iPS platform for modeling 2007;9:747-53. tubules contributes to non-uniform Ca2+ wavefronts 5. Tse HF, Kwong YL, Lo G, Ho CL, Chan JKF, Yeung in mouse and human embryonic stem cell-derived of different human diseases, DW, Lau CP. Angiogenesis in ischemic myocardium by cardiomyocytes. Stem Cell Dev 2009;18:1493-500. intramyocardial autologous bone marrow mononuclear 17. Liao SY, Liu Y, Siu CW, Lai WH, Wu Y, Yip P, Wu Y, such as premature aging due to cell implantation. Lancet. 2003; 361: 47-9. Wu EX, Lau CP, Li RA, Tse HF. Proarrhythmic risk laminopathy.21 6. Tse HF, Thambar S, Kwong YL, Rowlings P, Bellamy G, of transplantation of embryonic stem cell derived McCrohon J, Bastian B, Chen WH, Chan JKF, Lo G, Ho cardiomyocyte in infarcted myocardium. Heart CL, Lau CP. Safety of catheter-based intramyocardial Rhythm (in press). Finally, gene based therapy autologous bone marrow cells implantation for 18. Ng KM, Lee YK, Lai WH, Fung ML, Siu CW, Li RA, therapeutic angiogenesis. Am J Cardiol. 2006; 98: Tse HF. Exogenous expression of HIF-1α promotes 60-2. may also play a role in cardiac cardiac differentiation of embryonic stem cells. J Moll 7. Tse HF, Kwong YL, Chan JKF, Lo G, Ho CL, Parker A, Cell Cardiol 2010;48:1129-37. regeneration. We have previously Hauser T, Lau CP. Comparative evaluation of long-term 19. Lian Q, Chow Y, Esteban MA, Pei D, Tse HF. Future clinical efficacy with catheter-based percutaneous perspective of induced pluripotent stem cell for demonstrated that over-expression intramyocardial autologous bone marrow cells implantation versus laser myocardial revascularization diagnosis, drug screening and treatment of human of bioengineering pacemaker gene in patients with severe coronary artery disease. Am diseases. Thromb Haemost. (in press). via somatic gene transfer in heart Heart J. 2007;154:982.e1-6. 20. Lian Q, Zhang Y, Zhang J, Zhang HK, Wu X, Zhang Y, 8. Tse HF, Thambar S, Kwong YL, Rowlings P, Bellamy Lam FY, Kang S, Xia JC, Lai WH, Au KW, Chow YY, G, McCrohon J, Thomas P. Bastian B, Chan JKF, Lo Siu CW, Lee CN, Tse HF. Functional mesenchymal could initiating cardiac rhythm, and stem cells derived from human induced pluripotent 22-24 G, Ho CL, Chan WS, Kwong RY, Parker A, Hauser T, thus act as biological pacemaker. Chan J, Fong YT, Lau CP. Prospective randomized trial stem cells attenuate limb ischemia in mice. of direct endomyocardial implantation of bone marrow Circulation 2010;121:1113-23. This therapeutic approach may cells for treatment of severe coronary artery diseases 21. Liu B, Wang J, Chan KM, Tjia WM, Deng W, Guan X, (PROTECT-CAD trial). Eur Heart J. 2007; 28: 2998- Huang J, Li KM, Chan JD, Pei D, Pendas A, Lopez- potentially avoid or act as hybrid 3005. Otin C, Tse HF, Hutchison C, Chen J, Cao Y, Cheah therapy to reduce the dependence of 9. Chan WS, Kwong YL, Kwong RY, Lau CP, Tse HF. KSE, Tryggvason K, Zhou Z. Genomic instability in Therapeutic angiogenesis with direct endomyocardial laminopathy-based premature aging. Nat Med. 2005; electronic pacemaker in patients with implantation of autologous bone marrow cells 11: 780-85. in patients with severe coronary artery diseases: 22. Tse HF, Xue T, Lau CP, Siu CW, Wang K, Zhang QY, cardiac arrhythmias. In summary, Insight from cardiac magnetic resonance imaging. J Tomaselli GF, Akar FG, Li RA. Bioartificial sinus node Cardiovasc Magn Reson. 2010;12:6. constructed via in vivo gene transfer of an engineered it is anticipate that regenerative 10. Siu CW, Liao SY, Liu Y, Lian Q, Tse HF. Stem cells pacemaker HCN channel reduces the dependence on for myocardial repair. Thromb Haemost. 2010 Mar electronic pacemaker in a sick sinus syndrome model. medicine will play an ever more 29;104(1). [Epub ahead of print] Circulation. 2006; 114: 1000-11. prominent role in the new era of 11. Lian Q, Chow Y, Esteban MA, Pei D, Tse HF. Future 23. Xue T, Siu CW, Lieu DK, Lau CP, Tse HF, Li RA. perspective of induced pluripotent stem cell for Mechanistic role of If revealed by induction of modern cardiovascular therapies; diagnosis, drug screening and treatment of human ventricular automaticity by somatic gene transfer diseases. Thromb Haemost. (in press). of gating-engineered pacemaker (HCN) channels. however, significant challenges must 12. Moore JC, Fu J, Chan YC, Lin D, Tran H, Tse HF, Li Circulation. 2007; 115:1839-50. RA. Distinct cardiogenic preferences of two human 24. Chan YH, Siu CW, Chan YH, Lau VY, Lau CP, Li be overcome before that promise is embryonic stem cell (hESC) lines are imprinted in RA, Tse HF. Synergistic effects of inward rectifier their proteomes in the pluripotent state. Biochem (IK1) and pacemaker (If) currents on the induction realized. Biophys Res Commun. 2008; 372:553-8. of bioengineered cardiac automaticity. J Cardiovas 13. Moore JC, Tsang SY, Rushing SN, Lin D, Tse HF, Chan Electrophysiol 2009; 20:1048-54.

18 SYNAPSE • JANUARY 2011 SCIENTIFIC SECTION

Best Thesis Award Gold Award

Winner DR ALEXANDER LAU, DR VINCENT MOK (SUPERVISOR) AND PROF KN LAI

Good collateral Background circulation predicts Collateral circulation via circle of Willis (COW) and leptomeningeal anastomosis preserves perfusion and stabilizes cerebral blood flow, and is better outcome an important outcome predictor of revascularization in acute occlusion and in patients with symptomatic carotid stenosis. Its role in the prevalent intracranial large artery occlusive disease (ILAD) has not been explored. This study aimed intracranial large artery to assess the antegrade and collateral circulation status in patients with occlusive diseases symptomatic ILAD and to correlate with the stroke severity, neurological By Alexander Yuk Lun LAU recovery, and recurrence risk. The stroke topography was assessed to Department of Medicine and Therapeutics elucidate its pathogenesis. Prince of Wales Hospital

Methods Results more severe stroke (NIHSS 3±3 versus 3±2, p=0.029, and NIHSS This is a retrospective study of 79 patients were analyzed. The 3.5±2 versus 3±2, p=0.028, patients who had ischemic stroke majority (n=56, 71%) had MCA respectively). High-grade (>70%) related to ILAD (intracranial ICA, stenosis and mild stroke (median stenosis predicted multiple infarcts MCA, BA) and underwent MRI brain NIHSS 3). 44 (58%) patients had (OR 6.4, CI 1.20-34.30, p=0.03), and digital subtraction angiography good antegrade flow (TICI grade 2b and diabetes predicted pial infarcts (DSA). The angiograms were and 3), 66 (89%) patients had good (OR 4.9, CI 1.54-15.75, p=0.007). assessed by the Thrombolysis in collateral flow (ASITN/SIR grade Cerebral Infarction (TICI) grading 2-4), and 55 (70%) patients had for antegrade flow, and the complete COW; corresponding to 65 Conclusion American Society of Interventional (88%) patients with good circulation In patients with symptomatic and Therapeutic Neuroradiology/ score and 65 (88%) patients with ILAD, composite circulation Society of Interventional Radiology good global circulation score. assessment by incorporating (ASITN/SIR) grading for collateral Patients with good circulation score the leptomeningeal collateral flow. MRA was used to assess the had less severe index stroke (NIHSS and COW flow status provides COW. Composite circulation score 3±2 versus 3±4, p=0.038), better m o r e c o m p r e h e n s i v e and global circulation score were stroke recovery with functional prognostication. Better derived to incorporate antegrade, independence at 3-months p r o g n o s i s c a n b e collateral, and COW status. (94% versus 6%, p=0.035), anticipated in patients with Outcome measures included the and less recurrent stroke or TIA compromised antegrade flow National Institute of Health Stroke in 12-months (91% versus 9%, but compensated by good Scale (NIHSS) for index stroke p=0.073). Good circulation score collateral circulation. Pial, severity, functional independence (OR 13.9, 95% CI 1.37-142.4, borderzone, and multiple at 3-months, and recurrent stroke p=0.026), and complete COW (OR infarcts are unfavorable or transient ischemic attack (TIA) 15.3, CI 2.50-93.83, p=0.003) s t r o k e t o p o g r a p h y , in 12-months. Stroke topography predicted functional independence. suggesting that impaired was assessed according to vascular In the stroke topography analysis, washout of thromboemboli territories into perforator, pial, borderzone (n=41, 52%) and pial in hypoperfused region is borderzone, and territorial infarcts (n=28, 35%) infarcts were the important in the stroke using published templates. commonest and corresponded to pathogenesis.

SYNAPSE • JANUARY 2011 19 SCIENTIFIC SECTION

Best Thesis Award Silver Award

Winner DR BENJAMIN AU YEUNG, DR CHIU MING NG (SUPERVISOR) AND PROF KN LAI

Tests used in the Background subtype classification Clinical guidelines state that it is important to differentiate between and outcome of the different subtypes of primary aldosteronism (PA), notably between treatment in primary unilateral adenoma (APA) and bilateral hyperplasia (BAH). Treatment recommendations for these two subtypes differ. Adrenal venous sampling aldosteronism (AVS) is considered the reference standard for this purpose, though By Benjamin Yick Toa AU YEUNG imaging studies can also be helpful. Department of Medicine Queen Elizabeth Hospital

Objective than surgical therapy. Whether procedure, and failure to cannulate surgical therapy for BAH is a viable the adrenal veins, especially the The aim of this dissertation is to option awaits future exploration. right adrenal vein, can occur in review the evidence base for the For the time being, it is still 25 to 50%. However, suboptimal need to differentiate between APA worthwhile to differentiate between cannulation can also produce and BAH, and the evidence base unilateral and bilateral disease in useful data, and blood samples for the tests used for this purpose. view of the difference in treatment should always be obtained from the recommendations. nearest site. Methods Literature search as well as a For differentiation, imaging studies Conclusion retrospective analysis of the and posture stimulation test both The need for differentiating experience in our centre are have good positive predictive value APA and BAH should be performed. for APA. AVS is helpful when these further studied. Diagnosis of two tests are negative, or show PA subtypes should depend discordant results. AVS can lead to Results on a combination of imaging false lateralization in 10% of cases. The difference in prognostic and biochemical studies. implications between APA and BAH A cut-off lateralization ratio of > is uncertain. Medical therapy of 3:1 should suffice for diagnosing APA appears to be less effective in APA. A contralateral ratio of <1 terms of cardiovascular outcome is also very useful. It is a difficult

20 SYNAPSE • JANUARY 2011 SCIENTIFIC SECTION

Best Thesis Award Bronze Award Winner A prospective study on DR LEUNG LI, PROF WINNIE YEO (SUPERVISOR) AND PROF KN LAI the significance of quality of life Background Quality of life (QOL) assessment with EORTC QLQ-C30 questionnaire was measurement and reported to be prognostically significant in patients with hepatocellular clinical factors in carcinoma (HCC). The HCCspecific QOL EORTC QLQ-HCC18 may have a better reflection of QOL in HCC patients with chronic liver disease. The prediction of survival potential mechanisms of QOL being prognostic for survival were investigated. in Chinese patients Various staging systems were developed in different populations, however, differences in etiological pattern and prognosis between Chinese and with hepatocellular Caucasian HCC patients were noted. The objectives of this study were 1) carcinoma to evaluate the prognostic significance of EORTC QLQ-HCC18 module, 2) to validate the prognostic value of EORTC QLQ-C30 module, 3) to assess By Leung LI correlation between QOL and the stage of HCC and severity of cirrhosis, and Department of Clinical Oncology 4) to find the best HCC staging systems for Chinese HCC patients. Prince of Wales Hospital

Methods 9.6 months). 1) In combined multivariate analysis, independent Two hundred and three patients Conclusions poor prognostic factors for survival with newly diagnosed HCC were This study was the first among QLQ-HCC18 were worse prospectively recruited. Treatment to report the significant scores in HCC18 fatigue domain included surgery, loco-ablative prognostic value of EORTC (HR 1.146; p=0.0042) and therapies, transarterial therapies, QLQHCC18 module in HCC nutrition domain (HR 1.137; chemotherapies, sorafenib and best patients. The combined p=0.0244). 2) of the QLQ-C30, supportive care as determined by multivariate analysis was no factor was identified as clinicians. Patients’ baseline QOL unable to confirm previous independent prognostic factor. 3) assessment, clinical factors, staging report on EORTC QLQ-C30’s There were significant correlations and treatment were analysed to prognostic significance. between worse QOL scores in C30/ Worse QOL scores correlated identify independent factors for HCC18 and advanced cirrhosis, significantly with advanced survival in Cox proportionalhazards as well as advanced stages in cirrhosis and advanced HCC regression model. The correlations Chinese University Prognostic Index stage. CUPI and Okuda between QOL and stage of HCC and (CUPI), Okuda, the American Joint had significantly better severity of cirrhosis were analysed Committee on Cancer Tumor Node prognostic value in Chinese by Wilcoxon rank-sum test. Metastasis (AJCC TNM), Cancer of HCC patients. the Liver Italian Program (CLIP). Results 4) In Chinese HCC patients, CUPI Median overall survival of the (p=0.0037) and Okuda (0.0019) 203 HCC patients (79% hepatitis were significantly superior among B) was 8.1months (95% CI 6.2- various staging systems.

SYNAPSE • JANUARY 2011 21 EVENTS AND ANNOUNCEMENTS Distinguished Awards for Our Fellows Hearty congratulations to our Fellows and Honorary Fellows who have received prestigious awards in 2010 for their outstanding contributions.

PROFESSOR RICHARD YU YUE-HONG Silver Bauhinia Star (SBS)

Professor Yu is awarded the SBS in recognition of his distinguished public and community service, particularly his significant contribution to the health care sector and the development of nephrology in Hong Kong. He is also a staunch supporter of research and education on emerging infectious diseases.

22 SYNAPSE • JANUARY 2011 EVENTS AND ANNOUNCEMENTS

DR THE HONOURABLE EDWARD LEONG CHE-HUNG Grand Bauhinia Medal (GBM)

Dr Leong is awarded the GBM in recognition of his distinguished public and community service, particularly his significant contribution as a Member of the Executive Council and his dedication to the development of the medical profession in Hong Kong. With his extensive professional expertise, Dr Leong has provided valuable advice in the formulation of medical services and health care policies. During his tenure as Chairman of the Hospital Authority, he led the organisation to implement initiatives to improve the quality of patient care. He also played a pivotal role in championing the legislation and establishing the regulatory regime for human reproductive technology activities. In his capacity as the Chairman of the Elderly Commission, he has successfully introduced innovative programmes to benefit the elderly and address their long-term care needs.

DR LEO WONG KWAI-KUEN

Bronze Bauhinia Star (BBS)

Dr Wong is awarded the BBS for his achievements in photographic art and his exemplary efforts in promoting the development of photographic art in Hong Kong, the Mainland and overseas.

SYNAPSE • JANUARY 2011 23 EVENTS AND ANNOUNCEMENTS

Professor Kar Neng Lai

ur immediate Past President, Professor Kar Neng LAI, Yu Chiu OKwong Chair of Medicine, HKU, received the following honors given by the Asian-Pacific Society of Nephrology at Seoul in June 2010. They are the Priscilla Kincaid-Smith Award for outstanding contribution to science in nephrology from the Asian-Pacific Region and the Ross Bailey Lecture Award for outstanding scientific achievement.

Dr Chew Chin Hin (Honorary Fellow, HKCP)

r Chew received the Mastership of the American College of Physicians at a convocation ceremony in Toronto, Canada for his Dcontributions to the development of clinical medicine, medical education, research and medical ethics in Singapore. The Mastership has been given to fewer than 700 doctors worldwide since 1923.

Meeting with the CEO, Royal Australasian College of Physicians

r Jennifer Alexander, CEO of the Royal Australasian College of Physicians, met our College President, on 3 September D2010 at the College Chamber to discuss matters of mutual interest. Prof Philip Li, Hon Secretary, Dr Patrick Li (President-elect) and Dr Matthew Tong also joined the discussion. Dr Alexander gave a College tie to our President as a gift. Our College hosted a dinner in her honour at the Hong Kong Golf Club on the same evening.

Addendum Synapse July 2010 edition page 3 photo caption – Prof Choa with the then Governor of Hong Kong, Sir Murray MacLehose.

24 SYNAPSE • JANUARY 2011 EXAMINATIONS AND RESULTS

Pass Rates for the Joint Pass List for the October HKCPIE/MRCP(UK) PACES PACES 2010 Examinations examinationnation

October 2001 36/72 = 50% Au Chi Kit Au Chi Sum February 2002 34/74 = 46% Au Ho Yan Toni Chan Chi Pan October 2002 29/72 = 40% Chan Chung On Chan Kam Wa February 2003 30/69 = 43% Chan Koon Ming Chan Shuk Ying October 2003 27/59 = 46% Chan Wai Lun Larry Chan Yu Hong March 2004 39/64 = 61% Cheung Sze Wan Peggy Cheung Wing Sze Emily October 2004 26/69 = 38% Chu Yim Pui Fan Sin Ying March 2005 35/75 = 47% Fong Ho Fai Daniel Fong Man Chi October 2005 28/75 = 37% Ho Yim Ha Huang Shan Shan March 2006 36/75 = 48% Ip Muk Fai Kwok Wing Hang Dorothy October 2006 16/73 = 22% Kwong Kin Keung Lai Tin Lok March 2007 44/74 = 59% Lau On Cheung Lau Yue Leung Joulen June 2007 44/74 = 59% Lee Ching Man Margaret Li John Wing October 2007 36/55 = 65% Li Shi Piu Carlton Mui Chun Yue Shek Lam Hin Sin Chung Wah March 2008 36/74 = 49% Sze Yee Yan Tong Yee Hong Terence October 2008 29/65 = 45% Tsang Cheuk Hang Tsang Kai Fung February 2009 39/75 = 52% Wong Chi Kin Wong Ho Nam October 2009 24/72 = 33% Wong Lok Yan Ivy Yeung Pui Yu March 2010 33/75 = 44% Yu Wen Zhen Yung Sai Kwong October 2010 40/74 = 54%

TRAINING

Please note below the important announcements relevant to trainees and trainers.

Dual Specialty Training at a later date if they had already taken the first Annual Assessment in that specialty. The College noted that there has been a trend for trainees to give up AIM training after achieving specialist status in the first specialty. The College considers that practice Termination or change of HPT Training in Internal Medicine and its specialties require broad- Program based training, and accreditation in a single subspecialty The scenarios below serve to remind trainees the is not broad enough in terms of knowledge. As a result, importance of informing College prior to any change in the College has decided that, with immediate effect from the nature of their training programs. 28 October 2010, all future Higher Physician trainees entering dual training programs must choose AIM or Scenario 1 Geriatric Medicine as one of the broad-based specialties Doctor A was originally registered for dual training in . in addition to one subspecialty Specialties I and II in Training Institution P. Some time later Doctor A left Training Institution P and transferred Deferment of HPT training to another Training Institution Q, which is not a Training Centre for Specialties I and II. Doctor A did not inform All HPT trainees who wish to defer their training in a the College about his transfer and proceeded to register specialty will only have their previous training accredited to train in Specialty III.

SYNAPSE • JANUARY 2011 25 TRAINING

Scenario 2 with the Council’s decision on 29 January 2008, his application to be HPT again should be approved by both Doctor B was originally registered for dual training in the Education and Accreditation Committee and Council Specialties I and II in Training Institution M. Some time before Doctor C can apply for College Membership. His later Doctor B left Training Institution M and transferred first year’s membership fee would be HK$8,000.00, to another Training Institution N, which is not a Training being the total annual membership fee of HK$800 x Centre for Specialties I and II. Doctor B informed (2008 – 2003) years x 2. the College that he wished to terminate his training in Specialties I and II and applied to train in Specialty III. Membership is required before Annual Council’s decision regarding Scenario 1 and 2 Assessment At the 224th Meeting of 18 May 2010, the Council noted that many trainees as in Scenario I did not inform the In accordance with the Guidelines on Postgraduate College when they decided to terminate their originally Training in Internal Medicine, fourth edition, July 2007, registered HPT training programs. The Council therefore page 27, “After completing three years of accredited decided that, if such HPT trainees wished to rejoin Basic Physician Training and passing the Intermediate the College’s training programs in the same or another examination, the Trainee should report, through his/ specialty, a new payment of the HPT training fee of her Program Director, to the Basic Physician Board for HK$6,000.00 will be imposed. Therefore, Doctor A in certification of training completion. The Trainee should Scenario 1 will be charged a new HPT training fee of then apply to be admitted as Member of the Hong HK$6,000.00 to register to be a trainee in Specialty III. Kong College of Physicians before proceeding to Higher Physician Training in one or more specialty in Internal However, in Scenario 2, Doctor B will not be required to Medicine”. pay any additional fees when he/she registers to be an HPT trainee in Specialty III. At its 224th Meeting of 18 May 2010, the Council reiterated that HPT trainees must be College Members before undertaking Annual Assessment. Trainees who Default of College Membership – have not completed membership application after their Process for Re-application first Annual Assessment will not be allowed to continue to take Annual Assessment in the registered specialties. Scenario Doctor C completed his BPT training in June 2003. BPT and HPT Attendance at the HKCP Doctor C subsequently left Training Institution J in December 2003 and started private practice in Annual Scientific Meeting January 2004. Doctor C has never applied for College The College noted that many BPT and HPT trainees had Membership. In January 2008, Doctor C was recruited attended the Annual Scientific Meeting by signing the into Training Institution K and expressed his wish to attendance sheets and leaving the venue immediately commence his HPT training in Specialties I and II. The afterwards. In order to emphasize the importance of College Secretariat found that Doctor C was not a College attending the Meeting, the Council decided that the Member and informed him to apply for admission. Annual Assessment will include some questions based on After submission of Membership application, Doctor C topics delivered at the Annual Scientific Meeting. registered as HPT trainee in Specialties I and II. Doctor C was admitted as College Member in June 2008. HPT dissertations - Study design, Council’s decision regarding above Scenario medical statistics and research At its 224th Meeting of 18 May 2010, the Council decided that HPT trainees who are not College members methodology and not working in any training institutions as reported The Council noted that a number of trainees had by their trainers and Specialty Boards will be removed demonstrated knowledge deficiency in the use of from the Trainees’ Lists of the respective Boards. If such statistical methods and research methodology in their trainees wish to rejoin the HPT training program at a later dissertations. Trainees are advised to obtain such date, they must first apply for College Membership. The information from books and the internet and tutorials will first year’s membership fees for such trainees will be not be organised by the College. All Specialty Boards double the total sum of annual membership subscriptions have been reminded to ensure their Trainees are updated counting from the year when they first became eligible to on this aspect of training. be College Members to the year of application.

In the above Scenario, Doctor C has terminated the training program for more than three years. In accordance

26 SYNAPSE • JANUARY 2011 PROFILE DOCTOR

Professor Zhong Nan-Shan John MacKay

PROF ZHONG WITH DR JOHN MACKAY AT THE FRCPE SIGNING OF THE ROLL CEREMONY HELD IN HONG KONG IN 2009

rofessor Zhong Nan-shan Revolution. Soon he was sent to He remembers those days as was born in Nanjing in work in kitchens and as a labourer being most rewarding but also P1936. Both his parents near the Great Wall in Hebei hard, in that his funding from were doctors, his father a famous province. His wife was sent to China amounted to only GBP6 per paediatrician. rural Guangdong and their young month. child was given into the care of his When he was three months old his On his return to China Professor grandmother. parents left Nanjing, just before the Zhong was appointed to the Japanese took the city in 1937. During the Cultural Revolution the Guanzhou Institute of Respiratory medical system was in disarray. His schooling took place in areas Disease. In the following years When it was over there was a need outside the Japanese area of he published numerous papers to make good the ten years of lost control, but he recalls one time on original research.Here it was medical advancement. when he was walking with his that in 2003 he earned national family in a park, and watched a Deng Xiao Ping ordered that and international fame for his Japanese plane bomb their house, leading doctors be sent abroad leadership in combating the SARS destroying it completely. for further training. Under this epidemic. scheme, in 1979 Prof. Zhong At Beijing University he developed The first patient he saw in was sent to Edinburgh University an interest in athletics. In the December 2002 alerted him to work with Professor Flenley, first Chinese National Games he to the unusual features of this Professor of Respiratory Disease won the 400 meter hurdles in a atypical pneumonia; the decreased at the City Hospital, the successor time that is still a student record. compliance of the lungs and to the famous Professor Sir John the dramatic improvement after After graduation in 1960 he worked Crofton. administration of steroids. He as an assistant biochemistry He completed a second year emphasised that steroids had to lecturer at Beijing University. of studies in London in St. be given in the right dosage to 1966 saw the start of the Cultural Bartholomew’s Hospital. the right patient at the right time.

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Under this regime he had only two patients who suffered the side effect of aseptic necrosis of the hip, a lower incidence than elsewhere. The illness and deaths of colleagues working with him on SARS patients was a great sadness. But he was proud that none stepped back from the front line. Professor Zhong’s insistence that SARS was a viral infection was vindicated when the corona virus was identified as the culprit. His leadership was rewarded when he was appointed President of the Chinese Medical Association. PROF ZHONG AND PROF NEIL DOUGLAS Research is still proceeding on the corona virus carrier rates in civet Currently, Dr Zhong is the Head of People’s Political Consultative cats, carriers of the disease. He Guangzhou Institute of Respiratory Congress and a Representative of has shown that civet cats farmed in Diseases, Chief Committee the 15th CCPC. south China for eating had a high carrier rate, whereas wild civet cats Member of Society of Respirology It is fitting that in 2009 Professor in the north had a very low rate. to Chinese Medicine Association, Zhong Nan-shan should receive an Honorary Fellowship from In 2008 The Lancet published Medical Tutor of Smoking and Edinburgh University, where he Prof. Zhong’s PEACE study that Health WHO, Vice-director of first learned the techniques to do showed that carbocisteine given Dept.of Medicine and Healthcare, original research and developed to COPD patients during acute Chinese Academy of Engineering, confidence in his own abilities. exacerbations, was as effective as Vice chairman of Guangdong Abilities that he has put to such standard treatment with steroid Society of Scientific Technology, good use over the years, most and beta-agonist bronchodilators, Chairman of Guangzhou Society of spectacularly during the SARS and importantly was affordable to Scientific Technology, Committee epidemic. poor people. Member of the 8th and 9th Chinese

PROF ZHONG RECEIVED THE HONORARY FELLOWSHIP IN 2004

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