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DePierro JM, Chan CC, Mohamed N, Starkweather S, Ripp J, Peccoralo LA. Determinants of Staff Intent to Leave Health Care During the COVID-19 Pandemic. Am J Public Health 2024; 114:200-203. [PMID: 38354356 PMCID: PMC10916731 DOI: 10.2105/ajph.2024.307574] [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] [Accepted: 12/21/2023] [Indexed: 02/16/2024]
Abstract
Objectives. To identify potential drivers of health care worker attrition. Methods. We conducted a survey of 1083 nonphysician health care workers in a large urban health system in New York City from September to October 2022. Results. The results of a multivariable logistic regression analysis revealed that higher odds of intending to leave health care were significantly associated with male gender, registered nurse profession, burnout, self-perceived mental health service need, and verbal abuse from patients or visitors, whereas lower odds were seen among those reporting greater emotional well-being and a better workplace culture. A relative importance analysis indicated that burnout was the strongest correlate of intention to leave (22.5% relative variance explained [RVE]), followed by subjective emotional well-being (16.7% RVE), being a registered nurse (12.3% RVE), poorer perceived workplace culture (9.5% RVE), and male gender (5.9% RVE). Conclusions. Overall, our findings suggest the need for well-coordinated interventions that address both individual- and system-level factors in an effort to improve retention. Public Health Implications. Our results indicate a need for interventions targeting workplace culture, staff burnout, and mental health service provision. (Am J Public Health. 2024;114(S2):S200-S203. https://doi.org/10.2105/AJPH.2024.307574).
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Affiliation(s)
- Jonathan M DePierro
- Jonathan M. DePierro and Sydney Starkweather are with the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY. Chi C. Chan, Jonathan Ripp, and Lauren A. Peccoralo are with the Office of Well-being and Resilience, Mount Sinai Health System, New York, NY. Nihal Mohamed is with the Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Chi C Chan
- Jonathan M. DePierro and Sydney Starkweather are with the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY. Chi C. Chan, Jonathan Ripp, and Lauren A. Peccoralo are with the Office of Well-being and Resilience, Mount Sinai Health System, New York, NY. Nihal Mohamed is with the Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Nihal Mohamed
- Jonathan M. DePierro and Sydney Starkweather are with the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY. Chi C. Chan, Jonathan Ripp, and Lauren A. Peccoralo are with the Office of Well-being and Resilience, Mount Sinai Health System, New York, NY. Nihal Mohamed is with the Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sydney Starkweather
- Jonathan M. DePierro and Sydney Starkweather are with the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY. Chi C. Chan, Jonathan Ripp, and Lauren A. Peccoralo are with the Office of Well-being and Resilience, Mount Sinai Health System, New York, NY. Nihal Mohamed is with the Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jonathan Ripp
- Jonathan M. DePierro and Sydney Starkweather are with the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY. Chi C. Chan, Jonathan Ripp, and Lauren A. Peccoralo are with the Office of Well-being and Resilience, Mount Sinai Health System, New York, NY. Nihal Mohamed is with the Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Lauren A Peccoralo
- Jonathan M. DePierro and Sydney Starkweather are with the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY. Chi C. Chan, Jonathan Ripp, and Lauren A. Peccoralo are with the Office of Well-being and Resilience, Mount Sinai Health System, New York, NY. Nihal Mohamed is with the Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
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Chan CC, Alter S, Hazlett EA, Shafritz KM, Yehuda R, Goodman M, Haznedar MM, Szeszko PR. Neural correlates of impulsivity in bipolar disorder: A systematic review and clinical implications. Neurosci Biobehav Rev 2023; 147:105109. [PMID: 36813146 PMCID: PMC11073484 DOI: 10.1016/j.neubiorev.2023.105109] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 02/17/2023] [Accepted: 02/18/2023] [Indexed: 02/23/2023]
Abstract
Impulsivity is a common feature of bipolar disorder (BD) with ramifications for functional impairment and premature mortality. This PRISMA-guided systematic review aims to integrate findings on the neurocircuitry associated with impulsivity in BD. We searched for functional neuroimaging studies that examined rapid-response impulsivity and choice impulsivity using the Go/No-Go Task, Stop-Signal Task, and Delay Discounting Task. Findings from 33 studies were synthesized with an emphasis on the effect of mood state of the sample and affective salience of the task. Results suggest trait-like brain activation abnormalities in regions implicated in impulsivity that persist across mood states. During rapid-response inhibition, BD exhibit under-activation of key frontal, insular, parietal, cingulate, and thalamic regions, but over-activation of these regions when the task involves emotional stimuli. Delay discounting tasks with functional neuroimaging in BD are lacking, but hyperactivity of orbitofrontal and striatal regions associated with reward hypersensitivity may be related to difficulty delaying gratification. We propose a working model of neurocircuitry dysfunction underlying behavioral impulsivity in BD. Clinical implications and future directions are discussed.
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Affiliation(s)
- Chi C Chan
- Mental Illness Research, Education, and Clinical Center (MIRECC), James J. Peters VA Medical Center, Bronx, NY, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Sharon Alter
- Mental Illness Research, Education, and Clinical Center (MIRECC), James J. Peters VA Medical Center, Bronx, NY, USA
| | - Erin A Hazlett
- Mental Illness Research, Education, and Clinical Center (MIRECC), James J. Peters VA Medical Center, Bronx, NY, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Keith M Shafritz
- Department of Psychology, Hofstra University, Hempstead, NY, USA; Institute of Behavioral Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Rachel Yehuda
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Mental Health Patient Care Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Marianne Goodman
- Mental Illness Research, Education, and Clinical Center (MIRECC), James J. Peters VA Medical Center, Bronx, NY, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - M Mehmet Haznedar
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Mental Health Patient Care Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Philip R Szeszko
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Mental Health Patient Care Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
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Chan CC, Norel R, Agurto C, Lysaker PH, Myers EJ, Hazlett EA, Corcoran CM, Minor KS, Cecchi GA. Emergence of Language Related to Self-experience and Agency in Autobiographical Narratives of Individuals With Schizophrenia. Schizophr Bull 2023; 49:444-453. [PMID: 36184074 PMCID: PMC10016400 DOI: 10.1093/schbul/sbac126] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND HYPOTHESIS Disturbances in self-experience are a central feature of schizophrenia and its study can enhance phenomenological understanding and inform mechanisms underlying clinical symptoms. Self-experience involves the sense of self-presence, of being the subject of one's own experiences and agent of one's own actions, and of being distinct from others. Self-experience is traditionally assessed by manual rating of interviews; however, natural language processing (NLP) offers automated approach that can augment manual ratings by rapid and reliable analysis of text. STUDY DESIGN We elicited autobiographical narratives from 167 patients with schizophrenia or schizoaffective disorder (SZ) and 90 healthy controls (HC), amounting to 490 000 words and 26 000 sentences. We used NLP techniques to examine transcripts for language related to self-experience, machine learning to validate group differences in language, and canonical correlation analysis to examine the relationship between language and symptoms. STUDY RESULTS Topics related to self-experience and agency emerged as significantly more expressed in SZ than HC (P < 10-13) and were decoupled from similarly emerging features such as emotional tone, semantic coherence, and concepts related to burden. Further validation on hold-out data showed that a classifier trained on these features achieved patient-control discrimination with AUC = 0.80 (P < 10-5). Canonical correlation analysis revealed significant relationships between self-experience and agency language features and clinical symptoms. CONCLUSIONS Notably, the self-experience and agency topics emerged without any explicit probing by the interviewer and can be algorithmically detected even though they involve higher-order metacognitive processes. These findings illustrate the utility of NLP methods to examine phenomenological aspects of schizophrenia.
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Affiliation(s)
- Chi C Chan
- Mental Illness Research, Education, and Clinical Center, James J. Peters VA Medical Center, Bronx, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Raquel Norel
- IBM T.J. Watson Research Center, Yorktown Heights, NY, USA
| | - Carla Agurto
- IBM T.J. Watson Research Center, Yorktown Heights, NY, USA
| | - Paul H Lysaker
- Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Evan J Myers
- Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, USA
| | - Erin A Hazlett
- Mental Illness Research, Education, and Clinical Center, James J. Peters VA Medical Center, Bronx, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Cheryl M Corcoran
- Mental Illness Research, Education, and Clinical Center, James J. Peters VA Medical Center, Bronx, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kyle S Minor
- Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, USA
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Cohen B, DePierro J, Chan CC, Tolan E, Deshpande R, Feder A, Feingold JH, Peccoralo L, Pietrzak RH, Ripp J. Factors Associated With Burnout Among Nurses Providing Direct Patient Care During the COVID-19 Pandemic. J Nurs Adm 2022; 52:598-607. [PMID: 36301869 PMCID: PMC10624218 DOI: 10.1097/nna.0000000000001216] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aimed to identify factors associated with burnout in nurses and nurses' opinions regarding interventions to promote well-being during crisis conditions such as those experienced during the COVID-19 pandemic. BACKGROUND Burnout among nurses is prevalent under usual conditions and may increase during crises such as COVID-19. METHODS Researchers conducted a survey of 1103 frontline nurses in a single New York City hospital during the first (spring 2020) and second (fall 2020/winter 2021) local waves of COVID-19. RESULTS Burnout prevalence increased from 45% to 52% between the first and second wave. Younger age, female gender, posttraumatic stress, anxiety or depressive symptoms, history of burnout, feeling less valued by hospital leadership, less informed of responsibilities, less certain about duration of enhanced workload, and prepared by prepandemic experience were predictive of burnout in multivariable analyses. CONCLUSIONS Although some identified risk factors for burnout were nonmodifiable, others may be modifiable by hospital leadership.
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Affiliation(s)
- Bevin Cohen
- Author Affiliations: Associate Professor, Department of Geriatric and Palliative Medicine, and Director, Center for Nursing Research and Innovation (Dr Cohen); Assistant Professor, Department of Psychiatry, and Director, Center for Stress, Resilience and Personal Growth (Dr DePierro); Assistant Professor, Department of Psychiatry (Dr Chan); Nurse Practitioner, Vascular Surgery, The Mount Sinai Hospital (Ms Tolan); Biostatistician, Center for Biostatistics (Ms Deshpande); Associate Professor, Department of Psychiatry, and Director, Trauma and Resilience Program (Dr Feder); Psychiatry Resident, Department of Psychiatry (Dr Feingold); Associate Professor, Department of Medicine, and Senior Associate Dean of Faculty Well-being and Development (Dr Peccoralo); and Chief Wellness Officer (Dr Ripp), Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York; and Professor of Psychiatry, Yale School of Medicine, Professor of Public Health, Department of Social and Behavioral Sciences, Yale School of Public Health, and Director, Translational Psychiatric Epidemiology Laboratory Clinical Neurosciences Division, National Center for PTSD, VA Connecticut Healthcare System, New Haven (Dr Pietrzak)
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Cheung KO, Chan CC. Combined pulmonary fibrosis and emphysema: a commonly missed diagnosis. Hong Kong Med J 2022; 28:85.e1-85.e3. [DOI: 10.12809/hkmj219418] [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: 11/05/2022] Open
Affiliation(s)
- KO Cheung
- Department of Radiology, North District Hospital, Hong Kong
| | - CC Chan
- Department of Radiology, North District Hospital, Hong Kong
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Peccoralo LA, Pietrzak RH, Feingold JH, Syed S, Chan CC, Murrough JW, Kaplan C, Verity J, Feder A, Charney DS, Southwick SM, Ripp JA. A prospective cohort study of the psychological consequences of the COVID-19 pandemic on frontline healthcare workers in New York City. Int Arch Occup Environ Health 2022; 95:1279-1291. [PMID: 35064838 PMCID: PMC8783588 DOI: 10.1007/s00420-022-01832-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 01/06/2022] [Indexed: 12/20/2022]
Abstract
Objectives We sought to describe the course and correlates of psychological distress in frontline healthcare workers (FHCWs) during the COVID-19 pandemic in New York City (NYC). Methods A prospective cohort study of FHCWs at the Mount Sinai Hospital was conducted during the initial 2020 surge (T1) and 7 months later (T2). Psychological distress [i.e., positive screen for pandemic-related post-traumatic stress disorder (PTSD), major depressive disorder (MDD), and/or generalized anxiety disorder (GAD)], occupational and personal exposures to COVID-19, coping strategies, and psychosocial characteristics were assessed. Four courses of psychological distress response were identified: no/minimal, remitted, persistent, and new-onset. Multinomial logistic regression and relative importance analyses were conducted to identify factors associated with courses of distress. Results Of 786 FHCWs, 126 (16.0%) FHCWs had persistent distress; 150 (19.1%) remitted distress; 35 (4.5%) new-onset distress; and 475 (60.4%) no/minimal distress. Relative to FHCWs with no/minimal distress, those with persistent distress reported greater relationship worries [19.8% relative variance explained (RVE)], pre-pandemic burnout (18.7% RVE), lower dispositional optimism (9.8% RVE), less emotional support (8.6% RVE), and feeling less valued by hospital leadership (8.4% RVE). Relative to FHCWs with remitted symptoms, those with persistent distress reported less emotional support (29.7% RVE), fewer years in practice (28.3% RVE), and psychiatric history (23.6% RVE). Conclusions One-fifth of FHCWs in our study experienced psychological distress 7 months following the COVID-19 surge in NYC. Pandemic-related worries, pre-pandemic burnout, emotional support, and feeling valued by leaders were linked to persistent distress. Implications for prevention, treatment, and organizational efforts to mitigate distress in FHCWs are discussed. Supplementary Information The online version contains supplementary material available at 10.1007/s00420-022-01832-0.
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Affiliation(s)
- Lauren A Peccoralo
- Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1087, New York, NY, 10029, USA.
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Robert H Pietrzak
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Jordyn H Feingold
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shumayl Syed
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Chi C Chan
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mental Illness Research, Education, and Clinical Center, James J. Peters VA Medical Center, Bronx, NY, USA
| | - James W Murrough
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Depression and Anxiety Center for Discovery and Treatment, New York, USA
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Carly Kaplan
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jaclyn Verity
- Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1087, New York, NY, 10029, USA
| | - Adriana Feder
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dennis S Charney
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, USA
| | | | - Jonathan A Ripp
- Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1087, New York, NY, 10029, USA
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Kaplan CA, Chan CC, Feingold JH, Kaye-Kauderer H, Pietrzak RH, Peccoralo L, Feder A, Southwick S, Charney D, Burka L, Basist M, Ripp J, Akhtar S. Psychological Consequences Among Residents and Fellows During the COVID-19 Pandemic in New York City: Implications for Targeted Interventions. Acad Med 2021; 96:1722-1731. [PMID: 34380941 PMCID: PMC8603436 DOI: 10.1097/acm.0000000000004362] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE To examine the psychological impact of the COVID-19 pandemic on medical trainees (residents and fellows) working at Mount Sinai Hospital (MSH) in New York City (NYC), the initial epicenter of the United States pandemic. METHOD The authors administered a survey to 991 trainees in frontline specialties working at MSH in NYC between April and May 2020. The instrument assessed symptoms of major depressive disorder, generalized anxiety disorder, COVID-19-related posttraumatic stress disorder, and burnout. Psychiatric screens were aggregated into 1 composite measure, and meeting criteria on any of the 3 scales was considered a positive screen for psychiatric symptoms. The survey also assessed COVID-19-related exposures, worries, coping strategies, and desired interventions. Multivariable logistic regressions were conducted to identify factors associated with psychiatric symptoms and burnout. RESULTS Of the 560 respondents (56.6% response rate), 29.7% screened positive for psychiatric symptoms and 35.8% screened positive for burnout. History of a mental illness, COVID-19-related duties and personal/career worries, and coping by substance use were associated with increased likelihood of screening positive for psychiatric symptoms. Positive emotion-focused coping and feeling valued by supervisors were associated with decreased likelihood. Internal medicine and surgical specialties, a history of mental illness, increased duty hours, duty-related worries, personal/career worries, coping via self-blame and venting, and coping via substance use were associated with higher odds of burnout. Feeling valued by supervisors was associated with decreased burnout odds. The most common crisis-related needs included access to personal protective equipment, food provisions, and financial support. CONCLUSIONS Psychological distress and burnout affected approximately one-third of trainees sampled during the height of the pandemic in NYC. As the pandemic surged beyond NYC, these findings suggest that interventions should include addressing basic needs, promoting leadership affirmation, moderating duty hours, supporting trainees financially, and enhancing mental health support.
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Affiliation(s)
- Carly A. Kaplan
- C.A. Kaplan is a medical student, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Chi C. Chan
- C.C. Chan is assistant professor of psychiatry, Icahn School of Medicine at Mount Sinai, New York, and research health scientist, James J. Peters Veterans Affairs Medical Center, Bronx, New York
| | - Jordyn H. Feingold
- J.H. Feingold is a psychiatry resident, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Halley Kaye-Kauderer
- H. Kaye-Kauderer is a psychiatry resident, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Robert H. Pietrzak
- R.H. Pietrzak is associate professor of psychiatry and public health, Yale School of Medicine, New Haven, Connecticut, director, translational psychiatric epidemiology laboratory, Clinical Neurosciences Division, U.S. Department of Veterans Affairs National Center for PTSD, West Haven, Connecticut, and adjunct professor of psychiatry and environmental medicine and public health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Lauren Peccoralo
- L. Peccoralo is associate dean for faculty well-being and resilience and associate professor of medicine, general internal medicine, and medical education, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York
| | - Adriana Feder
- A. Feder is director for research, Center for Stress, Resilience, and Personal Growth, co-director, Ehrenkranz Laboratory for the Study of Human Resilience, and associate professor of psychiatry, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York
| | - Steven Southwick
- S. Southwick is professor emeritus of psychiatry, Yale School of Medicine, New Haven, Connecticut, and adjunct professor of psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Dennis Charney
- D. Charney is Anne and Joel Ehrenkranz Dean, Icahn School of Medicine at Mount Sinai, and president for academic affairs, Mount Sinai Health System, New York, New York
| | - Larissa Burka
- L. Burka is a registered nurse, Mount Sinai Hospital, Mount Sinai Health System, New York, New York
| | - Madeleine Basist
- M. Basist is a third-year internal medicine resident, Mount Sinai Hospital, Mount Sinai Health System, New York, New York
| | - Jonathan Ripp
- J. Ripp is senior associate dean for well-being and resilience, chief wellness officer, and professor of medicine, medical education and geriatrics and palliative medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York
| | - Saadia Akhtar
- S. Akhtar is associate dean for trainee well-being and resilience and associate professor of emergency medicine and medical education, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York
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Salgari GC, Potts GF, Schmidt J, Chan CC, Spencer CC, Bedwell JS. Event-related potentials to rare visual targets and negative symptom severity in a transdiagnostic psychiatric sample. Clin Neurophysiol 2021; 132:1526-1536. [PMID: 34030054 DOI: 10.1016/j.clinph.2021.02.398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 06/25/2020] [Revised: 01/05/2021] [Accepted: 02/06/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Negative psychiatric symptoms are often resistant to treatments, regardless of the disorder in which they appear. One model for a cause of negative symptoms is impairment in higher-order cognition. The current study examined how particular bottom-up and top-down mechanisms of selective attention relate to severity of negative symptoms across a transdiagnostic psychiatric sample. METHODS The sample consisted of 130 participants: 25 schizophrenia-spectrum disorders, 26 bipolar disorders, 18 unipolar depression, and 61 nonpsychiatric controls. The relationships between attentional event-related potentials following rare visual targets (i.e., N1, N2b, P2a, and P3b) and severity of the negative symptom domains of anhedonia, avolition, and blunted affect were evaluated using frequentist and Bayesian analyses. RESULTS P3b and N2b mean amplitudes were inversely related to the Positive and Negative Syndrome Scale-Negative Symptom Factor severity score across the entire sample. Subsequent regression analyses showed a significant negative transdiagnostic relationship between P3b amplitude and blunted affect severity. CONCLUSIONS Results indicate that negative symptoms, and particularly blunted affect, may have a stronger association with deficits in top-down mechanisms of selective attention. SIGNIFICANCE This suggests that people with greater severity of blunted affect, independent of diagnosis, do not allocate sufficient cognitive resources when engaging in activities requiring selective attention.
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Affiliation(s)
- Giulia C Salgari
- Department of Psychology, University of Central Florida, 4111 Pictor Lane, Orlando, FL 32816, USA
| | - Geoffrey F Potts
- Department of Psychology, University of South Florida, 4202 E Fowler Avenue, Tampa, FL 33620, USA
| | - Joseph Schmidt
- Department of Psychology, University of Central Florida, 4111 Pictor Lane, Orlando, FL 32816, USA
| | - Chi C Chan
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029, USA
| | - Christopher C Spencer
- Department of Psychology, University of Central Florida, 4111 Pictor Lane, Orlando, FL 32816, USA
| | - Jeffrey S Bedwell
- Department of Psychology, University of Central Florida, 4111 Pictor Lane, Orlando, FL 32816, USA.
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Feingold JH, Peccoralo L, Chan CC, Kaplan CA, Kaye-Kauderer H, Charney D, Verity J, Hurtado A, Burka L, Syed SA, Murrough JW, Feder A, Pietrzak RH, Ripp J. Psychological Impact of the COVID-19 Pandemic on Frontline Health Care Workers During the Pandemic Surge in New York City. ACTA ACUST UNITED AC 2021; 5:2470547020977891. [PMID: 33598592 PMCID: PMC7863176 DOI: 10.1177/2470547020977891] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [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: 10/28/2020] [Accepted: 11/11/2020] [Indexed: 11/30/2022]
Abstract
Background This study sought to assess the magnitude of and factors associated with mental health outcomes among frontline health care workers (FHCWs) providing care during the Spring 2020 COVID-19 pandemic surge in New York City. Methods A cross-sectional, survey-based study over 4 weeks during the Spring 2020 pandemic surge was used to assess symptoms of COVID-19-related posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and generalized anxiety disorder (GAD) in 2,579 FHCWs at the Mount Sinai Hospital. Participants were additionally asked about their occupational and personal exposures to COVID-19. Multivariable logistic regression and relative importance analyses were conducted to identify factors associated with these outcomes. Results A total of 3,360 of 6,026 individuals completed the survey (55.8% participation), with 2,579 (76.8%) analyzed based on endorsing frontline responsibilities and providing information related to the three outcomes. 1,005 (39.0%) met criteria for symptoms of COVID-19-related PTSD, MDD, or GAD. 599 (23.3%) screened positively for PTSD symptoms, 683 (26.6%) for MDD symptoms, and 642 (25.0%) for GAD symptoms. Multivariable analyses revealed that past-year burnout was associated with the highest risk of developing symptoms for COVID-19-related PTSD (odds ratio [OR] = 2.10), MDD (OR = 2.83), and GAD (OR = 2.68). Higher perceived support from hospital leadership was associated with a lowest risk of all outcomes [PTSD (OR = 0.75), MDD (OR = 0.72), and GAD (OR = 0.76). Conclusion In this large sample of FHCWs providing care during the 2020 NYC pandemic surge, 39% experienced symptoms of COVID-19-related PTSD, MDD, and/or GAD and pre-pandemic burnout as well as leadership support were identified as the most highly associated factors. These findings suggest that interventions aimed at reducing burnout and augmenting support from hospital leadership may be appropriate targets to mitigate the risk for developing further psychopathology in this population and others working in the midst of crisis.
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Affiliation(s)
- Jordyn H Feingold
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lauren Peccoralo
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
| | - Chi C Chan
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Carly A Kaplan
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Halley Kaye-Kauderer
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dennis Charney
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jaclyn Verity
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
| | - Alicia Hurtado
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Larissa Burka
- Department of nursing, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shumayl A Syed
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - James W Murrough
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Psychiatry, Depression and Anxiety Center for Discovery and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Adriana Feder
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robert H Pietrzak
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.,U.S. Department of Veterans Affairs National Center for PTSD, West Haven, CT, USA
| | - Jonathan Ripp
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
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10
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Leow Y, Kong PW, Liu Y, Pan JW, Fong DTP, Chan CC, Heng ML. Test-retest reliability of a clinical foot assessment device for measuring first metatarsophalangeal joint quasi-stiffness. Foot (Edinb) 2020; 45:101742. [PMID: 33022579 DOI: 10.1016/j.foot.2020.101742] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 08/24/2020] [Accepted: 08/29/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND The stiffness of the first metatarsophalangeal joint (MTPJ) is of interest in cases such as hallux rigidus and apropulsive gait. Subjective rating of joint mobility as 'hypermobile, normal, or stiff' is an unreliable method. Previous instruments for the assessment of first MTPJ stiffness can be too hard and uncomfortable for test subjects. Recently, a new device using a load cell and optical fiber with fiber Bragg grating (FBG) sensors was developed to provide a comfortable means of clinical foot assessment. This study aimed to evaluate the test-retest reliability of this FBG-load cell device in measuring the first MTPJ quasi-stiffness. METHODS The left foot of 13 female subjects were measured twice for their first MTPJ quasi-stiffness, approximately seven days apart. The FBG-load cell device measured the MTPJ range of motion from a resting position to maximum dorsiflexion and then returning to the resting start-position. The force applied by a clinician to displace the toe was simultaneously recorded using the load cell. The quasi-stiffness over the "working range" in loading and unloading directions were determined from the slope of the torque-angular displacement graph. The test-retest reliability of the MTPJ quasi-stiffness was evaluated using intra-class correlation coefficient [ICC (2,1)]. RESULTS The reliability was almost perfect for MTPJ quasi-stiffness over the loading phase (ICC = 0.814), moderate for MTPJ quasi-stiffness over the unloading phase (ICC = 0.477) and moderate for MTPJ maximum range (ICC = 0.486). CONCLUSION The foot assessment device comprising FBG and load cell was able to reliably measure the first MTPJ quasi-stiffness in a clinical setting. The measurement reliability was higher during the loading phase than the unloading phase.
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Affiliation(s)
- Yixuan Leow
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 639798, Singapore.
| | - Pui W Kong
- Physical Education and Sports Science Academic Group, National Institute of Education, Nanyang Technological University, 637616, Singapore.
| | - Yimin Liu
- School of Chemical and Biomedical Engineering, Nanyang Technological University, 639798, Singapore.
| | - Jing W Pan
- Physical Education and Sports Science Academic Group, National Institute of Education, Nanyang Technological University, 637616, Singapore.
| | - Daniel T P Fong
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, United Kingdom.
| | - Chi C Chan
- Sino-German College of Intelligent Manufacturing, Shenzhen Technology University, China.
| | - Marabelle L Heng
- Podiatry Department, Singapore General Hospital, Diabetes & Metabolism Centre, 168752, Singapore; School of Allied Health & Human Performance, University of South Australia, SA 5001, Australia.
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11
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Chan CC, Cheung M, Tsui M. Games supporting organ donation: an interview with Dr Ka-foon Chau. Hong Kong Med J 2020; 26:273-274. [PMID: 32554821 DOI: 10.12809/hkmj-hc202006] [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: 11/05/2022] Open
Affiliation(s)
- C C Chan
- Year 6, The Chinese University of Hong Kong
| | - M Cheung
- Year 5, The University of Hong Kong
| | - M Tsui
- Year 4, The Chinese University of Hong Kong
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12
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Chan CC, Bulbena-Cabre A, Rutter S, Benavides C, McClure MM, Calabrese W, Rosell DR, Koenigsberg HW, Goodman M, New AS, Hazlett EA, Perez-Rodriguez MM. Comparison of self-report and clinician-rated schizotypal traits in schizotypal personality disorder and community controls. Schizophr Res 2019; 209:263-268. [PMID: 30635257 PMCID: PMC6614007 DOI: 10.1016/j.schres.2018.12.050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 12/27/2018] [Accepted: 12/27/2018] [Indexed: 01/06/2023]
Abstract
Given the common use of self-report questionnaires to assess schizotypy in personality pathology and schizophrenia research, it is important to determine the concordance between self-report and clinician ratings. 250 individuals with schizotypal personality disorder (SPD) and 116 community controls (CTR) were assessed on schizotypal traits using a clinical interview, the Structured Interview for DSM-IV Personality disorders (SIDP), and a self-report questionnaire, the Schizotypal Personality Questionnaire (SPQ). Ordinal logistic regressions examined concordance between self-reported and clinician-rated scores in CTR and SPD separately. Analyses of variance examined how the SPQ performed on differentiating between CTR with low schizotypy, CTR with high schizotypy, and SPD. For both CTR and SPD, higher SPQ subscale scores were significantly associated with higher clinician ratings on the respective SIDP items for the Ideas of Reference, Magical Thinking, Unusual Perceptual Experience, Suspiciousness, and Social Anxiety items, but not the Odd Speech or Limited Affect items. Higher SPQ subscale scores for Odd Behavior and Lack of Close Friends were significantly associated with the clinician-rated SIDP item scores in CTR but not SPD. CTR with low schizotypy scored lower on all SPQ subscales than CTR with high schizotypy, who did not differ from SPD. Self-report ratings are concordant with clinician ratings for positive schizotypal traits, whereas certain disorganization and interpersonal traits are not, particularly for individuals with SPD. The SPQ can differentiate between high and low schizotypy controls, but not between high schizotypy controls and individuals with SPD. Assessment of schizotypal traits should include both self-report questionnaires and clinician ratings.
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Affiliation(s)
- Chi C. Chan
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA,VISN 2 Mental Illness Research Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA,Co-corresponding authors: Chi C. Chan, PhD, Mental Illness Research, Education, and Clinical Center, James J. Peters VA Medical Center, 130 West Kingsbridge Road, Bronx, NY 10468; tel: 718-584-5000 x3862; fax: 718-364-3576; .; M. Mercedes Perez-Rodriguez, MD, PhD. Psychiatry Department, Icahn School of Medicine, Mount Sinai, 1 Gustave L Levy Pl., PO BOX 1230, New York, NY 10029.
| | - Andrea Bulbena-Cabre
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA,VISN 2 Mental Illness Research Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Sarah Rutter
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA
| | - Caridad Benavides
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA
| | - Margaret M. McClure
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA,Fairfield University, Fairfield, CT, USA
| | - William Calabrese
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA
| | - Daniel R. Rosell
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA
| | - Harold W. Koenigsberg
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA,VISN 2 Mental Illness Research Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Marianne Goodman
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA,VISN 2 Mental Illness Research Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Antonia S. New
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA
| | - Erin A. Hazlett
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA,VISN 2 Mental Illness Research Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - M. Mercedes Perez-Rodriguez
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA,Co-corresponding authors: Chi C. Chan, PhD, Mental Illness Research, Education, and Clinical Center, James J. Peters VA Medical Center, 130 West Kingsbridge Road, Bronx, NY 10468; tel: 718-584-5000 x3862; fax: 718-364-3576; .; M. Mercedes Perez-Rodriguez, MD, PhD. Psychiatry Department, Icahn School of Medicine, Mount Sinai, 1 Gustave L Levy Pl., PO BOX 1230, New York, NY 10029.
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13
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Ospina LH, Shanahan M, Perez-Rodriguez MM, Chan CC, Clari R, Burdick KE. Alexithymia predicts poorer social and everyday functioning in schizophrenia and bipolar disorder. Psychiatry Res 2019; 273:218-226. [PMID: 30658205 PMCID: PMC6561815 DOI: 10.1016/j.psychres.2019.01.033] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 01/09/2019] [Accepted: 01/10/2019] [Indexed: 12/28/2022]
Abstract
Alexithymia, or the inability to identify and describe one's emotions, is significantly higher in bipolar disorder (BD) and schizophrenia (SZ), compared to healthy controls (HC). Alexithymia has also been observed to predict psychosocial functioning in SZ. We investigated whether alexithymia predicted social and everyday functioning in BD, as well as transdiagnostically in HC, BD, and SZ patients. 56 BD, 45 SZ, and 50 HC were administered and compared on tests measuring neurocognition, social cognition, functioning and alexithymia. We conducted linear regressions assessing whether alexithymia predicted functional outcomes in BD. Next, we conducted hierarchical stepwise linear regressions investigating the predictive ability of neurocognition, social cognition and alexithymia on everyday and social functioning in our overall sample. BD and SZ patients were comparable on most demographics and demonstrated higher alexithymia compared to HCs. In BD, alexithymia predicted social functioning only. In the overall sample, difficulty identifying and describing feelings predicted everyday functioning; difficulty describing feelings predicted social functioning. Results suggest that aspects of alexithymia significantly predict functioning among these psychiatric groups, above and beyond the contributions of previously identified factors such as neurocognition and social cognition. Results may aid in developing proper interventions aimed at improving patients' ability to articulate their feelings.
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Affiliation(s)
- L H Ospina
- Icahn School of Medicine at Mount Sinai, Departments of Psychiatry and Neuroscience, New York NY, United States.
| | - M Shanahan
- Icahn School of Medicine at Mount Sinai, Departments of Psychiatry and Neuroscience, New York NY, United States; Brigham and Women's Hospital, Department of Psychiatry, Boston MA, United States
| | - M M Perez-Rodriguez
- Icahn School of Medicine at Mount Sinai, Departments of Psychiatry and Neuroscience, New York NY, United States
| | - C C Chan
- Icahn School of Medicine at Mount Sinai, Departments of Psychiatry and Neuroscience, New York NY, United States
| | - R Clari
- Icahn School of Medicine at Mount Sinai, Departments of Psychiatry and Neuroscience, New York NY, United States
| | - K E Burdick
- Icahn School of Medicine at Mount Sinai, Departments of Psychiatry and Neuroscience, New York NY, United States; Brigham and Women's Hospital, Department of Psychiatry, Boston MA, United States; James J. Peters VA Medical Center, Bronx NY, United States; Harvard Medical School, Department of Psychiatry, Boston, MA, United States
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14
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Chan CC, Shanahan M, Ospina LH, Larsen EM, Burdick KE. Premorbid adjustment trajectories in schizophrenia and bipolar disorder: A transdiagnostic cluster analysis. Psychiatry Res 2019; 272:655-662. [PMID: 30616137 PMCID: PMC6441475 DOI: 10.1016/j.psychres.2018.12.169] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 12/10/2018] [Accepted: 12/30/2018] [Indexed: 11/17/2022]
Abstract
Despite the overlap between schizophrenia and bipolar disorder, neurodevelopmental abnormalities are thought to be associated primarily with schizophrenia. Transdiagnostic and empirical identification of subgroups based on premorbid adjustment (PMA) may enhance understanding of illness trajectories. 160 patients with bipolar I or II disorder (BD; n = 104) or schizophrenia or schizoaffective disorder (SZ; n = 56) were assessed on PMA course from childhood to late adolescence and current symptoms and functioning. A hierarchical cluster analysis was performed using social and academic PMA scores, resulting in three optimal clusters. Cluster 1 (n = 28 SZ, 65 BD) had normal social and academic PMA, the most education, and mildest current symptoms. Cluster 2 (n = 15 SZ, 24 BD) had normal social PMA but an impaired-declining academic course and had a greater proportion of males than Cluster 1. Cluster 3 (n = 13 SZ, 15 BD) had an impaired-stable social PMA and an impaired-declining academic course and the most severe current negative symptoms and childhood trauma. The proportions of SZ and BD diagnoses, current neurocognition, and functioning did not differ between clusters. These findings suggest shared neurodevelopmental abnormalities between SZ and BD, with subgroups exhibiting distinct PMA trajectories that cut across disorders.
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Affiliation(s)
- Chi C Chan
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; VISN 2 Mental Illness Research, Education, and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Megan Shanahan
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Brigham and Women's Hospital, Boston, MA, USA
| | - Luz H Ospina
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Emmett M Larsen
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Katherine E Burdick
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; VISN 2 Mental Illness Research, Education, and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA; Brigham and Women's Hospital, Boston, MA, USA.
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15
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Chan CC, Szeszko PR, Wong E, Tang CY, Kelliher C, Penner JD, Perez-Rodriguez MM, Rosell DR, McClure M, Roussos P, New AS, Siever LJ, Hazlett EA. Frontal and temporal cortical volume, white matter tract integrity, and hemispheric asymmetry in schizotypal personality disorder. Schizophr Res 2018; 197:226-232. [PMID: 29454512 PMCID: PMC8043048 DOI: 10.1016/j.schres.2018.01.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 11/29/2017] [Accepted: 01/21/2018] [Indexed: 12/29/2022]
Abstract
Abnormalities in temporal and frontal cortical volume, white matter tract integrity, and hemispheric asymmetry have been implicated in schizophrenia-spectrum disorders. Schizotypal personality disorder can provide insight into vulnerability and protective factors in these disorders without the confounds associated with chronic psychosis. However, multimodal imaging and asymmetry studies in SPD are sparse. Thirty-seven individuals with SPD and 29 healthy controls (HC) received clinical interviews and 3T magnetic resonance T1-weighted and diffusion tensor imaging scans. Mixed ANOVAs were performed on gray matter volumes of the lateral temporal regions involved in auditory and language processing and dorsolateral prefrontal cortex involved in executive functioning, as well as fractional anisotropy (FA) of prominent white matter tracts that connect frontal and temporal lobes. In the temporal lobe regions, there were no group differences in volume, but SPD had reduced right>left middle temporal gyrus volume asymmetry compared to HC and lacked the right>left asymmetry in the inferior temporal gyrus volume seen in HC. In the frontal regions, there were no differences between groups on volume or asymmetry. In the white matter tracts, SPD had reduced FA in the left sagittal stratum and superior longitudinal fasciculus, and increased right>left asymmetry in sagittal stratum FA compared to HC. In the SPD group, lower left superior longitudinal fasciculus FA was associated with greater severity of disorganization symptoms. Findings suggest that abnormities in structure and asymmetry of temporal regions and frontotemporal white matter tract integrity are implicated in SPD pathology.
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Affiliation(s)
- Chi C. Chan
- VISN 2 Mental Illness Research, Education, and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA,Corresponding author at: Mental Illness Research, Education, and Clinical Center, James J. Peters VA Medical Center, 130 West Kingsbridge Road, Room 6A-41G, Bronx, NY 10468, USA, (C.C. Chan)
| | - Philip R. Szeszko
- VISN 2 Mental Illness Research, Education, and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Edmund Wong
- Translational and Molecular Imaging Institute, Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Cheuk Y. Tang
- Translational and Molecular Imaging Institute, Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Caitlin Kelliher
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Justin D. Penner
- VISN 2 Mental Illness Research, Education, and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Daniel R. Rosell
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Margaret McClure
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Panos Roussos
- VISN 2 Mental Illness Research, Education, and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA,Department of Genetics and Genomic Sciences and Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Antonia S. New
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Larry J. Siever
- VISN 2 Mental Illness Research, Education, and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Erin A. Hazlett
- VISN 2 Mental Illness Research, Education, and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Tse PY, Chan CC, Wong WM, Cheung CC. Inguinal Hernia Mimicking as a Spigelian Hernia. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791302000310] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Inguinal hernia is a common surgical condition requiring surgical intervention. The usual clinical presentation is a supra-inguinal swelling with the neck just above and medial to pubic tubercle. We report a case of inguinal hernia in an old lady that presented as an abdominal wall swelling, clinically suggestive of a Spigelian hernia.
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Abstract
Objectives To study the practice of seclusion in an emergency department (ED) and to explore high-risk elements during seclusion. Methods The study consisted of two parts: an in-depth analysis on all incidents associated with seclusion in a six-year period (1998–2004) and a two-year (2002–2004) retrospective analysis of secluded patient records to understand the rationale and patient outcome. Results Part 1: A total of 9 incident records were collected. Four patients were related to setting fire. Five patients had violence or threat of violence. The median length of stay (LOS) in seclusion at the time of incident was 129 minutes. Although 66.7% of the patients had additional restraint prior to the seclusion, incidents still occurred. Two staff sustained injuries and hospital facilities were damaged in some of the incidents. Six patients were later admitted to psychiatric hospital. Part 2: 141 patient data were collected in the study (M: 89 and F: 52). The average monthly number of patients secluded was about 6. The mean age was 45 years (SD 19) and the mean LOS was 616 minutes (SD 478). There were three incidences (2.1%) during the two-year period. A total of 82 patients (58.2%) were associated with violence or threat of violence and 38 (46.3%) of the group had psychiatric illness; and 50 patients (35.5%) were associated with alcohol or drug intoxication. Ultimately, 56 patients (39.7%) were admitted to psychiatric hospital and 64 patients (45.4%) were treated and discharged from the ED. Conclusion Seclusion is a high-risk practice. In our department, the most frequent indication was violence (58.2%), with nearly half of them having history of psychiatric illness. Psychiatric illness had the highest risk for incidents, especially those with violence or threat of violence. The LOS in seclusion was relatively long in the ED and might be one of the risk factors for incidents. Inadequate removal of potentially dangerous belongings from patients before seclusion may end up with catastrophic outcomes. Curiously, ED nurses are not allowed to search patients before seclusion. They are exposed to legal liability in exercising restraint and in searching for potentially dangerous items from patients. It is suggested that clear protocols and quality assurance programs should be instituted to ensure safe seclusion.
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18
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Chan CC, Chan YC, Au A, Cheung GOC. Reliability and Validity of the “Extended - Hurt, Insult, Threaten, Scream” (E-Hits) Screening Tool in Detecting Intimate Partner Violence in Hospital Emergency Departments in Hong Kong. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791001700202] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives To assess the reliability and validity of a brief screening instrument, “E-HITS” (Extended - Hurt, Insult, Threaten, Scream), for detecting female intimate partner violence (IPV) in Hong Kong emergency departments (EDs). Method Quantitative data were collected from a victim group (n=110) and a control group (n=116). Statistical properties of the instruments were analysed to ascertain its internal consistency, test/re-test reliability, concurrent validity and discriminant validity. Results Cronbach's alpha was 0.90 for the E-HITS. Two-week test/re-test reliability was 0.71 (p<0.001). Respondents' scores on the E-HITS positively correlated with those on psychological aggression, physical assault, sexual coercion and injury scales, and negatively correlated with the negotiation scale of the revised Conflict Tactics Scale at a statistically significant level. Subsequent Receiver Operating Characteristic (ROC) curve analysis revealed that E-HITS reached a sensitivity of 98.2% and a specificity of 94.8% at a cut-off of 8.5. The overall accuracy of the E-HITS indicated by the area under curve (AUC) in the ROC is 0.991. Conclusion These results show that the E-HITS has good internal consistency, test/re-test reliability, as well as concurrent and discriminant validity. The E-HITS is a valid and reliable tool for screening intimate partner violence in Hong Kong EDs.
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Affiliation(s)
| | - YC Chan
- The Hong Kong Polytechnic University, Department of Applied Social Sciences, Hung Hom, Kowloon, Hong Kong
| | - A Au
- The Hong Kong Polytechnic University, Department of Applied Social Sciences, Hung Hom, Kowloon, Hong Kong
| | - GOC Cheung
- The Hong Kong Polytechnic University, Department of Applied Social Sciences, Hung Hom, Kowloon, Hong Kong
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Chan CC, Spencer CC, West C, Viegas C, Bedwell JS. Metacognitive processes in psychometrically defined schizotypy. Psychiatry Res 2015; 230:279-86. [PMID: 26381182 DOI: 10.1016/j.psychres.2015.09.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 07/11/2015] [Accepted: 09/04/2015] [Indexed: 12/01/2022]
Abstract
Metacognitive abnormalities have been implicated in the experience of psychotic symptoms; however, the process through which this occurs remains unclear. The aim of this study was to clarify the association of self-reported schizotypy with metacognitive beliefs and neural activity related to higher-order cognition. Event-related potentials (ERPs) including the error-related negativity (ERN) and error positivity (Pe) were recorded during a Flanker task in 20 controls and 22 individuals with high self-reported schizotypy on the Schizotypal Personality Questionnaire-Brief Revised (SPQ-BR). Participants continuously evaluated their task performance and completed the Metacognitions Questionnaire-30 (MCQ-30). The high schizotypy group demonstrated higher scores on all subscales of the MCQ-30. In contrast, task performance, accuracy of self-performance evaluation, and amplitudes of the ERN and Pe did not differ between groups. The MCQ-30 factors that measure cognitive confidence and positive beliefs about worry significantly predicted SPQ-BR total score, whereas ERPs did not. High self-reported schizotypy appears to be more associated with dysfunctional metacognitive beliefs than physiological abnormalities in brain areas related to metacognition.
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Affiliation(s)
- Chi C Chan
- Department of Psychology, University of Central Florida, Orlando, FL, USA.
| | | | - Chloe West
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Carina Viegas
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Jeffrey S Bedwell
- Department of Psychology, University of Central Florida, Orlando, FL, USA
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Chan LWY, Leung JHY, Chan CC. Immunoglobulin G4–related Systemic Disease: Pictorial Review of the Pancreatic and Extrapancreatic Manifestations. Hong Kong J Radiol 2015. [DOI: 10.12809/hkjr1414238] [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: 11/05/2022] Open
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21
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Bedwell JS, Butler PD, Chan CC, Trachik BJ. Transdiagnostic psychiatric symptoms related to visual evoked potential abnormalities. Psychiatry Res 2015; 230:262-70. [PMID: 26412383 DOI: 10.1016/j.psychres.2015.09.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 07/28/2015] [Accepted: 09/02/2015] [Indexed: 01/20/2023]
Abstract
Visual processing abnormalities have been reported across a range of psychotic and mood disorders, but are typically examined within a particular disorder. The current study used a novel transdiagnostic approach to examine diagnostic classes, clinician-rated current symptoms, and self-reported personality traits in relation to visual processing abnormalities. We examined transient visual-evoked potentials (VEPs) from 48 adults (56% female), representing a wide range of psychotic and mood disorders, as well as individuals with no history of psychiatric disorder. Stimuli were low contrast check arrays presented on green and red backgrounds. Pairwise comparisons between individuals with schizophrenia-spectrum disorders (SSD), chronic mood disorders (CMD), and nonpsychiatric controls (NC) revealed no overall differences for either P1 or N1 amplitude. However, there was a significant interaction with the color background in which the NC group showed a significant increase in P1 amplitude to the red, vs. green, background, while the SSD group showed no change. This was related to an increase in social anhedonia and general negative symptoms. Stepwise regressions across the entire sample revealed that individuals with greater apathy and/or eccentric behavior had a reduced P1 amplitude. These relationships provide clues for uncovering the underlying causal pathology for these transdiagnostic symptoms.
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Affiliation(s)
- Jeffrey S Bedwell
- Department of Psychology, University of Central Florida, Orlando, FL, USA.
| | - Pamela D Butler
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, USA
| | - Chi C Chan
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Benjamin J Trachik
- Department of Psychology, University of Central Florida, Orlando, FL, USA
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Tan YC, Tou ZQ, Chow KK, Chan CC. Graphene-deposited photonic crystal fibers for continuous refractive index sensing applications. Opt Express 2015; 23:31286-31294. [PMID: 26698755 DOI: 10.1364/oe.23.031286] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We present a pilot demonstration of an optical fiber based refractive index (RI) sensor involving the deposition of graphene onto the surface of a segment of a photonic crystal fiber (PCF) in a fiber-based Mach-Zehnder Interferometer (MZI). The fabrication process is relatively simple and only involves the fusion splicing of a PCF between two single mode fibers. The deposition process relies only on the cold transfer of graphene onto the PCF segment, without the need for further physical or chemical treatment. The graphene overlay modified the sensing scheme of the MZI RI sensor, allowing the sensor to overcome limitations to its detectable RI range due to free spectral range issues. This modification also allows for continuous measurements to be obtained without the need for reference values for the range of RIs studied and brings to light the potential for simultaneous dual parameter sensing. The sensor was able to achieve a RI sensitivity of 9.4 dB/RIU for the RIs of 1.33-1.38 and a sensitivity of 17.5 dB/RIU for the RIs of 1.38-1.43. It also displayed good repeatability and the results obtained were consistent with the modeling.
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Affiliation(s)
- J L Davis
- Department of Ophthalmology, University of Miami, Bascom Palmer Eye Institute, Fla
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Affiliation(s)
- J L Davis
- Department of Ophthalmology, University of Miami, Bascom Palmer Eye Institute, Fla
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Abstract
Evidence-based practice emphasizes the integration of empirically supported treatments with clinical expertise and unique client characteristics. The present study describes an integrative approach using Acceptance and Commitment Therapy (ACT) and skills training adapted from Dialectical Behavior Therapy (DBT) to treat a client with avoidant personality disorder (AvPD), comorbid adjustment disorder, and self-injurious behavior. The process of matching the therapies to the client and specific techniques to symptoms and problem behaviors is described. Ongoing clinical measures indicated reductions in depression, hopelessness, and anxiety. Behavioral measures indicated remission of cutting behavior and increases in social and physical activities. Results from a 1-month follow-up suggested maintenance of gains and continued reduction in symptoms. The Minnesota Multiphasic Personality Inventory–2 (MMPI-2) profile at follow-up as compared with pre-treatment indicated significant decreases in the client’s experience and perception of her symptoms. Endorsements on the Acceptance and Action Questionnaire–II (AAQ-II) at mid-treatment and follow-up suggested that the client achieved greater psychological flexibility. This case serves as evidence that individuals with AvPD and significant symptoms of anxiety and depression can be receptive to, and can benefit from, the integration of third-generation cognitive-behavioral therapies.
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Chan CC, Trachik BJ, Bedwell JS. An event-related potential investigation of error monitoring in adults with a history of psychosis. Clin Neurophysiol 2014; 126:1717-26. [PMID: 25515589 DOI: 10.1016/j.clinph.2014.11.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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: 05/01/2014] [Revised: 10/24/2014] [Accepted: 11/20/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Previous research suggests that deficits in error monitoring contribute to psychosis and poor functioning. Consistent with the NIMH Research Domain Criteria initiative, this study examined electrophysiological brain activity, appraisal of self-performance, and personality traits related to psychosis during error monitoring in individuals with and without a history of psychosis across disorders. METHODS Error-related negativity (ERN), correct response negativity (CRN), error positivity (Pe), and correct response positivity (Pc) were recorded in 14 individuals with a history of psychosis (PSY) and 12 individuals with no history of psychosis (CTR) during a flanker task. Participants continuously rated their performance and completed the Schizotypal Personality Questionnaire-Brief Revised (SPQ-BR). RESULTS Compared with CTR, PSY exhibited reduced ERN and Pe amplitudes and was also less accurate at evaluating their performance. Group differences were specific to error trials. Across all participants, smaller Pe amplitudes were associated with greater scores on the SPQ-BR Cognitive-Perceptual factor and less accuracy in subjective identification of errors. CONCLUSIONS Individuals with a history of psychosis, regardless of diagnosis, demonstrated abnormal neural activity and imprecise confidence in response during error monitoring. SIGNIFICANCE Results suggest that disruptions in neural circuitry may underlie specific clinical symptoms across diagnostic categories.
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Affiliation(s)
- Chi C Chan
- Department of Psychology, University of Central Florida, Orlando, FL, USA.
| | - Benjamin J Trachik
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Jeffrey S Bedwell
- Department of Psychology, University of Central Florida, Orlando, FL, USA
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Yeung PY, Wong LL, Chan CC, Leung JLM, Yung CY. A validation study of the Hong Kong version of Montreal Cognitive Assessment (HK-MoCA) in Chinese older adults in Hong Kong. Hong Kong Med J 2014; 20:504-10. [PMID: 25125421 DOI: 10.12809/hkmj144219] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [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] Open
Abstract
OBJECTIVE To validate the Hong Kong version of Montreal Cognitive Assessment (HK-MoCA) in identification of mild cognitive impairment and dementia in Chinese older adults. DESIGN Cross-sectional study. SETTING Cognition clinic and memory clinic of a public hospital in Hong Kong. PARTICIPANTS A total of 272 participants (dementia, n=130; mild cognitive impairment, n=93; normal controls, n=49) aged 60 years or above were assessed using HK-MoCA. The HK-MoCA scores were validated against expert diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed) criteria for dementia and Petersen's criteria for mild cognitive impairment. Statistical analysis was performed using receiver operating characteristic curve and regression analyses. Additionally, comparison was made with the Cantonese version of Mini-Mental State Examination and Global Deterioration Scale. RESULTS The optimal cutoff score for the HK-MoCA to differentiate cognitive impaired persons (mild cognitive impairment and dementia) from normal controls was 21/22 after adjustment of education level, giving a sensitivity of 0.928, specificity of 0.735, and area under the curve of 0.920. Moreover, the cutoff to detect mild cognitive impairment was 21/22 with a sensitivity of 0.828, specificity of 0.735, and area under the curve of 0.847. Score of the Cantonese version of the Mini-Mental State Examination to detect mild cognitive impairment was 26/27 with a sensitivity of 0.785, specificity of 0.816, and area under the curve of 0.857. At the optimal cutoff of 18/19, HK-MoCA identified dementia from controls with a sensitivity of 0.923, specificity of 0.918, and area under the curve of 0.971. CONCLUSION The HK-MoCA is a useful cognitive screening instrument for use in Chinese older adults in Hong Kong. A score of less than 22 should prompt further diagnostic assessment. It has comparable sensitivity with the Cantonese version of Mini-Mental State Examination for detection of mild cognitive impairment. It is brief and feasible to conduct in the clinical setting, and can be completed in less than 15 minutes. Thus, HK-MoCA provides an attractive alternative screening instrument to Mini-Mental State Examination which has ceiling effect (ie may fail to detect mild/moderate cognitive impairment in people with high education level or premorbid intelligence) and needs to be purchased due to copyright issues.
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Affiliation(s)
- P Y Yeung
- Department of Rehabilitation, Kowloon Hospital, 147A Argyle Street, Hong Kong
| | - L L Wong
- Department of Psychiatry, United Christian Hospital, Kwun Tong, Hong Kong
| | - C C Chan
- Department of Medicine and Geriatrics, United Christian Hospital, Kwun Tong, Hong Kong
| | - Jess L M Leung
- Department of Psychiatry, United Christian Hospital, Kwun Tong, Hong Kong
| | - C Y Yung
- Department of Medicine and Geriatrics, United Christian Hospital, Kwun Tong, Hong Kong
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Lui PY, Lee KL, Tam KY, Chan CC. Imaging in Salmonella spp. Infection. Hong Kong J Radiol 2014. [DOI: 10.12809/hkjr1413205] [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: 11/05/2022] Open
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Chan LWY, Chan CC, Wong FK. Calcium Pyrophosphate Dihydrate Crystal Deposition Disease of the Temporomandibular Joint. Hong Kong J Radiol 2013. [DOI: 10.12809/hkjr1311049] [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: 11/05/2022] Open
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Tam HKY, Chan CC, Lui PPY, Lee PSF. Angiosarcoma of the Spleen with Spontaneous Rupture. Hong Kong J Radiol 2013. [DOI: 10.12809/hkjr1312086] [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: 11/05/2022] Open
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31
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Chan CC, Roy A, Stanley PRW, Mathew B. A rare case of primary malignant melanoma in an ileostomy. J Plast Reconstr Aesthet Surg 2012; 65:e354-6. [PMID: 23059133 DOI: 10.1016/j.bjps.2012.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Revised: 07/04/2012] [Accepted: 09/10/2012] [Indexed: 02/03/2023]
Abstract
The vast majority of malignant melanomas occur in the skin. These are associated with sunlight exposure and thought to be due to ultraviolet radiation. Melanomas in rare instances (1.3-1.4 percent) may originate from extracutaneous tissues such as the leptomeninges.(1) They have also been reported arising from gastrointestinal, respiratory and genitourinary mucosa. Sunlight is not an aetiologic factor with mucosal melanomas. Herein, we report an extremely rare example of malignant melanoma arising from the mucocutaneous junction of an ileostomy. Only one such case has been reported in the literature.(2).
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Affiliation(s)
- C C Chan
- Plastic Surgery Department, Castle Hill Hospital, Castle Road, Cottingham HU165JQ, UK.
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Roberge FG, Martin DF, Xu D, Chen H, Chan CC. Synergism between corticosteroids and Rapamycin for the treatment of intraocular inflammation. Ocul Immunol Inflamm 2012; 3:195-202. [PMID: 22823241 DOI: 10.3109/09273949509069112] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The authors studied the combination effect of corticosteroids with the new immunosuppressant Rapamycin for the treatment of intraocular inflammation. A median-effect analysis, of the combined effect of Rapamycin and dexamethasone, was performed on the inhibition of lymphocyte proliferation in culture. The mathematical formulas allowed for the calculation of combination indices and dose-reduction factors. On the basis of these in-vitro results, treatment with reduced doses of drugs in combination was evaluated in the rat model of experimental autoimmune uveoretinitis. The results showed that Rapamycin and dexamethasone were synergistic over a wide concentration range. The calculated dose reduction factors indicated that an equivalent inhibition of lymphocyte proliferation was achieved with a combination of Rapamycin and dexamethasone reduced by 5-7 and 3-6 fold respectively, compared to the concentration required when each drug was used alone. In animals, there was a significant reduction of the incidence and severity of ocular inflammation with low doses of the drugs in combination. The authors conclude that the observed synergistic effect between Rapamycin and dexamethasone suggests that the use of this drug combination might be advantageous in the treatment of patients with severe uveitis.
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Affiliation(s)
- F G Roberge
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD, USA
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Shah DN, Piacentini MA, Burnier MN, McLean IW, Nussenblatt RB, Chan CC. Inflammatory cellular kinetics in sympathetic ophthalmia a study of 29 traumatized (exciting) eyes. Ocul Immunol Inflamm 2012; 1:255-62. [PMID: 22822781 DOI: 10.3109/09273949309085026] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
An immunohistochemical study was conducted on 29 cases of sympathetic ophthalmia (SO). Monoclonal antibodies against T, B, NK cells, macrophages, and MHC class II antigen (HLA-DR) were used. The choroidal infiltrate in 20 eyes was predominantly T cell while B cell predominated in four cases. All eyes with a B cell predominance came from males. A predominance of B cells was correlated to a longer duration of the disease (> 9 months) and in eyes showing phthisical changes. There was no correlation between a predominance of B cells with age, race, corticosteroid treatment or histological type (typical or atypical). These findings suggest that, although SO is a T cell mediated disease, the predominance of B cells in some cases may represent the end stage of the disease process, or seems a secondary pathological process. The kinetic change in cell populations during the disease may have therapeutic implication.
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Affiliation(s)
- D N Shah
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda
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Roberge FG, Kozhich A, Chan CC, Martin DF, Nussenblatt RB, De Smet MD. Inhibition of cellular transfer of experimental autoimmune uveoretinitis by Rapamycin. Ocul Immunol Inflamm 2012; 1:269-73. [PMID: 22822783 DOI: 10.3109/09273949309085028] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The crucial role of CD4(+) T cells in mediating uveitis is well recognized. One treatment strategy of non-infectious uveitis therefore seeks to inhibit T cell function. For that purpose the authors have evaluated the efficacy of Rapamycin (RAPA), an inhibitor of lymphocyte response to growth factors. To reproduce as best as possible the immune system condition during active disease, the adoptive transfer of activated T cells was used to induce experimental autoimmune uveoretinitis (EAU). Treatment with RAPA was delivered by continuous intravenous infusion. The results showed a complete inhibition of EAU transfer at the RAPA dose of 0.1 mg/kg/day. They indicate that RAPA could be a useful immunosuppressant for uveitis therapy.
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Affiliation(s)
- F G Roberge
- Laboratory of Immunology, National Eye Institute, Bethesda, MD, 20892, USA
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35
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Lee AWM, Ng WT, Chan LK, Chan OSH, Hung WM, Chan CC, Cheng PTC, Sze H, Lam TS, Yau TK. The strength/weakness of the AJCC/UICC staging system (7th edition) for nasopharyngeal cancer and suggestions for future improvement. Oral Oncol 2012; 48:1007-1013. [PMID: 22525607 DOI: 10.1016/j.oraloncology.2012.03.022] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 03/23/2012] [Accepted: 03/26/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE To evaluate the current AJCC/UICC staging system (7th edition) for nasopharyngeal carcinoma and to explore for future improvement. MATERIALS AND METHODS A total of 985 patients, initially staged with preceding 5-6th edition, were retrospectively re-staged with the 7th edition. All were assessed by magnetic resonance imaging, and all 945 non-disseminated patients were irradiated with conformal/intensity-modulated technique. RESULTS Staging factors by both the 5-6th edition and the 7th edition were strongly significance for important endpoints (p<0.001). Down-staging of the previous T2a to T1 and, stages IIA to I in the 7th edition was appropriate. However, the impacts on overall stage distribution and prognostication were minimal. Further down-staging of the current T2 to T1, N2 to N1, stages II to I, and merging of N3a and N3b, stages IVA and IVB were suggested. With the 7th edition, the 5-year disease-specific survival (DSS) was 100% for stage I, 95% for II, 90% for III, 67% for IVA, 68% for IVB and 18% for IVC. The corresponding DSS for the proposed stages I, II, III and IV were 95%, 86%, 67% and 18%, respectively. CONCLUSIONS The changes introduced in the 7th edition were appropriate, but the magnitude of improvement was minimal. With improving results by modern management, further simplification of the staging system is suggested. The proposed system could lead to more accurate prognostication, further validation is warranted.
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Affiliation(s)
- Anne W M Lee
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China.
| | - W T Ng
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - L K Chan
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Oscar S H Chan
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - W M Hung
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - C C Chan
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Peter T C Cheng
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Henry Sze
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - T S Lam
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - T K Yau
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
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Chim CS, Sim JP, Chan CC, Kho BC, Chan JC, Wong LG, Law M, Liang R, Kwong YL. Impact of JAK2V617F mutation on thrombosis and myeloid transformation in essential thrombocythemia: a multivariate analysis by Cox regression in 141 patients. ACTA ACUST UNITED AC 2010; 15:187-92. [PMID: 20670476 DOI: 10.1179/102453309x12583347113933] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To perform a multivariate analysis by Cox proportional hazard model of the impact of JAK2 V617F mutation on thrombosis and myeloid transformations in patients with essential thrombocythemia (ET). PATIENTS AND METHODS The clinicopathologic features and outcome of a cohort of Chinese ET patients were retrospectively reviewed. JAK2 V617F mutation was detected by allele-specific polymerase chain reaction. Potential risk factors including JAK2 V617F that might impact on thrombosis and outcome were studied by multivariate analysis with Cox proportional hazard model. RESULTS Of 141 patients studied, JAK2 V617F was found in 80 cases (57%). JAK2 V617F was positively correlated with hemoglobin and leukocyte count at diagnosis. Univariate analysis showed significant thrombotic risks to be JAK2 V617F (P=0.006), hemoglobin >13 g/dl (P=0.015), and age >55 years (P=0.011). However, in multivariate analysis, only age and hemoglobin were independent risk factors. JAK2 V617F was unrelated to survival or leukemic/myelofibrotic transformation. CONCLUSION In Chinese patients with ET, JAK2 V617F was positively associated with age, hemoglobin, and leukocyte count, but was not an independent risk for thrombosis.
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Affiliation(s)
- C S Chim
- Department of Medicine and Cancer Research Centre, Queen Mary Hospital, University of Hong Kong, Hong Kong.
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Wang IJ, Wu YN, Wu WC, Leonardi G, Sung YJ, Lin TJ, Wang CL, Kuo CF, Wu KY, Cheng WC, Chan CC, Chen PC, Lin SL. The association of clinical findings and exposure profiles with melamine associated nephrolithiasis. Arch Dis Child 2009; 94:883-7. [PMID: 19608552 DOI: 10.1136/adc.2009.163477] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [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: 11/04/2022]
Abstract
BACKGROUND Little is known about the exposure profiles of melamine in children. We evaluated the association of clinical findings, exposure patterns and biomarkers with nephrolithiasis in children with potential exposure to melamine. METHODS A case-control study was conducted in children aged 0-16 years with potential exposure to contaminated dairy products. Cases were defined as nephrolithiasis detected by renal ultrasonography. On the basis of different brands of contaminated dairy products consumed, subjects were classified into high exposure, low exposure and control groups with estimated melamine exposure levels of higher than 2.5 ppm, 0.05-2.5 ppm and lower than detection limits <0.05 ppm. We measured urine melamine for those with nephrolithiasis and age-matched and gender-matched controls within the subset of the study population. RESULTS The duration of consumption of contaminated products was longer in children with nephrolithiasis in the high exposure group than in controls (median (IQR) 12.0 (3.3-24.0) vs 6.0 (4.0-7.0) months; p = 0.048). High melamine exposure levels were significantly associated with nephrolithiasis (OR 61.04 (95% CI 12.73 to 292.84)). The risk was found to increase with estimate melamine exposure levels (p for trend <0.001). Two among 10 affected subjects with nephrolithiasis showed elevated urine melamine levels. In comparison, levels of all 20 controls were lower than the detection limit. CONCLUSIONS The risk of melamine-associated nephrolithiasis was related to duration of consumption of contaminated products and estimated melamine exposure levels. Though urine melamine was not a sensitive test, it might serve as an exposure biomarker in melamine-associated nephrolithiasis.
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Affiliation(s)
- I J Wang
- Department of Pediatrics,Taipei Hospital, Taipei, Taiwan
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Benezra D, Gery I, Chan CC, Nussen-Blatt RB, Palestine AG, Kaiser-Kupfer M, Maftzir G, Peer J. Cellular and humoral immune parameters among patients with retinitis pigmentosa and other retinal disorders. ACTA ACUST UNITED AC 2009; 4:193-7. [PMID: 6545397 DOI: 10.3109/13816818409006121] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Patients with retinitis pigmentosa, other retinal degenerations and a group of normal volunteers were included in a masked study designed to examine the existence of autoimmune reactions toward retinal antigens and the possible defect in lymphokine production (IL-1, IL-2 and gamma interferon). The results obtained did not show any specific anamnestic response to the retinal S-Ag nor any outstanding defect in gamma interferon production by the lymphocytes of patients with retinitis pigmentosa. It is suggested that a larger masked study be conducted as soon as possible in order to clarify these aspects of immune aberrations in patients with retinitis pigmentosa.
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Chan CC, Lau PY, Sun LK, Lo SS. Arachnoiditis ossificans. Hong Kong Med J 2009; 15:146-148. [PMID: 19342743] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Arachnoiditis ossificans is a rare type of chronic arachnoiditis characterised by the presence of calcification or ossification of the spinal arachnoid. There are a few reports of this condition in Japanese and western populations but no case has been reported in a Chinese population before. We describe a 35-year-old woman with typical findings of arachnoiditis ossificans. A brief review of the literature is also presented.
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Affiliation(s)
- C C Chan
- Radiology Department, United Christian Hospital, Kwun Tong, Hong Kong.
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Sun J, Chan CC, Shum P, Poh CL. Experimental analysis of spectral characteristics of antiresonant guiding photonic crystal fibers. Opt Lett 2008; 33:809-811. [PMID: 18414540 DOI: 10.1364/ol.33.000809] [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] [Indexed: 05/26/2023]
Abstract
Both numerical and experimental analyses are carried out to investigate the spectral characteristics of antiresonant guiding photonic crystal fibers. The transmission minima were observed at the wavelengths where LP(ml) (m<or=4, l=1,2,3,(...)) modes of the high-index inclusions in the cladding are cut off. As the order of modes increases, the bandwidths of the corresponding stop bands gradually reduce.
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Affiliation(s)
- J Sun
- Division of Bioengineering, School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore 637457.
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Chao HM, Chen YH, Liu JH, Lee SM, Lee FL, Chang Y, Yeh PH, Pan WHT, Chi CW, Liu TY, Lui WY, Ho LT, Kuo CD, Lin DE, Chan CC, Yang DM, Lin AMY, Chao FP. Iron-generated hydroxyl radicals kill retinal cells in vivo: effect of ferulic acid. Hum Exp Toxicol 2008; 27:327-39. [PMID: 18684804 DOI: 10.1177/0960327108092294] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Siderosis bulbi is vision threatening. An investigation into its mechanisms and management is crucial. Experimental siderosis was established by intravitreous administration of an iron particle (chronic) or FeSO4 (acute). After siderosis, there was a significant dose-responsive reduction in eletroretinogram (a/b-wave) amplitude, and an increase in •OH level, greater when caused by 24 mM FeSO4 than that by 8 mM FeSO4. Furthermore, the FeSO4-induced oxidative stress was significantly blunted by 100 μM ferulic acid (FA). Siderosis also resulted in an excessive glutamate release, increased [Ca++]i, and enhanced superoxide dismutase immunoreactivity. The latter finding was consistent with the Western blot result. Obvious disorganization including loss of photoreceptor outer segments and cholinergic amacrines together with a wide-spreading ferric distribution across the retina was present, which were related to the eletro-retinographic and pathologic dysfunctions. Furthermore, b-wave reduction and amacrine damage were respectively, significantly, dose-dependently, and clearly ameliorated by FA. Thus, siderosis stimulates oxidative stress, and possibly, subsequent excitotoxicity, and calcium influx, which explains why the retina is impaired electro-physiologically and pathologically. Importantly, FA protects iron toxicity perhaps by acting as a free radical scavenger. This provides an approach to the study and treatment of the iron-related disorders such as retained intraocular iron and Alzheimer disease.
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Affiliation(s)
- HM Chao
- Department of Ophthalmology, Veterans General Hospital, Taipei, Taiwan, Republic of China; Department of Ophthalmology, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China; Institute of Pharmacology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China; Institute of Biomedical Engineering, National Yang-Ming University, Taipei, Taiwan, Republic of China; Department of Ophthalmology, China Medical University Hospital,
| | - YH Chen
- Department of Ophthalmology, Veterans General Hospital, Taipei, Taiwan, Republic of China; Institute of Pharmacology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China
| | - JH Liu
- Department of Ophthalmology, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China; Cheng Hsin Rehabilitation Medical Center, Taipei, Taiwan, Republic of China
| | - SM Lee
- Department of Ophthalmology, Veterans General Hospital, Taipei, Taiwan, Republic of China; Department of Ophthalmology, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China
| | - FL Lee
- Department of Ophthalmology, Veterans General Hospital, Taipei, Taiwan, Republic of China; Department of Ophthalmology, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China
| | - Y Chang
- Institute of Biomedical Engineering, National Yang-Ming University, Taipei, Taiwan, Republic of China; Institute of Biophotonics, National Yang-Ming University, Taipei, Taiwan, Republic of China
| | - PH Yeh
- Institute of Pharmacology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China
| | - WHT Pan
- Institute of Pharmacology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China
| | - CW Chi
- Institute of Pharmacology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China; Department of Medical Research and Education, Veterans General Hospital, Taipei, Taiwan, Republic of China
| | - TY Liu
- Institute of Pharmacology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China; Department of Medical Research and Education, Veterans General Hospital, Taipei, Taiwan, Republic of China
| | - WY Lui
- Department of Surgery, Veterans General Hospital, Taipei, Taiwan, Republic of China; Department of Surgery, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China
| | - LT Ho
- Department of Medical Research and Education, Veterans General Hospital, Taipei, Taiwan, Republic of China
| | - CD Kuo
- Department of Medical Research and Education, Veterans General Hospital, Taipei, Taiwan, Republic of China
| | - DE Lin
- Department of Ophthalmology, Veterans General Hospital, Taipei, Taiwan, Republic of China; Institute of Biomedical Engineering, National Yang-Ming University, Taipei, Taiwan, Republic of China
| | - CC Chan
- Department of Ophthalmology, Veterans General Hospital, Taipei, Taiwan, Republic of China; Institute of Biophotonics, National Yang-Ming University, Taipei, Taiwan, Republic of China
| | - DM Yang
- Institute of Biophotonics, National Yang-Ming University, Taipei, Taiwan, Republic of China; Department of Medical Research and Education, Veterans General Hospital, Taipei, Taiwan, Republic of China
| | - AMY Lin
- Department of Medical Research and Education, Veterans General Hospital, Taipei, Taiwan, Republic of China
| | - FP Chao
- Department of Ophthalmology, Veterans General Hospital, Taipei, Taiwan, Republic of China; Department of Medical Research and Education, Veterans General Hospital, Taipei, Taiwan, Republic of China
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Aliferis K, Chan CC, Donati G, Baglivo E. Intraocular lymphoma following a primary testicular lymphoma in remission for 10 years. Int Ophthalmol 2007; 28:439-40. [PMID: 17985076 DOI: 10.1007/s10792-007-9157-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2007] [Accepted: 10/02/2007] [Indexed: 12/28/2022]
Affiliation(s)
- K Aliferis
- Clinique d'Ophtalmologie de Genève-Hôpitaux Universitaires de Genève, Rue Alcide-Jentzer, 22, Bethesda, 1205, Geneva, Switzerland
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Cassoux N, Giron A, Bodaghi B, Tran THC, Baudet S, Davy F, Chan CC, Lehoang P, Merle-Béral H. IL-10 measurement in aqueous humor for screening patients with suspicion of primary intraocular lymphoma. Invest Ophthalmol Vis Sci 2007; 48:3253-9. [PMID: 17591896 PMCID: PMC2078609 DOI: 10.1167/iovs.06-0031] [Citation(s) in RCA: 144] [Impact Index Per Article: 8.5] [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] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To determine the value of IL-10 measurement in aqueous humor (AH) for screening in primary intraocular lymphoma (PIOL). METHODS One hundred consecutive diagnostic or therapeutic vitrectomies were performed in patients with uveitis. During surgery, 100 microL of both AH and pure vitreous was taken. IL-10 levels were determined with a standard quantitative sandwich enzyme immunoassay technique. Patients were distributed in two groups: 51 patients with proven PIOL, 108 patients with uveitis divided into 74 with uveitis of proven etiology and 34 with idiopathic uveitis. Groups were compared by ANOVA and the Tukey-Kramer test or nonparametric Wilcoxon test. Distributions were compared by using the chi(2) test. Segmentation was derived from the ROC curves by choosing a tradeoff between sensitivity and specificity. RESULTS In patients with PIOL, IL-10 mean values were 2205.5 pg/mL (median: 1467 pg/mL) in the vitreous and 543.4 pg/mL (median: 424 pg/mL) in AH. In patients with uveitis (idiopathic and diagnostic uveitis), mean values were 26.6 pg/mL (median: 8 pg/mL) in the vitreous, and 21.9 pg/mL (median: 8 pg/mL) in AH. IL-10 mean values were significantly different between patients with PIOL and patients with uveitis (P < 10(-3)). The areas under the curves were 0.989 and 0.962 for vitreous and AH, respectively. A cutoff of 50 pg/mL in the AH was associated with a sensitivity of 0.89 and a specificity of 0.93. In the vitreous, a cutoff value of 400 pg/mL yielded a specificity of 0.99 and a sensitivity of 0.8. CONCLUSIONS Diagnosis of PIOL is often made months or years after the initial onset of ocular symptoms. Cytology remains the gold standard for diagnosis. However, measurement of IL-10 in the AH is a good screening test to reduce diagnostic delays.
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Affiliation(s)
- Nathalie Cassoux
- Department of Ophthalmology, Hopital Pitié-Salpêtrière, Paris, France.
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Leung VKS, Lam CYW, Chan CC, Ng WL, Loke TKL, Luk IS, Chau TN, Wu AHW, Fong WN, Lam SH. Spontaneous intra-hepatic haemorrhage in a patient with fever of unknown origin. Hong Kong Med J 2007; 13:319-22. [PMID: 17664537] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
Polyarteritis nodosa is a systemic necrotising vasculitis that affects the small- and medium-sized arteries. Multifocal aneurysmal formation in the renal, hepatic, and mesenteric vasculature is a hallmark of this condition, and spontaneous aneurysmal rupture may occur, resulting in life-threatening haemorrhage. We describe a 42-year-old man who initially presented with fever of unknown origin. A diagnosis could not be reached at that time despite extensive investigations. The fever subsided spontaneously after 8 weeks, and the patient remained well for 6 years until he was admitted again for evaluation of fever. During his hospital stay, he developed a spontaneous massive intra-hepatic haemorrhage resulting in hepatic rupture and a haemoperitoneum. The bleeding was controlled at emergency laparotomy. An abdominal angiography demonstrated multiple microaneurysms in the hepatic and mesenteric arterial vasculature. The clinical findings suggested polyarteritis nodosa, and the source of bleeding was probably a ruptured intra-hepatic artery aneurysm.
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Affiliation(s)
- Vincent K S Leung
- Department of Medicine and Geriatrics, United Christian Hospital, Kwun Tong, Hong Kong.
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Sun J, Chan CC. Effect of liquid crystal alignment on bandgap formation in photonic bandgap fibers. Opt Lett 2007; 32:1989-91. [PMID: 17632619 DOI: 10.1364/ol.32.001989] [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] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
A simple analytical model is proposed to study the formation of bandgaps in liquid crystal photonic bandgap fibers. The model shows good agreement with full-vectorial plane-wave simulations. Particularly, bandgap splitting is observed due to anisotropy. If the optic axis of the liquid crystal lies perpendicular to the fiber axis, splitting of the fundamental modes of E(x) and E(y) is also observed.
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Affiliation(s)
- J Sun
- Division of Bioengineering, School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore, 637457.
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Kong J, Tang DY, Chan CC, Lu J, Ueda K, Yagi H, Yanagitani T. High-efficiency 1040 and 1078 nm laser emission of a Yb:Y2O3 ceramic laser with 976 nm diode pumping. Opt Lett 2007; 32:247-9. [PMID: 17215934 DOI: 10.1364/ol.32.000247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
We report a high-efficiency diode-end-pumped polycrystalline Yb:Y2O3 ceramic laser. Pumped by a 976 nm laser diode bar and with an absorbed pump power of 2.8 W, cw output power of 1.74 W at 1078 nm, and 0.73 W at 1040 nm were obtained. The slope efficiency was measured to be 82.4% for the 1078 nm laser emission and 57.1% for the 1040 nm laser emission.
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Affiliation(s)
- J Kong
- School of Electrical and Electronic Engineering, Nanyang Technological University, Singapore 639798.
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Chan CC, Li A, Fan WC, Sun LK, Cheng HC, Chan JCS. Subchondral insufficiency fracture of the femoral head. Hong Kong Med J 2006; 12:460-2. [PMID: 17148800] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
Subchondral insufficiency fracture of the femoral head is a recently recognised entity. There are a few cases reported in Japanese and Caucasian patients but none in the Hong Kong population. The condition typically occurs in elderly females with osteoporosis. Acute hip pain is the usual presentation. The patient may have concomitant insufficiency fractures elsewhere. Magnetic resonance imaging is usually required to make the diagnosis. The prognosis of the condition is unknown. Reported complications include rapid collapse of the femoral head and coxopathy. Joint replacement should be considered if conservative management fails.
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Affiliation(s)
- C C Chan
- United Christian Hospital, Hong Kong: Department of Radiology.
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Chan CC, Saunders DE, Chong WK, Hartley BE, Raglan E, Rajput K. Advancement in post-meningitic lateral semicircular canal labyrinthitis ossificans. J Laryngol Otol 2006; 121:105-9. [PMID: 17123454 DOI: 10.1017/s002221510600377x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/06/2006] [Indexed: 11/06/2022]
Abstract
Objective: To assess whether lateral semicircular canal (LSCC) ossification is more advanced than that in the cochlear basal turn, in order to judge the value of the former as a predictor.Methods: Retrospective review of 33 paediatric patients from our cochlear implant programme, with profound sensorineural hearing loss after bacterial meningitis. Magnetic resonance imaging (MRI), computed tomography (CT) scans and operative findings were reviewed.Results: On CT, LSCC ossification scores were more advanced than those for the cochlear basal turn in 69.9 per cent of implanted ears. Forty-five per cent (15/33) of children had ossification at surgery. In predicting this, the sensitivity of CT LSCC ossification was 90 per cent and that of MRI LSCC ossification was 83.3 per cent.Conclusions: The more advanced ossification found in the LSCC, compared with that in the cochlear basal turn, adds to previous findings of LSCC pathology predicting cochlear ossification. Surprisingly, CT of the LSCC appears to be no less valuable than MRI in pre-operative cochlear implant assessment of post-meningitic children.
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Affiliation(s)
- C C Chan
- Department of Audiological Medicine, St Ann's Hospital, London, UK
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Wu J, Tang DY, Zhao LM, Chan CC. Soliton polarization dynamics in fiber lasers passively mode-locked by the nonlinear polarization rotation technique. Phys Rev E Stat Nonlin Soft Matter Phys 2006; 74:046605. [PMID: 17155190 DOI: 10.1103/physreve.74.046605] [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: 05/04/2006] [Revised: 08/12/2006] [Indexed: 05/12/2023]
Abstract
By numerically solving the coupled laser Ginzburg-Landau equations and using the pulse tracing technique to incorporate the cavity effect in the simulation, we have explicitly calculated the soliton polarization ellipses throughout the cavity of a fiber-ring laser mode-locked by the nonlinear polarization rotation technique, and investigated the soliton polarization dynamics in laser cavities. It was found that in a conventional stable soliton operation state, although the soliton polarization varies as the pulse propagates, at a fixed position inside the laser cavity the soliton polarization is invariant with time. However, in the presence of laser dynamics, at a fixed location within the cavity the soliton could either have multiple alternating fixed polarization states or no fixed polarization state at all, depending on the soliton dynamics.
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Affiliation(s)
- J Wu
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore 639798
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Abstract
A spacing-tunable multiwavelength Raman fiber laser with an independently-adjustable channel number is proposed and demonstrated. It uses a novel free-spectral-range (FSR)-tunable comb filter based on a superimposed chirped-fiber Bragg grating (CFBG) and a linear cavity formed by a bandwidth-tunable CFBG reflector, a pumped highly-nonlinear fiber for Raman gain, and an optical circulator based loop mirror. Multiwavelength laser operations with spacing tuning from 0.3 to 0.6 nm and channel number adjustment from 2 to 10 have been achieved.
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