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Huang KC, Lin DSH, Jeng GS, Lin TT, Lin LY, Lee CK, Lin LC. Left Ventricular Segmentation, Warping, and Myocardial Registration for Automated Strain Measurement. J Imaging Inform Med 2024:10.1007/s10278-024-01119-5. [PMID: 38639806 DOI: 10.1007/s10278-024-01119-5] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 04/07/2024] [Accepted: 04/09/2024] [Indexed: 04/20/2024]
Abstract
The left ventricular global longitudinal strain (LVGLS) is a crucial prognostic indicator. However, inconsistencies in measurements due to the speckle tracking algorithm and manual adjustments have hindered its standardization and democratization. To solve this issue, we proposed a fully automated strain measurement by artificial intelligence-assisted LV segmentation contours. The LV segmentation model was trained from echocardiograms of 368 adults (11,125 frames). We compared the registration-like effects of dynamic time warping (DTW) with speckle tracking on a synthetic echocardiographic dataset in experiment-1. In experiment-2, we enrolled 80 patients to compare the DTW method with commercially available software. In experiment-3, we combined the segmentation model and DTW method to create the artificial intelligence (AI)-DTW method, which was then tested on 40 patients with general LV morphology, 20 with dilated cardiomyopathy (DCMP), and 20 with transthyretin-associated cardiac amyloidosis (ATTR-CA), 20 with severe aortic stenosis (AS), and 20 with severe mitral regurgitation (MR). Experiments-1 and -2 revealed that the DTW method is consistent with dedicated software. In experiment-3, the AI-DTW strain method showed comparable results for general LV morphology (bias - 0.137 ± 0.398%), DCMP (- 0.397 ± 0.607%), ATTR-CA (0.095 ± 0.581%), AS (0.334 ± 0.358%), and MR (0.237 ± 0.490%). Moreover, the strain curves showed a high correlation in their characteristics, with R-squared values of 0.8879-0.9452 for those LV morphology in experiment-3. Measuring LVGLS through dynamic warping of segmentation contour is a feasible method compared to traditional tracking techniques. This approach has the potential to decrease the need for manual demarcation and make LVGLS measurements more efficient and user-friendly for daily practice.
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Affiliation(s)
- Kuan-Chih Huang
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- National Taiwan University Hospital, Hsin-Chu branch, Hsinchu, Taiwan
| | - Donna Shu-Han Lin
- Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Geng-Shi Jeng
- Institute of Electronics, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Ting-Tse Lin
- Section of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Lian-Yu Lin
- Section of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Kuo Lee
- National Taiwan University Hospital, Hsin-Chu branch, Hsinchu, Taiwan
| | - Lung-Chun Lin
- Section of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
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Pan HY, Lee CK, Liu TY, Lee GW, Chen CW, Wang TD. The role of wearable home blood pressure monitoring in detecting out-of-office control status. Hypertens Res 2024; 47:1033-1041. [PMID: 38242946 PMCID: PMC10994837 DOI: 10.1038/s41440-023-01539-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
Ambulatory blood pressure (ABP) and home blood pressure (HBP) monitoring is currently recommended for management of hypertension. Nonetheless, traditional HBP protocols could overlook diurnal fluctuations, which could also be linked with adverse cardiovascular outcomes. In this observational study, we studied among a group of treated hypertensive patients (N = 62, age: 52.4 ± 10.4 years) by using out-of-office ABP and wearable HBP. They received one session of 24-h ABP measurement with an oscillometric upper-arm monitor, and totally three sessions of 7-day/6-time-daily wearable HBP measurement separated in each month with HeartGuide. Controlled hypertension is defined as an average BP <130/80 mmHg for both daytime ABP and HBP. There was substantial reliability (intraclass correlation coefficient, ICC 0.883-0.911) and good reproducibility (Cohen's kappa = 0.600) for wearable HBP measurement, especially before breakfast and after dinner. Among all patients, 27.4% had both uncontrolled HBP and ABP, 30.6% had uncontrolled HBP only, while 6.5% had uncontrolled ABP only. Female gender and increased numbers of anti-hypertensive agents are correlated with controlled hypertension. Patients with uncontrolled hypertension had a significantly higher maximal daytime blood pressure, which was previously signified as an imperial marker for cardiovascular risk. In conclusion, wearable HBP monitoring in accordance with a dedicated daily-living schedule results in good reliability and reproducibility. Patients with an uncontrolled wearable HBP should benefit from repeated HBP or ABP measurement for risk stratification.
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Affiliation(s)
- Heng-Yu Pan
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu City, Taiwan
| | - Chih-Kuo Lee
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu City, Taiwan
| | - Tzu-Yao Liu
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu City, Taiwan
| | - Guan-Wei Lee
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu City, Taiwan
| | - Chiao-Wei Chen
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu City, Taiwan
| | - Tzung-Dau Wang
- Cardiovascular Center and Divisions of Cardiology and Hospital Medicine, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan.
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Boey JY, Kong U, Lee CK, Lim GK, Oo CW, Tan CK, Ng CY, Azniwati AA, Tay GS. The effect of spent coffee ground (SCG) loading, matrix ratio and biological treatment of SCG on poly(hydroxybutyrate) (PHB)/poly(lactic acid) (PLA) polymer blend. Int J Biol Macromol 2024; 266:131079. [PMID: 38537860 DOI: 10.1016/j.ijbiomac.2024.131079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 03/11/2024] [Accepted: 03/20/2024] [Indexed: 04/06/2024]
Abstract
This study investigates the effects of SCG embedded into biodegradable polymer blends and aimed to formulate and characterise biomass-reinforced biocomposites using spent coffee ground (SCG) as reinforcement in PHB/PLA polymer blend. The effect of SCG filler loading and varying PHB/PLA ratios on the tensile properties and morphological characteristics of the biocomposites were examined. The results indicated that tensile properties reduction could be due to its incompatibility with the PHB/PLA matrixSCG aggregation at 40 wt% content resulted in higher void formation compared to lower content at 10 wt%. A PHB/PLA ratio of 50/50 with SCG loading 20 wt% was chosen for biocomposites with treated SCG. Biological treatment of SCG using Phanerochaete chrysosporium CK01 and Aspergillus niger DWA8 indicated P. chrysosporium CK01 necessitated a higher moisture content for optimum growth and enzyme production, whereas the optimal conditions for enzyme production (50-55 %, w/w) differed from those promoting A. niger DWA8 growth (40 %, w/w). SEM micrographs highlighted uniform distribution and effective wetting of treated SCG, resulting in improvements of tensile strength and modulus of biocomposites, respectively. The study demonstrated the effectiveness of sustainable fungal treatment in enhancing the interfacial adhesion between treated SCG and the PHB/PLA matrix.
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Affiliation(s)
- J Y Boey
- School of Industrial Technology, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia
| | - U Kong
- School of Industrial Technology, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia
| | - C K Lee
- School of Industrial Technology, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia
| | - G K Lim
- School of Chemical Sciences, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia
| | - C W Oo
- School of Chemical Sciences, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia
| | - C K Tan
- PMI Packaging Sdn. Bhd., Taman Perindustrian Senai, 81400 Senai, Johor, Malaysia
| | - C Y Ng
- CY Enterprise Sdn. Bhd., Taman Perindustrian Murni, 81400 Senai, Johor, Malaysia
| | - A A Azniwati
- School of Industrial Technology, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia
| | - G S Tay
- School of Industrial Technology, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia.
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Huang KI, Su FY, Ho HY, Ho HC, Chen YW, Lee CK, Lai F, Lu HHS, Ko ML. Axial length, more than aging, decreases the thickness and superficial vessel density of retinal nerve fiber layer in non-glaucomatous eyes. Int Ophthalmol 2024; 44:130. [PMID: 38478099 PMCID: PMC10937793 DOI: 10.1007/s10792-024-02961-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 12/04/2023] [Indexed: 03/17/2024]
Abstract
PURPOSE This study seeks to build a normative database for the vessel density of the superficial retina (SVD) and evaluate how changes and trends in the retinal microvasculature may be influenced by age and axial length (AL) in non-glaucomatous eyes, as measured with optical coherence tomography angiography (OCTA). METHODS We included 500 eyes of 290 healthy subjects visiting a county hospital. Each participant underwent comprehensive ophthalmological examinations and OCTA to measure the SVD and thickness of the macular and peripapillary areas. To analyze correlations between SVD and age or AL, multivariable linear regression models with generalized estimating equations were applied. RESULTS Age was negatively correlated with the SVD of the superior, central, and inferior macular areas and the superior peripapillary area, with a decrease rate of 1.06%, 1.36%, 0.84%, and 0.66% per decade, respectively. However, inferior peripapillary SVD showed no significant correlation with age. AL was negatively correlated with the SVD of the inferior macular area and the superior and inferior peripapillary areas, with coefficients of -0.522%/mm, -0.733%/mm, and -0.664%/mm, respectively. AL was also negatively correlated with the thickness of the retinal nerve fiber layer and inferior ganglion cell complex (p = 0.004). CONCLUSION Age and AL were the two main factors affecting changes in SVD. Furthermore, AL, a relative term to represent the degree of myopia, had a greater effect than age and showed a more significant effect on thickness than on SVD. This relationship has important implications because myopia is a significant issue in modern cities.
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Affiliation(s)
- Kuan-I Huang
- Department of Ophthalmology, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Fang-Ying Su
- Institute of Statistics, National Chiao Tung University, Hsinchu City, Taiwan
- Biotechnology R&D Center, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
| | - Heng-Yen Ho
- School of Medicine, National Taiwan University, Taipei, Taiwan
| | - Heng-Chen Ho
- School of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yan-Wu Chen
- Department of Applied Mathematics, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Chih-Kuo Lee
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Feipei Lai
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | | | - Mei-Lan Ko
- Department of Ophthalmology, National Taiwan University Hospital, Hsin Chu Branch, Hsinchu City, Taiwan.
- Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu City, Taiwan.
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Hsu JY, Lee CK, Chaung SY, Cheng CH, Dai LP, Hsieh MY, Yang CW, Wu CC. Incidence and Predictors of Acute Coronary Syndrome in Patients on Maintenance Hemodialysis: A Prospective Cohort Study. Acta Cardiol Sin 2024; 40:191-199. [PMID: 38532820 PMCID: PMC10961640 DOI: 10.6515/acs.202403_40(2).20231022a] [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] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/22/2023] [Indexed: 03/28/2024]
Abstract
Background Cardiovascular diseases are the leading cause of death among patients on hemodialysis, with approximately 40% of the cardiovascular deaths linked to acute coronary syndrome. We aimed to investigate the incidence and risk factors of acute coronary syndrome in patients undergoing hemodialysis. Methods Patients undergoing hemodialysis were prospectively enrolled from January 2018. Data regarding hospitalization due to acute coronary syndrome were collected at 3-month intervals through December 31, 2021. Cox regression model was used to estimate the association between baseline factors and incident acute coronary syndrome during follow-up. Results Patients' mean age was 66 years, 48% were men, and 16% had a history of coronary artery disease at enrolment. Over a median follow-up of 1,187 days, 85 patients were hospitalized due to acute coronary syndrome. Left main or triple vessel disease was identified in 67 patients. Risk factors associated with incident acute coronary syndrome included aging, male sex, smoking, low diastolic blood pressure, and baseline comorbidities, in addition to dialysis factors including low urea clearance, central venous catheter use, and history of dialysis access dysfunction. After multivariate analysis, age, diabetes, hyperlipidemia, smoking, and frequent interventions for vascular access remained significant risk factors. Conclusions A high acute coronary syndrome incidence was observed in our cohort, with traditional risk factors playing a consistent role with that in the general population. A history of frequent dialysis access dysfunction was also associated with incident acute coronary syndrome.
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Affiliation(s)
- Ju-Yin Hsu
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu
- College of Medicine, National Taiwan University, Taipei
| | - Chih-Kuo Lee
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu
- College of Medicine, National Taiwan University, Taipei
| | - Shou-Yung Chaung
- Institute of Population Health Science, National Health Research Institutes, Zhunan, Miaoli County
| | | | - Li-Pei Dai
- Department of Internal Medicine, Catholic Mercy Hospital
| | - Mu-Yang Hsieh
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University
| | - Chung-Wei Yang
- College of Medicine, National Taiwan University, Taipei
- Hemodialysis Center
| | - Chih-Cheng Wu
- College of Medicine, National Taiwan University, Taipei
- Center of Quality Management, National Taiwan University Hospital Hsinchu Branch
- Institute of Biomedical Engineering, National Tsing-Hua University, Hsinchu
- Institute of Cellular and System Medicine, National Health Research Institutes, Zhunan, Taiwan
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Ng Y, Liao MT, Chen TL, Lee CK, Chou CY, Wang W. Few-shot transfer learning for personalized atrial fibrillation detection using patient-based siamese network with single-lead ECG records. Artif Intell Med 2023; 144:102644. [PMID: 37783539 DOI: 10.1016/j.artmed.2023.102644] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 06/15/2023] [Accepted: 08/28/2023] [Indexed: 10/04/2023]
Abstract
The proliferation of wearable devices has allowed the collection of electrocardiogram (ECG) recordings daily to monitor heart rhythm and rate. For example, 24-hour Holter monitors, cardiac patches, and smartwatches are widely used for ECG gathering and application. An automatic atrial fibrillation (AF) detector is required for timely ECG interpretation. Deep learning models can accurately identify AFs if large amounts of annotated data are available for model training. However, it is impractical to request sufficient labels for ECG recordings for an individual patient to train a personalized model. We propose a Siamese-network-based approach for transfer learning to address this issue. A pre-trained Siamese convolutional neural network is created by comparing two labeled ECG segments from the same patient. We sampled 30-second ECG segments with a 50% overlapping window from the ECG recordings of patients in the MIT-BIH Atrial Fibrillation Database. Subsequently, we independently detected the occurrence of AF in each patient in the Long-Term AF Database. By fine-tuning the model with the 1, 3, 5, 7, 9, or 11 ECG segments ranging from 30 to 180 s, our method achieved macro-F1 scores of 96.84%, 96.91%, 96.97%, 97.02%, 97.05%, and 97.07%, respectively.
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Affiliation(s)
- Yiuwai Ng
- Institute of Applied Mathematical Sciences, National Taiwan University, Taipei, Taiwan.
| | - Min-Tsun Liao
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan; Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Ting-Li Chen
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan.
| | - Chih-Kuo Lee
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan.
| | - Cheng-Ying Chou
- Department of Biomechatronics Engineering, National Taiwan University, Taipei, Taiwan.
| | - Weichung Wang
- Institute of Applied Mathematical Sciences, National Taiwan University, Taipei, Taiwan.
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Hur YJ, Kim J, Seong J, Lee CK, Kim BK, Kim DY. Combination of Radiotherapy and Atezolizumab plus Bevacizumab in Patients with Advanced Hepatocellular Carcinoma: A Pilot Study. Int J Radiat Oncol Biol Phys 2023; 117:e304-e305. [PMID: 37785109 DOI: 10.1016/j.ijrobp.2023.06.2325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Following the results of the IMbrave150 study, Atezolizumab plus bevacizumab (Atezo/beva) became the first-line treatment in patients with advanced hepatocellular carcinoma (HCC). However, its real-world efficacy has been less satisfied. In this study, we investigated the efficacy of radiotherapy (RT) combined with Atezo/beva in patients with advanced HCC. MATERIALS/METHODS Twenty patients received combination of RT and Atezo/beva between December 2021 and December 2022 at our institution. RT was administered in 10 fractions of 5 Gy between Atezo/beva cycles. Tumor response were evaluated on both imaging and tumor marker basis. The iRECIST guideline was used to assess treatment response after the combination treatment of RT and Atezo/beva. Primary endpoints were disease control rate (DCR) and overall response rate (ORR), and secondary endpoint was treatment related toxicity. RESULTS All patients were BCLC C with advanced tumors associated with lymph node metastasis (7, 35%) or distant metastasis (8, 40%). Patients received RT between cycles of Atezo/beva, mostly (14, 70%) between 2nd and 3rd cycles. After a median follow-up of 3.2 months, DCR was 65% and ORR was 20%. Significant decrease in tumor marker of over 2-fold was shown in 10 patients (50%). Regarding treatment related toxicity, only 1 patient (5%) showed grade 3 neutropenic fever, and no grade 4 or 5 toxicity was seen. CONCLUSION Combination of radiotherapy and Atezo/beva showed high response rate with tolerable treatment related toxicity in advanced HCC patients. Further prospective studies with larger patient cohort are warranted.
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Affiliation(s)
- Y J Hur
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea, Republic of (South) Korea
| | - J Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea, Republic of (South) Korea
| | - J Seong
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea, Republic of (South) Korea
| | - C K Lee
- Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea, Republic of (South) Korea
| | - B K Kim
- Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea, Republic of (South) Korea
| | - D Y Kim
- Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea, Republic of (South) Korea
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Cheung SKF, Choi LCW, Chan YS, Ho JCY, Lee CK, Kwok JSY. Identification of 58 novel HLA alleles identified in Chinese individuals by next-generation sequencing. HLA 2023. [PMID: 37376846 DOI: 10.1111/tan.15127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 06/29/2023]
Abstract
HLA genes are the most polymorphic in the human genome. High resolution HLA typing from 13,870 bone marrow donors in Hong Kong was obtained using Next-generation sequencing (NGS) technology. Among the 67 novel alleles identified, official HLA allele names of 50 novel class I alleles (HLA-A, -B, -C) and 8 novel class II alleles (HLA-DRB1, -DQB1) were assigned by the World Health Organization (WHO) Nomenclature Committee for Factors of the HLA System.
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Affiliation(s)
- Stephen K F Cheung
- Division of Transplantation and Immunogenetics, Department of Pathology, Queen Mary Hospital, Hong Kong SAR, China
| | - Leo C W Choi
- Division of Transplantation and Immunogenetics, Department of Pathology, Queen Mary Hospital, Hong Kong SAR, China
| | - Y S Chan
- Division of Transplantation and Immunogenetics, Department of Pathology, Queen Mary Hospital, Hong Kong SAR, China
| | - Jenny C Y Ho
- Division of Transplantation and Immunogenetics, Department of Pathology, Queen Mary Hospital, Hong Kong SAR, China
| | - C K Lee
- Hong Kong Red Cross Blood Transfusion Services, Hong Kong SAR, China
| | - Janette S Y Kwok
- Division of Transplantation and Immunogenetics, Department of Pathology, Queen Mary Hospital, Hong Kong SAR, China
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Ng SC, Chu AWH, Chan WM, Yip CCY, Leung KH, So CK, Leung JNS, To KKW, Lee CK. Re-examine the transfusion transmitted risk of SARS-CoV-2 virus during a major COVID-19 outbreak in 2022. Transfus Med 2023. [PMID: 37286528 DOI: 10.1111/tme.12981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/16/2023] [Accepted: 05/23/2023] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Although no case of COVID-19 transmission through transfusion has been reported, blood transfusion service (BTS) continues to implement pre-donation and post-donation measures to minimise the risk. In year 2022, when local healthcare system was badly impacted by a major outbreak, it opened an opportunity to re-examine the viraemia risk in these asymptomatic donors. MATERIALS AND METHODS Records were retrieved from blood donors who reported COVID-19 after donation and follow-up was also made for recipients who received their blood. Blood samples at donation were tested for SARS-CoV-2 viraemia by single-tube nested real-time RT-PCR assay designed to detect most SARS-CoV-2 variants including the prevailing delta and omicron variants. RESULTS From 1 January to 15 August 2022, the city with 7.4 M inhabitants recorded 1 187 844 COVID-19 positive cases and 125 936 successful blood donations were received. 781 donors reported to the BTS after donation with 701 being COVID-19 related (including close contact and symptoms respiratory tract infection). 525 COVID-19 were positive at the time of call back or follow-up. Of the 701 donations, they were processed into 1480 components with 1073 discarded upon donors' call back. For remaining 407 components, no recipient was found to have adverse event or COVID-19 positive. 510 samples from the above 525 COVID-19 positive donors were available and all tested negative for SARS-CoV-2 RNA. DISCUSSION With the negative SARS-CoV-2 RNA in blood donation samples and follow up data in transfusion recipients, the risk of transfusion transmitted COVID-19 appears negligible. However, current measures remains important in securing blood safety with ongoing surveillance of their effectiveness.
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Affiliation(s)
- S C Ng
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong, China
| | - A W H Chu
- State Key Laboratory for Emerging Infectious Diseases, Carol Yu Centre for Infection, Department of Microbiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - W M Chan
- State Key Laboratory for Emerging Infectious Diseases, Carol Yu Centre for Infection, Department of Microbiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - C C Y Yip
- State Key Laboratory for Emerging Infectious Diseases, Carol Yu Centre for Infection, Department of Microbiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - K H Leung
- State Key Laboratory for Emerging Infectious Diseases, Carol Yu Centre for Infection, Department of Microbiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - C K So
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong, China
| | - J N S Leung
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong, China
| | - K K W To
- State Key Laboratory for Emerging Infectious Diseases, Carol Yu Centre for Infection, Department of Microbiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - C K Lee
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong, China
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Chan MY, Man SC, Lam M, Lai WH, Qin ZS, Ng MKR, Lee CK, Chen YHE, Lee HME, Liu LY, Wong HK, Zhang ZJ. Berberine for antipsychotic-induced metabolic syndrome in patients with schizophrenia spectrum disorders: abridged secondary publication. Hong Kong Med J 2023; 29 Suppl 3:4-7. [PMID: 37357582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023] Open
Affiliation(s)
- M Y Chan
- School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - S C Man
- School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - M Lam
- Department of Adult Psychiatry, Castle Peak Hospital, Hong Kong SAR, China
| | - W H Lai
- Department of Adult Psychiatry, Castle Peak Hospital, Hong Kong SAR, China
| | - Z S Qin
- School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - M K R Ng
- Department of Psychiatry, Kowloon Hospital, Hong Kong SAR, China
| | - C K Lee
- Department of Psychiatry, Kowloon Hospital, Hong Kong SAR, China
| | - Y H E Chen
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - H M E Lee
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - L Y Liu
- Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
| | - H K Wong
- School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Z J Zhang
- School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
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Yusof MR, Mohd Sharin MF, Aizat Sabri I, Jagwani AV, Lee FY, Ahmad Zaidi AI, Saiful Azli MZ, Rk Rishitra RR, Fahmey O, Lee CK, Khairul-Asri MG. [Iatrogenic hypospadias a preventable rare complication with two-stage repair with buccal mucosa graft: a case presen- tation]. Urologiia 2023:115-117. [PMID: 37401715] [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] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
Urethral catheterization is a common procedure, but it is associated with a number of complications. Iatrogenic hypospadias can rarely occur. There is a limited literature dedicated to this condition. We report a young patient with COVID-19 with iatrogenic hypospadias of grade 3. He was undergone to a two-stage procedure with acceptable outcome. Surgical repair should be offered and performed for young patients to ensure good function with acceptable penile appearance. A surgical treatment will improve psychological, sexual and social outcomes.
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Affiliation(s)
- M R Yusof
- Department of Urology, Hospital Serdang, Serdang, Malaysia
- Department of Urology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
- Department of Urology, Hospital Sultan Abdul Aziz Shah UPM, Malaysia
- Plastic and Reconstructive Unit, Department of Surgery, Hospital Sultan Abdul Aziz Shah UPM, Malaysia
| | - M F Mohd Sharin
- Department of Urology, Hospital Serdang, Serdang, Malaysia
- Department of Urology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
- Department of Urology, Hospital Sultan Abdul Aziz Shah UPM, Malaysia
- Plastic and Reconstructive Unit, Department of Surgery, Hospital Sultan Abdul Aziz Shah UPM, Malaysia
| | - I Aizat Sabri
- Department of Urology, Hospital Serdang, Serdang, Malaysia
- Department of Urology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
- Department of Urology, Hospital Sultan Abdul Aziz Shah UPM, Malaysia
- Plastic and Reconstructive Unit, Department of Surgery, Hospital Sultan Abdul Aziz Shah UPM, Malaysia
| | - A V Jagwani
- Department of Urology, Hospital Serdang, Serdang, Malaysia
- Department of Urology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
- Department of Urology, Hospital Sultan Abdul Aziz Shah UPM, Malaysia
- Plastic and Reconstructive Unit, Department of Surgery, Hospital Sultan Abdul Aziz Shah UPM, Malaysia
| | - F Y Lee
- Department of Urology, Hospital Serdang, Serdang, Malaysia
- Department of Urology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
- Department of Urology, Hospital Sultan Abdul Aziz Shah UPM, Malaysia
- Plastic and Reconstructive Unit, Department of Surgery, Hospital Sultan Abdul Aziz Shah UPM, Malaysia
| | - A I Ahmad Zaidi
- Department of Urology, Hospital Serdang, Serdang, Malaysia
- Department of Urology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
- Department of Urology, Hospital Sultan Abdul Aziz Shah UPM, Malaysia
- Plastic and Reconstructive Unit, Department of Surgery, Hospital Sultan Abdul Aziz Shah UPM, Malaysia
| | - M Z Saiful Azli
- Department of Urology, Hospital Serdang, Serdang, Malaysia
- Department of Urology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
- Department of Urology, Hospital Sultan Abdul Aziz Shah UPM, Malaysia
- Plastic and Reconstructive Unit, Department of Surgery, Hospital Sultan Abdul Aziz Shah UPM, Malaysia
| | - Rk Rishitra Rk Rishitra
- Department of Urology, Hospital Serdang, Serdang, Malaysia
- Department of Urology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
- Department of Urology, Hospital Sultan Abdul Aziz Shah UPM, Malaysia
- Plastic and Reconstructive Unit, Department of Surgery, Hospital Sultan Abdul Aziz Shah UPM, Malaysia
| | - O Fahmey
- Department of Urology, Hospital Serdang, Serdang, Malaysia
- Department of Urology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
- Department of Urology, Hospital Sultan Abdul Aziz Shah UPM, Malaysia
- Plastic and Reconstructive Unit, Department of Surgery, Hospital Sultan Abdul Aziz Shah UPM, Malaysia
| | - C K Lee
- Department of Urology, Hospital Serdang, Serdang, Malaysia
- Department of Urology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
- Department of Urology, Hospital Sultan Abdul Aziz Shah UPM, Malaysia
- Plastic and Reconstructive Unit, Department of Surgery, Hospital Sultan Abdul Aziz Shah UPM, Malaysia
| | - M G Khairul-Asri
- Department of Urology, Hospital Serdang, Serdang, Malaysia
- Department of Urology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
- Department of Urology, Hospital Sultan Abdul Aziz Shah UPM, Malaysia
- Plastic and Reconstructive Unit, Department of Surgery, Hospital Sultan Abdul Aziz Shah UPM, Malaysia
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12
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Hsieh MY, Chuang SY, Lee CK, Luo CM, Cheng CH, Liao MT, Lin PL, Yang TF, Wu CC. Risks and outcomes of critical limb ischemia in hemodialysis patients: a prospective cohort study. Clin Kidney J 2022; 16:585-595. [PMID: 36865012 PMCID: PMC9972820 DOI: 10.1093/ckj/sfac263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Indexed: 12/13/2022] Open
Abstract
Background Peripheral arterial disease (PAD) is more common in patients receiving maintenance hemodialysis than in the general population. Critical limb ischemia (CLI), the most severe form of PAD, is associated with high amputation and mortality risk. However, few prospective studies are available evaluating this disease's presentation, risk factors and outcomes for patients receiving hemodialysis. Methods The Hsinchu VA study, a prospective multicentre study, investigated the impact of clinical factors on cardiovascular outcomes of patients receiving maintenance hemodialysis from January 2008 until December 2021. We evaluated the presentations and outcomes of patients with newly diagnosed PAD and the correlations of clinical variables with newly diagnosed CLI. Results Of 1136 study participants, 1038 had no PAD on enrolment. After a median follow-up period of 3.3 years, 128 had newly diagnosed PAD. Of these, 65 presented with CLI, and 25 underwent amputation or died from PAD. Patients presenting with CLI had more below-the-knee (52%) and multi-level (41%) disease, and completely occluded segments (41%), and higher risk for amputation or PAD-related death compared with patients without CLI (27.7% vs 9.5%, P = .01). After multivariate adjustment, disability, diabetes mellitus, current smoking and atrial fibrillation were significantly associated with newly diagnosed CLI. Conclusions Patients undergoing hemodialysis had higher rates of newly diagnosed CLI than the general population. Those with disabilities, diabetes mellitus, smoking and atrial fibrillation may require careful examination for PAD. Trial registration: Hsinchu VA study, ClinicalTrials.gov identifier: NCT04692636.
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Affiliation(s)
- Mu-Yang Hsieh
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan,College of Medicine, National Taiwan University, Taipei, Taiwan,Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
| | - Shao-Yuan Chuang
- Institute of Population Health Science, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
| | - Chih-Kuo Lee
- College of Medicine, National Taiwan University, Taipei, Taiwan,Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
| | - Chien-Ming Luo
- College of Medicine, National Taiwan University, Taipei, Taiwan,Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
| | | | - Min-Tsun Liao
- College of Medicine, National Taiwan University, Taipei, Taiwan,Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
| | - Po-Lin Lin
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan,Division of Cardiology, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
| | - Ten-Fang Yang
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan,Taipei Medical University and Hospital, Taipei, Taiwan
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13
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Aizat Sabri I, Yusof MR, Jagwani AV, Fahmy O, Lee CK, Mg-Khairul Asri MKA, Wan Muhamad Mokhzani WM, Dharmendra G, Ahmad Zhariff H. [A rare case of bladder leiomyoma in pregnancy: a case report]. Urologiia 2022:118-121. [PMID: 36625624] [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] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
We present a rare case of leiomyoma of the urinary bladder that was diagnosed during pregnancy. The case of a 29-year-old woman primigravida at 13 weeks of pregnancy who presented with 6 months history of abdominal swelling which was gradually increasing in size. Computed tomography done revealed a large heterogenous mass(enhancing) with an area of non-enhancing (necrosis) suggestive of malignant ovarian tumor. The histological findings of the surgical specimen confirmed a leiomyoma of the urinary bladder. The clinical presentation, imaging findings, and management of this relatively rare benign tumor are discussed in this case report.
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Affiliation(s)
- I Aizat Sabri
- Department of Urology, Hospital Pengajar Universiti Pengajar, Universiti Putra Malaysia, Malaysia.,Urology Division, Hospital Universiti Sains Malaysia, Kubang Kerian, Malaysia.,Obstetric Department, Hospital Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - M R Yusof
- Department of Urology, Hospital Pengajar Universiti Pengajar, Universiti Putra Malaysia, Malaysia.,Urology Division, Hospital Universiti Sains Malaysia, Kubang Kerian, Malaysia.,Obstetric Department, Hospital Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - A V Jagwani
- Department of Urology, Hospital Pengajar Universiti Pengajar, Universiti Putra Malaysia, Malaysia.,Urology Division, Hospital Universiti Sains Malaysia, Kubang Kerian, Malaysia.,Obstetric Department, Hospital Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - O Fahmy
- Department of Urology, Hospital Pengajar Universiti Pengajar, Universiti Putra Malaysia, Malaysia.,Urology Division, Hospital Universiti Sains Malaysia, Kubang Kerian, Malaysia.,Obstetric Department, Hospital Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - C K Lee
- Department of Urology, Hospital Pengajar Universiti Pengajar, Universiti Putra Malaysia, Malaysia.,Urology Division, Hospital Universiti Sains Malaysia, Kubang Kerian, Malaysia.,Obstetric Department, Hospital Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Mg-Khairul Asri Mg-Khairul Asri
- Department of Urology, Hospital Pengajar Universiti Pengajar, Universiti Putra Malaysia, Malaysia.,Urology Division, Hospital Universiti Sains Malaysia, Kubang Kerian, Malaysia.,Obstetric Department, Hospital Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - W M Wan Muhamad Mokhzani
- Department of Urology, Hospital Pengajar Universiti Pengajar, Universiti Putra Malaysia, Malaysia.,Urology Division, Hospital Universiti Sains Malaysia, Kubang Kerian, Malaysia.,Obstetric Department, Hospital Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - G Dharmendra
- Department of Urology, Hospital Pengajar Universiti Pengajar, Universiti Putra Malaysia, Malaysia.,Urology Division, Hospital Universiti Sains Malaysia, Kubang Kerian, Malaysia.,Obstetric Department, Hospital Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - H Ahmad Zhariff
- Department of Urology, Hospital Pengajar Universiti Pengajar, Universiti Putra Malaysia, Malaysia.,Urology Division, Hospital Universiti Sains Malaysia, Kubang Kerian, Malaysia.,Obstetric Department, Hospital Universiti Sains Malaysia, Kubang Kerian, Malaysia
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14
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Lim WS, Ho HY, Ho HC, Chen YW, Lee CK, Chen PJ, Lai F, Jang JSR, Ko ML. Use of multimodal dataset in AI for detecting glaucoma based on fundus photographs assessed with OCT: focus group study on high prevalence of myopia. BMC Med Imaging 2022; 22:206. [PMID: 36434508 PMCID: PMC9700928 DOI: 10.1186/s12880-022-00933-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 11/10/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Glaucoma is one of the major causes of blindness; it is estimated that over 110 million people will be affected by glaucoma worldwide by 2040. Research on glaucoma detection using deep learning technology has been increasing, but the diagnosis of glaucoma in a large population with high incidence of myopia remains a challenge. This study aimed to provide a decision support system for the automatic detection of glaucoma using fundus images, which can be applied for general screening, especially in areas of high incidence of myopia. METHODS A total of 1,155 fundus images were acquired from 667 individuals with a mean axial length of 25.60 ± 2.0 mm at the National Taiwan University Hospital, Hsinchu Br. These images were graded based on the findings of complete ophthalmology examinations, visual field test, and optical coherence tomography into three groups: normal (N, n = 596), pre-perimetric glaucoma (PPG, n = 66), and glaucoma (G, n = 493), and divided into a training-validation (N: 476, PPG: 55, G: 373) and test (N: 120, PPG: 11, G: 120) sets. A multimodal model with the Xception model as image feature extraction and machine learning algorithms [random forest (RF), support vector machine (SVM), dense neural network (DNN), and others] was applied. RESULTS The Xception model classified the N, PPG, and G groups with 93.9% of the micro-average area under the receiver operating characteristic curve (AUROC) with tenfold cross-validation. Although normal and glaucoma sensitivity can reach 93.51% and 86.13% respectively, the PPG sensitivity was only 30.27%. The AUROC increased to 96.4% in the N + PPG and G groups. The multimodal model with the N + PPG and G groups showed that the AUROCs of RF, SVM, and DNN were 99.56%, 99.59%, and 99.10%, respectively; The N and PPG + G groups had less than 1% difference. The test set showed an overall 3%-5% less AUROC than the validation results. CONCLUSION The multimodal model had good AUROC while detecting glaucoma in a population with high incidence of myopia. The model shows the potential for general automatic screening and telemedicine, especially in Asia. TRIAL REGISTRATION The study was approved by the Institutional Review Board of the National Taiwan University Hospital, Hsinchu Branch (no. NTUHHCB 108-025-E).
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Affiliation(s)
- Wee Shin Lim
- grid.19188.390000 0004 0546 0241Department of Computer Science and Information Engineering, National Taiwan University, Taipei City 10617, Taiwan, ROC
| | - Heng-Yen Ho
- grid.19188.390000 0004 0546 0241School of Medicine, National Taiwan University, Taipei City 10617, Taiwan, ROC
| | - Heng-Chen Ho
- grid.19188.390000 0004 0546 0241School of Medicine, National Taiwan University, Taipei City 10617, Taiwan, ROC
| | - Yan-Wu Chen
- grid.412036.20000 0004 0531 9758Department of Applied Mathematics, National Sun Yat-Sen University, Kaohsiung City 804201, Taiwan, ROC
| | - Chih-Kuo Lee
- grid.412094.a0000 0004 0572 7815Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu City 300, Taiwan, ROC
| | - Pao-Ju Chen
- grid.412094.a0000 0004 0572 7815Department of Ophthalmology, National Taiwan University Hospital Hsin-Chu Branch, No. 25, Lane 442, Sec.1, Jingguo Rd., Hsinchu City 300, Taiwan, ROC
| | - Feipei Lai
- grid.19188.390000 0004 0546 0241Department of Electrical Engineering, National Taiwan University, Taipei City 10617, Taiwan, ROC
| | - Jyh-Shing Roger Jang
- grid.19188.390000 0004 0546 0241Department of Computer Science and Information Engineering, National Taiwan University, Taipei City 10617, Taiwan, ROC
| | - Mei-Lan Ko
- grid.412094.a0000 0004 0572 7815Department of Ophthalmology, National Taiwan University Hospital Hsin-Chu Branch, No. 25, Lane 442, Sec.1, Jingguo Rd., Hsinchu City 300, Taiwan, ROC ,grid.38348.340000 0004 0532 0580Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Taipei City 10617, Taiwan, ROC
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15
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Kok PS, Antill YC, Scott CL, Lee CK. The impact of single agent PD-1 or PD-L1 inhibition on advanced endometrial cancers: meta-analysis. ESMO Open 2022; 7:100635. [PMID: 36410086 PMCID: PMC9808459 DOI: 10.1016/j.esmoop.2022.100635] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/05/2022] [Accepted: 10/13/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Immune checkpoint inhibitor (ICI) therapy is an emerging option for advanced endometrial cancer (EC). Mismatch repair (MMR) status is widely regarded as a biomarker predictive of response to ICIs. The predictive value of MMR based on small, single-arm trials, however, is conflicting. In this meta-analysis, we aimed to assess the activity of single-agent ICI in advanced EC, and compared the magnitude of treatment benefit in MMR deficient (dMMR) and MMR proficient (pMMR) EC. METHODS We carried out an electronic search to identify prospective trials of single-agent ICI in advanced EC. Data on objective response rate (ORR) and progression-free survival (PFS) were extracted and pooled. ORR was estimated using the inverse variance method and subgroup difference by MMR status was examined. PFS difference according to MMR status was summarized using the Kaplan-Meier approach. RESULTS From eight trials with 492 women, the pooled ORR was 19% [95% confidence interval (CI) 16% to 22%]. ORR was significantly greater in dMMR (n = 281) than pMMR EC (n = 211) (dMMR: 46%, pMMR: 8%; risk ratio 5.74, 95% CI 3.58-9.21; interaction P < 0.001). Complete response was 11% and 0.05% and median PFS was 8.3 and 2.1 months in dMMR and pMMR EC, respectively (hazard ratio PFS 0.58, 95% CI 0.38-0.89; P = 0.01). The 12-month PFS rates were 42.0% and 20.7%, respectively. CONCLUSION Single-agent ICI is associated with a 5.74 times greater objective response and 42% reduction in risk of disease progression or death in dMMR compared with pMMR EC. MMR status should be determined prospectively and be used as a stratification factor in future trials of advanced EC. Further translational analysis is urgently required to identify the cause of dMMR and allow subclassification of EC into different dMMR molecular subtypes.
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Affiliation(s)
- P-S Kok
- Australia New Zealand Gynaecological Oncology Group, Sydney, Australia; National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, Australia; Prince of Wales Hospital, Randwick, Australia.
| | - Y C Antill
- Australia New Zealand Gynaecological Oncology Group, Sydney, Australia; Faculty of Medicine, Dentistry and Health Sciences, Monash University, Melbourne, Australia
| | - C L Scott
- Australia New Zealand Gynaecological Oncology Group, Sydney, Australia; Walter and Eliza Hall Institute of Medical Research, Parkville, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Australia; Sir Peter MacCallum Cancer Centre Department of Oncology, University of Melbourne, Parkville, Australia
| | - C K Lee
- Australia New Zealand Gynaecological Oncology Group, Sydney, Australia; Cancer Care Centre, St George Hospital, Sydney, Australia
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16
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Frenel JS, Kim JW, Aryal N, Asher R, Berton D, Vidal L, Pautier P, Ledermann JA, Penson RT, Oza AM, Korach J, Huzarski T, Pignata S, Colombo N, Park-Simon TW, Tamura K, Sonke GS, Freimund AE, Lee CK, Pujade-Lauraine E. Efficacy of subsequent chemotherapy for patients with BRCA1/2-mutated recurrent epithelial ovarian cancer progressing on olaparib versus placebo maintenance: post-hoc analyses of the SOLO2/ENGOT Ov-21 trial. Ann Oncol 2022; 33:1021-1028. [PMID: 35772665 DOI: 10.1016/j.annonc.2022.06.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 06/16/2022] [Accepted: 06/20/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In the SOLO2 trial (ENGOT Ov-21; NCT01874353), maintenance olaparib in patients with platinum-sensitive relapsed ovarian cancer (PSROC) and BRCA mutation significantly improved progression-free survival (PFS) and prolonged overall survival (OS). Following disease progression on olaparib, efficacy of subsequent chemotherapy remains unknown. PATIENTS AND METHODS We conducted a post-hoc hypothesis-generating analysis of SOLO2 data to determine the efficacy of different chemotherapy regimens following RECIST disease progression in patients who received olaparib or placebo. We evaluated time to second progression (TTSP) calculated from the date of RECIST progression to the next progression/death. RESULTS The study population comprised 147 patients who received chemotherapy as their first subsequent treatment after RECIST progression. Of these, 69 (47%) and 78 (53%) were originally randomized to placebo and olaparib arms, respectively. In the placebo-treated cohort, 27/69 and 42/69 received non-platinum and platinum-based chemotherapy, respectively, compared with 24/78 and 54/78, respectively, in the olaparib-treated cohort. Among patients treated with chemotherapy (N = 147), TTSP was significantly longer in the placebo than in the olaparib arm: 12.1 versus 6.9 months [hazard ratio (HR) 2.17, 95% confidence interval (CI) 1.47-3.19]. Similar result was obtained on multivariable analysis adjusting for prognostic factors at RECIST progression (HR 2.13, 95% CI 1.41-3.22). Among patients treated with platinum-based chemotherapy (n = 96), TTSP was significantly longer in the placebo arm: 14.3 versus 7.0 months (HR 2.89, 95% CI 1.73-4.82). Conversely, among patients treated with non-platinum-based chemotherapy (n = 51), the TTSP was comparable in the placebo and olaparib arms: 8.3 versus 6.0 months (HR 1.58, 95% CI 0.86-2.90). CONCLUSIONS Following progression from maintenance olaparib in the recurrent setting, the efficacy of platinum-based subsequent chemotherapy seems to be reduced in BRCA1/2-mutated patients with PSROC compared to patients not previously receiving poly (ADP-ribose) polymerase inhibitors (PARPi). The optimal strategy for patients who relapse after PARPi is an area of ongoing research.
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Affiliation(s)
- J S Frenel
- Institut de Cancerologie de l'Ouest, GINECO, GINEGEPS, Centre René Gauducheau, Saint-Herblain, France.
| | - J W Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - N Aryal
- NHMRC CTC Centre, University of Sydney, Camperdown, Sydney, Australia
| | - R Asher
- NHMRC CTC Centre, University of Sydney, Camperdown, Sydney, Australia
| | - D Berton
- Institut de Cancerologie de l'Ouest, GINECO, GINEGEPS, Centre René Gauducheau, Saint-Herblain, France
| | - L Vidal
- GEICO & H Clínic de Barcelona, Barcelona, Spain
| | - P Pautier
- GINECO & Gustave Roussy Cancer Center, Villejuif, France
| | | | - R T Penson
- Massachusetts General Hospital, Boston, USA
| | - A M Oza
- Princess Margaret Cancer Centre, Toronto, Canada
| | - J Korach
- ISGO & Chaim Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - T Huzarski
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - S Pignata
- MITO & Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale Napoli, Naples, Italy
| | - N Colombo
- MaNGO & European Institute of Oncology IRCCS and University of Milan-Bicocca, Milano, Italy
| | - T W Park-Simon
- AGO & Medical School, Department of Gynecologic Oncology, Hannover, Hannover, Germany
| | - K Tamura
- Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - G S Sonke
- DGOG & Netherlands Cancer Institute, Amsterdam, Netherlands
| | - A E Freimund
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - C K Lee
- NHMRC CTC Centre, University of Sydney, Camperdown, Sydney, Australia
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17
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Meng SW, Huang CC, Lee CK, Chen CK, Yeh CF, Chen YH, Lin MS, Kao HL. Conus branch artery utilization in percutaneous coronary intervention for chronic total occlusion. Sci Rep 2022; 12:7219. [PMID: 35508644 PMCID: PMC9068759 DOI: 10.1038/s41598-022-10984-5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 04/12/2022] [Indexed: 11/22/2022] Open
Abstract
Data on the prevalence of conus branch artery (CBA) is scarce, and its utilization in percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) is non-existing. The present study examined carefully in a large cohort the angiographic prevalence of CBA, its role as a collateral channel for the occlusion, and the potential usage of CBA in contemporary CTO PCI. We retrospectively examined consecutive CTO PCIs from our database between 2016 and 2019. All CTO PCIs were evaluated and the results with complications were recorded to determine the prevalence and utilization of CBA. From January 2016 to December 2019, a total of 556 CTO PCI attempts in 546 patients by high-volume operators were enrolled. The clinical, angiographic, and procedural details were collected. CBA was identifiable in 85.3% of these patients, and CBA providing visible collaterals connected to CTO distal lumen was found in 27.8% of patients. 84 CBA were used for balloon anchoring, 17 for selective distal true lumen visualization, and 9 as actual retrograde interventional collateral channel during CTO PCI. Only 1 patient suffered from chest pain during CBA balloon anchoring, and no other procedural complication such as arrhythmia or perforation occurred.CBA is frequently seen in coronary CTO. Its existence provided potential for various CTO PCI technique applications, without increase in risk.
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Affiliation(s)
- Shih-Wei Meng
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan
| | - Ching-Chang Huang
- Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Rd, Taipei, 10002, Taiwan
| | - Chih-Kuo Lee
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan
| | - Chun-Kai Chen
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan
| | - Chih-Fan Yeh
- Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Rd, Taipei, 10002, Taiwan
| | - Ying-Hsien Chen
- Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Rd, Taipei, 10002, Taiwan
| | - Mao-Shin Lin
- Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Rd, Taipei, 10002, Taiwan
| | - Hsien-Li Kao
- Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Rd, Taipei, 10002, Taiwan.
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Liu SF, Hsu CY, Lee CK, Kao PHL. TCTAP A-045 Clinical Predictors of Successful Weaning VA-ECMO. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.03.066] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Yusof MR, Fairuz MS, Lee FY, Arvind VJ, Fahmy O, Lee CK, Saiful Azli MZ, Arunasalam AP, Khairul-Asri MG. [The tale of two stones in an obstructed partial duplex kidney: case presentation]. Urologiia 2022:78-80. [PMID: 35274865] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Duplex renal systems is a common anomalies. Incidence rate of 0.8% in healthy adult population and 2-4% in patients investigated for urinary tract symptoms. Urolithiasis management for patients with anomalies is complex and require proper imaging and planning. We have a patient with a partial duplex collecting system presented with a right renal calculus in a non-functioning lower moiety and multiple distal ureteric calculi. Preoperative planning done and surgery performed with good outcome without any early and late complications.
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Affiliation(s)
- M R Yusof
- Department of Urology, Hospital Pengajar Universiti Putra Malaysia
- Department of Urology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia
- Department of Urology, Hospital Serdang
- Selangor, Malaysia
| | - M S Fairuz
- Department of Urology, Hospital Pengajar Universiti Putra Malaysia
- Department of Urology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia
- Department of Urology, Hospital Serdang
- Selangor, Malaysia
| | - F Y Lee
- Department of Urology, Hospital Pengajar Universiti Putra Malaysia
- Department of Urology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia
- Department of Urology, Hospital Serdang
- Selangor, Malaysia
| | - V J Arvind
- Department of Urology, Hospital Pengajar Universiti Putra Malaysia
- Department of Urology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia
- Department of Urology, Hospital Serdang
- Selangor, Malaysia
| | - O Fahmy
- Department of Urology, Hospital Pengajar Universiti Putra Malaysia
- Department of Urology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia
- Department of Urology, Hospital Serdang
- Selangor, Malaysia
| | - C K Lee
- Department of Urology, Hospital Pengajar Universiti Putra Malaysia
- Department of Urology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia
- Department of Urology, Hospital Serdang
- Selangor, Malaysia
| | - M Z Saiful Azli
- Department of Urology, Hospital Pengajar Universiti Putra Malaysia
- Department of Urology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia
- Department of Urology, Hospital Serdang
- Selangor, Malaysia
| | - A P Arunasalam
- Department of Urology, Hospital Pengajar Universiti Putra Malaysia
- Department of Urology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia
- Department of Urology, Hospital Serdang
- Selangor, Malaysia
| | - M G Khairul-Asri
- Department of Urology, Hospital Pengajar Universiti Putra Malaysia
- Department of Urology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia
- Department of Urology, Hospital Serdang
- Selangor, Malaysia
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20
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Liu SF, Lee CK, Huang KC, Lin LY, Hsieh MY, Lin TT. Long-Term Effect of Non-Selective Beta-Blockers in Patients With Rheumatoid Arthritis After Myocardial Infarction-A Nationwide Cohort Study. Front Pharmacol 2021; 12:726044. [PMID: 34621167 PMCID: PMC8490958 DOI: 10.3389/fphar.2021.726044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/06/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: Rheumatoid arthritis (RA) is an independent nontraditional risk factor for incidence of myocardial infarction (MI) and post-MI outcome is impaired in the RA population. Use of beta-blockers improves the long-term survival after MI in the general population while the protective effect of beta-blockers in RA patients is not clear. We investigate the impact of beta-blockers on the long-term outcome of MI among RA patients. Methods: We identified RA subjects from the registries for catastrophic illness and myocardial infarction from 2003 to 2013. The enrolled subjects were divided into three groups according to the prescription of beta-blockers (non-user, non-selective, and β1-selective beta-blockers). The primary endpoint was all-cause mortality. We adjusted clinical variables and utilized propensity scores to balance confounding bias. Cox proportional hazards regression models were used to estimate the incidence of mortality in different groups. Results: A total of 1,292 RA patients with myocardial infarction were enrolled, where 424 (32.8%), 281 (21.7%), and 587 (45.5%) subjects used non-user, non-selective, and β1-selective beta-blockers, respectively. Use of beta-blockers was associated with lower risk of all-cause mortality after adjustment with comorbidities, medications (adjusted hazard ratio [HR] 0.871; 95% confidence interval [CI] 0.727–0.978), and propensity score (HR 0.882; 95% CI 0.724–0.982). Compared with β1-selective beta-blockers, treatment with non-selective beta-blockers (HR 0.856; 95% CI 0.702–0.984) was significantly related to lower risk of mortality. The protective effect of non-selective beta-blockers remained in different subgroups including sex and different anti-inflammatory drugs. Conclusion: Use of beta-blockers improved prognosis in post-MI patients with RA. Treatment with non-selective beta-blockers was significantly associated with reduced risk of mortality in RA patients after MI rather than β1-selective beta-blockers.
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Affiliation(s)
- Sheng-Fu Liu
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-chu, Taiwan.,College of Medicine, National Taiwan University, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chih-Kuo Lee
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-chu, Taiwan.,College of Medicine, National Taiwan University, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Kuan-Chih Huang
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-chu, Taiwan.,College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Lian-Yu Lin
- College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Mu-Yang Hsieh
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-chu, Taiwan.,College of Medicine, National Taiwan University, Taipei, Taiwan.,Institute of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsin-Chu, Taiwan
| | - Ting-Tse Lin
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-chu, Taiwan.,College of Medicine, National Taiwan University, Taipei, Taiwan
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21
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Dayan I, Roth HR, Zhong A, Harouni A, Gentili A, Abidin AZ, Liu A, Costa AB, Wood BJ, Tsai CS, Wang CH, Hsu CN, Lee CK, Ruan P, Xu D, Wu D, Huang E, Kitamura FC, Lacey G, de Antônio Corradi GC, Nino G, Shin HH, Obinata H, Ren H, Crane JC, Tetreault J, Guan J, Garrett JW, Kaggie JD, Park JG, Dreyer K, Juluru K, Kersten K, Rockenbach MABC, Linguraru MG, Haider MA, AbdelMaseeh M, Rieke N, Damasceno PF, E Silva PMC, Wang P, Xu S, Kawano S, Sriswasdi S, Park SY, Grist TM, Buch V, Jantarabenjakul W, Wang W, Tak WY, Li X, Lin X, Kwon YJ, Quraini A, Feng A, Priest AN, Turkbey B, Glicksberg B, Bizzo B, Kim BS, Tor-Díez C, Lee CC, Hsu CJ, Lin C, Lai CL, Hess CP, Compas C, Bhatia D, Oermann EK, Leibovitz E, Sasaki H, Mori H, Yang I, Sohn JH, Murthy KNK, Fu LC, de Mendonça MRF, Fralick M, Kang MK, Adil M, Gangai N, Vateekul P, Elnajjar P, Hickman S, Majumdar S, McLeod SL, Reed S, Gräf S, Harmon S, Kodama T, Puthanakit T, Mazzulli T, de Lavor VL, Rakvongthai Y, Lee YR, Wen Y, Gilbert FJ, Flores MG, Li Q. Federated learning for predicting clinical outcomes in patients with COVID-19. Nat Med 2021; 27:1735-1743. [PMID: 34526699 PMCID: PMC9157510 DOI: 10.1038/s41591-021-01506-3] [Citation(s) in RCA: 152] [Impact Index Per Article: 50.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 08/13/2021] [Indexed: 02/08/2023]
Abstract
Federated learning (FL) is a method used for training artificial intelligence models with data from multiple sources while maintaining data anonymity, thus removing many barriers to data sharing. Here we used data from 20 institutes across the globe to train a FL model, called EXAM (electronic medical record (EMR) chest X-ray AI model), that predicts the future oxygen requirements of symptomatic patients with COVID-19 using inputs of vital signs, laboratory data and chest X-rays. EXAM achieved an average area under the curve (AUC) >0.92 for predicting outcomes at 24 and 72 h from the time of initial presentation to the emergency room, and it provided 16% improvement in average AUC measured across all participating sites and an average increase in generalizability of 38% when compared with models trained at a single site using that site's data. For prediction of mechanical ventilation treatment or death at 24 h at the largest independent test site, EXAM achieved a sensitivity of 0.950 and specificity of 0.882. In this study, FL facilitated rapid data science collaboration without data exchange and generated a model that generalized across heterogeneous, unharmonized datasets for prediction of clinical outcomes in patients with COVID-19, setting the stage for the broader use of FL in healthcare.
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Affiliation(s)
- Ittai Dayan
- MGH Radiology and Harvard Medical School, Boston, MA, USA
| | | | - Aoxiao Zhong
- Center for Advanced Medical Computing and Analysis, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- School of Engineering and Applied Sciences, Harvard University, Boston, MA, USA
| | | | | | | | | | | | - Bradford J Wood
- Radiology & Imaging Sciences/Clinical Center, National Institutes of Health, Bethesda, MD, USA
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Chien-Sung Tsai
- Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Hung Wang
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Chun-Nan Hsu
- Center for Research in Biological Systems, University of California, San Diego, CA, USA
| | - C K Lee
- NVIDIA, Santa Clara, CA, USA
| | | | | | - Dufan Wu
- Center for Advanced Medical Computing and Analysis, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | | | | | - Gustavo Nino
- Division of Pediatric Pulmonary and Sleep Medicine, Children's National Hospital, Washington, DC, USA
| | - Hao-Hsin Shin
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Hui Ren
- Center for Advanced Medical Computing and Analysis, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jason C Crane
- Center for Intelligent Imaging, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | | | | | - John W Garrett
- Departments of Radiology and Medical Physics, The University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Joshua D Kaggie
- Department of Radiology, NIHR Cambridge Biomedical Resource Centre, University of Cambridge, Cambridge, UK
| | - Jung Gil Park
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, South Korea
| | - Keith Dreyer
- MGH Radiology and Harvard Medical School, Boston, MA, USA
- Center for Clinical Data Science, Massachusetts General Brigham, Boston, MA, USA
| | - Krishna Juluru
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | - Marius George Linguraru
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC, USA
- Departments of Radiology and Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Masoom A Haider
- Joint Dept. of Medical Imaging, Sinai Health System, University of Toronto, Toronto, Ontario, Canada
- Lunenfeld-Tanenbaum Research Institute, Toronto, Ontario, Canada
| | | | | | - Pablo F Damasceno
- Center for Intelligent Imaging, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | | | - Pochuan Wang
- MeDA Lab Institute of Applied Mathematical Sciences, National Taiwan University, Taipei, Taiwan
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei, Taiwan
| | - Sheng Xu
- Radiology & Imaging Sciences/Clinical Center, National Institutes of Health, Bethesda, MD, USA
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Sira Sriswasdi
- Research Affairs, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Center for Artificial Intelligence in Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Soo Young Park
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Thomas M Grist
- Departments of Radiology, Medical Physics, and Biomedical Engineering, The University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Varun Buch
- Center for Clinical Data Science, Massachusetts General Brigham, Boston, MA, USA
| | - Watsamon Jantarabenjakul
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Thai Red Cross Emerging Infectious Diseases Clinical Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Weichung Wang
- MeDA Lab Institute of Applied Mathematical Sciences, National Taiwan University, Taipei, Taiwan
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei, Taiwan
| | - Won Young Tak
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Xiang Li
- Center for Advanced Medical Computing and Analysis, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Xihong Lin
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Young Joon Kwon
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Andrew N Priest
- Department of Radiology, NIHR Cambridge Biomedical Resource Centre, Cambridge University Hospital, Cambridge, UK
| | - Baris Turkbey
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
- Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Benjamin Glicksberg
- Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai and Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bernardo Bizzo
- Center for Clinical Data Science, Massachusetts General Brigham, Boston, MA, USA
| | - Byung Seok Kim
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, South Korea
| | - Carlos Tor-Díez
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC, USA
| | - Chia-Cheng Lee
- Planning and Management Office, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chia-Jung Hsu
- Planning and Management Office, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chin Lin
- School of Medicine, National Defense Medical Center, Taipei, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Chiu-Ling Lai
- Medical Review and Pharmaceutical Benefits Division, National Health Insurance Administration, Taipei, Taiwan
| | - Christopher P Hess
- Center for Intelligent Imaging, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | | | | | - Eric K Oermann
- Department of Neurosurgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Evan Leibovitz
- Center for Clinical Data Science, Massachusetts General Brigham, Boston, MA, USA
| | | | - Hitoshi Mori
- Self-Defense Forces Central Hospital, Tokyo, Japan
| | | | - Jae Ho Sohn
- Center for Intelligent Imaging, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | | | - Li-Chen Fu
- MOST/NTU All Vista Healthcare Center, Center for Artificial Intelligence and Advanced Robotics, National Taiwan University, Taipei, Taiwan
| | | | - Mike Fralick
- Division of General Internal Medicine and Geriatrics (Fralick), Sinai Health System, Toronto, Ontario, Canada
| | - Min Kyu Kang
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, South Korea
| | | | - Natalie Gangai
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Peerapon Vateekul
- Department of Computer Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand
| | | | - Sarah Hickman
- Department of Radiology, NIHR Cambridge Biomedical Resource Centre, University of Cambridge, Cambridge, UK
| | - Sharmila Majumdar
- Center for Intelligent Imaging, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Shelley L McLeod
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sheridan Reed
- Radiology & Imaging Sciences/Clinical Center, National Institutes of Health, Bethesda, MD, USA
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Stefan Gräf
- Department of Medicine and NIHR BioResource for Translational Research, NIHR Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - Stephanie Harmon
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
- Clinical Research Directorate, Frederick National Laboratory for Cancer, National Cancer Institute, Frederick, MD, USA
| | | | - Thanyawee Puthanakit
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Thai Red Cross Emerging Infectious Diseases Clinical Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Tony Mazzulli
- Department of Microbiology, Sinai Health/University Health Network, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Public Health Ontario Laboratories, Toronto, Ontario, Canada
| | | | - Yothin Rakvongthai
- Chulalongkorn University Biomedical Imaging Group and Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Yu Rim Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | | | - Fiona J Gilbert
- Department of Radiology, NIHR Cambridge Biomedical Resource Centre, University of Cambridge, Cambridge, UK
| | | | - Quanzheng Li
- Center for Advanced Medical Computing and Analysis, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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22
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Planchard D, Feng PH, Karaseva N, Kim SW, Kim TM, Lee CK, Poltoratskiy A, Yanagitani N, Marshall R, Huang X, Howarth P, Jänne PA, Kobayashi K. Osimertinib plus platinum-pemetrexed in newly diagnosed epidermal growth factor receptor mutation-positive advanced/metastatic non-small-cell lung cancer: safety run-in results from the FLAURA2 study. ESMO Open 2021; 6:100271. [PMID: 34543864 PMCID: PMC8453202 DOI: 10.1016/j.esmoop.2021.100271] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [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: 03/31/2021] [Revised: 08/11/2021] [Accepted: 08/21/2021] [Indexed: 11/25/2022] Open
Abstract
Background The phase III FLAURA2 (NCT04035486) study will evaluate efficacy and safety of first-line osimertinib with platinum–pemetrexed chemotherapy versus osimertinib monotherapy in epidermal growth factor receptor mutation-positive (EGFRm) advanced/metastatic non-small-cell lung cancer (NSCLC). The safety run-in, reported here, assessed the safety and tolerability of osimertinib with chemotherapy prior to the randomized phase III evaluation. Patients and methods Patients (≥18 years; Japan: ≥20 years) with EGFRm locally advanced/metastatic NSCLC received oral osimertinib 80 mg once daily (QD), with either intravenous (IV) cisplatin 75 mg/m2 or IV carboplatin target area under the curve 5, plus pemetrexed 500 mg/m2 every 3 weeks (Q3W) for four cycles. Maintenance was osimertinib 80 mg QD with pemetrexed 500 mg/m2 Q3W until progression/discontinuation. The primary objective was to evaluate safety and tolerability of the osimertinib–chemotherapy combination. Results Thirty patients (15 per group) received treatment [Asian, 73%; female, 63%; median age (range) 61 (45-84) years]. Adverse events (AEs) were reported by 27 patients (90%): osimertinib–carboplatin–pemetrexed, 100%; osimertinib–cisplatin–pemetrexed, 80%. Most common AEs were constipation (60%) with osimertinib–carboplatin–pemetrexed and nausea (60%) with osimertinib–cisplatin–pemetrexed. In both groups, 20% of patients reported serious AEs. No specific pattern of AEs leading to dose modifications/discontinuations was observed; one patient discontinued all study treatments including osimertinib due to pneumonitis (study-specific discontinuation criterion). Hematologic toxicities were as expected and manageable. Conclusions Osimertinib–chemotherapy combination had a manageable safety and tolerability profile in EGFRm advanced/metastatic NSCLC, supporting further assessment in the FLAURA2 randomized phase. FLAURA2 aims to assess efficacy and safety of first-line osimertinib with platinum–pemetrexed in EGFRm advanced NSCLC. In the FLAURA2 safety run-in period, 30 patients received osimertinib and pemetrexed with carboplatin or cisplatin. Most common AEs were constipation and nausea; no AE patterns leading to dose modifications/discontinuations were observed. The FLAURA2 safety run-in study showed that the safety profile of this combination was as expected and manageable.
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Affiliation(s)
- D Planchard
- Institut Gustave Roussy, Department of Medical Oncology, Thoracic Oncology Unit, Villejuif, France.
| | - P-H Feng
- Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - N Karaseva
- City Clinical Oncology Dispensary, St. Petersburg, Russia
| | - S-W Kim
- Asan Medical Center, Seoul, Republic of Korea
| | - T M Kim
- Seoul National University Hospital, Seoul, Republic of Korea
| | - C K Lee
- Clinical Research Unit, Division of Cancer Services, St. George Hospital, Kogarah, Australia
| | - A Poltoratskiy
- Department of Clinical Trials, Petrov Research Institute of Oncology, St. Petersburg, Russia
| | - N Yanagitani
- Department of Thoracic Medical Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Koto-ku, Tokyo, Japan
| | | | | | | | - P A Jänne
- Dana-Farber Cancer Institute, Boston, USA
| | - K Kobayashi
- Department of Respiratory Medicine, Saitama Medical School International Medical Center, Saitama, Japan
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23
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Lee CK, Wu C, Lin CY, Huang PC, Sung FC, Su TC. Positive Association between Endothelium-Platelet Microparticles and Urinary Concentration of Lead and Cadmium in Adolescents and Young Adults. Nutrients 2021; 13:nu13092913. [PMID: 34578790 PMCID: PMC8468016 DOI: 10.3390/nu13092913] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/12/2021] [Accepted: 08/21/2021] [Indexed: 11/20/2022] Open
Abstract
(1) Background: In previous research, higher levels of urine heavy metals, especially lead and cadmium, have been associated with increased cardiovascular risk. However, there is no information linking exposure to heavy metal to endothelial and platelet microparticles (EMPs and PMPs), particularly in the younger population, which are novel biomarkers of endothelial dysfunction. (2) Methods: From a nationwide database, which was incepted in 1992–2000, screening for renal health among Taiwanese school children, a total of 789 subjects were recruited. Cross-sectional analysis was performed to evaluate the association between serum EMPs/PMPs and urine iron, nickel, copper, cadmium, lead, chromium, manganese, and zinc levels in the adolescent and young adult population. (3) Results: After we adjusted the conventional cardiovascular risk factors, CD31+/CD42a− and CD31+/CD42a+ counts, in subjects’ serum, respective markers of EMP and PMP displayed a significant positive dose-response relationship with urinary lead and cadmium levels. Higher quartiles of urine lead and cadmium levels were associated with an increased risk of higher EMPs/PMPs (≥75th percentile) in a multivariate logistic regression model. (4) Conclusion: Higher urinary lead and cadmium concentrations are strongly associated with endothelium–platelet microparticles in this adolescent and young adult population, which could help explain, in part, the mechanism through which heavy metal exposure results in cardiotoxicity.
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Affiliation(s)
- Chih-Kuo Lee
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu 300, Taiwan;
- College of Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Charlene Wu
- Global Health Program, College of Public Health, National Taiwan University, Taipei 100, Taiwan;
| | - Chien-Yu Lin
- Department of Internal Medicine, En Chu Kong Hospital, New Taipei City 237, Taiwan;
- School of Medicine, Fu Jen Catholic University, New Taipei City 242, Taiwan
- Department of Environmental Engineering and Health, Yuanpei University of Medical Technology, Hsinchu 300, Taiwan
| | - Po-Chin Huang
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli 350, Taiwan;
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung 404, Taiwan
- Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Fung-Chang Sung
- Institute of Environmental Health, College of Public Health, China Medical University, Taichung 404, Taiwan;
| | - Ta-Chen Su
- Department of Environmental and Occupational Medicine, National Taiwan University Hospital, Taipei 100, Taiwan
- Department of Internal Medicine and Cardiovascular Center, National Taiwan University Hospital, Taipei 100, Taiwan
- Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei 100, Taiwan
- Correspondence: ; Tel.: +886-2-23123456 (ext. 66719 or 67183)
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24
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Lee CK, Liao CW, Meng SW, Wu WK, Chiang JY, Wu MS. Lipids and Lipoproteins in Health and Disease: Focus on Targeting Atherosclerosis. Biomedicines 2021; 9:biomedicines9080985. [PMID: 34440189 PMCID: PMC8393881 DOI: 10.3390/biomedicines9080985] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 07/07/2021] [Revised: 08/01/2021] [Accepted: 08/04/2021] [Indexed: 12/15/2022] Open
Abstract
Despite advances in pharmacotherapy, intervention devices and techniques, residual cardiovascular risks still cause a large burden on public health. Whilst most guidelines encourage achieving target levels of specific lipids and lipoproteins to reduce these risks, increasing evidence has shown that molecular modification of these lipoproteins also has a critical impact on their atherogenicity. Modification of low-density lipoprotein (LDL) by oxidation, glycation, peroxidation, apolipoprotein C-III adhesion, and the small dense subtype largely augment its atherogenicity. Post-translational modification by oxidation, carbamylation, glycation, and imbalance of molecular components can reduce the capacity of high-density lipoprotein (HDL) for reverse cholesterol transport. Elevated levels of triglycerides (TGs), apolipoprotein C-III and lipoprotein(a), and a decreased level of apolipoprotein A-I are closely associated with atherosclerotic cardiovascular disease. Pharmacotherapies aimed at reducing TGs, lipoprotein(a), and apolipoprotein C-III, and enhancing apolipoprotein A-1 are undergoing trials, and promising preliminary results have been reported. In this review, we aim to update the evidence on modifications of major lipid and lipoprotein components, including LDL, HDL, TG, apolipoprotein, and lipoprotein(a). We also discuss examples of translating findings from basic research to potential therapeutic targets for drug development.
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Affiliation(s)
- Chih-Kuo Lee
- College of Medicine, National Taiwan University, Taipei 100, Taiwan; (C.-K.L.); (C.-W.L.); (S.-W.M.); (W.-K.W.)
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu 300, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Che-Wei Liao
- College of Medicine, National Taiwan University, Taipei 100, Taiwan; (C.-K.L.); (C.-W.L.); (S.-W.M.); (W.-K.W.)
- Department of Internal Medicine, National Taiwan University Cancer Center, Taipei 106, Taiwan
| | - Shih-Wei Meng
- College of Medicine, National Taiwan University, Taipei 100, Taiwan; (C.-K.L.); (C.-W.L.); (S.-W.M.); (W.-K.W.)
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu 300, Taiwan
| | - Wei-Kai Wu
- College of Medicine, National Taiwan University, Taipei 100, Taiwan; (C.-K.L.); (C.-W.L.); (S.-W.M.); (W.-K.W.)
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei 100, Taiwan
| | - Jiun-Yang Chiang
- College of Medicine, National Taiwan University, Taipei 100, Taiwan; (C.-K.L.); (C.-W.L.); (S.-W.M.); (W.-K.W.)
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei 100, Taiwan
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Center, National Taiwan University Hospital, Taipei 100, Taiwan
- Correspondence: (J.-Y.C.); (M.-S.W.)
| | - Ming-Shiang Wu
- College of Medicine, National Taiwan University, Taipei 100, Taiwan; (C.-K.L.); (C.-W.L.); (S.-W.M.); (W.-K.W.)
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei 100, Taiwan
- Correspondence: (J.-Y.C.); (M.-S.W.)
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Lee CK, Wang TD, Juang HT, Chang SC, Pan HY, Lin DSH, Chang CJ. Efficacy and safety of ticagrelor versus clopidogrel in patients with non-ST-elevation myocardial infarction in Taiwan. Sci Rep 2021; 11:14150. [PMID: 34239030 PMCID: PMC8266799 DOI: 10.1038/s41598-021-93712-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 06/29/2021] [Indexed: 01/31/2023] Open
Abstract
The clinical efficacy of ticagrelor versus clopidogrel has not been replicated in East Asian populations. The pronounced bleeding risk with ticagrelor was of concern given the increased bleeding tendency in Asian populations. This study evaluated efficacy and safety of ticagrelor versus clopidogrel in patients with non-ST-elevation myocardial infarction (NSTEMI) in the entire Taiwan. We used the Taiwan National Health Insurance Research Database to identify 6203 patients aged ≥ 20 years with NSTEMI hospitalization and prescription of dual antiplatelets at discharge between January 2014 and December 2014. Cohorts of ticagrelor and clopidogrel were matched 1:1 based on propensity score matching to balance baseline covariates. The primary composite efficacy endpoints included death from any cause, non-fatal myocardial infarction, and non-fatal stroke. The secondary efficacy endpoints were the individual components. The primary safety endpoint was major bleeding requiring hospitalization. The incidence of primary efficacy endpoint was 20.3% in the ticagrelor users and 20.7% in the clopidogrel users (adjusted HR 0.94; 95% CI 0.73–1.22), with the median (interquartile range, IQR) follow-up period of 5.2 (2.3–8.5) months. The incidence of primary safety endpoint was 2.3% in the ticagrelor users and 3.2% in the clopidogrel users (adjusted HR 0.67; 95% CI 0.33–1.35). Regarding the secondary efficacy endpoint, patients treated with ticagrelor had significantly lower incidence of stroke (adjusted HR 0.44; 95% CI 0.21–0.94; p = 0.033). In this nationwide Taiwanese cohort of NSTEMI, treatment with ticagrelor after discharge, as compared to clopidogrel, had similar rates of ischemic composite events and major bleeding. Nevertheless, the median follow-up time was only 5.2 months, and the reduced stroke events with ticagrelor compared to clopidogrel needs further verification.
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Affiliation(s)
- Chih-Kuo Lee
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan.,College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Tzung-Dau Wang
- College of Medicine, National Taiwan University, Taipei, Taiwan. .,Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, No. 7, Zhong-Shan South Road, Taipei City, 10002, Taiwan.
| | - Hsiao-Ting Juang
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyüan, Taiwan
| | - Shu-Chen Chang
- Research Services Center for Health Information, Chang Gung University, Taoyüan, Taiwan
| | - Heng-Yu Pan
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Donna Shu-Han Lin
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, No. 7, Zhong-Shan South Road, Taipei City, 10002, Taiwan
| | - Chee-Jen Chang
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyüan, Taiwan. .,Research Services Center for Health Information, Chang Gung University, Taoyüan, Taiwan. .,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyüan, Taiwan. .,Department of Cardiology, Chang Gung Memorial Hospital, Linkou, Taiwan. .,Department of Biomedical Sciences, Chang Gung University, Taoyüan, Taiwan.
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Hsieh YF, Lee CK, Wang W, Huang YC, Lee WJ, Wang TD, Chou CY. Coronary CT angiography-based estimation of myocardial perfusion territories for coronary artery FFR and wall shear stress simulation. Sci Rep 2021; 11:13855. [PMID: 34226598 PMCID: PMC8257574 DOI: 10.1038/s41598-021-93237-1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/21/2021] [Indexed: 11/30/2022] Open
Abstract
This study aims to apply a CCTA-derived territory-based patient-specific estimation of boundary conditions for coronary artery fractional flow reserve (FFR) and wall shear stress (WSS) simulation. The non-invasive simulation can help diagnose the significance of coronary stenosis and the likelihood of myocardial ischemia. FFR is often regarded as the gold standard to evaluate the functional significance of stenosis in coronary arteries. In another aspect, proximal wall shear stress (\documentclass[12pt]{minimal}
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\begin{document}$$\mathrm{{WSS}_{prox}}$$\end{document}WSSprox) can also be an indicator of plaque vulnerability. During the simulation process, the mass flow rate of the blood in coronary arteries is one of the most important boundary conditions. This study utilized the myocardium territory to estimate and allocate the mass flow rate. 20 patients are included in this study. From the knowledge of anatomical information of coronary arteries and the myocardium, the territory-based FFR and the \documentclass[12pt]{minimal}
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\begin{document}$$\mathrm{{WSS}_{prox}}$$\end{document}WSSprox can both be derived from fluid dynamics simulations. Applying the threshold of distinguishing between significant and non-significant stenosis, the territory-based method can reach the accuracy, sensitivity, and specificity of 0.88, 0.90, and 0.80, respectively. For significantly stenotic cases (\documentclass[12pt]{minimal}
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\begin{document}$$\le$$\end{document}≤ 0.80), the vessels usually have higher wall shear stress in the proximal region of the lesion.
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Affiliation(s)
- Yu-Fang Hsieh
- Department of Biomechatronics Engineering, National Taiwan University, Taipei, 106, Taiwan
| | - Chih-Kuo Lee
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, 300, Taiwan
| | - Weichung Wang
- Institute of Applied Mathematical Sciences, National Taiwan University, Taipei, 106, Taiwan
| | - Yu-Cheng Huang
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, 100, Taiwan
| | - Wen-Jeng Lee
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, 100, Taiwan
| | - Tzung-Dau Wang
- Cardiovascular Center and Divisions of Cardiology and Hospital Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan
| | - Cheng-Ying Chou
- Department of Biomechatronics Engineering, National Taiwan University, Taipei, 106, Taiwan.
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Lin YT, Wang LK, Cheng YT, Lee CK, Tsai HE. Molecularly Imprinted Polymer/Anodic Aluminum Oxide Nanocomposite Sensing Electrode for Low-Concentration Troponin T Detection for Patient Monitoring Applications. ACS Sens 2021; 6:2429-2435. [PMID: 34101435 DOI: 10.1021/acssensors.1c00738] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Various clinical studies have shown that myocardial troponin T (cTnT) is highly correlated with acute myocardial infarction (AMI). A highly sensitive molecularly imprinted polymer (MIP) sensing electrode for the detection of cTnT in patients' blood serum can enable cost-effective, rapid, and real-time testing for patients requiring intensive care. However, the existing MIP-based sensing electrode does not perform well for low-concentration detection of cTnT (<0.2 ng/mL). In this study, a new type of sensing electrode, an anodic aluminum oxide molecularly imprinted (MIP/AAO) nanocomposite electrode is developed. By incorporating the AAO structure, i.e., one-dimensional (1D) pillars, through a semiconductor-compatible process, the new electrode exhibits a great performance improvement, higher sensitivity of 1.08 × 10-4 and 4.25 × 10-4 in the low (<0.03 ng/mL)- and high-concentration regions, respectively, and a lower limit of detection (LoD) of 5.34 pg/mL. Because the composite electrode can maintain a linear characteristic in the measurement range of low-concentration cTnT, it can effectively improve the accuracy and reduce the error in cTnT measurement. In addition, the novel sensing electrode exhibits good reusability and specificity.
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Affiliation(s)
- Yu-Tsan Lin
- Microsystems Integration Laboratory, Institute of Electronics Engineering, National Yang Ming Chiao Tung University, Hsinchu, Taiwan 300, ROC
| | - Liang-Kai Wang
- Microsystems Integration Laboratory, Institute of Electronics Engineering, National Yang Ming Chiao Tung University, Hsinchu, Taiwan 300, ROC
| | - Yu-Ting Cheng
- Microsystems Integration Laboratory, Institute of Electronics Engineering, National Yang Ming Chiao Tung University, Hsinchu, Taiwan 300, ROC
| | - Chih-Kuo Lee
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu 300, Taiwan, ROC
- Department of Internal Medicine and Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei 10617, Taiwan, ROC
| | - Hsiao-En Tsai
- Department of Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan 300, ROC
- Department of Internal Medicine and Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei 10617, Taiwan, ROC
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28
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Wong MMC, Chung AKK, Yeung TMH, Wong DTW, Lee CK, Lai E, Chan GFY, Mak GKL, Wong JOY, Ng RMK, Tam KL, Mak KY. Consensus statements on the clinical usage and characteristics of aripiprazole for Hong Kong. Intern Med J 2021; 50 Suppl 3:6-14. [PMID: 32985093 DOI: 10.1111/imj.14896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Aripiprazole, a dopamine partial agonist, is a second-generation anti-psychotic that is widely used for the treatment of schizophrenia and other psychotic disorders. A group of psychiatric experts in Hong Kong developed a set of consensus statements, aiming to facilitate the understanding of clinical properties and usages of aripiprazole among local physicians. Of note, because aripiprazole long-acting injectable has been available locally not long before the establishment of the consensus panel, which limited the discussion on its use in the local context, the consensus statements were focused primarily on oral aripiprazole. To draft the consensus statements, the panellists discussed the published evidence and their clinical experience regarding aripiprazole in a series of meetings based on several areas. At the final meeting, each drafted statement was voted on anonymously by all panellists based on its practicability of recommendation in Hong Kong. A set of consensus statements on the characteristics and clinical use of aripiprazole was established and accepted by the panel. These statements serve to provide a practical reference for physicians in Hong Kong, and possibly other parts of the Asia-Pacific region, on the use of aripiprazole in people with schizophrenia spectrum disorders and other psychotic problems.
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Affiliation(s)
| | | | | | | | - C K Lee
- Asian Association of Neuropsychopharmacology
| | - Eric Lai
- Asian Association of Neuropsychopharmacology
| | | | | | | | | | - K L Tam
- Asian Association of Neuropsychopharmacology
| | - K Y Mak
- Asian Association of Neuropsychopharmacology
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29
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Chen HY, Hsu BWY, Yin YK, Lin FH, Yang TH, Yang RS, Lee CK, Tseng VS. Application of deep learning algorithm to detect and visualize vertebral fractures on plain frontal radiographs. PLoS One 2021; 16:e0245992. [PMID: 33507982 PMCID: PMC7842883 DOI: 10.1371/journal.pone.0245992] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 08/12/2020] [Accepted: 01/12/2021] [Indexed: 12/21/2022] Open
Abstract
Background Identification of vertebral fractures (VFs) is critical for effective secondary fracture prevention owing to their association with the increasing risks of future fractures. Plain abdominal frontal radiographs (PARs) are a common investigation method performed for a variety of clinical indications and provide an ideal platform for the opportunistic identification of VF. This study uses a deep convolutional neural network (DCNN) to identify the feasibility for the screening, detection, and localization of VFs using PARs. Methods A DCNN was pretrained using ImageNet and retrained with 1306 images from the PARs database obtained between August 2015 and December 2018. The accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were evaluated. The visualization algorithm gradient-weighted class activation mapping (Grad-CAM) was used for model interpretation. Results Only 46.6% (204/438) of the VFs were diagnosed in the original PARs reports. The algorithm achieved 73.59% accuracy, 73.81% sensitivity, 73.02% specificity, and an AUC of 0.72 in the VF identification. Conclusion Computer driven solutions integrated with the DCNN have the potential to identify VFs with good accuracy when used opportunistically on PARs taken for a variety of clinical purposes. The proposed model can help clinicians become more efficient and economical in the current clinical pathway of fragile fracture treatment.
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Affiliation(s)
- Hsuan-Yu Chen
- Institute of Biomedical Engineering, National Taiwan University, Taipei City, Taiwan
- Department of Orthopedics, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan
- Department of Orthopedics, National Taiwan University HsinChu Hospital, Hsin-Chu, Taiwan
| | - Benny Wei-Yun Hsu
- Institute of Computer Science and Engineering, National Chiao Tung University, Hsinchu, Taiwan
| | - Yu-Kai Yin
- Institute of Computer Science and Engineering, National Chiao Tung University, Hsinchu, Taiwan
| | - Feng-Huei Lin
- Institute of Biomedical Engineering, National Taiwan University, Taipei City, Taiwan
| | - Tsung-Han Yang
- Department of Orthopedics, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan
- Department of Orthopedics, National Taiwan University HsinChu Hospital, Hsin-Chu, Taiwan
| | - Rong-Sen Yang
- Department of Orthopedics, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Kuo Lee
- Department of Internal Medicine, National Taiwan University HsinChu Hospital, HsinChu, Taiwan
| | - Vincent S. Tseng
- Institute of Computer Science and Engineering, National Chiao Tung University, Hsinchu, Taiwan
- * E-mail:
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30
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Flores M, Dayan I, Roth H, Zhong A, Harouni A, Gentili A, Abidin A, Liu A, Costa A, Wood B, Tsai CS, Wang CH, Hsu CN, Lee CK, Ruan C, Xu D, Wu D, Huang E, Kitamura F, Lacey G, César de Antônio Corradi G, Shin HH, Obinata H, Ren H, Crane J, Tetreault J, Guan J, Garrett J, Park JG, Dreyer K, Juluru K, Kersten K, Bezerra Cavalcanti Rockenbach MA, Linguraru M, Haider M, AbdelMaseeh M, Rieke N, Damasceno P, Cruz E Silva PM, Wang P, Xu S, Kawano S, Sriswasdi S, Park SY, Grist T, Buch V, Jantarabenjakul W, Wang W, Tak WY, Li X, Lin X, Kwon F, Gilbert F, Kaggie J, Li Q, Quraini A, Feng A, Priest A, Turkbey B, Glicksberg B, Bizzo B, Kim BS, Tor-Diez C, Lee CC, Hsu CJ, Lin C, Lai CL, Hess C, Compas C, Bhatia D, Oermann E, Leibovitz E, Sasaki H, Mori H, Yang I, Sohn JH, Keshava Murthy KN, Fu LC, Furtado de Mendonça MR, Fralick M, Kang MK, Adil M, Gangai N, Vateekul P, Elnajjar P, Hickman S, Majumdar S, McLeod S, Reed S, Graf S, Harmon S, Kodama T, Puthanakit T, Mazzulli T, de Lima Lavor V, Rakvongthai Y, Lee YR, Wen Y. Federated Learning used for predicting outcomes in SARS-COV-2 patients. Res Sq 2021:rs.3.rs-126892. [PMID: 33442676 PMCID: PMC7805458 DOI: 10.21203/rs.3.rs-126892/v1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
'Federated Learning' (FL) is a method to train Artificial Intelligence (AI) models with data from multiple sources while maintaining anonymity of the data thus removing many barriers to data sharing. During the SARS-COV-2 pandemic, 20 institutes collaborated on a healthcare FL study to predict future oxygen requirements of infected patients using inputs of vital signs, laboratory data, and chest x-rays, constituting the "EXAM" (EMR CXR AI Model) model. EXAM achieved an average Area Under the Curve (AUC) of over 0.92, an average improvement of 16%, and a 38% increase in generalisability over local models. The FL paradigm was successfully applied to facilitate a rapid data science collaboration without data exchange, resulting in a model that generalised across heterogeneous, unharmonized datasets. This provided the broader healthcare community with a validated model to respond to COVID-19 challenges, as well as set the stage for broader use of FL in healthcare.
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Affiliation(s)
| | | | | | - Aoxiao Zhong
- Center for Advanced Medical Computing and Analysis, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | | | | | | | | | - Bradford Wood
- Radiology & Imaging Sciences / Clinical Center, National Institutes of Health
| | - Chien-Sung Tsai
- Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Chih-Hung Wang
- Tri-Service General Hospital, National Defense Medical Center
| | - Chun-Nan Hsu
- Center for Research in Biological Systems, University of California, San Diego
| | | | | | | | - Dufan Wu
- Center for Advanced Medical Computing and Analysis, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | | | | | | | | | | | - Hui Ren
- Center for Advanced Medical Computing and Analysis, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Jason Crane
- Center for Intelligent Imaging, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | | | | | - John Garrett
- The University of Wisconsin-Madison School of Medicine and Public Health
| | | | - Keith Dreyer
- Center for Clinical Data Science, Massachusetts General Brigham, Boston, MA
| | | | | | | | - Marius Linguraru
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital and School of Medicine and Health Sciences, George Washington University, Washington, DC
| | - Masoom Haider
- Joint Dept. of Medical Imaging, Sinai Health System, University of Toronto, Toronto, Canada and Lunenfeld-Tanenbaum Research Institute, Toronto, Canada
| | | | | | - Pablo Damasceno
- Center for Intelligent Imaging, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | | | - Pochuan Wang
- MeDA Lab and Institute of Applied Mathematical Sciences, National Taiwan University, Taipei, Taiwan
| | - Sheng Xu
- Center for Interventional Oncology, National Institutes of Health, Bethesda, MD, USA
| | | | | | - Soo Young Park
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | | | - Varun Buch
- Center for Clinical Data Science, Massachusetts General Brigham, Boston, MA
| | - Watsamon Jantarabenjakul
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand and Thai Red Cross Emerging Infectious Diseases Clinical Center, King Chulalongkorn Memorial Hospital, Bang
| | | | - Won Young Tak
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Xiang Li
- Center for Advanced Medical Computing and Analysis, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Xihong Lin
- Harvard T.H. Chan School of Public Health
| | | | | | - Josh Kaggie
- Department of Radiology, NIHR Cambridge Biomedical Resource Centre, University of Cambridge
| | - Quanzheng Li
- Center for Advanced Medical Computing and Analysis, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | | | - Andrew Priest
- Department of Radiology, NIHR Cambridge Biomedical Resource Centre, Cambridge University Hospital
| | | | | | - Bernardo Bizzo
- Center for Clinical Data Science, Massachusetts General Brigham, Boston, MA
| | - Byung Seok Kim
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, South Korea
| | - Carlos Tor-Diez
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC
| | - Chia-Cheng Lee
- Planning and Management Office, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C. and Division of Colorectal Surgery, Department of Surgery, Tri-Service General H
| | - Chia-Jung Hsu
- Planning and Management Office, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Chin Lin
- School of Medicine, National Defense Medical Center, Taipei, Taiwan, R.O.C. and School of Public Health, National Defense Medical Center, Taipei, Taiwan, R.O.C. and Graduate Institute of Life Scienc
| | - Chiu-Ling Lai
- Medical Review and Pharmaceutical Benefits Division, National Health Insurance Administration, Taipei. Taiwan
| | | | | | | | | | - Evan Leibovitz
- The Center for Clinical Data Science, Mass General Brigham
| | | | | | | | - Jae Ho Sohn
- Center for Intelligent Imaging, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | | | - Li-Chen Fu
- MOST/NTU All Vista Healthcare Center, Center for Artificial Intelligence and Advanced Robotics, National Taiwan University, Taipei, Taiwan
| | | | - Mike Fralick
- Division of General Internal Medicine and Geriatrics (Fralick), Sinai Health System, Toronto, Canada
| | - Min Kyu Kang
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, South Korea
| | | | | | - Peerapon Vateekul
- Department of Computer Engineering, Faculty of Engineering, Chulalongkorn University
| | | | - Sarah Hickman
- Department of Radiology, NIHR Cambridge Biomedical Resource Centre, University of Cambridge
| | - Sharmila Majumdar
- Center for Intelligent Imaging, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Shelley McLeod
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health, Toronto, ON, Canada and Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Sheridan Reed
- Center for Interventional Oncology, National Institutes of Health, Bethesda, MD, USA
| | | | | | | | - Thanyawee Puthanakit
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Center of Excellence in Pediatric Infectious Diseases and Vaccine, Chulalongkorn University
| | - Tony Mazzulli
- Department of Microbiology, Sinai Health/University Health Network, Toronto, Canada and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto. Canada Public Health Ontar
| | | | - Yothin Rakvongthai
- Chulalongkorn University Biomedical Imaging Group and Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Yu Rim Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
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Wang TD, Lee CK, Chia YC, Tsoi K, Buranakitjaroen P, Chen CH, Cheng HM, Tay JC, Teo BW, Turana Y, Sogunuru GP, Wang JG, Kario K. Hypertension and erectile dysfunction: The role of endovascular therapy in Asia. J Clin Hypertens (Greenwich) 2020; 23:481-488. [PMID: 33314715 PMCID: PMC8029574 DOI: 10.1111/jch.14123] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 10/20/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 11/30/2022]
Abstract
The prevalence of erectile dysfunction (ED) is above 40% in both Asian and non-Asian male populations after the age of 40 years. The prevalence of ED among hypertensive patients is approximately double than that in normotensive population. Pelvic arterial insufficiency is the predominant cause of ED in men aged over 50 years. Stenosis in any segment of the iliac-pudendal-penile arterial system, which is considered an erectile-related arterial axis, could lead to ED. Pharmacotherapy with lifestyle modification is effective in alleviating sexual dysfunction, yet a substantial number of patients still develop ED. Given the established applicability of angioplasty for the entire iliac-pudendal-penile arterial system, penile duplex ultrasound, and pelvic computed tomography angiography could be considered as the routine screening tools in ED patients with poor response to phosphodiesterase-5 inhibitors. Endovascular therapy for pelvic arterial insufficiency-related ED has been shown to be a safe and effective treatment option in patients who have anatomically suitable vessels and functionally significant stenoses. Clinical improvement was achieved in over 60% of patients at one year following pelvic angioplasty in the PERFECT registry from Taiwan. A 30%-40% restenosis rate in distal internal pudendal and penile arteries remains a hurdle. Angioplasty for pelvic arterial occlusive disease could be considered as a viable approach to arteriogenic ED.
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Affiliation(s)
- Tzung-Dau Wang
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan.,Division of Hospital Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan
| | - Chih-Kuo Lee
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Yook-Chin Chia
- Department of Medical Sciences, School of Healthcare and Medical Sciences, Sunway University, Bandar Sunway, Malaysia.,Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kelvin Tsoi
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Peera Buranakitjaroen
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chen-Huan Chen
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hao-Min Cheng
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medical Education, Center for Evidence-based Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jam Chin Tay
- Department of General Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Boon Wee Teo
- Division of Nephrology Department of Medicine, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Yuda Turana
- Faculty of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Guru Prasad Sogunuru
- MIOT International Hospital, Chennai, India.,College of Medical Sciences, Kathmandu University, Bharatpur, Nepal
| | - Ji-Guang Wang
- Department of Hypertension, Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
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Lee CK, Hsieh MC, Luo CM, Liao MT, Hsieh MY, Wu CC. Use of the Viabahn covered stent for the treatment of venous rupture during interventions of dysfunctional or thrombosed hemodialysis vascular access. J Vasc Access 2020; 22:759-766. [PMID: 33012250 DOI: 10.1177/1129729820961955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Angioplasty-related vessel rupture is a common complication of interventions. The effect of covered stents to treat venous rupture has been evaluated in smaller series, but should be further evaluated. OBJECTIVE To report the immediate outcomes and patency rates of a covered stent to rescue angioplasty-related venous rupture of hemodialysis vascular access. METHODS From January 2013 to December 2018, 113 procedures complicated with vessel ruptures were retrospectively analyzed from a prospectively collected database of 8146 hemodialysis access interventions. The strategies to salvage vessel ruptures were based on the discretion of the treating physicians. Follow-up outcomes were obtained via review of the angiographic images, procedural notes, and medical and dialysis records within 12 months after the index procedures. RESULTS A total of 52 vessel ruptures (21 fistulas, 31 grafts) salvaged by using Viabahn covered stents were enrolled. Vessel ruptures developed in 28 (53.8%) thrombectomy procedures. Device success was achieved in all procedures (100%) and clinical success was achieved in 50 (96.2%). The primary patency of the stent area was 66.0% at 6 months and 50.0% at 12 months. The primary patency of the entire access circuit was 27.4% at 6 months and 16.0% at 12 months. The most common cause of access circuit primary patency loss was thrombotic occlusion for graft accesses and restenosis at stent area for native accesses. Eleven vascular accesses were abandoned within 12 months after vessel ruptures, and the secondary patency rate of the entire access circuit was 78.0% at 12 months. CONCLUSIONS Treatment of angioplasty-induced vessel rupture of hemodialysis vascular accesses by using Viabahn covered stents has good immediate outcomes and patency results at the stent area. Nonetheless, the patency rate of entire access circuit was still below the threshold recommended by guidelines.
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Affiliation(s)
- Chih-Kuo Lee
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu.,College of Medicine, National Taiwan University, Taipei
| | - Ming-Chien Hsieh
- Cardiovascular Center, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu
| | - Chien-Ming Luo
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu.,Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu
| | - Min-Tsun Liao
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu.,Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei
| | - Mu-Yang Hsieh
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu.,College of Medicine, National Taiwan University, Taipei
| | - Chih-Cheng Wu
- College of Medicine, National Taiwan University, Taipei.,Cardiovascular Center, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu.,Institute of Biomedical Engineering, National Tsing-Hwa University, Hsinchu.,Institute of Cellular and System Medicine, National Health Research Institute, Miaoli
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Lee CK, Leung JNS, Cheng P, Lung DC, To KKW, Tsang DNC. Absence of SARS-CoV-2 viraemia in a blood donor with COVID-19 post-donation. Transfus Med 2020; 31:223-224. [PMID: 33015920 PMCID: PMC7677860 DOI: 10.1111/tme.12724] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 09/22/2020] [Indexed: 12/01/2022]
Affiliation(s)
- C K Lee
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong, SAR, China
| | - J N S Leung
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong, SAR, China
| | - P Cheng
- Public Health Laboratory Centre, Centre for Health Protection, Department of Health, Hong Kong, SAR, China
| | - D C Lung
- Department of Pathology, Queen Elizabeth Hospital, Hong Kong, SAR, China
| | - K K W To
- State Key Laboratory for Emerging Infectious Diseases, Carol Yu Centre for Infection, Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | - D N C Tsang
- Public Health Laboratory Centre, Centre for Health Protection, Department of Health, Hong Kong, SAR, China
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Chow YF, Cheng BCP, Cheng HK, Ho B, Lee CK, Ng SK, So R, Tse KC, Tsui C, Wan R, Wong S. Hong Kong Society of Clinical Blood Management recommendations for implementation of patient blood management. Hong Kong Med J 2020; 26:331-338. [PMID: 32807736 DOI: 10.12809/hkmj208397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Patient blood management (PBM) is a patient-centred, multidisciplinary approach to optimise red cell mass, minimise blood loss, and manage tolerance to anaemia in an effort to improve patient outcomes. Well-implemented PBM improves patient outcomes and reduces demand for blood products. The multidisciplinary approach of PBM can often allow patients to avoid blood transfusions, which are associated with less favourable clinical outcomes. In Hong Kong, there has been increasing demand for blood in the ageing population, and there are simultaneous blood safety and donor issues that are adversely affecting the blood supply. To address these challenges, the Hong Kong Society of Clinical Blood Management recommends implementation of a PBM programme in Hong Kong, including strategies such as optimising red blood cell mass, improving anaemia management, minimising blood loss, and rationalising the use of blood and blood products.
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Affiliation(s)
- Y F Chow
- Department of Anaesthesiology and OT Services, Queen Elizabeth Hospital, Hong Kong
| | - B C P Cheng
- Department of Anaesthesia and Operating Theatre Services, Tuen Mun Hospital, Hong Kong
| | - H K Cheng
- Department of Anaesthesia and Operating Theatre Services, Tseung Kwan O Hospital, Hong Kong
| | - B Ho
- Department of Anaesthesiology, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | - C K Lee
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong
| | - S K Ng
- Private Practice, Hong Kong
| | - R So
- Department of Anaesthesia, Princess Margaret Hospital, Hong Kong
| | - K C Tse
- Department of Anaesthesia and Operating Theatre Services, Tseung Kwan O Hospital, Hong Kong
| | - C Tsui
- Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, Hong Kong
| | - R Wan
- Private Practice, Hong Kong
| | - S Wong
- Department of Anaesthesiology and OT Services, Queen Elizabeth Hospital, Hong Kong
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Tsan SEH, Kamalanathan A, Lee CK, Zakaria SA, Wang CY. A survey on burnout and depression risk among anaesthetists during COVID-19: the tip of an iceberg? Anaesthesia 2020; 76 Suppl 3:8-10. [PMID: 32776524 PMCID: PMC7436440 DOI: 10.1111/anae.15231] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2020] [Indexed: 11/30/2022]
Affiliation(s)
- S E H Tsan
- University of Malaysia Sarawak, Sarawak, Malaysia
| | | | - C K Lee
- Sungai Buloh Hospital, Ministry of Health, Malaysia
| | - S A Zakaria
- Sungai Buloh Hospital, Ministry of Health, Malaysia
| | - C Y Wang
- University of Malaya, Kuala Lumpur, Malaysia
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Luen SJ, Asher R, Lee CK, Savas P, Kammler R, Dell'Orto P, Biasi OM, Demanse D, Hackl W, Thuerlimann B, Viale G, Di Leo A, Colleoni M, Regan MM, Loi S. Identifying oncogenic drivers associated with increased risk of late distant recurrence in postmenopausal, estrogen receptor-positive, HER2-negative early breast cancer: results from the BIG 1-98 study. Ann Oncol 2020; 31:1359-1365. [PMID: 32652112 DOI: 10.1016/j.annonc.2020.06.024] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 06/08/2020] [Accepted: 06/28/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In postmenopausal, estrogen receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative early breast cancer, the risk for distant recurrence can extend beyond 5 years of adjuvant endocrine therapy. This study aims to identify genomic driver alterations associated with late distant recurrence. PATIENTS AND METHODS Next generation sequencing was used to characterize driver alterations in primary tumors from a subset of 764 postmenopausal estrogen receptor-positive/HER2-negative patients from the BIG 1-98 randomized trial. Late distant recurrence events were defined as ≥5 years from time of randomization). The association of driver alterations with distant recurrence-free interval in early and late time periods was assessed using Cox regression models. Multivariable analyses were carried out to adjust for clinicopathological factors. Weighted analysis methods were used in order to correct for over-sampling of distant recurrences. RESULTS A total of 538 of 764 (70%) samples were successfully sequenced including 88 (63%) early and 52 (37%) late distant recurrence events after a median follow up of 8.1 years. In univariable analysis for late distant recurrence, PIK3CA mutations (58.8%) were significantly associated with reduced risk [hazard ratio (HR) 0.40, 95% confidence interval (CI) 0.20-0.82, P = 0.012], whereas amplifications on chromosome 8p11 (10.9%) (HR 4.79, 95% CI 2.30-9.97, P < 0.001) and BRCA2 mutations (2.3%) (HR 5.39, 95% CI 1.51-19.29, P = 0.010) were significantly associated with an increased risk. In multivariable analysis, only amplifications on 8p11 (P = 0.002) and BRCA2 mutations (P = 0.013) remained significant predictors. CONCLUSIONS In estrogen receptor-positive/HER2-negative postmenopausal early breast cancer, PIK3CA mutations were associated with reduced risk of late distant recurrence, whereas amplifications on 8p11 and BRCA2 mutations were associated with increased risk of late distant recurrence. The characterization of oncogenic driver alterations may aid in refining treatment choices in the late disease setting, and help identify potential drug targets for testing in future trials.
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Affiliation(s)
- S J Luen
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
| | - R Asher
- National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - C K Lee
- National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - P Savas
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
| | - R Kammler
- International Breast Cancer Study Group, Coordinating Center, Central Pathology Office, Bern, Switzerland
| | - P Dell'Orto
- International Breast Cancer Study Group Central Pathology Office, Department of Pathology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - O M Biasi
- Division of Pathology and Laboratory Medicine, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - D Demanse
- Novartis Pharma AG, Basel, Switzerland
| | - W Hackl
- OncogenomX Inc., Allschwil, Basel, Switzerland
| | - B Thuerlimann
- Breast Center, Cantonal Hospital, St Gallen, Switzerland; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - G Viale
- Department of Pathology, University of Milan, Milan, Italy; IEO European Institute of Oncology IRCCS, Milan, Italy
| | - A Di Leo
- Sandro Pitigliani Department of Medical Oncology, Hospital of Prato, Prato, Italy
| | - M Colleoni
- Division of Medical Senology, European Institute of Oncology, Milan, Italy
| | - M M Regan
- International Breast Cancer Study Group Statistical Center, Division of Biostatistics, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - S Loi
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia.
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Ng SC, Wong HK, So CK, Lau CW, Leung JNS, Tsoi WC, Lee CK. Streptococcus bovis bacteraemia should be investigated for early detection of colorectal pathology. Hong Kong Med J 2019; 25:414. [PMID: 31761757 DOI: 10.12809/hkmj198135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- S C Ng
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong
| | - H K Wong
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong
| | - C K So
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong
| | - C W Lau
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong
| | - J N S Leung
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong
| | - W C Tsoi
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong
| | - C K Lee
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong
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Kwon HY, Kim NJ, Lee CK, Yoon HG, Choi JW, Won C. An innovative magnetic state generator using machine learning techniques. Sci Rep 2019; 9:16706. [PMID: 31723230 PMCID: PMC6853879 DOI: 10.1038/s41598-019-53411-y] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 10/28/2019] [Indexed: 12/02/2022] Open
Abstract
We propose a new efficient algorithm to simulate magnetic structures numerically. It contains a generative model using a complex-valued neural network to generate k-space information. The output information is hermitized and transformed into real-space spin configurations through an inverse fast Fourier transform. The Adam version of stochastic gradient descent is used to minimize the magnetic energy, which is the cost of our algorithm. The algorithm provides the proper ground spin configurations with outstanding performance. In model cases, the algorithm was successfully applied to solve the spin configurations of magnetic chiral structures. The results also showed that a magnetic long-range order could be obtained regardless of the total simulation system size.
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Affiliation(s)
- H Y Kwon
- Department of Physics, Kyung Hee University, Seoul, 02447, South Korea
- Center for Spintronics, Korea Institute of Science and Technology, Seoul, 02792, South Korea
| | - N J Kim
- Department of Physics, Kyung Hee University, Seoul, 02447, South Korea
| | - C K Lee
- Department of Physics, Kyung Hee University, Seoul, 02447, South Korea
| | - H G Yoon
- Department of Physics, Kyung Hee University, Seoul, 02447, South Korea
| | - J W Choi
- Center for Spintronics, Korea Institute of Science and Technology, Seoul, 02792, South Korea
| | - C Won
- Department of Physics, Kyung Hee University, Seoul, 02447, South Korea.
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Wu CC, Hsieh MY, Lee CK, Chuang SY, Chung MY, Lin CC. Dimethylarginine Dimethylaminohydrolase 1 Polymorphisms and Venous Intimal Hyperplasia in Hemodialysis Patients. Am J Nephrol 2019; 50:454-464. [PMID: 31639806 DOI: 10.1159/000503949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 10/05/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND After angioplasty, veins are more prone to intimal hyperplasia than arteries. Veins tend to produce less nitric oxide (NO), which could lead to endothelial dysfunction. Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of NO synthase and contributes to cardiovascular disease. In humans, dimethylarginine dimethylaminohydrolase 1 (DDAH1) is the major enzyme for ADMA degradation. In this study, we aim to determine whether venous intimal hyperplasia in hemodialysis (HD) vascular access is influenced by common polymorphisms in the DDAH1 genes. METHODS This is a prospective observational cohort study. A total of 473 HD patients referred for the angioplasty of vascular access were enrolled. There were 190 arteriovenous grafts (AVG) and 283 arteriovenous fistulas (AVF). The follow-up lasted for 2 years after the interventions. Seven single nucleotide polymorphisms (SNPs) in DDAH1 were genotyped and ADMA were measured at baseline. The primary outcome was restenosis after angioplasty. RESULTS Among the 7 SNPs, plasma ADMA levels were significantly different in DDAH1 rs233112 (GA + GG vs. AA, 0.86 ± 0.23 vs. 0.82 ± 0.19 μM, p = 0.03) and rs1498373 (CT + TT vs. CC, 0.87 ± 0.23 vs. 0.82 ± 0.20 μM, p = 0.02) genotypes. The AVF group with GG + GA genotype of rs233112 and CT + TT genotype of rs1498373 had higher risks of early restenosis at 3 months. In the AVG group, only GG + GA genotype of rs233112 was associated with early restenosis. A combined analysis of AVG and AVF groups showed that patients with rs233112 GA + GG genotype and rs1498373 CT + TT genotype had higher risks of early restenosis (both p < 0.001). The multivariate analysis results showed that the association of these genotypes with early restenosis is independent of clinical, access, or biochemical factors. CONCLUSIONS Our findings suggest that certain DDAH1 polymorphisms modulate circulating ADMA levels and are associated with venous intimal hyperplasia.
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Affiliation(s)
- Chih-Cheng Wu
- College of Medicine, National Taiwan University, Taipei, Taiwan
- Cardiovascular Center, National Taiwan University Hospital, Hsinchu Branch, Hsinchu, Taiwan
- Institute of Biomedical Engineering, National Tsing-Hua University, Hsinchu, Taiwan
- Institute of Cellular and System Medicine, National Health Research Institute, Miaoli, Taiwan
| | - Mu-Yang Hsieh
- College of Medicine, National Taiwan University, Taipei, Taiwan
- Cardiovascular Center, National Taiwan University Hospital, Hsinchu Branch, Hsinchu, Taiwan
| | - Chih-Kuo Lee
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Shao-Yuan Chuang
- Division of Preventive Medicine and Health Services Research, Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Ming-Yi Chung
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Genome Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Chih-Ching Lin
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan,
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan,
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Huang CC, Lee CK, Meng SW, Hung CS, Chen YH, Lin MS, Yeh CF, Kao HL. Collateral Channel Size and Tortuosity Predict Retrograde Percutaneous Coronary Intervention Success for Chronic Total Occlusion. Circ Cardiovasc Interv 2019; 11:e005124. [PMID: 29311284 DOI: 10.1161/circinterventions.117.005124] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 11/27/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is little evidence on how to select an interventional collateral channel (CC) in retrograde chronic total occlusion (CTO) percutaneous coronary intervention. We aimed to identify independent angiographic predictors of CC tracking and technical success in retrograde CTO percutaneous coronary intervention. METHODS AND RESULTS From January 2012 to December 2015, a total of 216 consecutive retrograde CTO percutaneous coronary intervention attempts by a high-volume operator in a tertiary university-affiliated hospital were enrolled. The clinical, angiographic, and procedural details were collected. The characteristics analyzed included channel type, size, tortuosity, angle of attack, length to emerging point, and the Multicenter CTO Registry of Japan score. The Multicenter CTO Registry of Japan score was 4.2±0.8. A total of 242 CCs were attempted for intervention. CC tracking success rate was 83.5%, and the technical success rate (per CC) was 81.4%. The per-patient technical success rate was 91.2%, and the major procedural complication rate was 4.6%. The atrioventricular groove, epicardial, and septal CCs were used in 36 (14.9%), 84 (34.7%), and 122 (50.4%) tracking attempts, respectively. In multivariable analysis, only large channel size and lack of tortuosity were significant independent predictors of CC tracking and technical success. A new scoring system was developed, while large size was given 1 point and lack of tortuosity was given 2 points. The receiver-operating characteristic area by the new model to predict CC tracking and technical success were 0.800 and 0.752, respectively. CONCLUSIONS In retrograde CTO percutaneous coronary intervention, only size and tortuosity of a CC are independent angiographic predictors of CC tracking and technical success.
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Affiliation(s)
- Ching-Chang Huang
- From the Department of Internal Medicine, National Taiwan University Hospital, Taipei (C.-C.H., C.-S.H., Y.-H.C., M.-S.L., C.-F.Y., H.-L.K.); and Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu (C.-K. L., S.-W.M.)
| | - Chih-Kuo Lee
- From the Department of Internal Medicine, National Taiwan University Hospital, Taipei (C.-C.H., C.-S.H., Y.-H.C., M.-S.L., C.-F.Y., H.-L.K.); and Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu (C.-K. L., S.-W.M.)
| | - Shih-Wei Meng
- From the Department of Internal Medicine, National Taiwan University Hospital, Taipei (C.-C.H., C.-S.H., Y.-H.C., M.-S.L., C.-F.Y., H.-L.K.); and Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu (C.-K. L., S.-W.M.)
| | - Chi-Sheng Hung
- From the Department of Internal Medicine, National Taiwan University Hospital, Taipei (C.-C.H., C.-S.H., Y.-H.C., M.-S.L., C.-F.Y., H.-L.K.); and Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu (C.-K. L., S.-W.M.)
| | - Ying-Hsien Chen
- From the Department of Internal Medicine, National Taiwan University Hospital, Taipei (C.-C.H., C.-S.H., Y.-H.C., M.-S.L., C.-F.Y., H.-L.K.); and Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu (C.-K. L., S.-W.M.)
| | - Mao-Shin Lin
- From the Department of Internal Medicine, National Taiwan University Hospital, Taipei (C.-C.H., C.-S.H., Y.-H.C., M.-S.L., C.-F.Y., H.-L.K.); and Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu (C.-K. L., S.-W.M.)
| | - Chih-Fan Yeh
- From the Department of Internal Medicine, National Taiwan University Hospital, Taipei (C.-C.H., C.-S.H., Y.-H.C., M.-S.L., C.-F.Y., H.-L.K.); and Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu (C.-K. L., S.-W.M.)
| | - Hsien-Li Kao
- From the Department of Internal Medicine, National Taiwan University Hospital, Taipei (C.-C.H., C.-S.H., Y.-H.C., M.-S.L., C.-F.Y., H.-L.K.); and Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu (C.-K. L., S.-W.M.).
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Lee CK, Lai CL, Lee MH, Su FY, Yeh TS, Cheng LY, Hsieh MY, Wu YW, Liu YB, Wu CC. Reinforcement of patient education improved physicians' adherence to guideline-recommended medical therapy after acute coronary syndrome. PLoS One 2019; 14:e0217444. [PMID: 31170175 PMCID: PMC6553689 DOI: 10.1371/journal.pone.0217444] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 03/07/2019] [Accepted: 05/10/2019] [Indexed: 11/18/2022] Open
Abstract
Background Prescription of guideline-recommended medicines after acute coronary syndrome (ACS) has been suboptimal. Tools for improving the use of medications have been developed, but they mainly targeted physicians. Objective We evaluated the effects of reinforcement of patient and family education on the usage of guideline-recommended secondary prevention medications. Methods This was a retrospective analysis of a prospectively collected registry of patients with ACS who were admitted to a regional teaching hospital in Taiwan between February 2015 and April 2017. The control group included 76 patients discharged before implementing the electronic-based patient and family education (PFE) system. The intervention group included 206 patients discharged after implementation. The primary outcome was the prescription rate of all four guideline-recommended drugs. Predictors of adherence were also evaluated. Results The study cohort included 282 ACS patients (188 men and 94 women) with a mean age of 68.5 years (standard deviation, 14.2). The intervention group patients were younger, had more family history of premature cardiovascular disease, more dyslipidemia, and underwent more reperfusion therapy. The intervention group was prescribed more guideline-recommended drugs than the control group: dual antiplatelet agents, 79.61% vs. 47.37% (p<0.001); statins, 74.76% vs. 34.21% (p<0.001); beta-blockers, 81.07% vs. 46.05% (p<0.001); angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, 62.62% vs. 38.16% (p<0.001); and a combination of all four medications, 39.32% vs. 14.47% (p<0.001). After adjusting baseline variables, the PFE system remained a significant contributor to adherence to these drugs use (P = 0.02). Conclusions Reinforcement of patient education was associated with significant improvements in physicians’ adherence to guideline-recommended medical therapy after acute coronary syndrome.
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Affiliation(s)
- Chih-Kuo Lee
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Chao-Lun Lai
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Ming-Hsien Lee
- Department of Nursing, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan
| | - Fang-Ying Su
- Biotechology R&D Center, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Tzu-Shan Yeh
- Department of Nursing, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan
| | - Li-Ying Cheng
- Department of Nursing, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan
| | - Mu-Yang Hsieh
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- * E-mail: (MYH); (CCW)
| | - Yen-Wen Wu
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Division of Cardiology, Cardiovascular Medical Center, and Department of Nuclear Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Yen-Bin Liu
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chih-Cheng Wu
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Cardiovascular Center, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
- Institute of Biomedical Engineering, National Tsing-Hwa University, Hsinchu, Taiwan
- * E-mail: (MYH); (CCW)
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Park YM, Lee CK, Kim HJ. Gastrointestinal: Colon cast with segmental stricture following colonic ischemia. J Gastroenterol Hepatol 2019; 34:630. [PMID: 30592093 DOI: 10.1111/jgh.14550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 10/01/2018] [Accepted: 11/13/2018] [Indexed: 12/09/2022]
Affiliation(s)
- Y M Park
- Center for Crohn's and Colitis, Department of Gastroenterology, Kyung Hee University School of Medicine, Seoul, Korea
| | - C K Lee
- Center for Crohn's and Colitis, Department of Gastroenterology, Kyung Hee University School of Medicine, Seoul, Korea
| | - H J Kim
- Center for Crohn's and Colitis, Department of Gastroenterology, Kyung Hee University School of Medicine, Seoul, Korea
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Mak LY, Lau CW, Hui YT, Ng C, Shan E, Li MK, Lau JY, Chiu PW, Leong HT, Ho J, Wu JC, Lee CK, Leung WK. Joint recommendations on management of anaemia in patients with gastrointestinal bleeding in Hong Kong. Hong Kong Med J 2018; 24:416-422. [PMID: 30100584 DOI: 10.12809/hkmj187348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The demand for blood products continues to grow in an unsustainable manner in Hong Kong. While anaemia associated with gastrointestinal bleeding (GIB) is the leading indication for transfusion, there is no local recommendation regarding best practices for transfusion. We aimed to provide evidence-based recommendations regarding management of anaemia in patients with acute and chronic GIB. We reviewed all original papers, meta-analyses, systematic reviews, or guidelines that were available in PubMed. For acute GIB, a restrictive transfusion strategy, targeting a haemoglobin threshold of 7 to 8 g/dL, should be adopted because overtransfusion is associated with significantly higher all-cause mortality and re-bleeding. A liberal transfusion strategy should only be considered in patients with co-existing symptomatic coronary artery disease, targeting a haemoglobin threshold of 9 to 10 g/dL. When acute GIB settles, patients should be prescribed iron supplements if iron deficiency is present. For chronic GIB, iron stores should be replenished aggressively via iron supplementation before consideration of blood transfusion, except in patients with symptoms of severe anaemia. Oral iron replacement is the preferred first-line therapy, while intravenous iron is indicated for patients with inflammatory bowel disease, poor response or poor tolerability to oral iron, and in whom a rapid correction of iron deficit is preferred. Intravenous iron is underutilised and the risk of anaphylactic reaction to current preparations is extremely low. These recommendations are provided to local clinicians to facilitate judicious and appropriate use of red cell products and iron replacement therapy in patients with GIB.
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Affiliation(s)
- L Y Mak
- Hong Kong Society of Gastroenterology.,Hong Kong IBD Society
| | - C W Lau
- Hong Kong Red Cross Blood Transfusion Service
| | | | | | | | | | - J Yw Lau
- Hong Kong Society of Digestive Endoscopy
| | - P Wy Chiu
- Hong Kong Society of Digestive Endoscopy
| | - H T Leong
- Hong Kong Society of Digestive Endoscopy
| | - J Ho
- Hong Kong Society of Gastroenterology
| | - J Cy Wu
- Hong Kong Society of Gastroenterology
| | - C K Lee
- Hong Kong Red Cross Blood Transfusion Service
| | - W K Leung
- Hong Kong Society of Gastroenterology.,Hong Kong IBD Society
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Mooi JK, Wirapati P, Asher R, Lee CK, Savas P, Price TJ, Townsend A, Hardingham J, Buchanan D, Williams D, Tejpar S, Mariadason JM, Tebbutt NC. The prognostic impact of consensus molecular subtypes (CMS) and its predictive effects for bevacizumab benefit in metastatic colorectal cancer: molecular analysis of the AGITG MAX clinical trial. Ann Oncol 2018; 29:2240-2246. [PMID: 30247524 DOI: 10.1093/annonc/mdy410] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The consensus molecular subtypes (CMS) is a transcriptome-based classification of colorectal cancer (CRC) initially described in early-stage cohorts, but the associations of CMS with treatment outcomes in the metastatic setting are yet to be established. This study aimed to evaluate the prognostic impact of CMS classification and its predictive effects for bevacizumab benefit in metastatic CRC by correlative analysis of the AGITG MAX trial. PATIENTS AND METHODS The MAX trial previously reported improved progression-free survival (PFS) for the addition of bevacizumab (B) to chemotherapy [capecitabine (C)±mitomycin (M)]. Archival primary tumours from 237 patients (50% of trial population) underwent gene expression profiling and classification into CMS groups. CMS groups were correlated to PFS and overall survival (OS). The interaction of CMS with treatment was assessed by proportional hazards model. RESULTS The distribution of CMS in MAX were CMS1 18%, CMS2 47%, CMS3 12%, CMS4 23%. CMS1 was the predominant subtype in right-sided primary tumours, while CMS2 was the predominant subtype in left-sided. CMS was prognostic of OS (P = 0.008), with CMS2 associated with the best outcome and CMS1 the worst. CMS remained an independent prognostic factor in a multivariate analysis. There was a significant interaction between CMS and treatment (P-interaction = 0.03), for PFS, with hazard ratios (95% CI) for CB+CBM versus C arms in CMS1, 2, 3 and 4: 0.83 (0.43-1.62), 0.50 (0.33-0.76), 0.31 (0.13-0.75) and 1.24 (0.68-2.25), respectively. CONCLUSIONS This exploratory study found that CMS stratified OS outcomes in metastatic CRC regardless of first-line treatment, with prognostic effects of CMS groups distinct from those previously reported in early-stage cohorts. In CMS associations with treatment, CMS2 and possibly CMS3 tumours may preferentially benefit from the addition of bevacizumab to first-line capecitabine-based chemotherapy, compared with other CMS groups. Validation of these findings in additional cohorts is warranted. CLINICAL TRIAL NUMBER This is a molecular sub-study of MAX clinical trial (NCT00294359).
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Affiliation(s)
- J K Mooi
- Olivia Newton-John Cancer Research Institute, Heidelberg; Department of Medicine, University of Melbourne, Melbourne, Australia
| | - P Wirapati
- Bioinformatics Core Facility, Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - R Asher
- NHMRC Clinical Trials Centre, University of Sydney, Sydney
| | - C K Lee
- NHMRC Clinical Trials Centre, University of Sydney, Sydney
| | - P Savas
- Division of Research, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne
| | - T J Price
- Medical Oncology, The Queen Elizabeth Hospital, Woodville; School of Medicine, University of Adelaide, Adelaide
| | - A Townsend
- Medical Oncology, The Queen Elizabeth Hospital, Woodville; School of Medicine, University of Adelaide, Adelaide
| | - J Hardingham
- School of Medicine, University of Adelaide, Adelaide; The Basil Hetzel Institute, The Queen Elizabeth Hospital, Woodville
| | - D Buchanan
- Colorectal Oncogenomics Group, Department of Clinical Pathology, The University of Melbourne, Melbourne; University of Melbourne Centre for Cancer Research, Victorian Comprehensive Cancer Centre, Parkville; Genetic Medicine and Family Cancer Clinic, Royal Melbourne Hospital, Parkville
| | - D Williams
- Olivia Newton-John Cancer Research Institute, Heidelberg; Department of Pathology, Austin Health, Heidelberg; Department of Pathology, University of Melbourne, Melbourne, Australia
| | - S Tejpar
- Oncology, University Hospital Leuven, Leuven, Belgium
| | - J M Mariadason
- Olivia Newton-John Cancer Research Institute, Heidelberg; School of Cancer Medicine, La Trobe University, Melbourne
| | - N C Tebbutt
- Medical Oncology, Austin Health, Heidelberg, Australia.
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Roncolato FT, Gibbs E, Lee CK, Asher R, Davies LC, Gebski VJ, Friedlander M, Hilpert F, Wenzel L, Stockler MR, King M, Pujade-Lauraine E. Quality of life predicts overall survival in women with platinum-resistant ovarian cancer: an AURELIA substudy. Ann Oncol 2018; 28:1849-1855. [PMID: 28595285 DOI: 10.1093/annonc/mdx229] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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] [Indexed: 01/13/2023] Open
Abstract
Background Women with platinum-resistant ovarian cancer are a heterogeneous group whose median overall survival is 12 months. We hypothesized that their quality of life (QoL) scores would be prognostic. Patients and methods Data from AURELIA (n = 326), a randomized trial of chemotherapy with or without bevacizumab, were used to identify baseline QoL domains [EORTC (European Organisation for Research and Treatment of Cancer) QLQ-C30 and OV28] that were significantly associated with overall survival in multivariable Cox regression analyses. Patients were classified as having good, medium, or poor risk. Cutpoints were validated in an independent dataset, CARTAXHY (n = 136). Multivariable analyses of significant QoL domains on survival were adjusted for clinicopathological prognostic factors. The additional QoL information was assessed using C statistic. Results In AURELIA, all domains, except cognitive function, predicted overall survival in univariable analyses. Physical function (P < 0.001) and abdominal/gastrointestinal symptom (P < 0.001) scores remained significant in multivariable models. In high (score <67), medium (67-93), and low (>93) risk categories for physical function, median overall survival was 11.0, 14.7, and 19.3 months, respectively (P < 0.001). In CARTAXHY, median overall survival was 7.9, 16.2, and 23.9 months (P < 0.001), respectively. For high- (>44), medium- (13-44), and low- (<13) risk categories for abdominal/gastrointestinal symptoms, median overall survival was 11.9, 14.3, and 19.7 months in AURELIA (P < 0.001) and 10.5, 19.6, and 24.1 months in CARTAXHY (P = 0.02). Physical function (P = 0.02) and abdominal/gastrointestinal symptoms (P = 0.03) remained independent prognostic factors after adjustment for clinicopathological factors. The C statistic of the full model was 0.71. For QoL factors alone, patient factors alone and disease factors alone, the C statistics were 0.61, 0.61, and 0.67 respectively. Conclusions Physical function and abdominal/gastrointestinal symptom scores improved predictions of overall survival over clinicopathological factors alone in platinum-resistant ovarian cancer. This additional prognostic information could improve trial stratification, patient-doctor communication about prognosis, and clinical decision-making. Clinical trial registration NCT00976911.
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Affiliation(s)
- F T Roncolato
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney
- Macarthur Cancer Therapy Centre, Campbelltown
| | - E Gibbs
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney
| | - C K Lee
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney
- Medical Oncology, St George Hospital, Sydney
| | - R Asher
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney
| | - L C Davies
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney
| | - V J Gebski
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney
| | - M Friedlander
- Medical Oncology, Prince of Wales Hospital, Sydney, Australia
| | - F Hilpert
- Gynecology & Obstetrics, University of Schleswig-Holstein, Kiel, Germany
| | - L Wenzel
- Public Health, University of California, Irvine, USA
| | - M R Stockler
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney
| | - M King
- Psycho-oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney, Australia
| | - E Pujade-Lauraine
- Hematology & Medical Oncology, Hopital Hôtel-Dieu de Paris, Paris, France
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Lee CK, Choi SK, Shin DA, Yi S, Kim KN, Kim I, Ha Y. Parkinson's disease and the risk of osteoporotic vertebral compression fracture: a nationwide population-based study. Osteoporos Int 2018; 29:1117-1124. [PMID: 29460103 DOI: 10.1007/s00198-018-4409-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 01/24/2018] [Indexed: 01/23/2023]
Abstract
UNLABELLED Patients with Parkinson's disease (PD) were at higher risk of osteoporotic vertebral compression fractures (OVCF) compared to controls and had elevated mortality rates. Compared to conservative treatment, surgical treatment for OVCF in PD patients seemed to be associated with better outcomes. INTRODUCTION The purpose of this study was to evaluate the risk of OVCF in patients with PD. METHODS Data from patients over the age of 60 years who were diagnosed with PD were collected between 2004 and 2013 from the Korean National Health Insurance Database (n = 3370). The comparison group (non-PD) consisted of randomly selected patients (five per patient with PD; n = 16,850) matched to the PD group, who were newly diagnosed annually according to age and sex. Cox proportional hazard regressions were used to examine the relationships between osteoporosis, OVCF, surgery for OVCF, and PD. Household income and residential area of patients were also assessed. Overall survival rates were calculated after adjusting for confounding factors, such as hypertension, diabetes mellitus, and chronic kidney disease. RESULTS OVCF was developed in 12.5% of patients in the PD group and in 7.4% of patients in the control group. PD was associated with increased risk of osteoporosis (hazard ratio [HR], 1.32; 95% confidence interval [CI], 1.21-1.43; p < 0.001), OVCF (HR 1.66; 95% CI, 1.47-1.87; p < 0.001), and surgery for OVCF (HR 2.69; 95% CI, 1.78-4.08; p < 0.001). Household income was not significantly related with development of osteoporosis, incidence of OVCF, or surgery for OVCF. Residential area was statistically associated with osteoporosis, OVCF, and surgery for OVCF. The mortality rate of the PD group was about 1.7 times higher than that of the non-PD group after adjusting for potential confounders, and the mortality rate of the PD with OVCF group was higher than that of the non-PD group, but not significantly (p = 0.09). The survival rate of the PD group with surgery for OVCF showed a trend toward a more positive prognosis compared with that of the PD group with conservative treatment. CONCLUSIONS Patients with PD had significantly increased risk of osteoporosis and OVCF. Surgical treatment for OVCF in PD patients was associated with a better prognosis than conservative treatment.
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Affiliation(s)
- C K Lee
- Department of Neurosurgery, Keimyung University Dongsan Medical Center, Daegu, South Korea
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - S K Choi
- Biostatistics and Epidemiology, Neurosurgery, Yonsei University College of Medicine, Seoul, South Korea
| | - D A Shin
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - S Yi
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - K N Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - I Kim
- Department of Neurosurgery, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Y Ha
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, South Korea.
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Kwok J, Guo M, Yang W, Ip P, Lee CK, Lu L, Chan GCF, Middleton D, van der Zanden HGM. Simulation of non-inherited maternal antigens acceptable HLA mismatches to increase the chance of matched cord blood units: Hong Kong's experience. Hum Immunol 2018; 79:539-544. [PMID: 29660452 DOI: 10.1016/j.humimm.2018.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 02/22/2018] [Revised: 03/30/2018] [Accepted: 04/10/2018] [Indexed: 01/13/2023]
Abstract
In Cord blood transplantation (CBT), the non-inherited maternal antigen (NIMA) virtual six HLA matched CB is found to have similar outcomes to six HLA inherited matched CB. Such virtual HLA matched CB units can be generated by substituting the inherited alleles with one to three NIMAs. In Hong Kong Cord Blood Bank, CB units have no NIMA defined. 100 CB samples were collected with NIMA defined. Retrospective searches of Hong Kong patients (n = 520) were matched against the inherited and virtual HLA phenotypes of NIMA CB file. One to three NIMA matches was analyzed, virtual six HLA matches were identified for 31.7% patients, 29.4% from CB units with 5/6 HLA match with 1 NIMA match and 1.7% CB units with a 4/6 HLA match and 2 NIMA matches. However, searches in the 167,201 Bone Marrow Donors Worldwide CB units with defined NIMA did not yield similar increases, possibly due to the ethnicity differences between populations. The match performance rises from 26% to 60% after including the NIMA match. Comparing the match performance of 32% in a previous Dutch study, we calculated with 60% matching in this smaller size study. This provides a solid ground to considering NIMA in stem cell donor selection which was adopted in some centers, to be extended to Asian and local CB registries to increase the chance for matches and also to improve patient outcomes, increase the utilization of CB units, enhance clinical flexibility and signify economic intelligence.
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Affiliation(s)
- Janette Kwok
- Division of Transplantation and Immunogenetics, Queen Mary Hospital, Hong Kong.
| | - Mengbiao Guo
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong.
| | - Wanling Yang
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong
| | - C K Lee
- Hong Kong Red Cross Blood Transfusion Services, Hong Kong
| | - Liwei Lu
- Department of Pathology, The University of Hong Kong, Hong Kong
| | - Godfrey C F Chan
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong
| | - Derek Middleton
- Transplant Immunology, Royal Liverpool Hospital, Liverpool, UK
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Hsieh MC, Lin PS, Lee CK, Wu CC. TCTAP A-086 Salvage of Venous Rupture by Stent Graft During Percutaneous Intervention of Dialysis Vascular Access. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.03.151] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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49
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Wong NS, Lee CK, Ng SC, Wong HK, Chan DPC, Lee SS. Prevalence of hepatitis C infection and its associated factors in healthy adults without identifiable route of transmission. J Viral Hepat 2018; 25:161-170. [PMID: 29032634 DOI: 10.1111/jvh.12804] [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: 05/05/2017] [Accepted: 09/01/2017] [Indexed: 12/20/2022]
Abstract
While hepatitis C virus (HCV) infection is long known to be associated with parenteral exposure, the specific route of transmission is not identified in a proportion of infected patients. Taking blood donors as the surrogate of healthy adults in the community in Hong Kong, we identified 91 HCV-infected donors (≤0.02% positive rate) in 2014-2016, of whom 46 were recruited in a mixed-method study to examine their transmission routes. A majority (75%) of the recruited donors were HCV RNA positive, with the predominant subtypes being 1b and 6a. From the results of the structured self-administered questionnaire and in-depth interviews, only 14 (30%) recruited donors could be traced to past history of contaminated blood transfusion (n = 9) or injection drug use (n = 5). Case-control analyses with 3 different control groups were performed to examine factors associated with HCV infection in multivariable analyses. High-risk sexual behaviour, body piercing, intramuscular injection and vaccine inoculation abroad, having lived abroad for >3 months were significantly associated with HCV in donors with otherwise nonidentifiable source of infection. While the specific route of transmission cannot be established for each person, associations with multiple parenteral exposures outside Hong Kong were observed. The World Health Organization has advocated for the global elimination of HCV by 2030. With a high proportion of HCV-infected persons who are unaware of their infections, HCV elimination could be hard to achieve.
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Affiliation(s)
- N S Wong
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - C K Lee
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong, China
| | - S C Ng
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong, China
| | - H K Wong
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong, China
| | - D P C Chan
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - S S Lee
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Shatin, Hong Kong, China
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Tam K, Tang I, Ho J, Yeung W, Lee CK, Ip P, Kwok J. A study of human neutrophil antigen genotype frequencies in Hong Kong. Transfus Med 2017; 28:310-318. [PMID: 29280200 DOI: 10.1111/tme.12494] [Citation(s) in RCA: 4] [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: 03/01/2016] [Revised: 07/07/2017] [Accepted: 11/19/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Alloantibodies against human neutrophil antigens (HNA) are associated with a variety of clinical conditions. Over the past decade, the allelic and genotypic frequencies of the five HNA systems have been evaluated. Although the HNA system is less polymorphic than human leukocyte antigens (HLA), significant differences in the genotypic and allele frequencies still exist in different populations, even those living in close proximity. OBJECTIVES To delineate HNA genotypic and allele frequencies to provide vital information on estimating the risk of HNA-associated diseases for our local population. METHODS Using a validated, in-house-developed assay, genotyping for HNA-1, HNA-3, HLA-4 and HNA-5 was performed on 300 samples from Chinese blood donors from Hong Kong. In addition, the frequency of the HNA-2 c.843A > T allele was also determined. RESULTS The allele frequencies of HNA-1a, -1b and -1c alleles were 67·8, 31·5 and 0%, respectively, whereas the frequencies of HNA-3a and HNA-3b were 71·0 and 29·0%, respectively. The frequencies of HNA-4a and -4b alleles were 99·5 and 0·5%, respectively, and for HNA-5a and -5b, alleles were 85·2 and 14·8%, respectively. Homozygotes for the HNA-2 c.843 TT variant were absent in our population, whereas only <4% of the population were c.843AT heterozygote carriers. CONCLUSIONS This is the first study to define HNA genotype and allele frequencies using a validated modified in-house PCR-SSP method in the Hong Kong Chinese blood donor population. Our approach provides a cost-effective assay for conducting routine HNA typing and facilitates the incorporation of these assays into routine clinical service. Our results are comparable with those reported in the Guangzhou Chinese population, but the allele frequencies in our Hong Kong Chinese population are significantly different from the reported European frequencies, confirming that a geographical difference exists for HNA allele frequencies.
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Affiliation(s)
- K Tam
- Division of Transplantation and Immunogenetics, Department of Pathology, Queen Mary Hospital, Hong Kong SAR, China
| | - I Tang
- Division of Transplantation and Immunogenetics, Department of Pathology, Queen Mary Hospital, Hong Kong SAR, China
| | - J Ho
- Division of Transplantation and Immunogenetics, Department of Pathology, Queen Mary Hospital, Hong Kong SAR, China
| | - W Yeung
- Division of Transplantation and Immunogenetics, Department of Pathology, Queen Mary Hospital, Hong Kong SAR, China
| | - C K Lee
- Hong Kong Red Cross Blood Transfusion Service, Kowloon, Hong Kong SAR, China
| | - P Ip
- Department of Paediatrics & Adolescent Medicine, University of Hong Kong, Hong Kong SAR, China
| | - J Kwok
- Division of Transplantation and Immunogenetics, Department of Pathology, Queen Mary Hospital, Hong Kong SAR, China
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