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Kwon M, Joung CI, Shin H, Lee CC, Song YS, Lee YJ, Kang S, Kim JY, Lee S. Detection of novel drug-adverse drug reaction signals in rheumatoid arthritis and ankylosing spondylitis: analysis of Korean real-world biologics registry data. Sci Rep 2024; 14:2660. [PMID: 38302579 PMCID: PMC10834537 DOI: 10.1038/s41598-024-52822-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 01/24/2024] [Indexed: 02/03/2024] Open
Abstract
This study aimed to detect signals of adverse drug reactions (ADRs) associated with biological disease-modifying antirheumatic drugs (DMARDs) and targeted therapies in rheumatoid arthritis (RA) and ankylosing spondylitis (AS) patients. Utilizing the KOrean College of Rheumatology BIOlogics & Targeted Therapy Registry (KOBIO) data, we calculated relative risks, excluded previously reported drug-ADR pairs, and externally validated remaining pairs using US Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) and single centre's electronic health records (EHR) data. Analyzing data from 2279 RA and 1940 AS patients, we identified 35 significant drug-ADR pairs in RA and 26 in AS, previously unreported in drug labels. Among the novel drug-ADR pairs from KOBIO, 15 were also significant in the FAERS data. Additionally, 2 significant drug-laboratory abnormality pairs were found in RA using CDM MetaLAB analysis. Our findings contribute to the identification of 14 novel drug-ADR signals, expanding our understanding of potential adverse effects related to biological DMARDs and targeted therapies in RA and AS. These results emphasize the importance of ongoing pharmacovigilance for patient safety and optimal therapeutic interventions.
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Affiliation(s)
- M Kwon
- Department of Internal Medicine, School of Medicine, Konyang University, Daejeon, South Korea
- Konyang University Myunggok Medical Research Institute, Daejeon, South Korea
- Department of Biomedical Informatics, School of Medicine, Konyang University, Daejeon, South Korea
| | - C I Joung
- Department of Internal Medicine, School of Medicine, Konyang University, Daejeon, South Korea
| | - H Shin
- Healthcare Data Science Centre, Konyang University Hospital, Daejeon, South Korea
| | - C C Lee
- Department of Biomedical Informatics, School of Medicine, Konyang University, Daejeon, South Korea
| | - Y S Song
- Department of Pathology, School of Medicine, Konyang University, Daejeon, South Korea
| | - Y J Lee
- Department of Biomedical Informatics, School of Medicine, Konyang University, Daejeon, South Korea
- Department of Rehabilitation Medicine, School of Medicine, Konyang University, Daejeon, South Korea
| | - S Kang
- Department of Internal Medicine, School of Medicine, Konyang University, Daejeon, South Korea
| | - J Y Kim
- Department of Biomedical Informatics, School of Medicine, Konyang University, Daejeon, South Korea
- Healthcare Data Science Centre, Konyang University Hospital, Daejeon, South Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Konyang University, Daejeon, South Korea
| | - S Lee
- Department of Computer Engineering, Gachon University, (13120) 1342 Seongnamdaero, Sujeong-gu, Seongnam-si, Gyeonggi-do, South Korea.
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Lee CC, Hwang JI, Chang KH, Lin YC, Chao CC, Cheng TF, Chen YC, Hsueh KC. Comparison of contrast-enhanced ultrasonography and MRI results obtained by expert and novice radiologists indicating short-term response after transarterial chemoembolisation for hepatocellular carcinoma. Clin Radiol 2024; 79:e73-e79. [PMID: 37914602 DOI: 10.1016/j.crad.2023.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 08/21/2023] [Accepted: 09/21/2023] [Indexed: 11/03/2023]
Abstract
AIM To evaluate inter-reader agreement between novice and expert radiologists in assessing contrast-enhanced ultrasonography (CEUS) and magnetic resonance imaging (MRI) images for detecting viable tumours with different sizes after conventional transarterial chemoembolisation (cTACE). MATERIALS AND METHODS This prospective study included patients who had less than five hepatomas and who underwent cTACE. Hepatomas with one or two feeding arteries were selected as target lesions. CEUS and MRI were performed within 1 week after cTACE to evaluate viable tumours. RESULTS The expert group had higher kappa values in evaluating all tumour sizes via CEUS compared with MRI. The novice group had similar kappa values. In patients with tumours measuring ≤3 cm, the expert group had higher kappa values in reading CEUS compared with MRI images; however, in the novice group, the kappa value was lower in evaluating CEUS compared with MRI images. In patients with tumours measuring >3 cm, the expert and novice groups had good to excellent kappa values. The confidence level of the two groups in reading MRI images was high; however, the novice group had a lower confidence level. CONCLUSION CEUS is a convenient, cost-effective, and easy to apply imaging tool that can help interventionists perform early detection of viable hepatocellular carcinoma post-TACE. It has a higher inter-rater agreement in interpreting CEUS images compared with MRI images among expert radiologists even when they are extremely familiar with post-cTACE MRI images. In novice radiologists, there may be a learning curve to achieve good consistency in CEUS interpretation.
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Affiliation(s)
- C-C Lee
- Division of Interventional Radiology, Department of Medical Imaging, Tungs' Taichung Metroharbor Hospital, Taichung 43503, Taiwan
| | - J-I Hwang
- Division of Interventional Radiology, Department of Medical Imaging, Tungs' Taichung Metroharbor Hospital, Taichung 43503, Taiwan; Department of Radiology, National Defense Medical Center, Taipei 11490, Taiwan
| | - K-H Chang
- Department of Medical Research, Tungs' Taichung Metroharbor Hospital, Taichung Taiwan; Center for General Education, China Medical University, Taichung 404, Taiwan; General Education Center, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli 356, Taiwan; Department of Life Sciences and Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung 40227, Taiwan
| | - Y C Lin
- Division of Interventional Radiology, Department of Medical Imaging, Tungs' Taichung Metroharbor Hospital, Taichung 43503, Taiwan
| | - C C Chao
- Division of Interventional Radiology, Department of Medical Imaging, Tungs' Taichung Metroharbor Hospital, Taichung 43503, Taiwan
| | - T-F Cheng
- Division of Interventional Radiology, Department of Medical Imaging, Tungs' Taichung Metroharbor Hospital, Taichung 43503, Taiwan
| | - Y-C Chen
- Division of Interventional Radiology, Department of Medical Imaging, Tungs' Taichung Metroharbor Hospital, Taichung 43503, Taiwan; Department of Medical Research, Tungs' Taichung Metroharbor Hospital, Taichung Taiwan
| | - K-C Hsueh
- Division of Interventional Radiology, Department of Medical Imaging, Tungs' Taichung Metroharbor Hospital, Taichung 43503, Taiwan; Division of General Surgery, Department of Surgery, Tungs' Taichung Metroharbor Hospital, Taichung 43503, Taiwan; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, 40227, Taiwan.
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Lee CC, Soon YY, Koh WY, Leong CN, Ng IW, Tey J. Thoracic Radiation Dose Fractionation Schedules for Limited-Stage Small Cell Lung Cancer: A Systematic Review and Network Meta-Analysis of Randomized Trials. Int J Radiat Oncol Biol Phys 2023; 117:e34. [PMID: 37785188 DOI: 10.1016/j.ijrobp.2023.06.722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The Intergroup randomized controlled trial (RCT) established 45 Gy in 30 fractions (F) twice-daily (BID) as the standard thoracic radiation therapy (TRT) regimen with concurrent platinum-based chemotherapy (PBC) for limited-stage small cell lung cancer (LS-SCLC) in 1999. Since then, several RCTs were conducted to investigate novel TRT dose fractionation schedules (DoFS). However, it is unclear which is the optimal DoFS. This study aimed to compare the efficacy and safety of various DoFS of TRT in LS-SCLC using 45 Gy in 30F BID as the reference comparator. MATERIALS/METHODS We searched biomedical databases for eligible RCTs comparing at least two DoFS of TRT in LS-SCLC. The outcomes of interest were progression-free survival (PFS), overall survival (OS), treatment-related death, grade 3-5 pneumonitis and esophagitis. We employed GRADE approach to appraise the certainty of the evidence. Meta-analyses were performed using fixed effects frequentist network model. The ESMO-Magnitude of Clinical Benefit Score (MCBS) version 1.1 was used to judge the value of the novel DoFS. This study was registered with PROSPERO (CRD42022336338). RESULTS We identified six RCTs including 2,111 patients and six DoFS (45 Gy in 25F once-daily (OD), 42 Gy in 15F OD, 66 Gy in 33F OD, 60 Gy in 40F BID, 65 Gy in 26F OD and 70 Gy in 35F OD) that were compared with 45 Gy in 30F BID. There was high certainty evidence showing that 65 Gy in 26F OD (hazard ratio (HR), 0.67; 95% confidence interval (CI), 0.46-0.96) significantly improved PFS and 60 Gy in 40F BID (HR, 0.61; 95% CI, 0.41-0.91) significantly improved OS, compared to 45 Gy in 30F BID. There were no significant differences among the DoFS (42 Gy in 15F OD, 60 Gy in 40F BID, 65 Gy in 26F OD and 70 Gy in 35F OD) for PFS and OS. Both 65 Gy in 26F OD and 60 Gy in 40F BID were scored GRADE A on the ESMO-MCBS. The odds of grade 3-5 pneumonitis may be lower with 65 Gy in 26F OD (odds ratio (OR), 0.71; 95% CI, 0.12-4.32; low certainty) and higher with 60 Gy in 40F BID (OR, 6.60; 95% CI, 0.34-129.66); very low certainty). There were no significant differences among the DoFs (42 Gy in 15F OD, 66 Gy in 33F OD, 60 Gy in 40F BID, 65 Gy in 26F OD and 70 Gy in 35F OD) for treatment-related deaths or grade 3-5 esophagitis. CONCLUSION There was no evidence to suggest that there were significant differences among the newer DoFS for PFS and OS with 45 Gy in 30F BID as the reference. Both 65 Gy in 26F OD and 60 Gy in 40F BID were judged to provide clinically meaningful benefit based on ESMO-MCBS. Treatment with 65 Gy in 26F OD may be an option if once-daily treatment is preferred. Treatment with 60 Gy in 40F BD may be considered for select patients with excellent performance status.
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Affiliation(s)
- C C Lee
- Department of Radiation Oncology, National University Cancer Institute Singapore, Singapore, Singapore; National University Hospital, Singapore, Singapore
| | - Y Y Soon
- National University Hospital, Singapore, Singapore; Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - W Y Koh
- National University Hospital, Singapore, Singapore; Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - C N Leong
- Department of Radiation Oncology, National University Cancer Institute Singapore, Singapore, Singapore; National University Hospital, Singapore, Singapore
| | - I W Ng
- Department of Radiation Oncology, National University Cancer Institute Singapore, Singapore, Singapore; National University Hospital, Singapore, Singapore
| | - J Tey
- National University Hospital, Singapore, Singapore; Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
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Lehrer EJ, Gurewitz J, Kondziolka D, Niranjan A, Lunsford LD, Mathieu D, Deibert C, Ruiz-Garcia H, Patel SI, Bonney P, Hwang L, Zada G, Picozzi P, Prasad RN, Palmer JD, Lee CC, Rusthoven CG, Sheehan JP, Trifiletti DM, Ahluwalia M. Immune Checkpoint Inhibition and Single Fraction Stereotactic Radiosurgery in Non-Small Cell Lung Cancer Brain Metastases: An International Multicenter Study of 395 Patients. Int J Radiat Oncol Biol Phys 2023; 117:e127-e128. [PMID: 37784682 DOI: 10.1016/j.ijrobp.2023.06.923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Brain metastases most commonly arise from non-small cell lung cancer (NSCLC). In recent years, immune checkpoint inhibitors (ICI) have demonstrated improvements in overall survival (OS) in NSCLC. However, concerns remain about the risk of radiation necrosis (RN) when ICI are administered with stereotactic radiosurgery (SRS). MATERIALS/METHODS Logistic regression was used to evaluate prognostic factors associated with the development of any grade RN and symptomatic RN. Cumulative incidence of RN was evaluated using competing risks analysis and the Fine and Gray model, where the null hypothesis was rejected for p < 0.05. RESULTS There were 395 patients with 2,513 brain metastases treated across 11 international institutions included in the analysis. The median follow-up was 14.2 months. Median patient age was 67 years (Interquartile Range [IQR]: 61-73), 53.4% were male, the median Karnofsky Performance Status was 80 (IQR: 80-90), and 88.6% has active extracranial disease at the time of SRS. The median margin dose was 19 Gy (IQR: 18-20), 97.5% of patients were treated on the Gamma Knife ®, 3.8% underwent prior whole brain radiation therapy (WBRT). The median V12 Gy was 5.2 cm3 and 36.5% of patients had a V12 Gy ≥ 10 cm3, anti-PD-1 agents were administered in 91.6% of patients. A V12 Gy ³ 10 cm3 was associated with an increased risk of developing any grade RN; odds ratio (OR): 2.12, p = 0.04 and OR: 2.18; p = 0.03 on univariable and multivariable analysis, respectively. Similarly, a V12 Gy ≥ 10 cm3 was associated with an increased risk of developing symptomatic RN; OR: 3.80, p = 0.003 and OR: 3.95; p = 0.003 on univariable and multivariable analysis, respectively. Receipt of concurrent ICI and prior WBRT were not statistically significant. At 1-year, the cumulative incidence of any grade and symptomatic RN was 4.8% and 3.8%, respectively. The cumulative incidence of any grade RN was 3.8% vs. 5.3% for the concurrent and non-concurrent groups at 1-year, respectively (p = 0.35). The cumulative incidence of symptomatic RN was 3.8% vs. 3.6% for the concurrent and non-concurrent groups at 1-year, respectively (p = 0.95). CONCLUSION The risk of any grade and symptomatic RN following SRS and ICI administration for NSCLC brain metastases increases as the V12 Gy exceeds 10 cm3. Concurrent ICI and SRS does not appear to increase this risk. Radiosurgical planning techniques should aim to minimize the V12 Gy.
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Affiliation(s)
- E J Lehrer
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - J Gurewitz
- NYU Langone Medical Center, New York, NY
| | - D Kondziolka
- Department of Neurosurgery, NYU Langone Health, New York, NY
| | - A Niranjan
- Center for Image-guided Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - L D Lunsford
- Center for Image-guided Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - D Mathieu
- Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | | | - H Ruiz-Garcia
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL
| | - S I Patel
- Division of Radiation Oncology, University of Alberta, Edmonton, AB, Canada
| | - P Bonney
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - L Hwang
- Department of Radiation Oncology, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - G Zada
- Department of Neurosurgery, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - P Picozzi
- Humanitas Research Hospital, Rozzano, Italy
| | - R N Prasad
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - J D Palmer
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - C C Lee
- Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - C G Rusthoven
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO
| | - J P Sheehan
- Department of Neurosurgery, University of Virginia, Charlottesville, VA
| | - D M Trifiletti
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL
| | - M Ahluwalia
- Department of Medical Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL
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Wujanto C, Lee CC, Meng T, Ooi KH, Tan TH, Koh WY, Tseng MSF, Koh V, Yeoh T, Leong YH, Chia D, Ng IW, Ho F, Tey J, Soon YY. Adjuvant Breast Radiation Therapy for Early-Stage Breast Cancer or Ductal Carcinoma In-Situ in the Breast: A Systematic Review and Network Meta-Analysis of Randomized Trials. Int J Radiat Oncol Biol Phys 2023; 117:e214. [PMID: 37784885 DOI: 10.1016/j.ijrobp.2023.06.1106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) For selected patients with early-stage breast cancer (BC) or ductal carcinoma in-situ (DCIS) in the breast, adjuvant breast radiation therapy (RT) approaches include partial breast irradiation (PBI), altered fractionation (AF) whole breast irradiation (WBI) or tumor bed boost (TBB). However, it is unclear which is the optimal approach. This study aims to compare the effects of different PBI, AF-WBI and TBB options on ipsilateral breast tumor recurrence (IBTR), overall survival (OS) and patient reported cosmesis (PRC) outcomes. MATERIALS/METHODS We searched various biomedical electronic databases for eligible randomized trials (RCTs) from date of inception to January 2023. We constructed six separate random effects frequentist network meta-analyses (NMA) to compare the effects of various PBI options using WBI as the reference; various AF-WBI options using conventional fractionated (CF) WBI as the reference and various TBB options using no TBB as the reference on IBTR and OS. The GRADE approach was used to assess the certainty of evidence. The synthesis without meta-analysis approach was pre-specified for evaluation of PRC in anticipation of various assessment and reporting methods. RESULTS We included 34 RCTs comprising 49,899 participants and 11 treatment options. Evidence suggests that accelerated PBI (Hazard Ratio (HR) 1.36 (95% confidence interval (CI) 0.77 - 2.41, moderate certainty), moderately hypofractionated (MHF) PBI (HR 1.38 (0.60 - 3.19), moderate certainty) and intraoperative PBI (HR 1.47 (0.81 - 2.68), low certainty) was associated with a modest but not statistically significant increase in the hazards for IBTR when compared to WBI. There was moderate certainty evidence that there were no significant differences among the accelerated ultra-hypo fractionated (AUHF) WBI (HR 0.76 (0.50 - 1.14)), MHF-WBI (HR 0.99 (0.84 - 1.16)) or UHF-WBI (HR (1.35 (0.47 - 3.92)) when compared with CF-WBI for IBTR. The effects of sequential TBB (seqTBB) (HR 0.61 (0.52 - 0.70), high certainty) and simultaneous integrated TBB (simTBB) (HR 0.77 (0.55 - 1.09), moderate certainty) on IBTR were similar when compared to no TBB. There were no significant differences in OS between PBI options and WBI, AF-WBI options and CF-WBI, TBB options and no TBB. Among the PBI vs WBI trials, MHF-PBI and APBI may be associated with fewer adverse PRC events. Among the AF-WBI vs CF-WBI trials, half of the included trials reported fewer adverse PRC events with MHF-WBI. SeqTBB and simTBB had similar adverse PRC outcome. CONCLUSION There were no significant differences among the PBI, AF-WBI and TBB options for IBTR and OS. PBI and AF-WBI may be associated with less adverse PRC events compared with WBI and CF-WBI respectively. There was no evidence to suggest a difference between seqTBB and simTBB for PRC outcome. This study is registered with PROSPERO CRD 42021245074.
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Affiliation(s)
- C Wujanto
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - C C Lee
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - T Meng
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - K H Ooi
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - T H Tan
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - W Y Koh
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - M S F Tseng
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - V Koh
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - T Yeoh
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - Y H Leong
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - D Chia
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - I W Ng
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - F Ho
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - J Tey
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - Y Y Soon
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
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Singh C, Theriault BC, An Y, Yu JB, Knisely JPS, Shepard M, Wegner RE, Warnick RE, Peker S, Samanci Y, Trifiletti DM, Lee CC, Yang HC, Bernstein K, Kondziolka D, Tripathi M, Mathieu D, Mantziaris G, Pikis S, Sheehan JP, Chiang VL. Selected-Lesion SRS as a Novel Strategy in Treatment of Patients with Multiple Brain Metastases. Int J Radiat Oncol Biol Phys 2023; 117:e150-e151. [PMID: 37784735 DOI: 10.1016/j.ijrobp.2023.06.971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) With the increasing use of intracranial SRS (SRS) for treatment of patients with >10-15 brain metastases treatment; debate remains in the literature about how these patients should be treated. While many advocate for treatment of all lesions with either SRS or whole brain radiation therapy (WBRT), several groups are considering selected-lesion SRS (SL-SRS) where only a subset of intracranial lesions are treated. However, the current practice patterns of SL-SRS are not known. MATERIALS/METHODS A survey of 19 questions was created using open-ended and multiple-choice style questions on SL-SRS practices and indications. The survey was distributed to providers in the US and internationally who perform SRS frequently. Ten out of 50 institutions provided responses reflecting the practices of 16 providers. Descriptive statistics was used to compare answers to each question when applicable including percentages and ranges. RESULTS SL-SRS was performed at 8/10 institutions, (5 out of 6 US institutions and 3 out of 4 international institutions). Only 2 institutions had established clinical indications for SL-SRS (one in the US and one internationally) and one additional US institution reported clinical trials that require SL-SRS to study efficacy of CNS penetrating targeted therapies. One program reported research protocols for untreated brain metastases that would take priority over SL-SRS (program outside the US). Size of the lesion was cited as the most important factor (90%) when deciding to treat any single lesion. Next, lesion location and focal signs/symptoms were both considered moderately important. 80% ranked distance from prior SRS as the least important factor. Perilesional edema was also less important at most programs (90%). Lesion location and presence of symptoms were also considered important. There were several factors that would encourage providers to consider SL-SRS in a patient. Prior WBRT; progressing systemic disease and CNS-penetrating drug option available; and progressing systemic disease and immunotherapy option available were the most common responses. Most respondents cited "specific request by medical oncology" as well as "cooperative studies in this topic" as factors that might push them towards SL-SRS. Several institutions specified factors beyond the listed options. One institution reported that for patients with >20 lesions, they treated the largest lesions with SRS then follow with WBRT, termed the "pre-WBRT boost." Progression of untreated lesions was the most common reason why providers would bring back patients for additional treatment. CONCLUSION The responses to this survey demonstrate that patients with >15-20 intracranial lesions, prior WBRT, and worsening systemic disease with CNS penetrating systemic therapies available are being considered for SL-SRS.
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Affiliation(s)
- C Singh
- Yale University School of Medicine, New Haven, CT
| | | | - Y An
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT
| | - J B Yu
- Department of Radiation Oncology, Columbia University, New York, NY
| | - J P S Knisely
- Weill Cornell Medical College/New York-Presbyterian Hospital, New York, NY
| | - M Shepard
- Allegheny Health Network, Pittsburg, PA
| | - R E Wegner
- Allegheny Health Network Cancer Institute, Department of Radiation Oncology, Pittsburgh, PA
| | - R E Warnick
- Jewish Hospital, Mayfield Clinic, Cincinnati, OH
| | - S Peker
- Koc University School of Medicine, Istanbul, Turkey
| | - Y Samanci
- Koc University School of Medicine, Istanbul, Turkey
| | - D M Trifiletti
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL
| | - C C Lee
- Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - H C Yang
- Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - K Bernstein
- Department of Radiation Oncology, NYU Langone Health, New York, NY
| | - D Kondziolka
- Department of Neurosurgery, NYU Langone Health, New York, NY
| | - M Tripathi
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - D Mathieu
- Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - G Mantziaris
- Univers. Of Virginia Health System, Charlottesville, VA
| | - S Pikis
- Univers. Of Virginia Health System, Charlottesville, VA
| | - J P Sheehan
- Department of Neurosurgery, University of Virginia, Charlottesville, VA
| | - V L Chiang
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT
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7
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Huang CC, Lee CC, Wei PW, Chuang CC, Lee YS, Chang PH, Huang CC, Fu CH, Lee TJ. Sleep impairment in patients with empty nose syndrome. Rhinology 2023; 61:47-53. [PMID: 36306524 DOI: 10.4193/rhin22.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Empty nose syndrome (ENS) is characterized by paradoxical nasal obstruction that usually occurs after turbinate surgery. Patients with ENS may also experience significant psychiatric symptoms and sleep dysfunction, which negatively affect the quality of life of affected subjects. This study aimed to evaluate sleep impairment and sleepiness in patients with ENS. METHODS Patients with ENS and control participants were recruited prospectively. The Sino-Nasal Outcome Test-25 (SNOT-25), Empty Nose Syndrome 6-item Questionnaire (ENS6Q), Epworth Sleepiness Scale (EpSS), and modified sleep quality index (MSQI) were used to evaluate the participants before and after nasal surgery. RESULTS Forty-eight patients with ENS and forty-eight age- and sex-matched control subjects were enrolled. The SNOT-25, ENS6Q, EpSS, and MSQI scores in the ENS group were all significantly higher than those in the control group before and after surgery. After surgery, ENS patients all exhibited significant improvements in SNOT-25, ENS6Q, EpSS, and MSQI scores. Regression analysis revealed that SNOT-25 score was a significant predictor of EpSS and MSQI in preoperative evaluations. ENS patients experiencing daytime sleepiness suffered from significantly more "dryness of nose" and "suffocation" than those not experiencing daytime sleepiness. CONCLUSIONS Patients with ENS experienced significantly impaired sleep quality and sleepiness. Nasal reconstruction surgery improved the sleep quality of ENS patients. The severity of sleep dysfunction is associated with the severity of ENS symptoms. Recognizing individuals with significant sleep impairment and sleepiness and providing appropriate management are critical issues for ENS patients.
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Affiliation(s)
- C-C Huang
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - C-C Lee
- School of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taiwan; Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - P-W Wei
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Otolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Keelung, Taiwan
| | - C-C Chuang
- School of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taiwan
| | - Y-S Lee
- Genomic Medicine Research Core Laboratory, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Biotechnology, Ming Chuan University, Taoyuan, Taiwan
| | - P-H Chang
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taiwan
| | - C-C Huang
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - C-H Fu
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - T-J Lee
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Otolaryngology, Xiamen Chang Gung Hospital, Xiamen, China
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8
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Fan YH, Wu PW, Huang YL, Lee CC, Lee TJ, Huang CC, Chang PH, Huang CC. Identifying a sphenoid sinus fungus ball using a nomogram model. Rhinology 2022; 61:153-160. [PMID: 36375133 DOI: 10.4193/rhin22.329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background: Sphenoid sinus fungus ball (SSFB) is a rare entity and usually presents with non-specific symptoms. SSFB could potentially lead to serious orbital and intracranial complications. Computed tomography (CT) scan is usually the first imaging test of the diagnostic workup in patients with specific clinical symptoms. This study aimed to compare the clinical characteristics and CT features between SSFB and unilateral (non-fungus ball) chronic sphenoid rhinosinusitis (USRS) and help differentiate between these two most common inflammatory diseases of the sphenoid sinus. Methods: By retrospective database review, 66 patients with a histopathologic diagnosis of isolated SSFB were recruited for analysis. Fifty-four patients who underwent endoscopic sinus surgery with clinical and histopathological diagnoses of USRS were enrolled as the control group. Clinical characteristics and CT features were evaluated. Results: Headache, rhinorrhoea, nasal obstruction, postnasal dripping, and hyposmia were the most common symptoms in both groups. In the univariate analysis, older age, lower white blood cell counts, irregular surface, bony dehiscence, lateral wall sclerosis, and intralesional hyperdensity (IH) were significant predictors for SSFB. Older age, irregular surface, and IH remained statistically significant in the multivariate analysis. Based on the results of the regression analysis, a nomogram for predicting the probability of SSFB was plotted. Conclusions: We developed a nomogram model as a novel preoperative diagnostic tool for identifying SSFB according to the predictors both in clinical characteristics and on CT features. This could help the clinicians in predicting the probability of SSFB, to reduce ineffective or delayed treatment and occurrence of complications.
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Affiliation(s)
- Y H Fan
- Department of Medical Education, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - P W Wu
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Y L Huang
- Department of Anatomic Pathology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - C C Lee
- School of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taiwan
| | - T J Lee
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Otolaryngology, Xiamen Chang Gung Hospital, Xiamen, China
| | - C C Huang
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taiwan
| | - P H Chang
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taiwan
| | - C C Huang
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taiwan
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9
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Lee CC, Huang CC, Lee TJ, Wang YC, Liu YT, Chang TW, Huang APH, Chuang CC. Olfaction after endoscopic surgery for sellar and parasellar disease: an updated systematic review and meta-analysis. Rhinology 2022; 60:177-187. [PMID: 35233583 DOI: 10.4193/rhin21.348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: Whether endoscopic surgery for sellar/parasellar disease causes significant deficits in olfactory function remains unclear. We aimed to systematically review the olfactory outcomes in such settings based on the evidence up to date. Methods: PubMed, EMBASE, and CENTRAL were searched through February 1, 2021. Included studies were limited to endoscopic surgery for sellar/parasellar disease with follow-up olfactory function measured by standardized olfactory testing methods or subjective assessment. The primary outcome was the change in olfactory function after surgery assessed by standardized olfactory testing methods. The secondary outcome was the change in subjective olfactory function. Random-effects model was used in obtaining combine effects. Study quality was assessed using the Newcastle–Ottawa scale. Sensitivity analysis was carried out using the leave-one-out approach, and publication bias was assessed using Egger’s test. Results: The results show no significant difference in olfaction assessed by standardized olfactory testing methods at 1–3 months post-surgery (880 patients in 16 studies) or at 6–12 months post-surgery (1320 patients in 16 studies) compared to pre-surgery, whereas a significantly lower subjective olfaction at 3 months was observed. In addition, the lack of significant change in olfaction as assessed by standardized olfactory testing methods was observed regardless of whether patients were treated with or without the nasoseptal flap (NSF) harvesting. Heterogeneity and publication bias were observed, whereas sensitivity analysis showed the meta-analysis results are robust. Conclusion: The findings of this updated systematic review and meta-analysis support the conclusion that endoscopic surgery for sellar and parasellar pathology may pose no greater risk of olfactory dysfunction. In addition, the current evidence does not support there is an increased risk of diminished olfaction among patients treated with NSF during surgery.
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Affiliation(s)
- C-C Lee
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan City, Taiwan; Department of Biomedical Engineering, National Taiwan University, Taipei City, Taiwan
| | - C-C Huang
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - T-J Lee
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
| | - Y-C Wang
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan City, Taiwan
| | - Y-T Liu
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan City, Taiwan
| | - T-W Chang
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan City, Taiwan
| | - A P-H Huang
- Institute of Polymer Science and Engineering, National Taiwan University, Taipei City, Taiwan; Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei City, Taiwan
| | - C-C Chuang
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan City, Taiwan
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10
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Sirica N, Orth PP, Scheurer MS, Dai YM, Lee MC, Padmanabhan P, Mix LT, Teitelbaum SW, Trigo M, Zhao LX, Chen GF, Xu B, Yang R, Shen B, Hu C, Lee CC, Lin H, Cochran TA, Trugman SA, Zhu JX, Hasan MZ, Ni N, Qiu XG, Taylor AJ, Yarotski DA, Prasankumar RP. Photocurrent-driven transient symmetry breaking in the Weyl semimetal TaAs. Nat Mater 2022; 21:62-66. [PMID: 34750539 DOI: 10.1038/s41563-021-01126-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/08/2021] [Indexed: 06/13/2023]
Abstract
Symmetry plays a central role in conventional and topological phases of matter, making the ability to optically drive symmetry changes a critical step in developing future technologies that rely on such control. Topological materials, like topological semimetals, are particularly sensitive to a breaking or restoring of time-reversal and crystalline symmetries, which affect both bulk and surface electronic states. While previous studies have focused on controlling symmetry via coupling to the crystal lattice, we demonstrate here an all-electronic mechanism based on photocurrent generation. Using second harmonic generation spectroscopy as a sensitive probe of symmetry changes, we observe an ultrafast breaking of time-reversal and spatial symmetries following femtosecond optical excitation in the prototypical type-I Weyl semimetal TaAs. Our results show that optically driven photocurrents can be tailored to explicitly break electronic symmetry in a generic fashion, opening up the possibility of driving phase transitions between symmetry-protected states on ultrafast timescales.
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Affiliation(s)
- N Sirica
- Center for Integrated Nanotechnologies, Los Alamos National Laboratory, Los Alamos, NM, USA.
| | - P P Orth
- Ames Laboratory, Ames, IA, USA
- Department of Physics and Astronomy, Iowa State University, Ames, IA, USA
| | - M S Scheurer
- Institute for Theoretical Physics, University of Innsbruck, Innsbruck, Austria
| | - Y M Dai
- Center for Integrated Nanotechnologies, Los Alamos National Laboratory, Los Alamos, NM, USA
- Center for Superconducting Physics and Materials, National Laboratory of Solid State Microstructures and Department of Physics, Nanjing University, Nanjing, China
| | - M-C Lee
- Center for Integrated Nanotechnologies, Los Alamos National Laboratory, Los Alamos, NM, USA
| | - P Padmanabhan
- Center for Integrated Nanotechnologies, Los Alamos National Laboratory, Los Alamos, NM, USA
| | - L T Mix
- Center for Integrated Nanotechnologies, Los Alamos National Laboratory, Los Alamos, NM, USA
| | - S W Teitelbaum
- Department of Physics, Arizona State Univeristy, Tempe, AZ, USA
- Beus CXFEL Labs, Biodesign Institute, Arizona State Univeristy, Tempe, AZ, USA
| | - M Trigo
- Stanford PULSE Institute, SLAC National Accelerator Laboratory, Menlo Park, CA, USA
- Stanford Institute for Materials and Energy Sciences, SLAC National Accelerator Laboratory, Menlo Park, CA, USA
| | - L X Zhao
- Institute of Physics, Chinese Academy of Sciences, Beijing, China
| | - G F Chen
- Institute of Physics, Chinese Academy of Sciences, Beijing, China
| | - B Xu
- Institute of Physics, Chinese Academy of Sciences, Beijing, China
| | - R Yang
- Institute of Physics, Chinese Academy of Sciences, Beijing, China
| | - B Shen
- Department of Physics and Astronomy, University of California, Los Angeles, CA, USA
- State Key Laboratory of Optoelectronic Materials and Technologies, School of Physics, Guangzhou, China
| | - C Hu
- Department of Physics and Astronomy, University of California, Los Angeles, CA, USA
| | - C-C Lee
- Department of Physics, Tamkang University, New Taipei, Taiwan
| | - H Lin
- Institute of Physics, Academia Sinica, Taipei, Taiwan
| | - T A Cochran
- Laboratory for Topological Quantum Matter and Advanced Spectroscopy (B7), Department of Physics, Princeton University, Princeton, NJ, USA
| | - S A Trugman
- Center for Integrated Nanotechnologies, Los Alamos National Laboratory, Los Alamos, NM, USA
| | - J-X Zhu
- Center for Integrated Nanotechnologies, Los Alamos National Laboratory, Los Alamos, NM, USA
| | - M Z Hasan
- Laboratory for Topological Quantum Matter and Advanced Spectroscopy (B7), Department of Physics, Princeton University, Princeton, NJ, USA
- Materials Sciences Division, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - N Ni
- Department of Physics and Astronomy, University of California, Los Angeles, CA, USA
| | - X G Qiu
- Institute of Physics, Chinese Academy of Sciences, Beijing, China
| | - A J Taylor
- Center for Integrated Nanotechnologies, Los Alamos National Laboratory, Los Alamos, NM, USA
| | - D A Yarotski
- Center for Integrated Nanotechnologies, Los Alamos National Laboratory, Los Alamos, NM, USA
| | - R P Prasankumar
- Center for Integrated Nanotechnologies, Los Alamos National Laboratory, Los Alamos, NM, USA.
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11
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Lim ZC, Hoo GS, Ang JH, Teng CB, Ang LW, Lee CC, Leo YS, Law HL, Ng OT, Wong CS. Safety and effectiveness of switching to Abacavir/Lamivudine plus rilpivirine for maintenance therapy in virologically suppressed HIV-1 individuals in Singapore (SEALS). AIDS Res Ther 2021; 18:80. [PMID: 34724931 PMCID: PMC8561921 DOI: 10.1186/s12981-021-00402-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 10/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The efficacy and tolerability of an antiretroviral regimen are important considerations for selection of HIV-1 infection maintenance therapy. Abacavir/lamivudine plus rilpivirine (ABC/3TC + RPV) has been shown in international studies to be effective and well-tolerated in virologically suppressed individuals. This study evaluated the effectiveness and safety of switching to ABC/3TC + RPV as maintenance therapy in virologically suppressed HIV-1 infected individuals in Singapore. METHODS In this retrospective, single-centre study, we included individuals who were prescribed ABC/3TC + RPV, had HIV-1 viral load (VL) < 50 copies/ml immediately pre-switch, and had no documented history of resistance mutations or virologic failure to any of the components. The follow-up period was 48 ± 12 weeks. The primary outcome was the proportion of individuals who maintained virologic suppression of HIV-1 VL < 50 copies/ml at the end of follow-up period based on on-treatment analysis. The secondary outcomes were the resistance profiles associated with virologic failure, changes in immunologic and metabolic parameters, and the safety profile of ABC/3TC + RPV. RESULTS A total of 222 individuals were included in the study. The primary outcome was achieved in 197 individuals [88.8%, 95% confidence interval: 83.7-92.4%]. There were 21 individuals (9.5%) who discontinued treatment for non-virologic reasons. The remaining 4 individuals experienced virologic failure, of whom, 3 of these individuals had developed emergent antiretroviral resistance and had HIV-1 VL > 500 copies/ml at the end of the 48 ± 12 weeks follow-up period. The remaining individual experienced sustained low level viremia and subsequently achieved viral suppression without undergoing resistance testing. A total of 49 adverse events were observed in 31 out of 222 individuals (14.0%), which led to 13 individuals discontinuing therapy. Neuropsychiatric adverse events were most commonly observed (53.1%). A statistically significant increase in CD4 was observed (p < 0.01), with a median absolute change of 31 cells/uL (interquartile range: - 31.50 to 140.75). No significant changes in lipid profiles were detected. CONCLUSION ABC/3TC + RPV is a safe and effective switch option for maintenance therapy in virologically suppressed HIV-1 individuals with in Singapore.
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Affiliation(s)
- Z C Lim
- Department of Pharmacy, Ng Teng Fong General Hospital, Singapore, Singapore
| | - G S Hoo
- Department of Pharmacy, National Centre of Infectious Diseases, Singapore, Singapore.
- Department of Pharmacy, Tan Tock Seng Hospital, Singapore, Singapore.
| | - J H Ang
- Department of Pharmacy, Tan Tock Seng Hospital, Singapore, Singapore
| | - C B Teng
- Department of Pharmacy, Tan Tock Seng Hospital, Singapore, Singapore
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - L W Ang
- National Public Health and Epidemiology Unit, National Centre for Infectious Diseases, Singapore, Singapore
| | - C C Lee
- National Centre for Infectious Diseases, Singapore, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Y S Leo
- National Centre for Infectious Diseases, Singapore, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - H L Law
- Department of Pharmacy, National Centre of Infectious Diseases, Singapore, Singapore
- Department of Pharmacy, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - O T Ng
- National Centre for Infectious Diseases, Singapore, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - C S Wong
- National Centre for Infectious Diseases, Singapore, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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12
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Lee CC, Wu DY, Lee TM. Exercise intensities modulate cognitive function in spontaneously hypertensive rats through oxidative mediated synaptic plasticity in hippocampus. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Oxidative damage in the brain may lead to cognitive impairments. There was considerable debate regarding the beneficial effects of physical exercise on cognitive functions because exercise protocols have varied widely across studies.
Purpose
We investigated whether different exercise intensities alter performance on cognitive tasks.
Methods
The experiment was performed on spontaneously hypertensive rats (6 months at the established phase of hypertension) distributed into 3 groups: sedentary, low-intensity exercise, and high-intensity exercise.
Results
Systolic blood pressure measurements confirmed hypertension in spontaneously hypertensive rats. In comparison to normotensive Wistar-Kyoto rats, sedentary spontaneously hypertensive rats had similar escape latencies and a similar preference for the correct quadrant in the probe trial. Compared to the sedentary group, the low-intensity exercise group had significantly better improvements in spatial memory assessed by Morris water maze. Low-intensity exercise was associated with attenuated reactive oxygen species, as measured by dihydroethidine fluorescence and nitrotyrosine staining in the dentate gyrus of the hippocampus. This was coupled with increased numbers of neurons and dendritic spines as well as a significant upregulation of synaptic density. In contrast, the beneficial effects of low-intensity exercise are abolished in high-intensity exercise as shown by increased free radical levels and an impairment in spatial memory.
Conclusions
We concluded that exercise is an effective strategy to improve spatial memory in spontaneously hypertensive rats even at an established phase of hypertension. Low-intensity exercise exhibited better improvement on cognitive deficits than high-intensity exercise by attenuating free radical levels and improving downstream synaptic plasticity.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- C C Lee
- Kang-Ming Senior High School, Tainan, Taiwan
| | - D Y Wu
- Catholic Sheng Kung Girls' High School, Tainan, Taiwan
| | - T M Lee
- Cardiovascular Institute, An Nan Hospital, China Medical University, Tainan, Taiwan
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13
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Hsiao JQ, Huang YJ, Lee CC, Yu YT, Tsou CH, Liang HC, Chen YF. Powerful Q-switched Raman laser at 589 nm with a repetition rate between 200 and 500 kHz. Opt Lett 2021; 46:2063-2066. [PMID: 33929419 DOI: 10.1364/ol.423371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 03/29/2021] [Indexed: 06/12/2023]
Abstract
We demonstrate a highly powerful acousto-optically Q-switched Nd:YVO4 yellow laser at 589 nm by using a Np-cut KGW crystal and a phase-matching lithium triborate crystal to performance the intracavity stimulated Raman scattering and second-harmonic generation, respectively. We experimentally verify that the design of the separate cavity is superior to the conventional design of the shared cavity. By using the separate cavity, the optical-to-optical efficiency can be generally higher than 32% for the repetition rate within 200-500 kHz. The maximum output power at 589 nm can be up to 15.1 W at an incident pump power of 40 W and a repetition rate of 400 kHz.
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14
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Chen YF, Hsieh MX, Tu YC, Lee CC, Yu YT, Tsou CH, Liang HC. Pedagogically fast model to evaluate and optimize passively Q-switched Nd-doped solid-state lasers. Opt Lett 2021; 46:1588-1591. [PMID: 33793494 DOI: 10.1364/ol.422382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 03/02/2021] [Indexed: 06/12/2023]
Abstract
The coupled rate equations with the spatial overlap effect for four-level passively Q-switched lasers are fully considered. A transcendental equation is derived for the residual fraction of the inversion density after the finish of the Q-switched pulse. Comprehensive calculations for the transcendental equation were executed to attain an analytical function for precisely fitting the residual fraction of the inversion density. With the fitting function, a pedagogical model with the correction for high output coupling is developed to straightforwardly analyze the output pulse energy and peak power. Detailed experiments are carried out to validate the model.
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15
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Lee CC, Xhori O, Tannyhill RJ, Kaban LB, Peacock ZS. Variables associated with stability after Le Fort I osteotomy for skeletal class III malocclusion. Int J Oral Maxillofac Surg 2021; 50:1203-1209. [PMID: 33658151 DOI: 10.1016/j.ijom.2021.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 12/12/2020] [Accepted: 02/02/2021] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to assess skeletal stability and predictors of relapse in patients undergoing an isolated Le Fort I osteotomy. A retrospective cohort study of 92 subjects undergoing Le Fort I osteotomy for Class III malocclusion was implemented. Predictor variables were demographic and perioperative factors. The primary outcome variable was postoperative skeletal position with relapse defined as >2mm sagittal and/or vertical change at A-point on serial lateral cephalograms at immediate postoperative, 1 year, and latest follow-up time points. Mean advancement at A-point was 6.28±2.63mm and mean lengthening was 0.92±1.76mm. Eight subjects (8.70%) had relapse (>2mm) in the sagittal plane, and two subjects (2.17%) in the vertical plane. No subjects required reoperation for relapse as overbite and overjet remained in an acceptable range due to dental compensation. In regression analysis, magnitude of maxillary advancement was an independent predictor of relapse in the sagittal plane (P=0.008). There were no significant predictors of relapse in the vertical plane. This study suggests that isolated Le Fort I osteotomy for correction of skeletal Class III malocclusion is a stable procedure and that greater advancement is an independent risk factor for sagittal relapse.
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Affiliation(s)
- C C Lee
- Department of Oral & Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - O Xhori
- Harvard School of Dental Medicine, Boston, MA, USA
| | - R J Tannyhill
- Department of Oral & Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - L B Kaban
- Department of Oral & Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Z S Peacock
- Department of Oral & Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA, USA.
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16
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Chen YF, Li D, Lee YM, Lee CC, Huang HY, Tsou CH, Liang HC. Highly efficient solid-state Raman yellow-orange lasers created by enhancing the cavity reflectivity. Opt Lett 2021; 46:797-800. [PMID: 33577517 DOI: 10.1364/ol.415437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/08/2021] [Indexed: 06/12/2023]
Abstract
A new, to the best of our knowledge, output coupler (OC) with enhancement of the cavity reflectivity is proposed to remarkably elevate the output powers and efficiencies of diode-pumped Nd:GdVO4/KGW Raman yellow-orange lasers. The cavity reflectivity is effectively increased by using the double-sided dichroic coating on the OC. In comparison with the conventional single-sided coating, the conversion efficiency can be boosted from 15% to 26.3% in the experiment of a yellow laser at 578.8 nm, and the maximum output power can be increased from 5.7 to 10.5 W in the quasi-continuous-wave mode with 50% duty cycle and frequency of 500 Hz. Furthermore, in the operation of an orange laser at 588 nm, the maximum output power can be improved from 5.6 to 7.0 W by replacing the conventional OC with the new one.
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17
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Chen YF, Huang HY, Lee CC, Hsiao JQ, Tsou CH, Liang HC. High-power diode-pumped Nd:GdVO 4/KGW Raman laser at 578 nm. Opt Lett 2020; 45:5562-5565. [PMID: 33001947 DOI: 10.1364/ol.406173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 09/04/2020] [Indexed: 06/11/2023]
Abstract
A diode-pumped neodymium-doped gadolinium vanadate (Nd:GdVO4) laser is developed as a compact efficient yellow light at 578 nm by means of intracavity stimulated Raman scattering (SRS) in a potassium gadolinium tungstate (KGW) crystal and the second-harmonic generation in a lithium triborate crystal. The SRS process with a shift of 768cm-1 is achieved by setting the polarization of the fundamental wave along the Ng axis of the KGW crystal. The self-Raman effect arising from the Nd:GdVO4 crystal is systematically explored by employing two kinds of coating specification for the output coupler. With a specific coating on the output coupler to suppress the self-Raman effect, the maximum output power at 578 nm can reach 3.1 W at a pump power of 32 W. Moreover, two different lengths for the Nd:GdVO4 crystal are individually used to verify the influence of the self-Raman effect on the lasing efficiency.
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18
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Chen YF, Chen CM, Lee CC, Huang HY, Li D, Hsiao JQ, Tsou CH, Liang HC. Efficient solid-state Raman yellow laser at 579.5 nm. Opt Lett 2020; 45:5612-5615. [PMID: 33001961 DOI: 10.1364/ol.405970] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 09/04/2020] [Indexed: 06/11/2023]
Abstract
A highly efficient diode-pumped Nd:YVO4/KGW Raman yellow laser is developed to produce a 6.8 W yellow light at 579.5 nm accompanied by a 3.2 W Stokes wave at 1159 nm under an incident pump power of 30 W. The intracavity stimulated Raman scattering with the shift of 768cm-1 is generated by setting the polarization of the fundamental wave along the Ng direction of an Np-cut KGW crystal. The Nd:YVO4 gain medium is coated as a cavity mirror to reduce the cavity losses for the fundamental wave. More importantly, the KGW crystal is specially coated to prevent the Stokes wave from propagating through the gain medium to minimize the cavity losses for the Stokes wave.
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19
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Shyi GCW, Cheng PKH, Huang STT, Lee CC, Tsai FFS, Hsieh WT, Chen BYC. Predicting Performances on Processing and Memorizing East Asian Faces from Brain Activities in Face-Selective Regions: A Neurocomputational Approach. Front Hum Neurosci 2020; 14:269. [PMID: 32848662 PMCID: PMC7403502 DOI: 10.3389/fnhum.2020.00269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 06/16/2020] [Indexed: 11/13/2022] Open
Abstract
For more than two decades, a network of face-selective brain regions has been identified as the core system for face processing, including occipital face area (OFA), fusiform face area (FFA), and posterior region of superior temporal sulcus (pSTS). Moreover, recent studies have suggested that the ventral route of face processing and memory should end at the anterior temporal lobes (i.e., vATLs), which may play an important role bridging face perception and face memory. It is not entirely clear, however, the extent to which neural activities in these face-selective regions can effectively predict behavioral performance on tasks that are frequently used to investigate face processing and face memory test that requires recognition beyond variation in pose and lighting, especially when non-Caucasian East Asian faces are involved. To address these questions, we first identified during a functional scan the core face network by asking participants to perform a one-back task, while viewing either static images or dynamic videos. Dynamic localizers were effective in identifying regions of interest (ROIs) in the core face-processing system. We then correlated the brain activities of core ROIs with performances on face-processing tasks (component, configural, and composite) and face memory test (Taiwanese Face Memory Test, TFMT) and found evidence for limited predictability. We next adopted an multi-voxel pattern analysis (MVPA) approach to further explore the predictability of face-selective brain regions on TFMT performance and found evidence suggesting that a basic visual processing area such as calcarine and an area for structural face processing such as OFA may play an even greater role in memorizing faces. Implications regarding how differences in processing demands between behavioral and neuroimaging tasks and cultural specificity in face-processing and memory strategies among participants may have contributed to the findings reported here are discussed.
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Affiliation(s)
- Gary C-W Shyi
- Department of Psychology and Center for Research in Cognitive Sciences, National Chung Cheng University, Chiayi, Taiwan.,Advanced Institute of Manufacturing with High-tech Innovations, National Chung Cheng University, Chiayi, Taiwan
| | - Peter K-H Cheng
- Department of Psychology and Center for Research in Cognitive Sciences, National Chung Cheng University, Chiayi, Taiwan.,Research Center for Education and Mind Sciences, National Tsing Hua University, Hsinchu, Taiwan
| | - S-T Tina Huang
- Department of Psychology and Center for Research in Cognitive Sciences, National Chung Cheng University, Chiayi, Taiwan
| | - C-C Lee
- Department of Electrical Engineering, National Tsing Hua University, Hsinchu, Taiwan
| | - Felix F-S Tsai
- Department of Electrical Engineering, National Tsing Hua University, Hsinchu, Taiwan
| | - Wan-Ting Hsieh
- Department of Electrical Engineering, National Tsing Hua University, Hsinchu, Taiwan
| | - Becky Y-C Chen
- Department of Psychology and Center for Research in Cognitive Sciences, National Chung Cheng University, Chiayi, Taiwan
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Chen YF, Lee CC, Hsiao JQ, Huang HY, Tsou CH, Liang HC, Huang KF. Exploiting a monolithic passively Q-switched Nd:YAG laser to mimic a single neuron cell under periodic stimulation. Opt Lett 2020; 45:4032-4035. [PMID: 32667347 DOI: 10.1364/ol.399253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/20/2020] [Indexed: 06/11/2023]
Abstract
A monolithic passively Q-switched Nd:YAG laser under periodic pulse pumping is originally exploited to emulate the response of a single neuron cell stimulated by periodic pulse inputs. Experimental results reveal that the output characteristics of the monolithic passively Q-switched laser can analogously manifest not only the firing patterns but also the frequency-locked plateaus of the single neuron cell. Moreover, the sine circle map is innovatively used to generate the output pulse sequences that can exactly correspond to experimental firing patterns. The present exploration indicates that a monolithic passively Q-switched solid-state laser is highly feasible to be developed as a compact artificial neuron cell.
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21
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Chen YF, Chien PY, Lee CC, Huang KF, Liang HC. Timing jitter reduction of passively Q-switched solid-state lasers by coupling resonance between pumping and firing rates. Opt Lett 2020; 45:2902-2905. [PMID: 32412497 DOI: 10.1364/ol.394613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/25/2020] [Indexed: 06/11/2023]
Abstract
The coupling resonance between pumping and firing rates is originally proposed to achieve the timing jitter reduction of a Nd:YVO4 laser passively Q-switched with a saturable absorber. When the pumping rate is higher than the spontaneous emission rate, it is experimentally confirmed that the pulse firing rate can be fractionally locked with the pumping rate by controlling the pump power. The locking characteristics of the firing rate display a variety of complex plateaus that can be excellently manifested with the sine-circle map. From numerical analyses, the coupling strength can be verified to be effectively enhanced by reducing the duty cycle of the pumping rate.
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22
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Lee CC, Liu Y, Lu KT, Wei C, Su K, Hsu WT, Chen SC. Comparison of influenza hospitalization outcomes among adults, older adults, and octogenarians: a US national population-based study. Clin Microbiol Infect 2020; 27:435-442. [PMID: 32325126 DOI: 10.1016/j.cmi.2020.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 04/08/2020] [Accepted: 04/12/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES This study sought to more fully elucidate the age-related trends in influenza mortality with a secondary goal of uncovering implications for treatment and prevention. METHODS In this retrospective cohort analysis of data from the Nationwide Readmission Database, patients with influenza as a primary or secondary discharge diagnosis were separated into three age groups: 55 638 adults aged 20-64 years, 36 862 adults aged 65-79 years and 41 806 octogenarians aged ≥80 years. Propensity score (PS) weighting was performed to isolate age from other baseline differences. Crude and PS-weighted hazard ratios (HR) were calculated from the in-hospital all-cause 30-day mortality rate. Admission threshold bias was minimized by comparison of influenza with bacterial pneumonia mortality. RESULTS Adults aged 20-64 years experienced higher in-hospital 30-day mortality compared with older adults aged 65-79 years (HR 0.66; 95% CI 0.55-0.79). Octogenarians had the highest mortality rate, but this was statistically insignificant compared with the adult cohort (HR 1.09; 95% CI 0.94-1.27). This trend was not explained by admission threshold bias: the 30-day mortality rate due to in-hospital bacterial pneumonia increased consistently with age (older adult HR 1.45; 95% CI 1.32-1.59; octogenarian HR 1.99; 95% CI 1.82-2.18). CONCLUSIONS Adults aged 20-64 years and octogenarians were more likely to experience all-cause 30-day mortality during influenza hospitalization compared with older adults aged 65-79 years. These data emphasize the importance of prevention and suggest the need for more tailored treatment interventions based on risk stratification that includes age.
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Affiliation(s)
- C-C Lee
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Y Liu
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, School of Public Health, Birmingham, AL, USA
| | - K-T Lu
- Department of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - C Wei
- Harvard Medical School, Boston, MA, USA
| | - K Su
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - W-T Hsu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - S-C Chen
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
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23
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Lee CC, Chui WWH, Wong SL, Wong TCB, Lau SPF, Kwong PK, Hung SF, Yau SSW. Multi-disciplinary Psychiatric Case Management Model in Hong Kong: Service Coverage and Risk Stratification. East Asian Arch Psychiatry 2020; 30:12-19. [PMID: 32229642 DOI: 10.12809/eaap1848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Community mental health services in Hong Kong follow a multi-disciplinary case management model. We investigated whether at-risk patients received higher intensity care and whether risk stratification concorded between personalised care programmes and integrated community centres of mental wellness. METHODS Records of all patients in North Lantau and Mongkok districts who received case management services (from personalised care programmes and/or integrated community centres of mental wellness) between 1 April 2014 and 30 June 2015 were reviewed. Patients' levels of risk, demographic data, and clinical characteristics were analysed. RESULTS Identified at-risk patients received high-intensity care from personalised care programmes and integrated community centres of mental wellness. Case management was coordinated between the Hospital Authority and non-government organisations. However, risk stratification did not correlate with assessment rating scores of psychopathology or psychosocial functioning. Assessment rating scales appear unsuitable to provide any optimal cut-off scores for risk stratification. CONCLUSIONS Risk stratification should be a structured clinical judgement based on comprehensive and accurate information of protective and risk factors, rather than relying on cut-off scores of assessment rating scales.
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Affiliation(s)
- C C Lee
- Kwai Chung Hospital, Hong Kong
| | | | | | - T C B Wong
- New Life Psychiatric Rehabilitation Association, Hong Kong
| | | | | | - S F Hung
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong
| | - S S W Yau
- New Life Psychiatric Rehabilitation Association, Hong Kong
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24
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Lee CC, Chang WK. Response to: A rare case of holocord spinal epidural abscess. QJM 2020; 113:304. [PMID: 31693142 DOI: 10.1093/qjmed/hcz292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- C-C Lee
- Division of Cardiology, No. 325, Chengong Road, Section 2, Neihu, Taipei 114, Taiwan
| | - W-K Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Chengong Road, Section 2, Neihu, Taipei 114, Taiwan
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25
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Wu KK, Cheng JP, Leung J, Chow LP, Lee CC. Patients' Reports of Traumatic Experience and Posttraumatic Stress in Psychiatric Settings. East Asian Arch Psychiatry 2020; 30:3-11. [PMID: 32229641 DOI: 10.12809/eaap1880] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To determine the prevalence of traumatic experience (TE) among patients in psychiatric settings in Hong Kong and the associations between TE and levels of distress and anxiety and depressive symptoms. METHODS 129 patients who have received inpatient psychiatric services were recruited. Their lifetime TE was assessed using the Life Event Checklist (LEC), and TE in psychiatric settings using the Psychiatric Experiences Questionnaire (PEQ). Their level of distress symptoms was assessed using the Impact of Event Scale-Revised (IES-R), and the level of anxiety and depressive symptoms using the Hospital Anxiety and Depression Scale (HADS). RESULTS The prevalence of direct and indirect TE was 84.5%, as was the prevalence of TE in psychiatric settings. Common TE in psychiatric settings included witnessing another patient being taken down (61.2%), being put in restraints of any kind (41.1%), and witnessing another patient being physically assaulted by another patient (36.4%). TE in psychiatric settings associated with high prevalence of severe or extreme distress 1 week after the event included being forced to take medication against their will (52.2%), being threatened with physical violence (52.2%), and experiencing a physical assault (50.0%). Lifetime TE (the total number of LEC items reported) was associated with severity of distress and anxiety and depressive symptoms, whereas TE in psychiatric settings (the total number of PEQ items reported) was associated with severity of distress only. The total number of LEC items reported is the only predictor of levels of distress and anxiety and depressive symptoms. CONCLUSIONS Lifetime TE and TE in psychiatric settings are common among patients with SMI. Trauma-informed care is suggested for mental health services.
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Affiliation(s)
- K K Wu
- Kwai Chung Hospital, Hong Kong
| | | | - J Leung
- Kwai Chung Hospital, Hong Kong
| | | | - C C Lee
- Kwai Chung Hospital, Hong Kong
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26
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Affiliation(s)
- C-C Lee
- From the Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - W-K Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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27
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Chang CM, Shih HI, Wu CJ, Lauderdale TL, Lee NY, Lee CC, Chen YC, Huang CC, Ko WC. Fluoroquinolone resistance in Haemophilus influenzae from nursing home residents in Taiwan: correlation of MICs and mutations in QRDRs. J Appl Microbiol 2020; 128:1624-1633. [PMID: 31951091 DOI: 10.1111/jam.14580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 01/09/2020] [Accepted: 01/10/2020] [Indexed: 11/28/2022]
Abstract
AIMS To study the association between number and positions of mutations with MICs of fluoroquinolone non-susceptible Haemophilus influenzae. METHODS AND RESULTS More than 40% of 48 H. influenzae isolated from nursing home residents were not susceptible to fluoroquinolone. Amino acid changes in the quinolone resistance determining regions, and correlation with MICs and inhibition zone diameters were analysed. All isolates with reduced susceptibility to fluoroquinolones (MIC ≥0·125 µg ml-1 ) had at least one mutation in gyrA at position 84 and were resistant to nalidixic acid. Compared to isolates with reduced susceptibility, resistant isolates were associated with mutations in gyrA at positions 88 and 134, and in parC at position 88 (P < 0·001). Inhibition zone diameter for nalidixic acid disk ≥23 mm may detect susceptible isolates. CONCLUSIONS Reduced susceptibility to fluoroquinolones was associated with mutations at position 84 in gyrA. A further increase in fluoroquinolone MIC was associated with mutations in gyrA at positions 88 and 134, and parC at position 88. SIGNIFICANCE AND IMPACT OF THE STUDY Due to limited resistant H. influenzae strains, prior studies on association between positions of mutations and fluoroquinolone MICs were inconclusive. The comparison of mutations between isolates with susceptibility, reduced susceptibility and high resistance supported the importance of the present study.
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Affiliation(s)
- C-M Chang
- Division of Infectious Diseases, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.,Division of Geriatrics and Gerontology, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.,Center of Infection Control, National Cheng Kung University Hospital, Tainan, Taiwan.,Department of Medicine, National Cheng Kung University Medical College, Tainan, Taiwan
| | - H-I Shih
- Department of Emergency Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - C-J Wu
- Division of Infectious Diseases, National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Tainan, Taiwan
| | - T-L Lauderdale
- Division of Infectious Diseases, National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan
| | - N-Y Lee
- Division of Infectious Diseases, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.,Center of Infection Control, National Cheng Kung University Hospital, Tainan, Taiwan
| | - C-C Lee
- Division of Infectious Diseases, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.,Center of Infection Control, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Y-C Chen
- Division of Infectious Diseases, National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan
| | - C-C Huang
- Division of Infectious Diseases, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.,Division of Geriatrics and Gerontology, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - W-C Ko
- Division of Infectious Diseases, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.,Center of Infection Control, National Cheng Kung University Hospital, Tainan, Taiwan.,Department of Medicine, National Cheng Kung University Medical College, Tainan, Taiwan
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Abstract
We report four cases of fatal pulmonary embolism confirmed by autopsy among inpatients in a Hong Kong psychiatric hospital from 2010 to 2014. None of the four patients had a medical or premorbid condition associated with vascular thromboembolism or causing prolonged immobilisation. Only two patients were taking long-term antipsychotic medication, but all were physically restrained shortly before the event.
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Affiliation(s)
- C C Lee
- Department of Psychiatry, Kwai Chung Hospital, Hong Kong
| | - R Fung
- Department of Psychiatry, Kwai Chung Hospital, Hong Kong
| | - S W Pang
- Department of Psychiatry, Kwai Chung Hospital, Hong Kong
| | - T L Lo
- Department of Psychiatry, Kwai Chung Hospital, Hong Kong
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29
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Lee AF, Lee CC. 316 Use of Opioids and Outcomes of Pneumonia: Results from the United States Nationwide Inpatient Sample. Ann Emerg Med 2019. [DOI: 10.1016/j.annemergmed.2019.08.275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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30
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Shiozaki M, Inoue K, Suwa S, Lee CC, Chiang SJ, Shimizu M, Fukuda K, Hiki M, Kubota N, Tamura H, Fujiwara Y, Sumiyoshi M, Daida H. P2677A combination of HEART score and a 0-hour/1-hour algorithm for early and safe triage tool for patients in observe zone. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The European Society Cardiology guidelines recommend that a 0-hour/1-hour (0–1hr) algorithm using high sensitivity cardiac troponin T (hs-cTnT) improves the early triage of patients with suspected non-ST elevation acute coronary syndrome (NSTE-ACS). However, diagnostic uncertainty remains in the 25–30% of patients assigned to “observe” group.
Purpose
To establish a step wise risk score system using HEART score and 0-hour/1-hour algorithm to identify the low risk group from observation group.
Methods
This study was a prospective, multi-center, observational study of patients with suspected NSTE-ACS admitted to five hospitals in Japan and Taiwan from 2014 to 2018, respectively. We applied the algorithm and calculated HEART score simultaneously. Patients were divided into three groups according to the algorithm: hs-cTnT below 12 ng/L and delta 1 hour below 3 ng/L were the “rule out” group; hs-cTnT at least 52 ng/L or delta 1 hour at least 5 ng/L were in the “rule in” group; the remaining patients were classified as the “observe” group. All patients underwent a clinical assessment the included medical history, physical examination, 12-lead ECG, continuous ECG monitoring, pulse oximetry, standard blood test, chest radiography, cardiac and abdominal ultrasonography. Patients presenting with congestive heart failure, terminal kidney disease on hemodialysis state, arrhythmia, or infection disease (which causes to increase troponin level) were excluded. Thirty-day MACE was defined as acute myocardial infarction, unstable angina (UA), or death.
Results
Of the 1,332 patients enrolled, 933 patients were analyzed after exclusion. NSTE-ACS was the final diagnosis for 122 (13.1%) patients and none of death. The HEART score less than 4 points in observation groups identified as very low risk with a negative predictive value (NPV) of 98.1% (95% confidential interval (CI); 90.1%-100%) and sensitivity of 98.0% (95% CI; 89.6%-100%). There were only one patient (0.5%) with AMI. In case of the HEART score less than 5 points, it could also identify as very low risk with a NPV of 96.7% (95% CI; 90.8%-99.3%%) and sensitivity of 94.1% (95% CI; 83.8%-98.8%). There were only three patients (1.2%) with AMI.
Conclusion
A combination of HEART score and the 0-hour/1-hour algorithm strategy rapidly identified the patient in observation group of 30-day MACE including UA where nor further cardiac testing would be needed.
Acknowledgement/Funding
JSPS KAKENHI Grant Number JP18K09554
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Affiliation(s)
- M Shiozaki
- Juntendo University Nerima Hospital, Tokyo, Japan
| | - K Inoue
- Juntendo University Nerima Hospital, Tokyo, Japan
| | - S Suwa
- Juntendo University Shizuoka Hospital, Cardiology, Shizuoka, Japan
| | - C C Lee
- National Taiwan University Hospital, Emergency Medicine, Taipei, Taiwan
| | | | - M Shimizu
- Juntendo University Nerima Hospital, Tokyo, Japan
| | - K Fukuda
- Juntendo University Nerima Hospital, Tokyo, Japan
| | - M Hiki
- Juntendo University Nerima Hospital, Tokyo, Japan
| | - N Kubota
- Juntendo University Nerima Hospital, Tokyo, Japan
| | - H Tamura
- Juntendo University Nerima Hospital, Tokyo, Japan
| | - Y Fujiwara
- Juntendo University Nerima Hospital, Tokyo, Japan
| | - M Sumiyoshi
- Juntendo University Nerima Hospital, Tokyo, Japan
| | - H Daida
- Juntendo University School of Medicine, Tokyo, Japan
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31
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Shiozaki M, Inoue K, Suwa S, Lee CC, Chiang SJ, Shimizu M, Fukuda K, Hiki M, Kubota N, Tamura H, Fujiwara Y, Sumiyoshi M, Daida H. P2676Prospective validation of the 2015 ESC 0-hour/1-hour algorithm using high-sensitivity cardiac troponin T in Asian countries. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background/Introduction
Implementation of the 2015 ESC 0-hour/1-hour algorithm using high-sensitivity troponin (hs-cTn) T in Asian countries presents a challenge for clinical practice.
Purpose
We aimed to prospectively validate the 0-hour/1-hour algorithm in Asian countries.
Methods
We conducted a prospective, multi-center, international cohort already utilizing 0-hour/1-hour algorithm using hs-cTnT for evaluation of patients with suspected of non-ST elevation acute coronary syndrome (NSTE-ACS). All patients underwent a clinical assessment the included medical history, physical examination, 12-lead ECG, continuous ECG monitoring, pulse oximetry, standard blood test, chest radiography, cardiac and abdominal ultrasonography. Patients presenting with congestive heart failure, terminal kidney disease on hemodialysis state, arrhythmia, or infection disease (which cause to increase troponin level) were excluded. Patients were divided into three groups according to the algorithm: hs-cTnT below 12 ng/L and delta 1 hour below 3 ng/L were the “rule out” group; hs-cTnT at least 52 ng/L or delta 1 hour at least 5 ng/L were in the “rule in” group; the remaining patients were classified as the “observational” group. The final diagnosis was then adjudicated by 2 independent cardiologists using all available information, including coronary angiography, coronary computed tomography, stress electrocardiography and follow-up data. The presence of acute myocardial infarction (AMI) was defined according to the Fourth Universal Definition of Myocardial Infarction.
Results
Of the 1,332 patients enrolled in 2014 to 2018, 933 patients were analyzed after exclusion. AMI was the final diagnosis for 122 (13.1%) patients. The algorithm ruled out AMI in 401 patients with a negative predictive value and sensitivity of 100% (95% confidential interval [CI], 98.6%-100%) and 100% (95% CI, 94.0%-100%), respectively, in the rule-out group. None of the patients were diagnosed with AMI. Among the 211 patients classified into the rule-in group, 90 were diagnosed as having AMI. The positive predictive value and specificity were 43.1% (95% CI, 36.2%-50.2%) and 78.3% (95% CI, 74.5%-81.7%), respectively. The median length of hospital stay was 159 min (142–180) in rule out group.
Conclusion(s)
Our findings suggest that the 0-hour/1-hour algorithm using hs-cTnT provides very high safety and efficacy for the triage toward rapid rule-out to rule-in of AMI.
Acknowledgement/Funding
JSPS KAKENHI Grant Number JP18K09554
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Affiliation(s)
- M Shiozaki
- Juntendo University Nerima Hospital, Tokyo, Japan
| | - K Inoue
- Juntendo University Nerima Hospital, Tokyo, Japan
| | - S Suwa
- Juntendo University Shizuoka Hospital, Cardiology, Shizuoka, Japan
| | - C C Lee
- National Taiwan University Hospital, Emergency Medicine, Taipei, Taiwan
| | | | - M Shimizu
- Juntendo University Nerima Hospital, Tokyo, Japan
| | - K Fukuda
- Juntendo University Nerima Hospital, Tokyo, Japan
| | - M Hiki
- Juntendo University Nerima Hospital, Tokyo, Japan
| | - N Kubota
- Juntendo University Nerima Hospital, Tokyo, Japan
| | - H Tamura
- Juntendo University Nerima Hospital, Tokyo, Japan
| | - Y Fujiwara
- Juntendo University Nerima Hospital, Tokyo, Japan
| | - M Sumiyoshi
- Juntendo University Nerima Hospital, Tokyo, Japan
| | - H Daida
- Juntendo University School of Medicine, Tokyo, Japan
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32
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Fan CY, Lee WT, Hsu TC, Lee CH, Wang SP, Chen WS, Huang CH, Lee CC. Effect of chlorhexidine bathing on colonization or infection with Acinetobacter baumannii: a systematic review and meta-analysis. J Hosp Infect 2019; 103:284-292. [PMID: 31404567 DOI: 10.1016/j.jhin.2019.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 08/05/2019] [Indexed: 12/28/2022]
Abstract
Healthcare-associated infections (HAIs) caused by multi-drug-resistant Gram-negative bacteria (MDRGNB) have increased prevalence in intensive care units (ICUs). A common strategy to prevent HAIs is bathing patients with chlorhexidine gluconate (CHG). However, the effectiveness of CHG bathing against multidrug-resistant Acinetobacter baumannii (MDRAB) is still controversial. The aim of this study was to perform a systematic review and meta-analysis of the effectiveness of CHG bathing on Acinetobacter baumannii colonization and infection in the ICU setting. A systematic literature search of PubMed, EMBASE, Web of Science and CINAHL was performed from inception through to June 2018. Randomized controlled trials (RCTs), pre-post studies, or interrupted time series (ITS) studies were included. The numbers of patients with/without colonization or infection of A. baumannii in the experimental or control groups were extracted from each study. Quality assessment was performed by the related instruments of National Institute of Health. Pooled risk ratios (RRs) were calculated using the random-effects model. One RCT and 12 pre-post or ITS studies comprising 18,217 patients were included, of which 8069 were in the CHG bathing arm and 9051 in the control arm. CHG bathing was associated with a reduced colonization of A. baumannii (RR, 0.66; 95% confidence interval: 0.57-0.77; P<0.001). Chlorhexidine at 4% showed a better effect than 2% chlorhexidine (meta-regression P=0.044). CHG bathing was associated with a non-significant reduction of infection (pooled RR 0.41, 95% CI: 0.13-1.25). This study suggests that CHG bathing significantly reduces colonization of A. baumannii in the ICU setting. However, more trials are needed to confirm whether CHG bathing can reduce infections with A. baumannii.
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Affiliation(s)
- C-Y Fan
- Department of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - W-T Lee
- Department of Medicine, The University of Queensland, Queensland, Australia
| | - T-C Hsu
- Department of Emergency Medicine, National Taiwan University, Taipei, Taiwan
| | - C-H Lee
- Department of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - S-P Wang
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Emergency Medicine, National Taiwan University, Taipei, Taiwan
| | - W-S Chen
- Department of Dermatology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - C-H Huang
- Department of Emergency Medicine, National Taiwan University, Taipei, Taiwan
| | - C-C Lee
- Department of Emergency Medicine, National Taiwan University, Taipei, Taiwan.
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Tang CP, Hung SF, Lee CC, Ho TP, Leung PWL. 15-year computer-record study of adolescents exposed to peer suicide. Hong Kong Med J 2019; 25 Suppl 3:11-12. [PMID: 30792365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Affiliation(s)
| | | | | | - T P Ho
- Department of Psychiatry, The University of Hong Kong
| | - P W L Leung
- Department of Psychology, The Chinese University of Hong Kong
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Fan PY, Lee CC, Liu SH, Li IJ, Weng CH, Tu KH, Hsieh MY, Kuo CF, Chang TY, Tian YC, Yang CW, Wu HH. Preventing arteriovenous shunt failure in hemodialysis patients: a population-based cohort study. J Thromb Haemost 2019; 17:77-87. [PMID: 30472783 DOI: 10.1111/jth.14347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Indexed: 11/29/2022]
Abstract
Essentials Uncertainty remains about antiplatelets for vascular access patency in hemodialysis patients. 95 971 people under hemodialysis were followed in a claims database in Taiwan. Aspirin reduced vascular access failure rate and did not increase major bleeding rate. Clopidogrel, Aggrenox, and warfarin might increase major bleeding rate. SUMMARY: Background Dialysis adequacy is a major determinant of survival for patients with end-stage renal disease. Good vascular access is essential to achieve adequate dialysis. Objectives This study evaluated the impacts of different drugs on the vascular access failure rate of an arteriovenous fistula or an arteriovenous graft and the rate of major bleeding in hemodialysis patients. Patients and methods We studied patients with end-stage renal disease registered in the Taiwan National Health Insurance program from 1 January 1997 to 31 December 2012. A total of 95 971 patients were enrolled in our study. Vascular access dysfunction was defined as the need for thrombectomy or percutaneous angioplasty. Major bleeding was defined as emergency department visits or hospitalization with a primary diagnosis of gastrointestinal bleeding or intracerebral hemorrhage. The adjusted odds ratios between person-quarters with or without antiplatelet or oral anticoagulant use were calculated using a generalized estimating equation. Results The odds ratio of vascular access failure was 0.21 (0.11-0.39) for aspirin, 0.76 (0.74-0.79) for clopidogrel, 0.67 (0.59-0.77) for dipyridamole, 0.67 (0.53-0.86) for Aggrenox and 0.96 (0.90-1.03) for warfarin. The highest odds ratio for intracerebral hemorrhage was 5.33 (1.25-22.72) in younger patients using Aggrenox. The highest odds ratio for gastrointestinal bleeding was 1.34 (1.10-1.64) for clopidogrel. Conclusion Antiplatelet agents, but not warfarin, might reduce the vascular access thrombosis rate. The gastrointestinal bleeding rate was increased in the group using clopidogrel. Aggrenox should be used with caution in young individuals because it might increase the rate of intracerebral hemorrhage.
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Affiliation(s)
- P Y Fan
- Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Taoyuan, , Taiwan
- Department of Medicine, Chang Gung University, Taoyuan, , Taiwan
| | - C C Lee
- Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Taoyuan, , Taiwan
- Department of Medicine, Chang Gung University, Taoyuan, , Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, , Taiwan
| | - S H Liu
- Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Taoyuan, , Taiwan
- Department of Medicine, Chang Gung University, Taoyuan, , Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, , Taiwan
| | - I-J Li
- Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Taoyuan, , Taiwan
- Department of Medicine, Chang Gung University, Taoyuan, , Taiwan
| | - C H Weng
- Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Taoyuan, , Taiwan
- Department of Medicine, Chang Gung University, Taoyuan, , Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, , Taiwan
| | - K H Tu
- Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Taoyuan, , Taiwan
- Department of Medicine, Chang Gung University, Taoyuan, , Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, , Taiwan
| | - M Y Hsieh
- Big Data Research Office, Chang Gung Memorial Hospital, Taoyuan, , Taiwan
| | - C F Kuo
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - T-Y Chang
- Department of Neurology, Stroke Center, Chang Gung Memorial Hospital, Linkou Medical Center and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Y C Tian
- Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Taoyuan, , Taiwan
- Department of Medicine, Chang Gung University, Taoyuan, , Taiwan
| | - C W Yang
- Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Taoyuan, , Taiwan
- Department of Medicine, Chang Gung University, Taoyuan, , Taiwan
| | - H H Wu
- Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Taoyuan, , Taiwan
- Department of Medicine, Chang Gung University, Taoyuan, , Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, , Taiwan
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Briggs B, Jain C, C Morey M, Blanchard EH, Lee CC, Marcos Valencia W, Oursler KK. PROVIDING RURAL VETERANS ACCESS TO GEROFIT THROUGH CLINICAL VIDEO TELE-HEALTH. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- B Briggs
- Geriatric Research and Education, Salem VA Medical Center, Salem, Virginia, United States
| | - C Jain
- Geriatric Research and Education, Salem VA Medical Center, Salem, VA, USA
| | - Miriam C Morey
- Geriatric Research, Education, and Clinical Center Durham Veterans Affairs Healthcare System, Durham, NC; Center for the Study of Aging and Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - E H Blanchard
- Geriatric Research, Education, and Clinical Center, Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - C C Lee
- Geriatric Research, Education, and Clinical Center, Greater Los Angeles Healthcare System; Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
| | - W Marcos Valencia
- Miami VA Healthcare System, Geriatric Research, Education, and Clinical Center; Division of Epidemiology and Division of Geriatric Medicine, University of Miami School of Medicine, Miami, FL, USA
| | - K K Oursler
- Geriatric Research and Education, Salem VA Medical Center Salem, VA, USA; Department of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
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Andonian N, Lee CC, Blanchard E, Roberts C, Singh S, Russell M, Bojalian M, Castle SC. GEROFIT PREHABILITATION TO IMPROVE POST-OPERATIVE OUTCOMES IN AN OLDER/AT-RISK POPULATION. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- N Andonian
- UCLA, Los Angeles, California, United States
| | - C C Lee
- Geriatric Medicine UCLA/Veterans Affairs, Los Angeles, CA, USA
| | - E Blanchard
- Geriatric Medicine UCLA/Veterans Affairs, Los Angeles, CA, USA
| | - C Roberts
- Geriatric Medicine UCLA/Veterans Affairs, Los Angeles, CA, USA
| | - S Singh
- UCLA Department of Anesthesiology and Perioperative Medicine, Los Angeles, CA, USA; Greater Los Angeles VA Health System, Los Angeles, CA, USA
| | - M Russell
- Greater Los Angeles VA Health System, Los Angeles, CA, USA
| | - M Bojalian
- Greater Los Angeles VA Health System, Los Angeles, CA, USA
| | - S C Castle
- Geriatric Medicine UCLA/Veterans Affairs, Los Angeles, CA, USA
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Hsieh RW, Hsu TC, Lee M, Hsu WT, Chen ST, Huang HS, Hsieh AL, Lee CC. 4068Outcome and economic comparison for type B aortic dissection patients receiving open surgery, thoracic endovascular aortic repair, and medical treatment. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.4068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- R W Hsieh
- Albert Einstein Medical Center, Internal Medicine, Philadelphia, United States of America
| | - T C Hsu
- National Taiwan University Hospital, Emergency Medicine, Taipei, Taiwan ROC
| | - M Lee
- Medical Wisdom Consultants Inc., Houston, United States of America
| | - W T Hsu
- Harvard Medical School, Epidemiology, Boston, United States of America
| | - S T Chen
- Harvard Medical School, Epidemiology, Boston, United States of America
| | - H S Huang
- National Taiwan University, Medicine, Taipei, Taiwan ROC
| | - A L Hsieh
- Albert Einstein Medical Center, Neurology, Philadelphia, United States of America
| | - C C Lee
- National Taiwan University Hospital, Emergency Medicine, Taipei, Taiwan ROC
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Ogundele OM, Lee CC. CaMKIIα expression in a mouse model of NMDAR hypofunction schizophrenia: Putative roles for IGF-1R and TLR4. Brain Res Bull 2018; 137:53-70. [PMID: 29137928 PMCID: PMC5835406 DOI: 10.1016/j.brainresbull.2017.11.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 11/03/2017] [Accepted: 11/08/2017] [Indexed: 12/29/2022]
Abstract
Schizophrenia (SCZ) is a neuropsychiatric disorder that is linked to social behavioral deficits and other negative symptoms associated with hippocampal synaptic dysfunction. Synaptic mechanism of schizophrenia is characterized by loss of hippocampal N-Methyl-d-Aspartate Receptor (NMDAR) activity (NMDAR hypofunction) and dendritic spines. Previous studies show that genetic deletion of hippocampal synaptic regulatory calcium-calmodulin dependent kinase II alpha (CaMKIIα) cause synaptic and behavioral defects associated with schizophrenia in mice. Although CaMKIIα is involved in modulation of NMDAR activity, it is equally linked to inflammatory and neurotropin signaling in neurons. Based on these propositions, we speculate that non-neurotransmitter upstream receptors associated with neurotropic and inflammatory signaling activities of CaMKIIα may alter its synaptic function. Besides, how these receptors (i.e. inflammatory and neurotropic receptors) alter CaMKIIα function (phosphorylation) relative to hippocampal NMDAR activity in schizophrenia is poorly understood. Here, we examined the relationship between toll-like receptor (TLR4; inflammatory), insulin-like growth factor receptor 1 (IGF-1R; neurotropic) and CaMKIIα expression in the hippocampus of behaviorally deficient schizophrenic mice after we induced schizophrenia through NMDAR inhibition. Schizophrenia was induced in WT (C57BL/6) mice through intraperitoneal administration of 30mg/Kg ketamine (NMDAR antagonist) for 5days (WT/SCZ). Five days after the last ketamine treatment, wild type schizophrenic mice show deficiencies in sociability and social novelty behavior. Furthermore, there was a significant decrease in hippocampal CaMKIIα (p<0.001) and IGF-1R (p<0.001) expression when assessed through immunoblotting and confocal immunofluorescence microscopy. Additionally, WT schizophrenic mice show an increased percentage of phosphorylated CaMKIIα in addition to upregulated TLR4 signaling (TLR4, NF-κB, and MAPK/ErK) in the hippocampus. To ascertain the functional link between TLR4, IGF-1R and CaMKIIα relative to NMDAR hypofunction in schizophrenia, we created hippocampal-specific TLR4 knockdown mouse using AAV-driven Cre-lox technique (TLR4 KD). Subsequently, we inhibited NMDAR function in TLR4 KD mice in an attempt to induce schizophrenia (TLR4 KD SCZ). Interestingly, IGF-1R and CaMKIIα expressions were preserved in the TLR4 KD hippocampus after attenuation of NMDAR function. Furthermore, TLR4 KD SCZ mice showed no prominent defects in sociability and social novelty behavior when compared with the control (WT). Our results show that a sustained IGF-1R expression may preserve the synaptic activity of CaMKIIα while TLR4 signaling ablates hippocampal CaMKIIα expression in NMDAR hypofunction schizophrenia. Together, we infer that IGF-1R depletion and increased TLR4 signaling are non-neurotransmitter pro-schizophrenic cues that can reduce synaptic CaMKIIα activity in a pharmacologic mouse model of schizophrenia.
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Affiliation(s)
- O M Ogundele
- Department of Comparative Biomedical Sciences, Louisiana State University School of Veterinary Medicine, Baton Rouge, LA, United States.
| | - C C Lee
- Department of Comparative Biomedical Sciences, Louisiana State University School of Veterinary Medicine, Baton Rouge, LA, United States.
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Huang HS, Tsai CL, Chang J, Hsu TC, Lin S, Lee CC. Multiplex PCR system for the rapid diagnosis of respiratory virus infection: systematic review and meta-analysis. Clin Microbiol Infect 2017; 24:1055-1063. [PMID: 29208560 PMCID: PMC7128951 DOI: 10.1016/j.cmi.2017.11.018] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 11/16/2017] [Accepted: 11/22/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To provide a summary of evidence for the diagnostic accuracies of three multiplex PCR systems (mPCRs)-BioFire FilmArray RP (FilmArray), Nanosphere Verigene RV+ test (Verigene RV+) and Hologic Gen-Probe Prodesse assays-on the detection of viral respiratory infections. METHODS A comprehensive search up to 1 July 2017 was conducted on Medline and Embase for studies that utilized FilmArray, Verigene RV+ and Prodesse for diagnosis of viral respiratory infections. A summary of diagnostic accuracies for the following five viruses were calculated: influenza A virus (FluA), influenza B virus, respiratory syncytial virus, human metapneumovirus and adenovirus. Hierarchical summary receiver operating curves were used for estimating the viral detection performance per assay. RESULTS Twenty studies of 5510 patient samples were eligible for analysis. Multiplex PCRs demonstrated high diagnostic accuracy, with area under the receiver operating characteristic curve (AUROC) equal to or more than 0.98 for all the above viruses except for adenovirus (AUROC 0.89). FilmArray, Verigene RV+ and ProFlu+ (the only Prodesse assay with enough data) demonstrated a summary sensitivity for FluA of 0.911 (95% confidence interval, 0.848-0.949), 0.949 (95% confidence interval, 0.882-0.979) and 0.954 (95% confidence interval, 0.871-0.985), respectively. The three mPCRs were comparable in terms of detection of FluA. CONCLUSIONS Point estimates calculated from eligible studies showed that the three mPCRs (FilmArray, Verigene RV+ and ProFlu+) are highly accurate and may provide important diagnostic information for early identification of respiratory virus infections. In patients with low pretest probability for FluA, these three mPCRs can predict a low possibility of infection and may justify withholding empirical antiviral treatments.
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Affiliation(s)
- H-S Huang
- Department of Medicine, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan; Health Economics and Outcome Research Group, National Taiwan University Hospital, Taipei, Taiwan
| | - C-L Tsai
- Department of Medicine, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - J Chang
- Department of Gastroenterology, Nutrition, and Hepatology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - T-C Hsu
- Health Economics and Outcome Research Group, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - S Lin
- Health Economics and Outcome Research Group, National Taiwan University Hospital, Taipei, Taiwan; Industrial Engineering and Operations Research Department at the University of California, Berkeley, California, USA
| | - C-C Lee
- Health Economics and Outcome Research Group, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
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Lee SH, Hsu WT, Lai CC, Esmaily-Fard A, Tsai YW, Chiu CC, Wang J, Chang SS, Lee CC. Erratum to: Use of antipsychotics increases the risk of fracture: a systematic review and meta-analysis. Osteoporos Int 2017; 28:1763. [PMID: 28233021 DOI: 10.1007/s00198-017-3938-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- S-H Lee
- Department of Rehabilitation and Physical Medicine, Taipei Veteran General Hospital, Taipei, Taiwan
- Department of Medicine, College of Medicine, National Yang Ming University, Taipei, Taiwan
| | - W-T Hsu
- Health Economics and Outcome Research Group, Department of Emergency Medicine, National Taiwan University Hospital, No.7, Chung Shan S. Rd., Zhongzheng Dist., Taipei City 100, Taiwan
| | - C-C Lai
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - A Esmaily-Fard
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Y-W Tsai
- Department of Family Medicine, Chang Gung Memorial Hospital, University College of Medicine, Taoyuan, Taiwan
| | - C-C Chiu
- Department of Rehabilitation and Physical Medicine, Taipei Veteran General Hospital, Taipei, Taiwan
| | - J Wang
- University of Nevada School of Medicine, Las Vegas, Nevada, USA
| | - S-S Chang
- Department of Family Medicine, Chang Gung Memorial Hospital, No.5. Fu-Hsing street, Kuei Shan Hsiang, Taoyuan, Hsien, Taiwan.
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - C C Lee
- Health Economics and Outcome Research Group, Department of Emergency Medicine, National Taiwan University Hospital, No.7, Chung Shan S. Rd., Zhongzheng Dist., Taipei City 100, Taiwan.
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Lee SH, Hsu WT, Lai CC, Esmaily-Fard A, Tsai YW, Chiu CC, Wang J, Chang SS, Lee CC. Use of antipsychotics increases the risk of fracture: a systematic review and meta-analysis. Osteoporos Int 2017; 28:1167-1178. [PMID: 28083669 DOI: 10.1007/s00198-016-3881-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 12/11/2016] [Indexed: 01/19/2023]
Abstract
UNLABELLED Our systematic review and meta-analysis of observational studies indicated that the use of antipsychotics was associated with a nearly 1.5-fold increase in the risk of fracture. First-generation antipsychotics (FGAs) appeared to carry a higher risk of fracture than second-generation antipsychotics (SGAs). INTRODUCTION The risk of fractures associated with the use of antipsychotic medications has inconsistent evidence between different drug classes. A systematic review and meta-analysis was conducted to evaluate whether there is an association between the use of antipsychotic drugs and fractures. METHODS Searches were conducted through the PubMed and EMBASE databases to identify observational studies that had reported a quantitative estimate of the association between use of antipsychotics and fractures. The summary risk was derived from random effects meta-analysis. RESULTS The search yielded 19 observational studies (n = 544,811 participants) with 80,835 fracture cases. Compared with nonuse, use of FGAs was associated with a significantly higher risk for hip fractures (OR 1.67, 95% CI, 1.45-1.93), and use of second generation antipsychotics (SGAs) was associated with an attenuated but still significant risk for hip fractures (OR 1.33, 95% CI, 1.11-1.58). The risk of fractures associated with individual classes of antipsychotic users was heterogeneous, and odds ratios ranged from 1.24 to 2.01. Chlorpromazine was associated with the highest risk (OR 2.01, 95% CI 1.43-2.83), while Risperidone was associated with the lowest risk of fracture (OR 1.24, 95% CI 0.95-1.83). CONCLUSIONS FGA users were at a higher risk of hip fracture than SGA users. Both FGAs and SGAs were associated with an increased risk of fractures, especially among the older population. Therefore, the benefit of the off-label use of antipsychotics in elderly patients should be weighed against any risks for fracture.
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Affiliation(s)
- S-H Lee
- Department of Rehabilitation and Physical Medicine, Taipei Veteran General Hospital, Taipei, Taiwan
- Department of Medicine, College of Medicine, National Yang Ming University, Taipei, Taiwan
| | - W-T Hsu
- Health Economics and Outcome Research Group, Department of Emergency Medicine, National Taiwan University Hospital, No.7, Chung Shan S. Rd., Zhongzheng Dist., Taipei City, 100, Taiwan
| | - C-C Lai
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - A Esmaily-Fard
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Y-W Tsai
- Department of Family Medicine, Chang Gung Memorial Hospital, University College of Medicine, Taoyuan, Taiwan
| | - C-C Chiu
- Department of Rehabilitation and Physical Medicine, Taipei Veteran General Hospital, Taipei, Taiwan
| | - J Wang
- University of Nevada School of Medicine, Las Vegas, Nevada, USA
| | - S-S Chang
- Department of Family Medicine, Chang Gung Memorial Hospital, No.5. Fu-Hsing street, Kuei Shan Hsiang, Taoyuan, Hsien, Taiwan.
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - C C Lee
- Health Economics and Outcome Research Group, Department of Emergency Medicine, National Taiwan University Hospital, No.7, Chung Shan S. Rd., Zhongzheng Dist., Taipei City, 100, Taiwan.
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Chen YY, Yu BL, Lee CC, Wei HK, Lin CW, Tsai TJ, Cheng TY, Chen CM. Abstract P2-01-10: Cumulative analysis of breast cancer sentinel lymph node identification rate by radioisotope: A 13-year experience. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p2-01-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose:
To investigate the breast cancer sentinel lymph node(SLN) identification rate by radioisotope navigation over the past 13 years at a single cancer centre institution.
Method:
Retrospective, breast cancer sentinel lymph node data in the past 13 years was collected. Between May 2002 to August 2008, sulphur colloid was the radioisotope agent used at the institution. Between August 2008 to August 2012, the radioisotope agent was switched to phytate. Then, between September 2012 to June 2015, injection method of phytate was switched from subdermal to intradermal. The SLN identification rate from each three periods were compared and analysed.
Results:
In a 13-year period (May 2002~June 2015), a total of 5455 breast cancer axillary sentinel lymph node samples were collected. Each surgeon's first 50 cases were excluded, thus a reduction to 5105 samples were derived. 155 cases were bilateral. Out of the 5105 samples, 40 did not undergo radioisotope mapping.
During the 13-year period, total successful SLN identification rate was 96.7%(4897/5065). During the sulphur colloid period (May 2002~August 2008), successful SLN identification rate was 99.1%(996/1005). During the subdermal phytate period (August 2008~August 2012), successful SLN identification rate was 95.1%(2200/2313). During the intradermal phytate period (September 2012~June 2015), successful SLN identification rate was 97.4%(1701/1747).
After injection of radioisotope agent, lymphatic scan mapping may fail. However, radioisotope signals may still be detected by radioisotope navigator intra-operatively. During the sulphur colloid period (May 2002~August 2008), mapping failure rate was 5.2%(52/1005). SLN identification rate by intra-operative navigator after scan mapping failure was 96.1%(50/52). During the subdermal phytate period (August 2008~August 2012), mapping failure rate was 21.7%(501/2313). SLN identification rate by intra-operative navigator after scan mapping failure was 79.0%(396/501). During the intradermal phytate period (September 2012~June 2015), mapping failure rate was 12.8%(223/1747). SLN identification rate by intra-operative navigator after scan mapping failure was 83.4%(186/223).
Conclusion:
Different radioisotope agent may affect the identification rate of axillary sentinel lymph nodes in breast cancer patients. Change of injection method, such as from subdermal to intradermal, may improve identification rate in use of same radioisotope agent. Even when lymphatics scan mapping failed, intra-operative radioisotope navigator may still successfully identify axillary sentinel lymph nodes and avoid unnecessary dissection due to mapping failure.
Citation Format: Chen Y-Y, Yu B-L, Lee C-C, Wei H-K, Lin C-W, Tsai T-J, Cheng T-Y, Chen C-M. Cumulative analysis of breast cancer sentinel lymph node identification rate by radioisotope: A 13-year experience [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-01-10.
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Affiliation(s)
- Y-Y Chen
- Koo Foundation Sun Yat-Sen Cancer Centre, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - B-L Yu
- Koo Foundation Sun Yat-Sen Cancer Centre, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - C-C Lee
- Koo Foundation Sun Yat-Sen Cancer Centre, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - H-K Wei
- Koo Foundation Sun Yat-Sen Cancer Centre, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - C-W Lin
- Koo Foundation Sun Yat-Sen Cancer Centre, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - T-J Tsai
- Koo Foundation Sun Yat-Sen Cancer Centre, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - T-Y Cheng
- Koo Foundation Sun Yat-Sen Cancer Centre, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - C-M Chen
- Koo Foundation Sun Yat-Sen Cancer Centre, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Hsu KH, Wu TW, Wang YC, Lim WH, Lee CC, Lien R. Hemodynamic reference for neonates of different age and weight: a pilot study with electrical cardiometry. J Perinatol 2016; 36:481-5. [PMID: 26890553 DOI: 10.1038/jp.2016.2] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Revised: 11/27/2015] [Accepted: 01/04/2016] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Electrical cardiometry (EC) is an impedance-based monitor that provides noninvasive, real-time hemodynamic assessment. However, the reference values for neonates have not been established. STUDY DESIGN EC (Aesculon) was applied to hemodynamically stable preterm and term infants. Hemodynamic variables included cardiac output (CO), cardiac index (CI), stroke volume (SV) and heart rate (HR). Their gestational age (GA), weight and body surface area (BSA) were recorded. RESULTS A total of 280 neonates were studied. Their GA ranged from 26(5/7) to 41(4/7) weeks, weight 800 to 4420 g and BSA 0.07 to 0.26 m(2). CO was positively correlated to GA, weight and BSA (r=0.681, 0.822, 0.830, respectively; all P<0.001). Using regression analysis, CO was most significantly correlated to BSA. Mean CI was 2.55±0.37 l min(-1) per m(2). CONCLUSION Hemodynamic reference by EC is notably distinct among neonates of diverse maturity. CO is most closely correlated to BSA.
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Affiliation(s)
- K-H Hsu
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital Linkou Branch and School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - T-W Wu
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital Linkou Branch and School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Y-C Wang
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital Linkou Branch and School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - W-H Lim
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital Linkou Branch and School of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital Keelung Branch, Keelung, Taiwan
| | - C-C Lee
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital Linkou Branch and School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - R Lien
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital Linkou Branch and School of Medicine, Chang Gung University, Taoyuan, Taiwan
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Abstract
OBJECTIVE To examine the association between corticosteroid use and risk of active tuberculosis (TB) disease. METHODS We conducted a population-based nested case-control study based on Taiwan's National Health Insurance Research Database between January 1999 and December 2011. Each case of incident active TB was matched to 100 controls using a risk-set sampling scheme. RESULTS From a participant cohort of 1 million, 6229 cases of new active TB and 622,900 controls were identified. Current, recent, past, ever and chronic use of corticosteroids were associated with an increased risk of developing incident active TB, with adjusted rate ratios of respectively 2.76 (95%CI 2.44-3.11), 1.99 (95%CI 1.73-2.31), 1.17 (95%CI 1.06-1.29), 1.60 (95%CI 1.49-1.72), and 1.58 (95%CI 1.43-1.75). For subgroup analysis, the increased risk of TB in chronic corticosteroids users was substantially higher in subjects aged ≤70 years and female subjects. CONCLUSION In this relatively high TB prevalence setting, we found that use of corticosteroids was associated with an increased risk of TB. Current use of corticosteroids was associated with the highest risk of TB.
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Affiliation(s)
- C-C Lai
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - M-T G Lee
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - S-H Lee
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - S-H Lee
- Department of Rehabilitation and Physical Medicine, Taipei Veteran General Hospital, Taipei, Taiwan; Department of Medicine, College of Medicine, National Yang Ming University, Taipei, Taiwan, Taiwan
| | - S-S Chang
- Department of Family Medicine, Chang-Gung University Hospital, Linkou, Taiwan; Graduate Institute of Clinical Medicine, Chang-Gung University Hospital, Linkou, Taiwan
| | - C-C Lee
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine and General Medicine, National Taiwan University Hospital Yunlin Branch, Douliou, Taiwan
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Kong CL, Lee CC, Ip YC, Chow LP, Leung CH, Lam YC. Validation of the Hong Kong Cantonese Version of World Health Organization Five Well-Being Index for People with Severe Mental Illness. East Asian Arch Psychiatry 2016; 26:18-21. [PMID: 27086756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The World Health Organization Five Well-Being Index (WHO-5) has been developed to measure psychological wellbeing. Translation and linguistic validation of the WHO-5 into a Cantonese version has been accomplished for local use but it is not yet validated in people with severe mental illness in Hong Kong. This study aimed to examine the applicability of WHO-5 in measuring the psychological wellbeing dimension of people with severe mental illness. A brief and easily administrated tool to measure psychological wellbeing of people with severe mental illness can be used to provide an outcome measure in research studies and clinical trials. METHODS Subjects were randomly recruited from the Extended-Care Patient Intensive Treatment, Early Diversion and Rehabilitation Stepping-Stone Project (EXITERS) and the Rehabilitation Activity Centre (RAC) of Kwai Chung Hospital in Hong Kong. They were invited to complete the abbreviated version of Hong Kong Chinese World Health Organization Quality of Life (WHOQOL-BREF [HK]) and WHO-5 (Cantonese version) separately and concurrent validity was examined. RESULTS A total of 84 subjects were recruited, 42 each from EXITERS and RAC. In all, 49 (58%) were male and 35 (42%) were female. The mean ± standard deviation age was 43.2 ± 9.7 years. Their mean duration of mental illness was 16.4 ± 10.5 years and the mean years of education was 10.17 ± 2.5 years, i.e. about junior secondary school level in Hong Kong. The internal consistency of the WHO-5 was satisfactory (0.86) and was comparable with previous reports. Regarding validity, 1-factor structure with an eigenvalue of 3.24 explained 64.8% of total variance of WHO-5 for people with severe mental illness. Concurrent validity was established with moderate correlation (0.41-0.51) between WHO-5 and 4 domains of the WHOQOL-BREF (HK). CONCLUSION The WHO-5 (Cantonese version) is a reliable and valid tool to assess the psychological wellbeing of people with severe mental illness in Hong Kong. It can be used to monitor the effectiveness of psychological intervention aimed at improving the wellbeing of such patients.
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Affiliation(s)
- C L Kong
- Kwai Chung Hospital, Hong Kong SAR, PR China
| | - C C Lee
- Kwai Chung Hospital, Hong Kong SAR, PR China
| | - Y C Ip
- Kwai Chung Hospital, Hong Kong SAR, PR China
| | - L P Chow
- Kwai Chung Hospital, Hong Kong SAR, PR China
| | - C H Leung
- Kwai Chung Hospital, Hong Kong SAR, PR China
| | - Y C Lam
- Kwai Chung Hospital, Hong Kong SAR, PR China
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Chen PS, Chang HH, Huang CC, Lee CC, Lee SY, Chen SL, Huang SY, Yang YK, Lu RB. A longitudinal study of the association between the GNB3 C825T polymorphism and metabolic disturbance in bipolar II patients treated with valproate. Pharmacogenomics J 2016; 17:155-161. [PMID: 26856249 DOI: 10.1038/tpj.2015.96] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 10/06/2015] [Accepted: 11/16/2015] [Indexed: 12/30/2022]
Abstract
This longitudinal study aimed to investigate the associations between the polymorphisms of guanine nucleotide-binding protein subunit β-3 (GNB3) C825T and metabolic disturbance in bipolar II disorder (BP-II) patients being treated with valproate (VPA). A 100 BP-II patients received a 12-week course of VPA treatment, and their body weight and metabolic indices were measured. At baseline, the GNB3 C825T polymorphisms were associated with the triglyceride level (P=0.032) in BP-II patients. During the VPA treatment course, the polymorphisms were not only associated with body mass index (BMI) and waist circumference (P-values=0.009 and 0.001, respectively), but also with total cholesterol, triglyceride, low-density lipoprotein and leptin levels (P-values=0.004, 0.002, 0.031 and 0.015, respectively). Patients with the TT genotype had a lower BMI, smaller waist circumference, and lower levels of lipids and leptin than those with the CT or CC genotypes undergoing the VPA treatment course.
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Affiliation(s)
- P S Chen
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Addiction Research Center, National Cheng Kung University, Tainan, Taiwan
| | - H H Chang
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,School of Pharmacy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - C-C Huang
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - C C Lee
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - S-Y Lee
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - S-L Chen
- Department of Neurology, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - S-Y Huang
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Y K Yang
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Addiction Research Center, National Cheng Kung University, Tainan, Taiwan.,Department of Psychiatry, National Cheng Kung University Hospital, Dou-Liou Branch, Yunlin, Taiwan.,Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - R-B Lu
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Addiction Research Center, National Cheng Kung University, Tainan, Taiwan
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Kuse N, Jiang J, Lee CC, Schibli TR, Fermann ME. All polarization-maintaining Er fiber-based optical frequency combs with nonlinear amplifying loop mirror. Opt Express 2016; 24:3095-3102. [PMID: 26906874 DOI: 10.1364/oe.24.003095] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A fully stabilized all polarization-maintaining Er frequency comb with a nonlinear amplifying loop mirror with below 0.2 rad carrier-envelope-offset frequency phase noise is demonstrated. The integrated timing jitter is measured as 40 attosecond from 10 kHz to 10 MHz, which is the lowest value of any Er fiber frequency comb to date.
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Lee CC, Hayashi Y, Silverman KL, Feldman A, Harvey T, Mirin RP, Schibli TR. Monolithic device for modelocking and stabilization of frequency combs. Opt Express 2015; 23:33038-33043. [PMID: 26831973 DOI: 10.1364/oe.23.033038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We demonstrate a device that integrates a III-V semiconductor saturable absorber mirror with a graphene electro-optic modulator, which provides a monolithic solution to modelocking and noise suppression in a frequency comb. The device offers a pure loss modulation bandwidth exceeding 5 MHz and only requires a low voltage driver. This hybrid device provides not only compactness and simplicity in laser cavity design, but also small insertion loss, compared to the previous metallic-mirror-based modulators. We believe this work paves the way to portable and fieldable phase-coherent frequency combs.
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Lee CC, Luthringer DJ, Czer LSC. Dobutamine-induced fever and isolated eosinophilic myocarditis in a 66-year-old male awaiting heart transplantation: a case report. Transplant Proc 2015; 46:2464-6. [PMID: 25242803 DOI: 10.1016/j.transproceed.2014.06.064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 06/30/2014] [Indexed: 10/24/2022]
Abstract
A 66-year-old male with non-ischemic dilated cardiomyopathy who presented for decompensated heart failure and heart transplant evaluation had to be temporarily delisted from the transplant list due to fever. No infectious source was identified and drug fever was suspected. Dobutamine was discontinued and his fever subsequently defervesced. He eventually received an orthotopic heart transplantation without complication. Explanted heart showed eosinophilic myocarditis with pathologic features consistent with a drug-induced pattern of myocarditis. Throughout the hospital course, he did not develop peripheral blood eosinophilia to suggest eosinophilic myocarditis. The importance of this report is to have a greater awareness of dobutamine-induced fever and eosinophilic myocarditis even in patients without peripheral eosinophilia. In febrile patients receiving prolonged dobutamine infusion with no other evidence of infection, consideration should be given to discontinuing dobutamine or switching to an alternative inotrope such as milrinone.
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Affiliation(s)
- C C Lee
- Cedars-Sinai Medical Center, Department of Internal Medicine, Los Angeles, California, USA
| | - D J Luthringer
- Cedars-Sinai Medical Center, Department of Pathology, Los Angeles, California, USA; Cedars-Sinai Medical Center, Heart Institute, Los Angeles, California, USA
| | - L S C Czer
- Cedars-Sinai Medical Center, Heart Institute, Los Angeles, California, USA
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50
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Montealegre G, Reinhardt A, Brogan P, Berkun Y, Zlotogorski A, Brown D, Chira P, Gao L, Dare J, Schalm S, Merino R, Chapelle D, Kim H, Judd S, O'Brien M, De Jesus AA, Kim Y, Kost B, Huang Y, Paul S, Brofferio A, Lee CC, Hadigan C, Heller T, Minniti C, Rother K, Goldbach-Mansky R. Preliminary response to Janus kinase inhibition with baricitinib in chronic atypical neutrophilic dermatosis with lipodystrophy and elevated temperatures (CANDLE). Pediatr Rheumatol Online J 2015. [PMCID: PMC4597264 DOI: 10.1186/1546-0096-13-s1-o31] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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